Which of the following is NOT typically associated with decreased tactile fremitus?

• A. Pneumonia
• B. Pneumothorax
• C. Emphysema
• D. Pleural effusion

Answer: (A)

Tactile fremitus is the vibration you feel on the chest wall when the patient speaks. How well those vibrations travel depends on what’s inside the lungs and chest. When there’s more solid tissue or fluid to conduct the sound, fremitus tends to increase; when the chest contains more air or fluid barriers, fremitus decreases.

Pneumonia causes consolidation of lung tissue, which makes the lungs more able to transmit vibrations. So tactile fremitus is typically increased over the area of involvement, often with dull percussion and bronchial breath sounds.

In contrast, the other conditions introduce air or fluid that dampens vibrations: a pneumothorax puts air in the pleural space and reduces fremitus; pleural effusion adds fluid and also reduces fremitus; emphysema causes hyperinflated, air-filled lungs, which dampen transmission of vibrations.

Therefore, pneumonia is not associated with decreased tactile fremitus; it usually shows increased fremitus instead.