Decreased Vocal Fremitus Over in Medicine / Internal Medicine — 36yo Man | Respiratory / Pulmonology | SMLE Q#11904
SMLE Question #11904
Medicine / Internal Medicine
Respiratory / Pulmonology
Objective: OBJ-123
Last updated: February 2026
A 36-year-old man has 5 days of fever, productive cough, pleuritic right chest pain, and worsening dyspnoea. Exam shows dullness to percussion and markedly reduced breath sounds with decreased vocal fremitus over the right lower hemithorax. Chest radiograph shows right middle/lower lobe consolidation with a pleural effusion occupying about half of the right hemithorax. He has received initial empiric antibiotics in the emergency department. What is the most appropriate next step in management?
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