Which of the following is a sign of tension pneumothorax?

• A. Absent breath sounds with mild dyspnea
• B. Severe dyspnea, JVD, hypotension, tracheal deviation (late), absent breath sounds
• C. Productive cough with wheezing
• D. No distress with clear lungs

Answer: (B)

The key idea is that tension pneumothorax causes a rapidly increasing pressure in the chest that pushes the mediastinum and compresses the heart and great vessels, leading to poor ventilation and seriously impaired circulation. This produces severe shortness of breath, distended neck veins from reduced venous return, and low blood pressure as preload drops. The lung on the affected side loses breath sounds due to collapse, and the mediastinal shift can cause tracheal deviation. All together, these signs reflect a life-threatening pressure build-up that demands immediate action, which is why the described combination is the best fit for this condition.

Other scenarios don’t fit as well: absent breath sounds with only mild dyspnea can occur with a non-tension pneumothorax; productive cough with wheezing points to an airway disease like asthma or COPD; no distress with clear lungs suggests a normal or non-pneumothorax exam.