Which sign is a late indicator of tension pneumothorax?

• A. Absent breath sounds early
• B. Hyperresonance
• C. Tracheal deviation
• D. Sudden fever

Answer: (C)

The key idea is the sequence of signs in a tension pneumothorax as intrathoracic pressure rises. Early on, air accumulating in the pleural space causes the affected lung to collapse, producing hyperresonance on percussion and reduced or absent breath sounds on that side. As the condition worsens and pressure builds further, venous return to the heart becomes compromised, leading to hemodynamic changes such as hypotension and neck vein distention. Tracheal deviation occurs only after significant mediastinal shift has occurred, making it a late sign. Sudden fever isn’t part of this emergency process, since fever points more to infection than to the mechanical effects of a tension pneumothorax.