Which sign is most characteristic of tension pneumothorax?

• A. Tracheal deviation
• B. Fever
• C. Cough without dyspnea
• D. Normal breath sounds on both sides

Answer: (A)

Tension pneumothorax creates a large amount of air under pressure in the pleural space, which pushes the mediastinal structures, including the trachea, toward the opposite side. That mediastinal shift is the most characteristic and rapid clue on exam, hence tracheal deviation is the best answer. Fever argues for infection rather than a collapsed lung under pressure. Cough without dyspnea isn’t typical of a tension physiology, and normal breath sounds on both sides would contradict the presence of a collapsed lung with air under pressure. So, the tracheal deviation caused by mediastinal shift stands out as the key sign.