Which physical exam finding would NOT be associated with emphysema?

In the context of emphysema, a chronic lung condition characterized by damage to the alveoli, several specific physical exam findings are typically observed. Among these, pallor of the skin is not a common association with emphysema.

Emphysema generally leads to obstructed airflow and difficulty in breathing, which can result in manifestations like a barrel-shaped chest due to increased anterior-posterior diameter. Patients often exhibit the use of accessory muscles for breathing, leading to hypertrophy of those muscles as they compensate for the decreased lung function. Diminished breath sounds can also be noted during the examination, reflecting the reduced air movement in the affected lung areas.

Pallor, however, is more indicative of systemic issues, such as anemia or poor perfusion, rather than a direct consequence of emphysema itself. Therefore, the association of pallor of the skin with emphysema makes it the least fitting finding in this particular context.