Rosh Emergency Medicine Practice Test

What physical examination finding would be seen in a patient with pneumonia who exhibits increased vocal resonance?

1. Decreased tactile fremitus

2. Vesicular breath sounds over the left lower lobe

3. Words are faint when the patient whispers "one, two, three"

4. Words are louder when the patient repeats "99"

The correct answer is: Words are louder when the patient repeats "99"

In the context of pneumonia, increased vocal resonance is a significant physical examination finding. When a patient has pneumonia, the lung tissue becomes consolidated due to infection, leading to changes in how sound is transmitted through the lung fields. When the examiner asks the patient to repeat a phrase like "99," the vibrations from the voice are transmitted more effectively through the consolidated lung area compared to normal lung tissue. This results in the examiner hearing the words much louder than in areas where lung tissue is either normal or affected by fluid (such as in pleural effusion, where resonance is decreased). This increased transmission of sound—termed increased vocal resonance—occurs due to the denser nature of the lung tissue when it is consolidated (as seen in pneumonia), allowing for enhanced conduction of sound waves. Consequently, during the physical examination, the examiner would note that words are indeed louder and more distinct when the patient repeats "99," confirming the presence of pneumonia in the affected lung area.