Increased vocal resonance is seen in:
Correct Answer: Bronchial ca
Description: Ref: Harrison Principles of Internal Medicine, 18th edition, Page 2085. Bedside Examination By Panda, Page 94Explanation:VOCAL RESONANCE (VR)Auscultatory counterpart of Vocal Fremitus.Increased VR is of 3 types:o Bronchophony - Seen in consolidationo Aegophony - Seen in consolidation and Fibrosis.o Whispering pectoriloquy - Seen in consolidation and over large superficial cavity communicating with patent bronchusIncreased VR seen in:Pneumonic consolidation.Collapse with patent bronchus.Large cavity.Decreased/Absent VR seen in:Pleural effusion.Pneumothorax.Collapse with closed bronchus.Mass.Empyema.Thickened pleura.CONDITIONS CAUSING DIFFERENT LUNG PATHOLOGIESConsolidationPneumonia (Lobar).Tuberculosis.Neoplasms - Bronchogenic Ca.Pulmonary infarction.CavitationTuberculosis - usually upper lobes.Lung abscess- usually upper lobes.Bronchiectasis- usually lower lobes.Infected hydatid cyst.Pleuro pulmonary amebiasis (lower lobes).Pneumoconiotic nodule.Wegener's granulomatosis.CollapseLuminal obstruction by tumor, FB. Bronchial plug.External bronchial compression as in enlarged tracheobronchial lymph nodes in malignancy.FibrosisPulmonary tuberculosis.Interstitial lung disease.Pneumoconioses.PRIMARY PULMONARY TUBERCULOSISThe lungs are the usual location of primary infections.The initial focus of primary infection is the Ghon complex.Ghon complex consists of:o A parenchymal subpleural lesion, often just above or just below the interlobar fissure between the upper and the lower lobes.o Enlarged caseous lymph nodes draining the parenchymal focus.Primary TB can also present as a lower lobe pneumonia.NOTEBronchogenic ca may cause collapse with patent bronchus causing increased vocal resonance.Bronchogenic ca can also present as consolidation and cavitation, both increases VR.Ds spine sign at the T4 vertebra causing increased vocal resonance with tubular bronchial breath sounds--Seen in Mediastinal lymph node enlargement and posterior mediastinal tumors.In Fibrosing alveolitis, VR is normal early and late stages when extensive pulmonary fibrosis set in, VR is absent.There are multiple types of pulmonary tuberculosis like consolidation, cavitation, fibrosis and pleural effusion and VR will depend upon the type of pathology . Since it is mentioned as Primary TB of lung, the best answer would be Bronchogenic Ca.
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