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Old 10-05-2012
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Lungs old female with cough and foul sputum...

An 84-year-old woman who resides in an assisted living facility is brought to the emergency department because of fever and cough for 1 week. The cough has been productive of foul-smelling, yellow-green sputum for 24 hours. She has a 2-year history of dementia, Alzheimer type. Her temperature is 38.5C (101.3F), pulse is 80/min, respirations are 20/min, and blood pressure is 116/66 mm Hg. Coarse inspiratory crackles are heard over the right lung field. Laboratory studies show a leukocyte count of 13,500/mm3 (72% segmented neutrophils, 8% bands, 1% eosinophils, 16% lymphocytes, and 3% monocytes). A CT scan shows a cavitary lesion in the superior segment of the right lower lobe. The lesion has a thick wall and an irregular peripheral margin; there is no displacement of the adjacent bronchovascular bundle. Which of the following is the most likely cause of the lung lesion in this patient?

(A) Antecedent viral pneumonia
(B) Aspiration of gastric contents
(C) Bronchial obstruction by metastatic carcinoma
(D) Lung infarction secondary to arterial thrombosis
(E) Primary carcinoma of the lung
(F) Secondary infection of a congenital lung cyst
(G) Septic embolism from an extrapulmonary site

discussions are welcome!
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Old 10-05-2012
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Az patient
Common aspiration site
Increase in neutrophils
My best guess is
B. aspiration of gastric content


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Old 10-06-2012
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yes, agree with koolkiller

b) aspiration of gastric contents....my answer
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Old 10-06-2012
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Default my answer :)

(B) Aspiration of gastric contents
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Old 10-06-2012
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Yeah Gastric contents aspiration
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Old 10-06-2012
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My answer is aspiration of gastric contents....
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Old 10-06-2012
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yeah..,B is the answer but how does alziehmer's cause aspiration of gastric contents..? is there a link that i miss?? .. and moreover it is the aspiration of orophayngeal contents that lead to an abscess which will probably have an air fluid level?
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Old 10-06-2012
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Quote:
Originally Posted by alice View Post
yeah..,B is the answer but how does alziehmer's cause aspiration of gastric contents..? is there a link that i miss?? .. and moreover it is the aspiration of orophayngeal contents that lead to an abscess which will probably have an air fluid level?
coz alzheimer's cause altered mental status which lead to swallowing difficulties leading to aspiration ...i think it's the aspiration of gastric contents that lead to abscess formation(remember reading in goljan.....)
in contrast to stroke pts.....aspiration is caused by dysphagia due to paralysis..
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