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  #1  
Old 02-29-2012
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Default `An 87- year old nursing .........


5. An 87-year-old nursing home resident with dementia, Alzheimer's type, is admitted to the hospital because of progressive lethargy and decreased appetite for 3 days. She had a flu-like illness followed by a deep cough 1 week ago. Over the past 10 months, she has been hospitalized once for bacterial pneumonia. She is responsive only to painful stimuli. Her temperature is 38.6 C (101.5 F), blood pressure is 110/60 mm Hg, pulse is 123/min and regular, and respirations are 28/min. Examination shows dry mucous membranes. There is no adenopathy. Crackles are heard in the right lung base. An x-ray film of the chest shows an infiltrate at the right lung base. The remainder of the examination shows no abnormalities. Which of the following is the most likely predisposing factor for this patient's pneumonia?

A ) Decreased airway elasticity

B ) Decreased baroreflex

C ) Decreased gag reflex

D ) Decreased thyroid function

E ) Diastolic cardiac dysfunction

F ) Impaired cardiac response to exercise

G ) Impaired T-lymphocyte function

H ) Impaired thirst

I ) Increased lung compliance

J ) Renal salt wasting

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  #2  
Old 02-29-2012
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G ??

please post correct ans with explanation.
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  #3  
Old 02-29-2012
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why did u pick G. what is ur explanation?
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Old 02-29-2012
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elderly start loosing T cells. that i read it somewhere. nothing more logic than that...
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Old 02-29-2012
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I was thinking ANS A bcos this patient has been demented and has been apparently immobilized bcos she only respond to painful stimuli ,meaning she is been fed as immobile person . so considering her age (loss of neurological functions and airway inelasticity )and debilitated state i think she may be having repeated asipiration pneumonia which has caused the repeated lung infection.
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Old 02-29-2012
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Correct Answer

ur logic is correct but ans is C....gag is decreased in debilitated,alcoholic,unconscious,demented elderly etc....+ look at the location of the nfiltrate...it matches with aspiration associated site...plu the previous viral inf predisposed him to decreased ciliary clearance..

so its C..most appropriate...i think
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Old 03-02-2012
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yes C is the ans.
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