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  #1  
Old 01-14-2013
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Question NBME 3 block 1 Q 42

42 Twelve days after sustaining a cerebral infarction, a 72-year-old man has fever and cough. Initial symptoms included inability to move his right arm and leg, swallow, speak, or respond to questions. He has been receiving a diet of pureed foods since he recovered his ability to swallow 3 days ago. He is wearing false teeth. His temperature now is 38.8C (101.8T), blood pressure is 135/85 mm Hg, pulse is 94/min, and respirations are 28/min. Examination shows moderate weakness of the facial muscles and right extremities. Gag reflex is absent. Breath sounds are decreased, and there is dullness to percussion over the right lung base posteriorly. An x-ray film of the chest shows an infiltrate in the posterior basal segment of the right lung.
Which of the following is most likely to prevent recurrence of this patient's lung condition?
A) Removal of false teeth
B) Suppression of gastric acid production
C) Chronic antibiotic prophylaxis
D) Administration of metoclopramide to increase gastrointestinal motility
E) Insertion of a feeding jejunostomy tube

Guys i dint get the right option for this question...kindly tell us whats the best option for this acrdng to you.....

I first picked B as the correct, but i feel removing the false teeth is the way to go since the guy has been started on pureed foods......

Your thoughts....?
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Old 01-14-2013
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-since gag reflex is absent ithink feeding tube is needed =E).TO prevent aspiration pneumonia
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Old 01-16-2013
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Correct Answer

@um aala I completely agree with you.

The pxt doesn't have a gag reflex and so long as this status is unchanged, aspiration would continue to occur.

Option E makes the most sense.
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Old 01-16-2013
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Option E is the most appropiate answer
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am guessing if its a jejunostomy tube the patient can still have acid reflux

i would go with C.chronic antibiotic till the patient recovers gag reflex as its most due to his stroke.
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Now i feel E is the correct option......No gag reflex, feeding tube will most likely prevent aspiration......
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Old 01-17-2013
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Plz can you explain how does Jejunostomy tube cause an acid reflux???Because a J-tube is helpful for individuals with poor gastric motility, chronic vomiting, or at high risk for aspiration.
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