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* resp 9
  dolly123 - 10/31/06 21:33
  An 80-year-old Caucasian female is brought to the emergency room by her son with a three-day history of fever and a foul-smelling, productive cough. Her past medical history is significant for advanced dementia, diabetes, and hypertension. She takes aspirin, metformin, insulin, and atenolol. She was admitted two times with pneumonia during the past two months. Her temperature is 38.3 C (101 F), blood pressure is 100/70mmHg, pulse is105/min, and respirations are 20/min. The patient is not oriented in time and place. Physical examination reveals dry mucus membranes and decreased skin turgor. Breath sounds are decreased to the right. A chest x-ray revealed right, lower lobe infiltrate. Which of the following is the most important predisposing factor for this condition in this patient?

A. Decreased lung elasticity
B. Gastro-esophageal reflux
C. Impaired epiglottic reflex
D. Decreased thyroid function
E. Depressed cell-mediated immunity
F. Depressed humoral immunity
G. Impaired lymphatic drainage
H. Impaired venous drainage

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* Re:resp 9
  ben - 10/31/06 21:43
  C. Impaired epiglottic reflex
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* Re:resp 9
  xwxf - 10/31/06 21:47
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* Re:resp 9
  dolly123 - 10/31/06 21:56
C. Impaired epiglottic reflex

imp in cases of dementia..there is aspiration of oral secretions...often strep viridans indicated

in elderly without dementia we would look at pulmonary comorbitdities, depressed immunity etc
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