Answer :USMLE step 2 Mcq 238:An elderly gentleman is being fed through a nasogastric tube after extensive surgery to his pharynx for treatment of an invasive squamous cell carcinoma





Correct Answer: A

In aspiration pneumonitis the typical triad of dyspnea, cyanosis, and tachycardia usually appear within half an hour of aspiration, with rales and expiratory wheezes on auscultation. Chest films reveal interstitial pulmonary edema. Arterial blood gases demonstrate hypoxia and hypercapnia. The condition may rapidly deteriorate into respiratory failure and is associated with high mortality. In aspiration pneumonia , unlike aspiration pneumonitis, the episode of aspiration is usually not observed, and clinical signs of pneumonia develop gradually, with fever, productive cough, rales, decreased breath sounds, and bronchial breathing. In most instances following extensive oropharyngeal surgery, postsurgical nutrition is provided nonorally , such as a PEG tube or a nasogastric tube. Before resumption of oral intake, careful clinical evaluation of the oral pharynx is needed. Description of movement, tone, and reflexes during a variety of tasks that may include manipulation of material in the mouth; and evaluation of sensation and speech, can reveal much about the oral stages of swallowing including mastication, bolus preparation, and transport. Only instrumental approaches, such as the modified barium swallow, provide objective information about pooling, reflux, reduced peristalsis, and aspiration.


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