(MCQS 262-264 ):A seven year old child with chronic nasal obstruction has persistent disabling dysphagia causing sleep disturbance.

Question:262
Correct Answer: J
Explanation:
neoplastic involvement of the pericardium is typically secondary, with up to 10% of patients with malignant neoplasms developing cardiac or pericardial involvement. Almost any tumor can metastasize to this site, usually by hematogenous spread. Among specific neoplasms the highest percentage of metastases to the heart is seen with melanoma (70%), leukemia (37%), and lymphoma (24%). However, in absolute numbers, the most common neoplasms with cardiac metastases are lung cancer and breast cancer. Primary pericardial neoplasms are very rare tumors. About half are malignant, with mesothelioma the most common variant. Most mesotheliomas are diffuse and may encase the entire heart, infiltrate the superficial myocardium, or metastasize to mediastinal lymph nodes and lungs. These tumors may cause death by myocardial restriction. Benign tumors include teratomas (the most common), hemangiomas, leiomyofibromas, lipomas, and fibromas. When large they may produce symptoms from cardiac compression

Question:263
Correct Answer: J
Explanation:
Clinical Indicators for Tonsillectomy/Adenoidectomy include a) Patient with 3 or more infections of tonsils and/or adenoids per year despite adequate medical therapy. <br> b) **Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist. <br> c) **Hypertrophy causing upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications. <br> d) Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage. <br> e) Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy. <br> f) Chronic or recurrent tonsillitis associated with the streptococcal carrier state and not responding to beta-lactamase-resistant antibiotics. g) Unilateral tonsil hypertrophy presumed neoplastic. <br> h) Recurrent suppurative or otitis media with effusion. (Adenoidectomy alone. Tonsillectomy added requires one of the indications listed above.)

Question:264
Correct Answer: B
Explanation:
Reactive arthritis, also called Reiter's syndrome, is the most common type of inflammatory polyarthritis in young men. It is sometimes the first manifestation of human immunodeficiency virus infection. An HLA-B27 genotype is a predisposing factor in over two thirds of patients with reactive arthritis. The syndrome most frequently follows genitourinary infection with Chlamydia trachomatis, but other organisms have also been implicated. Treatment with doxycycline or its analogs sometimes shortens the course or aborts the onset of the arthritis. Reactive arthritis may also follow enteric infections with some strains of Salmonella or Shigella, but use of antibiotics in these patients has not been shown to be effective. Reactive arthritis should always be considered in young men who present with polyarthritis. Symptoms may persist for long periods and may, in some cases, cause long-term disability. Initial treatment consists of high doses of potent nonsteroidal anti-inflammatory drugs. Patients with large-joint involvement may also benefit from intra- articular corticosteroid injection. <br>Reactive arthritis is an aseptic inflammatory polyarthritis that usually follows nongonococcal urethritis or infectious dysentery. The classic triad of arthritis, urethritis and conjunctivitis does not occur in all patients . Onset typically occurs one to three weeks following the infection and may present acutely or insidiously. Urethritis is often symptomatic in male patients, usually with a mucopurulent discharge, but sometimes presents as gross hematuria secondary to hemorrhagic cystitis. In female patients, nonspecific cervicitis may occur. However, in either sex, urethritis may be asymptomatic.<br>The arthritis preferentially involves the lower extremities, is asymmetric and frequently associated with a 'sausage' digit. The presence of enthesitis, inflammation of the ligaments and tendons at the sites of their insertion into the bone, is a helpful distinguishing characteristic. It causes heel pain, Achilles tendonitis or pain at the insertion of the patella tendon into the tibial tubercle. Very large knee effusions, in excess of 100 mL, are not unusual


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