(MCQS 337-339) :the commonest pericardial manifestation of the Coxsackie infective agent is

Correct Answer: H
Coxsackie viruses A and B are the most common viral causes of acute pericarditis, and acute and convalescent antibody titers may establish the diagnosis. The clinical course is generally benign. Even when a significant effusion is present, diagnostic pericardiocentesis is rarely helpful in establishing the diagnosis, although it may rule out purulent pericarditis. Constrictive pericarditis rarely follows this process, and drainage of an asymptomatic pericardial effusion to prevent this complication is not indicated

Correct Answer: E
Abscesses occur in 15% to 20% of patients with Crohn's disease and are especially common in the terminal ileum. The typical clinical presentation of intra-abdominal abscess is fever, abdominal pain, tenderness, and leukocytosis. Abdominal abscess is most often diagnosed by computed tomography. Broad-spectrum antibiotic therapy, including anaerobic coverage, is indicated. Percutaneous drainage of abscesses in patients with Crohn's the abscess cavity and the intestinal lumen. Resection of the portion of involved intestine containing the communication is usually required for definitive therapy. The prevalence of fistulas is 20% to 40% in Crohn's disease. Most fistulas are enteroenteric or enterocutaneous, with smaller numbers that are enterovesical or enterovaginal

Correct Answer: B
These feature are suggestive of neonatal Herpes Simplex infection. In its simplest manifestation, it may appear as a localized abscess at the site of attachment of a scalp abscess or as isolated mucocutaneous lesions. In its more severe forms, it may present as widely disseminated mucocutaneous lesions, visceral infection, meningitis, and encephalitis. In such instances, mortality may approach 50 to 60 percent, and up to half of the survivors may have persistent morbidity. Most bacterial and a few viral (e.g., herpes simplex II) infections are acquired by way of the cervicovaginal route. In this situation, the principal mechanism of infection is direct contact with infected vesicles during the process of vaginal birth. The fetus usually acquires the infection either by inhaling infected amniotic fluid into the lungs shortly before birth or by passing through an infected birth canal during delivery. Accounting for 40% of all neonatal HSV infections, skin, eye, and mouth disease typically presents between 1 and 2 weeks and as late as 4-5 weeks of age with vesicular lesions and conjunctivitis. Lesions typically occur on the parts of the infant that present first during delivery, such as the scalp, or at sites of forceps or other trauma. Infection can be limited to the skin, eyes, and mouth (45% of cases) or can cause encephalitis (35%) or disseminated disease (20%). The pathogenesis of herpes encephalitis is apparently different from that of disseminated disease; the encephalitis presents at an average of 2 weeks after birth, whereas the disseminated disease presents at 7 to 9 days of age. The frequency of neonatal infection clearly is dependent on whether the mother has a primary or recurrent HSV infection. In the setting of a primary infection, the viral inoculum in the genital tract is high, and maternal antibody is not present. Approximately 40 percent of neonates delivered vaginally to such women will become infected. In the absence of antiviral chemotherapy, almost half of these infants die, and 35 to 40 percent experience severe neurologic morbidity such as chorioretinitis, microcephaly, mental retardation, seizures, and apnea. In women who have recurrent symptomatic HSV infection, the risk of neonatal infection following vaginal delivery is 5 percent or less.


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