USMLE STEP 3 MCQ 28:A seven year old child with chronic nasal obstruction has persistent disabling dysphagia causing sleep disturbance

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Question:
A seven year old child with chronic nasal obstruction has persistent disabling dysphagia causing sleep disturbance. On inspection there is an appeareance of a 'clusters of grapes' located in the passage that connects the nasopharynx to the oropharxynx. The most appropriate treatment for this child would be

 

a) incision and drainage
b) adenoidectomy
c) laser treatment
d) steroids
e) interferon therapy

 


Correct Answer: B

 

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.

b) Hypertrophy causing dental malocclusion or adversely affecting orofacial growth documented by orthodontist.

c) Hypertrophy causing upper airway obstruction, severe dysphagia, sleep disorders, or cardiopulmonary complications.

d) Peritonsillar abscess unresponsive to medical management and drainage documented by surgeon, unless surgery performed during acute stage.

e) Persistent foul taste or breath due to chronic tonsillitis not responsive to medical therapy.

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.

h) Recurrent suppurative or otitis media with effusion. (Adenoidectomy alone. Tonsillectomy added requires one of the indications listed above.)


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