NMS Q&A Family Medicine

chapter 13Respiratory Diseasesin ChildrenExamination questions: Unless instructed otherwise, choosethe ONE lettered answer or completion that is BEST ineach case.1 A 4-year-old boy is brought to the family doctor forinspiratory stridor that began last evening, 3 daysafter the onset of coryza and evolving tracheobronchialcough. His temperature was 99.8 °F orally(37.7 ° C). He demonstrates inspiratory stridor at restafter a temporary response to nebulized racemicepinephrine (2.25%). Lateral neck x-rays were readas normal. Which of the following would be the bestnext step, assuming hospitalization would not benecessary?(A) Send the child back to the urgent care center(B) Arrange for home-delivered oxygen(C) Inject 50 mg of ceftriaxone IM(D) Dexamethasone 0.6 mg/kg IM(E) Advise cool mist therapy at home2 A 10-year-girl, assumed to have viral croup, failed torespond to racemic epinephrine and other standardtreatments; she developed fever to 104 ° F (40 ° C) theevening of the visit with the family physician. A lateralx-ray of the neck shows no enlarged epiglottisbut a stenotic subglottic lumen. Which of the followingis the most critical likely diagnosis?(A) Bacterial tracheitis(B) Severe viral(C) Epiglottitis(D) Status asthmaticus(E) Bronchiolitis3 A 6-year-old boy is brought to the family doctor for arecurrence of attacks of productive coughing. Theboy has a history of “asthma” and chronic diarrheaand is small for his age. Further history reveals that asa newborn baby the boy had a serious bout of “bowelobstruction.” On examination the patient has rhonchiand wheezes and hepatomegaly. Which of the followingmay be most likely to be diagnostic of thischild’s condition?(A) Complete blood count (CBC)(B) Serum proteins(C) Sputum culture(D) Blood immunoreactive trypsin level(E) Sweat chloride4 A 2-week-old full-term baby boy has developedcough and exhibits fever, cyanosis, and tachypnea.Which of the following organisms should be consideredin the choice of antibiotic therapy of thiscommunity-acquired pneumonia (CAP)?(A) Streptococcus pneumoniae and beta-hemolyticstreptococci(B) Staphylococcus aureus and Hemophilusorganisms(C) Chlamydia organisms and Staphylococcus albus(D) Group B streptococci and coliform bacteria(E) Chlamydia trachomatis and Mycoplasmapneumoniae5 A 2-month-old baby girl who lived at home since hernormal birth and delivery has respiratory distress,although she manifests no fever. You suspect pneumonitis.Which of the following is the likely bestchoice of antibiotics, assuming the girl has a CAP andis to be treated as an outpatient?(A) Penicillin(B) Azithromycin(C) Amoxicillin(D) Ceftriaxone(E) Ampicillin6 A previously healthy 1-year-old child has a rapidonset of a rattling cough without preceding coryza.Temperature is 101 ° F. He has a dull facial expression.Which of the following is the best first choice of antibioticfor this CAP in an outpatient setting?(A) Penicillin V potassium(B) Amoxicillin(C) Erythromycin or other macrolide antibiotic(D) Gentamycin(E) Methicillin85