Question 1: A 4-year-old child presents with a fever, cough, and wheezing. The physical examination reveals inspiratory and expiratory wheezing, and the chest X-ray shows peribronchial cuffing. The nurse administers albuterol and inhaled corticosteroids. Which medication should be considered as an adjuvant therapy in this patient?
A) Ibuprofen
B) Acetaminophen
C) Amoxicillin
D) Montelukast
E) Epinephrine
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Explanation: In a child with wheezing and respiratory symptoms, especially if associated with atopy, montelukast, a leukotriene receptor antagonist, can be considered as an adjuvant therapy. It helps to reduce inflammation and improve lung function. Ibuprofen and acetaminophen can help manage fever and discomfort. Amoxicillin is an antibiotic primarily used for bacterial infections, and epinephrine is typically used for severe allergic reactions.
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Question 2: An 8-year-old child presents with a sore throat, low-grade fever, and malaise. The physical examination reveals pharyngeal erythema and tonsillar exudate. A throat culture is performed, and the results are negative for streptococcal infection. What additional diagnostic test should be considered to confirm mononucleosis?
A) Blood culture
B) Monospot test
C) Tuberculin skin test (TST)
D) Chest X-ray
E) Serum electrolyte panel
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Explanation: In cases of negative streptococcal throat culture with a clinical presentation suggestive of mononucleosis, the Monospot test should be considered to confirm the diagnosis, as it can detect EBV infection. Blood culture, tuberculin skin test (TST), chest X-ray, and serum electrolyte panel are not typically used to diagnose mononucleosis.
Question 3: A 6-month-old infant with a severe respiratory infection is admitted to the pediatric unit. The child is in respiratory distress with nasal flaring, intercostal retractions, and a heart rate of 160 bpm. What is the initial intervention in managing this patient?
A) Administer high-flow oxygen
B) Initiate broad-spectrum antibiotics
C) Administer nebulized epinephrine
D) Order a chest X-ray
E) Administer inhaled corticosteroids
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Explanation 3: In a pediatric patient with severe respiratory distress, the initial intervention is to provide adequate oxygenation and support their respiratory effort. Administering high-flow oxygen helps alleviate hypoxia and reduce respiratory distress. Broad-spectrum antibiotics, nebulized epinephrine, and chest X-ray may be indicated depending on the underlying cause, but oxygen therapy is the first step. Inhaled corticosteroids are not the initial management for acute respiratory distress.
Question 4: A 5-year-old child presents with a persistent cough, rhinorrhea, and low-grade fever for five days. The physical exam reveals bilateral otitis media. Which medication is most appropriate for the management of this patient’s condition?
A) Albuterol
B) Amoxicillin
C) Oseltamivir
D) Prednisolone
E) Montelukast
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Explanation 4: In a child with bilateral otitis media (middle ear infection), the first-line treatment is amoxicillin, an antibiotic effective against the most common pathogens causing otitis media. Albuterol is used for bronchospasm and not indicated in this case. Oseltamivir is used for influenza, prednisolone for severe asthma exacerbations, and montelukast for asthma with wheezing.
Question 5: A 3-year-old child with a history of eczema presents with acute respiratory distress, cough, and wheezing. On examination, there is severe wheezing and diffuse crackles. The child’s oxygen saturation is 88%. Which medication should be administered as the first-line treatment in this patient?
A) Epinephrine
B) Albuterol
C) Montelukast
D) Prednisolone
E) Oxygen therapy
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Explanation: In a child with severe respiratory distress and hypoxemia, the first-line treatment is oxygen therapy to improve oxygen saturation. This ensures adequate oxygen delivery to the body’s tissues. Epinephrine, albuterol, montelukast, and prednisolone may be considered as adjuvant therapies depending on the underlying cause, but oxygen is the initial priority in managing hypoxemic respiratory distress.
Question 6: A 15-year-old adolescent presents with a 5-day history of high fever, sore throat, and cervical lymphadenopathy. The physical examination reveals hepatomegaly and splenomegaly. Laboratory results show atypical lymphocytes on a peripheral blood smear. Which diagnostic test should be performed to confirm the suspected diagnosis of mononucleosis?
A) Rapid strep test
B) Throat culture
C) Monospot test
D) Tuberculin skin test (TST)
E) Chest X-ray
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Explanation: The clinical presentation with fever, sore throat, cervical lymphadenopathy, hepatomegaly, and splenomegaly is suggestive of infectious mononucleosis. The Monospot test is a rapid diagnostic test for Epstein-Barr virus (EBV) infection, the most common cause of mononucleosis. Rapid strep test, throat culture, tuberculin skin test, and chest X-ray are not relevant for diagnosing mononucleosis.
Question 7: A 5-year-old child presents with a purulent, foul-smelling nasal discharge, persistent cough, and fever. Physical examination reveals tender, swollen parotid glands. Which of the following diagnostic tests is most likely to confirm the suspected diagnosis?
A) Chest X-ray
B) Stool culture
C) Sputum culture
D) Throat culture
E) Parotid ultrasound
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Explanation: The presence of purulent nasal discharge, cough, and tender, swollen parotid glands is suggestive of parotitis, which can be caused by the mumps virus. Parotid ultrasound is a useful diagnostic tool to confirm the diagnosis. Chest X-ray, stool culture, sputum culture, and throat culture are not relevant to the assessment of parotitis.
Question 8: A 3-year-old child is brought to the clinic with a high fever, irritability, photophobia, and a stiff neck. The physical examination is significant for positive Brudzinski and Kernig signs. Which diagnostic test is most appropriate for evaluating the suspected condition?
A) Blood culture
B) Lumbar puncture
C) Throat culture
D) Urine culture
E) Chest X-ray
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Explanation: The clinical presentation with fever, irritability, photophobia, and a stiff neck, along with positive Brudzinski and Kernig signs, is highly suggestive of meningitis. The most appropriate diagnostic test for confirming this condition is a lumbar puncture to analyze cerebrospinal fluid for signs of infection. Blood culture, throat culture, urine culture, and chest X-ray are not primary tests for diagnosing meningitis.
Question 9: A 6-month-old infant presents with fever, cough, and respiratory distress. The chest X-ray shows bilateral interstitial infiltrates. Which diagnostic test is most likely to identify the causative organism in this patient?
A) Blood culture
B) Sputum culture
C) Urine culture
D) Throat culture
E) Respiratory viral panel
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Explanation: In an infant with fever, cough, and respiratory distress, along with chest X-ray findings of bilateral interstitial infiltrates, a respiratory viral panel is the most appropriate diagnostic test to identify the causative viral pathogen. Blood, sputum, urine, and throat cultures are typically not used to identify viral infections and may not yield the necessary information in this case.
Question 10: A 10-year-old child presents with a red, swollen, and painful finger. The physical examination reveals purulent discharge from a paronychia. Which diagnostic test is typically not necessary for the management of this condition?
A) Blood culture
B) Gram stain of the discharge
C) Pus culture
D) X-ray of the finger
E) Antibiotic sensitivity testing
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Explanation : For a localized infection like a paronychia, blood culture is typically not necessary unless there are systemic signs of infection, which are not mentioned in this scenario. Gram stain of the discharge, pus culture, and antibiotic sensitivity testing are more relevant to confirm the causative organism and guide antibiotic therapy. An X-ray of the finger may be considered if there are concerns about bone involvement, but it is not usually the initial test for a paronychia.
Question 11: A 12-year-old child presents with fatigue, malaise, and a sore throat. The physical examination reveals palatal petechiae, and the tonsils are enlarged and erythematous. A complete blood count (CBC) shows an increased lymphocyte count and the presence of atypical lymphocytes. What is the most appropriate initial diagnostic test in this case?
A) Monospot test
B) Blood culture
C) Tuberculin skin test (TST)
D) Chest X-ray
E) Stool culture
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Explanation: The clinical presentation with sore throat, palatal petechiae, and enlarged tonsils is suggestive of infectious mononucleosis. The initial diagnostic test to confirm the diagnosis should be the Monospot test, which is used to detect EBV infection. A blood culture, tuberculin skin test, chest X-ray, and stool culture are not relevant for diagnosing mononucleosis.
Question 12: A 2-year-old with a history of asthma presents with increased cough, shortness of breath, and a wheeze. The nurse administers albuterol with minimal improvement. Which diagnostic test is most appropriate to evaluate the severity of this child’s condition?
A) Pulmonary function tests (PFTs)
B) Bronchoscopy
C) Sputum culture
D) Chest X-ray
E) Complete blood count (CBC)
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Explanation: Pulmonary function tests (PFTs) are the most appropriate diagnostic test to assess the severity of asthma and other respiratory conditions. They provide objective data on lung function and can help guide treatment decisions. Bronchoscopy, sputum culture, and chest X-ray are typically reserved for more complicated cases, while a complete blood count (CBC) is not specific for respiratory evaluation.
Question 13: A 16-year-old adolescent presents with fever, malaise, and generalized lymphadenopathy. The physical examination reveals hepatosplenomegaly. Laboratory results show an elevated white blood cell count with atypical lymphocytes. Which of the following diagnostic tests should be performed to confirm mononucleosis and differentiate it from other causes of lymphadenopathy?
A) Streptococcal antibody testing
B) Cytomegalovirus (CMV) serology
C) Epstein-Barr virus (EBV) serology
D) Mantoux tuberculin skin test (TST)
E) Computed tomography (CT) of the chest
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Explanation: To confirm mononucleosis and differentiate it from other causes of lymphadenopathy, Epstein-Barr virus (EBV) serology should be performed, as EBV is the most common cause of mononucleosis. Streptococcal antibody testing, CMV serology, Mantoux tuberculin skin test (TST), and CT of the chest are not primary tests for diagnosing mononucleosis.
Question 14: A 14-year-old child presents with a high fever, sore throat, and hepatosplenomegaly. The physical examination reveals posterior cervical lymphadenopathy. A complete blood count (CBC) shows an increased lymphocyte count and atypical lymphocytes. What is the most appropriate test to confirm the diagnosis of mononucleosis in this patient? A) Rapid strep test B) Monospot test C) Chest X-ray D) Urine culture E) Tuberculin skin test (TST)
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Explanation: The clinical presentation with sore throat, hepatosplenomegaly, and posterior cervical lymphadenopathy is suggestive of mononucleosis. The most appropriate test to confirm the diagnosis is the Monospot test, which detects antibodies to EBV. Rapid strep test, chest X-ray, urine culture, and tuberculin skin test (TST) are not relevant for diagnosing mononucleosis.
Question 15: A 2-year-old child presents with a high fever, sore throat, and enlarged cervical lymph nodes. A rapid strep test is performed, which comes back negative. What is the most appropriate next step in the management of this patient?
A) Start empiric antibiotics for streptococcal pharyngitis.
B) Order a throat culture.
C) Administer antiviral medication.
D) Prescribe a course of oral steroids.
E) Initiate supportive care with fluids and analgesics.
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Explanation: In cases of negative rapid strep tests with clinical suspicion of streptococcal pharyngitis, the most appropriate next step is to order a throat culture. This test is more sensitive and specific for detecting group A Streptococcus. Empiric antibiotics are not indicated without confirmation. Antiviral medications are not used for bacterial infections, and steroids are not routinely prescribed for streptococcal pharyngitis. Supportive care can be provided, but further diagnostic testing is necessary.
Question 16: A 16-year-old adolescent presents with symptoms of mononucleosis, including sore throat, fever, and malaise. The monospot test confirms the diagnosis of Epstein-Barr virus (EBV) infection. What is the most appropriate recommendation for the management of this patient?
A) Prescribe antibiotics for bacterial infection.
B) Administer antiviral medications.
C) Recommend bed rest and supportive care.
D) Perform a tonsillectomy.
E) Administer corticosteroids.
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Explanation 1: The primary management for mononucleosis, which is caused by EBV, is supportive care, rest, and symptomatic relief. Antibiotics are not effective against viral infections, and antiviral medications are not typically used for EBV. Tonsillectomy is not indicated for mononucleosis, and corticosteroids are reserved for severe cases with airway obstruction.
Question 16:A 14-year-old child with mononucleosis presents with severe upper airway obstruction due to tonsillar hypertrophy. The patient is struggling to breathe. What is the most appropriate treatment for this situation?
A) Administer antibiotics
B) Initiate antiviral medications
C) Recommend bed rest and supportive care
D) Perform a tonsillectomy
E) Administer corticosteroids
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Answer 2: D) Perform a tonsillectomy
Explanation 2: In cases of severe upper airway obstruction due to tonsillar hypertrophy caused by mononucleosis, a tonsillectomy may be necessary to relieve the obstruction. Antibiotics and antiviral medications are not the primary treatment for airway obstruction. Bed rest and supportive care are more appropriate for mild to moderate cases, while corticosteroids are considered in cases of severe airway obstruction.
Question 16: A 12-year-old child diagnosed with mononucleosis presents with significant hepatosplenomegaly and abdominal pain. Laboratory tests show elevated liver enzymes and a decreased platelet count. What is the most appropriate action for the management of this patient’s hepatosplenomegaly?
A) Administer intravenous antiviral medications
B) Perform a liver biopsy
C) Recommend bed rest and supportive care
D) Start antibiotics
E) Discontinue contact sports and strenuous activities
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Explanation 3: In cases of hepatosplenomegaly associated with mononucleosis, the most appropriate management is to recommend discontinuing contact sports and strenuous activities. This precaution is taken to reduce the risk of splenic rupture. Antiviral medications, liver biopsy, and antibiotics are not the primary interventions for hepatosplenomegaly in mononucleosis.
Question 17: A 10-year-old child with mononucleosis presents with severe tonsillar enlargement and airway obstruction. The tonsils are coated with exudate. What is the most appropriate treatment for this patient’s tonsillar hypertrophy?
A) Administer antibiotics
B) Initiate antiviral medications
C) Recommend bed rest and supportive care
D) Perform a tonsillectomy
E) Administer corticosteroids
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Explanation 4: In cases of severe tonsillar enlargement with airway obstruction due to mononucleosis, a tonsillectomy may be indicated to relieve the obstruction. Antibiotics and antiviral medications are not the primary treatment for airway obstruction in mononucleosis. Bed rest and supportive care are typically recommended for mild to moderate cases, while corticosteroids are considered in severe cases.
Question 18: A 13-year-old child is diagnosed with mononucleosis and presents with significant fatigue and splenomegaly. What advice should be given regarding physical activities to manage the splenomegaly?
A) Encourage participation in contact sports and vigorous activities.
B) Recommend bed rest and limited physical activity.
C) Administer corticosteroids.
D) Start antibiotics.
E) Initiate antiviral medications.
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Explanation 5: To manage splenomegaly in mononucleosis and reduce the risk of splenic rupture, it is essential to recommend bed rest and limited physical activity, avoiding contact sports and strenuous activities. Encouraging participation in contact sports and vigorous activities can increase the risk of splenic rupture. Corticosteroids, antibiotics, and antiviral medications are not primary interventions for splenomegaly in mononucleosis.
Question 19: A 7-year-old child presents to the emergency department with acute respiratory distress, wheezing, and a prolonged expiratory phase. The child’s oxygen saturation is 88%, and the chest X-ray shows hyperinflation. Which medication should be administered as the first-line treatment for this patient?
A) Inhaled corticosteroids
B) Montelukast
C) Albuterol
D) Antibiotics
E) Epinephrine
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Explanation 1: In a child with acute respiratory distress and wheezing, the first-line treatment is a short-acting bronchodilator like albuterol to relieve bronchoconstriction. Inhaled corticosteroids are used for long-term asthma control. Montelukast is a leukotriene receptor antagonist and is not typically used as the first-line treatment for acute exacerbations. Antibiotics are not indicated for asthma, and epinephrine is reserved for severe allergic reactions.
Question 20: A 5-year-old child with known asthma presents with an acute exacerbation. The child is experiencing increased cough, wheezing, and difficulty breathing. The pulse oximetry reading is 90%. What is the initial step in managing this patient?
A) Administer inhaled corticosteroids
B) Begin continuous positive airway pressure (CPAP)
C) Administer albuterol nebulization
D) Order a chest X-ray
E) Prescribe oral antibiotics
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Explanation 2: In a child with an acute asthma exacerbation, the initial step is to administer a short-acting bronchodilator like albuterol nebulization to relieve bronchoconstriction and improve airflow. Inhaled corticosteroids are used for long-term asthma control. CPAP and chest X-ray may be considered in severe cases, but bronchodilators are the initial treatment. Antibiotics are not indicated unless there is evidence of a respiratory infection.
Question 21: A 10-year-old child with a history of asthma presents with worsening symptoms, including cough, wheezing, and chest tightness. The physical examination reveals decreased breath sounds on auscultation. What diagnostic test should be performed to evaluate the severity of this child’s asthma exacerbation?
A) Sputum culture
B) Pulmonary function tests (PFTs)
C) Blood culture
D) Erythrocyte sedimentation rate (ESR)
E) Electrocardiogram (ECG)
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Explanation 3: In a child with worsening asthma symptoms, especially if there are signs of decreased breath sounds on auscultation, pulmonary function tests (PFTs) are the most appropriate diagnostic test to evaluate the severity of the asthma exacerbation. PFTs can provide objective data on lung function and help guide treatment decisions. Sputum culture, blood culture, ESR, and ECG are not primary tests for assessing asthma exacerbations.
Question 22: An 8-year-old child with a recent asthma diagnosis presents with persistent cough, wheezing, and chest tightness. The physical examination is unremarkable. The spirometry results show airflow obstruction, and the peak expiratory flow rate (PEFR) is reduced. What is the most appropriate initial intervention for this patient?
A) Start inhaled corticosteroids
B) Prescribe albuterol for rescue use
C) Administer montelukast
D) Order a chest X-ray
E) Perform a skin prick test for allergies
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Explanation 4: In a child with newly diagnosed asthma and symptoms of cough, wheezing, and chest tightness, the most appropriate initial intervention is to prescribe a short-acting bronchodilator like albuterol for rescue use. This helps relieve acute symptoms. Inhaled corticosteroids are used for long-term control. Montelukast is an alternative for long-term management. A chest X-ray is not indicated without specific indications, and skin prick tests are used to identify allergies.
Question 23: A 6-year-old child presents with cough, wheezing, and difficulty breathing. The physical examination reveals wheezing and an increased respiratory rate. The child’s oxygen saturation is 93%. Which medication is the primary treatment for this patient’s acute asthma exacerbation?
A) Inhaled corticosteroids
B) Oral antibiotics
C) Montelukast
D) Albuterol nebulization
E) Epinephrine
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Explanation 5: In a child with an acute asthma exacerbation, the primary treatment is albuterol nebulization to relieve bronchoconstriction and improve airflow. Inhaled corticosteroids are used for long-term control. Oral antibiotics are not indicated for asthma exacerbations. Montelukast is an alternative for long-term management. Epinephrine is typically reserved for severe allergic reactions and is not the primary treatment for asthma exacerbations.
Question 24: A 10-year-old child with a history of asthma presents with persistent cough, wheezing, and exercise intolerance. The child’s spirometry results are normal. What is the most appropriate recommendation for this patient regarding physical activities and sports?
A) Encourage participation in all sports without restrictions.
B) Recommend avoiding all physical activities.
C) Limit activities to low-intensity sports only.
D) Restrict activities during asthma exacerbations.
E) Advise against any outdoor activities.
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Explanation 1: In a child with asthma and normal spirometry results, participation in all sports without restrictions is encouraged. It’s important for children with asthma to lead active, healthy lives. Restricting activities unnecessarily can have negative effects on their physical and emotional well-being.
Question 25: An 8-year-old child with a recent asthma diagnosis presents with good control of symptoms. The child is interested in joining a soccer team. What advice should be given regarding physical activities and sports?
A) Encourage participation in soccer with a written asthma action plan.
B) Discourage participation in soccer due to the risk of asthma exacerbations.
C) Allow participation in soccer only if the child uses inhaled corticosteroids regularly.
D) Recommend participation in non-competitive sports instead of soccer.
E) Advise against any outdoor activities.
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Explanation 2: For a child with well-controlled asthma, it is appropriate to encourage participation in sports like soccer, provided they have a written asthma action plan in place. With proper management and preparedness, asthma should not be a barrier to sports involvement. Regular use of inhaled corticosteroids may not be necessary for all children with asthma.
Question 26: A 12-year-old child with asthma is interested in track and field events at school. The child’s asthma symptoms are well controlled with medication. What advice should be given regarding physical activities and sports?
A) Encourage participation in track and field events without restrictions.
B) Discourage participation in any physical activities.
C) Limit activities to low-intensity sports only.
D) Recommend participation in indoor sports but not outdoor sports.
E) Advise against any activities involving running.
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Explanation 3: If a child’s asthma symptoms are well controlled with medication, it is appropriate to encourage participation in track and field events without restrictions. Asthma should not prevent a child from engaging in their desired sports or activities when their condition is well managed.
Question 27: 14-year-old adolescent with asthma presents with frequent nighttime cough, wheezing, and shortness of breath during exercise. The spirometry results show mild airflow obstruction. What advice should be given regarding physical activities and sports for this patient?
A) Encourage participation in any sports without restrictions.
B) Discourage participation in any physical activities.
C) Limit activities to low-intensity sports only.
D) Recommend participation in non-competitive sports instead of high-intensity sports. E) Advise against any activities involving swimming.
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Explanation 4: For an adolescent with mild airflow obstruction and exercise-induced symptoms, it is appropriate to recommend participation in non-competitive sports that are less likely to trigger asthma symptoms. This approach can help the patient enjoy physical activities without excessive strain on their respiratory system.
Question 28: A 6-year-old child with asthma is interested in joining a soccer team. The child’s symptoms are well controlled with a prescribed inhaler. What advice should be given regarding physical activities and sports?
A) Encourage participation in soccer without restrictions.
B) Discourage participation in any physical activities.
C) Limit activities to low-intensity sports only.
D) Recommend participation in indoor sports but not outdoor sports.
E) Advise against any activities involving jumping or running.
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Explanation 5: For a child with well-controlled asthma symptoms, it is appropriate to encourage participation in sports like soccer without restrictions. With proper medication management, children with asthma can enjoy a wide range of activities, including those involving running and jumping. Asthma should not limit their participation when well controlled.
Question 29: A 2-month-old infant is brought to the pediatric clinic with symptoms of gastroesophageal reflux, including frequent spitting up, irritability, and feeding difficulties. The infant’s weight gain is adequate, and physical examination is unremarkable. Which medication is a common first-line treatment for this infant’s condition?
A) Albuterol
B) Ranitidine
C) Ibuprofen
D) Cetirizine
E) Epinephrine
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Explanation 1: In infants with gastroesophageal reflux, a common first-line treatment is ranitidine, which is an H2-receptor antagonist that reduces gastric acid production. Albuterol, ibuprofen, cetirizine, and epinephrine are not indicated for the treatment of reflux in infants.
Question 30: A 4-week-old infant presents with symptoms of colic, including excessive crying, fussiness, and difficulty settling. Physical examination and laboratory tests are unremarkable. What medication is typically not recommended for the management of infantile colic?
A) Simethicone
B) Probiotics
C) Dicyclomine
D) Lactase drops
E) Parental reassurance
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Explanation 2: Dicyclomine is typically not recommended for the management of infantile colic due to potential safety concerns. The other options, including simethicone, probiotics, lactase drops, and parental reassurance, are considered more appropriate approaches to managing colic in infants.
Question 31: A 3-month-old infant is diagnosed with a respiratory syncytial virus (RSV) infection and presents with wheezing and respiratory distress. What medication is commonly prescribed to manage the symptoms and improve breathing in infants with RSV bronchiolitis?
A) Amoxicillin
B) Acetaminophen
C) Albuterol
D) Ranitidine
E) Furosemide
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Explanation 3: In infants with RSV bronchiolitis and respiratory distress, albuterol, a short-acting bronchodilator, is commonly prescribed to help relieve bronchoconstriction and improve breathing. Amoxicillin, acetaminophen, ranitidine, and furosemide are not the primary treatments for RSV bronchiolitis.
Question 32: A 6-month-old infant with a documented cow’s milk protein allergy presents with eczema and gastrointestinal symptoms. Which medication is often used in the management of this infant’s cow’s milk protein allergy?
A) Prednisolone
B) Epinephrine
C) Montelukast
D) Budesonide
E) Hydrolyzed formula
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Explanation 4: In the management of cow’s milk protein allergy in infants, a common approach is to use a hydrolyzed formula, which contains proteins broken down into smaller, less allergenic fragments. Prednisolone, epinephrine, montelukast, and budesonide are not the primary treatments for cow’s milk protein allergy.
Question 33: An 8-week-old infant presents with symptoms of constipation, including hard, infrequent stools. Physical examination and laboratory tests are unremarkable. What medication is typically not recommended for the management of infant constipation?
A) Polyethylene glycol
B) Lactulose
C) Docusate sodium
D) Magnesium hydroxide
E) Diphenhydramine
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Explanation 5: Diphenhydramine is typically not recommended for the management of infant constipation. The other options, including polyethylene glycol, lactulose, docusate sodium, and magnesium hydroxide, are more commonly used to relieve constipation in infants.
Question 34: A 4-year-old child presents with high fever, sore throat, drooling, and a muffled voice. The child appears anxious and sits forward with the neck extended. A lateral neck X-ray shows a “thumbprint sign.” Which condition is most likely responsible for these symptoms?
A) Croup
B) Tonsillitis
C) Laryngitis
D) Epiglottitis
E) Bronchiolitis
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1: D) Epiglottitis
Explanation 1: The clinical presentation of high fever, sore throat, drooling, muffled voice, and the “thumbprint sign” on lateral neck X-ray is highly indicative of epiglottitis. This is a medical emergency, and immediate intervention is necessary to secure the airway. Croup, tonsillitis, laryngitis, and bronchiolitis do not typically present with these specific findings.
Question 35: A 3-year-old child is brought to the emergency department with a high fever, inspiratory stridor, and respiratory distress. The child’s lateral neck X-ray shows narrowing of the subglottic airway. Which condition is most likely responsible for these symptoms?
A) Croup
B) Tonsillitis
C) Laryngitis
D) Epiglottitis
E) Bronchiolitis
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Explanation 2: The clinical presentation of high fever, inspiratory stridor, and narrowing of the subglottic airway on lateral neck X-ray is indicative of croup. Croup is a viral infection that can cause these symptoms. Tonsillitis, laryngitis, and epiglottitis typically present differently, and bronchiolitis affects the lower airways.
Question 36: A 5-year-old child complains of a sore throat, fever, and difficulty swallowing. On examination, you observe tonsillar exudate and anterior cervical lymphadenopathy. What is the most likely diagnosis in this case?
A) Croup
B) Tonsillitis
C) Laryngitis
D) Epiglottitis
E) Bronchiolitis
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Explanation 3: The clinical presentation of a sore throat, fever, tonsillar exudate, and anterior cervical lymphadenopathy is characteristic of tonsillitis. Croup, laryngitis, epiglottitis, and bronchiolitis have different clinical features and typically do not include these specific findings.
Question 37: A 2-year-old child presents with a bark-like cough, inspiratory stridor, and low-grade fever. The child’s lateral neck X-ray shows a “steeple sign.” What condition is most likely responsible for these symptoms?
A) Croup
B) Tonsillitis
C) Laryngitis
D) Epiglottitis
E) Bronchiolitis
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Explanation 4: The clinical presentation of a bark-like cough, inspiratory stridor, and the “steeple sign” on lateral neck X-ray is indicative of croup. Croup typically presents with these symptoms. Tonsillitis, laryngitis, epiglottitis, and bronchiolitis have different clinical features.
Question 38: A 6-year-old child presents with a hoarse voice, mild fever, and throat pain. The physical examination shows erythema and swelling of the vocal cords. What condition is most likely responsible for these symptoms?
A) Croup
B) Tonsillitis
C) Laryngitis
D) Epiglottitis
E) Bronchiolitis
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Explanation 5: The clinical presentation of a hoarse voice, mild fever, erythema, and swelling of the vocal cords is indicative of laryngitis. Laryngitis is characterized by inflammation of the larynx and vocal cords, leading to hoarseness and throat discomfort. Croup, tonsillitis, epiglottitis, and bronchiolitis have different clinical features.
Question 39: A 10-year-old boy with a known diagnosis of hemophilia A presents to the emergency department with severe bleeding after a minor fall. The physical examination reveals a swollen and painful joint. Laboratory tests show prolonged activated partial thromboplastin time (aPTT) and low factor VIII levels. What is the most appropriate initial management for this patient?
A) Administer vitamin K
B) Perform a bone marrow biopsy
C) Initiate factor VIII replacement therapy
D) Prescribe antibiotics
E) Order a chest X-ray
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Explanation 1: In a child with hemophilia A experiencing a bleeding episode, the most appropriate initial management is to initiate factor VIII replacement therapy to correct the factor deficiency and control bleeding. Administering vitamin K is not indicated for hemophilia. A bone marrow biopsy is not relevant for this condition. Antibiotics and chest X-ray are not indicated in the absence of specific indications.
Question 40: A 7-year-old boy with hemophilia B presents to the clinic with easy bruising and prolonged bleeding from minor cuts. Laboratory tests reveal a low level of factor IX. What is the definitive treatment for this child’s condition?
A) Administer antifibrinolytic agents
B) Initiate factor VIIa replacement therapy
C) Prescribe vitamin K supplements
D) Initiate factor IX replacement therapy
E) Perform a bone marrow biopsy
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Explanation 2: For a child with hemophilia B, the definitive treatment is to initiate factor IX replacement therapy to correct the factor deficiency and prevent bleeding. Antifibrinolytic agents may be used as adjunctive therapy. Factor VIIa replacement is not the primary treatment for hemophilia B. Vitamin K supplements are not indicated, and a bone marrow biopsy is not relevant for this condition.
Question 41: A 12-year-old boy with hemophilia A presents with acute joint pain and swelling. The physical examination and laboratory tests confirm a bleeding episode with a reduced factor VIII level. Which treatment is indicated for managing this patient’s acute joint bleeding?
A) Administer vitamin D supplements
B) Perform a lumbar puncture
C) Initiate factor VIII replacement therapy
D) Prescribe antihistamines
E) Order a brain MRI
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Explanation 3: For a child with hemophilia A experiencing acute joint bleeding, the treatment of choice is to initiate factor VIII replacement therapy. This helps correct the factor deficiency and control bleeding. Vitamin D supplements, lumbar puncture, antihistamines, and brain MRI are not indicated for acute joint bleeding in hemophilia.
Question 42: A 6-year-old boy with hemophilia B presents with a severe head injury following a fall. The physical examination reveals altered mental status. Laboratory tests show a reduced factor IX level. What is the primary treatment for this child’s condition?
A) Administer factor VIIa replacement therapy
B) Perform a lumbar puncture C) Initiate factor IX replacement therapy
D) Prescribe analgesics
E) Order an abdominal ultrasound
Explanation 4: In a child with hemophilia B who has suffered a severe head injury and has altered mental status, the primary treatment is to initiate factor IX replacement therapy to correct the factor deficiency and control bleeding. Factor VIIa replacement may also be considered, but factor IX replacement is the primary choice. Lumbar puncture, analgesics, and abdominal ultrasound are not indicated in this case.
Question 42: A 9-year-old boy with hemophilia A presents with prolonged bleeding following a dental procedure. The dental extraction site continues to ooze blood. What is the most appropriate initial treatment for this child’s condition?
A) Administer factor VIIa replacement therapy
B) Perform a bone marrow biopsy
C) Initiate factor VIII replacement therapy
D) Prescribe anti-anxiety medication
E) Order a chest X-ray
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Explanation 5: In a child with hemophilia A experiencing prolonged bleeding following a dental procedure, the most appropriate initial treatment is to initiate factor VIII replacement therapy to correct the factor deficiency and stop the bleeding. Factor VIIa replacement may also be considered, but factor VIII replacement is the primary choice. A bone marrow biopsy, anti-anxiety medication, and chest X-ray are not indicated in this case.
Question 43: A 3-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever. The child is alert and not in severe distress. What is the most likely diagnosis?
A) Asthma
B) Tonsillitis
C) Epiglottitis
D) Croup
E) Bronchiolitis
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Explanation 1: The clinical presentation of a barking cough, inspiratory stridor, and low-grade fever is characteristic of croup. Croup is typically caused by viral infections and leads to swelling of the upper airway, resulting in these symptoms. Asthma, tonsillitis, epiglottitis, and bronchiolitis present differently.
Question 44: A 2-year-old child presents with a harsh, barking cough, inspiratory stridor, and fever. On physical examination, the child appears anxious and restless. What is the most appropriate initial intervention for this patient?
A) Administer bronchodilators
B) Prescribe antibiotics
C) Initiate corticosteroid therapy
D) Perform a tonsillectomy
E) Order a chest X-ray
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Explanation 2: In a child with croup who presents with a barking cough, inspiratory stridor, fever, and anxiety, the most appropriate initial intervention is to initiate corticosteroid therapy to reduce airway inflammation and improve symptoms. Bronchodilators, antibiotics, tonsillectomy, and chest X-ray are not indicated for croup.
Question 44: A 4-year-old child with a barking cough and inspiratory stridor presents to the emergency department. The child’s chest X-ray is normal, and the lateral neck X-ray shows a “steeple sign.” What is the most likely diagnosis?
A) Tonsillitis
B) Epiglottitis
C) Asthma
D) Bronchiolitis
E) Croup
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Explanation 3: The presence of a barking cough, inspiratory stridor, and a “steeple sign” on lateral neck X-ray is indicative of croup. Croup is characterized by upper airway inflammation and the “steeple sign” on imaging. Tonsillitis, epiglottitis, asthma, and bronchiolitis have different clinical and radiological features.
Question 45: A 6-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever. The lateral neck X-ray shows a “steeple sign.” What is the most appropriate initial treatment for this patient?
A) Administer antibiotics
B) Initiate corticosteroid therapy
C) Perform a tonsillectomy
D) Order a chest X-ray
E) Prescribe antiviral medications
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Answer 4: B) Initiate corticosteroid therapy
Explanation 4: In a child with croup who presents with a barking cough, inspiratory stridor, and a “steeple sign” on lateral neck X-ray, the most appropriate initial treatment is to initiate corticosteroid therapy to reduce airway inflammation and improve symptoms. Antibiotics, tonsillectomy, chest X-ray, and antiviral medications are not indicated for croup.
Question 46: An 18-month-old child presents with a barking cough, inspiratory stridor, and low-grade fever. The physical examination is unremarkable. What is the most likely diagnosis in this case?
A) Tonsillitis
B) Epiglottitis
C) Asthma
D) Croup
E) Bronchiolitis
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Explanation 5: The clinical presentation of a barking cough, inspiratory stridor, and low-grade fever is characteristic of croup. Croup is typically caused by viral infections and leads to upper airway inflammation, resulting in these symptoms. Tonsillitis, epiglottitis, asthma, and bronchiolitis have different clinical features.
Question 47: A 9-month-old infant is brought to the pediatric clinic with symptoms of respiratory distress, including cough, wheezing, and increased work of breathing. The child has a low-grade fever, and physical examination reveals diffuse wheezing. Nasopharyngeal swab testing is positive for respiratory syncytial virus (RSV). What is the most appropriate initial intervention for this patient?
A) Administer antibiotics
B) Initiate corticosteroid therapy
C) Prescribe antipyretics
D) Start albuterol nebulization
E) Initiate oxygen therapy
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Explanation 1: In an infant with RSV infection and symptoms of respiratory distress, the most appropriate initial intervention is to start albuterol nebulization to relieve bronchoconstriction and improve breathing. Antibiotics are not indicated for viral infections like RSV. Corticosteroids are generally not recommended for RSV treatment. Antipyretics may be given for fever, but the primary concern is respiratory distress. Oxygen therapy may be needed for hypoxemia.
Question 48: A 6-month-old infant is admitted to the pediatric ward with a diagnosis of RSV bronchiolitis. The infant presents with nasal congestion, cough, and mild respiratory distress. What is the most appropriate nursing intervention for this patient?
A) Initiate contact precautions
B) Administer bronchodilators
C) Encourage cough suppressants
D) Position the infant upright
E) Administer ribavirin
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Explanation 2: For an infant with RSV bronchiolitis and mild respiratory distress, the most appropriate nursing intervention is to position the infant upright to facilitate breathing. Contact precautions are not necessary for RSV. Bronchodilators are typically reserved for moderate to severe cases. Cough suppressants are generally not recommended for young children with respiratory infections. Ribavirin is not a first-line treatment for RSV bronchiolitis in infants.
Question 49: A 10-month-old infant presents to the emergency department with increased respiratory distress, wheezing, and nasal flaring. The child is tachypneic, and physical examination reveals subcostal retractions. The pulse oximetry reading is 90%. What is the next appropriate intervention for this patient?
A) Administer oral antibiotics
B) Initiate corticosteroid therapy
C) Start albuterol nebulization
D) Perform a lumbar puncture
E) Initiate oxygen therapy
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Explanation 3: In an infant with severe RSV bronchiolitis and significant respiratory distress, the next appropriate intervention is to start albuterol nebulization to relieve bronchoconstriction and improve breathing. Antibiotics are not indicated for viral infections. Corticosteroids are generally not recommended for RSV treatment. Lumbar puncture is not indicated in the absence of neurological signs. Oxygen therapy is also crucial for maintaining oxygen saturation.
Question 50: A 7-month-old infant is brought to the pediatric clinic with symptoms of cough, rhinorrhea, and low-grade fever. Physical examination reveals bilateral wheezing. What is the most likely diagnosis in this case?
A) Pneumonia
B) Asthma
C) RSV bronchiolitis
D) Epiglottitis
E) Tonsillitis
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Explanation 4: The clinical presentation of an infant with cough, rhinorrhea, low-grade fever, and bilateral wheezing is indicative of RSV bronchiolitis. RSV is a common cause of lower respiratory tract infections in infants and young children, leading to symptoms like wheezing and bronchiolitis. Pneumonia, asthma, epiglottitis, and tonsillitis have different clinical features.
Question 51 A 5-month-old infant presents to the emergency department with signs of respiratory distress, including nasal flaring, grunting, and intercostal retractions. The infant’s pulse oximetry reading is 88%. What is the most appropriate initial intervention for this patient?
A) Administer antipyretics
B) Initiate oxygen therapy
C) Perform a lumbar puncture
D) Start albuterol nebulization
E) Administer oral antibiotics
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Explanation 5: In an infant with respiratory distress and low oxygen saturation, the most appropriate initial intervention is to initiate oxygen therapy to correct hypoxemia. Antipyretics are not the primary concern in this case. Lumbar puncture, albuterol nebulization, and oral antibiotics are not indicated for respiratory distress associated with RSV infection.
Question 52: A 6-year-old child presents to the pediatric clinic with symptoms of sudden high fever, cough, runny nose, and muscle aches. The child’s rapid influenza diagnostic test (RIDT) is positive for influenza A. What is the most appropriate treatment for this patient?
A) Administer antibiotics
B) Prescribe antiviral medication (oseltamivir)
C) Initiate corticosteroid therapy
D) Recommend rest and hydration
E) Perform a lumbar puncture
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Explanation 1: In a child with confirmed influenza infection caused by influenza A, the most appropriate treatment is to prescribe antiviral medication such as oseltamivir (Tamiflu). Antiviral treatment can help reduce the severity and duration of symptoms. Antibiotics are not effective against viral infections. Corticosteroid therapy is not routinely indicated for uncomplicated influenza. Rest and hydration are important supportive measures, but antiviral treatment is also beneficial. A lumbar puncture is not indicated for uncomplicated influenza.
Question 53: A 4-year-old child is brought to the emergency department with symptoms of high fever, cough, and shortness of breath. On physical examination, the child has decreased breath sounds over the right lung, and a chest X-ray reveals consolidation. What is the most likely complication of influenza in this case?
A) Bronchiolitis
B) Otitis media
C) Pneumonia
D) Gastroenteritis
E) Croup
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Explanation 2: The clinical presentation of high fever, cough, and shortness of breath with consolidation on chest X-ray is indicative of pneumonia, a common complication of influenza. Influenza can lead to secondary bacterial pneumonia, particularly in young children. Bronchiolitis, otitis media, gastroenteritis, and croup are possible complications of viral infections, but in this case, pneumonia is the most likely.
Question 53: A 9-year-old child with a known history of asthma presents to the clinic with symptoms of worsening cough, wheezing, and chest tightness. The child tested positive for influenza on a rapid antigen test. What is the most appropriate management for this patient?
A) Initiate corticosteroid therapy
B) Prescribe a bronchodilator (albuterol)
C) Administer antibiotics D) Recommend bed rest
E) Initiate antiviral medication (oseltamivir)
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Explanation 3: In a child with known asthma and a positive influenza test, the most appropriate management is to initiate antiviral medication, such as oseltamivir. Children with asthma are at increased risk of severe influenza complications, and antiviral treatment can help reduce the risk. Corticosteroid therapy may be considered for asthma exacerbation, but antiviral treatment is the primary intervention for influenza. Antibiotics are not indicated for viral infections, and bed rest alone is not the appropriate treatment.
Question 54: A 7-year-old child presents to the clinic with a sudden onset of high fever, headache, and photophobia. The physical examination is unremarkable. What diagnostic test is most appropriate to confirm the diagnosis in this case?
A) Rapid influenza diagnostic test (RIDT)
B) Throat culture
C) Blood culture
D) Lumbar puncture
E) Chest X-ray
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Explanation 4: In a child with symptoms of high fever, headache, and photophobia, the most appropriate diagnostic test to confirm the diagnosis is a lumbar puncture. These symptoms could indicate viral meningitis, and cerebrospinal fluid analysis through a lumbar puncture is necessary for evaluation. Rapid influenza diagnostic tests are used to confirm influenza infection. Throat cultures are typically performed for suspected streptococcal infections. Blood cultures are more relevant for bacterial infections, and chest X-rays are used to evaluate respiratory symptoms.
Question 55: An 8-year-old child with a history of heart disease presents with high fever, cough, and congestion. The child’s rapid influenza diagnostic test (RIDT) is positive for influenza B. What is the most appropriate intervention in this case?
A) Administer antibiotics
B) Initiate corticosteroid therapy
C) Prescribe antiviral medication (oseltamivir)
D) Recommend bed rest
E) Perform a cardiac catheterization
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Explanation 5: In a child with a history of heart disease and a positive influenza B test, the most appropriate intervention is to prescribe antiviral medication, such as oseltamivir. Children with underlying medical conditions, including heart disease, are at higher risk for severe influenza complications. Antiviral treatment can help reduce the risk. Antibiotics are not indicated for viral infections. Corticosteroid therapy is not routinely recommended for influenza. Bed rest may be part of supportive care but should be combined with antiviral treatment. Cardiac catheterization is not indicated for uncomplicated influenza.
