TreatmPneumon.

doc
Андрій Миколайович Лобода

2015
Зміст 3

Зміст
Зміст 4

A 3-year old girl is hospitalized with bacterial pneumonia. The organism is identified as H. influenzae. An
appropriate plan for management would be to
-Administer gentamycin in dose 5 mg/kg per day
-Administer ampicillin in dose 100 mg/kg per day
-Administer rifampin in dose 10 mg/kg per day
-Administer imipenem in dose 60 mg/kg per day
-Administer vancomycin in dose 60 mg/kg per day
?
You receive a telephone call from the mother of a 4-year-old child. She tells you that the child is
breathing fast,coughing,and has a temperature of 40°C. The most important, prudent approach is to:
-Prescribe aspirin and ask her to call back if the fever does not respond
-Make an office appointment for the next available opening
-Make an office appointment for the next day
-Refer the child to the laboratory for an immediate hematocrit, white blood cell count
-Admit the child to the hospital as an emergency
?
A 10-year-old boy is breathing fast, coughing, and has a temperature of 40°C. His arterial blood, while
breathing room air has pH 7,1, PO2 35 mmHg, SaO2 80%. While waiting for further examines of the
patient, it is necessary to administer:
-Sedation
-Bicarbonate by IV push
-Urea
-100% oxygen
-40% oxygen with 5% carbon dioxide
?
For the child, 3 months old, diagnoses a pneumocystic pneumonia, average degree, respiratory failure
2. From what preparation treatment is necessary to begin?
-Penicillin
-Cephalexin
-Lincomycin
-Biseptol (co-trimoxazolum)
-Erythromycin
?
At the child by age of 2 weeks, which was born in gestational term 34-35 weeks, is diagnosed а fungic
pneumonia. What preparation is choose for etiological therapies?
-Metronidazole
-Claforan
-Diflucan
-Nystatin
-Levorin
?
The child of 2 years has acted in a hospital in occasion of a pneumonia. Introduction ampioxum
intramuscularly is appointed. When it is necessary to replace an antibiotic at absence of its clinical effect?
-On a 3 day
-On a 2 day
-On a 5 day
-On a 7 day
-Through 24 hour
?
As a result of microbiological inspection of sputum at the patient with not hospital pneumonia is
established Chlamidia trachomatis. What following antibiotics will be the most adequate for treatment of
this patient?
-Claritromizin
-Cefazolin
-Gentamicin
-Ceftriaxon
-Biseptol (co-trimoxazolum)
?
Contrical at acute pneumonia appoint at the rate of:
-500 ED/kg 2 times per day
-1.500 ED/kg 3 times per day
-200 ED/kg 2 times per day
-5.000 ED/kg 3 times per day
Зміст 5
-10.000 ED/kg 1 times per day
?
Heparin at acute pneumonia (if hypercoaculation present) appoint at the rate of:
-50 ED/kg 4-6 times per day hypodermic
-150 ED/kg 3 times per day of intramuscular
-200 ED/kg 2 times per day hypodermic
-500 ED/kg 3 times per day of intramuscular
-1000 ED/kg 1 times per day of intramuscular
?
Choose the correct dose of the Amikacin sulfate at children with nosocomial pneumonia:
-1-5 mg/kg daily
-15-30 mg/kg daily
-30-50 mg/kg daily
-50-100 mg/kg daily
-5-10 mg/kg daily
?
Choose the correct dose of the Carbenicillin at children with nosocomial pneumonia:
-10-50 mg/kg daily
-200-400 mg/kg daily
-1-10 mg/kg daily
-50-100 mg/kg daily
-100-150 mg/kg daily
?
Choose the correct dose of the Fluconazole (Diflucan) at children with fungal pneumonia:
-15-20 mg/kg daily
-3-6 mg/kg daily
-20-30 mg/kg daily
-30-50 mg/kg daily
-50-75 mg/kg daily
?
A 13-year-old girl has a history of 2 days of cough and fever.The x-ray reveals a lung abscess involving
the right upper lobe characterized by the round density, the air-fluid level, and the opaque rim. The most
appropriate treatment is:
-N-acetylcysteine
-Prolonged course of ampicillin combined with a b-lactamase inhibitor
-Lobectomy
-Postural drainage
-Thoracentesis and chest tube
?
You admitted to the hospital the previous evening a 4-year-old boy who presented with cough, fever,
and mild hypoxia. At the time of his admission, he had evidence of a right upper lobe consolidation on his
chest radiograph. A blood culture has become positive in less than 24 h for Staphylococcus aureus.
Approximately 20 h into his hospitalization, the nurse calls you because the child has acutely worsened
over the last few minutes, with markedly increased work of breathing and increasing oxygen requirement.
As you move swiftly to the child ’s hospital room, you call ahead and order:
-A second chest radiograph to evaluate for pneumatocele formation
-A large-bore needle and chest tube kit for aspiration of a probable tension pneumothorax
-A change in antibiotics to include gentamicin
-A sedative to treat the child ’s attack of severe anxiety
-A thoracentesis kit to drain his probable pleural effusion
?
A 17 y.o. patient complains of acute pain in the right side of the thorax and sudden progress of
dyspnea following the lifting of a heavy object. The patient's condition is grave: lips and mucous
membranes are cyanotic, BR- 28/min, Ps- 122 bpm., AP- 80/40 mm Hg. There is tympanitis on
percussion and weakened breathing on auscultaion
on the right. S2 sound is accentuated above pulmonary artery. What is the main urgent measure on
the prehospital stage?
-Call for cardiologic team
-Oxygen inhalation
-Epinephrine introduction
-Euphilline introduction
-Air aspiration from the pleural cavity
?
A 14-year-old boy complains of shortness of breath and dull left-sided chest pain. Examination and
Зміст 6
chest X-ray are compatible with a large left-sided pleural effusion. At thoracentesis the pleural fluid is
straw colored and slightly turbid. After removing 1 l of pleural fluid, a pneumonia is seen involving the left
upper lobe. Gram stain of the pleural fluid reveals rare gram-positive diplococci and neytrophils.
Immediate management should include:
-Bronchoscopy
-Pleural biopsy
-Thoracic CT scan
-Chest tube insertion
-Pulmonary function testing
?
Choose the correct dose of Vancomycin:
-20 mg/kg daily
-40 mg/kg daily
-100 mg/kg daily
-150 mg/kg daily
-1 mg/kg daily
?
Choose the correct dose of Imipenem-cilastatin (tienam):
-20 mg/kg daily
-60 mg/kg daily
-200 mg/kg daily
-150 mg/kg daily
-1 mg/kg daily
?
Choose the correct dose of Cefepime:
-20 mg/kg daily
-60 mg/kg daily
-200 mg/kg daily
-100 mg/kg daily
-10 mg/kg daily
?
Choose the correct dose of Meropenem (Meronem) in children with destructive pneumonia:
-20 mg/kg daily
-60 mg/kg daily
-100 mg/kg daily
-150 mg/kg daily
-10 mg/kg daily
?
A 10-month-old infant has poor weight gain, a persistent cough, and a history of several bouts of
pneumonitis. The mother describes the child as having very large, foul-smelling stools for months. Which
of the following diagnostic maneuvers is likely to result in the correct diagnosis of this child?
-CT of the chest
-Serum immunoglobulins
-TB skin test
-Inspiratory and expiratory chest x-ray
-Sweat chloride test
?
A 3 y.o. child with weight deficiency suffers from permanent moist cough. In history there are some
pneumonias with obstruction. On examination: distended chest, dullness on percussion over the lower
parts of lungs. On auscultation: a great number of different rales. Level of sweat chloride is 80 mmol/L.
What is the most probable diagnosis?
-Pulmonary hypoplasia
-Bronchiectasis
-Mucoviscidosis (cystic fibrosis)
-Recurrent bronchitis
-Bronchial asthma
?
A 10 y.o. child complains of the cough with a purulent sputum, more often in the morning, short of
breath, Stable various moist rales at the inferior lobe of the right lung. Fingers like "watch glasses". Blood
count: increase ESR, leukocytosis, neutrophilia with shift to the left. Level of sweat chloride is 40 mmol/L.
At bronchoscopy: bronchial deformation at the inferior lobe of the right lung. What is the most probable
diagnosis?
-Cartagener's syndrome
Зміст 7
-Cystic fibrose
-Chronic pneumonia
-Abscess of the lung
-Lingering pneumonia
?
A 14-year-old boy hospitalized in a hospital with suspicion on an chronic pneumonia. What
instrumental method of research is it necessary to conduct a child for confirmation of diagnosis?
-Sweat chloride test
-Pulmonary function testing
-Bronchoscopy
-Chest X-ray
-Serum immunoglobulins
?
A 16 y.o. child complains of the cough with a purulent sputum, mainly at mornings, dyspnea after the
physical exam. He was ill from childhood, 2 – 3 times at year he was hospitalized because of relapse of
disease. He smokes. On auscultation: hard breathing at the inferior lobe of the right lung, stable various
moist and dry rales. Blood count: RBC – 5,2*10 12/l, WBC - 11*10 9/l, ESR 20 mm/h. Chest X-ray: a
strengthened lung figure, thickening of bronchi walls, diminishing of IX, X segments of the right lung. What
is the diagnosis?
-Bronchoectatiс disease
-Focal pneumonia of the inferior right lobe of the lung
-Lingering pneumonia
-Pulmonary abscesses
-Bronchial astma
?
A 15 y.o. child diagnozed a bronchoectatiс disease. He has edemas on lower limbs. At the urinalysis:
hyperproteinuria, cylinderuria, hypostenuria. What the most probable reason of changes to urinalysises?
-Amiloidosis of kidneys
-Acute nephritis
-Tuberculosis of kidneys
-Polycystic kidneys
-Chronic renal insufficiency
?
At 10 y.o. child, which during 4 years be ills by chronic pneumonia, is developped complication - a
pulmonary heart. What the most often sign of this complication on ECG?
-Low Т
-High P
-Depression ST
-Low P
-Left sided ECG
?
A 8 years old child presents with fever, cough, and tachypnea. Physical examination reveals reles in
the left posterior lung base, and a chest radiograph confirms pneumonia. Past history is positive for two
other episodes of pneumonia at the base at ages 4 and 6 years.The most likely diagnosis is?
-Eventration of the diaphragm
-Bronchoectatiс disease
-Pulmonary embolism
-Diaphragmatic hernia
-Resistant pneumococcal pneumonia

The following microorganisms may found at sputum of children with chronic pneumonia:
-S. pneumoniae
-H. influenzae
-Mycoplasma pneumoniae
-Legionella pneumoniae
-Pseudomonas aeruginosae
?
Choose the correct dose of сeftriaxone sodium:
-20 mg/kg daily
-50-75 mg/kg daily
-30 mg/kg daily
-750 mg/kg daily
-1 mg/kg daily