Question 1

A 2-year-old presents with a history of wheezing and persistent cough. The father reports the child had a coughing/choking episode about a week ago that was spontaneously resolved. A few days later she began to cough and wheeze. This scenario is most consistent with:

a. Restrictive airway disease
b. Sinusitis
c. Bronchiolitis
d. Foreign body aspiration

Question 2

Hope is a 7-month-old who presents in January with a 1-day history of cough, yellow nasal discharge, and low-grade temp (T max 100°F). She was previously healthy. She does have 2+ edema of the nasal turbinates and cloudy rhinorrhea. She is afebrile in the office. Her chest, mouth, and ears are clear. You prescribe:

a. Guaifenesin liquid suspension
b. Amoxicillin 80 mg/kg/day in two divided doses for 10 day
c. Neo-Synephrine half-strength drops three times a day for 5 to 6 days
d. Saline drops, bulb suction, humidified air, and increased PO fluids

Question 3

A 2-year-old presents to your office with the following symptoms: nasal congestion and rhinorrhea for 48 hours, low-grade fever, and a harsh/barky cough that is significantly worse at night. Inspiratory stridor is present and she has clear but slightly decreased breath sounds. Which of the following treatments is best?

a. Albuterol sulfate solution via nebulizer every 4 to 6 hours
b. Azithromycin (Zithromax) treatment for 5 days
c. One dose of oral dexamethasone
d. Oral dextromethorphan extended release at night only

Question 4

You are on call and receive a phone call from the parents of a 13-year-old known asthmatic. She has been having chest tightness and a worsening cough for 48 hours. She has significant nasal discharge that began 14 days ago and intermittent complaint of headache. She is now running a low-grade fever. Her peak flow the last 48 hours is 70-80% of personal best. Her temperature right now is 101.7°F. She is on salmeterol with corticosteroid (Advair) and PRN albuterol. Which of the following is most appropriate?

a. Continue home management with the use of inhaled beta agonists and inhaled corticosteroids, and add the use of oral antihistamine/decongestant combinations.
b. See her in the office in the morning and prescribe a 14-day course of amoxicillin plus the addition of a short course of oral steroids.
c. See her in the office in the morning and prescribe a short course of oral steroids.
d. Continue home management and add inhaled cromolyn sulfate.

Question 5

Shelby is a healthy 4-week-old who presents to your office in mid-January with a 3-day history of nasal congestion with occasional cough. She started running a low-grade fever last night (T max 101.5°F). Now she is refusing to nurse and has paroxysmal coughing and noisy/labored breathing. Physical exam reveals an ill-appearing infant with lethargy and tachypnea, intercostal retractions, expiratory wheezes, and occasional rales. She does not attend day care but has a 3-year-old sibling who does and who recently had a "cold." What is the MOST LIKELY cause of Shelby's illness?

a. Mycoplasma pneumonia
b. Bronchitis
c. RSV bronchiolitis
d. Upper respiratory tract infection

Question 6

A 16-year-old presents with pharyngitis, cough, and high fever. Her chest X-ray reveals bilateral pulmonary infiltrates. Her white blood cell count is normal and the neutrophil count is normal. The most likely etiology is:

a. Chlamydia pneumonia
b. Streptococcus pneumonia
c. Legionella
d. Staphylococcus aureus

Question 7

In children who have not received antibiotics in the past month, which antibiotic is recommended by the Centers for Disease Control and Prevention for the management of acute bacterial respiratory infection?

a. Azithromycin (Zithromax)
b. Amoxicillin (Amoxil)
c. Amoxicillin plus clavulanic acid (Augmentin)
d. Sulfamethoxasole (Bactrim)

Question 8

A 7-year-old presents with abrupt fever, stridor, drooling, and hyperextension of the neck. You examine the nose and throat and notice one tonsil is enlarged and there is marked erythema of the pharynx with uvular deviation. Which is most appropriate?

a. Start amoxicillin at the appropriate dose for weight after obtaining a throat culture.
b. Place on a 5-day course of oral steroids after obtaining a monospot, EBV titers, and a CBC.
c. Refer to otolaryngology for management of a peritonsillar abscess and possible hospital admission.
d. Start cephalexin (Keflex) at the appropriate dose for weight after obtaining a throat culture.

Question 9

Which of the following symptoms are most suggestive of pneumonia in a young child?

a. Headache, fever, malaise, congestion, scattered rhonchi
b. Fever, tachypnea, coryza, cough, scattered rales
c. Fever, vomiting, coryza, cough, scattered rales
d. Irritability, fever, decreased appetite, scattered rhonchi

Question 10

Anthony is a known asthmatic. He has symptoms three times a week but never more than once a day. Exacerbations affect his normal activities occasionally. He awakens with cough three to four times a month. You classify his asthma as:

a. Mild intermittent
b. Mild persistent
c. Moderate persistent
d. Severe persistent