Pediatrics Pulmonology

An infant with frequent pulmonal infections may have the following disease:

A) mucoviscidosis

B) hypogammaglobulinaemia

C) chronic granulomatous disease

D) all the above mentioned

D) all the above mentioned

• mucoviscidosis

• hypogammaglobulinemia

• chronic granulomatous disease

EXPLANATION

In mucoviscidosis, the disturbance of secretion transport, hypogammaglobulinaemia, and the deficiencies of humoral immunity, in chronic granulomatous disease the insufficiency of granulocyte function can both cause frequent pulmonary infections, thus all the above mentioned statements are true.

The following statements about newborn’s pneumothorax are true, except one. Which one is the exception?

A) neonatal hypoxic conditions and their respiratory treatment are the main causes

B) in the case of ventilation pneumothorax, the ipsilateral lobe is compressed, which can lead to a shock

C) transillumination is a good supplementation to physical examination

D) if the newborn was on a respirator, it must be taken off from the machine

E) a tensional or high-grade pneumothorax should be detensionated and a long-term suction should be introduced

D) if the newborn was on a respirator, it must be taken off from the machine

EXPLANATION

In neonatal hypoxic states pneumothorax may develop as a complication of respiratory therapy. In this case the ipsilateral lung is compressed by pneumothorax, this diagnosis can be complemented by transillumination, the treatment is aspiration. But a newborn in a severe respiratory failure, worsened by the pneumothorax, should be continually respirated.

The following statements are characteristic for pulmonary sequestration, except one. Which one is the exception?

A) the sequestered segment is not connected to the bronchial system

B) is mainly located in the upper lobe

C) may lead to repeated pneumonias

D) the sequestrated part must be removed by surgery

E) its blood flow is not from the pulmonary artery

B) is mainly located in the upper lobe

EXPLANATION

The statements contain facts about pulmonary sequestration, but pulmonary sequestration is much more frequent in the lower lobes, thus B is the exception.

The following statements are characteristic for congenital bronchial stenosis, except one. Which one?

A) the cause is the immaturity and softness of the cartilage

B) the secretion can accumulate after the stenosis

C) the hardening of the cartilage can be facilitated with the administration of vitamin D

D) the use of cough suppressors is prohibited

E) it can be diagnosed by bronchoscopy

C) the hardening of the cartilage can be facilitated with the administration of vitamin D

EXPLANATION

With the exception of point C, the other statements are correct considering the congenital bronchial stenosis, therefore the cause is the immaturity and softness of the cartilage, which results in a functional stenosis, behind secretion can accumulate, in these cases coughing should not be suppressed, but on the contrary, expectorants should be considered. The stenosis can be visualized by bronchoscopy. The administration of vitamin D does not facilitate the hardening of the cartilage, so the usual dose can be applied, but overdosing could be harmful.

The following statements are true about the neonatal pneumonia, except one. Which one?

A) can develop intrauterine, intrapartum, or postnatally

B) predispositions are the preterm rupture of the membrane, and maternal infections

C) a common pathogen is group B Streptococcus

D) symptoms are similar to RDS

E) elevated serum IgG level is an evidence of a conatal pneumonia

E) elevated serum IgG level is an evidence of a conatal pneumonia

EXPLANATION

Newborn’s pneumonia can develop intrauterine, intrapartum, or postnatally, predispositions are the preterm rupture of the membrane, and maternal pathogens, especially the group B Streptococci. The clinical symptoms resemble to RDS (respiratory distress syndrome). In neonatal pneumonia, the white blood cells count can be elevated or decreased, and usually, like in other neonatal infections, thrombocytopenia develops. At the same time, serum IgG levels do not increase, as the newborn has the mother's IgG, but a limited ability of producing its own IgG.

The following statements are true for an acute tonsillitis, except one. Which one?

A) can be caused by bacteria, viruses and fungal infections

B) a complication can be a rheumatic fever

C) the most common pathogen is Streptococcus pneumoniae

D) often accompanied with cervical lymphadenitis

E) a few days of fever

F) fluid intake is often difficult due to the swollen tonsils

C) the most common pathogen is Streptococcus pneumoniae

EXPLANATION

Streptococcus pneumoniae causes pneumonia and purulent meningitis, rather than acute tonsillitis, but other bacteria, viruses and fungi can cause acute tonsillitis. This is usually accompanied with a few days of fever. Fluid intake is often difficult due to the swollen tonsils, cervical lymphadenitis is common, and in two to three weeks later, a rheumatic fever may occur.

Tonsillectomy is required, except one. Which one?

A) frequently repeated follicular tonsillitis with fever

B) tonsillitis with peritonsillar abscess

C) tonsillitis with retropharyngeal abscess

D) repetitive upper respiratory tract infections

E) suspect of an intratonsillar tumor

D) repetitive upper respiratory tract infections

EXPLANATION

In recurrent otitis media, adenoidectomy should be performed to reduce infections, ascending from the pharynx. Thus, frequently repeated tonsillar infections are an indication for tonsillectomy. Peritonsillar and retropharyngeal abscesses are both indications for a tonsillectomy, just as a suspected tumor.

Which diagnostic test result is a proof of mucoviscidosis?

A) decreased xylose absorption

B) reduced vitalcapacity

C) reduced bile acid levels in duodenal excretion

D) steatorrhoea

E) a sweat Cl- concentration above 60 mmol/l

F) cor pulmonale

E) a sweat Cl- concentration above 60 mmol/l

EXPLANATION

In mucoviscidosis, the increased chlorine concentration in sweat is a diagnostic proof, a concentration above 60 mmol / l is a typical value. Decreased xylose absorption may occur in other types malabsorption, vital capacity can be reduced, but just as in other obstructive and restrictive pulmonary diseases. Steatorrhoea can be caused by any other illnesses associated with maldigestion. Cor pulmonale develops only in very severe, advanced pulmonary diseases in childhood. This can be a symptom in mucoviscidosis, but may also occur in pulmonary fibrosis, extremely severe bronchial asthma, etc. Reduced bile acid levels in duodenal excretion can only be exceptionally present in mucoviscidosis with progressive liver manifestation.

Characteristics of pseudocroup, except one:

A) usually occurs at night

B) coughing, stridor can be detected

C) is common in infants and toddlers

D) is mostly caused by bacterial infection

E) cool air, sitting position helps

D) is mostly caused by bacterial infection

EXPLANATION

The causes of pseudocroup can be habitual and allergic-type mechanisms and it is mostly caused by viral infections: acute purulent laryngitis and acute epiglottitis are usually bacterial infections. General characteristics are night-time appearance, coughing, stridor, it is more common in infants and toddlers, and cool air, sitting position helps.

The following diseases can be the complications of acute tonsillitis, except one. Which one?

A) lymphadenitis colli

B) acute febris rheumatica

C) sepsis

D) chronic rheumatoid arthritis

E) glomerulonephritis acuta

D) chronic rheumatoid arthritis

EXPLANATION

Chronic rheumatoid arthritis is an autoimmune disease which does not occur as a result of tonsillitis. At the same time, lymphadenitis colli is often associated with the acute phase of tonsillitis, exceptionally, even a sepsis can develop; consequently, as a complication, febris rheumatica and acute glomerulonephritis may develop.

The following statements are true for retropharyngeal abscess, except one. Which one is the exception?

A) complication of a purulent pharyngitis

B) disturbs swallowing

C) causes a laryngeal edema

D) head positioning resembles to meningism

E) spontaneous opening of the abscess should be preferred instead of surgery

F) laryngoscopy is required for the diagnosis

G) submandibular lymphadenitis is always present

E) spontaneous opening of the abscess should be preferred instead of surgery

EXPLANATION

Retropharyngeal abscess is an acute severe condition. When the diagnosis is certain, it is advisable to open and empty the abscess and not to wait for the spontaneous opening. The disease is usually a complication of an upper respiratory tract infection, mostly pharyngitis, swelling may disturb swallowing, can cause a laryngeal edema, just as headaches that may resemble to meningitis. The diagnosis can be confirmed with direct inspection, ie laryngoscopy; usually accompanied with the painful swelling of the lymph glands.

The following statements are true for acute epiglottitis, except one. Which one is the exception?

A) slow progression

B) high fever, restlessness

C) dyspnea, cyanosis, backward head position

D) can lead to suffocation

A) slow progression

EXPLANATION

Acute epiglottitis is an extremely acute condition characterized by high fever, restlessness, dyspnea, cyanosis, etc., backward head position and suffocation. The hyper acute disease may lead to death in a few hours, slow progression is not an option.

What kind of antimicrobial therapy would you apply in epiglottitis and why?

A) I would not use any antimicrobial treatment, as epiglottitis is caused by viruses

B) I would administer acyclovir, as the most common pathogens are Herpes viruses

C) III. generation cephalosporin, as the most common pathogen is Haemophilus influenzae

D) Vancomycin treatment, as epiglottitis is a result of a staphylococcal infection

C) III. generation cephalosporin, as the most common pathogen is Haemophilus influenzae

EXPLANATION

The most common pathogen of epiglottitis is Haemophilus influenzae, and therefore, III. generation cephalosporin, in an intravenous form, is the adequate treatment. Since it is not a viral disease, antimicrobial therapy should be applied; it is not caused herpesvirus, acyclovir is unnecessary. Staphylococci can rarely cause epiglottitis; thus, Vancomycin is not a first-line treatment.

The most common pathogen in bronchiolitis?

A) Haemophilus influenzae

B) Pneumococcus

C) coxsackie virus

D) Streptococcus haemolyticus

E) respiratory syncytial virus

E) respiratory syncytial virus

EXPLANATION

Bronchiolitis most commonly occurs in young infants, during the first 6 months of life and is most commonly caused by respiratory syncytial virus. The other listed pathogens can only exceptionally be the cause of this illness.

Most common causes of chronic bronchitis, except one. Which one?

A) community acquired repetitive infections

B) allergy

C) sinusitis

D) mucoviscidosis

E) IgE deficiency

E) IgE deficiency

EXPLANATION

The IgE deficiency is virtually not existing, any of its pathological significance can be disputed. Thus, it cannot be the cause of chronic bronchitis; however, repeated infections, including sinusitis, allergic processes, and mucoviscidosis-caused excretion transport disturbances are possible pathologies to bronchitis.

A wheezy bronchitis (so called bronchitis obstructiva) can be called infant’s or toddler’s asthma. One statement is false. Which one?

A) more common in infants and toddlers, than in later ages

B) malnutrition is a predisposition

C) physical finding is expiratory dyspnea

D) high fever is not common

B) malnutrition is a predisposition

EXPLANATION

Wheezy bronchitis (so called bronchitis or infant’s or toddler’s asthma) is not related to malnutrition, and even the old clinical experience is that it is more common in well-fed infants. Otherwise, the other listed statements are true to obstructive bronchitis; this is an infant and toddler illness; as in any obstructive process, expiration is more difficult; high fever can rarely join; and the swelling of the airways' mucous membrane plays an important role as a cause of dyspnea in this age group.

The following factors are present in the pathogenesis of asthma bronchiale, with one exception. Which one?

A) hyperreactivity of the bronchial system

B) IgE mediated antigen antibody response

C) smoking, humid air inhalation

D) physical stress

E) adrenergic drugs

F) psychological effects

E) adrenergic drugs

EXPLANATION

Adrenergic drugs dilate the bronchi; thus, they do not play a role in the pathogenesis of bronchial asthma, they rather improve this condition. In addition, the childhood asthma is based on the hyperreactivity of the bronchial system, most of the cases are allergic, atopic, IgE-mediated reactions. Physical stress can cause bronchospasm, just as psychological factors, other triggering factors are the inhalation of tobacco smoke or humid air.

Which of the following treatments are prohibited in severe asthma?

A) increased fluid intake

B) β -receptor agonists

C) β-receptor antagonists

D) theophylline and its derivatives

E) corticosteroid

C) β-receptor antagonists

EXPLANATION

As the asthmatic state is enhanced by adrenergic agents, therefore β-receptor-agonist, β-receptor antagonists, acting as bronchoconstrictors, deteriorate asthma and therefore their use is prohibited. β -receptor agonists and theophylline improve asthmatic state and corticosteroids reduce the eosinophilic inflammation. A person with a high respiratory rate loses more fluid, so additional fluid intake is recommended.

The assessment of an asthmatic child’s clinical condition is based on the following, except one:

A) frequency of night complaints

B) frequency of beta-2-agonist demand

C) total serum IgE level

D) assessment of the everyday limitations

E) frequency of daytime complaints

C) total serum IgE level

Can show the clinical symptoms of wheezy bronchitis or asthma bronchial, except one. Which one?

A) abnormal aortic arch (vascular ring)

B) cystic fibrosis

C) main bronchi stenosis

D) untreated celiac disease

E) vitium with pulmonary overflow

F) a chronic foreign body in the airways

D) untreated celiac disease

EXPLANATION

Celiac disease (gluten intolerance) usually does not have respiratory manifestation, nor wheezy bronchitis. The other above listed diseases may imitate the clinical symptoms of wheezy bronchitis, e.g. respiratory stenosis caused by a vascular ring, excretion congestion in cystic fibrosis, respiratory disturbances caused by main bronchi stenosis, vitium with pulmonary overflow, or a chronic foreign body in the airways.

These pathogens are most likely to cause a pneumonia among school-age children (only one answer is correct):

A) Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae

B) Klebsiella pneumoniae, Escherichia coli

C) Haemophilus influenzae, Staphylococcus aureus

D) group B Streptococcus

A) Mycoplasma pneumoniae, Chlamydia pneumoniae, Streptococcus pneumoniae

EXPLANATION

In school-age children and adolescents, Mycoplasma pneumoniae, Chlamydia pneumoniae and Streptococcus pneumoniae are relatively common pathogens in pneumonia. Klebsiella pneumoniae and Escherichia coli usually cause pneumonia in neonates and premature babies, Haemophilus influenzae in babies and toddlers, and children under the age of 6; group B Streptococci is predominantly causing a newborn infection, Staphylococcus aureus causes pneumonia in babies and toddlers.

The complications of pneumonia complications do not include one of the following. Which one?

A) pulmonary fibrosis

B) empyema

C) bronchiectasia

D) sepsis

E) abscess formation

A) pulmonary fibrosis

EXPLANATION

Pulmonary fibrosis does not develop as a complication of pneumonia. Causes can be idiopathic (pulmonary fibrosis, pulmonary haemosiderosis), can be caused by pulmonary sarcoidosis, histiocytosis X, etc., but as a complication of pneumonia purulent pleuritis (empyema), sepsis and pulmonary abscess formation can develop. In chronic recurrent, possibly immunodeficient pneumonias may also have bronchiectasia.

To differentiate between bacterial and viral pneumonia these statements are true, except one. Which one is incorrect?

A) in viral pneumonia the white blood cell count is lower than in bacterial pneumonia

B) viral pneumonia in infants are always mild

C) the progression of viral pneumonia is slower

D) lobar infiltrate refers to bacterial etiology

B) viral pneumonia in infants are always mild

EXPLANATION

Virus pneumonia of the infants can often cause a fulminant, life-threatening condition. The other statements although are true: lobar pneumonia usually has bacterial origin, in bacterial infection the white blood cell count is higher, than in virus pneumonia. Virus pneumonia usually has a slower progression compared to acute bacterial pneumonia.

Cytomegalovirus pneumonia does not occur in one case. Which one?

A) after renal transplantation

B) in AIDS

C) in respiratory distress syndrome

D) in case of immunosuppressive therapy

E) in other opportunistic infection

C) in respiratory distress syndrome

EXPLANATION

The newborn’s respiration distress syndrome is related mostly to prematurity and immaturity, and the lack of surfactant synthesis is the main factor. Usually CMV infection does not consort to it. In the other listed condition, like for example after renal transplantation due to the cystostatic therapy, in AIDS due to the essence of the disease, or in patient who gets immunosuppressive therapy due to any other reason, there is an immune system dysfunction. And CMV-pneumonia can connected to opportunist infection also.

What is typical for Mycoplasma pneumoniae infection? There is only answer correct. Which one is that?

A) typical for infants

B) fulminant process

C) mild cough

D) Incubation period is couple if weeks

E) Mainly alveolar

D) Incubation period is couple if weeks

EXPLANATION

The disease caused by Mycoplasma pneumoniae infection comes out several weeks incubation period, it is mostly a childhood disease with long-lasting progression, because it is an insterstitial process coughing is typical. Due to the previous statements it is basically not an alveolar course.

One of the following helminths does not cause eosinophil pneumonia. Which one is that?

A) Oxyuris vermicularis

B) Ascaris lumbricoides

C) Toxocara canis

D) Toxocara catis

A) Oxyuris vermicularis

EXPLANATION

Oxyuris vermicularis does not cause eosinophil pneumonia. The clinical course does not go beyond to intestines and the perianal location. All of the other helmintiasis are generalized, can cause diseases outside of the intestines and eosinophil pnuemonia is characteristic to them.

One of the followings cases we have to think to foreign body aspiration. Which one is that?

A) swallowing is regularly and permanently painful

B) swallowing liquids is easily possible, but the solid food gets stucked

C) coughing attack and vomiturition during eating

D) coughing only appears in lying position

E) unusual amount of hiccups/singultus and burps appear

C) coughing attack and vomiturition during eating

EXPLANATION

The suspicion of foreign body aspiration is raised, when coughing attack and retch appear during eating, because that is the time to food aspirating. The other listed process are not specific to foreign body aspiration. Swallowing is not painful and the solid food does not get stucked. Coughing appers in all posture due to the aspirate, hickups and burps are specific in diseases connected to the stomach.

A 3-year-old child, who goes to nursery, has serial mild, spontaneously healing airway infections. What do you think first?

A) immunglobulin deficiency

B) cellular immunodefeciency

C) the various possible infections originated from the environment

D) feeding deficiency

E) vitamin C deficiency

F) rachitis

C) the various possible infections originated from the environment

EXPLANATION

When infants or little children get to the nursery, it is common that the airway and mostly virus caused infections they catch from each other appear often, maybe multiply: this is an every day possibility. From the other conditions vitamin C deficiency has no connection to these airway infections. Only very severe, advanced rachitis – which in these days only exceptionally occurs – can lead to general extenuation, frequent infections. Immunglobulin and cellular immunnodeficiency can lead to cumulative infection usually before the nursery period and they are especially rare conditions. Feeding deficiency only in very severe cases leads to cachexy that comes with cumulative infections, and if the child goes the nursery, it is hardly imagnable.

All of the following are involved in the successful treatment of allergic disease, except one. Which one is that?

A) elimination of the allergens

B) drug therapy

C) antimikrobial medicines

D) immunotherapy (desensibilisation, allergene vaccination)

E) profilaxis (e.g. avoid environmental smoking)

C) antimikrobial medicines

EXPLANATION

In allergic diseases the role of bacteries is limited, so using antimicrobic and antibiotic drugs because of the allergic disease is unnecessary. The other listed method and drugs are parts of the therapy and the prevention of allergic diseases.

One of the followings is the most proper diagnostical procedure in case of foreign body aspiration. Which one is that?

A) exhaustive investigation of the anamnesis

B) anteroposterior chest x-ray

C) bronchoscopy

D) bronchography

E) chest transillumination

C) bronchoscopy

EXPLANATION

Foreign body aspiration can often diagnose by chest x-ray transillumination, when the so called Holzknecht sign appears, which means that during inspiration the aspirated side does take part less in the breathing, thus the intact side push the medistinum to the affected side, so during inspiration the mediastinum moves towards the affected side. Very careful clarification of the anamnesis is obviously very important, but it does not judge the diagnosis of aspiration. A simple chest x-ray only help in this case if there is a widespread atelectasia in the location of the aspiration. If there is a reasonable suspicion of foreign body aspiration, bronchoscopy decided he diagnose and elimination the foreign body during the examination is the therapy itself. Bronchography is only necessary to clarificate the complications (wreck lobe, bronchiectasy, etc.); we apply contrast-enhanced bronchography only in special cases.

Which intervention is wrong in Mucoviscidosis?

A) administration of oral antidiabetics is recommended due to pancreatic fibrosis

B) pancreatic enzymes are justified

C) hypercalorisation of patients

D) short chain fatty acids are preferred

E) Supplementation of fat-soluble vitamins

A) administration of oral antidiabetics is recommended due to pancreatic fibrosis

EXPLANATION

Diabetic process does not develop usually in mucoviscidosis. If pancreatic fibrosis causes carbohydrate metabolism disorder, this is due to insulin deficiency and then insulin treatment is justified. However, administration of pancreatic enzymes is also important because in mucoviscidosis the pancreatic exocrine function is frequently impaired. Among other, this is the cause of the poor nutritional status of the patients, therefore hypercalorization is needed, including the use of short-chain fatty acids which facilitate the absorption. Due to lipase deficiency fat catabolism is impaired, therefore replacement of fat-soluble vitamins is also important.

Tuberculosis is characterized by the following, except:

A) A positive Mantoux test will certainly certify the existence of tuberculosis

B) the tbc-bacillus can be easily detected from sputum, pharyngeal Lavage

C) meningitis may occur during the illness

D) PCR (polymerase chain reaction) accelerates the detection of tbc-bacillus

E) primary tuberculosis can be healed in weeks

A) A positive Mantoux test will certainly certify the existence of tuberculosis

EXPLANATION

A positive Mantoux test only confirms that the organism is infected with the tuberculosis bacterium, or that it came into contact with the BCG bacterium. The Mantoux test alone does not reflect the activity of the process, but might indicate BCG protection. Otherwise, the other listed entities are characteristic of the disease, since bacillus can be detected from sputum, and pharyngeal-lavage. This detection is accelerated by the PCR and thus the detection takes place sooner. Primary tuberculosis might heal within several weeks and tuberculosis meningitis is a known manifestation of the disease (meningitis basilaris tuberculosa).

The following, except one, predispose to tuberculotic disease:

A) malnutrition, poor social situation

B) simultaneous bronchial asthma

C) AIDS, cellular immunodeficiency

D) immunosuppression by drugs

E) measles, pertussis, after infectious mononucleosis

B) simultaneous bronchial asthma

EXPLANATION

Bronchial asthma does not predispose to tuberculosis, recently bronchial asthma has become more frequent, while tuberculosis has become rare in childhood. Among the other listed entities, although malnutrition and poor social status are not the only cause of tuberculosis, but they definitely confer predisposition. All the conditions that involve the suppression of the immune system (immunosuppressive drugs, measles, pertussis, mononucleosis, etc.) are also conferring predisposition to the disease.

The following procedures, except one, are useful in lung edema:

A) oxygen administration

B) diuretic and aminophylline administration

C) inhalation of steroids

D) intermittent positive pressure breathing

E) Correction of acidosis

C) inhalation of steroids

EXPLANATION

Inhaled steroids doesn’t have beneficial effect on the pathomechanism of pulmonary edema, however facilitating the respiration with intermittent positive pressure breathing and with oxygen administration is useful. The correction of the usually developing acidosis is needed. Diuretics and aminophylline have a beneficial effect on the process.

Which test is suitable to follow up fibrotic alveolitis?

A) regular control of erythrocyte sedimentation rate

B) control of serum immunoglobulins

C) detection of changes in allergy skin tests

D) performing respiratory function tests

D) performing respiratory function tests

EXPLANATION

Fibrotic alveolitis is associated with the continuous deterioration of respiratory function, successful treatment slows down this process, or even stops it, and in favorable cases the respiratory function even improves. Therefore the progression of the disease and the success of the treatment can be monitored by respiratory function tests. The other listed tests are not related to the process of alveolitis.

Typical symptoms of allergic rhinitis, except one:

A) abundant nasal discharge

B) frequent sneeze

C) often associated with conjunctivitis

D) many neutrophil granulocytes in nasal secretion

E) nasal congestion during the night disturbs the patient

F) patients complain about itching in the throat

D) many neutrophil granulocytes in nasal secretion

EXPLANATION

Allergic rhinitis is generally not a pustulous nasal process, and consequently the increase in neutrophil granulocytes number is not characteristic to the process. However, the main symptom of the disease is runny nose, sneezing, nasal congestion, itching in the throat or in the nose and accompanying allergic conjunctivitis.

Which statement is not correct in childhood asthma?

A) The endogenous form is more common than the exogenous

B) Bronchial hyperreactivity is characteristic

C) IgE level is increased

D) It is related with leukotrienes release

E) Between the attacks the patients may be without symptoms

A) The endogenous form is more common than the exogenous

EXPLANATION

In the overwhelming majority of cases, childhood asthma is exogenous (exogenous allergens play role in triggering symptoms). In adulthood this changes to the endogenous form. The other factors listed are bronchial hypersensitivity, elevated IgE levels, proliferation of leukotrien mediators are characteristics for the disease and non-serious patients become asymptomatic in phases between attacks.

Rhinitis allergica is an atopic disorder just as

1) atopic dermatitis is

2) chronic urticaria is

3) asthma bronchiale is

4) cereal protein sensitivity is

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) 1st, 2nd and 3rd answers are correct

1) atopic dermatitis is

2) chronic urticaria is

3) asthma bronchiale is

It has a decisive role in triggering seasonal allergic rhinitis:

1) House dust mite

2) Ragweed pollen

3) Cat fur

4) Grass pollen

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

C) 2nd and 4th answers are correct

2) Ragweed pollen

4) Grass pollen

EXPLANATION

In triggering seasonal allergic rhinitis, allergens with seasonal occurrence play a decisive role, like ragweed- and grass pollen. House dust mite and cat fur are triggers acting for the whole year, causing a year-long rhinitis

Symptoms characteristic for allergic conjuctivitis:

1) watery eye discharge can be seen

2) itchy eyes

3) cornea is not affected

4) it affects both sides

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) watery eye discharge can be seen

2) itchy eyes

3) cornea is not affected

4) it affects both sides

EXPLANATION

The symptoms listed above are all associated with allergic conjunctivitis, and it is also characteristic that the cornea is not involved in the conjunctival process. Due to the allergic pathomechanism, the process is two-sided, itching of the eye and eye discharge are, besides the redness of the eye, major symptoms of allergic conjunctivitis.

Typical of atopic diseases of the airways:

1) high grade seasonal variability

2) different conditions of the disease can be found at the same time at the same patient

3) positive family anamnesis

4) the occurrence of cumulative bacterial infections

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) 1st, 2nd and 3rd answers are correct

1) high grade seasonal variability

2) different conditions of the disease can be found at the same time at the same patient

3) positive family anamnesis

EXPLANATION

Atopic airway disorders are of allergic origin, non-bacterial diseases, therefore cumulative bacterial infections usually do not have to be counted. Because of the triggering factors, seasonal variability is expressed, and as atopic illnesses are characterized by several atopic conditions (asthma, hay fever, atopic dermatitis) they can occur together in the same patient and the illness often indicates family accumulation.

It has a main role in treating asthma:

1) in case of an attack, giving antihistamines

2) intravenous steroids, because they have immediate bronchodilator effect

3) for an irritated patient, giving tranquilizers

4) giving inhaled agents as far as possible

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

D) only the 4th answer is correct

4) giving inhaled agents as far as possible

EXPLANATION

For the treatment of asthma, inhalative agents acting in the target organ have the primary role. Antihistamines have a limited effect on asthma attacks, intravenous steroids may be important in severe conditions, but they do not have immediate bronchodilator effect, asthma patients are generally not allowed to be sedated, because it would depress respiration, which causes deterioration of the condition.

The treatment of allergic rhinitis is based on:

1) giving modern antihistamines

2) with adenoidectomy a better nose breathing can be achieved

3) for nasal congestion forms, giving steroid-containing nasal drops is required

4) the continuous use of vasoconstrictor nasal drops is required

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

B) 1st and 3rd answers are correct

1) giving modern antihistamines

3) for nasal congestion forms, giving steroid-containing nasal drops is required

EXPLANATION

Allergic rhinitis can be highly influenced by modern antihistamines. Nasal drops containing steroids (nasal sprays) for nasal congestion are suitable for reducing local eosinophilic allergic inflammation. Allergic rhinitis alone is not an indication of adenoidectomy as it does not affect the allergic process. Continuous administration of vasoconstrictor nose drops damages the nasal mucosa.

Recommended in treating acute tonsillitis with fever:

1) frequent use of antipyretics or physical cooling

2) intention for adequate fluid intake

3) in case of the identification of Streptococcus hemolyticus in throat culture, giving antibiotics

4) resting in bed is important

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

E) all of the answers are correct

1) frequent use of antipyretics or physical cooling

2) intention for adequate fluid intake

3) in case of the identification of Streptococcus hemolyticus in throat culture, giving antibiotics

4) resting in bed is important

EXPLANATION

Streptococcus hemolyticus is a commonly occurring pathogen of acute tonsillitis with fever, and if it is proven by microbiology, it is advisable to administer antibiotics, usually penicillin. In case of acute high fever, antipyretics and bed rest are all important, and as in all high-fever conditions, the patient consumes little food, so it is important to strive for adequate amounts of fluid intake.

The basics of treatment in pseudocroup:

1) cool room temperature is desirable

2) the inhalation of adrenergic agents

3) in severe cases, giving inhaled or systematic steroids

4) treating the irritated child with central-acting tranquilizers

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

A) 1st, 2nd and 3rd answers are correct

1) cool room temperature is desirable

2) the inhalation of adrenergic agents

3) in severe cases, giving inhaled or systematic steroids

EXPLANATION

A cooler room temperature generally has a good effect for pseudocroup patients (to open a window, etc.), as well as inhalation of adrenerg agents and the administration of inhaled or systemic steroids are required for lowering the inflammation of mucus membranes. The central sedative may deprive the patient of the possibility of respiratory compensation.

Important examinations which have to be performed with a patient who has acute bronchitis and fever:

1) chest X-ray

2) bacteriology of bronchoalveolar lavage

3) measurement of plasma oxigen and CO2

4) careful physical examination

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

D) only the 4th answer is correct

4) careful physical examination

EXPLANATION

Acute bronchitis with fever, which is usually lasting a few days, benign and easy to treat, can be diagnosed with careful physical examination. Chest X-ray is only needed if pneumonia is suspected, due to the uncertain auscultation or the prolonged illness. We don’t do bronchoscopy in acute bronchitis and the determination of the plasma oxygen and carbon-dioxide levels of a patient whose general condition is good is unnecessary.

Possible complications of Staphylococcus pneumonia:

1) purulent meningitis might develop

2) lung abscess

3) impetigo appears on the skin

4) development of purulent pleuritis (empyema)

A) 1st, 2nd and 3rd answers are correct

B) 1st and 3rd answers are correct

C) 2nd and 4th answers are correct

D) only the 4th answer is correct

E) all of the answers are correct

C) 2nd and 4th answers are correct

2) lung abscess

4) development of purulent pleuritis (empyema)

EXPLANATION

Staphylococcus pneumonia is a fast-spreading inflammation leading to tissue destruction, therefore lung abscess might appear frequently. The inflammation can easily spread to the pleura, hence purulent pleuritis might also occur. Although purulent meningitis and impetigo may be caused by Staphylococcus-associated processes, they appear rarely related to pneumonia.

Gastro-esophageal reflux might play a role in the pathogenesis of the following diseases:

1) bronchial asthma

2) obstructive bronchitis

3) irritative pharyngeal cough occurring only during daytime

4 esophagitis

5) delayed gastric emptying through the pylorus

A) all of the answers are correct

B) 2nd, 4th and 5th answers are correct

C) 1st, 4th and 5th answers are correct

D) 1st, 2nd and 4th answers are correct

E) 3rd, 4th and 5th answers are correct

F) only the 4th answer is correct

D) 1st, 2nd and 4th answers are correct

1) bronchial asthma

2) obstructive bronchitis

4) esophagitis

EXPLANATION

Gastro-esophageal reflux plays a role in the development of esophagitis because the acidic gastric contents damages the esophagus mucosa. The regurgitated gastric contents that is aspirated into the lungs can cause inflammatory processes in the lungs and contributes to the development of bronchial asthma and obstructive bronchitis through a reflexive pathway. Coughing is not related to any part of the day, but occurs more easily during the night, in lying position. The gastric emptying through the pylorus is not affected by the reflux activity.

Characteristics of mucoviscidosis:

1) meconium ileus might occur after birth

2) High sweat Na and Ca content

3) liver cirrhosis occurs

4) Pseudomonas infections are common

5) Due to altered sweat chronic eczema develops

A) 2nd, 4th and 5th answers are correct

B) 1st, 2nd and 5th answers are correct

C) 4th and 5th answers are correct

D) 1st, 3rd and 4th answers are correct

E) 3rd, 4th and 5th answers are correct

D) 1st, 3rd and 4th answers are correct

1) meconium ileus might occur after birth

3) liver cirrhosis occurs

4) Pseudomonas infections are common

EXPLANATION

A very common symptom of mucoviscidosis is that meconium is extremely dense due to ion- and transport disorders, thus leading to ileus in the newborn. Liver disease leading to cirrhosis is also a symptom of mucoviscidosis. The experience shows that Pseudomonas infections can be hardly eradicated in some of the children with mucoviscidosis. In the sweat, the Na and Cl ion content is high, thus mentioning Na together with Ca is incorrect. In the pathomechanism of chronic eczema, the ionic composition of sweat does not appear to play any role.

Part of the treatment of mucoviscidosis:

1) antibiotics due to frequent infections

2) chest physiotherapy which helps coughing

3) protein-poor meals to protect the liver

4) regular administration of pancreatic enzymes

5) regular replacement of water-soluble vitamins

A) 2nd, 3rd and 4th answers are correct

B) 2st, 4nd and 5rd answers are correct

C) only the 5th answer is correct

D) 1st, 2nd and 4th answers are correct

E) 1st, 4th and 5th answers are correct

D) 1st, 2nd and 4th answers are correct

1) antibiotics due to frequent infections

2) chest physiotherapy which helps coughing

4) regular administration of pancreatic enzymes

EXPLANATION

Patients with mucoviscidosis, because of frequent infections, are treated with repeated- and in some cases with continuous antibiotic therapy. Chest physiotherapy helps coughing in these patients. Due to pancreas involvement, regular pancreas enzyme replacement is needed. Patients are recommended to have a protein-rich diet, since due to the digestive disorder physical degradation occurs much more frequently. Water-soluble vitamins are normally absorbed from the food.

The spread of childhood tuberculosis is characterized by:

1) from mammals (cow) to humans

2) from rodents to humans

3) avian pathogens can spread to humans

4) dogs are intermediate hosts

5) from humans to humans

A) 2nd, 4th and 5th answers are correct

B) 1st, 3rd and 5th answers are correct

C) all of the answers are correct

D) 2nd, 3rd and 5th answers are correct

E) 1st, 4th and 5th answers are correct

F) only the 5th answer is correct

B) 1st, 3rd and 5th answers are correct

1) from mammals (cow) to humans

3) avian pathogens can spread to humans

5) from humans to humans

EXPLANATION

The typical route through which childhood tuberculosis spreads is from cows infected with bovine tuberculosis to humans. Less commonly tuberculosis is spread by tuberculosis bacteria in birds (avian). The most common route of spreading is from human to human through droplet infection. Rodents and dogs are never mentioned as animals that spreads tuberculosis.

Typical symptoms of basilar tuberculous meningitis:

1) common general symptoms: loss of appetite, headache, deterioration of performance

2) hair loss

3) After temporary weight loss, weight gain occurs

4) rising protein concentrations in the liquor

5) Mycobacterum tuberculosis can be cultivated from liquor

A) 2nd, 3rd and 5th answers are correct

B) only the 5th answer is correct

C) 1st, 2nd, 4th and 5th answers are correct

D) 1st, 3rd and 4th answers are correct

E) 3rd, 4th and 5th answers are correct

F) 1st, 4th and 5th answers are correct

F) 1st, 4th and 5th answers are correct

1) common general symptoms: loss of appetite, headache, deterioration of performance

4) rising protein concentrations in the liquor

5) Mycobacterum tuberculosis can be cultivated from liquor

EXPLANATION

The basilar tuberculous meningitis, at the beginning has common, non-typical symptoms for a longer period of time. If there is a suspicion, high protein concentration (along with other alterations) can be found in the liquor, and Mycobacterium tuberculosis can be cultivated from liquor. The physical status of the patients worsens and they lose weight, which is followed by weight gain only in the event of healing, thus weight gain is not a symptom of the active disease. Hair loss does not occur in the disease.

Childhood bronchial asthma has frequent an allergic etiology, therefore treatment of allergic events is important in these patients.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

A) both are correct, they have a cause-effect relationship

EXPLANATION

Bronchial asthma in children most commonly has allergic origins, therefore antiallergic treatment really plays a role.

Childhood pneumonia is rarely caused by bacteria, therefore there is no need for mucolytic therapy.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

E) both are incorrect

EXPLANATION

A major part of childhood pneumonia is caused by virus, however a still high percentage of cases have bacterial origin, thus the first statement is incorrect. The mucolytic treatment is necessary to get rid of the sometimes thickened respiratory tract discharge, so both parts of the statement are incorrect.

Epiglottitis is a life-threatening disease often caused by Haemophilus influenzae, therefore vaccination against this pathogen is justified.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

A) both are correct, they have a cause-effect relationship

EXPLANATION

Experience shows that the majority of epiglottitis is caused by Haemophilus influenzae bacteria; this is a hyperacute, life-threatening disease, thus vaccination against Haemophilus (which has been recently became available after a longer period of time) is justified. So both statements are correct and have a cause-effect relationship between them.

Staphylococcus pneumonia often leads to abscess formation, therefore prolonged administration of non-steroidal anti-inflammatory drugs is justified.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

C) the first is correct, the second is incorrect

EXPLANATION

In the experience Staphylococcus pneumonia leads relatively frequently to the development of lung abscesses, thus the first sentence is true. However the use of non-steroidal anti-inflammatory agents in this type of bacterial inflammation is completely unjustified.

Allergic rhinitis is rarely related to pollen counts, because pollen related symptoms do not occur during winter.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

D) the first is incorrect, the second is correct

EXPLANATION

Allergic rhinitis in most of the cases is seasonal and is caused by pollen, so this part of the statement is incorrect. However, pollen-induced symptoms do not occur during winter because there is no pollen in the air.

Acute tonsillitis may be bacterial, viral or fungal, therefore antibiotic treatment is always unnecessary.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

C) the first is correct, the second is incorrect

EXPLANATION

Studies proved that acute tonsillitis is often of bacterial, and even more frequently of viral origin, and tonsillitis can sometimes be caused also by fungi; therefore antibiotic treatment is indispensable in the case of proven bacterial origin. In clinical practice, in case of not proven bacterial infection it is still advisable being cautiousness to administer antibiotic.

Laryngotracheobronchitis can often be dry, therefore patients with acute fever should be kept in bed.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

B) both are correct but there is no cause-effect relationship

EXPLANATION

The severity of laryngotracheobronchitis is primarily caused by the dryness of the process, which leads to the obstruction of the respiratory tracts in large areas and finally to respiratory failure. It is a general truth that patient with acute fever should be kept in bed, however this is only a good advice for any acute feverish illness and has nothing to do with laryngobronchitis.

In obstructive (wheezy) bronchitis infantile asthma is rare, because asthma often starts in infant and toddler age.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

B) both are correct but there is no cause-effect relationship

Bronchiectasis can be associated with immune deficiencies, hence bronchiectasis repeatedly occurs in cystic fibrosis.

A) both are correct, they have a cause-effect relationship

B) both are correct but there is no cause-effect relationship

C) the first is correct, the second is incorrect

D) the first is incorrect, the second is correct

E) both are incorrect

B) both are correct but there is no cause-effect relationship

EXPLANATION

One of the causes of bronchiectasis is immune deficiency and the associated cumulative infections. However bronchiectasis in cystic fibrosis is based on a completely different mechanism, namely, on the difficulty to discharge the secretions. Therefore bronchiectasis is caused by the stasis of secretions, repeated airway infections, bronchtitis and pneumonia.

Laboratory changes characteristic to the disease.

The 8-year-old boy has been coughing for 2 months, he has moderate dyspnea, his complaints are more pronounced at night, but he is no fever. Recently they got a cat in their home, her mother is sensitive to ragweed and has hay fever.

1) eosinophils in the peripheral blood count

2) pronounced leukocytosis

3) Increased total serum IgE

4) positive skin tests for multiple respiratory allergens, including cat hair

5) Shadow in the upper right lung lobe

A) 3rd, 4th and 5th answers are correct

B) all of the answers are correct

C) 1st, 3rd and 4th answers are correct

D) 2nd, 4th and 5th answers are correct

E) only the 4th answer is correct

C) 1st, 3rd and 4th answers are correct

1) eosinophils in the peripheral blood count

3) Increased total serum IgE

4) positive skin tests for multiple respiratory allergens, including cat hair

EXPLANATION

Considering the family history and the presence of a cat it is best to consider an allergic pathology. In this case the number of eosinophils in the peripheral blood count may increase, these processes are often accompanied by an increase in immunoglobulin E levels, and positive skin tests may be found in these patients (against cat hair). At the same time, as in a non-bacterial processes, there is no leukocytosis and pneumonia related infiltrations in the lungs does not seem likely.

The most likely diagnosis:

The 8-year-old boy has been coughing for 2 months, he has moderate dyspnea, his complaints are more pronounced at night, but he is no fever. Recently they got a cat in their home, her mother is sensitive to ragweed and has hay fever.

1) chronic bronchitis

2) atopic status

3) sensitivity to cat hair

4) prolonged respiratory tract infection

5) beginning of bronchial asthma

A) 3rd, 4th and 5th answers are correct

B) 2nd, 3rd and 5th answers are correct

C) only the 5th answer is correct

D) there is no correct answer

E) 1st, 4th and 5th answers are correct answers

F) 4th and 5th answers are correct

B) 2nd, 3rd and 5th answers are correct

2) atopic status

3) sensitivity to cat hair

5) beginning of bronchial asthma

EXPLANATION

The process suggests an atopic process based on the elevated IgE level and positive skin tests. Cat hair sensitivity can be verified by the skin test. Prolonged coughing and dyspnea may indicate bronchial asthma. In chronic bronchitis, this atopic situation would be unlikely and the shortness of breath besides coughing speaks also against chronic bronchitis. The lack of fever and leukocytosis makes prolonged respiratory tract infection unlikely, and there is no infiltration in the lungs.

The following therapy can be applied:

The 8-year-old boy has been coughing for 2 months, he has moderate dyspnea, his complaints are more pronounced at night, but he is no fever. Recently they got a cat in their home, her mother is sensitive to ragweed and has hay fever.

1) the cat must be removed

2) continuous antihistamines administration

3) the patient should be provided with a beta-2 agonist

4) cannot do school gymnastics due to breathing difficulties

5) deciding on the administration of a prophylactic drug after waiting and observation

A) 1st, 3rd and 5th answers are correct

B) 1st, 2nd, 3rd and 4th answers are correct

C) 4th and 5th answers are correct

D) 2nd, 3rd and 5th answers are correct

E) all of the answers are correct

F) only the 3rd answer is correct

A) 1st, 3rd and 5th answers are correct

1) the cat must be removed

3) the patient should be provided with a beta-2 agonist

5) deciding on the administration of a prophylactic drug after waiting and observation

EXPLANATION

The pathogenic role of cat in the pathogenesis can emerge by the anamnesis, a positive skin test, and other atopic phenomena, so it is advisable to remove it from the environment. Because of breathing difficulties, these patients should be provided with a β-agonist and after some waiting and observation time, depending on the symptoms, an inhaled steroid or other prophylactic medication (chromoglycat, nedocromil) should be considered. In an asthmatic condition, continuous antihistamine administration is not necessary, and the child can take part in school gymnastics, because the β-agonist will help him/her to withstand the burden of physical education.

The most essential diagnostic tests:

11-year-old boy having fever, coughing for 10 days; Amoxicillin and clavulanic acid were taken for 6 days but his condition did not improve appropriately. He is eating less and consuming a small amount of fluid.

1) chest x-ray

2) white blood cell and qualitative blood cell counts

3) hemoculture

4) bronchoalveolar lavage from both lungs and bacterial examination of the exudate

5) quantitative immunoglobulins levels

A) 3rd, 4th and 5th answers are correct

B) 1st, 3rd and 5th answers are correct

C) only the 1st answer is correct

D) all of the answers are correct

E) 1st, 2nd and 3rd answers are correct

E) 1st, 2nd and 3rd answers are correct

1) chest x-ray

2) white blood cell and qualitative blood cell counts

3) hemoculture

EXPLANATION

In a prolonged febrile illness, it is necessary to make chest x-ray to rule out a possible pneumonia (which cannot be heard by ear), and to evaluate the inflammatory process, thus, white blood cell and qualitative blood tests are necessary. Hemoculture helps to identify the pathogen and to select or to alter the antibiotic treatment. This prolonged state is not an indication for a bronchoscopy with bronchoalveolar lavage; such a short-term infection with no recurrent nature does not suggest the presence of an immunodeficiency, so the quantitative measurement of immunoglobulin levels is unnecessary.

The chest x-ray shows interstitial thickening, erythrocyte sedimentation rate is elevated. What are the most likely diagnoses?

11-year-old boy having fever, coughing for 10 days; Amoxicillin and clavulanic acid were taken for 6 days but his condition did not improve appropriately. He is eating less and consuming a small amount of fluid.

1) Cytomegaloviral infection

2) Interstitial pneumonia

3) Chlamydia pneumoniae infection

4) chronic bronchitis

5) Mycoplasma pneumoniae infection

A) 1st, 4th and 5th answers are correct

B) 2nd, 3rd and 4th answers are correct

C) 3rd, 4th and 5th answers are correct

D) 2nd and 5th answers are correct

E) 2nd, 3rd and 5th answers are correct

F) 2nd, 4th and 5th answers are correct

E) 2nd, 3rd and 5th answers are correct

2) Interstitial pneumonia

3) Chlamydia pneumoniae infection

5) Mycoplasma pneumoniae infection

EXPLANATION

The interstitial process found on the chest x-ray supports the diagnosis of interstitial pneumonia. These are especially common in childhood (i.e., non-neonatal or infantile) often caused by Chlamydia pneumoniae, and Mycoplasma pneumoniae. This x-ray finding is not characteristic for a Cytomegaloviral infection, and the disease, that has been only present for ten days is against the diagnosis of chronic bronchitis, not to mention the chest x-ray finding.

What kind of medication and other treatment procedures would you apply in this case?

11-year-old boy having fever, coughing for 10 days; Amoxicillin and clavulanic acid were taken for 6 days but his condition did not improve appropriately. He is eating less and consuming a small amount of fluid.

1) administration of aminoglycosides for an additional 8 days

2) antipyretic therapy

3) after an antibiotic treatment, such treatment is unnecessary

4) the administration of erythromycin for a longer time

5) doxycycline administration for at least 8 days

A) 1st, 4th and 5th answers are correct

B) 2nd, 4th and 5th answers are correct

C) 1st, 2nd, 3rd and 4th answers are correct

D) 2nd, 3rd and 5th answers are correct

E) 1st, 2nd, 4th and 5th answers are correct

F) 3rd, 4th and 5th answers are correct

B) 2nd, 4th and 5th answers are correct

2) antipyretic therapy

4) the administration of erythromycin for a longer time

5) doxycycline administration for at least 8 days

EXPLANATION

In a febrile state, antipyretic treatment is necessary, and the suspected pathogens (Chlamydia, Mycoplasma) are usually responsive to erythromycin, and doxycycline is also alternative in the treatment. These pathogens are usually not responding to aminoglycosides, but in these cases, the antibiotic treatment in a presumably antibiotic-responsive form is advised.

The following are characteristics of controlled asthma, except one:

A) there is a maximum of two airway symptoms a week

B) the patient cannot get beta mimetics at all

C) asthmatic patient has no lifestyle restrictions

D) Respiratory performance values reach approx. over 80%

B) the patient cannot get beta mimetics at all

EXPLANATION

Betamimetics are effective tools for bronchodilation. Asthma patients should either be on a continuous or occasional treatment. In controlled asthma patients can have a maximum of two complaints a week, when short-acting betamimetics could be necessary. The controlled patients usually have a respiratory function value above 80% and the patients' lifestyle does not need to be limited.

The vanish of food allergy can be experienced, except one:

A) in case of milk, approx. up to 5 years of age

B) peanut allergy vanishes at the age of 4-5 years

C) clam and crab allergy will last for a lifetime

D) egg allergy will last up to 7 years of age

B) peanut allergy vanishes at the age of 4-5 years

EXPLANATION

Peanut allergy usually lasts for a lifetime. Milk allergy usually vanishes at the age of 5, egg allergy is over 7 years old. Clam and crab allergy last for a lifetime.

Most important disease leading to lung transplantation in childhood (only one answer is true):

A) Cystic fibrosis

B) bronchiectasia

C) ARDS

D) bronchiolitis

A) Cystic fibrosis

EXPLANATION

Among childhood pulmonary disorders, bronchiolitis is usually not associated with end-stage pulmonary insufficiency, ARDS is a temporary phenomenon. The bilateral occurrence of bronchiectasia may result in severe pulmonary failure, but this is a very rare childhood disorder. Cystic fibrosis is the most common cause of end-stage pulmonary failure in childhood. It can be expected, that with the improvement of care and treatment, this will shift to adulthood, but this is still the most common cause of transplantation.