Pediatric(101-150)

A 15-month-old is seen in your office for the 4th time this month with unexplained intermittent episodes of fever of 39°C. The mother has used children’s ibuprofen to treat the fever and has been able to bring the temperature down to 38°C. However, the mother is now frustrated because thisis her 4th visit to the office and nobody knows why her child is continuing to have these fevers. The child is not in day care and has no history of any serious illnesses, travel, or sick contacts. The child has had no symptoms of an upper respiratory infection. On examination, the child is actively playing with his toys. He does not look ill. His rectal temperature is 39°C. The head, neck, lungs, cardiovascular, abdominal, neurologic, and musculoskeletal examination are all normal.Your clinical judgment is that the child looks well and has no serious illness.What is the most appropriate next step in the workup of this patient?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which of the following best describes your clinical impression at this time?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which laboratory testing would you order at this time?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which of the following is the most likely organism that you need to consider in this situation?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. Which one of the following antibiotics would you consider in the treatment of this condition?

A 3-year-old girl presents to a health center with a fever for the past 36 hours. Maximum temperature was 40°C at 2 am, which decreased to38.7°F with children’s ibuprofen. Her appetite andfluid intake have decreased during the past 24 hours. Physical examination shows an ill-appearing child.Her temperature is 37.2°C. The skin has a macular–papular petechial rash on the chest and back. Theremainder of the physical examination is normal. What would you do next concerning this patient?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most likely diagnosis in this child?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most frequent pathogen associated with this condition?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What investigation should be done at this time?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. Which of the following statements regarding the common cold is true?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. Which of the following statements regarding treatment of the condition described in this case is true?

A 4-year-old child with a runny nose, congestion, sneezing, and a nonproductive cough comes to your office with his mother. These symptoms started 4 days ago with a sore throat that has since resolved. His appetite is mildly decreased, but he is well otherwise. He has had no fever, chills, or any other symptoms. On examination, the child’s temperature is 37.6°C. His ears are clear, and his throat is slightly hyperemic. He has grayish thick nasal discharge and the nasal mucosa appears swollen with erythematous nasal turbinates. His lung fields are clear, there is no significant cervical lymphadenopathy, and no other localizing signs are present. The child’s history is unremarkable, and he has had no significant medical illnesses. His immunizations are up to date. What is the most effective preventive measure against the common cold?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. What is the diagnosis?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following agents is the least likely cause of the condition?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following statements about the treatment of this condition in infants is true?

A 6-month-old infant is brought to your office by her mother with nasal congestion for 5 days. The child had a clear runny nose at 1st but now the drainage is thick and yellow and she seems tobe having difficulty with taking the bottle. The baby has had only low-gradetemperatures of less than 38°C. The mother tells you that the baby seems cranky but is consolable and has had difficulty sleeping because of the breathing. On examination, the infant is afebrile. There is no tachypnea. The conjunctivae are slightly hyperemic but without purulent exudates. The nose is congested with erythematous mucosa and thick yellow drainage bilaterally. The ears are clear. The throat is pink, but postnasal drip is noted. The chest is without retractions and is clear to auscultation. Which of the following is the most common bacterial complication of this condition?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which statement regarding management of this condition is true?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. The most common cause of bronchiolitis is

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which of the following statements about RSV is untrue?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. All of the following are associated with increased risk of severe bronchiolitis except

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Pathologic features of acute bronchiolitis include all but

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. In which of the following patients is palivizumabnot indicated?

A 4-month-old infant presents to the emergency department with cough and fever. The infant has been sick for 3 days but worsened in severity during the past 24 hours. Past medical history is otherwise negative. He was born preterm at 35 weeks but was discharged home after 3 days. Birth weight was 3kg and maternal group B strep was negative. Immunizations are current. Vital signs include a rectal temperature of 38°C, pulse of 120 beats/minute, blood pressure within normal limits, and a respiratory rate of 60 breaths/minute. The infant is well hydrated but ill appearing. Grunting, nasal flaring, intracostal retractions, and increased respiratory effort are evident. Wheezing and crackles are noted on physical exam. Chest radiographs show patchy atelectasis and hyperinflation of the lungs. Which of the following statements regarding antibiotic use in bronchiolitis is true?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following interventions provides the most useful information at this time?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following statements about childhood pneumonia is true?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following statements about CAP in neonates is false?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. What is the most common bacterial cause of CAP after the neonatal period?

A 3-year-old child is brought to the office for cough and fever. He has been sick for the past 4 days, but symptoms acutely worsened this morning. Appetite and activity levels are both decreased. Past medical history is unremarkable and immunizations are current. He lives at home with two brothers and goes to day care during the week. There are no sick contacts. On physical examination, he has a temperature of 38.5°C, pulse of 120 beats/minute, respiratory rate of 60 breaths/minute, and normal blood pressure. He appears mildly toxic but not cyanotic. Ears, nose, and throat are unremarkable. Retractions, grunting, and accessory muscle use are noted on the lung exam. Localized rales and wheezing are noted over the right lower lung zones. Which of the following signs is suggestive of hypoxemia?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is true concerning this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following differential diagnoses should you exclude in this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is true concerning treatment of this child?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. In discussing treatment plans with the parents, they ask about various medications used in asthma therapy. Which of the following medications has been shown to be most effective in the treatment of asthma in children and should be used at firstline treatment if maintenance therapy is begun?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following statements is false concerning asthma in children?

A 2-year-old male presents for a checkup. His parents tell you that he has been doing well, but he has had episodes of wheezing four times during the past year. He is the product of an uncomplicated pregnancy and delivery, but he was hospitalized at age 6 months for bronchiolitis. Both parents have a history of allergies, and his father has asthma. His mother smoked during pregnancy but quit smoking last year. The child was never breast-fed. Which of the following is included in the diagnosis of asthma in children?

A 7-year-old female presents to your office with a history of 1 week of gradually increasing chest tightness and mild dyspnea. She has had nasal drainage and a nighttime cough. Her mother states that she has had no fever and has been going to school. Her medical history is significant for only oneprevious episode of wheezing for which she was treated with an antibiotic and an inhaler. Her familyhistory is significant for an older brother with asthma. Her father is a smoker.On examination, she has a temperature of 38°C, blood pressure of 90/50 mmHg, respiratoryrate of 20 breaths/minute, and pulse of 100 beats/minute. She appears in no distress but is audibly wheezing. She has mild nasal turbinate swelling, postnasal drainage, and diffuse expiratorywheezes. After a nebulizer treatment with albuterol, she feels much better, and her lungs are completely clear. Which of the following do you advise the patient and her parent?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. She has a completely normal physical exam and her peak flow is 90% predicted. Which of the following diagnoses and treatments are correct?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. The patient returns for regular follow-up but she continues to have symptoms that require her to use the rescue medication four or five times a week. She now has daily symptoms and coughs more than one night a week. Which of the following would be appropriate to recommend?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. While discussing elimination of triggers with the child and her parents, you mention all of the following as possible triggers. Which of these is most commonly implicated in causing exacerbations, and possibly even influencing the development of asthma in populations as a whole?

Four months later, she comes in for a visit because she is having a nighttime cough. After a complete history, you find that she has continued to have chest tightness and dyspnea several days a week, especially after running in gym class, and two or three nights each month she cannot sleep well due to coughing. She has no fever, rhinorhea, or other symptoms. She finished her inhaler a month ago, after which her symptoms increased. Disease severity in asthma is not determined by which of the following?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements is true?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. You explain to her that the following pathologic change(s) is(are) found in the airways of patients with asthma, with or without symptoms:

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. You check an influenza swab, which is negative, and treat the child with inhaled albuterol with a spacer, an inhaled corticosteroid, and a short course of oral steroids. When he returns in 3 days, he has already improved dramatically and has a normal physical exam. Which of the following is true concerning monitoring of asthma in children?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Written action plans for asthma patients should include all of the following except

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Based on the history of this patient, which Medicine do you recommend for maintenance?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. All of the following statements concerning treatment of asthma in children have highest level Cevidence except

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements concerninguse of oral corticosteroids in children with asthmais true?

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Goals of asthma therapy (according to recentrecommendations) include all of the followingexcept

A 13-year-old boywas diagnosed with asthma at age 8 years, and has had one or two exacerbations a year. He was hospitalized 3 days for “pneumonia and asthma” at age 10 years. He has been prescribed a variety of medications, but he tells you that he left his inhaler at his father’s house and currently he does not have any medications. The child complains of “a little” fever, nasal congestion, and intermittent wheezing. He tells you that he has taken a bottle of cough syrup in the past 3 days because he coughs so much at night. Vital signs are normal. Physical examination is normal except for nasal congestion without sinus tenderness and scattered expiratory wheezes with no rales, rhonchi, or eegophony. Which of the following statements is correct,according to the most recent guidelines for asthma management?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. What do you think this child has?

A3-year-old girlpresent s with a 6 weeks of runny nose, congestion, sneezing, andcough. The child seems to havelong colds especially during spring, early summer,and, occasionally, late summer. The child also hadan episode of difficulty breathing a few days ago forwhich they visited a local emergency room and weregiven an inhaler. What is the first step in treatment that you would recommend to these patients?