Children infectious diseases

1. 
   Acute bronchiolitis.
   
2. 
   ARVI.
   
3. 
   Acute laryngotracheitis.
   
4. 
   Acute bronchitis.
   
5. 
   *Acute pneumonia.
   

239. 
     A boy, 8 years old, has addressed to pediatrician with complains of increasing of the body temperature to 37.5 ºС, sore throat, cough, serous discharge from nose, tearing. During examination mild hyperemia and edema of the tonsils and back pharyngeal wall, conjunctives, narrowing of ocular slots were revealed. The physician suspects adenoviral infection. Which method of express-diagnostics is better to use for acknowledgement of the diagnosis?
     
     1. 
        The separation of the virus on tissue culture
        
     2. 
        *Immunofluorescense method
        
     3. 
        Serological investigation
        
     4. 
        bacteriological investigation
        
     5. 
        Bacterioscopy investigation of pharyngeal swab
        

240. 
     A child of 10 months has acute bronchopneumonia with destruction of the left lung. Which agent is most likely caused this disease?
     
     1. 
        Pneumococcus (S. pneumonia)
        
     2. 
        *Aurococcus (S. aureus)
        
     3. 
        Colibacillus (E. Coli)
        
     4. 
        Pseudomonas aeruginosa
        
     5. 
        Proteus vulgaris
        

241. 
     A patient with nosocomeal pneumonia presents signs of collapse. Which of the following pneumonia complications is most likely to be accompanied by collapse?
     
     1. 
        Exudative pleurisy
        
     2. 
        Bronchial obstruction
        
     3. 
        Toxic hepatitis
        
     4. 
        *Septic shock
        
     5. 
        Emphysema
        

242. 
     A patient, aged 16, complains of headache, mainly in the frontal and temporal areas, superciliary arch, appearing of vomiting at the peak of headache, pain during the eyeballs movement, joints pain. On examination: excited, t° — 39°C, Ps – 110/min. Tonic and clones cramps. Uncertain meningeal signs. What is the most likely diagnosis?
     
     1. 
        *Influenza with cerebral edema manifestations
        
     2. 
        Parainfluenza
        
     3. 
        Adenovirus infection
        
     4. 
        Respiratory syncitial virus
        
     5. 
        Influenza, typical disease duration
        

243. 
     Mild pneumonia characterized by a moist nonproductive cough has developed at a previously healthy 13-year–old boy. Chose the medicine for symptomatic treatment:
     
     1. 
        *mucolytics
        
     2. 
        cough suppressors
        
     3. 
        euphylline
        
     4. 
        prednisolone
        
     5. 
        salbuthamol
        

244. 
     Among patients with the adenoviral infection in children the following forms of disease are diagnosed: pneumonia, catarrhal syndrome of UR-tract, pharyngoconjunctivitis, diarrhea. What variant of adenoviral infection is absent in this list?
     
     1. 
        Meningitis.
        
     2. 
        Encephalitis.
        
     3. 
        Balanopostitis.
        
     4. 
        Carditis.
        
     5. 
        *Mesadenitis.
        

245. 
     An 6-years-old child is taken to a hospital on the 4-th day of the disease. The disease began acutely with temperature 39 °C, weakness, cough, restlessness. He is pale, has cyanosis, febrile temperature for more than 3 days. There are crepitative fine bubbling rales at the auscultation. Percussion sound is shortened in right sub-scapular area. X-ray: inhomogeneous infiltration of 8-10 segments on the right, the increased vascular picture, unstructured roots. What is the most likely diagnosis?
     
     1. 
        Bronchitis
        
     2. 
        Bronchiolitis
        
     3. 
        Interstitial pneumonia
        
     4. 
        Influenza
        
     5. 
        *Segmental pneumonia
        

246. 
     An 18-month-old child is taken to hospital on the 4-th day of the disease. The disease has began acutely with temperature 39 °C, weakness, cough, restlessness. The child is pale has perioral cyanosis. There are crepitative fine bubbling rales at auscultation. Percussion sound is not changed. X-ray picture: focal infiltration bilaterally near the lung roots, the increase of vascular picture, nonstructural roots. What is the most likely diagnosis?
     
     1. 
        Bronchitis
        
     2. 
        Bronchiolitis
        
     3. 
        Interstitial pneumonia
        
     4. 
        Influenza
        
     5. 
        *Focal bronchopneumonia
        

247. 
     Inspiratory stridor, hoarse voice and barking cough had developed at night on the third day of common cold in infant, aged 1 year. Physical examination has revealed suprasternal and intercostal chest retractions. There is a bluish skin discoloration mostly seen over the upper lip. The respiratory rate is 52 per min and pulse — 122 bpm. The body temperature is 37,5°C. What disease does the infant have?
     
     1. 
        Acute bronchiolitis with respiratory distress
        
     2. 
        Bronchopneumonia without complications
        
     3. 
        Acute epiglottitis
        
     4. 
        *Acute infectious croup due to viral laryngotracheitis
        
     5. 
        Acute laryngitis
        

248. 
     Express diagnostic is performed in the focus of acute respiratory infection with the purpose of diagnosis establishment. What test is used for this purpose?
     
     1. 
        *Reaction of immune fluorescence
        
     2. 
        Complement binding reaction
        
     3. 
        Reaction of agglutination
        
     4. 
        Reaction of precipitation
        
     5. 
        Reaction of opsonization
        

249. 
     Child, 2 years, that is ill for 3 days, is hospitalized in the infectious department with diagnosis: upper respiratory tract viral infection, laryngotracheitis. Parainfluenza is suspected. What symptoms will be different from measles, prodromal period?
     
     1. 
        Absence of the expressed catarrhal syndrome, enanthem on a soft palate
        
     2. 
        Absence of croup syndrome
        
     3. 
        Presence of laryngeal stenosis of the 1^st or 2^nd degree
        
     4. 
        *Absence of the expressed catarrhal syndrome, the Koplick’s spots, enanthem on a soft palate
        
     5. 
        Presence of hyperemia of the pharynx, enanthem on a soft palate
        

250. 
     In a virology laboratory smears from nasopharynx of 4 years old boy with the “influenza” were brought. Which test will prove, what variety of virus has caused the disease in this child?
     
     1. 
        by rynocytoscopy
        
     2. 
        By virus CPD character
        
     3. 
        *indirect hemagglutination reaction with typospecific anti-virus sera
        
     4. 
        By hemagglutination reaction
        
     5. 
        By hemadsorption reaction
        

251. 
     An amount of patients with respiratory-syncitial infection grew sharply in a winter-spring period. What age-old category of children is most receptive to the this infection?
     
     1. 
        Infants.
        
     2. 
        *Babies aged 4-5 months till 3 years.
        
     3. 
        Children of 3-6 years.
        
     4. 
        Schoolboys.
        
     5. 
        Teenagers.
        

252. 
     Different variants of typical form of adenoviral infection are exposed in the focus of this infection: pneumonia, catarrhal syndrome of UR-tract, pharyngoconjunctivitis. Name another possible form of adenoviral infection.
     
     1. 
        *Diarrhea.
        
     2. 
        Nephritis.
        
     3. 
        Arthritis.
        
     4. 
        Carditis.
        
     5. 
        Otitis.
        

253. 
     5 years old girl with pharyngoconjunctivitis phenomena has admitted to the infectious hospital. The physician has suspect adenoviral infection. What method from express-diagnostics is reasonable to use to prove this diagnosis?
     
     1. 
        *The antibody fluorescence method
        
     2. 
        Binding complement reaction
        
     3. 
        Indirect hemagglutination reaction
        
     4. 
        Neutralization reaction
        
     5. 
        Direct hemagglutination reaction
        

254. 
     A patient with parainfluenza is revealed in the nursery group of orphanage. How long the patient is contagious for surrounders?
     
     1. 
        2-3 days.
        
     2. 
        3-5 days.
        
     3. 
        5-7 days.
        
     4. 
        *7-10 days.
        
     5. 
        10-14 days.
        

255. 
     A child aged 1.3 years has entered to the hospital with complaints on a dry paroxysmal cough, hoarse voice, cold with mucus excretions and increase of temperature to 38,2 ˚С. After the examination of patient a doctor has put a previous diagnosis: URT infection, acute stenotic laryngitis with larynx stenosis 2^nd degree. What agent more frequent causes this disease.
     
     1. 
        virus of flu.
        
     2. 
        *virus of parainfluenza.
        
     3. 
        rhinovirus.
        
     4. 
        rheovirus.
        
     5. 
        adenovirus.
        

256. 
     Pediatrician was called to the 2-years old child who has a subfebrile temperature, rhinitis, dry cough. He is ill for 3 days. During percussion: a clear pulmonary sound without dullness. During auscultation: puerile breathing. Laboratory findings: leukopenia, lymphocytosis, increased ESR. What clinical form of ARVI is possible in this case?
     
     1. 
        Acute obstructive bronchitis
        
     2. 
        *Acute rhinopharyngitis
        
     3. 
        Acute bronchopneumonia
        
     4. 
        Relapsed bronchitis
        
     5. 
        Acute bronchitis
        

257. 
     The 2 years old child during feeding started to cough, become worrisome, dyspnea has appeared. Objectively: cyanosis of mucus membranes distended left half of the thorax. During percussion: on the left near top of the lung is tympanic sound, from the 3^rd rib down – dull sound. What diagnosis is the most probable?
     
     1. 
        Left side pyopneumothorax
        
     2. 
        *Foreign body of the left bronchus
        
     3. 
        Acute cardiac failure
        
     4. 
        The lung abscess
        
     5. 
        Perycarditis
        

258. 
     The 4-years old child was hospitalized with interstitial pneumonia. What bacteria cause the disease?
     
     1. 
        Staphylococcus aureus
        
     2. 
        Streptococcus viridians
        
     3. 
        Klebsiella pneumonia
        
     4. 
        *Pneumocystis carinii
        
     5. 
        Pneumococcus
        

259. 
     The 5 years old boy complains of headache, high temperature of the body, dyspnea, nonproductive cough. During percussion: shortness of the sound paraveretebrally. During auscultation: harsh breathing. On X-ray: mediobasal pulmonary infiltration. What diagnosis is possible in this case?
     
     1. 
        Upper respiratory tract viral infection
        
     2. 
        Interstitial pneumonia
        
     3. 
        Obstructive bronchitis
        
     4. 
        Miliar tuberculosis
        
     5. 
        *Focal bronchopneumonia
        

260. 
     The 5-years child with an acute pneumonia was hospitalized. The clinical blood analysis is: erythrocytes 2.86 х 10¹²/l, Нb – 86 g/l, CI – 0.8, leucocytes 11,2 х 10^9/l, eosynophils – 3 %, neutrophils: band forms – 2 %, segments – 30 % lymphocytes – 58 %, monocytes – 7 %, ESR – 8 mm/hour. Name pathological changes.
     
     1. 
        Lymphopenia, anemia, shift to the left
        
     2. 
        *Leucocytosis, anemia, lymphocytosis
        
     3. 
        Leucopenia, increase of ESR
        
     4. 
        shift of the formula to the left, anemia
        
     5. 
        Lymphocytosis, monocytosis, eosynophilia
        

261. 
     The 5-months old child has subfebrile temperature, paroxysmal cough, and dyspnea. 3 days ago he contacted with sister ,who had acute upper respiratory tract viral infection. Objectively: the condition is severe, skin is cyanotic, considerable expiratory dyspnea, oral crepitation. Percussion: bandbox sound. Auscultation: a plenty of wet rales in both lungs, respiratory rate is 80 per 1 minute. What disease is possible?
     
     1. 
        Bronchial asthma
        
     2. 
        Aspiration of a foreign body
        
     3. 
        Acute bronchitis
        
     4. 
        *Bronchiolitis
        
     5. 
        Acute pneumonia
        

262. 
     The 7-months’ old child has body temperature 38.3 °C, cyanosis of perinasal triangle, breathing rate is 54 per minute. During percussion: dullness of the sound paravertebrally. During auscultation: big amount of small moist rales all over the lungs. The most possible diagnosis is:
     
     1. 
        Upper respiratory tract viral infection
        
     2. 
        Acute bronchitis
        
     3. 
        Acute bronchiolitis
        
     4. 
        *Acute bronchopneumonia
        
     5. 
        Acute interstitial pneumonia
        

263. 
     The 7-years’ old child was hospitalized with complaints on wet cough. His condition has worsened 10 days ago. He is ill during last 4 years: viral infections 3-4 times per year are accompanied by bronchitis. Objectively: cough with sputum. Percussion: a clear pulmonary sound. Auscultation: rough breathing, non-constant single diffuse moist rales. X-ray: lung pattern is intensified, roots are nonstructural. What disease is possible in this case?
     
     1. 
        Viral infection
        
     2. 
        Acute bronchitis
        
     3. 
        *Relapsed bronchitis.
        
     4. 
        Acute pneumonia
        
     5. 
        Chronic pneumonia
        

264. 
     The 7-years old child was hospitalized with complaints on: high body temperature 38.5ºC, often moist cough, dyspnea at rest. What investigation will resolve the diagnosis?
     
     1. 
        Clinical analysis of a blood
        
     2. 
        Bacteriological investigation of sputum
        
     3. 
        *Chest X-ray
        
     4. 
        Spirography
        
     5. 
        Bronchoscopy
        

265. 
     The 9 months old child who has cough, dyspnea, subfebrile body temperature was examined by district pediatrician. Focal bronchopneumonia was suspected. What auscultation picture is typical for this case?
     
     1. 
        Diffuse dry rales
        
     2. 
        Rough breathing
        
     3. 
        Diffuse wet rales
        
     4. 
        Decrease breathing
        
     5. 
        *Local wet rales
        

266. 
     The child is 10 years. He has influenza for 4 days. Stenosing laryngotracheitis of the I stage was diagnosed. What from named medicine is inadvisable to use?
     
     1. 
        Antihistamines
        
     2. 
        *Prednisone
        
     3. 
        Spasmolytics
        
     4. 
        Lapheron
        
     5. 
        Antiedematous inhalations
        

267. 
     The child is 7 years old. He has influenza for 5 days. The condition of the child sharply worsened. Once again has increased the body temperature, has appeared: moist cough with mucous-purulent phlegm, dyspnea. Breathing – 30 in 1 min, cyanosis of perioral triangle; in lower parts of the lungs, more on the right, dullness of the lung sound, moist fine rales. Pulse – 120 in 1 min., heart tones are weakened. What complication of influenza is possible?
     
     1. 
        Croup syndrome
        
     2. 
        *Pneumonia
        
     3. 
        Meningitis
        
     4. 
        Myocarditis
        
     5. 
        Obstructive bronchitis
        

268. 
     The child is 7 years old. He has influenza for 5 days. The condition of the child sharply worsened. Once again has increased the body temperature, has appeared: moist cough with separation of mucous-purulent phlegm, expiratory dyspnea. Breathing – 40 in 1 min. cyanosis of perioral triangle, intercostal retractions, bandbox sound during percussion, coarse diffuse rales. Pulse – 120 in 1 min., heart tones are weakened. What complication of influenza is possible in this case?
     
     1. 
        Croup syndrome
        
     2. 
        Pneumonia
        
     3. 
        Meningitis
        
     4. 
        Myocarditis
        
     5. 
        *Obstructive bronchitis
        

269. 
     The 0.05 % Deoxyribonucleic solution is dropped into the nostrils of the 1 year child for treatment of adenoviral infection. What is the course of such treatment?
     
     1. 
        1 day.
        
     2. 
        2 days.
        
     3. 
        3 days.
        
     4. 
        *5 days.
        
     5. 
        7 days.
        

270. 
     The child, 1 year old, is treated in infectious department with diagnosis of Parainfluenza. On the 2^nd day of the disease his condition became worse. The child is excited; inspiratory dyspnea, tachypnea, tachycardia, acrocyanosis, cool perspiration has appeared. Moderate intercostal retractions are noted at breathing. What degree of larynx stenosis is present?
     
     1. 
        1^st
        
     2. 
        *2^nd
        
     3. 
        3^rd
        
     4. 
        4^th
        
     5. 
        5^th
        

271. 
     The child, 2 years old, is treated from influenza. His condition suddenly became worse: the body temperature has increased to 39.8 ºС, has appeared rough barking cough, hoarseness of the voice, inspiratory dyspnea. What complication of influenza has developed?
     
     1. 
        Pneumonia
        
     2. 
        Bronchiolitis
        
     3. 
        *Croup syndrome
        
     4. 
        Obstructive bronchitis
        
     5. 
        Pharyngitis
        

272. 
     The child, 4 years old, complains of serous nasal discharge, frequent moist obtruding cough, itching in eyes. Objectively: hyperemia and edema of the nasal mucous membrane, soft palate, conjunctives. In lungs during auscultation: harsh breathing. The body temperature is 38.2 ºC. What diagnosis is most probable?
     
     1. 
        *Adenoviral infection
        
     2. 
        Rhinoviral infection
        
     3. 
        Influenza
        
     4. 
        Parainfluenza
        
     5. 
        Respiratory-syncitial infection
        

273. 
     The child, 5 years old, complains of: increasing of the body temperature to 39.5 ºС, headache, poor sleeping. What single dose of panadol should be given?
     
     1. 
        *0.01 g/kg
        
     2. 
        0.05 g/kg
        
     3. 
        0.1 g/kg
        
     4. 
        0.2 g/kg
        
     5. 
        0.5 g/kg
        

274. 
     The child, 7 years old, has measles for 10 days. He complains of increasing of the body temperature to 39 ºС, general weakness, and periodic moist cough with discharge of the mucous phlegm. Objectively: the general condition is moderate skin is pale with pigmented rashes. In lower parts of both lungs – dull sound, fine rales. What complication of the measles has appeared in child?
     
     1. 
        Tracheobronhitis
        
     2. 
        Bronchitis
        
     3. 
        Bronchiolitis
        
     4. 
        *Pneumonia
        
     5. 
        Pharyngitis
        

275. 
     With approaching the influenza epidemic district epidemiologist makes a request on prophylactic preparations. What from them will help to form an active specific immunity and is the least reactogenic?
     
     1. 
        Living vaccine.
        
     2. 
        Killed vaccine.
        
     3. 
        *sub-unite vaccine.
        
     4. 
        Donor’s gamma-globulin.
        
     5. 
        leucocytic interferon
        

276. 
     «Acute or chronic liver's disease, that is caused by a DNA-containing virus, with the parenteral mechanism of transmission, that runs across in various clinical-morphological variants: from a "healthy" carrying to the malignant forms, chronic hepatitis, cirrhosis of liver and hepatocellular carcinoma», it is the determination of:
     
     1. 
        Hepatitis A
        
     2. 
        *Hepatitis B
        
     3. 
        Hepatitis С
        
     4. 
        Hepatitis Е
        
     5. 
        Hepatitis D
        

277. 
     A 10-year-old child is sick with chronic viral hepatitis B with marked activity of the process. Total bilirubin —70/mmol/L, direct - 26/mmol/L, indirect — 44 mmol/L. AST — 6,2 mmol/L, ALT — 4,8 mmol/L. What is the mechanism of the transaminase level increase in this patient?
     
     1. 
        *Cytolysis of hepatocytes
        
     2. 
        Failure of bilirubin conjugation
        
     3. 
        Intrahepatic cholestasis
        
     4. 
        Hypersplenism
        
     5. 
        Failure of the synthetical function of the liver
        

278. 
     A 12-year-old girl complains of dull right subcostal pain, nausea, decreased appetite. History: the disease has started with jaundice in 2 months after appendectomy. She was treated in an infectious hospital. 1 year later present complaints have developed. Physical examination: subicteric sclera, enlarged firm liver. What is your preliminary diagnosis?
     
     1. 
        *Chronic viral hepatitis
        
     2. 
        Chronic cholangitis
        
     3. 
        Acute viral hepatitis
        
     4. 
        Calculous cholecystitis
        
     5. 
        Gilbert's disease
        

279. 
     A 13 years old boy suffering with virus hepatitis B presents with increase of jaundice and bloody vomiting after break of diet and nervous stress. Physical examination: Ps 110 bmp, BP 80/50 mmHg. The liver is painful at palpation and is reduced in size. What complication is the most likely being observed?
     
     1. 
        *Acute hepatic failure
        
     2. 
        Toxico-infection shock
        
     3. 
        Hemolytic crisis
        
     4. 
        Acute adrenal failure
        
     5. 
        Acute renal failure
        

280. 
     A 14 y.o. patient was admitted to the gastroenterological department with skin itching, jaundice, discomfort in the right subcostal area, generalized weakness. On examination: jaundice, scratches, liver is +5 cm, spleen is 6x8 cm. In blood: alkaline phosphatase — 2, 0 mmole/(hour*L), general bilirubin — 60 mcmole/L, cholesterol — 8,0 mmol/L. What is the leading syndrome in the patient?
     
     1. 
        Cytolytic
        
     2. 
        Astenic
        
     3. 
        Mesenchymal inflammation
        
     4. 
        Liver-cells insufficiency
        
     5. 
        *Cholestatic
        

281. 
     A 15-year-old patient was hospitalized in severe condition with complaints of chills, high grade temperature, dryness in the mouth, multiple vomiting, pain in the epigastrium, frequent watery, foamy, dirty green color stool of unpleasant odor. The tongue and the skin are dry. BP — 80/40 mm Hg. What first aid is necessary for the patient?
     
     1. 
        *Intravenous injection of sodium solutions
        
     2. 
        Hemosorption
        
     3. 
        Sympathomimetics
        
     4. 
        Fresh-frozen plasma transfusion
        
     5. 
        Poliglucin intravenously
        

282. 
     A 7 years boy complains of general weakness, spastic pain in the lower parts of his abdomen, mainly in the left iliac area, frequent defecations up to 18 times a day, feces contain admixtures of mucus and blood. The illness began abruptly 3 days ago with chill, fever, headache. General condition is moderately severe, body temperature is 37.8 °C. Sigmoid colon is spastic and painful. What is the most probable diagnosis?