kaoshibaoexcel20221101 (1)_在线真题试卷与模拟练习_kaoshibaoexcel20221101 (1)

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A 3-year-old boy is brought to the GP by his mother with a 6-month history of recurrent episodes of coughing and wheezing. These episodes typically occur at night and after physical activity. His mother reports that he has had three such episodes in the last month, each lasting 2-3 days. He was previously well with no significant past medical history. On examination, he has mild expiratory wheeze bilaterally. His oxygen saturation is 98% on room air. What is the most appropriate initial management?

A 7-year-old boy is brought to the GP by his mother with worsening asthma symptoms. He was diagnosed with asthma 6 months ago and has been using a beclometasone 100 mcg inhaler (2 puffs twice daily) and salbutamol as needed. His mother reports that he has been using his salbutamol inhaler 3-4 times per week, has been waking at night with cough once or twice weekly, and has had to miss PE at school twice in the last month due to breathlessness. His inhaler technique has been checked and is good. His peak flow readings have been consistently around 80% of his predicted value. What is the most appropriate next step in management?

A 7-year-old boy is brought to the GP by his mother with a 3-month history of recurrent cough and wheeze. His symptoms are worse at night and after playing football. He has had two episodes in the past month where he woke up coughing and wheezing, which resolved with his mother's salbutamol inhaler that she uses for her own asthma. He has a personal history of eczema and his father has allergic rhinitis. On examination, he has mild expiratory wheeze bilaterally. His peak flow is 160 L/min (predicted 200 L/min). Spirometry shows FEV1 of 78% predicted with 14% reversibility after salbutamol. What is the most appropriate initial pharmacological management?

A 4-year-old boy is brought to the GP by his mother due to a 3-month history of wheezing and shortness of breath, especially at night. He has no significant past medical history but has a family history of asthma. His mother reports that he struggles during physical activity and frequently uses his salbutamol inhaler, which provides temporary relief. On examination, a bilateral wheeze is noted with no signs of respiratory distress.

What is the most appropriate initial management plan for this child?一名 4 歲男孩因 3 個月的喘息和呼吸急促病史（尤其是在夜間）被母親帶去看全科醫生。他沒有明顯的既往病史，但有氣喘家族史。他的母親報告說，他在體力活動中掙扎，經常使用沙丁胺醇吸入器來暫時緩解疼痛。檢查時發現雙側喘息，沒有呼吸窘迫的跡象。

對於這個孩子最適合的初始管理計畫是什麼？

A distressed mother brings her 2-month-old son to the GP. For the last 3 weeks, the child cries inconsolably, turns bright red, draws his knees up to his abdomen and arches his back. His mother believes he is in pain. There is no associated diarrhoea or vomiting. These episodes occur in the afternoon or at night. There is no faltering growth and he is developing normally. The child is exclusively breastfed. On examination, the child's abdomen is soft and non-tender with no palpable masses. He is afebrile. What is the most appropriate next step in management?一位憂心忡忡的母親帶著兩個月大的兒子去看全科醫生。在過去的三個星期裡，孩子哭得無法安慰，臉色漲得通紅，膝蓋拉到腹部，弓起背。他的母親相信他很痛苦。沒有相關的腹瀉或嘔吐。這些發作發生在下午或晚上。沒有出現生長緩慢的情況，且發育正常。孩子純母乳哺育。檢查時，孩子腹部柔軟，無壓痛，未觸及腫塊。他沒有發燒。下一步最適合的管理步驟是什麼？

A 6-year-old boy presents to the emergency department with a rash. His parents deny any trauma and are not known to social services. He has had a recent coryzal illness which resolved without intervention. The child has no past medical history. He was born at term via vaginal delivery. He has reached all developmental milestones and is up-to-date with vaccinations. On examination, there is a petechial rash on the child's legs. He looks otherwise well with no other signs of bleeding. His blood tests:Hb 145 g/L Male: (135-180) Platelets 29 * 109/L (150 - 400) WBC 7.2 * 109/L (4.0 - 11.0) What is the indicated management?一名 6 歲男孩因皮疹到急診就診。他的父母否認有任何創傷，社會服務機構也不知曉他的情況。他最近患有鼻炎，無需幹預即可痊癒。孩子沒有既往病史。他經由陰道分娩足月出生。他已達到所有發育里程碑，並已接種最新疫苗。經過檢查，孩子的腿上出現了點狀皮疹。他看起來其他方面都很好，沒有其他流血的跡象。

A 2-year-old boy is taken to his GP with a 1 day history of right-sided limp. His parents report him being otherwise fit and well apart from a recent cold and his nursery deny observing any physical trauma. On examination, he is afebrile and evidently in pain however has a normal range of movement in the right hip. What would be the most appropriate management at this stage?一名 2 歲男孩因右側跛行 1 天而被送往全科醫生處。他的父母報告說，他在其他方面都很健康，而且最近沒有感冒，他的托兒所也否認觀察到任何身體創傷。經過檢查，他沒有發燒，明顯疼痛，但右臀部的活動範圍正常。現階段最適合的管理方式是什麼？

A 3-year-old girl presents to the emergency department with lethargy, cough and breathlessness for the last 2 weeks. The mother tells you that the cough has been getting worse, but it is not productive of sputum. Her observations show fever, tachycardia and tachypnoea. Based on her age and the worsening of the cough, you suspect that the infecting organism is Mycoplasma pneumonia. Chest x-ray shows right lower zone consolidation. What is the most appropriate oral therapy?根據她的年齡和咳嗽的加重情況，您懷疑感染的微生物是肺炎支原體。胸部 X 光檢查顯示右下區實變。

The paediatric doctor has been asked to see a woman on the postnatal ward who has a 12-hour old baby. The baby was born at 36 weeks with no complications. The midwife reports that the mother is exclusively breastfeeding but also attempting to hand express, and the latest capillary blood glucose is 0.9mmol/L. The baby is asymptomatic. What should be done next?兒科醫生被要求去產後病房探望一名產後 12 小時嬰兒的婦女。寶寶36週出生，沒有任何併發症。助產士報告，母親純母乳餵養，也嘗試用手擠奶，最新毛細血管血糖為0.9mmol/L。嬰兒沒有任何症狀。接下來該做什麼？

A 5-month-old baby is admitted with poor feeding. Over the last 24 hours, they have fed 25% of their usual amount and have had significantly fewer wet nappies than usual. The baby has been particularly irritable over this time and is not settling. There is no past medical history, no known allergies, and there has been no travel outside of the UK. On examination, the baby appears unsettled and grouchy. There are no rashes on exposure and the fontanelles appear normal. The physical observations reveal tachycardia and a fever of 39ºC. When you attempt to manually flex the baby's neck you note that they also flex the hips and knees. Which of the following is the most appropriate empirical intravenous treatment?一名5個月大的嬰兒因餵食不良而入院。在過去 24 小時內，他們的餵食量是平時的 25%，濕尿布的數量明顯少於平常。這段時間寶寶特別煩躁，一直不平靜。沒有既往病史，沒有已知的過敏史，也沒有到過英國以外的地方旅行.當您嘗試手動彎曲嬰兒的頸部時，您會注意到他們也會彎曲臀部和膝蓋。

A 6-day-old baby is admitted to the neonatal intensive care unit after having difficulty breathing in the last 24 hours. She was born at 39 weeks gestation weighing 2.0 kg with no complications during pregnancy. Her mother had an episode of tonsillitis that resolved spontaneously. The baby and her parents are of Bengali ethnicity but have lived in the UK their whole lives. On examination, there is nasal flaring and the baby is using accessory muscles to breathe. She is tachycardic and tachypnoeic and looks fatigued. Given the likely diagnosis, what factor has most likely contributed to its development?一名 6 天大的嬰兒在過去 24 小時內出現呼吸困難，被送往新生兒加護病房。孕39週出生，體重2.0公斤，孕期無併發症。她母親曾患過一次扁桃體炎，但後來自行消退。嬰兒和她的父母都是孟加拉裔，但一輩子都住在英國。檢查時發現嬰兒鼻腔張開，並且正在使用輔助肌肉呼吸。她心跳過速、呼吸急促，看起來很疲憊。鑑於可能的診斷，什麼因素最有可能促成其發展？

An 15-day old baby presents to the emergency department with his mother. His mother states he has not been feeding or drinking well for the last two days. She believes he is not gaining much weight and his stools have been more pale than usual. On examination, you note the baby is visibly jaundiced and has hepatomegaly. Your team conducts a newborn jaundice screen, with one of the differentials being biliary atresia. What finding would support this diagnosis most?一名 15 天大的嬰兒和他的母親一起來到急診室。他的母親說他過去兩天吃得或喝得不好。她認為他的體重沒有增加太多，而且他的大便比平常更蒼白。檢查時，您發現嬰兒明顯黃疸且肝腫大。您的團隊進行了新生兒黃疸篩檢，其中之一是膽道閉鎖。

A father brings a 9-month-old baby to her GP concerned about her development. She was born at 38 weeks with a low birth weight of 2,200 grams. Her development so far has been unremarkable. He reports that she is able to sit unsupported but that she tends to use her right hand only to grasp toys, even if they are placed on her left side. When a task requires two hands, she uses her left hand to assist the right but it appears uncoordinated. What is the most appropriate management?一位父親帶著一名 9 個月大的嬰兒去看全科醫生，擔心她的發育情況。她出生時 38 週，出生體重低至 2200 公克。迄今為止她的發展並不起眼。他報告說，她能夠在沒有支撐的情況下坐著，但她傾向於只用右手抓玩具，即使玩具放在她的左側。當需要兩隻手完成任務時，她用左手協助右手，但看起來不協調。

A 1-month-old baby suffers from intermittent episodes of cyanosis and tachypnoea, particularly when distressed. An examination reveals a harsh ejection-systolic murmur. Given the likely diagnosis, what is the best predictor of the clinical severity of this condition?1 個月大的嬰兒會間歇性出現紫紺和呼吸急促，尤其是在感到痛苦時。檢查發現有刺耳的射血收縮期雜音。考慮到可能的診斷，這種情況的臨床嚴重程度的最佳預測因子是什麼？

A six-week-old infant is brought into the emergency department with a history of poor feeding for 4 days and increasing difficulty in breathing. There is no significant medical history. On examination the infant has a blue tinge to the lips and a ejection systolic murmur on auscultation of the precordium.
一名六週大的嬰兒被送往急診室，嬰兒有 4 天餵食不良的病史並且呼吸困難加劇。沒有重要的病史。檢查時，嬰兒嘴唇呈藍色，心前區聽診時有噴射性收縮期雜音
What is the most likely underlying diagnosis?

A 6-week-old boy presents to the paediatric emergency department with fever, vomiting and reduced appetite for the last 48 hours. There are no concerns regarding his growth and development so far.

On examination, the patient appears to be lethargic and unsettled. He is tachypnoeic and his temperature is 39ºC. His blood pressure and pulse rate are within the normal range. There are no signs suggesting raised intracranial pressure. A diagnosis of bacterial meningitis is suspected at the time being and a lumbar puncture is performed.

Which of the following should be done next while waiting for the lumbar puncture results?

一名 6 週大的男孩在過去 48 小時內因發燒、嘔吐和食慾不振而到兒科急診就診。到目前為止，沒有人擔心他的成長和發展。

檢查時，患者顯得昏昏欲睡、情緒不穩定。他呼吸急促，體溫為 39°C。他的血壓和脈搏都在正常範圍內。沒有跡象顯示顱內壓升高。目前懷疑診斷為細菌性腦膜炎，並進行了腰椎穿刺。

在等待腰椎穿刺結果期間，接下來應該進行下列哪一項操作？

A 15 kg 3-year-old boy with a background of vomiting and passing loose stools for 5 days presents to the paediatric emergency department with increasing irritability and tiredness. He has not eaten for the past 2 days and has only been able to tolerate a minimal amount of fluid. His mother notices that he passes urine less often as well.

On examination, the boy appears to be lethargic and there is altered responsiveness. His heart rate is 160 beats per minute (95-140 /min), respiratory rate is 32 breaths per minute (25-30/min) and systolic blood pressure is 90 mmHg (80-100 mmHg). His temperature is normal.

There are no skin rashes. Capillary refill time is 4 seconds and his extremities are cold and pale. Skin turgor is reduced and the mucous membranes are dry.

What can you conclude about the hydration status of the patient and how would you manage the patient based on your conclusion?
一名 15 公斤重的 3 歲男孩因嘔吐和便稀而持續 5 天，並因煩躁和疲倦加劇而到兒科急診就診。他過去兩天沒有進食，只能耐受少量的液體。他的母親注意到他的排尿次數也減少了。

經過檢查，男孩似乎昏昏欲睡，反應能力也改變了。他的心率為每分鐘 160 次（95-140 次/分鐘），呼吸頻率為每分鐘 32 次呼吸（25-30 次/分鐘），收縮壓為 90 毫米汞柱（80-100 毫米汞柱）。他的體溫正常。

沒有皮疹。毛細血管再充盈時間 4 秒，四肢冰冷蒼白。皮膚彈性降低，黏膜乾燥。

關於患者的水合狀態，您能得到什麼結論？根據您的結論，您將如何管理患者？

An 11-year-old girl is brought by her mother for a generalised skin eruption. She began itching 2 days ago and has since developed fevers and a skin rash. On examination, there are various stages of lesions including macules, papules, crusted lesions, and vesicles which cover a majority of her body. Her mother has been giving her ibuprofen for the fever and discomfort.
一名 11 歲女孩因全身皮疹被母親帶回家。她兩天前開始發癢，此後出現發燒和皮疹。檢查發現，皮損有不同階段，包括斑疹、丘疹、結痂皮損和覆蓋全身大部分的水皰。她的母親一直在給她服用布洛芬治療發燒和不適。
Given the likely diagnosis, why would ibuprofen not be recommended in this scenario?