Why Is This Newborn Having Trouble Breathing?
为何这名新生儿有呼吸困难？
Prepare for the United States Medical Licensing Examination (USMLE) with these practice quizzes. Read the question thoroughly, choose the best answer.
通过这些练习题准备美国医师执业资格考试（USMLE）。仔细阅读以下问题，选择最佳答案。
Question 1.
问题1
A 24-year-old woman arrives in the emergency center in active labor. She is at term, but received no prenatal care after 16 weeks of gestation when she lost her insurance coverage. The mother has an uncomplicated vaginal delivery. You are paged shortly after birth when the baby is noted to have respiratory distress. The infant has diminished breath sounds on the left, and the PMI is shifted toward the right. A chest radiograph reveals a large multiloculated mass in the left hemithorax. The NG tube you placed earlier reveals the stomach to be below the diaphragm. Which of the following is the most likely diagnosis at this point?
一名24岁女性因活跃分娩来急救中心。她已到预产期，但是在妊娠16周后失去保险后就没有接受过产前保健。该母亲曾有一次无并发症的阴道分娩。婴儿出生后不久被发现有呼吸窘迫，此后不久您被传呼。该婴儿左肺呼吸音减弱，PMI移向右侧。胸部X线片显示左胸部有一个大的多叶肿物。早些时候置入的NG管显示胃位于膈下方。此时最有可能的诊断是？
a. Cystic adenomatoid malformation
b. Congenital diaphragmatic hernia
c. Bronchogenic cysts
d. Congenital lobar emphysema
e. Congenital pneumonia
a. 囊状腺样畸形
b. 先天性膈疝
c. 支气管源性囊肿
d. 先天性肺叶气肿
e. 先天性肺炎
Question 2.
问题2
You have just given a 10-year-old boy an injection of pollen extract as prescribed by his allergist. You are about to move on to the next patient when the boy starts to complain about nausea and a funny feeling in his chest. You note that his face is flushed and his voice sounds muffled and strained. Which of the following is the first priority in managing this episode of anaphylaxis?
您刚给一名10岁男孩注射了变态反应科医师开具的花粉提取物。在您就要继续看下一位患者时，这名男孩开始诉恶心和胸部有奇怪的感觉。您注意到他的面部潮红、声音压抑和紧张。处理这种过敏反应发作优先考虑的是？
a. Endotracheal intubation
b. Intramuscular injection of diphenhydramine
c. Administration of oxygen
d. Subcutaneous injection of 1:1000 epinephrine
e. Administration of corticosteroids
a. 气管插管
b. 肌内注射苯海拉明
c. 吸氧
d. 皮下注射1:1000的肾上腺素
e. 予皮质类固醇
Question 3.
问题3
A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?
一名完全免疫的2岁婴儿因低热数天、犬吠样咳嗽和呼吸作响来急诊室就诊。在过去数小时，他发热上升至40°C（104°F），看似中毒。他有吸气性和呼气性喘鸣。家属没有发现他流口水，他似乎可以没有痛苦地饮水。直接喉镜检查显示会厌正常。该疾病过程的处理应包括以下哪项？
a. Intubation and intravenous antibiotics
b. Inhaled epinephrine and oral steroids
c. Inhaled steroids
d. Observation in a cool mist tent
e. Oral antibiotics and outpatient follow-up
a.气管插管和静脉给予抗生素
b.吸入肾上腺素与口服类固醇
c.吸入类固醇
d.置于凉的喷雾帐篷中观察
e.口服抗生素和门诊随访
答案
第一题
正确答案为a；囊状腺样畸形
先天性囊状腺样畸形（CCAM）被认为发生于30天之前的胚胎破坏，导致细支气管不正确发育。囊性肿物通常在20周左右通过产前超声检查识别出来。大的病变有可能会压迫受累的肺脏，并导致肺发育不良，进而可能导致（肺）中线偏离病变。治疗通常是手术切除受累肺叶。一些患者可能具有发生原发性肺恶性肿瘤的风险。
第二题
正确答案为a；气管插管
过敏反应是一种医学急症，必须迅速识别和处理。症状通常为迅速出现。在本病例中，患儿声音的变化提示气道完整性即将被破坏，这使得您最应该做的是稳定气道。其他选择对于处理过敏反应也很重要，实际上可能应该与气管插管同时进行。在列出的答案中，皮下注射肾上腺素是首先要用的药物。根据该患者的临床病程，其他治疗包括血浆扩容剂、苯海拉明和西咪替丁。应尽早开始其他治疗（例如给予皮质类固醇），但是起效将会延迟。
第三题
正确答案是a，气管插管和静脉给予抗生素
细菌性气管炎是病毒性喉气管支气管炎一种罕见但严重且可致命的后遗症。该病例正是细菌性气管炎的典型，在病毒性上呼吸系统症状发生数天后出现体温急性升高和呼吸窘迫增加。吸气性喘鸣是哮吼的典型，该患儿双相喘鸣和高热应该提示考虑其他诊断。
儿童也有可能急性发病且没有最初的病毒性症状。鉴别诊断必须包括会厌炎。不存在流口水和吞咽困难（以及会厌炎罕见）有助于将该病例诊断为气管炎。气管炎的处理包括气管插管建立人工气道和给予静脉抗生素。必须特别注意保持气道开放，因为即使气管炎儿童进行了插管，也有可能有黏稠的分泌物，足以堵塞气道。
，要是我就二者都上，没优先
