Deck 41: Congenital Diaphragmatic Hernia

Question 1

Which of the following are major pathologic and structural changes associated with a CDH?
1) Increased numbers of bronchial generations and alveoli
2) Complete lung collapse
3) Atelectasis
4) Mediastinal shift

A)1, 2
B)3, 4
C)1, 3, 4
D)2, 3, 4

Answer 1

2, 3, 4

Question 2

Which of the following is described as abnormal elevation of an intact diaphragm into the chest cavity?

A) Diaphragmatic eventration
B) Morgagni's hernia
C) Bochdalek's hernia
D) Diaphragmatic altimetry

Answer 2

Diaphragmatic eventration

Question 3

If inhaled nitric oxide (iNO) does not work, what treatment might be required for a patient with a CDH and significant pulmonary hypoplasia?

A) Plasmapheresis
B) ECMO
C) Cardiac pacemaker
D) Bronchoscopy

Answer 3

ECMO

Question 4

In the delivery room, which of the following are recommended to manage a newborn with a CDH?
1) Administer oxygen.
2) Begin bag and mask manual ventilation.
3) Intubate and ventilate the neonate.
4) Place the newborn in the Trendelenburg position.

A)1, 2
B)3, 4
C)1, 3
D)1, 3, 4

Question 5

When does respiratory distress normally develop in a newborn with a CDH?

A) Shortly after delivery
B) 6 to 12 hours after delivery
C) 12 to 24 hours after delivery
D) 24 to 48 hours after delivery

Question 6

What pulmonary change is associated with a Bochdalek's hernia?

A) Pulmonary hypoplasia
B) Respiratory distress syndrome (RDS)
C) Pulmonary edema
D) Meconium aspiration

Question 7

What effect would a substantial left-sided CDH have on pulmonary function test findings?

A) A restrictive pulmonary disorder
B) An obstructive pulmonary disorder
C) An equally restrictive and obstructive disorder
D) A restrictive disorder with increased DLCO

Question 8

A newborn infant shows respiratory distress upon delivery. He is observed to have a scaphoid abdomen. Auscultation reveals diminished breath sounds with heart sounds on the right side of the chest. What is the infant's most likely diagnosis?

A) Tension pneumothorax
B) CDH
C) Pneumoperitoneum
D) Abdominal aortic aneurysm

Question 9

What is the medical term for the condition associated with some cases of CDH in which the heart is pushed to the right side of the chest?

A) Morgagni's movement
B) Dextrocardia
C) Ambidextrocardia
D) Bochdalek's shift

Question 10

Why would bag and mask ventilation be contraindicated in resuscitation of a neonate with CDH?

A) It results in air swallowing, which enlarges the stomach and compresses lung tissue.
B) It requires too much effort for the respiratory therapist to manually squeeze the bag.
C) The FIO₂ delivered by the device can cause oxygen toxicity and ROP.
D) The high tidal volumes may result in pulmonary interstitial emphysema.

Question 11

Which of the following auscultation findings would be associated with a CDH?
1) Bilateral bruits
2) Apical heartbeat heard over the unaffected side
3) Absent breath sounds over the affected area
4) Bowel sounds over the affected area

A)1, 2
B)3, 4
C)2, 3, 4
D)1, 2, 3

Question 12

What happens as an infant with a CDH creates an increased negative inspiratory pressure in order to breathe?

A) Meconium is drawn deeper into the airways.
B) Lung compliance is improved.
C) More of the gastrointestinal structures are sucked into the thorax.
D) Lungs fill and expand to full capacity.

Question 13

The prognosis of an infant with a diaphragmatic hernia depends on which of the following factors?
1) Spontaneous closure without the need for surgery
2) Size of the diaphragmatic defect
3) Condition of the lung on the unaffected side
4) Degree of hypoplasia

A)1
B)1, 2
C)1, 3, 4
D)2, 3, 4

Question 14

Which of the following chest radiograph findings is typically not associated with a CDH?

A) Steeple point sign.
B) Complete lung collapse.
C) Lungs do not meet the chest wall.
D) Heart is shifted to the unaffected side.

Question 15

An infant with a CDH also has pulmonary hypertension. Which of the following can be administered to relieve this problem?

A) Inhaled nitric oxide (iNO)
B) Inhaled parasympatholytic agent
C) 80% helium-20% oxygen
D) Corticosteroids

Question 16

What initial ventilator setting(s) would be recommended for a newborn with a CDH?
1) PEEP of 5 to 8 cm H₂O
2) FIO₂ of 1.0
3) Peak inspiratory pressure of <30 cm H₂O
4) Respiratory rate of 40 to 50 breaths/min

A)2
B)3, 4
C)1, 2, 3
D)2, 3, 4

Question 17

Which of the following anatomic alterations is not typically found in a patient with a congenital diaphragmatic hernia?

A) Lungs are compressed.
B) Atelectasis.
C) Hyperinflation.
D) Complete lung collapse.