Deck 23: Congenital and Surgical Disorders That Affect Respiratory Care

Question 1

Which of the following conditions is consistent with the presence of a scaphoid abdomen in a newborn with tachypnea?

A)Neonatal pneumonia
B)Congenital diaphragmatic hernia
C)Tracheoesophageal fistula
D)Esophageal atresia

Answer 1

B
Infants with congenital diaphragmatic hernia (CDH)usually develop respiratory distress shortly after birth.The diagnosis of CDH is confirmed by chest radiography but is suggested in a tachypneic newborn with a scaphoid abdomen.

Question 2

What intervention should the therapist perform when an infant is born with choanal atresia?

A)Perform nasotracheal intubation
B)Recommend a tracheotomy procedure
C)Insert an oropharyngeal airway
D)Perform a cricothyroidotomy

Answer 2

C
A newborn infant is an obligate nasal breather,so the presence of complete nasal obstruction caused by choanal atresia results in immediate respiratory distress and possible death by asphyxia.During the newborn's first breaths,the tongue becomes directly associated with the hard and soft palates,creating a vacuum.An oral airway should be inserted and maintained to relieve the airway obstruction.

Question 3

Which of the following interventions are used to treat congenital diaphragmatic hernia?
I)High-frequency oscillatory ventilation
II)Gastrointestinal tract decompression
III)Bag-mask ventilation immediately after birth
IV)Thoracostomy tube insertion if necessary

A)I and III only
B)II and IV only
C)I,II,and IV only
D)II,III,and IV only

Answer 3

C
After the diagnosis of congenital diaphragmatic hernia is made, the following interventions are implemented:
1. A large orogastric tube is placed to decompress the gastrointestinal tract.
2. Bag-mask ventilation is avoided to keep the stomach in the chest from becoming distended and causing tension pneumothorax pathophysiology.
3. An endotracheal tube is inserted, and the infant is mechanically ventilated, avoiding high airway pressures.
4. Barotrauma may be avoided by using high-frequency oscillatory ventilation.
5. Maintaining alkalosis reduces the amount of pulmonary vasospasm. Traditionally, PaCO₂ values were kept between 25 and 30 mm Hg, but more recently a protocol of "permissive hypercapnia" with increased PaCO₂ and decreased pH values seems to be safe.
6. If a pneumothorax is seen, chest tube placement is indicated. The pneumothorax is seen on the contralateral side and results from excessive ventilation pressures.

Question 4

Which of the following conditions is consistent with micrognathia,glossoptosis,and cleft palate in a newborn?

A)Pierre Robin syndrome
B)Choanal atresia
C)Treacher Collins syndrome
D)Esophageal atresia

Question 5

Which of the following interventions is used to treat macroglossia?

A)Positioning the patient appropriately corrects most cases.
B)Most cases are corrected surgically.
C)Polysomnography to determine any effect on sleep is all that is required.
D)Treatment is based on the severity of airway obstruction and etiology.

Question 6

What is the role of radiography in the determination of tracheoesophageal fistula and esophageal atresia?

A)The esophageal pouch can be observed.
B)The opening into the airway can be located.
C)The presence of left-to-right shunt can be seen.
D)The location of the nasogastric tube may confirm obstruction of the proximal esophagus caused by atresia.

Question 7

What are some of the complications associated with performing esophageal anastomoses to repair esophageal atresia that the therapist needs to be aware of?
I)Apnea
II)Bradycardia
III)Hyperventilation
IV)Recurrent pneumonia

A)I and II only
B)III and IV only
C)I,II,and III only
D)I,II,and IV only

Question 8

Why is pulmonary development often stifled in children who have asphyxiating thoracic dystrophy?

A)Because of gas exchange problems
B)Because the chest cavity is decreased
C)Because the thorax is too compliant
D)Because of a hypoplastic right ventricle

Question 9

An infant presents with abdominal distension,intolerance to feeding,rectal bleeding,and abdominal wall erythema.Laboratory findings include thrombocytopenia,neutropenia,and metabolic acidosis.An abdominal radiograph reveals distended loops and pneumatosis intestinalis.Which of the following conditions is consistent with these findings?

A)Necrotizing enterocolitis
B)Gastroschisis
C)Omphalocele
D)Umbilical coelom

Question 10

A newborn presents with respiratory distress and has a chest radiograph that reveals a circular or ovoid mass with smooth edges.Which of the following lung bud anomalies is consistent with these clinical features?

A)Bronchogenic cysts
B)Congenital cystic adenomatoid malformations
C)Pulmonary sequestration
D)Congenital lobar emphysema

Question 11

Which of the following conditions is the best explanation for the presentation of symptoms beyond infancy in patients with bronchogenic cysts or congenital cystic adenomatoid malformations?

A)Compromised immune system
B)Administration of antibiotics against resistant strains
C)Noncompliance with prescribed medications and bronchial hygiene techniques
D)Lack of communication between cysts and the tracheobronchial tree

Question 12

Which of the following patterns are commonly found in the presentation of lung bud anomalies?
I)Appear early in the newborn period
II)Emerge later in childhood
III)Frequent respiratory infections
IV)Systemic hypertension

A)I and III only
B)II and III only
C)II and IV only
D)I,II,and III only

Question 13

Which of the following clinical manifestations characterize congenital diaphragmatic hernia?
I)The herniated contents cause compression of the developing ipsilateral lung.
II)The ipsilateral side may be compressed from shifting of the mediastinum.
III)Histologic studies demonstrate increased musculature in the media of the arterioles.
IV)Lung tissue is hypoplastic,including the pulmonary vasculature,even on the contralateral side.

A)I and III only
B)II and III only
C)III and IV only
D)I,III,and IV only

Question 14

What is the most common patient complaint associated with pectus carinatum?

A)Cough
B)Dyspnea at rest
C)Cosmetic
D)Cardiac palpitations

Question 15

After surgical repair of a congenital diaphragmatic hernia,what is the potential problem generated by the rapid shift of the contralateral lung and mediastinum?

A)Inducing a pneumothorax
B)Causing pulmonary edema
C)Rupturing vascular structures
D)Tearing the sutured diaphragm on the ipsilateral side

Question 16

A newborn is brought to the emergency room for difficulty breathing.The mother of the baby reports constant drooling,coughing,and episodes of cyanosis.What should the therapist suspect this condition is?

A)Congenital diaphragmatic hernia
B)Tracheoesophageal fistula
C)Esophageal atresia
D)Pyloric dilation

Question 17

What should a respiratory therapist do to confirm a diagnosis of choanal atresia?

A)Recommend lateral mandibular radiographs
B)Inspect the nasal cavities with a rhinoscope
C)Attempt to insert an 8 French suction catheter through each nasal cavity
D)Gently pinch the infant's nose closed until oral breathing occurs

Question 18

Which of the following acronyms is associated with esophageal atresia and tracheoesophageal fistula?

A)VACTERL
B)PROM
C)CHARGE
D)PPHN

Question 19

Which of the following forms of tracheoesophageal fistula and esophageal atresia is most common?

A)Blind-ending upper esophageal pouch of variable length associated with a fistula from the lower trachea or main stem bronchi leading into the distal esophagus
B)An isolated esophageal atresia with a proximal blind-ending pouch and a "long gap" of missing esophagus above a small distal esophageal pouch
C)An esophageal atresia with a proximal and distal tracheoesophageal fistula
D)An isolated tracheoesophageal fistula presenting without atresia and usually occurring in the lower cervical or upper thoracic area

Question 20

What is a possible consequence of inadvertent rupture of the systemic arterial supply in cases of pulmonary sequestration when this supply arises directly from the aorta?

A)Hypoxemia
B)Pulmonary hypoperfusion
C)Significant blood loss or exsanguination
D)Decreased anatomic shunt