Question 1

You are assisting in the delivery room when a neonate with a CHD is born. What should be done to help the patient?
1) Give oxygen.
2) Begin bag and mask manual ventilation.
3) Intubate and ventilate the neonate.
4) Put the neonate in Trendelenburg position.

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

1, 3

Accepted Answer

Providing oxygen and intubating and ventilating the neonate are the most important interventions to support respiratory function in a neonate with a congenital heart defect (CHD). Putting the neonate in Trendelenburg position is not recommended as it can worsen respiratory distress and compromise cardiac function. Bag and mask ventilation may be necessary in some cases but intubation and mechanical ventilation is the preferred method for providing respiratory support. Therefore, choices 1 and 3 are the best options in this scenario.

Question 2

An infant with a CDH has lungs that are immature and hypoplastic. What can be done to help correct this situation?&#10;A) Suction out excessive lung fluid.&#10;B)Administer intermittent positive end-expiratory pressure (PEEP).&#10;C)Nebulized sympathomimetic agent&#10;D)Give pulmonary surfactant.

Accepted Answer

Giving pulmonary surfactant can help improve lung compliance and expand the hypoplastic lungs of an infant with a CDH. This can ultimately help with oxygenation and ventilation. Suctioning out excessive lung fluid, administering intermittent PEEP, and nebulized sympathomimetic agents may be helpful in other respiratory conditions, but they are not the best choice for correcting the hypoplastic lungs in CDH.

Question 3

A newborn infant shows respiratory distress upon delivery. It 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)Congenital diaphragmatic hernia (CDH)
C)Pneumoperitoneum
D)Abdominal aortic aneurysm

Accepted Answer

The scaphoid abdomen suggests the presence of a diaphragmatic hernia, which is confirmed by diminished breath sounds and heart sounds on the right side of the chest. Tension pneumothorax and pneumoperitoneum would present with different symptoms and findings, while abdominal aortic aneurysm is rare in newborns.

Question 4

In addition to utilizing a mechanical ventilator, what other medical support will a patient with a CDH usually need?&#10;A) Hemodialysis&#10;B)Extracorporeal membrane oxygenation (ECMO)&#10;C)Cardiac pacemaker&#10;D)Bronchoscopy

Accepted Answer

Patients with CDH have very poor lung function and may require extracorporeal membrane oxygenation (ECMO) to support their breathing. Hemodialysis, cardiac pacemaker, and bronchoscopy are not typically necessary for treatment of CDH.

Question 5

If a newborn is born with a CDH, when does respiratory distress develop?&#10;A) During labor&#10;B)Soon after birth&#10;C)Within the first 4 to 6 hours of birth&#10;D)Within the first 48 hours of birth

Accepted Answer

Respiratory distress in a newborn with a CDH usually develops soon after birth, typically within the first few minutes to hours. It is caused by the intestines and other abdominal organs pressing up against the lungs, making it difficult for the baby to breathe. Immediate intervention is required to stabilize the baby's breathing and manage the CDH.

Question 6

Your neonatal patient with a CDH will be placed on a mechanical ventilator. What initial settings should be recommended?
1) 2 to 3 cm water positive end-expiratory pressure (PEEP)
2) 100% oxygen
3) Low peak airway pressure
4) Rapid respiratory rate

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

Accepted Answer

The initial settings for a neonatal patient with a CDH on a mechanical ventilator should include:1) 2 to 3 cm water positive end-expiratory pressure (PEEP) to help keep the alveoli open2) 100% oxygen to provide adequate oxygenation3) Low peak airway pressure to minimize lung injury4) Rapid respiratory rate to maintain adequate ventilation

Question 7

An infant with a CDH also has pulmonary hypertension. What can be given to help correct this problem?&#10;A) Inhaled nitric oxide (iNO)&#10;B)Inhaled parasympatholytic agent&#10;C)100% oxygen&#10;D)Corticosteroids

Accepted Answer

Inhaled nitric oxide (iNO) is a selective pulmonary vasodilator that can improve oxygenation by reducing pulmonary vascular resistance in neonates with persistent pulmonary hypertension. It is considered the first-line therapy for pulmonary hypertension in infants with CDH.

Question 8

Your patient has a left-sided CDH. How would this manifest itself clinically?&#10;A) A restrictive pulmonary disorder&#10;B)An obstructive pulmonary disorder&#10;C)Equally restrictive and obstructive disorder&#10;D)A restrictive cardiac disorder

Accepted Answer

A left-sided CDH can lead to compression of the lung, decreasing its ability to expand and fill with air. This results in a restrictive pulmonary disorder.

Question 9

All of the following chest radiograph findings would be found in a patient with a CDH, EXCEPT:&#10;A) steeple point sign.&#10;B)complete lung collapse.&#10;C)lungs do not meet the chest wall.&#10;D)heart is shifted to the unaffected side.

Accepted Answer

The answer of All of the following chest radiograph findings...

Question 10

What will happen to the developing lungs of a fetus with a CDH?&#10;A) Pulmonary hypoplasia&#10;B)Respiratory distress syndrome (RDS)&#10;C)They will fill with amniotic fluid.&#10;D)Meconium will be aspirated.

Accepted Answer

A congenital diaphragmatic hernia (CDH) can result in compression and displacement of the developing lungs, which can lead to pulmonary hypoplasia or underdevelopment of the lungs. This can cause breathing difficulties and potentially life-threatening complications after birth.

Question 11

The major pathologic and structural changes associated with CDH include:
1) fewer bronchial generations.
2) complete lung collapse.
3) atelectasis.
4) mediastinal shift.

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

Accepted Answer

The answer of The major pathologic and structural changes associated...

Question 12

The prognosis of an infant with a diaphragmatic hernia depends on which of the following factors?
1) Success of the surgical diaphragmatic closure
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)2, 3, 4
D)1, 2, 3, 4

Accepted Answer

The answer of The prognosis of an infant with a...

Question 13

All of the following anatomic alterations may be found in a patient with a congenital diaphragmatic hernia (CDH), EXCEPT:&#10;A) lungs are compressed.&#10;B)atelectasis.&#10;C)hyperinflation.&#10;D)complete lung collapse.

Accepted Answer

The answer of All of the following anatomic alterations may...

Question 14

What happens as an infant with a CDH creates an increased negative inspiratory pressure in order to breathe?&#10;A) Meconium is drawn deeper into the airways.&#10;B)Its lung compliance is improved.&#10;C)More bowel is sucked into the thorax.&#10;D)It fills its lungs more completely.

Accepted Answer

The answer of What happens as an infant with a...

Question 15

Which of the following auscultation findings would be found in a patient with a CDH?
1) Bilateral bruits
2) Apical heart beat 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, 4

Accepted Answer

The answer of Which of the following auscultation findings would...

Deck 38: Congenital Diaphragmatic Hernia