Question 1

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?

Accepted Answer

When the heart is pushed toward the right side of the chest, the condition is termed dextrocardia.

Question 2

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

Accepted Answer

A CDH manifests itself clinically as a restrictive pulmonary disorder because the displaced abdominal organs limits lung expansion and result in reduced lung volumes.

Question 3

What pulmonary change is associated with a Bochdalek hernia?

Accepted Answer

Because of intestines in the chest cavity, the lungs are compressed in utero and pulmonary hypoplasia can result.

Question 4

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

Accepted Answer

Bag and mask ventilation should not be used on a newborn with CDH. It could result in air swallowing, which expands the stomach and intestines and further compresses the affected lung.

Question 5

All of the following anatomic alterations may be found in a patient with a congenital diaphragmatic hernia EXCEPT:

Accepted Answer

The lungs of a patient with a CDH are compressed rather than hyperinflated. This can lead to atelectasis or complete lung collapse.

Question 6

All of the following chest radiograph findings would be associated with a CDH EXCEPT:

Accepted Answer

The steeple point sign is associated with laryngotracheobronchitis rather than CDH.

Question 7

What initial ventilator setting(s) would be recommended for a newborn with a CDH? 1) PEEP of 2-3 cm H₂O 2) FIO₂ of 1.0 3) Peak inspiratory pressure of 18-20 cm H₂O 4) Respiratory rate of 40 breaths/min

Accepted Answer

All of the listed settings are appropriate. After the patient has been stabilized and arterial blood gas results have been evaluated, appropriate adjustments can be made per protocols.

Question 8

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

Accepted Answer

An abnormal elevation of an intact diaphragm is called diaphragmatic eventration.

Question 9

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

Accepted Answer

As the infant with a CDH and respiratory distress generates a more negative inspiratory pressure to breathe, more of the gastrointestinal structures are sucked into the thorax. This worsens the existing problem.

Question 10

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?

Accepted Answer

A newborn with a CDH will have diminished breath sounds and heart sounds on the right side of the chest. A scaphoid abdomen is seen when the stomach and intestines have moved into the thoracic cavity.

Question 11

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

Accepted Answer

An infant with a CDH may have all of the listed problems.

Question 12

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.

Accepted Answer

Immediately administer supplemental oxygen. The newborn should then have an endotracheal tube inserted and mechanical ventilation should be initiated.

Question 13

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

Accepted Answer

It has been shown that iNO causes vasodilation and is used to treat pulmonary hypertension.

Question 14

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

Accepted Answer

A newborn infant with a CDH will have respiratory distress soon after being born. As the infant begins to breathe, air will enter the stomach or intestine within the chest and compress the lungs.

Question 15

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

Accepted Answer

All of the listed options will impact the prognosis for an infant with a CDH. The mortality rate for this condition is about 40%.

Question 16

What additional procedures or treatments might be required for a patient with a CDH and significant pulmonary hypoplasia?

Accepted Answer

ECMO might be implemented when significant pulmonary hypoplasia exists to help improve oxygenation.

Question 17

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

Accepted Answer

Auscultation in a CDH patient will reveal an apical heartbeat heard over the unaffected side, absent breath sounds over the affected area, and bowel sounds over the affected area.

Quiz 39: Congenital Diaphragmatic Hernia