Question 1

A healthcare professional is educating a community parent group and informs them that which type of croup is most common?

Accepted Answer

In 85% of children with croup, a virus is the cause, most commonly parainfluenza. The healthcare professional would inform the parent group of this fact.

Question 2

Bronchiolitis tends to occur during the first years of life and is most often caused by what type of infection?

Accepted Answer

The most common associated pathogen is RSV, but bronchiolitis may also be associated with adenovirus, rhinovirus, influenza, parainfluenza virus (PIV), and Mycoplasma pneumoniae.

Question 3

Which statement by the healthcare professional accurately describes childhood asthma?

Accepted Answer

Asthma is an obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation. A disease with severe hypoxemia, decreased compliance, and diffuse densities on chest x-ray is ARDS. The viscous mucus lining the airways and other organs and tissues is seen in cystic fibrosis. Surfactant deficiency is found in RDS of the newborn.

Question 4

A 7 year-old-child presents to the clinic where parents report signs and symptoms consistent with asthma. What does the healthcare professional do in order to confirm this diagnosis?

Accepted Answer

Confirmation of the diagnosis of asthma relies on pulmonary function testing using spirometry, which can be accomplished after the child is 5 to 6 years of age. Reduced expiratory flow rates that are reversible in response to an inhaled bronchodilator would be characteristic abnormalities. For younger children, an empiric trial of asthma medications is commonly initiated. A positive parental history of asthma and elevated levels of IgE and eosinophils are major historical and physical factors that contribute but do not confirm the diagnosis of asthma in children.

Question 5

The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?

Accepted Answer

A lack of surfactant leads to RDS. Surfactant is secreted into fetal airways between 30 and 36 weeks, so a baby born between these weeks would have less of developing RDS.

Question 6

Which immunoglobulin (Ig) is present in childhood asthma?

Accepted Answer

Included in the long list of asthma-associated genes are those that code for increased levels of immune and inflammatory mediators (e.g., interleukin [IL]-4, IgE, leukotrienes), nitric oxide, and transmembrane proteins in the endoplasmic reticulum. IgM, IgG, and IgA are not associated with childhood asthma.

Question 7

Between which months of age does sudden infant death syndrome (SIDS) most often occur?

Accepted Answer

The incidence of SIDS is low during the first month of life but sharply increases in the second month of life, peaking at 2 to 4 months and is unusual after 6 months of age.

Question 8

Parents bring a 5-year-old to the Emergency Department and report sudden onset of high fever, drooling, and they describe a "hot potato voice." What action by the healthcare professional takes priority?

Accepted Answer

This child has manifestations of epiglottitis. Inflammation can lead to airway obstruction rapidly so the main focus of immediate care is securing the airway and keeping the child calm because agitation can worsen the airway problems. Allow the child to remain on the parent's lap for all examinations and tests. Examination of the throat in this condition may trigger laryngospasm and cause respiratory collapse so this is not done. The child should not be sent out of the department for x-rays as death can occur quickly. After the child has been stabilized, family members can begin post-exposure prophylaxis with rifampin.

Question 9

What information does the student learn about alveoli? (Select all that apply.)

Accepted Answer

Capillaries grow into the distal respiratory units that keep subdividing (alveolarization) to maximize the surface area for gas exchange. The number of alveoli continues to increase during the first 5 to 8 years of life, after which the alveoli increase in size and complexity. Surfactant is a lipid-protein mix that is produced by type II alveolar cells.

Question 10

What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn?

Accepted Answer

The primary problem is atelectasis, which causes significant hypoxemia and is difficult for the neonate to overcome because a significant negative inspiratory pressure is required to open the alveoli with each breath. Consolidation, pulmonary edema, and bronchiolar plugging are not the primary problems in RDS.

Question 11

Why is nasal congestion a serious threat to young infants?

Accepted Answer

Infants up to 2 to 3 months of age are obligatory nose breathers and are unable to breathe in through their mouths. Nasal congestion is therefore a serious threat to a young infant. This selection is the only option that accurately describes why nasal congestion is a serious threat to young infants. Although infants' nares are smaller than older children, this is not the main reason why congestion poses such a threat. Becoming dehydrated also is not a factor. The size of their epiglottis is also not as big a factor in young infants.

Question 12

Which statement by the professor best describes acute respiratory distress syndrome (ARDS)?

Accepted Answer

ARDS is a condition that can result from either a direct or indirect pulmonary insult. It is defined as respiratory failure of acute onset characterized by severe hypoxemia that is refractory to treatment with supplemental oxygen, bilateral infiltrates on chest x-ray imaging, and no evidence of heart failure, as well as decreased pulmonary compliance. The disorder with reversible airflow limitation is asthma. The disease with viscous mucus that lines the airways and other organs and tissues is cystic fibrosis. A surfactant deficiency occurs in RDS of the newborn.

Question 13

Which statement best describes cystic fibrosis?

Accepted Answer

Cystic fibrosis is best described as a pulmonary disorder involving an abnormal expression of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens. Reversible airflow limitations are seen in asthma. Severe hypoxemia and diffuse densities seen on x-ray are characteristic of ARDS. Surfactant deficiency leads to RDS of the newborn.

Question 14

Which T-lymphocyte phenotype is the key determinant of childhood allergic asthma?

Accepted Answer

Early onset allergic asthma is initiated by a type I hypersensitivity reaction primarily mediated by Th2 lymphocytes whose cytokines activate mast cells, eosinophilia, leukocytosis, and enhance B-cell IgE production.

Question 15

What abnormalities lead to the mucus plugging seen in children with cystic fibrosis (CF)?

Accepted Answer

Respiratory mucus in CF is dehydrated and viscous because of impaired chloride secretion and excess sodium absorption. The gut's ability to absorb water is not affected. The inflammatory response is active in this disease process. Pulmonary remodeling does lead to chronic hypoxia, but this is not related to mucus plugging.

Question 16

When assessing for the signs and symptoms of acute respiratory distress syndrome (ARDS), the absence of which condition is considered characteristic?

Accepted Answer

ARDS is characterized by progressive respiratory distress, severe hypoxemia refractory to treatment with supplemental oxygen, decreased pulmonary compliance, bilateral infiltrates on chest x-ray imaging, and no evidence of heart failure.

Question 17

A student asks the healthcare professional why researchers are trying to link specific genes to specific asthma phenotypes. What response by the professional is best?

Accepted Answer

Linking specific genes to specific asthma phenotypes is leading to targeted therapies and personalized approaches to asthma treatment. It may be true that some types are easier to treat or that some people could use different, less expensive medications, but those responses are too narrow in focus to be the best answer. Several phenotypes of asthma have already been recognized.

Question 18

What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

Accepted Answer

RDS is primarily caused by surfactant deficiency and secondarily by a deficiency in alveolar surface area for gas exchange. RDS is not caused by having an immature immune system, small alveoli, or anemia.

Question 19

What is the most common predisposing factor to obstructive sleep apnea in children?

Accepted Answer

In otherwise healthy children, the most common predisposing factor is adenotonsillar hypertrophy, which causes physical impingement on the nasopharyngeal airway. The other options are not associated with obstructive sleep apnea in children.

Question 20

Parents of a child with cystic fibrosis want to know the chance of their next baby having this disease. What response by the healthcare professional is most accurate?

Accepted Answer

Cystic fibrosis is an autosomal recessive inherited disorder. When two parents each have the trait (are carriers), each child will have a 25% chance of having normal genes and being unaffected, a 50% chance of inheriting one of the mutated genes and being a carrier, and a 25% chance of inheriting the mutated gene from both parents and having the disease.

Quiz 37: Alterations of Pulmonary Function in Children