Question 1

A therapist has been asked to evaluate a child suspected of having foreign body aspiration. Which of the following clinical conditions would guide the therapist to the diagnosis?&#10;A) Recurrent bronchitis&#10;B) Wheezing partially responsive to bronchodilators&#10;C) Unilateral wheezing&#10;D) Stridor

Accepted Answer

Signs and symptoms of foreign body aspiration vary with the location of impaction and the degree of airway obstruction. They can range from unilateral wheezing or recurrent pneumonia, as when peanuts or popcorn obstruct the smaller airways, to immediate occlusion of the upper airway with complete absence of air movement and rapid death from suffocation, as seen in hot dog or balloon aspiration fatalities.

Question 2

Tracheomalacia is a condition of dynamic tracheal collapse. Which of the following injurious events can be associated with this condition?&#10;A) Neonatal ventilation with high pressures&#10;B) Excessive use of racemic epinephrine&#10;C) Tracheal trauma due to CPT&#10;D) Neonatal ventilation with high oxygen concentrations

Accepted Answer

Common injurious events include neonatal ventilation with high pressures, chronic trauma to the trachea from a malpositioned ETT or aggressive endotracheal suctioning, and external compressive structures, such as a vascular ring.

Question 3

Which of the following lateral neck radiographic presentations is characteristic of laryngotracheobronchitis?  &#10;A) Posterior pharyngeal shadow&#10;B) Thumb sign&#10;C) Steeple sign&#10;D) Penumbra effect

Accepted Answer

A lateral neck radiograph, sometimes obtained to help differentiate laryngotracheobronchitis from epiglottitis, demonstrates a large retropharyngeal air shadow without epiglottic swelling. The anteroposterior (A-P) chest radiograph reveals the classic steeple sign, a sharply sloped, wedge-shaped, linear narrowing of the trachea. This demonstrates the subglottic tracheal edema that extends from the larynx to the thoracic trachea.

Question 4

Which of the following medications should be administered to a 4-year-old child with symptomatic LTB and respiratory compromise?&#10;A) Phenylephrine&#10;B) Racemic epinephrine&#10;C) Albuterol&#10;D) Antibiotics

Accepted Answer

If increasing respiratory effort, irritability, and inability to engage in play or eating develop, hospitalization may be indicated. Hospital care for the child with LTB is largely symptomatic and centers on careful monitoring for advancing respiratory compromise. Regular assessment of the respiratory rate, degree of retractions, mental status, and air exchange is essential. Oxygen saturation monitoring is useful, but generally desaturation is a late finding. Children requiring an FiO₂ of more than 0.35 are watched closely for evidence of impending respiratory failure. Nebulized racemic epinephrine is used to induce vasoconstriction of the upper airway. With the use of a 2.2% solution, 0.5 to 1.0 ml of medication is diluted to a 3.0 ml volume with normal saline and given by inhalation with a face mask over a period of approximately 10 minutes. The aerosols are often begun in an emergency department, and the child is evaluated for their effectiveness. A reduction in airway edema usually occurs within 10 to 20 minutes, with a gradual reduction of its effect over 2 hours.

Question 5

An 11-month-old child has been treated with bronchodilators for persistent wheezing without a positive clinical response. Which of the following conditions should the therapist suspect?&#10;A) Bronchitis&#10;B) Aspergillosis&#10;C) Bronchiolitis&#10;D) Endobronchial compression

Accepted Answer

The diffuse, chronic wheeze associated with these disorders is often confused with asthma. Endobronchial compression is suspected in an infant or child with persistent wheezing that does not respond to bronchodilator therapy.

Question 6

A 30-month-old child is brought to the emergency room (ER) by the parents. The child appears to have a sore throat along with dysphagia, fever, and voice changes. The child exhibits a "hot potato voice." Visualization of the posterior pharynx reveals a displaced retropharynx. What condition does this child likely have?

A) Peritonsillar abscess
B) Retropharyngeal abscess
C) Tonsillar enlargement
D) Pierre Robin syndrome

Accepted Answer

Retropharyngeal abscess commonly occurs in children younger than 3 years of age and can cause obstruction from forward displacement of the posterior pharyngeal wall. Infectious agents involved are Group A Streptococcus, Staphylococcus aureus, and, occasionally, anaerobic bacteria. The child often presents with a sore throat, fever, dysphagia, and voice changes. The voice sounds as if the child is attempting to speak without moving the tongue while maximally expanding the oropharyngeal airway. This is described as "hot potato voice." A lateral neck radiograph is obtained to determine the tissue thickness surrounding the abscess. Visualization of the posterior pharynx may reveal a displaced retropharynx. Surgical drainage is the preferred treatment, along with the administration of appropriate antibiotics based on culture results of the aspirated material.

Question 7

Relative to an adult's larynx, where is an infant's larynx situated?&#10;A) C1-2&#10;B) C2-3&#10;C) C3-4&#10;D) C4-5

Accepted Answer

The epiglottis is long, floppy, and angled away from the tracheal axis. It shrouds the laryngeal opening because of poor support by the surrounding tissues. Structurally, the infant's larynx is positioned higher in the neck (near C3-4) compared with an adult's larynx (at C4-5). Because of this superior location, the tongue base tends to "hide" the larynx from view during direct laryngoscopy.

Question 8

Why does a respiratory syncytial viral infection have little adverse effect on an older child but is often life-threatening to a younger child?&#10;A) The older child has a better developed immune system.&#10;B) The younger child has a less effective cough mechanism.&#10;C) The older child has a better developed mucociliary escalator.&#10;D) The younger child has fewer respiratory bronchioles.

Accepted Answer

In young children, the respiratory bronchioles are commonly attacked by viruses, such as respiratory syncytial virus (RSV), resulting in respiratory failure. The same infection will have little or no respiratory effect on an adult or older child with a larger number of terminal airways.

Question 9

A 10-month-old child has been brought into the emergency room (ER) by his or her parents, who state that after few days with low-grade fever, malaise, and rhinorrhea, their child presented with a "barking" cough and increased work of breathing. What condition is this child likely exhibiting?

A) Epiglottitis
B) Laryngotracheobronchitis (LTB)
C) Bronchitis
D) Bronchiolitis

Accepted Answer

The child with LTB presents with a gradual prodrome of low-grade fever, malaise, rhinorrhea, and hoarse voice. Over several days, the illness progresses to inspiratory stridor and a "barky" cough, often described as sounding like the bark of a seal. Physical examination reveals nasal flaring, nasal congestion, use of accessory muscles, and suprasternal, subcostal, and intercostal retractions that, along with the stridor, become worse when the child is agitated.

Question 10

An 18-month-old child has been admitted with a diagnosis of bronchiolitis due to RSV. The therapist has administered a single dose of albuterol and racemic epinephrine, but the child shows no signs of improvement. What should the therapist suggest at this time?

A) Alternate albuterol and racemic epinephrine every 4 hours
B) Use albuterol every 1 hour for 4 hours and then space treatments to every 4 hours
C) Discontinue therapy
D) Add an inhaled corticosteroid to the albuterol every 12 hours

Accepted Answer

Although the role of bronchodilators in the management of bronchiolitis is controversial, a single inhalation trial using epinephrine or albuterol can be considered for respiratory distress on an individual basis, such as when there is history of asthma, allergy, or atopy. It is recommended to discontinue inhalation therapy if there is no clinical response such as improved respiratory distress or improved bronchiolitis scores. Nebulized racemic epinephrine demonstrates better short-term improvement in pulmonary physiology and clinical scores but only in the outpatient setting. However, continuation of inhalation therapy despite documented nonresponse exposes the patient to unnecessary therapy and cost.

Question 11

The therapist is evaluating a child in the emergency department who displays the following signs: inability to cry, ineffective cough, high-pitched inspiratory sound, and cyanosis. What should the therapist suspect?

A) Tracheomalacia
B) Severe or complete airway obstruction
C) Vascular ring
D) Status asthmaticus

Accepted Answer

The answer of The therapist is evaluating a child in...

Question 12

A 4-year-old child is brought into the emergency room (ER) by her parents, who state that an abrupt high fever developed along with a severe sore throat, dysphagia with drooling, and cough. In the ER, the girl exhibits stridor, muffled voice without hoarseness, air hunger, and cyanosis. She also has suprasternal, substernal, and intercostal retractions, with nasal flaring, bradypnea, and dyspnea. The child is sitting upright with her chin thrust forward and her neck hyperextended in a tripod position. What condition is she likely exhibiting?

A) Laryngotracheobronchitis
B) Tracheomalacia
C) Bacterial tracheitis
D) Epiglottitis

Accepted Answer

The answer of A 4-year-old child is brought into the...

Question 13

Which of the following radiographic techniques is best for determining the presence of a ball-valve type obstruction?&#10;A) A standard portable A-P chest X-ray&#10;B) A lateral neck radiograph&#10;C) Either a right or left lateral decubitus film&#10;D) Inspiratory and expiratory A-P chest X-rays

Accepted Answer

The answer of Which of the following radiographic techniques is...

Question 14

As the therapist auscultates over an infant's larynx, he hears a very low-pitched sound. On the basis of this finding, what impression is he or she likely to have regarding the nature of the upper airway obstruction?

A) Mild obstruction
B) Moderate obstruction
C) Severe obstruction
D) Complete obstruction

Accepted Answer

The answer of As the therapist auscultates over an infant's...

Question 15

Why does an infant's respiratory distress from choanal atresia seem to lessen when the infant cries?&#10;A) Because the anterior nares widen more&#10;B) Because the infant breathes more through the mouth&#10;C) Because the infant is able to generate a stronger inspiratory effort&#10;D) Because accessory muscles of ventilation help stabilize the chest wall

Accepted Answer

The answer of Why does an infant's respiratory distress from...

Question 16

A 3-year-old child has the following clinical presentations in the ER:
Profound nasal congestion and productive cough
Chest auscultation revealing diffuse coarse, "sticky" crackles (sounding like Velcro)
Chest radiograph revealing lung hyperinflation with flattened hemidiaphragms
What pulmonary condition does this infant likely have?

A) Bronchiectasis
B) Primary ciliary dyskinesia
C) Supralaryngeal obstruction
D) Bronchiolitis

Accepted Answer

The answer of A 3-year-old child has the following clinical...

Question 17

A 3-year-old child has been diagnosed with epiglottitis and was intubated due to severe respiratory distress. After 24 hours of antibiotics, the therapist is considering extubation. What will be an acceptable leak before considering extubation?

A) 10 to 20 cm H₂O.
B) 20 to 30 cm H₂O.
C) 30 to 35 cm H₂O.
D) An audible leak at any pressure level is enough to consider extubation.

Accepted Answer

The answer of A 3-year-old child has been diagnosed with...

Question 18

The therapist has been asked to evaluate the chest radiograph of a 3-month-old boy with atelectasis. Which pulmonary lobe has the greatest tendency to collapse in young infants?&#10;A) RUL&#10;B) RML&#10;C) Lingula&#10;D) LUL

Accepted Answer

The answer of The therapist has been asked to evaluate...

Question 19

While performing auscultation on a 2-month-old child, the therapist hears wheezes equal in pitch across all regions of the chest; however, they seem loudest in the vicinity of the sternum. From which of the following anatomic structures is the wheezing likely originating?

A) Trachea
B) Terminal bronchioles
C) Segmental bronchi
D) Alveoli

Accepted Answer

The answer of While performing auscultation on a 2-month-old child,...

Question 20

In the ER, a chest radiograph reveals dilation of the segmental and subsegmental bronchi. The patient complains of expectorating copious amounts of thick mucus and frequent lung infections over the last year. Which of the following conditions does this child likely have?

A) Atelectasis
B) Bronchiectasis
C) Foreign body aspiration
D) Postoperative laryngotracheobronchitis

Accepted Answer

The answer of In the ER, a chest radiograph reveals...

Question 21

Diagnosis of TB in children requires which of the following special considerations?&#10;A) Three consecutive days of gastric washings&#10;B) A positive skin test&#10;C) A positive chest X-ray&#10;D) One positive respiratory washing

Accepted Answer

The answer of Diagnosis of TB in children requires which...

Question 22

Which of the following clinical interventions are used to treat complications of sickle cell anemia?
I) Supplemental oxygen
II) Bronchodilators
III) Diuretics
IV) Red blood cell transfusions

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

Accepted Answer

The answer of Which of the following clinical interventions are...

Question 23

Which of the following agents has been shown to be effective and safe in treating infants with bronchiolitis?&#10;A) Prednisone&#10;B) Nebulized 3% hypertonic saline&#10;C) Dexamethasone&#10;D) Theophylline

Accepted Answer

The answer of Which of the following agents has been...

Question 24

Bronchoalveolar lavage fluid is considered positive for VAP when which of the following conditions occur?
I. Polymorphonuclear neutrophils are greater than 25 per optic field at a magnification *100.
II. Squamous epithelial cells are less than 1%.
III. Axilary temperature of greater than 37°C.
IV. One or more microorganisms are seen per optic field at a magnification of 1:1000.

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

Accepted Answer

The answer of Bronchoalveolar lavage fluid is considered positive for...

Question 25

A child presents to the emergency department with fever, tachypnea, nasal flaring, and shallow breathing. The physical exam of the chest reveals the presence of crackles, increased tactile fremitus, and dullness to percussion. What should the therapist suspect the diagnosis is?

A) Bronchitis
B) Bronchiectasis
C) Bronchiolitis
D) Pneumonia

Accepted Answer

The answer of A child presents to the emergency department...

Deck 26: Pediatric Airway Disorders and Parenchymal Lung Diseases