Deck 31: Neonatal and Pediatric Respiratory Disorders

Question 1

In which infants is the surfactant administered as rescue?

A)infants delivered prematurely
B)infants with failure on CPAP trial
C)infants with diagnosis of RDS
D)infants with congenital heart disease

Answer 1

C

Question 2

You are caring for an infant with RDS. Nasal CPAP has been used; however, the infant suddenly deteriorates and is demonstrating severe hypoxemia on an FIO₂ of 0.60. What should be done next?

A)Increase the CPAP.
B)Intubate the infant and begin mechanical ventilation.
C)Switch to nasal CPAP.
D)Increase the FIO₂.

Answer 2

B

Question 3

In preterm infants, adequate amounts of surfactant are present; however, it is trapped inside type II cells.

Answer 3

True

Question 4

The current standard of care is delivery surfactant replacement to all infants with RDS.

Question 5

What treatment usually causes improvement in the initial treatment of transient tachypnea of the newborn?

A)mechanical ventilation with PEEP
B)oxygen with low FIO₂
C)bronchodilators
D)mucolytics

Question 6

What are the major factors in the pathophysiology of RDS?
I)qualitative surfactant deficiency
II)increased alveolar surface area
III)increased small airways compliance
IV)presence of the ductus arteriosus

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

Question 7

What radiographic finding is common in infants with transient tachypnea?

A)low lung volumes
B)bilateral perihilar lymphadenopathy
C)hyperinflation
D)mucus plugging

Question 8

What is the first clinical sign of RDS in the newborn infant?

A)cyanosis
B)wheezing
C)hypertension
D)tachypnea

Question 9

Mothers of infants with transient tachypnea tend to have longer labor intervals and a higher incidence of failure to progress in labor.

Question 10

Which of the following clinical signs is not consistent with the onset of RDS?

A)grunting
B)retractions
C)nasal flaring
D)cyanosis

Question 11

What treatment may improve lung fluid clearance in the infant with transient tachypnea?

A)CPAP
B)oxygen
C)mechanical ventilation
D)frequent turning of the infant

Question 12

Which of the following treatments is the least useful for the treatment of RDS?

A)CPAP
B)surfactant replacement therapy
C)high-frequency ventilation
D)bronchial hygiene techniques

Question 13

Which of the following findings on the chest radiograph is not typical for RDS?

A)hyperinflation
B)air bronchograms
C)diffuse hazy infiltrates
D)bilateral reticulogranular densities

Question 14

Another name for respiratory distress syndrome (RDS) is:

A)hyaline membrane disease
B)transient tachypnea of the newborn
C)type II RDS
D)persistent pulmonary hypertension

Question 15

Most infants with transient tachypnea are born premature.

Question 16

What is the maximum PIP that should be used with mechanical ventilation of larger premature infants to prevent volutrauma?

A)25 cm H₂O
B)30 cm H₂O
C)40 cm H₂O
D)50 cm H₂O

Question 17

Which of the following factors is associated with an increase in the incidence of RDS?

A)maternal heart disease
B)maternal diabetes
C)maternal asthma
D)long labor

Question 18

What treatment is indicated for infants with transient tachypnea requiring higher FIO₂?

A)frequent turning of the infant
B)oxygen
C)mechanical ventilation
D)CPAP

Question 19

What diagnostic parameter is most often used to confirm the diagnosis of RDS?

A)arterial blood gases
B)chest radiograph
C)pulmonary function test
D)serum enzymes

Question 20

What is believed to be the cause of transient tachypnea of the newborn (TTN)?

A)persistent hypoxemia
B)immature surfactant
C)delayed clearance of fetal lung fluid
D)persistent fetal circulation

Question 21

Which of the following ventilatory modalities has been associated with a lesser rate of air leak in MAS?
I)IMV
II)SIMV
III)HFV
IV)CPAP

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

Question 22

Which of the following should be done early in the treatment of the non-vigorous infant with meconium aspiration syndrome?

A)suctioning
B)mask CPAP
C)antibiotics
D)vasopressors

Question 23

What is associated with ball-valve obstruction in meconium aspiration syndrome?

A)volutrauma
B)atelectrauma
C)hypertension
D)hypotension

Question 24

Meconium-stained amniotic fluid is common among infants of less than 37 weeks' gestational age.

Question 25

Which of the following blood gas alteration is usually seen in meconium aspiration syndrome?

A)hypoxemia and respiratory acidosis
B)hypoxemia and mixed respiratory and metabolic alkalosis
C)hypoxemia and normal acid-base balance
D)hypoxemia and mixed respiratory and metabolic acidosis

Question 26

Treatment of the premature infant with apnea includes all the following except:

A)tactile stimulation
B)theophylline
C)transfusion
D)bronchial hygiene

Question 27

What physiologic abnormality is believed to be the cause of persistent pulmonary hypertension in the newborn (PPHN)?

A)right-to-left shunting
B)high cardiac output
C)high pulmonary vascular resistance
D)metabolic acidosis

Question 28

What clinical finding is typically seen with BPD infants?

A)areas of air-trapping on the chest film
B)areas of consolidation on the chest film
C)hypoxemia and hypercapnia
D)hypocapnia

Question 29

Which of the following clinical findings is NOT usually seen in meconium aspiration syndrome?

A)tachypnea and grunting
B)irregular pulmonary densities on the chest film
C)metabolic acidosis
D)respiratory alkalosis

Question 30

Which of the following therapies has little effect on long-term outcome such as mortality and duration of oxygen therapy in infants with BPD?

A)diuretics
B)steroids
C)antibiotics
D)bronchodilators

Question 31

Which of the following is not associated with apnea episodes in premature infants?

A)Apnea lasts longer than 15 seconds.
B)Apnea is associated with cyanosis.
C)Apnea is associated with bradycardia.
D)Apnea lasts longer than 1 minute.

Question 32

Which statements about TTN are true?
I .TTN and neonatal pneumonia have similar clinical signs.
II.The need for mechanical ventilation in TTN is rare.
III.A small number of infants with TTN eventually have persistent pulmonary hypertension.
IV.Intravenous administration of antibiotics should be considered.

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

Question 33

What factor is not associated with the new description of BPD?

A)improvements in ventilator management
B)use of surfactant
C)use of HFV
D)postnatal steroid therapy

Question 34

What percentage of births will present with meconium-stained amniotic fluid?

A)2%
B)12%
C)25%
D)50%

Question 35

Which of the following is NOT associated with causing apnea in premature infants?

A)gender
B)intracranial lesion
C)gastroesophageal reflux
D)impaired oxygenation

Question 36

Which of the following have been implicated in the origin of bronchopulmonary dysplasia (BPD)?
I)oxygen toxicity
II)malnutrition
III)mechanical ventilation

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

Question 37

Infants who have apnea of prematurity are at greater risk of SIDS than other infants.

Question 38

Which of the following is not a problem with the typical case of meconium aspiration syndrome?

A)lung tissue damage
B)pulmonary obstruction
C)hypovolemia
D)pulmonary hypertension

Question 39

What is the best strategy in the management of BPD?

A)adequate fluid management
B)prevention
C)aggressive mechanical ventilation
D)PEEP

Question 40

Normally, meconium is not passed by the infant until after birth.

Question 41

Which of the following is NOT true regarding ventricular septal defects in infants?

A)are quite common
B)usually cause right-to-left shunting
C)may cause congestive heart failure
D)usually do not appear immediately after birth

Question 42

Infants with persistent pulmonary hypertension usually have hypoxemia out of proportion to the lung disease detected by radiography.

Question 43

Normally the PVR/SVR ratio is greater than 1 in the fetus.

Question 44

The mortality rate for infants with congenital diaphragmatic hernia is usually low.

Question 45

In left ventricular outflow obstructions, systemic blood flow depends on patency of the ductus arteriosus.

Question 46

Which of the following is the most common defect of the abdominal wall?

A)inguinal hernia
B)omphalocele
C)gastroschisis
D)agenesis of abdominal muscles

Question 47

Clinical findings associated with congenital diaphragmatic hernia include all the following except:

A)severe cyanosis
B)decreased breath sounds
C)displaced heart sounds
D)hepatomegaly

Question 48

Which of the following is the most common type of esophageal atresia?

A)esophageal atresia with a proximal fistula
B)esophageal atresia with a distal fistula
C)intact esophagus with an H fistula
D)esophageal atresia without either fistula

Question 49

What are the three fundamental pathophysiologic events that explain PPHN?
I)vascular spasm
II)hypoxemia
III)increased muscle wall thickness
IV)decreased cross-sectional area

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

Question 50

Children with tetralogy of Fallot are at risk for sudden death from arrhythmia later in life.

Question 51

The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include all the following except:

A)malformation of the left ventricle
B)lung hypoplasia
C)pulmonary hypertension
D)unusual anatomy of the inferior vena cava

Question 52

Treatment of the infant with persistent pulmonary hypertension may include all the following except:

A)ECMO
B)high-frequency ventilation
C)nitric oxide
D)theophylline

Question 53

Which of the following defects is not associated with tetralogy of Fallot?

A)ventricular septal defect
B)right ventricular hypoplasia
C)pulmonary stenosis
D)dextroposition of the aorta

Question 54

Which of the following are common neuromuscular defect that affect infants?
I)spinal muscular atrophy
II)congenital myasthenia gravis
III)myotonic dystrophy
IV)poliomyelitis

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

Question 55

How soon after birth does the ductus typically close?

A)1 to 2 days
B)3 to 4 days
C)5 to 7 days
D)10 days

Question 56

Which of the following diagnostic tools serves to confirm the diagnosis of CDH?

A)sweat test
B)fluoroscopy
C)chest radiography
D)ultrasound

Question 57

Which of the following factors may stimulate pulmonary vascular spasm and cause persistent pulmonary hypertension in the newborn?
I)hypoxemia
II)hypoglycemia
III)hypotension
IV)pain

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

Question 58

Most infants with hypoplastic left heart syndrome do not need to be supported with mechanical ventilation.

Question 59

Which of the following is the most likely diagnosis in the newborn with severe cyanosis at birth?

A)persistent pulmonary hypertension
B)tetralogy of Fallot
C)transposition of the great vessels
D)ventricular septal defect

Question 60

Which of the following is an example of an internal obstruction to the infant's airway?

A)hemangiomas
B)neck mass
C)tracheoesophageal fistula
D)laryngomalacia

Question 61

Which of the following groups of infants should receive passive immunization for RSV?
I)chronic lung disease
II)infants born less than 32 weeks' gestational age
III)infants with congenital heart disease
IV)infants with retinopathy of prematurity

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

Question 62

The American Academy of Pediatrics recommends that infants be placed in either the supine or the side-lying position for the first 6 months of life to reduce the risk of SIDS.

Question 63

Ribavirin is recommended primarily for the infant with bronchiolitis who also has other complex morbidities.

Question 64

Which of the following statements is TRUE about croup?
I)caused by viral organism
II)most common form of airway obstruction in children aged 6 months to 6 years
III)causes subglottic swelling and obstruction
IV)most often caused by parainfluenza virus

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

Question 65

Which of the following clinical signs is NOT common with croup?

A)stridor
B)murmur
C)coughing
D)cyanosis

Question 66

Which of the following are used to diagnose GER?
I)esophageal pH testing
II)chest radiograph
III)upper GI contrast studies
IV)gastric scintiscanning

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

Question 67

Which of the following is the most common radiographic finding that suggests the presence of croup?

A)thumb sign
B)flail chest
C)sail sign
D)steeple sign

Question 68

Which of the following findings is not associated with gastroesophageal reflux (GER) disease?

A)stridor
B)apnea
C)reactive airways disease
D)syncope

Question 69

Which of the following treatments is least likely to be needed in the treatment of the child with croup?

A)oxygen
B)mechanical ventilation
C)aerosolized racemic epinephrine
D)budesonide

Question 70

In which of the following defects is heart transplantation an accepted option for treatment?

A)interrupted aortic arch
B)coarctation of the aorta
C)hypoplastic left heart syndrome
D)none of the above

Question 71

It is not difficult to differentiate death from SIDS from death by intentional suffocation.

Question 72

Which of the following therapies is considered controversial in the management of the infant with severe bronchiolitis?

A)hydration
B)oxygen
C)bronchodilator therapy
D)CPAP

Question 73

Which of the following infant characteristics is associated with an increased risk of SIDS?

A)female gender
B)preterm birth
C)high APGAR score
D)full-term birth

Question 74

The following diseases are commonly associated with bronchiolitis most likely to result in respiratory failure except:

A)infant with congenital heart failure
B)infant with BPD
C)child with cystic fibrosis
D)pneumonia

Question 75

What modality is believed to be the cause of a decrease in the reported incidence of epiglottitis over the past decade?

A)vaccine
B)better diet
C)improved epidemiology reporting
D)better quality of air

Question 76

Which of the following maternal characteristics is NOT associated with an increased frequency of SIDS?

A)younger than 20 years
B)low socioeconomic status
C)cigarette smoking
D)history of asthma

Question 77

Bronchiolitis is an acute infection of the lower respiratory tract usually caused by bacterial organisms.

Question 78

Which of the following clinical findings suggests the child with croup should be hospitalized?
I)stridor at rest
II)suprasternal retractions
III)cyanosis on room air
IV)harsh breath sounds

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

Question 79

Sudden infant death syndrome (SIDS) is the most common cause of death in infants under the age of 1 year.

Question 80

Which of the following findings is not typical for infants with bronchiolitis?

A)stridor
B)wheezing
C)dyspnea
D)tachypnea