Deck 34: Neonatal and Pediatric Respiratory Disorders

Question 1

Which of the following findings on the chest radiograph are typical for RDS?
1) Hyperinflation
2) Air bronchograms
3) Diffuse hazy infiltrates
4) Bilateral reticulogranular densities

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

Answer 1

D

Question 2

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

Answer 2

D
Explanation: Infants requiring a higher FiO₂ may benefit from CPAP.

Question 3

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

Answer 3

B
Explanation: Definitive diagnosis of RDS usually is made with chest radiography.

Question 4

What are the major factors in the pathophysiology of RDS?
1) Qualitative surfactant deficiency
2) Increased alveolar surface area
3) Increased small airways compliance
4) Presence of the ductus arteriosus

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

Question 5

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

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

Question 6

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 7

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

A) Volutrauma
B) Atelectrauma
C) Hypertension
D) Hypotension

Question 8

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

A) Cyanosis
B) Wheezing
C) Hypertension
D) Tachypnea

Question 9

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 10

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 11

Which statements about TTN are true?
1) TTN and neonatal pneumonia have different clinical signs.
2) The need for mechanical ventilation in TTN is rare.
3) A small number of infants with TTN eventually have persistent pulmonary hypertension.
4) Intravenous administration of antibiotics should be considered.

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

Question 12

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 13

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 14

What radiographic finding is common in infants with transient tachypnea?

A) Low lung volumes
B) Bilateral perihilar lymphadenopathy
C) Hyperinflation
D) Mucus plugging

Question 15

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 16

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.

Question 17

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

Question 18

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 19

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

A) Grunting
B) Retractions
C) Nasal flaring
D) Cyanosis

Question 20

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 21

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

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

Question 22

Which of the following have been implicated in the origin of bronchopulmonary dysplasia (BPD)?
1) Oxygen toxicity
2) Malnutrition
3) Mechanical ventilation

A)1 only
B)1 and 2 only
C)1 and 3 only
D)1, 2, and 3

Question 23

Which of the following ventilatory modalities have been associated with a lesser rate of air leak in meconium aspiration syndrome?
1) IMV
2) HFV
3) CPAP

A)1 only
B)1 and 2 only
C)2 and 3 only
D)3 only

Question 24

What is the best strategy in the management of BPD?

A) Adequate fluid management
B) Prevention
C) Aggressive mechanical ventilation
D) PEEP

Question 25

Which of the following factors may stimulate pulmonary vascular spasm and cause persistent pulmonary hypertension of the newborn?
1) Hypoxemia
2) Hypoglycemia
3) Hypotension
4) Pain

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

Question 26

Which of the following diagnostic tools serves to confirm the diagnosis of congenital heart disease?

A) Sweat test
B) Fluoroscopy
C) Chest radiography
D) Ultrasound

Question 27

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

A) Right-to-left shunting
B) High cardiac output
C) High pulmonary vascular resistance
D) Metabolic acidosis

Question 28

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 29

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 30

Clinical findings associated with congenital diaphragmatic hernia include which of the following?
1) Severe cyanosis
2) Decreased breath sounds
3) Displaced heart sounds
4) Hepatomegaly

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

Question 31

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

A) Suctioning
B) Mask CPAP
C) Antibiotics
D) Vasopressors

Question 32

The pathophysiologic abnormalities associated with congenital diaphragmatic hernia include which of the following?
1) Malformation of the left ventricle
2) Lung hypoplasia
3) Pulmonary hypertension
4) Unusual anatomy of the inferior vena cava

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

Question 33

What are the fundamental pathophysiologic events that explain PPHN?
1) Vascular spasm
2) Hypoxemia
3) Increased muscle wall thickness
4) Decreased cross-sectional area

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

Question 34

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 35

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 36

Which of the following clinical findings are usually seen in meconium aspiration syndrome?
1) Tachypnea and grunting
2) Irregular pulmonary densities on the chest film
3) Metabolic acidosis
4) Respiratory alkalosis

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

Question 37

Which of the following are associated with causing apnea in premature infants?
1) Gender
2) Intracranial lesion
3) Gastroesophageal reflux
4) Impaired oxygenation

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

Question 38

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 39

Treatment of the infant with persistent pulmonary hypertension may include which of the following?
1) ECMO
2) High-frequency ventilation
3) Nitric oxide
4) Caffeine citrate

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

Question 40

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 41

Which of the following clinical findings suggest the child with croup should be hospitalized?
1) Stridor at rest
2) Suprasternal retractions
3) Cyanosis on room air
4) Harsh breath sounds

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

Question 42

Which of the following is false 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 43

Which of the following are used to diagnose GER?
1) Esophageal pH testing
2) Chest radiograph
3) Upper GI contrast studies
4) Gastric scintiscanning

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

Question 44

Which of the following groups of infants should receive passive immunization for RSV?
1) Chronic lung disease
2) Infants born less than 32 weeks' gestational age
3) Infants with congenital heart disease
4) Infants with retinopathy of prematurity

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

Question 45

Which of the following clinical signs are common with croup?
1) Stridor
2) Murmur
3) Coughing
4) Cyanosis

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

Question 46

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 47

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 48

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 49

Which of the following are common neuromuscular defect that affect infants?
1) Spinal muscular atrophy
2) Congenital myasthenia gravis
3) Myotonic dystrophy
4) Poliomyelitis

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

Question 50

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

A) Stridor
B) Apnea
C) Reactive airways disease
D) Syncope

Question 51

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) Tetralogy of Fallot

Question 52

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 53

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 54

Which of the following statements are true about croup?
1) Caused by viral organism
2) Most common form of airway obstruction in children aged 6 months to 6 years
3) Causes subglottic swelling and obstruction
4) Most often caused by parainfluenza virus

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

Question 55

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 56

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 57

Which of the following maternal characteristics are associated with an increased frequency of SIDS?
1) Younger than 20 years
2) Low socioeconomic status
3) Cigarette smoking
4) History of asthma

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

Question 58

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 59

Which of the following findings are typical for infants with bronchiolitis?
1) Stridor
2) Wheezing
3) Dyspnea
4) Tachypnea

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

Question 60

Which of the following disease is not commonly associated with bronchiolitis and least likely to result in respiratory failure?

A) Infant with congenital heart failure
B) Infant with BPD
C) Child with cystic fibrosis
D) Pneumonia

Question 61

Which of the following are indications for RSV prophylactic therapy?
1) Infants less than 32 weeks and requiring FiO₂ greater than 0.21 for at least the first 28 days of life
2) Cyanotic heart defects in the first year of life
3) Severely immunocompromised children less than 24 months of age
4) Children with cystic fibrosis

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

Question 62

What therapy has been shown to reduce the rate of loss of lung function in patients with cystic fibrosis?

A) High doses of ibuprofen
B) Continuous oxygen therapy
C) Corticosteroids
D) Inhaled DNase

Question 63

A 2-year-old boy is in severe respiratory distress. The child is drooling and has labored breathing. Stridor is heard. RR is 42 breaths/min and HR is 148 beats/min. What should be done next?

A) Intubate.
B) Provide 100% oxygen on nonrebreather mask.
C) Administer racemic epinephrine.
D) Place on CPAP with low PSV.

Question 64

What therapy has been shown to reduce the incidence of bronchiectatic exacerbations in the patient with cystic fibrosis?

A) Autogenic lung drainage
B) Inhaled tobramycin
C) Chest physical therapy
D) Bronchodilator therapy

Question 65

Which of the following therapies is least likely to be needed in the child with epiglottitis?

A) Tracheostomy
B) Pressure support with low-level CPAP
C) High FiO₂
D) Humidity therapy

Question 66

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

A) Thumb sign
B) Flail chest
C) Sail sign
D) Steeple sign

Question 67

Which of the following clinical findings is not typically seen in patients with epiglottitis?

A) High fever
B) Stridor
C) Barking cough
D) Drooling

Question 68

What is the likely diagnosis of an 18-month-old patient in moderate respiratory distress with a 1-week history of a low-grade fever and chills, barking cough, and an AP chest radiograph which shows a steeple sign?

A) Pulmonary interstitial emphysema
B) Bronchopulmonary dysplasia
C) Epiglottis
D) Croup

Question 69

Which test is commonly used to confirm the diagnosis of cystic fibrosis?

A) Sweat chloride
B) Chest radiograph
C) Lung diffusion capacity
D) Serum enzyme levels

Question 70

What is the leading cause of death among patients with cystic fibrosis?

A) Pancreatic disease
B) Lung disease
C) Gastrointestinal disease
D) Diabetes