Deck 35: Meconium Aspiration Syndrome

Question 1

What is the consequence of meconium aspiration if there is a "ball-valve" effect in the small airways?

A) Air trapping on exhalation
B) Apnea of prematurity
C) Air trapping on inhalation
D) Bronchiectasis

Answer 1

Air trapping on exhalation

Question 2

About how many neonatal patients with MAS will require mechanical ventilation or CPAP?

A) 50% to 70%
B) 30% to 50%
C) 10% to 15%
D) Less than 10%

Answer 2

30% to 50%

Question 3

A neonate with MAS has hypoxemia. Which of the following can be a pulmonary effect of this?

A) Status asthmaticus
B) Persistent pulmonary hypertension of the newborn (PPHN)
C) Bronchopulmonary dysplasia (BPD)
D) Pulmonary fibrosis

Answer 3

Persistent pulmonary hypertension of the newborn (PPHN)

Question 4

It is highly suspected that a newborn has aspirated meconium. What actions should be immediately undertaken?
1) Instill exogenous surfactant
2) PRN suctioning of the airways
3) Gentle oral suctioning
4) Elective intubation for the clearance of meconium stained fluid

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

Question 5

Hyperinflation is noted on the chest radiograph of a patient with MAS. What sudden developments must be watched for?
1) PPHN
2) Pneumothorax
3) Cardiomegaly
4) Pneumomediastinum

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

Question 6

A patient has meconium aspiration syndrome (MAS) and a chemical pneumonitis as a result. What effects can this have?
1) Increased surfactant production
2) Increased bacterial growth
3) Edema of bronchial mucosa
4) Excessive bronchial secretions

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

Question 7

If mechanical ventilation is needed to support a neonate with MAS, which of the following settings is especially important?

A) High positive end-expiratory pressure (PEEP) level.
B) Long exhalation time.
C) High humidity level.
D) Give no more than 50% oxygen.

Question 8

What risks are there in positive-pressure ventilation before all meconium has been removed from the airways?
1) Forcing meconium into the lower airways
2) Pneumothorax
3) Triggering persistent pulmonary hypertension of the neonate (PPHN)
4) Triggering an asthma attack

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

Question 9

Risk factors for the development of MAS include:
1) being postterm.
2) a mother who is hypertensive.
3) a mother who is toxemic.
4) being the first twin born.

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

Question 10

The major pathologic or structural changes associated with the physical presence of meconium in MAS include:
1) partially obstructed airways, air trapping, and alveolar hyperinflation.
2) pulmonary air leak syndromes (pneumomediastinum or pneumothorax).
3) totally obstructed airways and absorption atelectasis.
4) pulmonary edema and alveolar flooding.

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

Question 11

Indications that a newborn has aspirated meconium include:
1) a high Apgar score.
2) meconium in amniotic fluid.
3) newborn is not actively breathing.
4) meconium staining on skin.

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

Question 12

A common finding in a neonate with MAS is a respiratory rate that is:

A) under 40/min.
B) between 40 and 60/min.
C) well over 60/min.
D) cyclical with faster and then slower breaths.

Question 13

How may a fetus respond when he/she becomes hypoxemic?

A) The fetus stops making breathing efforts.
B) The fetus makes rapid, shallow chest movements.
C) The fetus makes very deep, gasping inspiratory movements.
D) The fetus shows Kussmaul respirations.

Question 14

Infants who are older than 42 weeks' gestation are at greater risk for MAS because they have:
1) a full bowel.
2) strong peristalsis.
3) amniotic fluid in their stomach.
4) sphincter tone.

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

Question 15

An infant with MAS will show what clinical manifestations associated with the more negative intrapleural pressures needed during inspiration?
1) Seesaw breathing movement.
2) Breath sounds reveal rhonchi and crackles.
3) Expiratory grunting.
4) Cyanosis of the dependent thoracic areas.

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

Question 16

A patient with MAS has had a chest radiograph taken. What findings can be expected?

A) Elevated diaphragms
B) Mediastinal shift
C) Irregular densities throughout the lungs
D) Air bronchograms