Cluster IV (neonatal and pediatric) Flashcards
The RT is evaluating a newborn with mild respiratory distress due to tracheal stenosis. During which period of lung development did this problem develop?
A. Embryonal
B. Saccular
C. Canalicular
D. Alveolar
A. Embryonal
What is the purpose of the substance secreted by the type 2 pneumocyte?
A. To increase the gas exchange surface area
B. To reduce the surface tension
C. To maintain the lung elasticity
D. To preserve the volume of the amniotic fluid
B. To reduce the surface tension
Which of the ff tests of the amniotic fluid have been shown to be sensitive indicators of lung maturity
A. levels of prednisone
B. Levels of epidermal growth factor
C. Levels of prostaglandin
D. Levels of phosphatidglycerol and phosphatidycholine
D. Levels of phosphatidglycerol and phosphatidycholine
Approximately how much fetal lung fluid is secreted daily
A. About 150 to 200 mL
B. About 250 to 300 mL
C. About 350 to 400 mL
D. About 450 to 500 mL
B. About 250 to 300 mL
A pregnant woman is coming for an early prenatal evaluation and wants to know if she can listen to baby’s heartbeat. How early can be the fetal heartbeat be detected?
A. Day 8
B. Day 22
C. Day 42
D. Day 62
B. Day 22
Which of the ff. organs is considered to be the first complete form?
A. Heart
B. Brain
C. Kidney
D. Lungs
A. Heart
What is the function of the Wharton’s jelly inside the umbilical cord
A. To help provide nutrition to the fetus
B. To help prevent the vessels inside the cord from kinking
C. To deliver oxygen from placenta to the fetus
D. To regulate the temperature between the fetus and the mother
B. To help prevent the vessels inside the cord from kinking
Which of the ff embryonic germ layers gives information to the respiratory system?
A. Endoderm
B. Mesoderm
C. Ectoderm
D. Periderm
A. Endoderm
How long after birth should it take for the ductus arteriosus to close completely
A. 24 hours
B. 48 hours
C. 96 hours
D. 1 week
C. 96 hours
Which of the ff event causes cessation of right-to-left shunt through the foreamen ovale?
A. Increased level of PO2 in the blood of the neonate
B. Decreased level of PCO2 in the blood of the newborn
C. Increased systemic vascular resistance
D. Removal of the placenta, causing lowered blood volume returning to the right side of the fetal heart
C. Increased systemic vascular resistance
At what gestational age is extra uterine life possible?
A. 22 to 38 weeks
B. 24 to 36 weeks
C. 38 to 42 weeks
D. 20 to 23 weeks
C. 38 to 42 weeks
When does surfactant production begin?
A. 12 to 18 weeks
B. 24 to 26 weeks
C. 28 to 32 weeks
D. 32 to 42 weeks
B. 24 to 26 weeks
Where does gas exchange occur in the fetus?
A. Lungs
B. Heart
C. Placenta
D. Umbilical Cord
C. Placenta
How many umbilical veins and how many umbilical arteries?
A. 2 umbilical arteries and 1 umbilical vein
B. 1 umbilical artery and 2 umbilical veins
C. 2 umbilical arteries and 2 umbilical veins
D. 1 umbilical artery and 1 umbilical vein
A. 2 umbilical arteries and 1 umbilical vein
Which of the ff maternal focus is/are related to the health of the fetus and outcomes of pregnancy?
1. Maternal age
2. Prior maternal disease
3. Maternal drug use
4. Maternal birth history
A. 1, 2, and 3
B. 2 and 4
C. 1,2,3 and 4
D. 3, and 4
C. 1,2,3 and 4
Which of the ff techniques would you recommend to assess the state of pulmonary maturity before birth
A. Blood gas analysis
B. Ultrasonography
C. Maternal History
D. Amniocentesis
D. Amniocentesis
Temporary drops in the fetal heart rate during uterine contractions are known as
A. Fetal stress
B. Decelerations
C. Primary apnea
D. Secondary Bradycardia
B. Decelerations
Ate decelerations are consistent with which of the ff conditions
1. Uteroplacental insufficiency
2. Umbilical cord compression
3. Normal Contraction
4. Maternal Bradycardia
A. 1 and 2 only
B. 2 and 3 only
C. 3 and 4 only
d. 1,2,3,4
A. 1 and 2 only
Which of the ff. pH values is associated with fetal asphyxia?
A. Less than 7.1
B. Less than 7.2
C. Less than 7.3
D. Less than 7.4
B. Less than 7.2
At 1 min after birth a newborn infant exhibits the ff heart rate of 65 beats per min, a slow and irregular respiratory rate , some muscle flexion, a grimace when nasally suctioned and a pink body with blue extremities. What is the infant’s 1 minute APGAR
A. 3
B. 4
C. 5
D. 6
C. 5
Which of the ff methods is useful in determining gestational age of the newborn?
A. Dubowitz
B. Adams
C. Apgar
D. Perkinson
A. Dubowitz
Tachypnea in the newborn is defined as a respiratory rate greater than what level?
A. 40/min
B. 50/min
C. 60/min
D. 70/min
C. 60/min
You notice drawing (retractions) of chest wall muscle and tissue between the ribs, and above below the sternum, all occurring during inspiration. Which of the following conclusions is most consistent with this observation?
A. Airway resistance (RAW) is decreased
B. Lung Compliance (CL) is decreased
C. Work of breathing is decreased
D. Normal
B. Lung Compliance (CL) is decreased
You detect a “bounding” peripheral pulse on a newborn infant. Based on this findings, what should you suspect?
A. Patent ductus arteriosus
B. Peripheral vasoconstriction
C. Coarctation of the Aorta
D. Peripheral vasodilation
A. Patent ductus arteriosus
You notice paradoxical breathing. Which of the following conclusion is most consistent with this observation?
A. Airway resistance (RAW) is decreased
B. Lung Compliance (CL) is increased
C. Work of breathing is increased
D. Normal
C. Work of breathing is increased
What is the normal arterial PO2 in healthy infants?
A. Greater than 50 mmHg
B. Greater than 60 mmHg
C. Greater than 70 mmHg
D. Greater than 80mmHg
B. Greater than 60 mmHg
Which of the following O2 modalities would you recommend for a toddler needing a low FiO2?
A. Mist tent
B. Cannula
C. Oxy-hood
D.Mask
B. Cannula
Which of the ff L:S ratios indicates the stable surfactant production and mature lungs
A. 2:1
B. 1:1
C. 1:2
D. 2:3
A. 2:1
In which of the following conditions may bronchial hygiene therapy be considered for infants or children?
1. Hyaline Membrane Disease
2. Cystic Fibrosis
3. Epiglottitis
4. Bronchopulmonary dysplasia
A. 2, 3, and 4
B. 2 and 4
C. 1,2 and 4
D. 1,2,3,4
B. 2 and 4
Which of the ff sizes (internal diameter) of ETTs would you select to intubate a 4-year old child?
A. 3mm
B. 4mm
C. 5mm
D. 7mm
C. 5mm
Which of the ff. vacuum settings would you use to perform nasotracheal suctioning of a 5 year old child
A. -100 to -120 mmHg
B. -80 to -100 mmHg
C. -40 to -60 mmHg
D. -60 to -80 mmHg
B. -80 to -100 mmHg
What FiO2 should be used in neonates prior to endotracheal suctioning?
A. Same FiO2 on the ventilator
B. FiO2 of 100% for 2 minutes only to prevent ROP
C. FiO2 10% to 15% higher than FiO2 set in the ventilator
D. Low FiO2 to prevent ROP
C. FiO2 10% to 15% higher than FiO2 set in the ventilator
During resuscitation of a newborn, after 15 to 30 sec of positive pressure ventilation, what should the clinician do?
A. Evaluate Heart Rate
B. Suction the mouth, then the nose
C. Begin chest compressions
D. Initiate medications
A. Evaluate Heart Rate
Signs of infant respiratory distress that initiate a potential need for CPAP include which of the ff?
1. Cyanosis
2. Radiograph indicating hyaline membrane disease or respiratory distress syndrome
3. Grunting
4. Severe retractions
A. 3 and 4 only
B. 1, 2, and 3 only
C. 2 and 4 only
D. 1, 2, 3, 4
D. 1, 2, 3, 4
Which of the ff is considered a limitation o HFNC?
A. It does not meet patient’s flow needs
B. The amount of airway positive pressure cannot be measured
C. It does not provide for appropriate CO2 clearance
D. It does not reduce the use of noninvasive positive pressure ventilation
B. The amount of airway positive pressure cannot be measured
In a high frequency ventilation (HFV), Co2 elimination depends mainly on which of the ff?
A. Pressure amplitude
B. Mean airway pressure
C. High frequency rate
D. sinusoidal waveform
A. Pressure amplitude
What physiologic effect does inhaled nitric oxide have on the lung?
A. Pulmonary vasoconstriction
B. Pulmonary vasodilation
C. Smooth muscle dilation
D. Improved mucociliary clearance
B. Pulmonary vasodilation
What is the recommended dose of inhaled NO?
A. 10ppm
B. 20ppm
C. 30ppm
D.40ppm
B. 20ppm
Which of the following statements describe truncus arteriosus?
A. The pulmonary arteries arises from the left ventricle, and the aorta stems from the right ventricle
B. A large VSD allows total mixing of blood from the two ventricles
C. If SVR decreases relative to PVR, bloodflow will be shunted from right to left, bypassing the lungs
D. All of the above
D. All of the above
What factor is responsible for closure of the foramen ovale?
A. Increased PaO2
B. Increase pressure of the left side of the heart
C. Blood flowing through the lungs
D. High pulmonary vascular resistance
B. Increase pressure of the left side of the heart
What radiographic features is the therapist likely to see on a typical chest x-ray of an infant with MAS?
A. Ground glass appearance
B. Complete whiteout
C. Decreased lung volume
D. Patchy areas of atelectasis
D. Patchy areas of atelectasis
The therapist is treating a child with TOF who appears to be having a “tet” spell. What should the therapist suggest to treat this event?
A. Beta blockers
B. Knee-chest position to increase SVR
C. Morphine sulfate
D. all of the above
B. Knee-chest position to increase SVR
The therapist setting pulse oximetry to determine the presence of right-to-left shunt in an infant suspected of having a heart defect. Where should the therapist place the pulse ox probe to obtain the most accurate measure of preductal oxygen saturation?
A. Any finger of the right hand
B. Any finger of the left hand
C. Left earlobe
D. Lower extremities
A. Any finger of the right hand
Which of the ff physiologic mechanism need to be in place to ensure adequate systemic perfusion in infants with hydroplastic left heart syndrome (HLHS)?
A. Presence of an ASD
B. Presence of mitral regurgitation
C. Adequate left atrial function
D. Presence of PDA
D. Presence of PDA
Blood samples are simultaneously obtained from both radial artery and the umbilical artery, and the arterial partial pressure of oxygen value from the umbilical artery sample. On basis of this findings, which of the ff. conditions does the neonate likely have?
A. PPHN
B. MAS
C. Neonatal pneumonia
D. RDS
A. PPHN
What is the typical type of airway obstruction that occurs with MAS?
A. Ball Valve
B. Complete
C. No obstruction
D. Airway Inflammation
A. Ball Valve
How should the therapist interpret a preductal to postductal PaO2 difference of 8mmHg in a neonate?
A. Unreliable area
B. Absence of a ductal shunting
C. Presence of ductal shunting
D. Inconclusive data
B. Absence of a ductal shunting
Which of the following congenital cardiac anomalies is classified as conotruncal, associated with a “boot-shape” appearance of the heart
A. Tetralogy of Fallot
B. Transposition of the great vessels
C. Coarcation of Aorta
D. Atrioventricular canal defect
A. Tetralogy of Fallot
Which of the following medications should be the therapist recommend for an infant with apnea of prematurity experiencing episodes of apnea?
A. Caffeine
B. Benzodiazepines
C. Antibiotics
D. Doxapram
A. Caffeine
Which of the ff blood gas parameters should the therapist target when managing patients with PPHN
A. SaO2 > 95%
B. PaCO2 35-45 mmHg
C. pH 7.35- 7.45
D. All of the above
D. All of the above
8 hours after being born, a baby presents with cyanosis despite administration of adequate ventilation, tachypnea, and retractions. Which of the following conditions should be therapist suspect is affecting the newborn?
A. Normal baby
B BPD
C. PPHN
D. GBS pneumonia
C. PPHN
At birth, what factor causes dilation of the pulmonary vascular bed and a decrease in the pulmonary vascular resistance?
A. Increased arterial partial pressure of oxygen ( PaO2)
B. Decreased arterial partial pressure of carbon dioxide (PaCO2)
C. Lung inflation
D. Circulating indomethacin
A. Increased arterial partial pressure of oxygen ( PaO2)
How should the therapist interpret a lecithin to sphingomyelin (L:S) ratio of 2:1?
A. The presence of lung maturity
B. A gestational age of less than 28 weeks
C. The likelihood of RDS
D. Laboratory error
A. The presence of lung maturity
The therapist is treating a child with a congenital heart defect who is unresponsive to oxygen therapy. Although the chest x ray is relatively normal, the heart defects is more consistent with this description?
A. Complete transposition of the great arteries
B. Coarcation of the aorta
C. Truncus arteriosus
D. Tetralogy of Fallot
A. Complete transposition of the great arteries
Which of the following strategies can be used to increase pulmonary vascular resistance (PVR) in infants with hypoplastic left heart syndrome (HLHS)
A. FiO2 <0.21
B. Induce hypocapnia
C. Administer indomethacin
D. Close the PDA
A. FiO2 <0.21
Which of the ff methods is involved in the management of a PDA?
A. Increasing the circulating volume
B. Maintaining /optimizing the hematocrit at the low end of normal hemoglobin level
C. Administering indomethacin
D. Administering digoxin
C. Administering indomethacin
For which of the ff. congenital cardiac defects may spontaneous closure of the ductus arteriosus be catastrophic?
A. Tetralogy of Fallot with pulmonary atresia
B. Hypoplastic left heart syndrome
C. Severe contraction of the aorta
D. all of the above
D. all of the above
The therapist is reviewing the chest radiograph of a newborn, preterm infant and observes diffuse, fine reticulogranular densities, which provide a ground-glass appearance. On the basis of these radiographic findings, which of the following conditions should the therapist suspect is present?
A. Persistent pulmonary hypertension of the newborn
B. Respiratory distress syndrome
C. Bronchopulmonary dysplasia
D. Pulmonary interstitial emphysema
B. Respiratory distress syndrome
In addition to Group B Streprococcus, which of the following microorganisms are responsible for nosocomial pneumonia aquired after delivery
A. RSV
B. Escherichia coli
C. Pseudomona spp.
D. Haemophilus Influenzae
B. Escherichia coli
What is the significance of an infant with RDS demonstrating a grunt during each exhaustion
A. Resolution of the RDS
B. An effort to maintain its functional residual capacity (FRC)
C. An attempt to overcome increased airway resistance
D. Impending death
B. An effort to maintain its functional residual capacity (FRC)
Which of the following medication is the most common preoperative treatment to minimize preductal constriction until surgical correction of coarcation of the aorta can be achieved?
A. Indomethacin
B. Prostaglandin E1
C. Negative inotropes
D. Diuretics
B. Prostaglandin E1
When should a therapist consider CPAP for a newborn with respiratory distress?
A. FiO2>40% to 70% and SPO2< 85%
B. FiO2>90% and SPO2< 95%
C. Respiratory rate of 40 breaths per minute
D. PAO2 50 to 60mmHG
A. FiO2>40% to 70% and SPO2< 85%
A newborn suspected of having a pneumothorax is rapidly deteriorating. What should the therapist suggest at this time?
A. Intubation and mechanical ventilation
B. Mask CPAP
C. Needle Aspiration
D. Confirm air leak with a chest xray and place a tube afterwards
C. Needle Aspiration
How should the therapist interpret the lack of foam appearing during the shake test?
A. The test needs to be redone
B. The unborn infant’s lungs are immature
C. The infant’s lungs are immature
D. The patient has a 50% chance of developing RDS
C. The infant’s lungs are immature
Which of the following conditions increase the risk for developing RDS?
A. Maternal diabetes
B. Cesarean delivery
C. Multiple births
D. All of the above
D. All of the above
Which of the following vessels return blood to the right atrium?
A. Coronary Sinus
B. Inferior Vena Cava
C. Superior Vena Cava
D. All of the above
D. All of the above
The therapist is contemplating the possibility of intubating and suctioning a non-vigorous newborn with MAS. Which of the following clinical parameters confirms the indication for the procedure?
A. Good muscle tone
B. Presence of dark green meconium on the skin
C. Heart Rate < 100 beats per minute
D. Presence of coarse crackles on auscultation
C. Heart Rate < 100 beats per minute
What is the purpose of administering helium oxygen gas mixtures to patients?
A. To reduce the work of breathing
B. To improve gas exchange
C. To increase the functional residual capacity
D. To improve pulmonary compliance
A. To reduce the work of breathing
What is the primary physiologic activity of inhaled nitric oxide?
A. bronchodilation
B. Pulmonary vasodilation
C. Systemic vasodilation
D. Cerebral vasodilation
B. Pulmonary vasodilation
What clinical parameter is critically important to monitor when mechanical ventilation is administered?
A. Blood pressure
B. Heart Rate
C. Temperature
D. Respiratory Rate
A. Blood pressure
The therapist is treating a very irritable young child with upper airway obstruction. Which oxygen device will be the most appropriate to administer the greatest concentration of helium?
A. Close-fitting nonrebreathing mask
B. Close-fitting partial rebreathing mask
C. Nasal Cannula
D. High flow nasal cannula
A. Close-fitting nonrebreathing mask
What is the potential benefit of adding heliox to patients who have status asthmaticus while undergoing mechanical ventilation?
A. To improve pulmonary compliance
B. To reverse bronchospasm
C. To minimize air trapping
D. To facilitate the removal of tracheobronchial secretion
C. To minimize air trapping
The therapist is using an oxygen flowmeter to deliver an 80.20 heliox mixture to the patient. The reading on the flowmeter is 10 L/minute. What is the actual flow received by the patient?
A. 5.5 L/minute
B. 10 L/minute
C. 12.5 L/minute
D. 18 L/minute
D. 18 L/minute
The therapist is assessing a mechanically ventilated infant and observes that the transcutaneous electrode temperature is set between 41 C and 44 C. What action does the therapist need to take at this time?
A. The temperature range set is appropriate; therefore, no action is necessary
B. The therapist should increase the temperature range to 47 C to 48 C
C. The temperature of the transcutaneous electrode needs to be reduced to 36 C to 38 C
D. The electrode needs to be repositioned and maintained at the same temperature
A. The temperature range set is appropriate; therefore, no action is necessary
While observing a ventilator flow graphic for a 12 year old patient with asthma on a rate of 10 breaths/min., the clinician notices the expiratory flow does not return to basel0ine and the patient’s Auto-PEEP level is 6 cm H20. Which ventilator manipulation might help this patient the most?
A. Increase rr by 8 breaths/minute
B. Decrease the inspiratory time
C. Decrease the Peak Inspiratory flow
D. Increase the PEEP
B. Decrease the inspiratory time
In an infant having a L/S ratio of 2.5, likelihood of IRDS is
A. Virtually zero
B. Low
C. High
D. 50%
A. Virtually zero
Which of the following are indices of apgar scoring?
A. Birth weight, heart rate, respirations, muscle tone and irritability
B. Heart rate, respiration, muscle tone, irritability and color
C. Respirations, muscle tone, irritability, color, and blood pressure
D. Muscle tone, irritability, color, blood pressure and tidal volume
B. Heart rate, respiration, muscle tone, irritability and color
The following constitute maternal risk factors for the newborn EXCEPT;
A. Exposure to anesthetics, alcohol addiction, addiction to narcotics
B. Exposure to environmental pollution
C. Maternal hypotension, hypoxia, anemia, cardiac, or pulmonary disease
D. Abnormal presentations, hypoxia, anemia, cardiac or pulmonary disease
B. Exposure to environmental pollution
The following are parts of the fetal anatomy that differentiate them from adults
I. Umbilical vein
II. Umbilical artery
III. Foreamen ovale
IV. Ductus Arteriosus
A. I and II
B. II and III
C. III and I
D. I, II, III, and IV
E. I and IV
D. I, II, III, and IV
Which part of the fetal anatomy bypasses the right ventricle by carrying blood from the right ventricle by carrying blood from the right atrium to the left atrium?
A. Superior Vena Cava
B. Foramen Ovale
C. Ductus Arteriosus
D. Inferior Vena Cava
B. Foramen Ovale
Determineation of gestational age can be done by which of the following methods?
I. Calculation of dates based on the mother’s last menstrual period
II. Physical assessment of the neonate
III. Evaluation of obstetric parameters obtained during the prenatal period
IV. Apgar scores
A. III
B. IV
C. I
D. I, II, III
D. I, II, III
Which of the ff. is/are correct about Apgaar Scoring?
A. Describes the condition of the NB immediately after birth
B. Describes the degree of respiratory distress by the NB
C. Scores of 7 to 10 is excellent condition of the NB
D. All of the above
D. All of the above
At birth the fetal lung fluid is drained from the lungs primarily, via the
A. Mouth
B. Type I alveolar cells
C. Liver
D. Lymphatic vessels
D. Lymphatic vessels
A newborn has an APGAR score of 7 at one minute after birth. Five minutes after birth, the APGAR score is 9. You would expect the newborn to
A. require intubation and ventilation
B. Require supplemental oxygen
C. Do well
D. Require resuscitation
B. Require supplemental oxygen
The best indication of a neonate’s respiratory and metabolic status is
A. Pulse oximetry
B. Transcutaneous O2 monitor
C. Heelstick ABG
D. Arterial blood gas
D. Arterial blood gas
An infant is considered premature if the gestational age is determined to be
A. Between 28-32 weeks
B. Between 32-36 weeks
C. More than 38 weeks
D. Less than 38 weeks
D. Less than 38 weeks
The primary mechanism that causes the ductus arteriosus to close at birth is
A. Hypoxia
B. Normoxia
C. Hypocarbia
D. Hypercarbia
B. Normoxia
A correct statement pertaining to neonatal oxygen therapy would be
A. A FiO2 of greater than 50% is unacceptable
B. A PAO2 of greater than 70mmHg is unacceptable
C. A PAO2 of 70 mmHg is desirable
D. A FiO2 of greater than 50% will cause retinopathy of prematurity
E. A SpO2 of more than 95% is always the target
E. A SpO2 of more than 95% is always the target
An increase in Peak Inspiratory Pressure (PIP) during mechanical ventilation can
I. Increase PaO2
II. Increase alveolar ventilation
III. Decrease PaCO2
IV. Decrease MAP
A. I
B. II, III, IV
C. II and III
D. I, II, and III
D. I, II, and III
The signs and symptoms of MAS is/are
A. Dark green staining in the amniotic fluid
B. Tachypnea and retraction
C. Tachycardia
D. Apnea immediately after birth
E. All of the above
E. All of the above
Which of the following diseases caused by prolonged exposure to positive pressure ventilation and high O2 concentration?
A. NRDS
B. CF
C. MAS
D. BPD
E. None of the Above
D. BPD
Type of mechanical ventilation that uses a constant distending pressure with pressure variations oscillating around the MAP at very high rates is?
A. Pressure support ventilation
B. Neutrally adjusted ventilator assist
C. high frequency oscillatory ventilation
D. Positive Pressure Ventilation
C. high frequency oscillatory ventilation
In cystic fibrosis the chest x-rays shows?
A. Depressed or flattened diaphragms
B. Hyperinflated
C. Areas of atelectasis
D. All of the above
D. All of the above
During acute attack of epiglottitis the patient generally demonstrates;
I. Changes in the voice
II. Stridor
III. Cough and Fever
IV. Sore throat
A. II
B. I and II
C. I, III, and IV
D. I, II, III, IV
D. I, II, III, IV
The following are diagnosis of epiglottitis, EXCEPT;
I. X-ray
II. Larygoscopy
III. Biopsy of the neck
IV. ECG
A. I and II
B. II and III
C. III and IV
D. IV
C. III and IV
The commonly used technique of gestational age assessment is
A. Apgar score
B. Silverman Andersen Scoring
C. Ballard score
D. All of the above
C. Ballard score
The scoring system that describes the condition of the newborn immediately after birth is
A. Apgar score
B. Silverman Andersen Scoring
C. Ballard score
D. All of the above
A. Apgar score
A congenital obstruction of the upper airway which involved the softening of the tissues of the larynx
A. Laryngomalacia
B. Bronchomalacia
C. Tracheomalacia
D. Pharyngomalacia
A. Laryngomalacia
The neonatal parenchymal disease that involved the delay of pulmonary fluid absorption by the lymphatic system and pulmonary capillaries is
A. Transient Tachypnea of the Newborn
B. Cystic Fibrosis
C. Meconium Aspiration Syndrome
D. CROUP
A. Transient Tachypnea of the Newborn
The neonatal parenchymal disease caused by a lack of a slippery, protective substance called surfactant is:
A. Transient Tachypnea of the Newborn
B. Cystic Fibrosis
C. Meconium Aspiration Syndrome
D. Neonatal RDS
D. Neonatal RDS
The following pulse oximetry reading suggest right to left shunting
A. >5% in the presence of normal oxygen saturation in pre- and post-ductal measurement
B. > 10% in the presence of normal oxygen saturation in pre- and post-ductal measurement
C. > 15% in the presence of normal oxygen saturation in pre- and post-ductal measurement
D. > 20% in in the presence of normal oxygen saturation in pre- and post-ductal measurement
A. >5% in the presence of normal oxygen saturation in pre- and post-ductal measurement
The narrowest portion of the newborn’s upper airways is at the level of the
A. Trachea
B. Thyroid Cartilage
C. Oropharynx
D. Cricoid cartilage
D. Cricoid cartilage
The most precise method of diagnosing hyaline membrane disease is by examining the;
A. Pulmonary function and clinical appearance
B. Blood gas values and clinical appearance
C. Apgar Score
D. Chest X-ray study and clinical appearance
D. Chest X-ray study and clinical appearance
The most appropriate way to evaluate a patient with Guillain Barre is to do:
A. Both P-A and lateral chest x-rays
B. A Tensilon test
C. Daily arterial blood gas measurements
D. Frequent monitoring of vital capacity and inspiratory force
E. Spirometry before and after bronchodilator
D. Frequent monitoring of vital capacity and inspiratory force
What would you recommend if a neonate on 0.80 FIO2 and a PEEP of 5 cm H20 begins to improve as evidenced by chest x-ray physical examination and arterial blood gas values?
A. Decrease ventilatory rate
B. Decrease the Tidal Volume
C. Lower the peak inspiratory pressure
D. Remove PEEP
E. Decrease FIO2
E. Decrease FIO2
A neonatal patient has a pink color, pulse rate of 102, and a respiration rate of 27. SHe grimaces in response to stimuli, has limited muscle movement. The patient has an APGAR score of
A. 6
B. 7
C. 8
D. 9
B. 7
SIDS is characterized by the following features, EXCEPT
A. Sudden unexpected death of an infant <2 years
B. Unexplained after through investigation
C. Onset of fatal episode during sleep
D. No identifiable cause after complete autopsy
A. Sudden unexpected death of an infant <2 years
In airway suctioning, the recommended amount of negative pressure for infant is
A. 80 to 120 mmHg
B.20 to 40 mmHg
C. 20 to 30 mmHg
D. 60 to 80 mmHg
D. 60 to 80 mmHg
What is the approximate size of suction catheter for 8 years of patient?
A. Size 6
B. Size 8
C. Size 10
D. Size 12
C. Size 10
Which of the following can provide 3,000 bpm frequency?
I. High frequency positive pressure ventilation’
II. High frequency jet ventilation
III. High frequency oscillatory ventilation
IV. Time cycled pressure limited ventilation
A. I, II, III
B. III
C. II and III
D. II, III, IV
B. III
In airway suctioning the recommended amount of negative pressure for pediatric patient is
A. 80-120 mmHg
B. 50-60 mmHg
C. 60-80 mmHg
D. 80-100 mmHg
D. 80-100 mmHg
An APGAR score of 5 is determined 5 min after delivery of a term infant. Which of the following should be done at this time?
A. Stimulate and deliver low to moderate O2 concentrations
B. Intubate and place on CPAP and 80% O2
C. Intubate and place on mechanical ventilation
D. Place on nasal CPAP and 100% O2
A. Stimulate and deliver low to moderate O2 concentrations
The foramen ovale and ductus arteriosus remain patient in infants with persistent fetal circulation as a direct result of which of the following?
A. Hypocarbia
B. Pulmonary Hypertension
C. Hyperoxia
D. Arterial Hypotension
B. Pulmonary Hypertension
Which of the following is/are sssociated of bronchiolitis
I. accute inflammation
II. Increased mucus production
III. edema small airways
IV. Bronchospasm
A. I and III
B. II and III
C. I, II, III
D. I, II, III, IV
D. I, II, III, IV
Silverman-Anderson Index is used to continuous evaluation of an infant’s respiratory status. An index of distress in determined by grading each of the following five arbitrary criteria:
A. Chest lag, intercostal retractions xiphoid retraction, nares dilatation, inspiratory grunt
B. Chest lag, intercostal retractions, subcostal retraction, nares dilatation, expiratory grunt
C. Chest lag, intercostal retractions, subcostal retraction, nares dilatation, inspiratory grunt
D. Chest lag, intercostal retractions xiphoid retraction, nares dilatation, expiratory grunt
D. Chest lag, intercostal retractions xiphoid retraction, nares dilatation, expiratory grunt
An infant diagnosed with RDS subsequent to lung prematurity is receiving oxygen therapy with an FIO2 of 0.8 and NCPAP set at 10cmH20. The infant is experiencing progressive hypercapnia, and apneic episode are appearing prolonged. The next logical course of action is to:
A. Increase FIO2 to 0.1 and look for improvements in ABG parameters
B. start iNO therapy to improve lung V/Q ratio
C. Increase NCPAP to 12 cmH20 and refit the nasal prongs
D. Intubate the infant and begin mechanical ventilation
D. Intubate the infant and begin mechanical ventilation
Which condition would be the most critical in leading the caregiver to anticipate MAS
A. Desaturation refractory to oxygen therapy
B. Yellowish green amniotic fluid
C. Distinct chest wall retractions with inspiratory efforts
D. Cyanosis with nasal flaring
B. Yellowish green amniotic fluid
A newborn with a 25 week of gestational age appears cyanotic and ABG analysis indicates hypoxia and hypercapnia. The infant has severe chest wall retractions with inspiratory effort. The amniotic fluid appeared normal at birth. What is most likely the cause of respiratory distress?
A. Surfactant Deficiency
B. Meconium Aspiration Syndrome
C. Pneumonia
D. Bronchopulmonary Dysplasia
A. Surfactant Deficiency
A full term newborn diagnosed with PPHN is refractory to oxygen therapy and mechanical ventilation. What would the next logical therapy to try?
A. High Frequency Ventilation
B. Volume Therapy
C. iNO therapy
D. All would be have potential benefits
C. iNO therapy
A 30 weeks gestational age newborn has been on the ventilator for 9 weeks with PaCO2 values around 60 and PaO2 values around 60 despite increased ventilator settings. CXR reveals atelectasis, hyperlucencies cystic changes, hyperinflation, and mild cardiomegaly. The most likely diagnosis is which of the following?
A. Cystic fibrosis
B. Bronchopulmonary dysplasia
C. Bacterial Pneumonitis
D. Pulmonary interstitial emphysema
E. MAS
B. Bronchopulmonary dysplasia
Among the following, the information that is most helpful in distinguishing cyanotic heart disease from pulmonary parenchymal disease in a newborn who has respiratory distress is:
A. Decreased PO2 in blood gas analysis
B. Gestational age less than 32 weeks
C. Maternal infection during the third trimester
D. Respiratory rate of 70 breaths per minute
E. Result of a hyperoxia test
E. Result of a hyperoxia test
A 13 year old boy is admitted to the PICU with a diagnosis of ARDS. His PAO2/FIO2 ratio is 176 with a PEEP of 8. According to the 2011 Berlin consensus definition, what is the severity of his ARDS?
A. ALI
B. Mild
C. Moderate
D. Severe
C. Moderate
A patient undergoing mechanical ventilation has a mean airway pressure of 18 cmH20 and the blood gas shows a PAO2 or 90mmHg at a FIO2 of 0.80. What is the pts oxygenation
A. 20
B. 16
C. 140
D. 90
B. 16
Which of the following are pathological stages of ARDS
I. Exudative
II. Proliferative
III. Fibrotic
IV. Edematous
A. I, II, III
B. II, IV
C. II, III, IV
D. III, IV
A. I, II, III
Normal transition to extrauterine life depends on the pulmonary vascular system:
A. Remaining in a steady state of balance with the hepatic blood flow
B. Changing from a low pulmonary vascular resistance to a high pulmonary vascular resistance
C. Changing form a high pulmonary vascular resistance to a low pulmonary vascular resistance
D. Maintaining a patent ductus arteriosus
C. Changing form a high pulmonary vascular resistance to a low pulmonary vascular resistance
Which of the following affects pulmonary vascular resistance
A. Changes in PaO2
B. Changes in PaCO2
C. Changes in pH
D. All of the above
E. None of the above
D. All of the above
What are the two categories that have typically been used to classify congenital cardiac defects?
A. Right sided versus left sided
B. Atrial versus ventricular
C. Cyanotic versus Acyanotic
D. Simple versus Complex
E. Above versus below the diaphragm
C. Cyanotic versus Acyanotic
The patent ductus arteriosus connects which two vessels?
A. Superior vena cava and the pulmonary artery
B. Aorta to the pulmonary Artery
C. Pulmonary artery and the pulmonary vein
D. Coronary arteries and the aortic arch
E. Ductus venosus to the right atrium
B. Aorta to the pulmonary Artery
What is the therapeutic goal of sub-ambient oxygen therapy?
A. Increase the pulmonary vascular resistance
B. Balance blood flow between the vena cava and the right atrium
C. Decrease pulmonary vascular resistance
D. Increase diastolic blood pressure
A. Increase the pulmonary vascular resistance
Tetralogy of Fallot consists of which four concomitant conditions?
I. Truncus arteriosus
II. Left ventricular hypertrophy
III. Right Ventricular hypertrophy
IV. Overiding aorta
V. Interrupted aortic arc
VI. Pulmonary Stenosis
VII. Ventricular septal defect
VIII. Right ventricular outflow tract obstruction
A. I, II, III, V
B. III, IV, VI, VII
C. V, VI, VII, VIII
D. II, IV, VI, VII, VIII
B. III, IV, VI, VII
Rapid transport of a neonate or pediatric patient with a serious illness or trauma to a specialty facility can result in which of the following?
A. Improved outcomes
B. No difference
C. Worst Outcomes
D. Unknown
A. Improved outcomes
The passage of strong light through the body structure, to permit inspection by an observer on the opposite side.
A. Chest X ray
B. Arterial Blood Gas
C. Pulmonary function test
D. Transillumination
D. Transillumination
First sign of respiratory distress in a newborn
A. Crying
B. Tracheal lung
C. Nasal flaring
D. Cyanosis
C. Nasal flaring
An infant brought to the neonatal intensive care unit presents with cyanosis and upper airway obstruction relieved by crying with improvement in color. Suspecting choanal atresia, the best action is to
A. Insert a no 8 French suction catheter to verify the diagnosis
B. Insert an oral airway
C. Start nasal continuous positive airway pressure
D. Provide heated humidity
E. Stimulate the infant to induce crying
B. Insert an oral airway
Complications related to Chronic upper airway obstruction from anatomical malformations result in which of the following:
I. Chronic hypoxia and CO2 retention
II. Pulmonary hypertension and cor pulmonale
III. Hyperventilation and acidosis
IV. Failure to Thrive
V. Congestive heart failure
A. I, III
B. I, II, IV
C. I, II, III, V
D. II, III, IV
E. II, IV, V
B. I, II, IV
The most common tracheosophageal fistula and esophageal atresia lesion is classified as which type?
A. Esophagial atresia with a long gap
B. Esophageal atresia with distal tracheoesophageal fistula
C. H-type tracheosophageal fistula
D. Esophageal atresia with proximal fistula
E. Esophageal atresia with proximal and distal tracheoesophageal fistula
B. Esophageal atresia with distal tracheoesophageal fistula
Which of the following are true concerning a congenital diaphragmatic hernia?
I. Pulmonary hypoplasia is present in both lungs
II. Persistent pulmonary hypertension is the main complication
III. Surgical correction results in complete reversal of the respiratory distress
IV. CDH formation is a defect that occurs very early in gestational age
V. The right lung is not usually affected
A. I, II, IV
B. I, III, IV, V
C. I, IV, V
D. I, II, IV, V
A. I, II, IV
When comparing gastroschisis and omphalocele, which of the following is true?
A. They are both full thickness defects of the abdominal wall
B. They are both commonly associated with other anomalies
C. Omphalocele is a midline defect, whereas a gastroschisis is a lateral wall defect
D. An omphalocele is covered by epidermal tissue
E. Gastroschisis requires surgical reductions that often must be performed in several stages whereas omphalocele is completed in a single surgery
C. Omphalocele is a midline defect, whereas a gastroschisis is a lateral wall defect
It is the first stage in human lung development
A. Embryonal
B. Canicular
C. Saccular
D. Alveolar
A. Embryonal
What is the last stage of fetal lung development?
A. Embryonal
B. Canicular
C. Saccular
D. Alveolar
D. Alveolar
An acute viral disease affecting the trachea and small airways of young children, causing, fever, barking cough, grunting, and wheezing is known as:
A. Epiglottitis
B. Croup
C. RDS
D. Asthma
B. Croup
All of the following factors are considered signs of airway compromise in an infant with tracheostomy airway except:
A. Absence airflow
B. Capillary refill time of < 3 seconds
C. Silent cough
D. Copious, inspissated secretions
B. Capillary refill time of < 3 seconds
Which of the following has been implicated in the origin of bronchopulmonary dysplasia (BPD)?
1. Oxygen toxicity
2. Malnutrition
3. Mechanical ventilation
A. 1
B. 1, 2
C. 1, 3
D. 1, 2, 3
D. 1, 2, 3
What is the best strategy in the management of BPD?
A. Adequate fluid management
B. Prevention
C. Aggressive mechanical ventilation
D. PEEP
B. Prevention
Which of the ff is not associated with apnea episodes in premature infants?
A. Apnea last longer than 15 seconds
B. Apnea associated with bradycardia
C. Apnea associated with cyanosis
D. Apnea lasts longer than 1 minute
D. Apnea lasts longer than 1 minute
What is the upper limit of normal range for heart rate in the newborn?
A. 120 beats/min
B. 140 beats/min
C. 160 beats/min
D. 180 beats/min
C. 160 beats/min
What is the most common form of congenital heart disease?
A. Tetralogy of Fallot
B. Transposition of the great vessels
C. Atrial septal defect
D. Ventricular septal defect
D. Ventricular septal defect
What is the pathology in truncus arteriosus?
A. Hypertrophy of the ventricles
B. Common supply of the systemic & pulmonary circulations
C. No communication between the RA and RV
D. Malposition of the pulmonary vein and arteries
B. Common supply of the systemic & pulmonary circulations
A machinery type murmur is heard in:
A. Patent ductus arteriosus
B. Ventricular septal defect
C. Tetralogy of Fallot
D. Transposition of the great vessels
A. Patent ductus arteriosus
A congenital narrowing of the back of the nasal cavity that causes difficulty of breathing of infant is
A. Laryngomalacia
B. Epiglottitis
C. Tracheomalacia
D. Choanal Atresia
D. Choanal Atresia
