Neonatal & Peds RC

Question 1

Which of the following maternal factors is/are related to the health of the fetus and the outcomes of pregnancy?

1. Maternal age
2. Prior maternal disease
3. Maternal drug use
4. Maternal birth history

Answer 1

1. Maternal age
2. Prior maternal disease
3. Maternal drug use
4. Maternal birth history

Question 2

Which of the following techniques would you recommend to assess the state of pulmonary maturity before birth?

a. Blood gas analysis
b. Ultrasonography
c. Maternal history
d. Amniocentesis

Answer 2

d. Amniocentesis

Lung maturation can be assessed with amniocentesis.

Question 3

Temporary drops in the fetal heart rate during uterine contractions are known as:

a. fetal stress.
b. decelerations.
c. primary apnea.
d. secondary bradycardia.

Answer 3

B. Decelerations

Temporary drops in fetal heart rate are called decelerations and can be mild (<15 beats/ min), moderate (15 to 45 beats/min), or severe (>45 beats/min). Decelerations are classified by their occurrence in the uterine contraction cycle.

Question 4

Late decelerations are consistent with which of the following conditions?

1. Uteroplacental insufficiency
2. Umbilical cord compression
3. Normal contraction
4. Maternal bradycardia

Answer 4

1. Uteroplacental insufficiency
2. Umbilical cord compression

A late deceleration pattern indicates impaired maternal-placental blood flow or uteroplacental insufficiency.

Question 5

5. Which of the following 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

Answer 5

Less than 7.2

Question 6

6. At 1 min after birth, a newborn infant exhibits the following: heart rate of 65/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-min Apgar score?

Answer 6

5

Question 7

7. Which of the following methods is useful in determining gestational age of the newborn?
   a. Dubowitz
   b. Adams
   c. Apgar
   d. Perkinson

Answer 7

A

Two common systems are used to determine gestational age: the Dubowitz scales and the Ballard scales.

Question 8

You notice in the chart of an infant receiving neonatal intensive care the designation “preterm, AGA.” Based on this information, what can you correctly conclude?
a.
This is an infant whose weight falls between the tenth and ninetieth percentiles.
b.
This is an infant whose weight falls between the tenth and fiftieth percentiles.
c.
This is an infant whose weight falls between the fiftieth and ninetieth percentiles.
d.
This is an infant whose weight falls between the tenth and twentieth percentiles.

Answer 8

This is an infant whose weight falls between the tenth and ninetieth percentiles.

Question 9

Tachypnea in the newborn is defined as a respiratory rate greater than what level?

Answer 9

60/min

Question 10

10. You detect a “bounding” peripheral pulse on a newborn infant. Based on this finding, what should you suspect?

Answer 10

Patent ductus arteriosus

Bounding peripheral pulses occur with major left-to-right shunting through a patent ductus arteriosus.

Question 11

You notice paradoxical breathing. Which of the following conclusions is most consistent with this observation?

Answer 11

WOB is increased.

Paradoxical breathing in infants differs from the adult form. Instead of drawing the abdomen in during inspiration, the infant with paradoxical breathing tends to draw in the chest wall. This inward movement of the chest wall may range in severity, as with retractions, and paradoxical breathing indicates an increase in ventilatory work.

Question 12

What is the normal arterial PO2 in healthy infants?

Answer 12

Greater than 60mm Hg

In newborns older than 28 days, a PaO2 of less than 60 mm Hg or an SpO2 of less than
90% indicates hypoxemia.

Question 13

Which of the following L:S ratios indicates stable surfactant production and mature lungs?

Answer 13

2:1
At approximately 34 to 35 weeks’ gestation, this ratio abruptly increases to greater than 2:1. An L:S ratio greater than 2:1 indicates stable surfactant production and mature lungs.

Question 14

The most probable explanation for the flip-flop phenomenon in the newborn is:

Answer 14

Reactive Pulmonary Vasoconstriction

When the FiO2 is increased to original levels, the PaO2 fails to improve, which is
probably because of reactive pulmonary vasoconstriction.

Question 15

16. Which of the following O2 modalities would you recommend for a toddler needing a low FiO2?
    a. mist tent
    b. cannula
    c. oxyhood
    d. mask

Answer 15

b. cannula

Question 16

In which of the following conditions may bronchial hygiene therapy be considered for infants or children?

1. Hyaline membrane disease
2. Foreign body aspiration
3. Cystic fibrosis
4. Bronchopulmonary dysplasia (BPD)

Answer 16

2. Foreign body aspiration
3. Cystic fibrosis
4. Bronchopulmonary dysplasia (BPD)

Secretion retention is common in children who have pneumonia, BPD, cystic fibrosis, and bronchiectasis. Bronchial hygiene therapy can also be valuable in the initial management of aspirated foreign bodies.

Question 17

Which of the following sizes (internal diameter) of endotracheal tubes would you select to intubate a 4-year-old child?

Answer 17

5 mm

Question 18

Which of the following vacuum settings would you use to perform nasopharyngeal or nasotracheal suctioning of a 5-year-old child?

Answer 18

–80 to –100 mm Hg

With large infants and children, pressures in the –80 to –100 mm Hg range are generally safe and effective.

Question 19

What FiO2 should be used in neonates prior to endotracheal suctioning?

Answer 19

FiO2 10% to 15% higher than FiO2 set in the ventilator

Most clinicians recommend raising the FiO2 by 10% to 15% for at least 1 min before suctioning.

Question 20

During resuscitation of a newborn, after 15 to 30 sec of positive-pressure ventilation, what should the clinician do?

Answer 20

Evaluate the heart rate.

Question 21

Signs of infant respiratory distress that indicate a potential need for continuous positive airway pressure (CPAP) include which of the following?

1. Cyanosis
2. Radiograph indicating hyaline membrane disease or respiratory distress syndrome
3. Grunting
4. Severe retractions

Answer 21

1. Cyanosis
2. Radiograph indicating hyaline membrane disease or respiratory distress syndrome
3. Grunting
4. Severe retractions

Question 22

Which of the following is considered a limitation of the high-flow nasal cannula?
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.

Answer 22

The amount of airway positive pressure cannot be measured.

Instead of titrating levels of CPAP, the flow rate is incrementally adjusted; however, the amount of positive pressure that the high-flow nasal cannula potentially produces cannot be measured and inadvertent high levels may occur, particularly if the nasal cannula fits snugly in the nares.

Question 23

What VT range should be used for mechanical ventilation of a neonate?

Answer 23

6 to 8 ml/kg

When selecting VT, the clinician must consider a volume that provides adequate lung inflation without overstretching the alveoli. Setting VT that is too high most likely would result in lung injury. VT of 6 to 8 ml/kg is generally considered safe in most patients.

Question 24

What initial inspiratory time range would you suggest for a term newborn infant being placed on time-cycled, pressure-limited ventilation?

Answer 24

0.20 to 0.40 sec

Inspiratory time is usually set between 0.2 second and 0.4 second for neonates

Question 25

Which of the following mean airway pressures is considered potentially deleterious when applying positive end expiratory pressure?

Answer 25

15 cm H2O

Positive end expiratory pressure levels of 5 to 8 cm H2O are commonly used in
pediatrics. Anything above 15 can cause problems.

Question 26

What positive end expiratory pressure level is commonly used in pediatric patients during mechanical ventilation?

Answer 26

5 to 8 cm H2O
A −Paw exceeding 15 cm H2O is considered potentially deleterious, at which point other
strategies such as high-frequency ventilation are frequently considered.

Question 27

In high-frequency ventilation (HFV), CO2 elimination depends mainly on which of the following?

Answer 27

A. Pressure amplitude
The minute ventilation delivered with HFV has a greater dependency on alterations in tidal volume rather than breath frequency, with tidal volume most affected by changes in pressure or amplitude (increased pressure change or amplitude increases tidal volume).

Question 28

Which of the following may indicate a decrease in systemic vascular blood flow during high-frequency ventilation?

1. High central venous pressure (CVP)
2. Low CVP
3. Decreased mean arterial pressure (MAP)
4. Increased MAP

Answer 28

2. Low CVP
3. Decreased mean arterial pressure (MAP)

Increases in CVP or decreases in MAP indicate decreases in systemic blood flow as a result of overdistention of the lung and inappropriately high −Paw, after adequate
intravascular volume has been established.

Question 29

What physiologic effect does inhaled nitric oxide have on the lung?

Answer 29

Pulmonary vasodilation

Inhaled nitric oxide is a selective pulmonary vasodilator used to treat newborns who require mechanical ventilation for hypoxic respiratory failure.

Question 30

What is the recommended dose of inhaled NO?

Answer 30

20 ppm

The recommended inhaled NO dose is 20 ppm with an optimal response achieved when lung inflation is maximized.

Question 31

Which of the following tidal volume range would you recommend for an infant with severe ARDS?

Answer 31

4-5 ml/kg

Tidal volumes greater than 8 ml/kg are likely to over stretch the lung, resulting in acute lung injury and should be avoided. Patients with severe ARDS may require even lower tidal volumes in the rate of 4 to 5 ml/kg.

Question 32

Which of the following conditions affect placental blood flow during pregnancy?

1. Previous miscarriage
2. Smoking abstinence
3. Previous pregnancy complications
4. History of diabetes

Answer 32

1. Previous miscarriage
2. Previous pregnancy complications
3. History of diabetes

Question 33

You are called to the NICU to assess the blood pressure of a neonate who weighs 750 g. You determine that the pressure is normal. Which of the following pressure did you obtain?

Answer 33

40/25