Neuro Respiratory

Question 1

Risk factors for pulmonary disease in neonates

Answer 1

C-section, pre-term, meconium-stained amniotic fluid

Question 2

S/S of pulmonary disease

Answer 2

cyanosis, retractions, crackles/rhonchi, temp instability, split S2, grunting

Question 3

Fetal hgb has a _____ affinity for O2

Answer 3

higher

Question 4

Fetal hgb shifts the oxygen binding curve

Answer 4

left

Question 5

S/S of CHD in neonate

Answer 5

cyanosis, weak peripheral pulses, quiet tachypnea

Question 6

What is tachypnea in infants?

Answer 6

0-2mo >60, 2-12mo >50

Question 7

Hyperoxia Test

Answer 7

On 100% O2, if paO2 increases >150, suspect pulmonary dysfunction; if no change in paO2, suspect cardiac

Question 8

Retained Fetal Lung Fluid/Transient Tachypnea S/S

Answer 8

tachypnea, cyanotic, retractions

Question 9

Retained Fetal Lung Fluid/Transient Tachypnea Risk Factors

Answer 9

C-section, male, perinatal asphyxia, umbilical cord prolapse

Question 10

Retained Fetal Lung Fluid/Transient Tachypnea Maternal Complications

Answer 10

asthma, diabetes, analgesia in labor

Question 11

Retained Fetal Lung Fluid/Transient Tachypnea Treatment

Answer 11

Supportive; O2 is needed or CPAP; IV fluids; Improves w/ minimal treatment

Question 12

Meconium CXR

Answer 12

atelectasis or plugging, hyperexpanded (tarry stools allow air to enter, but cannot exit)

Question 13

Air Leak CXR

Answer 13

partial expansion of lungs

Question 14

Grunting

Answer 14

sound made on expiration against a partially closed epiglottis; helps open alveoli

Question 15

Findings in cardiac dysfunction

Answer 15

increased RR, but no increased work of breathing, Single S2, decreased peripheral pulses, hepatomegaly, unchanged paO2 on O2 challenge test

Question 16

Neonatal Respiratory Disease/Surfactant Deficiency S/S

Answer 16

tachypnea, grunting, retractions, nasal flaring, cyanosis, pulse ox <90%, temp instability

Question 17

Neonatal Respiratory Disease/Surfactant Deficiency risk factors

Answer 17

pre-term, mother w/ uncontrolled diabetes

Question 18

Neonatal Respiratory Disease/Surfactant Deficiency Labs

Answer 18

low pH, high paCO2, low paO2; hyperoxia challenge -> paO2 155mmHg

Question 19

Neonatal Respiratory Disease/Surfactant Deficiency Tx

Answer 19

intubate, CPAP, surfactant, Abx

Question 20

Testing before birth

Answer 20

Lecithin:Sphingomyelin in amniotic fluid is < 2 (or 1.5) indicates immature fetal lung

Question 21

If Lecithin:Sphingomyelin <1.5 how could treat this

Answer 21

antenatal steroids (beta-methasone) given 2d before delivery, decreased the risk in pre-term infants < 32wks; glucocorticoids (production) & beta-adrenergic (secretion)

Question 22

Hyaline Membrane disease

Answer 22

aka Neonatal Respiratory Disease/Surfactant Deficiency

Question 23

Which cells make surfactant

Answer 23

type II alveolar pneumocytes

Question 24

Surfactant composition

Answer 24

DPPC, SP-A, SP-D, SP-B, SP-C, Unsat phosphatidylcholine

Question 25

Meconium Aspiration S/S

Answer 25

brown amniotic fluid, infant deteriorates, grunting, retractions, tachycardia

Question 26

Meconium Aspiration Risk Factors

Answer 26

post-due date, diabetic mother, HTN, hypoxia or acidosis in utero (stress), pre-mature + Listeria infection

Question 27

Meconium Aspiration Complication

Answer 27

pneumothorax

Question 28

Meconium Aspiration Tx

Answer 28

Supportive + Abx

Question 29

Neonatal pneumonia peri-natal causes

Answer 29

GBS, E. coli, Klebsiella, Chlamydia, Listeria

Question 30

Neonatal pneumonia post-natal causes

Answer 30

RSV, Strep, Staph, etc

Question 31

Premature infant + brown amniotic fluid, unstable, rash, mom had fever

Answer 31

Listeria

Question 32

C-section at 35wks, mom had uncontrolled diabetes

Answer 32

Hyaline membrane disease

Question 33

C-section, tachypnea + grunting, good color, strong suck

Answer 33

Transient tachypnea

Question 34

Cystic Fibrosis genetics

Answer 34

autosomal recessive, mutation of CFTR gene on chromosome 7

Question 35

Cystic Fibrosis S/S

Answer 35

infant failure to thrive, poor weight gain, cough, dyspnea, increased sputum, rhinitis/sinusitis, nasal polyps, meconius ileus, prolapsed rectum

Question 36

Pathognomonic for Cystic Fibrosis Sx

Answer 36

meconius ileus

Question 37

Cystic Fibrosis Labs

Answer 37

elevated IRT (pancreatic enzymes)

Question 38

Diagnostic Test for Cystic Fibrosis

Answer 38

Cl- sweat test

Question 39

Cystic Fibrosis CXR

Answer 39

peribronchial cuffing, tram lines, infiltrates, fibrosis, blebs

Question 40

Cystic Fibrosis Triad

Answer 40

chronic pulmonary disease, pancreatic insufficiency, elevated sweat Cl

Question 41

Cystic Fibrosis complications

Answer 41

respiratory (pHTN, RSHF), GI, Endocrine, male infertility, hemoptysis, pneumothorax, cirrhosis, diabetes

Question 42

Cystic Fibrosis Tx

Answer 42

bronchodilators, mucolytics, pancreatic enzyme replacement, Abx, O2, vitamins, supportive

Question 43

Infections in Cystic Fibrosis pts in infants, think

Answer 43

S. aureus, NTHi, GNRs

Question 44

Infections in Cystic Fibrosis pts in children > 10, think

Answer 44

P. aeurginosa

Question 45

Pertussis S/S

Answer 45

infant with wet, barky cough

Question 46

Pertussis Testing

Answer 46

Serology (EIA, DFA, PCR), culture

Question 47

Pertussis Tx

Answer 47

Macrolides

Question 48

RSV S/S

Answer 48

young child in acute respiratory distress, Hx of URTI & low-grade fever, tachypneic, tachycardic, retractions, nasal flaring, hypoxia, apnea

Question 49

Poor prognostic factors for RSV

Answer 49

O2 SAT < 3mo, pre-mature, toxic appearance, atelectasis, tachypnea > 70,

Question 50

RSV Tx

Answer 50

Supportive (albuterol, O2, fluid)

Question 51

RSV complications

Answer 51

apnea, pneumonia, atelectasis, deydration, respiratory failure, superinfection, air leaks

Question 52

Most likely cause of pneumonia in a newborn

Answer 52

GBS > E. coli > Listeria > Chlamydia

Question 53

6 week old child with pneumonia who has a Hx of eye infection would likely have

Answer 53

Chlamydia

Question 54

Tx for mycoplasma pneumonia infection

Answer 54

Macrolides (erythromycin)

Question 55

Tx for Chlamyida pneumonia

Answer 55

Macrolides (erythromycin)

Question 56

Empiric therapy for child with suspected bacterial pneumonia

Answer 56

amoxicillin + ceftriaxone

Question 57

Young adults empiric therapy for pneumonia

Answer 57

fluoroquinolons

Question 58

Neonates w/ bacterial pneumonia Tx

Answer 58

ampicillin + cefotaxime