Pathophysiology: Chapter 37: Alterations of Pulmonary Function in Children

Question 1

How does chest wall compliance in an infant differ from that of an adult?

a. An adult’s chest wall compliance is lower than an infant’s.
b. An adult’s chest wall compliance is higher than an infant’s.
c. An adult’s chest wall compliance is the same as an infant’s.
d. An adult’s chest wall compliance is dissimilar to that of an infant’s.

Answer 1

ANS: A
Chest wall compliance is higher in infants than it is in adults, particularly in premature
infants.

Question 2

Why is nasal congestion a serious threat to young infants?

a. Infants are obligatory nose breathers.
b. Their noses are small in diameter.
c. Infants become dehydrated when mouth breathing.
d. Their epiglottis is proportionally greater than the epiglottis of an adult’s.

Answer 2

ANS: A
Infants up to 2 to 3 months of age are obligatory nose breathers and are unable to breathe
in through their mouths. Nasal congestion is therefore a serious threat to a young infant.
This selection is the only option that accurately describes why nasal congestion is a serious
threat to young infants.

Question 3

The risk for respiratory distress syndrome (RDS) decreases for premature infants when
they are born between how many weeks of gestation?
a. 16 and 20 c. 24 and 30
b. 20 and 24 d. 30 and 36

Answer 3

ANS: D
Surfactant is secreted into fetal airways between 30 and 36 weeks. The other options are
not true regarding the timeframe when the risk for RDS decreases.

Question 4

Which type of croup is most common?

a. Bacterial c. Fungal
b. Viral d. Autoimmune

Answer 4

ANS: B
In 85% of children with croup, a virus is the cause, most commonly parainfluenza.
However, other viruses such as influenza A or respiratory syncytial virus (RSV) also can
cause croup.

Question 5

What is the chief predisposing factor for respiratory distress syndrome (RDS) of the
newborn?
a. Low birth weight
b. Alcohol consumption during pregnancy
c. Premature birth
d. Smoking during pregnancy

Answer 5

ANS: C
RDS of the newborn, also known as hyaline membrane disease (HMD), is a major cause of
morbidity and mortality in premature newborns. None of the other options are considered
the chief predisposing factors for RDS.

Question 6

What is the primary cause of respiratory distress syndrome (RDS) of the newborn?

a. Immature immune system c. Surfactant deficiency
b. Small alveoli d. Anemia

Answer 6

ANS: C
RDS is primarily caused by surfactant deficiency and secondarily by a deficiency in
alveolar surface area for gas exchange. None of the other options are related to the cause
of RDS.

Question 7

What is the primary problem resulting from respiratory distress syndrome (RDS) of the
newborn?
a. Consolidation c. Atelectasis
b. Pulmonary edema d. Bronchiolar plugging

Answer 7

ANS: C
The primary problem is atelectasis, which causes significant hypoxemia and is difficult for
the neonate to overcome because a significant negative inspiratory pressure is required to
open the alveoli with each breath. None of the other options are considered a primary
problem associated with RDS.

Question 8

Which option shows the correct sequence of events after atelectasis develops in respiratory
distress syndrome of the newborn?
a. Increased pulmonary vascular resistance, atelectasis, hypoperfusion
b. Hypoxic vasoconstriction, right-to-left shunt hypoperfusion
c. Respiratory acidosis, hypoxemia, hypercapnia
d. Right-to-left shunt, hypoxic vasoconstriction, hypoperfusion

Answer 8

ANS: B
Atelectasis results in a decrease in tidal volume, causing alveolar hypoventilation and
hypercapnia. Hypoxia and hypercapnia cause pulmonary vasoconstriction, which increases
intrapulmonary resistance and shunting. This results in hypoperfusion of the lung and a
decrease in effective pulmonary blood flow. This selection is the only option that identifies
the correct sequence of events.

Question 9

Which statement about the advances in the treatment of respiratory distress syndrome
(RDS) of the newborn is incorrect?
a. Administering glucocorticoids to women in preterm labor accelerates the
maturation of the fetus’s lungs.
b. Administering oxygen to mothers during preterm labor increases their arterial
oxygen before the birth of the fetus.
c. Treatment includes the instillation of exogenous surfactant down an endotracheal
tube of infants weighing less than 1000 g.
d. Using continuous positive airway pressure (CPAP) supports the infant’s
respiratory function.
ANS: B
Administering oxygen to the mother is not a valid treatment of RDS. The other statements
provide correct information regarding RDS.

Answer 9

ANS: B
Administering oxygen to the mother is not a valid treatment of RDS. The other statements
provide correct information regarding RDS.

Question 10

Bronchiolitis tends to occur during the first years of life and is most often caused by what
type of infection?
a. Respiratory syncytial virus (RSV) c. Adenoviruses
b. Influenzavirus d. Rhinovirus

Answer 10

ANS: A
The most common associated pathogen is RSV, but bronchiolitis may also be associated
with adenovirus, rhinovirus, influenza, parainfluenza virus (PIV), and Mycoplasma
pneumoniae.

Question 11

Which immunoglobulin (Ig) is present in childhood asthma?

a. IgM c. IgE
b. IgG d. IgA

Answer 11

ANS: C
Included in the long list of asthma-associated genes are those that code for increased levels
of immune and inflammatory mediators (e.g., interleukin [IL]–4, IgE, leukotrienes), nitric
oxide, and transmembrane proteins in the endoplasmic reticulum. None of the other
options are associated with childhood asthma.

Question 12

Which T-lymphocyte phenotype is the key determinant of childhood asthma?

a. Cluster of differentiation (CD) 4 T-helper Th1 lymphocytes
b. CD4 T-helper Th2 lymphocytes
c. CD8 cytotoxic T lymphocytes
d. Memory T lymphocytes

Answer 12

ANS: B
Asthma develops because the Th2 response (in which CD4 T-helper cells produce specific
cytokines, such as interleukin [IL]–4, IL-5, and IL-13) promotes an atopic and allergic
response in the airways. This selection is the only option that accurately identifies the
appropriate T-lymphocyte phenotype.

Question 13

Which cytokines activated in childhood asthma produce an allergic response?

a. Interleukin (IL)–1, IL-2, and interferon-alpha (IFN-)
b. IL-8, IL-12, and tumor necrosis factor-alpha (TNF-)
c. IL-4, IL-10, and colony-stimulating factor (CSF)
d. IL-4, IL-5, and IL-13

Answer 13

ANS: D
Related to asthma, IL-4 and IL-13 are particularly important for B-cell switching to favor
immunoglobulin E (IgE) production, and IL-5 is crucial for local differentiation and
enhanced survival of eosinophils within the airways. This selection is the only option that
accurately describes how cytokines produce a childhood asthmatic response.

Question 14

Which statement accurately describes childhood asthma?
a. An obstructive airway disease characterized by reversible airflow obstruction,
bronchial hyperreactivity, and inflammation
b. A pulmonary disease characterized by severe hypoxemia, decreased pulmonary
compliance, and diffuse densities on chest x-ray imaging
c. A pulmonary disorder involving an abnormal expression of a protein, producing
viscous mucus that lines the airways, pancreas, sweat ducts, and vas deferens
d. An obstructive airway disease characterized by atelectasis and increased
pulmonary resistance as a result of a surfactant deficiency

Answer 14

ANS: A
Asthma is an obstructive airway disease characterized by reversible airflow obstruction,
bronchial hyperreactivity, and inflammation. This selection is the only option that
accurately describes childhood asthma.

Question 15

Which criterion is used to confirm a diagnosis of asthma in an 8-year-old child?
a. Parental history of asthma
b. Serum testing that confirms increased immunoglobulin E (IgE) and eosinophil
levels
c. Reduced expiratory flow rates confirmed by spirometry testing
d. Improvement on a trial of asthma medication

Answer 15

ANS: C
Confirmation of the diagnosis of asthma relies on pulmonary function testing using
spirometry, which can be accomplished only after the child is 5 to 6 years of age. Reduced
expiratory flow rates that are reversible in response to an inhaled bronchodilator would be
characteristic abnormalities. For younger children, an empiric trial of asthma medications
is commonly initiated. The remaining options are major historical and physical factors that
contribute but do not confirm the diagnosis of asthma in children.

Question 16

Which statement best describes acute respiratory distress syndrome (ARDS)?
a. An obstructive airway disease characterized by reversible airflow obstruction,
bronchial hyperreactivity, and inflammation
b. A pulmonary disease characterized by severe hypoxemia, decreased pulmonary
compliance, and the presence of bilateral infiltrates on chest x-ray imaging
c. A respiratory disorder involving an abnormal expression of a protein producing
viscous mucus that lines the airways, pancreas, sweat ducts, and vas deferens
d. A pulmonary disorder characterized by atelectasis and increased pulmonary
resistance as a result of a surfactant deficiency

Answer 16

ANS: B
ARDS is a condition that can result from either a direct or indirect pulmonary insult. It is
defined as respiratory failure of acute onset characterized by severe hypoxemia that is
refractory to treatment with supplemental oxygen, bilateral infiltrates on chest x-ray
imaging, and no evidence of heart failure, as well as decreased pulmonary compliance.
This selection is the only option that accurately describes ARDS.

Question 17

When considering the signs and symptoms of acute respiratory distress syndrome (ARDS),
the absence of which condition is considered characteristic?
a. Progressive respiratory distress c. Decreased pulmonary compliance
b. Bilateral infiltrates d. Heart failure

Answer 17

ANS: D
ARDS is characterized by progressive respiratory distress, severe hypoxemia refractory to
treatment with supplemental oxygen, decreased pulmonary compliance, bilateral infiltrates
on chest x-ray imaging, and no evidence of heart failure.

Question 18

Examination of the throat in a child demonstrating signs and symptoms of acute
epiglottitis may contribute to which life-threatening complication?
a. Retropharyngeal abscess c. Rupturing of the tonsils
b. Laryngospasms d. Gagging induced aspiration

Answer 18

ANS: B
Examination of the throat may trigger laryngospasm and cause respiratory collapse. Death
may occur in a few hours. This selection is the only option that accurately identifies the
life-threatening complication that can result from an examination of the throat of a child
who demonstrates the signs and symptoms of acute epiglottitis.

Question 19

Which statement best describes cystic fibrosis?
a. Obstructive airway disease characterized by reversible airflow obstruction,
bronchial hyperreactivity, and inflammation
b. Respiratory disease characterized by severe hypoxemia, decreased pulmonary
compliance, and diffuse densities on chest x-ray imaging
c. Pulmonary disorder involving an abnormal expression of a protein-producing
viscous mucus that obstructs the airways, pancreas, sweat ducts, and vas deferens
d. Pulmonary disorder characterized by atelectasis and increased pulmonary
resistance as a result of a surfactant deficiency

Answer 19

ANS: C
Cystic fibrosis is best described as a pulmonary disorder involving an abnormal expression
of a protein-producing viscous mucus that obstructs the airways, pancreas, sweat ducts,
and vas deferens. This selection is the only option that accurately describes cystic fibrosis.

Question 20

Cystic fibrosis is caused by which process?

a. Autosomal recessive inheritance c. Infection
b. Autosomal dominant inheritance d. Malignancy

Answer 20

ANS: A
Cystic fibrosis is an autosomal recessive inherited disorder that is associated with
defective epithelial ion transport. None of the other options cause cystic fibrosis.

Question 21

What are the abnormalities in cytokines found in children with cystic fibrosis (CF)?
a. Deficit of interleukin (IL)–1 and an excess of IL-4, IL-12, and interferon-alpha
(IFN-)
b. Deficit of IL-6 and an excess of IL-2, IL-8, and granulocyte colony-stimulating
factor (G-CSF)
c. Deficit of IL-10 and an excess of IL-1, IL-8, and TNF-
d. Deficit of IL-3 and an excess of IL-14, IL-24, and colony-stimulating factor (CSF)

Answer 21

ANS: C
Abnormal cytokine profiles have been documented in CF airway fluids, including
deficient IL-10 and excessive IL-1, IL-8, and TNF-, all changes conducive to promoting
inflammation. This selection is the only option that accurately identifies the abnormalities
in cytokines observed in children with CF.

Question 22

Between which months of age does sudden infant death syndrome (SIDS) most often
occur?
a. 0 and 1 
b. 2 and 4
c. 5 and 6 
d. 6 and 7

Answer 22

ANS: B
The incidence of SIDS is low during the first month of life but sharply increases in the
second month of life, peaking at 2 to 4 months and is unusual after 6 months of age

Question 23

Where in the respiratory tract do the majority of foreign objects aspirated by children
finally lodge?
a. Trachea c. Bronchus
b. Left lung d. Bronchioles

Answer 23

ANS: C
Approximately 75% of aspirated foreign bodies lodge in a bronchus. The other options are
not locations where children aspirate the majority of foreign objects.

Question 24

What is the most common predisposing factor to obstructive sleep apnea in children?

a. Chronic respiratory infections c. Obligatory mouth breathing
b. Adenotonsillar hypertrophy d. Paradoxic breathing

Answer 24

ANS: B
In otherwise healthy children, the most common predisposing factor is adenotonsillar
hypertrophy, which causes physical impingement on the nasopharyngeal airway. The other
options are not associated with obstructive sleep apnea in children.