Respiratory Tract Disorders

Question 1

Absence of airflow but persistent chest wall motion

Answer 1

Obsturctive apnea

Question 2

Airflow and chest wall motion are absent

Answer 2

Central apnea

Question 3

Most important determinant of respiratory control

Answer 3

Gestational age

Question 4

MC pattern of idiopathic apnea in preterm neonates

Answer 4

Mixed apnea

Question 5

Increase central respiratory drive by lowering threshold of response to hypercapnia, enhancing contractility of the diaphrag, and preventing diaphragmatic fatigue

Answer 5

Methylxanthines

Question 6

T/F Apnea of prematurity is a risk factor for SIDS

Answer 6

F

Question 7

Major constituents of surfactant

Answer 7

1) Lecithin (phosphatidylcholine) 2) Phosphatidylglycerol 3) Apoproteins 4) Cholesterol

Question 8

Surfactant is present in high concentrations in fetal lung homogenates by

Answer 8

20 weeks AOG

Question 9

Surfactant appears in amniotic fluid when

Answer 9

28-32 weeks AOG

Question 10

Mature level of pulmonary surfactant are present usually when

Answer 10

After 35 weeks AOG

Question 11

Signs and symptoms of RDS reach a peak within

Answer 11

3 days, after which improvement is gradual

Question 12

Improvement of RDS is often heralded by

Answer 12

1) Spontaneous diuresis 2) Improved blood gas values at lower FiO2 levels/ventilatory support

Question 13

Characteristic BUT NOT PATHOGNOMONIC appearance on radiographs of RDS

Answer 13

Fine reticular granularity of the parenchyma AND air bronchograms

Question 14

Measures of respiratory failure

Answer 14

ABG 1) pH less than 7.2 2) pCO2 ≥60mmHg 3) O2sat less than 85% at FiO2 40-70% and CPAP 5-10cmH2O

Question 15

Mild BPD, less than 32 weeks AOG

Answer 15

Need for O2 support for >28 days PLUS breathing room air at 36 weeks PMA or at discharge, whichever comes first

Question 16

Moderate BPD, less than 32 weeks AOG

Answer 16

Need for O2 support for >28 days PLUS need for O2 support less than 30% FiO2 at 36 weeks PMA or at discharge, whichever comes first

Question 17

Severe BPD, less than 32 weeks AOG

Answer 17

Need for O2 support for >28 days PLUS need for O2 support ≥30% FiO2 and/or PPV or NCPAP at 36 weeks or at discharge PMA or at discharge, whichever comes first

Question 18

Point of BPD assessment of neonates ≥32 weeks AOG

Answer 18

> 28 days or less than 56 days postnatal age, or at discharge, whichever comes first

Question 19

Most infants with TTN recover rapidly within

Answer 19

3 days

Question 20

TTN is believed to be secondary to

Answer 20

Slow absorption of fetal lung fluid

Question 21

Condition of severe morbidity and mortality reported in infants born by elective CS who initially present with signs and symptoms of TTN the demonstrate refractory hypoxemia due to pulmonary hypertension and require ECMO support

Answer 21

Malignant TTN

Question 22

MAS develops in ___% of patients with MSAF

Answer 22

5%

Question 23

___% of patients with MAS require mechanical ventilation

Answer 23

30%

Question 24

___% of patients with MAS die

Answer 24

3-5%

Question 25

MAS usually improves within

Answer 25

72 hours

Question 26

Typical chest X-ray of MAS

Answer 26

1) Patchy infiltrates 2) Coarse streaking of both lung fields 3) Increased AP diameter 4) Flattening of the diaphragm

Question 27

Condition suggested by a normal CXR, severe hypoxemia, and no cardiac malformation

Answer 27

Pulmonary hypertension

Question 28

T/F Amnioinfusion decreases the risk of MAS

Answer 28

F

Question 29

Administration of ___ and/or ___ to infants with MAS and hypoxemia respiratory failure or pulmonary hypertension requiring mechanical ventilation decreases the need for ECMO support

Answer 29

1) Exogenous surfactant 2) iNO

Question 30

Predisposing factors to PPHN

Answer 30

1) Birth asphyxia 2) MAS 3) Earl onset sepsis 4) RDS 5) Hypoglycemia 6) Polycythemia 7) Maternal use of NSAIDs 8) Maternal use of SSRIs 9) Pulmonary hypoplasia

Question 31

Parameters that suggest right-to-left shunting through the DA (preductal vs post ductal)

Answer 31

1) PaO2 gradient >20mmHg on ABG 2) O2sat gradient >5% on pulse oximetry

Question 32

Goals of mechanical ventilation in PPHN

Answer 32

1) PaO2 50-70mmHg 2) PaCO2 50-60mmHg

Question 33

The term congenital diaphragmatic hernia typically refers to what type

Answer 33

Bochdalek or posterolateral diaphragmatic defect

Question 34

Major limiting factor for survival in CDH

Answer 34

Associated pulmonary hypoplasia

Question 35

T/F In some cases of CDH, pulmonary hypoplasia precede the development of diaphragmatic hernia

Answer 35

T

Question 36

T/F re CDH: Females affected twice as often as males

Answer 36

T

Question 37

CDH is more common on what side

Answer 37

Left (85%), occasionally bilateral (5%)

Question 38

Cardinal sign of CDH, which may occur immediately after birth, or there may be a honeymoon period of up to 48hrs

Answer 38

Respiratory distress

Question 39

Poor prognostic sign of CDH

Answer 39

Early respiratory distress within 6 hours of life

Question 40

Anteromedial diaphragmatic defect

Answer 40

Foramen of Morgagni hernia

Question 41

Defect in Foramen of Morgagni hernia is caused by

Answer 41

Failure of the sternal and crural portions of the diaphragm to meet and fuse

Question 42

Foramen of Morgagni hernia is more common on what side

Answer 42

Right (90%)

Question 43

MCC of pneumothorax

Answer 43

Overinflation

Question 44

Pneumoediastinum occurs in at least ___% of patients with pneumothorax and is usually asymptomatic

Answer 44

25