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138 Cards in this Set
- Front
- Back
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What is the first stage of lung development?
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Embryonal Stage
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The embryonal stage of development lasts for how long
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the first two months of gestation
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What stage extends to week 16 of gestation
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Pseudoglandular
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What weeks does the canalicular stage last til?
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26
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When does the saccular stage end?
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35-36 weeks
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The alveolar stage occurs during what weeks?
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35 til birth
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What is the ideal time to assess the gestational age of a newborn?
a. within the first 30 minutes of birth b. within the first hour of life c. within the first 12 hrs of life d. within the first 24 hours of life |
c. within the first 12 hrs of life
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Ideally the gestational age is evaluated on the basis of
a. The gestational duration since the mother's last menstrual cycle b. prenatal ultrasound c. the ballard scoring system d. all of the above |
d. all of the above
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Any infant whose birth weight is less than ___ percentile for gestational age is small for gestational age
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10th
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Any infant whose birth weight is more than ___ percentile for gestational age is large for gestational age
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90th
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Which of the following best describes fetal lung liquid?
a. It lowers surface tension within the alveoli b. it maintains the structure of the airway lumen and developing alveoli, preventing complete collapse c. With fetal breathing movement it continuously flows out of the lungs and is swallowed or flows out of the lungs and is swallowed or excreted into the amniotic fluid d. A and B e. B and C |
e. B and C
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The ____ rather than the bronchial circulation is the major source of this liquid
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Pulmonary circulation
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Which of the following phases of human lung development occurs from 17-26 weeks of gestation and is characterized by the formation of a capillary network around airway passages?
a. psuedoglandular b. saccular c. alveolar d. canalicular |
d. canalicular
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Regarding postnatal lung growth by approximately what age do most of the alveoli that will be present in the lungs for life develop?
a. 6 months b. 1 year c. 1.5 years d. 2 years |
c. 1.5 years
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Which of the following vascular networks is the major source of fetal lung liquid?
a. pulmonary circulation b. pulmonary lymphatics c. systemic circulation d. bronchial circulation |
a. pulmonary circulation
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How is PPHN diagnosed?
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With pre and post ductal sat, doppler studies and cardiac catheterization
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During the third gestational week, which of the following organs is the first to form?
a. Heart b. Brain c. Lungs d. Kidneys |
a. Heart
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Which of the following anatomic structures constitute fetal shunts?
I. foramen ovale II. Sinus venosus III. Ductus venosus IV. Ductus arteriosus a. I, II, III b. I, III, and IV c. I, II, and IV d. II, III, and IV |
b. I, III, and IV
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Which of the following events causes cessation of right-to-left shunt through the foramen ovale?
a. Increased levels of PaO2 in the blood of the neonate b. Decreased levels of PaCO2 in the blood of the newbord 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
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How does oxygenated blood leave the placenta and travel to the fetus?
a. through the aortic artery b. through the umbilical vein c. through the umbilical artery d. through the spiral artery e. through the ductus arteriosus |
b. through the umbilical vein
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How is most of the fetal blood entering the main pulmonary artery shunted to the aorta?
a. through the foramen ovale b. through the ductus venosus c. through the ductus arteriosus d. through the superior vena cava e. through the iliac arteries |
c. through the ductus arteriosus
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How is most of the fetal blood entering via the umbilical vein shunted to the interior vena cava?
a. through the foramen ovale b. through the ductus venosus c. through the ductus arteriosus d. through the superior vena cava e. through the iliac arteries |
b. through the ductus venosus
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How is most of the fetal blood entering via the right atrium shunted to the left atrium?
a. through the foramen ovale b. through the ductus venosus c. through the ductus arteriosus d. through the superior vena cava e. through the aorto-iliac shunt |
a. through the foramen ovale
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What one set of actions causes the systemic circulation to transition from a low-resistance system to a high-resistance system?
a. clamping the umbilical cord and creating a short period of hypoxia b. getting a higher concentration of O2 into the lungs with the first breath c. clamping the umbilical cord, thus preventing blood flow to the placenta d. pulmonary hypertension from a change in blood flow direction |
c. clamping the umbilical cord, thus preventing blood flow to the placenta
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Which of the following conditions are associated with preeclampsia?
I. multiparity II. proteinuria III. generalized edema IV. hypertension a. II and III b. I, II, and III c. I, III, and IV d. II, III, and IV |
d. II, III, and IV
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Which of the following mechanisms appear to explain why oligohydramnios is associated with lung hypoplasia?
I. abnormal carbohydrate metabolism II. mechanical restriction of the chest wall III. Interference with fetal breathing IV. failure to produce fetal lung liquid a. I and III b. II and III c. I, II, and IV d. II, III, and IV |
d. II, III, and IV
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Which of the following maternal and or fetal conditions are associated with pregestational diabetes?
I. Hydrops fetalis II. Ketoacidosis III. Preeclampsia IV. Fetal death a. I and II b. II and III c. I, III, and IV d. II, III, and IV |
d. II, III, and IV
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What is the main potential problem associated with the premature rupture of membranes?
a. fetal dehydration b. fetal infection c. maternal hypotension d. maternal renal failure |
b. fetal infection
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Which of the following maternal or fetal conditions can be determined or assessed via amniocentesis?
I. maternal Rh isoimmunization II. Trisomy 21 III. Placenta previa IV. Placental abruption a. I and II b. III and IV c. I, II, and III d. II, III, and IV |
a. I and II
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What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate?
I. dry the infant's skin II. wrap the infant in prewarmed blankets III. remove wet linens from around the infant IV. Measure the neonates body temperature a. IV only b. I and II c. I, II, III d. I, II, and IV |
c. I, II, III
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While stablizing a preterm neonate infant before resuscitation, the therapist notices the infant displaying laryngeal spasm, bradycardia, and a delayed onset of spontaneous breathing. What could have caused these events to occur?
a. Applying vacuum pressure in the range of 50-60mm Hg b. performing aggressive pharyngeal suctioning c. applying positive pressure to the airway before suctioning the airway d. flicking the bottoms of the neonate's feet immediately on delivery |
b. performing aggressive pharyngeal suctioning
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As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats/min, and the physician notices that the infant has good muscle tone and a strong respiratory effort. What should the physician do at this time to provide airway care?
a. intubate the infant immediately b. perform pharyngeal and tracheal sxn immediately c. perform tracheal sxn only at this time d. Do not perform tracheal sxn on this infant at this time |
d. Do not perform tracheal sxn on this infant at this time
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A preterm neonate with a heart rate of 55 beats/min is receiving positive pressure ventilation immediately after delivery. What should the therapist do at this time?
a. Apply cardiac compressions and maintain positive pressure ventilation b. defibrillate the pt c. administer medication to increase myocardial contractility and maintain positive ventilation d. Increase the RR on the ventilator |
a. Apply cardiac compressions and maintain positive pressure ventilation
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A term infant is born displaying acrocyanosis. What should the therapist do at this time?
a. Administer O2 to the newborn b. begin resuscitative measures c. Institute positive pressure measures d. Do nothing, as this condition is often transient |
d. Do nothing, as this condition is often transient
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The therapist, working with a neonate, observes that the newborn has adequate ventilatory efforts and a heart rate of 120 beats/min. However, at the same time, the infant demonstrates cyanosis of the lips and mucous membranes. What should the therapist do at this time?
a. Direct 100% O2 at the flow of 8 L/min about 1/2 inch above the infants nose and mouth b. Initiate positive pressure mechanical ventilation c. Begin resuscitative efforts d. Perform pharyngeal and tracheal sxning |
a. Direct 100% O2 at the flow of 8 L/min about 1/2 inch above the infants nose and mouth
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A respiratory therapy supervisor is observing a staff member perform bag-mask ventilation on an infant who is being resuscitated. The supervisor notices that the therapist places his fingers on the anterior margin of the infant's mandible, and lifts the infant's face into the mask. What should the supervisor do at this time?
a. Recommend that the infant immediately receive ET intubation b. Correct the therapist and have him place his fingers onto the soft tissue and place under the mandible c. Recommend that the therapist perform endotracheal sxn d. Take no action because the therapist is correctly performing valve-mask ventilation |
d. Take no action because the therapist is correctly performing valve-mask ventilation
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What appears to be the reason for the infrequent need to administer chest compressions and CPR drugs to neonates in the delivery room?
a. Labor and delivery room personnel are highly trained and qualified with excellent assessment skills, thus avoiding the need for such actions b. Manipulation and stimulation of the neonate at birth excite the heart, obviating the need for these interventions c. The delivery of adequate ventilation is the primary factor in effective resuscitation d. The administration of O2 to the infants airway stimulates the heart |
c. The delivery of adequate ventilation is the primary factor in effective resuscitation
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What ratio of chest compressions and positive pressure breaths must the therapist administer to a newborn during CPR?
a. One breath for every three compressions b. Two compressions for every 5 breaths c. One compression for every 15 breaths d. Three compressions for every 15 breaths |
a. One breath for every three compressions
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The therapist has been performing cardiopulmonary resuscitation on a neonate for 90 seconds, applying ventilation with 100% O2 and chest compressions. The infant has maintained a spontaneous heat rate of 40 beats/min. What should the therapist recommend at this time?
a. Continuing resuscitative measures b. Initiating high-frequency measures c. Instituting ECMO d. Administering Epinephrine |
d. Administering Epinephrine
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Which of the following factors are taken into consideration when assessing the gestational age of a neonate?
I. previous maternal pregnancies II. Prenatal ultrasound evaluations III. Postnatal findings based on physical and neurological examinations IV. Gestational duration based on the last menstrual cycle a. I and III only b. I, II, III c. I, II, and IV d. II, III, IV |
d. II, III, IV
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For the purpose of assessing right-to-left shunting, as in the case of PPHN, which of the following sites would render postductal blood?
I, right arm II, left arm III. right leg IV. left leg a. I only b. II only c. I, III, and IV d. II, III, and IV |
d. II, III, and IV
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A newborn who presents as pale, mottled, floppy, with little interest in feeding, and slightly irritable most likely has which of the following conditions?
a. Sepsis b. RDS c. ROP d. Cri du Chat |
a. Sepsis
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A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting the signs of ____________.
a. Respiratory Distress b. Hypoxemia c. Hypercapnia d. Acidemia |
a. Respiratory Distress
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Which of the following pulmonary diseases are not chest wall deformities, but are characterized by an increased AP diameter?
I. Pectus excavatum II. Severe asthma III. Pneumonia IV. CF a. I and III b. II and IV c. II, III, and IV d. I, II, III, and IV |
b. II and IV
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When performing a physical examination of the thorax, in what order should the therapist proceed with the assessment?
a. Inspection, palpation, percussion, and ausculation b. Inspection, percussion, palpation, and auscultation c. Palpation, inspection, percussion and auscultation |
a. Inspection, palpation, percussion, and ausculation
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Which fetal assessments may suggest that when born, an infant will be at risk for MAS?
a. fetal oligohydramnios b. Abnormal fetal heart rate tracings c. Both A and B d. Neither A and B |
c. Both A and B
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PPHN can be associated with which underlying pulmonary disorders?
a. MAS b. RDS c. None (idiopathic) d. All of the above |
d. All of the above
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Which of the following neonatal skin presentations at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome?
a. mottling b. lanugo c. reddish/blue appearance d. vernix |
c. reddish/blue appearance
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The therapist notices that an infant presents with irregular areas of dusky skin alternating with areas of pale skin. On the basis of this observation, which of the following conditions should the therapist anticipate this patient having?
a. polycythemia b. hypotension c. Situs inversus with dextrocardia d. renal insufficiency |
b. hypotension
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What does the lung down show on a lateral decubitus?
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Pleural effusion
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What does the lung up show on a lateral decubitus?
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Pneumothorax
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What can a lateral decubitus also show?
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Foreign body aspiration
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The normal thymus has a characteristic appearance with several radiographic findings except:
a. displacement of the trachea to the opposite side of the mediastinum b. appearance of a sail c. wavy margins d. Increased density in the anterior mediastinum on the lateral view |
a. displacement of the trachea to the opposite side of the mediastinum
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What disease does the trachea abnormally collapse during expiration leading to an expiratory wheeze?
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Tracheomalacia
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How do you diagnose tracheomalacia
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Fluoroscopy
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What is on the right side of the lung, with wavy margins, and has increased density on the lateral view?
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Sail Sign
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What disease is caused by the haemophilus influenza type B?
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Epiglottits
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What disease presents with drooling, thumbprint sign on xray, and requires intubation asap due to emergency?
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Epiglottitis
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What disease presents with a barking cough and inspiratory strider?
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Croup
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What disease has a steeple sign on the xray?
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Croup
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What disease is caused by the parainfluenza?
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croup
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Meconium inactivates what?
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surfactant
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What disease has a severely increased PVR with Right to Left shunting?
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PPHN
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PPHN occurs most often in what GA infants?
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term/post-term
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List three diseases that can cause PPHN
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MAS, RDS, and birth asphyxia
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Which type of PPHN is associated with anatomic malformations?
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Primary PPHN
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Which type PPHN is associated with underlying disease processes
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Secondary PPHN
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Why is meconium passed?
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As a sign of stress or hypoxia
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What type of alveoli will not participate in iNO uptake?
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Atelectatic or fluid filled alveoli
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What is iNO used for? (3 diseases)
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hypoxic respiratory failure, ARDS, PPHN
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What is stenosis or absence of the nasal passageways?
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choanal atresia
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Choanal atresia typically presents when?
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immediate postnatal period
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What type of disease does the infant present with severe RDS that lessens with crying due to breathing through the mouth?
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Choanal atresia
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How is choanal atresia discovered?
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Through nasal sxning
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What disease are masses that obstruct the nasopharynx, such as encephaloceles, dermoid cysts, small mandibles, and small oropharynx causing the tongue to occlude the oropharynx?
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Pierre Robin Syndrome
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What disease is blockage of the passage of saliva or food by esophageal atresia and aspiration of either salivary contents or gastric secretions through a fistula between a trach and esophagus?
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TE Fistula
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What is the most common type of fistula?
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Esophageal atresia with distal TE fistula
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What disease shows signs of drooling, first feedings result in choking, coughing, and cyanosis and respiratory distress?
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TE Fistula
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Infants with CDH develop respiratory distress when?
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Shortly after birth
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How is CDH diagnosed
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by chest x-ray
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What disease shows a scaphoid abdomen, tracheal shift to the unaffected side, and tachypnea?
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CDH
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The main goals when treating CDH is to what?
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Prevent hypoxia, hypercapnia, and acidosis
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How does a lung bud anomaly present in the early newborn period?
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RDS
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How does a lung bud anomaly present in later childhood?
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repeated infections
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What disease has a hydropic appearance, intermittent tachypnea, lesions, hyperlucent lobe with a surrounding zone of atelectasis
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Lung bud anomalies
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What disease presents with abdominal distension, intolerance to feeds, rectal bleeding, and abdominal wall erythema?
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NEC
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What disease includes lab values of thrombocytopnea, neutropnea, and metabolic acidosis?
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NEC
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NEC is primarily a disease of infants of what GA?
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premature
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List 6 cardiac defects that need the PDA to stay open?
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Coarction of the aorta
Aortic stenosis TOF Transposition of the great arteries Hypoplastic Left Heart Syndrome Hypoplastic Right Ventricle |
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What % change in pre and post ductal Sats show a right-to-left shunt?
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5-10%
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What change in PaO2 shows a right-to-left shunt?
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15mmHg
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VSD is what type of shunt?
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left to right, but if severe enough can be right to left
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What secondary disease processes can show up with VSD
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PPHN and CHF
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Does VSD need O2 Caution?
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no
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What heart defect does the pulmonary artery and the aorta combine?
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Truncus Arteriosus
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Where is there no septum in truncus arteriosus
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Between the right and left ventricle
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CXR for truncus arteriosus will show what?
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Dialation of LA and LV, increased pulmonary vasculature, and symptoms of CHF
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Which heart defect has the aorta and the pulmonary artery switched locations?
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Transposition of the great arteries
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Which heart defect is egg shaped on xray with pulmonary vasculature enlargement and cardiomegaly
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Transposition of the great arteries
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Transposition of the great arteries has what type of shunt
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right to left shunt
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Transposition of the great arteries is acidotic or alkaltoic
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acidotic
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When drawing a blood gas from an infant, you dont want to draw from what two sites?
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Subclavian or carotid
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What blood gas draw site is your last choice?
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Femoral
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Advanced CF leads to what?
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Right ventricular failure
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Where do you want the ET tube to be placed on an xray
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between the thoracic inlet and the carina
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What disease has coarse patchy opacities secondary to atelectasis from broncial obstruction, enlargement of the heart was secondary to fluid overload
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MAS
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What LS ratio shows mature lungs
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2:1
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What test can also show fetal lung development
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PG
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For what disease do you insert a stiff NG tube until resistance is met?
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Esophageal atresia
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What is the PaO2 and the PCO2 will be in the 40's
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Rule of 40's
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For the hypoplastic ventricle, how would you treat it post surgery?
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Use rule of 40's
Subambiant O2, low FIO2 Maintain high PVR hypercarbia |
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What cardiac anomaly does the pulmonary vein into the right atrium and do you use the rule of 40's
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anomalous pulmonary venous return
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What is the formula for MAP
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(diastolic x 2) + systolic/ 3
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What do we monitor in the blood with iNO that is in the blood affecting oxygenation?
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methemoglobin
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What is produced from the oxidation of the iron in the hemoglobin
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methemoglobin
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With transcutaneous pacing the electrode is measuring what instead of the arterial gas tension
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the tension of the underlying tissue
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What do we use to deliver heliox
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non-rebreather
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What is the flow for a flow-inflating bag
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8-10
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A flow rate of what is sufficient to fill the bag and flush the reservoir tube, allowing exhaled gas to be continuously flushed out of the system?
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2-3x the pt's minute ventilation (3-15L a min)
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What is the proper length of the sxn catheter when sxn'ing?
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pass the end of the tube but not touch the carina
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What is the optimal catheter size for suctioning?
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less than half the size of the ET tube
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What is the single most important variable in evaluating the effectiveness of CPT?
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amount of secretions expectorated
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List 6 things that determine the effectiveness of CPT
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Changes in sputum production
Breath sounds Vital Signs Chest radiographic findings blood gas values lung mechanics |
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What is the narrowest portion of the pediatric airway until about 8 years of age?
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cricoid cartilage
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List several things that inactivate surfactant?
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Albumin, hemoglobin, fibrin, blood, meconium, fibrin, complement, other proteins, RBC membrane lipids, immunoglobins, and plasma proteins
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Where should the "pop-ff device" be placed to protect the patient from overpressurization, thereby limiting excessive volume delivery to the respiratory system
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close to the patient airway
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What is the PCO2 and the pH classifying ventilatory failure?
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PCO2 greater than 50/60 mm HG
pH less than 7.3 |
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What is the PaO2 and PCO2 classifying Respiratory Failure?
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PaO2 less than 60 mmHg
PCO2 greater than 50 mmHg |
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List 4 conditions that must be met before weaning a patient off of the ventilator?
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The patient's condition is stable
receiving adequate nourishment be able to breath spontaneously maintain acceptable PCO2 |
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What should be the vent setting for weaning for the following?
PEEP PIP FIO2 RR for neonate RR for infant/toddler RR for child/adolescent |
PEEP less than 8
PIP less than 30 FIO2 less than 0.4-0.5 Ventilator Rate for neonate- 20 Ventilator Rate for infant/toddler- 15 Ventilator Rate for pediatric/adolescent- 10 |
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High frequency ventilation is defined as mechanical ventilation using tidal volumes less than or equal to the _____ _____ volume and delivered at supraphysiologic rates.
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Dead space volume
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How can minute ventilation be weaned on the HFOV and HFJV?
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HFOV - reducing oscillatory amplitude
HFJV - decreasing PIP |
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The well inflated lung requires a reduction in ____ to avoid the negative consequences of excessive lung volumes.
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MAP
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How much should the MAP be weaned every 2-3 hours?
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0.5-1 cm H2O
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List some physiologic effects of PEEP
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Increases FRC
Decreases RAW Decreases WOB Increases Vt Decreases intrapulmonary shunt Increases pulmonary compliance Stabilizes the chest wall Improves the distribution of ventilation Improves the ventilation-to-perfusion ratio Improves gas exchange Reduces alveolar dead space Protects the developing lung Decreases the cellular indicators of lung injury Reduces the need for intubation and mechanical ventilation |
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When iNO is combined with oxygen what does it form?
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NO2
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Where do you add NO to prevent the making of NO2
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as close to the patient as possible
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What can you do to prevent the build up of NO2
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increase the inspiratory flow
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