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104 final
| Question | Answer |
|---|---|
| what is the incidence of RDS among infants borna at less than 28 wks gestation? | 60% |
| during RDS what conditions are responsible for the reduction in pulmonary blood flow? | hypoxemia, acidemia, and hypercarbia |
| why are term or ner term infants commonly overlooked as a grp of pts at risk for developing RDS? | because these infants tend to be stron and have excellent pulmonary reserve |
| what is the significance of an infant with RDS demonstrating a grunt during each exhalation? | an effort to maintain its FRC |
| upon review of x-ray of newborn preterm infant observes diffuse, fine, reticulogranular densities ground glass appearance, whats suspected? | respiratory distress syndrome (RDS) |
| how should the therapist interpret a L/S ratio of 2:1 | presence of lung maturity |
| how should therapist interpret fact that there is no supernatant foam during shake test? | infants lungs are devoid of pulmonary surfactant |
| while reveiwing an x-ray therapist observes pulmonary vascular congestion, prominant peripheral streaking, fluid in the interlobilar fissures, hyperexpansion, and flat diaphragm what condition? | transient tachypnea of newborn (TTN |
| what therapuetic interventions are used to treate TTN? | 40% oxygen hood |
| what microorganism are responsible for nosocomial pna? | candida albicans and serratia marcescens |
| when neonatal pna is suscpected how long does an infent receive broad spectrum antibiotics? | 72 hours |
| why does meconium staning occur predominantly in infants greater than 36 weeks of gestation? | because these infants demonstrate strong peristalsis, and have powerful sphincter tone |
| what is the typical type of airway obstruction that occurs with MAS? | ball valve |
| what x-ray features is therapist likely to see on x-ray of infant with MAS | patchy areas of atelectasis |
| wat conditions are responsible for causing PPPHN? | genetic differences in pulmonary smooth muscle development, alveolar capillary dysplasia, and intrauterine closure of ductus arteriosus |
| what % if normal pulmonary vascular resistance is achieved within 24 hours of birth? | 80% |
| if blood samples from the right radial is 20 mmHG greater than that of the umbilical what could the neo have? | PPHN |
| what conditions may favorably respond to inhaled NO therapy | hypoxic pulmonary hypertension, methacholine- induced bronchoconstriction and septic shock |
| which clinical presentations are asociated with apnea of prematurit? | snoring, mouth breathing, and choking |
| what medications should the therpist recommend for an infant w apnea prematurity experiencing prolonged apnea? | methylxanthines |
| what intervention should be performed when infant is born w choanal artesia? | insert an opa |
| ehat should an rt do to confirm diagnosis of choanal artesia? | attempt to onsert an 8 french through the nasal cavity |
| whcih intervention is used to treat macroglossia? | treatment is based on severity of airway obstruction end etiology |
| what conditions are consistent with micrognathia, glossoptosis and cleft palate in a newborn? | pierre robin syndrome/ sequence |
| what acronym is associated with esophageal artesia and tracheoesophageal fistula | VACTERL (vertebreal, anal... |
| what form of tracheoesophageal firstula and esophageal atresia is most common? | blind ending upper esophageal pouch of variable length associated with fistula from lower trachea or main stem bronchi leading into distal esophagus |
| whats the role of radiography in determination of trach and esophageal artesia | location of nasogastric tube may confirm obstrusction of proximal esophagus caused by atrasia |
| what are complications associated w performing esophageal anastomoses to repair esophageal atresia? | apnea, bradycardia, and recurrent pna |
| what is the current survival rate in infants w esophageal artesia? | 95% |
| which of the following clinical manifestations characterize congenital diphragmatic hernia | herniated contents cause compression of developing ipsilateral lung, histologic studies demonstrated increase musculature, lung tissue hypoplastic includijng oulmonary vasculature |
| what factors cause exacerbation of pulmonary hypertension in pts who have congenital diaphragmatic hernia? | hypoxemia, hypercapnia, and acidemia |
| which condition is consistent with presence of a scaphoid abdomen in newbornw w tachypnea? | congenital diaphragmatic hernia |
| what intervention is used to treate congenital diaphragmatic hernia | high frequency oscillation, gastrointestinal tract decompression, and thoracistomy tube insertion if necessary |
| after surgical repair of congential diaphragmatic hernia, what s the potential problem generated by the rapid shift of contralateral lung mediastinum | rupturing vascular structures |
| whats the most common pt complaint associated w pectus carinatum | cosmetic |
| why is pulmonary development often stifle in children who have asphyxiating thoracic dystrophy? | because chest cavity is decreased |
| what patters are commonly found in the presentation of lung bud abnormalities? | appear early in the newborn period, emerge later in childhood, and frequent respiratory infections |
| what conditions best explain the presentation of symptoms beyond infancy in pts w bronchogenic cysts or congeital cystic adenomatoid malformations? | lack of communication between cysts and tracheobronchial tree |
| newborn presents with respiratory distress has an xray revealing circular/ ovoid mass w smooth edges whad lung bud abnormality is consistent w this? | bronchogenic cysts |
| whats a possibly consequence of inadvertent rupture of systemic arterial supply in cases of pulmonary sequestration when this supply arises directly from aorta? | significant blood loss or exsanguination |
| an infant presents w abd distention, intolerance to feeding, rectal bleeding, abd wall erythema, lab finding include throbocytopnea, neutropenia, and metabolic acidosis? | necrotizing enterocolitis NEC |
| which xray stages of bronchopulmonary displasia (BPD) is characterized by presence of granular pattern, air bronchograms, and small lung volume? | stage 1 |
| pts who have persistent O2 requirements, chest xrays show hazy or hyperinflated appearance, occasionalyy cystic emphysemia after receiving O2 and mechanical vent as infants in a nicu described as having what? | "new" bronchopulmonary dysplasia |
| How is chronic lung disease in infants defined? | infant requiring I2 and continues to do so at 36 weeks of gestational age, infant who required mech vent and continues to do so. |
| what cell types are responsible for producing pulmonary surfactant? | alveolar type II cells |
| what cytotoxic metabolites of O2 is beleived to be responsible for lipid peroxidation of unsaturated fatty acids in the cell wall membranes? | superoxide, peroxide |
| what term describes air leaving the lungs and entering the pulmonary interstitial spaces a consequence of barotrauma | pulmonary interestitial emphysema |
| when newborn presents wit tachypnea, hypoxemia, or hypercarbia what condition should therapist suspect? | pnuemothorax |
| 1 day old infant receiving mech vent suddenly exhibits cyanosis drop in transcutaneous pressure of oxygen, bradycardia, hypotension xray shows gas surrounding collecting beneath inferior surface of heart. what condition is this? | pneumopericardium |
| what antioxdants work to alleviate xidative stress experiences by newborns who receive high concentrations of oxygen during resuscitation or mechanical ventilation | no antioxidants have proved safe for long-term use |
| immediately after delivery of newborn where should therapist place the transcutaneous PO2 electrode to obtain readings reflecting preductal oxygenation assessment? | on the right wrist |
| what action should therapist take regarding infants who don't favorably respond to surfactant replacement therapy and conventional mech ventilation? | initiate high frequency ventilation |
| what condition is consistent wit finding a tranq PO2 difference of 25 mmhg between infant's right wrest and left leg? | patent ductus arteriosus |
| what should therapist suspect if a newborn has respiratory rate greater than 60 beyond an hour after birth | sepsis |
| lactated ringers has been admited to neo however bp still low urine has decreased what should be done now? | dopamine |
| whats the role of steroids in the postnatal period in an effort to reduce risk of chronic lung disease | uncertain at this time |
| what mechanism has been implicated w development o retinopathy of prematurity? | fluctuation PaO2 values or PaCO2 values after vasoconstricitve injury |
| what problem associated w screening for retinopathy of prematurity in neonates born before 32 weeks of gestational age | retinas still immature |
| what is rationale for suggesting admin of o2 for treatment of ROP? | supplemental o2 limits production of VEGF |
| what measure may help reduce incidence of intraventricular hemorrhage in infants w mechanical vent? | perfrm transfusions to keep infant's hematocrit greater then 40% |
| which of following vessels return blood to right ventricle | inferior vena cava, superior vena cava, coronary sinus |
| at birth what factor causes dilation of pulmonary vascular bed and decrease in pulmonary vascular resistance? | increased arterial partial pressure of oxygen |
| what factor is responsible for closure of formen ovale | increased pressure on the left side of heart |
| for which congenital cardiac defects may spontaneous clisure of ductus arteriosus be catastrophic | tetralogy of fallot with pulmonary atresia, severe coarctation of aorta and hypoplastic left heart syndrome |
| how should therapist interpret preductal to postductal PO2 difference of 8mmHg in neonate? | absence of ductal shunting |
| which methods are involved in management of PDA? | maintaining he,atocrit at high end of normal and administering indomethacin (close PVA) |
| which clinical manifestation are consistent with an atrial septal defect? | right ventricle may become hypertrophic chest xrays normal |
| what clinical manifestation consistent w large ventricular septal defect? (VSD) | majority of blood flow shunted from left to right and x-ray shows enlarged cardiac siljouette and increased pulmonary vascular markings |
| why must supplemental O2 be judiciously admin to pts w atrioventricular canal defect? | minimize pulmonary vascular dilation |
| what clinical features characterize aortic stenosis in neonate? | patients are generally ductal dependent, left ventricle demonstrates hyerptrophy, infacnts are rarely symptomatic during first month of life |
| what medications are most common preoperative treatments to minimize preductal constriction until surgical correction of coarctation of aorta can be achieved | prostaglandin E1 negative inotropes |
| what mech vent techniques may be necessary during postop period after surgical intervention for hypoplastic left ventricular syndrome? | rule of forties and hypercarbic therapy |
| which of the following aberrant connections is consistent with anomalous pulmonary venous return | pulmonary veins connect directly to the right atrium and pulmonary veins connect directly to superious vena cava |
| what congenital cardiac anomalies are classified conotruncal | tetralogy of fallot and transposition of great vessels |
| what statement describes truncus arteriosus | pulmonary artery arises from left ventricle and aorta stems from right ventricle, if SVR decreases relative to PVR blood flow will be shunted from right to left, ;arge vsd allows total mixing of blood from two ventricles |
| what blood flow pattern occurs in complete transposition of great arteries | systemic venous blood passes through the right heart chambers |
| what cardiac defects requires use of balloon atrial septostomy? | cpmplete transposition of great arteries |
| when hypoplastic right ventricle is present what is the only pathway for blood to leave the right atrium? | through an ASD |
| infant becomes apneic, cyanotic, hypotonic, therapist nudges and stimulates infant, what has happened? | an apparent life threatening event |
| what describes the confition sids? | more than 70% victims found in early morning hours after night time sleep, most likely to be experienced in the first month of life, side in unncommen after 6 mths |
| whats the rold of a pneumocardiogram for assessing infatns atr risk for developing sids? | not an effective screening to ascertain preterm infants at risk of sids |
| what measurement is used to stage infatns sleep? | elevtroencephalogram, electrooculogram, electromyogram |
| to assess adequacy of vent to diff between central and obstructive apnea and severity what must polysomnography include? | movements of chest wall and abdomen, air flow at nose and mouth, end title CO2 |
| how is infant assessed for presence of gastirc reflux during polysomnogram? | esophageal pH continously measured |
| what chrarcterizes sleep in neonates? | full term infants can spend 50% total sleep in REM, in first few moths of life infants enter rem immediately |
| as infant matures what types of events occur as infant transitions to REM through lighter phase of NREM during night? | crying, vocalizing, and changing body poitions |
| what type of apnea occurs in sleep? | obstructive, central, and mixed |
| what best describes central sleep apnea? | no chest movement and hence no air flow |
| how will children who have osa breathe while awake? | normally |
| what conditions are often associated with osa? | large tonsils or adenoids, obesity, micrognathia |
| what type of effects are likely to develope in children who experience osa? | hyperactive behavior, poor school performance, daytime hypersomnolence |
| when can periodic breathing occur | anytime |
| why are apnea monitores used at home insensitive to determining osa? | can't differentiate between apnea and hypopneas |
| relative to an adults larynx where is an infant's larynx situated? | c3-4 |
| why does resp syncytual viral infection have little adverse effect on an older child yet life threatening to younger? | younger has fewer resp bronchioles |
| therapist hears low pitched shound on infants larynx, what impression on upper airway obstruction? | mild obstruction |
| why does an infant's res distress from choanal artesia seem to lessen when infant cries? | infant breates more through mouth |
| 30 mth child brought to the ER by parents child appears to have sore throat w dysphgia, fever and voice changes. hot potato voice, vizsualization reveals displaced retropharynx what condition is this? | retropharyngeal abscess |
| 4 yo child brought to er w high fever with severe soar throat, dysphagia w drollin and cough, + stridor,muffled voice without hoarseness air hunger and cyanosis supreasternal,substernal and intercostal retratctions with nasal flaring,bradypnea and dyspnea | epiglottitis |
| what lateral nech xray characteristic of larybgotracheobronchitis? | steeple sign |
| what medication should be admin to 4 yo w postextubation stridor | racemic epi and dexamothason |
| 2 yo wheezes equal in pitch all regions of chest loudest in vicinity of sternum, from which structure? | trachea |
| what x-ray is best for presence of ball valve type obstruction? | inspiratory and expiratory AP xray |
| what lobes of lungs are most at risk for collapse in intubated neonate lying supine | right upper lobe |
| xray shows dilation of segmental subsegmental bronchi, pt complains of expectorating copious thich mucus | bronchiectasis |
| 3 yo +nasal congestion +cough, sticky crackles, hyperinflation lung | bronchiolitis |
| what % pna in pediatric pt are viral | 80% |
| what interventions used to treat suckle cell anemia? | supplimental o2, bronchodilators, rbc transfusion |
| what types of cells play a role in pathophysiology of asthma? | mast cells, eosinophils, neutrophils |
| whats responsible for airway obstruction? | airway remodeling, airway edema, mucus plugging |
| what events occur during first phase of airway inflammation? | release of preformed mediators |
| what precesses are features of airway remodeling? | mucous hypersecretion, airway smooth muscle hypertrophy, inflammation |
| what appears to be the strongest identifiable predisposing factor for developing asthma? | atopy |
| what most common resp cirus isolated from infants who wheeze? | respiratory syncytial virus (RSV) |
| NAEPP when diagnosis of asthme is being made what criteria recomended? | physical exam, spriometry determine reversibility, detailed med history conducted |
| what spirometric measurements sensitive to small changes in airway | mean forced expiratory flow during middle half of FVC |
| hows clinical airflow limitation determined from pre and post bronch spirometry? | when pts FEV1 increases by 12% and 200ml/sec |
| which pharmocologic agents may be used for bronchoprovocation? | methacholine and histamine |
| what medications are classified as long term controllers of asthma? | leukotriene modifiers, methylxanthines, immunomodulators |
| if recomending short onset long acting beta agonist for pt w asthma? | formoterol |
| what medications indicated for 40 yo w mod/ severe asthma not controlled w inhaled corticosteroids and exibits + allergin test+ IgE level | omalizumab |
| whats typcial fist phar intervetion instituted by therpist to treat pt who entes ed | three treatments w alb 20-30 min apart |
Created by:
janeth4035