Unit 2.1 comprehensive review Buzbee 1/30/2007 8:09 AM 6
Kingwood College RSPT 2353: Unit 2-1 comprehensive review
Name: date: 2007
1. HMD [IRDS type I] is caused:
a. by insufficient levels of pulmonary surfactant, which decreases the lung compliance
b. by insufficient levels of pulmonary surfactant, which increases the air way resistance
c. no surfactant
d. none of these
2. Type II pneumocytes are the:
a. Cells that line the alveoli whose function is gas diffusion
b. Cells that secrete pulmonary surfactant
3. HMD [IRDS type I] results in a decreased FRC so that:
a. refractory hypoxemia results
b. baby’s WOB increases
c. both
d. none
4. The baby with HMD [IRDS type I] gets --- over the next 6 to 12 hours:
a. Better
b. Worse
5. Babies at risk for HMD [IRDS type I] include:
a. Preemies of less than 38 weeks
b. Preemies of less than 35 weeks
c. Full term infants of diabetic moms
d. A and c
e. B and c
6. TRUE/ FALSE Babies most at risk for premature birth are male infants born to teenage mothers who received very little prenatal care.
7. The X-ray of a patient with [IRDS type I] will show:
a. Areas of airtrapping
b. Widespread consolidation with air bronchograms
c. Ground glass with air bronchograms
d. b and c
e. a, b and c
8. The breath sounds of the infant with IRDS type II will have:
a. Diffuse inspiratory and expiratory wheezing
b. Rhonchi
c. Crackles in the apical lobes with basal BS diminished
d. a, b and c
9. The infant with HMD will have :
i. high Silverman
ii. low APGAR
iii. low Silverman
iv. high APGAR
a. i and ii
b. iii and iv
10. The arterial blood gases of a baby with HMD will display:
a. mixed acidosis with refractory hypoxemia and hypercapnia
b. uncompensated respiratory acidosis & severe hypoxia
c. none of the above
11. TRUE /FALSE The ratio of Lethcithin to sphingomyelin [L/S ratio] found in the amniotic fluid of the infant with low levels of surfactant will have a ratio below 2:1
12. TRUE /FALSE At lung maturity, the amniotic levels of phospha-tidyl-gycerol rises at 36 weeks; but in the diabetic ‘s infant this may be delayed.
13. In the shake test amniotic fluid is mixed with --.
a. Surfactant like "Cascade"
b. Ethanol
c. Blood
d. Sputum
14. If the surfactant is present in the shake test, bubbles will:
a. foam
b. not be foamy
15. Any preemie that gets enough supplementary 02 to get the Pa02 above ---- torr for even a short time can suffer the effects of excessive 02 on the eyes called retrolental fibroplagia or retinopathy of prematurity.
a. 45-55 torr
b. 60 torr
c. 80 torr
d. 90 torr
e. 120 torr
16. Anoxic episodes associated with HMD can lead to:
a. cerebral palsy
b. mental retardation
c. both are possible
17. Complications of HMD include:
a. Barotrauma from ventilation
b. 02 toxicity from supplemental 02
c. patent ductus arteriosus
d. Bronchopulmonary dysplagia [BPD]
e. All of these
18. Treatment of HMD includes supplementary 02 and or ventilation to:
a. Keep Pa02 between 55-65 torr
b. Keep pH above 7.25
c. Keep PaC02 below 60-65 torr
d. Bronchodilators
e. All but d
f. All but c
Case study # 1
19. Your patient is a 1200-gram preemie who is 30 weeks gestation by dates and exam. He has a Sp02 of 93% on Fi02 35% by heated hood. His respiratory rate is 48 bpm and his retractions are mild. You would treat him by:
a. Increase the Fi02 to 40% to get Sp02 up to 95%
b. Stay right where you are. He is fine
c. Place infant on CPAP at 35%
d. Intubate and ventilate
20. To monitor this infant you would like to see:
a. Arterial blood gases to assess the pH and the C02
b. X-ray to assess his lung disease
c. Both
21. Six hours later this same infant has a Sp02 87% on Fi02 of 45%. You suggest:
a. Draw an ABG and if the pH is acidotic and the C02 is increased intubate
b. Draw an ABG and if the pH and the C02 are WNL, place infant on CPAP at 5 cwp.
c. Both are correct
22. You draw arterial blood gases on a hood at 45% and see these gases:
PH 7.34
PaC02 45
HC03- 22
Pa02 48 torr
Sa02 87%
Fi02 45%
At this point in time you decide to:
a. intubate and ventilate and redo ABGs
b. place infant on nasal CPAP with Fi02 45% and redo ABGs
c. increase the Fi02 50% on hood and redo ABGs
23. Your patient is a 1050-gram infant who has Sp02 of 87% on hood of 50%. You suggest:
a. Get ABG and if Pa02 is 55-65 mmHg and C02 is ok stay there
b. Place infant on CPAP of 5 cwp & Fi02 50% & get ABGs
c. Place infant on CPAP of 10 cwp and Fi02 100% and get ABGs
24. Your patient is a 657 gram, 24-week preemie whose Sp02 is 87% on a heated hood at 50%; you would:
a. Intubate and provide CPAP 5-10 and repeat ABG
b. Place on nasal CPAP 5-10 and repeat ABGs
25. If you were given no specific orders and you had to set up a pressure ventilator for a preemie with HMD coming from L & D, what parameters would you select?
a. IMV 22 PIP 22 PEEP 6 Fi02 60% Ti .5 second
b. IMV 55 PIP 22 PEEP 5 Fi02 60% Ti .30 seconds
c. IMV 55 PIP 12 PEEP 10 Fi02 90% Ti .3o seconds
d. None of these
26. The inspiratory time for a preemie on mechanical ventilation needs to be:
a. between .3 and .5 seconds
b. between .5 and .7 seconds
c. about 1 second
27. If the ventilator settings for a child with HMD are correct, you would see:
a. The chest rise with the ventilator
b. The Sp02 rise
c. The child's spontaneous respirations decrease
d. All of these
28. Do patents with HMD need bronchodilators?
a. Yes
b. No
29. Do patients with HMD need chest physiotherapy?
a. Yes
b. no
30. Do patients with HMD need a lot of suctioning?
a. Yes
b. No
31. When the HMD patient's Sp02 rises without you increasing his PIP or Fi02, you might consider the fact that the patient might be:
a. Growing his own surfactant
b. Getting better
c. Both
d. None
32. If you wean a patient with HMD too rapidly you risk:
a. Throwing him into persistent fetal circulation
b. Making him hypoxic enough to cause brain damage or other organ failure
c. Both
d. None
33. If you wean a patient with HMD too slowly you risk:
a. Damaging his lungs with 02 toxicity
b. Damaging his lungs with barotrauma
c. Both
d. None
34. The cause of transient tachypnea of the newborn TTN is:
a. Transient fluid overload
b. A C-section without spontaneous labor
c. Pulmonary edema
d. All of these
35. The baby with HMD gets worse over 6 hours, the kid with TTN:
a. Gets worse over 12 hours
b. Gets better over 6 hours
36. Your infant is a 30-weeker who presents with APGARs of 7 and a Silverman score of 6. On Fi02 50%, he has a Sp02 89%. He most likely has:
a. HMD
b. Intrauterine pneumonia
c. TTN
d. Most likely has HMD but I need more info before I rule out "B"
37. The kid with TTN will have X-rays that show:
a. Hyper inflation alternating with consolidation
b. Ground glass and air bronchograms
c. Increased pulmonary engorgement and cardiomegaly
d. None of these
38. A child with TTN will be the one who:
a. Unexpectedly, got persistent fetal circulation
b. Unexpectedly, got better later in the day
39. Perinatal asphyxia is serious because:
a. Anoxia can happen without the clinician knowing about it
b. The fetus has too small a normal Pa02 to handle any compromise
c. The fetus will respond to anoxia by going into vasoconstriction of the peripheral blood vessels
d. All of these
e. A and b only
40. When the fetus gets hypoxic enough, his chemoreceptors will trigger breathing in utero.
a. If the Sa02 has dropped below 30% the fetus may have passed out and passed meconium
b. If the Sa02 has dropped below 70% the fetus may have passed out and passed meconium
41. Infants of less than – weeks rarely pass meconium
a. 40 weeks
b. 36 weeks
c. 34 weeks
d. 24 weeks
42. Post mature infants are at – risk of meconium aspiration
a. High
b. Low
43. Old meconium is yellow, new meconium is:
a. Black & tarry
b. Red
c. Green
44. The pathology of meconium includes:
a. atelectasis
b. air trapping
c. chemical pneumonitis
d. bacterial infection
e. all of these
45. Treatment of meconium includes:
a. Bag and suctioning
b. Suctioning below the cords before bagging
c. Chest PT and antibiotics
d. A and c
e. B and c
46. When a baby in severe respiratory failure has widespread alveolar hypoxia, the pulmonary capillary bed will:
a. Vasoconstrict
b. Vasodilation
c. Increase the work of the right heart
d. a and c
e. b and c
47. If the Pa02 in the Aorta drops too low the :
a. Foreman ovale re-opens
b. Ductus arteriosus re-opens
c. Both
48. When the RA pressure rises from the pulmonary HTN associated with low PA02 the :
a. Foreman ovale re-opens
b. Ductus arteriosus re-opens
c. Both
49. Prevention of Persistent Fetal Circulation includes :
a. keeping the Pa02 80-100 mmHg
b. keeping the Pa02 above 55 mmHg
c. keeping the Pa02 above 110 mmHg
50. Treatment of PFC may include:
a. keeping the Pa02 80-100 mmHg
b. keeping the Pa02 above 55 mmHg
c. keeping the Pa02 above 110 mmHg
51. If you are weaning a newborn and his Sp02 drops to the 80’s after a change, you must:
a. notify the doctor
b. immediately move to aggressive PFC prevention ventilator settings, then do A
c. Return to the last good parameter, then do A
52. Once the infant is in PFC, you must:
a. Get the patient into respiratory alkalosis
b. Get the patient into respiratory acidosis
c. Get the Pa02 back up – even with an Fi02 100%
d. a and c
e. b and c
53. Other therapies that work on PFC include:
a. Suctioning below the cords
b. Nitric oxide to vasodilate the pulmonary vessels
c. IV tolazoline to vasodilate all vessels
d. ECMO
e. All of these except A