Exam: Neonatal and Pediatric Pulmonary Care
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Select the best answer to each of the following items.

1. Common malformations originating in the _______ phase of lung development are the laryngeal cleft and tracheoesophageal fistula.
  1. embryonic
  2. canalicular
  3. pseudoglandular
  4. alveolar
2. In making the diagnosis of BPD, pulmonary function studies will show _______.
  1. a decreased respiratory rate
  2. decreased tidal volumes
  3. abnormal minute ventilation
  4. increased lung compliance
3. L/S ratios _______ are associated with pulmonary immaturity and respiratory distress syndrome (RDS).
  1. more than 2
  2. less than 3.5
  3. more than 3.5
  4. less than 1
4. Clinical signs of neonatal pneumonia include _______.
  1. hypothermia
  2. rosy skin color
  3. excessive signs of hunger
  4. inconsistent WBCs
5. A Approximately _____ of all pregnancies are deemed to be at risk for at least one of the various potential complications listed above.
  1. 7%
  2. 15%
  3. 29%
  4. 41%
6. While the fetal lung is not used as a gas exchange organ, it does have some very specific functions, including:
  1. a well-defined secretory function
  2. serves as a reservoir of carbohydrates
  3. a surfactant-producing organ
  4. all the above
7. Fetal breathing appears most related to _______.
  1. the central nervous system
  2. chemoreceptor stimulation
  3. arousal of the fetus
  4. all the above
8. Using the Apgar scoring system, a score of _____ indicates maximum distress/dysfunction for the parameter being evaluated.
  1. 0
  2. 1
  3. 2
  4. 3
9. Which of the following statements is NOT true regarding diaphragmatic hernia?
  1. It occurs in about 1 in 2,200 births.
  2. It is an extreme emergency and must be treated and corrected immediately upon diagnosis.
  3. In 90% of the cases, it occurs on the neonate's right side.
  4. It is caused by an incomplete embryologic formation of the diaphragm.
10. _______ is(are) considered to be the primary cause of BPD, which involves high pressures and high FIO2s.
  1. The treatment for RDS
  2. Enteric organisms such as E. coli and group B streptococcus
  3. Premature rupture of membrane with a delay before the onset of labor
  4. Meconium aspiration
11. _______ is a decrease in either lung weight or volume at birth.
  1. Hypoxia
  2. Hypoplasia
  3. Hypopnea
  4. Hypoxemia
12. In treating neonatal tension pneumothorax, the use of 100% oxygen can possibly increase the rate of absorption, but _______.
  1. it should be administered in conjunction with antibiotics
  2. treatment should only be initiated when alternative treatments have failed
  3. treatments cannot be administered prior to 20 days post delivery
  4. may increase the risk of developing retrolental fibroplasia
13. Surfactant produced during the _______ phase of lung development is immature and easily destroyed.
  1. embryonic
  2. canalicular
  3. pseudoglandular
  4. alveolar
14. _______ is the most common and significant of neonatal lung problems.
  1. Pneumonia
  2. Hyaline membrane disease
  3. BPD
  4. Croup
15. During lung development, _______ is the dominant connective tissue in airways, blood vessels, and nonrespiratory components of the lung.
  1. fibroblast
  2. elastin
  3. collagen
  4. mucous
16. _______ is useful only in the presence of abnormal FHR tracings, since normal tracing indicates a healthy infant in most instances.
  1. Pulmonary function testing
  2. L/S ratio calculation
  3. Fetal scalp pH assessment
  4. Fetal arterial blood gas evaluation
17. The best indicator of lung size is _______.
  1. lung weight
  2. DNA
  3. breaths per minute
  4. inflated lung volume
18. The most common manifestation of croup is laryngotracheitis, which is the result of a viral organism, with approximately 75% of all cases involving _______.
  1. RSV
  2. parainfluenza virus
  3. mycoplasma pneumonia
  4. influenzas
19. On the Silverman-Anderson scoring system, an infant with visible retractions of the lower chest and xiphoid, and with upper chest lagging compared to the lower on inspiration, receives a score of _____ on each of those parameters.
  1. 0
  2. 1
  3. 2
  4. 3
20. At about _____ weeks of gestational age, the tracheobronchial tree with 18 segmental bronchi has developed.
  1. 3
  2. 6
  3. 10
  4. 14
 

21. Infants of diabetic mothers are more _______.

  1. suseptible to infection
  2. likely to be hypoglycemic
  3. likely to be hypocalcemic
  4. all the above
22. When _______ is suspected, it can be assessed by measuring maternal urinary estriol levels.
  1. uteroplacental insufficiency
  2. toxemia
  3. RDS
  4. fetal asphyxia
23. Meconium passes into the amniotic fluid most frequently in _______ babies.
  1. preterm
  2. term
  3. postterm
  4. all are about the same
24. When monitoring FHR, if a pattern of severe bradycardia (<80/min) and loss of variability is observed, you should suspect that the fetal problem is likely _______.

  1. infection, often with apnea
  2. fetal hemorrhage, asphyxia
  3. asphyxia, possible hypovolemia
  4. severe anemia with asphyxia
25. _______ is(are) not only essential for reduction of surface tension and airway patency, but also for changing interstitial and capillary pressures.
  1. Elastin
  2. Alveoli
  3. Surfactant
  4. Amniotic fluid
26. By the time the _____ phase of lung development is occurring, the structure of the lung is usually sufficient to survive injuries.
  1. embryonic
  2. canalicular
  3. pseudoglandular
  4. alveolar
27. The treatments for croup include _______.
  1. nebulized racemic epinephrine
  2. aerosolized corticosteroids
  3. antibiotics such as chloramphenicol and ampicillin
  4. anti-inflammatory medications
28. Treatments for epiglottitis include _______.
  1. nebulized racemic epinephrine
  2. aerosolized corticosteroids
  3. antibiotics such as chloramphenicol and ampicillin
  4. anti-inflammatory medications
29. Which of the following statements regarding Bronchiolitis is NOT true?
  1. It is a bacterial infection.
  2. Treatment may require hospitalization to control intake of fluids and potential apea.
  3. It is highly contagious.
  4. About 75% of all cases are caused by RSV.
30. If fetal distress is suspected following FHR monitoring, _______ is an important secondary tool for determining fetal well-being.
  1. evaluating maternal estriol levels
  2. chorionic villus sampling
  3. amniocentesis to determine the L/S ratio
  4. assessment of fetal scalp pH .
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