Term
| What phase of human lung development occurs from 17 to 26 weeks of gestation, and is characterized by the formation of a capillary network around airway passages? |
|
Definition
|
|
Term
| Regarding postnatal lung growth, by approximately what age do most of the alveoli that will be present in the lungs for life develop? |
|
Definition
|
|
Term
| What mechanisms appear to explain why oligohydramnios is associated with lung hypoplasia? |
|
Definition
| The amount of lung liquid present in the fetus is a major determinant of lung growth, because chronic tracheal drainage produces pulmonary hypoplasia and tracheal ligation produces lungs with increased tissue mass. |
|
|
Term
| What is the purpose of the material secreted by the type II pneumocyte |
|
Definition
| The produce surfactant and the purpose of the surfactant is to reduce surface tension within the alveolus. |
|
|
Term
| What vascular networks is the major source of fetal lung liquid? |
|
Definition
| The pulmonary circulation |
|
|
Term
| What is the function of Wharton’s jelly inside the umbilical cord? |
|
Definition
| To protect the vessels inside the umbilical cord and keep the cord from kinking |
|
|
Term
| During the third gestational week, what organs is the first to form? |
|
Definition
|
|
Term
| What is the approximate fetal heart rate by the sixth week of gestation? |
|
Definition
|
|
Term
| What anatomic structures constitute fetal shunts? |
|
Definition
| Ductus venosus, foramen ovale, ductus arteriosus, |
|
|
Term
| What events cause cessation of right-to-left shunt through the foramen ovale? |
|
Definition
| When the cord is clamped, pressures in the right side of the heart decreased and pressures in the left side of the heart increase. Because the foramen ovale flap allows blood to flow only from right to left, it closes when the pressures in the left atrium become greater than those in the right atrium. |
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|
Term
| What events or conditions is the most important risk factor for preterm birth? |
|
Definition
|
|
Term
| What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid the development of fetal alcohol syndrome? |
|
Definition
|
|
Term
| What is the average birth weight difference between infants born of mothers who smoke and those born of nonsmoking mothers? |
|
Definition
| 200g less than those who don’t smoke |
|
|
Term
| What conditions are associated with preeclampsia? |
|
Definition
•Systolic BP higher than 160
•Diastolic BP higher than 110
•Proteinuria 5g/24hr
•Intrauterine growth restriction
•Pulmonary edema
•Oliguria (less than 500ml in 24 hr),
•Thrombocytopenia (100,000/ml)
•Headache
•Epigastric pain
•Hepatocellular dysfunction,
•Grand mal seizure |
|
|
Term
| What maternal and/or fetal conditions are associated with pregestational diabetes? |
|
Definition
Maternal:
•Ketoacidosis
•Proliferative retinopathy
•Preeclampsia
Fetal:
•Unexplained fetal death 3rd trimester
•Major structural malformations (most common: malformations of the cardiovascular system,
•CNS (Brain and spinal cord) malformation |
|
|
Term
| What drugs is recommended to treat a group B Streptococcus infection for a patient who is allergic to penicillin? |
|
Definition
| Vancomycin if sensitive to clindamycin and erythromycin |
|
|
Term
| What is the main potential problem associated with the premature rupture of membranes? |
|
Definition
|
|
Term
| What maternal or fetal conditions can be determined or assessed via amniocentesis? |
|
Definition
•Pulmonary surfactant
•Rh factor, bilirubin
•Chromosomal abnormalities (trisomy 21)
•Fetal enzyme deficiencies (Tay-Sachs)
•Genetic mutations (sickle cell disease) |
|
|
Term
| What of maternal complications are associated with cesarean section? |
|
Definition
•Significant blood loss,
•Anesthesia complications
•Intraoperative bowel injuries
•Post op wound infections
•Endomyometritis
•Thromboembolic events |
|
|
Term
| How should the therapist interpret an amniotic fluid index of 5 cm? |
|
Definition
| If the fluid is below 5 cm it's called oligohydramino they have too little amniotic fluid |
|
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Term
| A fetus is undergoing a contraction stress test. Uterine contractions are stimulated by the intravenous infusion of oxytocin into the mother. The fetal PO2 drops below 12 mm Hg and causes the fetal heart rate to slow. What conditions is likely indicated by this occurrence? |
|
Definition
| Late deceleration and uteroplacental insufficiency |
|
|
Term
| How should the therapist interpret a fetal biophysical profile score of 7? |
|
Definition
| Not normal, not abnormal; repeat the test in 24 hrs |
|
|
Term
| In lieu of obtaining a scalp blood gas sample, what can the therapist do to conduct intrapartum assessment of the fetus? |
|
Definition
|
|
Term
| What medication(s) are used as tocolytics? |
|
Definition
• Magnesium sulfate
• Beta-mimetic agents
• Indomethacin |
|
|
Term
| What outcomes is associated with intrapartum amnioinfusion of postterm infants demonstrating meconium-stained amniotic fluid? |
|
Definition
| Improvement in fetal outcome and lower cesarean delivery rate |
|
|
Term
| A team has been summoned to the delivery room to perform neonatal resuscitation. Because no perinatal history is available, what information would be useful for the resuscitation team to know in preparation for this event? |
|
Definition
•If mother ins in premature labor
•Approximate gestational age of infant
•Number of babies expected
•If meconium is present in amniotic flulid |
|
|
Term
| What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate? |
|
Definition
| Immediately remove wet linens, wrap infant in prewarmed blankets, if less than 1500g wrap new born in topical polyethylene film to reduce evaporative heat loss |
|
|
Term
| While stabilizing a preterm neonate before resuscitation, the therapist notices the infant display laryngeal spasm, bradycardia, and a delayed onset of spontaneous breathing. What could have caused these events to occur? |
|
Definition
| Aggressive pharyngeal or stomach suctioning |
|
|
Term
| As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats/minute, 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? |
|
Definition
|
|
Term
| As the head of a neonate contaminated with meconium emerges at birth, the heart rate monitor indicates 120 beats/minute, 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? |
|
Definition
|
|
Term
| A preterm neonate with a heart rate of 55 beats/minute is receiving positive-pressure ventilation immediately after delivery. What should the therapist do at this time? |
|
Definition
| Do not suction the stomach until vital signs are stable and infant has been fully resuscitated |
|
|
Term
| A term infant is born displaying acrocyanosis. What should the therapist do at this time? |
|
Definition
| This is common just make sure there is not central cyanosis |
|
|
Term
The therapist has completed a 1-minute Apgar score. The following evaluations were obtained:
(1) the infant is pale;
(2) the heart rate is 90 beats/minute;
(3) the respiratory effort is irregular;
(4) some muscle tone is noted; and
(5) no response to nasal suctioning is found.
On the basis of these findings, what Apgar score should be assigned to this neonate? |
|
Definition
|
|
Term
| The therapist, working with a neonate, observes that the newborn has adequate ventilatory efforts and a heart rate of 120 beats/minute. However, at the same time, the infant demonstrates cyanosis of the lips and mucous membranes. What should the therapist do at this time? |
|
Definition
| Administer 100% oxygen with a mask or funnel, hold maks ½ inch away from nose at a flow of 6-8L/min, withdraw as color improves |
|
|
Term
| 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? |
|
Definition
| Nothing, the therapist is displaying proper technique |
|
|
Term
| While performing positive-pressure mechanical ventilation on a neonate, the therapist notices that the infant’s thorax is not displaying bilateral expansion during each inspiration. Auscultation of the chest reveals diminished bilateral breath sounds. The infant’s heart rate is 85 beats/minute, and observation demonstrates central cyanosis. What events may have caused this clinical situation? |
|
Definition
| Poorly positioned or leaking mask, obstructed airway, inadequate inspiratory pressure, pneumothorax |
|
|
Term
| What appears to be the reason for the infrequent need to administer chest compressions and cardiopulmonary resuscitative drugs to neonates in the delivery rooms? |
|
Definition
| Providing adequate ventilation is the primary factor in the effective resuscitation of a neonate, Most neonates will respond once ventilation is established. |
|
|
Term
| What ratio of chest compressions and positive-pressure breaths must the therapist administer to a newborn during cardiopulmonary resuscitation? |
|
Definition
| 1 breath for every 3 chest compressions |
|
|
Term
| The therapist has been performing cardiopulmonary resuscitation on a neonate for about 90 seconds, applying ventilation with 100% oxygen and chest compressions. The infant has maintained a spontaneous heat rate of 40 beats/minute. What should the therapist recommend at this time? |
|
Definition
|
|
Term
| What medication is used to reverse respiratory depression induced by opioid overdose? |
|
Definition
|
|
Term
| What actions constitute appropriate stimulation of a neonate? |
|
Definition
| Flicking the bottoms of the feet, gently rubbing back drying with a towel |
|
|
Term
| What factors are taken into consideration when assessing the gestational age of a neonate? |
|
Definition
•Gestational duration based on the last menstrual cycle
•Prenatal ultrasound evaluation
•Postnatal findings based on physical and neurologic examination |
|
|
Term
| The gestational age of a newborn has been evaluated to be 34 weeks. The newborn’s birth weight is greater than the 90th percentile. How should the therapist classify this infant? |
|
Definition
| The baby is large for gestational age |
|
|
Term
| An infant arrives in the newborn nursery with an axillary body temperature of 95.6º F. What events may be responsible for this infant’s temperature? |
|
Definition
| The delivery room could have been cold |
|
|
Term
| A physical examination is being performed on a newborn, and the therapist notices that the infant’s arms do not move symmetrically. What situations could account for this problem? |
|
Definition
| The infant could have an broken clavicle or an injury to the brachial plexus |
|
|
Term
| 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, what conditions should the therapist anticipate this patient having? |
|
Definition
|
|
Term
| What neonatal skin presentation at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome? |
|
Definition
| A ruddy, reddish blue appearance |
|
|
Term
| Why are chest retractions more prominent among neonates than among older children and adults? |
|
Definition
| Chest wall retractions are more prominent and easily observed in the neonate than in an older child or adult. The newborn musculature is relatively thin and weak, and the thoracic cage is not as rigid. The flexible chest wall and thoracic cage of the newborn exhibit noticeable retractions as lung compliance worsens. |
|
|
Term
| Why is it difficult to localize auscultation findings of the thorax of a newborn? |
|
Definition
| The newborn chest is small and sounds easily transmit from one lung to another. Abdominal sounds may even transmit to the lungs |
|
|
Term
| While performing a physical examination on a newborn infant, the therapist notices that the point of maximal cardiac impulse is to the left of the sternal border. What conditions can cause this situation? |
|
Definition
|
|
Term
| What would you use the procedure called transillumination to diagnose? |
|
Definition
| Ductus arteriosus and left to right shunt. |
|
|
Term
| What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal? |
|
Definition
| The cause may be volume depletion with compensatory peripheral vasoconstriction |
|
|
Term
| For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, what sites would render postductal blood? |
|
Definition
| The left arm and lower extremities |
|
|
Term
| What conditions can cause abdominal distention? |
|
Definition
•Sepsis
•Obstruction
•Tumors
•Ascites
•Pneumoperitoneum
•Necrotizing entercolitis |
|
|
Term
| What conditions are associated with scaphoid abdomen? |
|
Definition
| Congential diaphragmatic hernia |
|
|
Term
| While performing an examination of the abdomen of a neonate, the therapist is able to palpate the infant’s liver 1 to 2 cm below the right costal margin. What conditions can account for this development? |
|
Definition
| Hepatomegaly or hemolytic disease |
|
|
Term
| After the umbilical cord has been cut in the delivery room during the delivery of a large for gestational age infant, the therapist notices that the umbilical cord is large and fat. What maternal condition is likely present? |
|
Definition
|
|
Term
| A newborn who presents as pale, mottled, floppy, with little interest in feeding, and slightly irritable most likely has what possible conditions? |
|
Definition
|
|
Term
| The therapist has placed a pulse oximeter probe on a finger of the right hand of a newborn and another pulse oximeter probe on a toe of the infant’s left foot. The pulse oximeter on the right hand reads 80% and the one on the left foot indicates 65%. What disease conditions does this neonate possibly have? |
|
Definition
| Significant shunting through ductus arteriosus |
|
|
Term
| What white blood cell counts constitutes the condition leukopenia? |
|
Definition
|
|
Term
| What is the incidence of respiratory distress syndrome (RDS) among infants born at less than 28 weeks of gestation? |
|
Definition
|
|
Term
| During the course of RDS, what conditions are responsible for the reduction in pulmonary blood flow? |
|
Definition
| Deficient surfactant production or deficient release of surfactant into the immature respiratory alveoli (coupled with extremely compliant chest wall) |
|
|
Term
| Why are term or near-term infants commonly overlooked as a group of patients at risk for developing RDS? |
|
Definition
| Because of their strength and pulmonary reserve, they may be able to cope with RDS for a longer period of time |
|
|
Term
| What is the significance of an infant with RDS demonstrating a grunt during each exhalation? |
|
Definition
| An attempt to maintain FRC and impending respiratory failure |
|
|
Term
| The therapist is reviewing the chest radiograph of a newborn, preterm infant and observes diffuse, fine, reticulogranular densities, which provide a ground-glass appearance. On the basis of these radiographic findings, which of the following conditions should the therapist suspect is present? |
|
Definition
|
|
Term
| How should the therapist interpret a lecithin-to-sphingomyelin (L/S) ratio of 2:1? |
|
Definition
| Infant not at risk for RDS, lung maturity |
|
|
Term
| How should the therapist interpret the fact that no supernatant foam appears during the shake test? |
|
Definition
|
|
Term
While reviewing the chest X-ray of a newborn, the therapist observes the following features:
•Pulmonary vascular congestion
•Prominent perihilar streaking
•Fluid in the interlobular fissures
•Hyperexpansion
•Flat diaphragm
Which of the following conditions does this patient likely have? |
|
Definition
| Transient tachypnea of the newborn |
|
|
Term
| What therapeutic interventions are generally needed to treat transient tachypnea of the newborn (TTN)? |
|
Definition
| Rule out pneumonia and sepsis and administer a broad spectrum antibiotic |
|
|
Term
| What microorganisms are responsible for nosocomial pneumonia acquired after delivery? |
|
Definition
•Listeria monocytogenes
•Haemophilus influenza
•Mycobacterium tuberculosis
•Treponema pallidum
•Toxoplasma
•Syphilis
•Rubella
•Varicela zoster |
|
|
Term
| When neonatal pneumonia is suspected, how long does an infant generally receive broad-spectrum antibiotics? |
|
Definition
|
|
Term
| Why does meconium staining occur predominantly in infants greater than 36 weeks of gestational age? |
|
Definition
| Because meconium passage into the amniotic fluid requires strong peristalsis and anal sphincter tone, preterm infants do not have this |
|
|
Term
| What is the typical type of airway obstruction that occurs with MAS? |
|
Definition
|
|
Term
| What radiographic features is the therapist likely to see on a typical chest X-ray of an infant with MAS? |
|
Definition
| Patchy areas of atelectasis due to obstruction, as well as hyperexpansion from air trapping |
|
|
Term
| What conditions is/are responsible for causing primary persistent pulmonary hypertension of the newborn (PPHN)? |
|
Definition
Primary
•Anatomic malformation( alveolar capillary dysplasia, pulmonary hypoplasia)
•Genetic differences in pulmonary smooth muscle development
•Chronic intrauterine stress
•Intrauterine closure of the ductus arteriosus
•Abnormal levels of vasoagents (vasoconstrictors/dilators)
Secondary: associated with other disease processes
•MAS
•Congential heart disease
•Infection
•Polycythemia
•Upper airway obstruction |
|
|
Term
| Blood samples are simultaneously obtained from both the right radial artery and the umbilical artery, and the arterial partial pressure of oxygen (PaO2) value from the right radial artery is 20 mm Hg greater than that analyzed from the umbilical artery sample. On the basis of this finding, what condition does the neonate likely have? |
|
Definition
|
|
Term
| What conditions may favorably respond to inhaled NO therapy? |
|
Definition
•PPHN
•Hypoxic pulmonary hypertension
•Methacholine-induced bronchoconstriction
•Septic shock
•ARDS
•High altitude pulmonary edema |
|
|
Term
| What clinical presentations signs are associated with apnea of prematurity? |
|
Definition
•Snoring
•Chocking
•Mouth breathing |
|
|
Term
| What medications should the therapist recommend for an infant with apnea of prematurity experiencing prolonged episodes of apnea? |
|
Definition
| Methylxanthine derivatives (caffeine, theophylline or doxapram) |
|
|
Term
| What intervention should the therapist perform when an infant is born with choanal atresia? |
|
Definition
| A surgical procedure that perforates the atresia to establish and maintain adequate choanae |
|
|
Term
| What should a respiratory therapist do to confirm a diagnosis of choanal atresia? |
|
Definition
| Stick an 8 french catheter through the nose into the oropharynx, if it fails to pass through the nose into the oropharynx, choanal atresia is suspected. |
|
|
Term
| What condition is consistent with the cluster of anomalies of micrognathia, glossoptosis, and cleft palate in a newborn? |
|
Definition
|
|
Term
| What forms of tracheoesophageal fistula and esophageal atresia is most common? |
|
Definition
| The most common comvination of lesions is esophageal atresia associated with distal tracheoesophageal fistula |
|
|
Term
| What is the role of radiography in the determination of tracheoesophageal fistula and esophageal atresia? |
|
Definition
| The lung fields must be examined to determine the presence of parenchymal changes resulting from aspiration |
|
|
Term
| What are the complications associated with performing esophageal anastomoses to repair esophageal atresia? |
|
Definition
| The most significant complication of primary esophageal anastomosis is stricture or recurrent fistula formation |
|
|
Term
| What clinical manifestations characterize congenital diaphragmatic hernia? |
|
Definition
| Compression of the developing ipsilateral lung bud. The contralateral side may be compressed as well from shift of the mediastinum. The lung tissue is hypoplastic including the pulmonary vasculature, even on the contralateral side. |
|
|
Term
| What factors cause exacerbation of pulmonary hypertension in patients who have congenital diaphragmatic hernia? |
|
Definition
| After birth, hypoxia, hypercapnia, and acidosis develop causing constriction of arterioles. The constriction exacerbates pulmonary hypertension and persistent fetal circulation |
|
|
Term
| What condition is consistent with the presence of a scaphoid abdomen in a newborn with tachypnea? |
|
Definition
| Congenital diaphragmatic hernia |
|
|
Term
| What interventions are used to treat congenital diaphragmatic hernia? |
|
Definition
•Orogastric tube decompresses the GI tract
•Bag mask ventilation avoided to keep chest from distention and causing tension pneumothorax
•ETT and mech vent to avoid high airway pressure
•HFOV to prevent barotrauma
•Maintianing alkalosis to reduce pulmonary vasospasm
•Surgical intervention |
|
|
Term
| What is the most common patient complaint associated with pectus carinatum? |
|
Definition
|
|
Term
| An infant presents with abdominal distension, intolerance to feeding, rectal bleeding, and abdominal wall erythema. Laboratory findings include thrombocytopenia, neutropenia, and metabolic acidosis. An abdominal radiograph reveals distended loops and pneumatosis intestinalis. What condition is consistent with these findings? |
|
Definition
|
|
Term
| What cell type is responsible for producing pulmonary surfactant? |
|
Definition
| Lung alveolar type II cells |
|
|
Term
| What term describes air leaving the lungs and entering the pulmonary interstitial spaces as a consequence of barotrauma? |
|
Definition
|
|
Term
| At 1 and 5 minutes after birth, a 30-week gestational age premature newborn had Apgar scores of 4. Now, at 3 days old, the infant is receiving mechanical ventilation with an inspired fraction of oxygen (FIO2) of 0.70 and high inspiratory pressures. Which of the following conditions is likely to develop? |
|
Definition
| Retinopathy of Prematurity |
|
|
Term
| When a newborn presents with tachypnea, hypoxemia, or hypercarbia, what condition should the therapist immediately suspect? |
|
Definition
|
|
Term
| A 1-day-old infant receiving mechanical ventilation suddenly exhibits cyanosis, a drop in transcutaneous pressure of oxygen (PO2), bradycardia, and hypotension. A chest radiograph shows gas surrounding and collecting beneath the inferior surface of the heart. Which of the following conditions should the therapist consider? |
|
Definition
|
|
Term
| Immediately after delivery of a newborn, where should the therapist place the transcutaneous PO2 electrode to obtain readings reflecting preductal oxygenation assessment? |
|
Definition
| On the right wrist or right thorax |
|
|
Term
| What action should the therapist take regarding infants who do not favorably respond to surfactant replacement therapy and conventional mechanical ventilation? |
|
Definition
| High frequency ventilation |
|
|
Term
| What condition is consistent with finding a transcutaneous PO2 difference of 25 mm Hg between an infant’s right wrist and left leg? |
|
Definition
|
|
Term
| At birth, what factor causes dilation of the pulmonary vascular bed and a decrease in the pulmonary vascular resistance? |
|
Definition
| Closure of the ductus arteriosus |
|
|
Term
| What factor is responsible for closure of the foramen ovale? |
|
Definition
| The ductus arteriosus closes spontaneously as a result of hormonal, chemical, and blood gas chanes |
|
|
Term
| What congenital cardiac defects may spontaneous closure of the ductus arteriosus be catastrophic? |
|
Definition
| Ductal- dependent lesions: severe coarctation of the aorta, hypoplastic left heart syndrome, tertralogy of fallot with pulmonary atresia |
|
|
Term
| How should the therapist interpret a preductal-to-postductal PO2 difference of 8 mm Hg in a neonate? |
|
Definition
| There is no indication of significant ductal shunting, shunting would be greater than 15mmHg |
|
|
Term
| What methods are involved in management of PDA? |
|
Definition
•Maintaing euvolemia
•Keeping hemoglobin level at the high end of normal
•Providing indomethacin treatment |
|
|
Term
| What clinical manifestations are consistent with a large ventricular septal defect (VSD)? |
|
Definition
| Congestive heart failure and pulmonary hypertension |
|
|
Term
| Why must supplemental oxygen be judiciously administered to patients with an atrioventricular canal defect? |
|
Definition
| To minimize pulmonary vascular dilation, which might increase pulmonary blood flow, causing pulmonary vascular engorgement |
|
|
Term
|
Definition
| Hypoplastic Right Ventricle |
|
|
Term
|
Definition
| Complete Transposition of the Great Arteries |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| Total Anomalous Pulmonary Venous Return |
|
|
Term
|
Definition
| Outflow obstruction Hypoplastic Left Ventricle |
|
|
Term
|
Definition
| Outflow Obstruction Coarctation of the Aorta |
|
|
Term
|
Definition
| Outflow obstruction Aortic Stenosis |
|
|
Term
|
Definition
| Atrioventricular Canal Defect |
|
|
Term
|
Definition
| Ventricular Septal Defect |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
