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Northeastern University
Perinatal Respiratory Care Midterm
. 1.   The greatest problem the mother experiences in preeclampsia  is:
  1.  diabetes
  2.   anemia
  3.   hypertension
  4.   dyspnea/respiratory insufficiency
2. The optimal range of machine delivered tidal volume for infants is:
  1. that volume which expands the lungs 9-10 ribs by CXR.
  2. 5-8 ml/kg
  3. the volume delivered by the peak pressure ordered by the physician
  4. 20 ml for an infant who weighs 2kg
  5. pressure which drives the PaCO2 to between 48 and 52 mmHg
  • 3.   The ductus arteriosus is located between:
    1.   the umbilical vein and the portal vein
    2.   the pulmonary artery and the aorta
    3.   the right and left atria
    4.   the pulmonary artery and the superior vena cava
  • 4. Artificial surfactant has just been delivered to a newborn and the O2 saturation is climbing fast.  Compared to just before surfactant delivery, we expect that the machine measured compliance initially:
    1. drops
    2. rises dramatically right away
    3. is unaffected by surfactant
    4. rises and then drops slowly over the next 20 minutes
  • 5.   In the process of labor and delivery, the term "station refers to:
    1. the location of the radiant warmer in the delivery room
    2. the various stages of labor
    3. the location of the fetal head
    4. the degree of dilation and effacement
  • 6. Of all listed situations transient tachypnea of the newborn is most likely the primary cause of respiratory distress in:
    1. infant born by scheduled caesarian section
    2. premature infant born 27 weeks after premature labor
    3. infant born after 6 hours labor 39 wks gestation by Caesarian for cephalopelvic disproportion (CPD)
    4. infant born after pitocin induced vaginal delivery at 42 weeks gestation for failure to progress
  • 7.  Fetal hemoglobin (HbF) plays which of the following roles in oxygen delivery to the fetus and newborn?
    1.    It raises mean arterial PO2
    2.    It provides for less hemoglobin affinity for oxygen than adult hemoglobin and therefore allows oxygen to be released more easily to the tissues
    3. It provides for a higher arterial oxygen saturation for a given PO2 than adult hemoglobin
    4.  It reduces diffusing capacity for oxygen between placental and fetal blood before birth and between alveolar gas and arterial blood after birth
  •   8.  Teratogenesis refers to the:
    1.  potential effects that preeclampsia has on the fetus
    2.   presence of hypoglycemia, hypocalcemia, and hyperbilirubinemia in the newborn shortly after birth
    3.   potential effects that drugs and tobacco have on the fetus
    4.   early development of congenital defects brought on by genetic factors
  •  9.  A premature newborn with low Apgar scores is in the delivery room.  His gestational age has not yet been determined, and his mother has had no prenatal care.  He is being evaluated for respiratory distress and the need for immediate prophylactic surfactant replacement therapy.  Which of the following would be most useful in the evaluation?
    1. shake test on fluid aspirated from the baby's orogastric tube
    2. L:S ratio from amniotic fluid
    3. estriol level of the newborn's urine
    4. Dubowitz/Ballard assessment
  •  10.  The overall pulmonary functional abnormality seen in an infant with Respiratory Distress Syndrome (RDS) is a(n):
    1. increased compliance
    2. decreased airway resistance
    3. decreased compliance
    4. increased airway resistance
  • 11.  Which of the following is reported to stimulate the initiation of the breathing pattern at birth?
    1. chemoreceptor response to changes in PO2, PCO2, and pH
    2.  recoil of the thorax after it is compressed in the birth canal
    3. environmental stimuli such as light and temperature changes
    4. all of the above
  • 12. Small exhaled tidal volume compared to inhaled volume suggest what problem(s):
    1. a. cystic adenomatiod malformation
    2.  tracheoesophageal fistula
    3. leak around the ett
    4.  large leak through a chest tube
    5.  gastroscheis
  •  13.  We compare a 24 wk gestation preemie's flow volume loops while ventilated at 2 days of age to those while still ventilated at 45 days of age. We see:
    1. shorter time constants at 45 days of age
    2. better bronchodilator response at two days of age
    3. greater expiratory airflow obstruction at 45 days of age
  •  14. A 6 week old infant (born at 28 weeks gestation) is evaluated for apnea with a 12 hour pneumogram study. The pneumogram inlcludes: pulse oximetry, nasal flow sensor, thoracic impedence monitoring of respirations, and EKG.  'Spells' are noted where there is evidence of chest movement (by impedence), but there is bradycardia, hypoxia and very low intensity thermister readings.  This is evidence of:
    1. RDS
    2. central apnea
    3. SIDS
    4. obstructive apnea
  •  15.  The goals for treating RDS are:
    1. to prevent further alveolar atelectasis
    2. to prevent the side effects of asphyxia and poor perfusion
    3. to prevent infection and the many complications associated with this disease
    4. all of the above
  • 16. Treatments for apnea include:
    1. CPAP
    2. aminophilline
    3. caffine
    4. all of the above
  • 17.  A newborn infant who shows the effects of a "ball-valve" type of airway obstruction is most likely suffering from:
    1.  pneumonia
    2. transient tachypnea of the newborn (TTN)
    3. hyaline membrane disease (HMD)
    4. meconium aspiration syndrome (MAS)
  • 18. On a pressure/volume trace, the inspiratory wave flattens out at the end of inspiration (duckbilling).  This may indicate:
    1. need to increase peep to improve FRC
    2. leak in flow sensor
    3. pressure is maximally distending the lung
    4. leak around the endotracheal tube
  • 19.  The problem that occurs in the condition of prolapsed umbilical cord is when the cord is:
    1. wrapped one or more times around the fetus' neck
    2. anatomically deformed, such as in the case of containing two blood vessels instead of three
    3. positioned distally to the fetal head and protrudes through the birth canal
    4. much too short to accommodate the growing fetus
  • 20.  Consider two alveoli, spheres or clown balloons.  One is less expanded than the other.  Which of the following is correct in describing the relationship of the values of surface tension, radius and pressure in a spherical shape?  (P=2ST/r)
    1. pressure varies inversely with surface tension
    2.  sphere radius varies inversely with pressure (i.e. the smaller balloon requires more pressure to sustain inflation)
    3. surface tension varies directly with radius (i.e. the larger sphere has higher surface tension than the smaller one)
    4. both radius and surface tension vary directly with pressure
  • 21.  The most effective post-natal treatment for hyaline membrane disease (HMD) to be developed since mechanical ventilators with CPAP/PEEP systems is:
    1. exogenous pulmonary surfactant
    2. corticosteroids
    3.  indomethacin
    4. surgical PDA ligation
  • 22  Intraventricular hemorrhage  (IVH) in the premature newborn, most often initially occurs in which area of the brain?
    1. the brain stem
    2. the shiny choroid plexus, where cerebrospinal fluid is produced
    3. the vascularly rich germinal matrix where glial cells develop
    4. any subdural area
  • 23. Which of the following statements is true regarding retinopathy of prematurity (ROP)
    1. ROP cannot develop in the term or near term infant
    2. High arterial PO2 may constrict retinal blood vessels in the newborn and may lead to vessel necrosis.
    3. The capillary network of the retina ceases it's development at birth therefore, subtotal or total detachment of the retina is inevitable in prematurity
    4. Low PaO2 has little effect on the growth of retinal vessels
  • 24. Necrotizing entero colitis  (NEC) is most likely to occur in the:
    1. very premature infant with hypoxic or asphyxic episodes
    2.  infant with duodenal atresia
    3. postmature infant with meconium aspiration
    4.  infant with serious multiple congenital anomalies
  • 25. Hyperbilirubinemia is treated with
    1. phototherapy
    2. oxygen
    3. potassium
    4. insulin
  • 26. Retinopathy in the NICU is related to
    1. hyperoxia
    2. hypoxemia
    3. prematurity
    4. all of the above
  • 27. Which of the following is the most common pattern of diaphragmatic hernia?
    1. right herniation due to an absent hemidiaphragm.
    2. Left herniation secondary to an accidental anomalous tear of the diaphragmatic tissue
    3. Left hernia through underdeveloped diaphragm (at foramen of Bochdaleck)
    4. Right herniation due to abnormal pressure by an enlarged liver and subsequent rupture of the diaprhragmatic wall.
  • 28. Concerning infant airway resistance:
    1. most resistance is in the lower airways
    2. changing an endotracheal tube from a 3.0 to a 2.5 will improve ventilation
    3. at ventilator  flows over 6 liters/minute,  endotracheal flow changes from laminar to turbulent
    4. shortening an endotracheal tube length by half reduces it's resistance to the fourth power.
  • 29. The most common cause of a premature infant’s central apnea, or apnea of prematurity is:
    1. hypothermia
    2. immaturity of the CNS
    3. the infants inability to go into REM sleep because of external NICU noises and stress
    4. the use of prostaglandins
  • 30. The herniation of abdominal viscera into the base of the umbilical cord is called:
    1. visceral prolapse
    2. gastroschesis
    3. omphalocele
    4. meconium ileus
  • 31. A mass occurring in the newborn lung which is comprised of terminal bronchiolar tissue with immature alveoli is most likely a(n):
    1. Hypoplastic pneumatocele
    2. area of pulmonary interstitial emphysema
    3. area of congenital lobar emphysema
    4. cystic adenomatoid malformation
  • 32. We perform a post-mortem investigation of a SUSPECTED SIDS (Sudden Infant Death Syndrome) victim.  Consider which of the following to be significant associated contributing factors in SIDS?
    1. prone positioning
    2. homicide
    3. maternal smoking, winter season, age 1-3 months
    4. all of the above
  • 33. Which of the following is the most commonly presenting form of tracheoesophageal anomaly?
    1.  a pouch and fistula in the superior trachea with atresia below the pouch
    2. a configuration in which the esophagus appears to grow into the trachea superiorly and out of the trachea inferiorly
    3.  a configuration in which there is esophageal atresia or sudden “interruption” in esophageal tube but there is no fistula between the esophagus and the trachea
    4.  a pouch due to esophageal atesia; inferiorly, there is growth of the esophagus out of the trachea
  • 34. An infant shows respiratory distress with some cyanosis.  You observe that when the baby cries, his color becomes pink and his breathing less labored.  You should suspect which of the following anomalies?
    1.  tracheoesophageal fistula
    2.  diaphragmatic hernia
    3. choanal atresia
    4. .transient tachypnea of the newborn (TTN)
  • 35. The first clinical manifestation of a tracheoesophageal anomaly in a newborn would most likely be:
    1. accumulation of secretions in the mouth
    2. tachypnea
    3. crackles or fine rales heard in lung fields
    4. scaphoid abdomen
  • 36. Micrognathia, such as that associated with the Pierre Robin syndrome refers to a(n):
    1. enlarged tongue
    2. small mandible
    3. cleft palate
    4. small glottic opening
  • 37. Lung structures and cells are differentiated to the point that extrauterine life can be supported around _____ weeks of gestation.
    1. 16-17
    2. 21-22
    3. 23-24
    4. 27-28
  • 38. Surfactant is produced in the:
    1. Type 1 pneumocyte
    2. Type 2 pneumocyte
    3.  Lamellated bodies
    4. Squamous epithelium
  • 39. The volume of lung fluid at term is approximately:
    1. 26-30 ml/kg
    2. 10-20 ml/kg
    3. 5-10 ml/kg
    4. 35-45 ml/kg
  • 40. Persistent pulmonary hypertension is characterized by:
    1. left-to-right shunting through aa patent ductus arteriosis
    2. right to left shunt through the foramen ovale and patent ductus
    3. bi-directional shunt through the ductus venosis
  • 41. The presence of right to left shunt may be most surely demonstrated by comparing arterial oxygenation of blood obtained from the
    1.  left radial and umbilical artery
    2.  right radial and umbilical artery
    3.  right radial and left temporal artery
    4.  left radial and right radial artery
  • 42. Infants do not have a developed sweat gland system for cooling.  Conversely, the main method of heat production in the newborn is:
    1. chemical thermogenisis (brown fat)
    2. involuntary shivering
    3. voluntary muscle activity
    4. rotoconductivity
  • 43. Flexion of the infants head moves a properly placed (T2-4) endotracheal tube toward the :
    1. carina
    2. glottis
  • 44. Per LaPlace’s Law,  as surface tension increases, alveolar radius:
    1. decreases
    2. increases
    3. stays the same
  • 45. Compliance is greatest when normal______ is maintained.
    1. tidal volume
    2. functional residual capacity
    3. alveolar ventilation
    4. inspiratory pressure
  • 46. The time constant of the lung is calculated by the following formula:
    1.  resistance X tidal volume
    2.  resistance X compliance
    3. compliance  X frequency
    4. compliance X tidal volume
  • 48. The pathophysiology of bronchopulmonary dysplasia (BPD) includes:
    1. cellular necrosis
    2. oedema
    3. fibrosis
    4. none of the above
  • 49. Carbon Dioxide elimination in HFO ventilation is controlled by:
    1. active expiration
    2. tidal volume and frequency
    3. positive end expiratory pressure
    4. mean airway pressure
  • 50. A newborn at 25 weeks gestation has received surfactant dose #1 . Still the patient is on PIP 28, PEEP 5, rate 30,  MAP 10 and CXR shows moderate worsening PIE.  You suggest:
    1. Increase PEEP
    2. inverse the I:E ratio
    3. give another STAT dose of surfactant
    4. switch to high frequency oscillatory ventilation
  • 51. A rH + baby from an rH- mom has hydrops fetalis.  His AP CXR shows blunted costophrenic angles and lung markings do not extend all the way laterally to the sides of the rib cage on either the R or L.  This baby seems to have:
    1. hyaline membrane disease
    2. pleural effusions
    3. congenital lobar emphesema

    4. pierre robin syndrome