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What phase of human lung development is characterized by the formation of a capillary network around airway passages
Canalicular Phase
Regarding postnatal lung growth, by approximately what age do most of the alveoli that will be present in the lungs for life develop?
Most of the postnatal formation of the alveoli in the infant occurs over the 1.5 years of life.
The respiratory therapist is evaluating a newborn with mild respiratory distress due to tracheal stenosis. During which period of lung development did this problem develop?
Embroyonal
What mechanisms are responsible for the possible association between oligohydramnios and lung hypoplasia?
1.mechanical restriction of the 2.chest wall Interference with fetal breathing 3. Failure to produce fetal lung liquid
What is the purpose of the substance secreted by the type II pneumocyte and what is it called?
surfactant To reduce surface tension
What tests of the amniotic fluid have been shown to be sensitive indicators of lung maturity?
Levels of phosphatidylglycerol and phosphatidylcholine
What embryonic germ layer gives formation to the respiratory system?
The endoderm
What is the function of Wharton's jelly inside the umbilical cord?
To prevent the vessels inside the cord from kinking
What organ is considered to be the first to form?
The heart
A pregnant woman is coming for an early prenatal evaluation and wants to know if she can listen to the baby's heartbeat. How early can the fetal heartbeat be detected?
Day 22
What anatomic structures are fetal shunts?
Foramen ovale, Ductus venosus, Ductus arteriosus
What events causes cessation of right-to-left shunt through the foramen ovale?
Increased systemic vascular resistance
How long after birth should it take for the ductus arteriosus to close completely?
96 hours
A pregnant woman has been diagnosed with pregestational diabetes. What risk factor should the therapist be aware at the time of delivery
Microcephaly, Fetal malformations
The respiratory therapist is attending a term labor of a woman diagnosed with gestational diabetes. The baby is very large for gestational age. What other metabolic disturbances should be considered?
Hypocalcemia Hyperkalemia Hypoglycemia
What microorganisms often affect pregnancy outcome?
Group B Streptococcus
What is generally accepted as a safe limit for alcohol consumption during pregnancy to avoid the development of fetal alcohol syndrome?
No range of alcohol is safe during pregnancy
What is the average birth weight difference between infants born of mothers who smoke and those born of nonsmoking mothers?
Infants born to mothers who smoke tend to be about 200 grams lighter than infants born to mothers who do not smoke.
A woman with a long history of smoking is now in the last part of the third trimester of her pregnancy. She is at high risk for what conditions
Premature rupture of membranes , Placental abruption, Placenta previa , Sudden infant death syndrome
What conditions are associated with preeclampsia?
Proteinuria, Generalized edema , Hypertension
What is the main potential problem associated with the premature rupture of membranes?
Fetal Infection
What condition is responsible for up to 40% of the preterm births in the United States?
Premature rupture of the fetal membranes
How should the therapist interpret an amniotic fluid index of 5 cm?
Oligohydramnios
Once preterm labor is diagnosed what medication should be considered as tocolytic?
Magnesium sulfate
A pregnant woman at 30 weeks of gestation with premature rupture of membranes has been admitted to the hospital with preterm labor. The physician has ordered betamethasone. When does the maximal benefit of antenatal corticosteroid occur to reduce RDS?
After 48 hours
What condition is a significant problem in post term pregnancy?
Meconium aspiration
A woman 41-weeks pregnant is at high risk for complication in the postpartum period. What agent will be more appropriate to induce labor
Oxytocin
What is the most common invasive procedure to assess the fetal condition?
Amniocentesis
The respiratory therapist is called to assist in the labor of a pregnant woman whose NST reported two accelerations in fetal heart rate, each of at least 15 beats per minute and lasting at least 15 seconds, associated with maternal perception of fetal movement over a period of 20 minutes. What is the best course of action?
The non-stress test is in normal limits, no actions are required
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 too slow. What condition is likely indicated by this occurrence?
Uteroplacental insufficiency
How should the therapist interpret a fetal biophysical profile score of 7?
This profile evaluation is normal
What maternal complications are associated with cesarean section?
Intraoperative bladder or bowel injuries
In lieu of obtaining a scalp blood gas sample, what can the therapist do to conduct intrapartum assessment of the fetus?
Fetal scalp stimulation
A therapist is called to the labor and delivery room to assist in the resuscitation of a term newborn. If necessary, what FiO2 should be used to start positive pressure ventilation?
21% and make changes according to preductal oximetry
A therapist treating a newborn with hypoxemia due to hypothermia should also be aware of what condition?
Hypoglycemia
A therapist is resuscitating a term newborn. What should be the rate of ventilation?
40 to 60 breaths per minute
A therapist is resuscitating a term newborn. The heart rate falls to 55 beats per minute. What is the best course of action?
Administer epinephrine through the IV or ET tube
What measures can the therapist take to prevent heat loss and cold stress before performing resuscitation on a preterm neonate?
Dry the infants skin. Wrap the infant in pre warmed blankets. Remove wet linens from around the infant
What should the therapist do to avert injury and atelectasis, and to avoid interfering with the infant's ability to establish adequate ventilation, while stabilizing a preterm neonate before resuscitation?
Use a bulb syringe. Avoid excessive suctioning of clear fluid from the nasopharynx. Use a suction catheter clearing the mouth first and then the nose.
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
Only perform tracheal suction to non-vigorous infants. This infant is not requiring suctioning.
A newborn does not appear to respond to the extrauterine environment. Cry is weak and the respiratory effort is not strong. What method should the therapist use to stimulate the newborn?
Gently rub their back Flick the bottoms of their feet
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.
Score of 3
What parameters of the Apgar score provides the most important prognostic value?
Heart rate
What factors are taken into consideration when assessing the gestational age of a neonate?
Prenatal ultrasound evaluations Postnatal findings based on physical and neurological examinations Gestational duration based on menstrual cycle
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?
Large for gestational age
An infant arrives in the newborn nursery with an axillary body temperature of 95.6° F. What may be responsible for this infant's temperature?
The delivery room temperature was low
A physical examination is being performed on a newborn, and the therapist notices that the infant's arms do not move symmetrically. What could account for this problem?
An injury to the infant's brachial plexus may have occurred during birth
The therapist notices that an infant present with irregular areas of dusky skin alternating with areas of pale skin. On the basis of this observation, what condition should the therapist anticipate this patient having?
Hypotension
What neonatal skin presentation at birth is associated with a high hematocrit value or polycythemia and neonatal hyperviscosity syndrome
Reddish blue appearance
Why are chest retractions more prominent among neonates than among older children and adults?
Newborns have thin weak musculature and a less rigid thorax
Why is it difficult to localize auscultation findings of the thorax of a newborn?
Neonates have a small chest wall that make sounds difficult to differentiate
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 condition can cause this situation?
Right sided pneumothorax
Explain what refers to the diagnostic procedure called transillumination?
A direct light source towards the ipsilateral surface of the patient's thorax
A neonate is found to have a bounding pulse. What condition may contribute to this finding?
Patent ductus arteriosus and a left to right shunt
What condition would be responsible for the therapist observing a pulse oximeter indicating decreased perfusion while central blood pressure remains normal?
Volume depletion with compensatory peripheral vasoconstriction
For the purpose of assessing right-to-left shunting, as in the case of persistent pulmonary hypertension, which sites would render postductal blood?
Left arm/ Left leg/ Right leg
The therapist is evaluating a newborn with an abdominal defect consisting of protrusion of the membranous sac that encloses abdominal contents through an opening in the abdominal wall into the umbilical cord. Which condition is consistent with this description?
Omphalocele
After the umbilical cord has been cut in the delivery room during the delivery of an infant who is large for gestational age, the therapist notices that the umbilical cord is large and fat. What maternal conditions is likely present?
Diabetes mellitus
The therapist notices that a preterm newborn has a grunting cry. Which condition is most consistent with this description?
Hypothyroidism
What pieces of information represent components of patient history for a new pediatric patient?
Chief complaint and Past medical history
Which components compose the history of present illness section of a patient's medical history?
Frequency and duration of symptoms and onset
Which components compose the past medical history section of the patient's medical history?
Birth weight ,Previous ER visits , Previous mechanical ventilation
What component of a patient's medical history is intended to determine the presence of symptoms not identified in the history of present illness and may be related or contribute to the child's underlying condition?
Review of symptoms
A child who demonstrates head bobbing, nasal flaring, and grunting is exhibiting signs of
Respiratory distress
What pulmonary disease is not considered a chest wall deformity but characterized by an increased anteroposterior diameter?
Asthma , Cystic fibrosis
During a physical examination of a child's chest, the therapist perceives increased tactile fremitus over the patient's right lower lobe. Which condition may cause this physical sign?
Pulmonary consolidation
While percussing the thorax of a child during a physical examination, the therapist hears a dull percussion note over the child's right lung. Which conditions may cause this physical finding?
Atelectasis , Pleural effusion , Consolidation
After placing a stethoscope over a small child's trachea, the therapist hears expiratory stridor. Which condition is consistent with this finding
Tracheomalacia
While auscultating a young child's thorax, the therapist hears bilateral fine crackles. Which condition can produce these adventitious sounds
Pulmonary edema
What type of X-ray view is obtained when the radiographic plate is placed behind the patient's back with the x, and the side up may better define
Anteroposterior view
The lateral decubitus view is a frontal radiographic projection whereby the side down can be evaluated for presence of
A pleural effusion, Pneumothorax
The respiratory therapist is evaluating a child with suspected foreign body aspiration. The radiographer gently adds pressure to the abdomen during expiration to take the chest radiograph. If an obstruction is confirmed, what changes should the RT expect to see?
The size of the affected lung will remain normal or the lung will be hyper-expanded
Which radiographic view would be the best suited for evaluating fractured ribs in a pediatric patient?
Oblique view
How will well-expanded, air-filled lungs appear on a chest radiograph?
Black
A respiratory therapist is evaluating a chest radiograph of a patient taken 2 days after being admitted for significant respiratory distress right middle lobe pneumonia. Although the therapist notices a dramatic clinical improvement of the patient, the chest X-ray appears to be more radiopaque than the one on admission. What could explain this situation?
Incorrect exposure of the image
A therapist is viewing a chest X-ray of a pediatric patient who recently emerged from general anesthesia after upper abdominal surgery. The right hemidiaphragm is elevated, and atelectasis is seen as a long, thick horizontal line within the right lower lobe. Which term describes this type of atelectasis?
Plate
A pediatric patient with pneumonia has an infiltrate in the lower half of the right lung. The right heart border is obliterated. In which lobe(s) of the right lung is the infiltrate located?
Right middle lobe
Which anatomical structure on a chest radiograph projects to the left, causes a prominent bulge of the superior mediastinum, and creates a mild indentation on the trachea?
Aortic arch
A therapist is examining an AP chest radiograph of a neonate and notices a structure projecting away from the mediastinum toward the right upper lung. This structure looks like a sail with a sharp inferior margin and lateral margins with wavy contours. What structure is the therapist observing?
Thymus
While viewing the chest X-ray of an 18-month-old boy, a therapist notices that the trachea is truncated and that the right lung is collapsed. What situation or condition may have caused this?
A mucous plug in the right mainstem bronchus
A therapist is viewing a frontal chest radiograph of a neonate who has just been endotracheally intubated. The tip of the endotracheal tube is located between the inferior clavicular border and the carina. What should the therapist do at this time?
Perform routine respiratory assessment and care for the patient as normal, the ET tube is placed correctly
While viewing an anteroposterior view of a chest radiograph of a 24-month-old intubated child, a therapist notices that the endotracheal tube has now migrated right above the inferior clavicular border. What could explain this new location of the endotracheal tube?
Flexion of the head
Which radiographic view provides the best perspective for ascertaining the position of an endotracheal tube in the patient's esophagus?
Lateral view
A therapist is viewing frontal and lateral neck X-rays of a 12-month-old child and notices what is described as the "steeple" or "church steeple" sign: subglottic narrowing below the vocal cords, and an over distended hypopharynx. What condition does this child likely have?
Croup
While viewing a lateral view of a neck radiograph of an 18-month-old child, a therapist notices that the epiglottis is enlarged, the aryepiglottic folds are thickened, and the hypopharynx is over distended. What condition does this child likely have?
Epiglottitis
A mother has just given birth to a 42-week infant who is small for his gestational age. A chest radiograph of this neonate reveals coarse, patchy opacities secondary to atelectasis from bronchial obstruction alternating with areas of hyperinflation. What clinical disorder does this infant likely have?
Meconium aspiration syndrome
A therapist is viewing frontal chest X-ray of a 12-year-old child and notices mediastinal shift towards the right hemithorax along with elevated hemidiaphragm and vascular crowding. What condition does this child likely have?
Atelectasis
What are the criteria to order a chest radiograph in a pediatric patient who does not have chest symptoms?
Fever , O2 saturation less than 95%, WBC higher than 20,000
In what condition is the oxygen-carrying capacity reduced despite the presence of a normal arterial oxygen tension?
Polycythemia
What is the minimum level of oxygen tension in a child that requires oxygen administration?
PaO2 of 60 mmHg
Where does the fetal oxyhemoglobin dissociation curve reside in comparison with the normal adult oxyhemoglobin dissociation curve?
The fetal oxyhemoglobin dissociation curve lies to the left of the adult curve
The therapist has evaluated a neonate's oxygenation status to be as follows: PaO2, 40 mm Hg, and SpO2 (oxygen saturation as determined by pulse oximetry), 80%. What should the therapist do at this time?
An FiO2 sufficient to raise the SpO2to 90% needs to be given.
Which disorder can develop in neonates as a result of receiving concentrations of oxygen that produce a high PaO2?
Retinopathy of prematurity
What problem occurs as a result of absorption atelectasis?
Increased intrapulmonary shunting
Which oxygen-delivery device would be most suitable for an infant being treated for choanal atresia?
Oxygen hood
When weaning an infant receiving oxygen from a nasal cannula attached to a low-flow flow meter set at 100%, what range represents the recommended oxygen flow reduction from the flow meter?
0.1-0.2L/min
What is the concern when administering oxygen to a sedated infant who is wearing a nasal cannula?
The Fio2 can be too high
In order to decrease the risk of nasal irritation in newborns, what is the maximum flow rate recommended?
2L/min
What range of oxygen flow needs to be set when administering oxygen to an infant via a simple mask?
6-10L/min
The therapist notices that the reservoir bag on a partial rebreathing mask being worn by a pediatric patient collapses completely during each inspiration. What should the therapist do at this time?
Increase the flow
A child with an exacerbation of asthma is a candidate for the administration of Heliox. Which gas delivery device is most suitable for its administration?
Nonrebreather
The respiratory therapist is treating a hypoxemic child with a nasal cannula at 3 L/min. However, after few hours the child becomes tachypneic, demonstrates shallow breathing, and becomes hypoxemic. What should the therapist do at this time?
Possibly intubate and increase the flow
Which device would be most appropriate to use for a 3-year-old patient who experiences immediate post extubation hypoxemia?
Aerosol mask
How will excess condensate present in aerosol tubing affect the delivered FiO2?
The Fio2 will increase
For which of the following condition(s) is a high-flow nasal cannula contraindicated?
II. Apnea of prematurity
When administering aerosol therapy to a pediatric patient, what factors can affect aerosol deposition?
Nasal breathing , Respiratory rate, Airway diameter
The respiratory therapist verifies an order to administer albuterol 1.25 mg to a 2-kg infant. Why does this dose have the same safety and efficacy profile as a 2.5-mg dose in the adult?
The deposition efficiency in the infant results in a similar lung dose per kg of the adult patient
The respiratory therapist is administering a nebulizer with a mask to a 2-year-old child. The mask is being held away from the child's face ("blow-by") due to excessive crying. What should the RT consider doing to improve aerosol lung deposition?
Hold the mask as close to the patient as possible to minimize the leak
By what percentage can breath holding increase particle deposition in the lungs?
10%
Pneumatic nebulizers operate according to which physics principle?
Bernoulli principle
A conventional jet nebulizer with a dead volume of 1 mL is filled with a 3-mL solution of albuterol. What percent of the medication is available for nebulization?
66%
When a conventional jet nebulizer is operated at a flow of 10 L/min versus 5 L/min, what should the respiratory therapist expect?
The particle size remains the same
An aerosol treatment is being administered via a jet nebulizer. After 8 minutes the nebulizer starts "sputtering." What should the therapist do at this point?
Stop the treatment
Which of the following suggestions will have the most significant impact on the inhaled dose of medications with nebulizers?
Increasing the flow rate powering the nebulizer Using breath-enhanced nebulizers
In order to guarantee the same performance of the nebulizer after repeated use, what should be suggested to the user?
Rinse with sterile water and air dry
Why are pass-over humidifiers preferred over pneumatic nebulizer humidifiers?
Pass-over humidifiers transmit fewer pathogens than pneumatic nebulizers
What consideration is most important when using a large-volume nebulizer to provide oxygen and humidification to an infant in an incubator
Preventing large noise levels from happening
Which nebulizer should be suggested to improve lung dose in patients undergoing invasive mechanical ventilation?
Jet nebulizer
How can a patient avoid the problem of terminating inhalation when a plume from a pressurized metered-dose inhaler (pMDI) impacts the oropharynx?
Use a spacer
What functions are served by spacer and holding chambers in conjunction with pMDIs?
Improvement for the drug deposition into the lower respiratory tract
Why should pMDIs containing steroids in particular be used with a valved holding chamber?
To reduce the risk of oral yeast infections
Which types of patients using a dry powder inhaler (DPI) for medication delivery are likely be contraindicated?
Children younger than 5, Altered mental status patients
The physician in the emergency department is attending to a 12-year-old child who has an exacerbation of asthma. The physician asks the therapist to recommend a medication that has a synergistic effect with beta-2 agonists during asthma exacerbations. What medication should the therapist recommend?
Ipratropium bromide
An 18-month-old patient brought to the emergency department is exhibiting signs and symptoms consistent with an acute asthma episode and is administered a beta-2 agonist to which the patient does not respond favorably. What condition could be responsible for this patient's problem?
Aspiration of a foreign body
Where in the ventilator circuit should a continuous jet nebulizer be placed to improve efficiency of aerosol delivery?
30cm from the ETT in the inspiratory limb
The therapist receives an order to administer a bronchodilator in-line to an infant receiving mechanical ventilation. The order also indicates that the nebulizer must not significantly increase the patient's delivered tidal volume. Which aerosol delivery devices could the therapist select
Vibrating mesh nebulizer , Ultrasonic nebulizer , MDI
What is the preferred method for delivering bronchodilators to spontaneously breathing and intubated, ventilated patients?
MDI
What are the minimal developmental features required for an immature human fetus to survive outside the uterus?
II. Sufficient alveolar and vascular surface area for gas exchange
IV. 22 to 24 weeks of gestation
V. Near completion of the canalicular stage of lung development
Which is the lung development stage formerly thought to be the last stage before birth, and characterized by relatively smooth-walled, cylindrical structures subdivided by ridges known as secondary crests
Alveolar phase
The initial lung bud emerges from which of the following?
Pharynx
The bronchial tree is formed at which gestational phase of lung development?
Pseudoglandular
The oxygenated blood leaves the placenta and travels to the fetus through the
Umbilical Vein
Normal circulatory changes occurring within the transitional stage at birth include which of the following?
A decrease in pulmonary vascular resistance
A decrease in pulmonary artery pressure
An increase in left ventricular pressure
An increase in pulmonary blood
What one set of actions causes the systemic circulation to transition from a low-resistance system to a high-resistance system?
Clamping the umbilical cord, thus preventing blood flow to the placenta
In preparing the delivery or operating room for the delivery of an infant expected to require resuscitation, which of the following should be prepared?
A pulse oximeter for the newborn that is capable of accurate readings in low perfusion states.