Question 1

Which of the following is the most common form of surfactant abnormality associated with acute lung injury?

Accepted Answer

A)  Inactivation by proteins 
B)  Altered surfactant metabolism 
C)  Altered surfactant pool 
D)  Altered surfactant composition 
A)  Inactivation by proteins 
B)  Altered surfactant metabolism 
C)  Altered surfactant pool 
D)  Altered surfactant composition A

Question 2

What appears to be the benefit of administering prophylactic surfactant replacement therapy to preterm infants?
I. Decreased risk of mortality
II. Reduced threat of pneumothorax
III. Decreased incidence of diaphragmatic hernia
IV. Reduced risk of developing pulmonary interstitial emphysema

Accepted Answer

A)  I and II only 
B)  II and IV only 
C)  I, II, and IV only 
D)  II, III, and IV only 
A)  I and II only 
B)  II and IV only 
C)  I, II, and IV only 
D)  II, III, and IV only C

Question 3

According to Laplace's law the pressure required to open an alveoli in the lung is:

Accepted Answer

A)  directly proportional to the radius. 
B)  inversely proportional to the length of the airway. 
C)  directly proportional to the surface tension. 
D)  indirectly proportional to the viscosity of the gas in the airway. 
A)  directly proportional to the radius. 
B)  inversely proportional to the length of the airway. 
C)  directly proportional to the surface tension. 
D)  indirectly proportional to the viscosity of the gas in the airway. C

Question 4

The respiratory therapist administering surfactant to a premature newborn notices a significant deterioration in vital signs. What should be done at this time?

Accepted Answer

A)  Pause the procedure and administer PPV until vital signs are stable. 
B)  Rapidly infuse the rest of the dose and reconnect the patient to the mechanical ventilator. 
C)  Extubate the patient and administer nasal CPAP until stable. 
D)  Continue administration of the surfactant while administering PPV. 
A)  Pause the procedure and administer PPV until vital signs are stable. 
B)  Rapidly infuse the rest of the dose and reconnect the patient to the mechanical ventilator. 
C)  Extubate the patient and administer nasal CPAP until stable. 
D)  Continue administration of the surfactant while administering PPV.

Question 5

Which of the following is(are) considered the most important component(s) of pulmonary surfactant?
I. Dipalmitoyl phosphatidylcholine
II. Phosphatidylglycerine
III. Phosphatidylinositol
IV. Sphingomyelin

Accepted Answer

A)  I only 
B)  I and IV only 
C)  I, II, and IV only 
D)  II, III, and IV only 
A)  I only 
B)  I and IV only 
C)  I, II, and IV only 
D)  II, III, and IV only

Question 6

Which of the following relationships is correct regarding the analysis of amniotic fluid to determine fetal lung maturity?

Accepted Answer

A)  Phosphatidylglycerol (PG) and phosphatidylcholine (lecithin) increase while sphingomyelin decreases during gestation. 
B)  PG increases and lecithin and sphingomyelin decrease during gestation. 
C)  PG and lecithin decrease while sphingomyelin increases during gestation. 
D)  PG and lecithin increase while sphingomyelin decreases during gestation. 
A)  Phosphatidylglycerol (PG) and phosphatidylcholine (lecithin) increase while sphingomyelin decreases during gestation. 
B)  PG increases and lecithin and sphingomyelin decrease during gestation. 
C)  PG and lecithin decrease while sphingomyelin increases during gestation. 
D)  PG and lecithin increase while sphingomyelin decreases during gestation.

Question 7

What is the role of SP-D in human pulmonary surfactant?
I. Suppresses proinflammatory responses
II. Enhances phagocytosis
III. Enhances killing of microbes
IV. Functions as an opsonin for bacteria

Accepted Answer

A)  II and III only 
B)  III and IV only 
C)  I, II, and III only 
D)  I, III, and IV only 
A)  II and III only 
B)  III and IV only 
C)  I, II, and III only 
D)  I, III, and IV only

Question 8

A full-term infant received surfactant as rescue therapy for RDS. Despite redosing, the infant has not been able to be extubated during the first 2 weeks of life. What should this neonate be evaluated for?

Accepted Answer

A)  $\alpha$1-Antitrypsin deficiency 
B)  Vitamin B deficiency 
C)  SP-A deficiency 
D)  SP-D deficiency. 
A)  $\alpha$1-Antitrypsin deficiency 
B)  Vitamin B deficiency 
C)  SP-A deficiency 
D)  SP-D deficiency.

Question 9

Which of the following clinical conditions should be suspected in a neonate unresponsive to surfactant due to its inactivation?

Accepted Answer

A)  Pulmonary hypertension 
B)  Pulmonary hemorrhage 
C)  Pneumonia 
D)  Methemoglobinemia 
A)  Pulmonary hypertension 
B)  Pulmonary hemorrhage 
C)  Pneumonia 
D)  Methemoglobinemia

Question 10

A pregnant woman believed to be at 26 weeks gestation has been admitted for premature labor. What should be administered to this woman to decrease the risk of RDS if the infant is delivered prematurely?

Accepted Answer

A)  Magnesium sulfate 
B)  Terbutaline 
C)  Systemic corticosteroids 
D)  Lecithin 
A)  Magnesium sulfate 
B)  Terbutaline 
C)  Systemic corticosteroids 
D)  Lecithin

Question 11

A term baby with meconium aspiration syndrome is receiving mechanical ventilation per protocol. On the third day, the therapist observes that the FiO2 requirement is increasing and both lung compliance and oxygenation index are worsening. What should be suggested at this time?

Accepted Answer

A)  Switch to a pressure-limited mode 
B)  High-frequency chest oscillation 
C)  ECMO 
D)  Administer surfactant 
A)  Switch to a pressure-limited mode 
B)  High-frequency chest oscillation 
C)  ECMO 
D)  Administer surfactant

Question 12

How do synthetic surfactants compare with bovine surfactants?

Accepted Answer

A)  Synthetic surfactants contain exclusively SP-A, SP-B, SP-C, and SP-D. 
B)  Synthetic surfactants contain only SP-A. 
C)  Bovine surfactants contain SP-B and SP-C, and synthetic surfactants contain SP-A and SP-D. 
D)  Bovine surfactants contain SP-A and SP-D, and synthetic surfactants contain SP-B and SP-C. 
A)  Synthetic surfactants contain exclusively SP-A, SP-B, SP-C, and SP-D. 
B)  Synthetic surfactants contain only SP-A. 
C)  Bovine surfactants contain SP-B and SP-C, and synthetic surfactants contain SP-A and SP-D. 
D)  Bovine surfactants contain SP-A and SP-D, and synthetic surfactants contain SP-B and SP-C.

Question 13

Which of the following physiologic conditions results from the presence of normal amounts of pulmonary surfactant in the lung?

Accepted Answer

A)  Pulmonary compliance decreases. 
B)  Uniform gas distribution during expiration occurs. 
C)  The functional residual capacity is maintained. 
D)  Pulmonary perfusion matches alveolar ventilation. 
A)  Pulmonary compliance decreases. 
B)  Uniform gas distribution during expiration occurs. 
C)  The functional residual capacity is maintained. 
D)  Pulmonary perfusion matches alveolar ventilation.

Question 14

Which of the following physiologic consequences would develop if the liquid-gas interface were without surfactant?

Accepted Answer

A)  Large alveoli would empty into smaller ones at the end of exhalation. 
B)  Every exhalation would demand ventilatory muscle activity. 
C)  Every breath would require a considerable amount of pressure to expand the lung with each inspiration. 
D)  Some alveoli would collapse during exhalation. 
A)  Large alveoli would empty into smaller ones at the end of exhalation. 
B)  Every exhalation would demand ventilatory muscle activity. 
C)  Every breath would require a considerable amount of pressure to expand the lung with each inspiration. 
D)  Some alveoli would collapse during exhalation.

Exam 14: Surfactant Replacement Therapy

Which of the following is the most common form of surfactant abnormality associated with acute lung injury?

What appears to be the benefit of administering prophylactic surfactant replacement therapy to preterm infants? I. Decreased risk of mortality II. Reduced threat of pneumothorax III. Decreased incidence of diaphragmatic hernia IV. Reduced risk of developing pulmonary interstitial emphysema

According to Laplace's law the pressure required to open an alveoli in the lung is:

The respiratory therapist administering surfactant to a premature newborn notices a significant deterioration in vital signs. What should be done at this time?

Which of the following is(are) considered the most important component(s) of pulmonary surfactant? I. Dipalmitoyl phosphatidylcholine II. Phosphatidylglycerine III. Phosphatidylinositol IV. Sphingomyelin

Which of the following relationships is correct regarding the analysis of amniotic fluid to determine fetal lung maturity?

What is the role of SP-D in human pulmonary surfactant? I. Suppresses proinflammatory responses II. Enhances phagocytosis III. Enhances killing of microbes IV. Functions as an opsonin for bacteria

A full-term infant received surfactant as rescue therapy for RDS. Despite redosing, the infant has not been able to be extubated during the first 2 weeks of life. What should this neonate be evaluated for?

Which of the following clinical conditions should be suspected in a neonate unresponsive to surfactant due to its inactivation?

A pregnant woman believed to be at 26 weeks gestation has been admitted for premature labor. What should be administered to this woman to decrease the risk of RDS if the infant is delivered prematurely?

A term baby with meconium aspiration syndrome is receiving mechanical ventilation per protocol. On the third day, the therapist observes that the FiO2 requirement is increasing and both lung compliance and oxygenation index are worsening. What should be suggested at this time?

How do synthetic surfactants compare with bovine surfactants?

Which of the following physiologic conditions results from the presence of normal amounts of pulmonary surfactant in the lung?

Which of the following physiologic consequences would develop if the liquid-gas interface were without surfactant?

Fetal Lung Development

Fetal Gas Exchange and Circulation

Antenatal Assessment and High-Risk Delivery

Examination and Assessment of the Neonatal and Pediatric Patient

Pulmonary Function Testing and Bedside Pulmonary Mechanics

Radiographic Assessment

Pediatric Flexible Bronchoscopy

Invasive Blood Gas Analysis and Cardiovascular Monitoring

Noninvasive Monitoring in Neonatal and Pediatric Care

Oxygen Administration

Aerosols and Administration of Inhaled Medications

Airway Clearance Techniques and Hyperinflation Therapy

Airway Management

Noninvasive Mechanical Ventilation and Continuous Positive Pressure of the Neonate

Noninvasive Mechanical Ventilation of the Infant and Child

Invasive Mechanical Ventilation of the Neonate and Pediatric Patient

Administration of Gas Mixtures

Extracorporeal Membrane Oxygenation

Pharmacology

Thoracic Organ Transplantation

Neonatal Pulmonary Disorders

Surgical Disorders in Childhood That Affect Respiratory Care

Congenital Cardiac Defects

Pediatric Sleep-Disordered Breathing

Pediatric Airway Disorders and Parenchymal Lung Diseases

Asthma

Cystic Fibrosis

Acute Respiratory Distress Syndrome

Shock

Pediatric Trauma

Disorders of the Pleura

Neurological and Neuromuscular Disorders

Transport of Infants and Children

Home Care

Quality and Safety

Filters

A term baby with meconium aspiration syndrome is receiving mechanical ventilation per protocol. On the third day, the therapist observes that the FiO₂ requirement is increasing and both lung compliance and oxygenation index are worsening. What should be suggested at this time?