Question 1

During mechanical ventilation of a preterm neonate, which of the following are considered to be important etiologic factors for the development of pulmonary air leak syndromes?
1) High levels of PEEP
2) High oxygen concentration
3) Prolonged inspiratory time
4) High PIP

Accepted Answer

A)  2, 3
B)  3, 4
C)  1, 3, 4
D)  1, 2, 4 C

Question 2

What clinical presentation would be seen in a patient with a pneumoperitoneum?

Accepted Answer

A)   Mediastinal shift toward affected area
B)   Change in point of maximum impulse
C)   Sudden onset of abdominal distention
D)   Pleural effusion C

Question 3

A physician is performing transillumination to determine whether a neonate has a pneumothorax. What finding would confirm the presence of a pneumothorax?

Accepted Answer

A)   The trachea will be illuminated.
B)   Light will shine through the hole in the lung.
C)   There will be increased illumination on the unaffected side.
D)   There will be increased illumination on the affected side. D

Question 4

Common strategies used to reduce the risk for mechanical ventilation include:
1) low tidal volume ventilation.
2) normalization of blood gases.
3) minimize intrinsic positive end-expiratory pressure.
4) increase the respiratory rate.

Accepted Answer

A)  1, 3
B)  1, 2, 3
C)  1, 3, 4
D)  2, 3, 4

Question 5

A neonate with pulmonary interstitial emphysema has developed a pneumothorax. In the early stages, a pneumothorax will manifest itself clinically as _____ disorder.

Accepted Answer

A)   an equally restrictive and obstructive
B)   an obstructive pulmonary
C)   a restrictive pulmonary
D)   neither a restrictive nor an obstructive

Question 6

Which of the following chest radiograph findings would confirm the presence of PIE?
1) Mediastinal shift to the unaffected side
2) Air below the diaphragms
3) Lung hyperinflation
4) Fine, bubbly appearance of the lungs

Accepted Answer

A)  2, 3
B)  1, 4
C)  2, 3, 4
D)  1, 3, 4

Question 7

Prior to the introduction of exogenous surfactant, with which condition were preterm neonates most likely to develop pulmonary air leak syndrome?

Accepted Answer

A)   Meconium aspiration syndrome (MAS) 
B)   Respiratory distress syndrome (RDS) 
C)   Transient tachypnea of the newborn (TTN) 
D)   Apnea of prematurity

Question 8

Which of the following are associated with a pneumopericardium?
1) Systemic hypotension
2) Reduced cardiac output
3) Decreased stroke volume
4) Increased cardiac index

Accepted Answer

A)  1, 3
B)  1, 2, 4
C)  2, 3, 4
D)  1, 2, 3

Question 9

Following delivery, when do pulmonary air leak syndromes commonly occur in preterm neonates?

Accepted Answer

A)   1 to 4 hours after delivery
B)   5 to 8 hours after delivery
C)   12 to 24 hours after delivery
D)   24 to 48 hours after delivery

Question 10

Which of the following conditions is described as dissection of gas into the fascial planes of the skin and neck?

Accepted Answer

A)   SIAHD
B)   Intravascular air embolism
C)   PIE
D)   Subcutaneous emphysema

Question 11

During the physical examination of a neonate with early pulmonary air leak syndromes, what respiratory rate would be expected?

Accepted Answer

A)   
B)   20 to 30 breaths/min
C)   40 to 60 breaths/min
D)   >60 breaths/min

Question 12

Which of the following medications would be recommended for the treatment of SIAHD?

Accepted Answer

A)   Beta2-agonists
B)   NSAIDs
C)   Diuretics
D)   Corticosteroids

Question 13

An intubated, mechanically ventilated neonate developed a pneumothorax of the right lung. What could the respiratory therapist recommend to help the injured lung to heal?

Accepted Answer

A)   Selectively place the endotracheal tube into the left mainstem bronchus.
B)   Selectively place the endotracheal tube into the right mainstem bronchus.
C)   Replace the endotracheal tube with a tracheostomy tube.
D)   Change to continuous positive airway pressure (CPAP) .

Question 14

A neonate on mechanical ventilation developed pulmonary air leak syndrome. What change should the respiratory therapist now recommend?

Accepted Answer

A)   Initiate the bronchopulmonary hygiene therapy protocol.
B)   Decrease the oxygen percentage.
C)   Initiate high-frequency ventilation.
D)   Insert bilateral pleural chest tubes.

Question 15

How does pulmonary interstitial emphysema (PIE) affect lung function?
1) Increased airway resistance
2) Decreased lung compliance
3) Increased lung compliance
4) Decreased airway resistance

Accepted Answer

A)  1, 3
B)  1, 2
C)  3, 4
D)  2, 4

Question 16

Which of the following might be used to relieve a tension pneumothorax in a neonate?

Accepted Answer

A)   Transillumination
B)   Needle thoracentesis
C)   Lung expansion therapy protocol
D)   Surfactant replacement therapy

Question 17

What clinical manifestations are associated with the more negative intrapleural pressures generated during inspiration by a patient with pulmonary air leak syndrome?
1) Cyanosis of dependent thorax and abdomen
2) Intercostal and substernal retractions
3) Flaring nostrils
4) Inspiratory stridor

Accepted Answer

A)  1, 3
B)  2, 4
C)  1, 2, 3
D)  2, 3, 4

Exam 38: Pulmonary Air Leak Syndrome

During mechanical ventilation of a preterm neonate, which of the following are considered to be important etiologic factors for the development of pulmonary air leak syndromes? 1) High levels of PEEP 2) High oxygen concentration 3) Prolonged inspiratory time 4) High PIP

What clinical presentation would be seen in a patient with a pneumoperitoneum?

A physician is performing transillumination to determine whether a neonate has a pneumothorax. What finding would confirm the presence of a pneumothorax?

Common strategies used to reduce the risk for mechanical ventilation include: 1) low tidal volume ventilation. 2) normalization of blood gases. 3) minimize intrinsic positive end-expiratory pressure. 4) increase the respiratory rate.

A neonate with pulmonary interstitial emphysema has developed a pneumothorax. In the early stages, a pneumothorax will manifest itself clinically as _____ disorder.

Which of the following chest radiograph findings would confirm the presence of PIE? 1) Mediastinal shift to the unaffected side 2) Air below the diaphragms 3) Lung hyperinflation 4) Fine, bubbly appearance of the lungs