Question 1

Your patient with pulmonary interstitial emphysema has developed a pneumothorax. It will manifest itself clinically as:&#10;A) equally restrictive and obstructive disorder.&#10;B)an obstructive pulmonary disorder.&#10;C)a restrictive pulmonary disorder.&#10;D)a restrictive cardiac disorder.

Accepted Answer

A pneumothorax leads to a restrictive pulmonary disorder because it limits lung expansion, reducing lung volume and compliance.

Question 2

Your intubated and mechanically ventilated neonatal patient has a pneumothorax of the right lung. What can be done to help the injured lung to heal?&#10;A) Selectively place the endotracheal tube into the left mainstem bronchus.&#10;B)Selectively place the endotracheal tube into the right mainstem bronchus.&#10;C)Replace the endotracheal tube with a tracheostomy tube.&#10;D)Change to continuous positive airway pressure (CPAP).

Accepted Answer

Selectively placing the endotracheal tube into the left mainstem bronchus will prevent mechanical ventilation from inflating the right lung, allowing it to rest and heal. This is known as selective ventilation or one-lung ventilation. However, it is important to ensure proper oxygenation and ventilation of the left lung during this time. CPAP and tracheostomy tubes would not address the issue of the injured lung, and placing the endotracheal tube into the right mainstem bronchus would continue to inflate the injured lung, potentially causing further damage.

Question 3

Your neonatal patient is receiving mechanical ventilation. Which of the following is/are considered to be an important etiologic factor(s) for pulmonary air leak syndromes?
1) Long expiratory time
2) High oxygen percentage
3) Prolonged inspiratory time
4) High PIP (peak inspiratory pressure)

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

3, 4

Accepted Answer

Pulmonary air leak syndromes, such as pneumothorax, pneumomediastinum, and pulmonary interstitial emphysema, can be caused by high pressure and prolonged mechanical ventilation. A high PIP can lead to overdistension of the alveoli, leading to tears and leaks in the lung tissue. Prolonged inspiratory time can also lead to overdistension and increased air trapping. Though high oxygen percentage can contribute to alveolar damage, it is not an etiologic factor for pulmonary air leak syndromes on its own. Long expiratory time is not typically associated with this condition.

Question 4

Your patient has developed pulmonary interstitial emphysema (PIE). How can this affect her lung function?
1) Increased airway resistance
2) Decreased lung compliance
3) Increased lung compliance
4) Development of persistent pulmonary hypertension of the newborn (PPHN)

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

Accepted Answer

Pulmonary interstitial emphysema (PIE) can lead to increased airway resistance and decreased lung compliance due to the accumulation of air in the lung tissue. This can ultimately result in difficulty with gas exchange and respiratory distress. PIE is not directly associated with increased lung compliance or the development of persistent pulmonary hypertension of the newborn (PPHN).

Question 5

What pulmonary condition can be identified by a change in the point of maximum impulse (PMI)?&#10;A) Pneumothorax&#10;B)PIE&#10;C)Pneumomediastinum&#10;D)Meconium aspiration syndrome (MAS)

Accepted Answer

A pneumothorax can cause a shift in the point of maximum impulse (PMI) due to the collapse of the lung and the resulting shift of the mediastinum and heart to the opposite side.

Question 6

Your patient has PIE and a pneumomediastinum. What clinical manifestations are associated with the more negative intrapleural pressures needed during an inspiration by your patient?
1) Lower thoracic areas are cyanotic
2) Substernal retractions
3) Flaring nostrils
4) Inspiratory stridor

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

Accepted Answer

The answer of Your patient has PIE and a pneumomediastinum....

Question 7

During the physical exam of a patient with PIE and a pneumoperitoneum, what respiratory rate is usually found?&#10;A) 80 to 120/min&#10;B)>60/min&#10;C)30 to 60/min&#10;D)Less than 30/min

Accepted Answer

Patients with PIE and pneumoperitoneum often have rapid, shallow breathing with respiratory rates exceeding 60 breaths per minute.

Question 8

When trapped gas causes alveolar overdistention and rupture, does where the gas initially go?
1) Both pleural spaces
2) Tissue sheaths surrounding airways and capillaries
3) Interlobular septa containing pulmonary veins
4) Pericardial sac

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

Accepted Answer

When alveolar overdistention and rupture occur, the gas initially moves into the tissue sheaths surrounding airways and capillaries (interstitial emphysema) and the interlobular septa containing pulmonary veins.

Question 9

If your patient were to develop a pneumoperitoneum, what clinical presentation would be seen?&#10;A) Mediastinal shift toward affected area&#10;B)Change in point of maximum impulse&#10;C)Abdominal distension&#10;D)Pleural effusion

Accepted Answer

Pneumoperitoneum refers to the presence of air or gas within the peritoneal cavity, which can result from various causes such as the perforation of gastrointestinal tract or laparoscopic procedures. The accumulation of air in the abdominal cavity causes distention or swelling of the belly, which is the most common clinical presentation of pneumoperitoneum. Mediastinal shift and pleural effusion are more likely to occur when there is a large pneumothorax, not pneumoperitoneum. Change in point of maximum impulse may be seen in heart diseases or abnormalities, and it is not a sign of pneumoperitoneum.

Question 10

Your patient with PIE has developed a pneumopericardium. This condition can cause all of the following, EXCEPT:&#10;A) Systemic hypotension&#10;B)Reduced cardiac output&#10;C)Decreased stroke volume&#10;D)Increased cardiac index

Accepted Answer

Pneumopericardium can cause compression of the heart and decrease cardiac output, stroke volume, and systemic blood pressure. Increased cardiac index, however, is not a typical effect of this condition.

Question 11

Your patient is suspected of having a pneumothorax and the physician is performing transillumination to assess the situation. What finding would confirm that there is a pneumothorax?&#10;A) The trachea will be illuminated.&#10;B)Light will shine through the hole in the lung.&#10;C)Increased illumination on the unaffected side&#10;D)Increased illumination on the affected side

Accepted Answer

The answer of Your patient is suspected of having a...

Question 12

Your neonatal patient needs to be on a mechanical ventilator for breathing support but has PIE. What change can be made to help treat the problem?&#10;A) Begin the bronchopulmonary hygiene therapy protocol.&#10;B)Decrease the oxygen percentage.&#10;C)Initiate high-frequency ventilation.&#10;D)Insert bilateral pleural chest tubes.

Accepted Answer

The answer of Your neonatal patient needs to be on...

Question 13

A pulmonary air leak syndrome will usually present itself within what time period?&#10;A) At the time of birth&#10;B)Within the first 4 to 6 hours of life&#10;C)Less than 24 hours after birth&#10;D)Within the first 24 to 48 hours of life

Accepted Answer

The answer of A pulmonary air leak syndrome will usually...

Question 14

What chest radiograph finding(s) would confirm that the patient has PIE?
1) Mediastinal shift to the unaffected side
2) Air below the diaphragms
3) Lung hyperinflation
4) Fine, bubbly appearance of the lungs

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

Accepted Answer

The answer of What chest radiograph finding(s) would confirm that...

Question 15

What preexisting condition is often being treated in a premature neonate who develops a pulmonary air leak syndrome?&#10;A) Meconium aspiration syndrome (MAS)&#10;B)Respiratory distress syndrome (RDS)&#10;C)Transient tachypnea of the newborn (TTN)&#10;D)Apnea of prematurity

Accepted Answer

The answer of What preexisting condition is often being treated...

Deck 35: Pulmonary Air Leak Syndromes