Are you ready to get your learning on about Perinatal Lung Diseases? I sure hope so because that is what this study guide is all about. As you will see below, we have compiled a list of practice questions that can help you learn everything you need to know about the Perinatal Lung Diseases that are required in Respiratory Therapy school. So let’s go ahead and dive right in!

Perinatal Lung Diseases Practice Questions:

1. What is Infant Respiratory Distress Syndrome?
A deficiency of surfactant production primarily due to prematurity of the pulmonary system.

2. What is another name for IRDS?
Hyaline membrane disease.

3. What is the mortality rate of IRDS in neonates?
30%

4. What is the mortality rate of IRDS in preterm infants?
70%

5. The highest incidence of mortality for IRDS happens in the first how many hours?
72

6. What is the main cause of IRDS?
A premature pulmonary system (lack of surfactant).

7. What are the risk factors for IRDS?
Less than 35 weeks gestation, maternal diabetes, second born twin, cesarean delivery and in neonates with poor APGAR scores.

8. Is there a higher incidence of IRDS in males or females?
Males.

9. What are the clinical signs and symptoms of IRDS?
RR > 60, grunting, chest retractions, nasal flaring, hypothermia, skin pallor, and flaccid muscle tone.

10. What does a chest x-ray look like with IRDS?
Under aerated bilaterally, clouded opaque frosted, ground glass (reticulogranular), or air bronchograms.

11. What are the treatments for IRDS?
Glucocorticoids two days before delivery, artificial surfactant replacement, maintain adequate alveolar ventilation with lowest pressures, restore blood gas values, and ideally prevent it from occurring.

12. What PaO2 should be kept with IRDS?
50-80 mmHg.

13. What PaCO2 should be kept with IRDS?
< 60 mmHg. 14. What pH should be kept with IRDS? >7.25

15. What must the RT do to prevent a long uphill battle against IRDS?
Intervene before the onset of respiratory failure.

16. What is bronchopulmonary dysplasia?
Secondary lung injuries due to prolonged exposure to oxygen and high ventilatory pressures.

17. What are the pathophysiological occurrences with BPD?
Oxygen toxicity, barotrauma, patent ductus arteriosus, and fluid overload.

18. How does IRDS relate to BPD?
The treatments for infant respiratory distress syndrome are the cause of bronchopulmonary dysplasia.

19. What is the goal with BPD regarding ventilation?
Reduce the factors that lead to its development using lowest possible airway pressures with high-frequency jet ventilation and lowest possible FiO2.

20. What is another name for pulmonary dysmaturity?
Wilson-Mikity Syndrome.

21. What is the pathology that defines pulmonary dysmaturity?
Emphysematous changes in the lungs.

22. What is retinopathy of prematurity?
It causes abnormal blood vessels to grow in the retina, the layer of nerve tissue in the eye that enables us to see. This growth can cause the retina to detach from the back of the eye, leading to blindness.

23. What is the occurrence of ROP in preemies up to 35 weeks of gestation?
25-35%

24. What percent of preemie ROP occurrences result in blindness?
3-5%

25. What is the pathophysiology of ROP?
The presence of high levels of PaO2 can cause the retinal vessels to constrict causing hemorrhage, vaso-obliteration, and necrosis.

26. What is the goal of oxygen therapy in ROP?
Decrease PaO2 until it is < 80 mmHg.

27. What is another term for retinopathy of prematurity?
Retrolental fibroplasia.

28. What is an Intracranial Hemorrhage?
Brain bleed.

29. Who is at risk for an intracranial hemorrhage?
Birth trauma, asphyxia, preterm neonates (24-32 weeks gestation), and neonates with birth weights < 1500g.

30. What in relation to ventilation can cause an intracranial hemorrhage?
Increased intrathoracic pressure.

31. What are some other causes of intracranial hemorrhage?
Birth trauma, asphyxia, and being put in the Trendelenburg position.

32. What is asphyxia?
Combination of hypoxia, hypercarbia, and acidosis.

33. What is the cause of asphyxia in the uterus?
Placental perfusion issues or umbilical issues.

34. How to assess asphyxia in a fetus?
Slow loss of baseline variability, late decelerations (slowing recovery), and prolonged periods of bradycardia.

35. How to assess asphyxia in the neonate?
Gasping reflex, apnea, bradycardia, and blood pressure drop.

36. What is the cause of asphyxia after birth?
Lung insufficiency.

37. What is meconium aspiration syndrome (MAS)?
It is a respiratory distress in a newborn who has aspirated fecal matter into the lungs before or around the time of birth.

38. Who is at the most risk for contracting MAS?
Post term infants due to diminished amniotic fluid and placental function.

39. What is the cause of MAS?
Asphyxia.

40. What is the incidence of MAS?
It is in amniotic fluid 9 to 20% of all births of which about half of those will aspirate.

41. When does MAS occur?
In the uterus, it is during birth or first breath.

42. What is meconium?
Fetal fecal matter.

43. What happens if meconium is aspirated?
Obstruction of the airways, atelectasis, and chemical pneumonitis.

44. How do you diagnose MAS?
It is observed in the airway, amniotic fluid, and mouth.

45. How do you treat MAS?
Suction the nose and mouth and if the Apgar score is low, then you should intubate.

46. What is a pneumothorax?
Air in the pleural space due to a rupture of the weak alveolar area.

47. What is a tension pneumothorax?
It is air obstructing the great arteries going to the lungs causing hypertension.

48. What are the clinical signs of a tension pneumothorax?
The shift of the trachea away, hyper-resonance to percussion, and in neonates a fiber-optic light used to see it.

49. What is the difference between a pneumothorax and pulmonary interstitial emphysema?
Air doesn’t migrate to interstitial space but remains in the tissue under the alveolus.

50. What is an air embolism?
It is the air bubble in the vasculature.

51. What is subcutaneous emphysema?
Air in tissue or crepitus.

52. What is persistent pulmonary hypertension of the neonate (PPHN)?
It is the failure of the normal circulatory transition that occurs after birth. The syndrome is characterized by marked pulmonary hypertension that causes hypoxemia secondary to right-to-left shunting of blood.

53. What happens physiologically during PPHN?
Vasoconstriction, decreased PaO2, and a return to fetal circulation or opening of the patent ductus arteriosus.

54. What are the tests for PPHN?
Preductal and postductal oxygen assessment, hyperventilation test (hyperoxia), or an echocardiogram with color flow doppler.

55. What drugs are used to help with PPHN?
Tolazoline and nitric oxide, which are vasodilators.

56. What are the possible treatment options for PPHN?
Hyperventilation therapy, high-frequency jet ventilation, and ECMO.

57. What is another name for transient tachypnea of the newborn (TTN)?
RDS type II.

58. What is the cause of TTN?
A cesarean section which causes retention of fetal lung fluid.

59. What is the treatment for TTN?
Oxygen delivered with CPAP.

60. What is apnea?
Cessation of breathing for a period that causes bradycardia.

61. What is obstructive apnea?
Soft tissue, anatomic abnormalities, pharyngeal musculature, or enlarged tonsils and adenoids.

62. What is central apnea?
CNS problems, chemoreceptor malfunction, and apnea of prematurity.

63. What is the treatment for apnea in neonates?
Methylxanthine.

64. What is Respiratory Distress Syndrome (RDS)?
An immature lung disorder caused by inadequate pulmonary surfactant.

65. What are the risk factors of RDS?
Male gender, low birth weight, born via C-section, multiple births (twins, quads), and moms who have diabetes.

66. What is the incidence of RDS?
The lower the gestation age the higher incidence of RDS.

67. What is the major underlying cause of RDS?
Insufficient amount of surfactant.

68. What is the pathophysiology of RDS?
Hyaline Membrane which the alveolar walls scar tissue of stiff lungs and decrease lung compliance.

69. What is the diagnosis for RDS?
L/S ratio & Presence of PG = test amniotic fluid that is ideal for lung maturity and the surfactant matures (2:1).

70. What is the treatment for RDS?
First line which is the prevention of premature labor, if she does give her corticosteroids to help lung maturity and improve surfactant magnesium sulfate.

71. When is surfactant replacement therapy given?
The first dose is given in the delivery room synthetic surfactant given right down the ETT to the lungs, depending on the response dosage will depend after.

72. What is thermoregulation?
Neonate needs warming to help decrease their oxygen consumption. Assist with RR, nasal CPAP first if does not improve then they will be intubated.

73. What strategy is used if an RDS patient is placed on a ventilator?
The low tidal volume strategy is required.

74. When does Bronchopulmonary Dysplasia or Chronic Lung Disease occur?
They begin as a severe form of RDS.

75. What are the causes of BPD or CLD?
ARDS, infection or Barrel trauma, damage from mech ventilation, intrauterine growth which causes retardation which they don’t grow and gain weight like they are supposed to, they are low birth weight, and inadequate nutrition.

76. What is CLD?
The need for oxygen beyond 28 days of life & an abnormal chest x-ray.

77. What happens in Retinopathy of Prematurity (ROP)?
It is a scar-like formation that develops behind the eye.

78. What are the causes of ROP?
A high PO2 which is basically too much oxygen that causes retinal constriction.

79. How is ROP diagnosed?
Eye exam by an ophthalmologist.

80. What is the treatment for ROP?
Laser ablation, cryotherapy-probe cooled and inserted behind eye.

81. What is an Intraventricular Hemorrhage (IVH)?
Bleeding in the cranium.

82. What are the risk factors of IVH?
Prematurity, neonates at greatest risk are those <32 weeks gestation & neonates with birth weight of <1500g (3Lbs) which is a very low birth weight VLBW.

83. What are the causes of IVH?
Prematurity of the central nervous system and any degree of asphyxia.

84. What is Pulmonary Interstitial Emphysema (PIE)?
It is an air leak syndrome on the left or right side. Air dissecting into the pulmonary interstitial then compress small airways.

85. What is the treatment for PIE?
HFOV.

86. What is the best positioning for PIE patients?
If only one side of the lung, lay patient on the affected side so it’s down for better oxygenation.

87. What is dexamethasone?
It has been shown to improve lung function. It is a diuretic for pulmonary edema.

88. How do you diagnose a pneumothorax?
It is through Trans illumination-method using a high-intense light source to quickly diagnosis of pneumothorax.

89. What does it mean if the light shows a halo or ring form?
This means that the patient has a normal lung and there in no pneumothorax present.

Final Thoughts

So there you have it. That wraps up our study guide on Perinatology and the Perinatal Lung Diseases that you must know as a Respiratory Therapy student. I hope that these practice questions were helpful for you. If you go through them a few times, you can development a good understanding that will help you ace your exams. Thank you for reading and as always, breathe easy my friend. 

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