KETTERING NPS ACTUAL FINAL EXAM

KETTERING NPS ACTUAL FINAL EXAM

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The pediatric pulmonologist is preparing to intubate a child with laryngotracheal stenosis. Which of the following devices would be most appropriate for this potentially difficult intubation?

• Laryngeal mask airway
• Laryngoscope with miller blade
• Laryngoscope with Macintosh blade
• Flexible fiberoptic bronchoscope - ANSWER-D. flexible fiberoptic

bronchoscope

An 11- year old patient on mechanical ventilation has a size 6 mm ID cuffed ETT in place. The neonatal/pediatric specialist uses a cofactor to measure the cuff pressure and notes that the cuff pressure is 24 cm H2O. The specialist should

• Maintain the current cuff pressure
• reinflate the cuff with minimal leak technique
• Change to a larger tube
• Change to a smaller tube - ANSWER-C. Change to a larger tube. (cuff pressure

should not exceed 20 cm H2O, if it is higher then the tube needs to be changed to a larger tube size)

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A 5-year old patient with epiglottitis was intubated for airway management.Following extubating, the neonatal/ pediatric specialist notes the presence of marked inspiratory stridor. The specialist should

• provide cool mist aerosol
• Reintubate the patient
• administer heliox therapy
• administer racemic epinephrine - ANSWER-B. reintubate the patient (airway

emergency!)

A 2-year old patient with a severe case of laryngotracheobronchitis was extubated earlier in the morning. The patient received aerosolized racemic epinephrine Q6HR throughout the day. During her initial assessment, the night shift neonatal/ pediatric specialist notes that the patient has mild to moderated inspiratory stridor. Vital

signs: BP 80/40 mmHg, HR 100/min, RR 28/min, temp 37 degrees C, and SpO2 is

93% on 30% oxygen by cool aerosol. Which of the following should the specialist recommend?

• levalbuterol (Xopenex)
• prostacyclin (flolan)
• Helium- Oxygen gas mixture
• Reintubate the patient - ANSWER-C. Helium- Oxygen gas mixture

A 3-year old patient is on mechanical ventilation after nearly drowning in his grandmother's backyard pool. He developed a kidney infection and has been on antibiotics for four days. The neonatal/pediatric specialist is also concerned about the development of ventilator- associated pneumonia. Which of the following should the specialist recommend to reduce the risk?

• keep head of bed elevated 30-45 degrees
• closed suction catheters
• change ventilator circuits every 72 hours
• use SVN for bronchodilators instead of MDI 2 / 4

• 1 and 2 only
• 3 and 4 only
• 1,2, and 4 only
• 1.3. and 4 only – ANSWER- A. 1 and 2 only (also routine oral care, avoid

routine circuit changes, MDI instead of SVN, and a hi-lo tube)

A 10-year old girl was involved in a personal watercraft accident and suffered a C-

• fracture requiring mechanical ventilation. Nine days following intubation, the

pediatric intensivist asks the neonatal/ pediatric specialist for a recommendation regarding an artificial airway for this patient. the specialist should recommend a/an

• uncuffed ETT
• Tracheostomy tube

C. LMA

• Carlen's tube - ANSWER-B. Tracheostomy tube

An infant born to a mother who smoked cigarettes during pregnancy is at a greater risk of

• central nervous system dysfunction
• intrauterine growth retardation
• teratogenic effects
• lower intellectual level - ANSWER-B. intrauterine growth retardation (also low

birth weight and preterm birth) During assessment of an infant’s nutritional status, the neonatal/pediatric specialist notes that the infant has a protruding belly with edematous face and limbs. this condition is best described as

• potter syndrome 3 / 4

• scaphoid abdomen
• kwashiorkor
• marasmus - ANSWER-C. Kwashiorkor (caused by sudden lack of protein and

calories with a protruding belly and edema to the face and limbs)

Potter syndrome: atypical appearance caused by oligohydramnios

Scaphoid abdomen: diaphragmatic hernia resulting from bowel being present in the chest

Marasmus: caused by an extreme lack of calories and protein over a lengthy

amount of time resulting in matchstick arms.

A feeding tube is inserted through the nose of a full-term newborn. When evaluating the post-procedure x-ray, the neonatal/pediatric specialist notes that the tube is coiled in the newborn’s mediastinum. This would indicate a/an

• diaphragmatic hernia
• Esophageal atresia
• trachea-esophageal fistula
• choanal atresia - ANSWER-B. esophageal atresia (top and bottom of the

esophagus have not grown together)

Diaphragmatic hernia: abnormal opening in the diaphragm.

Trachea-esophageal fistula: opening between trachea and esophagus

Choanal atresia: congenital blockage of the nasopharynx.

Upon examination of the chest x-ray of a premature newborn receiving positive pressure ventilation, the neonatal/pediatric specialist notes the presence of nodular, irregular bubbles radiating outward from the hilum accompanied by linear lucencies and streaks. These findings are consistent with:

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