NBRC TMC Neonatal and Pediatric Respiratory Care Exam
Questions and Verified Answers with Rationale | Latest
Edition 2026/2027
Question 1
A term newborn infant delivered via emergency cesarean section for
fetal distress develops tachypnea, nasal flaring, and mild intercostal
retractions within two hours of birth. A chest radiograph reveals
prominent perihilar streaking, fluid in the interlobar fissures, and
flattened diaphragms. Which of the following conditions is the most
likely diagnosis?
A. Respiratory distress syndrome
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Congenital diaphragmatic hernia
Correct Answer: B
Rationale: Transient tachypnea of the newborn results from delayed
resorption of fetal lung fluid, commonly seen after cesarean delivery.
Radiographic findings include fluid in the fissures, perihilar streaking,
and hyperinflation. It is typically a benign, self-limiting condition
resolving within 24 to 72 hours.
Question 2
An infant born at 28 weeks of gestation develops progressive respiratory
distress shortly after delivery. The infant requires intubation and
mechanical ventilation. A chest radiograph demonstrates a diffuse
bilateral reticulogranular ground-glass pattern with air bronchograms.
,Which of the following surfactant deficiencies or structural conditions is
the primary cause?
A. Deficiency of pulmonary surfactant leading to alveolar collapse
B. Massive mechanical airway obstruction from thick meconium
C. Pulmonary hypoplasia secondary to prolonged oligohydramnios
D. Bacterial pneumonia acquired via intrauterine infection
Correct Answer: A
Rationale: Respiratory distress syndrome in premature infants is caused
by a primary deficiency of pulmonary surfactant, leading to increased
alveolar surface tension, widespread alveolar collapse, decreased
compliance, and characteristic ground-glass appearances with air
bronchograms on chest radiographs.
Question 3
A post-term infant born through thick meconium-stained amniotic fluid
is limp, cyanotic, and exhibits poor respiratory effort at birth. After
immediate stabilization and endotracheal intubation, the respiratory
therapist notes coarse crackles and rhonchi bilaterally. A chest
radiograph reveals patchy areas of atelectasis intermingled with
hyperinflation. What is the most appropriate initial ventilator strategy?
A. Rapidly normalize carbon dioxide tension using high peak
pressures
B. Use lower respiratory rates with prolonged expiratory times to
minimize air trapping
C. Maintain high positive end-expiratory pressure with short
inspiratory times
, D. Apply continuous positive airway pressure via nasal mask without
intubation
Correct Answer: B
Rationale: Meconium aspiration syndrome causes partial airway
obstruction leading to a ball-valve effect, air trapping, and hyperinflation
alongside atelectasis. Ventilator management focuses on utilizing longer
expiratory times and lower rates to allow complete exhalation and
prevent barotrauma or volutrauma.
Question 4
A 3-year-old child presents to the emergency department with a 2-day
history of a seal-like barking cough, inspiratory stridor at rest, and low-
grade fever. The child appears anxious but has clear breath sounds
without wheezing. A lateral neck radiograph reveals a steepening
subglottic narrowing known as the steeple sign. Which of the following
interventions is most appropriate?
A. Immediate surgical tracheostomy in the operating suite
B. Administration of aerosolized racemic epinephrine and systemic
corticosteroids
C. Intravenous broad-spectrum antibiotic therapy for acute epiglottitis
D. Insertion of a rigid bronchoscope under general anesthesia
Correct Answer: B
Rationale: The clinical presentation of a barking cough, inspiratory
stridor, and the steeple sign on a neck radiograph confirms viral croup
(laryngotracheobronchitis). Mild to moderate cases are managed with
humidified oxygen, corticosteroids, and nebulized racemic epinephrine
for mucosal vasoconstriction when stridor occurs at rest.
, Question 5
A 4-year-old child is brought to the emergency department with a
sudden onset of high fever, drooling, severe dysphagia, and muffled
voice. The child is sitting upright in a tripod position, struggling to
breathe with marked inspiratory stridor. What is the most critical initial
rule to follow in managing this patient?
A. Immediately examine the oropharynx using a tongue depressor to
visualize the larynx.
B. Keep the child calm and avoid invasive agitation, securing an
artificial airway in a controlled setting.
C. Administer high-flow nebulized albuterol immediately via face
mask.
D. Place the child in a flat supine position to facilitate lumbar
puncture.
Correct Answer: B
Rationale: Acute epiglottitis is a life-threatening bacterial infection
(typically Haemophilus influenzae type b) causing rapid swelling of the
epiglottitis. Agitating the child or attempting visualization with a tongue
depressor can trigger acute, complete airway obstruction. The child
should be kept calm, and airway management should be performed by
experienced personnel in a controlled operating room setting.
Question 6
An 8-month-old infant is admitted to the pediatric ward with a 3-day
history of rhinorrhea, low-grade fever, wheezing, and increasing
respiratory distress. Physical examination reveals tachypnea, subcostal
retractions, and bilateral expiratory wheezes and crackles. A rapid viral
antigen test is positive for respiratory syncytial virus. Which of the
following treatments forms the cornerstone of supportive care?
Questions and Verified Answers with Rationale | Latest
Edition 2026/2027
Question 1
A term newborn infant delivered via emergency cesarean section for
fetal distress develops tachypnea, nasal flaring, and mild intercostal
retractions within two hours of birth. A chest radiograph reveals
prominent perihilar streaking, fluid in the interlobar fissures, and
flattened diaphragms. Which of the following conditions is the most
likely diagnosis?
A. Respiratory distress syndrome
B. Transient tachypnea of the newborn
C. Meconium aspiration syndrome
D. Congenital diaphragmatic hernia
Correct Answer: B
Rationale: Transient tachypnea of the newborn results from delayed
resorption of fetal lung fluid, commonly seen after cesarean delivery.
Radiographic findings include fluid in the fissures, perihilar streaking,
and hyperinflation. It is typically a benign, self-limiting condition
resolving within 24 to 72 hours.
Question 2
An infant born at 28 weeks of gestation develops progressive respiratory
distress shortly after delivery. The infant requires intubation and
mechanical ventilation. A chest radiograph demonstrates a diffuse
bilateral reticulogranular ground-glass pattern with air bronchograms.
,Which of the following surfactant deficiencies or structural conditions is
the primary cause?
A. Deficiency of pulmonary surfactant leading to alveolar collapse
B. Massive mechanical airway obstruction from thick meconium
C. Pulmonary hypoplasia secondary to prolonged oligohydramnios
D. Bacterial pneumonia acquired via intrauterine infection
Correct Answer: A
Rationale: Respiratory distress syndrome in premature infants is caused
by a primary deficiency of pulmonary surfactant, leading to increased
alveolar surface tension, widespread alveolar collapse, decreased
compliance, and characteristic ground-glass appearances with air
bronchograms on chest radiographs.
Question 3
A post-term infant born through thick meconium-stained amniotic fluid
is limp, cyanotic, and exhibits poor respiratory effort at birth. After
immediate stabilization and endotracheal intubation, the respiratory
therapist notes coarse crackles and rhonchi bilaterally. A chest
radiograph reveals patchy areas of atelectasis intermingled with
hyperinflation. What is the most appropriate initial ventilator strategy?
A. Rapidly normalize carbon dioxide tension using high peak
pressures
B. Use lower respiratory rates with prolonged expiratory times to
minimize air trapping
C. Maintain high positive end-expiratory pressure with short
inspiratory times
, D. Apply continuous positive airway pressure via nasal mask without
intubation
Correct Answer: B
Rationale: Meconium aspiration syndrome causes partial airway
obstruction leading to a ball-valve effect, air trapping, and hyperinflation
alongside atelectasis. Ventilator management focuses on utilizing longer
expiratory times and lower rates to allow complete exhalation and
prevent barotrauma or volutrauma.
Question 4
A 3-year-old child presents to the emergency department with a 2-day
history of a seal-like barking cough, inspiratory stridor at rest, and low-
grade fever. The child appears anxious but has clear breath sounds
without wheezing. A lateral neck radiograph reveals a steepening
subglottic narrowing known as the steeple sign. Which of the following
interventions is most appropriate?
A. Immediate surgical tracheostomy in the operating suite
B. Administration of aerosolized racemic epinephrine and systemic
corticosteroids
C. Intravenous broad-spectrum antibiotic therapy for acute epiglottitis
D. Insertion of a rigid bronchoscope under general anesthesia
Correct Answer: B
Rationale: The clinical presentation of a barking cough, inspiratory
stridor, and the steeple sign on a neck radiograph confirms viral croup
(laryngotracheobronchitis). Mild to moderate cases are managed with
humidified oxygen, corticosteroids, and nebulized racemic epinephrine
for mucosal vasoconstriction when stridor occurs at rest.
, Question 5
A 4-year-old child is brought to the emergency department with a
sudden onset of high fever, drooling, severe dysphagia, and muffled
voice. The child is sitting upright in a tripod position, struggling to
breathe with marked inspiratory stridor. What is the most critical initial
rule to follow in managing this patient?
A. Immediately examine the oropharynx using a tongue depressor to
visualize the larynx.
B. Keep the child calm and avoid invasive agitation, securing an
artificial airway in a controlled setting.
C. Administer high-flow nebulized albuterol immediately via face
mask.
D. Place the child in a flat supine position to facilitate lumbar
puncture.
Correct Answer: B
Rationale: Acute epiglottitis is a life-threatening bacterial infection
(typically Haemophilus influenzae type b) causing rapid swelling of the
epiglottitis. Agitating the child or attempting visualization with a tongue
depressor can trigger acute, complete airway obstruction. The child
should be kept calm, and airway management should be performed by
experienced personnel in a controlled operating room setting.
Question 6
An 8-month-old infant is admitted to the pediatric ward with a 3-day
history of rhinorrhea, low-grade fever, wheezing, and increasing
respiratory distress. Physical examination reveals tachypnea, subcostal
retractions, and bilateral expiratory wheezes and crackles. A rapid viral
antigen test is positive for respiratory syncytial virus. Which of the
following treatments forms the cornerstone of supportive care?
