RRT-NPS Exam with Accurate Solutions
Laryngotracheomalacia - ANSWER-"Floppy airway" Stridor, expiratory wheeze,
worsens with agitation
Tracheoesophageal fistula (TEF) - ANSWER-surgical intervention, pathway between
esophagus and trachea
Choanal Atresia - ANSWER-nasal passage blockage at birth. newborns are nose
breathers, surgical intervention
Pierre Robin Syndrome - ANSWER-cleft palate, small jaw (micrognahia), posterior
tongue, prone positioning and surgery may help
Croup (laryngotracheobronchitis) - ANSWER-virus, barking cough, subglottic narrowing,
steeple sign, stridor , tx: race epi, corticosteriods, inhaled steriods, o2
Epiglotitis - ANSWER-airway emergency Supraglottic swelling of the epiglottis usually
bacterial high fever, sore throat, muffled voice, drooling "thumb sign" on lateral neck x-
ray DO NOT directly visualize airway. DO NOT lay patient flat without a secure airway.
DO NOT SUCTION WITHOUT SECURE AIRWAY intubate, start antibiotics and
corticosteroid
central sleep apnea - ANSWER-Absence of respiratory effort during sleep May be due
to an immature respiratory drive (APNEA OF PREMATURITY) May be associated with
underlying conditions such as Ondine's Curse, Prader-Willi, drugs, sepsis Can occur
with obstructive sleep apnea (mixed sleep apnea)
OSA - ANSWER-Most commonly caused by large adenoids and tonsils, also occurs
with other predisposing factors I.E. obesity, Down Syndrome, neuromuscular diseases,
etc OSA symptoms are different from adults, these include: behavioral problems,
continuous snoring, sweating, mouth breathing, bedwetting Treatment includes fixing
physical anomalies (I.E. having tonsils and adenoids removed) or CPAP
Apparent Life-Threatening Event - ANSWER-when a child experiences respiratory or
cardiac arrest but resuscitation is successful
Sudden Infant Death Syndrome- - ANSWER-Leading cause of death in infants. A
previously healthy infant dies suddenly of unknown cause, usually during sleep.
Autopsy often show evidence of hypoxemic ischemia (lack of oxygen to the brain) More
common during winter, during sleep, during illness and while using prone sleeping
positions. Consider GERD in apparent life threatening event
, ASTHMA - ANSWER-Disease of inflammation Recurrent bronchospasm causing
wheezing, shortness of breath and cough Mucous plugging may lead to atelectasis
Confirmation of asthma diagnosis requires PFT along with clinical findings May present
with labored breathing, hypoxemia, acidosis, wheezing, cough Use peak flow meter to
assess obstruction. Green, Yellow, Red are the zones, Red being the worst severity of
obstruction
TREATING ASTHMA - ANSWER-Inhaled corticosteroids- Ex: Budesonide (Pulmicort),
Beclomethasone (Qvar), Fluticasone (Flovent). "controller" meds. Bronchodilators:
Albuterol (B2 agonist) for quick relief. Ipratropium (Atrovent) - anticholinergic Systemic
corticosteroids- prednisone or methylprednisone for acute asthma exacerbation. Very
important. Mechanically ventilate 6-8ml/kg with low to moderate PEEP, monitor for auto-
PEEP. May need longer expiratory time. Heliox and/or Magnesium Sulfate for severe
exacerbations. (See Heliox slide.)
BRONCHIOLITIS - ANSWER-Lower respiratory infection most common in infancy
Usually caused by Respiratory Syncytial Virus (RSV). Secondary pneumonia can occur
Thick mucus and inflammation blocks nasal passages and airways Presents with nasal
flaring, tachypnea, hypoxemia, retractions, accessory muscle use Treatment consists of
supportive care: oxygen, suctioning, fluid maintenance Severe respiratory distress and
apnea may occur, requiring intubation and mechanical ventilation Synagis (Palivizumab)
- protects infants with chronic lung or heart disease from RSV, very expensive, not
always effective
NEONATAL PNEUMONIA - ANSWER-Caused frequently by bacteria passed to the
infant by mom, also can occur by nosocomial infection. Group B strep is very common,
E. Coli is also very common Symptoms include poor feeding, temperature instability,
respiratory distress Can occur in infants of any gestational age Chest x-ray may show
diffuse granular pattern with bilateral involvement ABG may reveal hypoxemia and
respiratory acidosis Prevent with maternal antibiotics before delivery at signs of infection
Treat neonate after delivery with antibiotics and supportive care
GASTROCHISIS/OMPHALOCELE - ANSWER-Abnormal development of the
abdominal wall and GI tract in utero Essentially intestines herniates to outside of
abdomen during Patients may need ventilatory support during, before and after surgical
repair
PRUNE-BELLY SYNDROME - ANSWER-Congenital lack of abdominal muscles These
patients have a weak cough and increased secretions Ventilatory support and bronchial
hygiene may be necessary
Necrotizing Enterocolitis - ANSWER-Disease of prematurity, occurs when feeds are
introduced to a premature GI tract Metabolic acidosis, abdominal distention and sepsis
Laryngotracheomalacia - ANSWER-"Floppy airway" Stridor, expiratory wheeze,
worsens with agitation
Tracheoesophageal fistula (TEF) - ANSWER-surgical intervention, pathway between
esophagus and trachea
Choanal Atresia - ANSWER-nasal passage blockage at birth. newborns are nose
breathers, surgical intervention
Pierre Robin Syndrome - ANSWER-cleft palate, small jaw (micrognahia), posterior
tongue, prone positioning and surgery may help
Croup (laryngotracheobronchitis) - ANSWER-virus, barking cough, subglottic narrowing,
steeple sign, stridor , tx: race epi, corticosteriods, inhaled steriods, o2
Epiglotitis - ANSWER-airway emergency Supraglottic swelling of the epiglottis usually
bacterial high fever, sore throat, muffled voice, drooling "thumb sign" on lateral neck x-
ray DO NOT directly visualize airway. DO NOT lay patient flat without a secure airway.
DO NOT SUCTION WITHOUT SECURE AIRWAY intubate, start antibiotics and
corticosteroid
central sleep apnea - ANSWER-Absence of respiratory effort during sleep May be due
to an immature respiratory drive (APNEA OF PREMATURITY) May be associated with
underlying conditions such as Ondine's Curse, Prader-Willi, drugs, sepsis Can occur
with obstructive sleep apnea (mixed sleep apnea)
OSA - ANSWER-Most commonly caused by large adenoids and tonsils, also occurs
with other predisposing factors I.E. obesity, Down Syndrome, neuromuscular diseases,
etc OSA symptoms are different from adults, these include: behavioral problems,
continuous snoring, sweating, mouth breathing, bedwetting Treatment includes fixing
physical anomalies (I.E. having tonsils and adenoids removed) or CPAP
Apparent Life-Threatening Event - ANSWER-when a child experiences respiratory or
cardiac arrest but resuscitation is successful
Sudden Infant Death Syndrome- - ANSWER-Leading cause of death in infants. A
previously healthy infant dies suddenly of unknown cause, usually during sleep.
Autopsy often show evidence of hypoxemic ischemia (lack of oxygen to the brain) More
common during winter, during sleep, during illness and while using prone sleeping
positions. Consider GERD in apparent life threatening event
, ASTHMA - ANSWER-Disease of inflammation Recurrent bronchospasm causing
wheezing, shortness of breath and cough Mucous plugging may lead to atelectasis
Confirmation of asthma diagnosis requires PFT along with clinical findings May present
with labored breathing, hypoxemia, acidosis, wheezing, cough Use peak flow meter to
assess obstruction. Green, Yellow, Red are the zones, Red being the worst severity of
obstruction
TREATING ASTHMA - ANSWER-Inhaled corticosteroids- Ex: Budesonide (Pulmicort),
Beclomethasone (Qvar), Fluticasone (Flovent). "controller" meds. Bronchodilators:
Albuterol (B2 agonist) for quick relief. Ipratropium (Atrovent) - anticholinergic Systemic
corticosteroids- prednisone or methylprednisone for acute asthma exacerbation. Very
important. Mechanically ventilate 6-8ml/kg with low to moderate PEEP, monitor for auto-
PEEP. May need longer expiratory time. Heliox and/or Magnesium Sulfate for severe
exacerbations. (See Heliox slide.)
BRONCHIOLITIS - ANSWER-Lower respiratory infection most common in infancy
Usually caused by Respiratory Syncytial Virus (RSV). Secondary pneumonia can occur
Thick mucus and inflammation blocks nasal passages and airways Presents with nasal
flaring, tachypnea, hypoxemia, retractions, accessory muscle use Treatment consists of
supportive care: oxygen, suctioning, fluid maintenance Severe respiratory distress and
apnea may occur, requiring intubation and mechanical ventilation Synagis (Palivizumab)
- protects infants with chronic lung or heart disease from RSV, very expensive, not
always effective
NEONATAL PNEUMONIA - ANSWER-Caused frequently by bacteria passed to the
infant by mom, also can occur by nosocomial infection. Group B strep is very common,
E. Coli is also very common Symptoms include poor feeding, temperature instability,
respiratory distress Can occur in infants of any gestational age Chest x-ray may show
diffuse granular pattern with bilateral involvement ABG may reveal hypoxemia and
respiratory acidosis Prevent with maternal antibiotics before delivery at signs of infection
Treat neonate after delivery with antibiotics and supportive care
GASTROCHISIS/OMPHALOCELE - ANSWER-Abnormal development of the
abdominal wall and GI tract in utero Essentially intestines herniates to outside of
abdomen during Patients may need ventilatory support during, before and after surgical
repair
PRUNE-BELLY SYNDROME - ANSWER-Congenital lack of abdominal muscles These
patients have a weak cough and increased secretions Ventilatory support and bronchial
hygiene may be necessary
Necrotizing Enterocolitis - ANSWER-Disease of prematurity, occurs when feeds are
introduced to a premature GI tract Metabolic acidosis, abdominal distention and sepsis
