Copyright © 2019, Elsevier Inc. All Rights Reserved. 1Chapter 37: Alterations of Pulmonary Function in ChildrenMcCance/Huether: Pathophysiology: The Biologic Basis of Disease in Adults and Children, 8th EditionMULTIPLE CHOICE 1. Why is nasal congestion a serious threat to young infants?a. Infants are obligatory nose breathers.b. Their nares are small in diameter.c. Infants become dehydrated when mouth breathing.d. Their epiglottis is proportionally greater than the epiglottis of an adult’s.ANS: AInfants up to 2 to 3 months of age are obligatory nose breathers and are unable to breathe in through their mouths. Nasal congestion is therefore a serious threat to a young infant. This selection is the only option that accurately describes why nasal congestion is a serious threat to young infants. Although infants’ nares are smaller than older children, this is not the main reason why congestion poses such a threat. Becoming dehydrated also is not a factor. The size of their epiglottis is also not as big a factor in young infants.PTS: 1 DIF: Cognitive Level: Remembering 2. The risk for respiratory distress syndrome (RDS) decreases for premature infants when they are born between how many weeks of gestation?a. 16 and 20b. 20 and 24c. 24 and 30d. 30 and 36ANS: DA lack of surfactant leads to RDS. Surfactant is secreted into fetal airways between 30 and 36 weeks, so a baby born between these weeks would have less of developing RDS.PTS: 1 DIF: Cognitive Level: Remembering 3. A healthcare professional is educating a community parent group and informs them that which type of croup is most common?a. Bacterialb. Viralc. Fungald. AutoimmuneANS: BIn 85% of children with croup, a virus is the cause, most commonly parainfluenza. The healthcare professional would inform the parent group of this fact.PTS: 1 DIF: Cognitive Level: Remembering 4. What is the primary cause of respiratory distress syndrome (RDS) of the newborn?a. Immature immune systemb. Small alveolic. Surfactant deficiencyd. AnemiaANS: CRDS is primarily caused by surfactant deficiency and secondarily by a deficiency in alveolar surface area for gas exchange. RDS is not caused by having an immature immune system, small alveoli, or anemia.PTS: 1 DIF: Cognitive Level: Remembering 5. What is the primary problem resulting from respiratory distress syndrome (RDS) of the newborn?a. Consolidationb. Pulmonary edemac. Atelectasisd. Bronchiolar pluggingANS: CThe primary problem is atelectasis, which causes significant hypoxemia and is difficult for the neonate to overcome because a significant negative inspiratory pressure is required to open the alveoli with each breath. Consolidation, pulmonary edema, and bronchiolar plugging are not the primary problems in RDS.PTS: 1 DIF: Cognitive Level: Remembering 6. Bronchiolitis tends to occur during the first years of life and is most often caused by what type of infection?a. Respiratory syncytial virus (RSV)b. Influenza virusc. Adenovirusesd. RhinovirusANS: AThe most common associated pathogen is RSV, but bronchiolitis may also be associated with adenovirus, rhinovirus, influenza, parainfluenza virus (PIV), and Mycoplasma pneumoniae.PTS: 1 DIF: Cognitive Level: RememberingCopyright © 2019, Elsevier Inc. All Rights Reserved. 2 7. Which immunoglobulin (Ig) is present in childhood asthma?a. IgMb. IgGc. IgEd. IgAANS: CIncluded in the long list of asthma-associated genes are those that code for increased levels of immune and inflammatory mediators (e.g., interleukin [IL]-4, IgE, leukotrienes), nitric oxide, and transmembrane proteins in the endoplasmic reticulum. IgM, IgG, and IgA are not associated with childhood asthma.PTS: 1 DIF: Cognitive Level: Remembering 8. Which T-lymphocyte phenotype is the key determinant of childhood allergic asthma?a. Cluster of differentiation (CD) 4 T-helper Th1 lymphocytesb. CD4 T-helper Th2 lymphocytesc. CD8 cytotoxic T lymphocytesd. Memory T lymphocytesANS: BEarly onset allergic asthma is initiated by a type I hypersensitivity reaction primarily mediated by Th2 lymphocytes whose cytokines activate mast cells, eosinophilia, leukocytosis, and enhance B-cell IgE production.PTS: 1 DIF: Cognitive Level: Remembering 9. A student asks the healthcare professional why researchers are trying to link specific genes to specific asthma phenotypes. What response by the professional is best?a. Some types of asthma are easier to treat than others.b. Some people could use cheaper medications.c. It can lead to personalized approaches to treatment.d. More and more asthma phenotypes are being recognized.ANS: CLinking specific genes to specific asthma phenotypes is leading to targeted therapies and personalized approaches to asthma treatment. It may be true that some types are easier to treat or that some people could use different, less expensive medications, but those responses are too narrow in focus to be the best answer. Several phenotypes of asthma have already been recognized.PTS: 1 DIF: Cognitive Level: Understanding 10. Which statement by the healthcare professional accurately describes childhood asthma?a. An obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammationb. A pulmonary disease characterized by severe hypoxemia, decreased pulmonary compliance, and diffuse densities on chest x-ray imagingc. A pulmonary disorder involving an abnormal expression of a protein, producing viscous mucus that lines the airways, pancreas, sweat ducts, and vas deferensd. An obstructive airway disease characterized by atelectasis and increased pulmonary resistance as a result of a surfactant deficiencyANS: AAsthma is an obstructive airway disease characterized by reversible airflow obstruction, bronchial hyperreactivity, and inflammation. A disease with severe hypoxemia, decreased compliance, and diffuse densities on chest x-ray is ARDS. The viscous mucus lining the airways and other organs and tissues is seen in cystic fibrosis. Surfactant deficiency is found in RDS of the newborn.PTS: 1 DIF: Cognitive Level: Understanding 11. A 7 year-old-child presents to the clinic where parents report signs and symptoms consistent with asthma. What does the healthcare professional do in order to confirm this diagnosis?a. Assess for a parental history of asthmab. Draw serum levels of immunoglobulin E (IgE) and eosinophil levelsc. Measure expiratory flow rate with spirometry testingd. Give a trial of asthma medication
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