CPEN Respiratory Emergencies 5 — Questions and Answers
Question 1: A neonate born at 28 weeks gestation requires surfactant therapy. The PRIMARY purpose of surfactant is to:
- Reduce pulmonary vascular resistance
- Decrease alveolar surface tension to prevent collapse (Correct answer)
- Stimulate respiratory drive
- Decrease CO2 production
Correct answer: Decrease alveolar surface tension to prevent collapse
Surfactant reduces alveolar surface tension, preventing alveolar collapse at end-expiration in premature infants with surfactant deficiency (RDS).
Question 2: Which combination of findings is MOST consistent with carbon monoxide (CO) poisoning in a child?
- SpO2 88%, cyanosis, bradycardia
- Normal SpO2, headache, altered mental status (Correct answer)
- SpO2 70%, gasping, hypotension
- SpO2 95%, stridor, fever
Correct answer: Normal SpO2, headache, altered mental status
Pulse oximetry cannot distinguish carboxyhemoglobin from oxyhemoglobin, so SpO2 reads falsely normal despite significant CO poisoning causing neurological symptoms.
Question 3: A 6-year-old with a history of a congenital heart defect presents with a sudden respiratory emergency. Which finding suggests pulmonary hypertensive crisis?
- Bilateral wheezing with prolonged expiration
- Sudden cyanosis, bradycardia, and right heart failure signs (Correct answer)
- Inspiratory stridor with drooling
- Unilateral decreased breath sounds
Correct answer: Sudden cyanosis, bradycardia, and right heart failure signs
Pulmonary hypertensive crisis presents with sudden severe cyanosis, bradycardia, and signs of acute right heart failure due to massive rise in pulmonary vascular resistance.
Question 4: When using a non-rebreather mask for a pediatric patient, what minimum flow rate is required to keep the reservoir bag inflated?
- 2–4 L/min
- 4–6 L/min
- 10–15 L/min (Correct answer)
- 6–8 L/min
Correct answer: 10–15 L/min
A non-rebreather mask requires 10–15 L/min flow rate to maintain reservoir bag inflation and deliver approximately 95% FiO2.
Question 5: A child presents with subcutaneous emphysema in the neck, absent breath sounds on the left, and tracheal deviation to the right. These findings indicate:
- Massive hemothorax
- Left tension pneumothorax (Correct answer)
- Right tension pneumothorax
- Diaphragmatic hernia
Correct answer: Left tension pneumothorax
Left tension pneumothorax causes absent breath sounds on the left, tracheal deviation away from the affected side (to the right), and can cause subcutaneous emphysema.
Question 6: Which ventilator setting change would BEST address auto-PEEP (breath stacking) in an intubated child with severe asthma?
- Increase respiratory rate
- Increase tidal volume
- Decrease respiratory rate to allow longer expiratory time (Correct answer)
- Increase peak inspiratory pressure
Correct answer: Decrease respiratory rate to allow longer expiratory time
Auto-PEEP in asthma is caused by incomplete exhalation; decreasing respiratory rate lengthens expiratory time and allows trapped air to escape.
Question 7: A 3-year-old ingests a button battery and now presents with drooling, stridor, and respiratory distress. The PRIORITY is:
- Administer H2 blocker and observe
- Immediate endoscopy/removal as a surgical emergency (Correct answer)
- Obtain X-ray series over 24 hours
- Induce vomiting to remove the battery
Correct answer: Immediate endoscopy/removal as a surgical emergency
Button batteries lodged in the esophagus cause rapid liquefactive necrosis and airway compromise — immediate endoscopic removal is a surgical emergency.
CPEN Respiratory Emergencies 5
A neonate born at 28 weeks gestation requires surfactant therapy.
The PRIMARY purpose of surfactant is to: