NBRC Neonatal and Pediatric Respiratory Care 2 — Questions and Answers
Question 1: Croup (laryngotracheobronchitis) is most commonly caused by:
- Respiratory syncytial virus (RSV)
- Parainfluenza virus (Correct answer)
- Streptococcus pneumoniae
- Haemophilus influenzae type b
Correct answer: Parainfluenza virus
Parainfluenza virus (most commonly type 1) is the most frequent causative agent of croup, producing subglottic edema and the characteristic barking cough and stridor.
Question 2: Racemic epinephrine nebulization is used in croup primarily to:
- Treat the underlying viral infection
- Cause mucosal vasoconstriction and reduce subglottic edema (Correct answer)
- Improve alveolar ventilation
- Increase respiratory rate
Correct answer: Cause mucosal vasoconstriction and reduce subglottic edema
Racemic epinephrine stimulates alpha-adrenergic receptors in the subglottic mucosa, causing vasoconstriction and reducing edema to relieve upper airway obstruction in croup.
Question 3: Respiratory syncytial virus (RSV) most commonly causes which lower respiratory illness in infants?
- Lobar pneumonia
- Bronchiolitis (Correct answer)
- Empyema
- Lung abscess
Correct answer: Bronchiolitis
RSV is the leading cause of bronchiolitis in infants, causing small airway inflammation, mucus plugging, air trapping, and wheezing.
Question 4: The primary treatment for mild-to-moderate RSV bronchiolitis in infants is:
- Systemic corticosteroids
- Routine antibiotics
- Nebulized albuterol scheduled every 4 hours
- Supportive care: hydration, nasal suctioning, supplemental O2 as needed (Correct answer)
Correct answer: Supportive care: hydration, nasal suctioning, supplemental O2 as needed
Evidence supports supportive care for bronchiolitis; corticosteroids, routine bronchodilators, and antibiotics are not recommended for typical RSV bronchiolitis.
Question 5: Epiglottitis in children presents with the classic triad of:
- Barky cough, hoarseness, stridor
- Drooling, dysphagia, and high fever with muffled voice (Correct answer)
- Wheezing, retractions, and tachypnea
- Cyanosis, apnea, and bradycardia
Correct answer: Drooling, dysphagia, and high fever with muffled voice
Epiglottitis classically presents with drooling, dysphagia, and a toxic-appearing child with a high fever and muffled (hot potato) voice due to supraglottic inflammation.
Question 6: A normal respiratory rate for a 6-month-old infant is approximately:
- 12–20 breaths/min
- 20–30 breaths/min
- 30–60 breaths/min (Correct answer)
- 60–80 breaths/min
Correct answer: 30–60 breaths/min
Infants normally breathe 30–60 times per minute; respiratory rates above 60 in an infant at rest suggest respiratory distress.
NBRC Neonatal and Pediatric Respiratory Care 2
Croup (laryngotracheobronchitis) is most commonly caused by: