Meconium Aspiration Syndrome There are 30 questions on this test.  A score of 80% is required to be successful; no more than 6 questions may be incorrect.  Good Luck!!! Questions 31 to 35 are your evaluation of this learning activity.  The Program Evaluation must be completed to receive credit.  Thank you.  First name:   Last name:   Title   Email   Hosptial Name   Address   City, State, Zip Code   Phone   1 Meconium first appears in the fetal intestines about: 7-8 weeks' gestation 10-12 weeks' gestation 14-16 weeks' gestation 20-22 weeks' gestation 2 Some believe the presence of meconium in the amniotic fluid is a normal physiologic occurrence. True False 3 Meconium is composed of lanugo, vernix, bile salts, enzymes, water, among other things and ranges from thin and watery to thick and tenacious. True False 4 Meconium in the amniotic fluid may: a:  Stimulate vasospams of the umbilical vessels b:  Increase incidence of chorioamnionitis c:  Neutralize surfactant activity d:  Increase incidence of preterm labor. a, b, c b, c, d a, c, d All of the above 5 Fetal respiratory activity is a normal physiologic process resulting in amniotic fluid moving in & out of the tracheo-bronchial tree. True False 6 An in utero stressful event, such as asphyxia, triggers the chain of events that may result in meconium aspiration. True False 7 ______________ leads to fetal gasping, opening of the glottis allowing amniotic fluid into the large airways of the tracheo-bronchial tree. Umbilical cord compression Asphyxia Apnea None of the above 8 The fetus' next response is to                                        expelling meconium into the amniotic fluid. Relax the anal sphincter Increase peristalsis Defecate All of the above 9 It is the second and subsequent intrauterine stress events that really cause Meconium Aspiration Syndrome (MAS). True False 10 Meconium passed during the intrapartal time period is the most worrisome. True False 11 Passage of meconium occurs most frequently in the: Pre term infant Term infant Post term infant 12 More severe infant outcomes from intrauterine meconium exposure may be associated with: Acute, single exposure to thin green meconium Acute, single exposure to thick, viscous meconium Chronic over-time exposure to thin green meconium Chronic over-time exposure to thick, viscous meconium 13 The diagnosis of MAS should be made only after all other etiologies for respiratory distress have been ruled out. True False 14 The incidence of meconium stained amniotic fluid decreases with increasing gestational age. True False 15 In the case of a breech delivery, meconium passage is a normal event and poses no problems for the infant. True False 16 Respiratory distress associated with MAS may present with all of the following except: Gasping or apneic respirations Intercostal & supra-clavicular retractions Increased air exchange with inspiration and expiration Nasal flaring, grunting and a barrel chest 17 Metabolic disturbances in the infant with MAS may include: a:  Hypoglycemia b:  Hypocalcemia c:  Hypoxemia d:  Respiratory & Metabolic acidosis. a, b, c b, c, d d only All of the above 18 Radiologic findings are likely to include areas of both atelectasis and over-inflation. True False 19 Improved mortality and morbidity in infants with MAS is associated with: Suctioning of mouth, nose, pharynx & trachea with delivery of head Suctioning of mouth, nose, pharynx & trachea before initiation of respirations Amnioinfusion for all patients with meconium stained fluid All of the above 20 A major benefit of amnioinfusion is the correction of fetal oxygenation and perfusion. True False 21 In the delivery rooming setting during intubation and suctioning for meconium, suction is applied only as the ET tube is withdrawn and should be limited to 20 seconds. True False 22 One advantage of hi-frequency ventilation is diminished trauma to the lungs. True False 23 Nitric Oxide works by decreasing pulmonary resistance and improving the infant's  oxygen/carbon dioxide exchange. True False 24 Important aspects of patient care for infants receiving nitric oxide (iNO) include: a:  iNO-specific ventilator required b:  "Bag" with iNO and not O2 c:  Transported on iNO. d:  Continued for 21 days a, b, c b, c, d a, c, d All of the above 25 Infants with MAS are often placed on broad-spectrum antibiotics since meconium may serve as a culture medium for bacterial growth. True False 26 Pressor agents of choice in the infant with MAS include: Dopamine & Epinephrine Dopamine & Dobutamine Dobutamine & Epinephrine Dobutamine & Fentanyl 27 I promote muscle relaxation and paralysis, improve oxygenation and ventilation and reduce fluctuations in cerebral blood flow.  Who am I? Dopamine Fentanyl Pavulon Phenobarbital 28 Parents should be encouraged to visit and provide "hands on" care so they'll be prepared to care for their infant. True False 29 Associated complications from MAS may include: a:  Air Trapping, Atelectasis b:  Chemical  Pneumonitis, PPHN c:  Anemia, Thrombocytopenia d:  Siezures, ISADH. a, b, c b, c, d a, b, d All of the above 30 Despite current medical therapies, MAS continues to be a major cause of respiratory failure and death for these infants. True False 31 Discuss the etiology of Meconium Aspiration Syndrome (MAS). Excellent Good Fair Poor 32 Describe the clinical presentation of MAS. Excellent Good Fair Poor 33 Discuss the management, complications and outcomes fo MAS. Excellent Good Fair Poor 34 Please select the amount of time that most closely represents the time you needed to complete this activity. 15--30 minutes 31--60 minutes 1--1½ hours 1½--2 hours 2--2½ hours 2½--3 hours or longer 35 General Comments/How will you use?

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