6.Neonatal respiratory distress syndrome -ards -sleep apnea - pneum.ipertasi

Question 1

A newborn dies of neonatal respiratory distress syndrome. Lung tissue examined in the lab will reveal a deficiency of what chemical?

Answer 1

Surfactant

Question 2

• How does the lack of surfactant in neonatal respiratory distress syndrome impair gas exchange in the lungs?

Answer 2

Surfactant deficiency leads to an increase in surface tension, resulting in collapse of the alveoli

Question 3

What is used as a measure of lung maturity in neonates? What values are expected in neonatal respiratory distress syndrome (NRDS)?

Answer 3

The lecithin:sphingomyelin ratio in amniotic fluid;

Question 4

What vascular pathology is associated with persistently low oxygen tension due to neonatal respiratory distress syndrome?

Answer 4

Patent ductus arteriosus

Question 5

A newborn is cautiously administered oxygen by a neonatologist, who also performs serial eye exams. What is the physician worried about?

Answer 5

Retinopathy of prematurity (a side effect of therapeutic supplemental oxygen administration in newborns with NRDS)

Question 6

A newborn receives supplemental oxygen therapy for neonatal respiratory distress syndrome. This can lead to what three complications?

Answer 6

Retinopathy of prematurity, Intraventricular hemorrhage, and Bronchopulmonary dysplasia (RIB)

Question 7

What are three risk factors for neonatal respiratory distress syndrome?

Answer 7

Prematurity, maternal diabetes (due to elevated insulin), and cesarean delivery (due to decreased release of fetal glucocorticoids)

Question 8

A premature infant born to a diabetic mother exhibits intercostal retractions and appears hypoxic. What is the most likely diagnosis?

Answer 8

Neonatal respiratory distress syndrome

Question 9

A newborn diagnosed with neonatal respiratory distress syndrome is at risk of what complications?

Answer 9

Metabolic acidosis, PDA, necrotizing enterocolitis

Question 10

Medical treatment for neonatal respiratory distress syndrome includes what treatments for the mother and child?

Answer 10

Steroids for the mom prior to birth, and artificial surfactant for the newborn

Question 11

A patient hospitalized for acute pancreatitis suddenly has difficulty breathing. PaO2:FiO2 ratio is decreased. Diagnosis?

Answer 11

Acute respiratory distress syndrome

Question 12

Name seven conditions known to cause acute respiratory distress syndrome.

Answer 12

Trauma, sepsis, shock, gastric aspiration, acute pancreatitis, amniotic fluid embolism, and uremia

Question 13

Despite many etiologies, what pathophysiology is seen in all cases of acute respiratory distress syndrome?

Answer 13

Alveolar damage leads to capillary permeability, fluid leakage into alveoli, and pulmonary edema, resulting in thickened (hyaline) membranes

Question 14

In acute respiratory distress syndrome, acute alveolar damage leads to a(n) ____ (decrease/increase) in alveolar capillary permeability.

Answer 14

Increase

Question 15

Name three molecular mechanisms that contribute to the initial damage to alveoli in acute respiratory distress syndrome.

Answer 15

Neutrophilic toxins, activation of the coagulation cascade, and oxygen-derived free radicals

Question 16

An alcoholic man with acute pancreatitis and oxygen desaturation is having trouble breathing. What put him at risk for this disorder?

Answer 16

Pancreatitis, which triggers acute respiratory distress syndrome

Question 17

What obstetric complication can result in adult respiratory distress syndrome?

Answer 17

Amniotic fluid embolism

Question 18

A patient is diagnosed with dyspnea characterized by a decreased PaO2:FiO2 ratio. Management?

Answer 18

Low tidal volume mechanical ventilation, and treat underlying cause (trauma, sepsis, uremia) (this is acute respiratory distress syndrome)

Question 19

A man has daytime sleepiness; his wife attributes it to disrupted sleep from breathing pauses. His daytime PaO2 is ____ (normal/low/high).

Answer 19

Daytime PaO2 would be normal (this patient likely has sleep apnea)

Question 20

A patient is diagnosed with sleep apnea. What complications may arise from the hypoxia he experiences at night?

Answer 20

Arrhythmias (atrial fibrillation or flutter), systemic or pulmonic hypertension, sudden death

Question 21

What is the difference between central and obstructive sleep apnea?

Answer 21

Central apnea is due to a lack of CNS-derived respiratory effort, obstructive apnea is due to a mechanical airway obstruction

Question 22

An obese man complains of chronic fatigue. His wife says he is an especially loud snorer. What treatments can you offer?

Answer 22

Treat with weight loss, continuous positive airway pressure, surgery (this is obstructive sleep apnea)

Question 23

A child is diagnosed with obstructive sleep apnea. What anatomic abnormality is this associated with? Adults?

Answer 23

Adenotonsillar hypertrophy in children; excess parapharyngeal tissue in adults

Question 24

Name five conditions potentially associated with sleep apnea.

Answer 24

Obesity, loud snoring, pulmonary/systemic hypertension, arrhythmias, and possible sudden death

Question 25

An obese patient has daytime somnolence, disrupted sleep, and loud snoring. CBC shows elevated hematocrit. Why is his hematocrit high?

Answer 25

Increased erythropoietin and increased red blood cells (the patient likely has sleep apnea causing chronic hypoxia)

Question 26

• What is the normal pulmonary arterial pressure?

Answer 26

10&8211;14 mmHg

Question 27

What is the cutoff value for pulmonary hypertension?

Answer 27

≥25 mmHg during rest

Question 28

What three pathologic changes in the vasculature are caused by pulmonary hypertension?

Answer 28

Medial hypertrophy, arteriosclerosis, and intimal fibrosis of the pulmonary arteries

Question 29

A man is diagnosed with pulmonary hypertension. What undesirable outcome is possible when he finds himself in severe respiratory distress?

Answer 29

• Cyanosis and RVH, followed by death from cor pulmonale that is decompensated

Question 30

A patient with pulmonary hypertension is lost to follow up. Is he at risk for sequelae from his untreated pulmonary hypertension?

Answer 30

Yes (severe respiratory distress causing right ventricular hypertrophy and cyanosis, resulting in decompensated cor pulmonale and death)

Question 31

Name the five classification groups of pulmonary hypertension.

Answer 31

Pulmonary arterial hypertension, chronic thromboembolic PH, PH from left heart disease, PH from lung disease/hypoxia, and multifactorial

Question 32

Hereditary pulmonary arterial hypertension is caused by what?

Answer 32

An inactivating mutation in the BMPR2 gene, which normally inhibits vascular smooth muscle proliferation

Question 33

What is the prognosis for a patient diagnosed with pulmonary arterial hypertension?

Answer 33

Poor

Question 34

Name conditions that cause pulmonary arterial hypertension.

Answer 34

Persistent newborn HTN, pulmonic vein occlusion, HIV, schistosomiasis, drugs, connective tissue disease, portal HTN, congenital heart issues

Question 35

A patient with narcolepsy is prescribed amphetamines. What pulmonary side effect would you watch out for? Which other drug has this effect?

Answer 35

Pulmonary arterial hypertension; cocaine

Question 36

What are some of the potential causes of secondary pulmonary hypertension?

Answer 36

COPD, systolic/diastolic issues, mitral stenosis, recurrent microthrombi, sleep apnea, high altitudes, hematologic/metabolic/systemic illness

Question 37

Name conditions of the heart that can lead to pulmonary hypertension.

Answer 37

Systolic or diastolic dysfunction, valvular disease (e.g., mitral stenosis)

Question 38

A patient has mitral stenosis. How might this pathology ultimately cause pulmonary hypertension?

Answer 38

Increased resistance to flow in the left heart causes backup of pressure from the left atrium into the pulmonary vasculature

Question 39

Name primary conditions of the lungs that lead to pulmonary hypertension.

Answer 39

Lung parenchyma destruction (e.g., COPD), hypoxemic vasoconstriction (e.g., living in high altitudes, sleep apnea)

Question 40

A patient has chronic obstructive pulmonary disease (COPD). How might this pathology ultimately lead to pulmonary hypertension?

Answer 40

By the destruction of lung parenchyma, and subsequent vasoconstriction due to hypoxia

Question 41

How does obstructive sleep apnea or living at high altitudes cause pulmonary hypertension?

Answer 41

Obstructive sleep apnea and living at high altitudes cause hypoxia, which in turn causes pulmonary vasoconstriction

Question 42

A cancer patient has recurrent microthrombi and is repeatedly in the hospital. Could this cause him to develop pulmonary hypertension?

Answer 42

Yes (pressures increase because the emboli decrease the total cross-sectional area of the pulmonary vascular bed)

Question 43

Hematologic, metabolic, and systemic disorders cause what type of pulmonary hypertension?

Answer 43

Multifactorial

Question 44

A patient has autoimmune disease, but the exact type is unknown. Nonetheless, do you worry about pulmonary hypertension in this patient?

Answer 44

Yes (processes such as systemic sclerosis cause inflammation, leading to intimal fibrosis and medial hypertrophy in pulmonary vessels