Atelectasis and ARDS

Question 1

causes of obstruction in resorption atelectasis

Answer 1

Mucus/mucopurulent plug following surgery

foreign material

bronchial asthma, bronchitis, bronchiectasis

neoplasm

Question 2

contraction atelectasis

Answer 2

fibrotic changes in lung or pleura prevent full expansion (not reversible)

Question 3

hemosiderin laden macrophages found in

Answer 3

pulmonary edema (heart failure cells)

Question 4

histo compression atelectasis

Answer 4

collapsed, slit-like alveoli

Question 4

manifestations acute lung injury

Answer 4

Pul edema

Diffuse Alveolar Damage

ARDS

Question 5

ARDS presenetation

Answer 5

dypsnea

severe hypoxemia not responsive to O2

Respiratory acidosis

Question 7

clinical presentation resorption atelectasis

Answer 7

Fever+dypsnea within 24-36 hours of collapse

ispilateral trachea deviation

ipsilateral diaphragmatic elevation

absent breath sounds+vocal vibratory sensation (fremitius)

no expansion on inspiration

Question 8

histo neonatal atelactaiss

Answer 8

collapsed parenchyma

reduced open alveoli

open alveolie lined with pink hyaline membrane

Question 8

risk factors ARDS

Answer 8

gram negative sepsis

aspiration

severe trauma

pulmonary infections, heroin, smoke

Question 9

associations decreased neonatal surfactant

Answer 9

premature

maternal diabetes (fetal hyperglycemia)

Cesarean

Question 10

pathogenesis ARDS

Answer 10

acute injury to alveoli/capillary

macrophage cytokine release >

PMN chemotaxis > migrate to alveoli >

fibrin leakage > hyaline membrane

damage to type 2 pneumocytes

Repair by type 2 leads to interstitial fibrosis

Question 10

histology ARDS

Answer 10

hyaline membrane

hyperplastic type 2 pneumocytes

Question 12

neonatal atelactasis due to

Answer 12

loss of surfactant

Question 14

hormonal drivers of surfactant

Answer 14

increased by cortisol and thyroxine

decreased by insulin

Question 16

surfactant proteins implicated in atelactasis

Answer 16

B and C

reduce surface tension

Question 17

phases of ARDS

Answer 17

exudative stage: Edema (day 0-3)

exudative stage: Hyaline membranes (day 2-6-14)

proliferative stage: Interstitial inflam (starting day 3, 7-14)

Question 18

shift in compression atelectasis

Answer 18

away from affected lung

Question 19

atelectasis consequence of complete airway obstruction

Answer 19

resoption atelctasis

Question 19

surfactant stored in

Answer 19

lamellar bodies

Question 20

clinical presentation + xray neonatal altelactasis

Answer 20

RD within hours of birth

hypoxemia and respiratory acidosis

Ground glass CXR

Question 21

non cardiogenic pulmonary edema from acute alveolar capillary damage

Answer 21

ARDS

Question 22

air or fluid accumulation in pleual cavity > increased pressure > collapses lung

Answer 22

compression ateletasis

Question 23

most common cause of post surgery fever

Answer 23

resorption atelectasis

Question 24

pathogenesis resorption atelectasis

Answer 24

obstruction >

> no air reaches alveoli >

> resorption of air trapped in distal spaces through pores of Kohn >

> collapse