Developmental aspects of lung disease

Question 1

what are the 5 stages of lug morphogenesis?

Answer 1

Embryonic
Pseudo-glandular
Canicular
Saccular
Alveolar

Question 2

at what stage in the lung morphogenesis is extra uterine life possible?

Answer 2

at the late canicular/early saccular stage

Question 3

at what stage do you begin to see left and right lobes of the lungs?

Answer 3

pseudoglandular

Question 4

at what stage does gas exchange occur for the first time?

Answer 4

canalicular

Question 5

how many alveoli are present at birth and how much does this grow to after birth?

Answer 5

born with 100-150 million

200-600 million at 3-8 years

Question 6

at what week and stage is surfactant detectable in the amniotic fluid?

Answer 6

week 24- saccular stage

Question 7

at what week is the alveolar stage?

Answer 7

week 36

Question 8

when does the development of the lungs begin?

Answer 8

week 4

Question 9

what is airway malacia?

Answer 9

muscles haven’t developed properly in the airways causing floppy airways.

Question 10

what is sequestration?

Answer 10

the normal lung is not connected or has a different blood supply

Question 11

how are majority of congenital anomalies detected?

Answer 11

foetal ultrasound

Question 12

in newborns, what is the presentation of a respiratory anomaly?

Answer 12

respiratory distress (chest wall retraction)
tachypnoea

Question 13

in childhood, what is the presentation of a respiratory anomaly?

Answer 13

stridor/wheeze
recurrent pneumonia
incidental finding

Question 14

what is the clinical presentation of trachea-bronchomalacia?

Answer 14

barking/seal like cough
early onset/recurrent croup
stridor / wheeze
breathlessness on exertion

Question 15

what is the management of trachea-bronchomalacia?

Answer 15

chest physiotherapy
antibiotics
avoid asthma treatment (it causes relaxation of airways but problem in malaria is that the airways are too relaxed due to incomplete muscle formation)

Question 16

what are the 2 most common congenital lung diseases?

Answer 16

tracheo-bronchomalacia

pulmonary adenomatoid malformation

Question 17

when is the closure of the diaphragm?

Answer 17

18 weeks

Question 18

at what side is a diaphragmatic hernia most common?

Answer 18

left side

Question 19

what is a diaphragmatic hernia associated with?

Answer 19

pulmonary hypoplasia

persistent pulmonary hypertension

Question 20

what is eventuation?

Answer 20

outputting of diaphragm into the thoracic cavity

Question 21

what foetal complication is associated with caesarean section delivery?

Answer 21

‘wet lungs’
normally at birth, the baby lungs change from fluid secretion to fluid absorption but sometimes the baby doesn’t change as quick as it should resulting in wet lungs.

Question 22

when does wet lung usually resolve?

Answer 22

24-48 hours

Question 23

what is the presentation of wet lung in newborns?

Answer 23

transient tachypnoea

Question 24

what is the treatment for acute respiratory distress syndrome?

Answer 24

antenatal glucocorticosteroids

surfactant replacement

Question 25

what is another name for ARDS?

Answer 25

hyaline membrane disease

Question 26

what causes acute respiratory distress?

Answer 26

surfactant deficiency

Question 27

what is bronchopulmonary dysplasia / CLD prematurity?

Answer 27

chronic lung disease which mostly affects pre mature newborns

Question 28

what is the aetiology of bronchopulmonary dysplasia / CLD prematurity?

Answer 28

Antenatal infection barotrauma / oxygen toxicity genetic patent ductus arteriosus

Question 29

what is bronchopulmonary dysplasia / CLD prematurity associated with?

Answer 29

increased childhood respiratory morbidity | increased risk of future COPD / asthma

Question 30

what are the antenatal origins of adult lung disease?

Answer 30

``` inutero nicotine exposure fetal infection maternal infection maternal nutrition low birth weight / prematurity maternal micronutrients / vitamins ```

Question 31

what are the post natal origins of adult lung disease?

Answer 31

``` infection growth Alpha 1 antitrypsin deficiency environmental pollution micronutrients/ vitamins ```

Question 32

what does the term remodelling mean?

Answer 32

alteration of structure following an external influence

Question 33

what complications can prenatal nicotine exposure cause?

Answer 33

``` lung hypoplasia reduced alveolarisation reduced lung function in small airways increased incidence of wheeze syndrome increased suscpetibility to infection ```

Question 34

what is the remodelling in asthma?

Answer 34

``` external influence i.e allergen/atopy , exercise , emotion etc causes chronic inflammation which leads to remodelling of the airways; - increased bronchial responsiveness increase mucous secretion airway oedema airway narrowing ```

Question 35

what is the name for the outputting of the diaphragm into the thoracic cavity?

Answer 35

eventuation

Question 36

what is the name for bronchi/lung which is separate or has a different blood supply?

Answer 36

sequestration

Question 37

what is pulmonary adenomatoid malformation?

Answer 37

air filled cystic lesions in the lungs they may resolve on their own in utero but if not then conservative management if asymptomatic. they have a possible risk of malignant change

Question 38

when is the closure of the diaphragm?

Answer 38

week 18

Question 39

when do type II pnuemocytes first appear in utero?

Answer 39

week 12-14

Question 40

pre natal nicotine exposure causing lung hypoplasia and reduced alveolarisation is an example of .............

Answer 40

remodelling