Developmental Aspects of Lung Disease

Question 1

When is extra-uterine life possible

Answer 1

Canalicular
Saccular
Alveolar

Question 2

What are the 5 stages of lung morphogenesis

Answer 2

Embryonic
Pseudoglandular
Canalicular
Saccular
Alveolar

Question 3

Features of embryonic

Answer 3

Lung buds from ventral wall of foregut

Larynx and primitive trachea emerge and branch off

Question 4

Features of Pseudoglandular

Answer 4

Bronchi, bronchioles and acinar
Primitive trachea with no air sacs
All cells are metabolically active

Question 5

Features of Canalicular

Answer 5

Bronchioles
Increasing number of capillaries
Cuboidal and alveolar epithelium development
Epithelium cells flatten
Type 1 and 2 pneumocytes

Question 6

Features of Saccular

Answer 6

Alveolar ducts and air sacs are developed

Question 7

Features of Alveolar

Answer 7

Secondary separation

Increase in number and size of capillaries and alveoli

Question 8

In postnatal lung what occurs

Answer 8

Alveoli separation and development continues

Question 9

Airway stenosis

Answer 9

Narrowing

Question 10

Airway Malacia

Answer 10

Floppiness

Question 11

Pulmonary aggenesis/hypoplasia

Answer 11

long not formed at all/fully formed

Question 12

What are the common congenital anomalies

Answer 12

Tracheo-bronchomalacia

Pulmonary Adenomatoid

Question 13

Symptoms of Tracheo-bronchomalcia

Answer 13

Barking/seal like cough
Recurrent croup
Breathless on exertion

Question 14

Management of Tracheo-bronchomalacia

Answer 14

Airway clearance physio
Antibiotics
Avoid asthma treatment
Natural history resolution with time

Question 15

Symptoms of Pulmonary Adenomatoid

Answer 15

Problem in development that causes one of the lobes to contain a group of fluid or air-filled spaces (cysts) rather than lung tissue

Question 16

Management of Pulmonary Adenomatoid

Answer 16

May resolve spontaneously in utero
Conservative manangement if asymptomatic
Possible risk of malignant change

Question 17

Diaphragmatic Abnormalities

Answer 17

Hernia
Pulmonary hypoplasia
Persistent pulmonary hypertension
Abnormal opening in the diaphragm
Eventration

Question 18

Functional changes in Lung at birth

Answer 18

change from fluid secretion to fluid absorption
Transient tachypnoea of new born
associated with c-section
resolves within 24-48 hours

Question 19

When does surfactant pneumocytes appear

Answer 19

12-14 weeks

Question 20

What does surfactant deficiency cause

Answer 20

Hyaline membrane disease (RDS)

Question 21

What are the treatments for RDS

Answer 21

Antenatal glucocorticoids
Surfactant replacement
Supportive

Question 22

Chronic Neonatal Lung Disease

Answer 22

Bronchopulmonary dysplasia

Question 23

What is bronchopulmonary dysplasia

Answer 23

damage to lungs caused by mechnical ventilation (resipirator) and long-term use of oxygen

Question 24

Aetiology of Chronic Neonatal disease

Answer 24

Antenatal infection
Barotrauma/oxygen toxicity
Patent ductus arteriosus
Genetic

Question 25

Antenatal causes of lung disease

Answer 25

in utero nictoine exposure Foetal infection Maternal nutrition Low birth weight/prematurity and requiring steroids

Question 26

Post-natal causes of lung disease

Answer 26

``` Infection (Barker hypothesis) Growth Environmental tobacco smoke Environmental pollution Micronutrients/vitamins Gene-environment interactions ```

Question 27

What is the definition of remodelling

Answer 27

Alteration of structure following an external influence

Question 28

Symptoms of pre-natal nicotine exposure (6)

Answer 28

``` Lung hypoplasia Reduced alveolarisation Reduced lung function (smaller airways) Increased incidence of wheeze syndromes Increased susceptibility to infections Interference of inter-cellular signalling ```

Question 29

Symptoms of asthma (4)

Answer 29

Increased bronchial responsiveness Increase mucous secretions Airway oedema Airway narrowing

Question 30

Symptoms of Chronic New Born Lung Disease

Answer 30

Chronic inflammation Interference inter-cellular signalling Treatment toxicity Areas where the gas trapping occurs has increased opacification

Question 31

How is pulmonary function tracked from early life into adulthood

Answer 31

Fletcher-Peto Curve