DISORDERS OF THE RESPIRATORY SYSTEM PART 2.2 (based on T)

Question 1

What are the two layers of the pleura?

Answer 1

Parietal pleura (lines the chest wall) and visceral pleura (lines the lung)

Question 2

What is the function of pleural fluid?

Answer 2

Allows smooth movement of the lungs during normal ventilation

Question 3

How is pleural fluid produced?

Answer 3

By filtration from systemic capillaries within the parietal interstitium, with production greatest at the lung apex

Question 4

What maintains pleural fluid balance?

Answer 4

Pulmonary capillary hydrostatic and oncotic pressure, lymphatic drainage, and integrity of pleural and capillary membranes

Question 5

What can cause excess pleural fluid formation?

Answer 5

Disturbance in hydrostatic/oncotic pressures, lymphatic drainage, or membrane integrity

Question 6

What is pleural effusion?

Answer 6

Accumulation of fluid between the parietal and visceral pleura

Question 7

What are the clinical manifestations of a small pleural effusion?

Answer 7

Usually asymptomatic

Question 8

What are the clinical manifestations of a large pleural effusion?

Answer 8

Respiratory distress, dyspnea, dry cough, chest/shoulder pain worsened by inspiration

Question 9

What are general causes of pleural effusion due to increased pleural fluid formation?

Answer 9

LV failure, pneumonia, pulmonary embolus, increased capillary permeability, lung atelectasis, ascites, peritoneal dialysis

Question 10

What can cause decreased pleural fluid absorption?

Answer 10

Lymphatic obstruction, right ventricular failure, superior vena cava syndrome, aquaporin system disruption

Question 11

What are the diagnostic tests for pleural effusion?

Answer 11

Pleural fluid analysis (protein, LDH, bacterial culture, gram stain, glucose, pH, WBC/RBC counts, amylase, cytology) and serum tests (CBC, LDH, total protein, glucose)

Question 12

What are Light’s criteria for exudative pleural effusion?

Answer 12

Pleural fluid/serum LDH >0.6, Pleural fluid/serum protein >0.5, Pleural fluid LDH >2/3 upper limit of normal serum LDH, Pleural fluid cholesterol >55 mg/dL

Question 13

What is the key difference between exudative and transudative pleural effusion?

Answer 13

Exudative effusions fulfill at least one Light’s criteria, while transudative effusions do not

Question 14

What procedure is used to obtain pleural fluid for analysis?

Answer 14

Thoracentesis

Question 15

What is the first-line management of pleural effusion?

Answer 15

Thoracentesis if the cause is unresolved

Question 16

What is the preferred method for draining pleural effusion in chest trauma?

Answer 16

Tube thoracostomy

Question 17

What are some pleural fluid appearances and their causes?

Answer 17

Grossly purulent: Empyema;
Thick tan brown: Staphylococcus aureus;
Putrid: Anaerobes;
Bloody: Hemothorax, Malignancy;
Milky: Chylothorax;
Yellow-green: Rheumatoid arthritis;
Black: Aspergillus nigricans

Question 18

What is the key feature of transudative pleural effusion?

Answer 18

Results from imbalance of hydrostatic or oncotic pressures,
contains little protein and few cells (<500 cells/mm³), and
has serum-like glucose and hydrogen ion concentrations

Question 19

What are common causes of transudative pleural effusion in children?

Answer 19

Atelectasis, LV failure, nephrotic syndrome, free peritoneal fluid, hypothyroidism

Question 20

What distinguishes exudative pleural effusions from transudative?

Answer 20

Exudative effusions result from inflammation or lymphatic obstruction, causing fluid leakage with higher protein and cellular content

Question 21

What are parapneumonic effusions?

Answer 21

Pleural effusions as a complication of bacterial pneumonia, especially in children under 2 years old

Question 22

What are clinical signs of parapneumonic effusion?

Answer 22

Initially low WBC count, later high WBC count, elevated LDH, low glucose and pH, progressive fibrin deposition

Question 23

What is the management of parapneumonic effusion?

Answer 23

IV antibiotics for infection, thoracotomy if massive effusion

Question 24

What is pneumothorax?

Answer 24

Abnormal presence of air in the pleural space

Question 25

What are causes of pneumothorax?

Answer 25

Traumatic, iatrogenic, spontaneous, post-infectious, inhalation toxins, congenital

Question 26

What are clinical manifestations of pneumothorax?

Answer 26

Sudden chest pain, tachypnea, dyspnea, cyanosis, ipsilateral shoulder pain, hyperresonance on percussion

Question 27

What is the diagnostic test for pneumothorax?

Answer 27

Chest radiograph (CXR), CT scan for bullae and blebs

Question 28

What is the treatment for pneumothorax?

Answer 28

Evacuating air from the pleural space and sealing the leakage"

Question 29

What causes disorders of ventilation in short limb dwarfism?

Answer 29

Reduced thoracic cage size, lateral narrowing, and sometimes shortening of the thoracic spine.

Question 30

Do most patients with short limb dwarfism survive?

Answer 30

Most patients do not survive, but some with asphyxiating thoracic dystrophy improve their ventilation as they grow up.

Question 31

What is Werdnig-Hoffman disease caused by?

Answer 31

A decrease in motor neurons, chromatolysis, proliferation of astrocytes and microglia, and diminution of spinal cord ventral roots due to the loss of myelinated fibers.

Question 32

What is a common symptom of Werdnig-Hoffman disease?

Answer 32

Severe skeletal muscle weakness with or without diaphragm involvement.

Question 33

What does childhood interstitial lung disease (ILD) cause?

Answer 33

Rare respiratory disorders that are mostly chronic and associated with high morbidity and mortality.

Question 34

What is the typical presentation of childhood ILD?

Answer 34

Insidious onset with symptoms like cough, dyspnea, exercise limitation, respiratory crackles, and wheezing.

Question 35

What can be seen in the advanced stage of childhood ILD?

Answer 35

Finger clubbing and cyanosis during exercise or rest.

Question 36

What diagnostic test is used for childhood ILD?

Answer 36

High-resolution CT, pulmonary function tests, bronchoalveolar lavage, and lung biopsy (gold standard).

Question 37

What is the first-line management for childhood ILD?

Answer 37

Oxygen, nutrition, immunization, and avoidance of air pollution.

Question 38

What are superior mediastinal tumors commonly associated with?

Answer 38

Thymus masses and cystic hygromas.

Question 39

Where are cystic hygromas typically located?

Answer 39

In the superior and anterior mediastinum.

Question 40

Which tumors are most commonly found in the middle mediastinum in children?

Answer 40

Lymphatic tumors, which are most common childhood malignancies.

Question 41

What is the management for posterior mediastinum neurogenic tumors?

Answer 41

Surgery and radiation therapy, as they are often radiosensitive.

Question 42

What are common primary benign pulmonary tumors?

Answer 42

Hamartomas, plasma cell granulomas, bronchial adenomas, papillomas, and hemangiomas.

Question 43

What are the symptoms of obstructive sleep apnea (OSA)?

Answer 43

Loud snoring, difficulty breathing during sleep, and sleep-related breathing pauses.

Question 44

How is obstructive sleep apnea (OSA) diagnosed?

Answer 44

Lateral neck radiograph and sleep study.

Question 45

What is the treatment for obstructive sleep apnea (OSA)?

Answer 45

Tonsilloadenoidectomy, nasal continuous positive airway pressure (NCPAP), nasopharyngeal intubation, and craniofacial operations.

Question 46

What are the symptoms of alveolar hypoventilation?

Answer 46

Sleep-related cyanosis, hypoventilation without snoring, and unexplained cor pulmonale.

Question 47

How is congenital central hypoventilation syndrome treated?

Answer 47

With ventilatory support and, in some cases, diaphragmatic pacing.

Question 48

What is a common complication of pneumonia in children?

Answer 48

Lung abscess, often involving mixed flora of aerobes and anaerobes.

Question 49

What are the physical exam findings in lung abscess?

Answer 49

Decreased breath sounds (effusion and empyema), increased breath sounds (consolidation), scattered crackles, rhonchi, and finger clubbing in ⅓ of cases.

Question 50

What is the treatment for a lung abscess?

Answer 50

Broad-spectrum antibiotics for 4-6 weeks, chest physiotherapy, postural drainage, and surgical drainage if no response to antibiotics.

Question 51

What is pneumothorax?

Answer 51

Presence of gas in the pleural cavity.

Question 52

Which type of pneumothorax occurs without underlying lung disease?

Answer 52

Primary spontaneous pneumothorax, commonly observed in tall males and smokers.

Question 53

What is the treatment for pneumothorax?

Answer 53

Supplemental oxygen and chest tube thoracostomy (CTT) if the area is large.

Question 54

What is atelectasis?

Answer 54

Partial or total collapse of a previously expanded alveolus or lung segment.

Question 55

Which diagnostic sign is seen in atelectasis?

Answer 55

Ipsilateral mediastinal shift on chest x-ray (CXR).

Question 56

What is bronchiectasis caused by?

Answer 56

Abnormal dilation, distortion, and destruction of the bronchial tree due to chronic infections or inflammation.

Question 57

Which organisms are involved in bronchiectasis?

Answer 57

Necrotizing bacterial infections.

Question 58

What are common symptoms of bronchiectasis?

Answer 58

Chronic cough, increased sputum production, progressive shortness of breath, easy fatigability, hypoxia, and hemoptysis.

Question 59

What is the treatment for bronchiectasis?

Answer 59

Beta-2 agonists (salbutamol), broad-spectrum antibiotics, 2D echo, and annual vaccinations for influenza and pneumococcus.

Question 60

What defines respiratory failure in children?

Answer 60

Inability to deliver oxygen and remove carbon dioxide from the pulmonary capillary bed, often indicated by PaCO2 >50 mmHg or PaO2 <60 mmHg on room air.

Question 61

What are the types of respiratory failure?

Answer 61

Type I (Non-ventilatory): PaO2 is low; Type II (Ventilatory): PaCO2 is elevated.

Question 62

What is the management for acute respiratory failure in children?

Answer 62

Oxygen, intubation, mechanical ventilation, and treatment of the underlying cause.

Question 63

What is ARDS?

Answer 63

Acute non-cardiogenic pulmonary edema with bilateral infiltrates on CXR and a PaO2 to FiO2 ratio of <200.

Question 64

How is ARDS in children different from adults?

Answer 64

Pediatric ARDS has a different pathophysiology and response to treatment.

Question 65

What are the signs of respiratory failure?

Answer 65

Tachypnea, bradypnea, apnea, nasal flaring, chest retraction, head bobbing, and cyanosis.

Question 66

What is the treatment for chronic respiratory failure in children?

Answer 66

Continuous oxygen supplementation at home or tracheostomy.

Question 67

What is BiPAP used for in children?

Answer 67

Ventilatory support during sleep, especially for those with sleep apnea or intrinsic lung disease.