Neonatal, developmental, vascular lung disease

Question 1

Describe how the design of the lung works to protect the organism from airborne toxins while still performing gas exchange

Answer 1

Upper airway filter that filters out particles over 10 microns in diameter.
Tracheobronchial mucociliary apparatus filters out particles that are over 5 microns
Intraalveolar phagocytic system traps other particles.

Question 2

Normal histology of a bronchi from outter to inner

Answer 2

Pseudo-stratified ciliated columnar epithelium, thin Basement membrane, subepithelial layer, cartillaginous ring. (I think Heron says its a little more complicated. Check out his first pwrpt).

Question 3

Right mainstream bronchus is more vertical than the left?

Answer 3

True…creates a greater risk for aspiration on the right

Question 4

“Fetuses breathe with their placentas, newborns breathe with their lungs” What is the significance of this?

Answer 4

If a fetus has a lung problem we dont know it until its a newborn

Question 5

Name two developmental anomalies involving the lung

Answer 5

• Pulmonary agenesis or hypoplasia

- Tracheobronchial anomalies

Question 6

What is pulmonary agenesis or hypoplasia

Answer 6

multiple malformation syndromes such as a diaphragmatic hernia

Question 7

Tracheobronchial anomalies

Answer 7

…see slide

Question 8

Congenital emphysema?

What lobes does it tend to effect?

Answer 8

Accounts for half of congenital lung lesions in infancy. Tends to effect upper left lobe (50%) and right middle lobe (24%). Air traps due to a cartilage deficiency in bronchial tree

Question 9

Congenital cyst?

When is it found?

Answer 9

Mucus filled bronchial epithelium cells….not found until 14-30 yrs of age. May occur anywhere in the lungs

Question 10

Explain pulmonary sequestrations

Answer 10

It is pulmonary tissue that is within (intrlobar) or outside of (extralobar) normal lung. It does not connect to the tracheobronchial tree.

Question 11

Intralobar sequestration usually present as

Answer 11

recurrent infection

Question 12

Extralobar sequestration usually associated with

Answer 12

I dont know but they are usually recognized in kids as mass lesions

Question 13

3 types of neonatal aspiration syndromes

Answer 13

Inhalation of amniotic fluid/MECONIUM in utero due to fetal distress…most likely to see this
Inhalation of bloody amniotic fluid peripartum
Inhalation of gastric contents postpartum

Question 14

Hyaline membrane disease

Answer 14

Pulmonary edema, membrane formation, resorptive atelactisis, bronchiolar epithelium necrosis.
More common in males, prematures, twins, mild maternal diabetes, C-section, colder weather.
Due to the physiochemical shock of lung expansion

Question 15

What is atelectasis

Answer 15

collapsing of a lung or incomplete lung expansion at birth

Question 16

Three types of atelactasis

Answer 16

1) Resorption- intrabronchial obstruction in this one- it is reversible
2. ) compression- compression from outside- reversible
3. ) Contraction- Caused by parenchymal scarring, this is not reversible

Question 17

Which type of atelectasis is not reversibel

Answer 17

Contraction- caused by parenchymal scarring

Question 18

What is pulmonary edema

Answer 18

Intraalveolar pooling of proteinaceous fluid due to hemodynamic causes or microvascular injury.

Question 19

Two categories of pulmonary edema causes

Answer 19

hemodynamic and microvascular

Question 20

Hemodynamic causes of pulm edema are

Answer 20

increased hydrostatic pressure in the vasculature or decreased oncotic pressure

Question 21

Increased hydrostatic pressure can be caused from>

Answer 21

Left sided heart failure. Mitral valve stenosis, volume overload, pulmonary vein obstruction

Question 22

Decrease oncotic pressure causes

Answer 22

hypoalbuminemia, nephrotic syndrome, liver disease

Question 23

Microovascular causes of pulm edema are

Answer 23

infectious gasses, irritant gasses, toxic drugs, sepsis, radiation

Question 24

Proinflammatory cytokines

Answer 24

IL-1, IL-8, TNF….released by macrophages during acute lung injury and ARDS

Question 25

What factors do neutrophils release in the alveolar space and what do these things do>

Answer 25

Leukotrienes, oxidants, proteases, Platelett Activating Factor
These contribute to local tissue damage, accumulation of fluid, surfactant inactivation and hyaline membrane formation.

Question 26

What does MIF do?

Answer 26

MIF (macrophage inhibiting factor) sustains the local proinflammatory response.

Question 27

TGF-Beta and PDGF stimulate what

Answer 27

Fibroblast growth and collagen deposition associated with healing

Question 28

Two Pulmonary hemorrhagic syndromes

Answer 28

Goodpasture’s and Granulomatosis with polyangiitis

Question 29

Goodpastures syndrome triad is

Answer 29

Glomerulonephritis, lung hemorrhage, and antibodies to the alpha 3 chan of type IV collagen

Question 30

Typica goodpasture’s patient

Answer 30

Youbg adult male…20-30 yo

Left untreated….renal failure

Question 31

Granulomatosis with Polyangiitis affects?

Answer 31

Lungs and upper resp tract, potentially the kidney

Question 32

G w/ P is characterized by

Answer 32

necrotizing vasculitis and granulomas

Question 33

G w/ P most commonly affects

Answer 33

middle aged men

Question 34

Look for what with G w/ P

Answer 34

ELevated serum C-ANCA corresponding to ant PR# proteinase antibodies

Question 35

What the hell are ANCAs

Answer 35

Anti- neutrophil cytoplasmic antibodies are a family of autoantibodies that react with myeloid specific proteins found in white blood cells

Question 36

What is the most common tracheoesophageal fistulae?

Answer 36

One in which the trachea communicates with the distal portion of an esophagus that was atretic at the top.

Question 37

Common causes of ARDS

Answer 37

Burns, Near drowning, mechanical trauma

Smoke or irritant gasses