NRD/ ARD

Question 1

What characterises Acute Respiratory Distress Syndrome (ARDS)?

Answer 1

Non-cardiogenic pulmonary edema and diffuse lung inflammation

Question 2

What are the causes of pulmonary ARDS?

Answer 2

Chest sepsis
Aspiration
Inhalation injury
Pulmonary contusion
Transfusion-related lung injury

Question 3

What are the mechanisms underlying ARDS?

Answer 3

ARDS involves a V/Q mismatch where lung regions fail to ventilate properly (but still perfuse) due to injury, such as sepsis, trauma, or pneumonia.

Question 4

Describe the symptoms of ARDS

Answer 4

Rapid-onset respiratory failure
Unresponsive to supplemental oxygen
Severe dyspnea
Confusion
Presyncope

Question 5

Describe the signs of ARDS

Answer 5

An elevated respiratory rate
Bilateral lung crackles without heart failure features
Low SpO2

Question 6

What diagnostic procedures are typically employed for ARDS?

Answer 6

(1) Arterial blood gas analysis (ABGs)

(2) Chest X-ray revealing bilateral alveolar infiltrates devoid of heart failure indicators

Question 7

How is ARDS typically managed?

Answer 7

Oxygen therapy and mechanical ventilation, with emphasis on low tidal volume for improved outcomes.

Question 8

What is the primary cause of Respiratory Distress Syndrome in newborns?

Answer 8

Premature infants are deficient in surfactant, leading to increased effort in expanding the lungs, which damages cells

Question 9

Describe the pathophysiology of Respiratory Distress Syndrome in newborns

Answer 9

Strenuous inspiratory attempts to overcome high surface tension in the lungs.

This increased effort damages cells, including blood vessels, leading to fluid leakage into the alveoli

Question 10

How is the Respiratory Distress Syndrome of the Newborn managed?

Answer 10

Oxygen therapy and mechanical ventilation to support breathing.

Question 11

Explain chronic lung disease

Answer 11

Chronic Lung Disease characterized by;

(1) Oxygen requirement beyond 36 weeks
(2) Corrected gestation and evidence of parenchymal disease on CXR.
(3) High risk of RSV
(4) Wheezing, abnormal airways, growth and development issues

Question 12

What are the complications associated with Respiratory Distress Syndrome of the Newborn?

Answer 12

Chronic Lung Disease
Transient Tachypnoea of newborn

Question 13

Explain Transient Tachypnoea of newborn

Answer 13

Often caused by infection

Question 14

What is Transient Tachypnoea of the Newborn and what is its common cause?

Answer 14

Caused by infection and presents with rapid breathing in newborns

Question 15

Infants born before 34 weeks gestation are considered premature and are at a higher risk of developing what?

Answer 15

NRDS

Question 16

An infant is born at 30 weeks gestation with tachypnea, central cyanosis, and flaring of the nostrils with each breath. Which of the following is most likely responsible for the infant’s symptoms?

Answer 16

Insufficient secretion of type II alveolar cells

Question 17

A 45 year old male patient presents to the emergency department with epigastric pain and vomiting.

He drinks a bottle of vodka per day. His lipase level is 1000 U/L. He is managed appropriately and transferred to HDU. At the morning ward round the patient looks unwell.

His vital signs are: heart rate 90 bpm, respiratory rate 24/minute, blood pressure 110/85mmHg, temperature 36.9’C, oxygen saturations 90% which do not improve with 5L/min of oxygen via simple facemask.

Chest X-ray reveals bilateral infiltrates and a normal-sized cardiac silhouette.

Which of the following pathological features is consistent with the complication this patient has developed?

Answer 17

Diffuse alveolar damage with hyaline membrane formation

Question 18

How to recongnise NRDS

Answer 18

<1 week onset of a known risk factor; pulmonary oedema, non-cardiogenic; pO2/FiO2 <40.

Question 19

SIGNS AND SYMPTOMS of NRD

Answer 19

Rapid, labored breathing

Flaring nostrils

Grunting sounds during exhalation

Indrawing of the chest wall

Bluish discolouration of the skin due to low oxygen (cyanosis)

Question 20

A 44 year old man experiences severe epigastric pain which is improved upon leaning forward. He had had an ERCP (Endoscopic Retrograde Cholangiopancreatography) 2 days prior. He is started on treatment. 2 days after this, he has progressive shortness of breath; bilateral crackles are heard on auscultation and CXR shows bilateral alveolar opacities throughout the lung fields. His O2 saturations dip and he is mechanically ventilated through an endotracheal tube, but passes away a few days later. His autopsy results show ‘hyaline membrane formation’ in the lungs. What would have improved mortality in this patient?

Answer 20

Low tidal volume

Question 21

When do ARDS usually start?

Answer 21

12 - 48 hours after the initial insult with shortness of breath (dyspnea on exertion followed by dyspnea at rest) and hypoxia