"Other" Pulmonary Disorders

Question 1

Life threatening acute hypoxemia respiratory failure (organ failure from prolonged hypoxemia). Most commonly develops in critically-ill patients.

Answer 1

Acute respiratory distress syndrome (ARDS)

Question 2

What is the hallmark of ARDS?

Answer 2

Severe refractory hypoxemia NOT responsive to 100% O2

Question 3

What 3 things can help to identify ARDS?

Answer 3

1. Severe refractory hypoxemia
2. Bilateral pulmonary infiltrates on CXR
3. Absence of cariogenic pulmonary edema (Pulmonary capillary wedge pressure

Question 4

Inflammatory lung injury due to proinflammatory cytokines leads to diffuse alveolar damage which increases the permeability of the capillary barrier which causes pulmonary edema and alveolar fluid influx, loss of surfactant, and vascular endothial damage. This decreases blood oxygenation.

Answer 4

ARDS

Question 5

What are the clinical manifestations of ARDS?

Answer 5

Acute dyspnea, hypoxemia, and multi-organ failure if severe

Question 6

PaO2/FIO2 ratio 200-300mmHg + PEEP or CPAP > 5cm H20

Answer 6

Mild ARDS

Question 7

PaO2/FIO2 ratio 100-200mmHg + PEEP >5cm H20

Answer 7

Moderate ARDS

Question 8

PaO2/FIO2 ratio 5cm H20

Answer 8

Severe ARDS

Question 9

What should you expect to see on a CXR in a patient with ARDS?

Answer 9

Diffuse bilateral pulmonary infiltrates –> white out pattern (CXR resembles CHF)

Question 10

What does ARDS typically spare in a CXR?

Answer 10

Costophrenic angles

Question 11

How do you tell the difference between ARDS and pulmonary edema?

Answer 11

PWCP

Question 12

What is a normal PWCP?

Answer 12

12-18mmHg
(Low normal PWCP in ARDS)
(High normal PWCP in Pulmonary Edema)

Question 13

How do you manage ARDS?

Answer 13

Noninvasive or mechanical ventilation

CPAP with full face mask, PEEP

Question 14

Prevents airway collapse at end of expiration, increases FRC, decreases shunting and expands alveoli for increased diffusion

Answer 14

PEEP

Question 15

PE shows tachypnea, frothy pink or red sputum, and diffuse crackles

Answer 15

ARDS

Question 16

What are the three clinical settings that account for 75% of ARDS cases?

Answer 16

Sepsis syndrome
Severe multiple trauma
Aspiration of gastric contents

Question 17

Most common cause of respiratory disease in the preterm infant, usually within the 1st month of life?

Answer 17

Hyaline membrane disease

Question 18

What causes hyaline membrane disease?

Answer 18

Deficiency of surfactant

Question 19

When does surfactant production begin?

Answer 19

24-28 weeks

Question 20

When is enough surfactant produced for a baby to survive?

Answer 20

35 weeks

Question 21

Caucasian, males, C-section delivery, prenatal infections, multiple births (esp. premature), and maternal diabetes are all risk factors for which disease?

Answer 21

Hyaline membrane disease

Question 22

Presents shortly post partum with respiratory distress: Tachypnea, nasal flaring, cyanosis, chest wall retractions. May develop respiratory failure and apnea.

Answer 22

Clinical manifestations of hyaline membrane disease

Question 23

CXR of infant shows bilateral diffuse reticular ground-glass opacities and air bronchograms*; poor expansion and domed diaphragms

Answer 23

Hyaline membrane disease

Question 24

How do you manage hyaline membrane disease?

Answer 24

Exogenous surfactant given to open alveoli via endotracheal tube; CPAP, IV fluids

Question 25

How do you prevent hyaline membrane disease?

Answer 25

Steroids given to mature fetal lungs if premature delivery is suspected between 24-36 weeks

Question 26

What can you administer in the delivery room as a prophylaxis or rescue in established hyaline membrane disease?

Answer 26

Exogenous surfactants

Question 27

What are some common foreign bodies that can be aspirated?

Answer 27

Gastric contents Inert material Toxic material Poorly chewed food

Question 28

In aspiration of foreign bodies, the degree of injury depends on ______

Answer 28

The substance aspirated

Question 29

An epodes of choking and coughing or unexplained wheezing or hemoptysis should raise the suspicion of ?

Answer 29

Foreign body aspiration

Question 30

What may result from the aspiration of obstructing material?

Answer 30

Asphyxia

Question 31

What could develop secondary to the aspiration of toxic materials?

Answer 31

Pneumonia

Question 32

What is one of the most common causes of ARDS?

Answer 32

Aspiration of gastric contents

Question 33

What can you use to establish a diagnosis of foreign body aspiration and can also be used to help remove the foreign body?

Answer 33

Bronchoscopy

Question 34

What is the treatment of choice when removing an aspirated foreign body?

Answer 34

Bronchoscopy

Question 35

What do you do if you suspect post-obstructive pneumonia in a patient who has aspirated a foreign body?

Answer 35

Culture

Question 36

Expiratory radiography may reveal ____ ____ in a patient who aspirated a foreign body?

Answer 36

Regional hyperinflation caused by a check valve effect