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PCM Exam 3 > poorly defined lung pathologies > Flashcards

poorly defined lung pathologies Flashcards

1
Q

what are some examples of direct pulmonary insults leading to adults RDS (5)

A
  • pneumonia
  • aspiration
  • emboli
  • drowning
  • oxygen toxicity
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2
Q

which types of atelectasis are reversible which are irreversible?

A

reversible: resorption and compression
irreversible: contraction

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3
Q

what are some important findings in the exudative/acute phase of ARDS?

A
  • HYALINE MEMBRANES
  • interstitial and intralveolar edema/hemorrhage
  • necrosis and sloughing of epithelial cells
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4
Q

what are some indirect pulmonary causes of ARDS?

A
  • sepsis
  • trauma with shock
  • acute pancreatitis
  • severe burns
  • transfusion of blood products
  • uremia
  • drugs
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5
Q

what phase does alveolar septal thickening occur in ARDS?

A

proliferative phase/ organizing phase

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6
Q

in neonatal RDS, what is a classic histopathological finding?

A

hyaline membranes with minimal inflammation

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7
Q

surfactant is produced by _______, around the ______ week of gestation and is stored in ______

A

type 2 pneumocytes; 28 weeks;

stored in lamellar bodies

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8
Q

ventilation or perfusion is the cause of the V/Q mismatch in atelectasis

A

ventilation

normal perfusion

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9
Q

compression atelectasis is caused by ________

A

air or fluid accumulation in the pleural cavity which then compresses and collapses underlying lung

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10
Q

proliferation of type ___ cells occurs in the proliferative phase of ARDS

A

type II cells

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11
Q

_____ atelectasis is due to fibrotic changes in the lung for pleura

A

contraction

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12
Q

severe burns is an ____ injury to the lungs that can cause _____

A

indirect; ARDS

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13
Q

surfactant reduces surface tension in small airways and prevents collapse on _____

A

EXPIRATION; the alveoli have ↑ tendency to collapse on expiration as radius ↓

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14
Q

“ground glass appearance” on X ray is seen in _____

A

neonatal atelectasis / neonatal RDS

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15
Q

bronchopulmonary dysplasia is a complication of ______ q

A

oxygen therapy in treating neonatal RDS

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16
Q

what are the phases and time frames of each in the progression of acute respiratory distress syndrome in adults

A
  • acute (exudative phase): 0-4 days

- organizing (proliferative phase): 4 days - 3 weeks

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17
Q

hyaline membranes are composed of ____ and ____

A

fibrin (endothelial cell damage) + necrotic cells (alveolar epithelial cell damage)

18
Q

insulin ___ levels of surfactant in the fetus

A

↓

19
Q

____ and _____ are examples that can lead to compression atelectasis

A

pneumothorax (air in the pleural cavity) or hydrothorax / pleural effusion (fluid in pleural cavity)

20
Q

neonatal atelectasis occurs as a result of the loss of ______

A

surfactant

21
Q

what are the complications of oxygen therapy in treating neonatal atelectasis?

A
  • retinopathy of prematurity (cataracts/blindness)
  • intraventricular hemorrhage
  • bronchopulmonary dysplasia
    (RIB)
22
Q

atelectasis causes a V/Q mismatch because ______

A

loss of lung volume → ↓ oxygenation

however, the lung is still getting perfused thus leads to a V/Q mismatch

23
Q

respiratory acidosis/alkalosis is seen in neonatal atelectasis

A

respiratory acidosis and hypoxemia

24
Q

the collapsed alveoli in neonatal RDS is lined by ______

A

hyaline membranes

25
Q

hyaline membranes in the collapsed alveoli will _______ the diffusion gradient

A

↑

26
Q

_______ atelectasis is associated with COMPLETE airway instruction

A

resorption; resorption of air trapped in the distal airspaces back into the blood

27
Q

what are some manifestations of acute lung injury?

A
  • pulmonary edema (must make sure no cardiac dysfunction)
  • diffuse alveolar damage (RDS)
  • inflammatory infiltrate in alveoli
  • hyaline membrane formation
28
Q

drowning is a ______ cause of ARDS

A

direct

29
Q

what are some risk factors for neonatal respiratory distress syndrome?

A
  • maternal diabetes (↑ insulin will ↓ surfactant)
  • C section birth (↓ in cortisol will ↓ surfactant)
  • premature birth (surfactant production starts at 28 weeks but does reach max levels till week 35)
30
Q

_______ atelectasis can occur following surgery

A

resorption atelectasis due to the mucus plugs that can form post surgery (still unable to cough them out) and they cause COMPLETE obstruction

31
Q

which RDS is refractory to oxygen therapy: adult or neonatal

A

ADULT

32
Q

in resorption atelectasis, you will see ______ deviation of the trachea and _____ elevation of the diaphragm

A

IPSILATERAL deviation of the trachea and IPSILATERAL elevation of the diaphragm

33
Q

cortisol ____ levels or surfactant in the fetus

A

↑

34
Q

what are some findings in the organizing phase of ARDS?

A
  • proliferation of type II cells
  • fibrosis
  • alveolar septal thickening

MAINLY: interstitial inflammation and fibrosis

35
Q

what are some other names for adult respiratory distress syndrome

A
  • shock lung syndrome
  • acute lung injury
  • diffuse alveolar damage
  • non cardiogenic pulmonary edema
36
Q

in adults, the RDS is due to _______

A

underlying inflammation; rapid onset, severe hypoxemia with bilateral pulmonary infiltrates in the absence of cardiac failure

37
Q

hypoxia in the lungs lead to pulmonary vasoCONSTRICTION → pulmonary _________ →endothelial and alveolar epithelial damage → plasma leak into alveoli → fibrin + necrotic cells (hyaline membrane)

A

HYPOperfusion because of the vasoconstriction in the pulmonary vasculature

(all other parts of the body will respond to hypoxia with vasodilation)

38
Q

what is the difference between direct and indirect lung injury causes of adult RDS?

A

direct: direct pulmonary insult the alveoli resulting in inflammation while indirect: systemic causes of inflammation that goes to the lungs via capillaries

39
Q

trachea and mediastinum shift ______ to the site of the affected side in compression atelectasis

A

SHIFT AWAY from lesion (CONTRALATERAL SHIFT)

40
Q

what are some complications of neonatal RDS?

A
  • PDA (due to persistent hypoxemia because it closes due to oxygen in the lungs)
  • necrotizing enterocolitis (due to intestinal ischemia) = bloody diarrhea
  • HYPOglycemia (excessive insulin release in the case RDS is caused by maternal diabetes)
41
Q

acute lung injury is precipitated by ________ injury

A

endothelial and epithelial injury

PCM Exam 3 (32 decks)

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