poorly defined lung pathologies

Question 1

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

Answer 1

• pneumonia
• aspiration
• emboli
• drowning
• oxygen toxicity

Question 2

which types of atelectasis are reversible which are irreversible?

Answer 2

reversible: resorption and compression
irreversible: contraction

Question 3

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

Answer 3

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

Question 4

what are some indirect pulmonary causes of ARDS?

Answer 4

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

Question 5

what phase does alveolar septal thickening occur in ARDS?

Answer 5

proliferative phase/ organizing phase

Question 6

in neonatal RDS, what is a classic histopathological finding?

Answer 6

hyaline membranes with minimal inflammation

Question 7

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

Answer 7

type 2 pneumocytes; 28 weeks;

stored in lamellar bodies

Question 8

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

Answer 8

ventilation

normal perfusion

Question 9

compression atelectasis is caused by ________

Answer 9

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

Question 10

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

Answer 10

type II cells

Question 11

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

Answer 11

contraction

Question 12

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

Answer 12

indirect; ARDS

Question 13

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

Answer 13

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

Question 14

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

Answer 14

neonatal atelectasis / neonatal RDS

Question 15

bronchopulmonary dysplasia is a complication of ______ q

Answer 15

oxygen therapy in treating neonatal RDS

Question 16

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

Answer 16

• acute (exudative phase): 0-4 days

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

Question 17

hyaline membranes are composed of ____ and ____

Answer 17

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

Question 18

insulin ___ levels of surfactant in the fetus

Answer 18

↓

Question 19

____ and _____ are examples that can lead to compression atelectasis

Answer 19

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

Question 20

neonatal atelectasis occurs as a result of the loss of ______

Answer 20

surfactant

Question 21

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

Answer 21

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

Question 22

atelectasis causes a V/Q mismatch because ______

Answer 22

loss of lung volume → ↓ oxygenation

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

Question 23

respiratory acidosis/alkalosis is seen in neonatal atelectasis

Answer 23

respiratory acidosis and hypoxemia

Question 24

the collapsed alveoli in neonatal RDS is lined by ______

Answer 24

hyaline membranes

Question 25

hyaline membranes in the collapsed alveoli will _______ the diffusion gradient

Answer 25

↑

Question 26

_______ atelectasis is associated with COMPLETE airway instruction

Answer 26

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

Question 27

what are some manifestations of acute lung injury?

Answer 27

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

Question 28

drowning is a ______ cause of ARDS

Answer 28

direct

Question 29

what are some risk factors for neonatal respiratory distress syndrome?

Answer 29

- 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)

Question 30

_______ atelectasis can occur following surgery

Answer 30

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

Question 31

which RDS is refractory to oxygen therapy: adult or neonatal

Answer 31

ADULT

Question 32

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

Answer 32

IPSILATERAL deviation of the trachea and IPSILATERAL elevation of the diaphragm

Question 33

cortisol ____ levels or surfactant in the fetus

Answer 33

↑

Question 34

what are some findings in the organizing phase of ARDS?

Answer 34

- proliferation of type II cells - fibrosis - alveolar septal thickening MAINLY: interstitial inflammation and fibrosis

Question 35

what are some other names for adult respiratory distress syndrome

Answer 35

- shock lung syndrome - acute lung injury - diffuse alveolar damage - non cardiogenic pulmonary edema

Question 36

in adults, the RDS is due to _______

Answer 36

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

Question 37

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

Answer 37

HYPOperfusion because of the vasoconstriction in the pulmonary vasculature (all other parts of the body will respond to hypoxia with vasodilation)

Question 38

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

Answer 38

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

Question 39

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

Answer 39

SHIFT AWAY from lesion (CONTRALATERAL SHIFT)

Question 40

what are some complications of neonatal RDS?

Answer 40

- 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)

Question 41

acute lung injury is precipitated by ________ injury

Answer 41

endothelial and epithelial injury