Pulmonary HTN and RDS

Question 1

MAP for pHTN

Answer 1

25mmHg. Normal is 10

Question 2

PHTN Gross, Histologic, and Presentation

Answer 2

Athersclerosis of pulmonary trunk
Plexiform lesions (groups of bunched up capillaries)
Presents with exertional dyspnea

Question 3

Primary Pulmonary Hypertension (demographic and common mutation)

Answer 3

Young adult females

BMPR2 inactivating mutation

Question 4

Secondary Pulmonary Hypertension 3 Causes

Answer 4

Hypoxemia (COPD/ILD), Increased V in pulmonary circuit (congenital heart disease), or RECURRENT PULMONARY EMBOLISM (reorganization)

Question 5

ARDS (what it is)

Answer 5

Diffuse damage to alveolar-capillary interface w/ leaking of fluid and hyaline membrane formation in alveoli secondary to a bunch of processes causing neutrophilic protease-mediated/free radical destruction of both Type I and II pneumocytes - leads to thickened diffusion membrane and alveolar collapse

Question 6

ARDS (radiographic finding, treatment, long term complication)

Answer 6

“white out”
Address underlying cause and use PEEP to keep alveoli open
Fibrosis/scarring due to loss of Type II pneumocytes

Question 7

Neonatal Respiratory Distress Syndrome

Answer 7

RDS due to lack of surfactant

Question 8

3 Causes of Neonatal RDS

Answer 8

Prematurity: before 34 weeks or lecithin(phosphatidylcholine):sphingomyelin L:S ratio < 2
C-section: don’t get stress steroids to stimulate synth/release of surfactant
Maternal diabetes - increases insulin, which decreases surfactant

Question 9

Neonatal RDS Clinical and Radiographic Sign

Answer 9

Increased respiratory effort/grunting/accessory muscles

“Ground glass” appearance on Xray

Question 10

2 Complications of Supplemental Oxygen

Answer 10

Retinal injury/blindness

Bronchopulmonary dysplasia