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Neo Board Review > Pulmonology > Flashcards

Pulmonology Flashcards

1
Q

Total respiratory system resistance

A

R= change in pressure (cm H2O)/ change in flow (L/sec)

Total value is 40-55 cm H2O/L/sec

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2
Q

Greatest resistance in airway-location?

A

50% of airway resistance is due to nasal resistance

Distal airways contribute very little

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3
Q

What are the 3 factors that co2 elimination depend on?

A
  1. Alveolar minute ventilation
  2. Diffusion across capillary membrane
  3. Matching of alveolar ventilation with pulmonary blood flow.
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4
Q

Which factors increase MAP?

A 
Increase PEEP
Increase PEP
Increase rate
Increase flow
Increase itime
Decrease e-time
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5
Q

CCAM facts

A

Connected to tracheobronchial tree
Has 5 types, type 1 and 2 are most common
Most regress in utero
Supplied by pulmonary circulation

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6
Q

Which surfactant protein deficiency is not associated with clinical disease?

A

Surfactant protein D

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7
Q

Largest component of surfactant?

A

Disaturated phosphatidylcholine

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8
Q

Transport of which ion is responsible for fetal lung fluid formation

A

Chloride = Creation of Critical lung fluid

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9
Q

Which ion is responsible for fetal lung fluid clearance?

A

Sodium

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10
Q

Chest wall movements with unilateral diaphragmatic paralysis?

A

Affected side has fewer movements compared to unaffected

R sided paralysis more common

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11
Q

Embryonic stage of lung development:

  1. Weeks of gestation
  2. What forms?
  3. Defects during this stage
A
  1. 0 - 7 weeks
  2. Trachea and bronchi
  3. Tracheal stenosis, TE fistula, laryngeal cleft
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12
Q

Pseudoglandular stage of lung development:

  1. Weeks of gestation
  2. What forms?
  3. Defects during this stage
A
  1. 7 - 17 weeks
  2. Non respiratory bronchioles.
  3. Branching abnormalities, CDH, CCAM, bronchogenic cysts, congenital lobar emphysema
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13
Q

Canalicular stage of lung development:

  1. Weeks of gestation
  2. What forms?
  3. Defects during this stage
A
  1. 17 - 27 weeks
  2. Respiratory bronchioles. Type 2 pneumocytes differentiate into type 1
  3. Pulmonary hypoplasia
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14
Q

Saccular stage of lung development:

  1. Weeks of gestation
  2. What forms?
  3. Defects during this stage
A
  1. 27 - 36 weeks
  2. Alveolar ducts and sacs
  3. Pulmonary hypoplasia
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15
Q

Alveolar stage of lung development:

  1. Weeks of gestation
  2. What forms?
A
  1. After 36 weeks

2. Alveoli

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16
Q

Lecithin vs sphingomyelin: which reflects lung maturity?

A

Lecithin. Increases with increasing gestation.

Sphingomyelin decreases with inc gestation

17
Q

Surfactant protein associated with most severe lung disease?

A

Surfactant protein B

18
Q

Which chromosomes are each surfactant protein on?

A

A and D on chromosome 10
B on 2
C on 8

19
Q

Most abundant surfactant protein?

A

SP-A

20
Q

Most common known genetic cause of surfactant deficiency?

A

ABCA3 deficiency
Autosomal recessive
Lack of DPPC, PG and lamellar bodies

21
Q

Which factors determine the oxygen sat?

A

paO2 and O2 dissociation curve factors

22
Q

What is paO2 and what determines it?

A

Oxygen dissolved in the plasma. Determined by alveolar pO2 and the alveolar-capillary interface

23
Q

What does the oxygen sat reflect?

A

Percentage of all available heme binding sites that are bound to oxygen

24
Q

Which factors does oxygen content depend on?

A

Hb concentration, oxygen saturation and dissolved O2 (lower effect because paO2 x 0.003). Main factors are Hb conc and O2 sat in a linear relationship

25
Q

Best waveform to detect air leak?

A

Volume waveform

26
Q

What is the belly dancer’s sign? When is it seen?

A

Shift of umbilicus towards one side during inspiration. Seen during unilateral diaphragmatic paralysis, shift is towards affected side

27
Q

Most common type of stridor?

A

Biphasic stridor due to laryngeal obstruction

28
Q

Most common congenital laryngeal anomaly?

A

Laryngomalacia

29
Q

Most common vascular ring?

A

Double aortic arch due to prevailing right and left 4th branchial arches

30
Q

Diagnostic test for vascular rings?

A

Barium swallow

31
Q

What embryological defect leads to CDH?

A

Failure of closure of pleuroperitoneal canal at 8 weeks gestation

32
Q

During what stage does surfactant production begin?

A

Canalicular

33
Q

What is new BPD?

A

Pulmonary changes consistent with altered lung development

  1. Arrest of alveolarization
  2. Increased alveolar development
  3. Fewer alveoli
  4. Disruption of collagen network around the saccules
  5. Localization of elastin that is absent from sites of future septation
  6. Less airway reactivity compared to old BPD
  7. Less pHTN
  8. Minimal fibrosis

Results from impaired acinar development with alveolar simplification
New BPD interferes with lung development, old BPD is caused by direct injury to the lung

34
Q

Effect of antenatal and postnatal steroids on the lungs

A

Antenatal: matures the fetal lung, by decreasing mesenchymal tissue and increasing airspace volume. Results in arrest in alveolar septation

Postnatal: arrest in alveolar septation and microvascular development

35
Q

Which inhibitory neurotransmitters contribute to apnea of prematurity?

A

GABA and adenosine

36
Q

Most accurate ETT depth estimation is based on?

A

The most accurate methods currently available to estimate depth for initial endotracheal intubation are based on “nasal-tragus distance + 1 cm,” or gestational age.

37
Q

Core feature separating new from old BPD?

A

Alveolar simplification is the core pathologic feature that separates classic BPD from the new BPD.

38
Q

Why do premies need caffeine boluses as they get older?

A

Increased metabolism because the t1/2 decreased due to an increase in CYP1A2 activity

Neo Board Review (16 decks)

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