respiratory

Question 1

definition of congenital lobar emphysema

Answer 1

a neonatal condition associated with enlarged air

spaces in the lungs , The most affected is left upper lobe.

Question 2

diagnosis of congenital lobar emphysema

Answer 2

xray, ct

Question 3

Treatment of congenital lobar emphysema

Answer 3

Respiratory distress - emergency thoracotomy
Mild symptoms – delayed surgery
Resection of the affected lobe

Question 4

clinical presentation of congenital lobar emphysema

Answer 4

respiratory and cardiovascular collapse ( hypotension and low pao2).-massive lobar overdistention cause compression of the normal lung and the mediastinum

Question 5

definition of congenital cystic adenomatoid

malformations

Answer 5

(Defect in the development of the terminal bronchioles?)
and is a benign lung lesion appearing as a cyst or mass in the chest that can vary in size made from abnormal lung tissue.

Question 6

classification congenital cystic adenomatoid

malformation

Answer 6

Based on size
I.Big cysts > 2cm;
II.Small cysts< 1 cm;
III.Solid, no cystic component

Anatomical

• Macrocystic > 5cm –favorable, no symptoms
• Microcystic < 5 cm – unfavorable, fetal hydrops ( fluid overload), respiratory distress

Question 7

diagnosis of congenital cystic adenomatoid

malformations

Answer 7

Prenatal ultrasound- look for cysts, accumulation of amniotic fluid
respiratory distress
recurrent infections

Question 8

treatment of congenital cystic adenomatoid

malformations

Answer 8

prenatal- thoracoamniotic shunt
postnatal- resection of cyst ( risk of infection or malignancy)
Asymptomatic newborn- lobectomy at 3-6 months
Symptomatic- emergency surgery

Question 9

definition of Empyema

Answer 9

accumulation of infected fluid within the thoracic cavity

Question 10

classification of Empyema

Answer 10

stage 1 - exudative phase. 1-3 days. Thin pleural fluid treated with thoracocentesis.
stage 2- fibro purulent 7-10 days. Invasion of organism to pleural space> fibrin deposition creates loculations ( pockets of fluid). decreases in the pleural fluid glucose and pH levels and increased protein and lactate dehydrogenase (LDH) levels
stage 3- organising stage 14-28 days. Fibroblast proliferation> thickening of the visceral and parietal pleura ( pleural peel)

Question 11

etiology of Empyema

Answer 11

Most common is staphylococcus aureus, then streptococcus pneumonia

Question 12

Signs and symptoms of Empyema

Answer 12

URT: cough, shallow rapid breathing, diminished breath sounds, dullness to percussion
Digestive : ( may spread to peritonitis to cause ileus) abdominal pain with distension
General: fever, lethargy

Question 13

Diagnosis of Empyema

Answer 13

Lab- bloods ,
Imaging: ultrasound, chest xray, ct
Procedures: pleural fluid analysis obtained with thoracocentesis

Question 14

Treatment of Empyema

Answer 14

Stage 1- drainage with thoracocentesis + antibiotics
stage 2- fibrinolytic therapy + antibiotics
stage 3- thoracotomy + antibiotics

Question 15

Definition of congenital diaphragmatic hernia

Answer 15

Diaphragm doesn’t close properly during fetal development causing abdominal contents to go into the thoracic cavity ( mostly left side). The lungs will be smaller than expected (pulmonary hypoplasia)

Question 16

Diagnosis of congenital diaphragmatic hernia prenatal and postnatal

Answer 16

prenatal ultrasound- stomach, intestine or liver in chest , absence of gastric bubble, polyhydramnios

postnatal: signs and symptoms ( respiratory distress, repeated pneumonia, scaphoid abdomen, bowel sounds in chest) xray

Question 17

how to determine severity of congenital diaphragmatic hernia

Answer 17

Lung area to head circumference ratio (LHR)

Presence of liver ( and stomach) in chest is poor prognosis as there are smaller lungs

Question 18

signs and symptoms of congenital diaphragmatic hernia postnatally

Answer 18

Signs of respiratory distress ( chest wall retractions, cyanosis, tachypnea, grunting)
Expanded chest, scaphoid abdomen
Bowel sounds in the chest, reduced breath sounds
Displacement of apex beat

Question 19

Treatment of congenital diaphragmatic hernia

Answer 19

After birth- endotracheal intubation, NG tube ( for gastric decompression to allow space for lungs to expand)
extracorporeal membrane oxygenation (ECMO). ECMO provides temporary support for lung failure by circulating the baby’s blood through a heart-lung machine removes co2 and adds o2.
Surgery 1-2 days after stabilisation. Small hole- sewn, large hole- use muscle flap to close hole in diaphragm

Question 20

Fetal surgery for congenital diaphragmatic hernia

Answer 20

Fetoscopic endoluminal tracheal occlusion
a surgical procedure to treat the most severe cases
Normally fluid produced in the lungs escapes through the trachea. FETO blocks the trachea using a balloon to build up pressure in the trachea and stimulate development of lungs

Question 21

definition of esophageal atresia

Answer 21

incomplete formation of the esophagus, esophagus ends in a blind pouch rather than connecting to the stomach, frequently forms a tracheoesophageal fistula

Question 22

classification of esophageal atresia

Answer 22

type A - Esophageal atresia without fistula
Type B - Esophageal atresia with proximal TEF (< 1%)
Type C - Esophageal atresia with distal TEF (85%)
Type D - Esophageal atresia with proximal and distal TEFs (< 1%)

Question 23

signs and symptoms of esophageal atresia

Answer 23

excess salivation with bubbles ( baby cannot swallow spit)
respiratory distress
abdominal distension - baby cries, air from the trachea is forced through the fistula into the lower esophagus and stomach.
cough, cyanosis after feeding ( trachea is weak and may collapse)

Question 24

associated features of esophageal atresia

Answer 24

VACTERL (vertebral defects, anorectal malformations, cardiovascular defects, tracheoesophageal defects, renal anomalies, and limb deformities)

Question 25

Diagnosis of Esophageal Atresia

Answer 25

Prenatal ultrasound: polyhyramnios ( baby can’t swallow amniotic fluid so accumulates) lack of gastric bubble
Post natal- NG tube ( not able to pass through stomach) and xray

Question 26

Treatment of Esophageal Atresia

Answer 26

Preoperative management- prevent aspiration pneumonia. Continuous suction with an NGT in the upper esophageal pouch prevents aspiration of swallowed saliva.
Fluid resuscitation

Surgical:
closure of the tracheoesophageal fistula with anastomosis