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Neo Boards GF > Respiratory > Flashcards

Respiratory Flashcards

1
Q

What aortic arch forms the pulmonary blood vessels?

A

6th aortic arch (same as PDA)

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2
Q

What is difference between preacinar and intraacinar arteries?

A

Pre-acinar: near non-respiratory bronchioles, angiogenesis, growth complete at 16wks GA
Intra-acinar: near alveoli, develops via vasculogenesis (de novo, not angiogenesis). Grows for 8-10 years

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3
Q

How many alveoli does a term infant have? Adult?

A

Term: 50-150 million
Adult: 200-600 million

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4
Q

What factors delay alvelolar development?

A

Antenatal steroids, supplemental oxygen, poor nutrition, mechanical ventilation

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5
Q

What are the stages and weeks of lung development?

A

Embryonic (0-5 wk) - TEF, tracheal stenosis, laryngeal cleft
Pseudoglandular (5-16wk) - CDH, CCAM, bronchogenic cysts
Canalicular (16-25wk) - pulm hypo
Saccular (25-36wk) - pulm hypo
Alveolar (36+wk)

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6
Q

Type I vs type II pneumocyte

A

Type I: thin/flat, gas exchange, 90% of alvelolar surface, made by type II, less cells
Type II: cuboidal, surfactant, 10% of surface but higher # of cells

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7
Q

What is major cation of fetal lung fluid?

A

Chloride goes into alveoli and liquid follows. Then prior to birth Na leaves alveoli and liquid follows.

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8
Q

What is the largest component of surdactant?

A

DPPC (dipalmitoyl phosphatidylcholine)

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9
Q

What happens with surfactant protein A deficiency? B? C? D?

A

A: most abundant protein, some increase in RDS if deficient
B: critical, if partial def: CLD; if none, needs lung transplant
C: mild to sev sx after few months
D: no disease

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10
Q

What is phosphatidylglycerol (PG)?

A

Reflects lung maturity, present after 34-35 weeks; absent in infants with RDS

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11
Q

What is the L/S ratio?

A

Lecithin/sphingomyelin ratio
If >2= lung maturity
=2 at about 35 wks
Lecithin reflects lung maturity, increases w GA, sphingomyelin unrelated to lungs but decreases after 32 weeks

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12
Q

What is the largest factor in respiratory resistance?

A

55% airway resistance (50% nasal)
25% chest wall
20% lung tissue (friction between lung and chest wall)

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13
Q

What does time constant mean? How does it change in RDS? BPD?

A

Time constant: time is takes for lungs to empty. 63% (1), 84% (2), 95% (3)
Decreases in RDS
Increases in BPD

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14
Q

How does NO work?

A

NO -> activates guanylyl cyclase -> inc cGMP -> induces vascular muscle relaxation

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15
Q

Where does CCAM get blood supply? Bronchopulmonary sequestration?

A

CCAM: pulmonary blood supply

Bronchopulm sequestration: systemic blood supply (if extralobar may not need surgery, good prognosis)

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16
Q

Where is CO2 monitored?

A

Chemoreceptors in medulla, sense H ion concentration in extracellular fluid. Preterm infants less sensitive

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17
Q

Where is O2 monitored?

A

Peripheral chemoreceptors in carotid bodies and aortic bodies

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18
Q

What is the Bohr equation?

A

Dead space V = (arterial CO2 - expired CO2)/ arterial CO2 x TV

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19
Q

What is Poiseuilles law for laminar flow?

A

Flow= dP x pi x radius^4/ (8 x length x viscosity)
Laminar flow: small airways
Turbulent flow: large airways

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20
Q

How does lung volume change with RDS?

A

Dead space increases, all other volumes decrease

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21
Q

What lung volumes are increased in neonates compared to adults?

A

RR, alveolar and minute ventilation, residual volume

22
Q

What lung volumes are decreased in neonates compared to adults?

A

TV, TLC, VC, inspiratory capacity

23
Q

What is formula for O2 content in blood?

A

O2 content= (1.37 x Hb x O2 sat) + .003x paO2

24
Q

A - a gradient formula

A

A - a = [FiO2 x (760-47)] - (paCO2/0.8) - paO2

25
Q

O2 delivery formula

A

Amount of oxygen available to body in one minute (O2 content x cardiac output)
O2 delivery= CO x [(1.34 x Hb x O2 sat) + (0.003 x paO2)]

26
Q

O2 consumption formula

A

VO2= CO x (1.34 x Hb) (arterial O2 sat - venous O2 sat)

27
Q

What is the Bohr effect?

A

As CO2 rises, decreases oxygen affinity for Hb. Allows unloading of oxygen to tissues.

28
Q

What is the Haldane effect?

A

Describes CO2 unloading, high O2 binding of Hb in alveolar capillary induces increased unloading of CO2

29
Q

What is methemoglobin?

A

Iron on hemoglobin changes from reduced (ferrous) to oxidized (ferric) and decreases ability to bind O2.
paO2 normal but O2 sat low
Rx: methylene blue

30
Q

OI calculation

A

OI = MAP x FiO2 / paO2 (postductal) x 100

31
Q

What benefit do antenatal steroids have on lung?

A

Increase lung surface area (even though delay alveolarization)

32
Q

How much of secreted surfactant is recycled? What is turnover time?

A

95% recycled, 10 hour turnover time

33
Q

What are glycogen lakes? Lamellar bodies?

A

Glycogen lakes : found only in immature type II pneumocytes

Lamellar bodies: sign of lung maturity

34
Q

What protein do the animal surfactants not have? What do they all have?

A

None have SP-A

All have SP-B and SP-C

35
Q

What is LaPlaces law?

A

Relationship between Pressure, surface tenton, and radius
P=2T/r
*linear relationship between radius and pressure

36
Q

What is the relationship between Pa (alveolar), Pv (pulm venous pres), PA (pulm art pres) in the neonatal lung?

A

Pa > Pv > PA

37
Q

What is the Fick principle?

A

Oxygen consumption

VO2= CO x 1.34xHbx(art sat - ven sat)

38
Q

Does neonate or adult have higher oxygen consumption?

A

Neonate 6-8 ml/kg/min (adult 3.2)

Term > preterm infant

39
Q

What increases oxygen consumption?

A
  1. Increased caloric intake
  2. Decreased body temp
  3. AGA > SGA
  4. Term > preterm
40
Q

What shifts oxyhemoglobin dissociation curve to left?

A 
Low H
Low CO2
Low temp
Low 2,3 DPG
Fetal hemoglobin
41
Q

What shifts oxyhemoglobin dissociation curve to right?

A 
High acid
High temp
High CO2
High 2,3 DPG
Adult Hb
42
Q

Is unilateral or bilateral vocal cord paralysis more common? If unilateral, which side?

A

Unilateral, left

Because left recurrent laryngeal nerve with longer course, more fragile

43
Q

Are most CDH syndromic? Left or right more common?

A 
No, most nonsyndromic. But 40% with associated defects
Left 85% (bilateral 1%)
If syndrome:
Fryns syndrome
Denys-Drash
Cornelia de Lange
Marfan
Spondylocostal dysostosis
Craniofrontonadal syndrome
44
Q

What defects are most commonly associated with diaphragmatic hernia?

A

Heart defects
Undescended testes
Meckel diverticulum
Unilateral kidney

45
Q

Is diaphragm paralysis more common unilateral or bilateral? If unilateral which side? Outcome?

A

Unilateral, right (if 2/2 birth trauma)
Due to phrenic nerve injury
Will have no retractions on affected side
If birth trauma - most recover in 1 year

46
Q

What is the most common type of CCAM? Second most common?

A
  1. Type 1 (50-70%) most common, defect 7-10 weeks GA. Usually single cyst, can be multiloculated. Often causes compression. 2-10cm
  2. Type 2 (20-40%). With other anomalies (60%), TEF, renal agenesis, intestinal atresia, hydroceph, skeletal. Defect 3wks GA. Multiple small cysts and solid areas. 0.5-2cm. Doesnt compress.
47
Q

Where does diamox work? How does it work?

A

Proximal tubule

It is a carbonic anhydrase inhibitor, inhibits NaHCO3 reabsorption

48
Q

Where do lasix and bumex work? How?

A

Ascending loop of henle

Blocks active chloride transport. K losing

49
Q

Where does spironolactone work? How?

A

Collecting system
Competitive antagonist of aldosterone
K sparing

50
Q

Where does diuril work?

A

Distal tubule
Inhibits NaCl reabsorption
*can cause hyperbili and hyperglycemia

51
Q

How do methyxanthines work?

A

Increase cAMP and changing intraular Ca

Also inhibit central adrenergic receptor

52
Q

What are the criteria for mild, mod, severe BPD?

A
  1. Mild: o2 28 days plus RA at 36 weeks or dc
  2. Mod: o2 28 days and <30% Fi02 at 36 wks
  3. Severe: o2 28 days and FiO2 30% or more at 36 wks, or CPAP/PPV at 36 wks.

Neo Boards GF (14 decks)

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