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Pulmonology > 08.26 - Path of Neonatal, Developmental, and Pulmonary Vascular (Nichols) - Questions > Flashcards

08.26 - Path of Neonatal, Developmental, and Pulmonary Vascular (Nichols) - Questions Flashcards

(90 cards)

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1
Q

Cause of “death rattle”

A

Frothy white pulmonary edema fluid.

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2
Q

Character of edema in cardiogenic vs non-cardiogenic

A

Protein-poor if cardiogenic; Protein-rich if non-cardiogenic (pneumonia, ARDS, etc)

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3
Q

Physical exam sign to tell if pulmonary edema is cardiogenic or not?

A

JVD

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4
Q

Histologic apperance that corresponds to white frothy fluid

A

Pink eosinophilic fluid

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5
Q

Importance of IL-5

A

Eosinophil activation (Asthma)

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6
Q

ARDS is the clinical picture of

A

Acute Lung Injury

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7
Q

In ALI, single alveolar unit acts as

A

Shunt

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8
Q

Surfactant in ALI

A

Inactivated

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9
Q

ARDS is associated with intense

A

Inflammation

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10
Q

ARDS: profound ___-philia, even in the ____

A

Neutrophilia, even in the periphery

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11
Q

ARDS: Severe hypoxemia due to

A

Shunting

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12
Q

Compliance in ARDS

A

Acute decrease in compliance

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13
Q

4 phases of Acute Lung Injury

A

Exudative (edema), Transition (transition), Proliferative (inflammation), Fibrotic (fibroblasts)

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14
Q

Why not treat with maximal FiO2 in ARDS

A

Free radicals

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15
Q

How does PEEP improve oxygenation in ARDS

A

Recruits atelectatic alveoli and increases FRC

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16
Q

Patients with ARDS die due to

A

Multi-organ failure

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17
Q

ARDS survivors have reduction in

A

DLCO

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18
Q

Fat Embolism occurs in

A

long bone fractures in older individuals; sickle cell crisis; orthopedic surgery

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19
Q

What tumor is especially prone to throw emboli

A

Lung Primary

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20
Q

Air embolism is caused by

A

Vascular Catheter, Chest Wall Injury, Brain surg in sitting position, back surg in prone position

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21
Q

Most fat emobli are clinically ___

A

silent

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22
Q

Signs and Symptoms of Pneumothorax

A

Sudden onset dyspnea, chest pain, decreased breath sounds on one side

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23
Q

Primary vs Secondary Pneumothorax

A

Seconday has predisposing factor in lung

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24
Q

Tension Pneumothorax means

A

pressure in pleural cavity above atmospheric

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25
Most common type of TE Fistula
Dead-end esophagus with lower esophagus inlet in trachea
26
Presenation of TE Fistula
Pneumonia or Regurgitation of attempted feeding shortly after birth
27
Bronchogenic Cysts
Arise from abnormal detachments of primitive foregut
28
Pulmonary Sequestration
Discrete area of lung tissue that lacks connection to airway system and has abnormal blood supply from aorta
29
Discrete area of lung tissue that lacks connection to airway system and has abnormal blood supply from aorta
Pulmonary Sequestration
30
Arise from abnormal detachments of primitive foregut
Bronchogenic Cysts
31
Resorption Atelectasis
Endobronchial Mass
32
Plexiform lesion always only occurs in
Advanced severe stages of pulmonary HTN
33
What is common between Group 1 causes of Pulmonary HTN
Plexiform lesions
34
Lungs in Granulomatosis w/ Polyangiitis
Hemorrhagic consoldiated lungs with cavitating nodules
35
Hemorrhagic consoldiated lungs with cavitating nodules
Lungs in Granulomatosis w/ Polyangiitis
36
ELKS
Wegener's: Eyes, Lungs, Kidneys, Skin
37
Pulmonary edema from ALI is commonly due to __ and less commonly to __
Shock, less commonly pulmonary infection
38
Microhemorrhages are microscopically manifested by
Accumulation of hemosiderin-laden macrophages in alveoli (heart-failure cells)
39
What causes heart-failure cells
Microhemorrhages cleaned up to creat hemosiderin-laden macrophages
40
Most common cause of pulmonary edema
Left Sided Heart Failure
41
Normal pulmonary capillary pressure
10 mmHg
42
At what pulmonary capillary pressure does fluid leak into interstitium? Alveoli?
20mmHg; 25mmHg
43
Increased pulmonary venous pressure causes __ before it causes transudation of fluid into lungs (crackles)
Dyspnea
44
Gross Path of Pulmonary Edema
Lungs are red, wet, heavy, and exude white froth
45
When is pulmonary edema fluid pink
High hydrostatic pressure --> ruptured capillaries
46
Abrupt onset of hypoxemia and bilateral pulmomary infiltrates in absence of heart failure
ALI
47
Common scenario when ALI is first to endothelial cells
Septic Shock
48
Common scenario when ALI is first to pneumocytes
Gastric Acid Aspiration; Smoke inhalation
49
Cutoffs for mild, moderate, and severe ARDS
PaO2 300-200; 200-100; <100
50
Normal PaO2? PaO2/FiO2?
100mmHg; 475mmHg
51
ARDS is acute diffuse inflammatory lung injury, leading to
Incr vascular permeability and pulmonary edema
52
4 most common causes of ARDS
Sepsis, Diffuse Pneumonia, Gastric Aspriation, Trauma
53
2 notable molecular mediators of ARDS
TNF and IL-1, secreted by Macrophages
54
Role of Macrophages and Neutrophils in ARDS
Mac's secrete TNF and IL-1 --> Activate endothelium --> Recruit PMN's --> Release injurious mediators
55
Histopathological counterpart of ARDS
Diffuse Alveolar Damage
56
Earliest visible changes in ARDS
12-24 hours - Congestion, Interstitial and Alveolar Edema, PMN's
57
24-72 hours ARDS
Hyaline membranes
58
When do hyaline membranes appear in ARDS
24-72 hours after injury
59
What starts about 48 hours after injury in ARDS
Type 2 Pneumocytes proliferate and look scary
60
When do type 2 pneumocytes begin proliferating in ARDS
48 hours after injury
61
What starts about 72 hours after injury in ARDS
Lymphs, Macs, and Fibros infiltrate interstitium
62
What occurs in Organizing phase of ARDS
Granulation tissue forms in alveolar walls
63
Alveolar Hyaline Membranes is hallmark of
Diffuse Alveolar Damage -- ARDS
64
Clinical manifestations of ARDS appear how long after injury
Within 6-72 hours
65
Mainstay of treatment for ARDS
Mechanical ventilation
66
Presenting symptoms of ARDS
Dyspnea, Cyanosis, Diffuse Crackles
67
Pulmonary infarcts tend to be ___, wedge-shaped, and hemorrhagic
Subpleural
68
Top Sign and Symptom of PTE
Dyspnea, Tachypnea (Pleuritic Chest pain, Leg pain)
69
Best test for PTE
Spiral CT with IV Contrast
70
Pulmonary HTN is defined as
Mean Pulmonary Arterial Pressure >25mmHg at rest (Normal <20mmHg)
71
Pulmonary HTN is most often due to ___ or ___
Heart Disease or Intrinsic Lung Disease
72
Germline mutation found in 75% of Primary Pulmonary HTN
BMPR2
73
Haploinsufficiency of BMPR2 leads to dysfunction and ___
proliferation of endothelial cells and vascular SM cells
74
Finding common to all forms of pulmonary HTN
Hypertrophy and Hyperplasia of SM in Tunica Media of pulmonary muscular and elastic arteris
75
Sign of Pulmonary HTN
Incr intensity of pulmonic component of S2
76
Gold standard for dx of Pulmonary HTN
Right Heart Catheterization
77
Hemoptysis is most often due to
Pulmonary infection
78
Most pulmonary hemorrhagic syndromes are forms of
Autoimmune Vasculitis
79
Resorption Atelectasis results from
Complete obstruction of an airway
80
Contraction Atlectasis
Pulmonary or Pleural fibrosis prevents expansion
81
Histopathology of NRDS and ARDS
Essentially the same
82
Giving the mother __ reduces risk of RDS in premature infants
Glucocorticoids
83
Aspiration pneumonia is more common in which lung
Right
84
Pulmonary infarcts, because of dual blood supply, are typically ___
hemorrhagic
85
Holes between adjacent alveoli
Pores of Kohn
86
Typical alveolar bacterial infection spreads throughout a lobule via
Pores of Kohn, until it reaches interlobular septa
87
When will bacteria spread across interlobular septa
If it necrotizing
88
Oligohydramnios causes what lung problem
Hypoplasia
89
There is more blood in the __ of the lungs and more gas in the __
Blood = Base; Air = Apices
90
Hematogenous metastases are more numerous and larger in which parts of lungs
Bases = Better blood supply

Pulmonology (31 decks)

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