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

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

Flashcards in 08.26 - Path of Neonatal, Developmental, and Pulmonary Vascular (Nichols) - Questions Deck (90):
1

Cause of "death rattle"

Frothy white pulmonary edema fluid.

2

Character of edema in cardiogenic vs non-cardiogenic

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

3

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

JVD

4

Histologic apperance that corresponds to white frothy fluid

Pink eosinophilic fluid

5

Importance of IL-5

Eosinophil activation (Asthma)

6

ARDS is the clinical picture of

Acute Lung Injury

7

In ALI, single alveolar unit acts as

Shunt

8

Surfactant in ALI

Inactivated

9

ARDS is associated with intense

Inflammation

10

ARDS: profound ___-philia, even in the ____

Neutrophilia, even in the periphery

11

ARDS: Severe hypoxemia due to

Shunting

12

Compliance in ARDS

Acute decrease in compliance

13

4 phases of Acute Lung Injury

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

14

Why not treat with maximal FiO2 in ARDS

Free radicals

15

How does PEEP improve oxygenation in ARDS

Recruits atelectatic alveoli and increases FRC

16

Patients with ARDS die due to

Multi-organ failure

17

ARDS survivors have reduction in

DLCO

18

Fat Embolism occurs in

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

19

What tumor is especially prone to throw emboli

Lung Primary

20

Air embolism is caused by

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

21

Most fat emobli are clinically ___

silent

22

Signs and Symptoms of Pneumothorax

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

23

Primary vs Secondary Pneumothorax

Seconday has predisposing factor in lung

24

Tension Pneumothorax means

pressure in pleural cavity above atmospheric

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