week 1 -introduction to pulmonary pathology and pulmonary edema

Question 1

What tests are interpreted in the clinical examination of the respiratory system?

Answer 1

Pulmonary function tests (PFTs), including spirometry and DLCO

DLCO stands for diffusion capacity.

Question 2

What are the two types of pulmonary edema?

Answer 2

• Cardiogenic
• Non-cardiogenic

Differentiation is based on pathogenesis, histology, and radiological features.

Question 3

What is the definition of ARDS?

Answer 3

Acute Respiratory Distress Syndrome

It is characterized by abrupt onset of dyspnea within 1 week of an insult.

Question 4

What is the most common cause of ARDS?

Answer 4

Sepsis

Question 5

What does DLCO assess in pulmonary function?

Answer 5

Lung’s ability to transfer gas from inspired air to the bloodstream

It helps identify problems with the diffusion barrier.

Question 6

What are the components of lung volumes?

Answer 6

• Tidal Volume (TV)
• Inspiratory Reserve Volume (IRV)
• Expiratory Reserve Volume (ERV)
• Residual Volume (RV)

Question 7

What is the FEV1:FVC ratio used for?

Answer 7

To differentiate between obstructive and restrictive lung diseases.

Question 8

What are the common clinical features of pulmonary edema?

Answer 8

• Shortness of breath
• Cough with pink frothy sputum
• Crackles on auscultation

Question 9

What are the two categories of pulmonary insult related to ARDS?

Answer 9

• Direct Pulmonary Insult
• Indirect Pulmonary Insult

Question 10

What is the histological correlate of ARDS in the acute phase?

Answer 10

Diffuse alveolar damage

This includes heavy and firm lungs, congestion, and necrosis.

Question 11

What is the expected microscopy finding in cardiogenic pulmonary edema?

Answer 11

Transudate

This contrasts with ARDS, which shows exudate.

Question 12

What is the role of macrophages in the resolution of acute lung injury?

Answer 12

• Remove intra-alveolar debris
• Release fibrogenic cytokines
• Stimulate fibroblast growth

Question 13

What is a common diagnostic tool used for assessing lung pathologies?

Answer 13

Chest X-ray

Anteroposterior and lateral views are typically used.

Question 14

What is the primary symptom of a foreign body aspiration in a child?

Answer 14

Stridor

It is often accompanied by cough and breathlessness.

Question 15

What is the significance of the FEV1 measurement?

Answer 15

It measures the volume of air exhaled with force during the first second of expiration.

Question 16

What is the most likely diagnosis for a child with stridor and breathlessness after choking?

Answer 16

Foreign body aspiration

Question 17

What is the difference in chest X-ray findings between cardiogenic and non-cardiogenic pulmonary edema?

Answer 17

• Cardiogenic: Bilateral bibasilar infiltrates
• Non-cardiogenic: Uniform distribution of bilateral infiltrates

Question 18

What is the primary investigation for sputum analysis?

Answer 18

Cell analysis and microbiological studies

Question 19

What does ABG stand for?

Answer 19

Arterial Blood Gas analysis

Question 20

What does the presence of crackles on auscultation indicate?

Answer 20

Possible pulmonary edema or other respiratory conditions.

Question 21

What is the role of cytology in pathological investigations?

Answer 21

To analyze cellular components from samples such as bronchial washings.

Question 22

What is the organizing phase in the context of ARDS?

Answer 22

Proliferation of type II cells and formation of granulation tissue.

Question 23

What is one of the major complications of unresolved acute lung injury?

Answer 23

Fibrosis of alveolar walls

Question 24

What are hyaline membranes composed of?

Answer 24

Fibrin-rich edema fluid mixed with remnants of necrotic epithelial cells

Hyaline membranes are indicative of acute lung injury and are formed in the early phases of lung damage.

Question 25

What is the organizing (proliferative) phase in lung injury?

Answer 25

Proliferation of type II cells, formation of granulation tissue in alveolar walls and spaces, possible resolution or fibrotic thickening ## Footnote This phase occurs between Day 7 and 21 after the initial injury.

Question 26

What occurs during the healing stage of acute lung injury?

Answer 26

Resorption of hyaline membranes, thickening of alveolar septa, presence of reactive type II pneumocytes ## Footnote This stage is associated with regeneration and repair of lung tissue.

Question 27

List some signs and symptoms of acute lung injury.

Answer 27

* Rapid onset of dyspnea (within 1 week) * Advanced age * Cyanosis * Bacteremia/sepsis * Respiratory failure * Progression to multisystem organ failure ## Footnote These symptoms are poor prognostic indicators.

Question 28

What investigations are commonly used for acute lung injury?

Answer 28

* Chest x-ray: Diffuse bilateral infiltrates * ABG: hypoxemia (may be refractory to oxygen therapy) * High resolution CT scan ## Footnote These investigations help in assessing the severity and extent of lung injury.

Question 29

Most patients who survive acute lung injury recover normal respiratory function within how many months?

Answer 29

6 to 12 months ## Footnote However, some patients may develop diffuse interstitial fibrosis leading to chronic respiratory issues.

Question 30

True or False: Acute lung injury can lead to chronic respiratory insufficiency.

Answer 30

True ## Footnote Some patients may develop chronic conditions following the initial acute injury.

Question 31

Fill in the blank: The presence of bright pink hyaline membranes in the lungs is associated with _______.

Answer 31

Diffuse alveolar damage ## Footnote This is a characteristic finding in acute lung injury.

Question 32

What happens to alveoli during the acute phase of lung injury?

Answer 32

Some alveoli are collapsed, while others are distended ## Footnote This indicates varying degrees of lung damage and dysfunction.

Question 33

What is a common finding on high-resolution CT scan in patients with acute lung injury?

Answer 33

Diffuse bilateral infiltrates ## Footnote This imaging finding is critical for diagnosis.

Question 34

What is the primary cell type involved in the proliferation during the organizing phase?

Answer 34

Type II cells ## Footnote These cells play a crucial role in the repair and regeneration of alveolar epithelium.