32 Questions
What is the primary cause of hemodynamic pulmonary edema?
Increased hydrostatic pressure
Where are foregut cysts most often located?
In the hilum or middle mediastinum
What is characteristic of pulmonary sequestration?
Lack of any connection to the airway system
What type of pulmonary edema is caused by microvascular injury?
Pulmonary edema due to increased capillary permeability
What is a common association of pulmonary sequestration?
Other congenital anomalies
What is the characteristic feature of alveolar microhemorrhages and hemosiderin-laden macrophages?
They are a result of long-standing pulmonary congestion
Where does fluid initially accumulate in hemodynamic pulmonary edema?
In the basal regions of the lower lobes
What is the cause of noncardiogenic pulmonary edema?
Primary injury to the vascular endothelium or damage to alveolar epithelial cells
What is a characteristic of extralobar sequestrations?
Location external to the lung
What is the outcome of severe cases of noncardiogenic pulmonary edema?
Leakage of fluid into the alveoli
What is a complication of pulmonary edema in the early neonatal period?
Fatal outcome
What is the characteristic feature of intralobar sequestrations?
They occur within the lung
What is the outcome of long-standing pulmonary congestion?
Fibrosis and thickening of the alveolar walls
What is the characteristic feature of pneumonia?
Edema remains localized and is overshadowed by the manifestations of infection
Which of the following is a risk factor associated with a worse prognosis in Acute Respiratory Distress Syndrome (ARDS)?
Chronic alcoholism
What is the characteristic histologic manifestation of Acute Lung Injury (ALI) and ARDS?
Diffuse Alveolar Damage (DAD)
Which of the following is NOT a common cause of Acute Lung Injury (ALI)?
Pulmonary embolism
What is the effect of activated endothelium on microvascular permeability in the pathogenesis of Acute Lung Injury (ALI)?
It increases microvascular permeability
What is the characteristic clinical manifestation of Acute Respiratory Distress Syndrome (ARDS)?
Profound dyspnea and tachypnea
What is the effect of Type II pneumocyte necrosis on surfactant production in Acute Lung Injury (ALI)?
It decreases surfactant production
Which of the following is a feature of Restrictive Lung Disease?
Decreased total lung capacity (TLC)
What is the effect of Obstructive Lung Disease on FEV1?
It decreases FEV1
Which of the following is an example of Restrictive Lung Disease?
Pulmonary fibrosis
What is the effect of Acute Lung Injury (ALI) on lung function?
It impairs lung function
What is the primary characteristic of Pulmonary Hypoplasia?
Defective development of both lungs
What is the main complication of Atelectasis?
Inadequate oxygenation
What is the cause of Atelectasis due to Resorption?
Air or fluid in the alveoli
What is the characteristic of Contraction Atelectasis?
Tracheal deviation to the affected side
What is the primary difference between Compression and Resorption Atelectasis?
Cause of lung collapse
What is the impact of long-standing Contraction Atelectasis on tracheal deviation?
Tracheal deviation to the opposite side
What is the characteristic of Pulmonary Edema?
Generally reversible
What is the primary complication of Atelectasis?
Inadequate oxygenation and increased risk of infection
Study Notes
Congenital Anomalies
- Pulmonary Hypoplasia: defective development of both lungs, resulting in decreased weight, volume, and acini for body weight and gestational age
- Foregut Cysts: arise from abnormal detachments of primitive foregut, located in the hilum or middle mediastinum, classified as bronchogenic, esophageal, or enteric
- Pulmonary Sequestration: discrete area of lung tissue that lacks connection to the airway system, with abnormal blood supply arising from the aorta or its branches
- Types: extralobar (external to the lung, commonly found in infants) and intralobar (occur within the lung, present in older children)
Atelectasis
- Collapsed lung, generally reversible except for contraction
- Complications: inadequate oxygenation and increased risk of infection
Pulmonary Edema
- Leakage of excessive interstitial fluid that accumulates in alveolar spaces
- Causes: hemodynamic disturbances (cardiogenic pulmonary edema) or increase in capillary permeability due to microvascular injury
- Types:
- Hemodynamic Pulmonary Edema:
- Caused by increased hydrostatic pressure, commonly seen in left-sided congestive heart failure
- Fluid accumulates initially in the basal regions of the lower lobes (dependent edema)
- May be associated with alveolar microhemorrhages and hemosiderin-laden macrophages (“heart failure” cells)
- Edema Caused by Microvascular (Alveolar) Injury:
- Noncardiogenic pulmonary edema due to injury to the alveolar septa
- Primary injury to the vascular endothelium or damage to alveolar epithelial cells
- Inflammatory exudate leaks into the interstitial space and alveoli
- Hemodynamic Pulmonary Edema:
Acute Lung Injury and ARDS
- Abrupt onset of significant hypoxemia and bilateral pulmonary infiltrates in the absence of cardiac failure
- Acute respiratory distress syndrome (ARDS) - severe ALI
- Histologic manifestation: diffuse alveolar damage (DAD)
- Most common causes: sepsis, diffuse pulmonary infections, gastric aspiration, and mechanical trauma (head injuries)
- Pathogenesis:
- Endothelial activation and leukocyte adhesion
- Inflammation and tissue injury
- Pneumocyte necrosis and decreased surfactant production
- Diffusion defect and hypoxemia
Obstructive and Restrictive Lung Diseases
- Features:
- Obstructive: ↑ airway resistance due to obstruction, ↓ expansion of the lung parenchyma
- Restrictive: ↓ expansion of the lung parenchyma, ↓ TLC
- Examples:
- Obstructive: bronchial asthma, emphysema, chronic bronchitis, bronchiectasis
- Restrictive: pulmonary fibrosing diseases, chest wall disorders
- Lung Volumes:
- Obstructive: ↑ lung volumes, ↓ FEV1
- Restrictive: ↓ lung volumes, ↓ FVC
- FEV1/FVC:
- Obstructive: ↓
- Restrictive: ↓ (but not as low as obstructive)
This quiz covers diseases of the respiratory system, including atelectasis, pulmonary edema, and acute lung injury. It's designed for BSOT 1-1 students.
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