(ANSWERS SHOWN AFTER EACH QUESTION)

Which syndrome is characterized by diffuse alveolar damage, pulmonary edema, and 

respiratory failure?

ARDS

What type of material is seen in the alveoli of a patient in the acute phase of ARDS?

hyaline membranes formed by a fibrinous exudate and necrotic cellular debris

What are some of the causes of ARDS?

shock of any etiology, fat embolism, gram-negative sepsis, severe bacteria/viral 

infections, near-drowning, aspiration of GI contents, acute pancreatitis, heroin 

overdose, oxygen toxicity, cytotoxic drugs

What is the most common cause of respiratory failure in the newborn and also of 

death in premature infants 28 weeks gestational age?

neonatal respiratory distress syndrome (hyaline membrane disease)

What is the typical clinical presentation of neonatal respiratory distress syndrome?

preterm infants with initially normal respirations followed by cyanosis, tachypnea, and 

signs of respiratory distress

What is the pathogenesis of tneonatal distress syndrome?

deficiency of pulmonary surfactant leading to increased surface tension

What is the predominant chemical in pulmonary surfactant?

dipalmitoyl phosphatidylcholine (lecithin)

What is the diagnostic test of choice to judge fetal lung maturity?

amniotic fluid lecithin: sphingomyelin ratio (a ratio of 2:! implies adequate surfactant 

is present)

what are the 3 strongest risk factors for neonatal respiratory distress syndrome?

1. prematurity

2. maternal diabetes

3. delivery by C section

What is the classic pathologic finding in the alveoli of an infant with neonatal 

respiratory distress syndrome?

intra-alveolar hyaline membranes

Infants surviving an initial bout of neonatal respiratory distress syndrome are at risk 

for which 5 complications?

1. bronchopulmonary dysplasia (resulting in part from oxygen therapy)

2. retinopathy of prematurity (resulting from oxygen therapy)

3. patent ductus arteriosus

4. intraventricular cerebral hemorrhage

5. necrotizing enterocolitis

What medications can you give to prevent neonatal respiratory distress syndrome?

glucocorticoids given to the mother can accelerate fetal lung maturation and reduce 

the risk of neonatal distress syndrome

What are the most common clinical presentations of PE?

tachycardia, tachypnea, dyspnea, pleuritic chest pain or hemoptysis

What is the etiology of 95% of pulmonary emboli?

dislodged DVT from deep veins of the thigh

what factors favor the development of DVT?

virchow's triad:

1. stasis

2. hypercoagulability

3. endothelial damage

how do you diagnose a PE radiographically?

V/Q scan or CT angiogram (1st line), pulmonary angiography (gold standard)

what type of tumors commonly cause a DVT by inducing hypercoagulable state?

adenocarcinomas

what is the most common genetic disease that predisposes to the development of DVT?

factor V Leiden

what type of embolism can develop uniquely in a peripartum woman?

amniotic fluid embolism

for what type of embolism is a patient with a long bone fracture at risk?

fat embolism from bone marrow, pulmonary thromboembolism due to trauma and 

stasis

what type of infarction results from a PE?

hemorrhagic infarction (appears as wedge-shaped opacity on CXR)

what therapy is indicated for high risk patients during the workup of PE and for 

patients diagnosed with PE?

full treatment doses of heparin (unfractionated or low molecular weight)

what is used for long term prophylaxis for patients at risk of developing DVT?

warfarin

what is an alternative to warfarin for outpatient DVT prophylaxis?

subcutaneous heparin (LMW or unfractionated)