Chapter 36-40

Question 1

Neonatal Grunting

Answer 1

Increases Functional Residual Capacity
Sound produced by glottis closing

Question 2

Exogenous surfactant

Answer 2

Improves compliance
Improves oxygenation + ventilation
Maintains residual lung volume
Reduces critical closing volume

Question 3

RDS incidence

Answer 3

<28 weeks = 60-80%
32-26 weeks = 30%

Question 4

RDS main cause

Answer 4

Deficiency of surfactant in immature lung

Question 5

Critical closing volume

Answer 5

point at which airways collapse

Question 6

Surfactant production

Answer 6

26-36 weeks

Question 7

Alveoli growth maximal

Answer 7

32-termt

Question 8

Type 1 pneumocytes

Answer 8

Essential for gas exchange

Question 9

Type 2 pneumocytes

Answer 9

Surfactant

Question 10

Proteins A & D

Answer 10

Immunity
Hydrophilic

Question 11

Proteins B & C

Answer 11

Functional of surfactant
Hydrophobic

Question 12

Surfactant packaged

Answer 12

In Lamellar bodies
Unfold into complex lining of airspace

Question 13

When review ventilation

Answer 13

Problem with Co2 clearance?
Problem with oxygenation?
Or both?

Question 14

Oxygenation

Answer 14

Use paO2 as well as sats

Determined by Mean Airway Pressure (MAP)

Question 15

CO2 CLearance

Answer 15

Determined by Minute ventilation

Question 16

Calculating minute ventilation

Answer 16

Tidal volume x Respiratory rate

Question 17

Increasing MAP/ oxygenation

Answer 17

Increase PEEP
Increase PIP
Increase Inspiratory time
Increase rate

Question 18

Increasing Co2 Clearance

Answer 18

Increase Rate
Increase Tidal Volume

If on pressure control:
Increase PIP
Increase I time.
Decrease PEEP

Question 19

Tidal volume (ml/kg)

Answer 19

5ml/kg aim

Question 20

Too high PEEP?

Answer 20

Overdistended Alveoli
Barotrauma
Impedance of alveolar capillary blood flow

Question 21

Sodium in first 24 hrs

Answer 21

Affected by maternal sodium balance

Hyponatraemia common following excessive fluid resus/ iatrogenic

Tell Obstetrics team if very low

Question 22

Postnatal diuresis

Answer 22

2-3 days post delivery
10-15% weight loss

Question 23

Dilutional hyponatreamia

Answer 23

Can occur in RDS (normal diuresis delayed)
Reduce volume rather than add sodium

Question 24

Neonatal SIADH

Answer 24

Following perinatal asphyxia

Question 25

Extremely premature infants (<28weeks) sodium loss

Answer 25

Very large renal losses causing hyponatraemia Distal tubule cant keep up

Question 26

Starting additional sodium

Answer 26

Not until 24-48 hrs Ideally after some weight loss noted

Question 27

Exogenous excess fluid during resus

Answer 27

In normal kidney state, will have large diuresis, and may 'overshoot' High urine OP hyponatraemia, early.

Question 28

SIADH

Answer 28

Fluid overloaded Excess of anti diuretic hormone Low serum sodium Low urine output Urine sodium high Fluid restriction

Question 29

ADH

Answer 29

9 amino acid hormone Secreted from posterior pituitary AKA Vasopressin Acts on collecting ducts - reabsorb water.

Question 30

Anterior pituiatry | FLAT PIG

Answer 30

FSH LH ACTH TSH Prolactin GH

Question 31

Posterior pituitary

Answer 31

ADH Oxytocin

Question 32

Dehydration

Answer 32

Low serum sodium Low urine output Low urine sodium Careful rehydration with normal saline

Question 33

Central Diabetes Insipidus

Answer 33

Opposite of SIADH Not enough ADH Direct dysfunction of posterior pituitary Usually from severe head injury Hypernatraemia High urine output Low urine sodium/ osmolality Treatment with Desmopressin (synthetic ADH)

Question 34

Cerebral Salt Wasting

Answer 34

Head injury causing dehydration Excess sodium lost at kidneys High urine sodium Very high urine osmolality High urine output Low serum sodium Treat with fluid replacement and replace sodium

Question 35

Bowman's Capsule

Answer 35

Ultrafiltration High pressure pushes small molecules through glomerular capillary wall Large, negatively charged ions e.g. proteins, blood, platelets, repelled by negative charge.

Question 36

Proximal convoluted tubule | Sodium

Answer 36

2/3 sodium reabsorped here by Na+/K+ ATPase pump. Glucose, phosphate, bicarb IN Toxins OUT

Question 37

Loop of Henle

Answer 37

Sodium reabsorbed by Na+K+2Cl- co transporter

Question 38

Distal convoluted tubule

Answer 38

Filtrate is hypotonic Impermeable to water Sodium- hydrogen and sodium- potassium pumps controlled by aldosterone

Question 39

Collecting duct

Answer 39

passive diffusion urine concentration determined by ADH Acts on aquaporin-2 channel

Question 40

Reduced renal perfusion + Low sodium in DCT =

Answer 40

Renin release

Question 41

Aldosterone

Answer 41

Acts in DCT and collecting ducts Promote sodium and water reabsorption in exchange for hydrogen and potassium

Question 42

Loops diuretics

Answer 42

Furosemide Loop of Henle Block Na-K-Cl cotransporter Hypokalaemia, hyponatraemia, hypochloraemia metabolic acidosis

Question 43

Thiazide diuretics

Answer 43

Act in DCT Inhibit sodium chloride reabsoprtion

Question 44

Aldosterone antagonists

Answer 44

Spironolactone DCT and collecting ducts Block action of aldosterone. Sodium and water excretion increased. Potassium and hydrogen sparing

Question 45

Osmotic diuretics

Answer 45

Mannitol Altering osmotic pressure in renal tubule Excretion of all electrolytes increased. Freely filtered at Bownan's capsule.