LIBRO + ANEXOS NEUMOLOGÍA PEDIÁTRICA

Neumología Pediátrica. Anexos ❚ 203 1. Know the histologic characteristics of the alveolar stage of lung development 2. Know the postconceptional time of the alveolar stage (i.e., 36 weeks postconception through early childhood) f. Cellular structure 1. Know which cellular characteristics of the airway vary with fetal lung development 2. Know which cellular characteristics of the airspace vary with fetal lung development 3. Know which cellular characteristics of the pulmonary vasculature vary with fetal lung development 2. Physiology/Pathophysiology a. Circulation 1. Know that the fetal pulmonary circulation receives only minimal amounts of the combined ventricular output (approximately 5% to 7%) 2. Know that the systemic circulation has a low resistance circulation due to the placental vascular bed 3. Understand the mechanisms that maintain a high pulmonary vascular resistance in utero b. Airway and alveolus 1. Understand the mechanisms of production and the unique composition of fetal lung liquid 2. Know that normal lung development is dependent upon normal secretion of lung liquid 3. Understand the developmental timing and regulation of surfactant synthesis 4. Know the factors that interfere with alveolar development (external and internal limitation of space, oligohydramnios, fetal breathing abnormalities, maternal smoking) 5. Understand the role of surfactant proteins in surfactant homeostasis 6. Know the genetic defects associated with congenital pulmonary alveolar proteinosis 7. Know that obstruction to outflow of fetal lung liquid (e.g., laryngeal atresia) results in pulmonary hyperplasia c. Fetal breathing 1. Recognize the pattern of fetal breathing 2. Know that fetal breathing pattern is influenced by sleep state 3. Know that fetal breathing influences lung development d. Regulation 1. Understand the influence of growth factors on lung development 2. Understand the effects of thyroid hormones on lung development 3. Understand the effects of corticosteroid hormones on lung development 4. Know that mesenchymal cells play a directive role in the development of epithelium through a paracrine/autocrine interaction with the epithelium B. Perinatal 1. Circulation a. Know the mechanical, chemical, and vasoactive signals involved in lowering pulmonary vascular resistance after birth