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Block 2 > Clin Med: Pulm I > Flashcards

Clin Med: Pulm I Flashcards

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1
Q

What kind of disorder is asthma?

A

chronic inflammatory airway disorder w/ obstruction

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2
Q

What can predispose you to asthma? (endogenous)

A
  • genetic predisposition
  • atopy
  • airway hyperresponsiveness
  • gender
  • ethnicity
  • obesity
  • early viral infx
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3
Q

What can predispose you to asthma? (environmental)

A
  • indoor & outdoor allergens
  • occupational sensitizers
  • passive smoking
  • respiratory infxs
  • air pollution
  • diet
  • dampness & mold exposure
  • acetaminophen
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4
Q

Asthma triggers

A
  • allergens
  • viral URI
  • exercise & hyperventilation
  • cold air
  • sulfur dioxide & irritant gases
  • drugs (B-blockers, aspirin)
  • stress
  • irritants
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5
Q
A
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6
Q

Asthma pathophysiology

A

1) trigger
2) airway inflammation
3) combo: hypersecretion of mucus, airway muscle constriction, swelling bronchial membranes
4) narrow breathing passages
— small & large airways
5) wheezing, cough, SOB, tightness in chest

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7
Q

Asthma: History

A
  • recurrent wheezing
  • difficulty breathing
  • chest tightness
  • cough
  • can be WORSE AT NIGHT
  • family history of asthma, allergy, atopy
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8
Q

It is unlikely asthma if

A
  • lack of improvement after Tx w/ bronchodilator
  • onset after 50
  • Hx of >20 pack year history smoking
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9
Q

Asthma: clinical findings

A
  • EXPIRATORY wheezing
  • multiple pitches starting & stopping in the resp cycle
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10
Q

Asthma: clinical finding if severe airflow obstruction

A
  • tachypnea
  • tachycardia
  • decreased 02 saturation
  • accessory muscle usage
  • tripod position
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11
Q

Asthma: signs of atopy

A
  • cobblestone appearance of pharynx (allergic rhinitis)
  • nasal polyps
  • atopic derm
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12
Q

Which cell has an excessive reaction during asthma

A

TH2 cells (involved in atopic triad)

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13
Q

What does IL-4 do?

A
  • activated IgE antibodies
  • they bind to mast cells & release histamines, leukotrienes, & prostaglandins
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14
Q

What does IL-5 do?

A
  • activates eosinophils
  • stimulates release of cytokines & leukotrienes
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15
Q

With obstructive disorders, patients cannot fully ___.

A

exhale

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16
Q

With restrictive disorders, patients cannot fully ___.

A

inhale

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17
Q

Test to run when there is clinical suspicion of asthma.

A
  • PFT or chest x-ray
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18
Q

Pulmonary Function testing involves___

A
  • spirometry measuring FEV1 & FVC
  • bronchodilator response
  • Bronchoprovocation testing
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19
Q

What is spirometry measuring

A

how much air is being exhaled at any time

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19
Q
A
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20
Q

Chest x-ray involves___

A
  • done if Dx is unclear
  • CXR almost always normal in asthma
  • Helpful if Pt. has fever, chronic purulent sputum, hemoptysis, weight loss (rules things in/out)
  • Possible CT if CXR abnormal
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21
Q

Review: FEV1 & FVC

A
  • forced expiratory volume in 1 sec
  • forced vital capacity (total exhaled air)
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22
Q

Describe Asthma: intermittent

A
  • symptoms </= 2x a week
  • night symptoms </= 2x monthly
  • rescue meds </= 2days/week
  • asymptomatic b/t flares
  • FEV1 > 80% of predicted
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23
Q

Describe asthma: mild persistent

A
  • symptoms > 2x a week but not daily
  • night symptoms 3-4x monthly
  • rescue meds > 2 days/wk but not > 1x/day
  • minor limitations b/t flares
  • FEV1 > 80% predicted
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24
Describe asthma: moderate persistent
- symptoms are daily - night symptoms > 1x a week, but not nightly - rescue meds daily - some limitation b/t flares - FEV1 > 60% predicted
25
Describe asthma: severe persistent
- symptoms throughout the day - night symptoms several times per day - rescue meds several times/day - extremely limitations - FEV1 < 60% predicted
26
GINA cycle of asthma care - 3 steps
1. Assess: dx, inhaler comprehension, Pt. preferences, symptom control 2. Tx: meds, non pharm strategies, Treat modifiable risk factors 3. Review: symptoms exacerbations, SEs of meds, lung function, Pt. satisfaction
27
What are the two goals of asthma care?
- decrease impairment - decrease risk of severe attack
28
Non-pharm Tx for asthma
- encourage exercise - stop smoking - Pt. edu - control triggers
29
What are the starting points for treatment in asthma: stages and which severity stage
Stage 1: mild intermittent Stage 2: mild persistent Stage 3: moderate persistent Stage 4: severe persistent
30
Asthma: stage 1 Tx
- mild intermittent - low dose ICS - formoterol OR low dose ICS -control & rescue are the same b/c this is the mild intermittent asthma
31
Asthma: stage 2 Tx
- mild persistent - Con: low dose inhaled corticosteroid (ICS) - Res: ICS - formoterol
32
Asthma: stage 3 Tx
- moderate persistent - Con: low dose ICS-LABA - Res: ICS formoterol or SABA
33
Asthma: stage 4 Tx
- severe persistent - Con: medium dose ICS-LABA - Res: ICS - formoterol or SABA
34
Asthma: stage 5 Tx
- Con: high dose ICS-LABA - Res: ICS-formoterol or SABA
35
Asthma is being controlled if...
- daytime symptoms None (
36
Asthma is partially controlled if...
- daytime symptoms >/= 2/week - any limits to activities - any night awakenings - rescue meds >2x/wk - < 80% predicted
37
Asthma: w/ kids, what is the preferred method of rescue?
SABA (albuterol)
38
Say you are in a primary care office and a patient comes in with the following symptoms, what would your treatment be? broken sentences, not agitated, inc RR, HR 100-120, no acc. m. use, RA = 90-95%
- mild/moderate asthma - SABA via MDI or neb prednisolone: oral or IV O2 if needed - reassess at 1 hour: if improved discharge with at home instructions
39
Say you are in a primary care office and a patient comes in with the following symptoms, what would your treatment be? speaking in words, tripoding, rr>30, acc. m. use, HR= > 120
-severe asthma - call 911 - SABA - ipratropium - O2 - prednisolone
40
Asthma: mild (dyspnea w/ activity) Exacerbations Tx
- SABA (inhaled or nebulizer) - short course oral corticosteroids
41
Asthma: moderate (dyspnea interferes w/ activity--> symptoms improve in 1-2 days) exacerbations Tx
- SABA (may add ipratropium) - Oral corticosteroids
42
Asthma: severe (dyspnea at rest) last longer than 3 days exacerbations Tx
- req hospitalization - SABA/ipratropium hourly or continuously - oral corticosteroids - adjunctive tx (02 therapy, IV MgSO4, intubation/mechanical ventilation)
43
When do you refer a patient w/ asthma to a specialist?
- S/S are atypical - Difficulty achieving or maintaining control of asthma - Persistent asthma requiring step 4 care or higher
44
Asthma: Pt. Edu
- smoking cessation - avoid triggers - pneumococcal/flu vaccine recommended - caution w/ NSAIDS/ASA (esp. aspirin) - asthma diary - properly use inhalers - clear asthma tx plan w/ an emergency care plan in place
45
Risk of asthma related death increased if ___
- previous severe exacerbation - 2 or more hospitalization in the past year - 3 or more ED visits in the past year - 2 or more canisters of SABA per month - low socioeconomic status or inner-city resident
46
COPD is characterized by
persistent respiratory symptoms & airflow limitation that is not fully revisible
47
COPD includes what 3 conditions? (that occur together)
- chronic bronchitis - emphysema - small airway disease
48
Chronic bronchitis clinical dx is defined by___
excessive secretion of mucous & daily cough for 3 months or more in 2 consecutive year
49
Emphysema is a pathologic dx with ___
abnormal enlargement of air spaces distal to the terminal bronchiole, w/ destruction of alveolar walls (Look at lung tissue itself. can be seen on CT)
50
Risk factors for COPD
- cigarette smoking - occupational exposures - ambient air pollution - 2nd hand smoke - genetic (alpha 1 antitrypsin deficiency)
51
Chronic bronchitis large airways pathophys
oxidants from cigarette smoke cause mucous gland hyperplasia --> increased mucous production--> chronic cough
52
chronic bronchitis small airways pathophys
edema/increases mucous production/fibrosis--> airway narrowing/airway resistance
53
Chronic bronchitis alveoli pathophys
- macrophages release enzymes that digest alveolar walls--> decreases area for gas exchange--> damage to capillaries - damage to elastin fibers causes airway collapse
54
Emphysema pathophys
- structural changes in alveoli - inflammatory reaction in the alveoli attract immune cells, release chemicals/enzymes--> breaks down collagen & elastin - airways collapse during exhalation, causing air trapping - alveoli eventually coalesce into large air filled spaces (reduced surface area for gas exchange)
55
Chronic bronchitis: pink puffer s/s
-CO2 retention* -min cyanosis* -pursed lip breathing* -dyspnea -hyperressonance -barrel chest* -prolonged expiration -anxious -accessory muscle use -thin
56
Chronic bronchitis: blue bloater s/s
-airway flow problem -cyanotic -recurrent cough and sputum -hypoxia -hypercapnia -resp. acidosis -inc Hgb -digital clubbing -enlarged heart -accessory m use -right side heart failure: bilateral pedal edema, JVD
57
Age when COPD presents...
40-50 years old
58
COPD Hx symptoms that may be present for months-years...
- cough - sputum production - exertional dyspnea - physical activity changes? - smoking?
59
Symptoms in Hx for advanced COPD
- hypoxemia - pneumonia - pulmonary HTN - Cor pulmonale - Respiratory failure
60
PE findings in early stages of COPD
usually normal exam
61
PE findings in later stages of COPD
- prolonged expiratory phase - expiratory wheezing - signs of hyperinflation - accessory muscle use/ cyanosis in acute exacerbation
62
PE findings in advanced COPD
cachexia (very poor Px factor)
63
PE findings in acute exacerbation of COPD
- wheezing, tachypnea, decreased mental status
64
Most acute exacerbations of COPD are triggered by___
resp infx
65
Dx testing for COPD
- PFT - Chest x-ray - CT
66
Dx results of PFT for COPD
reduction in FEV1 & FEV1/FVC
67
Dx results for chest x-ray in COPD
normal or show hyperinflation w/ emphysema
68
Why run a CT in pt. with COPD
more sensitive/specific for dx of emphysema
69
What is used to assess the severity of COPD
"CAT" score
70
Describe the "CAT" score
used to assess progression, decline in functional status, & gauge effectiveness of pulm rehab
71
COPDL: initial Tx is based on
GOLD classification: this is the CAT score + number of exacerbations
72
COPD: what is the Tx for a pt. w/ a CAT <10 & >2 moderate exacerbations w/ 1 leading to hospitalizations?
LAMA Group C
73
COPD: what is the tx for a pt w/ a CAT <10 & 1 or 2 exacerbations w/o hospitalization?
bronchodilator Group A
74
COPD: what is the Tx for a pt. w/ a CAT of 10 or more & >2 exacerbations w/ a hospitalization?
LAMA + LABA or ICS + LABA Group D
75
COPD: what is the Tx for a pt. w/ a CAT of 10 or more & 0-1 exacerbations leading to no hospitalizations?
LABA or LAMA Group B
76
Describe the group categories for COPD.
- Group A: less symp, low risk - Group B: more symp, low risk - Group C: less symp, high risk - Group D: more symp, high risk
77
Describe COPD: Group A
less symp, low risk
78
Describe COPD: Group B
more symp, low risk
79
Describe COPD: Group C
less symp, high risk
80
Describe COPD: Group D
more symp, high risk
81
COPD: medications for acute exacerbations
- albuterol (SABA) (inhale or neb) - ipratropium (anticholinergic) - prednisone (oral glucocorticoids) - Abx (mod or severely ill patients) - O2, bipap, intubation if needed
82
COPD: Abx that can be used to treat acute exacerbations
- levofloxacin - moxifloxacin - doxycycline
83
COPD: Pt. Edu
- smoking cessation - get flu & pneumococcal vaccine - careful exercise programs
84
Make a COPD referral if...
- onset before 40yo - 2+ exacerbations/year - severe or rapid progression - need for long term O2 therapy
85
Make a COPD admission to hospital if...
- failing to respond to outpatient tx - worsening hypoxemia, peripheral edema - can't maintain nutrition/hydration due to symptoms
86
With COPD, what is alpha 1 antitrypsin (A1AT)deficiency?
an autosomal dominant genetic disorder that leads to an overproduction of elastace
87
COPD: What is elastace?
an enzyme that breaks down elastin in the lungs & liver
88
When to suspect A1AT deficiency in a Pt?
develop COPD earlier than age 40
89
COPD: Dx test for A1AT deficiency
- serum level of A1AT - genetic testing
90
COPD: Tx for A1AT deficiency
- COPD Tx + infusions of A1AT - Lung transplant
91
Bronchiectasis is a disease of what?
- bronchi & bronchioles - permanent dilation & destruction of bronchial walls
92
Bronchiectasis: focal development
obstruction (aspirated foreign body, mass)
93
Bronchiectasis: diffuse development
infection immunodeficiency (AIDs) genetic autoimmune recurrent aspiration idiopathic (most common)
94
Bronchiectasis: infectious pathophysiology
poor mucociliary clearance results in microbial colonization
95
Bronchiectasis: non infections pathophysiology
immune mediated reactions that damage the bronchial wall
96
Bronchiectasis: biggest pathophys concern
IMPAIRED SECRETION CLEARANCE
97
Bronchiectasis: History
persistent productive cough w/ ongoing production of thick sputum
98
Bronchiectasis: Physical
- crackles & wheezing on lung auscultation - In later stages, may have clubbing of digits
99
Bronchiectasis: Dx labs/imaging
- CXR: "tram tracks"--> lacks sensitivity - Chest CT: "tram tracks" or "signet ring" appearance--> more more sensitive & specific
100
Bronchiectasis: treatment
-treat underlying disease -hospitalization if tachy, hypotensive, fever, hypoxemia, failure to improve with abx -mucolytic agents/airway hydration -bronchodilators, oral/inhaled glucocorticoids
101
Bronchiectasis: acute exacerbation Tx
(based on culture results) fluoroquinolone empirically (levofloxacin, moxifloxacin)
102
CF: genetic factor
autosomal recessive exocrinopathy
103
CF is a ___, ___, & ___ disease
respiratory, pancreatic, hepatobiliary
104
CF: which gene regulates chloride
CFTR
105
CF: pathophys
CFTR gene is affected--> Cl- channels don't function right--> abnormal transport of Cl- & NA+ across epithelium--> results in abnormal secretions in the lungs & GI tract
106
CF: clinical findings
- resp findings: productive cough, very thick sputum, wheezing, recurrent pneumonia, exercise intolerance, dyspnea - chronic airway infx begin in infants leading to bronchiectasis - severe sinus disease
107
CF: What is the cause of chronic airway infx?
- S. aureus - pseudomonas - h. influenzae
108
CF: acute exacerbations hx/PE
increased cough, sputum production
109
CF: Dx - labs/imaging
- ** Elevated sweat chloride (>60mmol/L) - genetic testing: presence of 2 dz causing mutations - abnormal nasal potential difference if other results are inconclusive
110
CF: Tx for airway clearance
- inhaled tx (albuterol, hypertonic saline, Dnase) - Chest PT - Exercise
111
CF: prevention of infx tx
- seasonal flu vaccine - pneumococcal vaccine
112
Influenza A & B cause seasonal epidemics during what time of the year?
October to May
113
Flu: Pathophys has what two types of glycoproteins in the outer membrane?
- Hemagglutinin - Neuraminidase
114
Flu viruses are exceptionally good at:
- Antigenic drift: mutations during replication that occur in HA & NA - Antigenic shift: complete change in HA, NA, or both
115
How is the flu spread?
via air droplets or contaminated hands
116
The flu virus ____ viscosity of ___, promoting _____.
lowers; mucous, spread of the virus
117
Flu: incubation time & viral shedding time
Incubation: 1-4 days Viral shedding: from one day prior to sx to day 5
118
Flu: History/Physical
- Sudden onset fever, chills, fatigue, myalgia, malaise - appears ill w/ sweating, coughing, diffuse pharyngeal erythema - lung exam w/ scattered rales, rhonchi, wheezes - may have muscle pain elicited w/ pressure
119
Flu: Dx - Labs/Imaging
- largely based on clinical findings - nasal swab for rapid test - nasal swab for PCR
120
Flu: tx
oral oseltamivir
121
Who should get vaccinated for the flu?
Everyone
122
How is pertussis spread
- aka whopping cough - caused by Bordetella pertussis - Lasts 6 wks - vaccine preventable, immunity decreases overtime
123
How is pertussis spread?
via respiratory droplets
124
Pertussis: pathophys
bacteria attach to ciliated cells & causes destruction of the cilia leads to cough & inability to clear secretions PT: pertussis toxin TCT: tracheal cytotoxin LPS: lipopolysaccharides
125
Pertussis Stage 1: catarrhal stage length
1-2 weeks
126
Pertussis Stage 1: catarrhal stage symptoms
runny nose, low-grade fever, mild, occasional cough Highly contagious
127
Pertussis Stage 2: Paroxysmal stage length
1-6 weeks, may go up to 10
128
Pertussis Stage 2: Paroxysmal stage symptoms
numerous fits, rapid coughs w/ whoop sound; vomiting & exhaustions after coughing
129
Pertussis Stage 3: Convalescent stage length
2-3 weeks
130
Pertussis Stage 3: Convalescent Stage symptoms
recovery is gradual, cough lessens, but fits may return
131
Pertussis Dx - labs/imaging
- nasopharyngeal swab or nasopharyngeal aspirate (PCR) or culture - serologic testing
132
Pertussis Tx: within 3 wks of onset
- Azithromycin, Clarithromycin - eradicates bacteria , helps to prevent spread
133
Pertussis Tx: after 3 wks:
- no tx needed - cough is related to tissue damage
134
Pertussis: Tx for cough
dextromethorphan (DM)
135
Pertussis: post exposure prophylaxis Tx
- household contacts, regardless of vaccination history - same medication as tx (azithromycin, clarthromycin)
136
Pertussis: vaccine recommendations for infants & children
- 5 doses DTaP 2mo, 4mo, 6mo, 15mo, 18mo, & 4-6 yo
137
Pertussis: vaccine recommendations for adolescents
single dose of Tdap, 11-12 yo
138
Pertussis: vaccine recommendations for pregnant women
single dose of Tdap during, 27-36 wks
139
Pneumonias is what type of dz?
infx of the lung paranchyma
140
Pneumonias classifications
Infecting organism - bacteria, viral, fungal Community acquired vs healthcare/hospital acquired
141
Lung parenchyma defintion
the portion of the lung involved in gas transfer the alveoli, alveolar ducts, & respiratory bronchioles
142
Organisms that cause typical pneumonia.
S. pneumoniae, H. influenzae, S. aureus, Group A strep, Moraxella catarrhalis, anaerobes, & aerobic gram (-) bacteria
143
Organisms that causes atypical pneumonia
Legionella spp, M. pneumoniae, C. pneumoniae, & Chlamydia psittaci
144
Pneumonia: pathophys
infection of lung--> inflammatory response--> alveolar edema + exudate formation--> Alveoli & resp bronchioles fill w/ serous exudate, blood cells, fibrin, bacteria--> consolidation of lung tissues
145
Pneumonia: How is the sterile lower respiratory tract exposed to pathogens?
- aspiration - inhalation of infective resp droplet or aerosols
146
Pneumonia: What should you ask pt. about?
- occupation - animal exposure - travel history - tobacco & alcohol - immune suppressive drugs (steroids & biologics) - malignancy - chronic lung disease
147
Pneumonia: symptoms
- acute or subacute onset of fever, cough, w/ or w/o sputum, & dyspnea - rigors, sweats, chills, pleurisy, chest discomfort, & hemoptysis - fatigue, anorexia, HA, myalgias , & abdom pain
148
Pneumonia: physical findings
- fever or hypothermia - tachypnea - tachycardia - arterial O2 desaturation - altered breath sounds or rales - dullness to percussion may be found in lobar consolidation
149
Pneumonia: Dx - labs/imaging for all patients & what will it show?
chest x-ray( will show infiltrate)
150
Pneumonia: Dx - labs/imaging for admitted patients
- CBC - chemistries - arterial blood gases - sputum/blood cultures - UA assay for legionella & strep pneumo
151
Pneumonia: Treatment Protocol
Slide 96 & 97 notes
152
Pneumonia: Pt. Edu
Prevention: - Pneumococcal vaccine -->PCV13 for children 2-59 mo --> PPSV23 for all 65+ Quit smoking, early mobilization, flu vaccine
153
Pneumonia: When to admit?
based on age, comorbidities, altered mental status, vital signs
154
Pneumonia: complications
- effusion - empyema - sepsis - HF - increase risk of PE
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Hyaline membrane disease key factors
- aka respiratory distress of the newborn - pulmonary insufficiency in neonates due to surfactant deficiency & structural immaturity of the lung - most common in infants <28 weeks gestation, males, mothers w/ DM
504
Hyaline membrane disease clinical findings/history
consider RDS in any neonate with early respiratory distress symptoms, especially in premature neonates, including - retractions - tachypnea - nasal flaring - stridor - cyanosis - grunting
505
Hyaline Membrane Dx: labs & imaging
chest x-ray -- ground glass appearance evidence of oxygen requirement
506
Hyaline Membrane disease Tx
Delivery room stabilization: - oxygen - positive end airway pressure (PEEP) Surfactant (instilled in the trachea or via endotracheal tube)
507
How can PEs be classified
- gross appearance (blood, serous, pus) - underlying process (infectious, malignant) - characteristics of the fluid (transudative or exudative)
508
Describe transudative pleural effusion
- too much fluid leaves capillaries b/c either increased hydrostatic pressure or decreased oncotic pressure in BVs
509
Example of where hydrostatic pressure creates transudative PE
HF causes blood to back up into the pulm vessels--> increased pressure--> fluid leaves capillaries & goes into pleural space
510
Example of where oncotic pressure creates transudative PE.
cirrhosis--> liver makes less albumin--> decreased oncotic pressure in the BVs--> fluid moves into the pleural space
511
Describe exudative pleural effusion
- inflammation of the pulmonary capillaries makes them "leaky" allowing protein, immune cells, large proteins to leak out of the capillaries - could be due to infx, inflammation, malignancy
512
General Pleural effusion pathophysiology
accumulation of fluid within the pleural space
513
Examples of pleural effusion transudative
CHF, cirrhosis, nephrotic syndrome, PE, hypoalbuminemia
514
Examples of pleural effusion exudative
- e.g. pneumonia, cancer, TB, viral infection, PE, autoimmune
515
Pleural effusion: clinical findings - History/Physical
- Hx & symptoms depend on etiology - Pts will complain of dyspnea, cough, pleuritic chest pain - Ask about: --> Dyspnea on exertion (CHF) --> Sharp chest pain (pericarditis) --> Abdominal pain (pancreatitis) --> Hemoptysis (malignancy, PE, TB) - chest exam finding may include --> dullness to percussion --> decreased or absent tactile fremitus --> decreased breath sounds - other exam finding pertinent to underlying cause
516
Pleural effusion Dx: labs & imaging
- chest x-ray - thoracentesis w/ US guidance - pleural effusion evaluation
517
What's included in a Dx pleural effusion evaluation?
- gross appearance - RBC - WBC - Protein - LDH - Glucose - Cytology for malignancy - Culture
518
Pleural effusion: transudates appearance
clear, straw colored
519
Pleural effusion: transudates protein
< 3g/100mL
520
Pleural effusion: transudates pH
>7.2
521
Pleural effusion: transudates glucose
> 40 mg/dL
522
Pleural effusion: transudates LDH
Low, < 200IU/L
523
Pleural effusion: transudates number of cells
< 1000/mm3
524
Pleural effusion: exudates appearance
cloudy, purulent, opalescent
525
Pleural effusion: exudates protein
> 3g/100mL
526
Pleural effusion: Exudates pH
< 7.2
527
Pleural effusion: Exudates glucose
<40 mg/dL
528
Pleural effusion: Exudates LDH
high, >200 IU/L
529
Pleural effusion: Exudates number of cells
> 1000/mm3
530
Pleural effusion: Tx
- treat underlying disease - thoracentesis can be diagnostic & therapeutic
531
What is a potential complication of thoracentesis?
532
Obstructive Sleep Apnea: Overview
sleep disorder causing repetitive complete (apnea) or partial (hypopnea) upper airway obstruction during sleep, w/ recurrent arousals & sleep fragmentation
533
Describe excessive daytime sleepiness associated w/ obstructive sleep apnea
- drowsiness - decreased concentration & memory
534
Obstructive Sleep Apnea: Epidemiology/ Etiology
high-risk patients include those w/: - obesity - HF - Afib - HTN - Type II DM - Stroke - Pulm HTN
535
Obstructive Sleep Apnea: pathophysiology
536
Obstructive Sleep Apnea: History clinical findings
- sleep problems - excessive daytime sleepiness - morning headaches - nocturia - motor vehicle accidents
537
Describe sleep problems associated w/ obstructive sleep apnea.
- restless non refreshing sleep - snoring - awakenings (w/ gasping or paroxysmal nocturnal dyspnea) - witnessed apneas - sleep fragmentation
538
Obstructive Sleep Apnea: Physical clinical findings
- evaluate for obesity - evaluate for oropharyngeal anatomy associated w/ OSA
539
Obstructive Sleep Apnea Dx: labs/imaging
Lab polysomnogram; it measures: - respiratory effort - oxygen saturation - EKG, EEG, EOG, chin EMG - body position - anterior tibialis EMG
540
Tx: Gen considerations for Obstructive Sleep Apnea
- lifestyle modifications - weight reduction - positional therapy to keep patient in nonsupine position - oropharyngeal exercises may help snoring - continuous positive airway pressure (CPAP)
541
Obstructive Sleep Apnea Pt. Edu
- weight loss, ideally to BMI < or equal to 25 kg/m2 - exercise - positional therapy - avoidance of alcohol & sedatives before bedtime

Block 2 (13 decks)

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