OSA/PE/PNEUMONIA/OLD TB Flashcards
(61 cards)
OHS triad
Obesity/ restrictive defect on PFTs
Sleep disordered pattern breathing (OSA)
Daytime hypercapnia
What is another name for oHS
Pickwickian syndrome
What is the definition of OSA
Presence of an increased number of breathing cessations (Apnoeas) and/or reduction in tidal volume (hypopnoeas)
definition of apnoea
cessation of ventilation for > 10 seconds
systems you would examine in a patient with OSA
Obs: BP (Systemic HTN)
CVS: Cor pulmonale/ CCF
Resp: cor pulmonale, pulmonary HTN features
Mouth: enlarged tonsils/ micro or retrognathia
Increased neck circumference
OSA clinical signs
Obesity
Shallow breathing
Daytime somnolence
Facial plethora (secondary polycythaemia)
Central cyanosis
Snoring
Partner reports apnoeic episodes
Early morning headaches (hypercapnia)
Waking up several times at night
Peripheral oedema
Large collar size
HTN
ASK RE DRIVING’/ FALLIGN ASLEEP BEHIND THE WHEEL
Investigations
Obs: BP, Sao2
Bloods: FBC (polycythaemia), TFT
Morning ABG: Sao2 + PCO2
CXR
ECG +/- Echo
Overnight polysomnography = GOLD STANDARD
How is a diagnosis of OSA made from polysomnography?
Measure the respiratory disturbance index (RDI), measure of the apnoea: hypopnoea index - number of each event occurring per hour of actual sleep
What are the different types of OSA?
Central
Obstructive
Mixed
What is central OSA?
Cessation of ventilatory drive from the respiratory centres of the brain
No thoraco-abdominal movements detected
What is obstructive OSA?
Due to upper pharyngeal airway collapse
Thoraco-abdominal movements detected but no airflow at the mouth
How to tell between central and obstructive OSA?
In central, there are no thoraco-abdoinal movements detected but in obstructive there are however there is no airflow at the mouth
Things which exacerbate obstructive OSA
Adiposity
Micrognathia
ENlarged tonsils
Short neck
What causes the ‘obstruction’ in OSA?
Upper airway narrowing
Upper airway collapse
Examples of upper airway narrowing
Obesity
Tumours
Adenotonsillar hypertrophy (children)
Macroglossia (hypothyroidism, Down’s)
Retro/micrognathis
Mandibular hypertrophy (acromegaly)
Patient questionnaire for OSA
Epworth sleepiness scale
Treatment options for OSA and OHS
Conservative
Weight loss
Smoking cessation
Alcohol reduction
Medical
Manage CVS complications: hypertension, heart failure, pulm hTN
Nocturnal CPAP (1st line)
(BiPAP can be used in OHS where there is severe hypercapnia)
LTOT if chronic hypoxia
Oral appliances
Surgical
Uvulopalatopharyngoplasty
RFA of soft palate
Negative SE of CPAP
Dry mouth
Facial pain/discomfort
Mask leaks
Noise
OSA Complications
Cardiac arrhythmias
Pulmonary HTN
Polycythaemia
Hypertension
MI
Stroke
OHS
Increased mortality
Respiratory problems associated with obesity
OSA
OHS
Chronic hypoxia and hypercapnia and cyanosis
Pulmonary HTN and CCF
Risk factors for PE/DVT
Pregnancy (current or recent)
Malignancy
COCP
Smoking
Recent long haul travel/ immobility
Recent surgery
Previous VTE
FH VTE
Nephrotic syndrome
Systems to examine in a case of suspected PE
Resp (r/o pneumonia, pleural effusion etc)
Cardio (signs of R heart strain)
Legs for DVT
For lymphadenopathy/ organomegaly suggestive of malignancy
How would you investigate PE?
This is a medical emergency and i would initially ensure this patient is medically stabilised with an A-E assessment.
Obs - BP, HR, Sao2, RR
ECG - Right heart strain? S1Q3T3? Sinus tachycardia
CXR r/o ddx
Urine dip (protein and pregnancy test)
ABG
Calculate well’s score to assess the pre-test probability of PE
Bloods
FBC, UE, LFT, Coagulation, CRP, bone profile (malig), D-dimer (if low pre-test prob), troponin (may be +ve in PE)
Imaging
Leg USS
CTPA/VQ
Echo
In which patients may you choose a VQ scan over a CTPA?
Contrast allergy
V poor renal function
