Pulmonary Sleep Disorders

Question 1

OHS is defined as ___.

Answer 1

Awake/daytime hypercapnia (PaCO2 > 45 mmHg) in an obese individual (BMI > 30kg/m.sq) that cannot be attributed to alternate causes of hypercapnia and hypoventilation.

Question 2

More than ___ percent of patients with OHS also have OSA;
hence classified as OHS with OSA.

Answer 2

> 90%

*remaining 10% are classified as OHS with sleep-related hypoventilation (witnessed apneas during sleep are uncommon).

Question 3

What are the m/m strategies for OHS?

Answer 3

1. Weight loss and NIPPV as below

OHS + OSA:
-CPAP –> BiPAP (if CPAP fails)

-OHS + hypoventilation:
-BiPAP

2. Bariatric surgery
3. Tracheostomy

Question 4

List some 2nd-gen non-sedating antihistaminics.

Answer 4

-Cetrizine
-Loratidine
-Fexofenadine

Question 5

Non-allergic rhinitis accounts for about __% of cases of rhinitis in adults.

Answer 5

~ 50%

Question 6

Non-allergic rhinitis can be caused by ____ (list all EP factors).

Answer 6

-Irritants: cigarette, pollutants, & chemicals (occupational)

-Vasomotor: ↑ nasal blood flow d/t temperature, dry air, irritant odors.

-Gustatory: spicy food

-Hormonal: pregnancy

-Drugs: Anti-HTN, NSAIDS, PDE5Is, Cocaine

-Senile: Atrophic rhinitis.

Question 7

Nasal polyps are often associated with ____ conditions/states.

Answer 7

-Aspirin allergy
-Sinus infections
-Asthma

Question 8

____ is the first-line imaging modality for a nasal polyp.

Answer 8

coronal CT scanning for nasal sinuses.

Question 9

____ corticosteroid (? oral, intra-nasal) is the most effective treatment for nasal polyps.

Answer 9

Oral CS.

Question 10

Other than oral > > Intranasal corticosteroids, what are other escalated t/t options for nasal polyps?

Answer 10

-LT antagonists (montelukast)
-IL inhibitors (Dupilumab)

-Surgical removal (severe, refractory cases).

Question 11

Anterior epistaxis accounts for about __ % of cases of epistaxis.

Answer 11

~ 90%

Question 12

Anterior epistaxis most often results from bleeding from the ___ plexus formed by anastomosis of ___, ___, and ___ vessels.

Answer 12

Kiesselbach plexus formed by

-Ant. Ethmoidal a. (septal branch)
-Sphenopalatine a. (lateral nasal br)
-Sup. labial br. of facial a. (septal br)

Question 13

Posterior epistaxis results most commonly from bleeding from ____ vessels.

Answer 13

-Sphenopalatine a. (PL branch)
-Carotid a (rare)

Question 14

_____ agents can be used in the initial conservative m/m of epistaxis.

Answer 14

Topical vasoconstrictor (e.g. oxymetazoline)
+
IN-local anesthetic (lidocaine)
+
pinch nostrils for 10-15 minutes.
+/- apply a cold compress.

Question 15

When is rhinoscopy or speculum examination indicated in a patient in the ER p/w epistaxis?

Answer 15

When initial conservative measures fail to control the bleeding.

Question 16

What are the subsequent t/t options for anterior epistaxis if the initial conservative measures fail to control the bleeding?

Answer 16

-Chemical (silver nitrate) or electrical cauterization.

-Nasal Packing (unilateral –> bilateral)

Question 17

What are the subsequent t/t options for posterior epistaxis if the initial conservative measures fail to control the bleeding?

Answer 17

1. Posterior packing with catheter
   -balloon > > Foley’s
2. consider hospitalization and ENT consult.

Question 18

Prolonged nasal packing of more than ___ hours is a/w risk of ____ complications (list all).

Answer 18

> 72 hrs

Complications:
-Necrosis
-TSS
-Infections (sinus, naso-lacrimal)
-Dislodgement

Question 19

Both adenoidectomy and tonsillectomy are indicated in children with ___.

Answer 19

Obstructive SDB (sleep-disordered breathing.

Question 20

Acute laryngitis is defined as ___.

Answer 20

< 3 weeks of hoarseness.

Question 21

Chronic laryngitis is defined as ___.

Answer 21

> 3 weeks of hoarseness.