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Flashcards in Week 207 - OSA and Chest Wall Deck (30):
1

Week 207 - OSA and Chest Wall: Where does control of the respiratory rhythm come from?

Medulla Oblongata
- Ventral respiratory group (mostly expiratory firing)
- Dorsal respiratory group (mostly inspiratory firing)

2

Week 207 - OSA and Chest Wall: What is the group pacemaker hypothesis?

• Membrane properties of individual neurones and connections between neurones, generate rhythmic bursts of firing.

3

Week 207 - OSA and Chest Wall: What is the role o the pontine respiratory group?

Fine tunes the respiratory rhythm.

4

Week 207 - OSA and Chest Wall: What are the four airway and lung reflexes that fine tune respiration?

• Nose + upper airways; irritant receptors > Vagus nerve.
• Stretch receptors > Vagus nerve.
• Irritant receptors > Vagus nerve > Bronchoconstriction.
• J receptors in alveoli - Engorged capillaries / interstitial fluid > Vagus nerve > Dyspnoea.

5

Week 207 - OSA and Chest Wall: What is the main chemical stimulus for breathing when PaO2 and PaCO2 are normal?

Co2

6

Week 207 - OSA and Chest Wall: In what situation can O2 directly stimulate breathing?

At low levels of PO2.

7

Week 207 - OSA and Chest Wall: What is the name of scoring system for assessment of sleep apnoea?

Epworth sleepiness scale.

8

Week 207 - OSA and Chest Wall: What are the ABG results for a person in Type I respiratory failure?

PO2 : Low
PCO2 : Normal (or low)
pH : Normal (or alkalosis)
HCO3 : Normal (or low)

9

Week 207 - OSA and Chest Wall: What are the ABG results for a person in Type 2 respiratory failure?

PO2 : Low
PCO2 : High
pH : Acidosis (or normal)
HCO3 : High (or normal)

10

Week 207 - OSA and Chest Wall: What is the FEV1, FVC and FEV1:FVC in a restrictive lung disease?

• FEV1 and FVC are both reduced since there is a reduced volume.
• The ratio will therefore be normal (or may increase since FVC is reached quickly).

11

Week 207 - OSA and Chest Wall: What are the three types of Acid Maltase deficiency?

• It is an autosomal recessive disease.
• Defect of lysosomal enzyme.
• Causes painless, slow, progress proximal muscle myopathy. (Diaphragm involvement is common, presents with respiratory failure)

12

Week 207 - OSA and Chest Wall: What are the three types of Acid Maltase deficiency? Describe each briefly.

• Infantile - Organomegaly, skeletal muscle involvement, CVS, Resp. failure and usually death <2years.
• Juvenile - limited survival.
• Adult - Best prognosis.

13

Week 207 - OSA and Chest Wall: What is the definition of obstructive sleep apnoea?

Stopping (or slowing) of breathing during sleep due to obstruction of the upper airway.

14

Week 207 - OSA and Chest Wall: What is the incidence of OSA?

2-5% men and 1-2% of women have OSA worthy of treating.

15

Week 207 - OSA and Chest Wall: What is the aetiology of OSA?

• Pharyngeal incompetence brought on by sleep.
• Periods of arousal from sleep to clear airway.
• Markedly fragmented sleep.
• Daytime consequences (Sleepiness)

16

Week 207 - OSA and Chest Wall: What are the risk factors for developing OSA?

• Obesity
• Lower facial shape.
• Tonsils, Hypothyroid, smoking, acromegaly, nasal problems, alcohol, sedatives, menopause, neuromuscular diseases/stroke.

17

Week 207 - OSA and Chest Wall: What is the distribution of male:female in OSA?

M:F, 4:1 > 10:1

18

Week 207 - OSA and Chest Wall: What is the age distribution of OSA?

• Can occur at any age, but increases with age and the peak presentation is 40-60 years.

19

Week 207 - OSA and Chest Wall: What are the daytime symptoms of OSA?

• SLEEPINESS
• Dry mouth
• Morning Headaches
• Poor concentration
• Irritability
• Anxiety/depression
• Loss of libido

20

Week 207 - OSA and Chest Wall: What are the night time symptoms of OSA?

• Snoring
• Choking
• Nocturia
• Apnoeas
• Sweats
• Restless Sleep
• Vivid dreams

21

Week 207 - OSA and Chest Wall: What are the laboratory investigations available for OSA? Give a brief description of each.

• Simple oximetry.
• Embletta - Oximetry, Nasal flow, Snoring, Pulse, Chest movements.
• Visilab - Observation and data obs. (Sleeping position, Activity, sats, pulse)
• PSG - Polysomnography, studies EEG, EOG, EMG, ECG.

22

Week 207 - OSA and Chest Wall: What is the management of OSA?

• Address underlying cause (acromegaly, hypothyroidism)
• Stop evening alcohol and sedatives.
• Stop smoking.
• Lose weight.
• Posture training.

23

Week 207 - OSA and Chest Wall: What are the four functions of the pericardium?

• Stabilisation of the heart within the thoracic cavity, due to its ligamentous attachments.
• Protection.
• Pericardial fluid functions as a lubricant.
• Prevention of excessive dilation of the heart.

24

Week 207 - OSA and Chest Wall: What are the symptoms of reasonably large pericardial effusion?

• Disruption to haemodynamics of heart.
• SOB
• Dysphagia
• Hoarseness
• Hiccups

25

Week 207 - OSA and Chest Wall: What are the signs on an ECG of a pericardial effusion?

Low Voltage.
electrical alternans.

26

Week 207 - OSA and Chest Wall: What are the signs of tamponade?

• Tachycardia
• Hypotension
• Rales/oedema/ascites
• Muffled heartsounds
• pulsus pardoxus

27

Week 207 - OSA and Chest Wall: What is the basic outline of the jugular venous wave form?

• a Wave is first, this is due to contraction of the right atrium.
• x descent, small descent due to relaxation of the atria.
• c Wave, not normally visible.
• x descent, during early stage of systole, fall of R.atrial pressure, floor of RA and tricuspid valve drops due to rv contraction.
• v Wave, due to continuous filling of right atrium, whilst tricuspid valve is closed.
• y descent, reduction in right atrium pressure due to opening of tricuspid valve.

28

Week 207 - OSA and Chest Wall: Describe what is occurring during the a Wave of the JVP.

• First positive presystolic wave.
• Dominant wave in JVP.
• Due to the contraction of the right atrium.
• Precedes S1 but comes after the ECG p wave.

29

Week 207 - OSA and Chest Wall: The c Wave of the JVP is not always present, what does it interrupt and what can it signify?

• Appears as a wave during the x descent.
• Transmitted carotid pulsations.
• Upward bulge of closed tricuspid valve is isovolumic systole.

30

Week 207 - OSA and Chest Wall: What is the v Wave?

• Due to increased pressure in the right atrium due to continuous filling whilst the tricuspid valve is closed.