Dunedin-Resp

Question 1

Define Apnoea

Answer 1

An APNOEA is the cessation of flow for a minimum period of 10s

Question 2

Define hypopnea

Answer 2

A reduction in airflow of at least 30%, with 3% desaturation, and lasts at least 10s

Question 3

What is a RERA?

Answer 3

respiratory event related arousals

Question 4

What is the impact of CPAP on cardiovascular events in people with OSA?

Answer 4

Doesnt prevent cardiovascular events

Question 5

What are some of the effects of CPAP?

Answer 5

small improvements in BP
decreased erectile dysfunction
reduced risk of MVA
improved QoL scores

Question 6

What is Tirzepatide?

Answer 6

it is a carbonic anhydrase that has been shown to reduce AHI by 47%

Question 7

How to tell the difference between OSA and CSA?

Answer 7

Respiratory effort - will be trying in OSA

Question 8

What is obesity hypoventilation syndrome?

Answer 8

OHS requires an elevated pCO2 (during or immediately after sleep) PLUS BMI>35 AND no other reason for hypercarbia (e.g. COPD, neuromuscular)

Question 9

What is the treatment for central sleep apnoea?

Answer 9

adaptive servo ventilation (ASV) - not used frequently

Question 10

What deficiency is most commonly related to restless legs?

Answer 10

iron deficiency

Question 11

List some conditions associated with restless legs

Answer 11

• Coeliac
• COPD
• Depression, panic
• Fibromyalgia
• Medications- SSRIs, neuroleptics, lithium,
  beta blockade, dopamine antagonists
• Migraine, multiple sclerosis, Parkinson’s
  disease, shift work, PAH, neuropathies etc

Question 12

List some medications for restless leg syndrome

Answer 12

PRN Levodopa if rare occurence; otherwise gabapentin, ropinirole, clonazepam, tramadol, oxycodone, morphine, methadone

Question 13

What is the difference between Type 1 and Type 2 narcolepsy?

Answer 13

Type 1 has cataplexy

Question 14

What is the deficiency in narcolepsy?

Answer 14

orexin

Question 15

How is narcolepsy diagnosed?

Answer 15

Sleep latency <10 min
REM sleep latency <20 min
MSLT <8 min

AND

Two or more sleep-onset REM (SOREM) events

Question 16

Describe the treatment for narcolepsy

Answer 16

Modafinil –> doesn’t treat cataplexy

Methylphenidate, gamma hydroxybutyrate and dexamphetamine –> narcolepsy+ cataplexy

Anti-cataplectics: venlafaxine, clomipramine

Sodium oxybate

Question 17

How to treat REM behavioural disorder

Answer 17

clonazepam +/- melatonin

Question 18

What is Klein-Levin syndrome?

Answer 18

Periodic hypersomnia, eating disorder (excessive cravings), hypersexuality (often males) and depression (often females)

Question 19

What is the criteria for lung transplant?

Answer 19

high (>50%) risk of death due to lung disease within 2 years

high (>80%) likelihood of surviving at least 90 days after transplant

high (>80%) likelihood of 5 year post transplant survival

Question 20

What are absolute contraindications for lung transplant?

Answer 20

• recent malignancy with a high risk of recurrence of death
• major organ dysfunction (GFR <40, liver cirrhosis or synthetic dysfunction, ACS or CVA within 30 days)
• extra pulmonary or disseminated infection or active TB or HIV infection
• progressive cognitive impairment
• repeated non-adherence without evidence of improvement
• severely limited functional status with poor rehabilitation potential
• active substance use or dependent

Question 21

What are some infections that increase the risk of lung transplant?

Answer 21

M abscessus
Lomentospora prolificans
Burkholderia cenocepacia or gladiolii

Question 22

When can you do single vs bilateral lung transplant:

Answer 22

Single: COPD, ILD, older patients
Bilateral: CF, bronchiectasis, PAH

Question 23

What are the immunosuppression regimens post lung transplant?

Answer 23

Calcineurin inhibitors –> tacrolimus or cyclosporine

Cell cycle inhibitors –> azathioprine or MMF

Prednisone

Question 24

What prophylaxis do you do for lung transplant?

Answer 24

CMV, EBV, PCP, azithromycin

Question 25

What is CLAD?

Answer 25

Chronic lung allograft dysfunction
- BOS- bronchiolitis obliterates syndrome
- RAS - restrictive allograft syndrome