Geriatrics

Question 1

How are central and obstructive sleep apnea diagnosed?

Answer 1

Polysomnogram

Question 2

Central sleep apnea definition

Answer 2

when you repeatedly stop breathing during sleep because the brain temporarily stops sending signals to the muscles that control breathing

Question 3

Tx of central sleep apnea

Answer 3

Treat underlying cause, oxygen nasal CPAP, BPAP, meds used to stimulate breathing

Question 4

Categories of sleep related breathing disorderes

Answer 4

central sleep apnea syndrome, obstructive sleep apnea syndrome, and sleep related hypoventilation/hypoxemia syndromes

Question 5

List the sleep related hypoventilation/hypoxemic syndromes

Answer 5

Congenital central hypoventilation syndrome and obesity hypoventilation syndrome

Question 6

Apnea episode vs. Hypopnea episode

Answer 6

Apnea- cessation or pause in breathing

Hypopnea- decrease in airflow during breathing

Question 7

Obstructive sleep apnea definition

Answer 7

When you repeatedly stop breathing or have decreased airflow during sleep due to a narrowed, blocked, or floppy airway

Question 8

OSA risk factors

Answer 8

Obesity, large tongue, large neck, large tonsils and adenoids, abnormally shaped palate, short lower jaw

Question 9

60 year old man presents with chronic fatigue during the day, morning headaches, and restless sleep. He does not have snoring and is not obese. What kind of sleeping disorder is this most likely?

Answer 9

Central sleep apnea

Question 10

55 year old man with hypertension, diabetes, and obesity comes to the office with his nagging wife that complains of his unbearable snoring soon after he falls asleep. He looks fatigued and when provoked, complains of headaches and daytime sleepiness. His wife notes that he has been more irritable with mood swings. Diagnosis?

Answer 10

Obstructive sleep apnea

Question 11

Tx for OSA

Answer 11

Need to keep airway open- CPAP. Lifestyle changes- lose weight, control diabetes and HTN, avoid alcohol before bedtime, avoid sleeping on the back. Dental devices to keep mouth open, surgery

Question 12

Complications of untreated OSA

Answer 12

Heart arrythmias or failure, HTN, CVA

Question 13

Congenital central hypoventilation syndrome

Answer 13

congenital disorder in which children suffer from hypoventilation and hypoxemia in the first months of life

Question 14

Obesity hypoventilation syndrome

Answer 14

Condition in which obese patients suffer from poor breathing leading to hypoxemia and hypercarbia–>OSA

Question 15

Aspiration pneumonia causes

Answer 15

Chemical, bacterial- when normal defenses that usually protect lower airways are not working due to presence of inoculum

Question 16

Tx for chemical pneumonitis

Answer 16

Suctioning, supportive care

Question 17

True aspiration pneumonia cause

Answer 17

anaerobes and strep

Question 18

Bacterial aspiration pneumonitis vs. CAP

Answer 18

same symptoms, but CAP is rapid onset, while aspiration pneumonitis evolves over days-weeks

Question 19

Aspiration pneumonitis tx due to bacterial cause

Answer 19

Clindamycin

Question 20

Chemical pneumonitis symptoms

Answer 20

Abrupt onset, dyspnea, crackles, cyanosis, hypoxemia, infiltrates on CXR, fever

Question 21

What to do if dysphagia suspected in aspiration pneumonitis?

Answer 21

Bedside swallowing test, video fluoroscopic swallow test, endoscopic evaluation

Question 22

Prevention of aspiration pneumonitis

Answer 22

Positioning, dietary changes, oral hygiene, tube feeding

Question 23

Risk factors for aspiration pneumonitis

Answer 23

reduced consciousness (food may go down wrong way into lungs), dysphagia, upper GI disorders, chemical or infectious etiologies