Hubbard Review Flashcards
What is the clinical presentation of obstructive sleep apnea?
impaired daytime attention difficult with memory daytime sleepiness snoring witnessed apnea altered modd
What type of patients should be screened for OSA
obese patients with depression
OSA clinical findings?
obesity large neck nasal obstruction enlarged tonsils narrow oropharynx
What is the management goal of OSA?
improve daytime sleepiness and cognitive performance
How to treat OSA?
primarily - lose weight
avoid alcohol
nasal decongestants
What do you give if symptoms of OSA persist after lifestyle modifications ?
nocturnal CPAP
If OSA patients don’t respond to CPAP, then what?
bi-PAP
If biPAP doesn’t work, then what?
UPPP - uvulopalatopharnygeoplasty
What is pickwinian syndrome also known as? What disease does it mimic?
obesity-hypoventilation syndrome. can mimic COPD, but PFTs demonstrate a restrictive defect rather than obstructive.
What are some causes of cough? 4
infection
malignancy
medications (ACEI)
GERD
What are the causes of dyspnea?
CHF, CAD, perciardial disease
COPD, ILD, malignancy, chronic infection
CKD (anemia), acid base disorders
What is the differentiation between chronic cough and acute cough?
chronic cough = greater than 2 months
acute cough = less than 3 weeks
What is the differentiation between acute and chronic dyspnea?
Chronic dyspnea is longer than 1 month
acute dyspnea develops rapidly
What are the causes of wheezing in children?
asthma, bronchiolitis, atypical infection, bacterial tracheitis
foreign body aspiration
What are the causes of wheezing in adults?
asthma bronchiolitis atypical infection bacterial trachieitis foreign body aspiration esophageal foreign body upper airway tumors lower respiratory tract tumors anaphylaxis pneumonia pulmonary edema
What is the first thing you do for a tension pneumothorax?
needle thoracotomy
What do you see in a tension pneumothorax?
decreased chest movement on affected side
mediastinal shift
diaphragm not symmetrical
causes of a pneumothorax ?
spontaneous - young men
traumatic - post procedural, direct trauma
disease related - numerous diseases
What does an exudate fluid contain?
pleural protein/serum protein > 0.5
pleural LDH/serum LDH >0.6
pleural fluid LDH >2/3 upper limits of serum LDH in lab doing the measurement
What cause transudate effusions?
LVH, CHF
Misplaced central line
if you see increased eosinophils in effusion, what are you thinking?
increased air in pleural space
If you see lymphocytic cells in effusion, what are you thinking?
malignancy, tuberculosis
How do you manage a chronic pleural effusion?
PleurX Cathater
What is the most common cause of horners syndrome?
lung cancer/pancoast tumor
Who is at risk for silicosis?
spelunkers, occupations that are exposed to silicosis
What are two main causes of dramatic weight loss?
Malignancy
Tuberculosis
What is the term for the increase in risk of cancer in people who smoke and drink?
synergistic effect
hemoptysis is either ___ or ____ until you prove otherwise
tuberculosis, lung cancer
Not all that wheezes is asthma. What else could it be?
Look at ankles, think about fluid retention, think aspiration (idk he didn’t say much here)
What is the only reliable measure of dyspnea?
patient self reporting
