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CPR Exam 2 > Lecture 3: Pulmonary HTN and Sleep Apnea > Flashcards

Lecture 3: Pulmonary HTN and Sleep Apnea Flashcards

1
Q

Which finding on CXR is suggestive of pulmonary HTN?

A

Pulmonary artery enlargement

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2
Q

What is needed to confirm the diagnosis of pulmonary HTN and to assess its cause if therapy is to be considered?

A
  • Right heart catheterization*** and direct measurement of mean pulmonary artery pressure
  • Echocardiography w/ estimated mean systolic pulmonary artery pressure of 40 mmHg or greater is highly suggestive
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3
Q

What are the best predictors of prognosis for pulmonary HTN?

A
  • Right-sided heart function

AND

  • Functional status (as determined by 6-minute walk test)
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4
Q

What are the etiologies for group 1-group 5 pulmonary HTN?

A
  • Group 1 = idiopathic and CT diseases
  • Group 2 = heart (i.e., systolic, diastolic, valvular)
  • Group 3 = lungs
  • Group 4 = pulmonary emboli
  • Group 5 = all others (i.e., hematologic, systemic, metabolic..)
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5
Q

What are the classic findings of PFT’s in pt with pulmonary HTN?

A

Normal PFT EXCEPT isolated reduction in DLCO

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6
Q

Common EKG findings that may be seen in pt w/ pulmonary HTN?

A
  • Right-axis deviation
  • Right atrial enlargement = peaked ‘p’ waves
  • RVH
  • RV strain = repolarization abnormality
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7
Q

What are 3 echocardiogram findings which may be seen w/ pulmonary HTN?

A
  • Increased estimated PA pressures
  • RA enlargement
  • RV enlargement
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8
Q

What is a PE finding which may help distinguish pulmonary HTN from IHD?

A

↑ P2 in pulmonary HTN; parasternal heave and persistent splitting of S2

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9
Q

Which questionnaire has been shown to have a high sensitivity and negative predictive value for moderate to severe sleep apnea?

A

STOP-BANG questionnaire

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10
Q

Which validated questionnaire can be used to assess the level of somnolence during daytime activity to help determine need for diagnostic testing for sleep disorders?

A

Epworth Sleepiness Scale

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11
Q

What is the most important risk factor obstructive sleep apnea?

A

Excess body weight

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12
Q

What is the test of choice/needed for the diagnosis of obstructive sleep apnea?

A

Polysomnography

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13
Q

Which value of the apnea-hypopnea index (AHI) taken during a polysomnography confirms obstructive sleep apnea?

A

AHI >5 per hour

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14
Q

What will a polysomnography show in a person with central sleep apnea which distinguishes it from obstructive sleep apnea?

A

Absence of respiratory effort during apnea

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15
Q

The neurologic disorder termed “periodic limb movements of sleep” is most common in which patients?

A

Pt’s on dialysis

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16
Q

If a daytime awake pulse oximetry demonstrates hypoxemia in a pt with suspected OSA, what test should be drawn and what is a likely cause?

A
  • Arterial blood gasses (ABG’s)
  • Obesity hypoventilation syndrome (awake PCO2 >45 mmHg)
17
Q

Obese patients with depression must be screened for what?

A

Obstructive sleep apnea

18
Q

What are the major goals of tx for obstructive sleep apnea?

A
  • Improve daytime sleepiness and cognitive performance
  • Prevent long-term sequelae
19
Q

What are 4 lifestyle modifications which should be used in the tx of obstructive sleep apnea (i.e., obese, alcohol, sleep position, and OTC’s?

A
  • Obese? Lose 10% or more (may ↑ size of airway)
  • Avoid alcohol and sedatives 3-4 hrs prior to bed
  • Lateral decubitus sleeping position (keeps airways from collapsing)
  • Intranasal steroid/decongestants
20
Q

If moderate to severe OSA persists despite interventions, or if the changes cannot be instituted, what tx should be started?

A

Nocturnal CPAP

21
Q

Nocturnal CPAP has what effect on intraluminal airway pressure and FRC?

A

↑ intraluminal airway pressure and ↑ FRC

22
Q

What are 4 measures shown to improve adherence when using CPAP?

A
  • Early pt education
  • Follow-up
  • Heated humidification
  • Establishing a comfortable interface for the CPAP device
23
Q

What is a solution for pt’s that aren’t able to adjust to a nocturnal CPAP prior to surgery?

A
  • bi-level PAP (BiPAP)
  • Mandibular assist device
24
Q

Which tx device may eliminate the need for CPAP in mild/moderate cases of OSA?

A

Mandibular assist device

25
Q

What is the most common surgical intervention for OSA to remove obstruction to airflow?

A

Uvulopalatopharyngoplasty (UPPP)

26
Q

Obesity-hypoventilation syndrome can mimic COPD, but what is a major difference seen during PFT’s?

A

PFT’s demonstrate a restrictive defect rather than obstructive

27
Q

Erythema nodosum + fever + arthralgia + hilar adenopathy (on CXR) is characteristic of what?

A

Sarcoidosis

28
Q

What is the tx of choice for Sarcoidosis?

A

Prednisone

29
Q

Pleural plaques in the lungs which are often calcified is a characteristic finding in what cause of restrictive lung disease?

A

Asbestosis

CPR Exam 2 (21 decks)

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