OSA + OHS + Croup Flashcards
Review histoplasmosis
P -
miliary Pattern
Pancytopenia
Polysaccharide antigen assay + combo of 1st morning Pee
bat and bird droppings Ohio+Mississippi river
Mild: itraconazole
Severe: amphotericin B
Review cryptococcosis
MCC of fungal meningitis
Soil + bird feces
P
Pulmonary nodule
India ink
HemoPtysis, dysPnea, cP
depends on severity
Review coccidiomycosis
my my my
Valley
Erythema nodosum
verrucous skin lesions
itraconazole
IV amphotericin B
Review blastomycosis
Immunocompetent outdoor activities also in Ohio + Mississippi river valleys
B - body aches
L - lobar consolidation
A - after antibiotics presentation
S - skin lesions
T- tachy/pleuritic CP
Review epiglottitis
hot potato voice, drooling, URI, stridor, muffled, often from H. flu, burns from hot liquids, trauma, infection
thumbprint in xray, keep patient leaned forward
tx: trach, IV abx - cefixime, cefuroxime, dexamethasone
O2 support
What does this presentation indicate:
- witnessed breathing pauses, restless/non-refreshing sleep, awakenings w/ gasping/paroxysmal nocturnal dyspnea, insomnia, excessive daytime sleepiness, fatigue?
obstructive sleep apnea
What are RFs for OSA?
obesity, large neck circumfrence, male sex, older age, snoring, cigarette smoking, use of alcohol/sedatives before sleeping, abnormalities, endocrinopathies (Hypothyroidism)
Blacks, Asians, NAs, Hispanics
With OSA + HTN, what should you screen for?
primary aldosteronism
What do you need to order in order to get a sleep study for your OSA patient?
Epworth Sleepiness scale and neck circumfrence
What may you see on a PE that could lead you to OSA?
Modified Mallampati score (3-4), retrognathia or increased overjet, peritonsillar narrowing, hypertrophy, macroglossia, enlongated/enlarged uvula, odd shaped hard palate, nasal abnormalities, “bull neck”
What is common in bloodwork of OSA?
erythrocytosis
also consider thyroid tests
What is the gold standard of Dx for OSA?
in-lab polysomnography – confirmed by number of obstructive events >/5 events/hour WITH symptoms or >15 events/hour w/o symptoms
How do you rate OSA?
mild - RDI>/ 5 events<15
moderate - RDI>/15<30
severe RDI>/30/hour
How can you treat OSA?
weight reduction, avoidance of alcohol and hypnotic medications
CPAP = TOC
What is indicated for OSA patients w/ mild/moderate OSA, irresponsible to CPAP, or not candidates for CPAP, or fail behavioral measures?
Oral appliances (MAD, tongue retaining devices)
When are surgical procedures indicated for OSA?
obvious anatomical obstructions, fail or do not tolerate initial therapy w/ CPAP or MAD
always f/u to assess improvement
What’s the presentation of obesity hypoventilation syndrome?
obesity + daytime hypoventilation + sleep-disordered breathing
nocturnal hypoventilation: waking headaches, peripheral edema, hypoxemia (<94% on RA), unexplained polycythemia
stable may be consistent w/ OSA
What are risk factors for OHS?
BMI>40, pre-existing OSA
T/F: OHS have higher risk of complications in surgery so you must recognize this ahead of time
T
What does this PE indicate:
BMI>/30
breathing pattern shallow + rapid
large circumference
jugular venous distention –> RHF
peripheral edema –> RHF
OHS
What should you workup with OHS?
ABG, overnight in-lab polysomnography, daytime finger pulse oximetry, PFTs, ECG + TTE, TSH, Hgb
What is the diagnostic criteria for OHS?
1) BMI>/ 30
2) hypoventilation during awake hours
- hypercapnia >/ 45mmHg
- sleep disordered breathing confirmed by polysomnography
- exclusion of other causes
What should you suggest for OHS?
reduce weight, normalize sleep breathing, improve respiratory drive
What is your treatment for OHS?
CPAP
what should you avoid for OHS?
sedative hypnotics, alcohol, opioids
adjunct therapy = dietary consult, physical activity, oxygen
What does this indicate: Gradual onset w/ URI symptoms (nasal congestion, rhinorrhea, cough, low fever) –> barking cough, hoarseness, stridor, for 3-5 days but infectious up to 2 weeks?
croup
Who’s at risk for croup
6m -3 years
What can cause croup?
parainfluenza virus, RSV, influenza
croup is the MC cause of ______ in children
airway obstruction
What does a steeple sign and leukocytosis indicate?
croup
What do all croup patients need?
humidified room + one time oral steroid dose - dexamethasone or nebulized budesonide if PO is not tolerated
How do you treat moderate-severe croup (stridor at rest)?
nebulized racemic epinephrine
