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Clinical Medicine II > OSA + OHS + Croup > Flashcards

OSA + OHS + Croup Flashcards

1
Q

Review histoplasmosis

A

P -
miliary Pattern
Pancytopenia
Polysaccharide antigen assay + combo of 1st morning Pee

bat and bird droppings Ohio+Mississippi river

Mild: itraconazole
Severe: amphotericin B

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2
Q

Review cryptococcosis

A

MCC of fungal meningitis
Soil + bird feces
P
Pulmonary nodule
India ink
HemoPtysis, dysPnea, cP
depends on severity

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3
Q

Review coccidiomycosis

A

my my my
Valley
Erythema nodosum
verrucous skin lesions
itraconazole
IV amphotericin B

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4
Q

Review blastomycosis

A

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

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5
Q

Review epiglottitis

A

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

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6
Q

What does this presentation indicate:
- witnessed breathing pauses, restless/non-refreshing sleep, awakenings w/ gasping/paroxysmal nocturnal dyspnea, insomnia, excessive daytime sleepiness, fatigue?

A

obstructive sleep apnea

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7
Q

What are RFs for OSA?

A

obesity, large neck circumfrence, male sex, older age, snoring, cigarette smoking, use of alcohol/sedatives before sleeping, abnormalities, endocrinopathies (Hypothyroidism)

Blacks, Asians, NAs, Hispanics

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8
Q

With OSA + HTN, what should you screen for?

A

primary aldosteronism

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9
Q

What do you need to order in order to get a sleep study for your OSA patient?

A

Epworth Sleepiness scale and neck circumfrence

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10
Q

What may you see on a PE that could lead you to OSA?

A

Modified Mallampati score (3-4), retrognathia or increased overjet, peritonsillar narrowing, hypertrophy, macroglossia, enlongated/enlarged uvula, odd shaped hard palate, nasal abnormalities, “bull neck”

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11
Q

What is common in bloodwork of OSA?

A

erythrocytosis
also consider thyroid tests

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12
Q

What is the gold standard of Dx for OSA?

A

in-lab polysomnography – confirmed by number of obstructive events >/5 events/hour WITH symptoms or >15 events/hour w/o symptoms

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13
Q

How do you rate OSA?

A

mild - RDI>/ 5 events<15
moderate - RDI>/15<30
severe RDI>/30/hour

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14
Q

How can you treat OSA?

A

weight reduction, avoidance of alcohol and hypnotic medications

CPAP = TOC

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15
Q

What is indicated for OSA patients w/ mild/moderate OSA, irresponsible to CPAP, or not candidates for CPAP, or fail behavioral measures?

A

Oral appliances (MAD, tongue retaining devices)

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16
Q

When are surgical procedures indicated for OSA?

A

obvious anatomical obstructions, fail or do not tolerate initial therapy w/ CPAP or MAD

always f/u to assess improvement

17
Q

What’s the presentation of obesity hypoventilation syndrome?

A

obesity + daytime hypoventilation + sleep-disordered breathing

nocturnal hypoventilation: waking headaches, peripheral edema, hypoxemia (<94% on RA), unexplained polycythemia

stable may be consistent w/ OSA

18
Q

What are risk factors for OHS?

A

BMI>40, pre-existing OSA

19
Q

T/F: OHS have higher risk of complications in surgery so you must recognize this ahead of time

A

T

20
Q

What does this PE indicate:
BMI>/30
breathing pattern shallow + rapid
large circumference
jugular venous distention –> RHF
peripheral edema –> RHF

A

OHS

21
Q

What should you workup with OHS?

A

ABG, overnight in-lab polysomnography, daytime finger pulse oximetry, PFTs, ECG + TTE, TSH, Hgb

22
Q

What is the diagnostic criteria for OHS?

A

1) BMI>/ 30
2) hypoventilation during awake hours
- hypercapnia >/ 45mmHg
- sleep disordered breathing confirmed by polysomnography
- exclusion of other causes

23
Q

What should you suggest for OHS?

A

reduce weight, normalize sleep breathing, improve respiratory drive

24
Q

What is your treatment for OHS?

A

CPAP

25
Q

what should you avoid for OHS?

A

sedative hypnotics, alcohol, opioids

adjunct therapy = dietary consult, physical activity, oxygen

26
Q

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?

A

croup

27
Q

Who’s at risk for croup

A

6m -3 years

28
Q

What can cause croup?

A

parainfluenza virus, RSV, influenza

29
Q

croup is the MC cause of ______ in children

A

airway obstruction

30
Q

What does a steeple sign and leukocytosis indicate?

A

croup

31
Q

What do all croup patients need?

A

humidified room + one time oral steroid dose - dexamethasone or nebulized budesonide if PO is not tolerated

32
Q

How do you treat moderate-severe croup (stridor at rest)?

A

nebulized racemic epinephrine

Clinical Medicine II (11 decks)

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