Other, OSA, Cancer Flashcards
What is obstructive sleep apnoea?
Intermittent closure/collapse of pharyngeal airway during sleep - causing apnoeic episodes (cessation of air flow >10s during sleep) - terminated by partial arousal
Typical OSA patient
Obese, middle aged man
Presents with snoring or daytime somnolence
Features of OSA
Loud snoring Daytime somnolence Poor sleep quality Morning headache Decreased libido Cognitive performance decrease
Complications of OSA
Pulmonary hypertension, type 2 respiratory failure and hypertension
DX of OSA
Polysomnography - O2 sat at nose and mouth, ECG, EMG chest, abdominal wall movements
15 of more episodes of apnoea or hypopnoea during 1 hour of sleep indicates OSA
Management of OSA
Lose weight
Avoid smoking and alcohol
CPAP via nasal mask during sleep
Surgery to relieve obstruction is occasionally needed
Presentation of cor pulmonale
Dyspnoea fatigue and syncope
Cynaosis, tachycardia, raised JVP, ECG signs
Hepatomegaly and oedema
Management of cor pulmonale
Treat cause
Treat resp failure
Treat cardiac failure
What is pleural effusion - two types
Fluid in pleural space
Transudates 35g/l of protein
Causes of a transudative pleural effusion
Increased venous pressure
- Cardiac failure
- Fluid overload
- Constrictive pericariditis
Hypoproteinaemia
- Cirrhosis
- Nephrotic syndrome
- Malabsorption
Hypothyroidism
Causes of an exudative pleural effusion
Increased leakiness due to infection, inflammation or malignancy
Eg. pneumonia, TB, pulmonary infarction, RA
Symptoms of pleural effusion
Dyspnoea
Pleuritic chest pain
Signs of pleural effusion
Decreased expansion
Stony dull percussion
Diminished breath sounds
Vocal fremitus decreased
CXR in pleural effusion
Small effusions blunt costophrenic angle
Larger ones seen as water-dense shadows, concave upper borders
Other diagnostic measures in Pleural effusion
USS
Diagnostic aspiration
Management of pleural effusion
Drain - remove slowly
Pleurodesis (tetracycline, talc or bleomycin) if recurrent