Respiratory Extras

Question 1

What are the effects of a panic attack on the respiratory system?

Answer 1

• Panic attacks result in hyperventilation which causes a respiratory alkalosis.
• pO2 will be normal as there is no problems with gas exchange.
• There would be no metabolic compensation as the panic attack resolves rapidly.

Question 2

What is Kartagener’s syndrome?

Answer 2

• Kartagener’s syndrome also known as primary ciliary dyskinesia
  
  • Dynein arm defect results in immotile cilia

Question 3

What is Kartegener’s syndrome associated with?

Answer 3

• Dextrocardia
• Presents with
  
  • Quiet Heart Sounds
  • Small volume complexes in lateral leads

Question 4

What are features of Kartegener’s syndrome?

Answer 4

• Dextrocardia or complete situs inversus
• Bronchiectasis
• Recurrent sinusitis
• Subfertility (secondary to diminished sperm motility and defective ciliary action in the fallopian tubes)

Question 5

What is the preferred name for Churg-Stauss syndrome?

Answer 5

• Eosinophilic granulomatosis with polyangiitis (EGPA)
  
  • ANCA associated small-medium vessel vasculitis
• Leukotrience receptor antagonist can cause the disease

Question 6

What are the features of Eosinophilic granulomatosis with polyangiitis (EGPA)?

Answer 6

• Asthma
• Blood eosinophilia (e.g. > 10%)
• Paranasal sinusitis
• Mononeuritis multiplex
• pANCA positive in 60%

Question 7

What are the 3 main types of Altitude Related Disorders?

Answer 7

• Acute mountain sickness (AMS)
• High altitude pulmonary edema (HAPE)
• High altitude cerebral edema (HACE).

All three conditions are due to the chronic hypobaric hypoxia which develops at high altitudes

Question 8

How does Acute Mountain Sickness develop?

Answer 8

Features of AMS start to occur above 2,500 - 3,000m, developing gradually over 6-12 hours lasting a number of days

Question 9

What are symptoms of Acute Mountain Sickness?

Answer 9

• Headache
• Nausea
• Fatigue

Question 10

How is Acute Mountain sickness prevented?

Answer 10

• Risk of AMS may actually be positively correlated to physical fitness
• Gain altitude at no more than 500 m per day
• Acetazolamide (a carbonic anhydrase inhibitor) is widely used to prevent AMS

Question 11

How can Acute Mountain Distress be treated?

Answer 11

Descent

Question 12

What can AMS develop into and how?

Answer 12

A minority of people above 4,000m go on to develop:

• High altitude pulmonary oedema (HAPE) or High altitude cerebral oedema (HACE), potentially fatal conditions

Question 13

How do HAPE and HACE present?

Answer 13

HAPE presents with

• Classical Pulmonary Oedema features

HACE presents with:

• Headache
• Ataxia
• Papilloedema

Question 14

How is HACE managed?

Answer 14

• Descent
• Dexamethasone

Question 15

How is HAPE managed?

Answer 15

• Descent
• Nifedipine, Dexamethasone, Acetazolamide, Phosphodiesterase type V inhibitors*
• Oxygen if available

Question 16

What are some predisposing factors for Sleep Apnoea?

Answer 16

• Obesity
• Macroglossia: acromegaly, hypothyroidism, amyloidosis
• Large tonsils
• Marfan’s syndrome

Question 17

What is the consequence of Sleep apnoea?

Answer 17

• Daytime somnolence
• Hypertension

Question 18

How is Sleep Apnoea assessed?

Answer 18

• Epworth Sleepiness Scale: Questionnaire completed by patient +/- partner
• Multiple Sleep Latency Test (MSLT): measures the time to fall asleep in a dark room (using EEG criteria)

Question 19

What are diagnostic tests for Sleep Apnoea?

Answer 19

• Full polysomnography
• Monitoring of pulse oximetry at night
• EEG
• Respiratory Flow
• Thoraco-abdominal movement
• Snoring

Question 20

How can Sleep Apnoea be managed?

Answer 20

• Weight loss
• 1st Line: CPAP for moderate or severe OSAHS
  
  • Intra-oral devices (e.g. mandibular advancement) may be used if CPAP is not tolerated or for patients with mild OSAHS where there is no daytime sleepiness
  • The DVLA should be informed if OSAHS is causing excessive daytime sleepiness