Stridor

Question 1

What are the causes of stridor in adults? (4)

Answer 1

Neoplasms:

• Larynx
• Trachea
• Major bronchi

Anaphylaxis

Goitre (retrosternal)

Trauma (eg strangulation, burns, irritant gases)

Other (eg bilateral vocal cord palsy; Wegener’s granulomatosis; cricoarytenoid arthritis (RA); tracheopathia

Question 2

What investigations are carried out for stridor? (5)

Answer 2

Laryngoscopy (beware in acute epiglottitis)

Bronchoscopy

Flow volume loop

Chest X ray

Other imaging (CT; thyroid scan)

Question 3

What happens clinically in acute anaphalaxis?

Answer 3

Flushing, pruritus, urticaria,

Angioneurotic oedema (lips, tongue then face, larynx, bronchi)

(abdominal pain, vomiting)

Hypotension (vasodilatation and plasma exudation) then circulatory collapse (shock)

Stridor, wheeze and respiratory failure

Question 4

What is the treatment for acute anaphalaxis?

Answer 4

IM Epinephrine (adrenaline 500mcg)
IV antihistamine (chlorphenamine 10mg)
IV corticosteroid (200mg)
IV fluid challenge
High flow O2
Nebulised bronchodilators
Endotracheal intubation if necessary

Question 5

What are the preventative measures for anaphalaxis?

Answer 5

Allergen avoidance (where possible)

Desensitisation (immunotherapy) eg venom

Self-administered epinephrine

Question 6

What is obstructive sleep apnoea?

Answer 6

Intermittent upper airway collapse in sleep

apnoeas or hypopnoeas ± hypoxaemia

recurrent arousals / sleep fragmentation

Question 7

What are the 8 risk factors for sleep apnoea?

Answer 7

Enlarged tonsils, adenoids
Obesity
Retrognathia
Acromegaly, hypothyroidism
Oropharyngeal deformity
Neurological: stroke, MS, myesthenia gravis, myotonic dystrophy
Drugs: benzodiazepines, opiates, alcohol,
Post-operative period after anaesthesia

Question 8

What are the 4 consquences of sleep apnoea?

Answer 8

excessive daytime sleepiness
personality change
cognitive / functional impairment
Major impact on daytime function

Question 9

How is sleep apnoea diagnosed?

Answer 9

Snoring & EDS (raised Epworth score)
Overnight sleep study
		- oximetry
		- domicillary recording (airflow, oximetry, thoracic/abdominal movement)
		- full polysomnography

Question 10

What is the standard treatment of sleep apnoea?

Answer 10

Remove underlying cause
CPAP (continuous positive airway pressure)
- most effective therapy

Question 11

What two treatment can be used other than CPAP for sleep apnoea?

Answer 11

Mandibular Advancement Device

- improves snoring
- moderate reduction in 

AHI
	- use in mild OSA (AHI 5-15/hr)
	Surgery (UPPP, laser Rx)
	- avoid if sleep apnoea (future CPAP less effective)
	- may be used in simple snoring