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Respiratory > Stridor and sleep apnoea > Flashcards

Stridor and sleep apnoea Flashcards

1
Q

What is stridor?

A

This is a predominantly inspiratory wheeze, due to large airway obstruction

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2
Q

What are the 2 types of stridor?

A

Extra-thoracic (Subglottis)
Supraglottis

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3
Q

What are some causes of supraglottis stridor?

A

Laryngomalacia
Supraglottic mass
Glottic lesions
Vocal cord paralysis

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4
Q

What are the most common causes of stridor in children?

A

Infection
Foreign bodies
Anaphylaxis
Angioneurotic oedema
Trauma (e.g. burns)

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5
Q

What are some infections in children that can cause stridor?

A

Croup
Epiglottitis
Pseudomembranous croup
Retropharyngeal abscess
Diphtheria
Infection mononucleosis (EBV)

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6
Q

What is the most common foreign body that children intake?

A

Peanuts

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7
Q

What are the most common causes of stridor in adults?

A

Neoplasm
Anaphylaxis
Goitre
Foreign body
Trauma (e.g. strangulation)

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8
Q

What are some less common causes of stridor in adults?

A

Bilateral vocal cord palsy
Wegener’s granulomatosis
Cricoarytenoid arthritis
Tracheopathia
Tracheomalacia

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9
Q

What is tracheomalacia?

A

Degeneration of the tracheal cartilage

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10
Q

What are some investigations in stridor?

A

Laryngoscopy
Bronchoscopy
Flow volume loop
Chest X-ray
CT scan
Thyroid scan

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11
Q

What is a cricothyroidotomy?

A

An emergency procedure in which an incision is made between the cricoid and thyroid cartilage and a tube is inserted

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12
Q

What is a tracheostomy?

A

A procedure in which an incision is made into the trachea, around 2 finger breadths above the sternal notch, and a tube is inserted

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13
Q

What are some symptoms of acute anaphylaxis?

A

Flushing
Urticaria
Pruritus
Angioneurotic oedema
Abdominal pain
Vomiting
Hypotension - Anaphylactic shock
Stridor, wheeze, respiratory failure

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14
Q

How is acute anaphylaxis usually treated?

A

IM adrenaline (Epinephrine)
IV antihistamine (Not 1st line)
IV corticosteroids
High flow O2
Nebulised bronchodilators
Endotracheal tube insertion

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15
Q

What are some long term management options in allergies?

A

Allergen avoidance
Desensitisation (Immunotherapy) - effective in bee venom

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16
Q

What is obstructive sleep apnoea?

A

This is intermittent upper airway collapse in sleep, causing recurrent arousals and sleep fragmentation

17
Q

What is the cardinal symptom of obstructive sleep apnoea?

A

Daytime sleepiness

18
Q

How is daytime sleepiness measured?

A

Epworth sleepiness scale

19
Q

What is the Epworth sleepiness scale?

A

This requires patients to give a score from 0-3 on how likely they are to sleep during 8 situations

  • Sitting and reading
  • Watching TV
  • Sitting inactive in public
  • Car passenger for 1 hour
  • Lying down to rest in the afternoon
  • Sitting talking
  • Sitting after lunch without alcohol
  • In car, stopped for a few minutes in traffic
  • A total score ≤10 is considered normal
    • 0 = Would never doze
    • 1 = Slight chance of dozing
    • 2 = Moderate change
    • 3 = High chance
20
Q

What causes snoring?

A

This is a physiological phenomenon caused by relaxation of the pharyngeal dilator muscles during sleep, causing upper airway narrowing, turbulent airflow and vibration of the soft palate and tongue base

21
Q

What causes obstructive sleep apnoea?

A

This is caused by relaxation of the pharyngeal dilator muscles during sleep, causing short periods of airway closure, followed by awakening

22
Q

What is the most common cause of sleep apnoea in children?

A

Inflamed tonsils

23
Q

What are some risk factors of obstructive sleep apnoea?

A

Enlarged tonsils
Obesity
Retrognathia
Acromegaly
Hypothyroidsm
Oropharyngeal deformity
Neurological syndromes
Drugs (e.g. benzodiazepines, opiates, alcohol)
Post-anaesthesia

24
Q

What is retrognathia?

A

This is a condition characterised by a set back lower jaw which pushes the tongue back

25
Q

How does acromegaly cause obstructive sleep apnoea?

A

This causes excess growth hormone production which leads to an enlarged tongue

26
Q

What are some consequences of obstructive sleep apnoea?

A

Excessive daytime sleepiness
Personality change
Cognitive impairment
7x increased risk of road traffic accidents
Loss of drivers license
Raised CRP
Impaired glucose tolerance

27
Q

What are some investigations in obstructive sleep apnoea?

A

Oximetry
Domiciliary recording
Full polysomnography

28
Q

What are some management options in sleep apnoea?

A

CPAP machine
Remove underlying cause (e.g. weight loss)
Mandibular advancement device (Clip onto teeth and holds jaw forward)

29
Q

What is CPAP?

A

Continuous Positive Airway Pressure
This is a mask which applies gentle pressure into the mouth to keep the throat open

30
Q

What is obesity hypoventilation syndrome?

A

This is a condition in which increased weight and changes to neurological signalling decreases ventilation, due to obesity

Respiratory (23 decks)

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