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Respiratory > Stridor and Sleep Apnoea > Flashcards

Stridor and Sleep Apnoea Flashcards

1
Q

What is stridor?

A

Predominantly inspiratory wheeze due to large airway, (larynx, trachea or major bronchi) obstruction

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2
Q

What are the most common extrathoracic causes of stridor?

A

Laryngomalacia- congentital softening of the soft tissues of the larynx
Supraglottic mass- a mass above the glottis
Glotic lesions
Vocal chord paralysis (only if bilateral as the body will compensate for unilateral paralysis)

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3
Q

What are the most common causes of stridor in children?

A 
Croup
Epigolttisis (H. influenzae medical emergency)
Pseudomembranous croups
Reteropharangeal abcess
Dipthiria
Glandular fever
Foreign body
Anaphlyaxis
Burns- inhaled hot vapour causing oedema and traumatic insult to upper airway
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4
Q

Which bronchi is a foreign body more likely to be found in?

A

Right bronchi as it’s more vertical than the left

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5
Q

What are the signs of foreign body inhalation in children and older people at high risk?

A

Acute onset of stridor accompanied by a chocking spell

Children’s cough reflex is not as good as adults

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6
Q

What are the most common causes of stridor in adults?

A

Neoplasms in the larynx, trachea and major bronchi
Anaphylaxis
Goitre- enlarged thyroid
Trauma- burns strangulation or irrritant gases
Bilateral vocal chord palsy
Wenger’s granulomatous- inflamatory problem
Cricoarytenoid arthritis
Tracheopathia
Tracheomalacia

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7
Q

What is Tracheomalacia?

A

Tracheomalacia- Flaccidity of the supporting tracheal cartilage, widening of the posterior membranous wall and reduced anterior-posterior airway calibre => airway collapse during times of increase air flow

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8
Q

What is Tracheopathia?

A

Tracheopathia- benign endoluminal projection of cartilaginous and bony nodules arising in the sub mucosa

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9
Q

If smeone presents with stridor, what investigations are needed?

A

Laryngoscopy- beware acute epiglotitis as will irritate airway more
Bronchoscopy
Siprometry
CXR ?CT and ?thyroid scan

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10
Q

What will spirometry show with an upper airway obstruction?

A

Low peak flow but continues for a longer period of time before dropping off- like a table top mountain

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11
Q

What is the treatment for laryngeal obstruction?

A

Treat underlying cause- remove forign body etc
Mask bag ventilation with high flow oxygen
Cricothyroidotomy if the airway is entirely blocked
Tracheotomy- surgical incission in the neck and trachea

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12
Q

What is the treatment for malignant airway obstruction?

A 
Tumour removal using:
Laser/photodynamic therapy
Crycotherapy- freezing technique
Diathermy- electrical induced heat/electromagnetic current
Surgical resection 
Tumour compression using intraluminal stent 
Radiotherapy/Bracheotherapy 
Chemotherapy
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13
Q

What is acute anaphylaxis?

A

Type 1 sensitivity reaction- IgE mediated
Occurs when someone is already sensitised to the antigen and mast cells are already present and immediately degranulate causing inflammation and oedema

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14
Q

What are the signs of anaphylaxis?

A

Flushing, urticaria (Hives), Pruritus (severe itching of the skin)
Angioneurotic oedema (Lips, tongue, face, larynx, bronchi)
Abdominal pain and vommiting
Hypotention (casodilation and plasma exudation => shock)
Stridor, wheeze and respiratory failure

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15
Q

What are the most common causes of anaphylaxis?

A

Foods, insect venom, drugs and latex

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16
Q

What is the treatment for anaphylaxis?

A

5 micrograms of IM adrenaline-effect immediate
IV antihistamine- effect 15-20 mins
IV steriods (hydrocortisone or prednisalone)- effect hours
High flow oxygen
Nebulised bronchiodilators
Endotracheal intubation if necessary

17
Q

What are the important counselling points to give someone with a severe allergic reaction?

A

Allegen avoidance
Desensitisation (immunotherapy- give small doses of antigen weekly to build up a tolerance)
Epipen use- self administered adrenaline

18
Q

What does the epworth score assess and what is a normal score?

A

Sleepiness and a normal score is <10/24

8 questions scoring up to 3 for each

19
Q

What causes snoring?

A

Relaxation of pharyngeal dilator muscles during sleep, especially REM sleep => upper airway narrowing, turbulent airflow and vibration of soft palate and tongue base

20
Q

What is OSA?

A

Intermittant upper airway collapse in sleep

Apnoesa or hypoapnoeas +/- hypoxaemia which lead to recurrent arousals

21
Q

What are the consequences of OSA?

A

1) Sleep fragmentation. Normal people wake 30 times a night. OSA patients wake >100 times a night
2) Excessive daytime sleepiness
3) Personality change
4) Cognative/functional impairment due to differential oxygen flow to the brain
5) probable increase in CVD and CVA

22
Q

When do children get OSA?

A

Enlarged or infected tonsils

23
Q

What proportion of the adult population is affected by OSA?

A

1-4%

24
Q

What are the risk factors for OSA?

A

Obesity
Enlarged tonsils/adenoids (tissue at back of nose)
Retronathia- jaw set back
Acromegaly (excess growth hormone)/ Hypothyroidism
Neurological- anything that effects muscle tone
Drugs- benzodiazepines, opiates, alcohol
Post Op after anaesthesia

25
Q

Waking up regularly increases sympathetic stimulation which has multiple effects on the body. How does this effect:

1) C reactive protein
2) blood pressure
3) glucose tolerance

A

1) C reactive protein- raised => more inflamation
2) blood pressure- raised => OSA is an independant risk factor for hypertention
3) glucose tolerance- impaired => diabetes

26
Q

How is OSA diagnosed?

A

1) Snoring and excessive daytime sleepiness- high epworth score
2) Overnight sleep study including oximetry, domicillary recording (airflow oximetry and thoracic/abdominal movements

27
Q

How is OSA treated?

A

1) Remove underlying cause- for most people there is none
2) CPAP- continuous positive airway pressure
3) Mandibular advancement device
4) Surgery- uncommon

28
Q

What is CPAP?

A

Continuous positive airway pressure
Most effective and greatest increase in QoL
Uses a full face mask and helps to keep upper airways patent

29
Q

What is a mandibular advancement device?

A

Brings the jaw forward and tries to open the airway at the back
Improves snoring and good for mild cases/claustrophobia

Respiratory (26 decks)

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