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RESPIRATORY > Stridor and Sleep Apnoea > Flashcards

Stridor and Sleep Apnoea Flashcards

1
Q

What structures of the upper airway normally sit above the trachea?

A
  • larynx

- subglottis

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2
Q

How is stridor defined?

A
  • inspiratory wheeze
  • due to large airway obstruction
    => (larynx/trachea/major bronchi)
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3
Q

What are the most common causes of stridor in children?

A

Infections
Foreign Body
Anaphylaxis / angioneurotic oedema
Other (eg burns)

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4
Q

What infections can cause stridor in children?

A
  • Croup (or Pseudomembranous croup)
  • Epiglottitis
  • Retropharyngeal abscess
  • Diphtheria
  • Infectious mononucleosis
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5
Q

What can cause stridor in adults?

A
  • Cancers
  • Anaphylaxis
  • Goitre (retrosternal)
  • Foreign body
  • Trauma (eg strangulation, burns, irritant gases)
  • Other (eg vocal cord palsy; Wegener’s granulomatosis)
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6
Q

What cancers may cause stridor in adults?

A
  • Larynx
  • Trachea
  • Major bronchi
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7
Q

What is tracheomalacia and when may this cause stridor?

A
  • flaccidity of supporting tracheal cartilage
    => widening of the posterior membranous wall
    => reduced trachea diameter

This causes tracheal collapse
- especially during times of increased airflow
=> coughing, crying, or feeding

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8
Q

How is stridor investigated?

A
  • Laryngoscopy (beware in acute epiglottitis)
  • Bronchoscopy
  • Flow volume loop
  • CXR
  • Other imaging (CT; thyroid scan)
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9
Q

How is laryngeal obstruction treated?

A
  • Treat underlying cause
    => eg foreign body removal (Heimlich Manoeuvre) anaphylaxis (adrenaline)
  • Mask bag ventilation with high flow O2
  • Cricothyroidotomy
  • Tracheostomy
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10
Q

How is malignant airway obstruction treated?

A
  • Tumour removal
    => laser; photodynamic therapy; cryotherapy; diathermy; surgical resection
  • Tumour compression
    => intraluminal stent
  • Radiotherapy
    => external beam; brachytherapy
  • Chemotherapy
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11
Q

What symptoms would indicate a patient is in acute anaphylaxis?

A
  • Flushing, pruritus, urticaria,
  • Angioneurotic oedema (lips, tongue, face, larynx, bronchi)
  • Hypotension (vasodilatation and plasma exudation) circulatory collapse (shock)
  • Stridor, wheeze and respiratory failure
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12
Q

WHat can potentially cause anaphylaxis in patients?

A

Foods eg nuts; shellfish
Insect venom (bee, wasp)
Drugs (eg penicillin, aspirin, anaesthetics)
Other eg latex

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13
Q

How is anaphylaxis treated?

A 
IM Adrenaline
IV antihistamine
IV corticosteroid
High flow O2
Nebulised bronchodilators
Endotracheal intubation if necessary
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14
Q

How is anaphylaxis prevented?

A

Allergen avoidance (where possible)
Desensitisation (immunotherapy) eg venom
Self-administered epinephrine

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15
Q

What is meant by obstructive sleep apnoea?

A
  • Intermittent upper airway collapse in sleep
  • causes patient to stop breathing for short period (apnoea)
  • patient often wakes up => fragmented sleep
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16
Q

What are the risk factors for sleep apnoea?

A
  • Enlarged tonsils, adenoids OR Oropharyngeal deformity
  • Obesity
  • Acromegaly, hypothyroidism
  • Neurological muscle problem
  • Sedative Drugs: benzos, opiates, alcohol,
  • Post-op. after anaesthesia
17
Q

What consequences can sleep apnoea cause in a person’s daily life?

A
  • excessive daytime sleepiness
    => driving impaired
  • personality change
  • cognitive / functional impairment
18
Q

What other medical conditions are a potential consequence of sleep apnoea?

A
  • risk factor for hypertension (due to activating sympathetic system)
    => increased risk of stroke and cardiovascular events
  • Raised CRP
  • Impaired endothelial function
  • Impaired glucose tolerance
19
Q

Consequences of Sleep Apnoea are all improved by what type of ventilation?

A

CPAP

20
Q

What symptoms would raise a person’s Epworth Score and point towards a diagnosis of Sleep Apnoea?

A
  • snoring

- excessive daytime sleepiness

21
Q

What investigations can be used to diagnose sleep apnoea?

A
  • Overnight sleep study
    => oximetry
    => domicillary recording (airflow, oximetry, thoracic/abdominal movement)
22
Q

How is obstructive sleep apnoea treated?

A
  • Remove underlying cause
  • CPAP (continuous positive airway pressure)
    => patient wears mask over nose as they sleep
23
Q

What can be used to improve snoring for a patient?

A

Mandibular Advancement Device
- improves snoring
AND improves apnoea-hypoapnoea index

RESPIRATORY (9 decks)

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