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Week 207 - OSA and Chest Wall Flashcards

1
Q

Week 207 - OSA and Chest Wall: Where does control of the respiratory rhythm come from?

A

Medulla Oblongata

  • Ventral respiratory group (mostly expiratory firing)
  • Dorsal respiratory group (mostly inspiratory firing)
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2
Q

Week 207 - OSA and Chest Wall: What is the group pacemaker hypothesis?

A

• Membrane properties of individual neurones and connections between neurones, generate rhythmic bursts of firing.

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3
Q

Week 207 - OSA and Chest Wall: What is the role o the pontine respiratory group?

A

Fine tunes the respiratory rhythm.

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4
Q

Week 207 - OSA and Chest Wall: What are the four airway and lung reflexes that fine tune respiration?

A
  • Nose + upper airways; irritant receptors > Vagus nerve.
  • Stretch receptors > Vagus nerve.
  • Irritant receptors > Vagus nerve > Bronchoconstriction.
  • J receptors in alveoli - Engorged capillaries / interstitial fluid > Vagus nerve > Dyspnoea.
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5
Q

Week 207 - OSA and Chest Wall: What is the main chemical stimulus for breathing when PaO2 and PaCO2 are normal?

A

Co2

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6
Q

Week 207 - OSA and Chest Wall: In what situation can O2 directly stimulate breathing?

A

At low levels of PO2.

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7
Q

Week 207 - OSA and Chest Wall: What is the name of scoring system for assessment of sleep apnoea?

A

Epworth sleepiness scale.

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8
Q

Week 207 - OSA and Chest Wall: What are the ABG results for a person in Type I respiratory failure?

A

PO2 : Low
PCO2 : Normal (or low)
pH : Normal (or alkalosis)
HCO3 : Normal (or low)

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9
Q

Week 207 - OSA and Chest Wall: What are the ABG results for a person in Type 2 respiratory failure?

A

PO2 : Low
PCO2 : High
pH : Acidosis (or normal)
HCO3 : High (or normal)

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10
Q

Week 207 - OSA and Chest Wall: What is the FEV1, FVC and FEV1:FVC in a restrictive lung disease?

A
  • FEV1 and FVC are both reduced since there is a reduced volume.
  • The ratio will therefore be normal (or may increase since FVC is reached quickly).
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11
Q

Week 207 - OSA and Chest Wall: What are the three types of Acid Maltase deficiency?

A
  • It is an autosomal recessive disease.
  • Defect of lysosomal enzyme.
  • Causes painless, slow, progress proximal muscle myopathy. (Diaphragm involvement is common, presents with respiratory failure)
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12
Q

Week 207 - OSA and Chest Wall: What are the three types of Acid Maltase deficiency? Describe each briefly.

A
  • Infantile - Organomegaly, skeletal muscle involvement, CVS, Resp. failure and usually death <2years.
  • Juvenile - limited survival.
  • Adult - Best prognosis.
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13
Q

Week 207 - OSA and Chest Wall: What is the definition of obstructive sleep apnoea?

A

Stopping (or slowing) of breathing during sleep due to obstruction of the upper airway.

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14
Q

Week 207 - OSA and Chest Wall: What is the incidence of OSA?

A

2-5% men and 1-2% of women have OSA worthy of treating.

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15
Q

Week 207 - OSA and Chest Wall: What is the aetiology of OSA?

A
  • Pharyngeal incompetence brought on by sleep.
  • Periods of arousal from sleep to clear airway.
  • Markedly fragmented sleep.
  • Daytime consequences (Sleepiness)
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16
Q

Week 207 - OSA and Chest Wall: What are the risk factors for developing OSA?

A
  • Obesity
  • Lower facial shape.
  • Tonsils, Hypothyroid, smoking, acromegaly, nasal problems, alcohol, sedatives, menopause, neuromuscular diseases/stroke.
17
Q

Week 207 - OSA and Chest Wall: What is the distribution of male:female in OSA?

A

M:F, 4:1 > 10:1

18
Q

Week 207 - OSA and Chest Wall: What is the age distribution of OSA?

A

• Can occur at any age, but increases with age and the peak presentation is 40-60 years.

19
Q

Week 207 - OSA and Chest Wall: What are the daytime symptoms of OSA?

A
  • SLEEPINESS
  • Dry mouth
  • Morning Headaches
  • Poor concentration
  • Irritability
  • Anxiety/depression
  • Loss of libido
20
Q

Week 207 - OSA and Chest Wall: What are the night time symptoms of OSA?

A
  • Snoring
  • Choking
  • Nocturia
  • Apnoeas
  • Sweats
  • Restless Sleep
  • Vivid dreams
21
Q

Week 207 - OSA and Chest Wall: What are the laboratory investigations available for OSA? Give a brief description of each.

A
  • Simple oximetry.
  • Embletta - Oximetry, Nasal flow, Snoring, Pulse, Chest movements.
  • Visilab - Observation and data obs. (Sleeping position, Activity, sats, pulse)
  • PSG - Polysomnography, studies EEG, EOG, EMG, ECG.
22
Q

Week 207 - OSA and Chest Wall: What is the management of OSA?

A
  • Address underlying cause (acromegaly, hypothyroidism)
  • Stop evening alcohol and sedatives.
  • Stop smoking.
  • Lose weight.
  • Posture training.
23
Q

Week 207 - OSA and Chest Wall: What are the four functions of the pericardium?

A
  • Stabilisation of the heart within the thoracic cavity, due to its ligamentous attachments.
  • Protection.
  • Pericardial fluid functions as a lubricant.
  • Prevention of excessive dilation of the heart.
24
Q

Week 207 - OSA and Chest Wall: What are the symptoms of reasonably large pericardial effusion?

A
  • Disruption to haemodynamics of heart.
  • SOB
  • Dysphagia
  • Hoarseness
  • Hiccups
25
Q

Week 207 - OSA and Chest Wall: What are the signs on an ECG of a pericardial effusion?

A

Low Voltage.

electrical alternans.

26
Q

Week 207 - OSA and Chest Wall: What are the signs of tamponade?

A
  • Tachycardia
  • Hypotension
  • Rales/oedema/ascites
  • Muffled heartsounds
  • pulsus pardoxus
27
Q

Week 207 - OSA and Chest Wall: What is the basic outline of the jugular venous wave form?

A
  • a Wave is first, this is due to contraction of the right atrium.
  • x descent, small descent due to relaxation of the atria.
  • c Wave, not normally visible.
  • x descent, during early stage of systole, fall of R.atrial pressure, floor of RA and tricuspid valve drops due to rv contraction.
  • v Wave, due to continuous filling of right atrium, whilst tricuspid valve is closed.
  • y descent, reduction in right atrium pressure due to opening of tricuspid valve.
28
Q

Week 207 - OSA and Chest Wall: Describe what is occurring during the a Wave of the JVP.

A
  • First positive presystolic wave.
  • Dominant wave in JVP.
  • Due to the contraction of the right atrium.
  • Precedes S1 but comes after the ECG p wave.
29
Q

Week 207 - OSA and Chest Wall: The c Wave of the JVP is not always present, what does it interrupt and what can it signify?

A
  • Appears as a wave during the x descent.
  • Transmitted carotid pulsations.
  • Upward bulge of closed tricuspid valve is isovolumic systole.
30
Q

Week 207 - OSA and Chest Wall: What is the v Wave?

A

• Due to increased pressure in the right atrium due to continuous filling whilst the tricuspid valve is closed.

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