Sleep Disorders
Is sleep apnea a decrease in ventilation or increase in ventilation?
decrease in ventilatory drive
Your pt. presents to his PCP complaining of a chronic cough he has had for the past two years over 3 month periods. His px presents with cyanosis, productive cough, wheezing, and an increased hemoglobin. What is the biggest risk factor for this condition?
Smoking
What is the genetic form of COPD caused by inactivated elastase and what is your dx test of choice to confirm?
A1 antitrypsin deficincey
DX: serum AAT (GENETIC TESTING FOR ALL COPD pts)
What is your most common symptom of bilateral diaphragmatic paralysis?
Orthopnea
What are patients who suffer from kyphoscoliosis at risk for?
Respiratory failure, stay up to date on vaccines
Your pt. presents to the clinic c/o of non-restorative sleep. pt. has a history of heart failure with reduced ejection fraction. What type of sleep apnea do you suspect?
Central sleep apnea
note: brainstem is responsible
decreased FEV1 <80% <FEV1/FVC less than .70. Must be done with and without a bronchodilator to confirm diagnosis and rule out asthma
What test confirms a diagnosis of bronchiecstasis
HRCT- TRAM TRACK OPAITIES
Pt. had a blowing chest wound during a football game. He was knocked unconcious but upon chest examination there is paradoxical movement of the chest wall. What is the diagnosis?
Flail Chest
What obstructive lung disorder is autosomal recessive?
Primary ciliary dyskinesia
What is gold standard dx for sleep apnea?
polysomnography
Your pt. presents to the clinic with emphysema. He has minimal symptoms and no prior hospitalizations. What is his GRADE and how will you treat him?
Grade A bronchodialator
Pt. presents to the clinic with dyspnea. Px reveals hyperreasonance, and dead space on CXR >1cm. What is your dx?
Bullous Lung Disease
Pt. has a injury to their C2 what type of neuromuscular disorder is this and what is the treatment?
Functional transection
Tx: mechanical ventilation, abdominal binding
Your pt presents to the clinic with a lower respiratory infection, cough, and SOB for the past week. An NP wants to put them on amoxicillin. Is this the correct course of treatment?
No this is acute bronchitis. Wait it out
What type of breathing is seen in central sleep apnea?
cheyne strokes breaths
What are the two things that must be included in COPD treatment that improve risk of mortality
Smoking cessation and supplemental O2
What is the test of choice for CF, the tx of choice, and etiology?
chloride sweat test
Azithromycin, Recombination DNase (CF meds), shaking vest resp therapy
mutation on the CFTR gene on Chromosome 7
Pt. presents to clinic with a curved in chest and is complaining of difficulty breathing. What is a major risk factor for this and what is the treatment?
Marfans syndrom
surgery in youth
Your patient has a history of lung cancer and presents to your clinic with difficulty walking and breathing what is the cancer and what is the prognosis?
obstructive sleep apnea, Tx:CPAP
Your pt. presents to the clinic with dyspnea. They have a 20 year smoking history. Px reveals barrel chest, pursed lip breathing, and hyperreasonant percussion. What is your dx and what is the etiology?
Emphysema-destruction of parynchyma and alveolar wall destruction
Note CXR will reveal overinflation
Pt. presents to the clinic with dyspnea and cough. PFT reveals fixed obstruction. MH reveals viral infection of RSV. What would you expect to find on HRCT for this pt?
Mosaic pattern pt. has broncholitis obliterans
Pt. presents to the clinic with difficulty breathing. Px reveals unilateral paralysis of the phrenic nerve. What is your most common etiology for this disorder and diagnostic test of choice?
etiology: Lung mass
dx: sniff test
Your pt presents to the clinic with progressing paralysis affecting their breathing. They have a hx of parkinsons and are currently being treated for an infection with clindamycin. What is the reason for their paralysis?
The clindamycin
other drugs include succinylcholine, chloraquine, propranolol and botulism