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22 Cards in this Set

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define apnea

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no breathing for at least 10 seconds
define hypopnea

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decrease of airflow (50%) with a desaturation of O2 of 4%
what is the biggest problem in obstructive sleep apnea?
tongue drops back and occludes the airway
what is the difference between obstructive and central sleep apnea
obstructive: you will see the chest move in an attempt to breathe

central: chest wont move, signal is not sending down to breathe
wife says they need to kick or punch husband to get them to breathe during sleep
this is the normal way it comes to you in the clinic
what are 4 clinical risk factors for sleep apnea?
Neck Size > 17 in1

Epworth Sleep Score > 102

Mallampati score 3+3

History of apnea, heavy snoring/gasping
an Epworth score greater than what is likely to have sleep disordered breathing?
10

questions include: do you fall asleep when doing different shit
pulmonary HTN, arrhythmias, and HTN are all co-morbid conditions with what?
sleep apnea
how do you diagnose sleep apnea?

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Polysomnogram (PSG)

Overnight observation of sleep with EEG, pulse ox, EKG, flow sensors on chest
what is apnea hypopnea index (AHI)
number of apnea/hypopnea events per hour
what is the nonsurgical treatment of sleep apnea? 2
non surgical....masks

CPAP: one pressure throughout entire cycle
BiPAP: pressure change allows for gas exchange component
what is the amphetamine related drug that is good adjunct therapy for sleep apnea?
Modafinil
what is the newer version of Modafinil?

What is this used for?

MOA?
Nuvigil

Apnea

unknown
what is the gold standard last resort treatment of apnea?

problem with this?
tracheostomy

problem: Lose humidification of nasopharynx
Direct access to lower respiratory tract (easier to get sick)
what is Uvulopalatopharyngeoplasty
Surgical approach to reduce redundant tissue at one of the obstructive sites
Does not cover the lower pharynx occlusion which is more common
Used when patients cannot tolerate or wear CPAP (craniofacial abnormalities)
CPAP vs BiPAP?

**
CPAP: fixed amount running the whole time over your face

BiPAP: when you inspire you get a certain pressure. When expiration occurs, the pressure is dropped, the change in pressure allows for GAS EXCHANGE**
27 year old, low diffusion capacity level, no symptoms of pneumonia, no asthma or COPD. What can be the cause of this problem
if diffusion capacity is diminished but lungs are normal you have to look at blood flow problems
55 year old Caucasian male, smoker, with new gradual onset dyspnea on exertion
Recent clean cardiac catheterization (no cardiac problem). What should you order?
Spirometry

looking for COPD
30 year old African American female, nonsmoker, with cough, rhinitis and dyspnea. spirometry shows a reversible component and a restrictive component. What do you order due to the restrictive component?
Chest Xray
if you see cobble-stoning on the mucosal surface what should you think
Sarcoid!
37 year old white female, smoker with dyspnea and wheeze and abnormal CXR showing basilar predominate bullous emphysema..what is going on?

***
Alpha 1 deficiency

genetic testing shows she is a PIZZ
40 year old obese Caucasian white male presents to office with sudden onset dyspnea after returning from business trip to New York

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sudden onset with immobilization should ring bells for

PE