Term
| Which bacterocidal antibiotics is effective against anaerobes? |
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Definition
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Term
| What are the cellular effects of corticosteroids? |
|
Definition
1) Increase gluconeogenesis and promote insulin resistance
2) Increase RBC production and circulating leukocytes
3) Decrease fibroblast collagen formation and neovascularization |
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Term
| Where are H1 antagonists metabolized? |
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Definition
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Term
| which biologic agents are useful in the treatment of RRP? |
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Definition
1) Cidofovir: inhibits viral DNA polymerase, useful in cases needing frequent debridement
2) Bevacizumab (Avastin): VEGF inhibitor
**NOT steroid injection** |
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Term
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Definition
| Sclerosing agent coming from Strep pyogenes used in lymphatic malformations (works best in macrocystic) |
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Term
| Where are amide local anesthetics metabolized? |
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Definition
2 "i's" metabolized in the liver
Bupivacaine, lidocaine, prilocaine, mepivacaine |
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Term
| Where are ester local anesthetics metabolized? |
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Definition
Esters have one "i" and are metabolized by pseudocholinesterase.
Cocaine, benzocaine, procaine, novacaine, tetracaine |
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Term
| Methemoblobinemia can occur with use of prilocaine or benzocaine presenting as cyanosis and oxygen desaturation. What is the treatment? |
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Definition
| 1% methylene blue total 1-2 mg/kg |
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Term
| Which local anesthetics have the shortest and longest durations, respectively? |
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Definition
Lidocaine is shortest
Bupivacaine is longest (also cardiac concern) |
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Term
| How does botox type A differ from type B? |
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Definition
Type A is most commonly used.
Type B can be used if type A tolerance. It acts quicker and wears off sooner.
Type B only cleared for cervical dystonia and chronic sialorrhea. |
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Term
| What is Lugol's solution? |
|
Definition
| Potassium iodide and elemental iodine in water. Used as source iodine in iodine-deficient patients and for treatment of thyrotoxicosis prior to surgery. |
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Term
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Definition
| H1 antihistamine with anticholinergic properties |
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Term
| Which herbal supplements can increase bleeding risk? |
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Definition
| Gingko, Garlic, Ginseng, Feverfew, Saw Palmeto |
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Term
| What are the stages of the Stanford Protocol? |
|
Definition
1) UPP, genioglossus advancement and hyoid suspension.
2) MMA |
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Term
| What are the AHI tresholds for adults? |
|
Definition
AHI= apneas + hypopneas per hour
0-5 normal
5-15 mild
15-30 moderate
>30 severe |
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Term
| How does AHI compare to RDI? |
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Definition
Apnea= cessation of airflow for >10 seconds
AHI= apneas + hypopneas per hour
RDI= respiratory-even-related arousals + apneas + hypopneas per hour |
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Term
| How is an apneic event defined? How does this differ from a hypopnea? |
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Definition
Apnea= Cessation of airflow for 10 seconds or more associated with EEG arousal, hypoxia and a drop in peak signal excursion by >90%
Hypopnea= Drop is peak signal excursion by >30% for >10 seconds with >4% oxygen desat. |
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Term
| What is the diagnostic criteria for narcolepsy? |
|
Definition
1) mean sleep latency of <8 minutes on MSLT
Asked to nap 5 times at 2h intervals after full night sleep.
2) rapid onset REM sleep on PSG |
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Term
| What findings on lateral cephalometry are associated with increased risk of OSA? |
|
Definition
1) Decreased maxillary and mandibular projection
2) Low hanging hyoid
3) Increased vertical facial length
4) Increased tongue size and increased length and width of soft palate |
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Term
| How is the OSAHS score calculated and used to predict OSA? |
|
Definition
BMI + tonsil size + Friedman tongue size (each 0-4). Total score is 0-12.
Score 8 or greater has 90% chance of having moderate OSAHS and 74% chance of having severe.
Scores <4 have 67% chance of not having moderate/severe OSAHS |
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Term
| How is sleep-related hypoventilation defined? |
|
Definition
| >10 mmHg increase in PaCO2 compared to awake state, OR rise in PCO2 >55 mmHg for >10 min during sleep |
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Term
| What is the classic EEG findings by sleep stage (N1, N2, N3, REM)? |
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Definition
N1= cesation of alpha waves and transition to theta waves.
N2= K complexes and sleep spindles
N3= delta waves >30 % of sleep time
REM: wake pattern EEG with REMs |
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Term
| How is overall Friedman stage used to predict success with UPPP in treating OSA? |
|
Definition
Surgical success is defined as >50% reduction in pre-operative AHI or postop AHI <20).
3 possible stages, defined by BMI (< or >40), tonsil grade (1-4) and tongue position (1-4).
Stage 1= 80% chance of success.
Stage 2 (40%)-3 (10%)= UPPP not appropriate alone
Basically need BMI <40, large tonsils and palate position of 1-2. |
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|
Term
| Most common cardiac arrhythmia in OSA |
|
Definition
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Term
| What are the associated laboratory findings and treatment for narcolepsy? |
|
Definition
Low CSF hypocretin
Diagnosed on MSLT (<8 minutes sleep latency)
Treat with modafinil or methylphenidate
Treat cataplexy with antidepressants.
**gamma hydroxybutyrate is approaved for treatment of sleepiness and cataplexy associated with narcolepsy, in addition to TCAs and SSRIs)** |
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Term
| What hormonal changes occur during sleep? |
|
Definition
Cortisol, Prolactin, glucose and insulin increase with sleep
TSH and Growth hormone decrease with sleep |
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Term
| What % of patients who failed initial CPAP therapy will improve AHI <15 with oral appliance? |
|
Definition
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|
Term
| When is CPAP recommended? |
|
Definition
Symptomatic moderate (AHI 15-30) or any severe OSA.
Mild to asymptomatic moderate OSA can be treated first with lifestyle modifications |
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Term
| What is the Mueller maneuvar? |
|
Definition
Awake, either sitting or supine.
Reverse valsalva to assess retrolingual and retropalatal collapse. Abnormal if >50% collapse. |
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Term
| When do sleep terrors occur during the night compared to nightmares? |
|
Definition
Don't remember them, happen in first 1/3 of night
Nightmare remember, not confused, occur in REM sleep |
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Term
| How does upper airway resistance syndrome (UARS) compare to OSA? |
|
Definition
Overlapping symptoms, both benefit from CPAP.
UARS have similar symptoms to OSA< but lack significant number of obstructive events during PSG. |
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