Excessive Daytime Sleepiness

19 Questions

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Sleep Quizzes & Trivia

Questions from small group to help prepare for Course 3 exam


Questions and Answers
  • 1. 
    A 35-year-old female presents with a several year history of profound excessive daytime sleepiness.  She works as a school teacher, and has difficulty staying awake at the desk.  As long as she is on her feet teaching she is OK.  She falls asleep routinely at lunch.  The principal is concerned about her performance.  She is a known snorer, but no bedpartner, so no witnessed apneas.  Typically, she goes to bed at 2300h and falls asleep instantly.  She wakes up several times per night to go to the bathroom, but falls asleep shortly after returning to bed.  She gets up at 0500h.  She does not drink alcohol and takes 3 large coffees each morning to help her wake up.  She is on no sedative meds. Past history includes HTN for 3 years, controlled on medication, well-controlled depression on SSRI for many years.  Family history of hypertension.  What are the most relevant features to look for on physical exam that suggest complications of OSA (3)?
    • A. 

      Hypertension

    • B. 

      Cor pulmonale

    • C. 

      Clubbing

    • D. 

      Tachypnea

    • E. 

      Chronic hypoventilation

  • 2. 
    A 35-year-old female presents with a several year history of profound excessive daytime sleepiness.  She works as a school teacher, and has difficulty staying awake at the desk.  As long as she is on her feet teaching she is OK.  She falls asleep routinely at lunch.  The principal is concerned about her performance.  She is a known snorer, but no bedpartner, so no witnessed apneas.  Typically, she goes to bed at 2300h and falls asleep instantly.  She wakes up several times per night to go to the bathroom, but falls asleep shortly after returning to bed.  She gets up at 0500h.  She does not drink alcohol and takes 3 large coffees each morning to help her wake up.  She is on no sedative meds. Past history includes HTN for 3 years, controlled on medication, well-controlled depression on SSRI for many years.  Family history of hypertension.  Physical exam reveals a BMI of 30, O2 sat 94% on room air, BP 140/90 on medication, and neck circumference 45 cm.  Retrognathia/overbite, no enlarged tonsils, no adenopathy, no thyromegaly.  No elevation of JVP, no loud P2 or RV heave, no right sided heart sounds, no pedal edema.  All of the following findings are most predictive of a diagnosis of OSA EXCEPT
    • A. 

      Neck circumference

    • B. 

      History of snoring

    • C. 

      Daytime sleepiness

    • D. 

      Hypertension

  • 3. 
    A 35-year-old female presents with a several year history of profound excessive daytime sleepiness.  She works as a school teacher, and has difficulty staying awake at the desk.  As long as she is on her feet teaching she is OK.  She falls asleep routinely at lunch.  The principal is concerned about her performance.  She is a known snorer, but no bedpartner, so no witnessed apneas.  Typically, she goes to bed at 2300h and falls asleep instantly.  She wakes up several times per night to go to the bathroom, but falls asleep shortly after returning to bed.  She gets up at 0500h.  She does not drink alcohol and takes 3 large coffees each morning to help her wake up.  She is on no sedative meds. Past history includes HTN for 3 years, controlled on medication, well-controlled depression on SSRI for many years.  Family history of hypertension.  Physical exam reveals a BMI of 30, O2 sat 94% on room air, BP 140/90 on medication, and neck circumference 45 cm.  Retrognathia/overbite, no enlarged tonsils, no adenopathy, no thyromegaly.  No elevation of JVP, no loud P2 or RV heave, no right sided heart sounds, no pedal edema.  Which of the following scheme categories would you consider for this patient?
    • A. 

      Inadequate total sleep time

    • B. 

      Poor sleep quality

    • C. 

      Medical or psychogenic

    • D. 

      Intrinsic sleep disorders

  • 4. 
    Which of the following is an important physical exam finding in terms of OSA in children but less common in adults?
    • A. 

      Blood pressure

    • B. 

      Body mass index

    • C. 

      Neck circumference

    • D. 

      Cricomental space

    • E. 

      Pharyngeal grade

    • F. 

      Tonsil size

    • G. 

      Overbite

  • 5. 
    Which of the following is the gold standard test for OSA?
    • A. 

      Pulse oximetry

    • B. 

      Snoresat

    • C. 

      Polysomnography

  • 6. 
    • A. 

      Pulse oximetry

    • B. 

      Snoresat

    • C. 

      Polysomnography

  • 7. 
    All of the following are limitations of snoresat testing EXCEPT
    • A. 

      Only useful for diagnosing simple obstructive sleep apnea

    • B. 

      No EEG monitor to determine actual sleep

    • C. 

      Expensive and time-consuming

    • D. 

      No trouble-shooting during study

  • 8. 
    True or False: This patient requires treatment for OSA
    • A. 

      True

    • B. 

      False

  • 9. 
    Cardiovascuar risk, CVA risk and mortality is greatest for those with an apnea hyponea index of...
    • A. 

      >10 events per hour of sleep

    • B. 

      >20 events per hour of sleep

    • C. 

      >30 events per hour of sleep

    • D. 

      >40 events per hour of sleep

  • 10. 
    A 35-year-old female presents with a several year history of profound excessive daytime sleepiness.  She works as a school teacher, and has difficulty staying awake at the desk.  As long as she is on her feet teaching she is OK.  She falls asleep routinely at lunch.  The principal is concerned about her performance.  She is a known snorer, but no bedpartner, so no witnessed apneas.  Typically, she goes to bed at 2300h and falls asleep instantly.  She wakes up several times per night to go to the bathroom, but falls asleep shortly after returning to bed.  She gets up at 0500h.  She does not drink alcohol and takes 3 large coffees each morning to help her wake up.  She is on no sedative meds. Past history includes HTN for 3 years, controlled on medication, well-controlled depression on SSRI for many years.  Family history of hypertension.  Physical exam reveals a BMI of 30, O2 sat 94% on room air, BP 140/90 on medication, and neck circumference 45 cm.  Retrognathia/overbite, no enlarged tonsils, no adenopathy, no thyromegaly.  No elevation of JVP, no loud P2 or RV heave, no right sided heart sounds, no pedal edema. Her snoresat shows 28 events per hour of sleep (event scored by the computer program if O2 sat drops by 4%).  You would offer all of the following treatments EXCEPT:
    • A. 

      Medication use

    • B. 

      Sleep hygiene

    • C. 

      Weight loss, sleep position

    • D. 

      Smoking cessation, avoidance of alcohol

    • E. 

      CPAP

    • F. 

      Dental appliance

    • G. 

      UPPP or tracheostomy

  • 11. 
    Why is there chest paradox during an obstructive apnea?
    • A. 

      Increasingly negative pressure against closed airway

    • B. 

      Increasingly positive pressure against closed airway

    • C. 

      Hypoxic diaphragm

    • D. 

      Central apnea

  • 12. 
    This patient has to get up multiple times in the night to urinate.  What is the possible cause for the nocturia experienced by this patient?
    • A. 

      Too much coffee

    • B. 

      'dixie cup bladder'

    • C. 

      Increased diuresis stimulated by increased venous return to the heart

  • 13. 
    What would be the mechanism for development of cor pulmonale in a patient with OSA?
    • A. 

      Retention of CO2

    • B. 

      Hypoxia is a vasoconstrictor

    • C. 

      Hypercapnea is a vasoconstrictor

    • D. 

      All of the above

  • 14. 
    • A. 

      Increased afterload

    • B. 

      Increased preload

    • C. 

      Decreased contractility

    • D. 

      Hypoxia is a vasoconstrictor

  • 15. 
    50-year-old smoker, with recently diagnosed ALS, a progressive neurological disorder, presents to you with frequent awakenings due to a choking sensation and difficulty sustaining sleep.  He was previously well, until 1 year ago, when he was diagnosed with ALS dystrophy, after presenting with difficulty climbing stairs and lifting objects.  At present, he is quite weak, and is able to ambulate for short distances (within the house) without dyspnea.  He is able to eat on his own, without choking episodes or aspiration.  He does, however complain of 4 pillow-orthopnea for the past 3 months. On examination you find diffuse muscle atrophy and weakness, fasciculations, decreased lung expansion, high diaphragms on percussion, reduced breath sounds bilaterally with crackles at the bases.  Abdominal paradox is seen in supine position.  Normal JVP, negative AJR, normal heart sounds, no pedal edema.  Which of the following features on history and physical exam are NOT concerning for respiratory muscle (esp diaphragm) weakness?
    • A. 

      Dyspnea

    • B. 

      Orthopnea

    • C. 

      Morning headaches

    • D. 

      Crackles

    • E. 

      Cyanosis

    • F. 

      Poor chest/lung expansion

    • G. 

      Asterixis

    • H. 

      Signs of cor pulmonale

  • 16. 
    • A. 

      Restrictive defect with decreased diffusion

    • B. 

      Restrictive defect with preserved diffusion

    • C. 

      Obstructive defect with decreased diffusion

    • D. 

      Obstructive defect with preserved diffusion

  • 17. 
    ABG 7.35/48/58/27
    • A. 

      Chronic resp acidosis with normal A-a

    • B. 

      Chronic resp acidosis with abnormal A-a

    • C. 

      Acute resp acidosis with normal A-a

    • D. 

      Acute resp acidosis with abnormal A-a

  • 18. 
    50-year-old smoker, with recently diagnosed ALS, a progressive neurological disorder, presents to you with frequent awakenings due to a choking sensation and difficulty sustaining sleep.  He was previously well, until 1 year ago, when he was diagnosed with ALS dystrophy, after presenting with difficulty climbing stairs and lifting objects.  At present, he is quite weak, and is able to ambulate for short distances (within the house) without dyspnea.  He is able to eat on his own, without choking episodes or aspiration.  He does, however complain of 4 pillow-orthopnea for the past 3 months. On examination you find diffuse muscle atrophy and weakness, fasciculations, decreased lung expansion, high diaphragms on percussion, reduced breath sounds bilaterally with crackles at the bases.  Abdominal paradox is seen in supine position.  Normal JVP, negative AJR, normal heart sounds, no pedal edema.  How will you investigate this patient's sleep complaints?
    • A. 

      Snoresat

    • B. 

      Pulse oximetry

    • C. 

      Polysomnography

  • 19. 
    • A. 

      CPAP

    • B. 

      BiPAP

    • C. 

      Weight loss, alcohol cessation

    • D. 

      Dental appliance

    • E. 

      Tracheostomy