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Sleepiness

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frontal
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03/19/06 - 06:48 AM

A 60-year-old obese male complains of excessive daytime sleepiness. He has been in good health except for mild hypertension. He drinks alcohol in moderation. The patient's wife states that he snores at night and awakens frequently. Examination of the oropharynx is normal. Which of the following studies is most appropriate?

A) EEG to assess stage sleep patterns

B) Ventilation pattern to detect apnea

C) Arterial O2 saturation

D) Polysomnography to include all of the above

The patient above is found to have recurrent episodes of arterial desaturation-about 15 events per hour-with evidence of obstructive apnea. The treatment of choice for this patient is

A) Nasal continuous positive airway pressure

B) Uvulopalatopharyngoplasty

C) Weight reduction

D) Tracheostomy

Sometimes I get more questions wrong after having read a topic. This is really irritating and disgusting.

Edited by frontal on 03/19/06 - 06:56 AM

sobia naeem
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03/19/06 - 07:01 AM

the first one is polysomnography
the second one is to give nasal continous positive airway pressure as the next best step..
weight loss is something which takes a little time ..
enlighten me further smiling face

cyra
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03/19/06 - 07:05 AM

I agree with sobia.

achilles
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03/19/06 - 07:47 AM

i too agree with sobia, for the first question-polysomnography and for the 2nd-CPAP.

and what you are saying frontal happens with all of us...we all get our questions wrong even after reading the topic but then how i feel later on is that the understanding and concepts gets better when we solve questions on the topic...and the next time we are not going to make the same mistakes...so lets just keep working at it and god willingly we'll all get there.

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frontal
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03/19/06 - 08:09 AM

Sobia: you need no further enlightenment. You all have the answers right.

I can recall having answered A for the second question, based on commonsense and guessing, when I did it some months back. Now when I did quite a study on Pickwickian syndrome I chose weight reduction. (Sobia is right on the reason-takes time). Heaven help me. rolling eyes

Harrison's says that in patients with a high probability of Obstructive Sleep Apnea (based on a history of habitual snoring, nocturnal choking or gasping, witnessed apneas during sleep, and daytime sleepiness or fatigue) overnight recording of arterial 02 saturation by oximetry can be used to confirm the diagnosis and obviate the need for full polysomnography by demonstrating recurrent episodes of desaturation (@ at least 10-15 events/hour). Negative results in such a patient do not exclude the diagnosis and mandate that the patient proceeds to polysomnography. Based on this I chose C as the answer to the first one and got it wonderully wrong.

sobia naeem
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Topics: 30
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03/19/06 - 08:19 AM

relax frontal.it happens sometimes we get stuff wrong which we previously got right..i cant imagine what got into my head on that lyme disease question when i wrote that it was caused by a tick.when actually its a spirochete.. wink

..it happens to us all.

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