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Multiple Choice Questions (MCQ)

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Category: Critical Care Medicine-Pulmonary Disorders--->Sleep Apnea
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Question 1#Print Question

You assess a 55-year-old male patient who is a candidate for bariatric surgery. He is 175 cm, 120 kg and has arterial hypertension for which he takes ramipril. His wife tells you the patient snores during the night. His blood pressure (BP) is 125/75 mm Hg and pulse oximetry is 89% on room air.

What is the MOST appropriate management of this patient?

a. Proceed to surgery without further testing
b. Postpone surgery and proceed with a sleep study
c. Perform an arterial blood gas analysis
d. Recommend positive airway pressure (PAP) treatment at night and proceed to surgery


Question 2#Print Question

A 65-year-old male with a history of heart failure and central sleep apnea with Cheyne-Stokes (CSA-CSB) breathing presents to your clinic for evaluation. He had been started on continuous positive airway pressure (CPAP) therapy but did not tolerate it. His recent echocardiogram shows an ejection fraction (EF) of 40%. His medical therapy has already been optimized.

What is the MOST appropriate management of this patient?

a. Initiate adaptive servo-ventilation (ASV)
b. Perform an in-laboratory polysomnography (PSG)
c. Initiate supplemental nocturnal oxygen
d. Initiate bilevel positive airway pressure in a spontaneous timed mode (BPAP-ST)


Question 3#Print Question

You evaluate a 49-year-old patient who has been referred to you because of excessive daytime sleepiness. His past medical history includes drug-controlled hypertension, obesity (body mass index [BMI] 36 kg/m2 ), and low back pain for which he has been taking daily nonsteroidal anti-inflammatory drugs (NSAIDs) and oxycodone for the past 5 years. Upon questioning his wife reports loud snoring during the night, to the point where she has sometimes had to sleep in another room. She does not think she has witnessed any apneic episodes but states she cannot be certain.

What is the MOST appropriate next step in the management of this patient?

a. Overnight PSG for further investigation of sleep apnea
b. Overnight home sleep apnea testing (HSAT), for further investigation of sleep apnea
c. Initiating PAP treatment, as the diagnosis of sleep apnea can be made based on the information provided
d. Overnight pulse oximetry for further investigation of sleep apnea


Question 4#Print Question

You are asked to evaluate a 45-years-old female who is scheduled to undergo elective laparoscopic cholecystectomy. Her past medical history includes hypertension, which is controlled with an angiotensin-receptor blocker (ARB), and obesity (BMI 39 kg/m2 ). Upon questioning, she tells you she snores loudly during the night and often dozes off during the day. Investigating further, she reports she has been told she sometimes stops breathing during the night. Her vital signs during your examination are:

  •  BP of 135/75
  • heart rate (HR) 67
  • SpO2 97% on room air

She presents you with a recent echocardiogram, which is unremarkable. You take an arterial blood gas, which shows:

  • pH 7.38
  • pCO2 42
  • pO2 87
  • HCO3 − 25

What is the MOST appropriate management of this patient?

a. Advise the patient immediate further testing is necessary and postpone surgery
b. Make the patient aware she has a high probability of obstructive sleep apnea (OSA) and the implied risks and proceed to surgery without further immediate testing
c. Initiate PAP treatment and proceed to surgery
d. Perform a follow-up echocardiogram


Question 5#Print Question

A 43-year-old female is referred to your clinic by her primary care physician after undergoing a polysomnographic study, which supports a diagnosis of OSA (Apnea-Hypopnea Index [AHI] 25). Her BMI is 36 kg/m2 , her BP is 135/70, HR 82 bpm, and SpO2 88% on room air. She presents you with a recent arterial blood gas on room air (pH 7.35, pCO2 51 mm Hg, pO2 60 mm Hg, and HCO3 − 31 mEq/L), chest x-ray (which is reported as normal), and spirometry (showing a restrictive picture). She denies ever smoking or taking recreational drugs and only takes simvastatin for her high serum cholesterol levels (now under control).

What is the MOST likely diagnosis?

a. Chronic obstructive pulmonary disease (COPD)
b. OSA
c. Overlap syndrome
d. OSA and obesity hypoventilation syndrome (OHS)




Category: Critical Care Medicine-Pulmonary Disorders--->Sleep Apnea
Page: 1 of 1