July 01, 2010

MRCP 1 Question 7

An obese 40 year old woman was brought to the general practitioner by her husband. The husband explained that the patient's snoring at night was disturbing him.

On questioning, the GP found that the problem was distinct from being merely annoying because the husband noted that she was also gasping for air throughout the night - and this repeatedly roused her out of her refreshing, deep sleep.

On further questioning the physician identified the telltale signs of sleep apnea: excessive daytime sleepiness and difficulty functioning.

What treatment did the physician most likely recommend?

a) adenoidectomy
b) removal of the uvula
c) night time low dose of diazepam
d) tracheostomy
e) nasal continuous positive airway pressure




ANSWER
The correct answer is E

Explanation

Sleep apnea is among the most common and most dangerous types of sleep disorder.

An estimated 18 million Americans have the condition, which is marked by repeated episodes of cessation of breathing during sleep that over time can lead to high blood pressure, cardiac disease, and disordered thinking.

The most common effective treatment for obstructive sleep apnea is nasal continuous positive airway pressure, or CPAP. The patient wears a soft plastic mask over his or her nose while sleeping.

Surgery to increase the size of the airway is another possible option for sleep apnea treatment. The removal of adenoids and tonsils, especially in children, or other growths or tissue in the airway is sometimes effective, as are other, relatively more risky surgical procedures, including uvulopalatopharyngoplasty (shaving of the excess soft tissues in the mouth and throat) and tracheotomy (creating an opening in the neck through the windpipe) for the most severe cases.

The newest device for this condition is Somnoplasty, used to treat mild cases of sleep apnea. It is a radio frequency surgical device that shrinks the soft palate in a half-hour outpatient procedure. FDA approved the Somnoplasty device in July 1997

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