10. Case-Based Management of Respiratory Diseases Flashcards
Respiratory Disease
Obstructive
- asthma
- COPD
- cystic fibrosis
Restrictive
- sarcoidosis
- interstitial lung disease
- collagen disorder
Extraparenchymal Restrictive
- obesity
- scoliosis
- myasthenia gravis
- diaphragmatic weakness
- cervical spine injury• OBstructive
○ Asma - bronchiospasm - spam in smooth muscles > constriction of lung > in bronchi > resulting in resistance of flow of ____
○ COPD - obstructive process
○ Cystic fibrosis• Restrictive
○ Lung itself can expand; but something in the lung now is preventing it from expanding
○ Collagen disorder
§ Fibrosis• EPR
○ Outside of lung tissue (____, outside of that tissue)
○ Myasthenai gravis - muscles are so weak > ____ muscles cnanot fully expand chest wall
○ DW - car accident/surgery > ____ injury (palsy)
○ CS injury > cannot get to their ____, and cannot innervate intercostal to expand
O2 and Co2
parenchyma
phrenic nerve
diaphragm
Asthma
• The number of people with asthma continues to grow
o One in 12 people (about 25 million, or 8% of the U.S. population) had asthma in 2009, compared with 1 in 14 in 2001.
• Etiologies ○ Inflammatory process § \_\_\_\_, pollen allergies § Work - parking garage/car fumes ○ Irritants § \_\_\_\_ § Exercise § \_\_\_\_ § Stress ○ Others § \_\_\_\_ - acid irritating vocal cords § Occupational hazards § \_\_\_\_
cat allergies temperature odors reflux tobacco
Allergic Asthma
____ asthma is the most common form of asthma
• Pathogenesis of asthma ○ Something in enviro is driving this ○ Pollen is high > depending on year, may be more stable than other parts ○ Dendritic cells (APC) > takes up pollen and presents to T cells; dendritic cell starts releasing interleukins § T cell starts setting off with the IL > priming the \_\_\_\_ cells > makes the antibodies (\_\_\_\_) § Plasma sees pollen as foreign > will react and attack it □ Release IgE > genetic framework: sees the pollen as the \_\_\_\_ invader ® Specific to the allergen □ IgE contacts \_\_\_\_ ® Mast cells degranulate ® Floating around blood with \_\_\_\_, LTs, \_\_\_\_, and ready to release at any point ® Does release once \_\_\_\_ tells them to do it ® \_\_\_\_ try to affect this process □ \_\_\_\_ also participate, to a lesser degree
allergic plasma IgE foreign mast cells histamines PGs IgE antihistamines eosinophils
Asthma
Airway Hyperresponsiveness
o Excessive contractile response of ____ in asthma results in inordinate ____ and airflow obstruction in response to relatively little provocation
o Direct Stimuli of airway smooth muscle: ____, leukotrienes, and ____
• Once mast cells degranulate > impact the airway/lungs ○ Right: airway from reactive process § Muscle tone has changed □ Every time the patient with asthma has reacted > asthma attack > the SM in the airway become thickened (hypertrophic) in a bad way □ Instead of healthy lung § Secretions building up histamines (stimulating the production of secretions), and from the mediators > the SM will contract > the airway becomes narrow, and has thickened mucus □ This is an obstructive process • Planning on an IV sedation, oral sedation ○ Give the patient a medication that is going to weaken/suppress their ability to breathe ○ \_\_\_\_ outside > irritant; and some pollen § Coming in, and their airways are starting to become reactive § Now > sedated > become more \_\_\_\_, and give more sedative § Now the lung is more suppressed > and this process is undergoing > wheezing in the middle of a procedure
airway smooth muscle bronchoconstriction histamine prostaglandins cold day anxious
Asthma
Airway smooth muscle relaxation induced by ____
• What drives this process? ○ \_\_\_\_ § Something has to dilate the SM □ Albuterol - B2 adregnergic agonist □ Driving relaxation process (acute)
b2-adrenergic agonists
bronchoconstriction
What questions are relevant to the work-up of the patient with regards to his ASTHMA
- What ____ do you take for your asthma?
- What are the ____ for an asthma attack?
- When was your last ____?
- Have you ever been ____ or intubated for your asthma? If so when?
- How often do you use your ____?
- Do you have your inhaler with you ____?
medications triggers asthma attack hospitalized inhaler todayu
Management of Acute Asthma Attack
- ____ procedure. Make sure all objects are out of the patients mouth.
- Place patient on ____, and give ____ treatment.
- Does not improve call ____.
- Wheezing continues…consider ____ and/or ____ (1:1,000).• Want to get the patient on oxygen, and have the patient use their inhaler immediately
○ Don’t want it in their backpack
○ Have it sitting on the countertop
• Want to always call for help > always want to be ahead
• Ultimate bronchodilator: epinephrine; if the wheezing continues
STOP nasal cannula inhaler 911 PO/IV epinephrine
COPD
- ____ chronic airway restriction (obstructs airflow)
- Most common cause is ____• Not a contraindication to treat asthma, has to do with severity
• Asthma is ____
○ ____
○ ____ mediated
○ ____ mediated
○ ____, LT, ____ > excess secretions and bronchoconstriction
• COPD
○ Cannot be undone, but ____ in progression and worsening
nonreversible
cigarette smoking
reversible B2 agonists mast cell IgE histamine PG
prevented
COPD
• Emphysema ○ Lung loses its \_\_\_\_ ○ Lung as expire and inspire > inflates and deflates ○ Here > inflates, but never \_\_\_\_ § Lost recoil ability ○ \_\_\_\_ (the CXR) § Lost alveolar structure § Lost integrity § From chronic \_\_\_\_
• Bronchitis ○ Wet lung, but not in the lung, but in the tubing of the lung § Not pulmonary edema ○ Ton of \_\_\_\_ in lung ○ Chronic irritation and inflammation of lung > \_\_\_\_, and inflammation of the lung > happens in \_\_\_\_ airway > trachea and bronchi; or \_\_\_\_ airway which are the bronchioles § A lot of mucus in lungs ○ Little elasticity because it's so expanded • Obstructive processes
elasticity
deflates
hyperexpansion
smoking
secretions
hypersecretion
large
small
COPD
Emphysema
• ____ of airway and ____ distal to bronchioles
Chronic Bronchitis
• Chronic productive ____ for ____ months in ____ consecutive years
Emphysema: ____
Chronic Bronchitis: ____
• Pink puffer ○ Classic description of emphysema ○ Expanded chest > \_\_\_\_ ○ \_\_\_\_ to help breath § When sitting down, and palms and hands on knees • Blue bloater ○ Chronic bronchitis ○ \_\_\_\_ ○ High \_\_\_\_, low O2 levels ○ Forming more \_\_\_\_ § Because Hb carries oxygen § Not anemic > \_\_\_\_
enlargement
destruction
cough
3
2
barrel chested tripodding cyanotic CO2 Hb polycythemic
Alpha-1 Antitrypsin Deficiency
• Alpha-1 antitrypsin deficiency is an ____ disorder that may cause lung disease and ____ disease
o Approximately 15 percent of adults with alpha-1 antitrypsin deficiency develop ____ due to the formation of scar tissue in the liver
• Genetic condition • Emphysema and liver disease developed ○ Outside of this, empyhysema is heavy smoking causant
inherited
liver
cirrhosis
Management of COPD
- ____ CESSATION
- Management of inflammation (____)
- ____ therapy
- Vaccine to reduce infections (____ vaccine)
- Lung transplantation versus end-of-life care
- Cannot undo what’s been done > ____ process
- Steroids > prevent inflammation, which produces loss of elasticity and secretions in bronchi
- Vacciniation so don’t develop pneumonia
smoking
steroids
pneumococcal
irreversible
What questions are relevant to the work-up of the patient with regards to her EPMHYSEMA
- What ____ do you take for your emphysema?
- ____ was your last emphysema exacerbation?
- Have you ever been ____ or intubated for your emphysema? If so when?
- How often do you use your ____?
- Do you have your inhaler with you ____?
- Do you use ____? If so, how often and how many liters? Do you have your tank with you today?
medications when hospitalized inhaler today home oxygen
Patient asks if she can have nitrous oxide with her procedure as she is anxious about procedure…is this ok?
Patients with advanced COPD known as “CO2 retainers” have chronically elevated ____ levels…they begin to relay on ____ to drive their respirations
By increasing their oxygen levels the patient can lose her respiratory drive
• CO2 drives respiration; but in patients with COPD > low \_\_\_\_ levels drives respiration ○ If CO2 retaining (hypoxemic) > don't want to \_\_\_\_ the amount of oxygen they're taking in ○ Ask how many liters of oxygen per minute via nasal canula § Want to give them the same \_\_\_\_ they always get □ There's a fine balance
CO2 hypoxia O2 dilute amount
Lung Cancer
• Oral cancer is the 6th most common cancer in the world ○ 221k of lung cancer, and 50k cases of oral cancer ○ In the US, less than 6% of cancer cases • Each dental professional, will diagnose one \_\_\_\_ in their career ○ Depends on part of area you practice ○ Will see a lot more patients with \_\_\_\_
oral cancer
lung cancer
Lung cancer
* Most common for men > \_\_\_\_ * Most common for women > \_\_\_\_ * Lung cancer is the \_\_\_\_ for both
prostate
breast
second
Lung Cancer
• No synchronous second primary malignancies were discovered in the ____
12.1% of smoking patients were diagnosed with ____
• \_\_\_\_ can develop lung cancer ○ 12% of patients with oral cancer can have lung cancer
nonsmoking patients
synchronous primary cancers
oral cancer
Lung Cancer
• Oral and lung cancer ○ Not metastasis! § Lights up: \_\_\_\_ avid § Primary lung cancer > lung cancers are \_\_\_\_, and they tend to be isolated in one area □ Metastasis of oral cancer to lung: \_\_\_\_, and will be multiple spots ○ Do not survive past 5 years
FDG
medial/central
peripheral
Lung Cancer
• Does it make a difference to intervene? ○ Women hasn't dipped yet - women started smoking \_\_\_\_ than men in the US • Took 25 years to get a decrease ○ \_\_\_\_ tell parents to quit smoking
later
kids
Lung Cancer
____ of current smokers reported receiving advice to quit smoking from any health care practitioner
Only ____ smokers who visited a dentist received advice to quit
• A lot of room for improvement in advocating to stop smoking
half
1 in 10
Lung Cancer
• Do biopsy > scares them > gets them to stop smoking
○ Two ways for conversation:
§ This is leukoplakia
□ “ive got great new no cancer”
□ “but, your body is taking on changes to ____”
precancer
Is the patient at risk for “poor healing”? If so, why?
• What keeps her from healing? ○ \_\_\_\_ > BV is constricting > starving the area that's trying to heal ○ \_\_\_\_ § Antibodies fight off infections; made up of proteins > when someone has no sugar in inside of cell > cellular respiration > breakdown AA > \_\_\_\_ > cannot form antibodies ○ Prednisone § \_\_\_\_ - bad for wound healing • Can talk to them about smoking (detrimental from cancer), talk about effects on wound healing (steroids)
smoking
diabetes
gluconeogenesis
steroid
Cystic Fibrosis
• ____ (CF transmembrane conductance regulator)
• Most common autosomal recessive disease affecting ____
• Autosomal recessive ○ \_\_\_\_ diseae, like muscular dystrophy > autosomal dominant ○ \_\_\_\_ > autosomal recessive
autosomal recessive
caucasians
structural
metabolic
Cystic Fibrosis
• Dysfunction of ____ glands
• Abnormal ____ transport in the ____ membrane of epithelial cells (impaired clearance of secretions)
• \_\_\_\_, \_\_\_\_ glands ○ Not endocrine (adrenal, thyroid, pituirtyar gland) • Cannot clear the Cl- and ahvet thick mucus ○ Pancreas cannot release enzymes, cannot sweat the way they want to
exocrine chloride apical pancreatic sweat
Cystic Fibrosis
• High salt content in the ____ of the affected patient—”salty sweat”
• Impaired ____
sweat
reabsorption
Cystic Fibrosis
• National Cystic Fibrosis Foundation Diagnosis of CF (2 clinical criteria plus 1 laboratory criteria)
o ____ (100%)
o Insufficient function of ____ pancreas
o Reproductive complications
§ ____ positive sweat chloride tests (>60 mEq/L) obtained by ____ test (QPIT)
§ Two ____ consistent with diagnosis of CF
chronic mucous obstruction exocrine 2 pilocarpine iontophoresis alleles
Cystic fibrosis
- Respiratory System: ____ of lungs, ____ of sinuses plus nasal polyps, increase in ____, ventilation perfusion (V/Q) mismatch, increase in ____, reduction in forced expiratory volume in 1 second (FEV1), and reduction in ____
- Gastrointestinal System: affects both ____ cells, maldigestion/malabsorption of ____, decrease in absorption of ____soluble vitamins (A, D, E, K), and GERD
- Reproductive System: preserved ____ function, active ____, aspermia (absence of ____) not to be confused with azoospermia (absence of ____)
hyperinflation opacification total lung capacity functional residual capacity (FRC) forced vital capacity (FVC)
alpha and beta islet
nutrients
fat
sexual
spermatogenesis
semen
sperm
