10. Case-Based Management of Respiratory Diseases Flashcards

1
Q

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
A

O2 and Co2
parenchyma
phrenic nerve
diaphragm

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2
Q

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
			§ \_\_\_\_
A
cat allergies
temperature
odors
reflux
tobacco
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3
Q

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
A
allergic
plasma
IgE
foreign
mast cells
histamines
PGs
IgE
antihistamines
eosinophils
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4
Q

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
A
airway smooth muscle
bronchoconstriction
histamine
prostaglandins
cold day
anxious
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5
Q

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)
A

b2-adrenergic agonists

bronchoconstriction

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6
Q

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 ____?
A
medications
triggers
asthma attack
hospitalized
inhaler
todayu
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7
Q

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
A
STOP
nasal cannula
inhaler
911
PO/IV
epinephrine
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8
Q

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
A

nonreversible
cigarette smoking

reversible
B2 agonists
mast cell
IgE
histamine
PG

prevented

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9
Q

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
A

elasticity
deflates
hyperexpansion
smoking

secretions
hypersecretion
large
small

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10
Q

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 > \_\_\_\_
A

enlargement
destruction

cough
3
2

barrel chested
tripodding
cyanotic
CO2
Hb
polycythemic
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11
Q

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
A

inherited
liver
cirrhosis

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12
Q

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
A

smoking
steroids
pneumococcal
irreversible

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13
Q

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?
A
medications
when
hospitalized
inhaler
today
home oxygen
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14
Q

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
A
CO2
hypoxia
O2
dilute
amount
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15
Q

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 \_\_\_\_
A

oral cancer

lung cancer

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16
Q

Lung cancer

* Most common for men > \_\_\_\_
* Most common for women > \_\_\_\_
* Lung cancer is the \_\_\_\_ for both
A

prostate
breast
second

17
Q

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
A

nonsmoking patients
synchronous primary cancers

oral cancer

18
Q

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
A

FDG
medial/central
peripheral

19
Q

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
A

later

kids

20
Q

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
A

half

1 in 10

21
Q

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 ____”

A

precancer

22
Q

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)
A

smoking
diabetes
gluconeogenesis
steroid

23
Q

Cystic Fibrosis
• ____ (CF transmembrane conductance regulator)
• Most common autosomal recessive disease affecting ____

• Autosomal recessive
	○ \_\_\_\_ diseae, like muscular dystrophy > autosomal dominant
	○ \_\_\_\_ > autosomal recessive
A

autosomal recessive
caucasians

structural
metabolic

24
Q

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
A
exocrine
chloride
apical
pancreatic
sweat
25
Q

Cystic Fibrosis
• High salt content in the ____ of the affected patient—”salty sweat”
• Impaired ____

A

sweat

reabsorption

26
Q

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

A
chronic mucous obstruction
exocrine
2
pilocarpine iontophoresis
alleles
27
Q

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 ____)
A
hyperinflation
opacification
total lung capacity
functional residual capacity (FRC)
forced vital capacity (FVC)

alpha and beta islet
nutrients
fat

sexual
spermatogenesis
semen
sperm