case pres

Question 1

what is COPD

Answer 1

chronic obstructive pulmonary disease
chronic, progressive and irreversible disease
Combination of emphysema and chronic bronchitis

Question 2

what is emphysema

Answer 2

disease seeing damage to alveoli

Question 3

what is chronic bronchitis

Answer 3

damage to respiratory epithelium seeing excess mucous production and variable airway narrowing

Question 4

symptoms of COPD

Answer 4

shortness of breath
persistent chest cough
frequent chest infections
persistent wheexing

Question 5

aetiological factors of COPD

Answer 5

smoking!
air pollutants
genetics

Question 6

name 3 complications of COPD

Answer 6

heart failure
pneumonia
frailty

Question 7

classification of COPD

Answer 7

either stage 1-4 or ABCD classification (2017)

stage 1-4 based on FEV1
ABCD based on symptom assessment and exacerbation history

Question 8

name 4 dental implications of COPD

Answer 8

• may be unable to cope with dental dam
• majority of patients predisposed to tobacco related lesions
• inhaled steroids are a candida risk
• may not be able to lie flat as could cause breathlessness

Question 9

what can severe exacerbations of COPD lead to

Answer 9

respiratory failure

Question 10

type 1. vs type 2 respiratory failure

Answer 10

type 1 - hypoxia, reduced surface for gas exchange
type 2 - hypercapnia, ventilation failure

Question 11

sedation and COPD

Answer 11

inhalation - oxygen administration may cause respiratory depression - avoid
IV - midazolam can induce respiratory depression - avoid, referral to hospital if absolutely necessary

Question 12

salbutamol inhaler

Answer 12

short acting beta 2 agonist
smooth muscle relaxation and dilation of airways
patient takes as and when required to treat exacerbations

Question 13

active ingredients in trimbow inhaler

Answer 13

betametasone (corticosteroid)
formoterol (long acting beta agonist)
glycopyrronium (long acting muscarinic agonist)

Question 14

fexofenadine

Answer 14

antihistamine for hayfever

Question 15

naproxen

Answer 15

NSAID
patient takes for osteoarthritis related pain
similar antiplatelet effect as low dose aspirin

Question 16

senna

Answer 16

stimulant laxative
increases intestinal activity to cause a bowel movement

Question 17

values for hypertension

Answer 17

> 140/90mmHg

Question 18

risks associated with hypertension

Answer 18

heart attack
stroke
heart disease
heart failure
kidney disease
vascular dementia

Question 19

how was elizabeths hypertension treated

Answer 19

lifestyle changes rather than medications
stopped smoking, lost weight and altered her diet to contain less salt
regular GP visits to assess status

Question 20

possible medications for hypertension

Answer 20

ace-inhibitors
beta blockers
calcium channel blockers
diuretics

Question 21

dental elements of hypertension

Answer 21

• increased post op bleeding
• side effects of drugs (xerostomia, gingival hyperplasia)
• lichenoid drug reactions
• increased risk of cardiac complications - MI, angina

Question 22

osteoarthritis

Answer 22

degenerative joint disease seeing cartilage repair dysfunction

Question 23

treatment of osteoarthritis

Answer 23

nothing alters progression
treatment aims to reduce pain and maintain function
- NSAIDS
- muscle strengthening around joints
- walking aids
- weight loss
- prosthetic replacement

Question 24

dental implications of osteoarthritis

Answer 24

-TMJ involvement - rare
-chronic NSAID use - ulceration, prolonged bleeding
-controversy on whether antibiotic prophylaxis in prosthetic joint patients
-manual dexterity may become impaired limiting OH ability

Question 25

pack years

Answer 25

measurement of how much a patients has smoked over a long period of time number of packs per day (20 cigs/pack) x number of years patient has smoked

Question 26

6 dental implications of smoking

Answer 26

oral cancer periodontal disease necrotising conditions extrinsic staining of teeth dry socket candida xerostomia

Question 27

treatment of pseudomembranous candida if altered inhaler habits didn't work

Answer 27

miconazole 20mg/g gel to area 4 x day fluconazole 50mg 1x day 7 days

Question 28

staging vs grading of perio disease

Answer 28

staging - severity of disease (1-4 based on worst site of bone loss) grade - rate of progression (ABC, worst site of bone loss/ patient age)

Question 29

how do inhaled corticosteroids predispose patients to candida

Answer 29

deposit of some drug onto oral mucosa leading to topical effects (immunosuppression and anti inflammatory effects) decrease in local immune response allowing candida overgrowth

Question 30

what advice was given regarding inhaler use

Answer 30

patient was originally using her inhaler after brushing her teeth advised her to use inhaler before brushing, rinse with water then brush teeth

Question 31

how could pseudomembranous candidiasis be treated if inhaler change had not been successful

Answer 31

miconazole 20mg/g gel 4 x day fluconazole 50mg 1x day 7 days