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Special Patients > Chapter 6: Management Of The Patient With Respiratory Illnesses > Flashcards

Chapter 6: Management Of The Patient With Respiratory Illnesses Flashcards

1
Q

Is COPD reversible or irreversible?

A

Irreversible

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2
Q

3 respiratory illnesses:

A
  • COPD
  • asthma
  • tuberculosis
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3
Q

COPD is?

A

Chronic and irreversible obstructive disorder: obstruction of the airway at the pulmonary level

Has 2 main parts;
Chronic bronchitis
Pulmonary emphysema

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4
Q

Chronic bronchitis:

A

Main symptom: daily cough and mucus (sputum) production for at least 3 months a year for 2 consecutive years

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5
Q

Pulmonary emphysema:

A

Emphysema is a destructive disease of the lung in which the alveoli that promote oxygen exchange between the air and the bloodstream are destroyed

Alveoli destroyed

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6
Q

___% in men and ____% in men, mortality is much higher in?

A

14, 8, white men

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7
Q

Risk factors of COPD?

A
  • smoking
  • pollution
  • past lung infection
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8
Q

Symptoms of COPD:

A
  • chronic bronchitis: older than 50
  • cough and mucous production
  • fatigue
  • sore throat
  • pulmonary emphysema: older than 60
  • shortness of breath
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9
Q

Medical tx of COPD:

A
  • Stop smoking
  • Do exercise
  • Healthy diet
  • Flu vaccine
  • Antibiotic treatment
  • Hydration
  • Oxygen
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10
Q

Dental tx of COPD:

A
  • Semi-seated position to avoid orthopnea
  • Not recommend doing a nerve block
  • If sedation is needed, diazepam 5mg
  • Do not administer narcotics (respiratory depressor)
  • If treated with teofilin avoid macrolides (created a toxic reaction of teofilin)
  • No sedation with nitrous oxide (emphysema)
  • Avoid complete isolation
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11
Q

Asthma is:

A

A common lung disorder in which inflammation causes the bronchi to swell and narrow the airways, creating breathing difficulties that may range from mild to life threatening

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12
Q

Asthma in early ages is more common in? While asthma in later ages are more common in?

A

Men
Women

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13
Q

Symptoms of asthma:

A
  • Shortness of breath, cough (often worse at night)
  • Sudden episodes
  • Wheezing (respiratory wheezing): it is a high-pitched whistling sound produced
    by turbulent airflow through narrow airways, typically with exhalation)
  • Symptoms are episodic
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14
Q

Classification of asthma:

A
  • allergic (extrinsic)
  • non allergic (intrinsic): induced by foods, and medication (Aspirin), NSAIDs, beta blockers
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15
Q

Medical tx of asthma?

A

Bronchodilators, nebulisers, asthma inhalers , corticosteroids, aerosols 2-4 times a day

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16
Q

Drugs to avoid in patients with asthma?

A
  • avoid aspirin and paracetamol
  • avoid NSAIDs
  • avoid narcotics
  • avoid macrolides in teofilin-treated patients
17
Q

Oral side effects of asthma:

A
  • GI reflux: common and worsen with aerosols
  • oral candidiasis: glucocorticoids help candida develop: mouthwash after use of inhaler
18
Q

Treatment for asthma attack?

A
  • Inhalers of rapid action
  • Tranquillise the patient
  • Subcutaneous injection of adrenalin
  • Administer oxygen
19
Q

Tuberculosis is?

A

Respiratory infection that’s contagious in the acute phase

  • elderly patients in poor social conditions
  • secondary to HIV infections
  • mycobacterium tuberculosis
  • contagious between 2-8 week, tuberculin mantoux test is positive
20
Q

Patients at risk for tuberculosis ?

A
  • people in touch with someone infected with TB
  • HIV: IV drug users
  • health care workers
  • foreigners from countries with a high prevalence of tuberculosis
21
Q

How to minimise oral candidasis in patients with asthma?

A

Mouthwash after the use of the inhaler

22
Q

Symptoms of tuberculosis ?

A
  • fatigue
  • fever
  • unintentional weight loss
  • night sweats
  • coughing up blood
  • chest pain
23
Q

Medical tx of tuberculosis ?

A

For 8 weeks: isoniazid, rifampicin, and pyrazinamide
The next 4 months, isoniazid, and rifampicin for the next 6months

24
Q

Dental tx of TB?

A
  1. Active TB:
    - only emergency tx, in hospital never ambulatory
    - <6 years: ordinary treatment, if doctors allow
    - > 6 years: use of turbine, always in hospital, even if coughing tests are negative
  2. Latent TB: ordinary tx
  3. Recent return to active TB (tuberculin test):
    - isoniazid as prophylaxis
    - ordinary tx if in active
  4. If they have symptoms and signs of TB:
    - avoid tc
    - if necessary only emergency tx
25
Q

Administration of medication in TB:

A
  • Isoniazid and rifampicin: hepatoxicity, no paracetamol
  • Diazepam worthless
  • Gingival haemorrhage and infections due to leucopenia
  • If the patient is taking Streptomycin, no aspirin as it increases toxicity (happens in the ears)
26
Q

Oral complications of TB:

A
  • Deep and painful ulcer on the tongue
  • Palate, lips, mucosa and gingiva: small ulcers heal as scar
  • Neck lymph nodes are painful and infected (scrofula) Treatment: ATB tuberculosis (Antibiotic for tuberculosis)
27
Q

What clinical manifestation is frequent in patients with asthma?

A

a. Hairy leukoplakia
b. Pseudomembranous candidiasis
c. Infectious foci in apices
d. Paresthesia
e. Neutropenic ulcers

B

28
Q

Obstructive pulmonary disease is characterized by:

A

a. The two clinical conditions (emphysema and bronchitis) are indistinguishable in most patients.
b. Present dyspnea, chest pain and hemolysis
c. It is an irreversible disease that affects the lungs at the entrance level
d. The main etiology is environmental pollution and contamination
e. Treatment is aimed at depressing the respiratory system to improve quality of life

29
Q

The systemic pathology in a patient with respiratory disorders that implies the existence of an infection is:

A

a. Extrinsic asthma
b.Bronchitis
c.Intrinsic asthma
d. Tuberculosis
e. Emphysema

D

30
Q

What will be our attitude towards a patient with suspected tuberculosis?

A

a. The patient will be isolated to avoid contagion with other patients
b.Only emergency treatments will be performed
c. An inter-consultation will be carried out to determine what treatments can be performed.
d. Immediately report it to the health authorities
e. Perform an inter-consultation to rule out active disease

B

31
Q

To which pathology or drug will we associate a whitish lesion in the Jugal mucosa of several months of evolution that we found in a patent when performing the oral examination ?:

A

A. Oral anticoagulants
B. Oral bisphosphonates
C. Asthmatic patient
D. Intravenous bisphosphonates
E. Hypertension

C

32
Q

A patient with poorly controlled asthma without sequelae is classified as?

A

ASA III

33
Q

If a patient comes to the consult for pain on tooth 13, on treatment with isoniazid and rifampicin, we must avoid?

A

A. Ibuprofen 600mg
B. Nolotil
C. Dexketoprofen (enantyum) 25mg
D. Paracetamol 1gr
E. Ibuprofen 400mg

D

34
Q

Vasoconstrictors are completely contraindicated in the following except for a relative case which is?

A

A. Unstable angina pectoris
B. Recent myocardial infarction
C. Asthmatic in which the intrinsic factor is anaesthesia
D. Hyperthyroidism
E. Uncontrolled diabetes

?

35
Q

Indicate the correct answer:

A

a. The patient with chronic bronchitis is more prone to congestive heart failure
b. In a patient with Enfisema, Clindamycin will be avoided
c. One of the complications of patients with tuberculosis is nicotine stomatitis and periodontal disease
d. In asthmatic patients we will avoid steroid anti-inflammatory drugs
e. Tobacco is the most important etiologic factor in patients with COPD

E
But why is A wrong?

36
Q

After performing a simple extraction to an 18 year old patient with asthma taking theophylline. Which of the following would be prescribed for the patient?

A

A. erythromycin 500. 1 every 8 hours for a week
B. ibuprofen 600mg every 6 to 8 hours for 3 days
C. Spiramycin 600mg every 8h for a week
D. espidifen 600mg if there is pain, but never aspirin
E. paracetamol 1g every 6 to 8 hours

E

37
Q

Asthmatic patient of 18 years that while doing a root canal with rubber dam we are told to stop because it presents respiratory difficulty. Our attitude to follow will be:

A

a. Before the possibility of an asthmatic crisis, immediately notify to 061/112
b. Remove the instruments from the mouth and reassure the patient
c. Before the possibility of a bronchoaspiración, to realize immediately the maneuver of Heimlich
d. Allow the patient to take a dose of his inhaler and if it does not bring with him an aerosol of salbutamol
e. B and d

E?

38
Q

Before a patient who comes to the consultation
with COPD and comes to have a crown preparation of several pieces performed, the measure to follow will be

A

A. Appointment late in the morning for possible cross infections
B. You will be placed in the supine position to avoid orthopnea.
C. Narcotics or barbiturates will be prescribed if the patient comes very nervous
D. The anaesthesia will be infiltrative with or without VC
E. We will carry out an interconsultation beforehand

E

Special Patients (9 decks)

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