L10: respiratory diseases

Question 1

bluish discoloration of skin :

Answer 1

cyanosis

Question 2

FEV1:

Answer 2

normal is 80% or more

Question 3

hypoxemia:

Answer 3

arterial oxygen tention below 60 mmHg as a result of lung disease ( normal should be 80-100mmHg)

Question 4

hypoxemia:

Answer 4

arterial oxygen tension below 60 mmHg as a result of lung disease ( normal should be 80-100mmHg)

Question 5

type 1 respiratory failure:

Answer 5

hypoxemia with no CO2 retention : pneumonia , asthma

Question 6

type II respiratory failure:

Answer 6

CO2 retention with hypoxemia : chronic bronchitis , emphysema

Question 7

asthma is characterized by

Answer 7

increased responsiveness of lower airways to stimuli

-strongly associated with atopy

Question 8

wheezing in asthma is

Answer 8

most marked in expiration

Question 9

physical signs of asthma :

Answer 9

tachypnea
-wheezing on expiration
-hyperinflation of the chest
-nasal polyps (particularly in aspirin sensitive asthmatics )
-atopic eczema

Question 10

diagnosis of asthma is most often confirmed by :

Answer 10

daily recordings of peak expiration flow rate

Question 11

patient with unstable asthma should be referred for medical care and dental appointment should be postponed

Question 12

patient having night asthmatic attack should be given :

Answer 12

late morning appointments

Question 13

what drugs should be avoided for patients taking theophylline ?

Answer 13

macrolides and cephalosporins

Question 14

which sedative should be used in stressed asthmatic patients ?

Answer 14

nitrous oxide because it has no respiratory depressing properties

or if oral drug is required then benzodiazepines

Question 15

plain local anesthesia is recommended in asthmatic patients because:

Answer 15

local anesthesia containing epinephrine/ levonordefrin also contains sulfite component which may precipitate asthmatic attack

Question 16

characteristics of COPD :

Answer 16

airflow limitation that is not fully reversible . it is both progressive and associated with abnormal inflammatory response of the lung to noxious particles or gases associated with systemic manifestations

Question 17

what is chronic bronchitis ?

Answer 17

cough productive of sputum for at least 3 months of 2 consecutive years excluding other cardiopulmonary disease

Question 18

what is emphysema :

Answer 18

enlargement of terminal air space due to destruction of alveolar wall without fibrosis

Question 19

host factor genes for COPD

Answer 19

alpha 1 anti-trypsin deficiency

hyper-responsiveness
lung growth

Question 20

pathogenesis of COPD :

Answer 20

-inflammation
-protease-antiprotease imbalance
-oxidative stress
-mucus HYPERsecretion

Question 21

how does inflammation lead to airflow limitation ?

Answer 21

it causes small airway disease (airway inflammation and remodeling)

and also parenchymal destruction : loss of alveolar attachments —decreases elastic recoil

Question 22

symptoms of COPD:

Answer 22

-patient being a heavy smoker

-cough and putum production for many years

-cough often presents when waking up then it continues throughout the day

-sputum is usually mucoid and becomes purulent with exacerbation of disease

-insidious onset of breathlessness on exertion with wheezing or tightness of chest

Question 23

physical examination of patient suffering from COPD will show :

Answer 23

-large barrel shaped chest
-prominent accessory respiratory muscle in neck
-low , flat diaphragm causing costal margin retraction on inspiration

-diminished breath sound with distant heart sound

-prolonged expiration with general wheezing

-depressed liver which is not enlarged

Question 24

differential diagnosis of COPD :

Answer 24

-asthma
-congestive heart failure
-bronchiectasis
-pulmonary TB

Question 25

Diagnosis of COPD is dependent on :

Answer 25

-symptoms : couch , sputum , dyspnea (shortness of breathe)

-exposure to risk factors

-spirometry

Question 26

FEV1 for moderate COPD , severe COPD , and very severe COPD :

Answer 26

moderate : 50-79%

severe : 30-49%

very severe: <30%

Question 27

bronchodialators are also used in stable COPD

Question 28

smoking should be ceased 6 weeks before dental procedure

Question 29

asthma , bronchitis , and COPD are best managed by which anesthetic ?

Answer 29

local anesthetic ( avoid local anesthetic containing sulfites)

SEDATIVES SHOULD BE AVOIDED

Question 30

_____ cause respiratory depression

Answer 30

salicylates

Question 31

safe to use:

Answer 31

acetaminophen and COX2 inhibitors