Pathology of Respiratory disease

Question 1

What is the associated disease that causes SOBOE?

Answer 1

Asthma, bronchitis, COPD

Question 2

What is the associated disease that causes orthopnoea?

Answer 2

Left heart failure (causing ↑ fluid in lungs, ↓ gas exchange)

Question 3

What is the associated disease that causes PND?

Answer 3

Restrictive lung disease, heart failure

Question 4

What is the associated disease that causes wheeze?

Answer 4

On inspiration (tracheal/laryngeal obstruction) – Tumour 
On expiration (distal bronchus obstruction) – Asthma

Question 5

When does a cough lasting 3 months suggest?

Answer 5

Chronic infection

Question 6

What is the associated disease with clear/mucoid sputum?

Answer 6

Excess secretion from bronchial mucous glands in asthma, chronic bronchitis

Question 7

What is the associated disease with purulent (green/yellow) sputum?

Answer 7

INFLAMMATORY EXUDATE from respiratory tract infection

Question 8

What is the associated disease with blood in the sputum?

Answer 8

Cardiac failure, pulmonary infection, ulceration of respiratory mucosa by
tumour

Question 9

What should you be looking for in the face?

Answer 9

Mouth breathing
▪ COPD patients breath with PURSED LIPS
Central cyanosis - core, lips, tongue

Question 10

What is finger clubbing associated with?

Answer 10

Carcinoma of lung, pulmonary fibrosis, bronchiectasis.

Question 11

What 5 investigation scam be carried out for investigating lung pathologies?

Answer 11

Auscultation 
Chest X-ray
Ventilatory function
Sputum culture
Arterial blood gases & pH

Question 12

What would you be looking for in auscultation?

Answer 12

➢ Listen with statoscope for air entry, crackles and crepitus – crackling, popping sound when pressed
➢ Crackles are sudden INSPIRATIONAL opening of small airways RESISTED by FLUID or FIBROSIS
➢ Crepitus can indicate HOLE in AIRWAYS or bacterial infection

Question 13

What are you looking for in an x-ray?

Answer 13

Look for size of shadows and calcification

Question 14

What are you looking for in terms of ventilatory function?

Answer 14

➢ Peak expiratory flow rate (PERF)
▪ ↓ in OBSTRUCTED AIRWAYS or MUSCLE WEAKNESS
➢ Spirometry
▪ Measures the amount of EXHALED air PER SECOND
➢ Gas transfer
▪ Ventilation & perfusion

Question 15

Describe briefly COPD

Aetiology, pathogenesis, complications, pathological appearance, macroscopic and microscopic

Answer 15

Aetiology
➢ Smoking, second hand smoking

Pathogenesis
➢ Can consist of emphysema, chronic bronchitis or both

Complications
➢ Lung infections such as pneumonia
➢ Cor pulmonale– alteration in the structure and function of RIGHT VENTRICLE causing heart failure

Pathological Appearance
➢ Black lung

Macroscopic
➢ Emphysema and spaces present

Microscopic
➢ Increase in number of mucus glands causing mucosa thickening leading to obstruction of bronchus
➢ Emphysema decreases the ability of alveoli to transfer and absorb gas

Question 16

Aetiology, pathogenesis, macroscopic and microscopic appearance of Lobar pneumonia.

Answer 16

Aetiology
➢ S. pneumonia

Pathogenesis
➢ Diffused inflammation affecting the entire lobe with pleural exudate

Macroscopic appearance
➢ Red hepatisation, lung is red, solid and airless with massive accumulation of WBC, RBC and fibrous exudate

➢ Grey hepatisation Lung is grey & solid with accumulation of fibrin and
destruction of WBC & RBC

Microscopic
➢ Alveoli spaces filled with neutrophils and pus like material

Question 17

Aetiology, pathogenesis, macroscopic and microscopic appearance of Bronchopneumonia.

Answer 17

Aetiology
➢ Staphylococci, streptococci, more common in elderly, infants and patients with debilitating disease

Pathogenesis
➢ Acute infalmmation with exudation affecting small areas but often both lungs

Macroscopic appearance
➢ Affected areas basal and bilateral

➢ Lung is grey & grey-red

Microscopic
➢ Neutrophils and pus in bronchus, inflammation localised to a specific area

Question 18

Aetiology, pathogenesis, complications, macroscopic and microscopic appearance of TB.

Answer 18

Aetiology
❖ M. tuberculosis via air borne particles

Pathogenesis
❖ Phagocytosis → granuloma → bacteria remains dormant → reactivates casing caseous necrosis

Complications
❖ Meningitis
❖ Joint pain

Macroscopic
Look at pics

Microscopic
Pink rods – microbacteria
Caseous necrosis in centre of granuloma

Question 19

Mention how as a dentist you modify a treatment plan due to respiratory conditions

Answer 19

❖ Patients with orthopnoea, COPD, asthma may require treatment in upright position
❖ Several dental materials may trigger an asthma attack

Question 20

Name oral manifestations associated with respiratory

Answer 20

Patients on steroids have an increased susceptibility to xerostomia, caries and infections
such as oral candida
TB ulcer on tongue
Metastatic carcinoma

Question 21

Name some Systemic ill-effects and oral ill-effects of smoking

Answer 21

Oral ill-effects
o Impaired wound healing
o Periodontal disease accelerated
o Oral cancer risk ↑

Systemic ill-effects
o Peripheral venous disease
o Respiratory disease
o Cutaneous 
o Malignancies

Question 22

What are the 5 A’s and the 5 R’s of smoking cessation

Answer 22

• The 5 A’s 
✓ Ask
✓ Advice 
✓ Assess
✓ Assist 
✓ Arrange 
✓ Reinforcement 
• The 5 R’s
✓ Relevance 
✓ Risk 
✓ Reward 
✓ Roadblocks