pathology- respiratory disease

Question 1

non infectious chronic lung diseases can be split up into

Answer 1

can be obstructive or restrictive

Question 2

what is FEV1

Answer 2

forced expiratory volume in one second

Question 3

forced vital capacity definition

Answer 3

forced vital capacity

Question 4

what is the normal FEV1/FVC ratio

Answer 4

around 0.75 to 0.8 is normal

Question 5

what is it called when the FEV1/FVC ratio if you have an obstruction

Answer 5

the ratio is lower than <0.7

Question 6

what is it called when the FEV1/FVC is higher than 0.8

Answer 6

restrictive

Question 7

what are the two types of copd

Answer 7

emphysema

chronic bronchitis

Question 8

describe emphysema

Answer 8

alveolar wall destruction

overinfiltration

Question 9

describe chronic bronchitis

Answer 9

productive cough

airway inflammation

Question 10

describe asthma

Answer 10

reversible obstruction

bronchial hyper-responsiveness triggered by allergens, infection

Question 11

what is the FEV1/FVC ratio in obstructive lung disease

Answer 11

less than 0.7

Question 12

why do we group emphysema and chronic bronchitis together

Answer 12

most its have a mixture of both chronic bronchitis and emphysema

Question 13

what is the common aetiology of emphysema and chronic bronchitis

Answer 13

smoking

Question 14

definition of chronic bronchitis

Answer 14

persistent cough with sputum for at least 3 months over at least 2 consecutive years with the absence of any other identifiable cause

Question 15

what is the pathogenesis of chronic bronchitis

Answer 15

1. Chronic airway irritation
   
   2. Epithelial ciliary dysfunction
   3. Mucous hypersecretion/mucous gland hypertrophy
   4. Chronic inflammation
   5. Fibrosis
   6. Small airway obstruction
   7. Alveolar hypoxia
   8. Ventilation- perfusion confusion leading to pulmonary vasoconstriction
2. The blood in the lungs can be redirected to areas with more blood but this leads to hypoxaemia, pulmonary hypertension

Question 16

definition of emphysema

Answer 16

irreversible abnormal enlargement of airspaces distal to the terminal bronchioles

Question 17

what is emphysema characterised by

Answer 17

Alveolar wall and capillary destruction
Characterised by large alveolar spaces
Due to loss of recoil
The bronchioles collapse leading to airway obstruction

Question 18

what is the pathogenesis of emphysema

Answer 18

inflammatory stimulus
alveolar connective tissue breakdown
which affects the central acinus bronchioles and spare distal alveoli
affects entire acinus bronchioles and alveoli

Question 19

what do we call chronic bronchitis

Answer 19

blue bloaters

Question 20

describe people who have chronic bronchitis

Answer 20

Large, oedematous, cyanotic and mild dyspnoea, obesity

Question 21

what happens to people with chronic bronchitis

Answer 21

mucous hyper secretion leads to coughing and wheezing

impaired oxygenation leads to cyanotic and polycythaemia

Question 22

what do chronic bronchitis patients rely on

Answer 22

hypoxic drive

Question 23

which side of the heart fails during chronic bronchitis

Answer 23

right heart failure

Question 24

why does the right side of the heart fail in chronic bronchitis

Answer 24

Pulmonary vascular vasoconstriction leads to pulmonary hypertension

Question 25

what do we see in patients with emphysema

Answer 25

thin
cachectic
sever dyspnoea

Question 26

describe what happens in emphysema

Answer 26

Loss of parenchyma, loss of recoil–> breathe against pursed lips
Accessory muscles used to breathe therefore barrel chested

Question 27

clinical signs of pts with emphysema

Answer 27

Productive cough
Breathlessness
Respiratory failure
Cor pulmonale( right heart failure)

Question 28

management of emphysema and chronic bronchitis

Answer 28

Beta agonists- salbutamol
Muscarinic antagonists eg tiotropium
Inhaled steroids
Oxygen- beware of hypoxic drive

Question 29

what are the dental considerations of COPD

Answer 29

Keep upright 
Avoid rubber dam 
Avoid sedation 
Monitor oxygen 
Target saturation in COPD pts is 88-92%
Some pts rely on hypoxic drive 
But if in distress, give high flow O2 and adjust resp rate drops

Question 30

what is the definition of asthma

Answer 30

Reversible small airway obstruction characterised by bronchospasm, oedema and airway inflammation

Question 31

what is atopic asthma caused by

Answer 31

allergen, dust pollen sensitisation eg eczema

Question 32

what are the triggers for asthma

Answer 32

Allergens 
Chemical irritants 
Strong smells 
Temp change 
Exertion 
Stress
Drugs eg aspirin

Question 33

if asthma is atopic what type of hypersensitivity reaction is it

Answer 33

type 1 IgE mediated

Question 34

what is the process of asthma

Answer 34

Initial exposure leads to IgE production 
The exposure leads to IgE cross linking
Then mass cell degranulation 
Bronchospasm 
Vascular permeability 
Leading to
Oedema

Question 35

symptoms of asthma

Answer 35

Cough 
Wheeze 
Dyspnoea 
Often use accessory muscles in upper body 
Tight chest feeling

Question 36

treatment for asthma

Answer 36

Bronchodilator- salbutamol

Inhaled corticosteroids eg beclomatasone, budesonide, fluticasone

Question 37

what are dental associations with asthma

Answer 37

dental caries is higher in patients with asthma

Question 38

what bacterium causes tuberculosis

Answer 38

mycobacterium

Question 39

what is TB characterised by

Answer 39

Caseating granulomatous inflammation

Infection does not mean clinically active diseases

Question 40

how do we diagnose for TB

Answer 40

Mantoux test-skin prick
Histology to look for caseating granulomas
microbiology
Quantiferon test- used for needlesticks

Question 41

what is the treatment for TB

Answer 41

a lot of antibiotics for 6 months