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Y3 IWB > PATHOLOGY- Respiratory disorders > Flashcards

PATHOLOGY- Respiratory disorders Flashcards

1
Q

How can non infectious chronic lung diseases be classified?

A

Obstructive or restrictive

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2
Q

How do we distinguish between different types of chronic lung diseases?

A
  1. FEV1 (Forced expiratory volume in 1 sec)
  2. FVC (Forced vital capacity)
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3
Q

What does FEV1 stand for

A

Forced expiratory volume in 1 sec

amount of air expelled in 1s afer deepest breath

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4
Q

What does FVC stand for?

A

Forced vital capacity

total amount of air expelled

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5
Q

State the normal FEV1: FVC ratio

A

0.75 - 0.8

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6
Q

What would a FEV1: FVC < 0.7 mean

A

Obstructive (resistance to expiration)

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7
Q

What would a FEV1: FVC > 0.85 mean

A

Restrictive

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8
Q

Give examples of obstructive lung diseases

A
  1. Emphysema
  2. Chronic bronchitis
  3. Asthma
  4. Small airway disease
  5. Bronchiectasis
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9
Q

Which 2 lung diseases fall under chronic obstructive pulmonary diseases (COPD)

A
  1. Emphysema
  2. Chronic bronchitis
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10
Q

What is chronic obstructive pulmonary disease (COPD)
What is it characterised by

A

A clinical syndrome- chronic bronchitis and emphysema

Characterised by obstructive lung FTs and reduced expiratory flow

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11
Q

what is the difference between COPD and asthma

A

asthma is reversible, damage from COPD is not

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12
Q

How many people in the UK suffer from COPD

A

1.2 million

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13
Q

Name the most common lung disease in the uK

A

Asthma (followed by COPD)

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14
Q

What would the FEV1:FVC ratio of a person with COPD be

A

<0.7

obstruction to expiration

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15
Q

Why are Emphysema and Chronic bronchitis grouped together?

A

Both diseases are characterised by airflow restriction and therefore most patients have a mixture of both
They share similar aetiology (smoking)

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16
Q

Define chronic bronchitis

A
  1. Persistent cough with sputum production
  2. Cough present for at least 3 month over at least 2 consecutive years
  3. Absence of any other identifiable cause
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17
Q

What is the pathogenesis of chronic bronchitis

A
  1. Chronic airway irritation leading to epithelial/ cililary dysfunction
  2. Mucous hyper secretion/ mucous gland hypertrophy/ goblet cell metaplasia
  3. Mucous and cilliary dysfunction lead to airway obstruction
  4. Chronic inflammation leading to fibrosis and small airway obstruction
  5. Airway obstruction and mucous hyper secretion leading to decreased alverolar ventilation and so alveolar hypoxia
  6. Alveolar hypoxia leading to V:Q mismatch and pulmonary vasoconstriction

v:q mismatch= ventilation:perfusion mismatch

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18
Q

What are the overall effects of chronic bronchitis

A
  1. Hypoxaemia
  2. Hypercapnia
  3. Pulmonary hypertension
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19
Q

Define emphysema
What does it lead to

A

Irreversible abnormal enlargement of airspaces distal to the terminal bronchioles
This leads to alveolar wall and capillary destruction

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20
Q

How does emphysema lead to airway obstruction?

A

Abnormal enlargement occurs that leads to loss of recoil and bronchiole collapse
This leads to airway obstruction

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21
Q

Describe the pathogenesis of emphysema

A
  1. Inflammatory stimulus such as cytokines and proteases
  2. Alveolar connective tissue is broken down
  3. This affects the central acinus bronchioles and spare distal alveoli
  4. This affects the entire acinus bronchioles and alveoli
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22
Q

What is another term for chronic bronchitis

A

Blue bloaters

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23
Q

Describe patients with blue bloaters

A

They have a large, oedematous cyanotic with mild dyspnoea

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24
Q

Give some symptoms of chronic bronchitis

A
  1. Cough/ wheeze (due to mucous hypersecretion and airway obstruction)
  2. Cyanotic blue colour (due to impaired alveolar oxygenation)
  3. Often obese
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25
Q

Why do some patients with chronic bronchitis turn cyanotic

A

They have an impaired oxygenation leading ro decreased levels of oxygen and increased CO2 in the alveolus
This leads to hypoxaemia, hypercapnia and polycythaemia giving patients a blue hue

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26
Q

What is polycythaemia?

A

Increased production of red blood cells in response to hypoxia

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27
Q

What can some patients with COPD become resistant or tolerant to?

A

CO2

28
Q

Which side of the heart can fail in a patient with chronic bronchitis? Why?

A

Right heart failure
Pulmonary vascular vasoconstriction leading to pulmonary hypertension

29
Q

Why can oedemas form in patients with chronic bronchitis

A

Due to fluid retention

30
Q

What is another term for emphysema

A

Pink puffers

31
Q

Describe patients with Pink puffers

A

Thin, cachectic with severe dysnopea

32
Q

Why are patients with emphysema sometimes described as pink puffers?

A

As they have pursed lip breathing

33
Q

What causes patients with emphysema to have pursed lips

A

Loss of parenchyma/ loss of elastic recoil
This causes alveolar aid to trap and small airways to collapse
Leading to pursed lips

34
Q

Do patients with emphysema have increased or decreased expiratory volume?

A

Increased

35
Q

Give some symptoms of emphysema

A
  1. Pursed lips
  2. Barrel chested
  3. Dyspnoea/ cachexia
36
Q

Give some of the clinical features of COPD

A
  1. Productive cough
  2. Breathlessness
  3. Respiratory failure
  4. Cor pulmonate (rh failure)
37
Q

How do we manage COPD

A
  1. Beta- agonists
  2. Muscarinic antagonist
  3. Inhaled steroids
  4. Oxygen
  5. Smoking cessation
38
Q

When giving a patient with COPD oxygen what do you need to be careful of?

A

Hypoxic drive

39
Q

What do Emphysema and Chronic bronchitis have in common

A

They are both examples of chronic obstructive pulmonary diseases (COPD)

40
Q

If someone is describes as a pink puffer what might they have?

A

Emphysema

41
Q

If you have a patient with COPD what should you monitor and take into consideration being a dentist?

A
  1. Monitor oxygen
  2. Keep them upright
  3. Avoid rubber dam and sedation
  4. Avoid sedation if severe cases
42
Q

State the target saturation in COPD patients

A

88-92%

43
Q

What is asthma

A

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

44
Q

Is asthma a chronic or acute disorder?

A

Chronic disorder of conducting airways

45
Q

What are the episodic bronchoconstrictions in asthma due to?

A
  1. increased airway sensitivity to stimuli
  2. Inflammation of the bronchial walls
  3. Increased mucus secretion
46
Q

Name the 2 different types of asthma

A
  1. Atopic
  2. Non atopic
47
Q

What is atopic asthma

A

Allergen sensitisation

48
Q

what is non-atopic asthma

A

no evidence of antigen sensitivity

49
Q

Give some triggers for asthma

A
  1. Allergens
  2. Chemical irritants
  3. Strong smells
  4. Temperature change
  5. Exertion
  6. Stress
  7. Drugs
50
Q

What causes asthma

A

It is a type 1 hypersensitivity disorder mediated by IgE

  1. When you initially exposed to your trigger IgE is produced
  2. On second re exposure IgE cross linking occurs
  3. This leads to mast cell degeneration
  4. This causes bronchospasm and vascular permeability
  5. This all causes oedema/airway narrowing
51
Q

List some symptoms of asthma

A
  1. Cough
  2. Wheezing
  3. Difficulty creating
  4. Often need to use accessory muscles in upper body
  5. Tight chest feeling
52
Q

How should you manage an acute asthma attack

A
  1. Help the casualty take their reliever (blue inhaler)
  2. Sit the casualty upright and get them breathing normally
  3. Continue to give 2 puffs of reliever inhaler ever 2 minutes if symptoms don’t improve
  4. If symptoms don’t resolve after 10 puffs of inhaler call 999
  5. If casualty feels better after taking their inhaler they can go back to their previous activity
53
Q

what are 4 medications for asthma

A

Short acting relievers
- Inhaled $2 agonists (e.g. salutamol, terbutaline)

Long-acting relievers/disease controllers
- Inhaled long-acting 2 agonists (e.g. salmeterol, formoterol)
- Inhaled corticosteroids (e.g. beclometasone, budesonide, fluticasone)

Other bronchodilators / bronchodilator activity
- Inhaled antimuscarinic agents (e.g. ipratropium)
- Oral corticosteroids (e.g. prednisolone 40 mg daily)

Steroid sparing agents

54
Q

What is the relationship between asthma and dentistry

A

Possible increased caries risk in asthmatic patients

55
Q

What considerations should you take as a dentist if your patient is asthmatic

A
  1. Keep their reliever inhaler on hand during the appointment
  2. Keep appointment times later in the day
  3. Avoid aspirins and NSAIDs
56
Q

What is tuberculosis

A

An infectious disease characterised by caseating granulomatous inflammation

57
Q

who must be notified if somone has tuberculosis

A

PHE

58
Q

How many death annually are caused by tb

A

1.4 million deaths

59
Q

caseating granulomatous

A

A lesion that has a lot of macrophages leading to the formation of a granuloma

60
Q

Why can it be hard to diagnose primary tb?

A

95% of patients are asymptomatic

61
Q

Name the 2 different types of tb?

A

Primary (non immune host)
Secondary (immune host)

primary=unexposed
secondary=previous exposure

62
Q

Give some symptoms of tb

A
  1. Cough
  2. Malaise
  3. Weight loss
  4. Fever
  5. Haemoptysis
  6. Night sweats
  7. Pain on breathing
  8. Back pain
  9. heart failure
  10. Neurological symptoms
63
Q

How do you diagnose tb

A
  1. Mantoux test
  2. Look at histology for caseating granulomata
  3. Look at microbiology
  4. Interferon gamma release assay
64
Q

How is tb treated

A

Treated with a cocktail of antimicrobial therapy for 6 months

65
Q

What is the Mantoux test

A

Tuberculin skin prick test

Y3 IWB (31 decks)

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