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MED COMP PTS > pulmonary dx > Flashcards

pulmonary dx Flashcards

1
Q

COPD stages according to this class

A
  • Bronchitis (Stage I COPD)
  • Emphysema (Stage II COPD)
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2
Q

lung anatomy

#lobes?

A

3 in R, 2 in L

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3
Q

airway path

A

trachea>primary bronchus>secondary bronchus>tertiary bronchi> respiratory bronchioles> alveoli

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4
Q

asthma

A

Chronic inflammatory airway disorder
* Airway hyper-responsiveness to stimuli
* Bronchial edema
* Narrowing of the airways i.e., obstruction

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5
Q

asthma airway events

A

smooth mm contraction and increased mucus

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6
Q

normal vs asthmatic airway

A
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7
Q

asthma signs and symptoms

A

Recurrent, reversible episodes of:
*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest

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8
Q

Which of the following is a “true”
asthma symptom?
*Dyspnea (shortness of breath)
*Wheezing
*Coughing
*Tightness of chest

A

chest tightness

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9
Q

asthma aggrivating and complicating factors

A

● Smoking
● Air pollutants (quality)
- urban
- industrial

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10
Q

stages of asthma

A
  1. Controlled
  2. Partially Controlled
  3. Uncontrolled
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11
Q

controlled asthma

A
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12
Q

partially controlled asthma

A
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13
Q

uncontrolled asthma

A
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14
Q

types of asthma

A
  1. Extrinsic
  2. Exercise Induced
  3. Intrinsic
  4. Drug Induced
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15
Q

extrinsic asthma
* common?
* demo?
* family history?
* Triggered by?
* Exaggerated host response?

A
  • Most common
  • Children and young adults
  • Typical positive family history
  • Triggered by allergens (pollen, dust, house
    mites, animal dander, mold etc.)
  • Exaggerated inflammatory response
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16
Q

extrinsic asthma pathway

A

Allergen→ T Helper Lymphocyte Type 2 (Th2)
→ antibody production of high levels of IgE → activation of mast cells, basophils and eosinophils → bradykinin, histamine, leukotrienes → bronchoconstriction

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17
Q

exercise induced asthma
* Unknown?
* demo?
* Triggered by?
* Cold air role?

A
  • Unknown pathogenesis
  • Children and young adults
  • Triggered by exercise and thermal changes
  • Cold air irritates mucosa resulting in airway
    hyperactivity
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18
Q

exercise induced asthma pathway

A

Allergen→ T Helper Lymphocyte Type 2 (Th2)
→ antibody production of high levels of IgE
→ activation of mast cells, basophils and eosinophils
→ bradykinin, histamine, leukotrienes
→ bronchoconstriction

same as extrinsic

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19
Q

intrinsic asthma
* common?
* demo?
* Triggered by?
* Infrequently associated with?

A
  • Second most common
  • Middle-aged individuals
  • Triggered by respiratory irritants (tobacco, air
    pollution, emotional stress, gastroesophageal reflux
    disease (GERD)
  • Infrequently associated with family history
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20
Q

how is intrinsic asthma pathway dif from the others?

A

normal IgE levels

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21
Q

drug indcued asthma
subset of?
demo?

A
  • Subset of intrinsic
  • Affects children, young adults & middle-aged adults
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22
Q

common drugs of drug induced asthma

A

➢NSAIDs, ASA
➢β-blockers
➢ACEi
➢Anticholinergic drugs (?)
➢Food dye
➢Metabisulfites in food and in local anesthetics with
epinephrine

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23
Q

asthma tx

A

inhaled B2 agonists
SABA
LABA

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24
Q

inhlaed b2 agonists

A

bind to ẞ2 receptors in lungs
smooth muscle relaxation
i.e., bronchodilation

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25
Q

SABA

A

are single use (rescue) medications used alone

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26
Q

LABA

A

used in combination with steroids on a scheduled protocol used alone leads to CVD complications ( arrythmias, etc)

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27
Q

side effects asthma tx

A

Tremors
tachycardia
Increases blood sugar
Cough
K decrease

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28
Q

common SABA

A

albuterol

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29
Q

LABA often used with what asthma stage

A

uncontrolled

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30
Q

anticholergenics used for asthma

A

atrovent and spiriva

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31
Q

methyxanthine used for asthma

A

theophylline

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32
Q

mast cell stabilizer for asthma

A

cromolyn

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33
Q

corticosteroids for asthma

A

used with LABA
demethasone, fludrocotisone, methylprednisolone, predinosone

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34
Q

LT receptor antag for asthma name

A

singulair

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35
Q

combo inhalers names

A

advair diskus and symbicort

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36
Q

asthma oral signs

A
  • Mouth breather (high palatal vault, overjet, crossbite, greater facial height)
  • Dry mouth
  • Candida
  • Enamel defects and caries
  • Gingivitis/periodontitis
  • Enamel erosion possible with GERD
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37
Q

uncontrolled Asthma
Dental Treatment Considerations

A
  • Dental treatment should be limited to urgent care
    only
  • Treatment of acute pain, bleeding, or infection
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38
Q

stable asthma dental tx considerations

A
  • Any indicated dental treatment may be provided if
    management protocols are considered
  • Consult with physician for severe persistent
    asthma
    use of inhlaer before appt
39
Q

asthma rx interactions
* Aspirin?
* NSAIDs?
* Opioids and barbiturates?
* Sulfites in epinephrine?

A
  • Aspirin can trigger asthma➢Avoid in susceptible patients
  • NSAIDs can trigger asthma➢ Avoid in susceptible patients
  • Opioids and barbiturates➢ Worry about respiratory depression; avoid use
  • Sulfites in epinephrine preparation of local anesthetics➢Avoid in susceptible patients
40
Q

asthma pt on Theophylline with macrolides or ciprofloxacin

A

➢Potent inhibition of CYP3A4
➢Increases levels of theophylline
➢Toxicity (arrhythmia and seizures)

41
Q

asthma and cholergenic agonists

A

➢Effect of cholinergic agents promotes bronchoconstriction
➢Sialogogues are contraindicated in patients with uncontrolled asthma

42
Q

Status Asthmaticus

A

→ Severe prolonged asthma attack (more than 24 hours)
→ life threateningAsthma

43
Q

drug of choice for acute asthma attacks

A

SABA inhaler

44
Q

dental tx considerations of any asthma
avoid?
reducing risk?

A
  • Avoid known precipitating factors
  • Reduce risk of attack:
    ➢Have patient bring medication inhaler to each
    appointment
    ➢Recommend prophylaxis with inhaler before
    appointments for those with moderate to severe
    asthma.
45
Q

Rx to avoid with dental tx ans asthma

A

➢Aspirin, NSAIDs, Narcotics, Macrolide antibiotics
like erythromycin.
➢Sulfite (preservative) containing local anesthetics
may need to be avoided

46
Q

sedation for asthma pts

A

➢Nitrous (better)
➢Short-acting benzodiazepine

47
Q

before any tx for severe asthma what should be done?

A

consult

48
Q

asthma emergency pt presentation

A
  • Respiratory rate >25 breaths/min, labored breathing
  • Tachycardia >110 beats/min
  • Flushed appearance
49
Q

what to do with an asthma emergency in clinic

A
  • Stop treatment, inform supervising faculty, administer O2, and call 4444
    ➢ Remove all items from patient’s mouth
    ➢ Record the time attack began
    ➢ Raise the dental chair
    ➢ Give short-acting β2-adrenergic agonist inhaler
    ➢ Administer oxygen
    o Administer 0.3-0.5 ml of 1:1000 epinephrine –small doses are SM dilators
    o Call an ambulance
    o Re-administer short-acting β2-adrenergic agonist inhaler every 20 minutes until EMS arrive
    o The emergency team will continue treating the patient with bronchodilators and oral systemic corticosteroids
50
Q

Chronic obstructive bronchiolitis defined

A

Chronic obstructive bronchiolitis (obstruction small airways)
* Excessive tracheobronchial mucus production to cause coughing and sputum production for >/=3 months for >/=2 consecutive years in the absence of infection or other causes of chronic cough

51
Q

II. Emphysema

A
  • Longterm Chronic obstructive bronchiolitis leads to destruction of lung parenchyma and alveolar walls
  • Decreased elastic recoil
  • Difficulty in maintaining airway opening during expiration
52
Q

3rd leading cause of death in US

A

COPD

53
Q

COPD and corticosteroids

A

Corticosteroid-resistant progressive chronic inflammatory disease
* Poorly reversible/irreversible airway obstruction
* Entrapment of air and dyspnea upon exertio

54
Q

copd airway compared to healthy airway

A
55
Q

Aggravating/Complicating Factors of copd

A

● Smoking
● Air pollutants (quality)- urban and industrial
● CVD- comorbidity

56
Q

sign and symptoms COPD

A

dyspnea, cough, sputum

57
Q

stages and severity of COPD

A
58
Q

stage 1/mild COPD spirometry and s/s?

A
59
Q

stage 2/ moderate copd spirometry and s/s?

A
60
Q

stage 3/severe copd spirometry and s/s?

A
61
Q

stage 4/severe copd spirometry and s/s?

A
62
Q

copd exacerbating infections

A

Triggered by viral or bacterial infections
* Haemophilus influenza
* Moraxella catarrhalis
* Streptococcus pneumoniae

63
Q

copd complications

A
  • Pulmonary hypertension
  • Cor pulmonale (R-sided heart enlargement)
  • Thoracic bullae
  • Nocturnal hypoxia
64
Q

copd comorbidities

A
  • Hypertension
  • Ischemic heart disease
  • Heart failure
  • MI
  • Muscle wasting
  • Osteoporosis
65
Q

copd tx rx

only intervention that can reduce progression?

A
  • Inhaled long-acting bronchodilators
  • Corticosteroids if asthma also present and/or more reversible obstruction
  • Smoking cessation is only intervention that actually reduces disease progression
66
Q

copd oral manifestations

A
  • Dry mouth
  • Steven-Johnson syndrome with theophylline
    Exacerbates Smoking Side Effects of:
  • Halitosis
  • Tooth staining
  • Nicotine stomatitis
  • Periodontal disease
  • Oral potentially malignant disorders
  • Leukoplakia
  • Erythroplakia
  • Oral squamous cell carcinoma
67
Q

copd dental tx consideration of copd stage

A

Determine stage and severity of COPD
➢ Medical consultation for mild to moderate COPD to
determine the presence of respiratory failure right-sided heart failure
➢ If COPD Stage III or higher or who have respiratory and heart failure= Consider dental treatment in a hospital setting

68
Q

dental tx if less than stage 3 copd
➢ Place the patient in?
➢ Avoid using a?
➢ Avoid treating if what is present?
➢ Local anesthetic with epi and low flow O2 (2L/min)?
o May need to limit epi if?

A

➢ Place the patient in a semi-supine position to avoid
respiratory distress
➢ Avoid using a rubber dam (??)
➢ Avoid treating if upper respiratory infection is present
➢ Local anesthetic with epi is acceptable and low flow O2 (2L/min) can be used
o May need to limit epi if concomitant CVD

69
Q

meds to avoid with dental tx in copd

A
  • Avoid medications that cause respiratory depression
    ➢Barbiturates
    ➢Narcotics
    ➢Nitrous oxide is contraindicated
    ➢Benzodiazepines (low dose may be acceptable in
    certain situations)
    o Consult physician
70
Q

copd pts taking theophylline should not be prescribed?

A
  • Erythromycin, macrolide antibiotics (clarithromycin, azithromycin, etc.) and ciprofloxacin
71
Q

TB

A

Granulomatous infectious disease caused by
Mycobacterium tuberculosis
Lungs are most common site of infection
Due to the multiple species of Mycobacterium (m.
bovis, m. abscessus, m.microti, m.africanuum,
etc.), TB can also affect cutaneous, lymphatic and
other tissues

72
Q

how much of population has TB

A

estimates 1/3 of human population is infected, greatest single pahtogen killer

73
Q

why does the US have lower TB rates

A
  • better sanitation
  • improved hygiene
  • more efficient delivery of anti TB medications
74
Q

majority of new USA cases are?

A

54% of new USA cases are in foreign born
migrants or travelers; this rate has been on the
increase since 1993

75
Q

at risk TB populations

A
  • Racial and ethnic minorities
  • Inner city residents in congregate facilities
  • immunocompromised patients (HIV, medication
    suppressed, DM, etc
76
Q

Disproportionate affected populations of TB are?

A

Disproportionate affected populations are India,
eastern Europe, China

77
Q

trnasmission TB

A

Airborne Transmission via infectious respiratory droplets from
* Coughing
* Sneezing
* Talking
* Singing

78
Q

s/s of TB

A
  • Persistent, unexplained cough
  • Fever
  • Malaise
  • Night sweats
  • Unintentional weight loss
  • Hemoptysis
  • Dyspnea
79
Q

TB risk factors:
* Individuals from countries with?
* Individuals who visited areas with?
* Close contact with?
* Individuals who reside or work in?

A
  • Individuals from countries with high incidence or prevalence of TB
  • Individuals who visited areas with high prevalence of active TB
  • Close contact with individuals who have TB
  • Individuals who reside or work in facilities with high risk exposure
    ➢Health care facilities
    ➢Nursing homes
    ➢Correctional facilities
    ➢Homeless shelters
    ➢Accommodations for the mentally disabled
80
Q

TB risk factors
* Individuals who have had?
* Individuals at increased risk of?
* Infants, children and adolescents exposed to?

A
  • Individuals who have had skin test conversion within the past 2 years
  • Individuals at increased risk of latent TB
    ➢Medically disadvantaged/underserved
    ➢Low income
    ➢Alcohol or drug use disorder
  • Infants, children and adolescents exposed to
    ➢Individuals at increased risk of latent TB or active TB
    ➢Individuals with a positive TB skin test
81
Q

TST and IGRA TB test results

A
82
Q

TB oral signs

A

uncommon
* More frequent presentation:
➢ Deep irregular, painful ulcer on the tongue dorsum
➢ May occur in other areas as well (gingiva, lips, palate, buccal mucosa)
* SCROFULA

83
Q

scrofula

A
  • TB involvement of cervical and submandibular lymph nodes
  • Lymph nodes are enlarged and painful
  • Abscess with purulence may be present
84
Q

Risk of Progression to Active TB pt populations

A

demogrpahics

85
Q

TB tx phases for antibiotic regimen

A
86
Q

multidrug resistant TB tx

A
87
Q

multidrug resistant TB tx

A
88
Q

dental tx considerations for TB, determining infectivity?
Determining if a Patient is Noninfectious
* Patient has taken?
* Patient has been compliant with?
* acid-fast bacillus (AFB) testing?
* Patient is?
* Unlikely?
* All close contacts?

A

Determining if a Patient is Noninfectious
* Patient has taken standard multidrug therapy for TB for 2-3 weeks
* Patient has been compliant with standard multidrug therapy for TB
* Three (3) consecutive negative sputum smears on acid-fast bacillus (AFB) testing
* Patient is clinically improved
* Unlikely (negligible) multidrug-resistant TB
* All close contacts were identified, evaluated, and began treatment for latent TB, if necessary

89
Q

Dental Treatment Considerations
Active Sputum-Positive TB

A
  • Emergency care only in hospital environment
    ➢ Isolation
    ➢ Negative pressure ventilation
    ➢ Respiratory protection
  • If hospital unavailable treat urgent dental problems with palliative care (medications: analgesics, antibiotics)
  • Consult physician before treatment
    ➢ Place patient in an isolated area
    ➢ Provide patient with a mask
    ➢ Arrange transportation
90
Q

Recent Conversion to Positive Tuberculin Skin Test dental tx

A
  • Consult physician
    ➢ Rule out active TB
    ➢ Verify adequate completion of therapy (9 months)
  • If ”no clinically active tuberculosis” → treat as normal
    patient (noninfectious)
91
Q

if s/s of TB approach as?

A

sputum positive

92
Q

dental tx with hx of TB
* If consistently negative sputum?
* History to know?
consult/request?
when to postpone?

A
  • If consistently negative sputum
    ➢ Treat as normal (non-infectious)
  • History
    ➢ When
    ➢ How treated
    ➢ Exposures
    ➢ Treatment duration
    ➢ Review of systems
  • Consult physician before treatment
  • Request
    ➢ Results from periodic chest radiographs
    ➢ Results from recent physical examinations
  • Postpone treatment if
    ➢ Treatment time reported seems questionable
    ➢ Follow-up protocols since TB treatment are
    inadequate
    ➢ Signs and symptoms of reactivation/relaps
93
Q

hx of latent TB dental tx
* Similar to?
* Verify?
* Treat as?

A
  • Similar to history of TB
    ➢ Medical history
    ➢ Review of systems
    ➢ Consult physician to rule out active disease
  • Verify prophylactic isoniazid therapy (at least 6
    months of therapy)
  • Treat as non-infectious

MED COMP PTS (9 decks)

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