Respiratory

Question 1

Components of respiratory system

Answer 1

ventilation and gas exchange

Question 2

V/Q mismatch

Answer 2

ratio of oxygen to blood is not properly matched, leading to ventilation/perfusion misamtch or dead space ventilation

Question 3

investigations for respiratory conditions

Answer 3

sputum examination, chest radiograph, CT scan, pulmonary function spirometry, bronchoscopy, VQ scan

Question 4

drugs which improve airway patency [ability to breath]

Answer 4

bronchodilators [B2 agonist, anticholinergic]
anti-inflammatory [corticosteroid]

Question 5

durgs which impair ventilation

Answer 5

beta blockers - make airway narrower, increase effect of smooth muscle constriction
respiratory depressants - benzodiazepine, opoids

Question 6

drugs used to imrpove gas exchange

Answer 6

oxygen

Question 7

inhaled drug delivery methods

Answer 7

meter dose inhaler (MDI) = puffer
breath activated device

Question 8

methods to improve respiratory drug delivery

Answer 8

neubuliser = liquid drug in chamber, increased delivery, good in attack
spacer = using MDI, into chamber, get adequate drug volume

Question 9

Beta-2 agonists short acting + examples

Answer 9

relieves symptoms and bronchoconstriction
onset of 2-3mins, lasts 4-6hours
treats and in anticipation
sulbutamol, terbutaline [BLUE INHALER]

Question 10

Beta-2 agonists long acting + examples

Answer 10

relieves symptoms and bronchoconstriction
onset of 1-2hours, lasts 12-15hours
used to prevent, not in anticipation
always used with inhaled steroid
salmeterol [green inhaler]

Question 11

anticholinergics

Answer 11

inhibits nerve transmission, helps in bronchial dilation with beta-agonists and effective in reducing mucus secretion
ipratropium [GREY INHALER]

Question 12

corticosteroids

Answer 12

reduce inflammation in bronchial walls, mucus secretion
most effective
brown inhalers, orange inhaler, pink inhaler

Question 13

asthma

Answer 13

common, reversible airwflow obstruction
bronchial hyperactivty, overreaction of the airway, causes bronchial change in the wall which narrows and restricts air in and out

Question 14

asthma cellular response

Answer 14

allergen triggering of IgE production, B and T cell interaction, degranulation of mast cells = narrowing airway, oedema and mucus secretion

Question 15

airways narrow due to;

Answer 15

1. bronchial smooth muscle constriction
2. bronchial mucosal oedema
3. excessive mucous secretion into airway lumen

Question 16

symptoms of asthma

Answer 16

cough, wheezing, shortness of breath, worse and night/early morning, difficulty breathing out

Question 17

diagnosis of asthma

Answer 17

PEFR [tracks airway resistance, peak expiratory flow rate]
skin prick tests, biphasic response, spirometry

Question 18

triggers of asthma

Answer 18

unknown, infections, environmental stimuli, cold air

Question 19

risk assessment of treatment done by assessment of medication. what is the order

Answer 19

SA B2 agonist -> LD inhaled steroid -> LA B2 agonist -> others ->oral steroid/ever hospitalised

Question 20

dental aspects of asthma

Answer 20

know px has asthma, know severity, know triggers, know how to assess and treat acute asthma attack
- blue inhaler, subsequent oxygen if needed

Question 21

COPD

Answer 21

chronic obstructive pulmonary disease
lung conditions which cause breathing difficulties
can be chronic bronchitis and emphysema
causes damage to airways and alveoli, meaning less ability to ventilate and have gas exchange

Question 22

chronic bronchitis/bronchiectasis

Answer 22

disease of airways with recurring damage
damage to wall, increased mucus, less diameter for gas exchange
productive cough in winter

Question 23

emphysema

Answer 23

destruction of alveoli sacs and dilation of others
less air, more inflammatory changes, increased cardiac size

Question 24

symptoms of COPD

Answer 24

cough, mucus, fatigue, shortness of breath, dyspnoea, chest discomfort

Question 25

diagnosis of COPD

Answer 25

spirometry

Question 26

management of COPD

Answer 26

smoking cessation is key, long-acting bronchodilator combined with inhaled steroids, oxygen support, po=ulmonary rehabilitation therapy

Question 27

consequences of COPD

Answer 27

can lead to respiratory failure

Question 28

type 1 respiratory failure

Answer 28

hypoxia, hypoxaemia, thickening of alveolar barrier reduced area for gas exchange, often hyperventilate to compensate

Question 29

type 2 respiratory failure

Answer 29

CO2 retention and hypoxia hypercapnia, ventilation failure, airway anrrowing, restrictive lung effects

Question 30

oxygen use in COPD

Answer 30

used in acute stage until medical help arrives at home - only effective if 24/7, intermittent use not good, increased cardiovascular risk of death

Question 31

airflow obstructions and dentistry

Answer 31

ability to attend treatment - supplemental oxygen use of inhaled steroids - candida risk, use spacer device for MDI puffers, rinse mouth after use to remove powder deposition and local immunusuppression which leads to candida often smokers/ex-smokers - enhanced oral cancer risk

Question 32

cystic fibrosis

Answer 32

genetic disease where the lungs and digestive system can be clogged with thick, sticky mucus inherited defect in cell chloride channels, producing excess mucus

Question 33

aetiology of cystic fibrosis

Answer 33

CFTR gene on chromosome 7 affects the way ion channels open, recessive gene so both parents needed

Question 34

diagnosis of cystic fibrosis

Answer 34

prenatal screening, perinatal screening, sweat test [salt content higher in CF], CFTR gene testing

Question 35

symptoms of cystic fibrosis

Answer 35

troublesome cough, repeated chest infections, prolonged diarrhoea, poor weight gain

Question 36

consequences of cystic fibrosis

Answer 36

liver dysfunctions, prone to osteoporosis, diabetes symptoms [prolonged pancreas disease], reduced fertility

Question 37

treatment of cystic fibrosis

Answer 37

physiotherapy, medications, exercise, transplantation

Question 38

medications for cystic fibrosis

Answer 38

lungs - bronchodilators digestive - pancreatic enzyme replacement, supplemments CFTR modulators - change chloride channel regulation, allows for more normal secretion stem cell treatment - replace old

Question 39

lung tumours causes

Answer 39

mainly smoking but, radon, workplace chemicals, air pollution, genetics, radiation therapy, lung diease

Question 40

type of lung tumours

Answer 40

small cell non small cell - squamous cell carcinoma, adenocarcinoma

Question 41

symptoms of lung tumours

Answer 41

cough, harmoptysis, pneumonia, metastasis, dysphagia, SVC obstruction

Question 42

diagnosis of lung tumours

Answer 42

delayed as metastasis occurs before detactable and symptoms occur. outcome and prognosis poor

Question 43

role of dentist with lung tumours

Answer 43

smoking cessation advice, reduced chance of lung tumours in the first place offered to every px, recorded in notes

Question 44

obstructive sleep apnoea

Answer 44

airway obstruction, airwy muscle tone drops, allows tongue to fall back and block airway during sleep

Question 45

symptoms of sleep apnoea

Answer 45

snoring, drowsiness, poor sleep, irritable

Question 46

consequences of sleep apnoea

Answer 46

periods of hypoxia, less alert, impacts daily life, increased risk of road traffic accidents, increased risk of MI as low oxygen

Question 47

treatment of sleep apnoea

Answer 47

CPAP mask, mandibular advancement device, postional therapy