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4th yr- CMS- Medicine > Respiratory Disease > Flashcards

Respiratory Disease Flashcards

1
Q

Give examples of respirate disease

A
  1. Asthma
  2. Chronic Obstructive pulmonary Disease
  3. Upper and lower respiratory infection
  4. Lung and laryngeal cancers
  5. Pulmonary embolus
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2
Q

Give soem differences in asthma and COPD

A
  1. COPD more common in smokers
  2. Asthma starts in childhood or early adulthood whereas COPD later in life
  3. Chronic productive cough common in COPD
  4. Breathlessnes is persistent and progressive in COPD but variable in asthma
  5. Symptoms are worse at night in asthmatic patients
  6. Asthma symptoms more variable
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3
Q

What is asthma

A

A chronic inflammatory deists where the airway is obstructed and bronchial is hyper responsive to stimuli

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4
Q

How do we diagnose asthma

A

Combination of signs, symptoms and trigger

Also evaluation PEF and possibly spirometry

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5
Q

Give some triggers for asthma

A
  1. Exercise
  2. Viral infection
  3. NSAIDs
  4. Beta blockers
  5. Dust/pollen/ animals
  6. Coloiphony
  7. Latex
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6
Q

Give some symptoms fo asthma

A
  1. Wheeze
  2. Tight chest
  3. Cough
  4. Shortness of breath
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7
Q

Give some signs of asthma

A

Wheeze that is

  1. bilateral
  2. Polyphonic
  3. Diffuse
  4. Expiratory
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8
Q

What is a sign

A

Something a clinician can objectively see hear or measure

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9
Q

What is a symptom

A

Something the patient describes or complains of

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10
Q

Is asthma lethal

A

3 people die of acute asthma every day

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11
Q

Is the severity of asthma in a patient linear

A

No it changes with time so management is a stepwise approach

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12
Q

What do we aim to control in an asthmatic patient

A
  1. Minimal symptoms
  2. Minimal need for beta agonist medicine
  3. No exacerbations
  4. No limitation of physical activity
  5. Normal lung function
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13
Q

What is asthma management split into

A
  1. Pharmacological management

2. Non pharmacological management

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14
Q

What can pharmaceutical treatment of asthma be split into

A
  1. Relievers

2. Preventers

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15
Q

List some relieving medication we can give to treat asthma

A
  1. Beta 2 agonists
  2. Antimuscarinic drugs
  3. Theophyline tablets
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16
Q

Give examples of soem beta 2 agonist

A
  1. Salbutamol

2. Salmeterol

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17
Q

Give examples of some antimuscarinic drugs

A
  1. Ipratropium

2. Tiotropium

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18
Q

List some preventer medication we can give to treat asthma

A
  1. Inhaled corticosteroids
  2. Systemic corticosteroids
  3. Leukotriene receptor antagonists
  4. Theophylline tablets
  5. Cromoglycates
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19
Q

Give examples of some inhaled corticosteroids

A

Beclometasone

Fluticasone

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20
Q

Give examples of some systemic corticosteroids

A

Prednisolone tablets

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21
Q

What do beta 2 agonists act on

A

They act on beta-adrenoreceptor

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22
Q

What do beta 2 agonist drugs do

A

They aim to relax the smooth muscle in the bronchi

They also result in a degree of vasodilation

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23
Q

What happens when the beta 2 agonist drug binds to beta-adrenoreceptor

A
  1. Up regulates cyclic adenosine monophosphate (cAMP)
  2. This increases calcium levels intra cellularly
  3. CAMP will also activate protein kinase A
  4. Protein kinase A and calcium will inactivate myosin kinase and myosin phosphatase
  5. This will relax smooth muscle
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24
Q

What happens when the smooth muscle of the bronchi is relaxed

A

Relieves the construction of the lumen and increases the airflow through the lumen

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25
Q

What are the side effects of beta 2 agonist

A
  1. tremor
  2. tamycardia
  3. agitation
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26
Q

What type of drugs are inhaled corticosteroids

A

They are anti inflammatory

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27
Q

What colour inhaler is the beta 2 agonist

A

It is a blue inhaler

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28
Q

Which colour inhaler are the inhaled steroids

A

Brown inhaler

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29
Q

Which colour inhaler are the Antimuscarinic drugs

A

Green inhaler

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30
Q

What do Antimuscarinic drugs do

A

They act to dilate the bronchus

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31
Q

How do Antimuscarinic drugs work

A
  1. reduces the influence of acetyl Choline on bronchial smooth muscle
  2. Blocks muscular receptors
  3. This promotes degradation on cyclic GMP
  4. Affects calcium levels
  5. Decreases contractility of the smooth muscle
  6. Inhibits broncho restriction and reduces mucous secretion
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32
Q

What does Theophylline do

A

Relaxes bronchial smooth muscle

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33
Q

What type of drug is Theophylline

A

It is a phosphodiesterase inhibitor that raises CYCLIC AMP

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34
Q

Talk through how Theophylline works

A
  1. inhibits that raises CYCLIC AMP
  2. Activates protein kinase A
  3. Inhibits leukatrine synthesis
  4. This reduces inflammation
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35
Q

what is leukatrine

A

Inflammatory mediatory that brings on prostaglandins

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36
Q

What do Cromoglycates do

A

Stabilise mast cells which would otherwise make histamine

37
Q

What is histamine

A

It is a potent pro inflammatory mediator

38
Q

What is a key disadvantage of inhaled corticosteroids

39
Q

What is Candiasis

A

Oral thrush

40
Q

what do we recommend to patients who take inhalers

A

Rinse after you use your inhaler

41
Q

What do we need to consider as dentists in patients who have asthma

A
  1. Inhaled corticosteroids are associated with oral candidiasis
  2. Encourage good denture hygiene
  3. Avoid advising NSAIDs
  4. Avoid macrolide antibiotics and ciprofloxacin in patients taking theophylline
  5. Avoid colophony in anyone with a sensitivity, children with asthma and anyone with severe asthma
42
Q

Which asthmatic patient is more likely to develop oral candidiasis

A

Patients wearing dentures

43
Q

What does COPD stand for

A

Chronic obstructive pulmonary disease

44
Q

What is COPD

A

A choleric inflammatory disease of airways that is NOT fully reversible and progressively worsens

45
Q

What can damaged airways be due

A
  1. Inflammation

2. Fibrosis and narrowing

46
Q

What can damaged lung parenchyma be due to

A
  1. Inflammation of the alveoli
  2. Decreased surface area for gas exchange
  3. Altered lung compliance
47
Q

When is the diagnosis of COPD considered

A

in patients over 25 who have risk factors and :

  1. Exertional breathlessness or
  2. Chronic cough or
  3. Regular sputum productionor
  4. Frequent winter ‘bronchitis’ or
  5. Wheeze
48
Q

List some symtoms of COPD

A
  1. Worsening breathlessness
  2. Cough
  3. Increased sputum, production
49
Q

How do we manage COPD

A
  1. Limit complications
  2. Control symptoms
  3. Limit disease progression
50
Q

How do we limit the complication of COPD

A
  1. Stop smoking

2. Taking flu vaccine

51
Q

Name the most common risk factor for COPD

52
Q

What can we prescribe and do to manage COPD

A
  1. Prescribe inhaled muscarinic
  2. Short and long acting beta agonist
  3. Theophylline
  4. Inhaled corticosteroids steroids
  5. Respiratory physiotherapy
  6. Ambulatory oxygen
  7. Non invasive ventilation
  8. Surgery
53
Q

What effect does COPD have on the NHS

A

1 IN 8 hopsital admissions related to COPD

54
Q

How many deaths annually are caused by or related to COPD

A

30,000 deaths

55
Q

List some signs of exacerbation

A
  1. Marked dyspnea
  2. Tachyponea
  3. Pursed lip breathing
  4. Use of accessory muscles
  5. Acute confusion
  6. New onset cyanosis
  7. New onset peripheral oedema
  8. Marked reduction of activity in daily life
56
Q

What can we do to help mange exacerbation of COPD

A
  1. Increase dose of bronchodilator
  2. Nebulisers
  3. Short course of systemic steroids
  4. Antibiotics if requires
57
Q

What should we consider as a dentist if a patient has COPD

A
  1. Patient may be generally unwell
  2. Give smoking cessation
  3. Consider your dental environment eg stairs
  4. Give inhaler advice
58
Q

What are respiratory tract infections split into

A

Upper respiratory tract infections (URTI)

lower respiratory tract infections (LRTI)

59
Q

Give examples of some upper respiratory tract infections (URTI)

A
  1. Common cold
  2. Sinusitis
  3. Pharyngitis
  4. Laryngitis
  5. Obstructive laryngitis (Croup)
  6. Epiglottis
60
Q

Give examples of some lower respiratory tract infections (URTI)

A
  1. Pneumonia
  2. bronchitis
  3. legionella,
  4. mycoplasma,
  5. RSV (in babies), SARS
61
Q

What is Streptococcal sore throat caused by

A

Strep Pyogenes

62
Q

What are strep Pyogenes

A

A group A haemolytic streptococci

63
Q

List some of the symptoms of Streptococcal sore throat

A
  1. Sore throat
  2. Pain on swalloin
  3. Fever
  4. cervical lymphadenitis
  5. fatigue
64
Q

How long can Streptococcal sore throat last

65
Q

List some of the signs of Streptococcal sore throat

A
  1. inflamed pharyngeal tonsils,
  2. petechial rash of the soft palate and pharynx,
  3. skin rash in some,
  4. ‘strawberry tongue’
66
Q

How can we treat Streptococcal sore throat

A

Penicillins

67
Q

How does pneumonia occur

A
  1. Microbes multiply in the normally sterile alveoli and induces inflammation
  2. Alveoli fills with inflammatory cells and fluid
  3. This decreases gas exchange LEADING TO PROBLEMS
68
Q

What can pneumonia be caused by

A
  1. Bacteria
  2. Viral
  3. Aspirated
  4. Fungal
69
Q

Name some bacteria that can cause pneumonia

A
  1. Strep. Pneumoniae is most common,
  2. H. influenzae,
  3. S. aureus
  4. K. pneumoniae
70
Q

What can cause viral pneumonia

A

Typically a consequence of upper respiratory tract infections

71
Q

List some symptoms of pneumonia

A
  1. Dyspnoea
  2. Fever
  3. Cough
  4. Bad smell to sputum
  5. Chest pain when breathing
72
Q

The lungs are are common site for what

A

Primary tumours and secondary metastases

73
Q

What type of cancer can you get in the lungs

A
  1. Small cell tumours (20%)

2. Non small cell tumours (80%)

74
Q

Describe small cell tumours

A

They spread rapidly, aggressively and are difficult to treat

75
Q

Describe non small cell tumours

A

Most are adenocarcinomas or large cell carcinomas

76
Q

Give some risk factors for lung cancer

A

Smoking
Asbestos
Obesity

77
Q

List some of the symptoms of lung cancer

A
  1. Continuing cough
  2. Increasing breathlessness
  3. Cough up sputum and or blood
  4. Hoarse voice
  5. Cough and deep breathing
  6. Finger clubbing
78
Q

How common is lung cancer

79
Q

How can we treat lung cancer

A

Often includes radiotherapy

80
Q

List some risk factors fro laryngeal cancer

A
  1. Smoking
  2. Alcohol
  3. HPV
  4. Occupational hazard eg pain fumes, wood dust
81
Q

List some symptoms of laryngeal cancer

A
  1. Change in voice
  2. Difficulty swelling
  3. Globus cough
  4. Very bad breath
82
Q

How can we treat laryngeal cancer

A
  1. Radiotherapy
  2. Palliative
  3. Chemotherapy
  4. Total laryngectomy
83
Q

What can happen in a patient laryngectomy

A

Patients lose the ability to speak normally some people may need speech valves

84
Q

How can radiotherapy affect the mouth

A
  1. Increase xerostomia

2. Increased caries

85
Q

What do you need to be careful of in a patient who had had a laryngectomy

A

Air no longer passes through the nose and mouth into the lungs and no water can get into the stoma so in case of a medical emergency dont try and put a mask on the face

86
Q

What is a pulmonary embolus

A

Distant thrombosis (usually leg or pelvis) sheds and travels via venous circulation, through the RHS of the heart then out into the pulmonary artery

87
Q

Give some symptoms of pulmonary embolus

A
  1. Sudden onset dyspnoea
  2. Chest pain
  3. haemoptysis
88
Q

List some risk factors of pulmonary embolus stasis

A
  1. Recent surgery
  2. Bed bound
  3. Long haul flights
  4. Obesity
  5. Heart failure
89
Q

List some risk factors of pulmonary embolus hyper coagulable

A
  1. Cancer
  2. Factor V leiden
  3. Pregnancy
  4. OCP
  5. HIV

4th yr- CMS- Medicine (14 decks)

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