Respiratory Disease & Lung Cancer

Question 1

What is the process called which describes the action of drawing air containing 21% oxygen into lungs?

Answer 1

Ventilation

Question 2

What is the process called which describes carrying de-oxygenated blood to the lungs from the venous system and oxygenated blood away to the arterial system?

Answer 2

Perfusion

Question 3

What is the tidal volume?

Answer 3

The size of each breath

Question 4

What factors does ventilation depend on?

Answer 4

Tidal volume
Respiratory rate
Resistance of the airways
Distensibility of the lungs

Question 5

Periodontal infection can easily track down from the _________ into the lungs, giving rise to pneumonia or lung abscess

Answer 5

Oropharynx

Question 6

What respiratory diseases can affect the airways?

Answer 6

Asthma
COPD

Question 7

What respiratory diseases can affect the parenchyma of the lungs?

Answer 7

Fibrosis
Pneumonia

Question 8

What respiratory disease is vasculature related?

Answer 8

Pulmonary embolism

Question 9

What are symptoms of respiratory disease?

Answer 9

Breathlessness (persistent or not)
Wheeze
Cough
Sputum
Haemoptysis (coughing up blood)
Pain

Question 10

What are some clinical signs of a patient with respiratory problem?

Answer 10

Respiratory distress
Respiratory rate (faster than normal)
Pulse
Blood pressure
Cyanosis (bluish discolouration especially of the lip or the tongue)
Stridor (inspiratory)/wheeze (respiratory)

Question 11

What are the bedside tests that can be carried out to check for respiratory disease?

Answer 11

Peak flow
Oximetry

Question 12

What is the term for a patient with advanced COPD and emphysema who breathes very fast, purses their lips to blow air in & out (breathes hard), and fixes their chest in a slouched position with additional support from their hands by their sides, but still remains pink because they are well-oxygenated?

Answer 12

Pink Puffer

Question 13

What is the term for a patient with COPD and does not breathe fast, causing cyanosis of their lips and tongue due to low oxygen level, and may have right heart failure and peripheral oedema, usually swollen legs?

Answer 13

Blue Bloater

Question 14

What is the main cause of lung cancer?

Answer 14

Smoking cigarettes

Question 15

What symptoms presented would a patient who smokes be suspected of lung cancer?

Answer 15

Cough
Haemoptysis
Weight loss
Anorexia
Pain
Metastases

Question 16

What are possible causes of haemoptysis?

Answer 16

• Tumours eg bronchial carcinoma and laryngeal carcinoma
• Infections eg tuberculosis, pneumonia, bronchiectasis and bronchitis
• Infarction eg pulmonary embolism
• Pulmonary oedema
• Pulmonary vasculitis

Question 17

What are possible causes of finger clubbing?

Answer 17

Respiratory (most common) - carcinoma, fibrotic lung disease, bronchiectasis
Cardiac (rare) - endocarditis, cyanotic congenital heart disease
Gastrointestinal (rare) - hepatic cirrhosis, Crohn’s disease, Coeliac disease

Question 18

For patients coughing up blood, what investigation tests can be carried out to diagnose lung cancer?

Answer 18

Chest X-ray
CT Scan
Bronchoscopy
Biopsy

Question 19

What treatment options are available for lung cancer?

Answer 19

Surgery
Radiotherapy
Chemotherapy
Palliation

Question 20

What complication can have similar clinical features to a blue bloater?

Answer 20

Superior vena cava obstruction

Question 21

What can we suspect when we see a patient with swollen lymph nodes in the neck?

Answer 21

Lymphoma
Lung cancer metastasised to the lymph nodes

Question 22

What is the syndrome called when a patient presents with differently sized pupils, drooping of right eye lid (ptosis), constriction of right pupil (myosis), loss of sweating on right side of the face (anhidrosis)? *due to loss of sympathetic nerves supply to the right eye commonly due to a cancer group at the top of the right lung where it can hit the sympathetic nerve going up to the eye

Answer 22

Right Horner’s Syndrome

Question 23

What are the systemic effects of chemotherapy?

Answer 23

• Marrow suppresion: low Hb (anaemia), low WCC (predisposes to infection), low platelets (increased risk of haemorrhage)
• Alopecia
• Nausea, vomiting
• Infertility, ototoxicity, renal toxicity, neuropathy

Question 24

What are the oral effects of chemotherapy?

Answer 24

• Oral ulceration, mucositis
• Gingival bleeding, mucosal petechiae
• Xerostomia, caries
• Oral infection, dental abscess
• Oral candidiasis
• Altered taste
• Herpes simplex

Question 25

What are the precautions to take for patients who have had chemotherapy during oral surgery?

Answer 25

1. Liase with medical team in planning procedure
2. Ensure blood counts checked recently
3. Oral surgery should be as atraumatic as possible
4. Ensure haemostasis, local haemostatic measures (packs)
5. Consider risk of infection: antibiotics for those who have low WCC
6. Monitor for a period of time post procedure, give patient contact info if problems arise