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CHHD > Respiratory Diseases > Flashcards

Respiratory Diseases Flashcards

1
Q

What are the key symptoms of respiratory disease

A
  • Dyspnoea
  • Cough
  • Haemoptysis
  • Chest pain
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2
Q

What is the stridor

A

Respiratory disease symptom = harsh/narrow inspiratory noise suggestive of upper airway obstruction

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3
Q

What does the SOCRATES acronym stand for when trying to assess a patient’s condition

A 
Site
Onset
Character
Radiation
Associations
Time course
Exacerbating/relieving factors
Severity
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4
Q

What are some common respiratory diseases

A
  • Asthma
  • COPD
  • Pneumonia
  • TB
  • Lung cancer
  • Cystic fibrosis
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5
Q

What is asthma and what goes wrong when it affects a patient

A
  • Common chronic inflammatory condition of the airways
  • Airways are hyperesponsive and cause reversible airflow obstruction
  • Bronchospasm
  • Mucosal Oedema
  • Mucus Hypersecretion
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6
Q

What are the clinical features of Asthma

A
  • Wheeze
  • Dyspnoea
  • Chest tightness
  • Cough
  • May become distressed, anxious and tachycardic
  • Reduced chest expansion and use of accessory respiratory muscles
  • Symptoms intermittent
  • Clinical features may be absent in well-controlled asthmatic patients
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7
Q

What investigations can be done for Asthma

A
  • PEFR
  • Spirometry
  • Blood test
  • CXR
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8
Q

What do you look for in a PEFR asthma investigation

A

Shows diurnal variation - at least 15% with lowest values in the early morning.

  • Improvement after bronchodilator -> asthma
  • No improvement and smoker -> COPD
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9
Q

What do you look for in a spirometry test for asthmatics

A

FEV1 : FVC ratio is reduced (normal is >0.7)

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10
Q

What do you look for in the blood test of an asthmatic patient

A

Eosinophilia

Raised total IgE

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11
Q

Why do we do a CXR test for asthmatic patients

A

To rule out other causes e.g. pneumothorax

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12
Q

What ways can asthma be managed - excluding drugs

A
  • Patient education
  • Smoking cessation advice
  • Avoid exposure to triggers: irritants and allergens
  • Step-wise approach to treatment based on the severity recommended
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13
Q

What drugs are used in order to manage asthma

A
  • Short and long acting inhaled beta-agonists,
  • Inhaled corticosteroids
  • Leukotriene receptor antagonists
  • Oral corticosteroids
  • Anti-IgE monoclonal antibody e.g. omalizumab
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14
Q

What is the dental relevance of Asthma

A
  • Identify high risk patients and take precautions
  • Patients to attend with their usual medicaiton
  • GA and IV sedation is best avoided
  • Elective care deferred in severe asthmatics until condition improves
  • Triggers = NSAIDs, Penicillin, Stress and anxiety
  • Gastro-oesophageal reflux is common in asthmatics - tooth erosion
  • Medication - thrush, dry mouth, adrenal suppression with systemic corticosteroids
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15
Q

What is Chronic Obstructive Pulmonary Disease (COPD)

A
  • Common, progressive, poorly reversible airflow limitation associated with persistent inflammatory response of the lungs
  • Chronic bronchitis and/or emphysema = COPD
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16
Q

Name some of the risk factors for COPD

A
  • Smoking = major risk factor, pack years dependent
  • Air pollutants - indoor, outdoor
  • Occupational dusts and chemicals
  • Alpha-1 antitrypsin deficiency - early onset COPD
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17
Q

What is chronic bronchitis and what are the primary symptoms

A
  • Airway obstruction from chronic mucosal inflammation, mucus gland hypertrophy, mucus hyper secretion and bronchospasm
  • Persistent cough and sputum production on most days for three months of the year in 2 successive years
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18
Q

What is Emphysema

A
  • Dilatation of air spaces distal to the terminal bronchioles with destructions of alveoli, reducing the alveolar surface area available for gaseous exchange
  • Reduced elastic recoil, collapse and reduced total lung capacity
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19
Q

Name some of the clinical features of COPD

A
  • Progressive shortness of breath
  • Persistnet cough
  • Fatigue
  • Chronic sputum production
  • Weight loss
  • Barrel chest
  • Tachycardia
  • Reduced exercise tolerance and chest expansion
  • Flapping tremor
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20
Q

How is COPD diagnosed

A

FEV1 : FVC ratio < 0.7

- FEV1 predicts severity

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21
Q

Describe the general management of COPD

A
  • Smoking cessation
  • Vaccination for influenza pneumococcus
  • Pulmonary rehabilitation - weight loss and exercise
  • Long term oxygen therapy
  • Non-invasive ventilation
22
Q

Describe the pharmacological management of COPD

A
  • Bronchodilators: beta agonists and muscarinic antagonists
  • Inhaled and oral corticosteroids
  • Azithromycin
23
Q

What is the dental relevance of COPD

A
  • Best treated in upright position
  • Advise to always bring inhaler with them
  • Cough can make treatment difficult
  • Rubber dam can further obstruct breathing in mouth breathers
  • Best treated under LA
  • GA and sedation avoided if possible
  • Medication - thrush, dry mouth, adrenal suppression with systemic corticosteroids
24
Q

What is pneumonia

A

Acute infection of the lung parenchyma, usually by bacteria

25
Q

What are some risk factors for pneumonia

A
  • Smoking
  • Chronic lung disease
  • Chronic heart diseases
  • Alcohol excess
  • Immunosuppression
26
Q

What types of pneumonia are there

A
  • Primary or Secondary
  • Community or hospital acquired (nosocomial pneumonia)
  • Aspiration e.g. in stroke, oesophageal disease, drunk/postictal reduced consciousness
  • Immuno compromised
27
Q

What are some of the signs and symptoms of pneumonia

A
  • Cough
  • Sputum
  • Fever
  • Chest pain
  • Lung abscess
  • Confusion
  • Pyrexia
  • Tachypnoea
  • Tachycardia
  • Signs of consolidation
  • Pleural rubs
  • Empyema
28
Q

What management methods are there for pneumonia

A
  • Broad spectrum antibiotics
  • Supplemental oxygen therapy
  • Analgesics and antipyretics for symptom relief
  • Prophylaxis - immunisations
29
Q

What complications arise with pneumonia

A
  • Lung abscess
  • Empyema
  • Respiratory failure
30
Q

What is the dental relevance for pneumonia

A
  • Defer all dental treatment until recovery

- GA contraindicated

31
Q

What is tuberculosis

A

Chronic granulomatous infection caused by mycobacterium tuberculosis

32
Q

What kinds of people are at high risk of tuberculosis infection

A
  • HIV
  • Homeless
  • Prison
  • Alcoholism
  • IV drug users
  • Recent migrants
  • Asylum seekers
33
Q

Name some of the clinical features of tuberculosis

A
  • Initial infection can be subclinical
  • Chronic cough
  • Haemoptysis
  • Weight loss
  • Night sweats
  • Fever
  • Sputum production - mucopurulent
  • Lymphadenopathy
  • Loss of appetite
34
Q

Describe the onset of TB

A
  • Can be latent for years only becoming active when boys defences become weakened
  • Active TB can develop shortly after infection in impaired immunity like ageing, drug/alcohol abuse, HIV and cancer
  • Post primary TB can come from old primary lesion and cause cause complications like pneumonia, lung fibrosis or haematogenous spread of mycobacteria
35
Q

Describe the diagnosis options for TB

A
  • Chest X-ray +/- chest CT scan
  • Sputum sample - ziehl-nielsen stain for AFB and culture - if coughing
  • Bronchoscopy
  • Biopsy of affected organ - histology hallmark is caveating granulomata spread
36
Q

AY BAWS CAN I HABE DE NOTE PLZ

A

TB is a notifiable disease, contact tracing and isolation is important in limiting spread

37
Q

Describe the treatment process for TB

A
  • Combination of four drugs usually for 6 months
  • Initial therapy - Isoniazid, rifampicin, ethambutol, pyrazinamide for two months
  • Continuation therapy - isoniazid and rifampicin for four months
38
Q

What is the dental relevance of TB

A
  • TB is contagious, dental treatment best deferred until treated
  • Reduce splatter and aerosols by minimising coughing, avoiding ultrasonic instruments and using rubber dams
  • PPE
  • Avoid GA, LA is safe
  • Possible drug interactions
  • IV drug use, alcoholism, hepatitis and HIV may also influence dental management
  • TB ulcers in the mouth
  • Cervical lymphadenopathy
39
Q

Where does metastasis of lung cancer most commonly affect

A

Brain
Liver
Bone

40
Q

Describe the causes (aetiology) of lung cancer

A
  • Cigarette smoking majorly
  • Asbestos
  • Radon - released from granite rock
  • Arsenic
  • Coal tar
41
Q

What is the prevalence of different histological variants of lung cancer

A 
Non small cell carcinomas:
- Squamous cell carcinoma - 52%
- Adenocarcinoma - 13%
- Large cell carcinomas - 5%
Small cell carcinomas - 30% - aggressive type with early spread, poor prognosis
42
Q

What are the clinical features of lung cancer

A
  • Haemoptysis
  • Chest pain
  • Persistent cough
  • Dyspnoea
  • Unexplained weight loss
  • Recurrent chest infections
  • Hoarseness
  • Wheeze and stridor
  • Finger clubbing
  • Cervical lymphadenopathy
43
Q

What investigations are there for lung cancer

A
  • Chest x ray
  • CT scan, PET scan
  • Bronchoscopy
  • Sputum cytology
  • Biopsy
44
Q

What management options are there for lung cancer

A
  • TNM tumour staging
  • Surgery
  • Radiotherapy
  • Chemotherapy
  • Palliative care
45
Q

What is the dental relevance of lung cancer

A
  • Tobacco smoking is a common risk factor for oral and lung cancer
  • Metastasis to oro-facial region possible - cervical lymphadenopathy and jaw parathesia
  • LA is safe, GA and sedation only if absolutely necessary
  • Chemotherapy - immunosuppression
46
Q

What is cystic fibrosis and what is it caused by

A
  • Autosomal recessive hereditary disorder of metabolism

- Defect in CFTR - a protein that regulates Cl- and Na+ transport across membrane of exocrine glands

47
Q

What is cystic fibrosis characterised by

A
  • Decreased excretion of Cl- into the airway lumen
  • Increased Na+ reabsorption into the epithelial cells
  • Increased viscosity and stasis of secretions
  • Recurrent bronchopulmonary infections -> bronchiectasis
  • Pancreatic duct obstruction and fibrosis leading to insufficiency with malabsorption and bulky, foul smelling, fatty stools
  • Gallstones, diabetes, cirrhosis and pancreatitis can occur
48
Q

What are some of the clinical features of cystic fibrosis

A
  • Persistent cough
  • Wheeze
  • Haemoptysis
  • Finger clubbing
  • Cyanosis
  • Dyspnoea
49
Q

What is the diagnostic investigation for cystic fibrosis

A

Sweat chloride >60mmol/L

50
Q

What complications are associated with cystic fibrosis

A
  • Recurrent chest infections
  • Pneumothorax
  • Bronchiectasis
  • Cor Pulmonale
  • Nasal Polyps
  • Infertility
  • Gall stones
  • Biliary cirrhosis
  • DM
  • Stunted growth
51
Q

What management options are there for cystic fibrosis

A

Bronchodilators
Prophylactic antimicrobials
Vaccinations
- Diet - low fat intake and adequate vitamins
- Lung transplant may be required in severe cases

52
Q

What is the dental relevance of cystic fibrosis

A
  • recurrent sinusiti
  • Diabetes, lung and liver diseases may complicated treatment
  • Enamel hypoplasia
  • Major salivary gland swelling and xerostemia
  • Delayed development and eruption of dentition
  • Poor respiratory function - GA contra-indicated

CHHD (27 decks)

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