Respiratory Diseases Flashcards
1
Q
What are the key symptoms of respiratory disease
A
- Dyspnoea
- Cough
- Haemoptysis
- Chest pain
2
Q
What is the stridor
A
Respiratory disease symptom = harsh/narrow inspiratory noise suggestive of upper airway obstruction
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
4
Q
What are some common respiratory diseases
A
- Asthma
- COPD
- Pneumonia
- TB
- Lung cancer
- Cystic fibrosis
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
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
7
Q
What investigations can be done for Asthma
A
- PEFR
- Spirometry
- Blood test
- CXR
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
9
Q
What do you look for in a spirometry test for asthmatics
A
FEV1 : FVC ratio is reduced (normal is >0.7)
10
Q
What do you look for in the blood test of an asthmatic patient
A
Eosinophilia
Raised total IgE
11
Q
Why do we do a CXR test for asthmatic patients
A
To rule out other causes e.g. pneumothorax
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
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
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
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
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
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
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
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
20
Q
How is COPD diagnosed
A
FEV1 : FVC ratio < 0.7
- FEV1 predicts severity
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
What are some risk factors for pneumonia
- Smoking
- Chronic lung disease
- Chronic heart diseases
- Alcohol excess
- Immunosuppression
26
What types of pneumonia are there
- Primary or Secondary
- Community or hospital acquired (nosocomial pneumonia)
- Aspiration e.g. in stroke, oesophageal disease, drunk/postictal reduced consciousness
- Immuno compromised
27
What are some of the signs and symptoms of pneumonia
- Cough
- Sputum
- Fever
- Chest pain
- Lung abscess
- Confusion
- Pyrexia
- Tachypnoea
- Tachycardia
- Signs of consolidation
- Pleural rubs
- Empyema
28
What management methods are there for pneumonia
- Broad spectrum antibiotics
- Supplemental oxygen therapy
- Analgesics and antipyretics for symptom relief
- Prophylaxis - immunisations
29
What complications arise with pneumonia
- Lung abscess
- Empyema
- Respiratory failure
30
What is the dental relevance for pneumonia
- Defer all dental treatment until recovery
| - GA contraindicated
31
What is tuberculosis
Chronic granulomatous infection caused by mycobacterium tuberculosis
32
What kinds of people are at high risk of tuberculosis infection
- HIV
- Homeless
- Prison
- Alcoholism
- IV drug users
- Recent migrants
- Asylum seekers
33
Name some of the clinical features of tuberculosis
- Initial infection can be subclinical
- Chronic cough
- Haemoptysis
- Weight loss
- Night sweats
- Fever
- Sputum production - mucopurulent
- Lymphadenopathy
- Loss of appetite
34
Describe the onset of TB
- 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
Describe the diagnosis options for TB
- 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
AY BAWS CAN I HABE DE NOTE PLZ
TB is a notifiable disease, contact tracing and isolation is important in limiting spread
37
Describe the treatment process for TB
- 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
What is the dental relevance of TB
- 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
Where does metastasis of lung cancer most commonly affect
Brain
Liver
Bone
40
Describe the causes (aetiology) of lung cancer
- Cigarette smoking majorly
- Asbestos
- Radon - released from granite rock
- Arsenic
- Coal tar
41
What is the prevalence of different histological variants of lung cancer
```
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
What are the clinical features of lung cancer
- Haemoptysis
- Chest pain
- Persistent cough
- Dyspnoea
- Unexplained weight loss
- Recurrent chest infections
- Hoarseness
- Wheeze and stridor
- Finger clubbing
- Cervical lymphadenopathy
43
What investigations are there for lung cancer
- Chest x ray
- CT scan, PET scan
- Bronchoscopy
- Sputum cytology
- Biopsy
44
What management options are there for lung cancer
- TNM tumour staging
- Surgery
- Radiotherapy
- Chemotherapy
- Palliative care
45
What is the dental relevance of lung cancer
- 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
What is cystic fibrosis and what is it caused by
- Autosomal recessive hereditary disorder of metabolism
| - Defect in CFTR - a protein that regulates Cl- and Na+ transport across membrane of exocrine glands
47
What is cystic fibrosis characterised by
- 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
What are some of the clinical features of cystic fibrosis
- Persistent cough
- Wheeze
- Haemoptysis
- Finger clubbing
- Cyanosis
- Dyspnoea
49
What is the diagnostic investigation for cystic fibrosis
Sweat chloride >60mmol/L
50
What complications are associated with cystic fibrosis
- Recurrent chest infections
- Pneumothorax
- Bronchiectasis
- Cor Pulmonale
- Nasal Polyps
- Infertility
- Gall stones
- Biliary cirrhosis
- DM
- Stunted growth
51
What management options are there for cystic fibrosis
Bronchodilators
Prophylactic antimicrobials
Vaccinations
- Diet - low fat intake and adequate vitamins
- Lung transplant may be required in severe cases
52
What is the dental relevance of cystic fibrosis
- 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
