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BDS2; CHHD > Respiratory diseases > Flashcards

Respiratory diseases Flashcards

1. Identify and recognise signs and symptoms of common respiratory diseases 2. Recognise and carry out emergency management of acute episodes of respiratory diseases 3. Discuss the key features of asthma, COPD, pneumonia, TB and cystic fibrosis 4. Explain dental relevance of respiratory diseases and their clinical management

1
Q

What could the key symptoms of respiratory diseases include

A
  • dyspnoea (difficulty breathing)
  • cough
  • heamoptysis (coughing blood)
  • chest pain
  • wheezing (high pitched expiration)
  • stridor (high pitched inspiration)
  • fever, riggers, night sweats
  • hoarseness of voice (dysphonia)
  • weight loss
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2
Q

How should the history of symptoms be evaluated for respiratory diseases

A
  1. Onset and duration of symptoms
  2. Severity of symptoms
  3. What exacerbates/relieves the symptoms
  4. Character of cough
  5. Colour, frequency, consistency, smell and quantity of sputum
  6. Differentiation from haematemesis

SOCRATES

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3
Q

What medical histories should be taken for patients presenting with symptoms of respiratory diseases

A
  1. Previous medical history
  2. Drug history
  3. Allergies
  4. Family history
  5. Social history; smoking, pets, travel, occupation, close contacts, impact on quality of life
  6. Systemic review
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4
Q

What clinical signs of respiratory diseases can be seen on examination

A

Hand examination

  • tar staining (smoking)
  • peripheral cyanosis (indicates lung is compromised)
  • tremor (fine vs flapping in COPD)
  • finger clubbing (Schamroth’s sign)

Lymphadenopathy

Tracheal deviation

Chest wall deformity

Elevated jugular venous pressure

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5
Q

How can tracheal deviation be tested for

A

By placing the index and ring finger of one hand onto the rounded parts of the clavicle bone and then extending the middle finger of the same hand and placing it up onto the trachea - this should sit in the middle

If there is tracheal deviation then the finger will move more to one side

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6
Q

What is asthma

A

Chronic inflammatory condition of the airways where there is reversible airway hyper-responsiveness causing air flow obstruction due to

  1. Bronchospasm
  2. Mucosal oedema
  3. Mucus hyper secretion

And this will cause difficulty breathing

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7
Q

What are the clinical presentations of asthma

A
  • Wheeze
  • Dyspnoea
  • Chest tightness
  • Cough
  • Distress, anxiousness and tachycardia
  • Reduced chest expansion and use of accessory muscles
  • Intermittent symptoms worse at morning and night

Clinical features may be absent in well controlled asthmatic patients

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8
Q

What investigations are carried out for asthma

A
  1. Peak expiratory flow rate
  2. Spirometry - FEV1:FEC is reduced (<0.7)
  3. Blood test - eosinophilia, raised IgE
  4. Chest x-rays (rules out other causes e.g. pneumothorax = collapsed lung)
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9
Q

What does improvement in PEFR after a bronchodilator indicate

A

The patient has asthma

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10
Q

What does no change in PEFR after a bronchodilator indicate

A

COPD if the patient is a smoker

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11
Q

How is asthma managed

A
  1. Patient education and smoking cessation
  2. Avoidance of triggers (irritants and allergens)
  3. Drug treatment
    - inhaled beta-agonists
    - inhaled corticosteroids
    - leukotriene receptor antagonists
    - oral corticosteroids
    - anti-igE monoclonal antibody e.g. omalizumab
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12
Q

What is the dental relevance of asthma

A
  • Should avoid GA and IV sedation because will further compromise airways
  • Differ elective care until condition improves
  • NSAIDs, penicillin, stress and anxiety can trigger it
  • Gastro-oesophageal reflux is commun; tooth erosion
  • Medial emergencies could occur (adrenal suppression with systemic corticosteroids)
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13
Q

What can medication for asthma lead to

A
  1. Thrush
  2. Dry mouth
  3. Adrenal suppression with systemic corticosteroids
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14
Q

What is COPD

A

Chronic obstructive pulmonary disease = common, progressive, poorly reversible airflow limitation associated with persistent inflammatory response of lungs

Chronic bronchitis +/- Emphysema = COPD

COPD is NOT reversible

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15
Q

What are the risk factors for COPD

A

Smoking
Air pollutants
Occupational dusts and chemicals
Alpha-1 antitrypsin deficiency (early onset COPD)

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16
Q

Why is alpha-1 antitrypsin deficiency a risk factor for COPD

A

Because alpha-1 antitrypsin is a protease that protects the lung form inflammation caused by inhaled irritants ; as a result of its deficiency the recruited neutrophils will break down the lung elastin

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17
Q

What is chronic bronchitis

A

Airway obstruction from

  1. Chronic mucosal inflammation
  2. Mucus gland hypertrophy
  3. Mucus hyper secretion
  4. Bronchospasm
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18
Q

What is chronic bronchitis characterised by

A

Persistent cough and sputum production on most days for three months of the year in two successive years

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19
Q

What is emphysema

A

Dilation of airspaces distal to the terminal bronchioles with destruction of alveoli, reducing the alveolar surface area for gaseous exchange - there is reduced elastic recoil, collapse and reduced total lung capacity

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20
Q

What are the signs of COPD

A
  • Cyanosis due to poor gaseous exchange and CO2 retention
  • Use of accessory muscles
  • Flapping tremor
  • Tachypnoea (increased reparation rate)
  • Barrel chest
  • Tachycardia
  • Reduced chest expansion
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21
Q

What are the symptoms of COPD

A
  1. Progressive shortness of breath
  2. Persistent cough
  3. Chronic sputum production
  4. Wheeze
  5. Fatigue
  6. weightless
  7. Reduced exercise tolerance
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22
Q

How is COPD diagnosed

A

FEV1:FVC <0.7

23
Q

How is COPD managed

A
  • stop smoking
  • vaccinate for influenza and pneumococcus
  • pulmonary rehabilitation (weight loss and exercise)
  • long term oxygen therapy
  • non-invasive ventilation
  • bronchodilators (beta-agonists, muscarinic antagonists)
  • inhaled and oral corticosteroids
  • azithromycin
  • surgery in severe cases needs lung transplant
24
Q

What is the dental relevance of COPD

A

Treat in upright position, coughing can make treatment difficult and rubber dam can further obstuct

Avoid GA and sedation

25
Q

What complications can occur with the medications given for patients with COPD

A

Thrush
Dry mouth
Adrenal suppression with systemic corticosteroids

26
Q

What is pneumonia

A

Acute infection of the lung parenchyma (bacterial) associated with high morbidity and mortality

27
Q

What are the risk factors for pneumonia

A
  • smoking
  • chronic lung disease
  • chronic heart disease
  • alcohol excess
  • immunosuppression
28
Q

What are the different types of pneumonia

A
  1. Primary (lung infection)/ Secondary (other cause)
  2. Community/ hospital acquired (nosocomial)
  3. Aspiration e.g. stroke, oesophageal disease, drunk
  4. Immunocompromised
29
Q

What are the signs of pneumonia

A

pyrexia (fever)
tachypnoea
tachycardia
signs of consolidation
empyema (pus in pleural cavity)
reduced lung expansion due to consolidation
pleural rib (crepitation on breathing and crackles)

30
Q

What are the symptoms of pneumonia

A
  1. Cough
  2. Sputum (yellow - green)
  3. Fever
  4. Chest pain
  5. Lung abscess (because bacteria produce pus)
  6. Dyspnoea
  7. Confusion
31
Q

How is pneumonia managed

A
  • Broad spectrum antibiotics
  • Supplemental oxygen therapy
  • Analgesics and antipyretics for symptom relief
  • Prophylaxis - immunisations
32
Q

What complications can arise with pneumonia

A

lung abscess
empyema
respiratory failure

33
Q

What is the dental relevance of pneumonia

A

defer all dental treatment until recovery and GA is contraindicated

34
Q

What is TB

A

Tuberculosis is a chronic granulomatous infection caused by mycobacterium tuberculosis

High risk in; homeless, HIV, prison, alcoholics, IVD users, recent migrants and asylum seekers

35
Q

Outline how the onset of TB occurs

A

Latent for many years and becomes active when the body defences are weakened - or active shortly after infection in immunocompromised patients

Post primary TB can result from reactivation of old primary lesions and can cause complications like pneumonia, lung fibrosis or haematogenous spread of mycobacteria (miliary TB)

36
Q

Outline the clinical features of TB

A

Chronic cough, haemoptysis, sputum production (mucopurulent)

Wight loss, loss of appetite, night sweats, fever

Lymphadenopathy

37
Q

How is TB diagnosed

A
  • chest x-ray
  • sputum sample; ziehl-neelsen strain for AFB and culture
  • bronchoscopy
  • biopsy; caseating granuloma
  • it is a notifiable disease so contact tracing and isolate
38
Q

How is TB treated

A

4 drugs

2 months

  • rifampicin
  • isoniazid
  • pyrazinamide
  • ethambutol

4 months

  • rifampicin
  • ioniazide
39
Q

What is the dental relevance of TB

A
  1. Contagious so defer treatment
  2. Reduce splatter and aerosols, minimise coughing, avoid ultrasonic instruments and use rubber dam
  3. PPE
  4. Avoid GA
  5. Possible drug interactions
  6. Tuberculous ulcers in the mouth
  7. Cervical lymphadenopathy
40
Q

Where does lung cancer metastasise

A

Brain, liver, bone

41
Q

Outline aetiology of lung cancer

A
  • cigarette smoking
  • asbestos
  • radon released from granite
  • arsenic
  • coal tar
42
Q

What are the histological variants of lung cancers

A
  1. Non-small cell carcinomas
    - squamous cell carcinoma
    - adenocarcinoma
    - large-cell carcinoma
  2. Small cell carcinomas = aggressive with early spread and poor prognosis
43
Q

Outline 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

44
Q

What investigations are taken for lung cancer

A
  • chest x-ray
  • CT scan, PET scans
  • bronchoscopy
  • sputum cytology
  • biopsy
45
Q

What is the prognosis of lung cancer

A

Non-small cell; 50% have 2 year survival without spread

Small cell; 3 month survival if untreated 1.5 if treated

46
Q

What is the management of lung cancers

A 
TNM tumour staging 
Surgery 
Radiotherapy 
Chemotherapy
Palliative care
47
Q

What is the dental relevance of lung cancer

A
  • tobacco smoke is risk for oral and lung cancer
  • metastasis to oro-facial region is possible; cervical lymphadenopathy and jaw paraesthesia
  • LA is safe and GA/sedation only used if it must be
  • chemotherapy causes immunosuppression
48
Q

What is cystic fibrosis

A

Autosomal recessive hereditary disorder of metabolism as defect in CFTR protein which regulates Cl- and Na+ transport across membranes of exocrine glands

49
Q

What is cystic fibrosis characterised by

A
  • decreased excretion of Cl- into airway lumen
  • increased Na+ reabsorption into epithelial cells
  • increased viscosity and stasis of secretions
  • recurrent bronchopulmonary infections causing bronchiectasis
  • pancreatic duct obstruction and fibrosis leasing to insufficiency with malabsorption and bulky, foul smelling fatty stools
  • gall stones, diabetes, cirrhosis and pancreatitis
50
Q

What are the clinical features of cystic fibrosis

A
  • persistent cough
  • wheeze
  • haemoptysis
  • finger clubbing
  • cyanosis
  • dyspnoa
51
Q

What investigations are done for cystic fibrosis

A

sweat chloride >60mmol/L is diagnostic

52
Q

What complications occur with cystic fibrosis

A

recurrent chest infections, pneumothorax, bronchiectasis, cor pulmonale, nasal polyps, infertility, gall stones, biliary cirrhosis, diabetes mellitus, stunted growth

53
Q

How is cystic fibrosis managed

A

Brochodilators, prophylactic antimicrobials and vaccines
Diet; low fat and adequate vitamin
Lung transplant

54
Q

What is the dental relevance of cystic fibrosis

A
  • recurrent sinusitis
  • diabetes can complicate treatment
  • enamel hypoplasia due to developmental delay
  • major salivary gland swelling and xerostomia
  • delayed development and eruption of dentition
  • poor respiratory function (GA is contraindicated)

BDS2; CHHD (32 decks)

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