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CMS1 > Respiratory Disorders > Flashcards

Respiratory Disorders Flashcards

1
Q

What is the function of the lungs?

A

Gaseous exhange and Acid-base balance in blood (kidney does too)

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2
Q

What happens in asthma?

A
  1. The bronchioles become inflamed which causes the muscles to contract and that narrows the small airways
  2. The mucosa of the airways (lining) becomes oedematous + blocked up with fluid (can also be excess mucous prod. AS trying to get rid of the irritant)
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3
Q

What are some triggers for episodes of asthma?

A

Allergies, pollution, smoke (themselves or passive) and cold weather, infections, NSAIDs (be careful prescribing ibuprofen) and always ask for allergies!!!! - as more likely to have allergic reactions

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4
Q

How do we manage asthma

A

Mild - simple reliever (salbutamol) = beta 2 agonist acts to dilate the airways by relaxing smooth muscle BUT are not specific to the receptors in the bronchioles so can cause sensation of palpitations as beta agonists act on sympathetic pathways and causes heart to beat faster!! <3 - can also thicken saliva and increase the risk of dental caries

If Insufficent will be put on preventer inhaler (inhaled corticosteroid) to reduce inflammation in the airway (taken every day)
- eg: budesonide
—> CAN LEAD TO THRUSH - advice pt to wash their mouth with water after taking their inhaler or use of spacer

If that is insufficient they will be given a leukotriene receptor antagonist (tablet) eg: montelukast = dilates the airway AND anti inflammatory

AFTER THAT - long acting muscarinics

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5
Q

What are combination inhalers?

A

MART - maintenance and reliever therapy
Inhaler for poorly controlled inhaler
- contains preventer and reliever drug eg: FOSTAIR

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6
Q

If a patient is on 3 or more drugs what should u consider

A

Having a lower threshold for calling ambulance!

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7
Q

What are the signs of as asthma attack?

A

Shortness of breath, wheeze, high heart rate, hypoxia, reduced peak expiratory flow, high respiratory rate

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8
Q

What can chronic airway obstructive lead in the bronchioles?

A

Fibrosis and inflammation

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9
Q

What questions should you ask a patient with a medical history of asthma?

A
  1. Have you had a previous life threatening attacks?
  2. Have you ever been hospitalised in the last year
  3. How frequently do you use your reliever inhaler?
  4. Are you on 3 or more asthma medications?
  5. Are you dentally anxious?
  6. Have you been struggling with your Asthma recently?

IF ANSWER TO ANY OF THOSE QUESTIONS ARE YES - HAVE A LOWER THRESHOLD FOR CALLING 999

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10
Q

WHAT IS COPD?

A

Chronic obstructive pulmonary Disease
- airway obstruction
- from smoking (causes damage to the bronchi and alveoli
- cells produce mucous to clear the smoke which calls mucous producing cells to become hypertrophic - causes airway obstruction = chronic bronchitis
- damage to the walls of the alveoli - they merge to form large Bullae = emphysema

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11
Q

What are symptoms of COPD?

A

Similar to asthma
- wheeze
- cough
- constant

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12
Q

What are long term complications of COPD/

A

Lungs appear expanded at rest (barrel chested)
- pursed lips breathing to increase the pressure inside the thorax to help them inhale
- can become long term hypoxic (may require long term oxygen therapy)
- increased resistance to blood flow to the lungs due to tissue damage which puts stress on the right side of heart leading to heart failure in late stages of the Disease. right sided heart failure leads to oedema

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13
Q

What are the 2 types of Respiratory Failure?

A

Type 1 - Hypoxia (low oxygen saturations but normal carbon dioxide levels - due to impairment of gas exchange)
Type 2 - Hypercapnia (high carbon dioxide levels due to difficulties ventilating) = THIS IS WHAT WE SEE IN PATIENTS WITH COPD!

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14
Q

WHAT TYPE OF respiratory failure do patients with COPD have

A

Type 2 - hypercapnia

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15
Q

What happens if you give too much oxygen to pt with COPD?
What symptoms might they have?

A

Their respiratory and breathing rate decrease meaning less carbon dioxide is exhales (this is because your body is responding to the excess oxygen)
Symptoms: flushing, headache, tremor, confused, drowsy

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16
Q

What is hyperventilation? What symptoms do you get?

A

Anxiety causes the patient to increase the rate and depth of their respiration and so they’re blowing out their carbon dioxide which can result in respiratory alkalosis (alkaline and raised pH)
Symptoms : tingling, feeling lightheaded

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17
Q

How do you mange hyperventilation

A

Breathing techniques

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18
Q

How is COPD relevant to dentistry

A

Encourage stop smoking!
Patient may have accessibility issues due to breathlessness
Positioning may be challenging (such as lying flat)
Pts likely to breathe through mouth - more likely to suffer with dry mouth + oral candida risk
Consider drug interactions!
Be prepared for an exacerbation

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19
Q

What is obstructive sleep apnea? Causes? And treatment options?

A

Blocking during sleep and stopped breathing. (Narrowing upper pharyngeal airway)
PT will seize to breath at night as patient stops breathing and then will become restored
PT becomes tired due to poor sleep during night
Increased risk of CVD

Cause
Not clear, could be enlarged tonsils, Obesity or smoking and hypertension

Treatment CPAP or Mandibular advancement prostheses (occlusion will need to be monitored)

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20
Q

Fibrotic Lung disease?

A

Lung tissue becomes scarred and fibrous

21
Q

What causes FLD? And is it reversible?

A

Drugs, birds, RHoumatoid Arthritis (autoimmune disease) Irreversible and progressive

22
Q

What advice would you give to a patient with FLD?

A

Stop smoking, Eating healthy , Excercising

23
Q

What’s an Example of Fibrotic Lung Disease?

A

Sarcoidosis - Which is systemic disease
Causing Granulomas throughout the body

24
Q

Which can Sarcocidosis affect?

A

Kidney - Drug metabolism
Liver disease - Drug metabolism
Eyes
Gingiva - Gingival enlargement
Cranial Nerves - Cranial neuropathy

25
Q

Respiratory Tract Infections

A
  • Upper Respiratory Tract Infection - Above the larynx
  • Lower Respiratory tract infection - Below the Larynx
26
Q

Give examples of Upper respiratory tract infections and how they can occur?

A

Referred to as Ertes and they can progress and extend to Become lover tract infections if not managed properly
Viral - influenza, coronal
Bacterial
Fungal
ORAL HYGEINE CAN INCREASE RISK OF COLONISATION OF OROPHARYNX WITH BAC which can cause infections
Foreign bodies - Aspiration whilst treating. Causing Aspiration Pneumonia or Abscess.

27
Q

What is an example of Lower Respiratory tract infection?

A

Pneumonia can be caused by the progression of a lower respiratory tract infection
- Caused by multiple bacterial or viral infections
- Defined by infection of the lung tissue itself
- With Bacteria and inflammatory cells lining filling the alveoli

28
Q

How do you treat bacterial Pneumonia?

A

Antibiotics initially but in worse cases May require hospital admission

29
Q

What can happen to a patient with Pneumonia?**

A

PAtient may become hypoxic due to the reduction in the surface of the alveoli available for gas exchange because they are all blocked up with bacteria and inflammatory cells. Cans have a fever as they respond to bacteria. A cough present with green and yellow sputum due to the presence of bacteria in the mucus that’s being brought up
Chest pain - Plueuric - inflammation of pleura , they rub together and expand on inhalation - Pleura are membranes that surround the lungs, they line the outside of the lungs and inside of the rib cage .

** Sharp PAIN THATS WORSE ON INHALATION IS PLEURITIC PAIN**

30
Q

When can back pain be caused in respiratory tract problems

A

Pulmonary embolism

31
Q

What is Strep Throat?

A

More common in children and upper respiratory tract infection
Causedb by stgretococcus progenies
Symptoms
Sore throat , Fever
Maculopapular skin rash
Cervical lymph nodes
Swollen tonsils
Soft palate petechia Small red dots on palate and pharynx
Strawberry tongue - tongue looks strawberry swollen and bumpy
Rheumatic fever

32
Q

What is strep throat treated with and what will happen if not treated properly?

A

Penicillin and if not treated may turn into rheumatic fever

33
Q

What is Tuberculosis infection?

A

TB , Caused by Mycobacteriuym Tuberculosis
Usually PT who is immune suppressed
SYSTEMIC features
Night sweats, weight loss, cough and fever and Haemoptysis (coughing up Blood)

34
Q

Two categories of TB?

A

Active TB and Chronic TB
Active more symptomatic - minimise aerosolising procedures, use rubber dam, avoid general anaesthetic, because bacteria infect the machines, ultrasonic scalers are contraindicated

35
Q

What is legionnaires disease

A

Bacterial (legionella) - typically grow in water and cause pneumonia

36
Q

What is bronchiectasis

A

Pt suffering from cycle of infection and damage = causes damage to the bronchial wall
Or genetic abnormality eg: in cilia that prevents mucous from clearing the lungs effectively
- the damaged mucosa is then susceptible to further damage!

BUT the bronchi become dilated as they are repeatedly damaged - pts become chronically hypoxic

37
Q

What type of respiratory failure are patients with bronchiectasis at risk of

A

Type 2 hypercapnia

38
Q

What is cystic fibrosis

A

Genetic disease that causes chloride channel in the cell membrane to not work which disrupts ion transfer across the membrane and therefore fluid transfer across the cell wall . Particular not in the lungs where we have secretory cells to produce mucous that helps clear infections. With ion channel not working the mucous because sticky and thick so is hard for cilia to waft mucous. Bacteria remains in the lungs and causes recurrent infections (cause severe bronchiectasis)

. Can also affect other areas of the body - can cause plugging in the pancreatic duct (so patients are unable to excrete essential pancreatic enzymes for digestion so that can cause malnutrition

39
Q

What is management of cystic fibrosis

A

Drugs to thin down the mucous and regular chest physiotherapy to clear that mucus
- trying to reduce the change of infections

40
Q

Why might patients with cystic fibrosis need pancreatic enzyme replacement?

A

To aid their nutition

41
Q

What is lung cancer? What are the categories

A

Small cell cancer - neuroendocrine tumour - progresses rapidly
Non small cell cancer - progresses more slowly and is more amenable to surgical intervention in addition to chemo and radiotherapy

42
Q

what is the main risk factor for lung cancer

A

Smoking!

43
Q

How might lung cancer present?

A

With a new cough that is not clearing , coughing up blood, breathlessness and other classic symptoms, chronic chest pain or wheezing, stridor (acute emergency)
Systemic systems of malignancy: fatigue, weight loss

44
Q

What is horners syndrome

A

Tumour at the apex of the lung and it compresses the nerves up there causes ptosis, miosis, anhidtrosis
Pt may complain of difficulty swallowing / pain (can be from tumour pressing on oesophageal)
Can get facial and neck swelling if there is a tumour in the thorax - its compressing where the veins drain out from the head and neck
- hoarse voice

45
Q

What do you do if you suspect lung cancer

A

Chest x ray
Bronchoscopy
Biopsy
Aspirating fluid around the lungs
Fluid around the lungs and gap between the chest wall
Staging CT scan
Chemo radiotherapy or surgery

46
Q

What does chemo cause
And dental effects

A

Bone marrow suppression
Loss of taste, dry mouth, caries, mucousitis

47
Q

What is laryngeal cancer

A

Airway /: voice changes, sawllowimng difficulty, cough, halitosis

48
Q

What are risk factors for laryngeal cancer

A

Smoking, alcohol, HPV

CMS1 (12 decks)

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