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Respiratory Medicine Flashcards

1
Q

what are the three main disturbances that can happen to the respiratory system?

A

reduced transfer of oxygen
reduced ventilation of lungs
reduced perfusion of lungs

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2
Q

what are some respiratory symptoms?

A 
breathlessness dyspanea - b/c 3 main disturbances
wheeze - airways narrowing
cough - protective reflex
sputum production
chest pain - pleuritic pain
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3
Q

what is asthma?

A

reversible small airways obstruction

affects all ages

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4
Q

percent of children affected?

adults?

A

5-10% children

2-5% adults

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5
Q

is asthma a benign condition?

A

benign but life threatening

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6
Q

what is the pathophysiology of asthma?

A

an inflammatory allergic condition

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7
Q

symptoms of asthma?

A

wheeze
breathles - not always related to exerise, triggered by cold or emotion
cough - nocturnal, exercise induced, cold induced

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8
Q

how to assess asthma?

A

peak flow readings - plotted by age sex height

classically poorer in mornings - diurnal variation

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9
Q

asthma precipitated by?

A 
allergens - house dust mite, pet dander
irritants - dust smoke
exertion
NSAIDS
emotion
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10
Q

indications of severity of chronic asthma?

A

restriction of activities b/c symptoms
increased inhaler use
keep peak flow readings

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11
Q

how to manage chronic asthma?

A

inhaled beta antagonists - salbutamol - short, salmeterol - long activity
inhaled steroids - beclamethasone
combo inhalers - seretide
other - antileukotrienes - montelukast

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12
Q

what is acute asthma?

A

sudden worsening of symptoms. patients can tire

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13
Q

what is unstable asthma caused by?

A

recent infections

poor compliance

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14
Q

symptoms of unstable asthma?

A

using inhaler more frequently

reduced exercise limit

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15
Q

management of unstable asthma?

A

GP - short course of oral steroidss
prednisolone
alteration to regular inhalers if gradual worsening

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16
Q

avoid what meds in a dental practice with asthmatic patients?

A

NSAIDs

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17
Q

what might be seen orally with a asthmatic patient?

A

oral candidiasis, altered taste, dry mouth, side

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18
Q

what should you advise to an asthmatic patient after taking their inhalers?

A

gargle vigorously after use

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19
Q

what is COPD?

A

irriversible obstruction of airways

degenerative

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20
Q

pathophysiology of COPD?

A

damage to lung parenchyma

main process = emphysema = alveolar destruction and reduced area for gas exchange

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21
Q

what is bronchitis?

A

airway inflammation
increased mucous
reduced ventilation

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22
Q

symptoms of COPD?

A

breathless on exertion
consistent wheeze
chronic cough and sputum production
frequent infections - stagnant mucous

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23
Q

what are some pulmonary function tests?

A

lung function
spirometry
FEVL = forced expiratory volume in one second
FVC = forced vital capacity

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24
Q

chronic COPD management?

A

progressive addition of oral inhaled therapies depending on symptoms - tiotropium - spiriva
stop smoking
exercise training
if severe - home = oxygen

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25
drug management of copd?
increase inhalers or nebulisers steroids antibiotics
26
how to manage a COPD patient in the dentist?
how capable is patient to lie flat do not treat when unstable avoid NSAID's avoid sedation - diminished respiratory reserve
27
how to manage acute exacerbation in the chair?
stop tx and sit pt up ABCDE avoid high flow oxygen unless v unwell bronchodilator - spacer/nebuliser if possible
28
what is pneumonia?
an infection of the lung tissue may be diffuse or affect the lobes causative agents
29
symptoms of pneumonia?
``` acute illness cough and green sputum breathlessness fever pleuritic chest pain ```
30
how to manage pneumonia?
antibiotics | hospital - oxygen, IV fluids, airway support
31
``` pneumonia requires hospitlisation if? pulse? resp rate? bp? cap return time? o2 sats? ```
>100bpm >20 breathes/min systolic 2seconds
32
what is a pneumothorax?
leak of air into the pleural space = sudden onset of breathlessness and chest pain may be life threatening
33
what are the 2 susceptible groups for a pneumothorax?
tall young people - esp smokers | chronic lung disease pt's
34
what would be seen on a chest xray of a pneumothorax?
loss of lung markings
35
how to get rid of air?
aspirate chest drain surgery
36
what is sleep apnoea?
the collapse of the upper airways during sleep - associated with obesity
37
symptoms of sleep apnoea?
snoring | daytime sleepiness, irratibility, headaches, microsleeps
38
risk factors of sleep aponoea?
``` overweight large neck sedative meds/sleeping tablets unusual neck structure - narrow airway, large tonsils, small jaw smoking, drinking esp before sleep ```
39
management of sleep apnoea?
lifestyle changes - lose weight, cut down on alcohol, sleeping on side continuous positive airway pressure - prevents closure of airway during sleep MAP - mandiblular advancement device - holds jaw and tongue forward
40
sleep apnoea and the dentist?
caution with pt lying flat
41
what is interstitial lung disease?
inflammation of lung disease
42
what can interstitial lung disease lead to?
can progress to fibrosis = irreversible damage restrictive lung damage COPD = destructive
43
causes of ILD?
allergens - birds, occupational, drugs direct damage - coal, asbestos autoimmune disease - rheumatoid disease, sarcoidosis, systemic sclerosis
44
symptoms of ILD?
breathlessness, cough
45
management of ILD?
remove underlying cause suppression of immune system steroids - prednisolone immunosuppressant medications
46
dentally what to be aware of when treating an ILD pt?
avoid sedation - risk of respiratory compromise | oral side effects of treatment
47
what is cystic fibrosis?
most common inherited disease in scotland autosmal recessive 1 in 20 carriers 1 in 2000 births
48
what is the gene defect in cystic fibrosis?
abnormal chlorine ion channels | which leads to high viscosity mucous = lung, pancreas and male gonadal function affected
49
symptoms of cystic fibrosis in childhood?
recurrent resp infections = lung destruction malabsorption pancreatic duct destruction = cirrhosis bowel obstruction in infants
50
symptoms of cystic fibrosis in adulthood?
male infertility diabetes osteoporosis
51
how to diagnose cystic fibrosis?
blood test at birth and then sweat test
52
management of cystic fibrosis?
``` prompt tx of infections prophylactic antibiotics nutrition physiotherapy heart/lung transplant future = inhaled gene therapy ```
53
what to be cautious of when treating a CF pt dentally?
risk of respiratory compromise - avoid sedation | pt on immunosuppressants if transplant recipient
54
what is a DVT? | PE?
deep vein thrombosis | pulmonary embolism
55
what is the pathophysiology of dvt
clot formation in peripheral veins | dvt - usually legs
56
pathophysiology of pe?
clot migrates to lungs
57
predisposing factors for a pe/dvt?
obstructions to blood flow increased coagubility of blood immobility surgery
58
symptoms of a DVT?
painful lower leg | may be dilated veins, hot, red, swollen
59
PE symptoms?
``` pleuritic chest pain breathlessness haemoptysis collapse sudden death ```
60
how to diagnose a dvt?
ultrasound of limb
61
how to diagnose a pe?
chest CT pulmonary angiogram | ventilation perfusion scan
62
immediate anticoagulation?
low molecular weight heparin
63
longer term anticoagulation?
warfarin | new agents

CMS (42 decks)

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