Respiratory Medicine Flashcards
what are the three main disturbances that can happen to the respiratory system?
reduced transfer of oxygen
reduced ventilation of lungs
reduced perfusion of lungs
what are some respiratory symptoms?
breathlessness dyspanea - b/c 3 main disturbances wheeze - airways narrowing cough - protective reflex sputum production chest pain - pleuritic pain
what is asthma?
reversible small airways obstruction
affects all ages
percent of children affected?
adults?
5-10% children
2-5% adults
is asthma a benign condition?
benign but life threatening
what is the pathophysiology of asthma?
an inflammatory allergic condition
symptoms of asthma?
wheeze
breathles - not always related to exerise, triggered by cold or emotion
cough - nocturnal, exercise induced, cold induced
how to assess asthma?
peak flow readings - plotted by age sex height
classically poorer in mornings - diurnal variation
asthma precipitated by?
allergens - house dust mite, pet dander irritants - dust smoke exertion NSAIDS emotion
indications of severity of chronic asthma?
restriction of activities b/c symptoms
increased inhaler use
keep peak flow readings
how to manage chronic asthma?
inhaled beta antagonists - salbutamol - short, salmeterol - long activity
inhaled steroids - beclamethasone
combo inhalers - seretide
other - antileukotrienes - montelukast
what is acute asthma?
sudden worsening of symptoms. patients can tire
what is unstable asthma caused by?
recent infections
poor compliance
symptoms of unstable asthma?
using inhaler more frequently
reduced exercise limit
management of unstable asthma?
GP - short course of oral steroidss
prednisolone
alteration to regular inhalers if gradual worsening
avoid what meds in a dental practice with asthmatic patients?
NSAIDs
what might be seen orally with a asthmatic patient?
oral candidiasis, altered taste, dry mouth, side
what should you advise to an asthmatic patient after taking their inhalers?
gargle vigorously after use
what is COPD?
irriversible obstruction of airways
degenerative
pathophysiology of COPD?
damage to lung parenchyma
main process = emphysema = alveolar destruction and reduced area for gas exchange
what is bronchitis?
airway inflammation
increased mucous
reduced ventilation
symptoms of COPD?
breathless on exertion
consistent wheeze
chronic cough and sputum production
frequent infections - stagnant mucous
what are some pulmonary function tests?
lung function
spirometry
FEVL = forced expiratory volume in one second
FVC = forced vital capacity
chronic COPD management?
progressive addition of oral inhaled therapies depending on symptoms - tiotropium - spiriva
stop smoking
exercise training
if severe - home = oxygen
drug management of copd?
increase inhalers or nebulisers
steroids
antibiotics
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
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
what is pneumonia?
an infection of the lung tissue
may be diffuse or affect the lobes
causative agents
symptoms of pneumonia?
acute illness cough and green sputum breathlessness fever pleuritic chest pain
how to manage pneumonia?
antibiotics
hospital - oxygen, IV fluids, airway support
pneumonia requires hospitlisation if? pulse? resp rate? bp? cap return time? o2 sats?
> 100bpm
20 breathes/min
systolic 2seconds
what is a pneumothorax?
leak of air into the pleural space = sudden onset of breathlessness and chest pain
may be life threatening
what are the 2 susceptible groups for a pneumothorax?
tall young people - esp smokers
chronic lung disease pt’s
what would be seen on a chest xray of a pneumothorax?
loss of lung markings
how to get rid of air?
aspirate
chest drain
surgery
what is sleep apnoea?
the collapse of the upper airways during sleep - associated with obesity
symptoms of sleep apnoea?
snoring
daytime sleepiness, irratibility, headaches, microsleeps
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
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
sleep apnoea and the dentist?
caution with pt lying flat
what is interstitial lung disease?
inflammation of lung disease
what can interstitial lung disease lead to?
can progress to fibrosis
= irreversible damage
restrictive lung damage
COPD = destructive
causes of ILD?
allergens - birds, occupational, drugs
direct damage - coal, asbestos
autoimmune disease - rheumatoid disease, sarcoidosis, systemic sclerosis
symptoms of ILD?
breathlessness, cough
management of ILD?
remove underlying cause
suppression of immune system
steroids - prednisolone
immunosuppressant medications
dentally what to be aware of when treating an ILD pt?
avoid sedation - risk of respiratory compromise
oral side effects of treatment
what is cystic fibrosis?
most common inherited disease in scotland
autosmal recessive
1 in 20 carriers
1 in 2000 births
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
symptoms of cystic fibrosis in childhood?
recurrent resp infections = lung destruction
malabsorption
pancreatic duct destruction = cirrhosis
bowel obstruction in infants
symptoms of cystic fibrosis in adulthood?
male infertility
diabetes
osteoporosis
how to diagnose cystic fibrosis?
blood test at birth and then sweat test
management of cystic fibrosis?
prompt tx of infections prophylactic antibiotics nutrition physiotherapy heart/lung transplant future = inhaled gene therapy
what to be cautious of when treating a CF pt dentally?
risk of respiratory compromise - avoid sedation
pt on immunosuppressants if transplant recipient
what is a DVT?
PE?
deep vein thrombosis
pulmonary embolism
what is the pathophysiology of dvt
clot formation in peripheral veins
dvt - usually legs
pathophysiology of pe?
clot migrates to lungs
predisposing factors for a pe/dvt?
obstructions to blood flow
increased coagubility of blood
immobility
surgery
symptoms of a DVT?
painful lower leg
may be dilated veins, hot, red, swollen
PE symptoms?
pleuritic chest pain breathlessness haemoptysis collapse sudden death
how to diagnose a dvt?
ultrasound of limb
how to diagnose a pe?
chest CT pulmonary angiogram
ventilation perfusion scan
immediate anticoagulation?
low molecular weight heparin
longer term anticoagulation?
warfarin
new agents
