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Respiratory Medicine Flashcards

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Introductory Sommelier Exam (CMS) 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
Q

drug management of copd?

A

increase inhalers or nebulisers
steroids
antibiotics

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26
Q

how to manage a COPD patient in the dentist?

A

how capable is patient to lie flat
do not treat when unstable
avoid NSAID’s
avoid sedation - diminished respiratory reserve

27
Q

how to manage acute exacerbation in the chair?

A

stop tx and sit pt up
ABCDE
avoid high flow oxygen unless v unwell
bronchodilator - spacer/nebuliser if possible

28
Q

what is pneumonia?

A

an infection of the lung tissue
may be diffuse or affect the lobes
causative agents

29
Q

symptoms of pneumonia?

A 
acute illness
cough and green sputum
breathlessness 
fever
pleuritic chest pain
30
Q

how to manage pneumonia?

A

antibiotics

hospital - oxygen, IV fluids, airway support

31
Q 
pneumonia requires hospitlisation if?
pulse?
resp rate?
bp?
cap return time?
o2 sats?
A

> 100bpm
20 breathes/min
systolic 2seconds

32
Q

what is a pneumothorax?

A

leak of air into the pleural space = sudden onset of breathlessness and chest pain
may be life threatening

33
Q

what are the 2 susceptible groups for a pneumothorax?

A

tall young people - esp smokers

chronic lung disease pt’s

34
Q

what would be seen on a chest xray of a pneumothorax?

A

loss of lung markings

35
Q

how to get rid of air?

A

aspirate
chest drain
surgery

36
Q

what is sleep apnoea?

A

the collapse of the upper airways during sleep - associated with obesity

37
Q

symptoms of sleep apnoea?

A

snoring

daytime sleepiness, irratibility, headaches, microsleeps

38
Q

risk factors of sleep aponoea?

A 
overweight
large neck
sedative meds/sleeping tablets
unusual neck structure - narrow airway, large tonsils, small jaw
smoking, drinking esp before sleep
39
Q

management of sleep apnoea?

A

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
Q

sleep apnoea and the dentist?

A

caution with pt lying flat

41
Q

what is interstitial lung disease?

A

inflammation of lung disease

42
Q

what can interstitial lung disease lead to?

A

can progress to fibrosis
= irreversible damage
restrictive lung damage
COPD = destructive

43
Q

causes of ILD?

A

allergens - birds, occupational, drugs
direct damage - coal, asbestos
autoimmune disease - rheumatoid disease, sarcoidosis, systemic sclerosis

44
Q

symptoms of ILD?

A

breathlessness, cough

45
Q

management of ILD?

A

remove underlying cause
suppression of immune system
steroids - prednisolone
immunosuppressant medications

46
Q

dentally what to be aware of when treating an ILD pt?

A

avoid sedation - risk of respiratory compromise

oral side effects of treatment

47
Q

what is cystic fibrosis?

A

most common inherited disease in scotland
autosmal recessive
1 in 20 carriers
1 in 2000 births

48
Q

what is the gene defect in cystic fibrosis?

A

abnormal chlorine ion channels

which leads to high viscosity mucous = lung, pancreas and male gonadal function affected

49
Q

symptoms of cystic fibrosis in childhood?

A

recurrent resp infections = lung destruction
malabsorption
pancreatic duct destruction = cirrhosis
bowel obstruction in infants

50
Q

symptoms of cystic fibrosis in adulthood?

A

male infertility
diabetes
osteoporosis

51
Q

how to diagnose cystic fibrosis?

A

blood test at birth and then sweat test

52
Q

management of cystic fibrosis?

A 
prompt tx of infections
prophylactic antibiotics
nutrition
physiotherapy
heart/lung transplant
future = inhaled gene therapy
53
Q

what to be cautious of when treating a CF pt dentally?

A

risk of respiratory compromise - avoid sedation

pt on immunosuppressants if transplant recipient

54
Q

what is a DVT?

PE?

A

deep vein thrombosis

pulmonary embolism

55
Q

what is the pathophysiology of dvt

A

clot formation in peripheral veins

dvt - usually legs

56
Q

pathophysiology of pe?

A

clot migrates to lungs

57
Q

predisposing factors for a pe/dvt?

A

obstructions to blood flow
increased coagubility of blood
immobility
surgery

58
Q

symptoms of a DVT?

A

painful lower leg

may be dilated veins, hot, red, swollen

59
Q

PE symptoms?

A 
pleuritic chest pain
breathlessness
haemoptysis
collapse
sudden death
60
Q

how to diagnose a dvt?

A

ultrasound of limb

61
Q

how to diagnose a pe?

A

chest CT pulmonary angiogram

ventilation perfusion scan

62
Q

immediate anticoagulation?

A

low molecular weight heparin

63
Q

longer term anticoagulation?

A

warfarin

new agents

CMS (42 decks)

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