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Respiratory system Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

Explain briefly the anatomy of the respiratory system

A

The trachea leads from the larynx to the lungs splitting into two at the carina into the left and right bronchus. Bronchi branch into bronchioles and into alveoli - where gas exchange takes place.

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2
Q

What is the anatomy of alveoli?

A

Thin squamous epithelium - type 1 alveolar cells minimises distance between inhaled gases and blood vessels that will absorb these gases to carry them around.
Secretory type 2 alveolar cells release surfactant to reduce water tension preventing alveoli opening up from existing fluid in the lungs.

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3
Q

What epithelium higher up in the bronchioles allows mucus to be wafted up to the pharynx to protect against infection

A

Pseudostratified columnar epithelium with cilia

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4
Q

What are functions of the lung?

A
  • site of gas exchange - O2 absorption and CO2 removal taking place by partial pressure diffusion.
    Concentrations of CO2 are detected by chemoreceptors in carotid artery and aortic arch. Signal is sent to respiratory receptors in brain stem where oxygen is low to increase the rate and depth of breathing.
    There is also input from pH receptors - CO2 makes blood more acidic therefore excess is controlled by breathing to increase ventilation to rid of excess.
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5
Q

What is asthma?

A

Episodic bronchoconstriction - where the mucosa becomes oedematous blocked up by fluid and excess mucus production.
Exacerbations can have triggers - early in morning, night, allergies, pollution, inhaling smoke themselves or passively and infections.
NSAID’s can trigger - be careful with prescribing
Atopy - co existing hayfever and eczema as excess IgG’s are produced.

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6
Q

What is salbutamol?

A

A short acting Beta-2 antagonist - dilates airways by relaxing smooth muscles but not specific and acts on other beta receptors (sympathetic pathways)

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7
Q

What can salbutamol do and increase dental risk of?

A

Thicken saliva and increase risk of caries

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8
Q

What can inhaled corticosteroids increase the risk of?

A

Oral thrush - advise patient to wash mouth out after using this inhaler

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9
Q

What other medications may someone who has asthma be on?

A

Leukotriene receptor antagonist - tablet that dilates airways
Long acting beta 2 antagonist
Maintenance and reliever therapy (MART) - preventer and reliever
Long acting muscarinics - theophyline - dilates airways and anti-inflammatory
Prednisolone - rescue medication for bad flare, often after hospital admissions

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10
Q

What would lower the threshold for calling an ambulance for a patient having an asthma attack?

A

If they are on 3 or more drugs

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11
Q

What are some symptoms of an acute asthma exacerbation?

A

Airway - shortness of breath, wheeze, tight chested
Mucous and oedema - can cause cough
Breathing - high resp rate, reduced PEF, hypoxia
Patients will try to sit upright to compensate
Using accessory muscles to breathe - intercostal muscles
Circulation - high RR, arrythmia

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12
Q

What can repeated exacerbations of asthma lead to?

A

Fibrosis and inflammation of the bronchioles

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13
Q

What are questions to ask patients after having an asthma attack?

A
  • previous life threatening attack?
  • hospital in past year?
  • recent frequent use of reliever inhaler
  • on 3 or more asthma medications?
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14
Q

What is COPD?

A

Chronic obstructive pulmonary disease
Either or both - chronic bronchitis and emphysema
Leads to airway obstruction

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15
Q

How is COPD caused?

A

Smoking main causation
Leads to hypertrophy of mucus cells - to clear smoke - excess mucus production causing inflammation and obstruction of bronchi.
Damage to walls of alveoli and membranes - merge and form buli - emphysema

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16
Q

What are the symptoms of COPD?

A
  • cough
  • wheeze
  • breathlessness (chronic not episodic)
  • hypertrophy of mucus glands and airways
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17
Q

Management of COPD

A

Some response to drugs - salbutamol and corticosteroids to reduce inflammation
Carbocysteine - thins excess mucus so easier to clear
COPD patients are prone to chest infections therefore require more antibiotics

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18
Q

How does COPD progress?

A
  • Pt becomes barrel chested - lungs expanded at rest
  • Pursed lip breathing
  • May be on long term oxygen therapy
  • Right sided heart failure - increase resistance to blood flow through lungs strain right side of the heart leading to oedema
19
Q

What are the two types of respiratory failure?

A

Type 1 - hypoxia - low oxygen saturations but normal CO2 levels in blood normally due to impairment in gas exchange.
Type 2 - hypercapnia - high CO2 levels in blood due to difficulty in ventilation.
COPD patients get used to low oxygen levels, chemoreceptors reset to normal 88-92% oxygen saturations. In exacerbations the RR and depth decrease and less CO2 is exhaled. Body increases blood supply to parts of the lungs that are poorly ventilated, not good at expanding and collapsing. High O2 levels displace CO2 from where it is buffered by haemoglobin disrupting the acid balance and blood is more acidic.

20
Q

What would a patient who is hypercapnic look like?

A

Flushed, headache, flapping tremor of hands, drowsy

21
Q

What is hyperventilation?

A

Anxiety causing respiratory alkalosis - alkaline raised pH, low CO2 - tingling sensations and light headedness
Breathing techniques - slow, pursed lips

22
Q

How to manage a pt in a dental setting with COPD?

A

Stop smoking
Access arrangements
Lying flat - more short of breath so try and avoid
Dry mouth from pursed lip breathing - water, chewing gum
Oral candida
Consider drug interactions - take up to date drug history
Be prepared for exacerbations

23
Q

What is obstructive sleep apnoea?

A
  • upper airway obstruction - narrowing oropharyngeal airway
  • stop breathing whilst sleeping wakes patient up
  • causes tiredness (repeatedly waking up in the night) and cardiovascular disease at an increased risk.
  • cause is not lear - enlarged tonsils perhaps, but linked with obesity, smoking and hypertension
24
Q

What is given to patients with sleep apnoea?

A

CPAP - continuous positive airway pressure or mandibular advancement prosthesis - holds mandible open and tongue forward - monitor occlusion.

25
Q

What is fibrotic lung disease?

A

Long term and irreversible condition that can require long term oxygen caused by drugs, autoimmune diseases (RA)
Can cause sarcoidosis - a systemic disease that causes granulomas throughout the whole body
Kidneys - can affect drug metabolism
Liver
Eyes
Gingival enlargement
Cranial nerves

26
Q

What helps with fibrotic lung disease?

A

Stopping smoking, healthy diet and exercise

27
Q

what are some types of respiratory tract infections?

A
  • Upper respiratory tract infection - above larynx, can progress and descend into a lower infection
  • Lower respiratory tract infection
  • Bacterial
  • Viral
  • Oral hygiene - can cause a RTI if poor oral hygiene causes colonisation of oropharynx
  • Foreign bodies - aspiration can cause aspiration pneumonia/abscess. If it remained higher up in respiratory tract - BLS and choking
28
Q

What is pneumonia?

A

An infection of lung parenchyma
Multiple bacterial or viral infections filling the alveoli causing a cough with green/yellow sputum, purulent sputum, fever, breathlessness, pleurisy - pleuritic chest pain (inflammation of pleura - membranes of lungs and inside of ribcage) - pain worst on inhalation.
Hypoxia - reduction in alveolar surface for gas exchange

29
Q

What is strep throat?

A

Caused by streptococcus pyogenes
Sore throat and fever
Maculopapular skin rash
Swollen tonsils and cervical lymph nodes
Soft palate petechiae
Strawberry tongue - red, swollen and bumpy

treated with penicillins normally - if not treated accordingly can cause rheumatic fever

30
Q

What is tuberculosis?

A

Infectious disease caused by Mycobacterium tuberculosis
Causes: coughing, fever, night sweats and coughing up blood.
Severe lung disease with fibrosis
Likely with patients that are immunocompromised

31
Q

What has to be kept in mind with patients who have TB?

A

Risk of type 2 respiratory failure
Antibiotics - specific (mycobacterium has a thick cell wall that protects it against a number of antibiotics)
Active - infective vs latent (chronic TB)
Avoid AGP treatment when a patient has active TB (use rubber dam if you have to), GA
Keep in mind immunosuppressed staff

32
Q

What is legionnaire’s disease?

A

Legionella bacteria (stagnant water or dodgy aircon units) causes symptoms of pneumonia

33
Q

What is bronchiectasis?

A

Cycle of infection and damaged mucosa (from genetics or severe infection)
Genetic damage of cilia
Dilated bronchi in contrast to COPD
Causes breathlessness, cough and hypoxia
Severe - risk of type 2 respiratory failure, target saturations of 88-92%

34
Q

What is cystic fibrosis?

A

Genetic - causes chloride channel in cell membrane to not work, disrupting ion transfer and fluid transfer against cell wall. Mucus becomes thick and sticky and more difficult for cilia to remove. Bacteria remains in lungs that can cause recurrent infections and severe bronchiectasis.

35
Q

What else bar lung disease can CF cause?

A

Plugging of pancreatic ducts - enzymes cannot be released therefore can lead to malabsorption and failure to thrive in children.

36
Q

Management for patients with cystic fibrosis?

A

Drugs to thin mucus
Antibiotics - long term
Physiotherapy
Enzyme replacement - to aid nutrition
Home oxygen
Lung transplant
Immunosuppression

37
Q

What are the two types of lung cancer?

A

Small cell - neuroendocrine tumour progressing rapidly
Non small cell - progresses more slowly and amenable to surgery, radiation and chemo
Smoking is the main risk factor
Causes coughing, haemoptysis, wheeze, stridor (acute emergency as tumour compresses adjacent structures and airway), breathlessness and chronic chest pain.
Systemic symptoms - fatigue and weight loss

38
Q

What is Horner’s syndrome?

A

Tumour at very top of apex of lung compressing nerves causes ptosis - droopy eyelid, miosis - constricted pupil and no sweating on that side of the face.

39
Q

Investigations for cancer

A

Chest Xray, bronchoscopy - scope trachea and biopsy when down there, fluid around lungs site of cancer cells, CT scan - thorax, abdomen and pelvis look for any metastases.
Patient may complain of pain/difficulty swallowing

40
Q

Tumours in thorax signs

A

Facial and neck swelling, compressing veins and blood builds up in back of head and neck.
Hoarse voice due to tumour compressing nerves in vocal cords

41
Q

What are some lung cancer treatments and their effects?

A

Chemo
bone marrow suppression (10-14d later is worst)
Mucositis
Loss of taste
Xerostomia
Caries

42
Q

What is laryngeal cancer?

A

Airway problem causing voice changes, swallowing difficulty (globus), cough and halitosis

43
Q

Risk factors for laryngeal cancer

A

Smoking, alcohol, HPV

44
Q

Treatment for laryngeal cancer

A

Chemo, radiotherapy, surgery and laryngectomy - stoma (hole in neck through to windpipe) oxygen has to go through here in an emergency.

CMS (5 decks)

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