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CMS > Week 7 - Respiratory Medicine > Flashcards

Week 7 - Respiratory Medicine Flashcards

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Introductory Sommelier Exam (CMS) flashcards
1
Q

what is the principle role of the respiratory system

A

gas exchange: oxygen in, CO2 out

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2
Q

what are the 3 main disturbances in respiratory disease?

A
  • reduced transfer of oxygen
  • reduced ventilation of lungs
  • reduced perfusion of lungs
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3
Q

general respiratory symptoms?

A
  • dyspnea: caused by one of 3 main disturbances
  • wheeze: due to narrowing of airways
  • cough
  • sputum production
  • chest pain: “pleuritic pain”
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4
Q

what is pleuritic pain?

A

pain on inspiration, sneezing or coughing. induced with any kind of respiratory effort

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5
Q

asthma: what kind of disease?

A
  • a reversible, small obstruction of the airways

- occurs due to an inflammatory, allergic condition

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6
Q

asthma (chronic & acute) - symptoms?

A
  • wheeze
  • breathlessness
  • cough
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7
Q

asthma - assessment? when will assessment be different?

A
  • peak flow recordings: plot by age, sex, height
  • standardized recording technique
  • assessment could be poorer in the morning (diurnal variation)
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8
Q

asthma - precipitants?

A
  • allergens: house dust mite, pet dander
  • irritants: dust, smoke
  • exertion
  • NSAIDs
  • emotion
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9
Q

chronic asthma - what are indicators of severity?

A
  • restriction of activities
  • inhaler use: particular types?
  • peak flow recordings (diary)
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10
Q

chronic asthma - management?

A
  • medication mainly delivered through inhaled route
  • step wise increase in medications: inhaled salbutamol-> salmeterol-> inhaled steroids->combinatiaon inhalers-> other medications, anti-leuklotrienes
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11
Q

asthma - dental aspects

A
  • assess current symptoms: exercise tolerance? worsening symptoms? recent medication changes?
  • management of acute attack
  • recognition of unstable symptoms: delay tx, refer to gp
  • avoid NSAIDs
  • oral candidiasis, altered taste, dry mouth: side effects of inhaled medication, advise gargling after use
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12
Q

definition of COPD:

  • characterized by?
  • predominantly caused by?
  • when do exacerbations occur?
  • definition of COPD: FEV/FVC ratio?
  • if FEV1 is 80% predicted normal?
A
  • airflow obstruction that is not fully reversible. obstructions does not change markedly over months, progressive in the long term
  • smoking, also occupational exposures
  • when there is rapid and sustained worsening of symptoms beyond normal day-to-day variations
  • 0.7
  • diagnosis of COPD should only be made when there are symptoms present e.g. breathlessness
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13
Q

COPD - pathophysiology?main processes of disease?

A
  • damage to lung parenchyma
  1. emphysema: lung tissue for gaseous exchange damaged. e.g. alveolar destruction-> reduced area for gas exchange
  2. bronchitis:
    - airway inflammation
    - increased mucous production -> increased ventilation
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14
Q

COPD - symptoms?

A
  • breathlessness: linked to exertion
  • wheeze: consistent
  • chronic cough and sputum production
  • frequent infections (stagnant mucous)
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15
Q

COPD - investigations?

A
  • pulmonary function tests: checks lung function, spirometry, FEV1, FVC
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16
Q

COPD - management?

A
  • progressive addition of oral and inhaled therapies, depending on symptoms: tiotropium (spiriva)
  • stop smoking
  • exercise
  • severe-> home o2
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17
Q

home oxygen: how is it delivered?

A
  • usuall via nasal cannulae
  • face mask (drying to oral tissues)
  • o2 in cylinder or concentrator
  • safety briefing important
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18
Q

acute exacerbation of COPD - management:

  • depends on?
  • may need?
  • what medications?
  • acute exacerbation in chair: what to do?
A
  • depends on severity
  • may need hospitalization
  • increased inhalers/nebulizers
  • steroids
  • antibiotics
  • stop tx, sit up, check ABC
  • give oxygen, no high flow unless very unwell
  • bronchodilator: spacer or nebulizer
  • hospitalization
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19
Q

COPD - dental aspects:

  • what to assess?
  • what to do when unstable COPD?
  • avoid what drugs?
  • be aware of?
A
  • assess ability to lie flat, for worsening symptoms
  • if unstable, avoid tx
  • avoid NSAIDs
  • be aware of diminished respiratory reserve (avoid sedation)
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20
Q

pneumonia:
infection of?
may affect which areas in the lung?

A
  • infection of lung tissue

- may be diffuse or affect certain lobes

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21
Q

pneumonia - acute illness symptoms?

A
  • cough + green sputum
  • breathlessness
  • fever
  • pleuritic chest pain
22
Q

pneumonia - investigations?

A

sputum exams: examine for infectious agent

chest radiographs: grey area indicates infection

23
Q

pneumonia - management?

A
  • antibiotics

- may require hospitalization: oxygen, intravenous fluids, airway support

24
Q

pneumonia - severity: hospitalization if?

A
  • pulse: >100bmp
  • respiratory rate: >20breaths/min
  • BP: lower than 90/50mmHg
  • capillary return time >2 secs
  • oxygen saturation <96%
25
Q

pneumonia severity - CURB 65 criterias?

A
  • confusion
  • urea >/= 19mg/dl
  • respiratory rate >/= 30 breaths a min
  • BP lower than 90/50mmHg
  • age 65 and above
26
Q

pneumothorax: what is it? what are the types of peope susceptible?

A
  • leak of air into pleural space-> sudden onset of breathlessness and pain
  • tall young people (esp if smokers)
  • chronic lung disease
27
Q

pneumothorax - diagnosis?

A

chest radiograph; loss of lung markings

28
Q

pneumothorax - management?

A
  • main aim is to get rid of air
  • aspirate
  • chest drain
  • occasionally requires surgery: if chest drain fails, or if recurrent case
29
Q

sleep apnoea - what is it? symptoms?

A
  • collapse of upper airway during sleep (associated with obesity)
  • snoring, daytime sleepiness, irritability, headaches
  • “microsleeps”
30
Q

sleep apnoea - risk factors?

A
  • being overweight or obese
  • having a large neck
  • sedative medication - sleeping tablets
  • unusual structure of neck
  • smoking/drinking alcohol before sleep
31
Q

what type of unusual traits of the neck are present in those at risk of sleep apnoea?

A
  • narrow airway
  • large tonsils/adenoids/tongue
  • small lower jaw
32
Q

sleep apnoea - management?

A
  • lifestyle changes: lose weight, cut alcohol, sleeping on their side
  • continuous positive airways pressure device (CPAP): pressure prevents the airway closing while patients sleep
  • mandibular advancement device (MAD): holds jaw & tongue forward
33
Q

sleep apnoea - dental aspects?

A
  • refer to GP or sleep apnoea clinic
  • caution while lying flat on chair, in case pt falls asleep
  • consider alternative cause for snoring, nasal pathology?
  • caution if considering providing a mandibular advancement device (requires training)
34
Q

interstitial lung disease - pathophysiology?

A
  • inflammation of lung tissue that can progress to fibrosis - irreversible damage/restrictive lung defect
35
Q

interstitial lung disease - causes?

A
  • cryptogenic (no idea)
  • allergens: birds, occupational, drugs
  • direct damage: asbestos, coal
  • autoimmune disease: rheumatoid, sarcoidosis, systemic sclerosis
36
Q

interstitial lung disease: symptoms?

A

breathlessness & cough

37
Q

interstitial lung disease: management?

A
  • remove underlying cause

- suppression of immune system: steroids, prednisolone + other immunosuppressive medication

38
Q

interstitial lung disease: dental aspects?

A
  • risk of respiratory compromise: so avoid sedation

- oral side effects of treatment?

39
Q

cystic fibrosis: aetiology?

what kind of inheritance? how common?

A

gene defect-> abnormal chloride ion channels -> high viscosity mucous
- lungs, pancreas, male gonadal function

  • autosomal recessive
  • 1/20carriers, 1/2000 births affected
40
Q

cystic fibrosis - symptoms in childhood?

A
  • recurrent respiratory infections-> lung destruction
  • malabsorption
  • pancreatic duct obstruction-> cirrhosis
  • bowel obstruction in infants
41
Q

cystic fibrosis - symptoms in adulthood?

A
  • male infertility
  • diabetes
  • osteoporosis
42
Q

cystic fibrosis - diagnosis? management?

A
  • blood test at birth
  • sweat test
  • prompt treatment of infections
  • prophylactic antibiotics
  • nutrition
  • physiotherapy
  • heart-lung transplant
  • future: inhaled gene therapy
43
Q

cystic fibrosis - dental aspects?

A
  • risk of respiratory compromise: avoid sedation
  • will be on immunosuppresants if transplant recipient
  • take note: more than just lung disease present
  • treatment with special care dentist may be more appropriate, depending on morbidity
44
Q

DVT & PE: pathophysiology?

where does the clot affect body for each?

A
  • clot formation in peripheral veins
  • usually legs: DVT
  • clot migrates to lungs: PE
45
Q

DVT & PE: predisposing facors?

A
  • obstruction to blood flow
  • increased coagulability of blood
  • immobility
  • surgery

(often more than one factor present)

46
Q

DVT - symptoms?

A
  • painful lower leg (sometimes upper)

- may be dilated veins, hot, red, swollen

47
Q

PE - symptoms?

A
  • pleuritic chest pain
  • breathlessness
  • haemoptysis (vomiting blood from respiratory tract)
  • collapse
  • sudden death
48
Q

DVT & PE diagnosis?

A

DVT: ultrasound of limb

PE: chest CT pulmonary angiogram
ventilation-perfusion scan

49
Q

DVT & PE: management?

A
  • anticoagulation: immediate anticoagulation with low molecular weight heparin
  • long term anticoagulation: warfarin/new agents
50
Q

DVT & PE - dental aspects?

A
  • anticoagulated patients: be aware of SDCEP guidelines

- do not stop anticoagulation therapy unless guidance clearly says so, or GP consulted

CMS (16 decks)

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