Week 7 - Respiratory Medicine Flashcards
what is the principle role of the respiratory system
gas exchange: oxygen in, CO2 out
what are the 3 main disturbances in respiratory disease?
- reduced transfer of oxygen
- reduced ventilation of lungs
- reduced perfusion of lungs
general respiratory symptoms?
- dyspnea: caused by one of 3 main disturbances
- wheeze: due to narrowing of airways
- cough
- sputum production
- chest pain: “pleuritic pain”
what is pleuritic pain?
pain on inspiration, sneezing or coughing. induced with any kind of respiratory effort
asthma: what kind of disease?
- a reversible, small obstruction of the airways
- occurs due to an inflammatory, allergic condition
asthma (chronic & acute) - symptoms?
- wheeze
- breathlessness
- cough
asthma - assessment? when will assessment be different?
- peak flow recordings: plot by age, sex, height
- standardized recording technique
- assessment could be poorer in the morning (diurnal variation)
asthma - precipitants?
- allergens: house dust mite, pet dander
- irritants: dust, smoke
- exertion
- NSAIDs
- emotion
chronic asthma - what are indicators of severity?
- restriction of activities
- inhaler use: particular types?
- peak flow recordings (diary)
chronic asthma - management?
- medication mainly delivered through inhaled route
- step wise increase in medications: inhaled salbutamol-> salmeterol-> inhaled steroids->combinatiaon inhalers-> other medications, anti-leuklotrienes
asthma - dental aspects
- 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
definition of COPD:
- characterized by?
- predominantly caused by?
- when do exacerbations occur?
- definition of COPD: FEV/FVC ratio?
- if FEV1 is 80% predicted normal?
- 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
COPD - pathophysiology?main processes of disease?
- damage to lung parenchyma
- emphysema: lung tissue for gaseous exchange damaged. e.g. alveolar destruction-> reduced area for gas exchange
- bronchitis:
- airway inflammation
- increased mucous production -> increased ventilation
COPD - symptoms?
- breathlessness: linked to exertion
- wheeze: consistent
- chronic cough and sputum production
- frequent infections (stagnant mucous)
COPD - investigations?
- pulmonary function tests: checks lung function, spirometry, FEV1, FVC
COPD - management?
- progressive addition of oral and inhaled therapies, depending on symptoms: tiotropium (spiriva)
- stop smoking
- exercise
- severe-> home o2
home oxygen: how is it delivered?
- usuall via nasal cannulae
- face mask (drying to oral tissues)
- o2 in cylinder or concentrator
- safety briefing important
acute exacerbation of COPD - management:
- depends on?
- may need?
- what medications?
- acute exacerbation in chair: what to do?
- 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
COPD - dental aspects:
- what to assess?
- what to do when unstable COPD?
- avoid what drugs?
- be aware of?
- assess ability to lie flat, for worsening symptoms
- if unstable, avoid tx
- avoid NSAIDs
- be aware of diminished respiratory reserve (avoid sedation)
pneumonia:
infection of?
may affect which areas in the lung?
- infection of lung tissue
- may be diffuse or affect certain lobes
pneumonia - acute illness symptoms?
- cough + green sputum
- breathlessness
- fever
- pleuritic chest pain
pneumonia - investigations?
sputum exams: examine for infectious agent
chest radiographs: grey area indicates infection
pneumonia - management?
- antibiotics
- may require hospitalization: oxygen, intravenous fluids, airway support
pneumonia - severity: hospitalization if?
- pulse: >100bmp
- respiratory rate: >20breaths/min
- BP: lower than 90/50mmHg
- capillary return time >2 secs
- oxygen saturation <96%
pneumonia severity - CURB 65 criterias?
- confusion
- urea >/= 19mg/dl
- respiratory rate >/= 30 breaths a min
- BP lower than 90/50mmHg
- age 65 and above
pneumothorax: what is it? what are the types of peope susceptible?
- leak of air into pleural space-> sudden onset of breathlessness and pain
- tall young people (esp if smokers)
- chronic lung disease
pneumothorax - diagnosis?
chest radiograph; loss of lung markings
pneumothorax - management?
- main aim is to get rid of air
- aspirate
- chest drain
- occasionally requires surgery: if chest drain fails, or if recurrent case
sleep apnoea - what is it? symptoms?
- collapse of upper airway during sleep (associated with obesity)
- snoring, daytime sleepiness, irritability, headaches
- “microsleeps”
sleep apnoea - risk factors?
- being overweight or obese
- having a large neck
- sedative medication - sleeping tablets
- unusual structure of neck
- smoking/drinking alcohol before sleep
what type of unusual traits of the neck are present in those at risk of sleep apnoea?
- narrow airway
- large tonsils/adenoids/tongue
- small lower jaw
sleep apnoea - management?
- 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
sleep apnoea - dental aspects?
- 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)
interstitial lung disease - pathophysiology?
- inflammation of lung tissue that can progress to fibrosis - irreversible damage/restrictive lung defect
interstitial lung disease - causes?
- cryptogenic (no idea)
- allergens: birds, occupational, drugs
- direct damage: asbestos, coal
- autoimmune disease: rheumatoid, sarcoidosis, systemic sclerosis
interstitial lung disease: symptoms?
breathlessness & cough
interstitial lung disease: management?
- remove underlying cause
- suppression of immune system: steroids, prednisolone + other immunosuppressive medication
interstitial lung disease: dental aspects?
- risk of respiratory compromise: so avoid sedation
- oral side effects of treatment?
cystic fibrosis: aetiology?
what kind of inheritance? how common?
gene defect-> abnormal chloride ion channels -> high viscosity mucous
- lungs, pancreas, male gonadal function
- autosomal recessive
- 1/20carriers, 1/2000 births affected
cystic fibrosis - symptoms in childhood?
- recurrent respiratory infections-> lung destruction
- malabsorption
- pancreatic duct obstruction-> cirrhosis
- bowel obstruction in infants
cystic fibrosis - symptoms in adulthood?
- male infertility
- diabetes
- osteoporosis
cystic fibrosis - diagnosis? management?
- blood test at birth
- sweat test
- prompt treatment of infections
- prophylactic antibiotics
- nutrition
- physiotherapy
- heart-lung transplant
- future: inhaled gene therapy
cystic fibrosis - dental aspects?
- 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
DVT & PE: pathophysiology?
where does the clot affect body for each?
- clot formation in peripheral veins
- usually legs: DVT
- clot migrates to lungs: PE
DVT & PE: predisposing facors?
- obstruction to blood flow
- increased coagulability of blood
- immobility
- surgery
(often more than one factor present)
DVT - symptoms?
- painful lower leg (sometimes upper)
- may be dilated veins, hot, red, swollen
PE - symptoms?
- pleuritic chest pain
- breathlessness
- haemoptysis (vomiting blood from respiratory tract)
- collapse
- sudden death
DVT & PE diagnosis?
DVT: ultrasound of limb
PE: chest CT pulmonary angiogram
ventilation-perfusion scan
DVT & PE: management?
- anticoagulation: immediate anticoagulation with low molecular weight heparin
- long term anticoagulation: warfarin/new agents
DVT & PE - dental aspects?
- anticoagulated patients: be aware of SDCEP guidelines
- do not stop anticoagulation therapy unless guidance clearly says so, or GP consulted
