Respiratory medicine

Question 1

What are the clinical signs of respiratory disease?

Answer 1

• Respiratory rate • Breath sounds • Cough • Colour of mucous membranes (cyanosis) • Appearance of mouth and pharynx
• Finger clubbing • Leg oedema
• Cyanosis

Question 2

What is sinusitis?

Answer 2

• Infection of the paranasal sinuses which often complicates URTIs
• Streptococcus pneumoniae, Haemophilus influenzae
• Frontal headache, facial pain and tenderness, nasal discharge
• Treatment: expectant/antibiotics • Rare complications: local/cerebral abscess

Question 3

What is quinsy? and what is the treatment?

Answer 3

• Peritonsillar abscess
• A complication of acute tonsillitis
• Usually caused by Streptococcus
• A collection of pus arising outside the capsule of the tonsil (often causing the tonsil to be displaced)
• Patient already suffering from acute tonsillitis becomes more ill, may have earache, dysphagia, trismus

Treatment:
• Penicillin (erythromycin) • Drainage of abscess (ENT) • Consider tonsillectomy

Question 4

What is trismus?

Answer 4

• Trismus is a motor disturbance of the trigeminal nerve.
• In particular there is spasm of the masticatory muscles, with difficulty in opening the mouth - risus sardonicus or ‘lockjaw’ to the layperson.

Question 5

What is epiglottitis? what are the signs and what is the treatment?

Answer 5

• Epiglottitis is an acute inflammation in the supraglottic region of the oropharynx, including the epiglottis, vallecula, arytenoids and aryepiglottic folds
• Commonest in children aged 1-5
• Caused by Haemophilus influenzae, Streptococcus pneumoniae

• Symptoms:
– Stridor and respiratory distress which requires urgent attention
– Sore throat, dysphagia and drooling – Muffled voice
• If respiratory distress is present there is a high risk of life threatening airway obstruction. This can be precipitated by attempting to examine the throat.

Treatment:
• Transfer patient to ED • Secure airway (ENT & anaesthetic input) • Oxygen • Antibiotics
• May need intensive care treatment/monitoring

Question 6

What is stridor?

Answer 6

• A high pitched sound resulting from turbulent air flow in the upper airway
• May be inspiratory, expiratory or present on both inspiration and expiration
• Can be indicative of serious airway obstruction
• Stridor is indicative of a potential medical emergency

Question 7

What is Pneumonia? and what’s the treatment?

Answer 7

• Inflammation of the lung parenchyma, usually caused by infection
• Acute illness • Cough, fever, chest pain, unwell • Abnormal chest signs, tachypnoea • Abnormal chest x-ray: consolidation

Treatment:
• Antibiotics e.g. amoxycillin & clarithromycin
• Oxygen • Fluids • Analgesia

Question 8

What’s the severity assessment for pneumonia?

Answer 8

• Confusion
• Urea > 7
• Respiratory rate > 30
• BP diastolic < 60 or systolic < 90
• 65 age>65yrs
• Score 0-1: low risk consider home treatment • Score 2+: higher risk - hospital treatment

Question 9

What are the complications of pneumonia?

Answer 9

• Respiratory failure • Multiple organ failure • DVT/PE • Lung abscess • Empyema • Bronchiectasis

Question 10

What is asthma?

Answer 10

A chronic inflammatory disorder of the airways. In susceptible individuals, inflammatory symptoms are usually associated with widespread but variable airflow obstruction and an increase in airway response to a variety of stimuli. Obstruction is often reversible either spontaneously or with treatment.

Symptoms:
• Wheeze, SOB, chest tightness, cough. Tending to be:
• Variable • Intermittent • Worse at night • Provoked by triggers including exercise

Signs:
• Wheeze is a cardinal sign
• Usually diffuse, polyphonic, bilateral, expiratory
• May only be present during exacerbations
• Hyperinflation

Question 11

What is COPD?

Answer 11

• Emphysema • Chronic bronchitis • Small airways disease • Chronic progressive airflow obstruction • Usually caused by smoking • Presents in middle to older age • A leading cause of morbidity & mortality

Symptoms:
• Gradually worsening breathlessness • Cough • Sputum • Exacerbations
• Muscle wasting, weight loss & fatigue • Respiratory failure

Signs:
• Central cyanosis • Hyper-expanded (barrel) chest • Raised respiratory rate • Pursed lip breathing • Use of accessory muscles • Ankle swelling

Question 12

Respiratory disease and dentistry?

Answer 12

• Patients with severe respiratory disease will have difficulty lying flat and may find it difficult to tolerate dental procedures
• Sedation should be used with caution in patients with respiratory disease
• If acute epiglottitis is suspected do not attempt to examine the throat
• Stridor suggests major airway obstruction and is a medical emergency