Chapter 6: Management Of The Patient With Respiratory Illnesses

Question 1

Is COPD reversible or irreversible?

Answer 1

Irreversible

Question 2

3 respiratory illnesses:

Answer 2

• COPD
• asthma
• tuberculosis

Question 3

COPD is?

Answer 3

Chronic and irreversible obstructive disorder: obstruction of the airway at the pulmonary level

Has 2 main parts;
Chronic bronchitis
Pulmonary emphysema

Question 4

Chronic bronchitis:

Answer 4

Main symptom: daily cough and mucus (sputum) production for at least 3 months a year for 2 consecutive years

Question 5

Pulmonary emphysema:

Answer 5

Emphysema is a destructive disease of the lung in which the alveoli that promote oxygen exchange between the air and the bloodstream are destroyed

Alveoli destroyed

Question 6

___% in men and ____% in men, mortality is much higher in?

Answer 6

14, 8, white men

Question 7

Risk factors of COPD?

Answer 7

• smoking
• pollution
• past lung infection

Question 8

Symptoms of COPD:

Answer 8

• chronic bronchitis: older than 50
• cough and mucous production
• fatigue
• sore throat
• pulmonary emphysema: older than 60
• shortness of breath

Question 9

Medical tx of COPD:

Answer 9

• Stop smoking
• Do exercise
• Healthy diet
• Flu vaccine
• Antibiotic treatment
• Hydration
• Oxygen

Question 10

Dental tx of COPD:

Answer 10

• Semi-seated position to avoid orthopnea
• Not recommend doing a nerve block
• If sedation is needed, diazepam 5mg
• Do not administer narcotics (respiratory depressor)
• If treated with teofilin avoid macrolides (created a toxic reaction of teofilin)
• No sedation with nitrous oxide (emphysema)
• Avoid complete isolation

Question 11

Asthma is:

Answer 11

A common lung disorder in which inflammation causes the bronchi to swell and narrow the airways, creating breathing difficulties that may range from mild to life threatening

Question 12

Asthma in early ages is more common in? While asthma in later ages are more common in?

Answer 12

Men
Women

Question 13

Symptoms of asthma:

Answer 13

• Shortness of breath, cough (often worse at night)
• Sudden episodes
• Wheezing (respiratory wheezing): it is a high-pitched whistling sound produced
  by turbulent airflow through narrow airways, typically with exhalation)
• Symptoms are episodic

Question 14

Classification of asthma:

Answer 14

• allergic (extrinsic)
• non allergic (intrinsic): induced by foods, and medication (Aspirin), NSAIDs, beta blockers

Question 15

Medical tx of asthma?

Answer 15

Bronchodilators, nebulisers, asthma inhalers , corticosteroids, aerosols 2-4 times a day

Question 16

Drugs to avoid in patients with asthma?

Answer 16

• avoid aspirin and paracetamol
• avoid NSAIDs
• avoid narcotics
• avoid macrolides in teofilin-treated patients

Question 17

Oral side effects of asthma:

Answer 17

• GI reflux: common and worsen with aerosols
• oral candidiasis: glucocorticoids help candida develop: mouthwash after use of inhaler

Question 18

Treatment for asthma attack?

Answer 18

• Inhalers of rapid action
• Tranquillise the patient
• Subcutaneous injection of adrenalin
• Administer oxygen

Question 19

Tuberculosis is?

Answer 19

Respiratory infection that’s contagious in the acute phase

• elderly patients in poor social conditions
• secondary to HIV infections
• mycobacterium tuberculosis
• contagious between 2-8 week, tuberculin mantoux test is positive

Question 20

Patients at risk for tuberculosis ?

Answer 20

• people in touch with someone infected with TB
• HIV: IV drug users
• health care workers
• foreigners from countries with a high prevalence of tuberculosis

Question 21

How to minimise oral candidasis in patients with asthma?

Answer 21

Mouthwash after the use of the inhaler

Question 22

Symptoms of tuberculosis ?

Answer 22

• fatigue
• fever
• unintentional weight loss
• night sweats
• coughing up blood
• chest pain

Question 23

Medical tx of tuberculosis ?

Answer 23

For 8 weeks: isoniazid, rifampicin, and pyrazinamide
The next 4 months, isoniazid, and rifampicin for the next 6months

Question 24

Dental tx of TB?

Answer 24

1. Active TB:
   - only emergency tx, in hospital never ambulatory
   - <6 years: ordinary treatment, if doctors allow
   - > 6 years: use of turbine, always in hospital, even if coughing tests are negative
2. Latent TB: ordinary tx
3. Recent return to active TB (tuberculin test):
   - isoniazid as prophylaxis
   - ordinary tx if in active
4. If they have symptoms and signs of TB:
   - avoid tc
   - if necessary only emergency tx

Question 25

Administration of medication in TB:

Answer 25

- Isoniazid and rifampicin: hepatoxicity, no paracetamol - Diazepam worthless - Gingival haemorrhage and infections due to leucopenia - If the patient is taking Streptomycin, no aspirin as it increases toxicity (happens in the ears)

Question 26

Oral complications of TB:

Answer 26

- Deep and painful ulcer on the tongue - Palate, lips, mucosa and gingiva: small ulcers heal as scar - Neck lymph nodes are painful and infected (scrofula) Treatment: ATB tuberculosis (Antibiotic for tuberculosis)

Question 27

What clinical manifestation is frequent in patients with asthma?

Answer 27

a. Hairy leukoplakia b. Pseudomembranous candidiasis c. Infectious foci in apices d. Paresthesia e. Neutropenic ulcers B

Question 28

Obstructive pulmonary disease is characterized by:

Answer 28

a. The two clinical conditions (emphysema and bronchitis) are indistinguishable in most patients. b. Present dyspnea, chest pain and hemolysis c. It is an irreversible disease that affects the lungs at the entrance level d. The main etiology is environmental pollution and contamination e. Treatment is aimed at depressing the respiratory system to improve quality of life

Question 29

The systemic pathology in a patient with respiratory disorders that implies the existence of an infection is:

Answer 29

a. Extrinsic asthma b.Bronchitis c.Intrinsic asthma d. Tuberculosis e. Emphysema D

Question 30

What will be our attitude towards a patient with suspected tuberculosis?

Answer 30

a. The patient will be isolated to avoid contagion with other patients b.Only emergency treatments will be performed c. An inter-consultation will be carried out to determine what treatments can be performed. d. Immediately report it to the health authorities e. Perform an inter-consultation to rule out active disease B

Question 31

To which pathology or drug will we associate a whitish lesion in the Jugal mucosa of several months of evolution that we found in a patent when performing the oral examination ?:

Answer 31

A. Oral anticoagulants B. Oral bisphosphonates C. Asthmatic patient D. Intravenous bisphosphonates E. Hypertension C

Question 32

A patient with poorly controlled asthma without sequelae is classified as?

Answer 32

ASA III

Question 33

If a patient comes to the consult for pain on tooth 13, on treatment with isoniazid and rifampicin, we must avoid?

Answer 33

A. Ibuprofen 600mg B. Nolotil C. Dexketoprofen (enantyum) 25mg D. Paracetamol 1gr E. Ibuprofen 400mg D

Question 34

Vasoconstrictors are completely contraindicated in the following except for a relative case which is?

Answer 34

A. Unstable angina pectoris B. Recent myocardial infarction C. Asthmatic in which the intrinsic factor is anaesthesia D. Hyperthyroidism E. Uncontrolled diabetes ?

Question 35

Indicate the correct answer:

Answer 35

a. The patient with chronic bronchitis is more prone to congestive heart failure b. In a patient with Enfisema, Clindamycin will be avoided c. One of the complications of patients with tuberculosis is nicotine stomatitis and periodontal disease d. In asthmatic patients we will avoid steroid anti-inflammatory drugs e. Tobacco is the most important etiologic factor in patients with COPD E But why is A wrong?

Question 36

After performing a simple extraction to an 18 year old patient with asthma taking theophylline. Which of the following would be prescribed for the patient?

Answer 36

A. erythromycin 500. 1 every 8 hours for a week B. ibuprofen 600mg every 6 to 8 hours for 3 days C. Spiramycin 600mg every 8h for a week D. espidifen 600mg if there is pain, but never aspirin E. paracetamol 1g every 6 to 8 hours E

Question 37

Asthmatic patient of 18 years that while doing a root canal with rubber dam we are told to stop because it presents respiratory difficulty. Our attitude to follow will be:

Answer 37

a. Before the possibility of an asthmatic crisis, immediately notify to 061/112 b. Remove the instruments from the mouth and reassure the patient c. Before the possibility of a bronchoaspiración, to realize immediately the maneuver of Heimlich d. Allow the patient to take a dose of his inhaler and if it does not bring with him an aerosol of salbutamol e. B and d E?

Question 38

Before a patient who comes to the consultation with COPD and comes to have a crown preparation of several pieces performed, the measure to follow will be

Answer 38

A. Appointment late in the morning for possible cross infections B. You will be placed in the supine position to avoid orthopnea. C. Narcotics or barbiturates will be prescribed if the patient comes very nervous D. The anaesthesia will be infiltrative with or without VC E. We will carry out an interconsultation beforehand E