Pulmonary Disease

Question 1

Chronic inflammatory airway disorder
•Airway hyper-responsiveness to stimuli
•Bronchial edema
•Narrowing of the airways i.e., obstruction

Answer 1

Asthma

Question 2

Signs and Symptoms of \_\_\_\_\_:
Recurrent, reversible episodes of: 
•Dyspnea (shortness of breath)
•Wheezing 
•Coughing
•Tightness of chest

Answer 2

Asthma

Question 3

Which of the following is a “true” 
asthma symptom?
•Dyspnea (shortness of breath)
•Wheezing 
•Coughing
•Tightness of chest

Answer 3

•Tightness of chest

Question 4

What stage of asthma should not be treated for routine dental care?

Answer 4

Uncontrolled

Question 5

____ type of asthma
•Most common
•Children and young adults
•Typical positive family history
•Triggered by allergens (pollen, dust, house
mites, animal dander, mold etc.)
•Exaggerated inflammatory response Allergen →T Helper Lymphocyte Type 2 (Th2) →antibody production of high levels of IgE →activation of mast
cells, basophils and eosinophils → bradykinin, histamine, leukotrienes → bronchoconstriction

Answer 5

1. Extrinsic (allergic or atopic)

Question 6

____ type of asthma
•Unknown pathogenesis
•Children and young adults
•Triggered by exercise and thermal changes
•Cold air irritates mucosa resulting in airway
hyperactivity

Answer 6

2. Exercise-induced

Question 7

____ type of asthma

•Second most common
•Middle-aged individuals
•Triggered by respiratory irritants (tobacco, air
pollution, emotional stress, gastroesophageal reflux
disease (GERD)
•Infrequently associated with family history
•Normal IgE levels

Answer 7

Intrinsic (idiosyncratic, nonallergic, nonatopic)

Question 8

____ type of asthma

•Subset of intrinsic
•Affects children, young adults & middle-aged adults
•Common antigens
➢NSAIDs, ASA (acetyl salicylic acid)
➢β-blockers
➢ACE (angiotensin-converting enzyme) inhibitors
➢Anticholinergic drugs (?)
➢Food dye
➢Metabisulfites in food and in local anesthetics with
epinephrine

Answer 8

4. Drug-induced

Question 9

Oral signs of \_\_\_\_\_:
•Mouth breather (high palatal vault, overjet, 
crossbite, greater facial height)
•Dry mouth 
•Candida
•Enamel defects and caries
•Gingivitis/periodontitis
•Enamel erosion possible with GERD

Answer 9

Asthma

Question 10

_______ Asthma
• Dental treatment should be limited to urgent care
only
• Treatment of acute pain, bleeding, or infection

Answer 10

Unstable

Question 11

______ Asthma
• Any indicated dental treatment may be provided if
management protocols are considered
• Consult with physician for severe persistent
asthma

Answer 11

Stable

Question 12

What 2 drugs are mentioned that trigger asthma?

Answer 12

ASA and NSAIDs

Question 13

What 2 drugs are mentioned that cause respiratory depression causing issues with asthma?

Answer 13

Opioids and barbituates

Question 14

_______ in epinephrine preparation of local anesthetics should be avoided in asthmatic pts

Answer 14

Sulfites

Question 15

________
➢Potent inhibition of CYP3A4
➢Increases levels of theophylline
➢Toxicity (arrhythmia and seizures)

Answer 15

Theophylline and macrolides or ciprofloxacin

Question 16

______
➢Effect promotes bronchoconstriction
➢Sialogogues are contraindicated in patients with uncontrolled
asthma

Answer 16

Cholinergic agonists

Question 17

Can you use/ should use nitrous for asthmatic pts?

Answer 17

Yes

Question 18

Can you used nitrous for COPD pts?

Answer 18

No

Question 19

What are the 2 types of COPD?

Answer 19

Bronchitis

Emphysema

Question 20

Which type of COPD is more of a long term issue that is created by prolonged COPD complications

Answer 20

Emphysema

Question 21

3rd leading cause of death in USA
Characteristics
Corticosteroid-resistant progressive chronic inflammatory
disease
• Poorly reversible/irreversible airway obstruction
• Entrapment of air and dyspnea upon exertion

Answer 21

COPD

Question 22

• Excessive tracheobronchial mucus production to cause
coughing and sputum production for >3 months for >2
consecutive years in the absence of infection or other causes
of chronic cough

Answer 22

Bronchitis

Question 23

• Longterm Chronic obstructive bronchiolitis leads to destruction
of lung parenchyma and alveolar walls
• Decreased elastic recoil
• Difficulty in maintaining airway opening during expiration

Answer 23

Emphysema

Question 24

Signs and symptoms of ______:
• Dyspnea
• Cough
• Sputum

Answer 24

COPD

Question 25

``` The following are associated with _____: Exacerbations Triggered by viral or bacterial infections • Haemophilus influenza • Moraxella catarrhalis • Streptococcus pneumoniae Complications • Pulmonary hypertension • Cor pulmonale (R-sided heart enlargement) • Thoracic bullae • Nocturnal hypoxia Comorbidities • Hypertension • Ischemic heart disease • Heart failure • MI • Muscle wasting • Osteoporosis ```

Answer 25

COPD

Question 26

Tx of _____: • Inhaled long-acting bronchodilators • Corticosteroids if asthma also present and/or more reversible obstruction • Smoking cessation is only intervention that actually reduces disease progression

Answer 26

COPD

Question 27

``` Oral manifestations of ______: • Dry mouth • Steven-Johnson syndrome with theophylline Exacerbates Smoking Side Effects of: • Halitosis • Tooth staining • Nicotine stomatitis • Periodontal disease • Oral potentially malignant disorders • Leukoplakia • Erythroplakia • Oral squamous cell carcinoma ```

Answer 27

COPD

Question 28

T/F: • Erythromycin, macrolide antibiotics (clarithromycin, azithromycin, etc.) and ciprofloxacin should not be prescribed to COPD patients already taking theophylline

Answer 28

True

Question 29

Granulomatous infectious disease caused by Mycobacterium tuberculosis Lungs are most common site of infection Due to the multiple species of Mycobacterium (m. bovis, m. abscessus, m.microti, m.africanuum, etc.), TB can also affect cutaneous, lymphatic and other tissues

Answer 29

Tb

Question 30

WHO estimates 1/3 of human population is infected (~2 x 109 people) Greatest universal single pathogen killer of humans Not as morbid to the US population 1900 AD ~ 500 per 100,000 incidence 1980 AD ~ 9.3 per 100,000 incidence 1985-1992 ~10.6 per 100,000 incidence 2009 ~ 3.8 per 100,000 incidence

Answer 30

Tb

Question 31

``` Airborne Transmission via infectious respiratory droplets from •Coughing •Sneezing •Talking •Singing ```

Answer 31

TB

Question 32

``` Signs and symptoms of _____: •Persistent, unexplained cough •Fever •Malaise •Night sweats •Unintentional weight loss •Hemoptysis •Dyspnea ```

Answer 32

TB

Question 33

Oral signs of_____ • More frequent presentation: ➢Deep irregular, painful ulcer on the tongue dorsum ➢May occur in other areas as well (gingiva, lips, palate, buccal mucosa) • SCROFULA • TB involvement of cervical and submandibular lymph nodes • Lymph nodes are enlarged and painful • Abscess with purulence may be present

Answer 33

TB

Question 34

• TB involvement of cervical and submandibular lymph nodes • Lymph nodes are enlarged and painful • Abscess with purulence may be present

Answer 34

• SCROFULA