Flashcards in Respiratory Medicine Deck (63):
1
what are the three main disturbances that can happen to the respiratory system?
reduced transfer of oxygen
reduced ventilation of lungs
reduced perfusion of lungs
2
what are some respiratory symptoms?
breathlessness dyspanea - b/c 3 main disturbances
wheeze - airways narrowing
cough - protective reflex
sputum production
chest pain - pleuritic pain
3
what is asthma?
reversible small airways obstruction
affects all ages
4
percent of children affected?
adults?
5-10% children
2-5% adults
5
is asthma a benign condition?
benign but life threatening
6
what is the pathophysiology of asthma?
an inflammatory allergic condition
7
symptoms of asthma?
wheeze
breathles - not always related to exerise, triggered by cold or emotion
cough - nocturnal, exercise induced, cold induced
8
how to assess asthma?
peak flow readings - plotted by age sex height
classically poorer in mornings - diurnal variation
9
asthma precipitated by?
allergens - house dust mite, pet dander
irritants - dust smoke
exertion
NSAIDS
emotion
10
indications of severity of chronic asthma?
restriction of activities b/c symptoms
increased inhaler use
keep peak flow readings
11
how to manage chronic asthma?
inhaled beta antagonists - salbutamol - short, salmeterol - long activity
inhaled steroids - beclamethasone
combo inhalers - seretide
other - antileukotrienes - montelukast
12
what is acute asthma?
sudden worsening of symptoms. patients can tire
13
what is unstable asthma caused by?
recent infections
poor compliance
14
symptoms of unstable asthma?
using inhaler more frequently
reduced exercise limit
15
management of unstable asthma?
GP - short course of oral steroidss
prednisolone
alteration to regular inhalers if gradual worsening
16
avoid what meds in a dental practice with asthmatic patients?
NSAIDs
17
what might be seen orally with a asthmatic patient?
oral candidiasis, altered taste, dry mouth, side
18
what should you advise to an asthmatic patient after taking their inhalers?
gargle vigorously after use
19
what is COPD?
irriversible obstruction of airways
degenerative
20
pathophysiology of COPD?
damage to lung parenchyma
main process = emphysema = alveolar destruction and reduced area for gas exchange
21
what is bronchitis?
airway inflammation
increased mucous
reduced ventilation
22
symptoms of COPD?
breathless on exertion
consistent wheeze
chronic cough and sputum production
frequent infections - stagnant mucous
23
what are some pulmonary function tests?
lung function
spirometry
FEVL = forced expiratory volume in one second
FVC = forced vital capacity
24
chronic COPD management?
progressive addition of oral inhaled therapies depending on symptoms - tiotropium - spiriva
stop smoking
exercise training
if severe - home = oxygen
25
drug management of copd?
increase inhalers or nebulisers
steroids
antibiotics
26
how to manage a COPD patient in the dentist?
how capable is patient to lie flat
do not treat when unstable
avoid NSAID's
avoid sedation - diminished respiratory reserve
27
how to manage acute exacerbation in the chair?
stop tx and sit pt up
ABCDE
avoid high flow oxygen unless v unwell
bronchodilator - spacer/nebuliser if possible
28
what is pneumonia?
an infection of the lung tissue
may be diffuse or affect the lobes
causative agents
29
symptoms of pneumonia?
acute illness
cough and green sputum
breathlessness
fever
pleuritic chest pain
30
how to manage pneumonia?
antibiotics
hospital - oxygen, IV fluids, airway support
31
pneumonia requires hospitlisation if?
pulse?
resp rate?
bp?
cap return time?
o2 sats?
>100bpm
>20 breathes/min
systolic 2seconds
32
what is a pneumothorax?
leak of air into the pleural space = sudden onset of breathlessness and chest pain
may be life threatening
33
what are the 2 susceptible groups for a pneumothorax?
tall young people - esp smokers
chronic lung disease pt's
34
what would be seen on a chest xray of a pneumothorax?
loss of lung markings
35
how to get rid of air?
aspirate
chest drain
surgery
36
what is sleep apnoea?
the collapse of the upper airways during sleep - associated with obesity
37
symptoms of sleep apnoea?
snoring
daytime sleepiness, irratibility, headaches, microsleeps
38
risk factors of sleep aponoea?
overweight
large neck
sedative meds/sleeping tablets
unusual neck structure - narrow airway, large tonsils, small jaw
smoking, drinking esp before sleep
39
management of sleep apnoea?
lifestyle changes - lose weight, cut down on alcohol, sleeping on side
continuous positive airway pressure - prevents closure of airway during sleep
MAP - mandiblular advancement device - holds jaw and tongue forward
40
sleep apnoea and the dentist?
caution with pt lying flat
41
what is interstitial lung disease?
inflammation of lung disease
42
what can interstitial lung disease lead to?
can progress to fibrosis
= irreversible damage
restrictive lung damage
COPD = destructive
43
causes of ILD?
allergens - birds, occupational, drugs
direct damage - coal, asbestos
autoimmune disease - rheumatoid disease, sarcoidosis, systemic sclerosis
44
symptoms of ILD?
breathlessness, cough
45
management of ILD?
remove underlying cause
suppression of immune system
steroids - prednisolone
immunosuppressant medications
46
dentally what to be aware of when treating an ILD pt?
avoid sedation - risk of respiratory compromise
oral side effects of treatment
47
what is cystic fibrosis?
most common inherited disease in scotland
autosmal recessive
1 in 20 carriers
1 in 2000 births
48
what is the gene defect in cystic fibrosis?
abnormal chlorine ion channels
which leads to high viscosity mucous = lung, pancreas and male gonadal function affected
49
symptoms of cystic fibrosis in childhood?
recurrent resp infections = lung destruction
malabsorption
pancreatic duct destruction = cirrhosis
bowel obstruction in infants
50
symptoms of cystic fibrosis in adulthood?
male infertility
diabetes
osteoporosis
51
how to diagnose cystic fibrosis?
blood test at birth and then sweat test
52
management of cystic fibrosis?
prompt tx of infections
prophylactic antibiotics
nutrition
physiotherapy
heart/lung transplant
future = inhaled gene therapy
53
what to be cautious of when treating a CF pt dentally?
risk of respiratory compromise - avoid sedation
pt on immunosuppressants if transplant recipient
54
what is a DVT?
PE?
deep vein thrombosis
pulmonary embolism
55
what is the pathophysiology of dvt
clot formation in peripheral veins
dvt - usually legs
56
pathophysiology of pe?
clot migrates to lungs
57
predisposing factors for a pe/dvt?
obstructions to blood flow
increased coagubility of blood
immobility
surgery
58
symptoms of a DVT?
painful lower leg
may be dilated veins, hot, red, swollen
59
PE symptoms?
pleuritic chest pain
breathlessness
haemoptysis
collapse
sudden death
60
how to diagnose a dvt?
ultrasound of limb
61
how to diagnose a pe?
chest CT pulmonary angiogram
ventilation perfusion scan
62
immediate anticoagulation?
low molecular weight heparin
63