Respiratory Medicine

Question 1

How can the mast cells be stimulated if not directly from allergen?

Answer 1

Allergen stimulates cd4 lymphocyte ( th2 cells)
Interleukin 4 produced
Be cells stimulated to produce igE
Mast cells stimulated

Question 2

What are symptoms of asthma?

Answer 2

Wheeze
Breathlessness
Cough

Question 3

How is asthma assessed?

Answer 3

Peak flow readings- plotted by sex, age and heigh

Question 4

What can be precipitants of asthma?

Answer 4

Allergens
Irritants
Exertion
NSAIDs
Emotion

Question 5

What medications are used to treat asthma?

Answer 5

Inhaled b2 agonists
Inhaled steroids
Combination inhalers
Anti leukotrienes

Question 6

What b2 antagonist is short acting?

Answer 6

Salbutamol

Question 7

What b2 agonist is long acting ?

Answer 7

Salmeterol

Question 8

What is an inhaled steroid?

Answer 8

Beclamethasone

Question 9

What is a combination inhaler?

Answer 9

Seri tide

Question 10

What is an anti leukotrienes?

Answer 10

Montelukast

Question 11

How is moderate asthma defined?

Answer 11

Peak flow 50-75%
No features of acute
Resp and pulse rate normal

Question 12

What defines acute severe asthma?

Answer 12

Peak flow 33-50%
Resp rate >25
Heart rate > 110
Inability to complete sentences in one breath

Question 13

What defines unstable asthma?

Answer 13

Recent infections
Poor compliance
Symptoms- requiring more frequent inhaler or reduce exercise limit
Change of meds by gp

Question 14

Dental aspects re. Asthma

Answer 14

Avoid NSAIDs
Oral candidiasis
Altered taste
Dry mouth

Question 15

What IS COPD?

Answer 15

Airflow obstruction that is not fully reversible
Progressive
Often caused by smoking

Question 16

What is FEV.?

Answer 16

Forced expired volume in 1 second

Question 17

What is FVC

Answer 17

Vital capacity

Question 18

What defines obstruction?

Answer 18

FEV/FVC = less than 0.7

Question 19

What is the pathophysiology of COPD?

Answer 19

Emphysema- alveolar destruction

Bronchitis- airway inflammation, increased mucous

Question 20

What are symptoms of COPD?

Answer 20

Breathlessness pop exertion
Wheeze- consistent
Chronic cough and sputum
Frequent infections due to stagnant mucous

Question 21

What are pulmonary lung function test

Answer 21

Lung function
Spirometry
FEV1
FVC

Question 22

What is the management of COPD?

Answer 22

Oral and inhaled therapies- tiotropion
Cease smoking
Exercise training
Home o2 if severe

Question 23

Management of acute COPD

Answer 23

Stop tx
Give oxygen- not high flow unless desperate
Bronchodilator
Hospitalisation

Question 24

What is relevant re. Dental tx and COPD?

Answer 24

Avoid NSAIDs
Avoid sedation
Assess ability to lie flat

Question 25

What is pneumonia?

Answer 25

Infection of lung tissue

Question 26

What are symptoms of pneumonia?

Answer 26

``` Cough with green sputum Breathlessness Fever Pleuritic chest pain Shadow on chest X-ray ```

Question 27

Management of pneumonia?

Answer 27

Antibiotics | Hospitalisation re. IV fluid, o2

Question 28

What does curb stand for ?

Answer 28

Confusion Urea > 19 Resp rate >30 Bp 65

Question 29

What does a higher curb score mean?

Answer 29

Higher the score the higher the mortality rate

Question 30

What is pneumothorax

Answer 30

Leak of air into pleural space | Sudden onset of breathlessness and chest pain

Question 31

Who is susceptible re. Pneumothorax?

Answer 31

Tall young people Especially smokers Chronic lung disease

Question 32

What shows on chest X-rays?

Answer 32

Loss of lung markings

Question 33

What is management of pneumothorax?

Answer 33

Aspirate Chest drain Surgery

Question 34

What is sleep apnoea?

Answer 34

Collapse of upper airway during sleep

Question 35

What is sleep apnoea associated with ?

Answer 35

Obesity Large neck Sedative meds Smoking or alcohol before sleep

Question 36

What are symptoms of sleep apnoea?

Answer 36

``` Snoring Daytime sleepiness Micro sleeps Irritability Headaches ```

Question 37

Management of sleep apnoea?

Answer 37

Lifestyle Cpap- continuous positive airways device Mad- mandibular advancement device

Question 38

What are causes of interstitial lung disease?

Answer 38

Allergens Direct damage- asbestos Auto immune

Question 39

Symptoms of interstitial lung disease

Answer 39

Breathlessness | Cough

Question 40

Management of interstitial lung disease?

Answer 40

Avoid sedation Steroids Remove underlying cause

Question 41

What is cystic fibrosis?

Answer 41

Gene defect causing abnormal chloride ion channels

Question 42

What can occur as a result of cystic fibrosis?

Answer 42

High viscosity mucous Affects lung and pancreas Affects male gonadal function

Question 43

Childhood symptoms of cystic fibrosis?

Answer 43

Recurrent respiratory infections Malabsorption Pancreatic duct obstruction Bowel obstruction

Question 44

What are symptoms of cystic fibrosis in adults?

Answer 44

Diabetes Male infertility Osteoporosis

Question 45

How is cystic fibrosis diagnosed?

Answer 45

Blood test at birth | Sweat test

Question 46

What is management of cystic fibrosis?

Answer 46

``` Prophylactic ab cover Nutrition Physio Heart/ lung transplant Avoid sedation ```

Question 47

What is DVT?

Answer 47

Deep vein thrombosis. | Clot formation in peripheral veins ( usually legs)

Question 48

What is PE?

Answer 48

Pulmonary embolus | Clot migrates to lungs

Question 49

What are predisposing factors to DVT and PE?

Answer 49

Obstruction to blood flow Surgery Increased coagulation of blood

Question 50

Symptoms of DVT?

Answer 50

Painful lower leg | Dilated veins, hot red and swollen

Question 51

Symptoms of PE?

Answer 51

Pleuritic chest pain Breathlessness Haemolysis Collapse sudden death

Question 52

Management of DVT and PE

Answer 52

Anticoagulation Immediate- heparin Long term- warfarin

Question 53

What do mast cells produce to stimulate bronchoconstriction?

Answer 53

Leukotrienes and histamine