RT

Question 1

What are the causes of type 1 respiratory failure?

Answer 1

hypoxaemia
thickening in alveolar barrier
Diffusion abnormality or V/Q mismatch
PaO2 of below 8kPa
SaO2 of below 90% on air
=GAS EXCHANGE PROBLEM

Question 2

What are the causes of type 2 respiratory failure?

Answer 2

poor alveolar ventilation
diffusion abnormality
V/Q mismatch eg pulmonary embolism
=VENTILATION PROBLEM

Question 3

What are the causes of type 1 respiratory failure?

Answer 3

increased airway resistance
reduced breathing effort
decreased area of lung available for gas exchange
=GAS EXCHANGE PROBLEM

Question 4

What is the effect of asthma on the bronchioles?

Answer 4

Muscle contraction
Inflamed & swollen mucosa
Increased mucous secreton

Question 5

What is wheeze?

Answer 5

Expiratory noise affecting the bronchioles

Question 6

What is stridor?

Answer 6

Inspiratory noise affecting airways around the trachea

Question 7

What is dyspnoea?

Answer 7

Shortness of breath, breathlessness

Question 8

What are the signs of respiratory conditions?

Answer 8

Chest movement
Respiration rate changes (should be 12-15 breaths per minute)
Air entry: is it symmetrical? is it reduced?
Vocal resonance: solid medium in lung conducts sound better than air would do
Percussion note: resonant/dull

Question 9

What are the causes of type 2 respiratory failure?

Answer 9

hypercapnia
ventilation failure
airway blocking or narrowing
ventilation problems - muscles
acute on chronic infections
PaCO2 of greater than 6.7kPa
=VENTILATION PROBLEM

Question 10

What is the Tx for COPD?

Answer 10

Smoking cessation is advised to alleviate the damage smoking causes
Anticholingerics are given to reduce basal muscle tone
Steroids are given to reduce airway inflammation
Home oxygen therapy where required is also given.
Pulmonary rehabilitation therapy can also be given.

Question 11

How is cystic fibrosis managed?

Answer 11

CF management is given by:
Physiotherapy to improve mucus clearance from the lungs (up to an hour daily)
Exercise to improve lung efficiency and help build up bulk
Bronchodilators to open the airways
Steroids to reduce airway inflammation
DNAse to break down mucus
Antibiotics to reduce lung infections
Pancreatic Enzyme Replacement to alleviate problems posed by pancreatitis
High Calorie Diet to allow weight gain- this has dental relevance as it increases caries risk

Question 12

What is the system for Tx of asthma?

Answer 12

1. Occasional beta agonist only
2. Low dose inhaled steroid or sodium cromoglycate/nedocromil (mast cell stabiliser)
3. High dose inhaled steroid (brown inhaler - beclomethasone or budesonide)
4. Long acting beta agonist (salmeterol), theophylline, anti-muscarinic cells
5. Oral steroid (hospitalised)

Question 13

What is beclometasone?

Answer 13

A corticosteroid in a brown inhaler

Question 14

What are the inhaler colours?

Answer 14

SA B2 Agonist- Blue (salbutamol)
LA B2 Agonist- Green
Anticholingerics- Grey (impatropium)
Combinations- Purple

Question 15

What are the corticosteroid inhaler colours?

Answer 15

Beclometasone- Brown
Budesonide- Brown
Fluticosone- Orange
Momentasone- Pink

Question 16

What investigations can be carried out for obstructive airway diseases?

Answer 16

Sputum examination - colour, microscopy, bacteria
Chest X-ray
Pulmonary function tests (FEV1)
Bronchoscopy
VQ scan

Question 17

What is asthma?

Answer 17

Reversible airflow obstruction

Question 18

What are the symptoms of asthma?

Answer 18

Cough
Wheeze
SOB
Problem with breathing out - hyperinflated chest
Triggers - dust, smoke, environment

Question 19

What are the different respiratory drugs used?

Answer 19

B-adrenergic agonists
Anticholinergic
Corticosteroids
Leukotriene inhibitors
Chromones
Theophyllines

Question 20

What are the causes of type 2 respiratory failure?

Answer 20

hypercapnia
ventilation failure
airway blocking or narrowing
ventilation problems - muscles
acute or chronic infections
PaCO2 > 6.7kPa
chronic - renal compensation for acidosis
=VENTILATION PROBLEM

Question 21

What are theophyllines?

Answer 21

Immunostimulatory drugs
Immunomodulatory drugs
Used in severe asthma as a last resort due to adverse side effects - adenosine inhibition

Question 22

What is emphysema?

Answer 22

Loss of alveoli for gas exchange, resulting in dilation of the others to fill space - smaller number of bigger airway sacs

Question 23

How is COPD classified?

Answer 23

Gold’s classification
Gold 1 or 2 - mild/moderate, FEV1 50-80%
Gold 3 - severe, FEV1 30-50%, cough & sputum, SOB on exertion
Gold 4 - v severe, FEV1 30%, wheeze, cough, SOB on mild exertion, overinflated lungs

Question 24

What is COPD?

Answer 24

Combination of bronchitis and emphysema resulting in poor ventilation
Can progress to respiratory failure

Question 25

What causes COPD?

Answer 25

smoking
environmental lung damage - coal, asbestos, lung cancer
occupational lung disease
hereditary - emphysema

Question 26

What is occupational lung disease?

Answer 26

small airways are still present but have become thickened & less elastic
can lead to respiratory failure
fibrosis - dust related
tumours - asbestos (mesothelioma)