W14 48 respiratory medicine for dentists Flashcards
(47 cards)
What happens in bronchial infections?
Airway inflammation in the lungs with excessive mucous production
Cough +/- sputum expectoration
What is acute bronchitis?
Previously well people - usually a viral cause.
Often results by 3 weeks.
May be complicated by secondary bacterial infection
What is chronic bronchitis?
Productive cough >= 3 months for >=2 years
Commonly associated with chronic lung disease
Consider bacterial causes eg H influenzae, P aeruginosa or M catarrhalis
Look for underlying sinus infections, post-nasal drop or gas to-oesophageal reflux
What are the different clinical features between typical and atypical pneumonia?
Typical - sudden onset, fever, chills, productive cough and pleuritic chest pain, localised signs, diagnosed via culture methods, respond to b-Lactam antibiotics
Atypical - insidious onset, dry cough, myalgia, headaches, systemic upset (diarrhoea, rash), diagnosed via non-culture methods, does not respond to b-Lactam antibiotics
What is the grading severity for pneumonia?
C - confusion (AMYS <=8)
U - urea >7mmol/L
R - respiratory rate >=30
B - BP if lower than either 90/60
65 - older than this
0-1 is low score, 2 is moderate, more than 3 is severe with 15-40% 30 day mortality rates
How do you manage low severity, moderate severity and high severity CAP?
Low - oral amoxicillin preferred plus rest, smoking cessation, fluids and analgesics if pain
Moderate - consider hospital referral, don’t give antibiotics before referal
High - urgent hospital admission - consider giving intravenous benzylpenicillin or oral amoxicillin if life-threatening or if a delay in hospital treatment of >6hrs is likely
Complications of CAP?
Respiratory failure
Septic shock
Lung abscess
Parapneumonic effusion or empyema
What is the typical response to foreign body aspiration?
Choking
What are the signs and symptoms of foreign body aspiration?
Cough and shortness of breath
Difficult speaking
Haemoptysis
Vomitting
Decreased breath sounds on affected side (usually RHS)
Stridor and/or wheezing
What are the complications of foreign body aspiration?
Recurrent pneumonia
Lung abscess
Bronchiectasis (dilatation of airways) distal to the foreign body
Bronchial stenosis (narrowing of airways) due to inflammation
Can result in complete airway obstruction and subsequent hypoxic brain injury/death
What should you do as soon as someone aspirates a foreign body?
5 back blows, 5 abdominal thrusts
CPR if not resolved
Which lung is most likely to get foreign material stuck?
The right lung lobe
Since more vertical orientation
In a spirometry test, how much air should a normal person blow out within the first second?
80% of their total lung capacity
In spirometry tests for pulmonary function, what do different values of FEV1/FVC mean? (PG469 GRAPHS)
FEV1/FVC > 0.7 is normal
FEV1/FVC < 0.7 is airflow obstruction
FEV1/FVC > 0.7 but both FEV1 and FVC are reduced = lung restriction
Which lung diseases are obstructive or restrictive?
Obstructive - asthma, COPD
Restrictive - obesity, interstitial lung disease, muscle weakness
Why does a dentist need to know about lung disease?
What the disease is
How bad it is
What meds they’re on
Will they tolerate sedation or anaesthetic
What is bronchial asthma?
Chronic inflammatory disorder of the airways leading to airway obstruction
What are the 2 pathways (briefly) causing hyper responsiveness in the airways in asthma?
Inflammatory - by mast cells and eosinophils
Non-inflammatory - by neutrophils
Causes hyperresponsiveness of airways, remodelling, mucus production and smooth-muscle constriction and hypertrophy
What does a normal airway vs an asthmatic airway look like? (IMG PG471)
An asthmatic airway has hyperresponsiveness, remodelling, mucus production, and smooth-muscle constriction and hypertrophy
Collagen proliferation, fibrocyte proliferation, leading to airway narrowing
What are the signs and symptoms of asthma?
Coughing and wheezing
Chest tightness
Shortness of breath
Can be precipitated by various factors
Exacerbations lead to acute progressive worsening of symptoms
What are some asthma triggers?
Allergens - moulds, dust mites, animal dander, pollens, foods
Irritants - cigarette smoke, aerosols, VOCs, ozone, particulate matter
Other - viral respiratory infections, changes in weather, exercise, endocrine factors
How do genetic factors - alpha1-antitrypsin deficiency put you at higher risk for COPD?
It is an enzyme that limits the activities of proteases that are released by inflammatory cells. Inflammatory cells get into the airways and produce proteases, which if uncontrolled can lead to lung damage. In normal people the alpha-1-antitrypsin will help prevent this.
What is the difference between a healthy lung and a COPD lung? PG473!
Healthy lung tissue have functioning alveolar sacs with open airways and supported by surrounding lung tissue structures like elastin etc
In COPD, an excessive inflammatory response causes destruction of the alveolus and lots of mucus plugging and increased mucus production and a narrow bronchiole. So less effective gas exchange. Also disrupted alveolar attachments so the airways are not held open as much so increasing narrowed.
What is the MRC dyspnea scale?
Measures severity of airflow obstruction - breathlessness:
Grade 0 - I only get breathlessness with strenuous exercise
Grade 1 - I get short of breath when hurrying on the level or walking up a slight hill
Grade 2 - I walk slower than people of the same age on the level because of breathlessness, or I have to stop for breathing when walking my own pace on the level
Grade 3 - I stop for breath after walking about 100meters or after a few minutes on the level
Grade 4 - I am too breathless to leave the house or I am breathless when dressing or undressing
