Respiratory 2

Question 1

What is obstructive sleep apnea?

Answer 1

Upper oropharyngeal airway obstruction, leading to patient to stop breathing whilst asleep. This causes tiredness and cardiovascular disease.

Question 2

What causes obstructive sleep apnea?

Answer 2

Cause unclear - links to obesity, smoking and hypertension.

Question 3

What is the interventions for obstructive sleep apnea?

Answer 3

1. CPAP (continuous positive airway pressure): device worn at night which holds tongue down and mandible forward.
2. Mandibular advancement prostheses.

Question 4

What is fibrotic lung disease?

Answer 4

Scarred lung tissue that is irreversible and progressive.

Question 5

What causes fibrotic lung disease?

Answer 5

Numerous causes:
1. Drugs
2. Birds - hypersensitivity to faeces & feathers)
3. Autoimmune (eg. rheumatoid arthritis, dust)

Question 6

Give an example of fibrotic lung disease.

Answer 6

Sarcoidosis - this affects the whole body
-Breathlessness
- Kidney and liver damage
- Eyes
-Gingival enlargement
- Cranial nerve problems

-Advise patient on a standard healthy diet/lifestyle.

Question 7

What are the two types of respiratory tract infections?

Answer 7

• Divided depending on whether infection is above or below the larynx

1. Upper respiratory tract infection
2. This can extend to a lower respiratory tract infection if not treated effectively.

Question 8

What are the causes of respiratory tract infections?

Answer 8

1. Bacterial
2. Viral (eg. common cold/Covid)
3. Poor OH - more likely for bacteria to colonise the oropharynx leading to infection.
4. Foreign bodies- patient may aspirate something during dental procedure, taking down the bacteria to the lungs causing aspiration pneumonia /abscess
5. Fungal

Question 9

What is pneumonia and what are the symptoms/treatment for it?

Answer 9

• A lower tract infection
• Infection of lung parenchyma

Symptoms:
1. Cough (won’t stop)
2. Purulent sputum (green/yellow indicating bacteria)
3. Fever
4. Breathlessness
5. Pleurisy (chest pain due to inflammation of the pleura. When the sac covering the lungs rub against each other resulting in sharp pain on inhalation)
6. Hypoxia ( reduced gas exchange due to alveoli blocked up with bacteria and inflammatory cells)

Treated with antibiotics and if severe, hospitalisation.

Question 10

What is strep throat and the associated symptoms?

Answer 10

An upper respiratory tract infection common in children.

Caused by streptococcus pyogenes

Symptoms:
1. Sore throat
2. Fever
3. Maculopapular skin rash
4. Swollen cervical lymph nodes and tonsils
5. Soft palate petechiae - small dots
6. Strawberry tongue - red bumpy
7. Rheumatic fever if not treated properly

Question 11

What is tuberculosis and what are the symptoms?

Answer 11

A severe infection caused by mycobacterium tuberculosis which results in lung scarring (putting patient at risk of type 2 respiratory failure).

Symptoms:
1. Cough
2. Fever
3. Night sweats
4. Weight loss
5. Haemoptysis ( bloody cough)

Immunocompromised patients are at risk as TB can spread systemically.

Question 12

What is the treatment for tuberculosis?

Answer 12

Vaccines

Antibiotics - must be specific ABs because mycobacterium tuberculosis has a very thick cell wall, protecting them from many antibiotics.

Question 13

What are the two categories of tuberculosis and the management of them?

Answer 13

1. Latent - non-infectious
2. Active - infectious.
   - When active infection, we must avoid:
   a. aerosolising procedures - if absolutely necessary, then take as many precautions as possible such as rubber dam.
   b. General anaesthetic - bacteria can get into the machines
   c. Ultrasonic scalers
   d. Careful with immunosuppressed staff

Question 14

What is Legionnaire’s disease?

Answer 14

Caused by Legionella from stagnant water causing pneumonia like symptoms.

Question 15

What is bronchiectasis and its symptoms?

Answer 15

• Cycle of recurrent infection and damage, leading to dilated bronchi (in contract to COPD and causes patient to become chronically hypoxic 88-92% O2 sat).

-Severe cases have a risk of type 2 respiratory failure

• Symptoms: cough, breathlessness and hypoxia.

Question 16

What is cystic fibrosis?

Answer 16

A genetic condition which affects the entire body.
- Chloride channel in cell membrane does not work, disrupting ion transfer and therefore fluid transfer across cell membrane, resulting in thick sticky mucous making it hard for cilia to waft it out.

• This is an issue in the lungs because secretary cells make excess mucous.
• Mucous traps bacteria, leading to increased infection and severe bronchiectasis.
• Affects other areas of body - eg, mucus plugs pancreatic duct leading to malabsorption.

Question 17

How to manage cystic fibrosis?

Answer 17

1. Antibiotics - reduce bacterial infections
2. Physiotherapy - chest focused
3. Enzyme replacement - pancreatic to increase nutrition uptake.
4. Lung transplant - home oxygen system whilst waiting.

Question 18

What are the two broad categories of lung cancer?

Answer 18

1. Small cell - neuroendocrine tumours - fast progression
2. Non-small cell - slower progression and can be tackled with chemo/radiotherapy

Question 19

Main symptoms of lung cancer?

Answer 19

• Main risk factor is smoking

1. Cough
2. Haemoptysis
3. Wheeze
4. Stridor - acute emergency as tumour compresses airways
5. Breathlessness
6. Weight loss

There are also systemic symptoms:
1. painful swallowing
2. Facial/neck swelling due to tumour pressing on veins that drain the face
3. Hoarse voice

4. Horner’s syndrome (tumour compressing on nerves in the lung) : ptosis (droopy eyelid), miosis (constricted pupil), anhidrosis (no sweating on face)

Question 20

How do we test for lung cancer?

Answer 20

Tests:
1. chest x ray
2. bronchoscopy along with biopsy to type the cancer
3. Aspiration of any fluid around the lungs to find cancer cells
4. CT scan of thorax, abdomen and pelvis - check for metastasises.

Question 21

Treatments for lung cancer?

Answer 21

1. Chemotherapy
   May cause these dental side effects:
   - Bone marrow suppression (worst at 10-14days)
   -Mucositis
   - Loss of taste
   - Dry mouth
   -Caries
2. Radiotherapy
3. Surgery
4. Palliative care
   -Fan (for breathlessness - do not use oxygen as not hypoxic) or oxygen (if hypoxic)
   - Analgesia - strong ones which may need laxatives/anti-sickness meds to help tolerance.
   -Social support

Question 22

What is laryngeal cancer, its symptoms and treatment?

Answer 22

Cancer of the larynx.

Airway problems:
1. Voice changes
2. Swallowing difficulty/ globes ( something stuck in throat)
3. cough
4. halitosis

Risk factors: smoking, alcohol, HPV infection

Treatments:
1. Chemotherapy
2. Radiotherapy
3. Surgery
4. Laryngectomy (removal of larynx) and a stoma/tracheostomy
- Note if pt has stoma, they do not breath via nose/mouth so may lose ability to speak
-if in an emergency, administer oxygen via stoma rather than nose and mouth