diseases

Question 1

diabetes type 1

Answer 1

insulin deficient

autoimmune

B cell destruction

Question 2

type 2 diabetes

Answer 2

insulin resistant

metabolic disorder

(old, fat, no exercise, genetically predisposed)

Question 3

signs/symptoms of diabetes

Answer 3

• Ketoacidosis (rare in type 2)
• Hyperglycaemia
• Polydipsia (excessive thirst)
• Polyurea (need to urinate more frequently)
• Ketoacidosis (glucose cannot be used for energy, so fat used)
• Sweating
• Palpitations

Question 4

large vessel complications of diabetes

Answer 4

stroke risk

MI risk

claudication/foot amputation

Question 5

small vessel diabetes complications

Answer 5

poor wound healing

renal disease

maculopathy

neuropathy - weak/muscle wasting

Question 6

test for diabetes

Answer 6

RPG - random plasma glucose

Question 7

RPG for diabetes

Answer 7

>11.1mMol/l

Question 8

tx type 1

Answer 8

basal bolus insulin injections

split mixed insulin injection

Question 9

type 2 tx

Answer 9

less 10% fat intake in diet

• count carbohydrates
• gastric bypass
• diet pills - sibutramine
• oral hypoglycaemic agen

sulphonylureas- gliclazide

• inc insulin sectretion and sensitivity
• hypoglycaemia

biguanides metformin

• inc insulin sensitivity

Question 10

dental relevance of diabetes

Answer 10

• Gingivitis/ periodontitis
• Poor wound healing
• Oral candidiasis
• Xerostomia -> increased incidence of caries
• Give prophylactic antibiotics for invasive treatment
• LA given should not interfere with eating as may become hypoglycaemic
  
  • Treat in morning after breakfast and hypoglycaemic agents

Question 11

causes of hyperthyroidism

Answer 11

graves disease (70-80%) autoimmune - stimulates TSH (sign othalomopathy)

toxic muti-nodular goitre

pituitary adenoma (rare)

Question 12

signs/symptoms of hyperthyroidism

Answer 12

• increased metabolism
• diarrhoea
• palpitations, tachycardia, atrial fibrilation
• hypertension, heart failure

Question 13

test for hyperthyroidism

Answer 13

blood test for TSH

• low, T3 and T4
• high, if adenoma
• high TSH and T3 and T4

fine needle biopsy (FNB)

Question 14

tx of hyperthyroidism

Answer 14

radiopaque iodine

partial thyroidectomy

give carbimazole and T4 replacement (prolonged tx = hyperthyroidism)

Question 15

dental relevance of hyperthyroidism

Answer 15

• Increased pain and anxiety
• Goitre if detected by dentists
• Accelerate periodontal disease
• Premature tooth eruption
• Thyrotoxic crisis can be precipitated by stress, surgical procedures and infections
  
  • This is medical emergency and carries mortality of 10%
• Patients with hyperthyroidism may be sensitive to adrenaline (LA)

Question 16

causes of hypothyroidism

Answer 16

hashimoto’s thyroiditis - autoimmune

too much iodine

thyroidectomy

thyroid atrophy

drug induced - carbimazole

hypothalamic/pitutary disease - rare

Question 17

signs/symptoms of hypothyroidism

Answer 17

hair loss

slow mental state

heat intolerant

dry skin

weight gain

brachycardia

goitre

angine

delayed reflexes

constipation

Question 18

tests for hypothyroidism

Answer 18

blood tests

• high T3 and low T4
• rare - low TSH and T3 and T4

fine needle biopsy

Question 19

tx hypothyroidism

Answer 19

with T4 replacement

Question 20

dental relevance of hypothyroidism

Answer 20

• Low pain threshold
• Delayed tooth eruption
• Enlarge tongue
• Bad wound healing
• Myxoedema – if give sedation can cause Coma
• Sensitive to opioids and benzodiazepine