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Bds4 Oral Med > Bds2 Bams Revision > Flashcards

Bds2 Bams Revision Flashcards

1
Q

What is asthma?

A

Reversible airflow destruction (bronchial hyperactivity)

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2
Q

What are the 3 key characteristics of asthma?

A

Bronchial smooth muscle contraction
Bronchial mucosal oedema
Excessive mucous secretion

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3
Q

What is the mechanism of asthma?

A

Allergen triggers IgE production, causing B and T cell interaction, causes degranulation of mast cells, leads to narrowing of the airways, oedema and mucous secretion.

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4
Q

What are the symptoms of asthma?

A

Shortness of breath, use of accessory muscles, expiratory wheeze

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5
Q

What are the risk factors for asthma?

A

Obesity
FH
Atoptic history
GORD
Nasal polyps

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6
Q

How does an asthma attack affect pulse and respiratory rate?

A

Respiratory rate (normally 10-20), during asthma attach will be 25
Pulse (normally 70) during asthma attack 100

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7
Q

How is asthma measured?

A

PEFR - peak expiratory flow rate (one quick expiration, measure amount of air expelled)
Measure at the same time everyday as airway latency decreases at night
This tracks airway resistance
Normal value is 500

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8
Q

What is the biphasic response in asthma?

A

May have a more severe attack later (after initial attack) so monitor patient

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9
Q

What is the treatment of asthma?

A

SABA - salbutamol long acting beta agonist inhaler (blue) - relaxation of smooth muscle
Corticosteroids - (brown) - target immune and epithelial cells to reduce oedema and mucous secretion
LABA - long acting beta agonist (green) - preventative inhaler, salmeterol

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10
Q

How can you measure is asthma is severe?

A

If patient has ever been hospitalised
May take oral corticosteroids

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11
Q

What is the dental implications of asthma?

A

Increased risk of candida infection in pharynx due to use of corticosteroid inhaler, advice use of spacer or rinse mouth after use.

Contraindicates use of ibuprofen if “aspirin- sensitive asthma” (can trigger asthma or allergy)

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12
Q

What is COPD?

A

Mix of reversible obstruction and destructive lung disease - mix of asthma, bronchiectasis (damage to cell wall, increased mucous secretion), emphysema (destruction of air sacs and dilation of others- loss of SA).

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13
Q

What are the symptoms of COPD?

A

Chronic cough, increased mucous production, dysponea, chest discomfort, fatigue

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14
Q

What causes COPD?

A

Smoking, asthma, pollution, age, AAT deficiency

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15
Q

How does emphysema affect gas exchange?

A

Less alveoli SA

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16
Q

How does emphysema and bronchiectasis affect breathing?

A

Emphysema affects gas exchange
Bronchiectasis affect airway patency

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17
Q

What are the dental implications of COPD?

A

Patient may not be able to lie flat in chair
If oxygen is required during treatment, give through a mask with nose

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18
Q

What is respiratory failure?

A

A consequence of long term COPD
2 types:
Type 1 - emphysema (failure of oxygenation), pink puffer
Type 2 - chronic bronchitis (failure of ventilation), blue bloater

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19
Q

What is PUD?

A

Ulceration caused by acid (commonly seen in oesophagus gastric and small intestine)

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20
Q

What causes PUD?

A

Excess acid production, reduced protective lining in stomach, GORD, weak lower oesophageal sphincter

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21
Q

Where is ulceration in PUD most common and why

A

In duodenum
Excessive acid secretion OR pancreatic disease - cant neutralise the acid entering the duodenum

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22
Q

What are the main complications of PPI?

A

Gastric bleed - from persistent acid irritant
Perforation
Stricture - healing by secondary intention, resulting in fibrous tissue (narrowing)
Malignancy - from constant cell turn over and inflammation

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23
Q

What is the treatment for helicobacter infection?

A

Triple drug therapy:
2 antibiotics - amoxicillin and metronidazole
PPI - omeprazole
For 2 weeks then test with endoscope

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24
Q

What is Ulcerative colitis

A

Continuous, vascular inflammatory bowel disease presenting as ulceration (superficial) at the most distal part of bowel and extending through GI tract

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25
What is Chrons
A discontinuous (non vascular) inflammatory bowel disease resulting in cobblestone mucosa (full thickness)
26
What is the main risk of Chrons?
Polyp formation - monitor regularly as may become carcinoma
27
What is the treatment for inflammatory bowel disease?
Anti inflammatory drugs: Systemic steroids (prednisolone) Immune modulating drugs/ biologics (vedoluzimab) Anti TNF alpha monoclonal antibodies
28
What is the treatment for peptic ulcer disease?
PPI - eg omeprazole Irreversibly bind to and inhibit ATPase in parietal cells - therefore blocking gastric acid secretion
29
What are the symptoms of inflammatory bowel disease?
Malabsorption - anaemia Diarrhoea Abdominal pain PR bleeding
30
What is coeliac disease?
Sensitivity to alpha glisten, causing an inflammatory response. Patient requires a gluten free diet. May present with pernicious aneamia due to malabsorption of Vit B12 in terminal ileum
31
What is the test for coeliac disease?
TTG - serum transglutaminase
32
How does coeliac disease present in adults v children?
Adults - mouth ulceration (abnormal pattern) Children - failure to thrive due to malabsorption
33
What is anaemia?
Reduction in hemoglobinas levels May be due to reduced production (marrow failure), increased losses (PUD etc), increased demand (pregnancy, growth)
34
What are some oral conditions associated with haematinic deficiency?
Fungal and viral infections Oral ulceration (aphthous stomatitis) Burning mouth syndrome
35
What are the signs and symptoms of anaemia?
Pale, tachycardic, enlarged liver/ spleen Tired and weak, dizzy, palpitations Pale mucosa, smooth tongue, angular cheilitis, beefy tongue (Vit B12 deficiency)
36
What are the tests for anaemia?
FBC to test ferritin, Vit B12 and folate levels
37
What is Thalassemia?
Normal haem production, genetic mutation of the globin chains Managed through blood transfusions/ prevention of iron overload
38
What is pernicious anaemia?
Rare autoimmune disorder which decreases intrinsic factor in stomach, therefore decreasing absorption of Vit B12, leading to a deficiency
39
What are the 3 main types of anaemia? And their causes?
Microcytic - small RBC, iron deficiency/ Thalassemia Macrocytic - large RBC, B12/folate deficiency Normocytic - normal size RBC, reduced amount of haem, increased bleeding/ renal disease
40
What are hyperchromic RBC?
RBC appear pale due to less haemoglobin
41
What are ansiocytic RBC?
A range of very large and very small RBC
42
How are haematinic replaced?
FeSO4 200mg tds for 3 months 1mg IM Vit B12 injection 5mg folic acid daily
43
What is sickle cell anaemia?
Anaemia caused by abnormal globin chains - RBC becomes curled up at edges so increased cross section means at low oxygen levels, cannot fit through peripheral capillaries
44
What are the main types of inherited bleeding disorders?
An acquired defect which affects the coagulation of the blood - Coagulation cascade affected Platelets affected
45
what is haemophilia A and the treatment
Factor 8 deficiency Sex linked inheritance Mild and carriers - DDVAP and tranexamic acid Moderate and severe - recombinant factor 8
46
What is DDVAP?
Desmopressin Releases factor 8 that has been bound to the endothelial cells, giving a temporary rise in factor 8 levels
47
What is tranexamic acid?
Inhibitor of fibrinolysis Keeps any clot for longer
48
What is haemophilia B and its treatment?
Deficiency in factor 9 Sex linked inheritance All pts - requires use of recombinant factor 9 (this factor doesn't bind to vascular surfaces)
49
What is von willebrands disease and its management?
Reduced factor 8 levels due to deficiency of von willebrands factor and reduced platelet aggregation. Severe and moderate - DDVAP Mild and carriers - tranexamic acid
50
What are the dental implications of an inherited bleeding disorder?
If moderate/ severe, must be treated in haemophilia center May require medical cover before dental treatment id high risk of bleeding Cannot deliver LA as IDB or lingual infiltration due to bleeding risk Prevention!
51
What are the platelet levels which canm be treated in primary care?
Primary care - 100x 10^9/L Secondary care - 50x 10^9/L
52
What is thrombophilia
Increased clot formation ability
53
What is thrombocytopenia?
Reduced platelet numbers
54
What is diabetes?
Chronic disease in which the pancreas doesn’t produce enough/ any insulin or the body cannot effectively use the insulin it produces
55
What is the characteristic sign of diabetes?
High glucose levels - hyperglycaemia
56
What are some complications of diabetes?
Increase risk of micro vascular complications, heart attack, stroke and long term macro vascular disease
57
What is the difference between type 1 and type 2 diabetes?
Type 1: - autoimmune destruction of the pancreatic b cells - polyuria, polydipsia, tiredness Type 2: - associated with obesity and inactivity - strong FH - defective and delayed insulin secretion (insulin resistant)
58
What are the investigations for diabetes?
Measure HbA1C levels (glycated haemoglobin) Shows glucose levels over the past 3 months If you have diabetes, aim for 48 mmol/l (6.5%)
59
What is the management of type 1 diabetes?
Insulin injection via CGM (continuous glucose monitoring) Aiming for 4-7% hba1c
60
What is the management of type 2 diabetes?
Lifestyle changes- weight loss, exercise Medications - metformin, gliptins, GLP-1 mimetic, sulphonylureas
61
What is metformin?
Diabetes medication which enhances cell sensitivity to insulin
62
What is gliptins?
DDP4 inhibitors which block the enzyme metabolising incretin therefore it is maintained for longer - increases response to glucose
63
What does sulphonylureas do?
Diabetes medication which increases pancreatic insulin secretion
64
What are the dental implications of diabetes?
Ensure pt has eaten before and taken insulin Treat first appt in morning/ after lunch Ask about hypo signs and know how to manage Poor wound healing Synergistic link to perio
65
How do you manage a hypo?
Give patient something sweet to eat/ drink/ glucose tablet - pt needs subsequent substantial meal If unconscious- phone 999, give IM glucose (0.5mg)
66
What is dementia?
A syndrome of chronic or progressive nature with acquired loss of cognitive functions, intellectual and social abilities beyond what might be expected from normal ageing
67
What are the 4 types of dementia?
Alzheimer's Vascular Dementia with Lewy bodies Frontotemporal
68
What is Alzheimer's?
The most common Reduction in size of cortex, severe in hippocampus Plaque deposits of beta amyloid proteins build up between nerve cells and tangle between cells
69
What are risk factors for Alzheimer's?
Smoking Hypertension Low folate and high cholesterol
70
What is vascular dementia?
Caused by reduced blood flow to the brain which eventually damages and kills the brain cells Can be due to small vessel disease (narrowing), stroke, underlying health conditions eg uncontrolled diabetes or smoking
71
What are the distinctive features of Alzheimer's?
STML Aphasia Communication difficulties Mood swings
72
What are the distinctive features of vascular dementia?
Memory problems of sudden onset, visuospatial difficulties, anxiety, seizures
73
What is dementia with Lewy bodies?
Deposits of abnormal protein (Lewy body) inside brain cells Also found in patients with Parkinson's
74
What are the distinctive features of dementia with Lewy bodies?
STML Cognitive ability fluctuates Attention difficulties Speech and swallowing problems Sleep disorders
75
What is Frontotemporal dementia?
Affects frontal lobe (responsible for problem solving, planning and emotions) Younger onset
76
What are the distinctive features of Frontotemporal dementia?
Uncontrollable repetition of words, mutism, personality change, decline in personal and social conduct Not usually STML
77
What are the early signs of dementia?
STML Confusion Anxiety Inability to manage every day tasks Communication difficulties
78
What are middle stage signs of dementia?
Increasingly forgetful Distress/ aggression More support required with everyday tasks Hallucinations
79
What are the late signs of dementia?
Incontinence Failure to recognise familiar objects/ people Physical frailty Difficulties eating
80
What are the dental implications of dementia?
Assess if patient has capacity (AMCUR) Keep treatment plans realistic Carry out OHI with carer present and ensure denture hygiene is carried out at home/ in care setting Prevention - FV? etc
81
What is arthritis?
Inflammation of the joints
82
How long is the bone remodelling cycle?
3-6 months
83
What 3 things are required for bone remodelling?
Vitamin D Calcium Phosphatase
84
What happens when there is low serum calcium?
Increased PTH secretion which increases Vit D, therefore increasing intestinal calcium absorption. Reduced loss of calcium results in bone loss as calcium is absorbed into ECF Homeostasis
85
What is the role for vitamin D in bone remodelling? What are squires of vitamin d?
Necessary for absorption of calcium in intestine Sources - sunlight
86
What is osteomalacia?
Poorly mineralised osteoid matrix Serum calcium deficiency High alkaline phosphatase If during development, rickets
87
What is osteoporosis?
Loss of mineral and matrix (reduced bone mass) Reduced quantity of normally mineralised bone (age related change)
88
What role does oestrogen have in the bone remodelling cycle?
Oestrogen inhibits bone resorption (by direct actions on osteoclasts)
89
What is osteoarthritis?
Degenerative joint disease (weight bearing joints) Wear and tear
90
What is rheumatoid arthritis ?
Disease of the synovium with gradual inflammatory joint destruction Slow onset with symmetrical polyarthritis
91
What are early signs of RA?
Symmetrical synovitis of MCP, PIP and wrist joints
92
What are later signs of RA?
Ulnar deviation of fingers at MCP Hyper extension of PIP joints - Swan neck deformity Z deformity of thumb Subluxation of wrists
93
What are extra articular signs of RA
Due to systemic vasculitits: Scleritis, dry eyes, sjogrens, psoriasis
94
What is the management of RA?
Holistic: Physical therapy Occupational therapy Drug therapy - NSAIDs, analgesia, DMARDs (methotrexate) Surgical therapy - excision of inflamed tissue, joint replacement/ fusion
95
What are the dental aspects of RA?
Disability from disease (manual dexterity), access to care Sjogrens syndorme NSAIDs and methotrexate - ulceration Oral pigmentation from hydroxychloroquine
96
What are the features of Parkinson's?
Intention tremor Mask like face Rigidity Slow movement

Bds4 Oral Med (13 decks)

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