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1

Endocrine disorders

Hyperpituitarism
Hyperthyroidism
Hypothyroidism
Hyperparathyroidism
Diabetes mellitus
Addison disease

2

What does the endocrine system consist of?

A group of integrated glands and cells that secrete hormones

3

Endocrine disorders can result from what?

Too much or too little hormone production
Gland dysfunction
A problem with hormone control and production

4

What is hyperpituitarism?

Excess hormone production by the anterior pituitary gland

5

What is hyperpituitarism caused by?

A benign tumor called a pituitary adenoma, that produces growth hormone

6

What results when hyperpituitarism occurs before the closure of long bones?

Gigantism

7

What results when hypersecretion occurs during adult life?

Acromegaly

8

Who does hyperpituitarism affect?

Men and women in their 40’s

9

What are the clinics features and oral manifestations of hyperpituitarism?

Poor vision
Enlarged hands and feet
Increased rib size
Enlargement of maxilla and mandible
Enlargement of nasal bones
Voice deepening bc of enlarged sinus
May have thick lips and macroglossia

10

What disease is hyperthyroidism associated with?

Graves disease

11

What is hyperthyroidism?

Excess production of thyroid hormone

12

An autoimmune disorder that most commonly causes hyperthyroidism

Graves disease

13

Who is hyperthyroidism more common in?

Women in their 30s and 40s

14

A significant clinical characteristic often seen in patients with Graves’ disease

Exopthalmos (protrusion of eyeballs)

15

Oral manifestations of hyperthyroidism

Premature exfoliation of deciduous teeth and premature eruption of permanent teeth
Osteoporosis may affect alveolar bone
Caries and perio develops more rapidly
Burning tongue

16

What is hypothyroidism?

A decreased output of thyroid hormone

17

Infancy and childhood hypothyroidism

Cretinism

18

Hypothyroidism I’m older children and adults

Myxedema

19

Hypothyroidism oral manifestations in infants

Thickened lips
Enlarged tongue
Delayed eruption of teeth

20

Oral manifestation of hypothyroidism in adults

Enlarged tongue

21

Most commonly prescribed hormone replacement therapy for hypothyroidism

Levothyoxine

22

A chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels

Diabetes mellitus

23

High blood glucose levels

Hyperglycemia

24

What does diabetes mellitus result from?

A lack of insulin, defective insulin that does not work to lower blood glucose levels, or increased insulin resistance caused by obesity

25

What system is the most severely affected by diabetes?

Vascular

26

Clinical features of NIDDM

Decreased resistance to infection
Skin infections: furuncles
UTI’s
Tuberculosis
Blindness
Can affect nervous system
Atherosclerosis

27

A thickening of the blood vessel wall from fibrofatty plaques, can easily to impaired circulation, causing impaired oxygenation and nutrition in tissue

Atherosclerosis

28

Uncontrolled diabetes =

Uncontrolled periodontal conditions

29

What is Addison disease?

Insufficient production of adrenal steroids

30

What are the causes of adrenal gland destruction?

Malignant tumor
TB
deep fungal infections
HIV
Autoimmune disease
Unknown

31

What are the clinical manifestations of Addison disease?

Stimulation of melanocytes
(Bronze skin and macular on oral mucosa)

32

Treatment of Addison disease

Steroid replacement therapy

33

Clinical features of Addison disease do not appear until how much of the adrenal gland has been destroyed?

90%

34

What is hypercortisolism known as?

Cushing syndrome

35

What is Cushing syndrome caused by?

Sustained increase in glucocorticosteroid levels

36

What is the most significant and obvious clinical feature of Cushing syndrome?

Weight gain

37

Do the signs for Cushing syndrome develop fast or slow?

Slow

38

What are blood disorders?

Disorders of red blood cells and hemoglobin
Disorders of white blood cells
Bleeding disorders

39

A reduction in the oxygen carrying capacity of blood that is most often related to a decrease in the number of circulating red blood cells

Anemia

40

Clinical signs of anemia

Pallor of skin and oral mucosa
Angular cheilitis
Erythema and atrophy of oral mucosa
Loss of filiform and fungiform papillae on dorsum of tongue

41

An insufficient amount of iron is supplied to bone marrow for RBC development

Iron deficiency anemia

42

Possible causes for iron deficiency anemia

Deficient iron intake
Blood loss from menstrual bleeding or chronic GI bleeding
Poor iron absorption
Pregnancy or infancy

43

Caused by a deficiency in intrinsic factor

Pernicious anemia

44

Which anemia is probably an autoimmune disorder?

Pernicious anemia

45

What vitamin is needed for DNA synthesis?

B12

46

What is folic acid and vitamin B12 deficiency anemia associated with?

Malnutrition
Dietary deficiencies
Increased metabolic requirements
may be found with alcoholism or pregnancy

47

An inherited blood disorder predominantly in black individuals or those of Mediterranean or Asian origin. More common in women before age 30. RBCs in a sickle shape

Sickle cell anemia

48

What can oral cancer be treated with?

Surgery
Radiation therapy
Chemotherapy
Or a combo

49

When does mucositis begin?

About the second week of radiation therapy and subsides a few weeks after its completion

50

Mucositis features

Painful
Erythematous and ulcerated mucosa
Pts may have difficulty eating, pain on swallowing, and loss of taste

51

Destruction of major salivary glands (may result in xerostomia)
Pts are prone to rampant caries and oral candidiasis and osteoradionecrosis

Radiation therapy

52

Drugs for this cancer therapy affect nasal cells of the epithelium
Mucositis and oral ulceration are common complications
A decrease in all blood cells may occur

Chemotherapy

53

Lowered RBC count can lead to

Anemia

54

Lowered WBC count can lead to

Infections

55

Lowered platelet counts can lead to

Bleeding problems

56

Suppresses the immune system and can lead to candidiasis and oral infections

Prednisone

57

Which drugs can cause gingival enlargement?

Phenytoin (Dilantin)
Nifedipine (Procardia)
Cyclosporine

58

What is a complication associated with bisphosphonate therapy?

Osteonecrosis

59

Medication related osteonecrosis of the jaw may be considered if

Current or previous treatment with antiresorptive or antiangiogenic agent
Exposed bone or bone that can be proved through a fistula in maxillofacial region that has persisted at least 8 weeks
No history of radiation therapy to jaws