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CMS Flashcards

1
Q

what types of disease can arthersclerosis cause?

A

ischaemic heart disease
peripheral vascular disease
cerebrovascular disease
renovascular disease

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2
Q

what are the biggest risks of heart disease?

A 
smoking
high cholesterol
high bp
diabetes
genes
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3
Q

what is primary hypertension?

A

caused by obesity, alcohol, high salt diet, genetics

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4
Q

what is secondary hypertension?

A

endocrine - excess hormones

renal - kidneys not working

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5
Q

what drugs are used in the tx of hypertension?

A 
B blockers
duiretics
ACE inhibitors
angiotensin 2 inhibitors
Ca channel blockers
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6
Q

what are the types of ischaemic heart disease?

A

angina
acute coronary syndromes
heart failure
arrhytmias

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7
Q

what are the types of peripheral vascular disease?

A

chronic - intermittent claudication

acute - ischaemic limb

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8
Q

what medications manage angina?

A

antiplatelets
statins
symptom relief - nitrates, calcium antagonists, B blockers

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9
Q

why can heart failure happen?

A

IHD
hypertension
valvular heart disease
alcohol excess

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10
Q

why should NSAIDs be avoided in heart failure?

A

fluid retention

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11
Q

what is regurgitation?

stenosis?

A
  • leaky valve

- narrow valve

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12
Q

what do patients with valvular disease at risk of?

what is it caused by?

A

infective endocarditis
strep viridans
staph aureus

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13
Q

what is AF associated with? what does it cause an increased chance of?

A

cerebrovascular disease

Stroke

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14
Q

what is SVT?

A

tachyarrhytmia - too fast and irregular

adenosine

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15
Q

what is bradyarrhytmia?>

A

too slow

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16
Q

what is Ventricular arrythmia?

A

tachycardia

med emergency

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17
Q

what oral side effects can statins cause?

A

Taste disturbance

lichenoid reaction

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18
Q

what oral side effects can beta blockers cause?

A

lichenoid reactions

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19
Q

what oral side effects can nifedipine cause?

A

hyperplasia

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20
Q

what oral side effects can ACE inhibitors cause?

A

taste disturbance

lichen planus

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21
Q

what oral side effects can nicorandil cause?

A

painful oral ulcers

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22
Q

what oral side effects can antihypertensives cause?

A

dry mouth

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23
Q

in what situations would you not treat a cardiac patient?

A

1 month post MI

unstable angina

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24
Q

why should you be cautious with adrenaline?

A

interacts with vasoconstrictors

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25
what are the links of IE and dentistry?
no association with dental procedures reg TB as much of a risk prophylaxis not cost effective
26
what patients are at risk of IE?
valvular heart disease valve replacement structural congenital heart disease prev IE
27
what oral side effects can anaemia cause?
recurrent apthous stomatitis - minor, major, herpetiform
28
what oral side effects can type 2 diabetes cause?
acute pseudomembranous candidosis
29
what is burning mouth syndrome and what can it be associated with?
idiopathic burning and oral discomfort | amitryptiline, gabapentin
30
if a lichen planus pt has an oral lesion what percent chance do they have a skin lesion? if they have a skin lesion percent chance of an oral lesion?
25-30% | 70-75%
31
opthalmic disease can be associated with what orally?
mucous membrane pemphigoid
32
what can GI disease be associated with orally?
recurrent oral ulceration
33
what can HIV/AIDS present with orally?
hairy leukoplakia kaposi's sarcoma candidosis
34
what is the definition of MRONJ?
current or prev tx with bisphosphonates or anti angiogenic agents exposed bone or bone that can be probed through an intra oral or extra oral fistula in the maxillofacial region that has persisted for 8 or more weeks no history of radiation to the jaws or obvious metastatic jaw disease
35
what meds can cause MRONJ?
bisphosphonates Rank ligand inhibitor - denosumab antiangiogenics
36
what is the action of bisphosphonates? | used orally to tx? IV to tx?
``` deposit in bone and persist inhibit formation, recruitment and function of osteoclasts increase apoptosis orally - osteoporosis iv - cancer ```
37
what is the action of denosumab?
ab against RANK ligand inhibits osteoclast function inhibits bone resorption
38
what happens during MRONJ?
``` reduced bone turnover reduced vascularity inflammation and infection adverse effects on soft tissues immune dysfunction ```
39
what risks increase the chance of MRONj?
potency of drug route of administration antiangiogenic and bisphosphonate systemic corticosteroids, immunosuppressants, chemo and radio
40
what is stage 0 MRONJ?
no clinical evidence | non specific symptoms or clinical radiographic findings
41
what is stage 1 MRONJ?
exposed necrotic bone or fistulas that probe to bone | asymptomatic
42
what is stage 2 MRONJ?
exposed bone that is nectrotic or fistulas that probe to bone associated with infections pain/erythema
43
what is stage 3 MRONJ?
``` same as stage 2 with necrosis extending past alveolar bone pathological fracture extra oral fistula oral antral or nasal communication ```
44
what is the tx of the stages of MRONJ?
0 - nil 1- antimicrobial rinses 2- antimicrobial rinses with systemic antibiotics and analgesics and debridement
45
in pregnancy avoid high doses of what antibiotic?
metronidazole
46
caution with what local anaesthetic in early pregnancy?
mepivicaine
47
oral manifestations during pregnancy are secondary to?
increased vascular permeability reduced immunocompetence increased infection susceptibility
48
why is gingivitis likely to happen during pregnancy?
progesterone
49
when is a pregnancy epulis likely to happen?
1st trimester
50
what is pytalism?
linked to nausea | settles in 12-14 weeks
51
why is there an increased erosion risk during pregnancy?
secondary to vomitting
52
what is the link with gestational diabetes and perio?
9x more likely to suffer from perio disease
53
perio is associated with what in terms of pregnancy?
pre term birth weight pre eclampsia low birth weight
54
what is asthma?
reversible small airway obstruction
55
what drugs are used to tx asthma?
inhaled beta agonists - sabutamol inhaled corticosteroids combo inhalers anti leukotrienes
56
avoid prescribing what drug with asthma?
NSAIDs
57
what side effects can asthmatic drugs cause?
oral candidiosis altered taste dry mouth
58
what is COPD?
airway obstruction that is not fully reversible
59
what is pneumonia?
lung infection
60
what is a pneumothorax?
leak of air into the pleural space
61
what is sleep apnoea?
failure of upper airways during sleep
62
what is intersitial lung disease?
inflammation of lung tissue restrictive lung defect avoid sedation
63
what is CF?
gene defect = abnormal cl channels | highly viscous mucous - lungs, pancreas, gonads
64
avoid what in dentistry with CF patients?
immunosuppressants | sedation
65
``` what are too big cells? too small? increased white blood cells? reduced white blood cells? increased platelets? reduced platelets? ```
``` macrocytic microcytic leukocytosis leukopenia thrombocythaemia thrombocytopenia ```
66
what are the causes of anaemia?
lack of raw materials - vit b12, iron, folate production problems - erythropoietin lack, bone marrow failure longevity problem - haemolysis
67
what is neutropenia?
white cell deficiency BM failure, autoimmune candida, herpes simplex
68
what is leukeamia?
proliferation of immature cells in blood and bone marrow
69
what is lymphoma?
proliferation of cells in nodes/spleen, liver, bone marrow
70
what can haematological conditions cause orally?
atypical infections bleeding lymphadenopathy gum infiltraion
71
what is the coagulation cascade?
vessel injury - vasoconstriction, platelet aggregation, coagulation cascade = clot formation
72
what can interfere with coagulation cascade?
protein deficiency - liver disease/malnutrition | congenital - haemophilia, von wilebrands
73
what is haemophilia?
absent or low factor VIII, IX
74
what is von willebrands?
function problem of factor VIII
75
what are types of coagulopathy?
acquired - alcoholics, thrombocytopenia, drugs | congenital - haemophilia A/B, von willebrands, antiphsopholipid
76
what drugs should be avoided with idiopathic thrombocytopenic purpura?
NSAIDS | aspirin
77
what can anaemia cause orally?
angular chelitis candidiasis minor apthous ulcers
78
how does warfarin work?
antagonises Vit K 48-72 hours to develop reversed by vit K
79
what happens if INR is over 1?
longer clotting time
80
what should be established about the INR prior to tx?
assessed within 72 hours stable <4
81
what is INR controlled by warfarin influenced by?
irregular tablet taking high vit K alcohol indigestion cranberry juice
82
what are types of antiplatelets?
aspirin | clopidogrel
83
what are NOAC's and what are they used for?
rivaroxaban | prophylaxis of venous thromboembolism`
84
dentally, what should we be aware of with upper GI problems?
NCTSL - acid reflux osoephagus/stomach - caution with NSAIDs oral ulceration/chronic blood loss anaemia
85
what is coeliac?
multi system autoimmune problem not an allergy | Small intenstinal venous atrophy
86
what are oral feautres of malabsorption?
iron, folate deficiency | oral ulceration
87
caution with what drug an coeliac pts?
bisphosphonates
88
what is IBD?
crohns - entire GI tract, non continuous lesions | UC - large intestine - continuous
89
oral features of crohns disease?
``` ulcers facial labial swelling mucosal tags cobblestone mucosa angular chelitis ```
90
what are the stages of swallowing?
``` pre swallow oral prep oral stage pharyngeal stage oseophageal stage ```
91
with aging how is swallowing affected?
delayed pharyngeal elicitation loss of muscle reserve increased laryngeal penetration
92
what are causes of dysphagia?
``` dementia CVA poor oh thrush parkinsons head injruy degenerative neurological disorders burns facial trauma ```
93
what is trismus?
persistent contracture of masticatory muscles | hypervascularity, neural damage
94
what can cause dry mouth?
thrush sjogrens meds radiotherapy
95
what is osteoarthritis and what is the tx?
affects weight bearing joints and hands | steroid injections
96
what is rheumatoid arthritis?
autoimmune | synovial inflammation
97
what other body systems can rheumatoid arthritis?
``` nervous system lungs heart disease kidney failure eyes - inflammed sjogrens systemic inflammation ```
98
what medications treat rheumatoid arthritis?
DMARDS | corticosteroids
99
how is rheumatoid arthritis dentally relevant?
TMJ disease sjogrens hands - dexterity
100
what kind of disease is systemic sclerosis? what are some signs?
autoimmune sclerodactyly, telangiectasia, calcinosis, beaked nose, fixed expression, radial furrowing of lip, limited mouth movements
101
what is systemic lupus erythematous?
autoimmuni multi system disease
102
what does SLE effect?
``` photosensitive butterfly rash small joint arthritis raynouds fits and paralysis valvular disease and endocarditis lungs effusions kidney failure ```
103
what is gout?
accumulation of urate crystals in joints
104
what is psoriatic arthritis?
destructive arthritis and psoriasis
105
what is hyperparathyroidism?
excess parathyroid hormone | adenoma in parathyroid gland
106
what can hypercalcaemia and hyperparathyroidism cause dentally?
bone resporption loss of LD giant cell lesions
107
what is pagets disease?
abnormal bone remodelling
108
what is osteomalacia?
vit d deficiency bony pains and muscle weakness affects tooth development in children
109
what is osteoporosis?
loss of bone mass | increased fracture risk
110
what is the relations between osteoporosis and dentistry?
risk with bisphosphonate tx
111
what are some causes of dry mouth?
``` psychogenic drugs radiotherapy dehydration sarcoidosis HIV sjogrens syndrome ```
112
what is sjogrens syndrome?
autoimmune disease chronic inflammation of tear and saliva glands primary and secondary forms
113
what are the causes of secondary sjogrens syndrome?
rheumatoid arthritis systemic lupus erythematous primary billiary chirrocis mixed connective tissue disease
114
what is the drug tx of sjogrens syndrome?
5mg prilocaine 3 x daily
115
what are some salivary drug tx's for sjogrens?
``` orthana spray bioextra glandosene salivix pastilles sugar free gum ```
116
what is orthana spray?
gastric mucin xylitol sodium fluoride
117
what is bioextra?
lactoperoxidase lactoferrin xylitol
118
how can you spot sjogrens orally?
erythema | lubrication of tongue
119
what problems can arise from lack of saliva?
opportunistic oral infections perio disease caries - esp cervical margins
120
how are fungal infections managed?
nystatin | amphotericin C
121
what is diabetes mellitus?
group of metallic diseases characterized by hyperglycaemia resulting from defects in insulin secretion and action
122
what is type 1 diabetes?
pancreatic beta cell destruction | insulin dependant
123
what is type 2 diabetes?
insulin resistant bc beta cell dysfunction
124
what is insulin resistance?
insulin receptor not as responsive to the insulin molecule and therefore less glucose enters the cell = build up of glucose in the blood
125
what are complicatins of diabetes?
``` IHD stroke neuropathy nephropathy retinopathy erectile dysfunction psychaitric ```
126
what is diabetes the leading cause of?
blindness dialysis amputation
127
what are signs of low blood glucose?
sweats shakes flushing palpitations | confusion, reduced conscious, collapse, seizures, coma
128
what are types of hyperglycaemia>?
1 - diabetic ketoacidosis | 2 - hyperosmolar non ketotic coma
129
what should blood glucose pre meal? | after meal?
4-8mmol | <10
130
what are causes of hyperthyroidism?
autoimmune - graves disease goitre/toxic ademona pituitary driven
131
what are signs of hyperthyroidism?
``` sweating heat intolerance irritable poor sleep anxiety palpitations excess apatite weight loss pretibial myxoedema ```
132
what drugs tx hyperthyroidism?
beta blockers | antithyroid drusg
133
what are causes of hypothyroidism?
autoimmune iatrogenic iodine deficiency rarely pituaitary disease
134
what are signs of hypothyroidism?
reduced metabolism, cold intolerance, weight gain, mental slowness, hair loss, slow pulse, goitre
135
what is hypopthyroidism treated with?
thyroxine | levothyroxine
136
what are the types of goitre?
- not associated with disease - simple cysts/adenomas, iodine deficiency - associated with intrinsic disease - autoimmune, toxic adedoma - malignant
137
what difficulties can goitres cause?
dysphagia | breathing difficulties
138
what can anti thyroid drugs cause orally?
neutropenia | taste disturbances
139
what disease has excess corticosteroids?
cushings syndrome | excess ACTH, bc pituitary ademona, ecptopic production by cancers
140
what risks do cushings pts suffer from?
high bp diabetes prone to infection
141
what is a deficiency of corticosteroid production called?
addisons iatrogenic hypopituitarism adrenal destruction
142
what can be seen orally with addissons disease?
hyperpigmentation | buccal mucosa, scars, pressure points, skin creases
143
what can be seen orally with cushings disease?
oral infections
144
what is acromegaly?
excess growth hormone | prognathism, ID seperation, large tongue, diabetes
145
how common is type 1 diabetes? insulin dependent or independent? affects who what type of disease is it?
10% of diabetics dependent autoimmune disease in younger people
146
how common is type 2 diabetes? dependent or independent? what type of disease? affects who?
90% non insulin dependent insulin resistant and deficiency more likely if obese
147
what is a risk for diabetic patients?
increased infection risk
148
what drugs can cause xerostomia?
antidepressants antihypertensives anxiolytics
149
what can fungal infections be caused by?
fungal infections
150
why can angular chelitis be caused?
staph infection | iron deficiency anaemia
151
how can angular chelitis be treated?
miconazole
152
where are oral carcinomas commonly found and what type are they commonly?
lips and tongue | squamous cell
153
tumours found where in the mouth metabolise the fastest?
tongue and floor of mouth
154
what is the at risk dose of paracetamol? | normal toxic dose?
- 7g in 24 hours | - 10g in 24 hours
155
what are some signs of an apsirin overdose?
``` increased resp rate ringing in ears parasthesia vomitting, nausea drowsiness ```
156
what are some signs of an NSAID overdose?
antiplatelet effects - bleeding and bruising metabolic effects - dizzy, tired, parasthesia GI irritation - epigastric pain, nausea, vomitting
157
what are the eventual effects of an NSAID OD?
renal impairment cerebral oedema cardiac arrest
158
what are some signs of an opiate OD?
pupils constrict drowsiness - confusion and agitiation reduced GCS
159
what is a seizure?
excess electrical activity
160
what is a focal/partial seizure? | what is a generalised seizure?
part of brain affected | whole brain affected
161
what are types of generalised seizures?
grand mal | tonic clonic
162
what are some causes of seizures?
``` hereditary structural problems electrolyte disturbance alcohol withdrawl hypoglycaemia ```
163
what drugs are used to tx epilepsy?
phenytoin carbamazepine sodium valporate
164
what is used to treat tension headaches?
tricyclic antidepressants | conventional analgesics
165
what are migraines treated with?
conventional analgesia | metoclopramide, serotonin antagonists
166
what is trigeminal neuralgia and what is it treated with?
intense stabbing 10/10 pain touch shaving and waxing make it worse paroxsymal carbamazepine
167
what is raised intracranial pressure caused by?
tumours bleeding drainage problems abscess
168
what are signs of bacterial meningitis?
``` impaired conscious meningism +/- rash drowsy photophobia ```
169
what is encephalitis?
``` inflammation of brain parenchyma viral impaired conscious personality changes meningism/seizures ```
170
what is giant cell arteritis?
scalp tenderness and jaw claudication with vision loss risk of blindness, stroke and death high doses of prednisolone to tx
171
what is glaucoma?
constant aching around the eye reduced vision nausea and vomitting red congested and dilated non reactive pupil
172
what is a stroke and what is it caused by?
disorder of vascular supply to the brain infarction - atherosclerosis cardiac emboli haemorrhage - hypertension
173
what can brain infarctions cause?
transient ischaemic attacks | completed strokes
174
what is the tx of strokes caused by infarctions?
anti platelets warfarin if AF NOACs
175
what is parkinons disease and how can it be spotted?
degeneration of dopaminergic neurones in the basal ganglia bradykinesia, rigidity, tremor tx with dopaminergics
176
what is essential tremor? what is it treated with?
hereditary unilateral improves with alcohol tx with beta blocker and primidone
177
what is MS?
autoimmune destruction of the central nervous system loss of myelin - demylination - relapsing and remitting - chronic progressive
178
what do you tx MS with?
acute episodes tx with prednisolone | reduce relapse rate with beta interferron
179
where does peripheral neuropathy?
generalised and specific nerves
180
what is bells palsy?
viral palsy of lower motor neurone of facial nerve oral steroids in 72 hours improve outcome
181
what is motor neurone disease?
obstruction of motor neurones limb weakness swallowing problems
182
what problems can liver disease cause?
impaired wound healing impaired clotting - deficient clotting factors, reduced platelets risk of blood borne virus
183
what are primary infections of HSV1?
gingivostomatitis | pharyngitis
184
what is a recurrent infection involving HSV1?
herpes labialis
185
how long do orolabial herpes last for?
self limiting in 7-10 days
186
how many strains does HPV have? what can they cause? what strains are oncogenic? what does HPV hold links with orally?
>70 can cause orolabial warts oncogenic links to oral cancers
187
what causes syphillus?
treponema pallidium | invades skin and mucous membranes
188
what is the function or the kidney?
excretory function acid base balance endocrine function - erythropoietin and activates vit D
189
what are some consequences of renal failure?
excretion failure - oedema, high K acid base balance - acidosis endocrine - no erythropoietin, no vit D, high bp
190
what are some causes of renal failure?
``` atherosclerosis diabetes high bp hypovolaemia NSAIDs angiotensin 2 diuretics tetracyclines infections obstructions ```
191
what are the two types of dialysis?
peritoneal | haemolysis
192
what are issues with organ transplanting?
rejection immunosuppression high cardiovascular mortality
193
what are some oral considerations with renal failure?
care with prescribing NSAIDs secondary anaemia effects - slow tooth eruption oral opportunistic infections and stomatitis dry mouth/taste disturbances post op infections and bleeding renal osteodystrophy - loss of lamina dura, radiolucencies, problems with bone healing and XLA complications with immunosuppressants
194
when should you treat a patient on dialysis?
day after dialysis, heparin
195
what patients have bleeding tendancies?
abnormal platelet production diminished factor 3 von willebrands
196
what are oral side effects of chronic renal failure?
``` dry mouth halitosis metallic taste insidiuous oral bleeding and purpura salivary gland swelling anaemia - oral ulceration and changes ```
197
what is acne treated by?
topical abrasives and antibiotics, vitamin A, analgesics, isotretinoin
198
what is rosacea treated by?
isotretinoin | antibiotics
199
what is impetigo? what might it cause?
staph and strep | may cause glomerulonephritis
200
what is folliculitis caused by?
Staph aureus | infection of hair follicle
201
what is erysipelas?
form of cellulitis strep infection systemic antibiotics to tx
202
what is erythema multiforme caused by?
herpes viral infection | mucosal involvement
203
what is steven johnsons syndrome?
caused by infection or reaction to medications | acute onset and severe mucosal involvement, systemic disturbance
204
what is actinic keratoses?
hyperkeratotic areas on sun exposed skin | can progress to SCC but uncommon
205
what is bowens disease?
intra epidermal SCC | commonly on lower legs in elderly females
206
how can you spot a basal cell cancer?
``` sun exposed sites slow growing raised pearly edge telangiectasia, central ulceration locally invasive dont metastasise ```
207
where are melanomas common?
moles history of sun exposure sunbed use skin type
208
what is ABCD of mole severity?
a - asymmetry b - border - irregular c - colour - multiple d -- diameter - >6mm
209
what drugs induce anaesthesia?
propofol thiopental etomidate
210
what inhalation drugs can induce and maintain anaesthesia?
nitrous oxide | o2 and air
211
what are benzodiazepines used for in anaesthesia?
pre med for anaesthetic - reduces amount of anaesthetic required
212
what are the 4 stages of anaesthetic?
1 - loss of conscious 2- excitement and delirium, coughing and vomitting 3- stage of surgical anaesthesia 4- cessation of respiration to death
213
what is a short and long acting muscle relaxant?
short - sumexathonium | long - attracurium
214
what is malignant hyperthermia?
abnormal accumulation of calcium in muscle cells = hypermetabolism, muscle rigidity, muscle breakdown - increased expired CO2 - unexplained tachycardia - increased O2 need - increased temp - tx with dantrolene and cooling
215
what is nociceptive pain? | neuropathic pain?
- appropriate physiological response to painful stimuli | - inappropriate response to pain bc dysfunction in the NS
216
what is chronic pain managed by?
``` non opiod analgesics opiods antidepressants anticonvulsants topical analgesics ```
217
how can chemotherapy affect the mouth?
chemo affects rapidly dividing cells - oral mucosa included
218
what are short time effects of radiotherapy orally? long term?
short - oral mucositis | long - osteoradionecrosis, xerostomia
219
what can oral mucotaneous ulcers be associations of?
``` SJ syndrome pemphigoid herpes simplex varicella zoster SLE crohns ```
220
what are some organic psychiatric disorders?
dementia and delirium | protected by adults with incapacity act 2000
221
what is a consideration with schizophrenic patients and oral health?
hypersalivation drugs caused by anticholinergic drugs
222
what is dentally relevant about bullimia?
``` acid erosion caries cheilosis parotid gland enlarges palate reddening lymphadenopathy ```
223
what acts protect those with mental health issues?
mental health care and tx act 2005 | adults with incapacity act 2000
224
what can cancer tx cause orally?
``` ulceration and mucositis salivargy gland dysfunction and xerostomia radiation caries and perio disease infections - candidiasis loss of taste dysphagia osteoradionecrosis ```
225
what is mucositis and how is it treated?
inflammed mucosa - slough, ulceration, bleeding, heals 2-3 weeks post tx soft TB, H peroxide MW, chx MW, topical analgesics, soft bland non carious diet and at low temp, avoid alcohol and tobacco
226
what risks present to a patient with decreased salivary production?
increased infection risk increased demineralisation risk mastication or swallowing impaired
227
how is decreased saliva treated?
prilocarpine salivary substitutes - water atomiser, ice chips F sugar free gum
228
how should radiation caries be treated?
daily F application - 2800ppmF Salivary substitute caution with diet
229
what is osteoradionecrosis?
damage to blood vessels and bone cells change in endothelial cells = sclerosis of vessels = pain, trismus, exposed bone, suppuration, halitosis
230
what is dysgensia?
altered or loss of taste regained after 2-4 months of tx = dietary supplements plus zinc
231
if using chx and nystatin do what?
stagger use by one hour

2nd Year (4 decks)

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