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Diseases And Conditions Flashcards

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1
Q

What is anaemia?

A

Low Hb

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2
Q

What is polycythaemia?

A

High Hb

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3
Q

What is leukopenia?

A

Low WCC

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4
Q

What is leukocytosis?

A

High platelets

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5
Q

What is pancytopenia?

A

All cells reduced

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6
Q

What is the origin or red blood cells and platelets?

A

Myeloid origin

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7
Q

What are the normal Hb levels in a male?

A

130-180g/L

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8
Q

What are the normal Hb levels in a female?

A

115-165 g/L

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9
Q

What is the normal RCC in a male?

A

4.5-6.5 x10^12 /L

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10
Q

What is the normal RCC in a female?

A

3.8-5.8 x10^12 /L

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11
Q

What is the normal WCC?

A

4.0-11.0 x10^9/ L

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12
Q

What is the normal MCV?

A

80-100 fL

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13
Q

What is the normal HCT?

A

27-32 pg

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14
Q

What is the normal PLT?

A

150-450 x10^9 /L

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15
Q

What are the three haemantinics?

A

Iron, vitamin b12, folic acid

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16
Q

What are the three haemantinics?

A

Iron, vitamin b12, folic acid

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17
Q

What are the sources and losses of iron?

A

Sources: meat, green leafy veg, supplements
Losses: achlorhydria, IBD, bowel cancer

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18
Q

What are the sources and losses of vitamin b12?

A

Sources: milk, meat
Losses: lack of intake, lack of intrinsic factor, Crohn’s disease

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19
Q

What are the sources and losses of folic acid?

A

Sources: green veg, legumes
Losses: lack of intake, absorption failure

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20
Q

What is the therapeutic INR:

A

2-3

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21
Q

What is a dangerous INR?

A

> 4

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22
Q

What is the definition of lymphoma?

A

Clonal proliferation of lymphocytes

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23
Q

What are the symptoms of lymphoma?

A

Fever
Face/neck swellings
Lump in neck/armpits
Excessive night sweats
Weight loss
Loss of appetite

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24
Q

What is the clinical presentation of Hodgkin lymphoma?

A

Fever
Night sweats
Itching

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25
What is the clinical presentation of Non-Hodgkin Lymphoma?
Extra nodal disease Symptoms of marrow failure
26
What are the features of Hodgkin Lymphoma?
Peak age 15-40 years 2M:1F Stage I&II: 90% cure Stage III&IV: 50-70% cure
27
What are the features of Non-Hodgkin Lymphoma?
Peak age: any age 85% affects B cells 15% affects T cells >50% relapse rate
28
What are the investigations for lymphoma?
Physical exam Biopsy Blood tests Scanning
29
What is the treatment for lymphoma?
Chemotherapy Radiotherapy mAbs Haemopoietic stem cell transplant
30
What is the definition of multiple myeloma?
Malignant proliferation of plasma cells
31
What is the clinical presentation of multiple myeloma?
Monoclonal paraprotein in blood and urine Lytic bone lesions Excess plasma cells in bone marrow leading to marrow failure Anaemia Hypercalcaemia
32
What are the symptoms of leukaemia ?
Fever/chills Persistent fatigue Frequent infections Weightloss Swollen nodes
33
What are the symptoms of multiple myeloma?
Bone pain Fatigue Weight loss Repeated infections
34
What are the investigations for multiple myeloma?
CT/MRI scans Bone marrow biopsy
35
What is the treatment for multiple myeloma?
Anti-myeloma medicines Chemotherapy Radiotherapy mAbs Haemopoietic stem cell transplant
36
What is the definition of leukaemia?
Group of cancers of the bone marrow which prevents normal manufacture of the blood
37
What are the clinical features of leukaemia?
Anaemia Neutropenia Thrombocytopenia Lymphadenopathy Splenomegaly Bone pain
38
What are the features of Acute lymphoblastic leukaemia (peak age, % cured, prognosis m vs f)
Peak age: 4 years 80% children cured Better prognosis in females
39
What are the features of acute myeloid leukaemia? (Peak age, cure rate under 60, cure rate over 70)
Peak age: elderly 30-40% under 60s cured 10% over 70 cured
40
What are the features of chronic lymphocytic leukaemia (peak age, M:F, what it is)
Peak age: 70 years 2M:1F B-cell clonal lymphoproliferative disease
41
What are the features of chronic myeloid leukaemia (peak age, effect on neutrophils, presentation)
Peak age: 50-70 years Increase in neutrophils and their precursors Fatigue, weightloss and sweating
42
What chromosome is associated with chronic myeloid leukaemia?
Philadelphia chromosome
43
What are the risk factors of leukaemia?
Previous cancer treatment Genetic disorders Smoking Family history
44
What are the investigations for leukaemia?
Blood tests Bone marrow tests
45
What is the treatment for leukaemia?
Chemotherapy Radiotherapy mAbs Haemopoietic stem cell transplant
46
What is poryphyria?
An abnormality of haem metabolism
47
What is the presentation of porphyria?
Photosensitive rash Hypertension Tachycardia Neuropsychiatric disturbances
48
What are the signs of anaemia?
Pale Tachycardia Enlarged liver/spleen
49
What are the symptoms of anaemia?
Tired Dizzy Shortness of breath Palpitations
50
What are the causes of anaemia?
Reduced production: reduced haemantinics Increased loss: bleeding, autoimmune, thalassaemia, sickle cell)
51
What are the investigations for anaemia?
History Full blood count Faecal occult bloods Endoscopy Bone marrow examination
52
What is the treatment for anaemia?
Haematinic replacement Transfusion/eryththropoetin (in production failure)
53
What is the effect of anaemia on GA?
Reduced O2 capacity
54
What is the effect of anaemia on the oral cavity?
Mucosal atrophy Candidiasis Recurrent ulceration Sensory changes
55
What is the definition of Macrocytic?
>100 fL
56
What is the definition of Microcytic?
<80 fL
57
What is the definition of normocytic?
80-100 fL
58
What is Macrocytic anaemia associated with?
Vit b12 deficiency Folate deficiency Drug induced
59
What is Microcytic anaemia associated with?
Iron deficiency Chronic inflammatory disease Thalassaemia
60
What is normocytic anaemia associated with?
Haemolytic anaemia Blood loss Bone marrow disorders
61
What are the four stages in the process of haemostasis?
Vasoconstriction Platelet plug Coagulation Cascade Fibrin plug
62
What are the stages in the process of platelet plug formation?
ECM releases cytokines and inflammatory markers Platelets adhere to each other Platelet plug forms
63
What mediators do platelets release?
ADP Serotonin (maintains vasoconstriction) Prostaglandins and phospholipids (maintain vasoconstriction)
64
What is the intrinsic pathway in the coagulation cascade?
XII -> XIIa XI -> XIa (via XII) IX -> IXa (via XIa)
65
What is the extrinsic pathway in the coagulation cascade?
VII -> VIIa (via III)
66
What is the extrinsic pathway in the coagulation cascade?
VII -> VIIa (via III)
67
What is the common path in the coagulation cascade?
Prothrombin -> thrombin (via Va) Fibrinogen -> fibrin (via thrombin) Fibrin -> cross-linked fibrin clot (via XIIa)
68
What is the definition of haemophillia?
Rare inherited condition that affects the body’s ability to form clots
69
What are the clinical features of mild haemophilia?
Bleeding occurs after injury, surgery or extraction
70
What are the clinical features of moderate haemophilia?
Bleeding into joints and muscles after mild injury or spontaneously
71
What are the clinical features of severe haemophilia?
Spontaneous bleeding into joints and muscles
72
What is the cause of haemophilia A?
Low clotting factor VIII (8)
73
What is the cause of haemophilia B?
Low clotting factor IX (9)
74
What are the investigations for haemophilia?
Blood test Clotting screen Genetic test
75
What is the treatment of severe and moderate haemophilia A?
Recombinant factor VII
76
What is the treatment of mild haemophilia A and carriers?
DDAVP (desmopressin) Transaeximic acid
77
What is the treatment for haemophilia B?
Recombinant factor IX
78
What is the definition of Von Willebrand’s disease?
Deficiency of Von Willebrand’s factor resulting in reduction of factor VIII
79
What are the clinical features of Von Willebrand’s disease?
Large/easy bruising Frequent nose bleeds Bleeding gums Heavy periods
80
What kind of mutation causes Von Willebrands disease?
Autosomal dominant mutation
81
What are the investigations for Von Willebrand’s disease?
Blood test Genetic test
82
What is the treatment for severe and moderate Von willebrands disease?
DDAVP
83
What is the treatment of mild Von Willebrand’s disease and carriers?
Transexaemic acid
84
What is Thrombophilia?
Increased risk of blood clot development
85
What are the causes of Thrombophilia?
Protein s/c deficiency Antithrombin 3 deficiency Factor V Leiden variant Cancer Pregnancy
86
What is the minimum platelet count for primary care?
100 x10 ^9
87
What is the minimum platelet count for hospital care?
50 x10 ^9
88
What are the irreversible risk factors for CVD?
Age Sex Family history
89
What are the reversible risk factors of CVD?
Smoking Obesity Diet Exercise Hypertension Hyperlipidaemia Diabetes
90
What is the primary preventions for CVD?
Exercise Diet Not smoking
91
What are the secondary preventions for CVD?
Medical treatments to reduce risk
92
What are the four features of Stable angina? (Cause, ischaemic/infact, ECG, troponins)
Pain due to increased demand due to atherosclerotic plaque Demand ischaemia, not infarction Normal ECG Normal troponins
93
What are the four features of unstable angina? (Cause, ischaemic/infact, ECG, troponins)
Plaque ruptures, thrombus formation, partial occlusion of vessel, pain at rest Supply ischaemia, no infarct ECG: normal, inverted T waves or ST depression Normal troponins
94
What are the four features of an NSTEMI? (Cause, ischaemic/infact, ECG, troponins)
Plaque ruptures, thrombus formation, partial occlusion of vessel, subendocardial myocardium infarction Subendocardial infarct ECG: normal, inverted T waves or ST depression Elevated troponins
95
What are the four features of a STEMI? (Cause, ischaemic/infact, ECG, troponins)
Complete occlusion of blood vessel lumen, transmural injury and infarction to myocardium Transmural infarct ECG: hyperacute T waves or ST elevation Elevated troponin
96
What is cyanosis?
5g/dL or more deoxygenated Hb in blood
97
What is a cause of central cyanosis?
Congenital heart disease
98
What is a cause of peripheral cyanosis?
Cold environment
99
What is the definition of angina?
Reversible ischaemia of the heart muscle
100
What are the symptoms of angina?
Central crushing chest pain May radiate to arm/back/jaw
101
What are the investigations of angina?
ECG Angiography Echocardiogram Isotope studies
102
What are the treatment options for angina?
Reduce O2 demands Increase oxygen delivery Modify risk factors
103
How can you reduce O2 demands in angina?
Reduce hypertension Reduce heart filling pressure/dilate coronary vessels Emergency Tx: GTN
104
What medication can be used to reduce hypertension?
Diuretics Ca Channel agonists ACE inhibitors Beta blockers
105
What medications can be used to reduce heart filling pressure/dilate coronary vessels?
Nitrates
106
What can be done to increase oxygen delivery?
Angioplasty Coronary artery bypass graft (CABG)
107
What can be done to increase oxygen delivery?
Angioplasty Coronary artery bypass graft (CABG)
108
What is the definition of peripheral vascular disease?
Angina of the tissues
109
What are the clinical features of peripheral vascular disease?
Ateroma in femoral/popilteal vessels Claudication pain in limbs during exercise Poor wound healing Limited function May lead to necrosis and gangrene
110
What are the clinical features of peripheral vascular disease?
Ateroma in femoral/popilteal vessels Claudication pain in limbs during exercise Poor wound healing Limited function May lead to necrosis and gangrene
111
What is the definition of myocardial infarction?
Infarction of the coronary artery
112
What are the clinical features of a myocardial infarction?
Pain Nausea Sweaty ‘Going to die’
113
What are the investigations for a myocardial infarction?
History ECG Biomarkers (troponin)
114
What are the treatment options for a myocardial infarction?
Get patient to hospital Analgesia Aspirin BLS if needed Open blood flow by angioplasty/ stent (up to 3 hours) Thrombolysis (up to 6 hours) Bypass obstruction: CABG, fem/pop bypass
115
Which medications are used for prevention of myocardial infarction?
Aspirin Beta blockers ACE inhibitors
116
What is Bradyarrhythmia?
Slowed heart rate
117
What is the investigation for bradyarrythmia?
Prolonged p-q interval on ECG
118
What is the treatment for Bradyarrythmia?
Cardiac pacemakers
119
What is tachyarrhythmia?
Increased heart rate
120
How does atrial tachycardia present on an ECG?
Narrow QRS
121
How does ventricular tachycardia present on an ECG?
Broad QRS
122
What are the risk factors of infective endocarditis?
Prosthetic heart valve Congenital heart disease Damaged heart valves Previous endocarditis
123
What are the symptoms of infective endocarditis?
High temperature Chills Headache Joint and muscle pain
124
What are the causes of infective endocarditis?
Bacteria enters system and adheres to damaged endothelium and microthrombi
125
What is the duke criteria for infective endocarditis diagnosis?
Positive blood cultures (3x over 24 hours) Evidence of endocardia involvement
126
What is the treatment for infective endocarditis?
Antibiotics
127
What dental procedures put a patient at risk of bacteraemia?
Extractions Periodontal therapy Gingival surgery Implants
128
What is the definition of heart failure?
Output of heart is incapable of meeting demands of tissue
129
What are the clinical features of left heart failure?
Lungs and systolic effects Dysponea Tachycardia Low BP
130
What are the clinical features of right heart failure?
Venous pressure elevation Swollen ankles Aceites Raised jugular vein pressure Tender enlarged liver Poor GI absorption Pitting oedema
131
What are the causes of high output heart failure?
Demands of system increased beyond heart capacity Anaemia Thyrotoxicosis
132
What are the causes of low output heart failure?
Heart is failing and not strong enough to force blood around the body Cardiac defect
133
What are the investigations for heart failure?
Blood test ECG
134
What is the treatment for acute heart failure?
Emergency hospital management Oxygen Morphine Frusemide (for fluid removal)
135
What is the treatment of chronic heart failure?
Community based management Improve myocardial function (treat underlying disorders) Reduce compensation effects
136
What is hypertension?
Increased blood pressure
137
What are the clinical features of hypertension?
Systolic >140mmHg Diastolic >90mmHg
138
What are the clinical features of hypertension?
Systolic >140mmHg Diastolic >90mmHg
139
What are the risk factors of hypertension?
Age Race Obesity Stress Drugs (steroids, oral contraceptives)
140
What are the causes of hypertension?
Environment Genes Gene and environment interactions
141
What are the investigations for hypertension?
3 separate measurements: sitting, rested Urinalysis: serum biochemistry/lipids ECG
142
What is the treatment for hypertension?
Modify risk factors Single daily drug dose
143
What are the causes of valve disease?
Congenital abnormality Rheumatic fever Myocardial infarction
144
What is the treatment for valve disease?
Valve replacement
145
What are the features of a mechanical valve?
Longer life (up to 30 years) Ticking noise
146
What are the features of a porcine valve?
Short life <10 years Silent
147
What are the two components of respiration?
Ventilation Gas exchange
148
What are the features of ventilation?
Airway patency Active muscle
149
What are the features of gas exchange?
Adequate alveoli No alveolar wall fibrosis
150
What is type1 respiratory failure?
Inadequate gas exchange
151
What is type 1 respiratory failure associated with?
Thickening of alveolar walls Inadequate alveolar number V-Q mismatch
152
What is a V-Q mismatch?
A mismatch between where air goes into lungs and blood going into lungs
153
What is type 2 respiratory failure?
Inadequate ventilation
154
What is the definition of asthma?
Reversible airflow obstruction Bronchial hyper reactivity
155
What are the clinical features of asthma?
Cough Wheeze Shortness of breath Diurnal variation Difficulty breathing out
156
What are the triggers of asthma?
Infections Environmental stimuli (dust, smoke, chemicals) Cold air
157
What is the asthma triad?
1. Bronchial smooth muscle constriction 2. Bronchial smooth muscle oedema 3. Excessive mucous secretion into airway lumen
158
What is the investigation for asthma?
Peak expiratory flow rate (PEFR) to track airway resistance
159
What are the 5 stages of treatment for asthma?
1. Short acting b-agonist 2. Low dose inhaled corticosteroid 3. High dose inhaled corticosteroid 4. Long acting b-agonist 5. Adjuvant therapy
160
What are the adjuvant therapy options for asthma?
Regular montelukast Pulsed oral steroid (prednisolone) Biologic therapy
161
What is chronic obstructive pulmonary disease (COPD)?
Emphysema and chronic bronchitis
162
What is the risk factor of COPD?
Smoking
163
What are the symptoms of COPD?
Increased breathlessness Persistent productive cough Frequent chest infections Persistent wheezing
164
What does type 1 COPD result in?
Hypoxaemia
165
What does type 2 COPD result in?
Hypercapnia Ventilation failure
166
What is the PaO2 for type 1 COPD?
PaO2 <8.0 kPa
167
What is the PaCO2 for type 2 COPD?
PaCO2 >6.7 kPa
168
What are the investigations for COPD?
Spirometry Chest x-ray Blood test
169
What is the treatment for COPD?
Smoking cessation Long acting bronchodilator Inhaled steroid Oxygen support Pulmonary rehabilitation therapy
170
What is cystic fibrosis?
Inherited defect in cell chloride channels
171
What are the clinical features of cystic fibrosis?
Production of excess sticky mucous
172
What are the symptoms of cystic fibrosis?
Troublesome cough Repeated chest infections Prolonged diarrhoea Poor weight gain
173
What can cystic fibrosis progress to?
Liver dysfunction Osteoporosis Diabetes Reduced fertility
174
What mutation is associated with cystic fibrosis?
CFTR gene mutation
175
What are the different investigations for cystic fibrosis?
Prenatal screening: if sibling +ve Perinatal testing: blood spot test on day 5 of life Sweat test: suspected +ve, measures salt content of sweat CTFR gene testing
176
What are the treatment options for cystic fibrosis?
Physiotherapy (10-60 mins/day: to remove mucous in lungs) Medication: Lungs: bronchodilators (open airways), antibiotics (chest infection), steroids (airway inflammation) Digestive system: pancreatic enzyme replacement, nutritional supplements CFTR modulators Stem cell treatment Exercise (for lung function and physical strength) Transplantation (heart, lung)
177
What are the types of lung cancer?
Small cell or non-small cell
178
What are the symptoms of lung cancer?
Cough Haemoptysis Pneumonia Metastasis (bone, liver brain) Dysphagia
179
What are the causes of lung cancer?
Smoking Genetics Air pollution
180
What are the investigations for lung cancer?
Radiographs Biopsy Biomarkers
181
What are the treatment options for lung cancer?
mAbs Platinum based doublet therapy
182
What is sleep apnoea?
Airway obstruction during sleep
183
What are the treatment options for sleep apnoea?
Mandíbular advancement appliance Continuous positive airway pressure Positional therapy
184
What are the symptoms of bowel cancer?
Anaemia Rectal blood loss
185
What are the A B C D stages of bowel cancer?
A- submucosal (80% 5YS) B- muscularis (65% 5YS) C- lymph nodes (45% 5YS) D- liver (5% 5YS)
186
What are the causes of bowel cancer?
Genetics- p53 (75%) Ulcerative colitis Intestinal polyps Diet low in fibre and veg and high in fat and meat
187
What are the investigations for bowel cancer?
Screening - adults >50 every two years Endoscopy if +ve screening CT/MRI Carcinoembryonic antigen
188
What are the treatment options for bowel cancer?
Surgery Hepatic metastases Radiotherapy Chemotherapy
189
What is the definition for coeliac disease?
Sensitivity to alpha-gliaden component of gluten
190
What are the clinical features of coeliac disease?
Subtotal villus atrophy of the jejunum
191
What are the symptoms of coeliac disease?
Weightloss Lassitude Weakness Abdominal swelling Diarrhoea Oral aphthae Malabsorption of iron, folate, vit b12, fat
192
What are the risk factors of coeliac disease?
Family history Environmental factors Comorbidities
193
What are the investigations for coeliac disease?
Autoantibody tests (serum transglutaminase TTG, anti-gliadin/anti-endomyseal antibodies) Jejunal biopsy Faecal fat (increased due to malabsorption) Haemantinics (low b12, folate, ferritin)
194
What are the investigations for coeliac disease?
Autoantibody tests (serum transglutaminase TTG, anti-gliadin/anti-endomyseal antibodies) Jejunal biopsy Faecal fat (increased due to malabsorption) Haemantinics (low b12, folate, ferritin)
195
What is the treatment for coeliac disease?
Gluten free diet
196
What are the dental aspects of coeliac disease?
Oral ulcers and blisters due to malabsorption
197
What is pernicious anaemia?
Anaemia caused by vitamin b12 deficiency
198
What are the clinical features of pernicious anaemia?
Diarrhoea Lightheaded Loss of appetite Shortness of breath
199
What are the causes of pernicious anaemia?
Lack of b12 in diet Disease of gastric parietal cells (autoimmune) Crohn’s disease Bowel cancer
200
What are the investigations for coeliac disease?
Blood tests Schilling test/serological markers Biopsy
201
What is the treatment for pernicious anaemia?
Increase b12 in diet Supplements Vitamin b12 injections
202
What are the symptoms of Crohn’s disease?
Colonic disease: diarrhoea, abdominal pain, rectal bleeding Small bowel disease Orofacial granulamatosis
203
What are the ratios for Crohn’s disease in male/female and white/black
M>F W>B
204
What are the features of Crohn’s disease?
Discontinuous Rectum involved 50% Anal fissures 75% Ileum involved 30% Mucosa cobbled and fissured Non vascular Serosa inflammed
205
What is the microscopic appearance of Crohn’s disease?
Transmural Oedematous Granulomas
206
What is the presentation of necrotising ulcerative gingivitis/periodontitis?
Marginal gingival ulceration with loss of interdental papillae Grey sloughing on surface of ulcers Halitosis Pain
207
What are causative factors of NUG/NUP?
Anaerobic fusospirochatal bacteria Smoking Stress
208
What is used to treat NUG/NUP?
Metronidazole
209
What are the functions of the skin?
Anatomical barrier Sensory input Heat regulation Stores liquids and water Drug absorption and waste excretion
210
What is the impact of oily skin?
Increased sebaceous gland secretion Increased bacterial colonisation Increased spots and pimples Skin is heavier and thicker Increased pore blockage
211
What are comedones?
Black heads Buildup of keratin and sebum The pores oxidise leading to a black colour
212
What are bacterial infections that affect the skin?
Furuncles and carbuncles Acne Erysipelas Impetigo
213
What is a group of furuncles called?
Carbuncle
214
What is a furuncle?
Infection of the skin leading to pus filled pockets Red, painful and swollen
215
What bacteria causes furuncles?
Staphylococcus aureus
216
What does acne consist of?
Comedones, papeles, pustules, nodules and inflammatory cysts
217
What age groups are most commonly affected by acne’s?
13-18 years 25-40 years
218
What are some causes of acne?
Follicular sensitivity to testosterone Propionibacteruym acne’s overgrowth
219
What five things can worsen acne?
Contraceptives Greasy skin cleansers Systemic steroid treatment Anticonvulsants Squeezing spots
220
What is the local management of acne?
Reduce excess skin oil Antibacterial agents: benzoyl peroxide, retinoids, antibiotic lotions
221
What is the systemic management of acne?
Antibiotics; tetracycline based (minocylin) Retinoids: isotretinoin Hormone manipulation: anti androgens (cyproterone)
222
What bacteria causes erysipelas?
Streptococcus pyogenes
223
What do erysipelas present as?
Defined, sharp raised border; may blister and peel Systemic symptoms: fever, rigors
224
What is the management of erysipelas?
Systemic antibiotics
225
What is the progression of erysipelas?
Necrotising fasciitis Septic shock
226
What is impetigo?
Highly infectious skin disease Presents as red, crusty blisters
227
What bacteria is associated with impetigo?
Straphlococcal Streptococcal
228
What is the management of impetigo?
Topical antibiotics
229
What are some examples of viral skin infections?
Herpes simplex Shingles (herpes zoster) Mulluscum contagiosum Warts Measles Rubella Fifth disease Hand foot and mouth
230
What is herpes simplex virus activated by?
Trauma Physical Chemical UV Stress
231
What is the management of herpes simplex virus?
Aciclovir
232
What is the cause of shingles?
Recurrent herpes zoster virus that affects single dermatones
233
What is the management of shingles?
High dose aciclovir
234
What is mulluscum contagiosum caused by?
Pox virus
235
Who is mostly affected by mulluscum contagiosum?
Infants and small children Children with atopic eczema Adults with HIV
236
What is the presentation of mulluscum contagiosum?
Clusters of small papules
237
What is the presentation of mulluscum contagiosum?
Clusters of small papules
238
What conditions are warts associated with?
HPV1-3
239
What is the treatment for warts?
Keratosis is Cryosurgery Excision
240
What are some examples of fungal skin infections?
Athletes foot (tines pedis) Nail infections (oncycholysis) Ringworm Intertrigo Pityriasis versicolour
241
What is the treatment for athletes foot?
Keep skin clean, dry and damage free Antifungal/antibacterial cream: miconazole
242
What is onycholysis?
Associated with tinea unguium infection Nail becomes malformed, thick and crumbly
243
What is ringworm in feet associated with?
Tinea cruris
244
What is ringworm in the body associated with?
Tinea corporis
245
What is ringworm in the scalp associated with?
Tinea capitius
246
What is intertrigo?
Fungal infection due to chafing
247
What is the treatment for intertrigo?
Topical antifungal Clotrimazole Miconazole
248
What is pityriasis versicolor caused by?
Pityrosporum orbiculare Cradle cap
249
What is the presentation of pityriasis versicolor?
Patchy skin pigmentation
250
What is the treatment of pityriasis versicolour?
Topical or systemic antifungal Topical ketoconazole (shampoo/wash) Systemic itraconazole
251
What are two examples of skin infestations?
Scabies Lice
252
What is scabies?
Infection with scabies mite (sarcoptes scabiei) Burrow into skin
253
What is the presentation of scabies?
Itching Rash
254
What is the treatment of scabies?
Chemical insectides: Benzoyl benzoate Permethrin Malathion
255
What are the three types of lice and how are they transmitted?
Head, pubic, body Transmitted by close contact and shared items
256
What is the treatment for lice?
Personal clothing and hygiene Chemical insectides: permethrin, malathion, phenothrin
257
What are examples of inflammatory skin disease?
Eczema Occupational dermatitis Psoriasis
258
What is eczema?
Inflammation of skin Itchy, dry, flaky
259
What are the types of eczema?
Atopic Contact Seborrhoeic Discoid Gravitational
260
What type of surfaces does eczema affect?
Flexor
261
What are the features of atopic eczema?
Develops in childhood Improves with age and runs in families Associated with hay fever and asthma
262
What are the features of contact eczema?
Adult onset Contact with allergen
263
What are the features of seborrhoeic eczema?
Affects scalp and eyelashes
264
What are the features of gravitational eczema?
Related to poor circulation in legs
265
What are some triggers of eczema?
Stress Menstruation Illness Weather
266
What is the management of eczema?
Cotton clothing Emollients: oily and prevent the drying of irritated skin, apply after bath Soap substitutes Corticosteroids: remove inflammation and allow skin to return to normal
267
What is occupational dermatitis and how is it treated?
Reaction to an environmental agent Results in a rash, immediately or 72 hours after Treated with topical steroids and removal of stimuli
268
What is psoriasis?
Inflammatory skin disease affecting 2% pop Dysregulated epidermal proliferation
269
What surfaces are affected by psoriasis?
Extensor surfaces
270
What are the treatments for psoriasis?
Emollients Topical steroids Tar Dithranol Vitamin A derivatives PUVA (psoralen UV light A) Systemic: methotrexate, cyclosporine, aitretin, inflixamab, etanercept
271
What are examples of blistering immunological skin conditions?
Pemphigoid Pemphigus Epidermolysis bullosa
272
What are some examples of immunological connective tissue diseases?
Scleroderma Dermatomyositis Raynaulds
273
How do immunological skin conditions lead to blisters?
Auto-antibodies attack skin components causing a loss of cell-cell adhesion ‘Split’ forms in skin which fills with inflammatory exudate, forms vesicle/blister
274
What is pemphigoid?
Sub epithelial antibody attack Leads to thick walled blisters: clear or blood filled Can have oral and skin lesions
275
What is the treatment of pemphigoid?
Steroids or steroid sparing drugs
276
What does pemphigus affect?
Affects mucosa and skin
277
What are the signs and symptoms of denture induced stomatitis?
Inflammed mucosa Burning sensation Discomfort Bad taset
278
What are the types of dementia?
Alzheimers Vascular Dementia with Lewy bodies Fronto temporal Korsakoff syndtome
279
What are the signs of late stage dementia?
Unaware of time and place Difficulty in recognising faces Increased need for self care help Difficulty walking Behaviour changes
280
What are examples of cognitive tests for dementia?
Mini Mental State Exam Blessed Dementia Scale Montreal Cognitive Assessment Single test: clock draw, delayed word recall, category fluency
281
What are the risk factors for head and neck cancer?
Smoking Oral Hygiene Alcohol Betel chewing
282
What is a stroke?
An acute focal neurological deficit due to cerebrovascular disease
283
What are the risk factors for stroke?
Smoking Alcohol Hypertension Hyperlipodemia
284
What are the types of stroke?
Haemorrhage Infarction Embolic
285
What are the signs/symptoms of stoke?
Face drooping Arm weakness Speech difficulties
286
What are the methods of stroke prevention?
Antiplatelets (aspirin) Statins (reduce cholesterol) Stop smoking
287
What are the complications of stroke?
Sensory/motor loss Dysphagia Dysphonia Cognitive impairment
288
What is epilepsy?
Recurrent seizures associates with reduced GABA levels
289
What are the types of epilepsy?
Generalised tonic-clonic seizures Partial/Focal seizures Myoclonic seizures Tonic seizures Atonic seizures
290
What is an aura?
Abnormal sensation that a seizure may occur
291
What is tonic associated with?
Muscle tensing
292
What is clonic associated with?
Muscle jerking
293
What is a post-ictal period?
Post seizure Person is confused, tired, irritable and low
294
How does a partial/focal seizure present?
Occurs in isolated areas Affects hearing, speech, memory and emotions Awake during simple, Unconscious during complex Symptoms: deja vu, strange smell/tastes, unusual emotions/behaviours
295
What is an acute febrile convulsion?
A fit or seizure occurring in children 6 months - 6 years when they have a high fever
296
What are the causes of epilepsy?
Idiopathic CNS disease Trauma
297
What are the precipitators of epilepsy?
Illness Stress Fatigue
298
What is the treatment for epilepsy?
Anti-convulsants Anti-epileptics
299
What is the emergency treatment for epilepsy?
Protect head, clear area Give O2 >5minutes: buccal midazolam Post-seizure reassurance
300
What information should you gather in a fit history?
Last 3 fits Medications and compliance When fits are most likely
301
What is status epilepticus?
Single epileptic seizures lasting more than 5 minutes or 2 or more within a 5 minute period
302
What is multiple sclerosis?
Progressive demyelination of axons leading to reduced nerve conductivity
303
How does multiple sclerosis present?
Intention tremor Muscle weakness Paraesthesia Visual disturbance
304
What is motor neurone disease?
Degeneration of spinal cord affecting bulbar motor nuclei
305
What are the tests for bleeding disorders?
Prothrombin test Platelet count Activated partial prothrombin time Thrombin time
306
What drugs are associated with xerostomia?
Benzodiazepines Antidiuretics Antidepressants Anticholinergics
307
What is the definition of delusion?
False, fixed beliefs which dominate the person's mind and are contrary to education and culture
308
What are the dental implications of alcohol use disorder?
Xerostomia Poor oral hygiene Erosion and toothier Increased caries risk
309
What is schizophrenia?
Encompasses a number of symptoms associated with significant alterations to a person's perception, thoughts, moods and behaviour
310
What are the dental implications of schizophrenia?
Hypersalivation Tardive Dyskinesia Xerostomia Increased oral cancer risk
311
What is tardive dyskinesia most commonly caused by?
Typical antipsychotics
312
What are the side effects of atypical antipsychotic clozapine?
Agranulocytosis Neutropenia Hypersalivation Plasma levels can be influenced by tobacco withdrawal
313
What are the dental implications of cannabis use?
Increased dietary carbohydrates Can induce tachycardia and widespread vasodilation Use can be a contraindication to dentist led sedation Xerostomia
314
What is the safest LA to use on patients with advanced liver disease?
Articaine
315
What analgesia is best used for patients with liver cirrhosis?
Paracetamol
316
What is the liver responsible for producing?
Clotting factors 1,2,7,9,10,11 Thrombopoietin
317
What is the minimum UKLED score for a transplant?
49
318
What is cirrhosis?
Liver cell necrosis and inflammation followed by replacement with fibrotic tissue and regenerating nodules of hepatocytes and vascular derangement
319
What type of RNA does hepatitis D have?
Circular
320
What is the main route of hepatitis A transmission?
Faeco-oral
321
What is used for the treatment of hepatitis A
Sofosbuvir
322
What are the cardinal signs of Parkinson's?
Postural instability Muscle rigidity Resting tremor Bradykinesia
323
What are the oral health implications of Parkinsons?
Oral hygiene deteriorates Poor access Dry mouth Lack of muscle control
324
What are the signs of dental pain in a non-verbal patient?
Pulling at face and mouth Refusal to eat Disturbed sleep Increased restlessness
325
What is Parkinsons?
Degenerative brain disease: loss of dopaminergic neurone in the substantial Niagara
326
What is xerostomia?
Dry mouth 1/2 the amount of normal unstimulated flow rate Clinically <3ml/min
327
What medications are associated with xerostomia?
Tricyclic antidepressants Anticholinergics Antipsychotics Beta blockers Antihistamines Diuretics Benzodiazepines
328
What are the causes of xerostomia?
Sjögren's syndrome Anxiety Surgical removal Head and neck radiotherapy Dehydration Stress
329
What is the peak age for Acute Lymphoblastic Leukaemia?
0-4 years
330
What medications are associated with gingival hyperplasia?
Calcium channel blockers (nifedipine) Immunosuppressants (cyclosporine) Anticonvulsants (phenytoin)
331
How many cases of Acute Lymphoblastic Leukaemia occur annually?
440
332
What are the symptoms of Acute Lymphoblastic Leukaemia?
Breathlessness Pale Fatigue Easy bleeding/bruising Increased temperature Increased infections Swollen lymph nodes Irritable Bone pain Decreased appetite Fullness in stomach Swollen testicles
333
Examples of MDT for Acute lymphoblastic leukaemia:
Paeds Oncologist Paeds Haematologist Paeds Dentist GP Paeds Cancer Nurse Play Specialist Psychologist Social Worker
334
What are the management options for Acute Lymphoblastic Leukaemia?
Chemotherapy Stem cell or bone marrow transplant
335
What oral problems are associated with Acute Lymphoblastic Leukaemia?
Increased infection during treatment Oral and pharyngeal mucositis Xerostomia Increased caries Gingival hyperplasia ORN, MRONJ Trismus
336
What are the dental considerations to be made for an Acute Lymphoblastic Leukaemia patient?
Prevention Timing of appointments Immunosuppressant and bleeding risk Anxiety Fatigue Wider social and family circumstances
337
What is the presentation of diabetes?
Polyuria (Toilet) Excessive Thirst Lethargy (Tired) Weight Loss (Thinner)
338
What is the MDT associated with diabetes in Paeds?
Paediatric Endocrinologist Paeds diabetes specialist nurse Paeds dietician Clinical psychologist
339
What is the diagnostic value for diabetes in mmol/litre glucose?
11.1
340
What is type 1 diabetes managed with?
Insulin
341
What dental problems are associated with type 1 diabetes?
Increased perio risk Decreased saliva flow Increased caries Candidiosis Increased infection
342
What considerations should be made for the treatment of type 1 diabetes patients?
Prioritise prevention (high risk) Timing of appointment (early/mid morning) GA (liase with endocrinologist, may need overnight monitoring due to fasting) Anxiety Fatigue with care: fed up of tx
343
What is the ratio of autism M:F
3M:1F
344
What are the four cardinal signs of Parkinson's disease?
Postural instability (impaired gait and falls, impaired use of upper limbs) Resting tremor Bradykinesia (slow movement and slow initiation of movement) Rigidity (Increased muscle tone)
345
346
How may a Parkinson's patient present?
Mask-like face Slow speech Difficulty swallowing Abnormal posture Difficulty walking Memory problems
347
What are the dental issues associated with a Parkinson's patient?
Difficulty accepting treatment Tremor at rest Lack of control of muscles of mastication Dry mouth
348
What is xerostomia in Parkinson's patients associated with?
Anticholinergic effect of drugs (benzotropine) Increased drug interactions
349
How may pain display in a Parkinson's patient?
Fighting Pacing Repetitive motions Refusal to eat Crying Groaning and refusal to co-operate
350
What are the facial signs in a Parkinson's patient in pain?
Frowning Grimacing Teeth clenching Biting Rubbing area
351
What are the behavioural signs of a Parkinson's patient in pain?
Aggression Depression Isolation Sleep disturbance Withdrawal
352
What is the difference in tremors in Parkinson's and Cerebral Palsy?
Parkinsons is a resting tremor Cerebral palsy is an intention tremor
353
What are some management techniques for xerostomia?
Sucking on ice cubes Frequent sips of water Avoiding alcohol containing mouthwashes Avoiding dry foods and caffeine
354
355
What is Alzheimer’s?
Reduction in the cortex size, severe in the hippocampus Presence of plaques which are deposits of protein fragments of beta-amyloid that builds up in the space between the nerve cells and the tangles (twisted fibres of tau protein build up in cell)
356
What is vascular dementia caused by?
Reduced blood flow to the brain which damages and eventually kills brain cells
357
What is dementia with Lewy bodies?
Deposits of abnormal protein- Lewy bodies inside of brain cells
358
What is fronto-temporal dementia?
The frontal lobe has an associated ubiquitous associated protein linked with TDP-43
359
What are examples of rarer types of dementia?
HIV-related Corticobasal degenerative Parkinson’s Multiple Sclerosis Niemann-Pick disease Creutz-feld Jacob
360
What is the presentation of early stage dementia?
Short term memory loss Confusion Poor judgement/decisions Anxiety, agitation or distress over changes Inability to manage everyday tasks Communication problems Declines in talking, reading and writing
361
What is early stage dementia often attributed to?
Stress Bereavement Ageing
362
What is early stage dementia often attributed to?
Stress Bereavement Ageing
363
What is the presentation of mid stage dementia?
More support required to eat, wash, dress Increasingly forgetful, may fail to recognise people Distress, aggression, anger, mood changes Wandering and getting lost May behave inappropriately May experience hallucinations/throwback memories
364
What is the presentation of late stage dementia?
Inability to recognise familiar objects, surroundings or people Increased physical frailty Difficulty eating and swallowing, weight loss Associated incontinence Loss of speech Symptoms are progressive and irreversible
365
What are the three types of Von Willebrand disease?
Hereditary Acquired Psuedo/platelet type
366
What are the three types of Von Willebrand disease?
Hereditary Acquired Psuedo/platelet type
367
What are some examples of rarer blood disorders?
Haemophilia carriers Factor XIII deficiency Factor X deficiency Factor V deficiency Glandsman Disease
368
What is thrombocytopenia?
Abnormally low levels of thrombocytes
369
What is the reference value for thrombocytopenia?
<150x10^9/L
370
What is the reference value for thrombocytopenia?
<150x10^9/L
371
What are examples of blood tests?
Full blood count Coagulation screen Prothrombin time Partial thromboplastin time Activated partial thromboplastin time (APTT) APTT ratio INR D-dimer Fibrogen
372
What does the INR determine?
How long it takes for blood to clot
373
What is INR=1
Equal to a person not on warfarin
374
What is INR>1
Longer clotting time
375
What is INR <4?
Allows treatment without interruption
376
What are the risk factors of oral cancer?
Tobacco use Increased sun exposure Gender (M>F) Poor OH Weakened immune system Alcohol use Human papilloma virus (HPV) Increased age Poor diet and nutrition
377
What are the physical features of Down’s Syndrome?
Macroglossia Class II occlusion Hypodontia Short neck
378
What are the physical features of Down’s Syndrome?
Macroglossia Class II occlusion Hypodontia Short neck
379
Why are Down’s syndrome patients at increased Perio risk?
Immunocompromisation Poor OH
380
Why are Down’s syndrome patients at increased Perio risk?
Immunocompromisation Poor OH
381
What is the definition of NUG/NUP?
Painful ulceration and blunting of interdental papilla Associated with grey/yellow necrotic slough
382
What are the signs/symptoms of NUG/NUP?
Malodour/halitosis Interproximal necrosis Gingivitis Pain, swelling, bleeding Metallic taste Bleeding
383
What are the risk factors for NUG/NUP?
Poor OH Immunocompromised Stress Smoking
384
What is an abscess?
Localised collection of dead and dying neutrophils
385
What are the signs/symptoms of a dental abscess?
TTP in lateral direction Pain Swelling Redness Pus drainage Bleeding
386
What are the types of abscess?
Gingival Periodontal Pericoronal Periapical Perio-endo
387
What is atrial fibrillation (AF)?
Electrical impulses in atria fire irregularly and chaotically
388
What are the symptoms of atrial fibrillation?
Irregular and fast heartbeat
389
What are the risks associated with atrial fibrillation?
Risk of blood clot formation- stroke
390
What are the three types of diabetes?
Type 1 Type 2 Gestational
391
What are the associated side effects of diabetes?
Hypoglycaemic episodes Increased periodontal disease risk Xerostomia Oral dysaesthesia (burning mouth syndrome) Decreased wound healing Increased infection risk Parotid gland enlargement
392
What is hypertension>
Increased blood pressure
393
What are the risks associated with hypertension?
Heart attack Stroke Kidney failure Sight problems Vascular dementia
394
What are the primary risk factors for hypertension?
Genetics Black Smoking Lack of exercise SIMD Increased alcohol Increased weight Increased salt intake
395
What are the secondary causes of hypertension?
Increased adrenal hormone Kidney disease Diabetes Medications
396
What is neurosis?
Contact with reality maintained
397
What are two examples of neurosis?
Anxiety Phobias
398
What is psychosis?
Contact with reality lost
399
What are examples of anxiety disorders?
Generalised Anxiety Disorder Phobic Anxiety Panic Disorders
400
What is generalised anxiety disorder?
Free-floating anxiety in many/all situations
401
What is phobic anxiety?
Intense anxiety/panic in specific situations
402
What is panic anxiety?
Unpredictable extreme anxiety
403
What is somatosomal disorder?
Repeated presentation of physical symptoms and persistent requests for medical investigations in spite of negative findings and reassurance that the symptoms have no physical basis
404
What are psychological treatments for mental disorders?
Psycho-education Anxiety management techniques Cognitive behaviour therapy
405
What are examples of anxiolytic drugs?
Alcohol Benzodiazepines (diazepam, midazolam, temazepam) Antidepressants (tricyclics, mirtazepione, SSRIs)
406
What is the dental presentation of anxiety?
TMD and parafunction Oral dysaethesia Denture intolerance
407
What are adjustment disorders?
Maladaptive responses to severe past or continuing stress/trauma
408
How are adjustment disorders managed?
Psychological intervention
409
What is the dental presentation of mood disorders?
Face pain Dysaethesias
410
What is the occurrence of mood disorders based on gender?
3F1M
411
What are examples of depressive mood disorders?
Major depressive disorder Persistent depressive disorder Bipolar depression Post-partum depression Pre-menstrual dysphoria Seasonal affective disorder Atypical depression
412
What are the symptoms of depression?
Low mood Lethargy Appetite disturbance Loss of confidence/ self esteem Unreasonable self reproach and guilt Anxiety Reduced interest/motivation Sleep disturbance Poor concentration Recurrent thoughts of suicide
413
What are the two types of bipolar?
Mania Cyclothermia and Hypomania
414
What are the symptoms of cyclomania and hypomania?
Increased productivity and feeling of wellbeing Reduced need for sleep Gradual reduction in social/occupational function Increase in reckless behaviour, followed by period of depression
415
How does an euphoric mood disorder present?
Upbeat Talkative Inflated self esteem Feels that anything is possible
416
How does a dysphoric mood disorder present?
Irritable Agitated Aggressive Restless Rage
417
What are the treatment options for mood disorders?
Psychological: cognitive therapy, interpersonal psychotherapies Physical: exercise, phototherapy, ect Drugs: antidepressants, mood stabilising
418
What are examples of acute phase antidepressants?
Selective Serotonin Reuptake Inhibitors (SSRIs) Venalfaxine/Mirtazepine Tricylic Antidepressants (TCA) Monoamine Oxidase Inhibitor (MAOI)
419
What are examples of mood stabilising drugs?
Lithium Carbamazepine Valproate Lamotrigine
420
What are uses of antidepressants?
Treating depression/anxiety Pain relief Helps psychological treatments
421
What are examples of conditions with perceptual abnormalities?
Manic depression Schizophrenia Korsakoff's Psychosis Alcohol induced brain degeneration
422
What is schizophrenia?
Fundamental and characteristic distortions of thinking and perception Various types of delusions Auditory hallucinations Relapsing and remitting periods of acute psychosis
423
What causes schizophrenia?
Multifactorial abnormality of dopaminergic neurotransmission
424
What is schizophrenia associated with?
Genetic susceptibility Environmental: perinatal risk factors Drug abuse; cocaine, amphetamines, ecstasy, opiates
425
What is the prevalence of schizophrenia?
1-2%
426
How is schizophrenia managed?
Psychological therapy: CBT, cognitive remediation, family intervention Drug therapy: dopamine antagonist drugs (extrapyramidal effects), atypical antipsychotics
427
How are the extrapyramidal effects of antipsychotics treated?
Use an atypical antipsychotic Beta-adrenergic blockers Antichlolinergics
428
What is borderline personality disorder?
Instability in interpersonal relationships, self image, marked impulsivity
429
What is antisocial personality disorder?
Disregard for and violation of rights of others
430
What is histrionic personality disorder?
Excessive emotionality and attention seeking
431
What is narcissistic personality disorder?
Grandiosity, need for admiration, lack of empathy
432
What is avoidant personality disorder?
Social inhibition, feelings of inadequacy, hypersensitivity to negative evaluations
433
What is a dependent personality disorder?
Submissive and clinging behaviour
434
What is shizoid personality disorder?
Detachment from social relationships and restricted range of emotional expression
435
What is the presentation of necrotising stomatitis?
Bone denudation Osteitis and bone sequestrum
436
What is the management of orofacial granulomatosis?
Oral hygiene support Symptomatic relief as per ulceration Dietary exclusion Topical steroids Topical tacrolimus Short courses of oral steroids Intralesional corticosteriods Surgical intervention
437
What is the management of orofacial granulomatosis?
Oral hygiene support Symptomatic relief as per ulceration Dietary exclusion Topical steroids Topical tacrolimus Short courses of oral steroids Intralesional corticosteriods Surgical intervention
438
What is the treatment of necrotising periodontal disease?
Debridement and chlorhexidine mouthwash rinse 0.2% twice daily If systemic effects use metronidazole 400mg
439
What are the signs and symptoms of primary herpetic gingivostomatitis?
Fluid filled vesicles: rupture to painful, ragged ulcers on gingival, tongue, lips, buccal and palatal mucosa Severe oedematous marginal gingivitis Fever Malaise Headache Cervical lymphadenopathy
440
What is the NICE recommendation for patients with acute sinusitis that do not respond to first line treatments within 48 hours?
Referral to ENT specialist
441
What factors increase the risk of complications from acute sinusitis?
People with pre-existing co-morbidites: cystic fibrosis, immunosuppression, significant heart, liver, lung or renal disease People with acute cough >65 years with two of the following RF or >80 with one: hospitalisation in the previous year, type 1/2 diabetes, congestive heart failure, current use of oral corticosteroids
442
What is the treatment for primary herpetic gingivostomatitis?
Bed rest Hydration Soft diet Paracetamol Antimicrobial gel or mouthwash Topical acyclovir
443
What can be done for osteoporosis prevention?
Exercise : to increase peak bone mass Bisphosphonates
444
What is gout?
Monoarthropathy affecting a single joint such as the big toe
445
What is the cause of gout?
Deposit of uric acid crystaks
446
How does gout present?
Pain Swelling
447
How does gout present?
Pain Swelling
448
What is osteoarthritis?
Swelling of joints
449
What is osteoarthritis?
Swelling of joints
450
What does rheumatoid arthritis affect?
Synovial joints
451
How does rheumatoid arthritis present on the hands?
Z-thumb deformity PIP joint extension Ulnar deviation at MCP Symmetrical synovitis of PIP, DIP and MCP
452
What is z-thumb deformity?
Ulnar deviation of the fingers at MCP
453
What is PIP joint extension?
Symmetrical synovitis affecting PIP, DIP, MCP
454
What are the dental implications of rheumatoid arthritis?
Atlanto axial instability Sjogrens syndrome
455
What are the suprahyoid muscles?
Mylohyoid Anterior belly of digastric Stylohyoid Geniohyoid
456
What are the suprahyoid muscles?
Mylohyoid Anterior belly of digastric Stylohyoid Geniohyoid
457
How soon does an extradural haemorrhage present?
24 hours
458
How soon does an extradural haemorrhage present?
24 hours
459
What is affected by an extradural haemorrhage?
Pterion
460
When does a subdural haemorrhage present?
A long time after injurt
461
What vessels are affected by a subdural haemorrhage?
Cerebral veins
462
When does a subarachnoid injury present?
Sudden loss of consciousness
463
What vessel is affected by a subarachnoid haemorrhage?
Cerebral artery
464
What is the Philadelphia chromosome?
9 and 22 translocation
465
What is the Philadelphia chromosome associated with?
Chronic lymphoid leukeamia
466
What type of virus is HIV?
RNA
467
What is the role of matrix metalloproteins?
Inflammatory cells that cause breakdown of the ECM
468
What type of virus is Hep B?
DNA
469
What type of virus is Hep C?
RNA
470
Where are erythrocytes produced?
Bone marrow
471
What virus is associated with lymphoma?
Epstein barr viruse
472
What are the causes of thrombophillia?
Genetic susceptibility Protein S/C deficiency Anti-thrombin III deficiency Factor V leiden variant
473
What is the normal Hb range for females?
120-265g/l
474
What is the normal Hb range for males?
130-180g/l
475
What is the normal platelet count?
150-450/L
476
What is the normal RCC range for females?
3.8-5.8 x10^12/L
477
What is the normal RCC range for males?
4.5-6.5x10^12/L
478
What is the size of a microcytic blood cell?
<80fl
479
What is the size of a normal blood cell?
80-100fl
480
What is the size of a macrocytic blood cell?
>100fl
481
What do the alpha cells of the islet of langerhans produce?
Glucagon
482
What do the beta cells of the islet of langerhans produce?
Insulin
483
What do the delta cells of the islet of langerhans produce?
Somatostatin
484
What do the PP cells of the islet of langerhans produce?
Pancreatic peptide
485
What are the metastatic route of cancer?
Lymphatic Haematogenous Transcoelomic
486
Where does prostate cancer usually metastasise to?
Bone via lymphatics
487
What are the clinical classifications of cancer?
Benign Malignant
488
What are the histological classification of cancer?
Epithelial Mesenchyme
489
What are the features of benign tumours?
Slow rate of growth Do not metastasise Does not recur if removed Does not impinge on surrounding structures Tumour margins not well defined
490
What are the features of malignant tumours?
Fast rate of growth Invasive Recur if removed Can metastasize Margins well defined
491
What are two examples of benign tumours?
Chondroma: cartilage Lipoma: fat
492
What are two examples of malignant tumours?
Lymphoma Carcinoma
493
What are the effects of cystic fibrosis?
Diabetes (pancreatic enzymes decreased: decreased insulin) Productive cough Difficulty breathing Failure to thrive
494
What are the tests for cystic fibrosis?
Pre-natal (at risk/suspected) Peri-natal (all babies at 5 days old) Sweat test (increased salt concentration) Genetic testing for CFTR mutation
495
What is the gold standard test for cystic fibrosis?
Sweat test
496
What are the features of Addisons crisis?
Hypotension Vomiting Eventual coma
497
What is the role of TSH, T3 and T4 in primary hyperthyroidism?
Decreased TSH Increased T3 Increased T4
498
What is the role of TSH, T3 and T4 in secondary hyperthyroidism?
Increased TSH Increased T3 Increased T4
499
What are the symptoms of hyperthyroidism?
Excessive sweating Heat intolerance Palpatations Diahorrea Anxiety/irritability Weight loss
500
What is the role of TSH, T3 and T4 in primary hypothyroidism?
Increased TSH Decreased T3 Decreased T4
501
What is the role of TSH, T3 and T4 in secondary hypothyroidism?
Decreased TSH Decreased T3 Decreased T4
502
What are the symptoms of hypothyroidism?
Cold intolerance Constipation Fatigue Weight gain
503
What are possible causes of hypothyroidism?
Hashimotos thyroiditis Non-functional pituitary tumour
504
What is the proportion of small vs non-small cell lung cancers?
20% small cell lung cancer 80% non small cell lung cancer
505
What are examples of non-small cell lung cancers?
Adenocarcinoma Squamous cell carcinoma Large cell carcinoma
506
What is the cause of atherosclerosis?
Hyperlipademia Chronic inflammation followed by healing response Leads to the formation of atheroma
507
What are the risk factors for atheroscelosis?
Age Gender Genes (familial hypercholestraemia)
508
How are atheroma formed?
Chronic inflammation phase Endothelial cells change surface cell receptors, increased lipid permeability Increased cell adhesion
509
What happens during the healing phase of atheroma?
Smooth muscle proliferation Fibrous tissue formation Plaque is formed- central mass of lipid and necrotic tissue
510
What follows chronic endothelial cell injury?
Chronic endothelial cell injury Increased permeability (lipid deposited) Macrophages increase: foam cells, fatty streaks Smooth muscle proliferation: macrophages activate T cells, increase in inflammatory cells Fibrous tissue formation
511
What are the effects of atherosclerosis?
Decreased blood supply Occlusion leading to infarction Thrombosis Embolism
512
What are examples of tumours of blood vessels?
Hamartomas Kaposi sarcoma Angiosarcoma
513
What are examples of cardiac tumours?
Myoma Angiosarcoma
514
What is calcific aortic stenosis?
Calcium deposits as a result of chronic endothelial injury
515
What are ascoff bodies?
Nodules of heart characteristic of rheumatoid issue
516
What does SOCRATES stand for?
Site Onset Character Radiation Association Time Exacerbating Severity
517
What are the features of a medical history?
o Cardiovascular o Respiratory o Endocrinology o Gastrointestinal o Neurological o Musculoskeletal o Blood Disorders o Other (p. surgery/hospital admissions, other med conditions)
518
What medications are notable in a medical history?
Anticoagulants Antiplatelets Bisphosphates Steroids within last 2 years
519
What are the features of a medical history?
C/O HPC Pain history Past medical history Medications Allergies Past dental history Social history Family history
520
What can decrease the INR?
Carbamazepine Alcohol
521
What can increase the INR?
Antibiotics Alcohol (liver disease) NSAIDS
522
What are examples of complications with blood transfusions?
Incompatibility Fluid overload Infection transmission
523
What is the definition of lymphoma?
Clonal proliferation of lymphocytes
524
What is the clinical presentation of hodgekins lymphoma?
Lymphadenopathy (fluctuates with alcohol) Fever Night sweats Itching
525
What is the clinical presentation of non-hodgkins lymphoma?
Lymphadenopathy (widely disseminated) Extra nodal disease Symptoms of marrow failure
526
What are the symptoms of lymphoma?
Fever Face/neck swelling Lump in neck/armpit Excessive night sweats Weight loss Loss of appetite
527
What is factors are associated with non-hodgekin lymphoma?
Microbial factors Autoimmune disease Immunosuppresion
528
What is the peak age of Hodgkin lymphoma?
15-40 years
529
What gender is most affected by Hodgkin lymphoma?
2M:1F
530
What is the cure rate of hodgekin lymphoma?
Stage I&II: 90% Stage III&IV: 50-70%
531
What is the peak age of non hodgekin lymphoma?
Any age
532
What proportion of non-hodgekin lymphoma is B vs T cell?
B cell: 85% T cell: 15%
533
What is the % relapse in non-hodgekin lymphoma?
>50%
534
What investigations can be carried out for suspected non-hodgekin lymphoma?
Physical exam Biopsy Blood tests Scanning
535
What is the treatment for non-hodgekin lymphoma?
Chemotherapy Radiotherapy mAbs Haemopoietic stem cell transplant
536
What is leukaemia?
Group of cancers of the bone marrow which prevent normal manufacture of the blood
537
What is the clinical presentation of leukaemia?
Anaemia Neutropenia Thrombocytopenia Lymphadenopathy Splenomegaly Bone pain
538
What are the symptoms of leukaemia?
Fever/chills Persistent fatigue Frequent infection Weight loss Swollen nodes
539
What are the types of leukaemia?
Acute lymphoblastic leukaemia Acute myeloid leukaemia Chronic lymphocytic leukaemia Chronic myeloid leukaemia
540
What are the features of acute lymphoblastic leukaemia?
Peak age: 4 years 80% cured Better prognosis in females
541
What are the features of acute myeloid leukaemia?
More common in elderly 30-40% of under 60s cured 10% over 70s cured
542
What are the features of chronic lymphocytic leukaemia?
Peak age 70 2M:1F B cell clonal lymphoproliferative disease
543
What are the features of chronic myeloid leukaemia?
Peak age 50-70 years Increase in neutrophils and their precursors
544
What is chronic myeloid leukaemia associated with?
Philadelphia chromosome
545
What are the risk factors of leukaemia?
Previous cancer treatments Genetic disorders Smoking Family history
546
What are the investigations for leukaemia?
Blood tests Bone marrow tests
547
What are the treatments for leukaemia?
Chemotherapy Radiotherapy mAbs Haemopoietic stem cell transplant
548
What is porphyria?
Abnormality of haem metabolism
549
What is severe sepsis?
Sepsis and acute organ dysfunction
550
What is the definition of septic shock?
Sepsis in which the underlying circulatory and cellular and/or metabolic abormalities are marked enough to substantially increase mortality
551
What are the features of septic shock?
Persisting hypotension that requires vasopressors to maintain mean arterial pressure at >=65mmHg with a mean serum lactate concentration of >2mmol l-1
552
What does qSOFA stand for?
Quick Score for Sepsis
553
What are the components of qSOFA?
Respiratory; >= 22 breaths/ min Altered Mentation; GCS <15 Systolic Blood Pressure; <=100mmHg
554
What does the Glasgow Coma Score assess?
Eye opening Verbal response Motor response
555
What is the immunopathogenicity of sepsis?
Innate Immunity Complement System Vascular Endothelium Coagulation System Adaptive Immunity
556
What is peptic ulcer disease?
Ulcers affecting any acid affected site in the gastrointestinal tract due to gastric inflammation
557
What are the causes of peptic ulcer disease?
High acid secretion (duodenal) Normal acid secretion (stomach) but reduced protective barrier and high h.pylori involvement Drugs: NSAIDs, steroids
558
What is helicobactor pylori?
Bacterium associated with peptic ulcers
559
What is the triple therapy for h.pylori?
2 antibiotics (amoxycillin and metronidazole) Proton pump inhibitor (omeprazole)
560
What is the treatment for peptic ulcers?
Lifestyle changes Diet changes Ulcer healing drugs Surgical repair/endoscope which complications occur
561
What is the presentation of peptic ulcers?
Epigastric burning pain: worse before/after food, at night
562
What are the investigations for peptic ulcers?
Endoscopy Radiology FBC and FOB (anaemia) Pylori testing: breath, antibiotics, mucosa
563
What are complications associated with peptic ulcers?
Local: perforation, haemorrhage, stricture, malignancy Systemic: anaemia
564
What is coeliac disease?
Autoimmune disease in which exposure to gluten causes an autoimmune reaction leading to inflammation of the small bowel
565
What is the allergy in coeliac disease?
Beta-gliaden
566
What is polyphria?
Abnormality of Haem metabolism
567
How does polyphria present?
Photosensitive rash Hypertension Tachycardia Neuropsychiatric disturbances
568
What happens during vasoconstriction (in haemostasis)
Damaged vessel --> Vascular spasm --> Vasoconstriction
569
What are the steps of the formation of a platelet plug?
ECM releases cytokines and inflammatory markers --> Platelet adhesion --> Platelet plug formation
570
What do platelets release?
ADP Serotonin (maintains vasoconstriction) Prostaglandins and phospholipids (maintains vasoconstriction)
571
What is haemophilia?
Rare inherited condition that affects the body's ability to form blood clots
572
What are the clinical features of mild haemophilia?
Bleeding occurs after injury, surgery or extraction
573
What are the clinical features of moderate haemophilia?
Bleeding into joints and muscles after minor injury or spontaneously
574
What are the clinical features of severe haemophilia?
Spontaneous bleeding into joints and muscles
575
What type of genetic predisposition is assoicated with haemophilia?
Sex linked recessive Defective gene on X chromosome
576
What clotting factor is deficient in haemophilia A?
8
577
What clotting factor is deficient in haemophilia B?
9
578
What are the investigations for haemophilia?
Blood test Clotting screen Genetic test
579
What is the treatment of severe and moderate haemophilia A?
Recombinant factor VII
580
What is the treatment of mild and carriers of haemophilia B?
DDVAP (desmopressin) Transaxemic acid
581
How common is haemophilia A?
1 in 10,000
582
How common is haemophilia B?
1 in 50,000
583
What is the treatment for haemophilia B?
Recombinant factor IX
584
What dental treatments should be cautioned in patients with haemophilia?
LA: lingual infiltration, posterior superior alveolar nerve block, IDB Extractions Minor/Periodontal surgery Biopsies
585
What is Von Willebrand's Disease?
Deficiency of Von Willebrand factor (which reduces factor 8 levels)
586
What are the clinical features of VWD?
Large/easy bruises Frequent nose bleeds Bleeding gums Heavy periods
587
What is the genetic predisposition of VWD?
Autosomal dominant mutation
588
What investigations can be carried out for VWD?
Blood test Genetic tests
589
What is the treatment for severe and moderate VWD?
DDAVP
590
What is the treatment for mild and carriers of VWD?
Transaxemic acid
591
What is thrombophilia?
Increased risk of blood clot development
592
What are the causes of thrombophilia?
Inherited: protein S/C deficiency, antithrombin 3 deficiency, factor V Leiden variant Acquired: cancer, pregnancy
593
What is a potential treatment of thrombophilia?
Anti-thrombin
594
What is thrombocytopenia?
Reduced platelets
595
What are causes of thrombocytopenia?
Idiopathic Drug related
596
What is qualitative platelet disorders?
Normal platelet count but abnormal function
597
What are the causes of qualitative platelet disorders?
Inherited: Bernard Soulier Syndrome, Hermansky Pudlak, Glanzmann's Thrombasthenia Acquired: cirrhosis, drugs, alcohol, cardiopulmonary bypass
598
What are the investigations for qualitative platelet disorders
Blood test
599
What are irreversible risk factors for CVDs?
Age Sex Family history
600
What are reversible patient risk factors for CVDs?
Smoking Obesity Diet
601
What are reversible medical risk factors for CVDs?
Hypertension Hyperlipidaemia Diabetes
602
What are examples of primary preventions for CVDs?
Exercise Diet No smoking
603
What are examples of secondary prevention for CVDs?
Medical treatment to reduce risk: control cholesterol, hypertension, antiplatelet drugs
604
What are the 4 acute coronary syndromes?
Stable angina Unstable angina NSTEMI STEMI
605
What are the features of stable angina?
Pain due to increased demand due to atherosclerotic plaque Demand ischaemia, no infarct Normal ECG Normal troponins
606
What are the features of unstable angina?
Plaque ruptures, thrombus formation, partial occlusion of the vessel, pain at rest Supply ischaemia, no infection Normal, inverted T waves or ST depression (ECG) Normal troponins
607
What are the features of NSTEMI?
Plaque ruptures, thrombus formation, partial occlusion of vessel, subendocardial myocaridal infarction Subendocardial infection Normal, inverted T waves or ST depression (ECG) Elevated troponins
608
What are the features of STEMI?
Complete occlusion of blood vessel lumen, transmural injury and infarction to myocardium Transmural infarct Hyperacute T waves or ST elevation (ECG) Elevated troponin
609
What is cyanosis?
5g/dl or more deoxygenated Hb in blood
610
What are the causes of central cyanosis?
Congenital heart disease
611
What are the causes of peripheral cyanosis?
Cold environment
612
What are the symptoms of ulcerative colitis?
Colonic disease (diarrhoea, abdominal pain, pr bleeding)
613
What are the symptoms of ulcerative colitis?
Colonic disease (diarrhoea, abdominal pain, pr bleeding)
614
What demographic factors are most affected by ulcerative colitis?
F>M W>B
615
How does ulcerative colitis present?
Continuous Rectum always involved Anal fissures 25% Ilium involved 10% Mucosa granular and ulcerated Vascular Serosa normal
616
How does ulcerative colitis present microscopically?
Mucosal Vascular Mucosal abscesses
617
What risk is associated with ulcerative colitis?
Carcinoma
618
What investigations can be carried out to diagnose ulcerative colitis?
Blood tests (anaemia, C-reactive protein, erythrocyte sedimentation rate) Faecal cal protein Endoscopy Leukocyte scan Barium studies Bullet endoscopy
619
What investigations can be carried out for bowel bleeding/inflammation?
Biopsy Faecal occult blood test (FOBT) Colonoscopy
620
What treatments are carried out for ulcerative colitis?
Immunosuppressants: systemic steroids (prednisolone), local steroids (rectally administered), anti-inflammatory drugs (5-ASA based; pentasa, mesalazine), non-steroid immunosuppressants (azathioprine), anti-TNF alpha therapy: infliximab, adalimumab
621
What gender is most affected by crohns/ulcerative colitis?
Crohns: male Ulcerative colitis: female
622
What race is most affected by crohns and ulcerative colitis?
White
623
What is the pattern of crohns and ulcerative colitis?
Crohns: discontinuous Ulcerative colitis: continuous
624
What % rectum involvement in crohns and ulcerative colitis?
50% crohns 100% UC
625
What is the % of anal fissures in crohns and ulcerative colitis?
Crohns: 75% UC: 25%
626
What is the % ileum involvement in Crohns and UC?
Crohns: 30% UC: 10%
627
What is the mucosa in crohns and ulcerative colitis?
Crohns: cobbled UC: granular
628
What is the vascular role in crohns and ulcerative colitis?
Crohns: non-vascular UC: vascular
629
What is the serosa like in crohns vs ulcerative colitis?
Crohns: inflammation Ulcerative colitis: normal
630
What is the association between iron deficient anaemia and inflammatory bowel disease?
Due to inflammation and bleeding in intestines Inflammation can affect RBC productions Can affect iron absorption (irons/protein production affected) Medications such as NSAIDs and corticosteroids can affect iron absorption
631
Why can iron deficient ananemia lead to fatigue?
Lack of oxygen to tissues and organs
632
What is dysphagia?
Difficulty swallowing
633
What are the clinical features of dysphagia?
Food sticking
634
What are the causes of dysphagia?
External compression (lungs, aorta, atrial enlargement, cervical spine) Dysmotility disorders (fibrosis- scleroderma, acid related fibrosis) Neuromusclar dysfunction (Parkinson’s, diabetes, achalasia)
635
What are the clincial features of gastrointestinal reflux disease?
Epigastric burning (worse when lying down) Dysphagia GI bleeding Severe pain
636
What are the causes for GORD?
Defective lower oesophageal sphincter Impaired lower cleaning Impaired gastric emptying
637
What is the treatment of GORD?
Smoking cessation Weight loss Antacids H2 blockers Proton pump inhibitors
638
What are the clinical features peptic ulcer disease?
Asymptomatic Epigastric burning pain before/after meals Local complication: perforation, haemorrhage stricture Systemic: anaemia
639
What are the causes of peptic ulcer disease?
High acid secretion: duodenal Normal acid: stomach (helicobacter pylori involvement) Drugs: NSAIDs
640
What are the causes of peptic ulcer disease?
High acid secretion: duodenal Normal acid: stomach (helicobacter pylori involvement) Drugs: NSAIDs
641
What are the investigations for peptic ulcer disease?
Endoscopy Radiology Anaemia symptoms: fbc, fob, h.pylori (breath, antibodies, mucosa)
642
What are the medical treatments options for peptic ulcer disease?
Smoking cessation Small regular meals Ulcer healing drugs Eradication therapy
643
What are the surgical treatments for peptic ulcer disease?
Endoscope Surgical repair Vagotomy
644
What is bilroth 1?
Lower stomach removed Duodenum attached to top stomach
645
What is bilroth 2?
Lower stomach removed Duodenum stitched up Top stomach attached to small bowel
646
What is jaundice?
Accumulation of bilirubin in the skin
647
What are the clinical features of jaundice?
Yellow/orange pigmentation in skin and sclera of eye Conjugated bilirubin excreted in urine and faeces
648
What are the causes of pre-hepatic jaundice?
Increased harm load (autoimmune, spleen, abnormal RBCs) Excessive quantities of rbc breakdown products
649
What are the post-hepatic causes of jaundice?
Liver cell failure (cirrhosis, hepatitis) Prevents metabolism of rbc breakdown products
650
What are the post-hepatic causes of jaundice?
Liver cell failure (cirrhosis, hepatitis) Prevents metabolism of rbc breakdown products
651
What are the post-hepatic causes of jaundice?
Biliary, gall bladder and pancreatic disease Obstruction to bile outflow Gallstones can block biliary tree, cause inflammation and move out to biliary tree, causing pain in shoulder tip, RHS of abdomen (fatty foods)
652
What are the neonatal causes of jaundice?
Blood infection, difficult birth, hypoxia, abo and rhesus incompatibility Poor liver function in neonate Risk of kernicterus
653
What are the investigations for jaundice?
Ultrasound (detect dilated bile channels) Plain radiographs (show gall stones) Endoscopic Retrograde Cholangio Pancreatography (contrast radiograph of biliary tree)
654
What is the treatment of pre-hepatic jaundice?
Identify and treat cause
655
What is the treatment of post hepatic jaundice?
Remove obstruction (biliary tree stent)
656
What is the treatment of neonatal jaundice?
Phototherapy
657
What is the management of jaundice?
Remove gall bladder (cholescystectomy) Prevent build up of bile acid (urodeoxycholic acid, low cal/cholesterol diet) Prevent bile acid resorption for git (colestyramine)
658
What is the definition of liver failure?
Loss of liver function
659
What are the clinical features liver failure?
Loss of synthetic function: plasma proteins, clotting factors Loss of metabolic function: drug metabolism (affects first pass), detoxication, conjugation of rbc products
660
What are the effects of liver failure?
Fluid retention Raised INR Portal hypertension Inability to remove toxins (causes encelopathy) Jaundice
661
What are the causes of acute liver failure?
Paracetamol poisoning Rapid death due to bleeding Encephalopathy (brain damage)
662
What are the causes of chronic liver failure?
Cirrhosis Primary/secondary liver cancer
663
What are the investigations for liver failure?
Hepatic cell enzyme levels (alt, ggt (increase in liver inflammation) INR levels
664
What is the treatment of acute liver failure?
Liver transplant
665
What is MARS?
Molecular Adsorbent Recirculaitng System (MARS)
666
What are the dental implications of liver failure?
Prolonged effect of sedatives Drug doses may need to be reduced NSAIDs increase bleeding risk Reduced blood clotting
667
What is cirrhosis?
Mixture of damage, fibrosis and regeneration of liver structure
668
What are the clinical features of cirrhosis?
Often none Acute bleeding (portal hypertension) Jaundice Oedema Ascites (abdominal fluid) Encelopathy Spider naevi Palmar erythema
669
What are the causes of cirrhosis?
Alcohol Primary biliary cirrhosis Viral disease Autoimmune chronic hepatitis Cystic fibrosis Haemachromatosis
670
What are the investigations for cirrhosis?
Blood tests Scans Liver biopsy
671
What hormones does the anterior pituitary gland produce?
Thyroid stimulating hormone (TSH) Adrenocorticotrophic hormone (ACTH) Growth hormone (GH) Lutenising hormone (LH) Follicle stimulating hormone (FSH) Prolactin
672
What is the pathway of production of thyroid stimulating hormone?
Hypothalamus Thyroid releasing hormone (TRH) Anterior pituitary TSH Thyroid gland T3/4 Target tissue (Negative feedback control)
673
What is the pathway of adrenocorticotropic hormone (ACTH)?
Hypothalamus Corticotropin releasing hormone (CRH) Anterior pituitary ACTH Adrenal cortex Cortisol/Aldosterone/Androgens Target tissue
674
What is the pathway of growth hormone?
Hypothalamus Growth hormone releasing hormone- somatostain reduction Anterior pituitary Growth hormone Liver and target tissues Insulin like growth hormone
675
What is the pathway for LH and FSH?
Hypothalamus Gonadotropin-releasing hormone Anterior pituitary LH, FSH Gonads Sex hormone release
676
What hormones are produced by the posterior pituary gland?
Antidiuretic hormone Oxytocin
677
What is the pathway of antidiuretic release?
Hypothalamus Posterior pituitary ADH Kidney
678
What are the parts of the adrenal gland?
Zona glomerulosa (cortex) Zona fascularis Zona reticular is
679
What are the parts of the adrenal gland?
Zona glomerulosa (cortex) Zona fascularis Zona reticularis (medulla)
680
What does zona glomerulosa produce?
Aldosterone
681
What is aldosterone responsible for?
Salt and water retention (inc na+ resorption and k+ loss) Inhibited by ACE inhibitors and AT2 blockers
682
What does zona fasularis produce?
Cortisol
683
What is cortisol?
Natural glucocorticoid Physiological steroid effects- antagonist to glucose, lowers immune reaction, raises bp, inhibits bone synthesis
684
What is the zona reticularis responsible for?
Adrenal androgens
685
What is the effect of pituitary hypofunction due to pituitary failure?
Low ACTH Low cortisol Increased synACTHen
686
What is the effect of adrenal hypofunction due to gland destruction?
High ACTH Low cortisol Decreased synACTHen
687
What is the 5YS of thyroid cancer in young?
5%
688
What is the 5YS of thyroid cancer in older people?
80%
689
What is the definition of acromegaly?
Excess growth hormone
690
What are the clinical features of acromegaly?
30-50 years Coarse features Enlarged hands and mandible T2D CVD (ischaemic heart disease, acromegaly cardiomyopathy) Enlarged supra-orbital ridges Broad nose Thickened lips and soft tissues
691
What are the causes of acromegaly?
Associated with MEN1 Increased GH after bone plate fusion Pituitary adenoma
692
What are the investigations for acromegaly?
Blood tests for growth hormone
693
What are the treatments for acromegaly?
GH production reduction (drugs) Surgical removal of tumour
694
What are the dental aspects of acromegaly?
Enlarged tongue Interdental spacing Reverse over bite Shrunk dentures
695
What is addisons disease?
Primary adrenal hypofunction Affects cortisol
696
What are the symptoms of addisons disease?
Weakness Anorexia Body hair loss
697
What are the signs of addisons disease?
Postural hypertension Vitiligo Hyperpigmentation (more common in primary) Weightloss Lethargy
698
How does Addisons disease present?
Hypotension Vomiting Eventual coma
699
What are the causes of Addisons disease?
Tb association Autoimmune adrenalitis (organ specific autoimmune disease)
700
What would the investigation results for Addisons disease be like?
High ACTH Negative synACTHen test (no plasma cortisol rise in response to ACTH injection)
701
What is the treatment of Addisons disease?
Hormone replacement (fludrocortisone)
702
What are the dental aspects of Addisons disease?
Steroid precautions- may need increased dose for dental treatment due to stress to prevent adrenal crisis Oral pigmentation
703
What are the two types of corticosteroids?
Mineralcorticosteroids Glucocorticosteroids Inhaled
704
What do mineralcorticosteroids do?
Regulate salt and water balance (aldosterone)
705
What is an example of mineralcorticosteroids?
Fludrocortisone
706
What do glucocorticosteroids do?
Reduce inflammation and suppress immune system (cortisol)
707
What are examples of glucocorticosteroids?
Prednisone Dexamethasone Hydrocortisone
708
What are examples of glucocorticosteroids?
Prednisone Dexamethasone Hydrocortisone
709
What do inhaled corticosteroids do?
Treat respiratory conditions
710
What are examples of inhaled corticosteroids?
Fluticasone Budesonide
711
What is the definition of Cushing syndrome?
Adrenal gland hyper function (cortisol)
712
What are the symptoms of Cushing syndrome?
Poor infection resistance Osteoporotic changes (back pain, bone fractures) Psychiatric disorders (depression, emotional lability, psychosis) Hirsuitism (female hair growth) Skin and mucosal pigmentation (due to similarities between ACTH and melanostimulating hormone)
713
What are the signs of Cushing syndrome?
Centripetal obesity (moon face, buffalo hump) Hypertension Thick skin Púrpura Muscle weakness
714
What is the cause of primary Cushings?
Adrenal tumour
715
What is the cause of secondary cushings?
Pituitary tumour
716
What are the investigations for cushings?
High 24 hour urinary cortisol excretion Abnormal dexamethasone suppression tests CRH tests
717
What is the treatment for Cushings disease?
Detect cause Surgery (pituitary or adrenal)
718
What are the dental aspects of cushings?
Candidiasis Oral pigmentation
719
What is conns syndrome?
Adrenal hyperfunction (aldosterone)
720
What are the clinical features of conn’s syndrome?
Excessive thirst Fatigue Frequent urination Headache
721
What are the causes of conn’s syndrome?
Tumours of the adrenal gland Low blood potassium High blood pressure
722
What are the investigations for conn’s syndrome?
Aldosterone levels in blood
723
What is the treatment for Conn’s syndrome?
Drugs that block aldosterone Exercise Alcohol reduction Stop smoking
724
What is hyperthyroidism?
Increased thyroid production
725
What are the symptoms of hyperthyroidism?
Hot and excess sweating Weight loss Diarrhoea Palpitations Muscle weakness Irritable Manic Anxious
726
What are the signs of hyperthyroidism?
Warm Moist skin Tachycardia Atrial fibrillation Increased blood pressure Heart failure Tremor Palpitations Eye retraction Lid lag
727
What is the cause of hyperthyroidism?
Graves’ disease (70-80%),, proptosis of eye Toxic multinodular goitre, toxic adenoma, pituitary tumour Family history of autoimmune disease
728
What are the investigations for hyperthyroidism?
Blood tests for TSH, T3, T4, Ultrasound/radioisotope imaging Fine needle aspirate/biopsy
729
How would pituitary cause hyperthyroidism present in investigations?
High TSH High T3
730
How would graves/adenoma caused hyperthyroidism present in investigations?
Low TSH High T3
731
What is the treatment of hyperthyroidism?
Carbimazole Beta blockers Radioiodine-1311 Partial thyroidectomy
732
What are the dental aspects of hyperthyroidism?
Pain anxiety Psychiatric problems May have to postpone treatment
733
What is hypothyroidism?
Decreased thyroid hormone production
734
What are the symptoms of hypothyroidism?
Tired Cold intolerance Weight gain Constipation Hoarse voice Goitre Puffed face and extremities Angina ‘Slow’ Poor memory Hair loss
735
What are the causes of primary hypothyroidism?
Autoimmune thyroiditis (hashimotos) (90%) Idiopathic atrophy Radioiodone treatment Thyroidectomy Carbimazole Iodine deficiency Congenital
736
What does hashimotos present as and who is mainly affected?
Goitre and hypothyroidism features Middle aged and elderly women
737
Who does idiopathic atrophy affect and what is its cause?
Increases with age 10F:1M Autoimmune cause
738
What are the causes of secondary hypothyroidism?
Hypothalamic/pituitary disease
739
What are the investigations for hypothyroidism?
Blood tests for TSH, T3, T4 Ultrasound/radioisotope imaging Fine needle aspirate/biopsy
740
How may pituitary cause hypothyroidism present in investigations?
Low TSH, Low T4 (Rare)
741
How may gland failure hypothyroidism present?
High TSH, Low T4
742
What is the treatment of hypothyroidism?
T4 tablets (thyroxine)
743
What are the dental aspects of hypothyroidism?
Avoid sedative use
744
What is the definition of multiple endocrine neoplasia?
Disorders of the endocrine system that increase an individuals likelihood of developing endocrine tumours
745
What are the clinical feature of MEN1?
Tumours of parathyroid, pituitaty, pancreas and adrenal
746
What are the clincial features of MEN2a?
Medullary thyroid cancer (young adult) Pheochromocytoma (adrenal) Hyperparathyroidism Cutaneous lichen amyloidosis (itchy skin)
747
What are the clinical features of MEN 2b?
Medulary thyroid cancer (early childhood) Pheochromocytomas Tall, slender Benign tumours on lips and tongue Eyelid and lip thickening Spine curvature
748
What is the cause of MEN1?
Mutation of MEN1 TSG
749
What is the cause of MEN2?
Mutation of RET gene
750
What is the definition of T1DM?
Inability to produce insulin
751
How does T1DM present?
Increased thirst and urination Fatigue Weightloss
752
How does T1DM present in young?
Keroacidosis
753
What are acute complications of T1DM?
Hypoglycaemia
754
What are chronic complications of T1DM?
Cardiovascular Infection Neuropathy (weakness and wasting of muscles, bladder/bowel dysfunction)
755
What are large vessel complications of T1DM?
Atheroma
756
What are small vessel complications of T1DM?
Poor wound healing Wound infections Renal disease Eye disease (cataract, diabetic retinopathy)
757
What are the causes of T1DM?
Autoimmune reaction to pancreatic beta cells Familial
758
What are the investigations for T1DM?
Blood test Glucose toleraance test Random plasma glucose
759
What are the diagnostic results on a blood test for T1DM?
HbA1c >48mmol/mol
760
What are the diagnostic results of a glucose tolerance test for diabetes?
Before test (fasting plasma glucose) (mmol/L) <6.1 normal 6.1-7.0 impaired >7.0 diabetes 2 hours after load (75g) <7.8 normal 7.8-11.1 impaired >11.1 diabetes
761
What are the diagnostic results of a glucose tolerance test for diabetes?
Before test (fasting plasma glucose) (mmol/L) <6.1 normal 6.1-7.0 impaired >7.0 diabetes
762
What is the diagnostic result for random plasma glucose test?
>11.1 mmol/l on two occasions
763
What are the targets of T1DM treatment?
Preprandial (before meals): 4-6mmol/L Bedtime: 6-8mmol/L
764
What is the treatment of T1DM?
Insulin injections Glucose monitoring
765
What are two examples of insulin regimes?
Basal bolus Split mixed
766
What is the difference between basal bolus and split mixed insulin regime?
Basal bolus: more injections, better control Split mixed: fewer injections, poorer control
767
What is the difference between basal bolus and split mixed insulin regime?
Basal bolus: more injections, better control Split mixed: fewer injections, poorer control
768
What is the dental relevance of T1DM?
Effect of hypoglycaemia Managing diabetic complications
769
What is T2DM?
Insulin resistance
770
What are the clinical features of T2DM?
Increased thirst and urination Fatigue
771
What are the acute complications of T2DM?
Hypoglycaemia
772
What are the chronic complications of T2DM?
Cardiovascular disease Infection Neuropathy (weakness and wasting of muscles, Bladder/bowel complications
773
What are the large vessel complications of T2DM?
Atheroma
774
What are the small vessel complications of T2DM?
Poor wound healing Wound infections Renal disease Eye disease (cataract, diabetic retinopathy)
775
What are the causes of T2DM?
Obesity High sugar diet Lack of exercise Familial
776
What are the medical treatments for T2DM?
Metformin DDP-4 inhibitors GLP-1 mimentics Sulphonylureas
777
What is the patient focused treatment of T2DM?
Lifestyle changes: exercise, diet Patient education Plasma glucose monitoring Gastric band
778
What is atherosclerosis?
Narrowing of large blood vessels
779
What are the modificable risk factors for atherosclerosis?
Hyperlipidaemia Smoking Obesity Lack of exercise Diet
780
What are the non-modifiable risk factors for atherosclerosis?
Increased age M>F Genes (familial hypercholesterolaemia, mutation of LDL receptor)
781
What are the non-modifiable risk factors for atherosclerosis?
Increased age M>F Genes (familial hypercholesterolaemia, mutation of LDL receptor)
782
What is arteriosclerosis?
Age related changes in small blood vessels
783
What are the stages of Atheroma formation?
Cholesterol deposition in blood vessel walls Chronic inflammatory response Healing response Atheroma formation
784
What happens during the chronic inflammatory response phase?
Endothelial cells change cell receptor Increased permeability to lipids, cell adhesion changes to allow monocyte attachment
785
What happens during the chronic inflammatory response phase?
Endothelial cells change cell receptor Increased permeability to lipids, cell adhesion changes to allow monocyte attachment

Finals (20 decks)

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