Diseases of Human Systems Flashcards
(280 cards)
1
Q
what is arthritis?
A
inflammation of joints
2
Q
what is arthrosis?
A
non-inflammatory joint disease
3
Q
what is athralgia?
A
joint pain
4
Q
what makes up bone?
A
o Mineralised Connective tissue
o Calcium
o Phosphate
o Vitamin D
5
Q
what does the parathyroid hormone maintain?
A
serum calcium level
6
Q
what does parathyroid hormone increase?
A
Increases calcium release from BONE
7
Q
what does parathyroid hormone reduce?
A
Reduces RENAL calcium excretion
8
Q
what is hypothyroidism?
A
low serum calcium
9
Q
what are causes of vitamin D problem?
A
o Low Sunlight Exposure
o Poor GI Absorption
o Drug interactions
o Often a combination of factors
10
Q
what types of drugs causes vitamin D problems?
A
Some antiepileptic drugs
* Carbamazepine, Phenytoin
11
Q
what is osteomalacia?
A
Poorly mineralised osteoid matrix
Poorly mineralised cartilage growth plate
12
Q
what is difference between rickets and osteomalacia
A
rickets - during bone formation
osteomalacia - after bone formation
13
Q
what is osteomalacia and rickets related to?
A
Both related to calcium deficiency
* Serum calcium preserved at expense of bone
14
Q
what does low dietary calcium lead to?
A
leads to reduction in plasma calcium leads to increased PTH secretion - increase in lots stuff except decrease in urinary calcium then leads to restoration of normal calcium
15
Q
what are effects of hypocalcaemia?
A
o Muscle weakness
o Trousseau & Chvostek signs positive
Carpal muscle spasm
Facial twitching from VII tapping
16
Q
what is management of calcium problems in bone?
A
- Correct the cause
o Malnutrition
Control GI disease
o Sunlight exposure
30 mins x 5 weekly
o Dietary Vitamin D
17
Q
what is osteoporosis?
A
loss of mineral and matrix
- reduced bone mass
18
Q
what systemic problem is a risk factor for osteoporosis?
A
endocrine
19
Q
what are effects of osteoporosis?
A
- Increased bone fracture risk
o Height loss
o Kyphosis & Scoliosis
o Nerve root compression – back pain
20
Q
what is kyphosis?
A
cervical spine tipped forward
21
Q
what is scolisois?
A
abnormal twisting and curvature of spine
22
Q
how to prevent osteoporosis?
A
Build maximal Peak Bone Mass
Reduce rate of Bone Mass loss
23
Q
how to build maximal peak bone mass?
A
exercises
high dietary calcium intake
24
Q
how to reduce rate of bone mass loss?
A
o Continue exercise and calcium intake
o Reduce hormone related effects
o Reduce drug related effects
o Consider ‘Osteoporosis Prevention’ drugs
BISPHOSPHONATES
25
what are effects of oestrogen hormone replacement in reducing risk of osteoporosis?
o Reduces osteoporosis risk
o Increases breast cancer risk
o Increase endometrial cancer risk
Patients who have NOT had a hysterectory
Combine with a progestogen to reduce risk
o May reduce ovarian cancer risk
o Increases DVT risk
26
what are types of Multisystem vasculitic inflammatory diseases?
* Systemic lupus erythematosis (SLE)
* Systemic sclerosis (Scleroderma)
* Sjogrens syndrome (SS)
* Undifferentiated connective tissue disease (UCTD)
27
what are types of large vessel vasculitic diseases?
* Giant cell (temporal) arteritis
* Polymyalgia rheumatica
28
what are types of medium vessel vasculitic diseases?
* Polyarteritis nodosa
* Kawasaki disease
29
what are types of small vessel vasculitic diseases?
* Wegener’s Granulomatosis
30
how to manage connective diseases?
Analgesic NSAIDs (joint/muscle symptoms)
Immune modulating treatment
* Hydroxychloroquine
* Methotrexate
* Azathioprine
* Mycophenolate
* Biologic Medication – Cytokine inhibitors and lymphocyte depleting drugs
Systemic steroids – prednisolone
31
what does SLE look similar to?
lichen planus
32
what are circulating blood autoantibodies with SLE?
ANA, dsDNA & Ro antibodies
33
what are dental aspects of SLE?
- chronic anaemia
* oral ulceration
*GA risk
- Bleeding tendency
*thrombosytopaenia
- renal disease
*impaired drug metabolism
- drug reactions
- steroid and immunosuppresive therapy
*possible increased malignancy risk
- lichenoid oral reactions
- oral pigmentation from hydroxychlorquine use
34
what does chronic anaemia causes dentally?
-oral ulceration
- GA risk
35
what does taking hydroxychloroquine do dental?
oral pigmentation
36
what is Antiphospholipid Antibody Syndrome (APS) characterised by?
o Characterised by recurrent Thrombosis
DVT with pulmonary embolism
o Venous & arterial thrombosis
37
what do you not stop with when have Antiphospholipid Antibody Syndrome (APS)?
anticoagulant
38
what is sjogren's syndrome associated with what circulating autoantibodies?
ANA, Ro and La
39
what is sjogren syndrome associated with?
dry eyes and dry mouth
40
what is there a major involvement with in sjogren syndrome?
salivary glands
41
what is sicca syndrome?
Dry eyes or Dry mouth
42
what is primary sjogrens?
Not associated with any other disease
43
what is secondary sjogren?
Associated with another Connective Tissue disease – Rheumatoid Arthiritis, SLE, etc.
44
what are oral and dental implications of sjogrens syndrome?
Oral Infection
Caries risk
Functional loss
Denture retention
Sialosis
Salivary lymphoma
* Unilateral gland size change
* usually after years
45
what is systemic sclerosis?
o excessive collagen deposition
o connective tissue fibrosis
o loss of elastic tissue
46
what is there a gradual onset of with systemic sclerosis?
Raynoud’s phenomenon
renal failure
Malabsorbtion (GI involvement)
47
what are dental aspects of systemic sclerosis?
- involvement of perioral tissues
- Swallowing difficulties
- Dental erosion
- widening of periodontal ligament space - no mobility
48
what is the involment of the perioral tissues like with systemic sclerosis?
* limited mouth opening
* progressively poor oral access
* limited tongue movement
49
what must you do if someone has systemic sclerosis?
plan treatment 10 years ahead
50
what is systemic sclerosis sometimes compounded by?
sjogren
51
what must you watch for if someone has systemic sclerosis?
watch for drug metabolism due to cardiac and renal vasculitic disease
52
what is vasculitis?
* inflammation of blood vessels
53
what does infarction of tissue in vasculitis present as?
o May present as oral inflammatory masses
o May present as ulcers (tissue necrosis)
54
what happens in vasculitis?
Vessel wall thickens with inflammation
* Narrowing of lumen reduced blood flow
55
what is usually commonly involved with giant cell arteritis?
temporal artery
56
what may someone with giant cell arteritis present with?
headache/facial pain
57
what does giant cell arteritis involve?
Involves other carotid branches
* “Chewing claudication”
* Occlusion of central retinal artery (blindness)
58
what is polymalgia rheumatica?
Disease of the elderly
Pain & morning stiffness of muscles
Non-specific systemic features
* Malaise, weight loss, profound fatigue
Responds well to steroids
59
what are non specific systemic factors of polumyalgia rhematica?
* Malaise, weight loss, profound fatigue
60
what does polymyalgia rheumatica respond well to?
steroids
61
what does Kawasaki disease give clinically?
* Fever & lymphadenopathy
* Crusting/cracked tongue
* Strawberry tongue & erythematous mucosa
* Peeling rash on hands and feet
62
what is inflammoatory condition of wegener's granulomatosis?
* Can lead to destruction of hard and soft tissues of the face and oral cavity
* Spongy red tissue
63
what is fibyalgia?
Non-specific collection of musculoskeletal symptoms
* Joint pain
* Muscle pain
* ‘functional disorders’
64
what are dental aspects of vaculitis?
Steroid precautions may be needed
May present to the dentist
* Giant cell arteritis
* Wegener’s Granulomatosis
* Kawasaki Disease
65
what are crystal arthropathies?
Acute monoarthropathies
gout
66
what is Acute monoarthropathies?
* acute arthritis of a single joint
* can be initial stage of polyarthritis
67
what is common causes of acute monoarthropathies?
o infection - septic arthritis
o crystal arthropathy - gout
68
what is gout?
* Uric acid crystal deposition in joints
* Significant pain from reactive inflammation
69
what is hyperuricaemia?
high uric acid levels
70
what enhances gout?
obesity and alcohol enhance?
71
gout is less common in women until when?
menopause then equalises?
72
what are symptoms of gout?
o acute inflammation of SINGLE joint
o usually great toe
o usually a precipitating event
trauma, surgery, illness, diet/alcohol excess
o rapid onset - hours
o NSAIDs to treat
73
what are dental aspects of gout?
o avoid aspirin
interferes with uric acid removal
o drug treatments may give oral ulceration (allopurinol)
74
what happens to aspirin in gout?
o avoid aspirin
interferes with uric acid removal
75
what drug treatments may give oral ulceration?
allopurinol
76
what are symptoms of osteoarthris?
- pain - improve with rest worse with acitivty
- brief morning stiffness
- slowly progressive over years
77
what is treatment of osteooarthritis?
* nothing alters disease progression!
* Pain improved by
o increasing muscle strength around the joint
o weight loss
o walking aids
* role of NSAIDs
* Prosthetic replacement for PAIN
* Joint replacement
78
what is dental aspects of osteoarthrtis?
* TMJ can be involved
o symptoms RARE!
* Difficulty in accessing care
* chronic NSAID use
o oral ulceration possible
o bleeding tendency - anti-platelet
* Joint replacements - AB prophylaxis?
o Usually not needed
79
what is rheumatoid arthritis?
o Initially a disease of the synovium with gradual inflammatory joint destruction
80
what are diff patterns of joint involvement?
Sero-positive RA
* rheumatoid factor present
Sero-negative RA
* rheumatoid factor NOT present
81
what is there a slow onset to in rheumatoid arthrtiis?
* initially hands and feet
* proximal spread
* potentially ALL synovial structures
82
what are early signs of RA?
symmetrical synovitis of MCP joints
symmetrical synovitis of PIP joints
symmetrical synovitis of wrist joints
83
what are late signs of RA?
ulnar deviation of fingers at MCP joints
hyperextension of PIP joints
“Z” deformity of thumb
subluxation of the wrist
loss of abduction and external rotation of shoulders
flexion of elbows and knees
deformity of the feet & ankles
84
what shows up on radiographs with RA?
* erosions, loss of joint space, deformity
* joint destruction & secondary osteoarthritis
85
what are treatment options of RA?
* physiotherapy
* occupational therapy
* drug therapy
* Surgery
86
what is aim of physio therapy?
o Aim to keep the patient active for as long as possible!
o active and passive exercises
to maintain muscle activity
* to improve joint stability
o to maintain joint position
87
what is occupational therapy?
o maximising the residual function
o providing aids to independent living
o assessment & alteration of home
88
what are 2 types of disease modifying drugs?
* hydroxychloroquine, methotrexate,
89
what are dental aspects of RA?
- disability from disease
- sjogrens
- joint replacements
- drug effects
- chronic anaemia - GA problems
90
what does methroxate cuase orally?
oral ulceration
91
what is effects of Sero-negative Spondyloarthritides?
* Disabling progressive lack of axial movement
* symmetrical other joint involvement – e.g.hips
92
what does Sero-negative Spondyloarthritides result?
o low back pain
o limited back and neck movement – turning spine restricted
o limited chest expansion – breathing compromised
o cervical spine tipped forward (Kyphosis)
movements restricted
93
what are dental aspects of sero-negative Spondyloarthritides?
* GA hazardous
o limited mouth opening
o limited neck flexion
* TMJ involvement possible, but rare except in Psoriatic Arthritis
94
tmj involvement in connective disease is rare except in what?
psoriatic arthritis
95
what is stroke?
“acute focal neurological deficit resulting from cerebrovascular disease and lasting more than 24hrs or causing earlier death”
96
stroke is death of brain tissue from what?
hypoxia
97
what happens when there is no local cerebral blood flow?
Infarction of tissue
Haemorrhage into the brain tissue
98
what is transient ischaemic attack?
* Localised loss of brain function
o Ischaemic event – not haemorrhage
99
how long does it take to recover from TIA?
* FULL recovery within 24hrs
o Most recover in 30mins
100
in stroke what does FAST stand for?
facial drooping, arm weakness, speech difficulty and time
101
what are risks for stroke?
HYPERTENSION
SMOKING
Alcohol
ISCHAEMIC HEART DISEASE
Atrial Fibrillation
Diabetes Mellitus
102
when is there greatest risk for stroke in hypertension?
If DIASTOLIC >110mm Hg then a x15 risk compared to diastolic <80mm Hg
103
what are causes of stroke?
Ischaemic stroke – uncertain
Intracranial Bleed
Embolic Stroke
Atheroma of cerebral vessels
104
what happens with an intracranial bleed?
aneurysm rupture
105
what is embolic stroke?
* Embolism from left side of heart
o Atrial fibrillation
o Heart valve disease
o Recent MI
106
where do atheroma's happen?
* Carotid bifurcation
* Internal carotid artery
* Vertebral artery
107
in prevention of stroke what is antiplatelet action?
secondary prevention only
108
what is used in antiplatelet action for stroke?
* Aspirin
* Dipyridamole
* Clopidogrel
109
when are anticoagulants used in stroke?
when there is an embolic risk - AF, LV thrombus
110
what do you need to differentiate when you investigate stroke?
* INFARCT
* BLEED
* Subarachnoid Haemorrhage
111
what is best investigation of visualising brain circulation?
o MRA (MR angiography)
112
what risk factors should you assess in stroke?
* Carotid ultrasound
* Cardiac ultrasound (LV thrombus)
* ECG (arrhythmias)
* Blood pressure
* Diabetes screen
* Thrombophilia screen (young patients)
113
why do you assess for cardiac ultrasound?
for LV thrombus
114
when do you assess for thrombophilia screen
in younger patients
115
what is the effect of stroke?
Loss of functional brain tissue
* immediate nerve cell death
* Nerve cell ischaemia in penumbra around infarction
o Will die if not protected
Gradual or rapid loss of function
* Stroke may ‘evolve’ over minutes or hours
Inflammation in tissue surrounding the infarct/bleed
* Recovery of some function with time
116
what happens to tissue surrounding infarct/bleed?
inflammation
117
what happens when there is a loss of functional brain tissue in stroke?
* immediate nerve cell death
* Nerve cell ischaemia in penumbra around infarction
o Will die if not protected
118
what are complications of stroke?
Motor function loss
Sensory loss
Cognitive impairment
119
what happens to motor function loss in stroke?
* Cranial nerve or somatic (opposite side!)
* Autonomic in brainstem lesions
* Dysphonia
* Swallowing
o Aspiration of food & saliva
o Pneumonia and death
120
what happens in sensory loss in stroke?
* Cranial nerve or somatic (opposite side!)
* Body perception
o Neglect
o Phantom limbs
121
what happens in cognitive impairment for complication of stroke?
* Appreciation – special sensation
* Processing
o understanding of information
o Speech and language
Dysphasia, dyslexia,dysgraphia & dyscalculia
* Memory impairment
* Emotional lability and depression
122
what are the treatments in acute phase of stroke?
o Reduce damage
o Remove haematoma
o Prevent future risk
123
during acute phase of stroke how do you reduce damage?
Penumbra region – survivable ischaemia
* Calcium channel blockers (Nimodipine)
Improve blood flow/oxygenation
* Thrombolysis possible within 3hrs (alteplase)
* Maintain perfusion pressure to brain tissue
Normoglycaemia - hyper/hypo harmful
124
what do you do for treatment of penumbra region to reduce damage in acute phase of stroke treatment?
* Calcium channel blockers (Nimodipine)
125
how do you improve blood flow in acute phase of stroke treatment?
* Thrombolysis possible within 3hrs (alteplase)
* Maintain perfusion pressure to brain tissue
126
what do you remove heamatoma from in acute phase of stroke treatment?
Subarachnoid haemorrhage only
127
how do you prevent future risk in acute phase of stroke treatment?
Aspirin 300mg daily
Anticoagulation if indicated (delay 2 weeks)
* Atrial Fibrillation
* Left ventricular thrombus
128
how much aspirin do you give to prevent future risk of stroke in acute phase treatment?
300mg
129
what do you do if anticoagulation is indicated in acute phase of stroke treatment?
delay 2 weeks
130
when is anticoagulation is indicated in acute phase of stroke treatment?
* Atrial Fibrillation
* Left ventricular thrombus
131
what is given during treatment of chronic phase of stroke treatment?
Immobility support
Speech and language therapy
Occupational therapy
132
what are dental aspects of stroke?
Impaired mobility & dexterity
Communication difficulties
* Dysphonia, dysarthria
* cognitive difficulties
Risk of Cardiac Emergencies
* MI
* Further stroke
Loss of protective reflexes
* Aspiration
* Managing saliva
o ?anticholinergic drugs help
Loss of sensory information
* Difficulty in adaption to new oral environment
e.g. new dentures
‘Stroke pain’
* CNS generated pain perception
133
what is epilepsy associated with and what does it lead to?
* Epilepsy is associated with reduced GABA levels in the brain
* This leads to abnormal cell-cell message propagation
134
what are the types of generalised epilespy?
Tonic/clonic
Absence (petit mal)
myoclonic/atonic
135
what are types partial epilepsy?
simple partial
complex partial
simple sensory
136
what are epilepsy triggers?
o Idiopathic
o Trauma - head injury
o CNS disease
o Social
137
what is tonic clonic seizures?
prodromal aura
loss of consciousness/continence
initial tonic (stiff)
clonic - (contraction/relaxation)
post-ictal drowsiness
138
what does status epilepticus mean?
recurrent seizures
139
how long do petit mal seizures last?
5-15 seconds
140
what happens with a petit mal seizure?
loss of awareness – eyelids flutter, vacant stare, stops activity, loss of response
141
when do petit mal seizures usually happen?
CHILDHOOD usually
Can be multiple attacks in a single day
142
what must you do if someone is having a tonic clonic seizure?
INJURY - protect where possible
* remove objects from the mouth IF POSSIBLE
Asphyxia
* USE SUPPLEMENTAL OXYGEN
* GUEDEL airway IF POSSIBLE
* SUCTION any secretions
143
what are precipitators of tonic clonic seizures>
withdrawal/poor medication compliance
epileptogenic drugs
* some GA agents
* alcohol
* tricyclics & SSRIs
fatigue/stress
Infection
Menstruation
144
what are partial seizures?
o Motor localised to ONE region of the brain
o may move/spread to other motor areas
145
how do you treat epilepsy preventatively?
Anticonvulsant drugs
* Tonic –clonic
o Valproate, Carbamazapine, Phenytoin, Gabapentin, Phenobarbitone, Lamotrigine
* Absence
o Levitiracetam
146
how do you emergency treat epilepsy?
most require SUPPORTIVE treatment ONLY if UNCONSCIOUS - Airway & Oxygen
Status epilepticus requires BENZODIAZEPINES
147
what does status epilepticus require?
BENZODIAZEPINES
148
what are epilepsy drugs give GABA reception actions?
Valproate
* Gaba transaminase inhibitor
Benzodiazepines
* GABAA receptor action on Cl- enhanced
149
what are epilepsy drugs give sodium channel actions?
Carbamazepine
* Stabilises
Phenytoin
* ? Unsure of action
150
when is surgery for epilepsy used?
o Removal of focal neurological lesions
Brain tumours (benign)
o Focal seizures
Identifiable point of origin within the brain
Not well controlled by medication
151
what are dental aspects of epilepsy? in terms of fits?
o Complications of fits
oral soft tissue injury
dental injury/fracture
152
what are dental aspects of epilepsy? in terms of epilepsy treatment?
gingival hyperplasia (phenytoin)
bleeding tendency (valproate)
folate deficiency (rare)
153
what causes gingival hyperplasia with epilepsy treatment?
phenytoin
154
what causes bleeding tendency with epilepsy treatment?
valproate
155
what must you know when treating someone with epilepsy?
emergency care
156
how do you assess risk of fit for someone with epilepsy?
good & bad phases
ask when last three fits took place
ask about compliance with medication
ask about changes in medication
157
what is multiple sclerosis?
CNS lesions only
* DEMYELINATION of Axons
progressive functional loss
158
what are symptoms of MS?
- muscle weakness
- visual disturbance
- paraesthesia
- autonomic dysfunction
- dysarthria
- pain
- balance/hearing loss
159
what are signs of MS?
- muscle weakness
- spasticity
- altered reflexes
- tremor
- optic atrophy
- proprioreceptive loss
- loss of touch
160
what CSF analysis do you do to investigate MS?
* CSF analysis
o reduced lymphocytes
o increased IgG protein
161
what happens when someone has MS?
* Relapsing and remitting type - acute exacerbations and periods of respite
o Damage builds up with each episode
162
what will many people develop with MS?
secondary progressive
163
what is primary progressive type of MS?
* Primary progressive type – slow steady progressive deterioration
o Cumulative neurological damage
164
how do you manage MS symptoms?
o antibiotics, antispasmodics, analgesia, steroids
o physiotherapy & occupational therapy
165
what is disease modifying therapies of MS?
o Disease modifying therapies – may also slow some progressive forms
Cladribine
Siponomod
Ocrelizumab
166
what are dental aspects of MS?
* limited mobility & psychological disorders
* treat under LA
* orofacial motor & sensory disturbance
* Chronic orofacial pain possible
* Enhanced TRIGEMINAL NEURALGIA risk
167
what must you suspect in younger patients of MS?
* orofacial motor & sensory disturbance
* Enhanced TRIGEMINAL NEURALGIA risk
168
what is motor nuerone disease?
degeneration in the spinal cord
* corticospinal tracts/anterior horns
bulbar motor nuclei
169
when happens to people with motor neurone disease?
patients aged 30-60yrs
* death with 3 years of diagnosis
170
what happens to motor function of motor neurone disease?
Progressive loss of motor function
* limbs
* intercostal
* diaphragm
* motor cranial nerves VII – XII
171
what is death due to in motor neurone disease?
* ventilation failure
* aspiration pneumonia (swallowing/cough)
172
what is treatment of motor neurone disease?
* Physiotherapy & occupational therapy
* Riluzole
o some get 6-9 months life extension
* Aspiration prevention
o PEG tube feed
o Reduce salivation
173
what is purpose of riluzole in MND treatment?
o some get 6-9 months life extension
174
how do you prevent aspiration in MND?
o PEG tube feed
o Reduce salivation
175
what are dental aspects of MND?
* difficulty in acceptance of dental care
o muscle weakness of head & neck
* realistic treatment planning
* drooling & swallowing difficulties
176
what is cause of parkinson's?
* Degeneration of dopaminergic neurones in the basal ganglia of the brain (substantia nigra)
o Shortage of Dopamine results in difficulty of message passaging from ‘thinking’ to ‘doing’ brain
o Underlying reason for this is unclear
177
what are clinical signs of parkinsons?
* BRADYKINESIA
* RIGIDITY
* TREMOR
178
what is bradykinesia?
o Slow movement, and slow initiation of movement
179
what is rigidity?
increased muscle tone
180
what is tremor in MND?
o slow amplitude
o Can progress to on/off movement disorder – often after treatment
181
what are clinical observations of parkinsons?
* Manifestation
* Impaired gait and falls
* Impaired use of upper limbs
* Mask-like face
* Swallowing problems
182
what is physical support treatment of parkinsons?
physiotherapy and Occupational therapy
These work to maintain function at as high a level for as long as possible
183
what is medical treatment of parkinsons?
o Dopamine
Levadopa
o Dopamine analogues
Tablets – Promipexole, Selegiline
Injection – apomorphine - subcutaneous
Infusion – duodopa – directly into the gut
184
what is dopamine analogues?
Tablets – Promipexole, Selegiline
Injection – apomorphine - subcutaneous
Infusion – duodopa – directly into the gut
185
what is surgical treatment of parkinsons?
* Stereotactic surgery
o Deep brain stimulation
* Stem cell transplant?
186
what does anticholinergic effects of drugs do dentally?
dry mouth
187
what are dental aspects of parkinsons?
* Difficulty accepting treatment
o Tremor at rest of body
o Often facial tremor reduces on purposeful movements e.g. mouth opening
* Dry mouth
o Anticholinergic effects of the drugs
* Drug interactions?
188
what does increased oestorgen and porgestorone do in pregnancy?
act on kidney to increase Renin secretion
Increased salt & water retention
Increased plasma volume by 45%
189
what does the increase in plasma volume in pregnancy do?
* Dilution effect makes Hb fall from 15-12g/dL
* Protects against haemorrhage at birth
190
in pregnancy the lower oesophageal sphincter relaxes causing what?
With increase abdominal pressure gives increased GORD
191
what does increase in hormonal changes do during pregnancy?
reduce insulin sensitivity so diabetes
192
what happens haematologically when pregnant?
increased production of RC, WC, Platelets
20% increase in RC mass
Increased platelet consumption makes platelets normal to low
Increased WC makes diagnosing infections difficult
193
when pregnant the vascular smooth muscle relaxes so what happens?
Reduced peripheral resistance
Reduced systolic and diastolic blood pressure
Compensatory increase in heart rate by 25%
194
what happens to the coagulation screens when pregnant?
Clotting factor production increases
Fibrinolysis increases
Increased system sensitivity with increased DVT risk
195
when does development start in pregnancy
week 4
196
what does the zygote become?
embryo
197
when does embryonic circulation start?
o Week 6 – start of embryonic circulation
Weeks 6-10 embryonic development & growth
198
what happens week 10 in pregnancy?
Foetus 10-14 weeks – features and limbs become developed and active!
199
what is highest in first trimester?
miscarriage
200
when is 2nd trimester?
14 weeks
201
what happens 18 weeks pregnant?
toe and fingers formed
202
when is final development of vision and senses when pregnant?
20-26
203
when is 3rd trimester?
week 27
204
what is birth testing?
Physical examination
Hearing test
Blood spot
205
what is blood spot for?
* Phenylketonuria - PKU
* Hypothyroidism
* Cystic Fibrosis
* Sickle cell disease
206
what is blood spot for?
* Phenylketonuria - PKU
* Hypothyroidism
* Cystic Fibrosis
* Sickle cell disease
207
what does APGAR score stand for?
activity, pulse, grimace, appearance and respiration
208
what is dentistry during pregnancy?
Cost of dental care
Drugs in pregnancy
Pregnancy gingivitis
Periodontal health in pregnancy
Position of mother
209
in babies what happens month 1?
raise head
210
in babies what happens month 2?
smile and rolls
211
in babies what happens month 3?
eyes follow
212
in babies what happens month 4?
sits supported
213
in babies what happens month 5?
stands held
214
in babies what happens month 6?
sits little support
215
in babies what happens month 7?
sits without support
216
in babies what happens month 8?
sits steadily
217
in babies what happens month 9?
stand short time
218
in babies what happens month 10?
pull self up
219
in babies what happens month 11?
walk holding furniture
220
in babies what happens month 12?
walk one hand held
221
in babies what happens month 15?
walks self
222
in babies what happens month 18 months?
say 6 words
223
in babies what happens 2 years?
able run
224
in babies what happens 3 years?
can repeat 2 numbers in a row
225
in babies what happens 4 years?
repeat 6 word sentence
226
in babies what happens 5 years?
can follow 3 commands
227
what act is Concerned purely with management & treatment of psychiatric disorders?
mental health act (scotland) 2003
228
how long is emergency detention?
72 hours
229
how long is short term detention?
28 days
230
how long is compulsory treatment order?
6 months
231
how long is detention by a doctor?
2 hours
232
what is application of mental health act 2003?
That the person has a mental disorder.
Medical treatment is available which could stop their condition getting worse, or help treat some of their symptoms.
If that medical treatment was not provided, there would be a significant risk to the person or to others.
Because of the person's mental disorder, his/her ability to make decisions about medical treatment is significantly impaired.
That the use of compulsory powers is necessary.
233
what is neurosis and psychosis/
o Neurosis
Contact retained with reality
o Psychosis
Contact lost with reality
234
what is Generalised anxiety disorder?
free-floating anxiety in many/all situations
235
what is phobic anxiety?
intense anxiety / panic in specific situations
236
what is panic disorder?
unpredictable extreme anxiety
237
what are anxiolytic drugs?
o Alcohol
o Benzodiazepines
o Antidepressants – with anxiolytic features
238
what are types of benzodiapines?
diazepam, midazolam, temazepam, lorazepam
239
what are types of antidepressants?
Tricyclic (noradrenaline & 5HT)
* Amitriptyline, Dosulepin, Nortriptyline, Imipramine
Mirtazepine
SSRI (Selective Serotonin Reuptake Inhibitors – 5HT)
* Fluoxetine, Sertraline, Citalopram
240
what is bipolar 1?
mania
241
what is bipolar 2?
* Cyclothymia
* Hypomania
242
what is mania and hypomania symptoms?
Increased productivity & feeling of wellbeing
Reduced need for sleep
Gradual reduction in social functioning and occupational functioning
Increase in reckless behaviour
Followed by period of depression
243
what is drug treatment of mood disorders?
Antidepressant
Mood stabilising
244
how long does drug treatment of mood disorder last?
2 years
245
what are acute phase antidepressants?
Selective Serotonin Reuptake inhibitor (SSRI)
Venalfaxine/Mirtazepine
Tricyclic antidepressants (TCA)
Monoamine oxidase inhibitor (MAOI)
246
what are mood stabilising drugs>
Lithium
Carbamazepine
Valproate
Lamotrigine
247
what are side effects in tricylic antidepressants?
dry mouth, sedation, weight gain
248
what are cuations in tricylic antidepressants?
glaucoma, prostatism
249
what are SSRIs?
o prozac’ type drugs
fluoxetine, paroxetine, fluvoxamine
citalopram, sertraline
250
what are SSRIs side effects?
Acute anxiety disorders
some patients similar to TCA - sedation, dry mouth
gastrointestinal upset
251
what are interactions of MAOIs?
indirect acting sympathomimetic amines (e.g ephedrine)
* enhanced vasoconstrictor effect
* cold & cough remedies
foodstuffs - tyramine containing, alcohol/low alcohol
bovril/oxo/marmite, cheese, herring, beans
252
when on lithium what is avoided?
avoid NSAID, METRONIDAZOLE
253
what is lithium?
K+ subsitute
254
what is direct drug effect of anti depressants in dentistry?
dry mouth – caries (lithium)
sedation
facial dyskinesias
255
what are drug effects of psychoses?
dry mouth
drug interactions
dyskinesias - tonic or dystonia (tardive)
256
what are drug therapy of schizophrenia?
* Oral or depot IM injection - compliance, frequency of requirement
* Dopamine antagonist drugs - cause ‘extrapyramindal’ side effects, dry mouth and sedation
* Atypical Antispychotics – less likely to cause extrapyramidal side effects
257
what are antipsychotic drugs?
o Butryrophenones
o Phenothiazines
o Thioxanthenes
258
what are extrapyramidal side effects of antipsychotics?
o Akathisia
o Dystonia
o Parkinsonism
o Tardive dyskinesia
259
what is akathsia?
feeling of restlessness, making it hard to sit down or hold still
Symptoms include tapping your fingers, rocking, and crossing and uncrossing your legs
260
what is dystonia?
muscles involuntarily contract and contort leading to painful positions or movements
261
what is parkonism?
the same symptoms as someone with Parkinson's disease, but your symptoms are caused by medications, not by the disease
may include tremor, slower thought processes, slower movements, rigid muscles, difficulty speaking, and facial stiffness.
262
what is tardive dyskinesia?
uncontrollable facial movements such as sucking or chewing, lip-smacking, sticking your tongue out or blinking your eyes repeatedly
Do not go away if medicine is stopped
263
how do you treat extrapyramidal symptoms?
o Use an ‘atypical’ antipsychotic instead
o Beta-adrenergic Blockers (non-selective)
o Anticholinergics
264
what are common beta blockers?
Propranolol
Metropolol
265
what are common antichloinergics?
Procyclidine
Benztropine
Diphenhydramine
Pramipexole
266
what are oral effects of anorexia?
don’t eat - oral effects of malnutrition
* ulcers, dry mouth, infections, bleeding
267
what are oral effects of bulimia?
dental erosion & oesophageal stricture
o Comfort eating
268
what is sialosis and where does it usually happen?
enlargement of salivary glands and usually the parotid gland
269
what is ischaemia?
inadequate blood supply to part body
270
what is infarction?
tissue death of that part due to inadequate blood supply
271
what is aneurysm?
bulging of the blood vessel
272
what is atheroma?
fatty material build up in arteries
273
what is dysphonia?
abnormal voice
274
what is dysarthria?
difficulty speaking because of facial muscle weakness
275
what is hyperplasia?
enlargement of organ
276
what is lability?
rapid exaggerated changes in mood
277
what is dyspesia?
ingestion
278
what is cylcothymia?
periods of feeling low and periods of extreme happiness
279
what is hypomania?
periods of over active high energy
280
what is dykinesisa?
involuntary movements
