Final Exam

Question 1

• Colonoscopy revealed multiple linear and irregular ulcers in the colon and terminal ileum
• Diagnosis ?

Answer 1

Crohn’s Disease with aphthous stomatitis

Question 2

histology of ulcerative colitis

Answer 2

confined to the mucosal layer

Question 3

histology of chrohn’s disease

Answer 3

• Granulomas with multi- nucleated giant cells can be the HALLMARK histological sign
  o If we see these – we say Crohn’s but if we don’t see them we cannot rule out this disease

Question 4

crohn’s disease pattern

Answer 4

more segmental inflammation – patchy - think crohn’s

because it effecrs deeper layers - transmural - more severe signs and symptoms and bowel obstructions

Question 5

major oral manifestation assoicated with crohn’s?

Answer 5

Aphthous stomatitis

Question 6

affective mood disorders

Answer 6

1. major depression

2. bi-polar

Question 7

part of the CDC guidelines for infection control

Answer 7

standard barrier precautions to minimize formation of an exposure to aerosols. droplets, and splatters

Question 8

which is used to predict the risk of progression to AIDS

Answer 8

absolute CD4 cell count measured in the number of cells / mm3

Question 9

stuck with needle from patient what do you do next?

Answer 9

SOAP AND WATER and immediatley report to the ED for evaluation

Question 10

strongest risk factor for sporadic (non-heraditary) colon cancer?

Answer 10

increasing age

Question 11

major fact to know about gardners syndrom?

Answer 11

patients have a lifetime risk of developing colon cancer of 100% if untreated

Question 12

most important factor in the pathogenesis of GERD?

Answer 12

frequent transient relaxations of the lower esophageal sphincter

Question 13

the most common oral manifestation of GERD?

Answer 13

dental erosion involving the posterior teeth, lingual and occlusal surfaces

Question 14

25 year old with multiple osteomas of jaw and multiple un-urupted teeth..likely diagnosis?

Answer 14

colon polyposis/ cancer

Question 15

what about colorectal cancer should we know>

Answer 15

CRC is the seconf leading cause of death in the US

Question 16

sjorgens syndrome can be a secondary manifestation of what disease most likely?

Answer 16

Osteoarthritis

Question 17

bilateral knee swelling and pain is most associated with?

Answer 17

Rheumatoid Arthr.

Question 18

first manifestation of lupus?

Answer 18

hypertension (doesnt come first but first notiecable one)

Question 19

two antihyperglycemic agents that are most likely to cause hypoglycemia

Answer 19

1. glyburide

2. glipizid

Question 20

T/F you can do elective dental tx on diabetic patient if FBS is <200 g/dl

Answer 20

TRUE – cannot if it is above this

Question 21

T/F managing a patient with anxiety should avoid prescribing post-operative pain medications

Answer 21

FALSE - you can

Question 22

T/F shortness of breathe / dyspnea can be caused by deep vein thrombosis?

Answer 22

False

Question 23

describe abuterol

Answer 23

inhaled beta-2 agonist

Question 24

what vital sign is most diagnostic in differentiating syncope from other manifestations

Answer 24

pulse

Question 25

healthy patient and give LA then starts freaking out and pulse increases what likely happened?

Answer 25

intravascular injection of vasoconstrictor

Question 26

diabetic patient unconsciouss in you waiting room what do you give first?

Answer 26

glucose

Question 27

T/F albuterol is a systemic corticosteroid?

Answer 27

false- inhaled

Question 28

time for appointments for diabetic patients

Answer 28

morning

Question 29

T/F GFR can be used to test for acute kidney failure?

Answer 29

FALSE - only accurate in a steady state

Question 30

GFR is under-estimated in?

Answer 30

ingestion of cooked meats increases plasma Cr and CC is underestimated so plasma levels higher -- underestimattion

Question 31

GFR is over-estimated in?

Answer 31

low muscle ass decreases Cr production and over-estimates CR

Question 32

Stages of Chronic Kidney Disease

Answer 32

``` - Stage I o GFR is above 90 - Stage II o GFR is between 60-90 - Stage III o GFR is between 30-59 ml/min - Stage IV o GFR is between 15-29 - Stage V o GFR is below 15 and needs replacement if uremia also present ```

Question 33

creatine 2 implication?

Answer 33

lost about half their GFR - normal creatinine is 1 (GFR is 120)

Question 34

most common cause of renal failure in hospitilized patients?

Answer 34

acute -- PRE-RENAL failure due to VOLUME DEPLETION

Question 35

Chronic renal failure is defined by?

Answer 35

GFR - or creatine clearance - small shrunken kidneys **

Question 36

drugs you should not give renal impaired patients? why?

Answer 36

NSAIDs - like ibprofen - inhibit prostaglandins but these patients need them for physiologic compensation

Question 37

*common cause of secondary hypertension

Answer 37

NASAL DECONGESTANTS

Question 38

*common cause of secondary hypertension

Answer 38

NASAL DECONGESTANTS

Question 39

proph abx tx with dialysis patient?

Answer 39

2 grams amoxicillin 2 hours before any dental procedure for PERIOTENAL DIALYSIS ONLY

Question 40

pattern of OA?

Answer 40

joint pain gets WORSE with use (NOT associated with prolonged morning stiffness) Hips, knees, 1st metatarsal-phalangeal joints, distal interphalangeal joints, proximal interphalangeal joints, 1st carpo-metacarpal joints, and lumbar spine (ankle, wrist, and elbow are rarely involved)

Question 41

pattern of Rheumaoid arthritis

Answer 41

SYMETTRICAL and typically affecting the peripheral joints Proximal interphalangeal, metacarpophalangeal, and wrists in 90% of cases involves, elbows, ankles, knees, and cervical spine rarely distal interphalangeal and

Question 42

antibody production in systemic lupus

Answer 42

ANA -- positive in 99% of time Anti-dsDNA - very specific but only found in 40% anti-Ro/SSA- found in 15% of SLE, but found in ALL ANA negative SLE and seen in Sjorgen's syndrome

Question 43

will ANA test help for positive of negative lupus?

Answer 43

positive is non-specific so more helpful if this is negatives

Question 44

major malignant risk with sjorgen's syndrome

Answer 44

development of Lymphoma - increases 44% - compared to others and more likely to die if do

Question 45

antibodies for Sjorgens

Answer 45

anti-Ro/SSA

Question 46

RA vs sjorgens

Answer 46

RA -- targeting joints more

Question 47

treatment for RA?

Answer 47

initial - glucocorticoids mild disease - hydroxyxhloroquine

Question 48

use of hydroxyxhloroquine? implication for dental treatment>

Answer 48

1. Non- immunosuppressive  so if need to do surgery  not at increased risk for wound infections 2. Check blood count with this (white count) but DO NOT NEED to discontinue

Question 49

methotrexate use? implication with dental treatment>

Answer 49

RA - should stop if CBC count is low - usually are not immunosuppressive but good to get a white blood cell count

Question 50

describe syncope | type?

Answer 50

neurogenic shock vaso/vagal problem 1.

Question 51

very important treatment intervention with emergencies

Answer 51

OXYGEN

Question 52

patient presents as - Pulse and BP not too abnormal now - Color is pink, pupils are normal - Receptionist says patient came in and seemed nervous, was breathing rapidly, complained that her fingers and toes were cramping and collapsed onto the floor what could be diagnosis?

Answer 52

hyperventilation syndrome leading to respiratory alkalosis o H+ CO3-  H2CO3 H2O + CO2 - With high pH, calcium metabolism in muscles is affected  muscle spasms

Question 53

treat hyperventilation syndrome?

Answer 53

rebreathe in bag or mask with low flow O2

Question 54

TREATMENT OF ANGINA

Answer 54

nitroglycerin - repeat 3 x if necessary - if does not come down - assume MI and treat with MONA

Question 55

syncope that is not responsive to oxygen may respond to? which?

Answer 55

atropine -- which blocks parasymathetic slowing of the heart

Question 56

management of seizure

Answer 56

protect patient from self-inflicted injury

Question 57

suffering from hyperventilation syndrome and may develop muscle spasms caused by?

Answer 57

respiratory alkalosis

Question 58

T/F lupus and RA are both inflammatory and OA is not

Answer 58

TRUE!

Question 59

presentation of celiac's disease

Answer 59

- Painful cracks at corner of mouth - Burning tongue - Frequent loose, grey, foul stool - Abnormal fat in stool, anemic, deficient in iron and folic acid, serologic testing shows elevated levels of anti- tissue transglutaminase (TTG) antibodies  how you diagnose

Question 60

histologic sign of celiacs

Answer 60

small bowel biopsy --> LOSS OF VILLI - intra-epithelial lymphocytes, crpt hyperplasia, villous atrophy

Question 61

major findings with alcoholic

Answer 61

alcoholic cirrhosis with periodontal disease and sialadenosis --> major swelling of the parotid gland

Question 62

generalized anxiety disorder characterized as

Answer 62

persistant feeligns of anxiety , most of the day, for over 6 months - restlessness, easy fatigue, difficulty concentratin, irritable, muscel tensionn, insomnia

Question 63

major discriminating feature between type I and type II diabetes

Answer 63

autoimmune destruction of beta cells in type I

Question 64

sulfonylureas, repaglinide and nateglinide can all?

Answer 64

INCREASE INSULIN SECRETION

Question 65

BIGUANIDE - METFORMIN is effective when?

Answer 65

nocturnally as well

Question 66

obstructive renal disease is most commonly caused by?

Answer 66

enlarged prostate

Question 67

characteristics of nephrotic syndrome?

Answer 67

a lot of protein in urine (proteinuria) hypoalbuminemia with resulting edema hyperlipidemia NOT macroscopic hematuria (red blood cells in urine)

Question 68

bleeding complications in acute or chronic renal failure due to?

Answer 68

FUNCTIONALLY ABNORMAL platalets (NOT that they are not there) bleeding time is only thing different

Question 69

most common cause of chronic liver failure

Answer 69

diabetic nephropathy

Question 70

most common way to assess GFR?

Answer 70

Creatinine clearance