MedComplex-Exam 2 Part 2 (TB, DentalAllergy,PUD)

Question 1

Freakin tricky: what is the genus and species of TB?

Answer 1

MYCO-BACTERIUM Tuberculosis

Question 2

Myco-bacterium tuberculosis is a _______-shaped bacterium with a _____ capsule….

Answer 2

rod-shaped….waxy

Question 3

Is TB aerobic or anaerobic? What is the complex lipid in its cell wall?

Answer 3

Mycolic Acid

Question 4

TB is transmitted from person to person by _________ and the initial site of infection is in the _____….What is a secondary portal of entry for TB?

Answer 4

respiratory aerosols…lungs….secondary: GI tract (i don’t know how)

Question 5

What is the name of the stain used for TB since it does not stain gram negative nor positive?

Answer 5

acid fast

Question 6

Does TB attract acute inflammatory cells?

Answer 6

No, PMNs are not attracted.

Question 7

What type of inflammatory cells go after TB? What is the transformation process?

Answer 7

macrophages transform into multi-nucleated giant cells

Question 8

What are the components of a GHON COMPLEX?

Answer 8

1.Peripheral Parenchymal Granuloma 2. Mediastinal (hilar) lymph node

Question 9

Yikes. This is hard to remember- In TB: what is the name for a peripheral parenchymal granuloma PLUS a mediastinal (hilar) lymph node?

Answer 9

a GOHN Complex

Question 10

Where are Ghon Complexes usually found in the lungs?

Answer 10

the LOWER lobes

Question 11

In TB: Grossly, the healed, _______ (supra or sub pleural?) Ghon nodule is well ________ with ________ necrosis. In later stages, the lesion is fibrotic and calcified.

Answer 11

sub pleural…. circumscribed…. central

Question 12

What is a unilateral CERVICAL adenitis that presents with swollen non-tender nodes in pt’s experiencing miliary TB?

Answer 12

SCRO-FULA

Question 13

What is the name for VERTEBRAL osteoarthritis after military spread of TB?

Answer 13

POTTS disease

Question 14

What are the two groups of people most at risk for spread of TB to other parts of the lungs? What is this called?

Answer 14

ImmunoCompromised and children…called “Progressive Primary Tuberculosis”

Question 15

In miliary TB, granulomas can go to the brain/spinal chord and cause meningitis…what is the name for a granuloma in this area?

Answer 15

A Tuberculoma

Question 16

What area of the body are Tuberculoma’s found in miliary spread of TB?

Answer 16

the Brainstem

Question 17

How long does it take to culture a TB sample? What is the name of the special media needed to culture it?

Answer 17

6-8 weeks (rather slow)…Lowenstein-JJ Jensen Agar

Question 18

Which STAGE of TB do we see a GHON complex?

Answer 18

PRIMARY (not secondary, not miliary)

Question 19

What is it called when a primary granuloma in TB can is calcified and can be seen on a chest X ray?

Answer 19

coin lesion

Question 20

What is the sign of a positive PPD TB test? What is the name of the TB vaccine that can yield an ALMOST positive TB test?

Answer 20

10cm…BCG vaccine (5-9cm induration)

Question 21

TB in the oral cavity is relatively _____ and usually secondary to lung involvement, usually affecting what type of people??

Answer 21

rare…elderly people

Question 22

ORAL TB Lesions are usually seen as superficial ulcers or patches, although marked swelling of the ______ may also be seen.

Answer 22

GINGIVA

Question 23

What is another name for an allergy to latex?

Answer 23

NRL “Natural Rubber Latex” protein allergy

Question 24

What is the most common cause of latex allergy?

Answer 24

Direct Contact

Question 25

What are the 4 major risk factors/groups of people for Latex allergy?

Answer 25

1. Kids with Spina Bifida 2. ppl w/ food allergies 3.family hoof allergies 4.health care workers

Question 26

About what percent of people with spina bifida are going to have a latex allergy?

Answer 26

about 50%!

Question 27

Interesting! What group of people are most likely to have a latex allergy?

Answer 27

Children with spina bifida

Question 28

What type of reaction is a NRL protein allergy? Which antibody is associated with it???

Answer 28

Type I (immediate) hypersensitivity...IgE

Question 29

While the NRL Protein allergy was more common in the 90's it has gone down to about what % of health care workers affected?

Answer 29

less than 10% (down from 12-17%)

Question 30

What are the three types of Reactions to Latex and what type of immune mediated response occurs for each?

Answer 30

1.NRL protein allergy-Type I 2.ACD (Allergic Contact Dermatitis) - Type IV 3. ICD (Irritant Contact Dermatitis) - NO immune response

Question 31

**RememberTHAT**For an ACD rxn what is the specific immune cell that is activated?

Answer 31

T-cell lymphocyte

Question 32

What is the role of Gluteraldehyde in the dental practice?

Answer 32

disinfectant

Question 33

What are the 3 main chemicals that cause ACD in a dental practice?

Answer 33

1.Gluteraldehyde 2.Methacrylate 3.Metals

Question 34

What are the two types of allergic reactions associated with Gluteraldehyde?

Answer 34

1.ACD 2.ICD

Question 35

What is the cause of a hiatal hernia MOST OF THE TIME?

Answer 35

Hiatal Hernia

Question 36

What are the two basic types of hiatal hernias? What % of the time are each?

Answer 36

1.Sliding (95%) 2.Paraesophageal (5%)

Question 37

Sliding Hernia: An enlargement of the diaphragmatic hiatus and laxity of the of the _________ connective tissue allows a cap of gastric cardia to move upward to a position above the diaphragm.

Answer 37

circumferential

Question 38

Sliding Hernia: Must be hard to Dx because its _________ in the large majority of patients and only 5% of patients diagnosed _________ complain of symptoms referable to gastroesophageal reflux.

Answer 38

asymptomatic... radiographically

Question 39

Paraesophageal hernia: This form is characterized by herniation of a portion of the gastric ______ alongside the esophagus through a defect in the diaphragmatic connective tissue membrane that defines the esophageal hiatus.

Answer 39

fundus

Question 40

WOAH in extreme cases of _________ hernias most of the stomach herniates into the thorax!!

Answer 40

Paraesophageal

Question 41

BOOM. TEST QUESTION. _______ hernias are often treated medically, whereas __________ should be tx. surgically.

Answer 41

Sliding=medically...Paraesophageal=surgically

Question 42

What is replacement of squamous epithelium of the esophagus by columnar epithelium as a result of chronic GE reflux?

Answer 42

Barretts Esophagus

Question 43

In Barretts Esophagus what is the type of metaplasia going on? (what cell type to what cell type?)

Answer 43

Stratified Squamous TO Columnar epi

Question 44

Barretts Esophagus occurs in the ______ third of the esophagus, particularly among _____ men.

Answer 44

lower...white

Question 45

Barretts Esophagus has a greater than twofold increased risk among ______.

Answer 45

smokers

Question 46

What type of cancer is a person with Barrett's esophagus at greater risk for?

Answer 46

Adenocarcinoma (not SCC since there was metaplasia)

Question 47

Cool aside: What is the end product of the urease secreted that buffers H. Pylori in the stomach acid?

Answer 47

ammonia

Question 48

The common factor that unites both GASTIC and DUODENAL ulcers is secretion of ________.

Answer 48

HydroChloric Acid....HCl

Question 49

Gastric vs. Duodenal: peak incidence between 30 and 60 years old

Answer 49

duodenal ulcer disease

Question 50

Gastric vs. Duodenal: affects more males than females

Answer 50

dude-odinal ulcers :) LOL

Question 51

Gastric vs. Duodenal: affect middle aged and elderly more than young

Answer 51

gastric ulcer disease

Question 52

Gastric vs. Duodenal: affects men and women equally

Answer 52

gastric (grandma)

Question 53

Gastric vs. Duodenal: In the U.S., the incidence for _______ ulcers is the same for blacks and whites, but in Africa, they are RARE among blacks. In the western urban setting, all racial and ethnic groups are susceptible.

Answer 53

duodenal

Question 54

The common stereotype of the patient with a peptic ulcer is that of a highly motivated executive operating in a ________ environment.

Answer 54

STRESSFUL

Question 55

PUD: Environmental Factors: High amounts of ______ and cirrhosis of the liver are associated with PUD. _______ as well as NSAID’s and high-dose _______ have all been incriminated in the production of peptic ulcers. _______ is also a risk for PUD, particularly gastric ulcers, although the mechanism is controversial.

Answer 55

Alcohol... Aspirin... Corticosteroids... smoking

Question 56

Gastric vs. Duodenal: genetic susceptibility

Answer 56

duodenal (no increase c/o genetics in gastric ulcers)

Question 57

Gastric vs. Duodenal: Type O blood

Answer 57

duOdenal (no assoc. with gastric)

Question 58

Gastric vs. Duodenal: Kissing ulcers

Answer 58

duodenal

Question 59

The classic case of _______ ulcer is characterized by burning epigastric pain that is experienced 1-3 hours after a meal or that awakens the patient at night.

Answer 59

duodenal

Question 60

Gastric vs. Duodenal: perforations

Answer 60

duodenal

Question 61

Gastric vs. Duodenal: need BIOPSY

Answer 61

gastric (duodenal does not need biopsy-no known cases of malignancy)