Medicine For The Elderly And Musculoskeletal/Connective Tissue Disorders Flashcards
(154 cards)
1
Q
What is meant by multi-infarct dementia?
A
Blocking of small blood vessels (vascular dementia)
2
Q
What is the treatment for dementia?
A
- cholinesterase inhibitors
- sedatives
3
Q
What act is very important to consider for patients with dementia in regards to their capacity to consent to treatment?
A
Adults with Incapacity Act 2000 Section 47
4
Q
If a patient with dimentia lacks capacity to consent to treatment, what is required to be done before treatment is carried out?
A
Need to obtain Adults with incapacity (AWI) form from GP
5
Q
What is the risk of prescribing analgesics to a patient with dimentia?
A
Risk of delirium (acute confusion)
6
Q
Why should NSAIDS be avoided in over 80’s?
A
High risk of GI side effects
7
Q
What are four erosive conditions that lead to tooth wear in the elderly, excluding dietary?
A
- alcohol abuse
- hiatus hernia
- duodenal ulceration
- certain medications (e.g. NSAIDS)
8
Q
What is the consequence of extensive coverage of partial dentures over the gingiva?
A
Lead to damage, particularly at the gingival margins
9
Q
What three types of medications are likely to induce xerostomia?
A
- antidepressants
- antihypertensives
- anxiolytics
10
Q
How does the tongue usually appear in a patient with xerostomia?
A
Lobulated with deep fissures
11
Q
Use of what medications are likely to cause gingival overgrowth?
A
- calcium channel blockers
- anti-epileptic drugs
- cyclosporine
12
Q
What enhances retention of an overdenture, other than presence of surrounding natural teeth?
A
Precision attachments
13
Q
Name three casues of angular chelitis?
A
- associated with chronic candidal infection
- staphylococcal infection from the nasal cavity
- iron deficiency anaemia
14
Q
Define, inflammation of the joints/
A
Arthritis
15
Q
Define, non-inflammatory joint disease.
A
Arthrosis
16
Q
Define, joint pain.
A
Arthralgia
17
Q
What cells remove bone?
A
Osteoclasts
18
Q
What cells deposit bone?
A
Osteoblasts
19
Q
What three substances are very important in bone formation?
A
- calcium
- phosphate
- vitamin D
20
Q
Why must calcium in the blood be maintained at a very precise level?
A
Because it is involved in nerve and muscle function
21
Q
What hormone maintains cerium calcium levels, increases calcium release from bone, and reduces renal calcium excretion?
A
Parathyroid hormone (PTH)
22
Q
What happens to PTH levels if calcium levels fall?
A
PTH levels increase
23
Q
What effect does hypoparathyroidism have in serum calcium levels?
A
Results in low serum calcium levels
24
Q
What effect does primary hyperparathyroidism have on serum calcium levels?
A
Results in high serum calcium levels
25
What effect does primary hyperparathyroidism have on osteoclast action?
Inappropriate activation of osteoclasts
26
What effect does secondary hyperparathyroidism have on serum calcium levels?
Results in low calcium levels
27
What drugs can interfere with Vitamin D synthesis?
Some antiepileptic drugs such as carbamazepine and phenytoin
28
What are main causes of vitamin D deficiency?
- low sunlight exposure
- poor GI absorption (poor nutrition or malabsorption)
29
Define, a disorder of the bone where there is poorly mineralised osteoid matrix and cartilage growth plate, resulting in “bone softening”. This is often due to a calcium deficiency.
Osteomalacia
30
Define, a bone disorder where there is loss of mineral and matrix and a reduced bone mass.
Osteoperosis
31
What is osteomalacia referred to as in children, whilst the bone is still continuing to form?
Rickets
32
What measure of bone turnover is very high when there are issues with calcium levels?
Alkaline phosphotase
33
What are patient factors for osteoporosis?
- inactivity
- smoking
- excess alcohol use
- poor dietary calcium
34
Use of what medical drugs can be a risk factor for osteoporosis?
- steroids
- antiepileptics
35
What are genetic risk factors for osteoporosis?
- family history
- race-Caucasian and Asian women
- early menopause
36
What are endocrine risk factors for osteoporosis?
- oestrogen and testosterone deficiency
- Cushing’s syndrome
37
Why is Cushing’s syndrome a risk factor for osteoporosis?
Cushing’s syndrome increases corticosteroid levels in the blood
38
What effects does osteoporosis have on the vertebrae?
- height loss
- kyphosis and scoliosis
- nerve root compression (back pain)
39
What are two ways to build maximal peak bone mass in prevention of osteoporosis?
1. Exercise
2. High dietary calcium intake
40
What treatment can be used for women (specifically) to reduce osteoporosis risk?
- oestrogen hormone replacement therapy
41
What are the three most commonly used Bisphosphonates in the treatment of osteoporosis?
1. Alendronate
2. Ibandronate
3. Zoledronate
42
Name the bisphosphonate that’s potency is high it only has to be given once a year.
Zolendronate
43
Define, connective tissue that lines the sin side of the joint capsule.
Synovium
44
What could redness around a joint suggest?
Infection, due to inflammation and high vascular content
45
Define, a noise made by bone ends moving- usually associated with loss of Norwalk cartilaginous covering to the bone ends.
Crepitus
46
What is arthography?
Where a radio-opaque dye is injected into the joint to outline the articular surfaces and the joint capsule
47
What is a key inflammatory marker found in the blood?
C-reactive protein (CRP)
48
Define, a group of joint disorders caused by deposits of crystals in joints and the soft tissues around them.
Crystal arthropathies
49
What is a crystal arthropathy indicative of?
Gout
50
Define, uric acid crystal deposition in joints.
Gout
51
What drugs induce hyperuricaemia?
Thiazide diuretics
52
What are the main symptoms of gout?
- acute inflammation of a single joint
- rapid onset
53
What drugs are used to treat gout?
NSAIDS
54
Why should aspirin be avoided if someone has gout?
Aspirin interferes with uric acid removal so could exacerbate gout
55
What drug, taken to treat gout may casue oral ulceration?
Allopurinol
56
What joints are predominantly affected by osteoarthritis?
Hips and knees
57
What characterises osteoarthritis?
Cartilage repair dysfunction
58
What are the symptoms of osteoarthritis?
- pain (improves with rest, worse with activity)
- brief morning stiffness
- slowly progressive
59
What are the signs of osteoarthritis?
- joint swelling and deformity
- radiographs: loss of joint space and subchondral sclerosis and osteophite lipping
60
What is subchondral sclerosis?
Thickening of bone under the cartilaginous layer as the bone having more force directed straight to it and less cushioning from the cartilage
61
What is osteophyte lipping?
Small bony projections at edge of bone
62
Define, a disease of the synovium with gradual inflammatory joint destruction.
Rheumatoid arthritis
63
How would you categorise someone as sero-positive RA?
Presence of rheumatoid factor (RF)
64
How would you categorise someone as sero-negative RA?
No rheumatoid factor present
65
What are the symptoms of RA?
- fatigue
- morning stiffness
- joint stiffness and pain
- minor joint swelling
- fever
- numbness and tingling
- decrease in range of motion
66
Joints in what parts of the body are most likely to be affected by RA initially?
Hands and feet
67
Name three systemic symptoms of RA?
- fever
- weight loss
- anaemia
68
What does MCP joints stand for?
Meta-carpal pharyngeal
69
What does PIP joints stand for?
Proximal inter-pharyngeal
70
What three specific joint types are usually effected early on, showing initial signs of RA?
- MCP joints
- PIP joints
- wrist joints
71
What are late signs of RA?
- ulnar deviation of fingers at MCP joints
- swan neck deformity of PIP joints
- deformity of thumb
- subluxation of wrists
- deformity of feet and ankles
72
Name 7 extra-articular features of RA.
1. Inflammation of blood vessels
2. Psoriasis
3. Eye involvement
4. Subcutaneous nodules (pressure points)
5. Amyloidosis (organs don’t work properly)
6. Pulmonary inflammation
7. Neurological
73
What will radiograph investigations into RA be able to assess?
- erosions, loss of joint space and deformity
- joint destruction and secondary osteoarthritis
74
What type of anaemia can be associated with RA?
Normocytic, nirmochromic anaemia
75
What are the 4 treatment modalities for RA?
- physiotherapy
- occupational therapy
- drug therapy
- surgery
76
What analgesics are usually prescribed for RA pain?
- Paracetamol
- cocodamol
77
Name two commonly used DMARDS for treatment of RA?
1. Hydroxychoroquine
2. Methotrexate
78
Name the 4 main drug group types that are used for treatment of RA?
1. Analgesics
2. NSAIDS
3. DMARDS
4. Steroids
79
Name three immune modulators drugs that are used in the treatment of moderate/severe RA?
Azothioprene
Mycophenolate
Biologics (e.g. TNF inhibitors)
80
What oral steroid is normally used in the treatment of RA?
prednisolone
81
What would surgery for RA entail?
- excision of inflamed tissue
- joint replacement
- joint fusion
- osteotomy
82
How can disability from RA cause issues in regards to dental care?
- reduced dexterity (issues with OH)
- access to care
83
What oral side effect can occur from taking methotrexate to treat RA?
Oral ulceration
84
What dental side effects can occur from taking hydroxychloroquine to treat RA?
- oral lichenoid reactions
- oral pigmentation
85
Give 4 examples of rheumatic conditions categorised within seronegative spondyloarthritides?
- ankylosing spondylitis
- psoriatic arthritis
- IBD associated arthritis
- reactive arthritis
86
How does seronegtaive sponyloarthritides differ from RA?
Their primary focus of disease is on the axial skeleton
87
What does it mean if you are HLA-B27 positive on a blood test?
You may have an autoimmune disease, most commonly associated with HLA-B27 antigens is ankylosing spondylitis
88
What are the effects of ankylosing spondylitis?
- disabling progressive lack of axial movement
- low back pain
- limited chest expansion
- kyphosis
89
What is meant by “kyphosis”?
Cervical spine tipped forward
90
What are the dental aspects of ankylosing spondylitis?
- GA hazardous as there is limited mouth opening and limited neck flexion so risk to airways
- TMJ involvement possible (rare)
- difficulties in dental chair due to restricted movements
91
What two broad groups are connective tissue diseases broken down into?
1. Autoimmune conditions
2. Vascular vasculitis diseases
92
Name 4 multisystem vascultitic inflammatory diseases
1. Systemic lupus erythematosis (SLE)
2. Systemic sclerosis (sclerodoma)
3. Sjögren’s syndrome
4. Undifferentiated connective tissue disease (UCTD)
93
What categorises vasculitic diseases?
- the size of the vessel involved (e.g. large vessel disease, medium vessel disease, small vessel disease)
94
Give an example of a large vessel vasculitic disease
Giant cell (temporal) arteritis (arteries at the temples become inflamed)
95
Give two examples of medium vessel vasculitic disease?
- polyarteritis nodosa
- Kawasaki disease
96
Define, a rare form of vasculitis in which medium and/or smaller sized arteries become inflamed and damaged?
Polyarteritis nodosa
97
Name the disease also known as mucocutaneous lymph node syndrome.
Kawasaki syndrome
98
Name a small vessel vasculitic disease
Wegeners granulomatosis
99
What is the general management of connective tissue disease?
1. Analgesic NSAIDS
2. Immune modulating treatment
3. Systemic steroids
100
What 4 antibodies are most commonly found in connective tissue diseases?
1. Anti-nuclear antibody (ANA)
2. Anti- double- strand DNA (dsDNA)
3. Anti-Ro antibody (Ro)
4. Anti- La antibody (La)
101
What are the two antibodies commonly found in sclerodoma?
1. Anti-centromere antibody
2. Anti-Sclerosis-70 antibody
102
What are the two forms of lupus?
1. Discoid lupus
2. Systemic lupus erythematosis
103
What are the two forms of lupus?
1. Discoid lupus
2. Systemic lupus erythematosis
104
What form of lupus mainly affects the skin?
Discoid lupus
105
What form of lupus can affect any part of the body?
Systemic lupus erythematosis
106
What are the typical external features of systemic lupus erythematosis?
- photosensitivity
- butterfly zygomatic rash in areas most exposed to sunlight
107
Name dental aspects that can occur as a result of systemic lupus erythematosis?
- oral ulceration and GA risk from chronic anaemia
- bleeding tendency
- lichenoid reactions
- oral pigmentation from drug use
108
What particular group of lupus patients have a marker in their blood termed “lupus anticoagulant”?
Antiphospholipid antibody syndrome
109
What syndrome is characterised by recurrent thrombosis, where patients frequently have a tendency to develop DVT and pulmonary emboli?
Antiphospholipid antibody syndrome (APS)
110
What inflammatory disease is associated with circulating autoantibodies, ANA, ro, and La?
Sjögren’s syndrome
111
What oral manifestations does Sjögren’s syndrome have?
- leads to xerostomia and oral disease
112
What is meant by the sicca syndromes which present in Sjögren’s syndrome?
Dry eyes and dry mouth
113
What type of biopsy is the most guaranteed histopathological method to identify Sjögren’s syndrome?
Labial gland biopsy
114
What disease is characterised by excessive collagen deposition, connective tissue fibrosis and loss of elastic tissues?
Systemic sclerosis
115
What are the 4 physical symptoms of systemic sclerosis?
1. Sclerodactyly
2. Raynauds
3. Nailfold capillaroscopy
4. Telangiectasia
116
What are the dental manifestations of systemic sclerosis?
- involvement of peri-oral tissues with limited mouth opening and tongue movement leading to poor or impossible oral access - swallowing difficulties
- dental erosion
- widening of periodontal ligament space
117
What is another name for giant cell arteritis?
“Temporal” arteritis
118
What are symptoms of giant cell arteritis?
Headache/facial pain
119
What can be the consequence of giant cell arteritis effecting the central artery of the retina?
Narrowing of this artery can cause occlusion and ischaemic necrosis of retina which can lead to permanent blindness
120
What disease is characterised in the elderly who experience pain & morning stiffness in muscles (particularly the shoulder and hips)?
Polymyalgia rheumatica
121
What medication should be used to treat symptoms of polymyalgia rheumatica?
Steroids
122
What is another name for Kawasaki disease?
“Mucocutaneous lymph node syndrome”
123
What disease is mainly seen in children presenting with: fever, lymphadenopathy, crusting/cracked tongue, strawberry tongue, erythematous mucosa, peeling on hands and feet?
Kawasaki disease
124
What inflammatory condition can lead to destruction of hard and soft tissues of the face and oral cavity, appearing as spongy red tissue?
Wegners granulomatosis
125
What bodily systems are most effected by wegners granulomatosis?
Renal and respiratory tracts
126
What condition has a non-specific collection of musculoskeletal symptoms such as joint pain & muscle pain?
Fibromyalgia
127
What syndrome is characterised by chronic inflammation of tear and saliva glands?
Sjögren’s syndrome
128
What four diseases is secondary Sjögren’s syndrome mainly associated with?
1. Rheumatoid arthritis (RA)
2. Systemic lupus erythematosus
3. Primary biliary cholangitis (PBC)
4. Mixed connective tissue disease (MCTD)
129
What effect does Sjögren’s syndrome have on denture wear?
Poor retention of dentures
130
What are the two main therapies for Sjögren’s syndrome?
1. Pilocarpine
2. Acupuncture
131
In Sjögren’s syndrome, what will the lack of saliva predispose the patient to in regards to their oral health?
1. Opportunistic oral infections (candidosis)
2. Periodontal disease
3. Caries
132
What considerations should be made during dental treatment for an individual with dry mouth?
- lubrication lips with Vaseline
- constant lubrication of mucosa using 3 in 1
- wet mirror or avoid contact with mucosa where possible
- retract buccal mucosa with dampened swab
- offer patient water frequently
- avoid suction where possible
133
What are often two underlying causes of recurrent oral ulceration?
1. Anaemia
2. Haematinic deficiencies (vitamin B12, folate, iron)
134
What oral manifestation can be an indication of poor diabetic control?
Thrush- acute pseudomembranous candidosis
135
What cause of facial pain is sudden, usually unilateral, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve?
Trigeminal neuralgia
136
Define which syndrome is characterised by an idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa in whom a medical or dental cause has been excluded?
Burning mouth syndrome
137
What is the treatment for burning mouth syndrome?
- amitripytline
- gabapentin
- cognitive behavioural therapy
138
What areas of the body are mainly affected by lichen planus?
- oral mucosa
- skin
- scalp
- nails
- genitals
139
Why is it important to biopsy anyone who presents with desqaumative gingivitis?
It is suggestive of both lichen planus and mucous membrane pemphigoid
140
What are the oral manifestations of HIV/AIDS?
- hairy leukoplakia
- kaposi’s sarcoma
- Candidosis
141
What gland is involved in removal of T cells that have receptors with a strong affinity for self-antigens, preventing auto-immunity?
Thymus gland
142
Where do T cells mature and differentiate?
The thymus gland
143
Define the disease where T cells attack and destroy the beta cells in the pancreas that produce insulin.
Type 1 diabetes
144
What is the termed used for antibodies directed against a persons own red blood cells causing them to burst resulting in anaemia?
Autoimmune haemolytic anaemia
145
What disorder is characterised by a decrease in number of platelets in the blood?
Immune throbocytopenic anaemia
146
Define, multiple sclerosis.
Where the activation of immune cells attack the CNS and cause demyelination of nerves
147
What condition affects the mucous membranes where blisters can form within the epithelium and then burst to form erosive ulcers?
Pemphigus vulgaris
148
What condition is characterised by blistering that affects mucous membranes in the body and presents beneath the epithelium?
Mucous membrane pemphigoid
149
What does DMARDS stand for?
Disease modifying anti-rheumatic drugs
150
When prescribing an NSAID, what else could be prescribed to protect against GI side effects? And when would this be particularly important to consider?
1. Proton pump inhibitor
2. If patient is also taking systemic steroids
151
What is the main action of corticosteroids?
To suppress the immune system and reduce inflammation
152
What two ways can corticosteroids be administered?
- orally
- injection
153
Name the most common corticosteroid injection given to treat autoimmunity?
Hydrocortisone/ triamcinolone intra-articular injection
154
What are the consequences of abruptly withdrawing a steroid, such as prednisolone, from treatment?
This can lead to acute adrenal insufficiency, leading to severe hypotension which can be fatal.
