OPF Systemic Disease (Ch17) Flashcards
(151 cards)
1
Q
What is a heterogenous group of conditions characterized by the deposition of an extracellular proteinaceous substance called amyloid?
A
Amyloidosis
2
Q
What are 2 categories of amyloidosis?
A
- Organ limited (rarely oral)
2. Systemic
3
Q
What are 5 forms of systemic amyloidosis?
A
- Primary
- Myeloma associated
- Secondary
- Hemodialysis associated
- Heredofamilial
4
Q
Primary and Myeloma associated Amyloidosis affects which demographic symptoms?
A
- Older adults
- Petechia and ecchymosis
- Macroglossia
- Xerostomia (amyloid deposits in salivary glands)
5
Q
What can be the character of the macroglossia associated with Amyloidosis?
A
Tongue with translucent papules, some are hemorrhagic
6
Q
What can happen on the lips associated with amyloidosis?
A
Papules on lip (slide looks like red blisters)
7
Q
What amyloidoisis type is associated with person on dialysis whos β2 Microglobulin protein is not removed and therefore accumulates, normally in bones and joints
A
Hemodialysis associated amyloidosis
8
Q
What is the form of amyloidosis that can result from long term inflammation such as osteomyelitis, tuberculosis, sarcoidosis?
A
Secondary amyloidosis
9
Q
Secondary Amyloidosis can form what that is also found in Chrone’es, Tb, Funcal infections, Sarcoidosis?
A
Granulomas
10
Q
Hemodialysis associated Amyloidosis can manifest where orally?
A
Tongue
11
Q
How is Secondary Amyloidosis treated?
A
Treat underlying inflammatory process
12
Q
Does a renal transplant arrest progression of bone lesions in hemodialysis associated amyloidosis?
A
No
13
Q
What are 3 things used to improve the prognosis of primary amyloidosis , though there is no effective therapy for amyloidosis?
A
- Colchicine
- Prednisone
- Melphalan
14
Q
Amyloidosis patients normally die of what 3 things?
A
- Cardiac failure
- Arrythmia
- Renal disease
15
Q
What histology stain is associated with Amyloidosis
A
Congo Red
16
Q
What disease must Amyloidosis be differentiated from and why?
A
Multiple myeloma, both have large amounts of plasma cells
17
Q
What is used to differentiate amyloidosis from multiple myeloma?
A
Serum electrophoresis to determine whether monoclonal gammopathy exists
18
Q
What is a radiographic indication of multiple myeloma?
A
Punched out bony lesions
19
Q
What is the prognosis of Cutaneous form of Amyloidosis?
A
Good, no impact on survival while systemic form will result in death from cardiac or renal failure
20
Q
If the patient has a Vitamin A Deficiency what is the organ effected?
A
Eye problems (dry skin and conjunctiva) leading to blindness or night blindness in adults
21
Q
Retinol is the animal form of what vitamin and can be converted to what for what?
A
Vitamin A, essential for vision Converted to Retinoic Acid for skin health, teeth remineralization and bone growth
22
Q
What is the synonymn for Vitamin B1?
A
Thiamin
23
Q
Thiamin/Vit B1 is involved in function of what?
A
Proper function of neurons
24
Q
Generally, Thiamin/Vit B1 deficiency is associated with what type of problems?
A
Neurologic problems
25
In what demographic is Vit B1/Thiamin deficiency found?
Alcoholics or diets in Southeast Asia
26
What is a specific disease associated with Thiamin/Vit B1 deficiency?
Beriberi
27
What is a synonymn for Vit B2?
Riboflavin
28
Riboflavin/Vit B2 is involved in what cellular reactions?
Cellular oxidation reduction reactions
29
What can Riboflavin/Vit B2 deficiency look like?
Anemias (glossitis, angular cheilitis, erythemic mucosa)
30
If see bald tongue and angular cheilitis what can be the differential?
Anemia or Vit B2/Riboflavin deficiency
31
What is a synonymn for Vit B3?
Niacin
32
What is a diet in which a Niacin/Vit B3 deficiency would be found?
High corn(maize) diet(b/c corn is low in niacin)
33
Name of the disease associated with Niacin/Vit B3 deficiency?
Pellagra
34
Triad of symptoms associated with Pellagra/Niacin/Vit B3 deficiency?
1. Dermatitis
2. Dementia
3. Diarrhea
35
What are 4 things that can cause smooth tongue?
1. Vitamin deficiency
2. Anemia
3. Malabsorption
4. Antibiotics
36
What is a synonym for Vit C and its importance?
Ascorbic Acid. Necessary for proper collagen synthesis.
37
What is a disease associated with Vit C/Ascorbic Acid deficiency?
Scurvy
38
What are gingival lesions associated with Scurvy/Vit C/Ascorbic Acid?
Scorbutic gingivitis
39
Is is wound healing affected in Scurvy/Vit C/Ascorbic Acid deficiency?
Yes
40
What is a vitamin that is considered a hormone and is commonly low?
Vitamin D
41
What is the term for adult Vit D deficiency?
Osteomalasia (weak bone structure)
42
What is the term for childhood Vit D deficiency?
Rickets
43
What is the he Rickets Rosary of Vit D deficiency in children?
Costochondral junction enlargement (looks like a chain running down the ribcage)
44
What is a fat-soluble vitamin necessary for proper synthesis of various proteins including clotting factors 2, 7, 9, and 10?
Vitamin K
45
If the patient has a Vitamin K deficiency,what will be an associated problem?
Bleeding/clotting problems
46
Why would a malabsorption syndrome or a microflora elimination due to antibiotic therapy cause a Vitamin K deficiency?
Stop Vit K uptake
47
What are 2 examples of Vitamin K drugs?
1. Plavix
2. Coumadin
(both decrease Vitamin K in order to decrease clotting)
48
What esults in coagulopathy due to inadequate synthesis of prothrombin and other clotting factors?
Vitamin K Deficiency
49
What immune cells do not function as well in Anemias?
T-cells
50
What is a reduction in the oxygen-carrying capacity of blood?
Anemia
51
What are 4 conditions leading to anemia?
1. Excessive blood loss
2. Increased RBC demand
3. Decreased Iron intake
4. Decreased iron absorption
52
What are 3 nutritional anemias?
1. Iron deficiency
2. Folic acid deficiency
3. Vit B12 deficiency
53
What are 4 oral manifestations of Anemia?
1. Skin/mucosal pallor
2. Angular cheilitis
3. Erythema and atrophy of oral mucosa
4. Loss of filiform and fungiform papillae on dorsum of tongue
54
What is an anemia caused by insufficient amount of iron available in bone marrow for red blood cell development. Siversky thinks this is the most important deficiency anemia. It is most common anemia in United States?
Iron deficiency
55
What are the 2 most common causes Iron Deficiency anemia?
1. Pregnancy
| 2. Heavy menses
56
What are the hemoglobin and hematocrit findings in iron deficiency anemia?
Both are low
57
What can superimpose on Iron deficiency anemia?
Candidiasis
58
Besides reduced red blood cells in iron deficiency anemia, what is the character of the red blood cells
Hypochromic microcytic
59
What is the treatment for iron deficiency anemia?
Iron supplementation
60
What is the syndrome of Iron Deficiency + Glossitis + Dysphagia?
Plummer-Vinson syndrome
61
Is Plummer-Vinson syndrome premalignant?
Yes
62
Plummer-Vinson syndrome is associated with what cancer(s)?
Oral and esophageal squamous cell carcinoma
63
What is the demographic for Plummer-Vinson syndrome?
Scandanavian women or Northern Europeans, 30- 50 yrs old
64
What is the treatment for Plummer-Vinson syndrome?
Treat iron deficiency and dilate the esophagus
65
What are the symptoms of Plummer-Vinson syndrome?
Dysphagia
Esophageal webs
Spoon shaped nails (koilonychea)
66
What is a megablastic anemia caused by poor absorption of cobalamin (Vit B12, extrinsic factor)?
Pernicious anemia
67
What disorder is caused by autoimmune destruction of parietal cells of stomach resulting in decreased absorption of cobalamin?
Pernicious anemia
68
What is a vitamin needed for DNA synthesis, if it is lacking, rapidly dividing cells (marrow, epithelium) are affected?
Vitamin B12
69
What is the standard workup for burning tongue?
Blood tests for Vit B and diabetes
70
What are 4 causes of pernicioius anemia?
1. Autoimmune
2. Gastrectomy
3. Gastric cancer
4. Gastritis
71
What is the only possible difference in the oral manifestations of anemias and pernicious anemia?
Pernicious anemia may have patchy bald tongue while Iron deficiency anemia tongue is completely bald
72
What is difference histologically between iron deficiency anemia and pernicious anemia?
Iron deficiency has microcytic cells while pernicious red blood cells are large (megablastic) and have nuclei
73
What is the treatment for Pernicious Anemia?
Vitamin B12 (cyanocobalamin) injections, possible that not all tongue papillae will regenerate
74
What is a common complaint in pernicious anemia?
Burning tongue
75
What is the difference between a pituitary dwarf and an achondroplastic dwarf as far as proportions?
Pituitary dwarfs are proportional
76
What are 2 causes of Pituitary Dwarfism?
1. Diminished production of growth hormone
| 2. Reduced capacity of tissues to respond to growth hormne
77
What is the term for excessive hormone production by anterior pituitary gland?
Hyperpituitarism
78
What causes the overproduction of excess growth hormone by anterior pituitary?
Pituitary adenoma
79
Hyperpituitarism is associated with what disorders?
Gigantism and Acromegaly
80
What is the syndrome associated with iincreased production of growth hormone (usually related to pituitary adenoma) taking place before closure of epiphyseal plates?
Gigantism
81
What is the syndrome associated with excess production of growth hormone after closure of epiphyseal plates?
Acromegaly
82
What are the oral-facial symptoms associated with acromegaly?
Increased growth of mandible with prognathism, apertognathia (open bite), teeth spacing, macroglossia
83
What is the treatment for hyperpituitarism?
Remove pituitary adenoma
84
What is the average age of a patient receiving an acromegaly diagnosis?
42
85
What are some systemic problems seen in acromegaly?
```
Hypertension
Diabetes mellitus
Coronary artery disease
Congestive heart failure
Respiratory disease Colon cancer
```
86
What is the term for decreased output of thyroid hormone?
Hypothyroidism
87
What is the term for hypothyroidism during infancy/childhood?
Cretinism
88
What are 6 things that will be seen with cretinism/hypothyroidism in infancy?
```
Thick lips
Enlarged tongue
Short stature
Puffy face
Cold intolerance
Mental retardation
Lethargy
```
89
What are 2 types of hypothyroidism?
1. Primary
| 2. Secondary
90
Which type of hypothyroidism is when the thyroid cannot produce the amount of hormones the pituitary calls for?
Primary
91
Which type of hypothyroidism is when the thyroid is not being stimulated by pituitary to produce hormones?
Secondary
92
What are the general symptoms of hypothyroidism versus hyperthyroidism?
```
Hypo = slow down, get chubby
Hyper = speed up, get thin
```
93
What is the treatment for hypothyroidism?
Thyroxine to normalize serum TSH concentration
94
What is the clinical clue for hypothyroidism in adult?
Non-pitting edema due to glucosaminoglycan ground substance deposition
95
What is the synonym for hypothyroidism in adults?
Myxedema
96
What is the term for excess production of thyroid hormone?
Hyperthyroidism
97
What is the main cause of hyperthyroidism thought to be caused by autoantibodies that are directed against receptors for thyroid stimulating hormone (TSH) on the surface of thyroid cells?
Grave’s disease
98
What are 5 causes of hyperthyroidism?
1. Grave’s disease
2. Thyroid hyperplasia
3. Benign or Malignant thyroid tumors
4. Pituitary disease
5. Metastatic tumors
99
What does excess thyroid hormone of hyperthyroidism cause?
Increased metabolism
100
How does one initially control Grave’s disease/hyperthyroidism?
Kill the thyroid
101
What is the demographic for Grave’s disease/hyperthyroidism?
30-40 y.o. women
102
What is the eye bulging (exopthalmos) of Grave’s Disease / hyperthyroidism caused by?
Accumulation of glycosaminoglycans in retro
| orbital connective tissue
103
How does one make a diagnosis for hyperthyroidism?
Assay free T4 (thyroxine) and TSH levels. T4 should be elevated and TSH will be depressed
104
What is the treatment for hyperthyroidism?
Radioactive ablation of thyroid followed by lifelong administration of appropriate levels of thyroid meds (soloxine)
105
What is the term for uncontrolled hyperthyroidism resulting in delirium, elevated temperature and tachycardia?
Thyroid storm
106
Which pathology involves xcessive secretion of parathyroid hormone (PTH) by the 4 parathyroid glands which plays a critical role in calcium and phosphorus metabolism. Causes elevated blood calcium (hypercalcemia) and phosphorus (hyperphosphatemia) which creates altered bone metabolism?
Hyperparathyroidism
107
What is the character of the Giant Cell Granuloma associated with Hyperparathyroidism?
Resorptive whereas the ones we have learned dentally are expansile
108
Hyperparathyroidism is normally the result of what?
Tumor
109
What is the demographic for Hyperparathyroidism?
Middle aged women
110
What is the term for hyperparathyroidism resulting from disease in the parathyroid glands
Primary hyperparathyroidism
111
What is the term for hyperparathyroidism resulting from abnormal excretion of calcium by the kidneys?
Secondary hyperparathyroidism
112
What is a 4 word memory aid for clinical manifestations of hyperparathyroidism?
Stone, bones, groans, moans
113
What are the "stones" associated with hyperparathyroidism?
Kidney stones
114
What is the cause of bone pain in hyperparathyroidism?
Excessive calcium mobilization in both bones and joints
115
What are the cause of the "groans" associated with hyperparathyroidism
GI cramps due to excess Calcium absorption
116
What are the "moans" associated with hyperparathyroidism?
Personality disorders of variable scope, lethargy, coma
117
What is the oral manifestation of hyperparathyroidism?
Brown tumor that is histologically identical to central Giant Cell Granuloma
118
What is the classic radiographic sign for hyperparathyroidism?
Loss of lamina dura
119
What is the classic radiographic sign for Scleraderma?
Scleraderma (WTF?)
120
How is the treatment determined for hyperparathyroidism?
It depends on what is causing increased PTH levels (tumor, kidney disease, Vitamin D deficiency)
121
What happens to the bone lesions of hyperparathyroidism once the disease is successfully treated?
Bone lesions (WTF?)
122
What is the term for a primary adrenal cortical insufficiency causing insufficient production of adrenal steroids which in turn causes Pituitary to secrete ACTH to stimulate the adrenal cortex?
Addison’s disease
123
What are 3 causes of Addison’s disease?
1. Idiopathic adrenal cortex destruction (autoimmune)
2. Malignant tumor
3. Tuberculosis
124
What increases in pt with Addison’s disease due to the increased ACTH?
Increased melanin pigmentation
125
How can increased melanin pigmentation can manifest itself in the oral cavity?
As oral melanotic macules or gingival pigmentation
126
What is a differential if see gingival pigmenting on a person who previously had no normal or variant of normal gingival pigmentation?
1. Smoker's melanosis
| 2. Addison's disease
127
What is the treatment for Addison's disease?
10 mg steroids/day
128
What are 2 causes of hypercortisolism?
1. Prescription drugs causing increased glucocorticoid levels
2. Adrenal or pituitary tumor
129
If hypercortisolism is due to adrenal or pituitary disease it is called what?
Cushing’s Syndrome
130
What is the most consistent clinical observation of hypercortisolism/Cushing’s syndrome?
Weight gain in central areas of the body
131
What are 2 characteristic clinical findings on a patient with hypercortisolism / Cushing’s syndrome due to increased fat deposition?
Buffalo hump and moon facies
132
What is a chronic disorder of carbohydrate (glucose) metabolism. Patients have abnormally high blood glucose levels (hyperglycemia)?
Diabetes Mellitus
133
What are 3 pathways for Diabetes Mellitus?
1. Lack of insulin
2. Defective insulin that does not lower blood glucose
3. Insulin resistance due to obesity
134
Normally, what should glucose do in the body?
Should stimulate pancreas to secrete insulin which causes uptake of glucose into skeletal muscle and fat
135
What happens to skeletal muscle and fat when insulin is lacking or defective to the point that glucose is not taken up into muscles or fat?
Breakdown of muscle and fat
136
What is the danger of the breakdown of fat due to lack of glucose uptake?
Turns into ketone acids that lower blood pH that can lead to diabetic coma and death (ketoacidosis)
137
Insulin-dependent diabetes mellitus is which type of diabetes?
Type I
138
What are the 3 P’s of Diabetes Mellitus?
1. Polydipsia (excessive thirst)
2. Polyuria(excessive urination)
3. Polyphagia (excessive appetite)
139
What is the body type for a patient with Type I (Insulin dependent) diabetes mellitus?
Thin
140
By what age is Type I (Insulin dependent) diabetes mellitus diagnosed?
By early 20’s
141
Non-insulin dependent diabetes mellitus is what type of diabetes?
Type II diabetes
142
When is Type II (non-insulin dependent) diabetes mellitus found and in what body type?
Early middle age; overweight
143
How is Type I (Insulin dependent) diabetes mellitus treated?
Rigorous control of blood glucose with multiple insulin injections, proper diet, exercise
144
When are the oral complications of Diabetes Mellitus most severe?
When blood glucose level is not well controlled (brittle diabetics)
145
If a diabetes mellitus patient has candidiasis or mucormycosis (both fungal infections) what does this indicate?
That the patient is immunocompromised
146
What are the oral complications of diabetes mellitus?
1. Erythematous hyperplastic gingiva
2. Excessive perio, tooth mobility
3. Early tooth loss
4. Slow wound healing
147
What is a hereditary decrease in serum alkaline phosphatase?
Hypophosphatasia
148
What is serum alkaline phosphatase important for?
Calcification of bone and cementum of teeth
149
Lack of cementum or abnormal cementum in hypophosphatasia causes what orally?
Premature loss of deciduous anterior teeth
150
Which are the the only teeth not affected by hypophosphatasia?
Deciduous molars and permanent teeth
151
What are some systemic features of hypophosphatasia?
1. Bowing of legs
| 2. Bone fractures
