Flashcards in Oral Medicine I - fishing again Deck (93):
Occlusion of the Right Coronary Artery causes an infarct in what 2 areas of the heart?
Posterior wall Left Ventricle
Where do coronary artery occlusions happen most often?
LAD (left anterior descending): over 50%
RCA (right coronary artery): 30-40%
Left Circumflex Artery: 10-20%
RCA goes to:
posterior wall and right ventricle
lateral wall of left ventricle
LAD is the artery of...
What are the 3 complications of an MI?
Ventricular (myocardial) Rupture (5-7 days after)
Left Ventricular Aneurism
What % of pts survive onset of MI?
of those ___% of pts develop Heart Failure and cardiogenic shock
inadequate blood flow causes what 2 organs to fail?
% pts that undergo complete heart failure due to V-fib/heart block/pump failure during MI
In a Transmural MI, the infarction involves what layers?
free wall Lt ventricle and Interventricular septum
Subendocardial/Intramural MI the infarction is usually concentric around what layer?
What type of MI is more common (vast majority of MI's)
The vast majority of coronary blockages (over 50%) are in what artery?
An MI due to a Thrombus will only occur in what instance?
Preceding atherosclerotic plaque blocking greater than 75%
Cardiac Tamponade: after _____ cc fills sac every heart beat
Left Ventricular Aneurism: myocardial infarcts replaced with _____ and _________ tissue that can bulge under pressure and form aneurism
In left ventricular aneurism, the heart contracts _______ b/c fibrous tissue forming wall does not contract
Mural Thrombus: endocardium overlying infarct is damaged, blood coagulates, causes ______
granulation / fibrous tissue
There is a relationship between atherosclerosis, MI's, and poor dental health
The mechanism that relates atherosclerosis, MI's, and poor dental health are _________ infections due to caries, perio, __________, and blood coagulation
Dental caries and ischemic heart disease share low SES, smoking, diabetes as comorbidities
High consumption of sucrose = atherosclerosis and caries
Dental caries/perio more common in pts w/ MI's among controls matched for age/sex
Acute Bacterial Endocarditis (ABE) due to:
Subacute Bacterial Endocarditis (SBE) due to:
S. aureus or G-'s
Viridans Strept (S. mutans/S. mitis) - Caries!!!
What type of endocarditis is caused by same bugs that cause dental caries?
What side of the heart will ABE and SBE most likely occur?
What specific valves?
mitral, aortic semilunar
Vegetations in ABE or SBE are highly infected, big, and can occur anywhere on or near the valve, chorda tendinae, etc (not restricted)
Endocarditis in IVDA's is caused by what bug?
Occurs in what valve?
1st Organ these vegetations go to?
Staph aureus (50-60%)
Tricuspid (Right side of the heart)
What bug causes the vast majority of Prosthetic Valve Endocarditis?
What bug damages previously damaged/otherwise abnormal heart valves?
What bug damages normal heart valves (and prosth/IVDA):
ABE and SBE are both caused by:
Gram positives (Staph. aureus/Strept Viridans)
90% of endocarditis can be isolated by blood culture unless Abx were given prior
3 skin manifestations of infective endocarditis:
Jane Way lesions
Splinter hemorrhages are linear hemorrhages seen where?
Osler nodes are tender, small, raised, discolored cutaneous lesions seen where?
Jane Way lesions are small, erythematous/hemorrhagic lesions seen where?
under nails (subungual)
What 4 procedures get pre-op Abx?
Prosthetic heart valves
Hx infective endocarditis
Congenital heart defects/prosthetic repair
Valvulopathy after heart transplant
Give pre-op pts _______
How long prior?
What are the 3 compensatory mechanisms to CHF?
Increase sympathetic stimulation
Cardiac hypertrophy (left ventricle)
CHF is failure of the heart as a pump
Causes of CHF most often due to what 4 conditions?
ischemic heart disease
aortic/mitral valve disease
mon-ischemic myocardial disease
CHF has a characteristic pathology of enlargment of what part of the heart?
may cause atrial _______ with blood ______ and possible _______ formation w/ chance of emboli
Pulmonary congestion/edema w/ heavy/wet lungs and "heart failure cells"
fibrillation, stasis, thrombus
What is the main reason #1 cause the right side of the heart fails?
Causes congestion of what?
Left side fails
peripheral organs (nutmeg liver, edema, ascites, etc)
Stroke is a result of a compensatory mechanism of the body
LV hypertrophy, pulmonary congestion
Left side fails, peripheral back-up
RAS (renin angiotensin system) is one of the main causes of what?
Regulates what 2 things?
*decrease Renal flow/Renin released/ACE converts AngI to II/II is a vasoconstrictor/increases blood flow/bp/renal flow
plasma Na and arterial BP
Primary HTN, greater than ___% pts have no specific cause
Secondary HTN represents ____% of cases
age, race, stress, genetics, salt, obesity, RAS
less than 10%
What type of HTN is most often seen in middle-aged Black Males?
*accelerated, potentially fatal, 5-10% of cases
Malignant HTN will cause hemmorhage in what organ?
2 Calcium channel blockers:
Epinephrine can cause what 4 things?
Some HTN meds can cause altered sense of taste, aka...
Islets of Langerhans, Alpha cells secrete/%:
*3 types of Islets!!!
Type I diabetes antibodies destroy what?
Type II islets:
islets normal or increased in size
Ketoacidosis results from what 2 things?
inadequate fat utilization
FFA to Ketones
TypeII: B/c decreased lipogenesis, ____ is converted to Ketones, causing what?
6 signs of Diabetes:
glucosuria (sweet pee)
polyuria (pee much)
In diabetes, what system is responsible for most morbidity/mortality?
Microangiopathy, Atherosclerosis of coronaries
Insulin is stored in Beta Cells in _______ granules
1 word that typifies the pathology of Diabetes:
Lack of Thyroid hormones in children?
2x common in:
what levels low?
What levels high?
Cretinism (can be endemic/sporadic/genetic)
2 Thyroid diseases - hyper/hypo / antibodies
Graves - Hyper - TSH receptors increase
Hashimoto - Hypo - destroys receptors
Autoimmune diseases are all more common in:
Hashimoto's has a ___% increase in _____
*this is not present in Graves
Most prevalent Autoimmune disease in the US?
Graves and Hashimotos are both Autoimmune
Therefore, what else would be in the tissues?
#1 cause of Nodular Goiter
A Toxic Goiter is...
Hyperthyroidism, increased _____, sweat, and intolerant of ______
Hypothyroidism, tired, sensitivity to ______
Graves, low levels of..
IgG antibodies stimulate what receptors?
TSH receptors on follicles
Which Adrenal glucocorticoid disease is Autoimmune?
Which Cushing is more common?
Cushing Disease 5x (pituitary)
Cushing Disease (pituitary) most seen in what demographic:
excessive ectopic production of ______ lead to adrenal cortical hyperplasia
middle aged women (25-45)
What is the most common cause of Cushing Syndrome in the US?
2nd most common:
over prescription of Steroids
paraneoplastic lung cancer effects
What test differentiates Cushing Disease from Cushing Syndrome?
Dexamethasone suppression test
Addison's disease presents w/ weakness, fatigue, weight loss, anorexia, nausea, personality changes:
Affects blood how:
Tan pigment from
Hypoglycemic, electrolyte imbalace
ACTH precursor is a Melanocyte stimulating hormone
3 physical Characteristics of Cushing's Disease:
Osteoporosis occurs in ___% of pts
Glucose intolerance/diabetes/HTN/CHF common
Moon face, buffalo hump, abdominal striae
What G- causes Waterhouse-Friedrickson Syndrome?
Neisseria meningiditis speticemia causes what Syndrome?
This bacteria is Gram ____
What kills pt w/ Waterhouse-Friedrickson syndrome?
this disease destroys acutely,
What is the final insult?
Bilateral adrenal hemmorhage, infarction, rupture
Both Adrenals Rupture
Rare neoplasm of Chromaffin Cells in the adrenal medulla that synthesized/releases catecholamines:
Pheochromocytoma is more frequent in...
Presents clinically w/ abrupt...
Pathogenesis is _____ bound dense core granules and minority are _____
HTN, tachycardia, palpitations, sweating, tremor, abdominal/chest pain
Etiology of MS is...
genetic, immune, infection
Parkinson's Disease is a neurotransmitter deficiency in what?
and pathological loss of neurons in the _______
Parkinson's mostly idiopathic, what are the Gross features are Pigmentation loss in what 2 areas?
Substantia nigra, locus ceruleus
pigmented neurons scarce, melanin deposits, Lewy Bodies
Increased Drooling, Mask-face, Cogwheel rigidity, pill rolling tremor
Von Economo Encephalitis was an influenza epidemic in 1916-1920 and caused what in the survivors?
Lewy Body: residual atrophic _______ cell containing ______, ______, and _______ cytoplasmic inclusions
Pick Body: expressed clinically as ______ and is indistinguishable from ______
Nerve, Spherical, Granular, Eosinophilic
4 Clinical Features of Parkinson's
Pill rolling tremor
What class of drugs can cause Parkinsonian type syndrome to occur?
*2 of them
75% HTN related hemorrhages are found in what general area of the brain?
Berry Aneurism occurs where in brain?
Rupture causes what?
Sudden severe headache followed by _____
What is the name of aneurysms seen in HTN bleeds?
Old stroke (cerebral infarct)
liquefactive necrosis (soft)
astrogliosis with cyst formation
What is the etiology of a Berry Aneurism?
Underlying etiology of Stroke is a blockage where?
*can be progressive atherosclerosis
Circle of Willis
What does a big clot in the Striate Arteries cause?
Hemiparesis or Hemiplegia
Alzheimers is progressive, loss of memory, occurs in what part of the brain?
what sex more often?
***Chromosome ____ is where Alz gene found
Senile plaques with an _____ core
Hydrocephalus ex Vacuo
Loss of brain Parenchyma makes lateral ventricles appear dilated
In Alzheimers the ______ narrow and the _____ widen
Amyloid Angiopathy found with ____ red stains
Neurofibrillary tangles: bundles of paired, _____ filaments in the cytoplasm of cortical neurons/hippocampal pyramidal cells displace/encircle nucleus