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Flashcards in Oral Medicine I - fishing again Deck (93):
1

Occlusion of the Right Coronary Artery causes an infarct in what 2 areas of the heart?

Right ventricle

Posterior wall Left Ventricle

2

Where do coronary artery occlusions happen most often?

3 locations

LAD (left anterior descending): over 50%

RCA (right coronary artery): 30-40%

Left Circumflex Artery: 10-20%

3

RCA goes to:

LAD:

Left Circumflex:

posterior wall and right ventricle

anterior wall

lateral wall of left ventricle

4

LAD is the artery of...

Sudden Death

5

What are the 3 complications of an MI?

Ventricular (myocardial) Rupture (5-7 days after)

Cardiac Tamponade

Left Ventricular Aneurism

Mural Thrombus

6

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?

75%

60%

kidney, brain

7

% pts that undergo complete heart failure due to V-fib/heart block/pump failure during MI

25%

8

In a Transmural MI, the infarction involves what layers?

Additionally?

all 3

free wall Lt ventricle and Interventricular septum

9

Subendocardial/Intramural MI the infarction is usually concentric around what layer?

where?

subendocardial layer

left ventricle

10

What type of MI is more common (vast majority of MI's)

Transmural

11

The vast majority of coronary blockages (over 50%) are in what artery?

LAD

12

An MI due to a Thrombus will only occur in what instance?

Preceding atherosclerotic plaque blocking greater than 75%

13

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 ______

300-350 cc

granulation / fibrous tissue

irregularly

necrosis/thrombus

14

There is a relationship between atherosclerosis, MI's, and poor dental health

True

15

The mechanism that relates atherosclerosis, MI's, and poor dental health are _________ infections due to caries, perio, __________, and blood coagulation

gram-negative bacterial

plasma lipoproteins

16

Dental caries and ischemic heart disease share low SES, smoking, diabetes as comorbidities

True

17

High consumption of sucrose = atherosclerosis and caries

True

18

Dental caries/perio more common in pts w/ MI's among controls matched for age/sex

True

19

Acute Bacterial Endocarditis (ABE) due to:

Subacute Bacterial Endocarditis (SBE) due to:

S. aureus or G-'s

Viridans Strept (S. mutans/S. mitis) - Caries!!!

20

What type of endocarditis is caused by same bugs that cause dental caries?

SBE (subacute)

21

What side of the heart will ABE and SBE most likely occur?

What specific valves?

Left

mitral, aortic semilunar

22

Vegetations in ABE or SBE are highly infected, big, and can occur anywhere on or near the valve, chorda tendinae, etc (not restricted)

True

23

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)

Lung

24

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:

Staph epidermidis

Viridans strep

Staph aureus

Gram positives (Staph. aureus/Strept Viridans)

25

90% of endocarditis can be isolated by blood culture unless Abx were given prior

True

26

3 skin manifestations of infective endocarditis:

Splinter hemorrhages

Osler's nodes

Jane Way lesions

27

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)

pads fingers/toes

palms/soles

28

What 4 procedures get pre-op Abx?

*AHA recommendations

Prosthetic heart valves

Hx infective endocarditis

Congenital heart defects/prosthetic repair

Valvulopathy after heart transplant

29

Give pre-op pts _______

How long prior?

oral amoxicillin

30-60 minutes

30

What are the 3 compensatory mechanisms to CHF?

Increase sympathetic stimulation

Fluid retention

Cardiac hypertrophy (left ventricle)

31

CHF is failure of the heart as a pump

True

32

Causes of CHF most often due to what 4 conditions?

*Left-sided HF

ischemic heart disease

HTN

aortic/mitral valve disease

mon-ischemic myocardial disease

33

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"

LV

fibrillation, stasis, thrombus

34

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)

35

Stroke is a result of a compensatory mechanism of the body

False

*NOT compesatory

36

Left HF:

Right HF:

LV hypertrophy, pulmonary congestion

Left side fails, peripheral back-up

37

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

HTN

plasma Na and arterial BP

38

Primary HTN, greater than ___% pts have no specific cause

Risk factors:

Secondary HTN represents ____% of cases

Causes:

90%

age, race, stress, genetics, salt, obesity, RAS

less than 10%

disease/medication/pregnancy

39

What type of HTN is most often seen in middle-aged Black Males?

Malignant HTN

*accelerated, potentially fatal, 5-10% of cases

40

Malignant HTN will cause hemmorhage in what organ?

Kidney

*punctate
***black males

41

2 Calcium channel blockers:

Used for:

side effect:

Procardia, Nifedipine

HTN

gingival hyperplasia

42

Epinephrine can cause what 4 things?

hypertensive crisis

angina pectoris

MI

Cardiac arrythmias

43

Some HTN meds can cause altered sense of taste, aka...

dysgeusia

44

Islets of Langerhans, Alpha cells secrete/%:

Beta cells/%:

Delta cells/%:

*3 types of Islets!!!

Glucagon, 20%

Insulin, 70%

Somatostatin, 10%

45

Type I diabetes antibodies destroy what?

Type II islets:

beta cells

islets normal or increased in size

46

Ketoacidosis results from what 2 things?

inadequate fat utilization

reduced lipogenesis

FFA to Ketones

47

TypeII: B/c decreased lipogenesis, ____ is converted to Ketones, causing what?

FFA

acidosis

= ketoacidosis

48

6 signs of Diabetes:

glucosuria (sweet pee)

polyuria (pee much)

polydipsia (thirst)

ketogenesis

osmotic diuresis

anaerobic glycolysis

49

In diabetes, what system is responsible for most morbidity/mortality?

2 reasons:

Cardiac

Microangiopathy, Atherosclerosis of coronaries

50

Insulin is stored in Beta Cells in _______ granules

Neurosecretory

51

1 word that typifies the pathology of Diabetes:

Microangiopathy

52

Lack of Thyroid hormones in children?

2x common in:

what levels low?

What levels high?

Cretinism (can be endemic/sporadic/genetic)

females

T4/T3

TSH

53

2 Thyroid diseases - hyper/hypo / antibodies

Graves - Hyper - TSH receptors increase

Hashimoto - Hypo - destroys receptors

***both IgG

54

Autoimmune diseases are all more common in:

women

55

Hashimoto's has a ___% increase in _____

*this is not present in Graves

40%

B-cell lymphoma

56

Most prevalent Autoimmune disease in the US?

Graves

57

Graves and Hashimotos are both Autoimmune

Therefore, what else would be in the tissues?

True

lymphocytes (lots)

58

#1 cause of Nodular Goiter

Idiopathic

59

A Toxic Goiter is...

Non-toxic...

Functional

euthyroid/non-functional

60

Hyperthyroidism, increased _____, sweat, and intolerant of ______

Hypothyroidism, tired, sensitivity to ______

apetite, heat

cold

61

Graves, low levels of..

high levels...

IgG antibodies stimulate what receptors?

TSH

T4, T34

TSH receptors on follicles

62

Cushing Syndrome:

Cushing Disease:

Adrenal

Pituitary (exogenous)

63

Hyperfunctioning Adrenal:

Hypofunctioning Adrenal:

*cortex

Cushing Syndrome

Addison's Disease

64

Which Adrenal glucocorticoid disease is Autoimmune?

Addison's

*hypofunctioning

65

Which Cushing is more common?

Cushing Disease 5x (pituitary)

66

Cushing Disease (pituitary) most seen in what demographic:

excessive ectopic production of ______ lead to adrenal cortical hyperplasia

middle aged women (25-45)

ACTH

67

What is the most common cause of Cushing Syndrome in the US?

2nd most common:

over prescription of Steroids

paraneoplastic lung cancer effects

68

What test differentiates Cushing Disease from Cushing Syndrome?

Dexamethasone suppression test

69

Addison's disease presents w/ weakness, fatigue, weight loss, anorexia, nausea, personality changes:

Affects blood how:

Tan pigment from

True

Hypoglycemic, electrolyte imbalace

ACTH precursor is a Melanocyte stimulating hormone

70

3 physical Characteristics of Cushing's Disease:

Osteoporosis occurs in ___% of pts

Glucose intolerance/diabetes/HTN/CHF common

Moon face, buffalo hump, abdominal striae

75%

True

71

What G- causes Waterhouse-Friedrickson Syndrome?

Neisseria meningitidis

72

Neisseria meningiditis speticemia causes what Syndrome?

This bacteria is Gram ____

Waterhouse-Friedrickson

negative

73

What kills pt w/ Waterhouse-Friedrickson syndrome?

aka...

this disease destroys acutely,

What is the final insult?

Bilateral adrenal hemmorhage, infarction, rupture

Acute meningococcemia

True

Both Adrenals Rupture

74

Rare neoplasm of Chromaffin Cells in the adrenal medulla that synthesized/releases catecholamines:

Pheochromocytoma

75

Pheochromocytoma is more frequent in...

Presents clinically w/ abrupt...

Pathogenesis is _____ bound dense core granules and minority are _____

women

HTN, tachycardia, palpitations, sweating, tremor, abdominal/chest pain

membrane, familial

76

Etiology of MS is...

3 possibilities:

Unknown

genetic, immune, infection

77

Parkinson's Disease is a neurotransmitter deficiency in what?

and pathological loss of neurons in the _______

Dopamine

Substantia Nigra

78

Parkinson's mostly idiopathic, what are the Gross features are Pigmentation loss in what 2 areas?

Microscopic?

Clinical:

Substantia nigra, locus ceruleus

pigmented neurons scarce, melanin deposits, Lewy Bodies

Increased Drooling, Mask-face, Cogwheel rigidity, pill rolling tremor

79

Von Economo Encephalitis was an influenza epidemic in 1916-1920 and caused what in the survivors?

Parkinson's

80

Lewy Body: residual atrophic _______ cell containing ______, ______, and _______ cytoplasmic inclusions

Pick Body: expressed clinically as ______ and is indistinguishable from ______

Nerve, Spherical, Granular, Eosinophilic

Dementia, Alzheimers

81

4 Clinical Features of Parkinson's

Increased Drooling

Mask-like face

Cogwheel rigidity

Pill rolling tremor

82

What class of drugs can cause Parkinsonian type syndrome to occur?

*2 of them

Phenothiazine

Haldol

83

75% HTN related hemorrhages are found in what general area of the brain?

Specific?

Basal ganglia

Thalamus

84

Berry Aneurism occurs where in brain?

Rupture causes what?

Sudden severe headache followed by _____

Anterior circulation

subarachnoid hemorrhage

coma

85

What is the name of aneurysms seen in HTN bleeds?

Charcot-Bouchard

86

Fresh stroke:

Old stroke (cerebral infarct)

liquefactive necrosis (soft)

astrogliosis with cyst formation

87

What is the etiology of a Berry Aneurism?

Congenital (90%)

88

Underlying etiology of Stroke is a blockage where?

*can be progressive atherosclerosis

Circle of Willis

89

What does a big clot in the Striate Arteries cause?

Hemiparesis or Hemiplegia

90

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

Hippocampus

Women

21

Amyloid

91

Hydrocephalus ex Vacuo

Loss of brain Parenchyma makes lateral ventricles appear dilated

92

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

gyri, sulci

congo

helical

93

Vast majority of Alzheimer disease found in what area of the brain?

Hippocampus

*senile plaques, tangles, amyloid all found here

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