Oral Medicine I - fishing again Flashcards by Tim Agee

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

Right ventricle

Posterior wall Left Ventricle

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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%

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RCA goes to:

LAD:

Left Circumflex:

posterior wall and right ventricle

anterior wall

lateral wall of left ventricle

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LAD is the artery of…

Sudden Death

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What are the 3 complications of an MI?

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

Cardiac Tamponade

Left Ventricular Aneurism

Mural Thrombus

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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

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

25%

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In a Transmural MI, the infarction involves what layers?

Additionally?

all 3

free wall Lt ventricle and Interventricular septum

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

where?

subendocardial layer

left ventricle

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

Transmural

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

LAD

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

Preceding atherosclerotic plaque blocking greater than 75%

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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

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

True

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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

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

True

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High consumption of sucrose = atherosclerosis and caries

True

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

True

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Acute Bacterial Endocarditis (ABE) due to:

Subacute Bacterial Endocarditis (SBE) due to:

S. aureus or G-‘s

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

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

SBE (subacute)

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

What specific valves?

Left

mitral, aortic semilunar

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

True

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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

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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)

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

True

3 skin manifestations of infective endocarditis:

Splinter hemorrhages Osler's nodes 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) pads fingers/toes palms/soles

What 4 procedures get pre-op Abx? *AHA recommendations

Prosthetic heart valves Hx infective endocarditis Congenital heart defects/prosthetic repair Valvulopathy after heart transplant

Give pre-op pts _______ How long prior?

oral amoxicillin 30-60 minutes

What are the 3 compensatory mechanisms to CHF?

Increase sympathetic stimulation Fluid retention Cardiac hypertrophy (left ventricle)

CHF is failure of the heart as a pump

True

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

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

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

False *NOT compesatory

Left HF: Right HF:

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

HTN plasma Na and arterial BP

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

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

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

Malignant HTN will cause hemmorhage in what organ?

Kidney * punctate * **black males

2 Calcium channel blockers: Used for: side effect:

Procardia, Nifedipine HTN gingival hyperplasia

Epinephrine can cause what 4 things?

hypertensive crisis angina pectoris MI Cardiac arrythmias

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

dysgeusia

Islets of Langerhans, Alpha cells secrete/%: Beta cells/%: Delta cells/%: *3 types of Islets!!!

Glucagon, 20% Insulin, 70% Somatostatin, 10%

Type I diabetes antibodies destroy what? Type II islets:

beta cells islets normal or increased in size

Ketoacidosis results from what 2 things?

inadequate fat utilization reduced lipogenesis FFA to Ketones

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

FFA acidosis = ketoacidosis

6 signs of Diabetes:

glucosuria (sweet pee) polyuria (pee much) polydipsia (thirst) ketogenesis osmotic diuresis anaerobic glycolysis

In diabetes, what system is responsible for most morbidity/mortality? 2 reasons:

Cardiac Microangiopathy, Atherosclerosis of coronaries

Insulin is stored in Beta Cells in _______ granules

Neurosecretory

1 word that typifies the pathology of Diabetes:

Microangiopathy

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

2 Thyroid diseases - hyper/hypo / antibodies

Graves - Hyper - TSH receptors increase Hashimoto - Hypo - destroys receptors ***both IgG

Autoimmune diseases are all more common in:

women

Hashimoto's has a ___% increase in _____ *this is not present in Graves

40% B-cell lymphoma

Most prevalent Autoimmune disease in the US?

Graves

Graves and Hashimotos are both Autoimmune Therefore, what else would be in the tissues?

True lymphocytes (lots)

#1 cause of Nodular Goiter

Idiopathic

A Toxic Goiter is... Non-toxic...

Functional euthyroid/non-functional

Hyperthyroidism, increased _____, sweat, and intolerant of ______ Hypothyroidism, tired, sensitivity to ______

apetite, heat cold

Graves, low levels of.. high levels... IgG antibodies stimulate what receptors?

TSH T4, T34 TSH receptors on follicles

Cushing Syndrome: Cushing Disease:

Adrenal Pituitary (exogenous)

Hyperfunctioning Adrenal: Hypofunctioning Adrenal: *cortex

Cushing Syndrome Addison's Disease

Which Adrenal glucocorticoid disease is Autoimmune?

Addison's *hypofunctioning

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) ACTH

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

True 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 75% True

What G- causes Waterhouse-Friedrickson Syndrome?

Neisseria meningitidis

Neisseria meningiditis speticemia causes what Syndrome? This bacteria is Gram ____

Waterhouse-Friedrickson negative

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

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

Pheochromocytoma

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

Etiology of MS is... 3 possibilities:

Unknown genetic, immune, infection

Parkinson's Disease is a neurotransmitter deficiency in what? and pathological loss of neurons in the _______

Dopamine Substantia Nigra

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

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

Parkinson's

Lewy Body: residual atrophic _______ cell containing ______, ______, and _______ cytoplasmic inclusions Pick Body: expressed clinically as ______ and is indistinguishable from ______

Nerve, Spherical, Granular, Eosinophilic Dementia, Alzheimers

4 Clinical Features of Parkinson's

Increased Drooling Mask-like face Cogwheel rigidity Pill rolling tremor

What class of drugs can cause Parkinsonian type syndrome to occur? *2 of them

Phenothiazine Haldol

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

Basal ganglia Thalamus

Berry Aneurism occurs where in brain? Rupture causes what? Sudden severe headache followed by _____

Anterior circulation subarachnoid hemorrhage coma

What is the name of aneurysms seen in HTN bleeds?

Charcot-Bouchard

Fresh stroke: Old stroke (cerebral infarct)

liquefactive necrosis (soft) astrogliosis with cyst formation

What is the etiology of a Berry Aneurism?

Congenital (90%)

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

Hippocampus Women 21 Amyloid

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

gyri, sulci congo helical

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

Hippocampus *senile plaques, tangles, amyloid all found here

Oral Medicine I - fishing again Flashcards

(93 cards)