Oral Medicine II - fishyfishy Flashcards by Tim Agee

4 Types of COPD

Chronic Bronchitis

Emphysema

Bronchial Asthma

Bronchiectasis

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Define Chronic Bronchitis

Chronic cough

Sputum production minimum 3 months/year

For 2 Consecutive years

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Smoking is the main cause of Chronic bronchitis in ___% of cases

90%

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Chronic Bronchitis is due to hypertrophy of what?

The mucosa is infiltrated w/ lymphocytes, macrophage, and plasma cells, but no…

Surface epithelium may undergo metaplasia from columnar to…

Bronchial mucous glands

neutrophils

stratified squamous

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Chronic Bronchitis can result in what type of heart failure?

*This leads to what?

Right heart failure

aka Cor Pulmonale

*venous stagnation/cyanosis

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Blue Bloaters

Pink Puffers

Chronic Bronchitis

Emphysema

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Blebs appear on the ____ surface of the lung

Bullae appear in the _____ of the lung

Both are associated with what?

pleural

parenchyma (greater than 1 cm)

Emphysema

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What causes the actual breakdown of lung tissue in Emphysema?

Proteases from bacteria, PMN’s, monocytes, macrophage

*destroys Elastin/Reticular figers

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Which COPD has Curschmann Spirals?

Bronchial Asthma

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Bronchial asthma has many mucosal infiltrates which include…

Mucous sometimes contain whorls of shed epithelial cells called _______ which are seen microscopically

Eosinophils

Curshmann’s spirals

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Bronchiectasis is a ______ of the bronchi

This is the most common complication of chronic _____

Bronchi/Bronchioles are filled with ______ that stagnates and can’t be cleared with coughing

Permanent Dilation

Chronic Bronchitis

Mucopurulent

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Hx COPD, difficulty breathing, severe halitosis, respiratory attack, what does the pt have?

Bronchioectasis

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2 Ways to get Emphysema:

Smoking

Genetic (Alpha 1 antitrypsin deficient)

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Alpha 1 Antitrypsin is a ________

If you don’t have it what happens?

anti-protease

protease destroys lung tissue

***primary function is to neutralize naturally occurring proteases

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As opposed to an Alpha 1 Antitrypsin deficiency, in a smoker what causes Emphysema?

Inflammatory mediators release elastases

Destroys elastic tissue of the alveolar sac

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Usually COPD is related to Pneumonia and Oral Health via

Cigarette smoking

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Onset of COPD is dependent on smoking (almost always) and repeated _________ can worsen the disease

______ bacteria can travel to the lungs

Teeth bacteria are ______ and lead to pneumonia in smokers w/ COPD

bacterial infections (pneumonia)

Periodontal

Strep Viridans

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Genus, Species for legionella

It is a G___

American Legion in Philly caused pneumonia via inhalation from humidifiers, thus spread requires…

Legionella pneumophilia

gram negative rod

man-made water based environments

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What Gram Positive is associated with Pulmonary Abscesses?

Stapylococcus aureus

*virulent organisms

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Rust Colored Sputum:

Current Jelly Sputum:

**both cause pneumonias, remember, G-‘s can be just as bad as S. aureus

Pneumococcal/Streptococcus pneumoniae (Gram +)

Klebsiella pneumonia (Gram -)

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4 different routes that can cause Pneumonias:

Airborne - inhalation of droplets

Aspiration of gastric infected particles

Aspiration of infected Upper Resp Tract (strep/staph)

Hematogenous spread - sepsis, UTI, GI infections

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mycoplasma pneumonia =

mycobacterium tb -

Klebsiella

Tuberculosis

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Interstitial pneumonias:

Broncho (alveolar) pneumonias:

Viral

Bacteria

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Alveolar (broncho) pneumonia can be _______

Interstitial (viral) affects _____

diffuse/lobular

wall of alveoli

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There is an association between ______ pneumonia and Periodontal Disease This is b/c long-term ______ causes S. aureus, Pseudomonas, Kebsiella to gather in oral cavity What happens to these pathogens?

nosocomial Abx Aspirated to lungs (poor cough/gag reflex)

TB stains how? _____ acid that is anti-phagocytic It causes what in the lungs?

Acid Fast Mycolic Caseating granulomas

Most common portal of entry for TB: #2:

Respiratory GI

TB infecting Cervical Lymph nodes:

Scroffula

Initial lung lesion of TB that appears in the lower lobes: _____ lung lesion draining to ______ (combines to form this thing)

Gohn Complex subpleural, hilar lymph node

Primary TB starts with what? ***when pt First Exposed

Gohn Complex

Pott's Disease is a form of ______ TB TB can appear where? Causing what?

milliary Vertebrae (interevertebral joints) Arthritis

Tuberculoma: mimics: Well-defined ____ mass Most common occurs in what 2 areas?

TB conglomerates Tubercles into Firm Lump cancer focal Brain/Lung

PPD: Used for:

Purified Protein Derivative TB skin test *makes wheal

AFB: Used for:

Acid Fast Bacilli staining TB cells

BCG: Skin test implications:

TB immunization used outside US positive for skin test but negative for TB

INH

Isoniazid TB tx

Primary TB: Secondary TB:

Gohn Complex, in immunosuppressed out of control Reactivation spreads to Apex

Non-productive, dry cough, low-grade fever, no appetit, minor hemoptysis

Secondary TB

Tubercobacillus secretes toxins

False ***we secrete those to keep it in check

The part of our immunity that drives the response to TB: There is no:

cell-mediated Antibodies (IgG, etc)

What type of hypersensitivity is seen in the NRL (Natural Rubber Latex) protein allergy? What Antibody is involved?

Type 1 hypersensitivity IgE

NRL second exposure is IgE + degranulation =

release of histamine

What type of hypersensitivity Rxn is seen in ACD (Allergic Contact Dermatitis)? Cell that mediates:

Type IV delayed T-cell lymphocyte (cell mediated) *no plasma cells (b cells)

ICD is what kind of rxn? due to:

non-hypersensitivity inflammation of physical/mechanical/chemical irritation **no immune cells involved

Type I hypersensitivity rxn Type IV delayed hypersensitivity rxn inflammation rxn (no hypersensitiviy)

NRL - natural rubber latex ACD - allergy contact dermatitis ICD - irritant contact dermatitis

Glutaraldehyde: Donning Powder: Both can cause:

Cleaning disinfectant Irritant ICD

Glutaraldehyde can cause ICD/ACD

True

Bonding agents contain ______, which can cause ACD

methacrylates

2 kinds of Hiatal Hernia: Which is Tx w/ surgery?

Sliding (95%) (medically treated) Paraesophageal - SURGICAL

Hiatal hernia is a separation in the _______

Diaphragm

Which Hiatal Hernia is associated with Reflux Esophagitis?

Sliding *95%, medically Tx

In a Hiatal Hernia the stomach goes up into the Thorax and when the pt ______ the symptoms are worse

Lays down

Paraesophageal (hiatal) hernia progressively enlarges and the cause in unknown

True

Candida Esophagitis: Herpes Esophagitis: CMV Esophagitis:

AIDS/immunocompromised HSV1, Lymphoma/Leukemia, vescicular, PINK AIDS/Basophilic inclusion bodies, not in Epithelium (in endothelial cells and fibroblasts of granulation tissue) *all 3 can be due to HIV

Candida Esophagitis: Herpes Esophagitis: CMV Esophagitis:

Pseudohyphae Acidophilic internuclear inclusions Basophilic internuclear inclusions

Barrett's esophagus metaplastic chain:

Squamous cell epithelium replaces with Columnar epithelium Adenocarcinoma (from stomach, not squamous of esophagus)

Barrett's occurs where?

lower 1/3 of esophagus * white men * 2x smokers

How does healing occur in Barrett's Esophagitis?

2 types of PUD (peptic ulcer disease)

Gastric ulcers Duodenal ulcers

What bacteria causes Gastric/Duodenal ulcers of PUD? common factor besides this

Helicobacter pylori HCl over secretion

Duodenal Ulcer peak age: Gastric: Duodenal ulcer sex distribution: Gastric:

30-60 middle and elderly more than younger male both

O blood has an association w/ what ulcer? how much higher?

Duodenal *30% higher

___% of pts w/ gastric ulcers harbor H. pylori

75%

Which ulcer has kissing pairs?

Duodenal

All racial/ethnic groups equally susceptible to ulcers in US what liver disease is associated? aspirin/nsaids/corticosteroids associated Malignant transformation occur commonly:

True Cirrhosis/alcohol True False (only 1%)

PUD associated w/ cigarettes

True

4 features of Crohn's Disease:

Skip lesions Transmural inflamation Ulcerations Fissures

2 features of CUC (chronic ulcerative colitis)

Pseudopolyp Ulcer

Crohn's vs. CUC: which has pseudopolyps? fistula formation? Transmural inflammation? Cobblestoning? rubber hose fibrosis? toxic megacolon? higher malignant transformation? higher bleeding? Granulomas? Skip lesions? Diffuse?

CUC Crohn's Crohn's Crohn's Crohn's CUC CUC CUC Crohn's Crohn's CUC

What is not seen in CUC, but is diagnostic in Crohn's?

non-caseating Granulomas

Crohn's is a chronic inflammation of the GI that most often involves the _____ and ______

terminal ileum colon

Granuloma's seen in Crohn's causes the wall to thicken and become rigid, termed also has ____ on the surface of the serosa lesions? adjacent adhesion:

Rubber-Hose Fibrosis Creeping Fat Skip fistula

CUC most often involves the _____ unlike Crohn's, CUC location: Usually does not extend into ileum, but there is

colon diffuse backwash ileitis

CUC is not transmural but is limited to what 2 layers? Mucosa shows what? spread of these ulcerations create?

mucosa/submucosa crypt abscesses inflammatory pseudopolyps

Most significant late complication of CUC: 70% 20% 10%

malignant transformation chronic fulminant (surgery) single episode

Left side of colon: Right side of colon:

CUC Crohn's

CUC ulcers: Crohn's ulcers:

wide/diffuse/pseudopolyps linear/cobblestones

more friable and bleed more: colonic wall thinner: thicker: higher risk of cancer:

CUC CUC - toxic megacolon Crohns - transmural inflammation CUC

Extraintestinal complications Crohn's vs CUC name 3

same *arthritis, eye lesions, skin lesions

Oral Medicine II - fishyfishy Flashcards

(79 cards)