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Flashcards in Oral Medicine III - Fishiale Deck (97):
1

Aplastic Anemia is a ______anemia

due to bone marrow ____ or _____

A common cause of what?

normocytic

hypoplasia, aplasia

Pancytopenia

2

What is the complication of Pancytopenia?

This is due to different anemias causing what 3 symptoms?

Pancytopenia leads to anemia, ______ and ______ due to leukopenia

Bleeding disorders

weakness, fainting, lethargy

thrombocytopenia, infection

3

Aplastic Anemia is ____ idiopathic

Secondary due to bone marrow suppression drugs or what 4 other causes?

2/3

Cytotoxic drugs (nsaids/chemo/anticonvulsants)

Viral infection (CMV, EBV, HIV)

Radiation therapy

Benzene

4

Only known Tx for idiopathic aplastic anemia:

secondary anemia:

Marrow transplant

remove cause (Benzene, etc)

5

Megaloblastic anemias are caused by what?

RBC's look like...

Deficient B12 or Folic Acid

megaloblasts, large, Blue Inclusions (basophilic stippling)

6

Most common type of Megaloblastic Anemia?

Define:

Pernicious anemia

no IF, no B12 absorption

7

Groups more likely to get Pernicious Anemia:

Most common in what stage of life?

Rare when?

Irish, English, Scandinavian

late in adult life

under 30

8

A genetic predisposition is suspected in pernicious anemia, but not proven

True

9

What condition often accompanies Pernicious Anemia?

This may explain the pathogenesis via what mechanism?

Atrophic Gastritis

alcohol/tobacco

10

No IF in pernicious anemia is due to what?

no gastric parietal cells

11

Extravascular Hemolysis:

_____ is converted to ______

by the ________ at a RATE LIMITING STEP

causes what 2 things?

overabundance of RBC's destroyed in Spleen

HEME to Bilirubin

Liver

Hyperbilirubinemia, Jaundice

12

What happens in Mononuclear Phagocytic cells of the Spleen?

Extravascular Hemolysis

*not intravascular

13

90% of pts with Pernicious Anemia have what?

Antibodies to Parietal cells

*no IF

14

Diagnosis of Pernicious Anemia:

Schilling Test

radioactive Cobalamine absorption

15

IF + B12 complex usually absorbed where?

If Pernicious Anemia bad enough what can happen?

CNS lesions found in 3/4 of cases, partial gastrectomy possible, and dreaded _____

terminal ileum small intestine

Heart Failure

fish tapeworm infection

16

Lack of Folic Acid (other megaloblastic anemia) is due to what 3 conditions?

Pregnancy

Alcoholics

Malnourished

17

What is a reason for Intravascular hemolysis?

Mismatched blood transfusion

18

What is the most common type of Anemia?

Bone marrow is...

blood cells are...

Iron Deficiency

Hyperplastic

Hypochromic, Microcytic

19

Antidote for Heavy metal poisoning by thallium and radioactive caesium, orally administered.

Also test for Iron Deficiency

Prussian Blue

20

Space occupying lesions destroying marrow (cancer)

Myelophthistic Anemia

21

Most common human enzyme defect anemia:

G6PD deficiency anemia

22

Anemia of Mediterranean

Alpha chromo

Beta chromo

Thalassemia

16

11

23

Pathogenesis, Sickle Cell anemia substitution:

At position:

What chain:

Valine replaces Glutamic Acid

6

Beta chain Hb

24

Sickling Crisis brought about by what?

Causes what?

spontaneously, fever, hypoxia

Infarcts (neuro, bones, spleen, extremities)

25

Consequence of Sickling Crisis infarcts to Spleen?

Fibrotic

Autosplenectomy

26

3 Physical consequences to Sickle Cell?

Skull bossing (marrow hyperplasia, "hair on end")

Dactylitis (back of hand swelling)

Infections

27

Normal is Hb A

Sickle cell is Hb S

True

28

Unlike B12, Folate doesn't need:

Folate deficiency, no _____ signs/symptoms

Folate seen in ______ compared to B12

IF

neuro

Prego

29

Folic Acid Deficiency more common than B12 deficiency

Symptoms similar, except what?

True

no Neuro in Folic

30

Spontaneous, or can be aggravated by Fever, Resp distress, other hypoxia

Hemolytic/Vasoocclusive Crisis

31

Iron Deficiency is #1 cause of Anemia, what is #1 cause of Iron deficiency?

Acute Blood Loss

32

Reason for Iron Deficiency Anemia in Males:

in Females, _____ , then ______

#1 cause Fe anemia:

GI

Reproductive, GI

acute blood loss

33

Sickle Cell can cause what in the Spleen?

Bones:

Backs of Hands/Feet:

Increased...

Autosplenectomy

Hair on End (bossing)

Dactylitis in children

Infections (facilitated by Spleen/Liver)

34

3 Ways Pernicious Anemia is Diagnosed:

Low B12

Schilling Test (Oral Cyanobobalamine)

Over 90% antibodies to IF from Parietal Cells

35

What are the 2 most common reasons for Microcytic Anemia?

What are the 2 most common reasons for Megaloblastic Anemia?

Fe Deficiency, Thallassemia

B12, Folic acid

36

What are the 3 features of Megaloblastic Anemia on a peripheral blood smear?

Megaloblasts (decreased #, but larger)

Hypersegmentation of Neutrophils

Basophilic Stippling of Erythrocytes (megaloblasts)

37

What is a Reticulocyte?

How are they used in diagnosing disease?

Immature RBC

When high, indicates disease (bone marrow compensation for low RBC's in blood)

38

What is characteristic of a Myeolophthistic Anemia?

Metastatic Cancer

39

#1 metastatic cancer causing Myeolophthistic Anemia:

#2:

*remember, this is a cancer metastasizing TO the marrow

Breast

Prostate

40

What is involved in an Aplastic Anemia?

all 3 formed elements

*RBC, WBC, platelets

41

Is the bone marrow involved in Aplastic Anemia?

yes - transplant only Tx for idiopathic form

42

4 Reasons for DIC

*other than Massive Trauma (Shock) and Surgery, burns, hypotensive states

Obstetric emergencies

Mucus-producing Adenocarcinomas (metastatic/primary)

AML (acute mylogenous leukemia) granules

G- Sepsis (esp shock)

43

Disseminated Intravascular Coagulation: widespread ____ changes secondary to microvasculature ________

This is accompanied by the consumption of ______ and ______

Leading to ______

ischemic, fibrin thrombi

platelets, coagulating factors

Hemorrhagic diathesis

44

Fragmented RBC's found in DIC

Schistocyte

45

What are Schistocytes?

What disorder?

Fragmented RBC's

DIC

46

The most important cause of DIC is what chemical on what type of organism?

This acts as what?

LPS, G- bacteria

Synthetic thromboplastin

47

The LPS of G- bacteria acting as a Synthetic thromboplastin is what kind of pathway?

Extrinsic

48

What clotting factor fools the body into believing it must release massive amounts of anti-clotting factors in DIC

Intravascular Fibrin Strands (FSP - fibrin split products)

*results in microangiopathic anemia

49

Hemophilia A: Factor ______

Hemophilia B: Factor ______, aka...

Both are...

Which more common?

VIII

IX, Christmas Disease

sex linked

A

50

Intrinsic path abnormality of Hemophilia A:

Bleeding/prothrombin time are...

prolonged PPT (partial thromboplastin time)

normal

51

Specific tests distinguishing Factor VIII and IX must be done to determine hemophilia A or B

True

52

2 cells that synthesize Von Willebrand factor:

Where stored?

If rupture, released into subendothelium and binds to _______ , promoting adherence

Endothelial cells, Megakaryocytes

endothelial cells

platelet receptors

53

Von Willebrands Disease mimics...

b/c it binds/protects...

Hemophilia A

Factor VIII

54

Most common hereditary coagulation abnormality:

Incidence:

vWD

1/100

55

3 types of vWD w/ %'s

Type 1: 60-80% - mild

Type 2: 20-30% - variable

Type 3: - mucosal bleeding, little/no vWF

56

#1 cause of UTI:

G- enterics (E.coli)

also, Pseudomonas, Klebsiella, Enterobacter, Serratia, Proteus

57

Cause of UTI in women:

men:

both:

pregnancy

enlarged prostate

diabetes, kidney stones, immunosuppression, radiation/chemo

58

Over 90% of Cystitis (infection bladder)/UTI's in female esp. is caused in what way:

only 10% caused what way?

Ascending

Blood

59

Infection of the Bladder:

When women gets UTI, she has this most of the time

Cystitis

True

60

Infection of the Kidneys:

If acute, renal surface is round, yellow, and has raised _______

Pyelonephritis

Microabscesses

61

Ascending bacterial infection acquired during sex, catheter, surgical...

Honeymoon Cystitis

62

One major group that gets Renal Papillary Necrosis:

Common complication:

Diabetics

necrotic Renal pyramid sloughing, blocks ureter, renal colic

63

Inflammation of Urinary Bladder:

Suppurative infection of the kidneys with pus foci:

Cystitis

Acute Pyelonephritis

64

Cystitis is most frequent UTI, often nosocomial, secondary, female, prego, Abx tx

Pyelonephtritis: G- rods, suppurative, microabscesses,

True

True

65

Complications of Acute Pyelonephritis:

Renal Papillary Necrosis

66

What does the surface of the Kidney look like in Acute Pyelonephritis microabscesses? 3 features

Round

Yellow

Raised

67

Renal Papillary Necrosis in the diabetic, what is the number 1 complication if the pyramid tip necrosis, breaks, and lodges?

Hydronephrosis

*after urethra obstruction, renal colic

68

Hemorrhagic Cystitis can be caused by this bacteria:

Or this Anti-Cancer drug:

(or pelvic radiation)

E.coli

Cytoxine (cyclophosphamide)

69

Main reason females get more UTI's

short urethra

70

2 most common chronic diseases that make up the vast majority of Chronic Renal Failure:

*same 2 reasons for Dialysis/Transplant lists

HTN

Diabetes

71

HTN and Diabetes are most common causes of renal failure, but glomerulonephritis and cystic kidney disease also cause

True

72

Diabetes, HTN, Lupus, Uropathy, polycistic KD, renal cystic dysplasia, pyelonephritis, glomerulonephritic, analgesic nephropathy,

Chronic Renal Failure

73

Most feared complication of immunosuppressive drugs post Renal Transplant

nephrotoxicity/injury of Renal Allograft

74

Highest recurrent disease in Transplanted Kidney:

Diabetic glomeruloscerosis

75

4 components of HIV that allow for Serologic testing:

*diagnostic in ELISA and Western Blot

gp120: lollipop

gp41: lollipop stick

p17: matrix outer shell

p24: capsid inner shell

76

What organism is the most common cause of meningitis in AIDS?

What kind of organism is it?

Cryptococcus

Fungus

77

HIV is what kind of virus?

Transmitted through:

most common mode of transmission:

Virus goes after what cell?

Destroys what kind of immunity?

Retrovirus

body fluids

homosexual/bisexual men (over 50%)

CD4+

Cell-mediated

78

Vaginal, heterosexual transmission of HIV is __% of cases

IVDA transmission ___%

Male - Male/Male-Female is __x more common than Female-Male in US

Transmission greatly enhanced by what?

33%

25%

20x

coexisting STD's (esp w/ genital ulcerations)

79

HIV reservoir cells include monocytes, macrophage, dentritic cells, microglial cells

True

80

4 neoplasms/tumors of HIV/AIDS:

B-Cell Non-Hodgkins lymphoma

Kaposi Sarcoma (malignant angiosarcoma)

Uterine/Cervix

Primary lymphoma of Brain

81

ELISA tests for the presence of what?

Pts serum added to ______

___ antibodies bind

Another ____ is added

A _______ is added that will change color

Antibodies to HIV

known antigen

IgG

IgG anitibody enzyme links

Substrate

82

Western Blot, viral proteins are separated by acrylamide gel ________

transferred (blotted) to from gel to _____

Pt's serum added and ______ binds viral proteins

_____ added

_____ added

electrophoresis

paper

IgG antibodies

enzyme IgG

Substrate - color

83

According to the CDC, any HIV infected person is considered to have AIDS when their CD4+ t-cell count is below what level?

200 mm3

84

2 Parasites that cause GI problems in AIDS pts

Cryptosporidium

Isospora

85

In the Acute phase the CD4 count is at:

Down to:

Rebounds to:

Virus count goes from 0 to:

Then down to:

1000

500

650

950

300

86

Primary infection and Acute HIV Syndrome occur in what phase?

Clinical Latency is seen in what phase?

Constitutional symptoms, Opportunistic disease, and death are in what phase?

Acute

Chronic

Crisis

87

Where does the virus go in acute HIV syndrome?

wide dissemination

seeds lymphoid organs

88

And of Acute Phase HIV (time):

Beginning of Crisis phase:

9 weeks

8 years

89

4 CNS changes to HIV:

Aseptic meningitis

Subacute encephalitis

Vacuolar myelopathy

AIDS-related myopathy

90

% AIDS pts neuro involvement at autopsy:

% clinically manifested neuro involvement:

90%

40-60%

91

What eating disorder is associated w/ alcohol/drug abuse, sexual promiscuity, and aberrant sexual behavior?

Bulimia nervosa

92

Enamel erosion pattern/tooth decay seen in eating disorders if purging (fingers in throat)?

Lingual of Mx Anterior

93

3 similarities between Anorexia and Bulimia:

Depression (psycho disorders)

suicidal tendencies

both might purge

94

Increased cavities, scurvy, vitamin deficiencies may be seen in Anorexia/Bulimia

True

95

Organism responsible for nursing caries:

S. mutans

96

If prego women lose Calcium, are they going to lose it from their teeth?

Where?

Negative

Bone

97

What is the underlying etiology of prego women and gingivitis?

Increased progesterone

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