Oral Medicine VI - Patel's Puzzle Flashcards Preview

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Flashcards in Oral Medicine VI - Patel's Puzzle Deck (91):
1

Chronological age is the number of years you have lived and the Functional Age is the age you are _______ to function at

perceived

2

Geriatric patients have ______ symptoms

More _____ responses on health questionnaires

Atypical

positive

3

With age, there are changes in both pharmokinetics and pharmodynamics

True

4

Drug related complications in Geriatric pts are separated into types by ________ list

Beer's

5

Drug related complications can occur via what 5 mechanisms in geriatric pts?

DDI's

Adverse drug rxn

Under medication

Polypharmacy

non-adherence

6

Criteria for potentially inappropriate meds in older adults

Beers

7

Types of chronic conditions in geriatric pts:
(leading causes of death over 65)

Heart disease

Cancer

Resp disease

Stroke

Alzheimers

Diabetes

Influenza

Pneumonia

8

3 Changes to CV system in elderly:

Stiffened aorta

Reduction max cardiac output

Coronary artery disease

9

Cellular and molecular alterations affecting both innate/adaptive immunity due to aging

Immunosenescence

10

Salivary gland hypofunction is a common age-related oral change

True

11

3 age-related Oral changes:

salivary hypofunction

mucosal fragility

impaired healing/immunity

12

Pulpal sensitivity _____ with increasing age

Increased prevalence of _______ disorders

decreases

neuropathic

13

TMJ affects what % of general population?

12%

14

Geriatric oral mucosa disorders (6):

Traumatic ulcers

Vesiculobullous disease

lichen planus

malignancy

candidiasis

denture stomatitis

15

Xerostomia vs. Salivary gland hypofunction

Subjective vs Objective

16

Whole stimulated flow rate, unstimulated flow rate =

Sialometry

17

Sialometry Hypofunction Unstimulated:

Stimulated:

less than 0.1 ml/min

less than 0.7 ml/min

18

Sore swollen tongue, cavities, metallic taste, bad breath, spicy/acidic food intolerance

Xerostomia/hypofunction

19

4 questions for dry mouth questionaire:

saliva seem too little?

difficulty swallowing?

when eating meal feel dry?

sip liquids to aid in swallowing?

20

Chronic GVHD and Sjogrens

Autoimmune

*salivary gland disorders

21

Salivary gland aplasia can happen _______

developmentally

22

4 infections that can affect the salivary glands:

CMV

HIV

HepC

TB

23

Non-neoplastic condition causing salivary gland disorder

Sialolithiasis

24

4 Iatrogenic means of causing salivary gland disorder:

External beam radiation

Internal beam radiation

Post-surgical

Botox

25

Systemic conditions that involve the salivary glands (5):

Anorexia

Bulimia

Diabetes

Alcoholism

Sarcoidosis

26

Classification of Sjogren Syndrome is based on a weighted sum of _____ items

First 2 are ___ points

Last 3 are ____ points

Primary Sjogren's must have a score of...

5

3 points each

1 point each

4 or greater

27

What are the 5 items

Anti-SSA/Ro or Anti-SSB/La antibody

focal lymphocytic sialadenitis (more than 1 foci/4mm2)

Abnormal ocular staining score (> 5)

Shirmer's Test (<5)

Unstimulated salivary flow rate <0.1 ml/min

28

The Sjogren's scoring system has high sensitivity and specificity (96% and 95%)

True

29

Clinical signs/symptoms of Sjogren's:

dry eyes, corneal ulcerations/infections, difficulty swallowing, hearburn, reflux, dry nose, nose bleeds, dry mouth, mouth sores, dental decay, etc

30

Oral complications of Sjogren's and Xerostomia:

Dry mouth

Parotid swelling

Sialadenitis

Glossodynia

Caries

Candidiasis

31

6 Salivary gland disorders associated w/ HIV:

HIV SGC (pre-malignant)

Acute sialadenitis

neoplasms

DILS (diffuse infiltrative lymphocytosis syndrome)

Salivary gland enlargement (1-10% or pts)

Changes in salivary flow rate/composition

32

More than 500 meds can cause dry mouth

True

33

7 drug classes that cause dry mouth:

Analgesics

Antihistamines

Antidepressants

Cytotoxics

Sedatives

Anticonvulsants

Antiretrovirals

34

5 clinical assessments for salivary gland disease:

Palpation

Sialometry

imaging

biopsy

serology

35

5 Red Flags for salivary gland disease:

Facial nerve paralysis

multiple masses

fixed masses

presence of cervical lymphadenopathy

smaller gland = higher risk of malignancy

36

Ulceration, induration , invation, dysphagia, otalgia, trismus, parasthesia, unintentional weight loss

signs salivary gland disease

37

Objective measurement of salivary flow

Sialometry

38

S;pitting, absorben sponge, draining, and suction are various methods for what?

Sialometry

39

Unstimulated salivary flow rate less than_______ is hypofunction

Stimulated less than ______

0.1 ml/min

0.7 ml/min

40

CT is good for, requires:

MRI is good for:

hard tissue, dye injection

soft tissue (no radiation)

41

What to use preventatively for xerostomia?

Recall schedule?

Topical fluoride

3-4 months

42

chewing gum, sugar free lemon candies, palpation, moist heat application:

For xerostomia

43

Systemic drug for Salivary Stimulation:

dosage:

Pilocarpine HCL

5-10 mg 3x/day

44

Pilocarpine is FDA approved for Tx of xerostomia following what?

also for what?

Head and Neck radiation

Sjogrens

45

What drug is FDA approved for the Tx of oral dryness in pts w/ Sjogrens? (but not radiation)

dosage?

Cevimeline HCL

30 mg 3x/day

46

Anti-HTN

dry mouth

47

Oral candidiasis secondary to ______ in inhalers

steroids

48

Fe deficiency anemia oral manifestations:

mucosal pallor

depapillated tongue

generalized mucosal atrophy

burning tongue

angular chelitis

aphthous ulcerations

49

Oral manifestations of Pernicious anemia:

burning tongue

burning lips

burning oral mucosa

erythema/atrophy focal/patchy

50

Oral manifestations of bleeding disorders:

severe gingival bleeding

ecchymoses

petechiae

hemoarthroses of TMJ

51

Oral manifestations Leukemia:

gingival enlargement

bleeding

ulceration

infection

52

Oral manifestation Lymphoma:

cervical lymph nodes enlarged

unexplained oral cavity swelling

53

Diabetes is related to Perio disease which means delayed wound healing, increased infection, ________ enlargement,

________

________ disturbances leading to _______

parotid gland

xerostomia

sensory, burning mouth syndrome

54

Ulcerative Colitis oral manifestations:

aphthous

pyostomatitis vegetans

*lesions resolve after Tx

55

Crohn's disease oral manifestations:

atypical mucosal ulcerations

diffuse lip swelling

cobblestone mucosa

56

3 oral manifestations for liver disease/bleeding tendency:

hemorrhagic changes

taste dysfunction

sialadenosis

57

Candidiasis, bacterial infection, Kaposi, Hairy leukoplakia, HSV

HIV

58

2 types of Type IV hypersensitivity in the mouth:

Contact stomatitis

Lichenoid mucositis

59

Amalgam may be a type ____ hypersensitivity

Need to inquire about what?

IV

contacts w/ matls around time allergy reported

60

2 Rheumatoid arthritis oral manifestations:

degenerative changes of TMJ

Anterior open bitn

61

4 types of Dermatologic disorders:

oral lichen planus

mucous membrane pemphigoid

pemphigus vulgaris

paraneoplastic pemphigus

62

What are the 3 types of Lichen Planus?

Reticular

Erosive (ulcerative, bullous)

Plaque-type

63

4 clinical features of Type IV hypersensitivity rxn:

Erythema

Vesicles

Ulcers

Hyperkeratosis

64

Aconthosis, hyperkeratosis, heay lymphocytic inflammaotry infiltrate w/ variable histocytes, eosinophils, and plasma cells, dilated papollary vessels w/ perivascular lymphohistocytic infiltrate

Histopathological features Type IV sensitivity rxns

65

Drug induced oral rxns:

salivary gland rxn

mucosal irritation/ulceration

taste disturbance

swelling

discoloration

trigeminal sensory distrubance

motor distrubance

malodor

66

4 diagnostic steps for diagnosing Drug-induced rxn:

Hx

Allergic profile/risk

Stop putative drug and observe

Start putative drug again and observe

67

The only way to show causality in single subject trial:

A-B only shows what?

A-B-A-B

association

68

3 most common oral side effects of the most frequently prescribed drugs:

Xerostomia

Dysgeusia (bad taste)

Stomatitis (painful swelling in mouth)

69

5 types of salivary gland rxns:

Hypo

swelling

hyper

pain

discoloration of saliva

70

3 taste disturbances w/ definition:

Hypogeusia (loss of taste)

dysgeusia (distortion)

ageusia (loss)

71

Drug related oral ulcerations can cause the following:

Oral burns

aphthous

eruptions (fixed)

mucositis

neoplasm

pemphigoid/bullous

erythema multiforme

epidermal necrolysis

lupus like disorders

72

The highest frequency of allergic rxns in the mouth are seen in what 2 drugs?

Oral Abx

NSAIDS

73

3 dental matls that can cause oral burns:

Silver Nitrate

Formocresol

Acid-etch matls

74

Repeated ulceration at same site in response to a particular drug. Can go from solitary to multiple w/ repeated exposure. Localized in mouth or associated with other mucocutaneous sites:

Fixed Drug Eruption

75

Drug-related mucositis caused by what?

Cytotoxic drugs

76

Stevens-Johnson Syndrome presents the same as...

Toxic Epidermal Necrolysis

77

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 4 features:

Flu-like prodromal

Cutaneous lesions (erythematous macule on trunk)

maculopapular exanthema then Mucocutaneous epidermolysis

painful blistering intra-orally

78

7 drug-related white lesions:

burns

lichenoid eruptions

lupus-like rxns

candidiasis

papillomas

hairy leukoplakia

leukoplakia

79

3 drugs that cause gingival hyperplasia:

phenytoin (dilantin)

cyclosporine

calcium channel blockers

80

Class of drugs that cause Burning Mouth Syndrome:

3 drugs in this class:

ACE inhibitors

enalapril, captopril, lisinopril

81

What is the most common oropharyngeal infection?

Candida albicans

82

Sjogren's is autoimmune and most common in peri and post menopausal women

True

83

Sarcoidosis is a noncaseating granuloma

True

84

TB is often unilateral in the mouth

True

85

Oral cancer is an example of a drug induced oral rxn

False

86

Swelling, ulcration, malodor are drug induced interactions

True

87

Repeat ulceration at the same site

Fixed drug eruption

88

Methotrexate is a chemo drug that causes oral ulcerations ___% of the time

Exacerbated by...

indistinguishable from...

14%

folate deficiency

mild dysplasia

89

Type I hypersensitivity is a true allergic rxn and can be caused by penicillin, ACE, aspirin, barbiturates, etc

True

90

What drug can turn a pt blue?

Minocycline

91

SSRI's and SNRI's can cause sleep bruxism

True

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