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Dr C - Medical > ALL Qs > Flashcards

ALL Qs Flashcards

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USMLE® Step 1 flashcards
1
Q

lupus erythematosus - what

  • 2 types
  • what do the oral lesions mimic
  • what feature of the lesions separate it from the other disease
  • what antibodies are associated
A
  • autoimmune CT disease,
  • systemic/cutaneous
  • Lichen Planus
  • discrete, unilaeteral lesion. Most are patches of atrophy/keratosis on H/S palate
  • ANA/DSDNA
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2
Q

Lupus erythematosus

  • management
  • dental considerations
A

-immune suppression/analgesics
-chronic anaemia/bleeding risk/renal disease (drug met)
immunosupression (inf risk)/lichenoid reactions/oral pigmentation

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3
Q

what is lupus anticoagulant
symps
important info

A

anti-phospholipid antibody syndrome
-recurrent thrombosis

NEVER STOP ANTICOAGULANT

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4
Q

sjogren - antibodies associated

A

Snti Ro/La/ANA

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5
Q

systemic sclerosis - what
antibodies
dental considerations

A

excessive collagen deposits - loss of elastic tissue
anticentromere(local)/anti scl70 (generealised)
-reduced mouth opening/dysphagia/renal disease - reduced drug metabolism/raynaud’s syndrome

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6
Q 
Giant cell (temporal) arteritis
what
major complication
tests
managed
A 
pain - facial/headache
chewing claudication
occlusion of central retinal artery - blind
-ESR > and c reactive protein
high dose steroids - prednisolone 60mg
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7
Q

MS
what
sign/symp
dental

A

demyelination of axons, progressive functional loss
-muscleweakness/dysarthria/tremor/spasticity/visual disturbance/altered reflexes/balance and hearing loss/proprioreception loss
-limited mobility/chronic orofacial pain/sensory disturbance
>trigeminal neuralgia risk

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8
Q

Parkinson’s - what
features
dental

A

degeneration of dopaminergic neurones in substantia nigra (basal ganglion)
-bradykinesia/resting tremor/difficulty initiating movement/rigidity/impaired gait/mask like face/swallowing issues/communication issues

-difficulty accepting /tremor/dry mouth from antiparksonian drugs

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9
Q

epilepsy -what

classification

A
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10
Q

tonic clonic seizure features

precipators

A

prodromal dura, LOC, postictal drowsiness, hypoxic

alcohol/lights(strobe)/poor medical compliance/stress or fatigue

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11
Q

tretament of epilpsy

  • preventative - gaba receptor action/sodium channel
  • surgery
A

carbamazepine/valproate/phenobarbitone
GABA - BZD/valproate
sodium channel - carbamazepine/phenytoin

surgery - removal of focal neurological lesion

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12
Q

dental complications of epilepsy

A

fit complications - ST injury/emergency

  • drugs
  • phenytoin=gingival hyperplasia
  • anticonvulsants=xerostomia
  • valproate=bleeding risk
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13
Q

stroke

  • risk
  • sources
  • complications/dental

*WHAT PART OF MOTOR NEURONE AFFECTED

A
  • hypertentsion/smoking/alcohol/AF/IHD/diabetes mellitus
  • infarction/haemorrhage/subarachnoid haemorrhage/venous thrombosis
  • motor function loss/swallowing difficulty/sensory loss/cognitive impairment

UPPER motor neurone - muscle spasm/LOWER - muscle atrophy
-dental - impaired dexterity/mobility/communication difficulty/cardiac emergency (MI/FURTHER STROKE)/lack of protective reflexes

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14
Q

osteoarthristis

  • symps
  • treatment
  • dental considerations
A

degenerative joint disease - cartilage repair dysfunction

  • pain - worse in morning/improved with rest, loss of joint space on Rg
  • NSAIDs/replace joint
  • TMJ involvement/chronic NSAID use - bleeding risk/oral ulceration
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15
Q

Rh arthritis

  • early signs
  • late signs
  • dental
A

early-symmetrical synovitis of: MCP/PIP/wrist joints
late-hyperextension of PIP/ulnar deviation at PIP/z deformity of thumb/subluxation of wrist/feet and ankle deformity

  • reduced dexterity/sjogren associated/joint replacement
  • drugs-NSAIDs (bleeding/OU)/Steroids (inf risk)/oral pigmentation and ulceration-methotrexate/oral lichneoid reaction - gold
  • atlanto axial instability
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16
Q

osteoporosis

  • risk
  • effect
  • prevent
A
  • Loss if mineral/matrix - reduced bone density
  • female/age/genetic/race (caucasian)/inactivity/smoking/poor dietary calcium/early menopause/antiepilectics/steroid use
  • greater # risk/scoliosis/height loss

-daily excersise and calium/HRT

17
Q

HRT for osteoporosis issues

Bisphosphonates

A

Oestrogen - breast cancer risk and endometrial cancer risk
>DVT risk
Bisphosphonates - MRONJ risk

18
Q

chemotherapy side effects

A

rapidly dividing cells killed - hair loss/oral ulceration
later cancer risk/nephrotoxicity/taste loss
-oral - xerostomia/halitosis/mucositis risk/ulcers/greater bleeding and bruising/>inf risk

19
Q

Radiotherapy side eff

A 
Xerostomia
Osteoradionecrosis
Increased risk of infection
Increased risk of poor wound healing
Caries
Oral ulceration
Dry mouth/taste loss
Burns
20
Q

microcytic anaemia blood results

A

MCV<80,

21
Q

GI conditions causing microcytic anaemia

A

Crohn’s, UC, Carcinoma

22
Q

Oral consequences of microcytic anaemia

A 
Recurrent aphthae
o Poor wound healing
o Generalised Mucosal atrophy
o Increased Candida infection
o Atrophic glossitis
o Tenderness or burning sensation of oral mucosa
23
Q

white plaque that scrapes off leaving erythematous base - diagnosis

A

pseudomembranous candidosis

24
Q

local and medical condition that cause ps candidosis

A

local - inh steroid use/nutritional def/broad spe AB

med - HIV/immunocomprimised/diabetes mellitus

25
Q

oral swab vs oral rinse

A

Oral swab
§ Simple and site specific but can be easily contaminated and
uncomfortable
o Oral rinse
§ Records whole mouth and can separate healthy organisms but is not site
specific and some patients find the rinse process difficult to do.
§ It is a quantifiable amount but difficult to standardise

26
Q

features of erythematous candidosis

newton’s classification

A

burning sensation/halitosis/erythema and oedema of denture bearing area/bad taste
-newton
I - localised inflammation/hyperaemic foci
II - diffuse inflam confined to denture bearing mucosa
III - granular inflam, erythema and papillary hyperplasia

27
Q

what can cause smokers/traumatic keratosis

  • what histological features may indicate malignancy
  • what clinical features may indicate malignancy
A 
Tobacco smoke
o Pipe smoking
o Long term drinking of very hot beverages
o Chronic inflammation
o Drugs – hydroxychloroquine
-Hyperkeratosis
o Hyperchromatism
o Atypia
o Dysplasia
o Infiltrate of macrophages
-Raised rolled border
o Indurated (hard) lesion
o Non-homogenous (speckled, flat and raised area)
28
Q

desquamative gingivitis - what

-what conditions have this

A

It is the clinical descriptive term of non-specific clinical expression in the gingivae
(redness, burning, erosion, pain and plaque) of several dermato-mucous disorders

-LP/Pemphigoid/pemphigus

29
Q

what exaccerbates DG

A 
Smoking
o Plaque build up
o Poor overhanging restorations
o Partial dentures
o SLS toothpaste
30
Q

how to treat DG

A

Confirm diagnosis and any underlying conditions and manage these
appropriately
§ Blood tests
§ Immunofluorescence assay
o Treat underlying cause:
§ Allergy to SlS – use SLS free toothpaste
o Improve oral hygiene as plaque aggravates lesions/smoking cessation
o Topical steroid use – betamethasone
§ rinse or meter dose inhaler or use of steroid cream in gum shield
o Topical tacrolimus immunomodulator mouthwash rinse or cream
o Systemic immunosuppressant

31
Q

cause of pigmented patch on mucosa

A

Local:
§ Amalgam tattoo due to macrophages (melanin) and granulation tissue
surrounding amalgam
§ Pigmented Incontinence linked with chronic inflammation
§ Macule (flat) due to increased melanin production
§ Naevus (raised) due to increased melanocytes
§ Mucosal melanoma secondary to metastatic cancers
§ Vascular malformations (haemangioma)
o General:
§ Racial/familial
§ Smoking = leakage of melanocytes and sub-mucosal fibrosis
§ Medications – contraceptive pill, iron tablets, antimalarials
§ Addison’s disease – reduced cortisol and aldosterone from adrenaline
glands causes brown patch due to increased ACTH

Dr C - Medical (7 decks)

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