Bds2 Bams Revision Flashcards
What is asthma?
Reversible airflow destruction (bronchial hyperactivity)
What are the 3 key characteristics of asthma?
Bronchial smooth muscle contraction
Bronchial mucosal oedema
Excessive mucous secretion
What is the mechanism of asthma?
Allergen triggers IgE production, causing B and T cell interaction, causes degranulation of mast cells, leads to narrowing of the airways, oedema and mucous secretion.
What are the symptoms of asthma?
Shortness of breath, use of accessory muscles, expiratory wheeze
What are the risk factors for asthma?
Obesity
FH
Atoptic history
GORD
Nasal polyps
How does an asthma attack affect pulse and respiratory rate?
Respiratory rate (normally 10-20), during asthma attach will be 25
Pulse (normally 70) during asthma attack 100
How is asthma measured?
PEFR - peak expiratory flow rate (one quick expiration, measure amount of air expelled)
Measure at the same time everyday as airway latency decreases at night
This tracks airway resistance
Normal value is 500
What is the biphasic response in asthma?
May have a more severe attack later (after initial attack) so monitor patient
What is the treatment of asthma?
SABA - salbutamol long acting beta agonist inhaler (blue) - relaxation of smooth muscle
Corticosteroids - (brown) - target immune and epithelial cells to reduce oedema and mucous secretion
LABA - long acting beta agonist (green) - preventative inhaler, salmeterol
How can you measure is asthma is severe?
If patient has ever been hospitalised
May take oral corticosteroids
What is the dental implications of asthma?
Increased risk of candida infection in pharynx due to use of corticosteroid inhaler, advice use of spacer or rinse mouth after use.
Contraindicates use of ibuprofen if “aspirin- sensitive asthma” (can trigger asthma or allergy)
What is COPD?
Mix of reversible obstruction and destructive lung disease - mix of asthma, bronchiectasis (damage to cell wall, increased mucous secretion), emphysema (destruction of air sacs and dilation of others- loss of SA).
What are the symptoms of COPD?
Chronic cough, increased mucous production, dysponea, chest discomfort, fatigue
What causes COPD?
Smoking, asthma, pollution, age, AAT deficiency
How does emphysema affect gas exchange?
Less alveoli SA
How does emphysema and bronchiectasis affect breathing?
Emphysema affects gas exchange
Bronchiectasis affect airway patency
What are the dental implications of COPD?
Patient may not be able to lie flat in chair
If oxygen is required during treatment, give through a mask with nose
What is respiratory failure?
A consequence of long term COPD
2 types:
Type 1 - emphysema (failure of oxygenation), pink puffer
Type 2 - chronic bronchitis (failure of ventilation), blue bloater
What is PUD?
Ulceration caused by acid (commonly seen in oesophagus gastric and small intestine)
What causes PUD?
Excess acid production, reduced protective lining in stomach, GORD, weak lower oesophageal sphincter
Where is ulceration in PUD most common and why
In duodenum
Excessive acid secretion OR pancreatic disease - cant neutralise the acid entering the duodenum
What are the main complications of PPI?
Gastric bleed - from persistent acid irritant
Perforation
Stricture - healing by secondary intention, resulting in fibrous tissue (narrowing)
Malignancy - from constant cell turn over and inflammation
What is the treatment for helicobacter infection?
Triple drug therapy:
2 antibiotics - amoxicillin and metronidazole
PPI - omeprazole
For 2 weeks then test with endoscope
What is Ulcerative colitis
Continuous, vascular inflammatory bowel disease presenting as ulceration (superficial) at the most distal part of bowel and extending through GI tract
What is Chrons
A discontinuous (non vascular) inflammatory bowel disease resulting in cobblestone mucosa (full thickness)
What is the main risk of Chrons?
Polyp formation - monitor regularly as may become carcinoma
What is the treatment for inflammatory bowel disease?
Anti inflammatory drugs:
Systemic steroids (prednisolone)
Immune modulating drugs/ biologics (vedoluzimab)
Anti TNF alpha monoclonal antibodies
What is the treatment for peptic ulcer disease?
PPI - eg omeprazole
Irreversibly bind to and inhibit ATPase in parietal cells - therefore blocking gastric acid secretion
What are the symptoms of inflammatory bowel disease?
Malabsorption - anaemia
Diarrhoea
Abdominal pain
PR bleeding
What is coeliac disease?
Sensitivity to alpha glisten, causing an inflammatory response.
Patient requires a gluten free diet.
May present with pernicious aneamia due to malabsorption of Vit B12 in terminal ileum
What is the test for coeliac disease?
TTG - serum transglutaminase
How does coeliac disease present in adults v children?
Adults - mouth ulceration (abnormal pattern)
Children - failure to thrive due to malabsorption
What is anaemia?
Reduction in hemoglobinas levels
May be due to reduced production (marrow failure), increased losses (PUD etc), increased demand (pregnancy, growth)
What are some oral conditions associated with haematinic deficiency?
Fungal and viral infections
Oral ulceration (aphthous stomatitis)
Burning mouth syndrome
What are the signs and symptoms of anaemia?
Pale, tachycardic, enlarged liver/ spleen
Tired and weak, dizzy, palpitations
Pale mucosa, smooth tongue, angular cheilitis, beefy tongue (Vit B12 deficiency)
What are the tests for anaemia?
FBC to test ferritin, Vit B12 and folate levels
What is Thalassemia?
Normal haem production, genetic mutation of the globin chains
Managed through blood transfusions/ prevention of iron overload
What is pernicious anaemia?
Rare autoimmune disorder which decreases intrinsic factor in stomach, therefore decreasing absorption of Vit B12, leading to a deficiency
What are the 3 main types of anaemia? And their causes?
Microcytic - small RBC, iron deficiency/ Thalassemia
Macrocytic - large RBC, B12/folate deficiency
Normocytic - normal size RBC, reduced amount of haem, increased bleeding/ renal disease
What are hyperchromic RBC?
RBC appear pale due to less haemoglobin
What are ansiocytic RBC?
A range of very large and very small RBC
How are haematinic replaced?
FeSO4 200mg tds for 3 months
1mg IM Vit B12 injection
5mg folic acid daily
What is sickle cell anaemia?
Anaemia caused by abnormal globin chains - RBC becomes curled up at edges so increased cross section means at low oxygen levels, cannot fit through peripheral capillaries
What are the main types of inherited bleeding disorders?
An acquired defect which affects the coagulation of the blood -
Coagulation cascade affected
Platelets affected
what is haemophilia A and the treatment
Factor 8 deficiency
Sex linked inheritance
Mild and carriers - DDVAP and tranexamic acid
Moderate and severe - recombinant factor 8
What is DDVAP?
Desmopressin
Releases factor 8 that has been bound to the endothelial cells, giving a temporary rise in factor 8 levels
What is tranexamic acid?
Inhibitor of fibrinolysis
Keeps any clot for longer
What is haemophilia B and its treatment?
Deficiency in factor 9
Sex linked inheritance
All pts - requires use of recombinant factor 9 (this factor doesn’t bind to vascular surfaces)
What is von willebrands disease and its management?
Reduced factor 8 levels due to deficiency of von willebrands factor and reduced platelet aggregation.
Severe and moderate - DDVAP
Mild and carriers - tranexamic acid
What are the dental implications of an inherited bleeding disorder?
If moderate/ severe, must be treated in haemophilia center
May require medical cover before dental treatment id high risk of bleeding
Cannot deliver LA as IDB or lingual infiltration due to bleeding risk
Prevention!
What are the platelet levels which canm be treated in primary care?
Primary care - 100x 10^9/L
Secondary care - 50x 10^9/L
What is thrombophilia
Increased clot formation ability
What is thrombocytopenia?
Reduced platelet numbers
What is diabetes?
Chronic disease in which the pancreas doesn’t produce enough/ any insulin or the body cannot effectively use the insulin it produces
What is the characteristic sign of diabetes?
High glucose levels - hyperglycaemia
What are some complications of diabetes?
Increase risk of micro vascular complications, heart attack, stroke and long term macro vascular disease
What is the difference between type 1 and type 2 diabetes?
Type 1:
- autoimmune destruction of the pancreatic b cells
- polyuria, polydipsia, tiredness
Type 2:
- associated with obesity and inactivity
- strong FH
- defective and delayed insulin secretion (insulin resistant)
What are the investigations for diabetes?
Measure HbA1C levels (glycated haemoglobin)
Shows glucose levels over the past 3 months
If you have diabetes, aim for 48 mmol/l (6.5%)
What is the management of type 1 diabetes?
Insulin injection via CGM (continuous glucose monitoring)
Aiming for 4-7% hba1c
What is the management of type 2 diabetes?
Lifestyle changes- weight loss, exercise
Medications - metformin, gliptins, GLP-1 mimetic, sulphonylureas
What is metformin?
Diabetes medication which enhances cell sensitivity to insulin
What is gliptins?
DDP4 inhibitors which block the enzyme metabolising incretin therefore it is maintained for longer - increases response to glucose
What does sulphonylureas do?
Diabetes medication which increases pancreatic insulin secretion
What are the dental implications of diabetes?
Ensure pt has eaten before and taken insulin
Treat first appt in morning/ after lunch
Ask about hypo signs and know how to manage
Poor wound healing
Synergistic link to perio
How do you manage a hypo?
Give patient something sweet to eat/ drink/ glucose tablet - pt needs subsequent substantial meal
If unconscious- phone 999, give IM glucose (0.5mg)
What is dementia?
A syndrome of chronic or progressive nature with acquired loss of cognitive functions, intellectual and social abilities beyond what might be expected from normal ageing
What are the 4 types of dementia?
Alzheimer’s
Vascular
Dementia with Lewy bodies
Frontotemporal
What is Alzheimer’s?
The most common
Reduction in size of cortex, severe in hippocampus
Plaque deposits of beta amyloid proteins build up between nerve cells and tangle between cells
What are risk factors for Alzheimer’s?
Smoking
Hypertension
Low folate and high cholesterol
What is vascular dementia?
Caused by reduced blood flow to the brain which eventually damages and kills the brain cells
Can be due to small vessel disease (narrowing), stroke, underlying health conditions eg uncontrolled diabetes or smoking
What are the distinctive features of Alzheimer’s?
STML
Aphasia
Communication difficulties
Mood swings
What are the distinctive features of vascular dementia?
Memory problems of sudden onset, visuospatial difficulties, anxiety, seizures
What is dementia with Lewy bodies?
Deposits of abnormal protein (Lewy body) inside brain cells
Also found in patients with Parkinson’s
What are the distinctive features of dementia with Lewy bodies?
STML
Cognitive ability fluctuates
Attention difficulties
Speech and swallowing problems
Sleep disorders
What is Frontotemporal dementia?
Affects frontal lobe (responsible for problem solving, planning and emotions)
Younger onset
What are the distinctive features of Frontotemporal dementia?
Uncontrollable repetition of words, mutism, personality change, decline in personal and social conduct
Not usually STML
What are the early signs of dementia?
STML
Confusion
Anxiety
Inability to manage every day tasks
Communication difficulties
What are middle stage signs of dementia?
Increasingly forgetful
Distress/ aggression
More support required with everyday tasks
Hallucinations
What are the late signs of dementia?
Incontinence
Failure to recognise familiar objects/ people
Physical frailty
Difficulties eating
What are the dental implications of dementia?
Assess if patient has capacity (AMCUR)
Keep treatment plans realistic
Carry out OHI with carer present and ensure denture hygiene is carried out at home/ in care setting
Prevention - FV? etc
What is arthritis?
Inflammation of the joints
How long is the bone remodelling cycle?
3-6 months
What 3 things are required for bone remodelling?
Vitamin D
Calcium
Phosphatase
What happens when there is low serum calcium?
Increased PTH secretion which increases Vit D, therefore increasing intestinal calcium absorption.
Reduced loss of calcium results in bone loss as calcium is absorbed into ECF
Homeostasis
What is the role for vitamin D in bone remodelling? What are squires of vitamin d?
Necessary for absorption of calcium in intestine
Sources - sunlight
What is osteomalacia?
Poorly mineralised osteoid matrix
Serum calcium deficiency
High alkaline phosphatase
If during development, rickets
What is osteoporosis?
Loss of mineral and matrix (reduced bone mass)
Reduced quantity of normally mineralised bone (age related change)
What role does oestrogen have in the bone remodelling cycle?
Oestrogen inhibits bone resorption (by direct actions on osteoclasts)
What is osteoarthritis?
Degenerative joint disease (weight bearing joints)
Wear and tear
What is rheumatoid arthritis ?
Disease of the synovium with gradual inflammatory joint destruction
Slow onset with symmetrical polyarthritis
What are early signs of RA?
Symmetrical synovitis of MCP, PIP and wrist joints
What are later signs of RA?
Ulnar deviation of fingers at MCP
Hyper extension of PIP joints - Swan neck deformity
Z deformity of thumb
Subluxation of wrists
What are extra articular signs of RA
Due to systemic vasculitits:
Scleritis, dry eyes, sjogrens, psoriasis
What is the management of RA?
Holistic:
Physical therapy
Occupational therapy
Drug therapy - NSAIDs, analgesia, DMARDs (methotrexate)
Surgical therapy - excision of inflamed tissue, joint replacement/ fusion
What are the dental aspects of RA?
Disability from disease (manual dexterity), access to care
Sjogrens syndorme
NSAIDs and methotrexate - ulceration
Oral pigmentation from hydroxychloroquine
What are the features of Parkinson’s?
Intention tremor
Mask like face
Rigidity
Slow movement
