Dental Articles - Exceptions Flashcards
Not a risk factor for atherosclerosis
Alcoholism
Doesn’t characterize chlamydial infection
Ability of the Chlamydiae to survive in the host extracellularly… CANNOT.
Thrombophlebitis
clots (thrombi) formed within veins, esp. deep leg veins
Esophageal varices
causes severe bleeding
Endarteritis
inflammation of the lining of arteries
Lymphangitis
inflammation of the lining of lymph vessels
Buergers disease
involves immune complexes causing damage to arteries and other vessels – often causes thrombosis in legs
Bronchiectasis
abnormal dilatation of the bronchi following chronic infection; not precancerous
Bronchial asthma
narrowing of the bronchi and excess mucus production causing difficulty in breathing; not precancerous
Bronchial carcinoids
benign lesions of neuroendocrine argentaffin cells of bronchial mucosa
Pulmonary emphysema
involves distention of air spaces with destruction of alveoli; not precancerous
Streptococcus pneumoniae
1 cause of meningitis in elderly
Cause meningitis
Neisseria meningitidis Streptococcus pneumoniae (elderly)
Streptococcus faecalis
causes urinary tract infections in hospitalized patients; rare cause of subacute endocarditis; part of the normal fecal flora
Streptococcus pyogenes (Group A, B-Hemolytic)
obligate human parasite spread person-to-person by respiratory secretion via droplets, direct contact with the skin, or fomites; clinical manifestations (suppurative or nonsuppurative = pus produced) — predominantly involving pharyngitis and various skin infections
Mycoplasma hominis
sexually transmitted agent; major source of infection in postpartum women
Leptospira pomona
caused by ingestion or contact through broken skin or mucous membranes with water contaminated by urine from infected reservoirs (dogs, sheep, goats cattle, horses, & rats)
Actinomyces israelii
part of the normal oral flora and are usually pathogenic only after oral trauma
Typically presents with watery [“rice water”] diarrhea (20 liters/day) with the loss of Na+, Cl-, K+, and bicarbonate (HCO3). Clinical manifestations: Nausea, vomiting, abdominal cramps, metabolic acidosis and hypovolemic shock.
Vibrio
Protozoa, thus cannot specifically cause bacillary dysentery. Clinically, the disease may be mild with diarrhea, abdominal cramps nausea, vomiting, and flatulence.
Entamoeba
Inflammatory diarrhea with fever and variable septicemia. In contrast to Shigella, a large
inoculum (> 1 million cells) is needed to survive gastric acid and cause disease. LESS likely a cause than Shigella.
Salmonella
“Traveler’s diarrhea”; >100 serotypes; causes non-inflammatory, secretory diarrhea SIMILAR to Vibrio, but less severe.
Escherichieae
Presents clinically as aseptic meningitis, fever, rash, enteritis, common colds and/or acute hemorrhagic conjunctivitis. Less common symptoms include paralysis, pleurodynia, encephalitis, myocarditis, and respiratory illness.
Echovirus
Most commonly associated with the common cold. Clinical manifestations: upper respiratory tract irritation, headache, nasal discharge, cough, malaise, chills, and myalgia.
Rhinovirus
May cause herpangina, with headache, sore throat, dysphasia, stiff neck, fever, anorexia, and abdominal pain. Discrete vesicles are seen in the oropharynx; cause meningitis; etiologic agent of hand-foot-and-mouth disease
Coxsackievirus Type A
May cause myocarditis, pericarditis, and pleurodynia; cause meningitis
Coxsackievirus Type B
Elicits a mononucleosis illness including fatigue, malaise, tender lymphadenopathy, pharyngitis, fever, headache, and splenomegaly. The majority of these infections are subclinical (with no overt symptoms) but may lead to life-long latent infection; In immunosuppressed patients infection is more severe and marked by fever, adenopathy, leukopenia, hepatosplenomegaly, and myalgias.
Cytomegalovirus
Juvenile periodontitis
Primary pathogen: Actinobacillus actinomycetemcomitans (AA)
Site predilection: incisors and first molars
Absence of plaque and calculus
Very fast in progression
Associated with calculus, plaque, inflammation
Pathogens (anaerobic organisms within the periodontal pocket):
- Bacteroides
- Fusobacteria
- Porphyromonas
- Prevotella
Adult chronic periodontitis
- Hypoperfusion of the kidney and brain
- Chronic passive congestion of the lungs
Signs of LEFT-sided ventricular cardiac failure
- Edema of ankles
- General systemic VENOUS congestion (fluid back- up, rather than pulmonary)
- Ascites = edematous swelling of the abdomen
Signs of RIGHT-sided ventricular cardiac failure
Single, benign, most common tumor
Fibroadenoma
Generally a solitary lesion within a duct or cyst; benign when single
Intraductal papilloma
Tumor in adrenal medulla which produces catecholamines (epinephrine and norepinephrine) – may result in severe hypertension
Pheochromocytoma
Involves limited motion of the mitral valve and causes chronic heart dysfunction.
Mitral stenosis
Heart pain caused by poor blood flow in the coronary arteries; does not usually lead to sudden cardiac arrest.
Angina pectoris
Involves the growth of fibrous tissue in the pericardium, causing decreased ventricular filling, but the condition is not acute.
Constrictive pericarditis
Involves infection of heart valves by bacteria (usually streptococci) Results may include valve damage, myocardial abscess, and septic emboli. However, it does not involve sudden cardiac arrest.
Subacute bacterial endocarditis
A malignant tumor of chondroblasts, found mostly in adults 30-60, male more often than female.
Chondrosarcoma
Most common type is found in glandular elements of the respiratory tract, especially in male adult smokers between 40-70 years old
Adenocarcinoma
Neoplasm of plasma cells resulting in excessive abnormal immunoglobulins, including Bence-Jones proteins; most common in adults 50-60 years old
Multiple myeloma
Malignant skin neoplasms most common in middle aged and older adults
Basal cell carcinomas
Active infection by Mycobacterium tuberculosis with accompanying fever, anorexia, necrosis of lung tissue and destruction of blood vessels in lung parenchyma; blood in sputum
Tuberculosis
Infection is present which can erode surrounding blood vessels; blood in sputum
Lobar pneumonia
Thrombus, most likely from a leg vein, becomes lodged in the lung. If the embolus becomes infected (septic embolus), then can erode surrounding blood vessels; blood in sputum
Pulmonary embolism
Can cause bleeding as it expands into nearby vascular tissue; blood in sputum
Bronchogenic carcinoma
Most common cause of bacterial pneumonia; also causes otitis media, sinusitis, bronchitis, and bacteremia; most common cause of meningitis in the elderly
Alpha-hemolytic streptococci
Causes skin infections (cellulitis) deep infections (bone), systemic infections secondary to deep infections, and toxin mediated disease (toxic shock syndrome).
Staphylococcus aureus
Causes oral and genital lesions by infecting epithelial cells. Upon resolution of acute illness, latent infections are commonly found in neurons
Herpes simplex virus
Causes meningitis, otitis media, and epiglottis. Primarily children under the age of five are affected
Hemophilus influenzae
Collapse of alveolar walls with loss of diffusional surface area, cough, dyspnea and barreled chest.
Emphysema
Components involved in walling off chronic infections
Langhans and epitheliod cells (macrophages)
Tetanus Toxoid
Antibody production
Tetanus Antitoxin
Passive immunity from disease (transferred antibodies)
- (non)encapsulation
- rapid growth rate [both]
- ability to metastasize
- lack of differentiation
- excessive mitotic activity [both]
Factors of related to tumor growth
- Defined shape, capsulated
- Slower mitotic growth rate
- Does not metastasize
Benign tumors
- Formless, nondistinctive boundaries, nonencapsulated
- Faster mitotic growth rate
- Lack differentiation (cells in neoplasm do not form well-specialized tissues);
- requires cell mitosis
- Metastasizes
Malignant tumors
Condition of soft bones subsequent to vitamin D deficiency; impaired mineralization of the osteoid.
Osteomalacia
Weakening of bones due to loss of bone mass (common in older women) [due to estrogen deficiency, malnutrition or immobilization]
Osteoporosis
Benign tumor of bone at diaphysis of long bones; when malignant, doesn’t develop into osteosarcoma.
Osteoblastoma/Osteoid osteoma
Inherited defect of collagen synthesis - thin, fragile bones, small discolored teeth and blue sclera.
Osteogenesis imperfecta
Lack of cell growth or proliferation
Aplasia
Loss of cell differentiation and tissue organization
Anaplasia
Wide variety of size and shape of nuclei and cells
Pleomorphism
Intense color and staining of nuclear material
Hyperchromatism
Enzyme projecting form the outer membrane of the bacteria
Glucosyltransferase
Insoluble adherent that promotes accumulation of bacteria on tooth enamel + prevents diffusion of organic acids produced by the bacteria
Dextran
Enzyme present in the outer membrane of RNA viruses (para-myxoviruses, orthomyxoviruses) and the bacteria Vibrio cholerae; it cleaves N-acetylneuraminic acid (NANA, essential for hemoagglutination, without it process is inhibited) from glycoproteins on the surface of red blood cells
Neuraminidase
Enzymes play a vital role in determining cell shape; present in all cells; not in viruses; these proteins attach to the ends of cytoskeletal proteins + determine the rate at which these ends elongate/depolymerize.
Capping enzymes
Found in all animal cells; responsible for transcription, the process whereby RNA is formed from a DNA template
DNA-dependent RNA-polymerase
Large cells (100 micrometers); localized DNA (in discreet bundles/condensation during mitosis) in nucleus; contains specialized organelles; possess complex cytoskeleton (capable of endo/exocytosis) utilizes Krebs’ cycle (thus, can generate more ATP per molecule of glucose metabolized); organized in multicellular systems wherein each cell is specialized for a different function
Characteristics of EUKARYOTIC cells – (fungi, plants, animals)
Simple cells, small (1-10 micrometers), rarely aggregate to form multi-cellular units; modified prokaryotic cells (bacteria, blue algae); lack specialized organelles (nucleus, mitochondria, ER, Golgi, peroxisomes, lysosomes); lack cytoskeleton (unable to perform endo/exocytosis); lack Krebs’ cycle enzymes (dependent on glycolysis for ATP production)
Characteristics of PROKARYOTIC cells
Process where organism becomes virulent through the acquisition of a set of genes which encode virulence factors
Transformation
Self-replicating, autonomous segments of DNA; they code for proteins which have a variety of functions.
Plasmids
Kills microorganisms by an unknown mechanism; effective against live bacteria and spores+ most widely used antiseptic in hospitals
Iodine
Works as an antiseptic by precipitating protein; not effective against spores
Alcohol
Includes silver (effective agent for precipitating proteins + interfering w/ bacterial metabolism) and mercury (precipitates proteins & has an added effect of self-hydro-enzyme inhibition)
Cationic detergents
Kills microorganisms by precipitating proteins; effective against spores only when applied for several hours
Acid glutaraldehyde
Interferes with cross-linking step of peptidoglycan polymers –> prevents the formation of a durable cell coat –> highly susceptible to rupture and fragmentation
Penicillin
- Penicillin
- Bacitracin
- Cephalosporins
- Vancomycin
Antibiotics that interfere w/ cell wall synthesis
- Antifungal agents
- Amphotericin-B
- Nystatin
Antibiotics that disrupt integrity of cell membrane (via forming channels in fungal wall & disrupting ion gradients required for normal metabolism)
- Aminoglycosides
- Chloramphenicol
- Erythromycin
- Tetracycline
Antibiotics inhibit protein synthesis
- Rifampin
- Sulfonamides
- Trimethoprim
Antimicrobials inhibit the bacterial DNA synthesis
- Autoimmune phenomena
- Tuberculosis infiltration
- Metastatic tumor
- Amyloidosis
Manifestations of Primary Addison’s
- Abnormalities of the hypothalamus or pituitary
- Exogenous administration of steroids
Manifestations of Secondary Addision’s
Dry mouth; most common in Sjogren’s disease + other rheumatologic illnesses.
Xerostomia
Painful tongue; results from a local burn or trauma or from metastatic tumor infiltration of the lingual nerve.
Glossodynia
Radiographic appearance of bone in Paget’s disease (metabolic disorder of bone characterized by an increased rate of bone resorption coupled with new bone synthesis)
“Cotton wool bone”
Thick layer of tissue lining the dental alveolar bone, which is lost in periodontal disease (uninvolved in Addison’s disease)
Lamina dura
- EBV = Burkitt’s lymphoma
- Human immunodeficiency virus [HIV] = Kaposi’s sarcoma
- Hep B virus = Hepatocellular carcinoma
- Herpes simplex II = Cervical carcinoma
Viruses linked to human cancers
- Burkitt’s lymphoma
- Hodgkin’s disease
- Multiple myeloma
- Acute lymphocytic leukemia
- Chronic myelogenous leukemia
Human tumors of the lymphoid system
Commonly in children/adolescents; infection of bone which may/may not involve the bone marrow; begins when a blood-borne organism (commonly Staph aureus, but various strains of Streptococci, Pneumococci and Neisseria too) deposited in bone; can occur following penetrating trauma – organism directly introduced into bone; requires a protracted course of IV antibiotics + surgical debridement occasionally.
Osteomyelitis
Rarely enters bone; causes abscesses in connective tissue – forms sinus tracts in the skin
Actinomyces
Spirochetes like T. pallidum; causes syphilis – linked to relapsing fever, skin and mucous membrane ulcers and lung lesions (not associated with osteomyelitis)
Borrelia
Pathogen in the lung that causes suppurative fibrotic/necrotic lesions (cavitary + diffuse)
Nocardia
Elevated in patients with hepatocellular carcinoma or yolk sac tumors
Alpha-fetoprotein
Enzyme found primarily in liver and bone; elevated in both benign and malignant diseases involving these tissues
Alkaline phosphatase
Elevated in patients with adenocarcinomas of the colon or lung and in various benign conditions
Carcinoembryonic antigen
Oral candidiasis + risk factors for AIDS; if patient has dysphagia, obtain esophagram; treatable disease
Esophageal candidiasis
Causes infections of soft tissue – leads to abscess formation; follows oral trauma or aspiration of saliva; not a marker of immunosuppression
Actinomyces israelii
Only in immunocompromised patients; infection shows sufficient for a diagnosis of AIDS; lung pathogen that causes severe pneumonia with a large alveolar to arteriole oxygen gradient; unlike candida, does not cause infection in the mouth.
Pneumocystis carinii
Responsible for the development of dental caries; present in normal and immunocompromised hosts
Strep. mutans
Alpha-hemolytic; can cause endocarditis (common in IV drug abusers + valvular heart disease); typically not infection of immunocompromised patients – who may have a particularly poor prognosis if they do develop endocarditis.
Strep. salivarius
Resulting in tetany (characterized by muscle spasms, cramps and seizures; associated with hypocalcemia)
Hypofunction of the parathyroid
Associated with generalized lethargy + slowing of mental/motor functions; coarse skin, dry brittle hair, hoarse voice, and peripheral and periorbital edema
Hypothyroidism
Manifested as hypothyroidism, adrenal insufficiency, growth retardation, ovarian failure, loss of libido, and diabetes insipidus OR deficiency syndromes of any or all of these hormones:
- thyroid-stimulating hormone (TSH)
- adrenal corticotropic hormone (ACTH)
- growth hormone (GH)
- follicle-stimulating hormone (FSH)
- luteinizing hormone (LH)
- prolactin, antidiuretic hormone (ADH)
- oxytocin
Hypofunction of the hypophysis/pituitary
Most commonly due to adrenal suppression secondary to the administration of steroids or from infiltration of the adrenals by tumor; manifests as clinically as weakness, weight loss, hypotension, hyperpigmentation and salt craving
Hypofunction of the adrenal cortex
Hypofunction of the adrenal medulla, no distinct clinical syndrome
Clinical syndrome resulting from hypothyroidism; characterized by generalized lethargy, slowing of mental/motor functions, coarse skin, hoarse voice, peripheral and periorbital edema, and coma (extreme case)
Myxedema
Hypersecretion of growth hormone; characterized by enlargement of the jaw, hands + feet, and coarsening of the facial features
Acromegaly
When glucose filtration exceeds glucose resorption; commonly in diabetes mellitus or renal tubular disease.
Glycosuria
Tumor of chromaffin cells, neoplasm that secretes catecholamines (esp. norepinephrine, which causes paroxysmal hypertension); commonly located in the abdomen, 80% are found in the adrenal medulla; others in aortic bifurcation. If tumor is resected, hypertension relieved.
Pheochromocytoma
Use with extreme caution; utilization leads to the eradication of the normal flora (holds growth of organisms resistant to antibiotics in check) colonizing many sites throughout the body – if normal flora cleared, resistant organisms can replicate freely as competition for nutrients decreases.
Resistant organisms (Pseudomonas, E. coli, Klebsiella species) cause SEPSIS – can only be treated with newer, more powerful antimicrobial agents that select for resistant strains for which no antibiotic treatment is available
Broad spectrum antibiotics
Extremely nephrotoxic; signs of nephrotoxicity should be monitored when utilizing these drugs, but fear of inducing nephrotoxicity should not inhibit the physician from using them when indicated
Aminoglycosides
Can occur with any drug, but is most common with the penicillins and cephalosporins;
Anaphylaxis
Acute rxn from ragweed or drugs; sensitized mast cells coated with IgE molecules; then, mast cells cross-linked by the introduction of antigen –> degranulation of mast cells –> histamine released –> bronchospasm and bronchial edema + various chemotactic agents –> summon eosinophils and neutrophils to the site.
Atopy
The body produces immunoglobulins against host tissue; phenomenon responsible for diseases such as – systemic lupus erythematosus (Abs against nuclear/ribosomal proteins) or myasthenia gravis (Abs against acetylcholine receptors)
Autoimmunity
Process whereby immunoglobulins from one host are transferred to another host in whom they confer protection; primary immunization strategy utilized by the medical community prior to the advent of vaccines; plays fundamental role in the protection of newborns (IgG mother –> fetus [via placenta] or newborn [via breastfeeding] – infant depends on IgG to fend off infection during the first 6 months of life (developing immune system)
Passive immunity
Bronchogenic carcinoma/mesothelioma causes…
#1 Pneumoconiosis #2 Asbestos exposure
Common lung finding among smokers and city dwellers; refers to the accumulation of carbon in macrophages in the lung; by itself is of no clinical significance; may be present in severe diseases including coal worker’s pneumoconiosis
Anthracosis
Granulomatous disease of the lung resulting from heavy beryllium exposure – associated with the development of bronchogenic carcinoma, not mesothelioma
Berylliosis
Causes a megaloblastic anemia; common finding in chronic alcoholism + other diseases associated with malnutrition
Folate deficiency
Causes of iron deficiency
#1 Acute/chronic hemorrhage OR physiologic bleeding i.e. menses; occurs when iron demand increases (pregnant), little iron intake (impoverished countries) #2 Chronic blood loss [microcytic hypochronic anemia] #3 Increase in iron demand (pregnancy) #4 Decreased iron intake (impoverished countries) #5 Malabsorption [only common in Crohn's disease] #5 Unable to utilize iron body stores due to chronic inflammatory diseases/cancer
