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BDS4 EXAM STUDY > Diseases of Human Systems > Flashcards

Diseases of Human Systems Flashcards

1
Q

What is the difference between primary endocrine disease and secondary endocrine disease?

A

PRIMARY = gland failure
SECONDARY = control failure

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2
Q

Where is the pituitary gland located?

A

At base of brain & sits in the sella tursica

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3
Q

What can occur if there is abnormal growth of the pituitary gland?

A

Presses on the optic chiasm & affects vision

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4
Q

What hormones are released from the anterior pituitary gland?

A
  • thyroid stimulating hormone
  • growth hormone
  • adrenocorticotrophic hormone
  • follicle stimulating hormone
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5
Q

What hormones are released from the posterior pituitary gland?

A
  • anti-diuretic hormone (ADH)
  • oxytocin
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6
Q

What is the difference between a function pituitary adenoma vs a non functional pituitary adenoma?

A

Functional - produces an active hormone eg GH causes acromegaly

Non-Functional - space occupying does not secrete hormone, causes visual field defects

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7
Q

How is growth hormone released into the body?

A
  1. Hypothalamus secretes GHRH (growth hormone releasing hormone)
  2. Anterior pituitary stimulated & releases growth hormone
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8
Q

What is the result of excess growth hormone production?

A

In children - gigantism

In adults - acromegaly

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9
Q

What might spacing of teeth & spontaneous changes in occlusion be a sign of?

A

Acromegaly

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10
Q

What are the general presenting features of acromegaly?

A
  • enlarged supraorbital ridges
  • broad nose
  • thickened lips
  • enlarged hands
  • large mandible (class III)
  • spacing of teeth
  • large tongue
  • T2 diabetes
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11
Q

Give some intraoral features of Acromegaly:

A
  • enlarged tongue
  • interdental spacing
  • ‘shrunk’ dentures
  • reverse overbite
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12
Q

Give a type of hyperthyroidism:

A

Graves disease
- auto antibodies stimulating the TSH receptor, release of more hormone

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13
Q

What are some signs of hyperthyroidism?

A
  • warm moist skin
  • tachycardia & atrial fibrillation
  • high BP
  • tremor
  • proptosis of eyes
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14
Q

What are some symptoms of hyperthyroidism?

A
  • hot & excess sweating
  • weight loss
  • diarrhoea
  • palpitations
  • irritable
  • manic
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15
Q

What autoimmune disease may this person be suffering from?

A

Graves disease (hyperthyroidism)

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16
Q

What is a cause of Hypothyroidism?

A

Hashimoto’s autoimmune disease

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17
Q

What are some primary forms of Hypothyroidism?

A
  • Hashimotos
  • idiopathic atrophy
  • thyroidectomy surgery
  • iodine deficiency
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18
Q

What are some signs of Hypothyroidism?

A
  • dry coarse skin
  • bradycardia
  • confusion
  • goitre (hashimotos can cause inflammation of thyroid gland)
  • delayed reflexes
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19
Q

What are some symptoms of Hypothyroidism?

A
  • tiredness
  • cold intolerance
  • weight gain
  • constipation
  • goitre
  • puffed face & extremities
  • angina
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20
Q

What investigations may be used to look into a pt with suspected thyroid disease?

A

Blood
- TSH
- T3 & T4

Imaging
- ultrasound scan
- radioisotope scans

Tissue
- biopsy

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21
Q

How is hyperthyroidism treated?

A
  • Carbimazole
  • Beta blockers to reduce anxiety, tremors & palpitations
  • Radioiodine
  • Partial thyroidectomy
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22
Q

How is Hypothyroidism treated?

A
  • Give T4 tablets (thyroxine)
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23
Q

What is T1 diabetes mellitus?

A

INSULIN DEFICIENCY
- autoimmune destruction of pancreatic B cells

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24
Q

What very dangerous side effect can occur in young people suffering from T1 diabetes?

A

Ketoacidosis
- body cells cannot access glucose for metabolism so they start to metabolise fat & this results in ketones production (which is acidic!!)

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25
Q

What are some symptoms of T1 diabetes?

A
  • polyuria
  • polydipsia (extreme thirst)
  • tiredness
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26
Q

What is T2 diabetes?

A

Defect in insulin synthesis, secretion & action
- inadequate B cell response to hyperglycaemia
-

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27
Q

What medications can induce diabetes?

A
  • corticosteroids
  • immune suppressants (clyclosporin)
  • cancer medication (imatinib, nilotinib)
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28
Q

What are the risk factors for development of gestational diabetes?

A
  • overweight
  • family history of diabetes
  • previous gestational diabetes
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29
Q

What are some complications associated with diabetes?

A
  • CV risk due to atheroma = angina & MI
  • poor wound healing
  • renal disease
  • eye disease
  • neuropathy
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30
Q

How does Diabetes affect dentistry?

A
  • infection risk
  • poor wound healing risk
  • periodontal disease risk
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31
Q

What does “anemia” mean?

A

low haemoglobin levels

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32
Q

What does “leukopenia” mean?

A

low white cell count

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33
Q

What does “thrombocytopenia” mean?

A

low platelet count

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34
Q

What does “pancytopenia” mean?

A

reduction in ALL cells

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35
Q

What are some potential reasons for a pt to have low iron levels?

A
  • low intake of meat, green leafy veg
  • achlorhydria (lack of stomach acid so non-haem iron not converted)
  • coeliac disease causes reduction in absorption
  • GI tract bleeding (crohns, UC, gastric ulcer etc)
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36
Q

What are haematinics?

A

Things used to make RBCs
- vitamin B12
- iron
- folic acid

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37
Q

Explain how vitamin B12 is absorbed:

A
  • gastric parietal cells release intrinsic factor
  • intrinsic factor binds to Vit B12
  • this is then absorbed in the Ileum
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38
Q

Why might a pt be deficient in vitamin B12?

A
  • lack of intake (vegans)
  • lack of intrinsic factor (eg Pernicious Anaemia or gastric disease)
  • disease of terminal ileum (eg Crohns)
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39
Q

What can a folic acid deficiency in foetas cause?

A

Spina bifida

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40
Q

What types of anaemia are as a result of abnormal globin chains?

A
  • thalassaemia
  • sickle cell
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41
Q

What is Thalassaemia?

A

Anemia condition in which:
- normal haem production
- genetic mutation of globin chains

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42
Q

What clinical effects can arise as a result of thalassaemia?

A
  • chronic anaemia
  • marrow hyperplasia
  • splenomegaly
  • cirrhosis
  • gallstones
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43
Q

How is thalassaemia managed?

A
  • blood transfusions
  • prevent iron overload
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44
Q

How do RBCs in sickle cell anaemia differ from normal RBCs?

A

Curled up edges
- no longer able to squeeze through capillaries

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45
Q

What are the clinical signs of anaemia?

A
  • pale
  • tachycardia
  • pale mucosa
  • smooth tongue
  • beefy tongue in vitamin B12 deficiency
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46
Q

You suspect that your patient may be suffering from anaemia, what should you do?

A

Refer them for
- FBC
- renal function tests
- faecal occult blood test if suspected GI bleeding

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47
Q

How does anaemia affect dentistry?

A
  • lower O2 capacity for GA
  • mucosal atrophy
  • candidiasis
  • recurrent oral ulceration
  • sensory changes
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48
Q

What is lymphoma?

A

clonal proliferation of lymphocytes arising in a lymph node or associated tissue (solid mass but some cells in blood)

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49
Q

What are some warning symptoms of potential lymphoma?

A
  • fever
  • swelling of face & neck
  • lump in neck, armpit or groin
  • excessive sweating at night
  • unexpected weight loss
  • loss of apetite
  • breathlessness
  • weak feeling
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50
Q

How does chemotherapy work?

A

Targets cells with a high turnover rate
**HENCE WHY THE ORAL MUCOSA IS SO OFTEN AFFECTED

51
Q

Give examples of macrocytic anaemias:

A

Iron/folate/vit b12 deficiency

52
Q

What is an inherited bleeding disorder?

A

Acquired defect that affects the coagulation of the blood by either affecting:
- coagulation factors/control proteins
- platelets
- both

53
Q

Give examples of disorders that reduce coagulation factors:

A
  • Haemophilia A (factor VIII)
  • Haemophilia B (factor IX)
  • von Willebrand’s disease (factor VIII & reduced platelet aggregation)
54
Q

What is the normal amount of factor production (of coagulation products)

A

1iu (international unit)

55
Q

How is mild/carrier haemophilia A managed?

A
  • DDAVP = desmopressin which releases factor VIII that has been bound to endothelial cells
  • Tranexamic acid = inhibitor of fibrinolysis
56
Q

How is moderate & severe haemophilia A managed?

A

recombinant factor VIII medication

57
Q

What is the incidence of Haemophilia A in the UK?

A

1:10,000

58
Q

What is the incidence of Haemophilia B in the UK?

A

1:50,000

59
Q

A pt has severe haemophilia A, where will their dental treatment be carried out?

A

Dental treatment unit attached to the haemophilia centre for monitoring

60
Q

What local anaesthetic techniques can be dangerous for pts with haemophilia?

A
  • IDB
  • lingual infiltration
61
Q

A pt with severe haemophilia has just had a dental extraction, what is their post-op regime?

A

Pts observed overnight at the haemophilia centre

62
Q

A pt with mild haemophilia has just had a dental extraction, what is their post-op regime?

A

Pt observed for 2-3 hours following surgery

63
Q

What can cause thrombocytopenia?

A
  • idiopathic
  • drug related = penicillin based drugs or heparin
  • alcohol
  • leukaemia
64
Q

What platelet count is considered “safe” and means dental treatment can be carried out in a primary care setting?

A

100x10^9/L

(50 x 10^9 in a hospital setting)

65
Q

What is an example of a coumarin anticoagulant drug?

A

Warfarin

66
Q

What is an example of a direct thrombin inhibitor drug?

A

Dabigatran

67
Q

What are examples of factor Xa inhibitor drugs?

A
  • apixaban
  • rivaroxaban
  • edoxaban
68
Q

How does warfarin work as an anticoagulant?

A

Inhibits production of vitamin K dependent clotting factors (2, 7, 9 ,10)
- slow onset over three days

69
Q

How is warfarin response measured?

A

INR (ratio of pro-thrombin to thrombin)
- normal between 2-3
- <4 for dental treatment

70
Q

What drugs can interact with warfarin?

A
  • metronidazole
  • NSAIDs
  • carbamazepine
  • aspirin
  • fluconazole
71
Q

What is type 1 respiratory failure?

A

Gas exchange failure eg
- emphysema
- thickening of alveolar wall

72
Q

How do wheeze & stridor differ?

A

Wheeze - expiratory noise
Stridor - inspiratory noise

73
Q

What drug types can improve airway patency?

A
  • bronchodilators = B2 agonist & anticholinergics
  • anti-inflammatory = corticosteroids
74
Q

What drugs can impair ventilation?

A

Beta blockers = make airway narrower by increasing effect of smooth muscle contraction

Benzodiazepines
Opioids

75
Q

What type of drug is salbutamol?

A

Short acting beta2 agonist

76
Q

How do anticholinergic drugs work?

A

Inhibit muscarinic nerve transmission in autonomic nerves
- relaxation of smooth muscle

77
Q

What occurs in asthma pts?

A

Airway narrowing due to:
- bronchial smooth muscle constriction
- bronchial mucosal oedema
- excessive mucous secretion into the airway lumen

78
Q

What are the symptoms of asthma?

A
  • cough
  • wheeze
  • shortness of breath in acute attack
  • worse overnight & early morning
  • difficulty breathing OUT
79
Q

What core asthma drugs are used to treat the condition?

A
  1. short acting beta-adrenergic agonists
  2. inhaled corticosteroids (low dose initially but can move to high dose if need be)
  3. Regular long acting beta adrenergic agonist
  4. Adjuvant therapy = prednisolone etc.
80
Q

When should asthma pts begin using low dose inhaled corticosteroids everyday?

A

If using short acting b2 agonist >3 times a week

81
Q

What is COPD?

A

Condition with mixed airway obstruction & destructive lung disease
- asthma component
- empysema component

82
Q

What is emphysema?

A

Destruction of alveoli

83
Q

What is the biggest preventable risk factor associated with COPD?

A

Smoking !

84
Q

What are the symptoms of COPD?

A
  • chronic cough
  • production of mucous
  • fatigue
  • shortness of breath
  • dyspnea
  • chest discomfort
85
Q

What do inhaled steroids put pts at risk of?

A

Candida risk
- can be lowered by rinsing mouth after use & using spacer devices

86
Q

Mutation to what gene causes cystic fibrosis?

A

CFTR gene found on chromosome 7

87
Q

What is cystic fibrosis?

A

Inherited genetic disease in which:
- excess sticky mucous production
- from all body systems

88
Q

What are the main symptoms seen in children with cystic fibrosis?

A
  • troublesome cough
  • repeated chest infections
  • prolonged diarrhoea
  • poor weight gain
89
Q

What can be some consequences of cystic fibrosis?

A
  • liver dysfunction
  • prone to osteoporosis
  • diabetes symptoms (due to prolonged pancreas disease)
  • reduced fertility
90
Q

What treatment is available for cystic fibrosis patients OTHER than medication?

A
  • physiotherapy
  • exercise
  • transplantation
91
Q

What medications can be used to treat pts with cystic fibrosis?

A
  • bronchodilators
  • antibiotics to treat chest infections
  • steroids to reduce inflammation
  • pancreatic enzyme replacement
  • CFTR modulators
  • stem cell treatment
92
Q

Give some different causes of lung cancer:

A
  • smoking
  • asbestos
  • second hand smoke
  • radiotherapy
93
Q

What are some signs and symptoms of lung tumours?

A
  • persistent cough
  • blood stained sputum
  • pneumonia
  • dysphagia
  • persistent hoarseness
94
Q

What is sleep apnoea?

A

Airway obstruction whilst asleep that prevents pt breathing normally
- 10secs or more duration

95
Q

What can occur as a result of sleep apnoea?

A
  • drowsiness during the day
  • increased MI risk
96
Q

What can be used to treat obstructive sleep apnoea?

A
  • mandibular advancement appliance
  • CPAP (continuous positive airway pressure)
97
Q

Give examples of some GI diseases than can cause malabsorption:

A
  • pernicious anaemia
  • coeliac disease
  • crohn’s disease
98
Q

What are antacids?

A

Medications taken to help with excess gastric acid formation
- alkalis that for a salt with gastric acid & neutralise its effects

99
Q

What drug groups can reduce acid secretion in the stomach?

A
  • H2 receptor blockers
  • proton pump inhibitors
100
Q

What type of drug is omeprazole?

A

Proton pump inhibitor

101
Q

What may be some causes of dysphagia?

A
  • external compression from tumour
  • fibrosis of muscles due to GORD or scleroderma
  • neuromuscular dysfunction (eg parkinsons)
102
Q

What are the 3 main causes of GORD?

A
  • defective lower oesophageal sphincter
  • impaired lower clearing
  • impaired gastric emptying
103
Q

What are some signs & symptoms of GORD?

A
  • epigastric burning
  • dysphagia
  • GI bleeding
  • severe pain due to oesophageal spasm
104
Q

How can GORD be managed?

A
  • stop smoking
  • lose weight
  • antacids (eg gaviscon)
  • PPIs & H2 blockers
105
Q

Infection with what organism can cause peptic ulcer disease?

A

Helicobacter pylori
- causes loss of protective mucous barrier within stomach

106
Q

What are some complications associated with peptic ulcer disease?

A
  • perforation of stomach
  • haemorrhage
  • malignancy
  • anaemia
107
Q

What are the effects of liver failure?

A
  • prolonged bleeding (raised INR)
  • ascites (fluid retention)
  • portal hypertension
  • encephalopathy
  • jaundice
108
Q

What are some effects of hepatic disease on dentistry?

A
  • bleeding tendency (due to reduced clotting factor synthesis)
  • prolonged effect of sedatives
  • avoid antifungals
  • drug dosages may need reduced
  • may need to avoid NSAIDs due to bleeding risk
109
Q

Give examples of reversible risk factors for cardiovascular disease:

A
  • smoking
  • obesity
  • diet
  • exercise
  • hypertension
  • T2 diabetes
110
Q

How can the dental team aid with cardiac disease prevention?

A
  • deliver general health educational messages
  • smoking cessation advice
111
Q

What drugs are used to prevent CV disease?

A
  • statins
  • diuretics
  • calcium channel blockers
  • ACE inhibitors
  • beta adrenergic blockers
112
Q

What drugs may you prescribe that interact with statins?

A

Fluconazole (statin should be omitted during antifungal therapy)

112
Q

What CV drugs make heart failure worse?

A

Beta blockers

113
Q

What may patients taking beta-blockers experience getting out of dental chair?

A

postural hypotension

114
Q

What is the effect of diuretics?

A

Increase salt & water LOSS
- reduce plasma volume
- reduce cardiac workload

115
Q

How do ACE inhibitors work?

A
  • inhibit conversion of angiotensin I to angiotensin II (vasoconstrictor)
  • prevents aldosterone dependent reabsorption of salt & water
116
Q

How do nitrates work (CV medication)?

A
  • dilate veins which reduces preload to heart
  • dilate resistance arteries
117
Q

What emergency treatment is used for angina?

A

GTN spray to reduce preload to heart
- sometime aspirin can be chewed if unsure if MI or angina

118
Q

What are some risk factors associated with hypertension?

A
  • increasing age
  • obesity
  • alcohol
  • smoking
  • stress
  • drugs (corticosteroids, oral contraceptives etc)
  • pregnancy
  • family history
119
Q

What is infective endocarditis?

A

Infection/microbial colonisation of thrombi of the endocardium (usually on the valves)

120
Q

What dental procedures are a risk for development of IE?

A

Procedures involving manipulation of the dento-gingival junction and causing a bacteraemia
- XLAs
- perio treatment
- gingival surgery
- implants

121
Q

Who makes the decision on wether or not to give antibiotic prophylaxis before dental treatment?

A

Made my patient and their physician (eg GP)

122
Q
A

BDS4 EXAM STUDY (39 decks)

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