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Dentistry Year 2 Term 3 > Marcello Montes > Flashcards

Marcello Montes Flashcards

1
Q

What is infective endocarditis

A

A life threatening infection of the heart valves or endocardium usually caused by bacteria entering the bloodstream and infecting the heart

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2
Q

What is bacteraemia

What are the durations (continuous, transient, intermittent)

A

The presence of bacteria in the blood, always abnormal as blood usually sterile. It is detected by blood culture

Continuous- persistent bacteraemia usually due to infected heart valve, blood infection, infected blood clot or blood vessel graft
Transient- bacteria in bloodstream from mins to hrs (15-30mins) typically harmless, can result from brushing teeth
Intermittent- periodic seeding of same bacteria in blood by existing infection elsewhere

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3
Q

What are the types of bacteraemia (primary, secondary)

A

Primary- the result of direct inoculation of bacteria into the bloodstream usually through IV drug use or contaminated venous catheter

Secondary- bacteria enters via alternative site such as cut in skin or mucous membrane, allowing microorganisms causing infection at another site to invade blood

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4
Q

What are some symptoms of infective endocarditis

A

Aching joints and muscles, chest pain, fatigue, flu like symptoms, night sweats, shortness of breath, swellings, heart murmur, weight loss, cutaneous manifestations, ocular changes (roths spots), splenomegaly, heart failure

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5
Q

What are the cutaneous manifestations of infective endocarditis (5)

A

Conjunctival petechiae: small red or purple spot on conjunctiva caused by minor bleed from broken capillaries

Mucosal petechiae: pinpoint haemorrhage in subcutaneous or submucosal tissue

Splinter haemorrhage: tiny blood clots running vertically under a nail caused by haemorrhage

Janeway lesion: non tender small erythematous or haemorrhagic lesion on palms or soles

Oslers node: tender purple pink nodules with pale centre generally found on distal fingers and toes as a result of immune complex formation in skin

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6
Q

What % of infective endocarditis have oral streptococci present

A

40%

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7
Q

What is sepsis

What is septicaemia

A

Sepsis- the putrefactive destruction of tissues by disease causing bacteria or their toxins, it is a life threatening reaction to an infection when the immune system overreacts and starts damaging own tissues and organs via inflammatory response

Septicaemia- a complication of sepsis, widespread tissue destruction due to presence presence of pathogenic microorganism or toxins in blood

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8
Q

What is SIRS

What is septic shock

A

SIRS - systemic inflammatory response syndrome, an inflammatory state affecting the whole body in response to infectious or non infectious insult

Septic shock- hypotension following an infection, sepsis often progresses to septic shock

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9
Q

Amber flag criteria of sepsis

10

A
  1. Relatives concerned about mental status
  2. acute deterioration in functional ability
  3. Immunosuppressed
  4. Trauma or surgery in past 6 weeks
  5. RR 21-24
  6. Systolic BP 91-100
  7. Heart rate 91-130 or new arrhythmia
  8. Not passed urine 12-18hrs
  9. Temp under 36 degrees
  10. Wound, device or skin infection
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10
Q

Red flag criteria of sepsis

10

A
  1. Unresponsive or responds only to voice or pain
  2. Systolic BP under 90
  3. Heart rate over 130bpm
  4. RR over 25
  5. Needs oxygen to keep SpO2 92%
  6. Non blanching rash
  7. Not passed urine 18hrs
  8. Urine output less than 0.5ml/kg/hr
  9. Lactate over 2 mmol/l
  10. Recent chemotherapy
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11
Q

What are the treatments for sepsis

3

A

Fluid replacement

IV Antibiotic combination therapy - usually broad spectrum (beta lactam) antibiotic + aminoglycoside or fluoroquinolone

Steroids

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12
Q

What are the criteria of SIRS

4

A

Temperature: >38 or <36

HR: over 90BPM

RR: >20 or PaCO2 <32

WBC count: >12,000 or <4,000

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13
Q

What is the criteria for sepsis
2

What is the criteria for severe sepsis
2

What is the criteria for septic shock
2

What is the criteria for MOF
2

A

SIRS + confirmed infection

Sepsis with evidence of organ dysfunction, hypo perfusion or hypotension

Sepsis + prolonged hypotension

Sepsis + irreversible organ failure

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14
Q

Theories of sepsis:

Gut hypothesis

Endotoxin macrophage hypothesis

A

Gut hypothesis: decreased gut blood flow and permeability lead to translocation of bacteria into the bloodstream

Endotoxin macrophage hypothesis: endotoxins released during infection cause release of pro inflammatory cytokines , thromboxane A2, prostacyclin, platelet activating factor and NO leading to whole body inflammation

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15
Q

Theories of sepsis:

Tissue hypoxia microvascular hypothesis

Mitochondrial DNA hypothesis

Integrated hypothesis

A

Tissue hypoxia microvascular hypothesis: insufficient supply of oxygen occurs after vascular changes leading to cell death and organ dysfunction

Mitochondrial DNA hypothesis: following cel death mitochondrial DNA leaks into bloodstream triggering neutrophil extracellular traps (NETs), this deadly immune response leads to MOF

Integrated hypothesis: sepsis caused by compromised homeostasis involving combination of mechanisms

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16
Q

Gram positive bacteria of sepsis
2

Gram negative bacteria of sepsis
3

A

Strep pneumoniae
Staph aureus

E coli
Klebsiella spp
Pseudomonas aeruginosa

17
Q

What is the role of pathogen recognition receptors in sepsis

A

PRR recognise signals in the form of pathogen associated molecular patterns (PAMPs)

This causes activation of inflammation of inflammatory mediators and microvascular endothelium resulting in inflammation and thrombosis

This leads to occlusion of small blood vessels resulting in free radical production triggering ischaemia, tissue damage and MOF

18
Q

What is the role of oxygen free radicals in sepsis

A

Immune cells, tissue hypoxia and cytokines produce oxygen free radicals

Oxygen free radicals cause mitochondrial dysfunction by decreasing capacity of ATP synthesis

19
Q

What are the key pro inflammatory cytokines initiating SIRS response
2

What is the key pro inflammatory cytokine of sepsis
1

A

TNF alpha
IL 1

IL 6

20
Q

What does endothelial cell damage in sepsis lead to

3

A

Vasodilation
Capillary leak
Leukocyte endothelial interactions

21
Q

What is disseminated intravascular coagulation seen in sepsis

A

Blood clots form particularly in capillaries blocking vessels and reducing oxygen supply to organs and tissues

This can cause increased bleeding due to insufficient clotting factors left over

Symptoms include chest pain, shortness of breath, leg pain, problems speaking and moving

22
Q

What is basic/fundamental research

What is applied research

What is clinical research

A

Basic/fundamental research is discovery research that increases knowledge of mechanisms of life or disease, it has no anticipated direct application

Applied research is directed towards development of treatment or drug

Clinical research tests drugs on humans in clinical trials

23
Q

What is mathematical modelling and bioinformatics (in silico research)

A

Computer modelling- use of computers to study and simulate systems and behaviour using mathematical language

Bioinformatics- developing methods and software for understanding biological data

24
Q

What are in vitro studies

What are in vivo studies

A

Studies performed in lab often using human cells and tissues - they do not involve model organism or animal

Lab studies involving animals

25
Q

What are the phases of clinical trials

4

A

Phase 1- small number of healthy volunteers, determines drugs interaction with human system, lasts 1yr

Phase 2- 100-300volunteer patients, determines drugs effectiveness on certain organs and assesses safety, 2-4yrs

Phase 3- 1000-3000 volunteers, confirms results of earlier tests and identifies adverse reactions, 3yrs

Phase 4- sometimes follows phase 3 to address more side effects and long term risks of drug

26
Q

Who regulates establishment of new drugs inEU

Who regulates medicines in uk

A

EMA; European medicines agency

MHRA; medicines and healthcare products regulatory agency

27
Q

What are stages of PCR

3

A

1- denaturing of DNA to separate strands

2- annealing of primer

3- synthesis of DNA by taq polymerase

28
Q

What is SDS PAGE
What are the stages (3)

What is western blotting
What are the stages (4)

A

SDS PAGE - separation of proteins from sample according to mass on polyacrylamide gel

  1. Detergent (SDS) degenerates proteins and makes them -ve
  2. Current applied to gel so proteins migrate towards +ve electrode
  3. Smaller proteins migrate faster and further

Western blotting- detection of proteins in sample by specific antibody binding

  1. Proteins separated by SDS PAGE are transferred to nitrocellulose membrane
  2. Membrane incubated with primary antibody
  3. Membrane incubated with secondary antibody
  4. Detection of protein of interest
29
Q

What is immunoprecipitation

What is immunohistochemistry and immunocytochemistry

What is ELISA

A

Isolation of specific proteins and their binding partners

Localisation of specific proteins in tissues and cells respectively

Plate based assay to detect antigens proteins in a liquid sample (blood, plasma, saliva, cell culture) using antibodies

30
Q

What is the difference between polyclonal and monoclonal antibodies

A

Polyclonal- recognises multiple different epitopes on an antigen

Monoclonal- recognises single epitope on an antigen

31
Q

Tissue engineering therapies:

Auto grafting
Allografting
Xenografting
Synthetic biometric materials

A

Auto-grafting- harvesting of tissue from one location in body and transplanting tissue to another part of same patient

Allografting- harvesting tissue or organ from donor and transplanting to patient

Xenografting- removing tissue from animal source and transplanting to human patient

Synthetic biometric materials- materials or devices created by engineers or scientists to replace or extend functions performed by biological systems

32
Q

What are stem cells

Totipotent, pluripotent, multipotent

A

Undifferentiated cells capable of self renewal and differentiation into different cell types or tissues during embryonic development and throughout adulthood

Totipotent can differentiate into any cell or whole organism
Pluripotent can differentiate into all tissue types but now whole organism
Multipotent can differentiate into range of cells within tissue type

33
Q

Embryonic stem cell (3)

Adult stem cell (3)

Induced pluripotent stem cells (3)

A

Embryonic: stem cells derived from undifferentiated inner cell mass of human embryo, pluripotent, clinical feasibility limited due to ethical issues

Adult: stem cells found in small numbers in most adult tissues with limited ability to give rise to cells of the body, multipotent, easier to isolate with fewer ethical issues

iPSC: pluripotent stem cell generated directly from a somatic cell, pluripotent, 3-4 genes found in stem cells transferred to donor cell using vectors

34
Q

How can parkinsons disease be treated using stem cells

4

A
  1. Dead nerve cells not producing dopamine
  2. Patients own stem cells implanted into damaged part of brain
  3. Stem cells transform into new nerve cells producing dopamine
  4. Dopamine allows transmission of nerve signals
35
Q

What is the single stem cell population model

A

Single stem cells capable of self renewal proliferates and differentiates
Asymmetric division maintains the balance between self renewal and differentiation

36
Q

What is the two stem cell populations model

A

Co existing quiescent and active stem cell populations located in adjacent zones with corresponding inhibitory and stimulatory signals

Quiescent stem cells replace damaged stem cells
Active stem cells may replace lost quiescent stem cells

37
Q

What are the types of dental stem cell

5

A 
Dental pulp SC
SHED- stem cells from exfoliated deciduous teeth
PDLSC
SCAP- stem cells from apical papilla
DFPC - dental follicle progenitor cells
38
Q

What is the best age to recover stem cells from primary teeth
What teeth are best

What is the best age to recover stem cells from wisdom teeth

What is the best age to recover stem cells from permanent teeth

A

Baby teeth-Age 6-12 -canine to canine

Wisdom teeth- 16-20

Permanent teeth- over 20

Dentistry Year 2 Term 3 (4 decks)

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