MedComplex-Exam 2 Part 2 (TB, DentalAllergy,PUD) Flashcards
Freakin tricky: what is the genus and species of TB?
MYCO-BACTERIUM Tuberculosis
Myco-bacterium tuberculosis is a _______-shaped bacterium with a _____ capsule….
rod-shaped….waxy
Is TB aerobic or anaerobic? What is the complex lipid in its cell wall?
Mycolic Acid
TB is transmitted from person to person by _________ and the initial site of infection is in the _____….What is a secondary portal of entry for TB?
respiratory aerosols…lungs….secondary: GI tract (i don’t know how)
What is the name of the stain used for TB since it does not stain gram negative nor positive?
acid fast
Does TB attract acute inflammatory cells?
No, PMNs are not attracted.
What type of inflammatory cells go after TB? What is the transformation process?
macrophages transform into multi-nucleated giant cells
What are the components of a GHON COMPLEX?
1.Peripheral Parenchymal Granuloma 2. Mediastinal (hilar) lymph node
Yikes. This is hard to remember- In TB: what is the name for a peripheral parenchymal granuloma PLUS a mediastinal (hilar) lymph node?
a GOHN Complex
Where are Ghon Complexes usually found in the lungs?
the LOWER lobes
In TB: Grossly, the healed, _______ (supra or sub pleural?) Ghon nodule is well ________ with ________ necrosis. In later stages, the lesion is fibrotic and calcified.
sub pleural…. circumscribed…. central
What is a unilateral CERVICAL adenitis that presents with swollen non-tender nodes in pt’s experiencing miliary TB?
SCRO-FULA
What is the name for VERTEBRAL osteoarthritis after military spread of TB?
POTTS disease
What are the two groups of people most at risk for spread of TB to other parts of the lungs? What is this called?
ImmunoCompromised and children…called “Progressive Primary Tuberculosis”
In miliary TB, granulomas can go to the brain/spinal chord and cause meningitis…what is the name for a granuloma in this area?
A Tuberculoma
What area of the body are Tuberculoma’s found in miliary spread of TB?
the Brainstem
How long does it take to culture a TB sample? What is the name of the special media needed to culture it?
6-8 weeks (rather slow)…Lowenstein-JJ Jensen Agar
Which STAGE of TB do we see a GHON complex?
PRIMARY (not secondary, not miliary)
What is it called when a primary granuloma in TB can is calcified and can be seen on a chest X ray?
coin lesion
What is the sign of a positive PPD TB test? What is the name of the TB vaccine that can yield an ALMOST positive TB test?
10cm…BCG vaccine (5-9cm induration)
TB in the oral cavity is relatively _____ and usually secondary to lung involvement, usually affecting what type of people??
rare…elderly people
ORAL TB Lesions are usually seen as superficial ulcers or patches, although marked swelling of the ______ may also be seen.
GINGIVA
What is another name for an allergy to latex?
NRL “Natural Rubber Latex” protein allergy
What is the most common cause of latex allergy?
Direct Contact
What are the 4 major risk factors/groups of people for Latex allergy?
- Kids with Spina Bifida 2. ppl w/ food allergies 3.family hoof allergies 4.health care workers
About what percent of people with spina bifida are going to have a latex allergy?
about 50%!
Interesting! What group of people are most likely to have a latex allergy?
Children with spina bifida
What type of reaction is a NRL protein allergy? Which antibody is associated with it???
Type I (immediate) hypersensitivity…IgE
While the NRL Protein allergy was more common in the 90’s it has gone down to about what % of health care workers affected?
less than 10% (down from 12-17%)
What are the three types of Reactions to Latex and what type of immune mediated response occurs for each?
1.NRL protein allergy-Type I 2.ACD (Allergic Contact Dermatitis) - Type IV 3. ICD (Irritant Contact Dermatitis) - NO immune response
RememberTHATFor an ACD rxn what is the specific immune cell that is activated?
T-cell lymphocyte
What is the role of Gluteraldehyde in the dental practice?
disinfectant
What are the 3 main chemicals that cause ACD in a dental practice?
1.Gluteraldehyde 2.Methacrylate 3.Metals
What are the two types of allergic reactions associated with Gluteraldehyde?
1.ACD 2.ICD
What is the cause of a hiatal hernia MOST OF THE TIME?
Hiatal Hernia
What are the two basic types of hiatal hernias? What % of the time are each?
1.Sliding (95%) 2.Paraesophageal (5%)
Sliding Hernia: An enlargement of the diaphragmatic hiatus and laxity of the of the _________ connective tissue allows a cap of gastric cardia to move upward to a position above the diaphragm.
circumferential
Sliding Hernia: Must be hard to Dx because its _________ in the large majority of patients and only 5% of patients diagnosed _________ complain of symptoms referable to gastroesophageal reflux.
asymptomatic… radiographically
Paraesophageal hernia: This form is characterized by herniation of a portion of the gastric ______ alongside the esophagus through a defect in the diaphragmatic connective tissue membrane that defines the esophageal hiatus.
fundus
WOAH in extreme cases of _________ hernias most of the stomach herniates into the thorax!!
Paraesophageal
BOOM. TEST QUESTION. _______ hernias are often treated medically, whereas __________ should be tx. surgically.
Sliding=medically…Paraesophageal=surgically
What is replacement of squamous epithelium of the esophagus by columnar epithelium as a result of chronic GE reflux?
Barretts Esophagus
In Barretts Esophagus what is the type of metaplasia going on? (what cell type to what cell type?)
Stratified Squamous TO Columnar epi
Barretts Esophagus occurs in the ______ third of the esophagus, particularly among _____ men.
lower…white
Barretts Esophagus has a greater than twofold increased risk among ______.
smokers
What type of cancer is a person with Barrett’s esophagus at greater risk for?
Adenocarcinoma (not SCC since there was metaplasia)
Cool aside: What is the end product of the urease secreted that buffers H. Pylori in the stomach acid?
ammonia
The common factor that unites both GASTIC and DUODENAL ulcers is secretion of ________.
HydroChloric Acid….HCl
Gastric vs. Duodenal: peak incidence between 30 and 60 years old
duodenal ulcer disease
Gastric vs. Duodenal: affects more males than females
dude-odinal ulcers :) LOL
Gastric vs. Duodenal: affect middle aged and elderly more than young
gastric ulcer disease
Gastric vs. Duodenal: affects men and women equally
gastric (grandma)
Gastric vs. Duodenal: In the U.S., the incidence for _______ ulcers is the same for blacks and whites, but in Africa, they are RARE among blacks. In the western urban setting, all racial and ethnic groups are susceptible.
duodenal
The common stereotype of the patient with a peptic ulcer is that of a highly motivated executive operating in a ________ environment.
STRESSFUL
PUD: Environmental Factors: High amounts of ______ and cirrhosis of the liver are associated with PUD. _______ as well as NSAID’s and high-dose _______ have all been incriminated in the production of peptic ulcers. _______ is also a risk for PUD, particularly gastric ulcers, although the mechanism is controversial.
Alcohol… Aspirin… Corticosteroids… smoking
Gastric vs. Duodenal: genetic susceptibility
duodenal (no increase c/o genetics in gastric ulcers)
Gastric vs. Duodenal: Type O blood
duOdenal (no assoc. with gastric)
Gastric vs. Duodenal: Kissing ulcers
duodenal
The classic case of _______ ulcer is characterized by burning epigastric pain that is experienced 1-3 hours after a meal or that awakens the patient at night.
duodenal
Gastric vs. Duodenal: perforations
duodenal
Gastric vs. Duodenal: need BIOPSY
gastric (duodenal does not need biopsy-no known cases of malignancy)
