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Dentistry Human Disease > Medicine For The Elderly And Musculoskeletal/Connective Tissue Disorders > Flashcards

Medicine For The Elderly And Musculoskeletal/Connective Tissue Disorders Flashcards

1
Q

What is meant by multi-infarct dementia?

A

Blocking of small blood vessels (vascular dementia)

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2
Q

What is the treatment for dementia?

A
  • cholinesterase inhibitors
  • sedatives
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3
Q

What act is very important to consider for patients with dementia in regards to their capacity to consent to treatment?

A

Adults with Incapacity Act 2000 Section 47

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4
Q

If a patient with dimentia lacks capacity to consent to treatment, what is required to be done before treatment is carried out?

A

Need to obtain Adults with incapacity (AWI) form from GP

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5
Q

What is the risk of prescribing analgesics to a patient with dimentia?

A

Risk of delirium (acute confusion)

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6
Q

Why should NSAIDS be avoided in over 80’s?

A

High risk of GI side effects

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7
Q

What are four erosive conditions that lead to tooth wear in the elderly, excluding dietary?

A
  • alcohol abuse
  • hiatus hernia
  • duodenal ulceration
  • certain medications (e.g. NSAIDS)
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8
Q

What is the consequence of extensive coverage of partial dentures over the gingiva?

A

Lead to damage, particularly at the gingival margins

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9
Q

What three types of medications are likely to induce xerostomia?

A
  • antidepressants
  • antihypertensives
  • anxiolytics
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10
Q

How does the tongue usually appear in a patient with xerostomia?

A

Lobulated with deep fissures

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11
Q

Use of what medications are likely to cause gingival overgrowth?

A
  • calcium channel blockers
  • anti-epileptic drugs
  • cyclosporine
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12
Q

What enhances retention of an overdenture, other than presence of surrounding natural teeth?

A

Precision attachments

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13
Q

Name three casues of angular chelitis?

A
  • associated with chronic candidal infection
  • staphylococcal infection from the nasal cavity
  • iron deficiency anaemia
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14
Q

Define, inflammation of the joints/

A

Arthritis

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15
Q

Define, non-inflammatory joint disease.

A

Arthrosis

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16
Q

Define, joint pain.

A

Arthralgia

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17
Q

What cells remove bone?

A

Osteoclasts

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18
Q

What cells deposit bone?

A

Osteoblasts

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19
Q

What three substances are very important in bone formation?

A
  • calcium
  • phosphate
  • vitamin D
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20
Q

Why must calcium in the blood be maintained at a very precise level?

A

Because it is involved in nerve and muscle function

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21
Q

What hormone maintains cerium calcium levels, increases calcium release from bone, and reduces renal calcium excretion?

A

Parathyroid hormone (PTH)

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22
Q

What happens to PTH levels if calcium levels fall?

A

PTH levels increase

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23
Q

What effect does hypoparathyroidism have in serum calcium levels?

A

Results in low serum calcium levels

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24
Q

What effect does primary hyperparathyroidism have on serum calcium levels?

A

Results in high serum calcium levels

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25
Q

What effect does primary hyperparathyroidism have on osteoclast action?

A

Inappropriate activation of osteoclasts

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26
Q

What effect does secondary hyperparathyroidism have on serum calcium levels?

A

Results in low calcium levels

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27
Q

What drugs can interfere with Vitamin D synthesis?

A

Some antiepileptic drugs such as carbamazepine and phenytoin

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28
Q

What are main causes of vitamin D deficiency?

A
  • low sunlight exposure
  • poor GI absorption (poor nutrition or malabsorption)
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29
Q

Define, a disorder of the bone where there is poorly mineralised osteoid matrix and cartilage growth plate, resulting in “bone softening”. This is often due to a calcium deficiency.

A

Osteomalacia

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30
Q

Define, a bone disorder where there is loss of mineral and matrix and a reduced bone mass.

A

Osteoperosis

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31
Q

What is osteomalacia referred to as in children, whilst the bone is still continuing to form?

A

Rickets

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32
Q

What measure of bone turnover is very high when there are issues with calcium levels?

A

Alkaline phosphotase

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33
Q

What are patient factors for osteoporosis?

A
  • inactivity
  • smoking
  • excess alcohol use
  • poor dietary calcium
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34
Q

Use of what medical drugs can be a risk factor for osteoporosis?

A
  • steroids
  • antiepileptics
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35
Q

What are genetic risk factors for osteoporosis?

A
  • family history
  • race-Caucasian and Asian women
  • early menopause
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36
Q

What are endocrine risk factors for osteoporosis?

A
  • oestrogen and testosterone deficiency
  • Cushing’s syndrome
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37
Q

Why is Cushing’s syndrome a risk factor for osteoporosis?

A

Cushing’s syndrome increases corticosteroid levels in the blood

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38
Q

What effects does osteoporosis have on the vertebrae?

A
  • height loss
  • kyphosis and scoliosis
  • nerve root compression (back pain)
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39
Q

What are two ways to build maximal peak bone mass in prevention of osteoporosis?

A
  1. Exercise
  2. High dietary calcium intake
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40
Q

What treatment can be used for women (specifically) to reduce osteoporosis risk?

A
  • oestrogen hormone replacement therapy
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41
Q

What are the three most commonly used Bisphosphonates in the treatment of osteoporosis?

A
  1. Alendronate
  2. Ibandronate
  3. Zoledronate
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42
Q

Name the bisphosphonate that’s potency is high it only has to be given once a year.

A

Zolendronate

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43
Q

Define, connective tissue that lines the sin side of the joint capsule.

A

Synovium

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44
Q

What could redness around a joint suggest?

A

Infection, due to inflammation and high vascular content

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45
Q

Define, a noise made by bone ends moving- usually associated with loss of Norwalk cartilaginous covering to the bone ends.

A

Crepitus

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46
Q

What is arthography?

A

Where a radio-opaque dye is injected into the joint to outline the articular surfaces and the joint capsule

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47
Q

What is a key inflammatory marker found in the blood?

A

C-reactive protein (CRP)

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48
Q

Define, a group of joint disorders caused by deposits of crystals in joints and the soft tissues around them.

A

Crystal arthropathies

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49
Q

What is a crystal arthropathy indicative of?

A

Gout

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50
Q

Define, uric acid crystal deposition in joints.

A

Gout

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51
Q

What drugs induce hyperuricaemia?

A

Thiazide diuretics

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52
Q

What are the main symptoms of gout?

A
  • acute inflammation of a single joint
  • rapid onset
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53
Q

What drugs are used to treat gout?

A

NSAIDS

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54
Q

Why should aspirin be avoided if someone has gout?

A

Aspirin interferes with uric acid removal so could exacerbate gout

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55
Q

What drug, taken to treat gout may casue oral ulceration?

A

Allopurinol

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56
Q

What joints are predominantly affected by osteoarthritis?

A

Hips and knees

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57
Q

What characterises osteoarthritis?

A

Cartilage repair dysfunction

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58
Q

What are the symptoms of osteoarthritis?

A
  • pain (improves with rest, worse with activity)
  • brief morning stiffness
  • slowly progressive
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59
Q

What are the signs of osteoarthritis?

A
  • joint swelling and deformity
  • radiographs: loss of joint space and subchondral sclerosis and osteophite lipping
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60
Q

What is subchondral sclerosis?

A

Thickening of bone under the cartilaginous layer as the bone having more force directed straight to it and less cushioning from the cartilage

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61
Q

What is osteophyte lipping?

A

Small bony projections at edge of bone

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62
Q

Define, a disease of the synovium with gradual inflammatory joint destruction.

A

Rheumatoid arthritis

63
Q

How would you categorise someone as sero-positive RA?

A

Presence of rheumatoid factor (RF)

64
Q

How would you categorise someone as sero-negative RA?

A

No rheumatoid factor present

65
Q

What are the symptoms of RA?

A
  • fatigue
  • morning stiffness
  • joint stiffness and pain
  • minor joint swelling
  • fever
  • numbness and tingling
  • decrease in range of motion
66
Q

Joints in what parts of the body are most likely to be affected by RA initially?

A

Hands and feet

67
Q

Name three systemic symptoms of RA?

A
  • fever
  • weight loss
  • anaemia
68
Q

What does MCP joints stand for?

A

Meta-carpal pharyngeal

69
Q

What does PIP joints stand for?

A

Proximal inter-pharyngeal

70
Q

What three specific joint types are usually effected early on, showing initial signs of RA?

A
  • MCP joints
  • PIP joints
  • wrist joints
71
Q

What are late signs of RA?

A
  • ulnar deviation of fingers at MCP joints
  • swan neck deformity of PIP joints
  • deformity of thumb
  • subluxation of wrists
  • deformity of feet and ankles
72
Q

Name 7 extra-articular features of RA.

A
  1. Inflammation of blood vessels
  2. Psoriasis
  3. Eye involvement
  4. Subcutaneous nodules (pressure points)
  5. Amyloidosis (organs don’t work properly)
  6. Pulmonary inflammation
  7. Neurological
73
Q

What will radiograph investigations into RA be able to assess?

A
  • erosions, loss of joint space and deformity
  • joint destruction and secondary osteoarthritis
74
Q

What type of anaemia can be associated with RA?

A

Normocytic, nirmochromic anaemia

75
Q

What are the 4 treatment modalities for RA?

A
  • physiotherapy
  • occupational therapy
  • drug therapy
  • surgery
76
Q

What analgesics are usually prescribed for RA pain?

A
  • Paracetamol
  • cocodamol
77
Q

Name two commonly used DMARDS for treatment of RA?

A
  1. Hydroxychoroquine
  2. Methotrexate
78
Q

Name the 4 main drug group types that are used for treatment of RA?

A
  1. Analgesics
  2. NSAIDS
  3. DMARDS
  4. Steroids
79
Q

Name three immune modulators drugs that are used in the treatment of moderate/severe RA?

A

Azothioprene
Mycophenolate
Biologics (e.g. TNF inhibitors)

80
Q

What oral steroid is normally used in the treatment of RA?

A

prednisolone

81
Q

What would surgery for RA entail?

A
  • excision of inflamed tissue
  • joint replacement
  • joint fusion
  • osteotomy
82
Q

How can disability from RA cause issues in regards to dental care?

A
  • reduced dexterity (issues with OH)
  • access to care
83
Q

What oral side effect can occur from taking methotrexate to treat RA?

A

Oral ulceration

84
Q

What dental side effects can occur from taking hydroxychloroquine to treat RA?

A
  • oral lichenoid reactions
  • oral pigmentation
85
Q

Give 4 examples of rheumatic conditions categorised within seronegative spondyloarthritides?

A
  • ankylosing spondylitis
  • psoriatic arthritis
  • IBD associated arthritis
  • reactive arthritis
86
Q

How does seronegtaive sponyloarthritides differ from RA?

A

Their primary focus of disease is on the axial skeleton

87
Q

What does it mean if you are HLA-B27 positive on a blood test?

A

You may have an autoimmune disease, most commonly associated with HLA-B27 antigens is ankylosing spondylitis

88
Q

What are the effects of ankylosing spondylitis?

A
  • disabling progressive lack of axial movement
  • low back pain
  • limited chest expansion
  • kyphosis
89
Q

What is meant by “kyphosis”?

A

Cervical spine tipped forward

90
Q

What are the dental aspects of ankylosing spondylitis?

A
  • GA hazardous as there is limited mouth opening and limited neck flexion so risk to airways
  • TMJ involvement possible (rare)
  • difficulties in dental chair due to restricted movements
91
Q

What two broad groups are connective tissue diseases broken down into?

A
  1. Autoimmune conditions
  2. Vascular vasculitis diseases
92
Q

Name 4 multisystem vascultitic inflammatory diseases

A
  1. Systemic lupus erythematosis (SLE)
  2. Systemic sclerosis (sclerodoma)
  3. Sjögren’s syndrome
  4. Undifferentiated connective tissue disease (UCTD)
93
Q

What categorises vasculitic diseases?

A
  • the size of the vessel involved (e.g. large vessel disease, medium vessel disease, small vessel disease)
94
Q

Give an example of a large vessel vasculitic disease

A

Giant cell (temporal) arteritis (arteries at the temples become inflamed)

95
Q

Give two examples of medium vessel vasculitic disease?

A
  • polyarteritis nodosa
  • Kawasaki disease
96
Q

Define, a rare form of vasculitis in which medium and/or smaller sized arteries become inflamed and damaged?

A

Polyarteritis nodosa

97
Q

Name the disease also known as mucocutaneous lymph node syndrome.

A

Kawasaki syndrome

98
Q

Name a small vessel vasculitic disease

A

Wegeners granulomatosis

99
Q

What is the general management of connective tissue disease?

A
  1. Analgesic NSAIDS
  2. Immune modulating treatment
  3. Systemic steroids
100
Q

What 4 antibodies are most commonly found in connective tissue diseases?

A
  1. Anti-nuclear antibody (ANA)
  2. Anti- double- strand DNA (dsDNA)
  3. Anti-Ro antibody (Ro)
  4. Anti- La antibody (La)
101
Q

What are the two antibodies commonly found in sclerodoma?

A
  1. Anti-centromere antibody
  2. Anti-Sclerosis-70 antibody
102
Q

What are the two forms of lupus?

A
  1. Discoid lupus
  2. Systemic lupus erythematosis
103
Q

What are the two forms of lupus?

A
  1. Discoid lupus
  2. Systemic lupus erythematosis
104
Q

What form of lupus mainly affects the skin?

A

Discoid lupus

105
Q

What form of lupus can affect any part of the body?

A

Systemic lupus erythematosis

106
Q

What are the typical external features of systemic lupus erythematosis?

A
  • photosensitivity
  • butterfly zygomatic rash in areas most exposed to sunlight
107
Q

Name dental aspects that can occur as a result of systemic lupus erythematosis?

A
  • oral ulceration and GA risk from chronic anaemia
  • bleeding tendency
  • lichenoid reactions
  • oral pigmentation from drug use
108
Q

What particular group of lupus patients have a marker in their blood termed “lupus anticoagulant”?

A

Antiphospholipid antibody syndrome

109
Q

What syndrome is characterised by recurrent thrombosis, where patients frequently have a tendency to develop DVT and pulmonary emboli?

A

Antiphospholipid antibody syndrome (APS)

110
Q

What inflammatory disease is associated with circulating autoantibodies, ANA, ro, and La?

A

Sjögren’s syndrome

111
Q

What oral manifestations does Sjögren’s syndrome have?

A
  • leads to xerostomia and oral disease
112
Q

What is meant by the sicca syndromes which present in Sjögren’s syndrome?

A

Dry eyes and dry mouth

113
Q

What type of biopsy is the most guaranteed histopathological method to identify Sjögren’s syndrome?

A

Labial gland biopsy

114
Q

What disease is characterised by excessive collagen deposition, connective tissue fibrosis and loss of elastic tissues?

A

Systemic sclerosis

115
Q

What are the 4 physical symptoms of systemic sclerosis?

A
  1. Sclerodactyly
  2. Raynauds
  3. Nailfold capillaroscopy
  4. Telangiectasia
116
Q

What are the dental manifestations of systemic sclerosis?

A
  • involvement of peri-oral tissues with limited mouth opening and tongue movement leading to poor or impossible oral access - swallowing difficulties
  • dental erosion
  • widening of periodontal ligament space
117
Q

What is another name for giant cell arteritis?

A

“Temporal” arteritis

118
Q

What are symptoms of giant cell arteritis?

A

Headache/facial pain

119
Q

What can be the consequence of giant cell arteritis effecting the central artery of the retina?

A

Narrowing of this artery can cause occlusion and ischaemic necrosis of retina which can lead to permanent blindness

120
Q

What disease is characterised in the elderly who experience pain & morning stiffness in muscles (particularly the shoulder and hips)?

A

Polymyalgia rheumatica

121
Q

What medication should be used to treat symptoms of polymyalgia rheumatica?

A

Steroids

122
Q

What is another name for Kawasaki disease?

A

“Mucocutaneous lymph node syndrome”

123
Q

What disease is mainly seen in children presenting with: fever, lymphadenopathy, crusting/cracked tongue, strawberry tongue, erythematous mucosa, peeling on hands and feet?

A

Kawasaki disease

124
Q

What inflammatory condition can lead to destruction of hard and soft tissues of the face and oral cavity, appearing as spongy red tissue?

A

Wegners granulomatosis

125
Q

What bodily systems are most effected by wegners granulomatosis?

A

Renal and respiratory tracts

126
Q

What condition has a non-specific collection of musculoskeletal symptoms such as joint pain & muscle pain?

A

Fibromyalgia

127
Q

What syndrome is characterised by chronic inflammation of tear and saliva glands?

A

Sjögren’s syndrome

128
Q

What four diseases is secondary Sjögren’s syndrome mainly associated with?

A
  1. Rheumatoid arthritis (RA)
  2. Systemic lupus erythematosus
  3. Primary biliary cholangitis (PBC)
  4. Mixed connective tissue disease (MCTD)
129
Q

What effect does Sjögren’s syndrome have on denture wear?

A

Poor retention of dentures

130
Q

What are the two main therapies for Sjögren’s syndrome?

A
  1. Pilocarpine
  2. Acupuncture
131
Q

In Sjögren’s syndrome, what will the lack of saliva predispose the patient to in regards to their oral health?

A
  1. Opportunistic oral infections (candidosis)
  2. Periodontal disease
  3. Caries
132
Q

What considerations should be made during dental treatment for an individual with dry mouth?

A
  • lubrication lips with Vaseline
  • constant lubrication of mucosa using 3 in 1
  • wet mirror or avoid contact with mucosa where possible
  • retract buccal mucosa with dampened swab
  • offer patient water frequently
  • avoid suction where possible
133
Q

What are often two underlying causes of recurrent oral ulceration?

A
  1. Anaemia
  2. Haematinic deficiencies (vitamin B12, folate, iron)
134
Q

What oral manifestation can be an indication of poor diabetic control?

A

Thrush- acute pseudomembranous candidosis

135
Q

What cause of facial pain is sudden, usually unilateral, brief, stabbing, recurrent episodes of pain in the distribution of one or more branches of the trigeminal nerve?

A

Trigeminal neuralgia

136
Q

Define which syndrome is characterised by an idiopathic burning discomfort or pain affecting people with clinically normal oral mucosa in whom a medical or dental cause has been excluded?

A

Burning mouth syndrome

137
Q

What is the treatment for burning mouth syndrome?

A
  • amitripytline
  • gabapentin
  • cognitive behavioural therapy
138
Q

What areas of the body are mainly affected by lichen planus?

A
  • oral mucosa
  • skin
  • scalp
  • nails
  • genitals
139
Q

Why is it important to biopsy anyone who presents with desqaumative gingivitis?

A

It is suggestive of both lichen planus and mucous membrane pemphigoid

140
Q

What are the oral manifestations of HIV/AIDS?

A
  • hairy leukoplakia
  • kaposi’s sarcoma
  • Candidosis
141
Q

What gland is involved in removal of T cells that have receptors with a strong affinity for self-antigens, preventing auto-immunity?

A

Thymus gland

142
Q

Where do T cells mature and differentiate?

A

The thymus gland

143
Q

Define the disease where T cells attack and destroy the beta cells in the pancreas that produce insulin.

A

Type 1 diabetes

144
Q

What is the termed used for antibodies directed against a persons own red blood cells causing them to burst resulting in anaemia?

A

Autoimmune haemolytic anaemia

145
Q

What disorder is characterised by a decrease in number of platelets in the blood?

A

Immune throbocytopenic anaemia

146
Q

Define, multiple sclerosis.

A

Where the activation of immune cells attack the CNS and cause demyelination of nerves

147
Q

What condition affects the mucous membranes where blisters can form within the epithelium and then burst to form erosive ulcers?

A

Pemphigus vulgaris

148
Q

What condition is characterised by blistering that affects mucous membranes in the body and presents beneath the epithelium?

A

Mucous membrane pemphigoid

149
Q

What does DMARDS stand for?

A

Disease modifying anti-rheumatic drugs

150
Q

When prescribing an NSAID, what else could be prescribed to protect against GI side effects? And when would this be particularly important to consider?

A
  1. Proton pump inhibitor
  2. If patient is also taking systemic steroids
151
Q

What is the main action of corticosteroids?

A

To suppress the immune system and reduce inflammation

152
Q

What two ways can corticosteroids be administered?

A
  • orally
  • injection
153
Q

Name the most common corticosteroid injection given to treat autoimmunity?

A

Hydrocortisone/ triamcinolone intra-articular injection

154
Q

What are the consequences of abruptly withdrawing a steroid, such as prednisolone, from treatment?

A

This can lead to acute adrenal insufficiency, leading to severe hypotension which can be fatal.

Dentistry Human Disease (29 decks)

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