MEDICINE RELEVANT TO DENTISTRY Flashcards
Clinical features of anaemia
general fatigue
heart failure
angina
pallor
brittle nails
oral discomfort/ ulceration
glossitis
angular cheillitis
types of anaemia
microcytic
normocytic
macrocytic
drugs for iron deficiency
ferrous sulfate 200mg
pernicious anaemia
deficit in intrinsic factor
macrocytic anaemia causes
low vit B12
low folate
causes of vitb12 deficiency
alcohol abuse
small gut disease
chronic exposure to nitrous oxide
causes of low folate
dietary
coeliac/ skin disease
drugs - phenytoin, methotrexate
normocytic anaemia causes
chronic disease
pregnancy
acute blood loss
microcytic anaemia causes
iron deficiency through chronic blood loss (menstrual or GI), diet.
thalassaemia
a neoplastic proliferation of white blood cells which account for 50% of childhood malignancy
leukaemia
leukaemia oral presentation
gingival hypertrophy
bleeding
solid tumours arising in lymphoid tissue
lymphomas
lymphoma classifications
hodgkins
non hodgkins
what must be avoided, as a dental practitioner, in pts with haematological malignancy, anaemia and bleeding disorders?
aspirin
NSAIDs
IM injections
what local measures would you use for a pt with a bleeding disorder post xLA?
tranexamic acid
platelet transfusion
causes of coagulation disorders
hemophilia’s
anticoagulants
liver disease
von williebrands disease
factor VIII deficiency
haemophillia A - clotting disorder
factor IX deficiency
haemophilia B - clotting disorder
combined platelet and factor VIII disorder
von williebrands disease
common oral symptom of von williebrands disease
mucosal purpuras
warfarin
oral anticoagulant
what is hypertension
a consistently raised BP
hypertensive reading
140/90
what is hypertension a risk factor for?
ischaemic heart disease
cerebrovascular accidents
renal failure
what is the term used to describe hypertension that doesnt have a definable cause?
essential hypertension
what diseases are risk factors for hypertension?
renal dysfunction
endocrine disorders
define ischaemic heart disease
decrease in blood supply to a part of the heart due to the narrowing of coronary arteries, usually by atheroma
what pain presents with IHD
pain of angina pectoris
how does MI progress from ischaemic heart disease
if myocardial cells die as a result of iaschaemia
what is the principal sign of left heart failure
breathlessness
define a collapse of peripheral circulation due to a sudden decrease in circulating volume
hypovolaemic shock
what investigation can differentiate heart murmurs from being functional or significant of structural disorders
echocardiography
why are heart murmurs of great relevance to dentists
their presence warms of the potential colonisation of damaged valves by blood-borne bacteria - bacteraemia can be caused by dental procedures
are patients with PMH of rheumatic fever at risk of cardiovascular disease?
yes - they are likely to have damage to a heart valve, usually mitral
what dental procedures should be avoided for pts with compromised CV systems?
avoid GA, especially within 3 months of an MI
use adequate LA with sedation if necessary
avoid excessive adrenaline loads
pts at risk of bacteraemia?
heart transplant recipients
prosthetic valves
valvular damage
Hx of IE
what is dyspnoea?
breathlessness
what is haemoptysis?
coughing of blood
what respiratory symptom mandates that malignancy be excluded?
haemoptysis
drug of choice for streptococcal sore throat?
penicillin
what antibiotics must be avoided when treating a sore throat?
amoxicillin and ampicillin
what upper respiratory tract infection is an emergency?
epiglottitis
give examples of upper respiratory tract infections?
common cold
sinusitis
pharyngitis/ tonsilitis
laryngotracheitis
acute epiglossitis
the cause of COPD?
a combination of bronchitis and emphysema
what is the prime risk factor of COPD?
smoking
term for reversible bronchocontriction?
asthma
what drug may precipitate asthma?
NSAIDS
allergy to penicillin and aspirin
an inherited disorder in which viscosity of mucus is increased
cystic fibrosis
what do pts with CF experience?
pancreatic exocrine insufficiency
recurrent chest infections
an industrial disease caused by asbestos exposure?
mesothelioma
what dental procedures must be avoided in the presence of respiratory disease?
GA
sedatives and analgesics (opiods) decrease resp drive
NSAIDs exacerbate asthma
how is dysphagia investigated?
CXR
barium swallow
endoscopy
what is a common cause of dyspepsia, sore throat, cough and bad taste?
reflux oesophagitis
what bacteria cause PUD?
helicobacter pylori
other than H.pylori, what are other causes of PUD?
stress ulceration in critically ill or major surgical pts
elderly pts on NSAIDs
what is dyspepsia
indigestion
what drug is used to clear non malignant PUD? and what drug is used to maintain?
1 month of omeprazole 10-20mg (PPI)
ranitidine or cimetidine (H2 antagonist)
name 2 diseases of the small bowel?
coeliac
Crohn’s
what is coeliac disease?
hypersensitivity to gluten
oral symptoms of coeliac disease?
cobblestone mucosa
what area of the GI tract has crohns disease got a preference for?
ileo-caecal area
a chronic granulomatous disease affecting the full thickness of the mucosa?
Crohn’s disease
where does ulcerative colitis affect?
colorectum only
treatment for small bowel disease i.e., Crohn’s
systemic steroids
immunosuppressants
how may colonic cancer present?
rectal bleeding
change in bowel habit
intestinal obstruction
abdominal pain
anaemia
what bacteria is associated with gardener syndrome (large bowel disease)?
familial polyposis coli
cause of antibiotic induced colitis?
overgrowth of toxigenic C.difficile after use of ampicillin and clindamycin
what organ has the worst prognosis when malignant?
pancreas
what is the main cause of acute pancreatitis?
alcohol abuse
main problems presented by liver disease
increase risk of bleeding
inability to metabolise and excrete drugs
Hep B.C.D transmission
the prime symptom of liver disease?
jaundice
jaundice cause?
inability of liver to process bilirubin (the breakdown product of haemoglibin) which occurs by either:
1. haemolytic anaemia
2. cholestatic jaundice
dental implications for pt with liver diease?
do not administer GA
caution with LA and drug prescribing
additional local bleeding precautions
a syndrome of proteinuria, hypoalbuminaemia, and generalised oedema?
nephrotic syndrome
what symptom is prominent in nephrotic syndrome?
facial oedema
what is the major precipitant of nephrotic syndrome?
glomerulonephritis
a medical emergency causing a rapid rise in creatinine, urea, and potassium?
acute renal failure/ kidney injury
marker of acute renal failure?
inability to pass urine
treatment of chronic renal failure?
peritoneal dialysis
haemodialysis
transplants
main problems relevant to dentistry for a pt with renal disease
increase risk of infection
increase bleeding tendancy
decrease ability to excrete drugs
potential carriage of hep B HIV
in a pt with renal disease, what causes bone lesions of the jaws
hyperparathyroidism
addisons disease aetiology
atrophy of adrenal cortices = failure of cortisol and aldosterone secretion
Conn syndrome aetiology
hyperaldosteronism
*causing hypertension
cushings syndrome aetiology
excess cortisol (corticosteroid) production and adrenal hyperplasia due to increase ACTH
classical features of cushings syndrome?
obesity (moon face and buffalo bump)
osteoporosis
skin thinning
hypertension
define diabetes insipidus
production of too much dilute urine due to a decrease in diuretic hormone secretion
define diabetes mellitus
persistent hyperglycaemia due insulin deficiency
acromegaly aetiology
excess production of growth hormone
what is a goitre?
a large thyroid gland
symptoms and signs of hyperthyroidism?
symptoms:
heat intolerance
weight loss
sweating
signs:
tachycardia
lid lag
tremor
commonest cause of hyperthyroidism
graves disease
causes of hypothyroidism?
thyroid disease
hypothalamic/ pituitary dysfunction
signs and symptoms of hypothyroidism?
symptoms:
poor tolerance to cold
hair loss
weight gain
loss of appetite
poor memory
signs:
bradycardia
hoarse voice
a rare tumour of the adrenal medulla, secreting adrenaline and noradrenaline?
phaeochromocytoma
phaeochromocytoma symptoms?
palpitations
headache with sweating
simultaneous hypertension
main symptom of pituitary tumours? and why
blindness as they may erode the pituitary fossa and cause optic chiasma compression
when is it best to treat a pregnant woman?
2nd trimester
what is MEN 2b?
medullary thyroid cancer
phaeochromocytoma
oral mucosal neuromas
what type of disorder is osteogenensis imperfecta?
autosomal dominant type 1 collagen defect
osteogenesis imperfecta symptoms?
blue sclera
deafness
dentinogenesis imperfecta
failure of bone mineralisation?
rickets/ osteomalacia
causes of rickets/ osteomalacia?
vitD deficiency
a lack of bone matrix and mineralisation?
osteoporosis
causes of osteoporosis?
steroid therapy
post-menopausal hormone changes
immobilisation
endocrine abnormalities
treatment to prevent osteoporosis in post menopausal women?
HRT
osteoporosis treatment drugs
bisphosphonates
what is Pagets disease of bone?
common disorder of the elderly, where normal bone is replaced by chaotic structure of new bone, causing enlargement and deformity
Pagets disease treatment?
bisphosphonates
What is polymyalgia rheumatica?
vasculitis affecting proximal axial muscles - shoulders, neck and hips
polymyalgia rheumatica tx
steroids
degeneration of articular cartilage?
osteoarthritis
commonly affected joints with osteoarthritis?
knees, hips and lumbar spine
immunologically mediated disease where joint pain and damage are symptoms?
rheumatoid arthritis
rheumatoid arthritis symptoms
symmetrical morning pain and stiffness in hands and feet
may be systemic upset and anaemia
ulnar deviation of fingers
RA treatment?
NSAIDS
steroids
physiotherapy
DMARDS (at expense of unwanted effects)
what disease is an outcome of RA?
secondary sjogrens syndrome
define gout
urates deposited in joints, causing sudden severe joint pain often in the great toe
what causes gout?
drug abuse
radiotherapy
haematological disease
what joint disease affects the spine and is usually seen in young men?
ankylosing spondylitis
what gene is ank spond associated with?
HLA-B27
What is Reiters syndrome?
seronegative arthritis, urethritis, and conjunctivitis in response to an infection
an indolent skin cancer which very rarely metastasises?
basal cell carcinoma
basal cell carcinoma aetiology? and appearance
sun exposure
ulcerated nodule with raised pearly margins and a telangiectatic surface
most aggressive site for SCC
external ear
SCC of skin presentation
ulcerated lesion with raised edges, keratin horns
may present in areas of previous sun exposure or in gravitational leg ulcers
what is the prognosis of a malignant melanoma dependant of?
thickness of lesion
malignant melanoma aetiology?
sun exposure
what is bowens disease and presentation?
carcinoma in situ which presents as scaly, red plaque
bascially a SCC which hasnt penetrated the basal layer
actinic keratosis
persistently sun damaged areas of skin in which cancer may arise
kaposi sarcoma presentation
purple, vascular, malignant tumour seen in AIDS
a common relapsing proliferative inflammatory skin disease
psoriasis
psoriasis presentation
red plaque with silvery scale, on knees and elbows
psoriasis tx
topical steroids
what is also known as dermatitis
eczema
when does atopic eczema show and what is its presentation?
first year of life
red symmetrical scaly rash
what triggers exogenous eczema? where does it present and what does it look like?
irritants
presents on the hands
blistering, erythema, crackling of skin
what causes allergic contact eczema?
genuine allergic response
what is seborrhoeic eczema?
fungal infection mainly affecting the scalp (‘cradle cap’) in babies
what is erysipelas?
streptococcal cellulitis
list skin infections caused by viruses
herpes zoster
herpes simplex
molluscum contagiosum
warts
what characterises acne vulgaris? and what is it?
blackhead (comedone)
inflammatory condition caused by increased sebum secretion due to hormones
tends to scar
what does dermatitis herpetiformis present as and what is it associated with?
vesicular rash of knees, elbows and scalp
associated with coeliac disease
what is the condition with the highest profile among immunocompromised pts?
AIDS
List drugs that suppress the immune system
corticosteroids
ciclosporin
azathioprine
cytotoxics
common congenital immunodeficiency state
IgA deficiency
what levels control AIDS development?
CD4 levels
AIDS tx
HAART
list oral manifestations of AIDS
candidiasis
hairy leukoplakia
HIV gingivitis
NUG
HIV periodontitis
Kaposi sarcoma
hairy leukoplakia presentation and tx
bilateral, white non removable, corrugated lesions of the tongue
tx - aciclovir or valaciclovir
hairy leukoplakia associations and indications
associated with EBV and HIV
indicated development of lymphoma
what is the name of lesions caused by septic emboli?
janeway lesions
what are septic emboli?
little infective clots from the infected endocardium that work towards periphery and lodge themselves
