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General medicine > Midterm > Flashcards

Midterm Flashcards

0
Q

Imatinib mechanism of action

A

Inhibit BCR-Abl tyrosine kinase in Philadelphia chromosome positive cancer cells

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1
Q

What do cytostatic cancer drugs do?

A

Target mechanisms involved in growth of cancer cells- as opposed to cytotoxic drugs, which randomly kill all cells.

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2
Q

Under what conditions are a hematopoietic cell transplant made?

A
  1. Recovery requires new marrow/ immune cells

2. Chemo/radiation treatment will destroy the marrow

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3
Q

Sources of hematopoietic stem cells for transplantation

A
  1. Self

2. HLA (human leukocyte antigen) matched donor- twin, relative, other

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4
Q

Types of stem cell transplant conditioning therapy

A
  1. Myeloablative- destroys stem cells

2. Nonmyeloablative- doesn’t kill stem cells

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5
Q

Treatment goals before chemotherapy

A
  1. Reduce infection risk- perio
  2. Stabilize dentition, function
  3. Eliminate trauma, irritation
  4. Reduce bleeding risk
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6
Q

Concerns in treating patients who are undergoing chemo

A
  1. Bleeding problems
  2. Infection control
  3. Wound healing
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7
Q

Preventing spread of infection in chemo patients

A
  1. Prophylactic antibiotics
  2. Dental treatment
    - slow speed hand piece
    - rubber dam
    - high power suction
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8
Q

Precaution against bleeding problems in chemo patients

A

Administer platelets, coagulation agents

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9
Q

Sites most susceptible to oral mucositis

A

Non keratinized mucosa:

  • labial
  • buccal
  • lateral, ventral tongue
  • soft palate, oropharynx
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10
Q

Prevention of oral mucositis

A

Cryotherapy
Palifermin
Low energy laser

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11
Q

Basic care of oral mucositis

A

Bland rinses
Oral hygiene
Prophylactic antifungal and antiviral

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12
Q

Symptom management for oral mucositis

A

Topical anesthetics
Coating agents
Systemic analgesics

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13
Q

Causes of salivary gland dysfunction in cancer patients

A

Radiation
Chemo
Anti cholinergic medications

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14
Q

Dental developmental abnormalities associated with cancer

A
  • agenesis of teeth

- microdontia

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15
Q

Most common causes of renal failure

A

Diabetes
Hypertension
Chronic glomuleronephritis

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16
Q

Signs of uremia

A 
Nausea
Vomiting
Headache
Vertigo
Visual changes
Seizures 
Azotemic breath
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17
Q

Electrolyte disturbances in renal failure

A

Metabolic acidosis
Hyperkalemia
PO4+
NA+

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18
Q

Renal failure- cardiovascular disease connection

A

Fluid buildup
Pulmonary edema
Hypertension

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19
Q

Blood disorders and renal failure

A

Anemia- decreased erythropoietin production

Coagulopathy- anticoagulant medication

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20
Q

How does renal failure lead to osteodystrophy?

A

Increased PO4++ retention leads to hyperparathyroidism, causing increased serum ca++, resorted from bone

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21
Q

Three conditions found in osteodystrophy in renal failure patients

A

Osteomalacia
Osteosclerosis
Osteitis fibrosa

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22
Q

Conservative renal failure management

A

Control fluid intake
Remove parathyroid
Medications
Limit protein intake

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23
Q

Two types of dialysis

A

Peritoneal- fluid placed in perotineal cavity to draw toxins, then drained.
Hemodialysis- blood is removed, filtered, and returned

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24
Q

Explain an artervenous fistula for hemodialysis

A

A large vein and artery are joined to make a larger vessel that can withstand the high pressure and repeated punctures required for hemodialysis

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25
Q

Explain a cannula for hemodialysis

A

Like an external shunt placed in a blood vessel. Left closed for blood flow normally, the opened for access during hemodialysis

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26
Q

Symptoms of renal disease patients

A

Osteomalacia
Carotenemia
Uremic frost on oral tissues

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27
Q

Medical concerns for kidney patients

A

Avoid nephrotoxic drugs or drugs metabolized in kidneys
Watch blood pressure
Manage coagulative disorders
Schedule procedures 24 hours after dialysis
Watch out for the shunt
Consider patients Hepatitis +
Dialysis may remove drugs from blood

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28
Q

Pretreatment screening tests for coagulation disorders

A 
Bleeding time
Prothrombin time
Partial thromboplastin time
Hematocrit 
Hemoglobin
29
Q

Shunt precautions

A

No cramped positions
Avoid injections
Avoid long sitting times
Don’t take blood pressure in the shunt arm

30
Q

Surgical management for renal patients

A 
Prophylactic antibiotics?
Bleeding time
Consider extra presurgical dialysis
Local hemostasis- avitene
Platelet transfusion if needed
31
Q

Diabetes secondary problems

A 
MI- most common cause of death 
Retinopathy
Cataracts
Stroke
Amputation
Renal failure
Neuropathy 
Ulcers
Fungal infections
32
Q

Purpose of sulfonylureas

A

Stimulate production of insulin

33
Q

Function of biguanides

A

Inhibit hepatic glucose production

34
Q

Function of gamma-glucosidase drugs

A

Inhibit carbohydrate absorption

35
Q

Function of thiazolidinedione drugs

A

Enhance insulin sensitivity

36
Q

Signs of mild insulin reaction shock

A 
Hunger
Weakness
Tachycardia
Pallor
Sweating 
parasthesia
37
Q

Signs of moderate insulin shock

A 
Incoherence
Uncooperative
Belligerence
Judgement off
Poor orientation
38
Q

Signs of severe insulin shock

A 
Unconscious 
Tonic-clonic movement
Hypotension
Hypothermia
Rapid pulse
39
Q

Treatment for severe insulin shock

A

IV glucose
Glucagon
Epinephrine if unconscious

40
Q

Dental management considerations- patient with insulin controlled diabetes (5items)

A
  • check they’ve had normal eating/injections that day
  • have glucose on hand
  • am appointment better
  • inform staff about signs of shock
  • consider antibiotic prophylactic for surgery
41
Q

Dental treatment for uncontrolled diabetic patients

A

If elevated blood sugar and any other complication, do only emergency treatment and refer

42
Q

Oral problems in diabetes

A 
Caries
Perio
Odontogenic infections
Xerostomia 
Salivary gland problems
Poor healing 
Candida
Lesions
Dysplasia
Mental health problems and not following dr orders
43
Q

Symptoms of leukemia (5items)

A 
Fatigue and malaise
Unintentional weight loss
Infections 
Back and abdominal pain
Bleeding and bruising
44
Q

Oral signs of leukemia (6 items)

A 
Hemorrhage 
Infections 
Ulcerations
Gingival infiltrates and chloromas
Lymphadenopathy 
Neural symptoms
45
Q

Signs of lymphoma

A

Lymphadenopathy- rubbery, firm, not fixed
Malaise, fatigue, low grade fever, night sweats
Weight loss
Pruritis

46
Q

Risk factors for diabetes to watch out for in screening (7 items)

A 
Parent with diabetes
History of still births
Large babies
Obesity 
>40
Hypertension
Lack of regular exercise
47
Q

General medical problems associated with hyperthyroidism (5 items)

A 
Adverse rxn to epinephrine 
Cardiac arrhythmia 
Congestive heart failure 
Other cardiovascular conditions 
thyrotoxic crisis precipitated by infections, surgical procedures
48
Q

Medical problems associated with hypothyroidism (2 items)

A

Exaggerated response to CNS depressants, narcotic analgesics, sedatives
Myxedemetous coma precip. by CNS depressants, surgery, infection

49
Q

Causes of hyperthyroidism (10 items)

A 
Graves' disease 
Toxic multinodular goiter
Toxic adenoma
Pituitary disorder 
Pituitary tumor 
Subacute thyroiditis- leaks hormone
Thyroid hormone use
Ectopic thyroid
Metastatic thyroid cancer 
Iatrogenic overdose
50
Q

Skin symptoms of hyperthyroidism

A 
Warm moist skin
Easy blushing
Palmar erythema and sweating
Pigmentation 
Fine thin hair
Soft nails
51
Q

Eyes symptoms of hyperthyroidism

A 
Retracted lids, stare
Lid lag
Jerky eye movement 
Exophthalmos 
Ocular neuritis 
Ocular muscle weakness
52
Q

Skeletal, gastrointestinal symptoms of hyperthyroidism

A

Osteoporosis
Weight loss
Increased appetite
Pernicious anemia

53
Q

Cardiovascular symptoms of hyperthyroidism

A 
Palpitations
Increased heart rate
Arrhythmias 
Cardiomegaly 
Congestive heart failure 
Angina 
Myocardial infarction
54
Q

CNS a symptoms of hyperthyroidism

A 
Anxiety restlessness 
Sleep problems 
Impaired concentration 
Tremor 
Weakness
55
Q

Symptoms of hyperthyroid crisis

A 
Restlessness 
Nausea
Vomiting 
Stomach pain
Fever 
Sweating 
Tachycardia 
CHF
Stupor
Coma
Hypotension
56
Q

Treatment for hypothyroid crisis

A 
Propythiouracil
KI
Steroids 
Hydrocortisone
Glucose
CPR
57
Q

What to avoid with untreated hyperthyroidism

A

Surgery
Epinephrine
Amine pressors
Treat acute infections

58
Q

Adult hypothyroidism

Child hypothyroidism

A

Adults- myxedema

Children- cretinism

59
Q

Some symptoms of hypothyroidism

A 
Pale
Reduced intelligence 
Goiter 
Dry skin
Large tongue
Coarse brittle hair
60
Q

Untreated hypothyroidism patients are sensitive to

A 
Narcotics 
Tranquilizers
Cold
Stress
Surgery
Infections
61
Q

How to deal with a myxedematous coma

A

Get medical help
Hydrocortisone
CPR
IV glucose and saline

62
Q

Symptoms of multiple myeloma

A 
Bence jones proteins in urine
Lambda and kappa light chains
Skeletal related events- bones are damaged
Fever, fatigue, malaise, weight loss
Renal dysfunction
Peripheral neuropathy 
Hypercoagulability
63
Q

B- cell malignancy is called

A

Plasmacytoma if one location

Multiple myeloma if several

64
Q

Leukemia that affects children and older adults

A

Acute lymphoblastic

65
Q

Leukemia that affects mostly older adults

A

Acute myelogenous

Chronic myelogenous

66
Q

Treatment for chronic myelogenous leukemia

A

Hematopoietic cell transplant

67
Q

Three phases of chronic myelogenous leukemia

A

Chronic
Accelerated
Blast crisis

68
Q

Leukemia that rarely progresses to acute form

A

Chronic lymphocytic leukemia

69
Q

Which populations are most affected by Hodgkin’s lymphoma?

A

Young adults

Older adults over 55

70
Q

Signs of graft vs host disease

A

Itching, redness, rash
Jaundice/ other liver problems
Nausea and vomiting
Dry itchy eyes

General medicine (1 decks)

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