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3rd Year BDS > More Human Diseases > Flashcards

More Human Diseases Flashcards

1
Q

Name 6 pathophysiologies for upper GI disease?

A 
Peptic
Malignancy
Autoimmunity
Funcional
Infective
Genetic
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2
Q

What is the definition of helicobacter pylori and how is it transmitted?

A

Flagellate bacteria from spirochete

Transmitted human to human

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3
Q

How is helicobacter pylori adapted to survive in the stomach?

A

Adapted to stomach

Converts urea to ammonia to neutralise periplasm

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4
Q

What disease does helicobacter pylori cause?

A 
Chronic gastritis
Atrophic gastritis (impaired acid prod)
Antral gastritis (increased acid production)
Pan gastritis (increased prolif of gastric cells)
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5
Q

Which precancerous conditions can helicobacter pylori cause?

A

Gastric carcinoma

MALToma

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6
Q

How to diagnose for helicobacter pylori infection?

A

Serum
Faecal antigen
Urease breath test
CLO test

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7
Q

What is the definition of gastro-oesophageal reflux disease?

A

Reflux acid content into the oesophagus

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8
Q

What are the symptoms for Gastro-oesophageal reflux disease?

A

Chronic cough

Hoarse voice

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9
Q

What are the predisposing factors for Gastro-oesophageal reflux disease?

A 
Lifestyle 
Obesity
Increased Intra-abdominal pressure
Smoking
Alcohol
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10
Q

What causes GORD?

A

Lower oesophageal sphincter relaxation

increased or higher frequency

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11
Q

What treatment can be prescribed for GORD?

A

Proton pump inhibitor
Change lying position
Diet

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12
Q

Name the 4 grades for oesophagitis?

A

A
B
C
D

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13
Q

What is the definition of metaplasia?

A

Where one organ’s lining mutates and becomes the lining of a different organ

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14
Q

What is the definition of Barrett’s oesophagus?

A

Metaplasia of the oesophagus from acid exposure

Can be precancerous

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15
Q

What is the aetiology for peptic disease for upper GI disease?

A

Helicobacter pylori
NSAIDs
Zollinger-Ellison disease

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16
Q

Name the 2 types of oesophageal cancer?

A

Squamous cell carcinoma

Adenocarcinoma

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17
Q

Prognosis of squamous cell carcinoma?

A

1 yr 36%

5 yrs 12%

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18
Q

Prognosis of adenocarcinoma?

A

5 yrs:

  • localised 45%
  • nodes 24%
  • meta 4%
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19
Q

What are the risk factors squamous cell carcinoma?

A

Smoking

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20
Q

How to diagnose and stage oesophageal squamous cell carcinoma?

A 
Endoscopy
Biopsy
CT
Ultrasound
PET
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21
Q

What is the treatment for oesophageal squamous cell carcinoma?

A

Radiotherapy

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22
Q

What are the risk factors adenocarcinoma?

A

Smoking
Alcohol
HP

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23
Q

What are the signs and symptoms for adenocarcinoma?

A

Dysphagia

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24
Q

How to diagnose and stage oesophageal adenocarcinoma?

A 
Endoscopy
Biopsy
CT
Ultrasound
PET
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25
Q

How to treat oesophageal adenocarcinoma?

A

Radiotherapy
Oesophagectomy
Chemotherapy

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26
Q

What are the risk factors for gastric adenocarcinoma?

A

HP
Smoking
Obesity

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27
Q

How do patient present when they have a gastric adenocarcinoma?

A

Late stage:
- significant invasion of wall
- metastasis to nodes
Little symptoms till disease advanced

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28
Q

What is a diagnostic aid for a patient with gastric adenocarcinoma

A

Iron-deficiency anaemia

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29
Q

How to diagnose and stage gastric adenocarcinoma?

A 
Endoscopy
Biopsy
CT
Ultrasound
PET
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30
Q

What is the prognosis of gastric adenocarcinoma?

A

Less than 20% after 2 years

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31
Q

What is the definition of a MALToma?

A

HP related

Indolent marginal zone b cell lymphoma of the mucosa-associated lymphoid tissue or aggressive large b-cell lymphoma

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32
Q

What is the treatment for MALToma?

A

Resolution of HP infection for MALToma
DLBCL more problematic
Radiotherapy
Surgery (bypass)

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33
Q

What is the prognosis for MALToma?

A

90% survival at 5 years

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34
Q

What is the definition of a neuroendocrine tumour and treatment?

A

Enterochromaffin-like cells of the gastric mucosa
Incidental finding
Treatment:
- treat symptoms

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35
Q

What is the definition of a GIST and treatment?

A 
Gastrointestinal stromal tumour:
- SM cells
- cajal cells tumour
- low malignancy rate
Treatment:
- surgery
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36
Q

What is the definition of Crohn’s disease?

A

Full GI tract
Genetic
Environment related to vit D

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37
Q

What are the symptoms for Crohn’s disease?

A

Mouth ulcers
Abdominal pain
Diarrhoea
Obstruction

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38
Q

What are the treatments for prognosis? *****

A

Surgery
Medical management
Immunosuppression

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39
Q

What is the definition of coeliac disease?

A

Allergy to gluten
Malabsorption of nutrients
Abs made against gluten
Inflammation of SI

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40
Q

What are the symptoms for coeliac disease?

A

Dyspepsia
Diarrhoea
Abdominal bloating
Weight loss

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41
Q

What is the treatment for Coeliac disease?

A

Diet modification

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42
Q

What are the complications for coeliac disease?

A

Refractory

Lymphoma

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43
Q

What is the treatment for oesophageal dysmotility?

A

Botox injection
Rat tail oesophagus
Surgery

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44
Q

Name 2 types of infection the upper GI tract can get?

A

Candida

Tropical sprue

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45
Q

What are the risk factors for candida infection?

A

Immunocompromised

Steroid inhalers

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46
Q

What is the treatment for candida?

A

Fluconazole

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47
Q

What are the signs and symptoms for candida?

A

Dysphagia

Odynophagia

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48
Q

What causes tropical sprue?

A

Bacteria
Parasites
Viruses

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49
Q

How does tropical sprue cause har,?

A

Flattens villi causing malabsorption

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50
Q

What are the symptoms for tropical sprue?

A

Nutrient deficiency
Diarrhoea
Fatigue

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51
Q

What is a form of tropical sprue?

A

Giardiasis

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52
Q

What is the definition of small bowel bacterial overgrowth?

A

Bacterial overgrowth in the small bowel?

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53
Q

What are the predisposing factors for small bowel bacterial overgrowth?

A

Absence of ileocecal valve
Bypass surgery
Diabetes
Developmental

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54
Q

What is the treatment for small bowel bacterial overgrowth?

A

Antibiotics

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55
Q

What are the symptoms for small bowel bacterial overgrowth?

A

Malabsorption

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56
Q

Name 5 other things that can cause harm to the oesophagus?

A 
Caustic injury
Foreign body
Food bolus
Strictures
EoE
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57
Q

Name 8 rare oesophageal disorders?

A 
Vasculitis
Behcet (ulcer)
Churg-strauss (ulcer)
Dermatomyositis (ulcer)
CT disease
Scleroderma (dysmobility)
Mix CT disease (dysmobility)
Crest syndrome (dysmobility)
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58
Q

NAme 4 rare gastric diseases?

A

Genetic:

  • menetrier disease (overgrowth of mucous cells)
  • HHT
  • FAP
  • Peutz-Jegher
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59
Q

What are the oral manifestations for Crohn’s?

A

Oral mucosal ulceration
Mucogingivitis
Cobblestoning

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60
Q

What are the oral manifestations for Coeliac disease?

A

Enamel hypoplasia
Delayed tooth eruption
Glossitis
IDA

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61
Q

What are the oral manifestations Pernicious anaemia?

A

Atrophic glossitis

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62
Q

What are the oral manifestations Peutz Jegher syndrome?

A

Melanotic macules

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63
Q

What are the oral manifestations Plummer vision?

A

Stomatitis

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64
Q

What are the oral manifestations HP and PUD?

A

Dental erosion
Bad taste in mouth
Halitosis
Mucositis

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65
Q

What are the oral manifestations Gardner’s syndrome?

A

Osteomas

Supernumerary teeth

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66
Q

What are the functions of the liver?

A

Synthesis
Excretory
Metabolic
Storage

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67
Q

Name 2 types of liver disease?

A

Acute

Chronic (inflammation, fibrosis and cirrhosis)

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68
Q

Name 5 features of liver disease?

A 
None
Jaundice
Synthetic dysfunction
Metabolic dysfunction
Features of portal hypertension
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69
Q

Name 2 types of jaundice for the liver?

A

Hepatic

Cholestatic

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70
Q

Name 2 types of synthetic dysfunction for the liver?

A

Oedema

Coagulopathy

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71
Q

Name 2 types of metabolic dysfunction for the liver?

A

Hypoglycaemia

Encephalopathy

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72
Q

Name 2 features of portal hypertension for the liver?

A

GI bleeding
Ascites
Hernia

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73
Q

What are the risk factors for liver disease?

A 
Alcohol*
Blood-borne viruses
Obesity
Diabetes
Hyperlipidemia
Autommunity
Medication
Family history
UC
Chronic biliary tract disease/hepatobiliary surgery
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74
Q

What is the mechanism for alcoholic liver disease?

A 
Liver excretes the alcohol
Alcohol causes fat accumulation in liver
Alcohol is a toxin to the liver
Steatosis
Continued for a while causes fibrosis and cirrhosis
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75
Q

What is the treatment for alcoholic liver disease?

A

Stop drinking

Possible liver transplant

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76
Q

What is the definition of hepatitis A?

A 
Acute
RNA
Oro-faecal transmission
Long life disease
Vaccination and avoid contaminated food and water
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77
Q

What is the definition of hepatitis B?

A

DNA
Vertical/parenteral/sexual transmission
Chronic
Co-infection with hepatitis D

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78
Q

What is the definition of hepatitis C and its treatment?

A 
ssRNA
Parenteral
Vertical
Sexual
Combination therapy
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79
Q

What is the definition of hepatitis E?

A

Via contaminated food and water
Hepatic failure in pregnancy
No chronic
No treatment

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80
Q

What is the definition of non-alcoholic fatty liver disease?

A

Fatty liver
Leads to steatohepatitis
Further to fibrosis and cirrhosis

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81
Q

What are the risk factors for non-alcoholic fatty liver disease?

A 
Obesity
Diabetes
Hyperlipidemia
Malnutrition
TPN
Alcohol/Drugs
Genetical
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82
Q

How to diagnose for non-alcoholic liver disease and treatment?

A

Blood testing

No specific treatment

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83
Q

What is the definition of autoimmune liver diseases?

A

Inflammatory

Autoantibodies against nuclear and cytosolic microsomal

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84
Q

Name 3 types of autoimmune liver disease?

A

AIH
PBC
PSC

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85
Q

How to diagnose autoimmune liver disease?

A

Abs test

Histology

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86
Q

What is the definition of drug and toxin-related liver disease?

A

Zonal necrosis leads to hepatitis leads to cholestasis leads to steatosis leads to fibrosis leads to cirrhosis

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87
Q

Name 4 heritable liver diseases?

A

Hereditary haemochromatosis (Fe overload)
Wilson’s disease (Cu overlaod)
Alpha-1 antitrypsin deficiency
Gilbert’s disease (more unconjugated bilirubin)

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88
Q

Name the most common liver cancer?

A

Hepatocellular carcinoma:

  • cirrhosis, hep B and C
  • scans and detect alpha-fetoprotein
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89
Q

Name 4 rare causes of liver disease?

A

Cryptogenic
Infections (bac or parasite)
Vascular insults
Systemic diseases

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90
Q

Name 3 biliary diseases?

A

Gallstones
Autoimmune disease
Cancer:

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91
Q

How to monitor liver function test?

A 
Bilirubin
Albumin 
Enzymes
Clotting profile
FBV
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92
Q

What are 2 types of autoimmune disease of the biliary tract?

A
  • primary biliary cirrhosis

- primary sclerosing cholangitis

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93
Q

What are the 2 types of cancer of the biliary tract?

A

Cholangiocarcinoma

Cancer of the gallbladder

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94
Q

Name the 2 most common child cancers?

A

Leukaemia (80 % ALL)

Lymphoma

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95
Q

Name the 5 most common adult cancers?

A 
Breast
Prostate
Lung
Colorectal
Bladder
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96
Q

Name the 4 risk factors for breast cancer?

A

Reproductive history
Hormone therapy
Breast density
BRAC1/2

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97
Q

Name the 6 types of breast cancer?

A 
Ductal carcinoma in situ
Lobular carcinoma in situ
Invasive ductal breast cancer
Invasive lobular breast cancer
Inflammatory breast cancer
Paget disease
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98
Q

Name the 3 types of treatment for breast cancer?

A

Surgery
Radio
Chemo
Combo of all

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99
Q

Name the 4 types of leukemia?

A

Acute myeloid
Acute lymphoblastic
Chronic myeloid
Chronic lymphocytic

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100
Q

What is the definition of a leukaemia?

A

The malignant cell is a bone marrow derived haemopoietic stem cell which grows uncontrollably and invades and takes over the bone marrow.
Invade blood cells and enlarge all organs

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101
Q

Name the 3 environmental associations for leukemias?

A

Benzene
Chlorambucil
Radiation treatment

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102
Q

Name the 3 clear genetic events that link to leukaemia progression?

A

Down’s syndrome patients
CML and ALL:
- philadelphia chromosome
- long arm of Ch22 translocated to long arm of chromosome 9
- forms bcr-abl
AML:
- associated with t15:17 preventing the natural maturation of the myeloid cell line

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103
Q

What is the definition of acute leukaemia?

A

Acute leukaemia is when the bone marrow is overrun with immature myeloid and lymphoid precursors are unable to mature further.

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104
Q

What are the signs for acute leukaemia?

A

Anemia
Bleeding
Infection
Organ enlargement

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105
Q

What are the treatment options for acute leukaemias?

A

Correction of RBC and platelet problem
Treat infection
Keep hydrated
Guard against acute tumour lysis syndrome

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106
Q

What is the specific treatment for AML?

A

Cytosine arabinoside

Daunorubicin

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107
Q

What is the specific treatment for ALL?

A

Vincristine
Prednisone
Daunorubicin
If involves brain needs methotrexate or radiation therapy

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108
Q

What are the signs and symptoms for CML?

A 
Weight loss Sweating
Anaemia
Bleeding
Infections
Enlarged spleen.
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109
Q

What is the treatment for CML?

A

Alpha interferon

Hydroxyurea

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110
Q

What can CML progress to?

A

Acute leukemia (blast transformation) can cause rapid death

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111
Q

What is the definition of chronic lymphocytic leukaemia?

A

Incurable malignant proliferation of predominantly mature B cells

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112
Q

What ae the signs and symptoms for CLL?

A

Anaemia
Bleeding
Infection
Enlarged lymph nodes and spleen

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113
Q

How can a blood test confirm a diagnosis of CLL?

A

Increase in WBC and predominantly lymphocytes, anaemia and thrombocytopenia on blood testing
Lymphocytes on blood film (smear cells as they rupture)
Bone marrow biopsy

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114
Q

What is the treatment for CLL?

A

Oral chlorambucil

+/- prednisolone

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115
Q

Name the 9 most common side effects of chemotherapy?

A

Anaemia (reduced bone marrow)
Thrombocytosis (thrombocytopenia)
Mandibular tori
Mucositis (and ulceration)
Dysphagia
Hair loss (hair follicle turnover - reversible)
Sterility (affects high turnover sperm cell. Pre-treatment samples can be saved)
Cataracts
Vomiting (there is a direct stimulation of the vomiting centre in brain stem)

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116
Q

Name the 2 types of lymphoma?

A

Hodgkin’s

Non-Hodgkin’s

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117
Q

What are the signs and symptoms for Hodgkin’s lymphoma?

A 
Sweating (especially at night)
Fever
Weight loss
Pruritus
Fatigue
Anorexia
Pain in the lymph nodes on drinking alcohol
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118
Q

How is Hodgkin’s lymphoma diagnosed and staged?

A

Lymph node biopsy
Chest x-ray
CT
BM scan

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119
Q

What is the definition of Non-Hodgkin’s lymphoma?

A

highly heterogenous disease of malignant lymphatic cells which can infiltrate a variety of structures.

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120
Q

What are the 2 types of Non-Hodgkin’s lymphoma?

A

High grade

Low grade

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121
Q

What is the treatment regime for High grade NHL?

A

CHOP:

  • cyclophosphamide
  • hydroxyaunrubicin
  • oncovin
  • prednisolone.
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122
Q

What does CHOP stand for?

A
  • cyclophosphamide
  • hydroxyaunrubicin
  • oncovin
  • prednisolone.
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123
Q

What is the treatment for low grade NHL?

A

Not curable and rumbles on for years with symptomatic treatment with chlorambucil or radiotherapy for masses as they arise.

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124
Q

What are the signs and symptoms for NHL?

A

Bruising

Anaemia and Infections

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125
Q

What tests ca be conducted to confirm a diagnosis of NHL?

A

Reduced RBC and platelet numbers, with raised white cell count on blood tests
Abnormal liver function tests if liver involved
A chest x-ray and CT scan will show masses which will require a biopsy to provide sub-type diagnosis.
Bone marrow aspirate is needed to determine spread

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126
Q

What are the risk factors for lung cancer?

A 
Smoking
Urban living
Asbestos exposure
Coal burning
Passive smoking
Arsenic
Fe oxide
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127
Q

What are the clinical features of lung cancer?

A 
Cough
Haemoptysis
Chest pain
Bone spread leading to fractures
Metastases to bone and the brain
Finger clubbing
Weight loss
Lymphadenopathy
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128
Q

What is the definition of Pancoast’s tumour in relation to lung cancer?

A

Invasion of the brachial plexus causing pain (Pancoast’s tumour)

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129
Q

What is the definition of Horner’s syndrome in relation to lung cancer?

A

Invasion of the sympathetic ganglions (Horner’s syndrome); involves recurrent laryngeal nerves leading to hoarseness and invasion of the oesophagus, heart and veins

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130
Q

What investigations can be conducted to diagnose lung cancer?

A

Chest x-ray for masses
Sputum cytology for malignant cells
Bronchoscopy for biopsy
CT scan for peripheral lesions.

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131
Q

What investigation to use to stage a lung cancer tumour?

A

MRI

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132
Q

Name the 2 types of lung cancers?

A

Non-small cell

Small cell

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133
Q

Name 4 types of non-small cell lung cancers?

A

Squamous cell carcinoma
Large cell
Adenocarcinoma
ALveolar

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134
Q

Name a type of small cell lung cancer?

A

Endocrine cell

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135
Q

How can skin change with lung cancer?

A

Pigmented skin in axillae (acanthosis nigricans)

Herpes zoster Dermatomyositis

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136
Q

What are the treatment options for lung cancer?

A 
Surgery
Radiotherapy
Chemo for small cell cases
Haemodialysis
Haemofiltration
Peritoneal dialysis
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137
Q

What are the risk factors for colorectal cancer?

A

High meat/low fibre diet
Family history
Hereditary non-polyposis carcinoma Familial adenomatous polyposis

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138
Q

What genetic mutations contribute to colorectal cancer?

A

K-ras

c-myc

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139
Q

Dukes stage A?

A

Bowel only

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140
Q

Dukes stage B?

A

Through bowel wall

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141
Q

Dukes stage C?

A

Spread to regional lymph nodes

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142
Q

Dukes stage D?

A

Distant metastases

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143
Q

What are the signs and symptoms for lower colorectal cancer

A

descending colon with bleeding, narrowing and obstruction, leading to alternating diarrhoea and constipation, which may be accompanied by bleeding per rectum

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144
Q

What are the signs and symptoms for upper colorectal cancer

A

mass on examination or blood loss related anaemia

Liver involvement will present with jaundice

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145
Q

What investaigantions can be done to aid diagnosis?

A

Barium enema
Endoscopy
USS of Liver
Bloods

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146
Q

What is the treatment for colorectal cancer?

A

Surgery
Chemotherapy for B/C (5-Fluorouracil and levamisole)
Radio

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147
Q

How to diagnose prostate cancer?

A

Palpation of hard prostate
Elevated PSA
Biopsy
Transrectal USS

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148
Q

What are the signs and symptoms for prostate cancer?

A

Presence of prostatic specific antigen

Obstructive urinary flow

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149
Q

What is the treatment for prostate cancer?

A

Surgery
Radiotherapy
Metastasis:
- androgen ablation therapy

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150
Q

Name the 4 risk factors for bladder cancer?

A

Smoking
Benzidine
Cyclophosphamide
Chronic infection like schistosomiasis

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151
Q

What are the signs and symptoms of bladder cancer?

A

Haematuria

Painless

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152
Q

What investigations aid diagnosis of bladder cancer?

A

Cytological exam of urine
Urography
Cystoscopy

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153
Q

What is the treatment for bladder cancer?

A

Surgery
Radio
Chemo

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154
Q

What is an oral side effect for radiotherapy?

A

Osteoradionecrosis

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155
Q

What is an oral side effect for chemotherapy?

A

Candidiasis

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156
Q

What is the 5 Yr survival rate for NSCLC?

A

25%

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157
Q

Name the 4 stages of Hodgkin’s disease?

A

I
II
III
IV

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158
Q

Describe stage I of Hodgkin’s Lymphoma?

A

Single site with radio

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159
Q

Describe stage I of Hodgkin’s Lymphoma?

A

2 or more sites on same side of diaphragm
Radio
+/- chemo if symptomatic

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160
Q

Describe stage III of Hodgkin’s Lymphoma?

A

SItes on both sides of diaphragm

Chemo

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161
Q

Describe stage IV of Hodgkin’s Lymphoma?

A

Widespread involvement of non-lymphatic tissue

Chemo

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162
Q

What is SI 5 Yr survival rate for Hodgkin’s lymphoma?

A

90%

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163
Q

What is the 5 yr survival for colorectal cancer?

A

45%

Dukes A 95%

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164
Q

What is the 5 yr survival for prostate cancer after surgery?

A

80-90%

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165
Q

Which gender is more at risk of haem cancers?

A

Men

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166
Q

What % of all cancers are haem cancers?

A

10%

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167
Q

What is the most common child cancer?

A

Leukemia

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168
Q

What % of all cancers does leukemia comprise of for childhood cancer?

A

30%

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169
Q

Explain the normal hematopoiesis process for the common myeloid progenitor cell?

A

Differentiate to erythromegakaryotic progenitor cells formins erythrocytes and platelets
Common myeloid progenitor cells differentiation to monocytes that become macrophages
Myeloid progenitor cells can also differentiate into neutro, eosino and basophils

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170
Q

What cells does acute lymphocytic leukemia affect?

A

Lymphoid progenitor

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171
Q

What cells do Acute myeloid leukaemia affect?

A

Myeloid progenitor

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172
Q

What cells fo chronic lymphoid leukemia?

A

B cells/T cells

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173
Q

What cells do multiple myeloma?

A

Plasma cells

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174
Q

What cells do myeloproliferative disorders affect?

A 
Neutro
Eosino
Baso
Mono
Platelets
Red cells
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175
Q

Name 2 types of acute leukemias?

A

Acute lymphoblastic leukemia

Acute myeloid leukemia

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176
Q

Name 2 types of chronic leukaemias?

A

Chronic myeloid leukaemia

Chronic lymphocytic leukaemia

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177
Q

Name 2 types of malignant lymphomas?

A

NHL

HL

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178
Q

Name 3 other categories of haem cancers?

A

Multiple myeloma
Myelodysplastic syndrome
Chronic myeloproliferative disease

179
Q

When does NHL peak epidemiologically?

A

18-35

75+

180
Q

Describe the difference between acute and chronic leukemias?

A 
Acute:
- leukaemic cells do not differentiate
- BM failure
- rapidly fatal if untreated
- curable
Chronic:
- leukaemic cells can differentiate
- prolif without BM failure
- survival for a few years
- No cure with BM transplant
181
Q

What diseases has been related for NHL?

A

Glandular fever

Also has peak at 18-35

182
Q

Describe the difference between leukaemia vs lymphoma?

A 
Leukemia - BM:
- stem cell
- lymphoid progenitor
- b progenitor
- pre B
- immature B
Lymphoma - lymphoid tissue:
- Germinal centre B cell
- Plasma cell
- mature naive b cell
- memory b cell
183
Q

What are the clinical features for acute leukaemia?

A

BM failure:

  • anaemia
  • thrombocytopenic bleeding
  • infection because of neutropenia
184
Q

What are the key properties for multipotential hematopoietic stem cells?

A

Self-renewing population

Multi-potent

185
Q

Name 4 myeloid malignancies?

A

Red
Plat
Gran
Mono

186
Q

Name 2 Lymphoid malignancies?

A

B and T

187
Q

What are the systemic symptoms for a patient with lymphoma?

A 
Fever
Drenching sweat
Weight loss
Pruritus
Fatigue
188
Q

What are the nodal diseases found with lymphoma presentation?

A

Lymphadenopathy:

  • > 90% HL with nodal disease
  • 60% NHL present with nodal disease
189
Q

What was the most common localisation of cancer for head and neck lymphomas?

A

Waldeyer’s ring 149 hits

Parotid and salivary glands 41

190
Q

What are the different presenastions of lymphadenopathy?

A

Localised and painful
Localised and painless
Generalised and painful
Generalised and painless

191
Q

Give 1 example of a disease present for localised and painful type of lymphadenopathy?

A

Bacterial infection in draining site

192
Q

Name 5 diseases present for localised and painless type of lymphadenopathy?

A 
Rae infections
Catch scratch fever
TB
Metastatic carcinoma from draining site (hard)
Lymphoma (rubbery)
193
Q

Name 5 disease for generalised and painful type of lymphadenopathy?

A 
Viral infections
EBV
CMV
Hepatitis
HIV
194
Q

Why is ALL/Lymphoblastic lymphoma related?

A

Same disease

Different area

195
Q

Why is CLL/SCLL related?

A

Same disease with different presentation

196
Q

Why is Burkitt’s lymphoma/leukaemia related?

A

Same disease with different presentations

197
Q

Why is HL/DLBLFL related?

A

Same disease with different presentations

198
Q

Name 5 diseases for generalised and painless type of lymphadenopathy?

A 
Lymphoma
Leukaemia
CT diseases
Sarcoidosis
Drugs
199
Q

Name the 7 clinical features for multiple myeloma?

A 
Bone pain and lytic lesions
Anaemia
Recurrent infections
Renal failure
Amyloidosis
Bleeding tendency
Hyperviscosity syndrome
200
Q

Name 5 risk factors for oestonecrosis of the jaw?

A 
Dental disease or surgery
oral trauma
Periodontitis
Chemotherapy or steroids
Nitrogen-containing bisphosphonates
201
Q

Describe the structure of the lymph node?

A

Cortex
Paracortex
Medulla

Germinal centre
Mantle zone
Marginal zone
Forms the B cell follicle

202
Q

Where does osteonecrosis of the jaw normally affect?

A

Mandible 2/3 cases

203
Q

Explain the B cell maturation pathway?

A 
Progenitor  cell
Pre B cell
Immature B cell
Naive B cell
Enter GC
Interacts with antigen
Somatic hypermutation
Forms centrocyte
Differentiates to Memory B cell or plasma cell
204
Q

What is the definition of lymphadenopathy?

A

Swollen lymph nodes

205
Q

What are the extranodal diseases presentation for lymphoma?

A

40% of NHL present with extranodal component

206
Q

How much fluid does a kidney process?

A

180L

207
Q

Name the 6 functions of the kidney?

A 
Maintain homeostasis
Regulate body water
Eliminate waste products of metabolism
Regulate blood pressure
Ca and bone meta
Erythropoiesis
208
Q

Name the 6 ways to assess kidney function?

A 
Serum urea
Serum creatinine
Endogenous creatinine clearance
GFR
Isotope GFR (GS) - 55 chromium EDTA
Derived formulae for GFR
209
Q

What is the average GFR?

A

120mL/min

210
Q

When can the kidneys be considered compromised when judging GFR?

A

Less than 60mL/min

211
Q

What is creatinine and its levels in M/F?

A 
Breakdown of creatine in muscles
Mr 113
Can give info on renal function
60-90 F
70-116 M
212
Q

What are the 2 formulas to estimate GFR?

A

MDRD

Cockroft-Gault

213
Q

How does estimated GFR equation change for an African patient?

A

Usually have higher muscle mass compared to other ethnicity (less fat)
Raised to 1.210

214
Q

How to measure the degree of renal insufficiency?

A 
eGFR = % kidney function
Only an estimate
Wide CI
Usually underestimates
Remember ethnicity
215
Q

What is a healthy GFR value?

A

> 60 mL/min

216
Q

What is the creatinine difference between blood and urine?

A

Higher in urine, as it is being excreted

Excretion test may give false results

217
Q

Stage 1 kidney disfunction GFR?

A

Kidney damage

>90 GFR

218
Q

Stage 2 kidney disfunction?

A

Mild

60-89 GFR

219
Q

Stage 3 kidney dysfunction GFR?

A

Moderate

30-59 GFR

220
Q

Stage 4 kidney disfunction?

A

Severe

15-29 GFR

221
Q

Stage 5 kidney disfunction GFR?

A

Kidney failure

<15 or RRT GFR

222
Q

What are the levels of kidney disease and their prevalence per 10,000 patients?

A 
At risk 460
Initiation 380
Progression 60
End stage 6
per 10,000 at GP practice
223
Q

What are the clinical problems of CKD?

A

Underecognition at earlier stages of kidney dysfunction

Growth of 6-8% per annum of dialysis patients

224
Q

Name the 7 causes of kidney disease?

A 
Diabetes TI/II
High BP
Glomerular disease
Congenital disease
Inherited diseases (polycystic)
Obstruction to flow of urine
Unknown
225
Q

What is the size of a kidney?

A

11cm

226
Q

What type of genetic is polycystic kidney disease?

A

Autosomal dominant disease

227
Q

What to implement to delay progression and reduce CVS risk for CKD?

A

ACEI
BP control
Glucose control
SMoking cessation

228
Q

What to implement to prevent uraemic complications for CKD?

A

Malnutrition
Anaemia
CaPO4 PTH
Acidosis

229
Q

What are the comorbidities of CKD?

A

Cardiac diseases
Vascular diseases
Drug inters
Neuropathy/Retinopathy

230
Q

How to prepare for RRT?

A

Education
Informed choice
Timely access placement/transplant listing
Timely initiation of RRT

231
Q

What are the contraindications for dialysis?

A

Blindness
IHD
Dementia
Non-english speaker

232
Q

What ae the causes of hypertension in chronic renal failure?

A

Volume/total body Na excess
Stimulation of renin-angiotensin system
Augmented sympathetic tone

233
Q

What is the rationale for ACE/All inhibition in chronic renal failure?

A

Reduction of proteinuria and BP
Reduced hyperfiltration and reduced loss of albumin and proteins
Less renal cell growth and fibrosis

234
Q

What drug is best for TI diabetes for HBP?

A

ACE-I

235
Q

What drug is best for TII diabetes for HBP?

A

ARBs

236
Q

What are the results of taking ACE/ARBs?

A

Prevent progression of neuropathy and promote regression to normoalbuminuria

237
Q

What type of care does a SI/II CKD patient need?

A

Assessment and shared care

238
Q

What type of care does a SIII CKD patient need?

A

Renal clinic and shared care

239
Q

What type of care does a SIV/V CKD patient need?

A

Pre-dialysis

Low clearance clinic

240
Q

What is the GS treatment for HT in CKD?

A

Converting enzyme inhibitor or AllA

241
Q

Which stages of CKD is HT usually present?

A

SII/III/IV

Common

242
Q

Which stages of CKD does anaemia usually present?

A

SII - rare
SIII - uncommon
SIV - common

243
Q

Which stages of CKD does divalent ion metabolism usually present?

A

SII - rare
SIII - rare
SIV - uncommon

244
Q

Name the 5 causes of anaemia of renal disease?

A 
Iron deficiency
Blood loss
Haemolysis
Inhibitor of erythropoiesis
Relative erythropoietin deficiency
245
Q

What are the disordered haemostasis diseases present with renal disease and how to treat it?

A 
Uraemic platelet dysfunction
- increased bleeding time
Desmopressin:
- releases vWF multimers from endothelium
- promote platelet aggregation
246
Q

Name 4 examples of renal bone disease?

A

Hyperparathyroidism
Osteoporosis
Osteomalacia
Adynamic bone disease

247
Q

Why does renal bone disease occur in renal disease?

A

Reduced GFR leads to hyperphosphatemia
Loss of renal tissues leads to lack of active Vit D
Indirect reduction in Ca absorption

248
Q

What are the signs that renal bone disease is present in renal disease?

A

Low Ca
Raised PO4
Secondary hyperparathyroidism (elevated PTH)
Can progress to teritary

249
Q

How to manage renal bone disease?

A 
Control PO4:
- diet
- PO4 binders (Ca acetate)
Normalise Ca and PTH:
- active Vit D (calcitriol)
Parathyroidectomy
250
Q

Name the 4 types of ahemodialysis access?

A

Arteriovenous fistula
AV prosthetic graft
Tunnelled venous catheter
Temporary venous catheter

251
Q

What are the fluid and dietary restrictions for dialysis?

A 
Fluid:
- dictated by residual urine output
- interdialytic weight gain
Dietary:
- K
- Na
- PO4
252
Q

Explain the process of peritoenal dialysis?

A

A balanced dialysis solution is instilled into the peritoneal cavity via a tunnelled, cuffed catheter, using the peritoneal mesothelium as a dialysis membrane
After a dwell time the fluid is drained out and fresh dialysate is instilled

253
Q

What are the modalities of peritoneal dialysis?

A

Continuous ambulatory peritoneal dialysis
Automated peritoneal dialysis
Hybrid

254
Q

What is contained in a dialysis fluid?

A

Balanced concentration of electrolytes
Glucose is a osmotic agent for ultrafiltration of fluid
Peritoneal transport can be high or low transporter
Dwell times can be adjusted according to transport characteristics

255
Q

What are the complications for peritoneal dialysis?

A 
Gram +ve:
- skin contaminant
Gram -ve:
- bowel origin
Mixed:
- suspected complicated peritonitis (perforation)
Exit site infection
Ultrafiltration failure
Encapsulating peritoneal sclerosis
256
Q

Name the 4 oral complications of end stage renal disease?

A

Parotitis
Stomatitis
Uraemic factor
Oesophagitis

257
Q

Explain the process of renal transplantation?

A

Placed into the iliac fossa and anastomosed to the iliac vessels
Native kidney stays

258
Q

When would the native kidney be removed?

A

Size (polycystic)

Infection (pyelonephritis)

259
Q

Name the 4 complication for renal transplantation?

A

Rejection
Infection
CV
Malignancy

260
Q

Name the CV complication after renal transplantation?

A 
Underlying renal disease
CRF
HT
Hyperlipidaemia
PT diabetes
261
Q

Name 5 types of immunosuppressants in renal transplantation?

A 
Non specific
T cell
mTOR inhib
Anti-IL2 receptor abs
T cell abs
262
Q

Name 2 example of non-specific immunosuppression for renal transplant?

A

Prednisone

Azathioprine

263
Q

Name 3 example of T cell activation immunosuppression for renal transplant?

A

Cyclosporine
Tacrolimus
MMF

264
Q

Name 1 examples of mTOR inhibitor immunosuppression for renal transplant?

A

Rapamycin

265
Q

Name 2 T cell abs immunosuppression for renal transplant?

A

AKG

OKT3

266
Q

WHat are the risk factors for CKD?

A 
Genetics
HT
RAS
Lipids
Smoking
Diet
Exercise
267
Q

Name 4 examples of conventional infection after renal transplantation?

A

HepB
UTI (bacteremia)
Pneumonia
HSV

268
Q

Name 6 examples of unconventional infection after renal transplantation?

A 
TB
CMV
EBV
Aspergillus 
HepA
Cryptococcus
269
Q

What are the oral complications following renal transplantation?

A 
Gingival hyperplasia
Aphthous ulceration
Herpes simplex virus (cold sore)
Leukoplakia (can become squamous carcinoma)
Candidiasis (co with HSV)
Kaposi's sarcoma
270
Q

What drugs can cause gingival hyperplasia?

A 
Cyclosporine
Phenytoin
Nifedipine
Diltiazem 
(Ca antag)
271
Q

What is post transplant lymphoproliferative disease?

A

1-2% of all transplantees
Incidence rising
After primary or reactivation of EBV infection

272
Q

What type of cancers can occur after renal transplantation and their RR

A 
Relative risk
2 - colon, lung and breast
3 - testes and bladder
5 - melanoma, leukaemia and cervical
15 - renal
20 - non-melanoma skin, Kaposi, carcom, NHL and PTLD
273
Q

Where is the liver positioned?

A

RUQ

274
Q

How many lobes does the liver have?

A

2

275
Q

What is the blood flow rate to the Liver?

A

5L per min

276
Q

What type of blood does the portal vein carry?

A

Nutrient rich blood from GI

50% O2 and 75% BF

277
Q

What are kupffer cells?

A

Special white blood cells (macrophages) which help regulate molecules entering the sinusoids. The phagocytose molecules

278
Q

What is the function of stellate cells?

A

Around sinusoid and help with structural integrity

279
Q

Which zone of the liver acinus has more O2?

A

Zone 1 most

Zone 3 least

280
Q

What are the metabolic functions the liver?

A 
Biotransformation of:
- drugs
- toxins
- hormones
Nilfe formation and excretion
haem meta
Intermediate meta of:
- glycogen and lactate
- plasma port
- clot factor
- ammonia removal
Lipids
281
Q

What would happen if a patient had no bile?

A

Weight loss

Vitamin deficiency

282
Q

Explain the basic process of RBC destruction?

A 
In spleen:
- converted to haem and globin
Globin recycled
Haem oxidised forming iron and biliverdin
Biliverdin converted to bilirubin
283
Q

What happens to bilirubin?

A

Travels to liver via albumin
Undergoes phase 2 reaction to become unconjugated
Helps form bile acid

284
Q

What is the most common cause of unconjugated hyperbilirubinemia?

A

Haemolysis

Increased RBC breakdown

285
Q

What causes conjugated hyperbilirubinemia?

A

Obstructive jaundice:

  • no bile release, not enter bowel
  • due to gallstones
286
Q

What causes non-obstructive or hepatocellular jaundice?

A

Dysfunction or death of hepatocytes, resulting in release into circulation

287
Q

What is a key plasma protein the liver produces?

A

Albumin

288
Q

Which vitamin is essential cofactor for II VII IX and X

A

D

289
Q

How can liver disease impact clotting?

A

Vit D absorption

Clotting factor synthesis

290
Q

Name the 6 common causes of Liver diesease?

A 
Alcohol
Non-alcoholic steatohepatitis
Viral
Drugs
Autoimmunity/genetic
Cancer
291
Q

Name 6 symptoms of liver disease?

A 
Fatigue
Nausea
Weight loss
Drowsiness
Jaundice
Abnormal bleeding
292
Q

Name 6 signs for liver disease?

A 
Jaundiced sclera
General jaundice
Ascites
Hepatomegaly
Splenomegaly
Bruising
293
Q

Name the 4 dental considerations for a patient with liver disease?

A

Oral and gingival hygiene
Bleeding tendency
Altered drug metabolism (local anaesthetic, sedation)
Risk of viral hepatitis for the dental practitioner

294
Q

Name 6 oral signs for liver disease?

A 
Angular cheilitis
Haematomas, petechiae
Gingival bleeding
Xerostomia, sialadenitis
Lichen planus – associated with HCV
Glossitis – associated with alcoholism and nutritional deficiencies
295
Q

What is necessary to check before any dental procedure of a patient with liver disease?

A

Check that the patient’s clotting and platelet count is normal. Where any derangement is seen, seek medical advice prior to proceeding.
During the dental procedure, minimise mucosal trauma and keep any procedure to the minimum required.
No NSAIDs
If difficult send to hospital setting

296
Q

Should sedation be avoided for liver disease patient?

A 
Yes
Altered excretion function
Ammonia excretion
Overdosing
Hospital for GA
297
Q

Name the 6 the signs for LA toxicity?

A 
Peri-oral tingling
Drowsiness, confusion
Unconsciousness
Seizures
Arrhythmias
Cardiac arrests
298
Q

How can liver disease impact LA?

A

Reduced amount for LA toxicity

299
Q

Name the 5 drugs contraindicated for liver disease patients?

A 
Benzodiazepines
Aspirin
Antifungals e.g. miconazole
Antibiotics e.g. erythromycin, metronidazole, tetracycline
Strong opiates e.g. morphine
300
Q

Name the 4 drugs to be wary about prescribing for a liver disease patient?

A

Amide local anaesthetics
NSAIDs
Paracetamol
Mild opiates e.g. codeine

301
Q

What is considered to be the foregut?

A

Mouth-mid duodenum

302
Q

What is considered to be the midgut?

A

mid-duodenum to mid-transverse colon

303
Q

What is considered to be the hindgut?

A

Mid-transverse colon to anus

304
Q

What are the symptoms for gastroesophageal reflux disease?

A 
Heartburn
Regurgitation
Dysphagia
Chest pain
Hypersalivation
Globus sensation
Odynophagia
305
Q

What treatment can be used for GI disease?

A

Lifestyle changes
Proton pump inhibitors
H.pylori testing (CLO test)
Anti-reflux surgery

306
Q

What drugs are avoided for GI disease patients?

A

Ca ch blockers
NSAIDs
Anticholinergics

307
Q

What alarming symptoms of GI disease should suggest a urgent referral?

A 
Dysphagia
Persistent vom
Unintentional weight loss
Gi bleeding
Abdominal swelling
308
Q

Dental implications of GI disease?

A

Tooth erosion
Halitosis
Mucosal erythema
Burning mucosal sensation

309
Q

What drug should be avoided for GI disease patients?

A

Aspirin

310
Q

What preventative action can be taken for patients with GI disease?

A

Dietary advice
Treatment of reflux with PPI
ENhancing tooth surface integrity
Place adhesive physical barrier on susceptible tooth surfaces

311
Q

Name the 5 general symptoms of Liver disease?

A 
Jaundice
Fever 
Loss of body hair
Coagulopathy
Bruising
312
Q

Name 11 causes of jaundice?

A 
Viral 
Bacterial
Hepatoma
Metastatic disease
Drugs
Alcohol
Wilson's disease
Ischaemia
Obstruction
Sepsis
Autoimmune 
Congestive
313
Q

Symptoms for pre-hepatic jaundice?

A

Haemolytic anaemia or excessive prod of blood cells

314
Q

Name 3 causes for hepatic jaundice?

A

Poisons
Infections
Tumours

315
Q

WHat is the definition of post-hepatic jaundice?

A

Obstruction to the drainage of bile from liver

316
Q

Name 7 antibiotics contraindicated for liver disease patients?

A

Erythromycin estolate - causes cholestasis
Tetracycline - dose related hepatotoxicity
Chloramphenicol - markedly increased half life
Antituberculous therapy in combinations, pyrazinamide
Griseofulvin - contraindicated
Nalidixic acid
Nitrofurantoin prolonged use

317
Q

What should a dentist do in situations a patient becomes acutely unwell?

A

Ensure adequate airway
Breathing: central cyanosis or fetor
Circulation: tachy, pale or suggestion of other complications

318
Q

Name 4 causes of IBD?

A

Ischemia
Infection
Degenerative
Inflammatory

319
Q

What are the signs and symptoms of Crohn’s?

A

Lesions may be found anywhere between the mouth and the anus
Thickened bowel wall with cobblestone appearance
Deep ulcers that cross the muscularis mucosae
Granulomas are common

320
Q

What are the signs and symptoms of UC?

A

Disease is confined to the colon
Thin bowel wall
Disease is continuous
Ulcers do not cross the muscularis mucosae
Granulomas are uncommon and associated with crypts

321
Q

Name 7 oral manifestations for patient with IBD?

A

Periodontitis
Aphthous lesions/stomatitis (typically labial/buccal mucosa)
Pyoderma (pyostomatitis) vegetans
Nodular granulomatous submucosal lesions
Cobblestone mucosal swelling
Oral tags
Swollen lips (orofacial granulomatosis)

322
Q

Name 5 types of immunomodulators for treatment of IBD?

A 
Thiopurines, for example, azathioprine
Methotrexate
Calcineurin inhibitors, for example, cyclosporin A, tacrolimus
Corticosteroids
Anti-TNFa, for example, infliximab
323
Q

What oral symptoms do iron deficiency anaemia patient show?

A

Angular cheilitis and aphthous ulcers

But this anaemia may be of greater concern such as bowel cancer

324
Q

Name 2 enzymes present in the mouth?

A

Salivary amylase

Lingual lipase

325
Q

What does the terminal ileum absorb?

A

B12

Bile acid

326
Q

How does the SI have a large SA?

A

Folds of the bowel surface covered by villi and microvilli

327
Q

Function of cheif cells?

A

Secretes pepsinogen and converted to pepsin

328
Q

Function of parietal cell?

A

Secrete HCl and intrinsic factor (bind B12)

329
Q

What is the function of the colon?

A

Water reabsorption

200g into the stool

330
Q

What are the macroscopic pathology of Crohn’s disease?

A

Deep ulcers and fissures in the mucosa
Strictures
Fistulae, for example between bowel and bladder/vagina (in women)
Areas of affected mucosa that are not continuous, called ‘skip lesions’

331
Q

What are the symptoms of Crohn’s disease?

A

Abdominal pain
Weight loss
Diaarhoea

332
Q

What are the oral manifestations for Crohn’s disease?

A

Diffuse facial and lip swelling
Cobblestoning of the mucosa
Ulceration
Mucosal tags

333
Q

What tests can be done to investigate Crohn’s disease?

A

Blood test
Barium enema
GI endoscopy

334
Q

What drug treatment can be undertaken for a Crohn’s patient?

A

Oral steroids
Anti-inflammatory
Immunosuppressive drugs
High fibre low fat diet

335
Q

What surgical treatment can be undertaken for a Crohn’s patient?

A

Complications such as strictures and fistulas intervention

336
Q

What are the macroscopic pathology of ulcerative colitis?

A

Affects only the colon
Starts in the rectum and then extends backwards (proximally) by varying amounts
Continuously involves bowel (NO skip lesions, unlike Crohn’s)
Produces ulcers and pseudo-polyps

337
Q

What are the extraintestinal features for UC and Crohn’s?

A 
Anaemia (due to blood loss)
Arthritis
Clubbing
Skin conditions
Uveitis
338
Q

What are the oral manifestations for UC?

A

Aphthous ulcers

Angular cheilitis

339
Q

What tests can be done to investigate ulcerative colitis?

A

Blood test
Stool culture
Barium enema
GI endoscopy

340
Q

What drug treatment can be undertaken for a ulcerative colitis?

A

Oral steroids
Anti-inflammatory
Immunosuppressive drugs
High fibre low fat diet

341
Q

What surgical treatment can be undertaken for a Crohn’s patient?

A

Colectomy

Stoma

342
Q

What are the symptoms of Coeliac disease?

A 
Feeling generally tired and weak
Weight loss
Diarrhoea +/- steatorrhoea
Abdominal distension and pain
Anaemia
343
Q

What tests can be done to investigate coeliac disease?

A

Blood test

GI endoscopy

344
Q

What are the oral presentations for Coeliac disease?

A 
Features of anaemia
Oral ulceration
Glossitis
Angular cheilitis
Enamel defects
345
Q

What is the definition of TI diabetes?

A

Autoimmune destruction of Beta cells leads to reduced insulin production

346
Q

What is the definition of TII diabetes?

A

Body becomes increasingly resistant to effects of insulin

Pancreas works harder to control plasma glucose levels

347
Q

Name 8 diseases that cause 2nd diabetes?

A 
Chronic pancreatitis
Haemochromatosis
Cystic fibrosis
Acromegaly
Cushing's
Glucagonoma
Pheochromocytoma
Steroids
348
Q

What is the definition monogenic diabetes?

A

Maturity onset diabetes of the young
Not TI or TII
Autosomal dominant
Glucokinase, HNF1A and NHF4A

349
Q

What is the treatment for monogenic diabetes?

A

HNF1A and HNF4A responds to sulfonylurea

Glucokinase no treatment

350
Q

Describe the signs and symptoms of undiagnosed diabetes?

A 
Thirst
Polyuria
Polydypsia
Weight change
Lethargy
SKin changes
Blurred vision
Recurrent candida infections
351
Q

What is the normal value for fasting plasma glucose?

A

<6.0

352
Q

What is the diabetic valve for fasting plasma glucose?

A

> 7.0

353
Q

What is the intermediate valve for fasting plasma glucose?

A

6.1-6.9

354
Q

What is the normal value of 2hr OGTT?

A

<7.7

355
Q

What is the intermediate value of 2hr OGTT?

A

7.8-11.0

356
Q

What is the diabetes value of 2hr OGTT?

A

> 11.1

357
Q

What are the requirements for a clinical diabetes diagnosis?

A

1 typical symptom + 1 diagnostic blood test

2 diagnostic blood test

358
Q

When should HbA1c should be used?

A

True fasting blood sampling is not possible OR

following identification of impaired fasting plasma glucose

359
Q

Explain how the HbA1c test works?

A

Glucose binds irreversibly to haem in RBCs forming Hb1Ac
Higher glucose, Higher Hb1Ac
Can reflect the blood glucose over 2-3 months

360
Q

Name low, medium and high levels of the Hb1Ac test?

A

Low: 48
Medium: 64
High: 97
Lowering your Hb1Ac by 10 mmol/mol reduces your risk of complications by 20%

361
Q

Name the 3 macrovascular complications for diabetes?

A

Coronary artery disease
Cerebrovascular disease
Peripheral vascular disease

362
Q

Name the 4 microvascular complications for diabetes?

A

Peripheral neuropathy
Retinopathy
Nephropathy
Autonomic neutropathy

363
Q

How do diabetics monitor their blood glucose?

A

Capillary blood glucose
Prick fingers
Devices available

364
Q

What should the blood glucose targets be over the day?

A

Before breakfast: 5-6 mmol/L
Before meals: 4-7 mmol/L
2 hrs after meal: 5-9 mmol/L
Bedtime: 6-8 mmol/L

365
Q

How can ketone monitoring be useful for diabetics?

A

Presence of ketones indicates lack of insulin
Urine or blood test
Levels change much faster

366
Q

What are the normal, rapid action and immediate action for ketone monitoring?

A

Normal: <0.6
Rapid: 0.6-1.5
Immediate: >1.5

367
Q

What is the definition of Flash CGM?

A

Freestyle libre sensor contains a small filament underneath the disk that is inserted into the back of the arm
Filament measures the glucose level of the interstitial tissue under your skin
Sensor lasts up to 14 days and needs to be scanned at least every 8 hours - continuous glucose info
Water resistant up to 1m for 30 mins
Measures interstitial rather than blood glucose

368
Q

Name the 4 categories for treatment of TII diabetes?

A

Diet
Exercise
Drugs
Insulin

369
Q

Name the oral manifestations for diabetes?

A

Xerostomia; burning sensation in the mouth
Impaired/delayed wound healing; increased incidence and severity of infections;
Secondary infection with candidiasis;
Parotid salivary gland enlargement;
Gingivitis; and/or periodontitis.

370
Q

Name 7 drug treatment options for diabetes?

A 
Metformin
Sulfonylureas
Pioglitazone
DPP-4 inhibitors
SGLT-2 inhibitors
GLP-1
Insulin
371
Q

How successful is counterweight plus to aid TII diabetes?

A

Counterweight Plus: 53/149 achieved remission
Control diet: 5/149 achieved remission
Remission defined as Hb1Ac <48 mmol/mol

372
Q

How can exercise impact TII diabetes?

A

Compared to a very low control

Exercise can help

373
Q

Why should we treat diabetes?

A

Reduce hyperglycaemia and CVD

374
Q

Describe 2 types of regimes for insulin taking?

A

Basal, basal bolus or basal plus

Twice daily mixed

375
Q

Name the 4 requirements for an insulin pump therapy?

A

TI diabetes
Testing at least 4 times a day
Educated on carb counting
significant hypos or poor control despite optimal basal bolus therapy

376
Q

Explain how the closed loop device works?

A 
Artificial pancreas
Low user input
Accurate and reliable glucose monitoring
Algorithms incorp glucose data to adjust dose
Internal or external
377
Q

Name 2 types of hypoglycaemia?

A

Mild

Severe

378
Q

Name 2 causes of hypoglycaemia?

A 
Insulin therapy
Sulfonylurea therapy (glipizide and gliclazide)
379
Q

What is the frequency of hypos for a T1 diabetes patient?

A

2 mild hypos per week

1 severe hypo per year

380
Q

Name the 11 clinical features of a hypoglycaemic attack?

A 
Confusion
Drowsiness
Odd behaviour
Speech difficulty
Incoordination
Malaise
Headache
Palpitations
Hunger
Trembling
Sweating
381
Q

Explain glucose metabolism?

A

Oral intake
Gluconeogenesis + glycogen breakdown
Glucose use in brain, muscle and adipose tissue

382
Q

Name the 6 adverse effects of hypoglycaemia?

A 
Coma
Seizure
Hemiplegia
Fracture
Arrhythmia
Myocardial ischaemia
383
Q

Describe S1 of immediate management of conscious patient?

A

Give 15-20g quick acting carbs patient choice:

e. g.
- 150-200 mL of pure fruit juice
- 5-7 Dextrosol tablets or 4-5 glucotabs
- 3-4 heaped teaspoons of sugar dissolved in water

384
Q

Describe S2 of immediate management of conscious patient?

A

Repeat capillary blood glucose measurement 10-15 minutes later.
If less than 4.0 mmol/L repeat step 1 up to 3 times

385
Q

Describe S3 of immediate management of conscious patient?

A

Blood glucose remains less than 4.0 mmol/L after 45 mins contact doctor
Consider 1mg of glucagon IM or IV 10% glucose infusion at 100ml/hr

386
Q

Describe S4 of immediate management of conscious patient?

A

Once blood glucose above 4.0mmol/L and recovered, then give long acting carb e.g.

  • 2 biscuits
  • sliced bread
387
Q

Describe S1 of immediate management of conscious patient whom is confused and disorientated?

A

Uncoop but able to swallow:
- 1.5-2 tubes glucogel/dextrogel
- glucagon 1mg IM
Glucagon may not be effective for sulfonylurea or malnourished

388
Q

Describe S1 of immediate management of unconscious patient?

A

Check ABC
Give IV glucose over 15 mins as 75ml 20% or 150ml 10%
Or 1mg glucagon IM
Recheck after 10 mins to see above 4 mmol/L

389
Q

What are the sick day rules for TI diabetes?

A

Body stressed = blood glucose higher
Don’t stop insulin
Drink plenty
Check levels of glucose and ketones

390
Q

What are the consequences of missing insulin?

A 
Increased resp rate
Ketones on breath
Abdominal pain
Nausea
Vomiting
391
Q

What are the sick day rules for TII diabetes?

A 
Rest 
FLuids
Treat associated symptoms
Antibiotics indicated
Check levels more reg
Adjust meds:
- stop metformin if risk of dehydration
- stop SGLT-2 inhibitor if very unwell
392
Q

What is the definition of diabetic ketoacidosis?

A

Characterised by hyperglycaemia, acidosis and ketonaemia
BG >11
Ketones > 3
pH < 7.3 (HCO3 <15)

393
Q

If DKA is detected, what should you do?

A

1L IV NaCl 0.9% over 1 hr within 30 mins

Sol IV insulin of 6 units/hr within 30 mins

394
Q

How to detect DKA clinically?

A 
H+ > 45
HCO3 <18
pH <7.3
Check U and Es 
Lab blood glucose
Check urine and blood ketones
395
Q

What pH, HCO3 and H+ is severe DKA?

A

pH <7.1
HCO3 < 5mmol/L
H+ > 80mEq/L

396
Q

Name the 10 endocrine organs?

A 
Testes
Ovaries
Pancreas
Adrenal gland
Thymus
Parathyroid
Thyroid
Pituitary
Hypothalamus
Pineal gland
397
Q

WHat hormones are required for repro?

A

LH and FSH

398
Q

What hormones are required for metabolish?

A

TSH

399
Q

What hormone is required for lactation?

A

Prolactin

400
Q

What hormone is required for growth

A

GH

401
Q

What hormones is required for stress?

A

ACTH

402
Q

WHat hormones is required for water balance?

A

ADH

403
Q

What hormones is required for parturition?

A

Oxytocin

404
Q

What are some endocrine conditions?

A 
Hypothyroidism
Amyloidosis
Lymphoma
Syphilis
Secondary macroglossia from benign or malignant space occupying lesions
405
Q

Name 6 endocrinopathies?

A 
Adrenal insufficiency
Cushing's
Hypothyroidism
Thyrotoxicosis
Goitre
Acromegaly
406
Q

What does the glomerulosa produce in the adrenal gland?

A

Mineralocorticoids

407
Q

What does the fasciculata produce in the adrenal gland?

A

Glucocorticoids

408
Q

What does the reticularis produce in the adrenal gland?

A

Androgens

409
Q

What do the adrenal glands produce?

A

Adrenaline

Noradrenaline

410
Q

Name the 2 types of adrenal insufficiency?

A

Primary - High ACTH

Secondary - Low ACTH

411
Q

What is the definition of primary adrenal insufficiency?

A

Autoimmune (tuberculous adrenalitis)

ACTH not able to interact with Adrenal gland

412
Q

What is the definition of secondary adrenal insufficiency?

A

Tumour in the hypothalamic-pituitary region

No form of ACTH

413
Q

What is the definition of tertiary adrenal insufficiency?

A

WIthdrawal of exogenous glucocorticoid admin

414
Q

Name the 4 discriminatory diagnostic features for adrenal insufficiency?

A

Skin hyperpigmentation
Alabaster-coloured pale skin
Low BP
Postural hypotension

415
Q

Name a test for adrenal insufficiency?

A

Short synacthen test

416
Q

Explain how the short synacthen test works?

A 
Assess renal reserve
Any time of day without fasting
Inj synthetic ACTH
Take baseline cortisol before and one 30 mins later
Only for adrenal gland
417
Q

For a dental patient with adrenal insufficiency what must they take addition to their current medication before a dental extraction?

A

20mg (double/triple of normal dose) hydrocortisone or double usual dose of prednisolone before procedure
Resume normal dose after

418
Q

Name the 4 clinical features that best discriminate Cushing’s syndrome?

A

Easy bruising
Facial plethora
Proximal myopathy or proximal muscle weakness
Striae - especially if reddish purple and >1cm wide
Moon faced

419
Q

What is the definition of Cushing’s syndrome?

A

ACTH dependent - Cushing’s or Ectopic ACTH secrete
ACTH independent - Adrenal adenoma/carcinoma
Exogenous steroids

420
Q

What investigation can aid in the diagnosis for Cushing’s?

A

Demonstrate excess cortisol:

  • 24 hr urinary free cortisol
  • overnight dexamethasone suppression test
421
Q

Name 4 conditions associated with hypercortisolism without cushing’s syndrome?

A

Preg
Depression/other psy conditions
Alcohol dependence
Morbid obesity

422
Q

What is the definition of hypothyriodism?

A

Negative feedback loop

Low thyroid hormone Low T4/3 but high TSH

423
Q

Name the 2 types of thyroid hormone?

A

T4 - thyroxine
T3 - triiodothyronine
Deiodinase enzymes convert T4 to T3

424
Q

What is the normal range for TSH?

A

0.35-0.45

425
Q

What is the normal range for free t3?

A

3-7

426
Q

What is the normal range for free t4?

A

10-25

427
Q

What is the definition of thyrotoxicosis?

A

High T4/T3 and low TSH

428
Q

What is the treatment for hypothyroidism?

A

Levothyroxine

429
Q

How to test for hypothyroidism?

A

TFT testing interval

GAFUR

430
Q

WHat are the main causes for hypothyrodism?

A

Atrophic autoimmune thyroiditis
Hashimoto’s thyroiditis
Post-treat thyrotoxicosis

431
Q

Name 4 diseases that have thyrotoxicosis common as a symptom?

A

Graves
Toxic multinodular goitre
Autonomously functioning adenoma
Thyroiditis

432
Q

What are the discriminatory signs for thyrotoxicosis?

A

Goitre
Tremor
Ocular signs

433
Q

What investigations help for thyrotoxicosis diagnosis?

A

TSH, T4 and T3

TPO and TRABs

434
Q

What treatment options are there for thyrotoxicosis?

A 
Carbimazole:
- once daily
- gives rash
Propylthiouracil:
- 2 daily
- rash
Beta blocker
Low dose radioiodine:
- can cause hypothyroidism
Thyroid surgery:
- recurrent laryngeal nerve
- Ca issue
435
Q

What are the 3 differential diagnoses for thyroid nodules?

A

Multinodular goitre with a dominant nodule
Thyroid cyst
Thyroid cancer

436
Q

What is the aetiology for goitre?

A 
Autoimmune thyroid disease
Sporadic
Endemic
Preg
Drug induced
Thyroiditis
437
Q

What can a ultrasound signify for thyroid lumps?

A

3cm mass in R lobe of thyroid suggestive but not diagnostic of follicular thyroid cancer
R diagnostic hemithyroidectomy

438
Q

What is the definition of acromegaly?

A

An increased secretion of growth hormone causing changes in appearance

439
Q

What could acromegaly be caused by?

A

Growth hormone secreting tumour

440
Q

Name 9 complications associated with acromegaly?

A 
Visual field defect
Headaches
Diabetes
Decreased libido
Sleep apnoea
Hypertension
Cardiomyopathy
Arthritis
Carpal tunnel
441
Q

Give 5 tests that can aid acromegaly diagnosis?

A

Blood test:

  • IGF1
  • Glucose
  • Thyroid hormone
  • Oestrogen
  • FSH
442
Q

Explain how the oral glucose tolerance test is carried out?

A

Baseline blood sample
Measured dose of glucose
Blood drawn at intervals
Determine how quickly blood can be cleared
For acromegaly, check growth hormone levels

Can do MRI after

443
Q

What are the treatment options for acromegaly?

A

Removal of tumour
Sandostatin analogue if surgery fails
GH inhibition (Pegvisomant)
Dopamine can suppress GH secretion

3rd Year BDS (21 decks)

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