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xD2 Oral Path Final Exam > OPF Systemic Disease (Ch17) > Flashcards

OPF Systemic Disease (Ch17) Flashcards

1
Q

What is a heterogenous group of conditions characterized by the deposition of an extracellular proteinaceous substance called amyloid?

A

Amyloidosis

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2
Q

What are 2 categories of amyloidosis?

A
  1. Organ limited (rarely oral)

2. Systemic

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3
Q

What are 5 forms of systemic amyloidosis?

A
  1. Primary
  2. Myeloma associated
  3. Secondary
  4. Hemodialysis associated
  5. Heredofamilial
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4
Q

Primary and Myeloma associated Amyloidosis affects which demographic symptoms?

A
  1. Older adults
  2. Petechia and ecchymosis
  3. Macroglossia
  4. Xerostomia (amyloid deposits in salivary glands)
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5
Q

What can be the character of the macroglossia associated with Amyloidosis?

A

Tongue with translucent papules, some are hemorrhagic

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6
Q

What can happen on the lips associated with amyloidosis?

A

Papules on lip (slide looks like red blisters)

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7
Q

What amyloidoisis type is associated with person on dialysis whos β2 Microglobulin protein is not removed and therefore accumulates, normally in bones and joints

A

Hemodialysis associated amyloidosis

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8
Q

What is the form of amyloidosis that can result from long term inflammation such as osteomyelitis, tuberculosis, sarcoidosis?

A

Secondary amyloidosis

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9
Q

Secondary Amyloidosis can form what that is also found in Chrone’es, Tb, Funcal infections, Sarcoidosis?

A

Granulomas

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10
Q

Hemodialysis associated Amyloidosis can manifest where orally?

A

Tongue

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11
Q

How is Secondary Amyloidosis treated?

A

Treat underlying inflammatory process

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12
Q

Does a renal transplant arrest progression of bone lesions in hemodialysis associated amyloidosis?

A

No

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13
Q

What are 3 things used to improve the prognosis of primary amyloidosis , though there is no effective therapy for amyloidosis?

A
  1. Colchicine
  2. Prednisone
  3. Melphalan
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14
Q

Amyloidosis patients normally die of what 3 things?

A
  1. Cardiac failure
  2. Arrythmia
  3. Renal disease
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15
Q

What histology stain is associated with Amyloidosis

A

Congo Red

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16
Q

What disease must Amyloidosis be differentiated from and why?

A

Multiple myeloma, both have large amounts of plasma cells

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17
Q

What is used to differentiate amyloidosis from multiple myeloma?

A

Serum electrophoresis to determine whether monoclonal gammopathy exists

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18
Q

What is a radiographic indication of multiple myeloma?

A

Punched out bony lesions

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19
Q

What is the prognosis of Cutaneous form of Amyloidosis?

A

Good, no impact on survival while systemic form will result in death from cardiac or renal failure

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20
Q

If the patient has a Vitamin A Deficiency what is the organ effected?

A

Eye problems (dry skin and conjunctiva) leading to blindness or night blindness in adults

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21
Q

Retinol is the animal form of what vitamin and can be converted to what for what?

A

Vitamin A, essential for vision Converted to Retinoic Acid for skin health, teeth remineralization and bone growth

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22
Q

What is the synonymn for Vitamin B1?

A

Thiamin

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23
Q

Thiamin/Vit B1 is involved in function of what?

A

Proper function of neurons

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24
Q

Generally, Thiamin/Vit B1 deficiency is associated with what type of problems?

A

Neurologic problems

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25
Q

In what demographic is Vit B1/Thiamin deficiency found?

A

Alcoholics or diets in Southeast Asia

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26
Q

What is a specific disease associated with Thiamin/Vit B1 deficiency?

A

Beriberi

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27
Q

What is a synonymn for Vit B2?

A

Riboflavin

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28
Q

Riboflavin/Vit B2 is involved in what cellular reactions?

A

Cellular oxidation reduction reactions

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29
Q

What can Riboflavin/Vit B2 deficiency look like?

A

Anemias (glossitis, angular cheilitis, erythemic mucosa)

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30
Q

If see bald tongue and angular cheilitis what can be the differential?

A

Anemia or Vit B2/Riboflavin deficiency

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31
Q

What is a synonymn for Vit B3?

A

Niacin

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32
Q

What is a diet in which a Niacin/Vit B3 deficiency would be found?

A

High corn(maize) diet(b/c corn is low in niacin)

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33
Q

Name of the disease associated with Niacin/Vit B3 deficiency?

A

Pellagra

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34
Q

Triad of symptoms associated with Pellagra/Niacin/Vit B3 deficiency?

A
  1. Dermatitis
  2. Dementia
  3. Diarrhea
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35
Q

What are 4 things that can cause smooth tongue?

A
  1. Vitamin deficiency
  2. Anemia
  3. Malabsorption
  4. Antibiotics
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36
Q

What is a synonym for Vit C and its importance?

A

Ascorbic Acid. Necessary for proper collagen synthesis.

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37
Q

What is a disease associated with Vit C/Ascorbic Acid deficiency?

A

Scurvy

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38
Q

What are gingival lesions associated with Scurvy/Vit C/Ascorbic Acid?

A

Scorbutic gingivitis

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39
Q

Is is wound healing affected in Scurvy/Vit C/Ascorbic Acid deficiency?

A

Yes

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40
Q

What is a vitamin that is considered a hormone and is commonly low?

A

Vitamin D

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41
Q

What is the term for adult Vit D deficiency?

A

Osteomalasia (weak bone structure)

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42
Q

What is the term for childhood Vit D deficiency?

A

Rickets

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43
Q

What is the he Rickets Rosary of Vit D deficiency in children?

A

Costochondral junction enlargement (looks like a chain running down the ribcage)

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44
Q

What is a fat-soluble vitamin necessary for proper synthesis of various proteins including clotting factors 2, 7, 9, and 10?

A

Vitamin K

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45
Q

If the patient has a Vitamin K deficiency,what will be an associated problem?

A

Bleeding/clotting problems

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46
Q

Why would a malabsorption syndrome or a microflora elimination due to antibiotic therapy cause a Vitamin K deficiency?

A

Stop Vit K uptake

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47
Q

What are 2 examples of Vitamin K drugs?

A
  1. Plavix
  2. Coumadin
    (both decrease Vitamin K in order to decrease clotting)
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48
Q

What esults in coagulopathy due to inadequate synthesis of prothrombin and other clotting factors?

A

Vitamin K Deficiency

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49
Q

What immune cells do not function as well in Anemias?

A

T-cells

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50
Q

What is a reduction in the oxygen-carrying capacity of blood?

A

Anemia

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51
Q

What are 4 conditions leading to anemia?

A
  1. Excessive blood loss
  2. Increased RBC demand
  3. Decreased Iron intake
  4. Decreased iron absorption
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52
Q

What are 3 nutritional anemias?

A
  1. Iron deficiency
  2. Folic acid deficiency
  3. Vit B12 deficiency
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53
Q

What are 4 oral manifestations of Anemia?

A
  1. Skin/mucosal pallor
  2. Angular cheilitis
  3. Erythema and atrophy of oral mucosa
  4. Loss of filiform and fungiform papillae on dorsum of tongue
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54
Q

What is an anemia caused by insufficient amount of iron available in bone marrow for red blood cell development. Siversky thinks this is the most important deficiency anemia. It is most common anemia in United States?

A

Iron deficiency

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55
Q

What are the 2 most common causes Iron Deficiency anemia?

A
  1. Pregnancy

2. Heavy menses

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56
Q

What are the hemoglobin and hematocrit findings in iron deficiency anemia?

A

Both are low

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57
Q

What can superimpose on Iron deficiency anemia?

A

Candidiasis

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58
Q

Besides reduced red blood cells in iron deficiency anemia, what is the character of the red blood cells

A

Hypochromic microcytic

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59
Q

What is the treatment for iron deficiency anemia?

A

Iron supplementation

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60
Q

What is the syndrome of Iron Deficiency + Glossitis + Dysphagia?

A

Plummer-Vinson syndrome

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61
Q

Is Plummer-Vinson syndrome premalignant?

A

Yes

62
Q

Plummer-Vinson syndrome is associated with what cancer(s)?

A

Oral and esophageal squamous cell carcinoma

63
Q

What is the demographic for Plummer-Vinson syndrome?

A

Scandanavian women or Northern Europeans, 30- 50 yrs old

64
Q

What is the treatment for Plummer-Vinson syndrome?

A

Treat iron deficiency and dilate the esophagus

65
Q

What are the symptoms of Plummer-Vinson syndrome?

A

Dysphagia
Esophageal webs
Spoon shaped nails (koilonychea)

66
Q

What is a megablastic anemia caused by poor absorption of cobalamin (Vit B12, extrinsic factor)?

A

Pernicious anemia

67
Q

What disorder is caused by autoimmune destruction of parietal cells of stomach resulting in decreased absorption of cobalamin?

A

Pernicious anemia

68
Q

What is a vitamin needed for DNA synthesis, if it is lacking, rapidly dividing cells (marrow, epithelium) are affected?

A

Vitamin B12

69
Q

What is the standard workup for burning tongue?

A

Blood tests for Vit B and diabetes

70
Q

What are 4 causes of pernicioius anemia?

A
  1. Autoimmune
  2. Gastrectomy
  3. Gastric cancer
  4. Gastritis
71
Q

What is the only possible difference in the oral manifestations of anemias and pernicious anemia?

A

Pernicious anemia may have patchy bald tongue while Iron deficiency anemia tongue is completely bald

72
Q

What is difference histologically between iron deficiency anemia and pernicious anemia?

A

Iron deficiency has microcytic cells while pernicious red blood cells are large (megablastic) and have nuclei

73
Q

What is the treatment for Pernicious Anemia?

A

Vitamin B12 (cyanocobalamin) injections, possible that not all tongue papillae will regenerate

74
Q

What is a common complaint in pernicious anemia?

A

Burning tongue

75
Q

What is the difference between a pituitary dwarf and an achondroplastic dwarf as far as proportions?

A

Pituitary dwarfs are proportional

76
Q

What are 2 causes of Pituitary Dwarfism?

A
  1. Diminished production of growth hormone

2. Reduced capacity of tissues to respond to growth hormne

77
Q

What is the term for excessive hormone production by anterior pituitary gland?

A

Hyperpituitarism

78
Q

What causes the overproduction of excess growth hormone by anterior pituitary?

A

Pituitary adenoma

79
Q

Hyperpituitarism is associated with what disorders?

A

Gigantism and Acromegaly

80
Q

What is the syndrome associated with iincreased production of growth hormone (usually related to pituitary adenoma) taking place before closure of epiphyseal plates?

A

Gigantism

81
Q

What is the syndrome associated with excess production of growth hormone after closure of epiphyseal plates?

A

Acromegaly

82
Q

What are the oral-facial symptoms associated with acromegaly?

A

Increased growth of mandible with prognathism, apertognathia (open bite), teeth spacing, macroglossia

83
Q

What is the treatment for hyperpituitarism?

A

Remove pituitary adenoma

84
Q

What is the average age of a patient receiving an acromegaly diagnosis?

A

42

85
Q

What are some systemic problems seen in acromegaly?

A 
Hypertension 
Diabetes mellitus 
Coronary artery disease 
Congestive heart failure 
Respiratory disease Colon cancer
86
Q

What is the term for decreased output of thyroid hormone?

A

Hypothyroidism

87
Q

What is the term for hypothyroidism during infancy/childhood?

A

Cretinism

88
Q

What are 6 things that will be seen with cretinism/hypothyroidism in infancy?

A 
Thick lips
Enlarged tongue 
Short stature 
Puffy face 
Cold intolerance
Mental retardation 
Lethargy
89
Q

What are 2 types of hypothyroidism?

A
  1. Primary

2. Secondary

90
Q

Which type of hypothyroidism is when the thyroid cannot produce the amount of hormones the pituitary calls for?

A

Primary

91
Q

Which type of hypothyroidism is when the thyroid is not being stimulated by pituitary to produce hormones?

A

Secondary

92
Q

What are the general symptoms of hypothyroidism versus hyperthyroidism?

A 
Hypo = slow down, get chubby 
Hyper = speed up, get thin
93
Q

What is the treatment for hypothyroidism?

A

Thyroxine to normalize serum TSH concentration

94
Q

What is the clinical clue for hypothyroidism in adult?

A

Non-pitting edema due to glucosaminoglycan ground substance deposition

95
Q

What is the synonym for hypothyroidism in adults?

A

Myxedema

96
Q

What is the term for excess production of thyroid hormone?

A

Hyperthyroidism

97
Q

What is the main cause of hyperthyroidism thought to be caused by autoantibodies that are directed against receptors for thyroid stimulating hormone (TSH) on the surface of thyroid cells?

A

Grave’s disease

98
Q

What are 5 causes of hyperthyroidism?

A
  1. Grave’s disease
  2. Thyroid hyperplasia
  3. Benign or Malignant thyroid tumors
  4. Pituitary disease
  5. Metastatic tumors
99
Q

What does excess thyroid hormone of hyperthyroidism cause?

A

Increased metabolism

100
Q

How does one initially control Grave’s disease/hyperthyroidism?

A

Kill the thyroid

101
Q

What is the demographic for Grave’s disease/hyperthyroidism?

A

30-40 y.o. women

102
Q

What is the eye bulging (exopthalmos) of Grave’s Disease / hyperthyroidism caused by?

A

Accumulation of glycosaminoglycans in retro

orbital connective tissue

103
Q

How does one make a diagnosis for hyperthyroidism?

A

Assay free T4 (thyroxine) and TSH levels. T4 should be elevated and TSH will be depressed

104
Q

What is the treatment for hyperthyroidism?

A

Radioactive ablation of thyroid followed by lifelong administration of appropriate levels of thyroid meds (soloxine)

105
Q

What is the term for uncontrolled hyperthyroidism resulting in delirium, elevated temperature and tachycardia?

A

Thyroid storm

106
Q

Which pathology involves xcessive secretion of parathyroid hormone (PTH) by the 4 parathyroid glands which plays a critical role in calcium and phosphorus metabolism. Causes elevated blood calcium (hypercalcemia) and phosphorus (hyperphosphatemia) which creates altered bone metabolism?

A

Hyperparathyroidism

107
Q

What is the character of the Giant Cell Granuloma associated with Hyperparathyroidism?

A

Resorptive whereas the ones we have learned dentally are expansile

108
Q

Hyperparathyroidism is normally the result of what?

A

Tumor

109
Q

What is the demographic for Hyperparathyroidism?

A

Middle aged women

110
Q

What is the term for hyperparathyroidism resulting from disease in the parathyroid glands

A

Primary hyperparathyroidism

111
Q

What is the term for hyperparathyroidism resulting from abnormal excretion of calcium by the kidneys?

A

Secondary hyperparathyroidism

112
Q

What is a 4 word memory aid for clinical manifestations of hyperparathyroidism?

A

Stone, bones, groans, moans

113
Q

What are the “stones” associated with hyperparathyroidism?

A

Kidney stones

114
Q

What is the cause of bone pain in hyperparathyroidism?

A

Excessive calcium mobilization in both bones and joints

115
Q

What are the cause of the “groans” associated with hyperparathyroidism

A

GI cramps due to excess Calcium absorption

116
Q

What are the “moans” associated with hyperparathyroidism?

A

Personality disorders of variable scope, lethargy, coma

117
Q

What is the oral manifestation of hyperparathyroidism?

A

Brown tumor that is histologically identical to central Giant Cell Granuloma

118
Q

What is the classic radiographic sign for hyperparathyroidism?

A

Loss of lamina dura

119
Q

What is the classic radiographic sign for Scleraderma?

A

Scleraderma (WTF?)

120
Q

How is the treatment determined for hyperparathyroidism?

A

It depends on what is causing increased PTH levels (tumor, kidney disease, Vitamin D deficiency)

121
Q

What happens to the bone lesions of hyperparathyroidism once the disease is successfully treated?

A

Bone lesions (WTF?)

122
Q

What is the term for a primary adrenal cortical insufficiency causing insufficient production of adrenal steroids which in turn causes Pituitary to secrete ACTH to stimulate the adrenal cortex?

A

Addison’s disease

123
Q

What are 3 causes of Addison’s disease?

A
  1. Idiopathic adrenal cortex destruction (autoimmune)
  2. Malignant tumor
  3. Tuberculosis
124
Q

What increases in pt with Addison’s disease due to the increased ACTH?

A

Increased melanin pigmentation

125
Q

How can increased melanin pigmentation can manifest itself in the oral cavity?

A

As oral melanotic macules or gingival pigmentation

126
Q

What is a differential if see gingival pigmenting on a person who previously had no normal or variant of normal gingival pigmentation?

A
  1. Smoker’s melanosis

2. Addison’s disease

127
Q

What is the treatment for Addison’s disease?

A

10 mg steroids/day

128
Q

What are 2 causes of hypercortisolism?

A
  1. Prescription drugs causing increased glucocorticoid levels
  2. Adrenal or pituitary tumor
129
Q

If hypercortisolism is due to adrenal or pituitary disease it is called what?

A

Cushing’s Syndrome

130
Q

What is the most consistent clinical observation of hypercortisolism/Cushing’s syndrome?

A

Weight gain in central areas of the body

131
Q

What are 2 characteristic clinical findings on a patient with hypercortisolism / Cushing’s syndrome due to increased fat deposition?

A

Buffalo hump and moon facies

132
Q

What is a chronic disorder of carbohydrate (glucose) metabolism. Patients have abnormally high blood glucose levels (hyperglycemia)?

A

Diabetes Mellitus

133
Q

What are 3 pathways for Diabetes Mellitus?

A
  1. Lack of insulin
  2. Defective insulin that does not lower blood glucose
  3. Insulin resistance due to obesity
134
Q

Normally, what should glucose do in the body?

A

Should stimulate pancreas to secrete insulin which causes uptake of glucose into skeletal muscle and fat

135
Q

What happens to skeletal muscle and fat when insulin is lacking or defective to the point that glucose is not taken up into muscles or fat?

A

Breakdown of muscle and fat

136
Q

What is the danger of the breakdown of fat due to lack of glucose uptake?

A

Turns into ketone acids that lower blood pH that can lead to diabetic coma and death (ketoacidosis)

137
Q

Insulin-dependent diabetes mellitus is which type of diabetes?

A

Type I

138
Q

What are the 3 P’s of Diabetes Mellitus?

A
  1. Polydipsia (excessive thirst)
  2. Polyuria(excessive urination)
  3. Polyphagia (excessive appetite)
139
Q

What is the body type for a patient with Type I (Insulin dependent) diabetes mellitus?

A

Thin

140
Q

By what age is Type I (Insulin dependent) diabetes mellitus diagnosed?

A

By early 20’s

141
Q

Non-insulin dependent diabetes mellitus is what type of diabetes?

A

Type II diabetes

142
Q

When is Type II (non-insulin dependent) diabetes mellitus found and in what body type?

A

Early middle age; overweight

143
Q

How is Type I (Insulin dependent) diabetes mellitus treated?

A

Rigorous control of blood glucose with multiple insulin injections, proper diet, exercise

144
Q

When are the oral complications of Diabetes Mellitus most severe?

A

When blood glucose level is not well controlled (brittle diabetics)

145
Q

If a diabetes mellitus patient has candidiasis or mucormycosis (both fungal infections) what does this indicate?

A

That the patient is immunocompromised

146
Q

What are the oral complications of diabetes mellitus?

A
  1. Erythematous hyperplastic gingiva
  2. Excessive perio, tooth mobility
  3. Early tooth loss
  4. Slow wound healing
147
Q

What is a hereditary decrease in serum alkaline phosphatase?

A

Hypophosphatasia

148
Q

What is serum alkaline phosphatase important for?

A

Calcification of bone and cementum of teeth

149
Q

Lack of cementum or abnormal cementum in hypophosphatasia causes what orally?

A

Premature loss of deciduous anterior teeth

150
Q

Which are the the only teeth not affected by hypophosphatasia?

A

Deciduous molars and permanent teeth

151
Q

What are some systemic features of hypophosphatasia?

A
  1. Bowing of legs

2. Bone fractures

xD2 Oral Path Final Exam (6 decks)

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