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Tim's Cards > Oral Medicine I - fishing again > Flashcards

Oral Medicine I - fishing again Flashcards

1
Q

Occlusion of the Right Coronary Artery causes an infarct in what 2 areas of the heart?

A

Right ventricle

Posterior wall Left Ventricle

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2
Q

Where do coronary artery occlusions happen most often?

3 locations

A

LAD (left anterior descending): over 50%

RCA (right coronary artery): 30-40%

Left Circumflex Artery: 10-20%

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3
Q

RCA goes to:

LAD:

Left Circumflex:

A

posterior wall and right ventricle

anterior wall

lateral wall of left ventricle

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4
Q

LAD is the artery of…

A

Sudden Death

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5
Q

What are the 3 complications of an MI?

A

Ventricular (myocardial) Rupture (5-7 days after)

Cardiac Tamponade

Left Ventricular Aneurism

Mural Thrombus

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6
Q

What % of pts survive onset of MI?

of those ___% of pts develop Heart Failure and cardiogenic shock

inadequate blood flow causes what 2 organs to fail?

A

75%

60%

kidney, brain

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7
Q

% pts that undergo complete heart failure due to V-fib/heart block/pump failure during MI

A

25%

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8
Q

In a Transmural MI, the infarction involves what layers?

Additionally?

A

all 3

free wall Lt ventricle and Interventricular septum

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9
Q

Subendocardial/Intramural MI the infarction is usually concentric around what layer?

where?

A

subendocardial layer

left ventricle

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10
Q

What type of MI is more common (vast majority of MI’s)

A

Transmural

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11
Q

The vast majority of coronary blockages (over 50%) are in what artery?

A

LAD

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12
Q

An MI due to a Thrombus will only occur in what instance?

A

Preceding atherosclerotic plaque blocking greater than 75%

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13
Q

Cardiac Tamponade: after _____ cc fills sac every heart beat

Left Ventricular Aneurism: myocardial infarcts replaced with _____ and _________ tissue that can bulge under pressure and form aneurism

In left ventricular aneurism, the heart contracts _______ b/c fibrous tissue forming wall does not contract

Mural Thrombus: endocardium overlying infarct is damaged, blood coagulates, causes ______

A

300-350 cc

granulation / fibrous tissue

irregularly

necrosis/thrombus

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14
Q

There is a relationship between atherosclerosis, MI’s, and poor dental health

A

True

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15
Q

The mechanism that relates atherosclerosis, MI’s, and poor dental health are _________ infections due to caries, perio, __________, and blood coagulation

A

gram-negative bacterial

plasma lipoproteins

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16
Q

Dental caries and ischemic heart disease share low SES, smoking, diabetes as comorbidities

A

True

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17
Q

High consumption of sucrose = atherosclerosis and caries

A

True

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18
Q

Dental caries/perio more common in pts w/ MI’s among controls matched for age/sex

A

True

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19
Q

Acute Bacterial Endocarditis (ABE) due to:

Subacute Bacterial Endocarditis (SBE) due to:

A

S. aureus or G-‘s

Viridans Strept (S. mutans/S. mitis) - Caries!!!

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20
Q

What type of endocarditis is caused by same bugs that cause dental caries?

A

SBE (subacute)

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21
Q

What side of the heart will ABE and SBE most likely occur?

What specific valves?

A

Left

mitral, aortic semilunar

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22
Q

Vegetations in ABE or SBE are highly infected, big, and can occur anywhere on or near the valve, chorda tendinae, etc (not restricted)

A

True

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23
Q

Endocarditis in IVDA’s is caused by what bug?

Occurs in what valve?

1st Organ these vegetations go to?

A

Staph aureus (50-60%)

Tricuspid (Right side of the heart)

Lung

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24
Q

What bug causes the vast majority of Prosthetic Valve Endocarditis?

What bug damages previously damaged/otherwise abnormal heart valves?

What bug damages normal heart valves (and prosth/IVDA):

ABE and SBE are both caused by:

A

Staph epidermidis

Viridans strep

Staph aureus

Gram positives (Staph. aureus/Strept Viridans)

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25
Q

90% of endocarditis can be isolated by blood culture unless Abx were given prior

A

True

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26
Q

3 skin manifestations of infective endocarditis:

A

Splinter hemorrhages

Osler’s nodes

Jane Way lesions

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27
Q

Splinter hemorrhages are linear hemorrhages seen where?

Osler nodes are tender, small, raised, discolored cutaneous lesions seen where?

Jane Way lesions are small, erythematous/hemorrhagic lesions seen where?

A

under nails (subungual)

pads fingers/toes

palms/soles

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28
Q

What 4 procedures get pre-op Abx?

*AHA recommendations

A

Prosthetic heart valves

Hx infective endocarditis

Congenital heart defects/prosthetic repair

Valvulopathy after heart transplant

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29
Q

Give pre-op pts _______

How long prior?

A

oral amoxicillin

30-60 minutes

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30
Q

What are the 3 compensatory mechanisms to CHF?

A

Increase sympathetic stimulation

Fluid retention

Cardiac hypertrophy (left ventricle)

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31
Q

CHF is failure of the heart as a pump

A

True

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32
Q

Causes of CHF most often due to what 4 conditions?

*Left-sided HF

A

ischemic heart disease

HTN

aortic/mitral valve disease

mon-ischemic myocardial disease

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33
Q

CHF has a characteristic pathology of enlargment of what part of the heart?

may cause atrial _______ with blood ______ and possible _______ formation w/ chance of emboli

Pulmonary congestion/edema w/ heavy/wet lungs and “heart failure cells”

A

LV

fibrillation, stasis, thrombus

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34
Q

What is the main reason #1 cause the right side of the heart fails?

Causes congestion of what?

A

Left side fails

peripheral organs (nutmeg liver, edema, ascites, etc)

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35
Q

Stroke is a result of a compensatory mechanism of the body

A

False

*NOT compesatory

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36
Q

Left HF:

Right HF:

A

LV hypertrophy, pulmonary congestion

Left side fails, peripheral back-up

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37
Q

RAS (renin angiotensin system) is one of the main causes of what?

Regulates what 2 things?

*decrease Renal flow/Renin released/ACE converts AngI to II/II is a vasoconstrictor/increases blood flow/bp/renal flow

A

HTN

plasma Na and arterial BP

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38
Q

Primary HTN, greater than ___% pts have no specific cause

Risk factors:

Secondary HTN represents ____% of cases

Causes:

A

90%

age, race, stress, genetics, salt, obesity, RAS

less than 10%

disease/medication/pregnancy

39
Q

What type of HTN is most often seen in middle-aged Black Males?

A

Malignant HTN

*accelerated, potentially fatal, 5-10% of cases

40
Q

Malignant HTN will cause hemmorhage in what organ?

A

Kidney

  • punctate
  • **black males
41
Q

2 Calcium channel blockers:

Used for:

side effect:

A

Procardia, Nifedipine

HTN

gingival hyperplasia

42
Q

Epinephrine can cause what 4 things?

A

hypertensive crisis

angina pectoris

MI

Cardiac arrythmias

43
Q

Some HTN meds can cause altered sense of taste, aka…

A

dysgeusia

44
Q

Islets of Langerhans, Alpha cells secrete/%:

Beta cells/%:

Delta cells/%:

*3 types of Islets!!!

A

Glucagon, 20%

Insulin, 70%

Somatostatin, 10%

45
Q

Type I diabetes antibodies destroy what?

Type II islets:

A

beta cells

islets normal or increased in size

46
Q

Ketoacidosis results from what 2 things?

A

inadequate fat utilization

reduced lipogenesis

FFA to Ketones

47
Q

TypeII: B/c decreased lipogenesis, ____ is converted to Ketones, causing what?

A

FFA

acidosis

= ketoacidosis

48
Q

6 signs of Diabetes:

A

glucosuria (sweet pee)

polyuria (pee much)

polydipsia (thirst)

ketogenesis

osmotic diuresis

anaerobic glycolysis

49
Q

In diabetes, what system is responsible for most morbidity/mortality?

2 reasons:

A

Cardiac

Microangiopathy, Atherosclerosis of coronaries

50
Q

Insulin is stored in Beta Cells in _______ granules

A

Neurosecretory

51
Q

1 word that typifies the pathology of Diabetes:

A

Microangiopathy

52
Q

Lack of Thyroid hormones in children?

2x common in:

what levels low?

What levels high?

A

Cretinism (can be endemic/sporadic/genetic)

females

T4/T3

TSH

53
Q

2 Thyroid diseases - hyper/hypo / antibodies

A

Graves - Hyper - TSH receptors increase

Hashimoto - Hypo - destroys receptors

***both IgG

54
Q

Autoimmune diseases are all more common in:

A

women

55
Q

Hashimoto’s has a ___% increase in _____

*this is not present in Graves

A

40%

B-cell lymphoma

56
Q

Most prevalent Autoimmune disease in the US?

A

Graves

57
Q

Graves and Hashimotos are both Autoimmune

Therefore, what else would be in the tissues?

A

True

lymphocytes (lots)

58
Q

1 cause of Nodular Goiter

A

Idiopathic

59
Q

A Toxic Goiter is…

Non-toxic…

A

Functional

euthyroid/non-functional

60
Q

Hyperthyroidism, increased _____, sweat, and intolerant of ______

Hypothyroidism, tired, sensitivity to ______

A

apetite, heat

cold

61
Q

Graves, low levels of..

high levels…

IgG antibodies stimulate what receptors?

A

TSH

T4, T34

TSH receptors on follicles

62
Q

Cushing Syndrome:

Cushing Disease:

A

Adrenal

Pituitary (exogenous)

63
Q

Hyperfunctioning Adrenal:

Hypofunctioning Adrenal:

*cortex

A

Cushing Syndrome

Addison’s Disease

64
Q

Which Adrenal glucocorticoid disease is Autoimmune?

A

Addison’s

*hypofunctioning

65
Q

Which Cushing is more common?

A

Cushing Disease 5x (pituitary)

66
Q

Cushing Disease (pituitary) most seen in what demographic:

excessive ectopic production of ______ lead to adrenal cortical hyperplasia

A

middle aged women (25-45)

ACTH

67
Q

What is the most common cause of Cushing Syndrome in the US?

2nd most common:

A

over prescription of Steroids

paraneoplastic lung cancer effects

68
Q

What test differentiates Cushing Disease from Cushing Syndrome?

A

Dexamethasone suppression test

69
Q

Addison’s disease presents w/ weakness, fatigue, weight loss, anorexia, nausea, personality changes:

Affects blood how:

Tan pigment from

A

True

Hypoglycemic, electrolyte imbalace

ACTH precursor is a Melanocyte stimulating hormone

70
Q

3 physical Characteristics of Cushing’s Disease:

Osteoporosis occurs in ___% of pts

Glucose intolerance/diabetes/HTN/CHF common

A

Moon face, buffalo hump, abdominal striae

75%

True

71
Q

What G- causes Waterhouse-Friedrickson Syndrome?

A

Neisseria meningitidis

72
Q

Neisseria meningiditis speticemia causes what Syndrome?

This bacteria is Gram ____

A

Waterhouse-Friedrickson

negative

73
Q

What kills pt w/ Waterhouse-Friedrickson syndrome?

aka…

this disease destroys acutely,

What is the final insult?

A

Bilateral adrenal hemmorhage, infarction, rupture

Acute meningococcemia

True

Both Adrenals Rupture

74
Q

Rare neoplasm of Chromaffin Cells in the adrenal medulla that synthesized/releases catecholamines:

A

Pheochromocytoma

75
Q

Pheochromocytoma is more frequent in…

Presents clinically w/ abrupt…

Pathogenesis is _____ bound dense core granules and minority are _____

A

women

HTN, tachycardia, palpitations, sweating, tremor, abdominal/chest pain

membrane, familial

76
Q

Etiology of MS is…

3 possibilities:

A

Unknown

genetic, immune, infection

77
Q

Parkinson’s Disease is a neurotransmitter deficiency in what?

and pathological loss of neurons in the _______

A

Dopamine

Substantia Nigra

78
Q

Parkinson’s mostly idiopathic, what are the Gross features are Pigmentation loss in what 2 areas?

Microscopic?

Clinical:

A

Substantia nigra, locus ceruleus

pigmented neurons scarce, melanin deposits, Lewy Bodies

Increased Drooling, Mask-face, Cogwheel rigidity, pill rolling tremor

79
Q

Von Economo Encephalitis was an influenza epidemic in 1916-1920 and caused what in the survivors?

A

Parkinson’s

80
Q

Lewy Body: residual atrophic _______ cell containing ______, ______, and _______ cytoplasmic inclusions

Pick Body: expressed clinically as ______ and is indistinguishable from ______

A

Nerve, Spherical, Granular, Eosinophilic

Dementia, Alzheimers

81
Q

4 Clinical Features of Parkinson’s

A

Increased Drooling

Mask-like face

Cogwheel rigidity

Pill rolling tremor

82
Q

What class of drugs can cause Parkinsonian type syndrome to occur?

*2 of them

A

Phenothiazine

Haldol

83
Q

75% HTN related hemorrhages are found in what general area of the brain?

Specific?

A

Basal ganglia

Thalamus

84
Q

Berry Aneurism occurs where in brain?

Rupture causes what?

Sudden severe headache followed by _____

A

Anterior circulation

subarachnoid hemorrhage

coma

85
Q

What is the name of aneurysms seen in HTN bleeds?

A

Charcot-Bouchard

86
Q

Fresh stroke:

Old stroke (cerebral infarct)

A

liquefactive necrosis (soft)

astrogliosis with cyst formation

87
Q

What is the etiology of a Berry Aneurism?

A

Congenital (90%)

88
Q

Underlying etiology of Stroke is a blockage where?

*can be progressive atherosclerosis

A

Circle of Willis

89
Q

What does a big clot in the Striate Arteries cause?

A

Hemiparesis or Hemiplegia

90
Q

Alzheimers is progressive, loss of memory, occurs in what part of the brain?

what sex more often?

***Chromosome ____ is where Alz gene found

Senile plaques with an _____ core

A

Hippocampus

Women

21

Amyloid

91
Q

Hydrocephalus ex Vacuo

A

Loss of brain Parenchyma makes lateral ventricles appear dilated

92
Q

In Alzheimers the ______ narrow and the _____ widen

Amyloid Angiopathy found with ____ red stains

Neurofibrillary tangles: bundles of paired, _____ filaments in the cytoplasm of cortical neurons/hippocampal pyramidal cells displace/encircle nucleus

A

gyri, sulci

congo

helical

93
Q

Vast majority of Alzheimer disease found in what area of the brain?

A

Hippocampus

*senile plaques, tangles, amyloid all found here

Tim's Cards (140 decks)

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