Oral Medicine I - fishing again Flashcards
Occlusion of the Right Coronary Artery causes an infarct in what 2 areas of the heart?
Right ventricle
Posterior wall Left Ventricle
Where do coronary artery occlusions happen most often?
3 locations
LAD (left anterior descending): over 50%
RCA (right coronary artery): 30-40%
Left Circumflex Artery: 10-20%
RCA goes to:
LAD:
Left Circumflex:
posterior wall and right ventricle
anterior wall
lateral wall of left ventricle
LAD is the artery of…
Sudden Death
What are the 3 complications of an MI?
Ventricular (myocardial) Rupture (5-7 days after)
Cardiac Tamponade
Left Ventricular Aneurism
Mural Thrombus
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?
75%
60%
kidney, brain
% pts that undergo complete heart failure due to V-fib/heart block/pump failure during MI
25%
In a Transmural MI, the infarction involves what layers?
Additionally?
all 3
free wall Lt ventricle and Interventricular septum
Subendocardial/Intramural MI the infarction is usually concentric around what layer?
where?
subendocardial layer
left ventricle
What type of MI is more common (vast majority of MI’s)
Transmural
The vast majority of coronary blockages (over 50%) are in what artery?
LAD
An MI due to a Thrombus will only occur in what instance?
Preceding atherosclerotic plaque blocking greater than 75%
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 ______
300-350 cc
granulation / fibrous tissue
irregularly
necrosis/thrombus
There is a relationship between atherosclerosis, MI’s, and poor dental health
True
The mechanism that relates atherosclerosis, MI’s, and poor dental health are _________ infections due to caries, perio, __________, and blood coagulation
gram-negative bacterial
plasma lipoproteins
Dental caries and ischemic heart disease share low SES, smoking, diabetes as comorbidities
True
High consumption of sucrose = atherosclerosis and caries
True
Dental caries/perio more common in pts w/ MI’s among controls matched for age/sex
True
Acute Bacterial Endocarditis (ABE) due to:
Subacute Bacterial Endocarditis (SBE) due to:
S. aureus or G-‘s
Viridans Strept (S. mutans/S. mitis) - Caries!!!
What type of endocarditis is caused by same bugs that cause dental caries?
SBE (subacute)
What side of the heart will ABE and SBE most likely occur?
What specific valves?
Left
mitral, aortic semilunar
Vegetations in ABE or SBE are highly infected, big, and can occur anywhere on or near the valve, chorda tendinae, etc (not restricted)
True
Endocarditis in IVDA’s is caused by what bug?
Occurs in what valve?
1st Organ these vegetations go to?
Staph aureus (50-60%)
Tricuspid (Right side of the heart)
Lung
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:
Staph epidermidis
Viridans strep
Staph aureus
Gram positives (Staph. aureus/Strept Viridans)
90% of endocarditis can be isolated by blood culture unless Abx were given prior
True
3 skin manifestations of infective endocarditis:
Splinter hemorrhages
Osler’s nodes
Jane Way lesions
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?
under nails (subungual)
pads fingers/toes
palms/soles
What 4 procedures get pre-op Abx?
*AHA recommendations
Prosthetic heart valves
Hx infective endocarditis
Congenital heart defects/prosthetic repair
Valvulopathy after heart transplant
Give pre-op pts _______
How long prior?
oral amoxicillin
30-60 minutes
What are the 3 compensatory mechanisms to CHF?
Increase sympathetic stimulation
Fluid retention
Cardiac hypertrophy (left ventricle)
CHF is failure of the heart as a pump
True
Causes of CHF most often due to what 4 conditions?
*Left-sided HF
ischemic heart disease
HTN
aortic/mitral valve disease
mon-ischemic myocardial disease
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”
LV
fibrillation, stasis, thrombus
What is the main reason #1 cause the right side of the heart fails?
Causes congestion of what?
Left side fails
peripheral organs (nutmeg liver, edema, ascites, etc)
Stroke is a result of a compensatory mechanism of the body
False
*NOT compesatory
Left HF:
Right HF:
LV hypertrophy, pulmonary congestion
Left side fails, peripheral back-up
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
HTN
plasma Na and arterial BP
Primary HTN, greater than ___% pts have no specific cause
Risk factors:
Secondary HTN represents ____% of cases
Causes:
90%
age, race, stress, genetics, salt, obesity, RAS
less than 10%
disease/medication/pregnancy
What type of HTN is most often seen in middle-aged Black Males?
Malignant HTN
*accelerated, potentially fatal, 5-10% of cases
Malignant HTN will cause hemmorhage in what organ?
Kidney
- punctate
- **black males
2 Calcium channel blockers:
Used for:
side effect:
Procardia, Nifedipine
HTN
gingival hyperplasia
Epinephrine can cause what 4 things?
hypertensive crisis
angina pectoris
MI
Cardiac arrythmias
Some HTN meds can cause altered sense of taste, aka…
dysgeusia
Islets of Langerhans, Alpha cells secrete/%:
Beta cells/%:
Delta cells/%:
*3 types of Islets!!!
Glucagon, 20%
Insulin, 70%
Somatostatin, 10%
Type I diabetes antibodies destroy what?
Type II islets:
beta cells
islets normal or increased in size
Ketoacidosis results from what 2 things?
inadequate fat utilization
reduced lipogenesis
FFA to Ketones
TypeII: B/c decreased lipogenesis, ____ is converted to Ketones, causing what?
FFA
acidosis
= ketoacidosis
6 signs of Diabetes:
glucosuria (sweet pee)
polyuria (pee much)
polydipsia (thirst)
ketogenesis
osmotic diuresis
anaerobic glycolysis
In diabetes, what system is responsible for most morbidity/mortality?
2 reasons:
Cardiac
Microangiopathy, Atherosclerosis of coronaries
Insulin is stored in Beta Cells in _______ granules
Neurosecretory
1 word that typifies the pathology of Diabetes:
Microangiopathy
Lack of Thyroid hormones in children?
2x common in:
what levels low?
What levels high?
Cretinism (can be endemic/sporadic/genetic)
females
T4/T3
TSH
2 Thyroid diseases - hyper/hypo / antibodies
Graves - Hyper - TSH receptors increase
Hashimoto - Hypo - destroys receptors
***both IgG
Autoimmune diseases are all more common in:
women
Hashimoto’s has a ___% increase in _____
*this is not present in Graves
40%
B-cell lymphoma
Most prevalent Autoimmune disease in the US?
Graves
Graves and Hashimotos are both Autoimmune
Therefore, what else would be in the tissues?
True
lymphocytes (lots)
1 cause of Nodular Goiter
Idiopathic
A Toxic Goiter is…
Non-toxic…
Functional
euthyroid/non-functional
Hyperthyroidism, increased _____, sweat, and intolerant of ______
Hypothyroidism, tired, sensitivity to ______
apetite, heat
cold
Graves, low levels of..
high levels…
IgG antibodies stimulate what receptors?
TSH
T4, T34
TSH receptors on follicles
Cushing Syndrome:
Cushing Disease:
Adrenal
Pituitary (exogenous)
Hyperfunctioning Adrenal:
Hypofunctioning Adrenal:
*cortex
Cushing Syndrome
Addison’s Disease
Which Adrenal glucocorticoid disease is Autoimmune?
Addison’s
*hypofunctioning
Which Cushing is more common?
Cushing Disease 5x (pituitary)
Cushing Disease (pituitary) most seen in what demographic:
excessive ectopic production of ______ lead to adrenal cortical hyperplasia
middle aged women (25-45)
ACTH
What is the most common cause of Cushing Syndrome in the US?
2nd most common:
over prescription of Steroids
paraneoplastic lung cancer effects
What test differentiates Cushing Disease from Cushing Syndrome?
Dexamethasone suppression test
Addison’s disease presents w/ weakness, fatigue, weight loss, anorexia, nausea, personality changes:
Affects blood how:
Tan pigment from
True
Hypoglycemic, electrolyte imbalace
ACTH precursor is a Melanocyte stimulating hormone
3 physical Characteristics of Cushing’s Disease:
Osteoporosis occurs in ___% of pts
Glucose intolerance/diabetes/HTN/CHF common
Moon face, buffalo hump, abdominal striae
75%
True
What G- causes Waterhouse-Friedrickson Syndrome?
Neisseria meningitidis
Neisseria meningiditis speticemia causes what Syndrome?
This bacteria is Gram ____
Waterhouse-Friedrickson
negative
What kills pt w/ Waterhouse-Friedrickson syndrome?
aka…
this disease destroys acutely,
What is the final insult?
Bilateral adrenal hemmorhage, infarction, rupture
Acute meningococcemia
True
Both Adrenals Rupture
Rare neoplasm of Chromaffin Cells in the adrenal medulla that synthesized/releases catecholamines:
Pheochromocytoma
Pheochromocytoma is more frequent in…
Presents clinically w/ abrupt…
Pathogenesis is _____ bound dense core granules and minority are _____
women
HTN, tachycardia, palpitations, sweating, tremor, abdominal/chest pain
membrane, familial
Etiology of MS is…
3 possibilities:
Unknown
genetic, immune, infection
Parkinson’s Disease is a neurotransmitter deficiency in what?
and pathological loss of neurons in the _______
Dopamine
Substantia Nigra
Parkinson’s mostly idiopathic, what are the Gross features are Pigmentation loss in what 2 areas?
Microscopic?
Clinical:
Substantia nigra, locus ceruleus
pigmented neurons scarce, melanin deposits, Lewy Bodies
Increased Drooling, Mask-face, Cogwheel rigidity, pill rolling tremor
Von Economo Encephalitis was an influenza epidemic in 1916-1920 and caused what in the survivors?
Parkinson’s
Lewy Body: residual atrophic _______ cell containing ______, ______, and _______ cytoplasmic inclusions
Pick Body: expressed clinically as ______ and is indistinguishable from ______
Nerve, Spherical, Granular, Eosinophilic
Dementia, Alzheimers
4 Clinical Features of Parkinson’s
Increased Drooling
Mask-like face
Cogwheel rigidity
Pill rolling tremor
What class of drugs can cause Parkinsonian type syndrome to occur?
*2 of them
Phenothiazine
Haldol
75% HTN related hemorrhages are found in what general area of the brain?
Specific?
Basal ganglia
Thalamus
Berry Aneurism occurs where in brain?
Rupture causes what?
Sudden severe headache followed by _____
Anterior circulation
subarachnoid hemorrhage
coma
What is the name of aneurysms seen in HTN bleeds?
Charcot-Bouchard
Fresh stroke:
Old stroke (cerebral infarct)
liquefactive necrosis (soft)
astrogliosis with cyst formation
What is the etiology of a Berry Aneurism?
Congenital (90%)
Underlying etiology of Stroke is a blockage where?
*can be progressive atherosclerosis
Circle of Willis
What does a big clot in the Striate Arteries cause?
Hemiparesis or Hemiplegia
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
Hippocampus
Women
21
Amyloid
Hydrocephalus ex Vacuo
Loss of brain Parenchyma makes lateral ventricles appear dilated
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
gyri, sulci
congo
helical
Vast majority of Alzheimer disease found in what area of the brain?
Hippocampus
*senile plaques, tangles, amyloid all found here
