Oral Medicine II - fishyfishy Flashcards
4 Types of COPD
Chronic Bronchitis
Emphysema
Bronchial Asthma
Bronchiectasis
Define Chronic Bronchitis
Chronic cough
Sputum production minimum 3 months/year
For 2 Consecutive years
Smoking is the main cause of Chronic bronchitis in ___% of cases
90%
Chronic Bronchitis is due to hypertrophy of what?
The mucosa is infiltrated w/ lymphocytes, macrophage, and plasma cells, but no…
Surface epithelium may undergo metaplasia from columnar to…
Bronchial mucous glands
neutrophils
stratified squamous
Chronic Bronchitis can result in what type of heart failure?
*This leads to what?
Right heart failure
aka Cor Pulmonale
*venous stagnation/cyanosis
Blue Bloaters
Pink Puffers
Chronic Bronchitis
Emphysema
Blebs appear on the ____ surface of the lung
Bullae appear in the _____ of the lung
Both are associated with what?
pleural
parenchyma (greater than 1 cm)
Emphysema
What causes the actual breakdown of lung tissue in Emphysema?
Proteases from bacteria, PMN’s, monocytes, macrophage
*destroys Elastin/Reticular figers
Which COPD has Curschmann Spirals?
Bronchial Asthma
Bronchial asthma has many mucosal infiltrates which include…
Mucous sometimes contain whorls of shed epithelial cells called _______ which are seen microscopically
Eosinophils
Curshmann’s spirals
Bronchiectasis is a ______ of the bronchi
This is the most common complication of chronic _____
Bronchi/Bronchioles are filled with ______ that stagnates and can’t be cleared with coughing
Permanent Dilation
Chronic Bronchitis
Mucopurulent
Hx COPD, difficulty breathing, severe halitosis, respiratory attack, what does the pt have?
Bronchioectasis
2 Ways to get Emphysema:
Smoking
Genetic (Alpha 1 antitrypsin deficient)
Alpha 1 Antitrypsin is a ________
If you don’t have it what happens?
anti-protease
protease destroys lung tissue
***primary function is to neutralize naturally occurring proteases
As opposed to an Alpha 1 Antitrypsin deficiency, in a smoker what causes Emphysema?
Inflammatory mediators release elastases
Destroys elastic tissue of the alveolar sac
Usually COPD is related to Pneumonia and Oral Health via
Cigarette smoking
Onset of COPD is dependent on smoking (almost always) and repeated _________ can worsen the disease
______ bacteria can travel to the lungs
Teeth bacteria are ______ and lead to pneumonia in smokers w/ COPD
bacterial infections (pneumonia)
Periodontal
Strep Viridans
Genus, Species for legionella
It is a G___
American Legion in Philly caused pneumonia via inhalation from humidifiers, thus spread requires…
Legionella pneumophilia
gram negative rod
man-made water based environments
What Gram Positive is associated with Pulmonary Abscesses?
Stapylococcus aureus
*virulent organisms
Rust Colored Sputum:
Current Jelly Sputum:
**both cause pneumonias, remember, G-‘s can be just as bad as S. aureus
Pneumococcal/Streptococcus pneumoniae (Gram +)
Klebsiella pneumonia (Gram -)
4 different routes that can cause Pneumonias:
Airborne - inhalation of droplets
Aspiration of gastric infected particles
Aspiration of infected Upper Resp Tract (strep/staph)
Hematogenous spread - sepsis, UTI, GI infections
mycoplasma pneumonia =
mycobacterium tb -
Klebsiella
Tuberculosis
Interstitial pneumonias:
Broncho (alveolar) pneumonias:
Viral
Bacteria
Alveolar (broncho) pneumonia can be _______
Interstitial (viral) affects _____
diffuse/lobular
wall of alveoli
There is an association between ______ pneumonia and Periodontal Disease
This is b/c long-term ______ causes S. aureus, Pseudomonas, Kebsiella to gather in oral cavity
What happens to these pathogens?
nosocomial
Abx
Aspirated to lungs (poor cough/gag reflex)
TB stains how?
_____ acid that is anti-phagocytic
It causes what in the lungs?
Acid Fast
Mycolic
Caseating granulomas
2:
Most common portal of entry for TB:
Respiratory
GI
TB infecting Cervical Lymph nodes:
Scroffula
Initial lung lesion of TB that appears in the lower lobes:
_____ lung lesion draining to ______ (combines to form this thing)
Gohn Complex
subpleural, hilar lymph node
Primary TB starts with what?
***when pt First Exposed
Gohn Complex
Pott’s Disease is a form of ______ TB
TB can appear where?
Causing what?
milliary
Vertebrae (interevertebral joints)
Arthritis
Tuberculoma:
mimics:
Well-defined ____ mass
Most common occurs in what 2 areas?
TB conglomerates Tubercles into Firm Lump
cancer
focal
Brain/Lung
PPD:
Used for:
Purified Protein Derivative
TB skin test
*makes wheal
AFB:
Used for:
Acid Fast Bacilli
staining TB cells
BCG:
Skin test implications:
TB immunization used outside US
positive for skin test but negative for TB
INH
Isoniazid
TB tx
Primary TB:
Secondary TB:
Gohn Complex, in immunosuppressed out of control
Reactivation spreads to Apex
Non-productive, dry cough, low-grade fever, no appetit, minor hemoptysis
Secondary TB
Tubercobacillus secretes toxins
False
***we secrete those to keep it in check
The part of our immunity that drives the response to TB:
There is no:
cell-mediated
Antibodies (IgG, etc)
What type of hypersensitivity is seen in the NRL (Natural Rubber Latex) protein allergy?
What Antibody is involved?
Type 1 hypersensitivity
IgE
NRL second exposure is IgE + degranulation =
release of histamine
What type of hypersensitivity Rxn is seen in ACD (Allergic Contact Dermatitis)?
Cell that mediates:
Type IV delayed
T-cell lymphocyte (cell mediated)
*no plasma cells (b cells)
ICD is what kind of rxn?
due to:
non-hypersensitivity
inflammation of physical/mechanical/chemical irritation
**no immune cells involved
Type I hypersensitivity rxn
Type IV delayed hypersensitivity rxn
inflammation rxn (no hypersensitiviy)
NRL - natural rubber latex
ACD - allergy contact dermatitis
ICD - irritant contact dermatitis
Glutaraldehyde:
Donning Powder:
Both can cause:
Cleaning disinfectant
Irritant
ICD
Glutaraldehyde can cause ICD/ACD
True
Bonding agents contain ______, which can cause ACD
methacrylates
2 kinds of Hiatal Hernia:
Which is Tx w/ surgery?
Sliding (95%) (medically treated)
Paraesophageal - SURGICAL
Hiatal hernia is a separation in the _______
Diaphragm
Which Hiatal Hernia is associated with Reflux Esophagitis?
Sliding
*95%, medically Tx
In a Hiatal Hernia the stomach goes up into the Thorax and when the pt ______ the symptoms are worse
Lays down
Paraesophageal (hiatal) hernia progressively enlarges and the cause in unknown
True
Candida Esophagitis:
Herpes Esophagitis:
CMV Esophagitis:
AIDS/immunocompromised
HSV1, Lymphoma/Leukemia, vescicular, PINK
AIDS/Basophilic inclusion bodies, not in Epithelium (in endothelial cells and fibroblasts of granulation tissue)
*all 3 can be due to HIV
Candida Esophagitis:
Herpes Esophagitis:
CMV Esophagitis:
Pseudohyphae
Acidophilic internuclear inclusions
Basophilic internuclear inclusions
Barrett’s esophagus metaplastic chain:
Squamous cell epithelium replaces with
Columnar epithelium
Adenocarcinoma (from stomach, not squamous of esophagus)
Barrett’s occurs where?
lower 1/3 of esophagus
- white men
- 2x smokers
How does healing occur in Barrett’s Esophagitis?
??
2 types of PUD (peptic ulcer disease)
Gastric ulcers
Duodenal ulcers
What bacteria causes Gastric/Duodenal ulcers of PUD?
common factor besides this
Helicobacter pylori
HCl over secretion
Duodenal Ulcer peak age:
Gastric:
Duodenal ulcer sex distribution:
Gastric:
30-60
middle and elderly more than younger
male
both
O blood has an association w/ what ulcer?
how much higher?
Duodenal
*30% higher
___% of pts w/ gastric ulcers harbor H. pylori
75%
Which ulcer has kissing pairs?
Duodenal
All racial/ethnic groups equally susceptible to ulcers in US
what liver disease is associated?
aspirin/nsaids/corticosteroids associated
Malignant transformation occur commonly:
True
Cirrhosis/alcohol
True
False (only 1%)
PUD associated w/ cigarettes
True
4 features of Crohn’s Disease:
Skip lesions
Transmural inflamation
Ulcerations
Fissures
2 features of CUC (chronic ulcerative colitis)
Pseudopolyp
Ulcer
Crohn’s vs. CUC: which has pseudopolyps?
fistula formation?
Transmural inflammation?
Cobblestoning?
rubber hose fibrosis?
toxic megacolon?
higher malignant transformation?
higher bleeding?
Granulomas?
Skip lesions?
Diffuse?
CUC
Crohn’s
Crohn’s
Crohn’s
Crohn’s
CUC
CUC
CUC
Crohn’s
Crohn’s
CUC
What is not seen in CUC, but is diagnostic in Crohn’s?
non-caseating Granulomas
Crohn’s is a chronic inflammation of the GI that most often involves the _____ and ______
terminal ileum
colon
Granuloma’s seen in Crohn’s causes the wall to thicken and become rigid, termed
also has ____ on the surface of the serosa
lesions?
adjacent adhesion:
Rubber-Hose Fibrosis
Creeping Fat
Skip
fistula
CUC most often involves the _____
unlike Crohn’s, CUC location:
Usually does not extend into ileum, but there is
colon
diffuse
backwash ileitis
CUC is not transmural but is limited to what 2 layers?
Mucosa shows what?
spread of these ulcerations create?
mucosa/submucosa
crypt abscesses
inflammatory pseudopolyps
Most significant late complication of CUC:
70%
20%
10%
malignant transformation
chronic
fulminant (surgery)
single episode
Left side of colon:
Right side of colon:
CUC
Crohn’s
CUC ulcers:
Crohn’s ulcers:
wide/diffuse/pseudopolyps
linear/cobblestones
more friable and bleed more:
colonic wall thinner:
thicker:
higher risk of cancer:
CUC
CUC - toxic megacolon
Crohns - transmural inflammation
CUC
Extraintestinal complications Crohn’s vs CUC
name 3
same
*arthritis, eye lesions, skin lesions
