Oral Medicine III - Fishiale Flashcards by Tim Agee

Aplastic Anemia is a ______anemia

due to bone marrow ____ or _____

A common cause of what?

normocytic

hypoplasia, aplasia

Pancytopenia

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What is the complication of Pancytopenia?

This is due to different anemias causing what 3 symptoms?

Pancytopenia leads to anemia, ______ and ______ due to leukopenia

Bleeding disorders

weakness, fainting, lethargy

thrombocytopenia, infection

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Aplastic Anemia is ____ idiopathic

Secondary due to bone marrow suppression drugs or what 4 other causes?

2/3

Cytotoxic drugs (nsaids/chemo/anticonvulsants)

Viral infection (CMV, EBV, HIV)

Radiation therapy

Benzene

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Only known Tx for idiopathic aplastic anemia:

secondary anemia:

Marrow transplant

remove cause (Benzene, etc)

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Megaloblastic anemias are caused by what?

RBC’s look like…

Deficient B12 or Folic Acid

megaloblasts, large, Blue Inclusions (basophilic stippling)

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Most common type of Megaloblastic Anemia?

Define:

Pernicious anemia

no IF, no B12 absorption

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Groups more likely to get Pernicious Anemia:

Most common in what stage of life?

Rare when?

Irish, English, Scandinavian

late in adult life

under 30

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A genetic predisposition is suspected in pernicious anemia, but not proven

True

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What condition often accompanies Pernicious Anemia?

This may explain the pathogenesis via what mechanism?

Atrophic Gastritis

alcohol/tobacco

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No IF in pernicious anemia is due to what?

no gastric parietal cells

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Extravascular Hemolysis:

_____ is converted to ______

by the ________ at a RATE LIMITING STEP

causes what 2 things?

overabundance of RBC’s destroyed in Spleen

HEME to Bilirubin

Liver

Hyperbilirubinemia, Jaundice

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What happens in Mononuclear Phagocytic cells of the Spleen?

Extravascular Hemolysis

*not intravascular

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90% of pts with Pernicious Anemia have what?

Antibodies to Parietal cells

*no IF

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Diagnosis of Pernicious Anemia:

Schilling Test

radioactive Cobalamine absorption

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IF + B12 complex usually absorbed where?

If Pernicious Anemia bad enough what can happen?

CNS lesions found in 3/4 of cases, partial gastrectomy possible, and dreaded _____

terminal ileum small intestine

Heart Failure

fish tapeworm infection

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Lack of Folic Acid (other megaloblastic anemia) is due to what 3 conditions?

Pregnancy

Alcoholics

Malnourished

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What is a reason for Intravascular hemolysis?

Mismatched blood transfusion

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What is the most common type of Anemia?

Bone marrow is…

blood cells are…

Iron Deficiency

Hyperplastic

Hypochromic, Microcytic

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Antidote for Heavy metal poisoning by thallium and radioactive caesium, orally administered.

Also test for Iron Deficiency

Prussian Blue

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Space occupying lesions destroying marrow (cancer)

Myelophthistic Anemia

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Most common human enzyme defect anemia:

G6PD deficiency anemia

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Anemia of Mediterranean

Alpha chromo

Beta chromo

Thalassemia

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Pathogenesis, Sickle Cell anemia substitution:

At position:

What chain:

Valine replaces Glutamic Acid

Beta chain Hb

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Sickling Crisis brought about by what?

Causes what?

spontaneously, fever, hypoxia

Infarcts (neuro, bones, spleen, extremities)

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Consequence of Sickling Crisis infarcts to Spleen?

Fibrotic Autosplenectomy

3 Physical consequences to Sickle Cell?

Skull bossing (marrow hyperplasia, "hair on end") Dactylitis (back of hand swelling) Infections

Normal is Hb A Sickle cell is Hb S

True

Unlike B12, Folate doesn't need: Folate deficiency, no _____ signs/symptoms Folate seen in ______ compared to B12

IF neuro Prego

Folic Acid Deficiency more common than B12 deficiency Symptoms similar, except what?

True no Neuro in Folic

Spontaneous, or can be aggravated by Fever, Resp distress, other hypoxia

Hemolytic/Vasoocclusive Crisis

Iron Deficiency is #1 cause of Anemia, what is #1 cause of Iron deficiency?

Acute Blood Loss

Reason for Iron Deficiency Anemia in Males: in Females, _____ , then ______ #1 cause Fe anemia:

GI Reproductive, GI acute blood loss

Sickle Cell can cause what in the Spleen? Bones: Backs of Hands/Feet: Increased...

Autosplenectomy Hair on End (bossing) Dactylitis in children Infections (facilitated by Spleen/Liver)

3 Ways Pernicious Anemia is Diagnosed:

Low B12 Schilling Test (Oral Cyanobobalamine) Over 90% antibodies to IF from Parietal Cells

What are the 2 most common reasons for Microcytic Anemia? What are the 2 most common reasons for Megaloblastic Anemia?

Fe Deficiency, Thallassemia B12, Folic acid

What are the 3 features of Megaloblastic Anemia on a peripheral blood smear?

Megaloblasts (decreased #, but larger) Hypersegmentation of Neutrophils Basophilic Stippling of Erythrocytes (megaloblasts)

What is a Reticulocyte? How are they used in diagnosing disease?

Immature RBC When high, indicates disease (bone marrow compensation for low RBC's in blood)

What is characteristic of a Myeolophthistic Anemia?

Metastatic Cancer

#1 metastatic cancer causing Myeolophthistic Anemia: #2: *remember, this is a cancer metastasizing TO the marrow

Breast Prostate

What is involved in an Aplastic Anemia?

all 3 formed elements *RBC, WBC, platelets

Is the bone marrow involved in Aplastic Anemia?

yes - transplant only Tx for idiopathic form

4 Reasons for DIC *other than Massive Trauma (Shock) and Surgery, burns, hypotensive states

Obstetric emergencies Mucus-producing Adenocarcinomas (metastatic/primary) AML (acute mylogenous leukemia) granules G- Sepsis (esp shock)

Disseminated Intravascular Coagulation: widespread ____ changes secondary to microvasculature ________ This is accompanied by the consumption of ______ and ______ Leading to ______

ischemic, fibrin thrombi platelets, coagulating factors Hemorrhagic diathesis

Fragmented RBC's found in DIC

Schistocyte

What are Schistocytes? What disorder?

Fragmented RBC's DIC

The most important cause of DIC is what chemical on what type of organism? This acts as what?

LPS, G- bacteria Synthetic thromboplastin

The LPS of G- bacteria acting as a Synthetic thromboplastin is what kind of pathway?

Extrinsic

What clotting factor fools the body into believing it must release massive amounts of anti-clotting factors in DIC

Intravascular Fibrin Strands (FSP - fibrin split products) *results in microangiopathic anemia

Hemophilia A: Factor ______ Hemophilia B: Factor ______, aka... Both are... Which more common?

VIII IX, Christmas Disease sex linked A

Intrinsic path abnormality of Hemophilia A: Bleeding/prothrombin time are...

prolonged PPT (partial thromboplastin time) normal

Specific tests distinguishing Factor VIII and IX must be done to determine hemophilia A or B

True

2 cells that synthesize Von Willebrand factor: Where stored? If rupture, released into subendothelium and binds to _______ , promoting adherence

Endothelial cells, Megakaryocytes endothelial cells platelet receptors

Von Willebrands Disease mimics... b/c it binds/protects...

Hemophilia A Factor VIII

Most common hereditary coagulation abnormality: Incidence:

vWD 1/100

3 types of vWD w/ %'s

Type 1: 60-80% - mild Type 2: 20-30% - variable Type 3: - mucosal bleeding, little/no vWF

#1 cause of UTI:

G- enterics (E.coli) also, Pseudomonas, Klebsiella, Enterobacter, Serratia, Proteus

Cause of UTI in women: men: both:

pregnancy enlarged prostate diabetes, kidney stones, immunosuppression, radiation/chemo

Over 90% of Cystitis (infection bladder)/UTI's in female esp. is caused in what way: only 10% caused what way?

Ascending Blood

Infection of the Bladder: When women gets UTI, she has this most of the time

Cystitis True

Infection of the Kidneys: If acute, renal surface is round, yellow, and has raised _______

Pyelonephritis Microabscesses

Ascending bacterial infection acquired during sex, catheter, surgical...

Honeymoon Cystitis

One major group that gets Renal Papillary Necrosis: Common complication:

Diabetics necrotic Renal pyramid sloughing, blocks ureter, renal colic

Inflammation of Urinary Bladder: Suppurative infection of the kidneys with pus foci:

Cystitis Acute Pyelonephritis

Cystitis is most frequent UTI, often nosocomial, secondary, female, prego, Abx tx Pyelonephtritis: G- rods, suppurative, microabscesses,

True True

Complications of Acute Pyelonephritis:

Renal Papillary Necrosis

What does the surface of the Kidney look like in Acute Pyelonephritis microabscesses? 3 features

Round Yellow Raised

Renal Papillary Necrosis in the diabetic, what is the number 1 complication if the pyramid tip necrosis, breaks, and lodges?

Hydronephrosis *after urethra obstruction, renal colic

Hemorrhagic Cystitis can be caused by this bacteria: Or this Anti-Cancer drug: (or pelvic radiation)

E.coli Cytoxine (cyclophosphamide)

Main reason females get more UTI's

short urethra

2 most common chronic diseases that make up the vast majority of Chronic Renal Failure: *same 2 reasons for Dialysis/Transplant lists

HTN Diabetes

HTN and Diabetes are most common causes of renal failure, but glomerulonephritis and cystic kidney disease also cause

True

Diabetes, HTN, Lupus, Uropathy, polycistic KD, renal cystic dysplasia, pyelonephritis, glomerulonephritic, analgesic nephropathy,

Chronic Renal Failure

Most feared complication of immunosuppressive drugs post Renal Transplant

nephrotoxicity/injury of Renal Allograft

Highest recurrent disease in Transplanted Kidney:

Diabetic glomeruloscerosis

4 components of HIV that allow for Serologic testing: *diagnostic in ELISA and Western Blot

gp120: lollipop gp41: lollipop stick p17: matrix outer shell p24: capsid inner shell

What organism is the most common cause of meningitis in AIDS? What kind of organism is it?

Cryptococcus Fungus

HIV is what kind of virus? Transmitted through: most common mode of transmission: Virus goes after what cell? Destroys what kind of immunity?

Retrovirus body fluids homosexual/bisexual men (over 50%) CD4+ Cell-mediated

Vaginal, heterosexual transmission of HIV is __% of cases IVDA transmission ___% Male - Male/Male-Female is __x more common than Female-Male in US Transmission greatly enhanced by what?

33% 25% 20x coexisting STD's (esp w/ genital ulcerations)

HIV reservoir cells include monocytes, macrophage, dentritic cells, microglial cells

True

4 neoplasms/tumors of HIV/AIDS:

B-Cell Non-Hodgkins lymphoma Kaposi Sarcoma (malignant angiosarcoma) Uterine/Cervix Primary lymphoma of Brain

ELISA tests for the presence of what? Pts serum added to ______ ___ antibodies bind Another ____ is added A _______ is added that will change color

Antibodies to HIV known antigen IgG IgG anitibody enzyme links Substrate

Western Blot, viral proteins are separated by acrylamide gel ________ transferred (blotted) to from gel to _____ Pt's serum added and ______ binds viral proteins _____ added _____ added

electrophoresis paper IgG antibodies enzyme IgG Substrate - color

According to the CDC, any HIV infected person is considered to have AIDS when their CD4+ t-cell count is below what level?

200 mm3

2 Parasites that cause GI problems in AIDS pts

Cryptosporidium Isospora

In the Acute phase the CD4 count is at: Down to: Rebounds to: Virus count goes from 0 to: Then down to:

1000 500 650 950 300

Primary infection and Acute HIV Syndrome occur in what phase? Clinical Latency is seen in what phase? Constitutional symptoms, Opportunistic disease, and death are in what phase?

Acute Chronic Crisis

Where does the virus go in acute HIV syndrome?

wide dissemination seeds lymphoid organs

And of Acute Phase HIV (time): Beginning of Crisis phase:

9 weeks 8 years

4 CNS changes to HIV:

Aseptic meningitis Subacute encephalitis Vacuolar myelopathy AIDS-related myopathy

% AIDS pts neuro involvement at autopsy: % clinically manifested neuro involvement:

90% 40-60%

What eating disorder is associated w/ alcohol/drug abuse, sexual promiscuity, and aberrant sexual behavior?

Bulimia nervosa

Enamel erosion pattern/tooth decay seen in eating disorders if purging (fingers in throat)?

Lingual of Mx Anterior

3 similarities between Anorexia and Bulimia:

Depression (psycho disorders) suicidal tendencies both might purge

Increased cavities, scurvy, vitamin deficiencies may be seen in Anorexia/Bulimia

True

Organism responsible for nursing caries:

S. mutans

If prego women lose Calcium, are they going to lose it from their teeth? Where?

Negative Bone

What is the underlying etiology of prego women and gingivitis?

Increased progesterone