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Tim's Cards > Oral Medicine III - Fishiale > Flashcards

Oral Medicine III - Fishiale Flashcards

1
Q

Aplastic Anemia is a ______anemia

due to bone marrow ____ or _____

A common cause of what?

A

normocytic

hypoplasia, aplasia

Pancytopenia

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2
Q

What is the complication of Pancytopenia?

This is due to different anemias causing what 3 symptoms?

Pancytopenia leads to anemia, ______ and ______ due to leukopenia

A

Bleeding disorders

weakness, fainting, lethargy

thrombocytopenia, infection

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3
Q

Aplastic Anemia is ____ idiopathic

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

A

2/3

Cytotoxic drugs (nsaids/chemo/anticonvulsants)

Viral infection (CMV, EBV, HIV)

Radiation therapy

Benzene

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4
Q

Only known Tx for idiopathic aplastic anemia:

secondary anemia:

A

Marrow transplant

remove cause (Benzene, etc)

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5
Q

Megaloblastic anemias are caused by what?

RBC’s look like…

A

Deficient B12 or Folic Acid

megaloblasts, large, Blue Inclusions (basophilic stippling)

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6
Q

Most common type of Megaloblastic Anemia?

Define:

A

Pernicious anemia

no IF, no B12 absorption

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7
Q

Groups more likely to get Pernicious Anemia:

Most common in what stage of life?

Rare when?

A

Irish, English, Scandinavian

late in adult life

under 30

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8
Q

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

A

True

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9
Q

What condition often accompanies Pernicious Anemia?

This may explain the pathogenesis via what mechanism?

A

Atrophic Gastritis

alcohol/tobacco

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10
Q

No IF in pernicious anemia is due to what?

A

no gastric parietal cells

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11
Q

Extravascular Hemolysis:

_____ is converted to ______

by the ________ at a RATE LIMITING STEP

causes what 2 things?

A

overabundance of RBC’s destroyed in Spleen

HEME to Bilirubin

Liver

Hyperbilirubinemia, Jaundice

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12
Q

What happens in Mononuclear Phagocytic cells of the Spleen?

A

Extravascular Hemolysis

*not intravascular

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13
Q

90% of pts with Pernicious Anemia have what?

A

Antibodies to Parietal cells

*no IF

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14
Q

Diagnosis of Pernicious Anemia:

A

Schilling Test

radioactive Cobalamine absorption

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15
Q

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 _____

A

terminal ileum small intestine

Heart Failure

fish tapeworm infection

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16
Q

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

A

Pregnancy

Alcoholics

Malnourished

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17
Q

What is a reason for Intravascular hemolysis?

A

Mismatched blood transfusion

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18
Q

What is the most common type of Anemia?

Bone marrow is…

blood cells are…

A

Iron Deficiency

Hyperplastic

Hypochromic, Microcytic

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19
Q

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

Also test for Iron Deficiency

A

Prussian Blue

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20
Q

Space occupying lesions destroying marrow (cancer)

A

Myelophthistic Anemia

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21
Q

Most common human enzyme defect anemia:

A

G6PD deficiency anemia

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22
Q

Anemia of Mediterranean

Alpha chromo

Beta chromo

A

Thalassemia

16

11

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23
Q

Pathogenesis, Sickle Cell anemia substitution:

At position:

What chain:

A

Valine replaces Glutamic Acid

6

Beta chain Hb

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24
Q

Sickling Crisis brought about by what?

Causes what?

A

spontaneously, fever, hypoxia

Infarcts (neuro, bones, spleen, extremities)

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25
Q

Consequence of Sickling Crisis infarcts to Spleen?

A

Fibrotic

Autosplenectomy

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26
Q

3 Physical consequences to Sickle Cell?

A

Skull bossing (marrow hyperplasia, “hair on end”)

Dactylitis (back of hand swelling)

Infections

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27
Q

Normal is Hb A

Sickle cell is Hb S

A

True

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28
Q

Unlike B12, Folate doesn’t need:

Folate deficiency, no _____ signs/symptoms

Folate seen in ______ compared to B12

A

IF

neuro

Prego

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29
Q

Folic Acid Deficiency more common than B12 deficiency

Symptoms similar, except what?

A

True

no Neuro in Folic

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30
Q

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

A

Hemolytic/Vasoocclusive Crisis

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31
Q

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

A

Acute Blood Loss

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32
Q

1 cause Fe anemia:

Reason for Iron Deficiency Anemia in Males:

in Females, _____ , then ______

A

GI

Reproductive, GI

acute blood loss

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33
Q

Sickle Cell can cause what in the Spleen?

Bones:

Backs of Hands/Feet:

Increased…

A

Autosplenectomy

Hair on End (bossing)

Dactylitis in children

Infections (facilitated by Spleen/Liver)

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34
Q

3 Ways Pernicious Anemia is Diagnosed:

A

Low B12

Schilling Test (Oral Cyanobobalamine)

Over 90% antibodies to IF from Parietal Cells

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35
Q

What are the 2 most common reasons for Microcytic Anemia?

What are the 2 most common reasons for Megaloblastic Anemia?

A

Fe Deficiency, Thallassemia

B12, Folic acid

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36
Q

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

A

Megaloblasts (decreased #, but larger)

Hypersegmentation of Neutrophils

Basophilic Stippling of Erythrocytes (megaloblasts)

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37
Q

What is a Reticulocyte?

How are they used in diagnosing disease?

A

Immature RBC

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

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38
Q

What is characteristic of a Myeolophthistic Anemia?

A

Metastatic Cancer

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39
Q

1 metastatic cancer causing Myeolophthistic Anemia:

*remember, this is a cancer metastasizing TO the marrow

A

Breast

Prostate

40
Q

What is involved in an Aplastic Anemia?

A

all 3 formed elements

*RBC, WBC, platelets

41
Q

Is the bone marrow involved in Aplastic Anemia?

A

yes - transplant only Tx for idiopathic form

42
Q

4 Reasons for DIC

*other than Massive Trauma (Shock) and Surgery, burns, hypotensive states

A

Obstetric emergencies

Mucus-producing Adenocarcinomas (metastatic/primary)

AML (acute mylogenous leukemia) granules

G- Sepsis (esp shock)

43
Q

Disseminated Intravascular Coagulation: widespread ____ changes secondary to microvasculature ________

This is accompanied by the consumption of ______ and ______

Leading to ______

A

ischemic, fibrin thrombi

platelets, coagulating factors

Hemorrhagic diathesis

44
Q

Fragmented RBC’s found in DIC

A

Schistocyte

45
Q

What are Schistocytes?

What disorder?

A

Fragmented RBC’s

DIC

46
Q

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

This acts as what?

A

LPS, G- bacteria

Synthetic thromboplastin

47
Q

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

A

Extrinsic

48
Q

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

A

Intravascular Fibrin Strands (FSP - fibrin split products)

*results in microangiopathic anemia

49
Q

Hemophilia A: Factor ______

Hemophilia B: Factor ______, aka…

Both are…

Which more common?

A

VIII

IX, Christmas Disease

sex linked

A

50
Q

Intrinsic path abnormality of Hemophilia A:

Bleeding/prothrombin time are…

A

prolonged PPT (partial thromboplastin time)

normal

51
Q

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

A

True

52
Q

2 cells that synthesize Von Willebrand factor:

Where stored?

If rupture, released into subendothelium and binds to _______ , promoting adherence

A

Endothelial cells, Megakaryocytes

endothelial cells

platelet receptors

53
Q

Von Willebrands Disease mimics…

b/c it binds/protects…

A

Hemophilia A

Factor VIII

54
Q

Most common hereditary coagulation abnormality:

Incidence:

A

vWD

1/100

55
Q

3 types of vWD w/ %’s

A

Type 1: 60-80% - mild

Type 2: 20-30% - variable

Type 3: - mucosal bleeding, little/no vWF

56
Q

1 cause of UTI:

A

G- enterics (E.coli)

also, Pseudomonas, Klebsiella, Enterobacter, Serratia, Proteus

57
Q

Cause of UTI in women:

men:

both:

A

pregnancy

enlarged prostate

diabetes, kidney stones, immunosuppression, radiation/chemo

58
Q

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

only 10% caused what way?

A

Ascending

Blood

59
Q

Infection of the Bladder:

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

A

Cystitis

True

60
Q

Infection of the Kidneys:

If acute, renal surface is round, yellow, and has raised _______

A

Pyelonephritis

Microabscesses

61
Q

Ascending bacterial infection acquired during sex, catheter, surgical…

A

Honeymoon Cystitis

62
Q

One major group that gets Renal Papillary Necrosis:

Common complication:

A

Diabetics

necrotic Renal pyramid sloughing, blocks ureter, renal colic

63
Q

Inflammation of Urinary Bladder:

Suppurative infection of the kidneys with pus foci:

A

Cystitis

Acute Pyelonephritis

64
Q

Cystitis is most frequent UTI, often nosocomial, secondary, female, prego, Abx tx

Pyelonephtritis: G- rods, suppurative, microabscesses,

A

True

True

65
Q

Complications of Acute Pyelonephritis:

A

Renal Papillary Necrosis

66
Q

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

A

Round

Yellow

Raised

67
Q

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

A

Hydronephrosis

*after urethra obstruction, renal colic

68
Q

Hemorrhagic Cystitis can be caused by this bacteria:

Or this Anti-Cancer drug:

(or pelvic radiation)

A

E.coli

Cytoxine (cyclophosphamide)

69
Q

Main reason females get more UTI’s

A

short urethra

70
Q

2 most common chronic diseases that make up the vast majority of Chronic Renal Failure:

*same 2 reasons for Dialysis/Transplant lists

A

HTN

Diabetes

71
Q

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

A

True

72
Q

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

A

Chronic Renal Failure

73
Q

Most feared complication of immunosuppressive drugs post Renal Transplant

A

nephrotoxicity/injury of Renal Allograft

74
Q

Highest recurrent disease in Transplanted Kidney:

A

Diabetic glomeruloscerosis

75
Q

4 components of HIV that allow for Serologic testing:

*diagnostic in ELISA and Western Blot

A

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

76
Q

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

What kind of organism is it?

A

Cryptococcus

Fungus

77
Q

HIV is what kind of virus?

Transmitted through:

most common mode of transmission:

Virus goes after what cell?

Destroys what kind of immunity?

A

Retrovirus

body fluids

homosexual/bisexual men (over 50%)

CD4+

Cell-mediated

78
Q

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?

A

33%

25%

20x

coexisting STD’s (esp w/ genital ulcerations)

79
Q

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

A

True

80
Q

4 neoplasms/tumors of HIV/AIDS:

A

B-Cell Non-Hodgkins lymphoma

Kaposi Sarcoma (malignant angiosarcoma)

Uterine/Cervix

Primary lymphoma of Brain

81
Q

ELISA tests for the presence of what?

Pts serum added to ______

___ antibodies bind

Another ____ is added

A _______ is added that will change color

A

Antibodies to HIV

known antigen

IgG

IgG anitibody enzyme links

Substrate

82
Q

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

A

electrophoresis

paper

IgG antibodies

enzyme IgG

Substrate - color

83
Q

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

A

200 mm3

84
Q

2 Parasites that cause GI problems in AIDS pts

A

Cryptosporidium

Isospora

85
Q

In the Acute phase the CD4 count is at:

Down to:

Rebounds to:

Virus count goes from 0 to:

Then down to:

A

1000

500

650

950

300

86
Q

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?

A

Acute

Chronic

Crisis

87
Q

Where does the virus go in acute HIV syndrome?

A

wide dissemination

seeds lymphoid organs

88
Q

And of Acute Phase HIV (time):

Beginning of Crisis phase:

A

9 weeks

8 years

89
Q

4 CNS changes to HIV:

A

Aseptic meningitis

Subacute encephalitis

Vacuolar myelopathy

AIDS-related myopathy

90
Q

% AIDS pts neuro involvement at autopsy:

% clinically manifested neuro involvement:

A

90%

40-60%

91
Q

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

A

Bulimia nervosa

92
Q

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

A

Lingual of Mx Anterior

93
Q

3 similarities between Anorexia and Bulimia:

A

Depression (psycho disorders)

suicidal tendencies

both might purge

94
Q

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

A

True

95
Q

Organism responsible for nursing caries:

A

S. mutans

96
Q

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

Where?

A

Negative

Bone

97
Q

What is the underlying etiology of prego women and gingivitis?

A

Increased progesterone

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