Oral Medicine III - Fishiale Flashcards
Aplastic Anemia is a ______anemia
due to bone marrow ____ or _____
A common cause of what?
normocytic
hypoplasia, aplasia
Pancytopenia
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
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
Only known Tx for idiopathic aplastic anemia:
secondary anemia:
Marrow transplant
remove cause (Benzene, etc)
Megaloblastic anemias are caused by what?
RBC’s look like…
Deficient B12 or Folic Acid
megaloblasts, large, Blue Inclusions (basophilic stippling)
Most common type of Megaloblastic Anemia?
Define:
Pernicious anemia
no IF, no B12 absorption
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
A genetic predisposition is suspected in pernicious anemia, but not proven
True
What condition often accompanies Pernicious Anemia?
This may explain the pathogenesis via what mechanism?
Atrophic Gastritis
alcohol/tobacco
No IF in pernicious anemia is due to what?
no gastric parietal cells
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
What happens in Mononuclear Phagocytic cells of the Spleen?
Extravascular Hemolysis
*not intravascular
90% of pts with Pernicious Anemia have what?
Antibodies to Parietal cells
*no IF
Diagnosis of Pernicious Anemia:
Schilling Test
radioactive Cobalamine absorption
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
Lack of Folic Acid (other megaloblastic anemia) is due to what 3 conditions?
Pregnancy
Alcoholics
Malnourished
What is a reason for Intravascular hemolysis?
Mismatched blood transfusion
What is the most common type of Anemia?
Bone marrow is…
blood cells are…
Iron Deficiency
Hyperplastic
Hypochromic, Microcytic
Antidote for Heavy metal poisoning by thallium and radioactive caesium, orally administered.
Also test for Iron Deficiency
Prussian Blue
Space occupying lesions destroying marrow (cancer)
Myelophthistic Anemia
Most common human enzyme defect anemia:
G6PD deficiency anemia
Anemia of Mediterranean
Alpha chromo
Beta chromo
Thalassemia
16
11
Pathogenesis, Sickle Cell anemia substitution:
At position:
What chain:
Valine replaces Glutamic Acid
6
Beta chain Hb
Sickling Crisis brought about by what?
Causes what?
spontaneously, fever, hypoxia
Infarcts (neuro, bones, spleen, extremities)
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
1 cause Fe anemia:
Reason for Iron Deficiency Anemia in Males:
in Females, _____ , then ______
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:
*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
