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Tim's Cards > Oral Medicine VI - Patel's Puzzle > Flashcards

Oral Medicine VI - Patel's Puzzle Flashcards

1
Q

Chronological age is the number of years you have lived and the Functional Age is the age you are _______ to function at

A

perceived

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2
Q

Geriatric patients have ______ symptoms

More _____ responses on health questionnaires

A

Atypical

positive

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3
Q

With age, there are changes in both pharmokinetics and pharmodynamics

A

True

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4
Q

Drug related complications in Geriatric pts are separated into types by ________ list

A

Beer’s

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5
Q

Drug related complications can occur via what 5 mechanisms in geriatric pts?

A

DDI’s

Adverse drug rxn

Under medication

Polypharmacy

non-adherence

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6
Q

Criteria for potentially inappropriate meds in older adults

A

Beers

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7
Q

Types of chronic conditions in geriatric pts:

leading causes of death over 65

A

Heart disease

Cancer

Resp disease

Stroke

Alzheimers

Diabetes

Influenza

Pneumonia

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8
Q

3 Changes to CV system in elderly:

A

Stiffened aorta

Reduction max cardiac output

Coronary artery disease

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9
Q

Cellular and molecular alterations affecting both innate/adaptive immunity due to aging

A

Immunosenescence

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10
Q

Salivary gland hypofunction is a common age-related oral change

A

True

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11
Q

3 age-related Oral changes:

A

salivary hypofunction

mucosal fragility

impaired healing/immunity

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12
Q

Pulpal sensitivity _____ with increasing age

Increased prevalence of _______ disorders

A

decreases

neuropathic

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13
Q

TMJ affects what % of general population?

A

12%

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14
Q

Geriatric oral mucosa disorders (6):

A

Traumatic ulcers

Vesiculobullous disease

lichen planus

malignancy

candidiasis

denture stomatitis

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15
Q

Xerostomia vs. Salivary gland hypofunction

A

Subjective vs Objective

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16
Q

Whole stimulated flow rate, unstimulated flow rate =

A

Sialometry

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17
Q

Sialometry Hypofunction Unstimulated:

Stimulated:

A

less than 0.1 ml/min

less than 0.7 ml/min

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18
Q

Sore swollen tongue, cavities, metallic taste, bad breath, spicy/acidic food intolerance

A

Xerostomia/hypofunction

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19
Q

4 questions for dry mouth questionaire:

A

saliva seem too little?

difficulty swallowing?

when eating meal feel dry?

sip liquids to aid in swallowing?

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20
Q

Chronic GVHD and Sjogrens

A

Autoimmune

*salivary gland disorders

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21
Q

Salivary gland aplasia can happen _______

A

developmentally

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22
Q

4 infections that can affect the salivary glands:

A

CMV

HIV

HepC

TB

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23
Q

Non-neoplastic condition causing salivary gland disorder

A

Sialolithiasis

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24
Q

4 Iatrogenic means of causing salivary gland disorder:

A

External beam radiation

Internal beam radiation

Post-surgical

Botox

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25
Q

Systemic conditions that involve the salivary glands (5):

A

Anorexia

Bulimia

Diabetes

Alcoholism

Sarcoidosis

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26
Q

Classification of Sjogren Syndrome is based on a weighted sum of _____ items

First 2 are ___ points

Last 3 are ____ points

Primary Sjogren’s must have a score of…

A

5

3 points each

1 point each

4 or greater

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27
Q

What are the 5 items

A

Anti-SSA/Ro or Anti-SSB/La antibody

focal lymphocytic sialadenitis (more than 1 foci/4mm2)

Abnormal ocular staining score (> 5)

Shirmer’s Test (<5)

Unstimulated salivary flow rate <0.1 ml/min

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28
Q

The Sjogren’s scoring system has high sensitivity and specificity (96% and 95%)

A

True

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29
Q

Clinical signs/symptoms of Sjogren’s:

A

dry eyes, corneal ulcerations/infections, difficulty swallowing, hearburn, reflux, dry nose, nose bleeds, dry mouth, mouth sores, dental decay, etc

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30
Q

Oral complications of Sjogren’s and Xerostomia:

A

Dry mouth

Parotid swelling

Sialadenitis

Glossodynia

Caries

Candidiasis

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31
Q

6 Salivary gland disorders associated w/ HIV:

A

HIV SGC (pre-malignant)

Acute sialadenitis

neoplasms

DILS (diffuse infiltrative lymphocytosis syndrome)

Salivary gland enlargement (1-10% or pts)

Changes in salivary flow rate/composition

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32
Q

More than 500 meds can cause dry mouth

A

True

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33
Q

7 drug classes that cause dry mouth:

A

Analgesics

Antihistamines

Antidepressants

Cytotoxics

Sedatives

Anticonvulsants

Antiretrovirals

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34
Q

5 clinical assessments for salivary gland disease:

A

Palpation

Sialometry

imaging

biopsy

serology

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35
Q

5 Red Flags for salivary gland disease:

A

Facial nerve paralysis

multiple masses

fixed masses

presence of cervical lymphadenopathy

smaller gland = higher risk of malignancy

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36
Q

Ulceration, induration , invation, dysphagia, otalgia, trismus, parasthesia, unintentional weight loss

A

signs salivary gland disease

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37
Q

Objective measurement of salivary flow

A

Sialometry

38
Q

S;pitting, absorben sponge, draining, and suction are various methods for what?

A

Sialometry

39
Q

Unstimulated salivary flow rate less than_______ is hypofunction

Stimulated less than ______

A
  1. 1 ml/min

0. 7 ml/min

40
Q

CT is good for, requires:

MRI is good for:

A

hard tissue, dye injection

soft tissue (no radiation)

41
Q

What to use preventatively for xerostomia?

Recall schedule?

A

Topical fluoride

3-4 months

42
Q

chewing gum, sugar free lemon candies, palpation, moist heat application:

A

For xerostomia

43
Q

Systemic drug for Salivary Stimulation:

dosage:

A

Pilocarpine HCL

5-10 mg 3x/day

44
Q

Pilocarpine is FDA approved for Tx of xerostomia following what?

also for what?

A

Head and Neck radiation

Sjogrens

45
Q

What drug is FDA approved for the Tx of oral dryness in pts w/ Sjogrens? (but not radiation)

dosage?

A

Cevimeline HCL

30 mg 3x/day

46
Q

Anti-HTN

47
Q

Oral candidiasis secondary to ______ in inhalers

48
Q

Fe deficiency anemia oral manifestations:

A

mucosal pallor

depapillated tongue

generalized mucosal atrophy

burning tongue

angular chelitis

aphthous ulcerations

49
Q

Oral manifestations of Pernicious anemia:

A

burning tongue

burning lips

burning oral mucosa

erythema/atrophy focal/patchy

50
Q

Oral manifestations of bleeding disorders:

A

severe gingival bleeding

ecchymoses

petechiae

hemoarthroses of TMJ

51
Q

Oral manifestations Leukemia:

A

gingival enlargement

bleeding

ulceration

infection

52
Q

Oral manifestation Lymphoma:

A

cervical lymph nodes enlarged

unexplained oral cavity swelling

53
Q

Diabetes is related to Perio disease which means delayed wound healing, increased infection, ________ enlargement,

________

________ disturbances leading to _______

A

parotid gland

xerostomia

sensory, burning mouth syndrome

54
Q

Ulcerative Colitis oral manifestations:

A

aphthous

pyostomatitis vegetans

*lesions resolve after Tx

55
Q

Crohn’s disease oral manifestations:

A

atypical mucosal ulcerations

diffuse lip swelling

cobblestone mucosa

56
Q

3 oral manifestations for liver disease/bleeding tendency:

A

hemorrhagic changes

taste dysfunction

sialadenosis

57
Q

Candidiasis, bacterial infection, Kaposi, Hairy leukoplakia, HSV

58
Q

2 types of Type IV hypersensitivity in the mouth:

A

Contact stomatitis

Lichenoid mucositis

59
Q

Amalgam may be a type ____ hypersensitivity

Need to inquire about what?

A

IV

contacts w/ matls around time allergy reported

60
Q

2 Rheumatoid arthritis oral manifestations:

A

degenerative changes of TMJ

Anterior open bitn

61
Q

4 types of Dermatologic disorders:

A

oral lichen planus

mucous membrane pemphigoid

pemphigus vulgaris

paraneoplastic pemphigus

62
Q

What are the 3 types of Lichen Planus?

A

Reticular

Erosive (ulcerative, bullous)

Plaque-type

63
Q

4 clinical features of Type IV hypersensitivity rxn:

A

Erythema

Vesicles

Ulcers

Hyperkeratosis

64
Q

Aconthosis, hyperkeratosis, heay lymphocytic inflammaotry infiltrate w/ variable histocytes, eosinophils, and plasma cells, dilated papollary vessels w/ perivascular lymphohistocytic infiltrate

A

Histopathological features Type IV sensitivity rxns

65
Q

Drug induced oral rxns:

A

salivary gland rxn

mucosal irritation/ulceration

taste disturbance

swelling

discoloration

trigeminal sensory distrubance

motor distrubance

malodor

66
Q

4 diagnostic steps for diagnosing Drug-induced rxn:

A

Hx

Allergic profile/risk

Stop putative drug and observe

Start putative drug again and observe

67
Q

The only way to show causality in single subject trial:

A-B only shows what?

A

A-B-A-B

association

68
Q

3 most common oral side effects of the most frequently prescribed drugs:

A

Xerostomia

Dysgeusia (bad taste)

Stomatitis (painful swelling in mouth)

69
Q

5 types of salivary gland rxns:

A

Hypo

swelling

hyper

pain

discoloration of saliva

70
Q

3 taste disturbances w/ definition:

A

Hypogeusia (loss of taste)

dysgeusia (distortion)

ageusia (loss)

71
Q

Drug related oral ulcerations can cause the following:

A

Oral burns

aphthous

eruptions (fixed)

mucositis

neoplasm

pemphigoid/bullous

erythema multiforme

epidermal necrolysis

lupus like disorders

72
Q

The highest frequency of allergic rxns in the mouth are seen in what 2 drugs?

A

Oral Abx

NSAIDS

73
Q

3 dental matls that can cause oral burns:

A

Silver Nitrate

Formocresol

Acid-etch matls

74
Q

Repeated ulceration at same site in response to a particular drug. Can go from solitary to multiple w/ repeated exposure. Localized in mouth or associated with other mucocutaneous sites:

A

Fixed Drug Eruption

75
Q

Drug-related mucositis caused by what?

A

Cytotoxic drugs

76
Q

Stevens-Johnson Syndrome presents the same as…

A

Toxic Epidermal Necrolysis

77
Q

Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis 4 features:

A

Flu-like prodromal

Cutaneous lesions (erythematous macule on trunk)

maculopapular exanthema then Mucocutaneous epidermolysis

painful blistering intra-orally

78
Q

7 drug-related white lesions:

A

burns

lichenoid eruptions

lupus-like rxns

candidiasis

papillomas

hairy leukoplakia

leukoplakia

79
Q

3 drugs that cause gingival hyperplasia:

A

phenytoin (dilantin)

cyclosporine

calcium channel blockers

80
Q

Class of drugs that cause Burning Mouth Syndrome:

3 drugs in this class:

A

ACE inhibitors

enalapril, captopril, lisinopril

81
Q

What is the most common oropharyngeal infection?

A

Candida albicans

82
Q

Sjogren’s is autoimmune and most common in peri and post menopausal women

83
Q

Sarcoidosis is a noncaseating granuloma

84
Q

TB is often unilateral in the mouth

85
Q

Oral cancer is an example of a drug induced oral rxn

86
Q

Swelling, ulcration, malodor are drug induced interactions

87
Q

Repeat ulceration at the same site

A

Fixed drug eruption

88
Q

Methotrexate is a chemo drug that causes oral ulcerations ___% of the time

Exacerbated by…

indistinguishable from…

A

14%

folate deficiency

mild dysplasia

89
Q

Type I hypersensitivity is a true allergic rxn and can be caused by penicillin, ACE, aspirin, barbiturates, etc

90
Q

What drug can turn a pt blue?

A

Minocycline

91
Q

SSRI’s and SNRI’s can cause sleep bruxism

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