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Summer 2017-Oral Medicine Final > Rheumatology and Orthopedics > Flashcards

Rheumatology and Orthopedics Flashcards

1
Q

Osteogenesis Imperfecta

A
  1. imperfect formation of bone
  2. usually autosomal dominant
  3. brittle bone (fracture)
  4. easy bruising
  5. joint hypermobility
  6. HEARING problems
  7. blue sclera
  8. osteosclerosis (deafness)
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2
Q

Dentinogenesis imperfecta

A
  1. imperfect formation of dentin
  2. often seen associated with osteogenesis imperfecta
  3. abnormal translucency
  4. brown-purple color
  5. abnormal wear
  6. altered enamel-dentin interface
  7. obliterated pulp chamber (NOT seen on x-rays)
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3
Q

Cleidocranial Dysplasia

A
  1. autosomal dominant
  2. absent/defective clavicles
  3. hyperdontia
  4. retained deciduous dentition
  5. unerupted permanent teeth seen in pan (mis-shapen, mal-formed)
  6. malformed teeth
  7. dentigerous cysts (surrounds crown of un-erupted teeth)
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4
Q

Rickets

A
  1. lack of vitamin D or calcium in children (osteomalacia in adults)
  2. dietary, lack of sunlight, malabsorption
  3. excessive calcium demands
  4. renal disease
  5. Vitamin D resistant rickets
  6. accelerated metabolism
  7. bone deformity
  8. Rachitic rosary (costochondral junction)
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5
Q

Vitamin D-resistant rickets

A
  1. large pulp chambers (pulp horns go almost to DEJ)

2. pulpitis–>abscess

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6
Q

Osteoporosis

A
  1. diminished bone mass
  2. low bone density
  3. risk factors
    * *age, sex, family history, lifestyle, drugs, disease
  4. VERY COMMON
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7
Q

Tx of Osteoporosis

A
  1. Calcitonin
  2. Bisphosponates–>interferes with normal bone turnover
  3. Denosumab
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8
Q

Side effects of Bisphosphonates

A
  1. may cause osteonecrosis of jaw
  2. IV intake greatly increases risk (versus oral)
  3. can also be seen with denosmab, bevacizumab, sunitinib, and tooth extraction
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9
Q

Osteonecrosis of the Jaw - Prevention

A
  1. endodontic therapy instead of extractions
  2. avoid periodontal surgery with oral BPs (no periodontal surgery with IV BPs)
  3. no apical surgery
  4. NO implants in IV BPs
  5. drug holiday (6 months) may increase chances of success
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10
Q

Tx of Osteonecrosis of Jaw

A
  1. chlorhexidine rinses
  2. antibiotics
  3. debridement/resection
  4. pain control
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11
Q

Osteomyelitis

A
  1. hematogenous vs. direct
  2. acute (not seen very often) vs. chronic
  3. focal sclerosisng (small area of dense bone, not much inflammation) vs. diffuse sclerosing
  4. proliferative periostitis (proliferation of bone)
  5. jaws (usually direct and acute)
    * *odontogenic infections: most common
    * *heamtogenous: rare
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12
Q

What microbe causes osteomyelitis?

A

Staph Aureus

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13
Q

Osteomyelitis - Process

A
  1. inflammation
  2. vascular thrombosis
  3. bone necrosis
  4. sinus formation
  5. sequestrum (piece of dead bone that works its way to surface)
  6. involucrum (piece of dead bone that hasn’t made its way to surface)
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14
Q

Osteomyelitis - Clinical features

A
  1. fever, pain swelling
  2. mobile tender teeth
  3. purulent gingival exudate
  4. labial anesthesia
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15
Q

What are two reasons lips go numb?

A
  1. infection

2. tumor

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16
Q

Management of osteomyelitis

A
  1. antibiotics
  2. drainage
  3. sequestrectomy
  4. hyperbaric oxygen
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17
Q

Fibrous Dysplasia

A

unknown etiology

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18
Q

Monostatic Fibrous Dysplasia

A
  1. most common
  2. F > M
  3. maxillary involvement common
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19
Q

Polyostotic Fibrous Dysplasia

A
  1. AKA Albright Syndrome
  2. cafe au lait skin lesions
  3. precocious puberty in females
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20
Q

Characterization of Fibrous Dysplasia

A
  1. ground-glass appearance
  2. no defined margin
  3. normal Ca and P
  4. elevated alkaline phosphatase and urinary hydroxyproline
  5. self-limiting disease
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21
Q

Paget Disease of Bone

A
  1. osteitis deformans
  2. M > F
  3. uncoordinated overactivity of osteoclasts and osteoblasts
  4. lysis–>apposition–>sclerosis–>deformity
  5. NORMAL Ca and P
  6. elevated alkaline phosphatase and urinary hydroxyproline
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22
Q

Clinical Featuers - Paget Disease

A
  1. “cotton wool” appearance of skull
  2. malar bulging (“leontiasis ossea”)
  3. wided alveolar ridge
  4. loss of lamina dura
  5. hypercementosis
  6. extractions diffficult
  7. frequent denture remakes
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23
Q

Marfan Syndrome

A
  1. most common genetic CT disorder
  2. autosomal dominant
  3. long limbs, archnodactyl, loose joints, pectus excava
  4. dilation of ascending aorta; dissectin aortic anuerysm; aortic regurgitation; mital valve prolapse
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24
Q

Ehlers-Danlos Syndrome

A
  1. usually autosomal dominant
  2. hyperextensible skin, bleeding tendency; bruising; loose-jointedness
  3. tendency for mitral valve prolapse
    * *increased risk for infective endocarditis
    * *increased risk for mitral insufficiency
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25
Q

Symptoms of Ehlers-Danlos Syndrome

A
  1. microdontia
  2. short roots
  3. pulp stones
  4. deciduous teeth: abnormal molars, obliterated tooth pulp, enamel attrition
  5. permanent teeth: agenesis, microdontia
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26
Q

Osteoarthritis

A
  1. most common form of arthritis
  2. multiple risk factors
  3. caused by articular cartilage with compensatory thickening of bone and periarticular cyst formation
  4. usually weight-bearing or traumatized joints
  5. progressive distal joint deformity
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27
Q

Do people with osteoarthritis have TMJ problems?

A

NO

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28
Q

Rheumatoid Arthritis

A
  1. multi-system, immune complex autoimmune disease
  2. common (2% of population)
  3. elevated ESR; positive RF; ANA; other
    * *progressive proximal joint deformity
    * *ulnar deviation of fingers
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29
Q

Rheumatoid Arthritis - Dental Aspects

A
  1. sjogren syndrome
  2. some TMJ effects, but not MAJOR
  3. stomatitis medicementosa
  4. multiple supportive devices, short morning appointments, treat sitting up with neck and leg supports
  5. consider bleeding tendency (corticosteroid supplementation and prophylactic antibiotic coverage)
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30
Q

What causes gout?

A

deposit of urate crystals in joints–>PMNs release lysosomal enzymes–>inflammation (great toe)

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31
Q

Primary gout

A

inborn error of metabolism

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32
Q

Secondary gout

A

drug side effect

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33
Q

Meat-eating gout

A
  1. eating
  2. beer drinking
  3. obese
  4. old men
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34
Q

Tophi gout

A

helix of inner ear

35
Q

Muscular dystrophy

A
  1. includes types of progressive muscle degeneration
  2. XLR: females carry it, skips a generation
  3. Duchenne type
    * *most common
    * *early childhood onset
    * *death by mid-20s
36
Q

Myasthenia Gravis

A
  1. autoimmune disease
  2. young adults; F > M
  3. destroy Ach receptors on neuromuscular junction
  4. weakness, fatigue of voluntary muscles
  5. facial muscles affected (speech, chewing, swallowing)
  6. occasionally associated with other autoimmune diseases (Sjogren syndrome, pemphigus)
37
Q

Medication-Related Osteonecrosis of the Jaws

A
  1. 1/20 patients with IV bisphosphonates
  2. 1/1500 with oral bisphosphonates
  3. also seen in patients with denosumab, bevacizumab, sunitnib
  4. commonly triggered by TOOTH EXTRACTION
38
Q

What precautions should you take with dental patients who have osteoarthritis?

A
  1. multiple supportive devices
  2. short morning appointments
  3. treat sitting up
  4. neck and leg supports
  5. consider bleeding tendency (possible corticosteroid supplementation and prophylactic antibiotic coverage)
39
Q

Imperfect formation of bone

A

Osteogenesis imperfecta

40
Q

Usually autosomal dominant

A

Osteogenesis imperfecta, Cleidocranial dysplasia, Marfan syndrome, Ehlers-Danlos

41
Q

Brittle bone (fracture)

A

Osteogenesis imperfecta

42
Q

Easy bruising

A

Osteogenesis imperfecta

43
Q

Joint hypermobility

A

Osteogenesis imperfecta

44
Q

Hearing problems

A

Osteogenesis imperfecta

45
Q

Blue sclera

A

Osteogenesis imperfecta

46
Q

Abnormal translucency

A

Dentinogenesis imperfecta

47
Q

Brown-purple color

A

Dentinogenesis imperfecta

48
Q

Abnormal tooth wear

A

Dentinogenesis imperfecta

49
Q

Altered enamel-dentin interface

A

Dentinogenesis imperfecta

50
Q

Obliterated pulp chamber (NOT seen on x-rays)

A

Dentinogenesis imperfecta

51
Q

Absent/defective clavicles

A

Cleidocranial dysplasia

52
Q

Hyperdontia

A

Cleidocranial dysplasia

53
Q

Retained deciduous dentition

A

Cleidocranial dysplasia

54
Q

Unerupted permanent teeth in pan

A

Cleidocranial dysplasia

55
Q

Malformed teeth

A

Cleidocranial dysplasia

56
Q

Dentigerous cysts (around crowns of un-erupted teeth)

A

Cleidocranial dysplasia

57
Q

Sequestrum (piece of dead bone that worked its way to surface)

A

Osteomyelitis

58
Q

Involucrum (piece of dead bone that hasn’t made its way to surface)

A

Osteomyelitis

59
Q

Albright Syndrome

A

Polystotic Fibrous Dysplasia

60
Q

Precocious puberty in females

A

Polystotic Fibrous Dysplasia

61
Q

Ground glass appearance

A

Fibrous Dysplasia

62
Q

No defined margin

A

Fibrous Dysplasia

63
Q

Normal Ca and P

A

Fibrous Dysplasia, Paget Disease of Bone

64
Q

Elevated alkaline phosphatase and urinary hydroxyproline

A

Fibrous Dysplasia, Paget Disease of Bone

65
Q

Self-limiting disease

A

Fibrous Dysplasia

66
Q

Osteitis deforans

A

Paget Disease

67
Q

Uncoordinated overactivity of osteoclasts/blasts

A

Paget Disease

68
Q

Cotton wool appearance of bone

A

Paget Disease

69
Q

Malar bulging

A

Paget Disease

70
Q

Widened alveolar ridge

A

Paget Disease

71
Q

Hypercememtosis

A

Paget Disease

72
Q

Difficult extractions, frequent denture remakes

A

Paget Disease

73
Q

Most common genetic CT disorder

A

Marfan syndrome

74
Q

Elevated ESR

A

Rheumatoid Arthritis

75
Q

Positive RF

A

Rheumatoid Arthritis

76
Q

Sjogren syndrome is associated with __

A

Rheumatoid arthritis

77
Q

Stomatitis medicementosa

A

Rheumatoid arthritis

78
Q

Myasthenia gravis affects __ (age)

A

young adults

79
Q

Myasthenia gravis affects __ (gender)

A

females more than men

80
Q

Destroys Ach receptors on neuromuscular juntion

A

Myasthenia Gravis

81
Q

Weakness, fatigue of voluntary muscles

A

Myasthenia Gravis

82
Q

Speech/chewing/swallowing/facial muscles affected

A

Myasthenia Gravis

83
Q

Sometimes associated with other autoimmune diseases (Sjogren syndrome, pemphigus)

A

Myasthenia Gravis

Summer 2017-Oral Medicine Final (17 decks)

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