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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
Symptoms of Ehlers-Danlos Syndrome
1. microdontia 2. short roots 3. pulp stones 4. deciduous teeth: abnormal molars, obliterated tooth pulp, enamel attrition 5. permanent teeth: agenesis, microdontia
26
Osteoarthritis
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
27
Do people with osteoarthritis have TMJ problems?
NO
28
Rheumatoid Arthritis
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
29
Rheumatoid Arthritis - Dental Aspects
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)
30
What causes gout?
deposit of urate crystals in joints-->PMNs release lysosomal enzymes-->inflammation (great toe)
31
Primary gout
inborn error of metabolism
32
Secondary gout
drug side effect
33
Meat-eating gout
1. eating 2. beer drinking 3. obese 4. old men
34
Tophi gout
helix of inner ear
35
Muscular dystrophy
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
Myasthenia Gravis
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
Medication-Related Osteonecrosis of the Jaws
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
What precautions should you take with dental patients who have osteoarthritis?
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
Imperfect formation of bone
Osteogenesis imperfecta
40
Usually autosomal dominant
Osteogenesis imperfecta, Cleidocranial dysplasia, Marfan syndrome, Ehlers-Danlos
41
Brittle bone (fracture)
Osteogenesis imperfecta
42
Easy bruising
Osteogenesis imperfecta
43
Joint hypermobility
Osteogenesis imperfecta
44
Hearing problems
Osteogenesis imperfecta
45
Blue sclera
Osteogenesis imperfecta
46
Abnormal translucency
Dentinogenesis imperfecta
47
Brown-purple color
Dentinogenesis imperfecta
48
Abnormal tooth wear
Dentinogenesis imperfecta
49
Altered enamel-dentin interface
Dentinogenesis imperfecta
50
Obliterated pulp chamber (NOT seen on x-rays)
Dentinogenesis imperfecta
51
Absent/defective clavicles
Cleidocranial dysplasia
52
Hyperdontia
Cleidocranial dysplasia
53
Retained deciduous dentition
Cleidocranial dysplasia
54
Unerupted permanent teeth in pan
Cleidocranial dysplasia
55
Malformed teeth
Cleidocranial dysplasia
56
Dentigerous cysts (around crowns of un-erupted teeth)
Cleidocranial dysplasia
57
Sequestrum (piece of dead bone that worked its way to surface)
Osteomyelitis
58
Involucrum (piece of dead bone that hasn't made its way to surface)
Osteomyelitis
59
Albright Syndrome
Polystotic Fibrous Dysplasia
60
Precocious puberty in females
Polystotic Fibrous Dysplasia
61
Ground glass appearance
Fibrous Dysplasia
62
No defined margin
Fibrous Dysplasia
63
Normal Ca and P
Fibrous Dysplasia, Paget Disease of Bone
64
Elevated alkaline phosphatase and urinary hydroxyproline
Fibrous Dysplasia, Paget Disease of Bone
65
Self-limiting disease
Fibrous Dysplasia
66
Osteitis deforans
Paget Disease
67
Uncoordinated overactivity of osteoclasts/blasts
Paget Disease
68
Cotton wool appearance of bone
Paget Disease
69
Malar bulging
Paget Disease
70
Widened alveolar ridge
Paget Disease
71
Hypercememtosis
Paget Disease
72
Difficult extractions, frequent denture remakes
Paget Disease
73
Most common genetic CT disorder
Marfan syndrome
74
Elevated ESR
Rheumatoid Arthritis
75
Positive RF
Rheumatoid Arthritis
76
Sjogren syndrome is associated with __
Rheumatoid arthritis
77
Stomatitis medicementosa
Rheumatoid arthritis
78
Myasthenia gravis affects __ (age)
young adults
79
Myasthenia gravis affects __ (gender)
females more than men
80
Destroys Ach receptors on neuromuscular juntion
Myasthenia Gravis
81
Weakness, fatigue of voluntary muscles
Myasthenia Gravis
82
Speech/chewing/swallowing/facial muscles affected
Myasthenia Gravis
83
Sometimes associated with other autoimmune diseases (Sjogren syndrome, pemphigus)
Myasthenia Gravis

Summer 2017-Oral Medicine Final (17 decks)

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