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Human Diseases September PRH > September > Flashcards

September Flashcards

1
Q

What drugs are renal transplant patients likely to be on?

A

A corticosteroid plus a steroid sparing drug e.g. cyclosporin

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2
Q

What is the main side effect of cyclosporin?

A

Gingival overgrowth

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3
Q

Is antibiotic cover needed for MOS renal transplant patient?

A

No

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4
Q

What infections are renal transplant patients predisposed to?

A

Candidosis, herpes simplex or zoster virus (give low dose acyclovir in some cases)

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5
Q

What does renal osteodystrophy result in?

A

Secondary hyperparathyroidism

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6
Q

What does secondary hyperparathyroidism mean happens in the body?

A

Ca moves out of the bones

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7
Q

What chemical is not produced which means anaemia occurs?

A

EPO is not produced by the kidney

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8
Q

How would you describe anaemia of chronic disease?

A

Normocytic and normochromic

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9
Q

What drug do dialysis patients take?

A

Heparin

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10
Q

When is the optimum time for dental treatment in dialysis patients?

A

The day after dialysis - optimal renal function and heparin has worn off

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11
Q

What other oral symptoms could renal transplant/ dialysis patients present with?

A

Increased oral ulceration, increased oral infection, swelling of salivary glands in particular parotid palatal and buccal keratosis, in kids, delayed eruption etc

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12
Q

What do you have to be aware of when prescribing to a renal patient?

A

Impaired drug excretion

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13
Q

What drug is nephrotoxic?

A

Gentamycin

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14
Q

Give 3 examples of drugs that should be given in a reduced dose in renal patients?

A

Acyclovir, erythromycin, amoxicillin, ampicillin

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15
Q

What drugs should be avoided in renal patients?

A

Gentamycin, NSAIDs, tetracyclines

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16
Q

What are AKI patients at risk of?

A

Because of increased K, arrhythmias . Med emergency - calcium resonium and glucose and insulin infusions IV?

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17
Q

What is the effect of PTH?

A

Increased serum Ca therefore Ca moves out of bones

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18
Q

What is an example of a bone turnover marker?

A

Beta crosslaps - if increased, bone breaking down more rapidly

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19
Q

What is used to assess osteoporosis?

A

DEXA - assesses bone mineral density

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20
Q

What is the difference between prim and sec parathyroidism?

A

Primary - abnormal glands causing hypercalcaemia

Secondary - Ca low for another reason so PTH is appropriately high

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21
Q

What can vit D defincency cause?

A

Tetany as low Ca

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22
Q

What does a pagets disease x ray look like?

A

Moth eaten

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23
Q

What is the treatment for pagets?

A

High dose bisphosphonates

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24
Q

What 3 things are treated with high dose bisphos?

A

Metastases, pagets, hypercalcaemia

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25
Q

Low dose bisphos?

A

Osteoporosis

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26
Q

What can cause osteoporosis?

A

Cushings, steroid treatment, menopause, something effecting Ca and vit D e.g. liver, kidney, nutritional

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27
Q

What DEXA score means osteoporosis?

A

-2.5 or below

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28
Q

Osteoporosis tx options?

A

HRT, low dose bisphos, denosumab, PTH injections, Ca and D3 in elderly

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29
Q

Bone metastases tx?

A

IV bisphos (high dose), radiotherapy, surgery

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30
Q

common primary metastatic cancer sites?

A

breast, prostate, lung

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31
Q

What is filtered through the glomerulus?

A

Water, electrolytes, urea, uric acid, glucose, creatinine

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32
Q

What is the macula dense?

A

Closely packed cells lining the distal tubule wall, where is touches glomerulus (specialised cells)

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33
Q

GFR?

A

Sum of filtration rate in all functioning nephrons

34
Q

What is creatinine clearance?

A

Amount of blood kidneys clear of creatinine (USUALLY PER MIN)

35
Q

When GFR decreases…

A

Creatinine increases (a small increase in creatinine indicates big drop in GFR so is significant)

36
Q

what is creatinine clearance?

A

Urinary creatinine concxvolume/plasma creatinine conc

37
Q

What occurs with platelets in CKD?

A

Don’t work properly but normal count

38
Q

What is caused by CRF?

A

Hyperkalaemia and hypocalcaemia, restless legs, hormones crazy and twitches

39
Q

What is academia treated?

A

Sodium bicarbonate

40
Q

What does fluid overload cause - dialysis?

A

Cardiac tamponade, pericardial effusion, pul oedema, becks triad

41
Q

What would you give prophy if someone had metal heart valve and dialysis?

A

Amoxicillin 3g 1hour pre procedure - clindamycin If allergic. Or IV vancomycin or gentamycin?

42
Q

Name some drugs used immunosuppression dialysis etc?

A

Prednisolone, Cyclosporin, Tacrolimus, Sirolimus

43
Q

What are symptoms of orofacial digital syndrome?

A

Liver cysts, bifid tongue, dental abnormalities, facial milia, cleft palate, limb abnormalities, digit abnormalities X linked dominat

44
Q

What is korsakoffs psychosis>

A

B and thiamine deficiency

45
Q

What is osteoarthritis treated with?

A

Analgesics, NSAIDs, Steroid injections, Hyaluronan injections, Glucosamine sulphate, weight loss

46
Q

RA symptoms?

A

Symmetrical, more deforming and inflammatory than OA, longer morning stiffness, serum RF,

47
Q

Radiographs - OA vs RA?

A

OA - whiter X ray, RA = darker x ray, periarticular bone lesions

48
Q

`further symptoms RA?

A

Pleurisy, Sjrogens, Anaemia of chronic disease, muscle atrophy, pericarditis, ulna deviation

49
Q

Give two examples of DMARDs?

A

Methotraxate, cyclosporin

50
Q

Patients on anti TNF drugs? Dentally relevant…

A

FBC before dental tx. Patient should be dentally fit before starting these drugs.

51
Q

Treatment for psoriasis with psoriatic arthritis?

A

Methotrexate? anti TNF

52
Q

What is reiters syndrome?

A

Reactive arthritis and conjunctivitis and urethritis

53
Q

Tx Reiters?

A

DMARds, sometimes NSAIDs, steroid injection or self limiting

54
Q

What is sjorgens?

A

The lymphocytic infill of lac/sal glands (interstitial lung disease, renal tubular acidosis, raynauds)

55
Q

Treatment sjrogens?

A

things to relieve dryness and steroids

56
Q

What to do if teeth are involved in a jaw fracture?

A

It is an open fracture, aim to treat within 24 hours

57
Q

Classifying fractures?

A

Site, joint involvement, traumatic/pathological, extent

58
Q

What does angulation mean in terms of fractures?

A

Spiral fracture

59
Q

What does avulsion mean in terms of fractures?

A

Bone pulled by tendon attached to it

60
Q

What are the 3 stages of fracture healing?

A

Inflammation, reparative, remodelling

61
Q

Rehabilitation for a fracture?

A

minimise immobilisation, early mobilisation, soft diet, physio

62
Q

Dental treatment and joint replacement?

A

oral strep rarely causes infection so not prophylactic advised, if patient is immunocompromised ask!

63
Q

what happens in osteoporosis?

A

the bone marrow fills in with bone

64
Q

What are osteoporosis patients at risk of ?

A

Post extraction osteomyelitis

65
Q

Fibrous dysplasia?

A

Hyperthyroidism, Chinese letter bone

66
Q

What dental problems pagets?

A

Ill fitting dentures! Mosaic bone under microscope, Hugh out put cardiac failure, enlarging head

67
Q

Osteoradionecrosis definition?

A

Dead bone caused by secondary reaction to radiotherapy - set off by Xla/trauma. Avoid XLA 6 months -1year after radiotherapy

68
Q

Post DXT xls?

A

Dont do - refer! but prophy antibiotics for 1 month / till socket heals. when XLA really minimise periosteal lifting and trauma Close St accurately. Trim sharp bone edges. No vasoconstrictor.

69
Q

What is an oral feature of ankylosing spondylitis?

A

Minimal mouth opening

70
Q

Treatment of gout?

A

NSAIDs then allopurinol

71
Q

Cleidocranial dystosis oral indications?

A

Delayed eruption, supernumerary or non eruption of teeth

72
Q

When is cyclosporin used?

A

Transplant patient or RA

73
Q

When is methotrexate used?

A

Transplant patient or RA

74
Q

Methotrexate oral effects?

A

Increased oral ulceration

75
Q

Baclofen effects?

A

Xerostomia

76
Q

Pencillamine oral effects?

A

Ulceration, lichenoid reactions

77
Q

BZDs agonist?

A

Flumazenil

78
Q

What do antihistamines do?

A

CNS depress

79
Q

Uses of anxiolytics?

A

Sedation, muscle relaxants, premed - oral, amnesic, epilepsy emergency

80
Q

What is midazolam used for?

A

IV sedation

Human Diseases September PRH (1 decks)

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