Systemic Diseases Flashcards
Chronic obstructive pulmonary disease is a general term for
pulmonary disorders
characterized by chronic airflow limitation from the lungs that is not fully reversible
COPD encompasses two main diseases:
Chronic bronchitis and
emphysema
Chronic inflammation of the bronchi that
produces excessive tracheobronchial
mucus production and a persistent cough
with sputum for at least 3 months in at
least 2 consecutive years in a patient in
whom other causes of productive chronic
cough have been excluded.
chronic bronchitis
Permanent enlargement of the air
spaces in the lungs that is accompanied
by destruction of the air space (alveolar)
walls without obvious fibrosis
emphysema
These 2 conditions are related, and often represent
the progression of disease and may have overlapping symptoms, making differentiation difficult
The recommended use of COPD is used and is diagnosed on the presence of, (2) together with an abnormal measurement of — function
sputum production, and dyspnea
lung
The onset of COPD takes many years in
most patients and usually begins after
age
40
Symptoms develop —, and many
patients are unaware of the emerging
condition
slowly
“Blue Bloaters”
Traditionally, patients with chronic bronchitis have been described as
sedentary, overweight, cyanotic, edematous and breathless
Patients diagnosed with emphysema
were traditionally know as “Pink Puffers” because they demonstrated (6)
enlarged chest walls (barrel-chested appearance),
weight loss with disease progression,
severe exertional dyspnea,
seldom coughing,
lack of cyanosis,
pursing of the lips with efforts to forcibly exhale air from the lungs
with patients with COPD, monitor
vitals
what kind of oxygen do patients with COPD get?
low flow oxygen only
why low flow oxygen only?
they depend on
elevated arterial CO2
levels to stimulate
breathing
questions with Emphysema,
bronchitis (5)
How severe? How long have you had it? What medications are you on? “Does it bother you to recline completely?” “Will the rubber dam be a problem?”
how many attacks a week with mild asthma?
<3 /week
duration of mild asthma attack
<30 min duration
when do you have a mild asthma attack?
only w exercise or allergen
do those with mild asmtha use an inhaler?
rarely
age of mild asthma
usually childhood, usually outgrow
how many attacks with moderate asthma
3-5 attacks/week
how long does a moderate asthma attack last
30 min-several hours
moderate asthma affects
sleep
inhaler use with moderate asthma
more common
amount of attacks with severe asthma
daily attacks
inhaler use with severe asthma
daily
severe asthma may require (2)
frequent ER visits, hospitalized
steroids
severe asthma limits
daily activity
Shortness of Breath (S.O.B.) questions (2)
“how many blocks can you walk before tiring?” “can you walk two flights of stairs without having to stop?”
sleep apnea (2)
Paroxysmal nocturnal dyspnea
waking suddenly in middle of
night short of breath
symptoms of sleep apnea (4)
Snoring with occasional apneas
Tired (difficulty concentrating during day)
Sore throat in morning
Increased gastric reflux
behavioral treatment of sleep apnea (2)
weight loss
cessation of alcohol use
surgery as treatment for sleep apnea (4)
Uvulopalatopharyngoplasty genial advancement hyoid suspension maxillomandibular advancement (MMA)
sleep apnea treatment option includes
Constant Positive
Air Pressure
(CPAP) machine
Constant Positive
Air Pressure
(CPAP) machine
+ pressure during
sleep
rhematic fever (2)
Usually from Strep throat as a child (5-15 yrs. old)
Autoimmune condition
Strep symptoms (5)
Sore throat Fever Headache swollen tonsils White patches on tonsils
rheumatic fever group
Group A, β-hemolytic
Strep
what can rheumatic fever involve? (4)
Heart valves= rheumatic heart disease
Inflamed joints
Brain (chorea =uncontrolled movements)
Broad pink patches on skin
rheumatic heart disease is used to premeditate for
invasive dental procedures
rheumatic heart disease is not included in
latest recommendations
what should you do if concerned?
med consult
coronary bypass graft surgery (2)
Single, double, triple, quadruple.
Redirects blood around a partially blocked or blocked artery in your heart
what type of graft? (2)
Synthetic?
Allograft?
- Synthetic?-Dacron
* Allograft?-autologous vein, human umbilical vein
for coronary bypass graft surgery, no elective treatment for at least
2 months
after that,
med consult
symptoms of Alzheimers disease (3)
Memory loss
Cognitive decline
Behavioral and
personality changes
Dementia is a disorder of cognition that consequently interferes with
the daily functions and results in a loss of independence
Most common causes of dementia are
3
Alzheimer’s disease,
vascular dementia,
dementia caused by Parkinson’s disease
Prevalence of Alzheimer’s increases with age:
age 65 7%
by age 85, more than 40%
Women are at greater risk primarily
because they
live longer
Cause of Alzheimer’s disease is unknown
but appears to involve the loss of
cholinergic neurons
Genetic predisposition contributes to
less than –% of all cases
20%
Average lifespan after diagnosis
8 years
Dental Management (3)
Knowledge of the stage of the disease,
medications taken,
cognitive abilities of the patient
Patients with mild to moderate disease generally (2)
maintain normal systemic organ function and can receive routine dental treatment
As disease progresses, (3) are frequently are used to manage
behavioral disturbances
antipsychotics
antidepressants
anxiolytics
these medications contribute to — with increased risk for dental caries
xerostomia
adrenal glands
small endocrine glands located bilaterally at the superior pole of each kidney
adrenal medulla functions as a
sympathetic ganglion
adrenal medulla secretes
catecholamines, primarily epinephrine
adrenal cortex secretes
several steroid hormones
etiology of Addisons disease
primary adrenal insufficiency
adddisons disease is caused by
progressive destruction of the adrenal cortex
progressive destruction of the adrenal cortex is usually due to (2)
autoimmune disease
chronic infectious disease
chronic infectious disease examples (4)
TB
hIV
cytomegalovirus infections
fungal infections
secondary adrenal insufficiency is caused by (2)
pituitary disease or critical illness
tertiary adrenal insufficiency is caused by
processes that impair function of the hypothalamus
most common cause of tertiary adrenal insufficiency
use of corticosteroids
adrenal insufficiency symptoms (6)
TIRED-FATIGUE WEAK ORTHOSTATIC HYPOTENSION POOR HEALING INABILITY TO TOLERATE STRESS INCREASED INFECTIONS
adrenal insufficiency healing
poor
increased — with adrenal insufficiency
infections
adrenal insufficiency has inability to tolerate
stress
adrenal insufficiency may be from
oral steroid use
SECONDARY ADRENOCORTICAL INSUFFICIENCY IS FAR
MORE COMMON A PROBLEM AND MAY BE CAUSED BY (2)
SUCTURAL LESIONS OF THE HYPOTHALAMUS OR PITUITARY
GLAND
ADMINISTRATION ON EXOGENOUS CORTICOSTEROIDS
A DIAGNOSIS OF SUBSTANCE ABUSE REQUIRES THE
2
RECURRENT USE OF A SUBSTANCE OVER THE PAST 12
MONTHS WITH SUBSEQUENT ADVERSE CONSEQUENCES
alcohol and drug abuse results in
FAILURE TO FULFILL A MAJOR ROLE AT WORK, SCHOOL,
HOME; LEGAL PROBLEMS;PERSISTENT INTERPERSONAL
PROBLEMS
FEATURES SUGGESTIVE OF ALCOHOL ABUSE INCLULDE (4)
MISSED APPOINTMENTS
ALCOHOL ON BREATH
ENLARGEMENT OF THE PAROTID GLANDS
SPIDER ANGIOMAS
alcohol use can result in (6)
LIVER AND BONE MARROW DAMAGE CIRRHOSIS VITAMIN K DEFICIENCY REDUCED EFFECT OF LOCAL ANESTHETICS AND BENZODIAZEPINES NUTRITIONAL DIFICIENCIES CANDIDAL INFECTIONS
binge drinking
> 5 oz /4 hours
Excessive drinking = Increased cancer of: (3)
Mouth
Larynx
Esophagus
combo of smoking and alcohol greatly increases the chance of
oral cancer
alcohol can act as an irritant and damage cells which could lead to
DNA changes
drug abuse interacts with
Rx, anesthetic
drug abuse leads to — damage
liver
infectious diseases if shared
needles
oral complications with drugs alcohol: tends to have more (4)
plaques
calculus
caries
gingival inflammation
cocaine leads to (2)
gingival recession and erosion of facial aspects
meth mouth (4)
xerostomia
rampant caries
bruxism
muscle trimus
should not provide extensive care until — improves
homecare
anemia
reduction in the oxygen carrying capacity of the blood
most common blood condition in the US
anemia
anemia is usually associated with (2)
decrease number of circulating RBC
an abnormality in the Hb contained within RBC
who does anemia affect mostly
females>males
anemia may be caused by
an underlying disease especially in men
more than - million US cases of anemia per year
3
types of anemia (4)
IRON DEFCIENCY
FOLATE DEFCIENCY
HEMOLYTIC ANEMIA
SICKLE CELL ANEMIA
symptoms of anemia (5)
Pale (= pallor) Fatigue Low blood pressure SOB Rapid heart rate
oral signs of anemia (2)
Smooth, burning red tongue
Bleeding gums
anemia results in delayed — and increased —
healing
infections
pagophagia
Craving and chewing ice associated with
iron deficiency, with or without anemia
2 major eating disorders
anorexia nervosa
bulimia nervosa
ANOREXIA NERVOSA
SEVERE RESTRICTION OF FOOD
INTAKE, LEADING TO WEIGHT LOSS AND THE MEDICAL
SEQUELAE OF STARVATION
BULIMIA NERVOSA
RESTRICTION OF FOOD BY BINGE
EATING FOLLOWEED BY VARIOUS METHODS OF TRYING TO
RID THE FOOD.(VOMITING,LAXATIVES,DIURETICS)
age onset of anorexia
14-18
anorexia is rare after
age 40
who does anorexia affect
females (90-95)
mortality rate of anorexia
5-20% usually by starvation, suicide, electrolyte imbalance
anorexia nervosa symptoms (8)
Hair thin and brittle Neck / facial swelling Fainting Irritable Low b.p. Anemia Osteoporosis Amenorrhea
with bulimia nervosa, — — are higher than surrounding enamel
amalgam restorations
age onset of bulimia
20 years
who does bulimia affect
females, 90-95% of cases
more than –% abuse alcohol and stimulants
30%
how many of bulimics have personality disorders
1/2
bulimia nervosa results in enamel erosion from
acidic chemicals
where does enamel erosion occur
Lingual of ant teeth
perimylolysis
LOSS OF ENAMEL AND DENTIN
ON THE LINGUAL SURFACES BY CHEMICAL AND
MECHANICAL EFFECTS
PT measures
how quickly your blood clots
if you take blood thinning medication, your PT test will be expressed as
a ratio, INR
IF THE INR SCORE IS TOO LOW- PATIENT CAN BE AT RISK FOR
A BLOOD CLOT
IF THE INR SCORE IS TOO HIGH, PATIENT CAN EXPERIENCE
BLEEDING ISSUES
TYPICAL INR SCORE RANGE FOR PATIENT ON BLOOD
THINNER IS
2-3
HEALTHY PEOPLE NOT ON BLOOD THINNER __ OR
BELOW
1.1
