PBL Exam 3

Which bilirubin give you yellowish skin?

Unconjugated bilirubin causes jaundice, leading to yellowish skin.

Direct and Indirect bilirubin

Direct: conjugated (in urine)

Indirect: unconjugated (jaundice)

Bile salts digest fat but accumulation causes ________

itching (cholestatic pruritus)

Pemphigus vs Pemphigoid

Pemphigus: Intraepithelial (within epidermis) (nikolsky sign) (mortality)

Pemphigoid: Subepithelial (beneath epithelium)

Which viral hepatitis is never chronic?

Hepatitis A

Time for acute and chronic hepatitis

Acute is less than 6 month

Chronic more than 6 month

3 stages of Hep B

Prodromal: 3 to 10 days, 

Icteric: Dark urine, light color stool, jaundice, pale color stool

Convalescent: Recovery

Acholic Stool

Light color pale stool in hepatitis

HBsAg vs HBsAb vs HBcAb

Active Hep B

Vaccinated and immune to Hep B (appear last)

Antibody to Hep B

Urobilinogen is excreted by 

feces (gut)

Murphy’s Sign

Deep palpation in right upper abdomen causes pt to stop breathing due to sharp pain

Indicates cholecystitis (gall bladder)

SSYC culture

Salmonella, Shigella, Yersinia, Campylobacter

If you have Anti-HAV IgG but not IgM, what does that mean?

Previous infection of HAV

Anti-HBs negative

Anti-HBc IgM positive

HBV DNA positive

HBsAg positive

No immunity yet

Early infection

Virus actively replicating

Active infection

Window period

Antigen is not present

Antibody not yet made

Hepatitis B vaccine is made form _______

HBsAg

Antibiotics safe in hepatitis

Antibiotics high risk in hepatitis

Beta-lactams, cephalosporins, Aminoglycosides, Macrolides (azithromycin)

Tetracycline, Erythromycin, Fluoroquinolones

Serum concentration of ______ mg /L of tylenol will require treatment of antidote

150

Trigeminal neuralgia suppresses what artery?

superior cerebellar artery

Glasgow Coma Scale

EVM

Eye opening

Verbal

Motor

Etomidate and Succinylcholine

Rapid sedative-hypnotic agent and Short acting muscle relaxant

Dopamine on blood pressure

Low to intermediate dose: Cause vasodilation and decrease BP

High dose: Vasoconstriction and increase BP

N-acetylcystine

Treat acetaminophen overdose

Piperacillin/Tazobactam

Levofloxacin

Extended spectrum penicillin and beta-lactamse inhibitor

Levofloxacin: Fluroquinolone on DNA gyrase (QT prolongation)

Vancomycin

Glycopeptide

Inhibit synthesis of cell wall

Clindamycin MOA

Bacterial protein synthesis of 50S

Alpha 1 Antitrypsin

Inhibit elastase (elastase breakdown lung tissue)

What is FFP

Fresh frozen plasma

Increase INR

What is the toxic dose of acetaminophen in adult?

4000 mg/day

Lactulose

Removes ammonia from blood

Why did the pt get cerebral edema from acetaminophen toxicity?

High ammonia caused astrocyte swelling

Fluid shifts and increased intracranial pressure

What is torticollis?

Neck muscles are tight causing head to tilt to one side and chin point other

Auer Rods are in what disease?

Acute Myeloid Leukemia

Which bone marrow cancer causes DIC

Acute Myeloid Leukemia

Myeloperoxidase stain for what disease?

Acute myeloid leukemia

Cytarabine

Idarubicin

Inhibit DNA polymerase kills rapidly dividing myeloblasts

Induces DNA breaks apoptosis of leukemic cells

Philidelphia chromosome is associated with what blood cancer

Chronic Myeloid Leukemia

9 and 21

Prostate cancer usually spread to ______ 

bone

Check calcium level to see bone metastasis

What is adenocarcinoma?

cancer made of cells from glands

Goserelin is a GnRH _______

Flutamide is a anti-________ drug

agonist, androgen

Used to treat prostate cancer

Raise testosterone at first but then shut down pituitary becuase the GnRH receptor desensitizes and stops releasing of LH.

Without LH, testes don’t make testosterone

Condyloma acuminatum is caused by which HPV virus

6 and 11

16 and 18 cause most cervical cancer

______ differentiated cells are more aggressive

Poorly

What is brachytherapy

Internal radiation. Places radioactive source right next to tumor inside so higher dose can be given

How does chemotherapy help with radiation?

It enhances the effectiveness of radiation by sensitizing cancer cells to the effects of radiation.

Koilocyte is a squamous epithelial cell showing changes caused by _______ infection

HPV

Tamoxifen

Estrogen receptor modulator

Blocks estrogen from binding to breast cancer cells

Stop growing or dividing

Anastrozole is a _______ inhibitor

aromatase

Stops body from making estrogen from other hormones

Stops breast cancer cells from growing

HER2 is a protein on breast cancer cells

HER2 positive tumors are grow ______ and more _____

They are treated with ________

Grow faster and more aggressive

Trastuzumab (Herceptin) block HER2 signaling

4 types of lung cancer

Adenocarcinoma

Squamous cell carcinoma

Large cell carcinoma

Small cell lung cancer

Adenocarcinoma: most common and in EGFR

Squamous cell carcinoma: most common in smoker

Large cell carcinoma: rare, fast growing

Small cell lung cancer: Most dangerous, Very aggressive and fast growing (strongly associated with smoking)

Which clotting factor have the shortest half life?

Factor VII

napqi

Active toxic metabolite of acetaminophen

Sentinel lymph nodes

Node right beside cancer

Separation between pemphigus vs pemphigoid

Pemphigus: Suprabasilar separation

Pemphigoid: Sub basilar separation

What is the primary infection of varicella-zoster virus

What is the secondary

Vericella (chickenpox)

Herpes zoster (shingles)

What disease is this?

Chronic inflammation of bronchi and persistent cought with mucus

Permanent enlargement of air spaces

Chronic Bronchitis

Emphysema

What is the most important cause of COPD

Smoking

Recurrent lung infections are common with what 3 bacteria?

Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis

Pulmonary hypertension can cause cor pulmonale (_____ sided heart failure)

right

Blue Bloaters

Pink Puffers

Chronic Bronchitis

Emphysema (Barrel-chested)

A dianosis of COPD is made when pt have FEV1/FVC less than ______

Stages of COPD

70%

Stage 1: FEV1 less than 80%

Stage 2: 50-80%

Stage 3: 30-50%

Stage 4: Less than 30%

Ipratropium

Tiotropium

Short acting anticholinergic: Relax airway by blocking ACH

Long actign anticholinergic:

Short Acting B agonist

Long Acting B agonist

Albuterol

Salmeterol and Formoterol

Inhaled corticosteroids should be added in what stage COPD

3 or 4

Theophylline

Roflumilast

Nonselective PDE inhibitor (relax airway but many side effect)

Selective PDE inhibitor (less side effect)

If the O2 sat is less than _____ or there is dyspnea or an URI present, then the patient is considered unstable, and the appointment should be rescheduled and an appropriate medical referral made.

91%

Dental care can be provided to patients with stages I to _____ COPD

III

IV should be avoided

Should pt of stage III or IV COPD be treated in supine position

No should be semisupine (upright)

Nitrous Oxide in COPD pt

Safe in stage 1-2

Narcotics and Barbiturates in COPD

Avoided (cause respiratory depression)

Use benzodiapenze (Diazepam) instead

Anticholinergics and Antihistamine in COPD

Macrolides in COPD

Use cautiously cause cause dry secretion and thicker mucus

Avoid with theophylline

5 types of Asthma

Extrinsic

Intrinsic

Drug Induced

Exercise Induced

Infection

Extrinsic: Allergic (IgE and Eosinophils)

Intrinsic: Nonallergic normal IgE

Drug Induced: Mostly NSAIDs and can be beta blocker, ACE inhibitors

Exercise Induced:Cold air inhalation

Infection:

Long acting bronchodilator is given to ______ to ______ persistent asthma

moderate, severe

Exercise-induced asthma can be prevented with use of both β2-adrenergic agonists (and _______ sodium when taken 30 minutes before initiation of physical activity).

cromolyn

A significant drop in lung function (greater than ______ drop from previously recorded values) indicates that prophylactic use of inhaler or referral to a physician

10%

Selection of local anesthetic may require adjustment because those containing ______ may cause allergic-type reactions in susceptible individuals.

sulfites (in epinephrine)

With a severe asthma attack, use of subcutaneous injections of ________ or inhalation of ________ is the most potent and fastest acting method for relieving the bronchial constriction.

epinephrine, epinephrine

M. tuberculosis is an acid-fast obligate _______

aerobe

The term _______ complex is used when the tuberculosis infection involves a primary granulomatous lung lesion and an infected hilar lymph node.

Ghon

Is tuberculosis caseating or noncaseating

caseating

What is Pott disease

Tuberculosis infection in the spine

Does IGRA test for active TB

No only way to test active TB is culture

IGRA is for latent TB

What is pt noninfectious of TB

more 2-3 weeks of multidrug TB therapy

Three consecutive negative AFB sputum smears

Can you treat LTBI if clinician provide absence of clinically active disease?

Yes treat standard precaution

If there are not medical care, dental care should not be rendered

What is the 4 drug regimen for TB?

RIPE

Rifampin

Isoniazid

Pyrazinamide

Ethambutol

How many mg of nicotine is in 1 cigarette?

1 mg

The rationale for NRT is to replace cigarettes or smokeless tobacco with a source of nicotine that does not have the _____ and _____ _____ of tobacco and then to gradually reduce the use of that replacement product to (ideally) the point of abstinence.

tars, carbon monoxide

What is the fastest nicotine delivery

Nicotine spray

What is Bupropion (Zyban)

What is Varenicline (Chantix)

Antidepressent (reduce craving of smoking) Causes dry mouth

Nicotinic receptor agonist (stimulates dopamine) causes nausea

Viruses that target the liver can cause _______ and are of concern to dentistry because of risk of infection and the need for proper infection control to help prevent infections.

hepatitis

Practitioners should be aware that impairment of liver function can lead to important physiological and biochemical abnormalities including:

• altered synthesis of coagulation factors leading to bleeding tendencies

• altered drug metabolism

• portal hypertension

• serious end-stage liver dysfunction including chronic or fulminant hepatitis, cirrhosis, or hepatocellular carcinoma

Explain fulminant hepatitis and cirrhosis

Fulminant Hepatitis is severe and sudden onset

Cirrhosis is scarring of liver

_____ hepatitis is a major cause of liver cancer and chronic liver disease globally and in the United States.

Chronic

Which viral hepatitis infection have vaccine to treat

A and B

The clinical manifestations of the five types of viral hepatitis are quite similar, and the diseases can be distinguished from each other only by serologic assays.

Which Hepatitis is Oral

Which Hepatitis is Sexual

A and E are fecal-oral route (vowel affect bowels)

B,C,D are parenternal

The exact mechanism of liver injury in viral hepatitis remains unclear as none of 5 primary viruses appear to be cytopathic (kill liver cells). Instead, liver damage is largely _____ mediated with _____ being the primary drivers

Immune

Cytotoxic T cells (Recognize and destroy hepatocytes with viral antigens)

4 Phases of Acute Hepatitis

Incubation

Preicteric

Icteric

Recovery

When is replication at peak

What and when is the first sign

Preicteric is when replication at peak

Icteric is when Dark Urine becomes first noticeable sign. Jaundice also appear

If Ig____ is the only marker then the hepatitis virus is likely (2)

M

Hepatitis A and E

Drug

Interferon Alfa is used to treat Hep B by:

Lamivudine is a nucleoside used to treat Hep B by:

boosting immune response

inhibiting HBV replication

DAA (direct-acting antivirals) can cure most persons with _____ infection

HCV

Peginterferon alfa and _____ are drugs used to treat Hep C

Ribavirin

What prefix or suffix are for drugs used to treat Hepatitis B and C

drugs end with vir such as entecavir

A couple end in dine