DH Path Exam 1 update
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| Disease caused by a healthcare worker | Iatrogenic
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| what is the scientific study of disease | Pathology
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| Unknown cause | Idiopathic
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| '5' Clinical signs of Inflammation | Redness, Heat
Pain, Swelling
loss of normal tissue functiom
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| Systemic signs of Inflammation | Fever- pyrogen production
Leukocytosis- more WBC in blood
Lymphadenopathy- Hyperplasia & Hypertropy of Lymphocytes
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| 4 stages of Mitosis | Prophase, Metaphase, Anaphase, Telophase
P M A T
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| A complete 2nd set of chromosomes (92) incompatible with life | Euploid
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| Larger than normal, extra segment is identical to a segment of the normal chromosome | Duplication
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| Aneuploid | and extra number, but isn't an exact multiple of chromosomes
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| The observable appearance of an individual | Phenotype
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| Identical Allelic Genes(genes located same level/same function) | Homozygote i.e. Blood type AA
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| Different Allelic Genes | Heterozygote
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| The pathological wearing away of tooth structure from repetitive mechanical habit | Abrasion
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| Wedge shaped lesion cervical areas of tooth weakened/fatigued structure=susceptibility | Abfraction
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| 70-75% of defense pool, major antibody in the blood serum Initial Defense, (Fetal-1st passive immunity)) | IgG (Immunoglobin or antibodies)
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| Defends body fluids from microorganisms | IgA (Immunoglobin)
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| Activation of B lymphocytes (along w/ IgD) involved in early immune response | IgM
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| Activates of B lymphocytes | IgD
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| Involved in hypersensitivity reactions- release histamines | IgE
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| level of a specific antibody | Antibody Titer
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| link between inflammatory & immune response, act as antigen presenting cells, amplifies the immune response phagocytosis does NOT have Memory | Macrophages
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| develop from bone marrow stem cells, reside in lymphoid tissue. Produces plasma cells and B memory cells. | B lymphocytes
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| Pin wheel shaped nucleus, visible cytoplasm. Produces antibody proteins or Immunoglobulins | Plasma Cells
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| develop from bone marrow stem cells, mature in the Thymus. Memory Cells, T-helper cell (T4 marker, T-Cytotoxic cells (viral surveillance) & T supressor cells (turn off B lymphocites) T8 marker | T lymphocytes
Cell Mediated Immunity
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| 'B' Lymphocytes primary role and the production of Antibodies | Humoral Immunity
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| 'T' Lymphocytes assisted by macrophages are the predominant role in: | (CMI) Cell Mediated Immunity
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| Type I hypersensitivity | occurs within minutes
IgE--> histamine release
constricts smooth muscle in lungs
swelling edema i.e. asthma, hay fever, anaphylaxis
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| IgG and IgM antibodies combine with antigen. Tissue destruction where antigen is present | Type II hypersensitivity
i.e. incompatible blood transfusions
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| Immune complexes formed (microorganisms+antibody) deposit in circulation, Acute inflammatory response. neutrophils->phagocytosis-> lysosomal enzymes->Tissue destruction | Type III hypersensitivity
(Auto Immune disease)
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| Delayed hypersensitivity, Cell Mediated Immunity | Type IV hypersensitivity
(i.e. Tuberculosis Dx, Organ Transplant rejection)
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| What is Uticaria? | Hives, multiple well demarcated swelling w/ Itching
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| Arthritis, Urethritis, Conjuctivitis Antigenic marker HLA-B27 Men 10:1 Oral ulcers & tongue depapillation. lower extremities affected (knees ankles) | Reiter Syndrome aka Reactive arthritis
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| Histocytosis X Letter-Siwe disease- Hand Schuller Christian disease Eosinophilic Granuloma of bone | Langerhans Cell Disease
Langerhans cell present (type of macrophage)
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| Acute, rapid, children under 3yrs can be fatal, oral manifestations rare | Letter-Siwe disease
(Langerhans)
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| Chronic, multifocal, children under 5yrs 'punched out' skull radiolucencies mimics advanced perio disease | Hand Schuller Christian disease
(Langerhans disease)
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| Chronic. localized older children,young adults skull & mandible commonly involved eosinophilic granuloma males affected 2x as much | Solitary Eosinphilic Granuloma of the Bone (Langerhans)
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| Combination of dry mouth and dry eyes | Sicca Syndrome
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| Auto-immune, Just sicca=Primary w another auto immune disease= Secondary bilateral enlarged parotid glands Sicca and Raynaud's Syndrome (fingers and toe circulation) 90% positive reaction to Rheumatoid factor | Sjogren Syndrome
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| 85% sin lesions (butterfly rash) Oral Lesions 25%, Raynaund 15% arthritis, arthralgis, kidneys possible sjorgen's present (bloodwork before dental work may need to pre-med) | SLE Systemic Lupus Erythematous
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| confined to skin & mucous membranes mildest form: | DLE Discoid Lupus Erythematous
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| Severe, progressive auto-immune disease affecting skin and mucous membranes.50% 1st sign in oral cavity Nikolsky's sign: gentle pressure on mucosa form bulla Epithelial cell destruction | Pemphigus Vulgaris
mortality now 8-10%
Corticosteroids
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| Acantholytic or Tzanck cells- | detached epithelial cells (rounded appearance)biopsy to confirm
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| Cicatrical Pemphigoid aka(benign) Mucous membrane pemphigoid | Gingiva-most common site
affects oral & genital mucosa, skin, conjuctiva Cicatrical- 'healing w/ scarring'
severe eye lesions may occur desquamative gingivitis. Nikolsky's sign
hard to control. corticosteroids
periods of exacerberation-> remission
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| 60yrs + lesions more extensive, painful anti-inflammatory, corticosteroids | Bullous Pemphigoid
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| Chronic, recurrent, autoimmune disease. Avg age 30yrs, must have 2 of 3 lesions present Oral, Genital, Eye lesions, (Skin) | Behcet Syndrome
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| 60-70% of entire WBC population 1st wbc recruited by chemotaxis Main Function: Phagocytosis | Neutrophils (PMN)
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| 3-8% of entire wbc pop. 2nd to injury site longer lifespan than neutrophil function: phagocytosis, and immune response | Monocyte becomes MACROPHAGE
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| Non specific response to injury, occurs in the same manner regardless of the nature of the injury | Inflammation
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| Arterioles, capillaries, venules | (MC) Microcirculation
Constricts than Dilates during inflammation
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| Salivary gland stone formed by calcium salts around a central core (major and minor glands) | Sialolith
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| Unilateral 'frog-pouch' mucocele-like lesion sublingual and submandibular glands duct obstruction likely cause | Ranula
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| Radicular or Periapical cyst | True cyst (lined w/ epithelium)
most commonly occuring oral cyst
epi rest of Malassez proliferation
usually asymptomatic
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| Alveolar Osteitis | 'Dry Socket'
lost blood clot after tooth extraction
bone surface exposed. Painful, but no inflammation because no infection exists
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| Trisomy 21 (Down Syndrome) | most common abnormality in humans
fissured/pebbly tongue, Macroglossia w/ protrusion, High arch palate, Enamel hypoplasia, microdontia, >90% Perio disease
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| Trisomy 13 | 70% live to 7mos only
Bilateral cleft lip and palate
small/No eyes micro/anophthalmia, supernumerary digits
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| Missing an 'X' chromosome short,neck webbing, hands &feet edema, broad chest, genital underdeveloped, lack the 'Barr bodies' | Turner Syndrome
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| XXY, male phenotype Taller, wide hips, female pubic hair, >50% breasts Maxilla slighty hypoplastic, detected after puberty 1 barr body for each extra x | Klinefelter Syndrome
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| Caused by deletions on the short arm of CH5 Mental retardation, (No Oral abnormalities) 'catlike cry' | Cri du Chat Syndrome
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| Wolf-Hirschhorn Syndrome | Deletion on CH4
Cleft Palate
IQ > 30
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| Autosomal(non-sex chromosomes) dominant,cyclic decrease in Neutrophils 21-27dys intervals, lasting 2-3dys, Oral ulcers G-CSF Tx | Cyclic neutropenia
Chronic= Kotsmann Syndrome
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| Autosomal Recessice Inheritance Periodontal destruction, perm. tooth loss before age 14, Palmer & Plantar hyperkeratosis (retinoid Tx) | Papillon-Lefevre Syndrome
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| Gingival Hyperkeratosis | band-like, few mm in width, Free gingiva not affected
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| Gingival Hypertrophy, Very firm, corrugated, paler, lips may protrude | Gingival Fibromatosis
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| Laband Syndrome | Gingival Fibromatosis, nail loss,malformed nose & ears, enlarged liver & spleen, fingers/toes frog-like appearance
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| 'Soap bubble' radiographic jaw appearance, eyes far apart, delayed eruption=pseudoanodontia Fibrous CT | Cherubism
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| Ellis-Van Creveld Syndrome | affects dwarfs, Polydactyl, toenails missing, 50% heart defects, and present natal teeth, no anterior Max. Vestibule, Conical tooth shape
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| > size of mand. teeth, supernumerary teeth,missing/minimal clavicles skull defects, open fontanelles | Cleidocranial Dysplasia
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| Gardner Syndrome | Osteomas (jaw,skull,long bones) and Odontaomas, Intestinal Polyps become malignant age 30+
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| Mandibulofacial Dysostosis (Assoc. w/ Treacher's Collins Syndrome) | 'fish-like' commisures
Deafness
Hypoplastic mandible, Open bite, 30% high palate or cleft
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| Nevoid Basal Cell Carcinoma Syndrome (Gorlin Syndrome) | wide spaced eyes, Jaw cysts, basal cell carcinomas,Nevi: pigmented skin lesions
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| Osteogenesis Imperfecta | 30% W/ Family Hx, brittle bones
Dentinogenesis imperfecta (dentin can't suppoprt enamel) 80% Primary teeth affected. 35% Permanent
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| Tori | Mandibular: rare before age 15 smooth or lobulated
Palate: mucosa thin, trauma easy
2:1 women > Native Americans
Rare younger than 14yrs
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| Ehlers-Danlos Syndrome | Collagen & CT defect, very elastic, joint hypermobility
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| Cleft palate/lip | 1 in 800 births
cogenital lip pits
midline of lower lip vermillion border
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| Hereditary Hemorrhagic Telangiectasia | Serious Nosebleeds (Note in DX Tx)
Pinpoint/spider-like red lesions lips,eyelids,nose
Tip Anterior Dorsom tongue
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| Multiple Mucosal Neuroma Syndrome MEN2 B | Thyroid Carcinoma 75%, early Dx can become malignant
oral neuromas, tip of tongue
Pt: tall, large thick lips, everted eyelids
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| Von Recklinghausen Disease | Neurofibromatosis of CNS, eyelids, nasoloabial fold (hearing/visual)
Cafe au lait
105 Oral involvment
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| Peutz-Jeghers syndrome | 98% lip & buccal mucosa lesions
multiple melanin macules skin and mucosa, diminish w age
GI Polyposis (rarely malignant)
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| White Sponge Nevus | birth or after puberty
white, corrugated, soft mucosa
Always the buccal, never free gingiva, usually bilateral
Keratin desquamates- raw mucosa
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| Amolgenesis Imperfecta 4 TYPES | HYPO:(1)Plastic-irregular thickness,pitted(2)Calcified,yelloworange,chips easily-openbite? 3)Maturation-i.e. snowcap,soft enamel (4)Plastic-Maturation- yellow,brown pitted
ALL teeth, Severe Sensitivity
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| Dentinogenesis Imperfecta | most common
AKA Hereditary Opalescent Dentin
dentin soft (restorations fail), enamel chips-Attrition, NO PULP CHAMBERS, Roots are short blunt
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| Dentin Dysplasia Type I RADICULAR | Normal crowns, Short roots-early exfoliation. half moon pulp chamber appearance. Disturbance in Hertwig's epi root sheath
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| Dentin Dysplasia Type II CORONAL | pulp stones, Translucent/amber primary teeth Permanent: Normal crown/color, small roots no pulp chambers shown radiographically
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| Hypohydrotic ectodermal Dysplasia | X linked recessive
less hair,sweat
hypo or anodontia, alveolar ridge-only if teeth present
no minor salivary glands or respiratory tract mucosa
soft,dry skin
incisors,canines small conical
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| Hypophosphatasia | decrease in serum alkaline phosphates (calcifies bone and cementum) bow-legged, fractures
no pdl, spontaneous loss of primary teeth
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| Hypophosphatemic Vitamin D resistant rickets | Large pulp chambers, gingival abscesses, pulpal disease, Dentin cracks, bowlegged
low phosphorous serum levels
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| Pegged/Absent Max. Laterals | primary and Secondary dentition
1-3% white 7% Asian
Premolars missing 10-20%
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| Taurodontism | Large, Pyramid Molars
Large Pulp chambers, furcations, freq found in Klinefelter (XXY) Syndrome
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| Giant Cell Granuloma | CENTRAL_Within bone, multi-nucleated giant cells
only in jaw
PERIPHERAL- Outside bone, Dk red, on gingiva or alveolar mucosa
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| Pyogenic Granuloma | No pus, response to injury
pregnant, teenagers, young adults
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| Chronic Hyperplastic Pulpitis | Granulation tissue fill caries void
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| Increased dilation of blood vessels | Kinin System
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| c-Reactive protein | produced in liver
acute & chronic
> 10mg is high
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| Parenteral | Injection
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| Serum sickness Drug Hypersensitivity | Type III allergy
i.e. horse anti-toxin (no longer done) for immunity
penicillin, barbituates
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| Lichen Planus | 1% pop
almost always bilateral
Wickham's Striae
benign, chronic skin(lumbar), oral mucosa (buccal)
desquamative gingivitis
basal cell layer degeneration
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| Dental or Periapical granuloma | painful, localized
slightly extruded from socket
opening in pulp canal (apex usually)
thickened PDL (slight)
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| Focal Sclerosing Osteomyelitis aka condensing osteomitis | change in bone, near apex (usually Mand 1st Molar) usually reaction to infection, asymptomatic, no tx
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