157 Questions
In which region of the body is the liver located?
Right hypochondrium
How many lobes is the liver divided into?
4
What is the main function of the hepatic artery?
To supply the liver with oxygenated blood
Which of the following is a function of the liver?
Production of albumin
What is a common cause of liver disease?
Viral hepatitis
What is a metabolic cause of liver disease?
Non-alcoholic fatty liver disease
What is the average incubation period for hepatitis B?
75 days
What percentage of people with hepatitis C are asymptomatic?
80%
How is hepatitis prevented?
95% effective vaccine with 3 doses
What type of virus is hepatitis C?
Hepacivirus of Flaviviridae family
What percentage of people with hepatitis C will develop liver cirrhosis within 20 years?
15-30%
What is the primary difference between acute and chronic liver disease?
Acute liver disease is when the liver is coping with reduced capacity, while chronic liver disease is when the liver is failing to cope.
Dentally, what method of anaesthesia is recommended for people with liver disease?
Local anaesthesia
What is the primary cause of jaundice?
Buildup of bilirubin in the blood and body tissues.
What is the risk of transmission percentage for hepatitis B from a patient to a healthcare worker with a needlestick injury?
Up to 30%
What is the primary way bilirubin is normally reduced in the blood?
Through the secretion of bilirubin into the small intestine via the bile duct.
What is the main risk of obstructive jaundice in surgery?
Bleeding due to vitamin K malabsorption
What is the primary dental complication of jaundice?
Dental hypoplasia.
What is dental hypoplasia and a greenish discoloration of the teeth in liver disorders associated with?
Rhesus disease
What is the primary symptom of liver failure?
All of the above.
What is the primary cause of cirrhosis?
All of the above.
What are 2 risk factors for non-alcoholic fatty liver disease?
Type II diabetes and HBP
What is the primary investigation used to diagnose liver disease?
All of the above.
What is the primary complication of non-alcoholic fatty liver disease?
Cirrhosis.
What is the primary risk factor for gallstones?
All of the above.
What is the primary treatment for gallstones?
Laparoscopic cholecystectomy.
What type of infection precedes the development of rheumatic fever?
Group A streptococcal infection
Which heart valve is most commonly affected by rheumatic fever?
Mitral valve
What is the typical age range for the onset of rheumatic fever?
5-15 years
What is the duration of the latent period before rheumatic fever sets in?
2-6 weeks
What is a risk factor for developing rheumatic fever?
HLA DR4 positive
What is a complication of rheumatic fever in the heart?
Pancarditis
What type of patients are at risk of developing infective endocarditis?
Adults and children with structural cardiac defects
How can a dentist aid in the prevention of infective endocarditis?
By removing caries that contain streptococci viridians on a regular basis
What is hematuria a sign of?
Kidney stone or tumor in the urinary tract
What does the presence of white blood cells in the urine, along with red blood cells, indicate?
Urinary tract infection
What is one of the possible causes of hematuria?
All of the above
What is a possible complication of prolonged exercise or horseback/bicycle riding?
Hematuria
What is the primary diagnostic criterion for rheumatic fever?
The presence of 2 major and 1 minor criteria
What is the most common joint involvement in polyarthritis associated with rheumatic fever?
Large joints of the legs and arms
What is the percentage of patients with rheumatic fever who develop carditis?
40-50%
What is the characteristic of the rash seen in erythema marginatum?
It is a round, pale-pink center, surrounded by a slightly raised red outline
What is the association between subcutaneous nodules and rheumatic fever?
They occur 4-6 weeks after rheumatic fever
What is the percentage of patients with rheumatic fever who develop chorea?
10-20%
What is the primary reason for the increasing incidence of endocarditis?
Increasing number of elderly people with abnormal/prosthetic valves
What is the primary mechanism of endocarditis?
Infection of the endocardial surface of the heart or valves
What is the primary risk factor for developing endocarditis?
Abnormal cardiac endothelium
What is the primary consequence of endocarditis?
Valvular damage
What allows organisms to adhere and grow, leading to characteristic infections?
Small thrombi
What percentage of endocarditis patients have negative blood cultures?
5-10%
What is a common feature of endocarditis in patients over 65?
Minor degenerative lesions
What is the most common organism involved in the pathogenesis of endocarditis?
Streptococci
What is a characteristic clinical feature of late-stage endocarditis?
Splenomegaly
What is the purpose of blood culture assessment in endocarditis?
To guide future antibiotic therapy
What is a complication of endocarditis that can lead to stroke?
Embolism
What is the purpose of echocardiogram in endocarditis?
To identify the presence of vegetations or abscesses
What is the typical duration of antibiotic therapy for endocarditis?
4-6 weeks
What is a condition that may require surgical intervention in endocarditis?
Extensive damage to a valve
What is a medically compromised patient?
A patient with a condition or treatment of the condition that may impact on the delivery of safe and optimal dental care
What is the primary purpose of taking a thorough medical history?
To understand the significance of the disease and how it affects dental care
What is a risk factor for infective endocarditis?
All of the above
What is the preferred anaesthetic for patients with a compromised cardiovascular system?
Citanest without adrenaline
What is a possible consequence of compromising cardiovascular system?
All of the above
What is no longer routinely recommended for patients with infective endocarditis?
Antibiotic prophylaxis
What is the primary treatment for hypertension?
Antihypertensive drugs
What is a potential problem with patients who have respiratory disease?
Inhaled steroid and oral candida
What dose of corticosteroid should a patient take if they are having surgery, and have been taking corticosteroids for over 3 weeks at more than 30mg a day?
Double their normal dose
What must be considered when scheduling appointments for patients with diabetes?
Timing of appointments to avoid hypoglycaemia
What is a common dental side effect of corticosteroids?
Oral candidiasis
What is a potential dental problem for patients with epilepsy?
Convulsions
What is one of the functions of the liver?
Excreting bile for fat digestion
What should be avoided in patients taking corticosteroids and why?
NSAIDs, because they increase the risk of peptic ulceration
What is the most commonly used long-term anticoagulant?
Warfarin
What is a potential consequence of alcohol dependence?
Liver disease
What must be avoided in patients with liver disease?
NSAIDs and metronidazole
What does the INR measure?
The time for the blood to clot using prothrombin proteins
What is the purpose of corticosteroids?
To reduce inflammation and suppress the immune system
What should the INR levels be if a patient is taking warfarin to treat DVT or PE?
3.5-4.5
What is a potential side effect of using corticosteroids?
Cushings syndrome
When should a dental appointment be booked for a patient with a bleeding risk?
Early in the day
What is the purpose of taking a history of a patient with a bleeding risk?
To identify potential bleeding risks
What must be considered when taking patients with corticosteroids off the medication?
If the patient has been taking the medication for over 3 weeks and more than 30mg a day
What should be avoided in patients with a bleeding risk?
All of the above
What can the use of antibiotics do to the potency of warfarin?
Potentiate it
What is the term for a state where the immune system is below the optimum level?
Immunodeficient
What is the process of artificially depressing the immune system?
Immunosuppression
Which of the following is a feature of innate immunity?
Immediate
What is the term for individuals who are at risk due to reduced immune function?
Immunocompromised
What is the first step of innate immunity?
Recognition of pathogens
Which of the following is an example of an acquired immunodeficiency?
HIV infection
What is the primary difference between intrinsic and acquired resistance?
Intrinsic resistance is inherent, whereas acquired resistance is developed through mutation and natural selection.
What is the primary way that microbes can acquire resistance through horizontal evolution?
Through the transfer of genes or genetic material between microbes.
What is the primary function of transposons in acquired resistance?
To copy and move genes within a genome or between genomes.
What is the primary way that microbes can acquire resistance through vertical evolution?
Through spontaneous mutations and natural selection.
What is the primary characteristic of intrinsic resistance?
It affects almost all species strains and existed before antibiotic use.
What is the primary way that genes can duplicate to cause resistance in a strain?
Through homologous recombination.
What is the purpose of the minimum inhibitory concentration (MIC) test?
To determine the smallest concentration of antibiotic that inhibits the growth of an organism
Which of the following mechanisms of resistance involves the breakdown of antibiotics by enzymes?
Enzymatic degradation
What is the primary means of genetic exchange in conjugation?
Sexual pilus
Which of the following bacteria can genetically exchange their antimicrobial resistant genes?
Enterobacteriaceae and Pneumococci
What is the term for the process by which bacteria take up short fragments of naked DNA?
Transformation
What is the primary difference between the MIC tests in liquid media and solid media?
The method of measuring antibiotic susceptibility
What is the mechanism of resistance by which microbes prevent antibiotics from entering the cell?
Antimicrobial exclusion
Which of the following is an example of a beta-lactamase?
An enzyme that breaks down beta-lactam antibiotics
What is the primary difference between beta-lactamases in gram-negative and gram-positive bacteria?
The location of the enzyme
How do beta-lactam antibiotics combat beta-lactamases?
By modifying the antibiotic structure
What is an example of a drug that can be a victim to enhanced target production?
Trimethoprim
What is the function of efflux pumps in antibiotic resistance?
To pump antibiotics out of the cell
What is the resistome?
A collection of antibiotic-resistant genes
What is an advantage of using bacteriophages as antibiotics?
They are specific to individual bacterial species
What is the lysogenic cycle of bacteriophages?
The cycle where the phage genome integrates into the bacterial chromosome
What is a limitation of using bacteriophages as antibiotics?
They require specific identification of the infecting bacteria
What is an example of an antifungal drug that can be affected by drug resistance mechanisms?
Fluconazole
What is a mechanism of drug resistance in fungi?
All of the above
What is a way to combat drug resistance?
Using the correct antibiotic
What is the mechanism by which clavulanic acid inhibits beta-lactamases?
By causing irreversible acylation of beta-lactamases
What is the lytic cycle of bacteriophages?
The cycle where the phage lyses the bacterial cell
How do glycopeptides inhibit bacterial cell wall synthesis?
By binding to the amino acids in the peptidoglycan
What is the mechanism of resistance to glycopeptides in some bacteria?
Modification of the peptidoglycan precursor
How do aminoglycosides work against bacterial infections?
By inhibiting protein synthesis
What is the mechanism of trimethoprim resistance in bacteria?
Modification of the dihydrofolate reductase enzyme
What is drug target bypass in the context of antibiotic resistance?
A mechanism by which bacteria side-step the target of the antibiotic
How do quinolones work against bacterial infections?
By inhibiting DNA replication
What is the mechanism of quinolone resistance in bacteria?
Modification of the topoisomerase IV enzyme
How do chloramphenicol acetyl transferases contribute to antibiotic resistance?
By acetylating chloramphenicol, making it unable to bind to the ribosome
What is the mechanism of enhanced target production in antibiotic resistance?
Bacteria increase the production of the target enzyme
What is the primary cause of anaemia, neutropenia, and thrombocytopenia in leukaemia?
Bone marrow failure
What is the recommended oral care advice following radiotherapy?
Reinforcement of oral hygiene and preventative dental care
What are the two main cell lines that leukaemias take?
Lymphoid and Myeloid
What is the type of HSCT that uses cells from another human that match?
Allogenic
What is the classification of leukaemia based on the maturity of cells?
Acute and Chronic
What is the purpose of analysing blood film and bone marrow in the diagnosis of leukaemia?
All of the above
What is a complication of Allogenic HSCT?
Graft vs host disease
What is a clinical feature of GvHD?
Lichenoid inflammation on the tongue and buccal mucose
What is a known risk factor for developing leukaemia?
All of the above
What is the effect of leukaemic cells on the immune system?
It impairs the immune function, making the individual more susceptible to infections
How is xerostomia managed in patients with GvHD?
With pilocarpine or cevimeline to stimulate saliva production
What is the prognosis for Non-Hodgkin's lymphoma relative to?
Stage of disease
What percentage of patients with Non-Hodgkin's lymphoma experience complete remission?
60-90%
What is the typical age range for the peak incidence of Non-Hodgkin's lymphoma?
40-60
What is the aetiology of Non-Hodgkin's lymphoma?
Immunodeficiency, infections, and ionising radiation
What is the primary cause of tissue infiltration in leukaemia?
Neoplastic cells spill out of the bone marrow into blood
What is the primary treatment approach for low-grade Non-Hodgkin's lymphoma?
Intermittent oral chemotherapy
What is the characteristic of multiple myeloma that leads to bone destruction?
Stimulation of osteoclasts
What is the most common leukaemia in adults?
Acute Myeloid Leukaemia (AML)
What is the peak incidence age for Acute Lymphoblastic Leukaemia (ALL)?
Children that are 4-5 years old
What is the typical asymptomatic phase of multiple myeloma known as?
Monoclonal gammopathy of undetermined significance (MGUS)
What is the primary investigation used to diagnose multiple myeloma?
Protein electrophoresis
What is the treatment for Acute Lymphoblastic Leukaemia (ALL)?
Remission induced with non-myelosuppressive chemotherapy
What is the characteristic of the Philadelphia chromosome in Chronic Myeloid Leukaemia (CML)?
A balanced translocation between chromosome 9 and 22
What is the primary oral complication of multiple myeloma?
Leukaemic infiltration
What is the primary management approach for intraoral lymphomas?
Combination therapy
What is the primary dental symptom of leukaemia?
Gingival hypertrophy
What is the peak incidence age for Chronic Lymphoblastic Leukaemia (CLL)?
The elderly (over 60s)
What is the primary treatment for Chronic Lymphoblastic Leukaemia (CLL)?
Chemotherapy typically effective
What is the median age for the onset of Chronic Myeloid Leukaemia (CML)?
40-50 years old
What is the primary clinical feature of Hodgkin's disease?
Painless, non-tender, rubbery lymphadenopathy
Test your knowledge of the liver's location, structure, and functions in the human body. Learn about the liver's blood supply, lobes, and role in metabolism, production, and excretion.
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