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Questions and Answers

What is the primary characteristic of leukaemias?

  • Benign neoplasms of haemopoietic stem cells
  • Malignant neoplasms of haemopoietic stem cells (correct)
  • Malignant tumours of blood vessels
  • Benign growths of bone marrow

    • What is the effect of bone marrow failure in leukaemia?

  • Increased immunity to infections
  • Anaemia, neutropenia, and thrombocytopenia (correct)
  • Increased production of blood cells
  • Enhanced coagulation

    • What are the two main cell lines that leukaemias involve?

  • Lymphoid and Myeloid (correct)
  • Erythroid and Lymphoid
  • Myeloid and Erythroid
  • Myeloid and Megakaryocytic

    • What is the characteristic of acute leukaemia?

    <p>More than 50% of cells are myeloblasts or lymphoblasts</p> Signup and view all the answers

    What is one of the aetiological factors of leukaemia?

    <p>Ionising radiation</p> Signup and view all the answers

    What is the effect of leukaemia on the immune system?

    <p>Fever and infections</p> Signup and view all the answers

    What is the primary cause of tissue infiltration in leukemia?

    <p>Neoplastic cells spreading through the bloodstream</p> Signup and view all the answers

    What is the peak incidence age for Acute Lymphoblastic Leukemia (ALL)?

    <p>Children between 4-5 years old</p> Signup and view all the answers

    What is the term for the type of leukemia characterized by a Philadelphia chromosome?

    <p>Chronic Myeloid Leukemia (CML)</p> Signup and view all the answers

    What is the most common leukemia in adults?

    <p>Acute Myeloid Leukemia (AML)</p> Signup and view all the answers

    What is the dental symptom of leukemia?

    <p>Gingival overgrowth</p> Signup and view all the answers

    What is the primary difference between Hodgkin and Non-Hodgkin lymphoma?

    <p>Hodgkin is nodal and contiguous</p> Signup and view all the answers

    What is the aetiology of Hodgkin lymphoma?

    <p>Unknown</p> Signup and view all the answers

    What is the primary treatment for Acute Lymphoblastic Leukemia (ALL) in children?

    <p>Combination chemotherapy</p> Signup and view all the answers

    What is the characteristic of Stage I Hodgkin's disease?

    <p>Single lymph node region on one side of the diaphragm</p> Signup and view all the answers

    What is the indication for lymph node biopsy in Hodgkin's disease?

    <p>To identify Reed-Sternberg cells</p> Signup and view all the answers

    What is the characteristic of Chronic Lymphoblastic Leukemia (CLL)?

    <p>Peak incidence in adults over 60 years old</p> Signup and view all the answers

    What is the percentage of complete remission in advanced stage Hodgkin's disease?

    <p>60-90%</p> Signup and view all the answers

    What is the result of the Philadelphia chromosome in Chronic Myeloid Leukemia (CML)?

    <p>Oncogene with tyrosine kinase activity</p> Signup and view all the answers

    What is the peak incidence of non-Hodgkin's lymphoma?

    <p>Increases with age, rare under 40s</p> Signup and view all the answers

    What is the characteristic of bone marrow infiltration in multiple myeloma?

    <p>Anemia, thrombocytopenia, and neutropenia</p> Signup and view all the answers

    What is the investigation of choice to diagnose multiple myeloma?

    <p>Protein electrophoresis</p> Signup and view all the answers

    What is the management of multiple myeloma?

    <p>Treated only if there is evidence of organ damage</p> Signup and view all the answers

    What is the feature of leukaemic infiltration in the oral cavity?

    <p>Typically occurs on the gingivae</p> Signup and view all the answers

    What type of leukaemia is leukaemic infiltration most common in?

    <p>AML</p> Signup and view all the answers

    What is the common site of intraoral lymphomas?

    <p>Fauces and gingivae</p> Signup and view all the answers

    What is the most common oral complication of leukaemia treatment?

    <p>Mucositis</p> Signup and view all the answers

    Which chemotherapy agent is associated with mucositis?

    <p>Methotrexate</p> Signup and view all the answers

    What is a clinical feature of chemotherapeutic-induced mucositis?

    <p>Rapid onset and good recovery following cessation of chemotherapy</p> Signup and view all the answers

    What is a complication of radiotherapy on leukaemias?

    <p>Osteoradionecrosis and osteomyelitis</p> Signup and view all the answers

    What is suggested when chemotherapy/radiotherapy fails?

    <p>Haematopoietic stem cell transplant (HSCT)</p> Signup and view all the answers

    What is used to treat xerostomia in graft vs host disease (GvHD)?

    <p>Pilocarpine (Salagen)</p> Signup and view all the answers

    What is the primary function of red blood cells?

    <p>Transportation of oxygen from lungs to tissues</p> Signup and view all the answers

    What is the haemoglobin level range for adult males?

    <p>130-170 g/L</p> Signup and view all the answers

    What dictates the symptoms and signs of anaemia?

    <p>The rate at which anaemia develops</p> Signup and view all the answers

    What is a sign of anaemia?

    <p>Pallor</p> Signup and view all the answers

    What is the function of monocytes and macrophages?

    <p>Chemotaxis, phagocytosis, and killing of micro-organisms</p> Signup and view all the answers

    What is the result of a reduction in haemoglobin levels below the reference range for age and sex?

    <p>Anaemia</p> Signup and view all the answers

    What is the primary function of hemoglobin in the human body?

    <p>To carry oxygen from the lungs to the tissues</p> Signup and view all the answers

    Which type of anemia is characterized by membrane defects?

    <p>Hereditary spherocytosis</p> Signup and view all the answers

    What is the primary cause of immune-mediated hemolytic anemia?

    <p>IgG coated red cells interacting with macrophages</p> Signup and view all the answers

    What is the percentage of Hb A in adult hemoglobin?

    <p>97%</p> Signup and view all the answers

    Which of the following is a clinical feature of hemolytic normocytic anemia?

    <p>Pallor</p> Signup and view all the answers

    What is the composition of adult hemoglobin?

    <p>2 alpha and 2 beta chains</p> Signup and view all the answers

    What is the most common cause of microcytic anemia worldwide?

    <p>Iron deficiency</p> Signup and view all the answers

    What is the mechanism of iron deficiency development in vegetarians and vegans?

    <p>Poor dietary intake</p> Signup and view all the answers

    What is the treatment for iron deficiency microcytic anemia?

    <p>Addressing underlying cause and oral supplementation</p> Signup and view all the answers

    What is the characteristic of megaloblastic anemia?

    <p>Macrocytic</p> Signup and view all the answers

    What is the function of vitamin B12 in the body?

    <p>Required in a number of enzymatic reactions</p> Signup and view all the answers

    What is the characteristic of normocytic anemia?

    <p>Normal red blood cells</p> Signup and view all the answers

    What is the cause of iron deficiency in menorrhagia?

    <p>Increased loss of iron</p> Signup and view all the answers

    What is the investigation of choice for iron deficiency microcytic anemia?

    <p>Iron studies</p> Signup and view all the answers

    What is the clinical feature of vitamin B12 deficiency?

    <p>Peripheral neuropathy</p> Signup and view all the answers

    What is the association of normocytic anemia?

    <p>Chronic inflammatory disease</p> Signup and view all the answers

    What is the definition of dysphagia?

    <p>Difficulty in swallowing</p> Signup and view all the answers

    What is a common symptom of dysphagia?

    <p>Something sticking in the throat or chest during or after swallowing</p> Signup and view all the answers

    What is the most common type of tumour that causes dysphagia in the oesophagus?

    <p>Squamous cell carcinoma (SCC)</p> Signup and view all the answers

    What is a cause of oesophageal stricture that can lead to dysphagia?

    <p>Radiation</p> Signup and view all the answers

    What is a condition that can cause oesophageal spasm and lead to dysphagia?

    <p>All of the above</p> Signup and view all the answers

    What is a characteristic of achalasia that can lead to dysphagia?

    <p>Failure of relaxation of the lower oesophageal sphincter</p> Signup and view all the answers

    What is the primary reason for retained oesophageal contents causing respiratory problems?

    <p>Regurgitation</p> Signup and view all the answers

    What is the characteristic of globus hystericus?

    <p>Sensation of a lump in the throat</p> Signup and view all the answers

    What is the name of the muscle that connects the pharynx to the stomach?

    <p>Oesophagus</p> Signup and view all the answers

    What is the type of muscle that makes up the upper 2/3 of the oesophagus?

    <p>Striated muscle</p> Signup and view all the answers

    What is the term for the passage of pale bulky stools that contain fat?

    <p>Steatorrhoea</p> Signup and view all the answers

    What is the weak point of the oesophagus where Zeneker's diverticulum can form?

    <p>Killian's dehiscence</p> Signup and view all the answers

    What is the type of epithelium that lines the mucosal layer of the oesophagus?

    <p>Stratified Squamous Non Keratinising Epithelium</p> Signup and view all the answers

    What is the main reason for oesophagitis?

    <p>Inflammation of the oesophagus due to reflux</p> Signup and view all the answers

    What is the term for the relaxation of the gastro-oesophageal sphincter in achalasia?

    <p>Loss of ganglia</p> Signup and view all the answers

    What is the primary characteristic of pharyngeal pouch disease?

    <p>Herniation of mucosa through the fibres of the inferior pharyngeal constrictor muscle</p> Signup and view all the answers

    What is the result of achalasia of the cardia?

    <p>Functional obstruction to oesophageal emptying with dysphagia for solids and liquids</p> Signup and view all the answers

    What is the purpose of balloon dilatation in treating achalasia?

    <p>To restore the flow in the oesophagus</p> Signup and view all the answers

    What is an oesophageal spasm?

    <p>A term for spasm due to a variety of causes</p> Signup and view all the answers

    What is a potential result of an oesophageal spasm?

    <p>A corkscrew oesophagus</p> Signup and view all the answers

    What is an oesophageal web?

    <p>A fibrous structure that forms at the upper end of the oesophagus</p> Signup and view all the answers

    Why is it important to identify oesophageal webs?

    <p>Because it is premalignant</p> Signup and view all the answers

    What is the difference between peptic and gastric ulcers in terms of aetiology?

    <p>Peptic ulcers have an acidic aetiology, while gastric ulcers have a non-acidic aetiology</p> Signup and view all the answers

    What is the common aetiology of peptic and gastric ulcers?

    <p>Mucosal inflammation due to acid and pepsin destruction of the lining mucosa</p> Signup and view all the answers

    What is the difference between acute and chronic duodenal ulcers?

    <p>Chronic ulcers penetrate the submucosa and muscular wall, while acute ulcers only get to the muscularis mucosae</p> Signup and view all the answers

    What are two investigations used to diagnose peptic ulcers?

    <p>Endoscopy and barium meal</p> Signup and view all the answers

    What is a consequence of chronic inflammation in the stomach?

    <p>Reduced acid production leading to iron deficiency</p> Signup and view all the answers

    What is the most common type of carcinoma in oesophageal carcinoma?

    <p>Squamous cell carcinoma</p> Signup and view all the answers

    What is a risk factor for carcinoma of the oesophagus?

    <p>Heavy alcohol use</p> Signup and view all the answers

    What is a symptom of carcinoma of the oesophagus?

    <p>Dysphagia</p> Signup and view all the answers

    How can carcinoma of the oesophagus spread to the liver?

    <p>Through the lymph nodes and eventually the liver</p> Signup and view all the answers

    What is a local spread effect of carcinoma of the oesophagus?

    <p>Fistulae to the trachea</p> Signup and view all the answers

    What is the diagnostic test of choice for carcinoma of the oesophagus?

    <p>Endoscopy and biopsy</p> Signup and view all the answers

    What is the treatment of choice for carcinoma of the oesophagus?

    <p>Surgery with a 5cm resection margin</p> Signup and view all the answers

    What is a cause of haematemesis?

    <p>All of the above</p> Signup and view all the answers

    What is the characteristic of vomited blood in haematemesis?

    <p>Partially digested and dark</p> Signup and view all the answers

    What is the typical presentation of colon cancer on the left colon?

    <p>Change of bowel habit</p> Signup and view all the answers

    What is the dental relevance of carcinoma in the colon?

    <p>It causes tooth decay and gum disease</p> Signup and view all the answers

    What is the characteristic feature of osteomas?

    <p>Unexplained pain relieved by analgesics</p> Signup and view all the answers

    What is the treatment for diverticular disease?

    <p>High fibre diet and surgery</p> Signup and view all the answers

    What is a common symptom of IBS-C?

    <p>Hard, lumpy stools</p> Signup and view all the answers

    What can IBS mask?

    <p>Both A and B</p> Signup and view all the answers

    What are the three components of the small intestine?

    <p>Duodenum, Jejunum, and Ileum</p> Signup and view all the answers

    What is the dietary source of coeliac disease?

    <p>Gluten sensitivity - wheat, barley, and rye</p> Signup and view all the answers

    What is the genetic source of coeliac disease?

    <p>The HLA B8 tissue type</p> Signup and view all the answers

    What are the three ways coeliac disease is diagnosed?

    <p>Using antibodies to gliadin, endomysium, and transglutaminase, and endoscopic biopsy</p> Signup and view all the answers

    What is a common gastrointestinal symptom of coeliac disease?

    <p>Diarrhea</p> Signup and view all the answers

    What is a common extra-intestinal symptom of coeliac disease?

    <p>All of the above</p> Signup and view all the answers

    What is the primary treatment for coeliac disease?

    <p>Gluten restriction</p> Signup and view all the answers

    What is the risk of coeliac disease in terms of lymphoma and adenocarcinoma?

    <p>Oesophagus, small bowel, pancreas, and biliary tract</p> Signup and view all the answers

    What is the consequence of vitamin D deficiency in coeliac disease?

    <p>Osteomalacia and rickets in children</p> Signup and view all the answers

    What is the characteristic of enamel defects in coeliac disease if the onset is in childhood?

    <p>Hypoplasia in permanent dentition</p> Signup and view all the answers

    Which inflammatory bowel disease is more common?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What is the age of onset for Crohn's disease?

    <p>26</p> Signup and view all the answers

    What is the immune aetiology of inflammatory bowel diseases?

    <p>Defective immune system, leading to autoimmunity</p> Signup and view all the answers

    What is the effect of smoking on Crohn's disease?

    <p>Increased incidence</p> Signup and view all the answers

    What is the characteristic of Crohn's disease in terms of the areas affected?

    <p>Anywhere from mouth to anus</p> Signup and view all the answers

    What is the treatment used to improve the quality of life for a Crohn's patient?

    <p>Both medical and surgical treatment</p> Signup and view all the answers

    What is the most common oral manifestation of ulcerative colitis?

    <p>Aphthous ulcers</p> Signup and view all the answers

    Which of the following is a cutaneous manifestation of ulcerative colitis?

    <p>Erythema Nodosum</p> Signup and view all the answers

    What is the primary purpose of sigmoidoscopy in diagnosing IBDs?

    <p>To examine the sigmoid colon</p> Signup and view all the answers

    What is the primary goal of the first step in treating IBDs?

    <p>To induce remission</p> Signup and view all the answers

    What is the effect of cyclosporin on dental management in some patients?

    <p>Tenderness, swelling, or bleeding of the gums</p> Signup and view all the answers

    What is the acronym used to remember the indications for surgery in IBDs?

    <p>I CHOP</p> Signup and view all the answers

    What is the prognosis for ulcerative colitis?

    <p>1/3 single attack, 1/3 relapsing attacks, 1/3 progressively worsen requiring colectomy within 20 years</p> Signup and view all the answers

    What is the increased risk of colon cancer associated with?

    <p>Ulcerative colitis</p> Signup and view all the answers

    What is the valve located in the colon?

    <p>Ileocaecal valve</p> Signup and view all the answers

    What is the primary purpose of aminosalicylates in treating ulcerative colitis?

    <p>To maintain remission</p> Signup and view all the answers

    What is the impact of long-term systemic corticosteroid therapy on dental treatment?

    <p>Increased risk of infection and impaired wound healing</p> Signup and view all the answers

    Which of the following is a specific dental lesion associated with Crohn's disease?

    <p>Cobblestones</p> Signup and view all the answers

    What is the disease with symptoms similar to Crohn's disease?

    <p>Orofacial granulomatosis</p> Signup and view all the answers

    What diet is used to combat orofacial granulomatosis?

    <p>Cinnamon-free diet and Benzoates-free diet</p> Signup and view all the answers

    What is the definition of ulcerative colitis?

    <p>Diffuse mucosal inflammation of the colon with backwash involvement of the terminal ileum</p> Signup and view all the answers

    What is the potential aetiology of ulcerative colitis?

    <p>Dysregulated interaction between mucosal immunology and intestinal microflora</p> Signup and view all the answers

    What is the family history that predisposes to ulcerative colitis?

    <p>Jewish</p> Signup and view all the answers

    What is the diagnosis and characteristic feature of ulcerative colitis?

    <p>Colonoscopy and biopsy, with exudates, ulcerations, and loss of vascular pattern</p> Signup and view all the answers

    What is the complication/risk of ulcerative colitis?

    <p>Colorectal cancer</p> Signup and view all the answers

    What is the eye manifestation that can occur with inflammatory bowel diseases, and which one is more prevalent in?

    <p>Episcleritis, more prevalent in Crohn's disease</p> Signup and view all the answers

    What is a characteristic of trigeminal neuralgia?

    <p>Recurrent, brief, lancing pain lasting approximately 30 seconds</p> Signup and view all the answers

    What is the primary cause of trigeminal neuropathic pain?

    <p>Insult to peripheral nerves</p> Signup and view all the answers

    What is the treatment for trigeminal neuralgia?

    <p>Anticonvulsants like carbamazepine and vascular decompression</p> Signup and view all the answers

    What is burning mouth syndrome characterized by?

    <p>Idiopathic burning sensation on the tongue</p> Signup and view all the answers

    What is the trigger for burning mouth syndrome?

    <p>Stress</p> Signup and view all the answers

    What is the treatment used for burning mouth syndrome?

    <p>Difflam mouthwash and lidocaine gels</p> Signup and view all the answers

    What is the main characteristic of multiple sclerosis?

    <p>Areas of demyelination in the central nervous system</p> Signup and view all the answers

    What is the pathology of multiple sclerosis?

    <p>Peri-venular plaques of demyelination known as perineural oedemas</p> Signup and view all the answers

    What is the definition of epilepsy?

    <p>A neurological disorder marked by sudden recurrent episodes of sensory disturbance, loss of consciousness, or convulsions, associated with abnormal electrical activity in the brain.</p> Signup and view all the answers

    What is the name of the seizure that is also referred to as Grand-Mal seizures?

    <p>Tonic-clonic seizure</p> Signup and view all the answers

    What is the dental relevance of multiple sclerosis?

    <p>People living with MS may be at increased risk of dental diseases due to reduced manual dexterity</p> Signup and view all the answers

    What is the definition of allodynia pain?

    <p>Pain from normally non-painful stimulus</p> Signup and view all the answers

    What is the symptom of a person having an absence seizure?

    <p>Stare blankly into space</p> Signup and view all the answers

    What is the most common reason for facial pain?

    <p>Dental pain</p> Signup and view all the answers

    What is the purpose of an EEG in diagnosing epilepsy?

    <p>To see if different parts of the brain are functioning</p> Signup and view all the answers

    What is the main treatment for epilepsy?

    <p>Anti-epileptic drugs (AEDs)</p> Signup and view all the answers

    What are the two things that cause dental pain?

    <p>All of the above</p> Signup and view all the answers

    What is the effect of AEDs on epilepsy?

    <p>They change the levels of chemicals in the brain</p> Signup and view all the answers

    What is the importance of taking a pain history in identifying facial pains?

    <p>To identify the cause of the pain</p> Signup and view all the answers

    What is the definition of hyperalgesia pain?

    <p>Increased response to normally painful stimulus</p> Signup and view all the answers

    What is the requirement for using AEDs?

    <p>They must be used every day</p> Signup and view all the answers

    What is the result of cessation of AEDs?

    <p>A seizure will be provoked</p> Signup and view all the answers

    What is the definition of neuropathic pain?

    <p>Pain from nerve pathology or damage</p> Signup and view all the answers

    What is the definition of neuralgia pain?

    <p>Nerve distribution pain</p> Signup and view all the answers

    What is the purpose of a CT scan in diagnosing epilepsy?

    <p>To find any anatomical abnormalities</p> Signup and view all the answers

    What is the percentage of people who use AEDs to control their seizures?

    <p>70%</p> Signup and view all the answers

    What is the primary function of the frontal lobe of the brain?

    <p>Motor control, concentration, and speech</p> Signup and view all the answers

    What is the purpose of the reflex test in neurology?

    <p>To evaluate the patient's involuntary responses to stimuli</p> Signup and view all the answers

    What is the term for a focal neurological deficit that lasts longer than 24 hours, resulting from a vascular lesion?

    <p>Stroke</p> Signup and view all the answers

    What is the level of consciousness characterized by a patient who responds to verbal commands?

    <p>Responds to verbal commands</p> Signup and view all the answers

    What is the function of the parietal lobe of the brain?

    <p>Touch and pressure, body awareness</p> Signup and view all the answers

    What is the purpose of the tone test in neurology?

    <p>To assess the patient's resistance to passive movement of a joint</p> Signup and view all the answers

    What is the main cause of an ischemic stroke?

    <p>Blockage of a blood vessel in the brain</p> Signup and view all the answers

    What is the FAST acronym used for in strokes?

    <p>Face, Arms, Speech, Time to act</p> Signup and view all the answers

    What is the percentage of stroke events that are ischemic?

    <p>80%</p> Signup and view all the answers

    What is a transient ischemic attack (TIA)?

    <p>A temporary focal neurological deficit</p> Signup and view all the answers

    What is the most common lesion that causes stroke?

    <p>Hemiplegia</p> Signup and view all the answers

    What is the treatment of choice for ischemic stroke?

    <p>Thrombolysis</p> Signup and view all the answers

    What is a subarachnoid haemorrhage?

    <p>A type of hemorrhagic stroke</p> Signup and view all the answers

    What is the cause of an extra dural haematoma?

    <p>Head strike</p> Signup and view all the answers

    What is a carotid endarterectomy?

    <p>A surgical procedure to remove erythematous plaques in the internal carotid artery</p> Signup and view all the answers

    What is the treatment used to improve the quality of life for a patient with chronic stroke?

    <p>Rehabilitation</p> Signup and view all the answers

    Study Notes

    Leukaemias

    • Leukaemias are malignant neoplasms of haemopoietic stem cells
    • Leukaemias result in:
      • Diffuse replacement of bone marrow and normal blood precursor cells by neoplastic cells
      • Bone marrow failure, leading to anaemia, neutropenia, and thrombocytopenia
      • Leukaemic cells spilling over into blood and infiltrating organs
    • Leukaemias can be classified into two cell lines:
      • Myeloid (resulting in basophils, neutrophils, eosinophils, monocytes, and macrophages)
      • Lymphoid (resulting in B, T cells, and plasma cells)
    • Leukaemias can be classified into two types of maturity:
      • Acute (more than 50% myeloblasts or lymphoblasts in bone marrow at clinical presentation)
      • Chronic (more differentiated cells)

    Diagnosis of Leukaemia

    • Blood film and bone marrow analysis are important prognostic indicators, helping to identify:
      • Leukaemia type
      • Cell phenotype
      • Chromosomal abnormalities

    Aetiology of Leukaemia

    • Leukaemia can be caused by:
      • Ionising radiation
      • Chemicals (e.g., benzene and alkylating agents)
      • Viruses (e.g., HTLV - human T-cell leukaemic virus)
      • Genetic factors (e.g., Down's syndrome)
      • Acquired haematological disorders (e.g., aplastic anaemia)

    Clinical Features of Leukaemia

    • Marrow infiltration causes:
      • Pallor
      • Malaise
      • Fever and infections due to the effect on the immune system
      • Bleeding due to the impact on coagulation
      • Bruising/petechiae
    • Tissue infiltration causes:
      • Lymphadenopathy
      • Hepatosplenomegaly
      • Central nervous system involvement
      • Bone and joint pain (acute lymphoblastic leukaemia, ALL)
      • Testicular involvement (ALL)
      • Gingival hypertrophy (acute myeloid leukaemia, AML)

    Types of Leukaemia

    • AML (Acute Myeloid Leukaemia)
    • ALL (Acute Lymphoblastic Leukaemia)
    • CML (Chronic Myeloid Leukaemia)
    • CLL (Chronic Lymphoblastic Leukaemia)

    Management of Leukaemia

    • AML:
      • Higher than 80% cure rate with intensive chemotherapy in young patients
      • 15% of patients have a disease resistant to chemo
      • Autologous and allogenic stem cell transplant used if chemo fails
    • ALL:
      • More than 60% cure rate with chemotherapy in 2-12-year-olds
      • 20% cure rate with chemotherapy in adults
      • Combination chemotherapy used to induce remission
      • CNS treatment performed prophylactically
      • Maintenance therapy for up to 2 years increases disease-free survival
    • CLL:
      • Asymptomatic patients do not require treatment
      • 30% of patients with early-stage disease die of unrelated causes
      • Chemo typically effective
      • Median survival 10-12 years
      • Mortality usually due to infection or bone marrow failure
      • Bone marrow transplantation occasionally attempted in younger patients with poor prognostic disease

    Lymphomas

    • Hodgkin's Lymphoma:
      • Peak incidence in the 3rd decade
      • Aetiology unknown but EBV (infectious mononucleosis) suggested
      • Clinical features:
        • Lymphadenopathy
        • Constitutional 'B' symptoms
        • Anorexia and fatigue
        • Fever
        • Night sweats
        • Weight loss
        • Pruritus and erythematous rash
        • Mediastinal involvement
        • Hepatosplenomegaly
      • Staging:
        • Ann Arbor system
        • I - Single LN region
        • II - Two LN regions on the same side of the diaphragm
        • III - Groups on both sides of the diaphragm
        • IV - Widespread disease outside lymphatic sites
      • Treatment:
        • Early stage disease: Chemotherapy + radiotherapy
        • Advanced stage disease: Combination chemotherapy
        • Complete remission 60-90%
        • Prognosis relative to stage of disease
    • Non-Hodgkin's Lymphoma:
      • Peak incidence increases with age
      • Aetiology:
        • Immunodeficiency
        • Infections
        • Ionising radiation
        • Carcinogenic chemicals
        • Inherited disorders affecting DNA damage and repair
      • Clinical features:
        • Generalised lymphadenopathy
        • Oropharyngeal involvement
        • Bone marrow infiltration
      • Treatment:
        • Low-grade disease: Asymptomatic patients require no treatment
        • High-grade disease: Combination chemotherapy
      • Management:
        • If asymptomatic, no treatment
        • Chemotherapy used if evidence of organ damage

    Multiple Myeloma

    • Peak incidence: 40-80 years old
    • Aetiology:
      • Arises from malignant transformation of terminally differentiated B cell (plasma cell)
      • Results in secretion of Ig or light chains (paraproteins)
    • Clinical features:
      • Typically long asymptomatic phase
      • Bone destruction
      • Bone marrow failure
      • Renal failure
      • Hyperviscosity syndrome
      • Amyloidosis
    • Investigations:
      • FBC to detect bone marrow failure
      • Raised ESR and Ca2+
      • U&Es demonstrate renal damage
      • Protein electrophoresis demonstrates monoclal paraprotein
      • Bence-Jones proteins in urine
    • Management:
      • Only treated if there is evidence of organ damage
      • Chemotherapy used if evidence of bone marrow failure or bone lesions
      • Most patients respond, but relapse is common
      • Radiotherapy is useful if there is bone pain### Dysphagia
    • Difficulty in swallowing
    • Symptoms: sticking sensation in the throat/chest during or after swallowing
    • 9 oesophageal reasons for dysphagia:
      • Tumours (SCC and adenocarcinoma)
      • Inflammation (acid reflux, drugs, chemical burn)
      • Stricture (radiation, acid reflux)
      • Foreign body (soft food, impacted coins, bones)
      • Trauma (bony, surgical)
      • Webs (atrophic mucosa, fibrous stricture at upper end of oesophagus)
      • Goitre, enlarged left atrium, mediastinal glands
      • Oesophageal spasms
      • Achalasia (loss of ganglia, failure of relaxation of cardiac sphincter)

    Oesophagus

    • Musculo-tendinous tube connecting the pharynx to the stomach
    • Symptoms:
      • Dysphagia
      • Pain (from acid reflux)
      • Cough or vomiting (foods/liquids refluxing into pharynx)
      • Bleeding (haematemesis)
    • Diseases associated with oesophagus:
      • Pharyngeal pouch
      • Achalasia
      • Oesophageal spasm
      • Oesophageal web
      • Peptic ulcer disease/reflux
      • Carcinoma
    • Composition of oesophagus:
      • Upper 2/3: striated muscle
      • Lower 2/3: non-striated muscle
      • Middle 1/3: mixed muscle
    • Innervation: vagus nerve (X)
    • Epithelium: stratified squamous non-keratinising epithelium

    Swallowing

    • Peristaltic wave triggered
    • Food bolus pushed to stomach
    • Gut stretches, causing depolarisation and action potential, propagating peristalsis

    Pharyngeal Pouch

    • Herniation of mucosa through weakness in pharyngeal constrictor muscles
    • Symptoms:
      • Dysphagia
      • Vomiting
      • Respiratory symptoms
      • Zeneker's Diverticulum forms
    • Treatment: dilatation of stricture, correction of iron deficiency, excision of web

    Oesophagitis

    • Inflammation of oesophagus due to acid reflux from the stomach
    • Causes:
      • Acid reflux
      • Immunocompromised: transplant, chemo, HIV infection

    Achalasia of the Cardia

    • Loss of ganglia from intramural plexus, leading to failure of relaxation of cardiac sphincter
    • Symptoms:
      • Dysphagia for solids and liquids
      • Eventual failure of peristalsis, leading to progressive dilatation of oesophagus
    • Treatments:
      • Drugs (nifedipine to relax sphincter)
      • Balloon dilatation
      • Cardiomyotomy

    Oesophageal Spasm

    • Term for spasm due to various causes
    • Causes:
      • Atypical achalasia
      • Gastro-oesophageal reflux
      • Motor disorders
      • Symptomatic peristalsis
      • Obstruction at cardia
      • Neuromuscular disorders
    • Result: corkscrew oesophagus, pain, and reflux; treated with muscle relaxants

    Peptic Ulcer Disease/Reflux

    • Failure of upper (cardiac) sphincter
    • Acid refluxing into oesophagus
    • Symptoms:
      • Pain
      • Vomiting
      • Haematemesis (vomiting blood)
      • Ulcer with scarring
    • Investigations:
      • Endoscopy
      • Barium meal
    • Treatments:
      • Control predisposing factors (antacids)
      • Decrease secretions (H-2 blockers, proton pump inhibitors)
      • Treat H. pylori with quadruple therapy

    Gastritis

    • Inflammation of stomach lining
    • Consequences:
      • Chronic inflammation and irritation
      • Reduced acid production
      • Iron deficiency (glossitis and microcytic anaemia)
      • Vitamin B12 deficiency (macrocytic anaemia and sore mouth)

    Barrett's Oesophagus

    • Long-standing reflux from stomach causing change in inflammation in lower oesophageal lining
    • Risk factor for oesophageal carcinoma### Gastrointestinal System
    • The small intestine consists of three components: Duodenum, Jejunum, and Ileum
    • The large intestine consists of three components: Cecum, Rectum, and Anal canal

    Coeliac Disease

    • Dietary source: Gluten sensitivity (wheat, barley, rye, and oats)
    • Genetic source: The HLA B8 tissue type
    • Presentation: Change of bowel habit (COBH)
    • Gastrointestinal symptoms:
      • Diarrhea
      • Flatulence
      • Borborygymus
      • Weight loss
      • Weakness, fatigue
      • Abdominal pain
      • Secondary lactose intolerance
      • Steatorrhea
    • Extra-intestinal symptoms:
      • Anaemias (10-15%): Fe and B12 deficiencies
      • Neurological symptoms (8-14%)
      • Skin disorders (10-20%): Endocrine disturbances (infertility, impotence, amenorrhea, delayed menarche)
    • Diagnosis:
      • Using antibodies to gliadin, endomysium, and transglutaminase (TTG)
      • Endoscopic biopsy
      • Pillcam camera for non-invasive inspection
    • Treatment:
      • Gluten restriction (cures 95%)
      • Corticosteroids (for the remaining 5%)
    • Risks:
      • Lymphoma and adenocarcinoma of the pancreas, oesophagus, small bowel, and biliary tract
      • T and B cell non-Hodgkin lymphoma

    Malabsorption Problems

    • Vitamin deficiencies:
      • B12, folate, and ferritin deficiency leading to glossitis, angular cheilitis, anaemia, burning mouth, and smooth tongue
      • Vitamin K deficiency leading to bleeding tendency
      • Vitamin D deficiency leading to osteomalacia and rickets in children
    • Dental problems:
      • Enamel defects in the permanent dentition, such as hypoplasia, if the onset is in childhood

    Inflammatory Bowel Diseases (IBDs)

    • Types:
      • Crohn's disease
      • Ulcerative colitis
    • Ulcerative colitis is more common than Crohn's disease
    • Gender ratio:
      • Females: 1.2:1
      • Males: 1.2:1
    • Age of onset:
      • Crohn's disease: 26 years old
      • Ulcerative colitis: 34 years old
    • Immune aetiology: Defective immune systems, leading to autoimmunity
    • Hygiene and prevalence:
      • Crohn's disease: occurs in good hygiene and developed countries
      • Ulcerative colitis: no relation to hygiene
    • Protective factors:
      • Appendicectomy is protective of Ulcerative colitis
      • Breast feeding
    • Differences in affected areas:
      • Crohn's disease: anywhere from mouth to anus
      • Ulcerative colitis: proximal from the rectum

    Crohn's Disease

    • Definition: A lifelong condition where parts of the digestive system become inflamed
    • Symptoms:
      • Intermittent abdominal pain, diarrhea, abdominal distension
      • Decreased appetite
      • Anaemia and weight loss
      • Fresh blood or melaena
      • Fistulae and perianal sepsis
    • Macroscopic changes:
      • Thickened bowel
      • Narrowed lumen
      • Deep ulcers
      • Mucosal fissures
      • Cobblestoning
      • Fistulae
      • Abscess
      • Aphthoid ulceration
    • Microscopic changes:
      • Chronic inflammatory cells occur transmurally
      • Lymphoid hyperplasia
      • Granulomas occur in Langhan's cells
    • Diagnosis:
      • Barium enema
      • Sigmoidoscopy, biopsy, and colonoscopy
      • Differential diagnosis includes TB and sarcoidosis
    • Treatment:
      • Medical: glucocorticoids, immunomodulators, and biologics
      • Surgical: intestinal resection

    Ulcerative Colitis

    • Oral manifestations:
      • Aphthous ulcers
      • Tongue coating
      • Gingivitis
      • Periodontitis
      • Halitosis
      • Acidic taste
      • Cutaneous manifestations
    • Treatment:
      • Aminosalicylates
      • Steroids
      • Azathioprine

    Triggers and Treatment of IBDs

    • Triggers:
      • Rashes
      • Mouth ulcers
      • Joint/back pain
      • Eye problems
      • Family history
      • Smoking status
    • Bedside investigations:
      • Stool culture
      • Sigmoidoscopy
    • Blood investigations:
      • Full blood counts
      • Haematemics
      • Inflammatory markers
      • Liver function tests
      • Blood cultures
      • Serological tests
    • Imaging investigations:
      • Abdominal x-ray
      • Barium
      • CT scan
      • Chest x-ray
      • Ultrasound scan
    • Treatment steps:
      1. Induce remission
      2. Maintain remission
      3. Biologics for Crohn's disease only

    Cyclosporin and Dental Management

    • In some patients, tenderness, swelling, or bleeding of the gums may appear soon after treatment with cyclosporine
    • Brushing and flossing teeth carefully and regularly, and massaging gums may help prevent this
    • Regular dental check-ups are necessary

    Surgery and IBDs

    • Acute indications for surgery in Ulcerative colitis:
      • Failure of medical treatment for 3 days
      • Toxic dilatation
      • Haemorrhage
      • Perforation
    • Chronic indications for surgery in Ulcerative colitis:
      • Poor response to medical treatment
      • Excessive steroid use
      • Non-compliance with medication
      • Risk of cancer
    • ICHOP acronym for surgery: Infection, Carcinoma, Haemorrhage, Obstruction, and Perforation

    Prognosis and Colorectal Cancer

    • Prognosis of Ulcerative colitis:
      • 1/3 single attack
      • 1/3 relapsing attacks
      • 1/3 progressively worsen requiring colectomy within 20 years
    • Prognosis of Crohn's disease: Varied, new biological agents improving, so course of condition always changing
    • Ulcerative colitis has an increased risk of colon cancer
    • Predisposing factors for colon cancer:
      • Neoplastic polyps
      • Ulcerative colitis
      • Familial polyposis coli
      • Previous cancer
      • Crohn's disease

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    Learn about the basics of leukemia, including what they consist of, the effects on the bone marrow and blood cells, and the two cell lines that leukemia can take. Test your knowledge of this important topic in hematology!

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