Comp Pt

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Comp Pt
2011-04-13 01:54:56
Chapter sixty four

week thirteen
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  1. List 10 Oral findings that may suggest a blood disorder in a pt:
    • Gingival bleeding: spontaneously or upon gentl probing
    • history of difficultin in controlling bleeding
    • History of bruising easily: with large ecchymoses
    • numerous petechia
    • marked pallor of the mucous membrane
    • atrophy of the papillae of the tongue
    • persistent sore or painful tongue: glossodynia
    • acute or chronic infections (candidiasis): that do not respond to usualy treatment
    • exaggerated gingival response to local irritants: sometimes with characteristics of necrotizing ulcerative gingivitis
  2. Blood is composed of _______% plasma fluid and _________% formed elements
    • 55%
    • 45%
  3. The 45% elements of blood composition consists of _____% erythrocytes (red blood cells) and ____% leukocytes (white blood cells)
    • 44%
    • 1%
  4. Name the 7 elements that blood is made up of
    • plasma
    • Red blood cells: erhythrocytes
    • White blood cells: leukocytes:
    • neutrophil
    • eosinophil
    • basophil
    • monocyte
    • lymphocyte
  5. destruction of red blood cells also called hemolytic anemia
  6. What are the 2 main types of disorders in which red blood cells are destroyed?
    • hereditary hemolytic disorder: sickle cell disease
    • Acquired hemolytic disorder: drugs, infections, and certain physical and chemical agents can cause RBC destruction. or erythroblastosis fetalis occurs when a mother is Rh positive
  7. Plasma is made up of _______% water and ________% of additional substances
    • 90%
    • 10%
  8. Plasma has 90% water, the other 10% is made up of what 4 substances?
    • plasma proteins: albumin (tissue fluid pressure); gamma globulins (curculating antibodies); beta globulins (transport stuff); fibrinogen and prothrombin (clotting)
    • inorganic salts: sodium, potassium, calcium, bicarbonate, chloride
    • gases: dissolved oxygen, carbon dioxide, nitrogen
    • substances being transported: hormones, nutrients, waste products, enzymes
  9. Which plasma protein functions to maintain tissue fluid pressure?
  10. Which plasma protein functions in circulating antibodies essential in the immune system?
    gamma globulins
  11. Which plasma protein functions in the transport of hormones, metallic ions, and lipids?
    beta globulins
  12. Which plasma proteins function in blood clotting?
    • fibrinogen
    • prothrombin
  13. What component of blood functions to transport oxygen, carry oxyten to the body cells in the form of oxyhemoglobin, and carbon dioxide is transferred from cells?
    Red blood cells (erythrocytes)
  14. What are 2 possible causes of diminished productino of red blood cells?
    • nutritional deficiency
    • bone marrow failure
  15. The following is what cause for diminished production of red blood cells?
    inadequate dietary choices or intake, defective absorption from the GI pernicious anemia is an example from a B12 vitamin absorption deficiency or iron deficiency may occur diring pregnancy or growth spurt
    nutritional deficiency
  16. The following is what cause for diminished production of red blood cells?
    aplastic anemia is an example can be inherited; can occur without apparent cuase or when bone marrow is injured by meds, radiation, chemotherapy, or infection; in aplastic anemia a combination of anemia, neutropenia, and thrombocytopenia occurs, which leads to a quantitative decrease in all cells formed in the bone marrow
    bone marrow failure
  17. What is a genetic blood disorder that is characterized by absent or decreased production of normal hemoglobin?
  18. What are 5 groups of people that the inherited blood disease thalassemia typically effects?
    • mediterranean
    • african
    • middle eastern
    • southeast asia
    • middle eastern
  19. What is the most severe form of the inherited blood disorder thalassemia?
    Cooley's anemia
  20. What is the only available curative approach for the inherited blood disorder thalassemia?
    hematopoietic stem-cell transplantation
  21. What are the 5 basic causes of anemia?
    • blood loss: acute - trauma or disease; chronic - internal lesion w/slow constant bleeding
    • increased hemolysis: destruction of red blood cells
    • diminished production of RBC's: nutritional deficiency; bone marrow failure
    • anemia of chronic diseases: second most prevalent after anemia caused by iron deficiency
    • genetic blood disorders: thalassemia
  22. What is the oral effect of liquid ferrous that is sometimes used for children to treat iron deficiency anemia?
    may stain teeth
  23. What type of anemia is characterized by abnormally large red blood cells; many which are oval shaped? And what are 2 principle types of this type of anemia?
    • megaloblastic anemia
    • types: pernicious; folate deficiency
  24. Which type of megaloblastic anemia is cuase by a deficiency of vitamin B12, is rare, and is not usually developed until late adulthood?
    pernicious anemia
  25. Which type of megaloblastic anemia is most often seen in 40-70 yr old european women with fair skin, or african american women?
    pernicious anemia
  26. true or false. vitamin B12 and folate are essential in red blood cell production in the bone marrow.
  27. What are 3 factors that can cuase a deficiency in vitamin B12 (pernicious anemia)?
    • decreased intake: inadequate diet or impaired absorption
    • increased requirement: pregnancy, hyperparathyroidism, disseminated cancer
    • impaired absorption of B12: failure of production of intrinsic factor; or lack of production of intrinsic factor (chronic atrophic gastritis, or surgical removal of partial or all of stomach)
  28. List 8 good dietary sources of vitamin B12.
    • meat
    • kidney
    • fish
    • oyster
    • clams
    • mild
    • cheese
    • eggs
    • liver: rich source originally used for therapy until development of synthetic vitamin
  29. Which vitamin deficiency can cause neural tube defects and can cause spina bifida: a severe condition affecting the formation fo the nerves of the spinal cord, and resulting in infant paralysis?
    folate deficiency anemia
  30. What blood disorder is a hereditary form of hemolytic anemia, resulting from a defective hemoglobin molecule. the name is derived from the crescent shape the erythrocytes assume when they become deoxygented?
    sickle cell disease
  31. What happens to the red blood cells when blood experiences lowered oxygen tension, or decreased pH, or the body is dehydrated?
    The RBCs become sickle shaped (sickle cell anemia)
  32. What are 7 effects of changes from sickle cell anemia blood disease?
    • erythrostasis
    • increased blood viscosity
    • decreased blood flow
    • hypoxia
    • increased adhesion of RBCs
    • vascular occlusion
    • further sickling
  33. Is the pt with sickle cell trait at risk during the dental appointment?
    no - unless severe hypoxia, severe infection, or dehydration occurs
  34. What 2 ethnic groups are at the most risk for sickle cell anemia?
    • African american population
    • white mediterranean origin
    • It is more commonly found in regions that have malaria and populations who have migrated from these areas, because of the mutated gene from malaria
  35. The following bone changes can be identified by the hygienist in pts with what type of blood disorder?
    changes in bone; including the mandible results from thrombosis with infarction and from infection
    trabecular pattern of the bone and x-rays may be affected due to hyperplasia of marrow elements in response to increased destruction of RBC's
    enlarged bone marrow spaces
    bone marrow hyperplasia
    decreased number of trabeculations
    trabeculae between teeth appear as horizontal rows or step ladder
    sickle cell anemia
  36. In severe hemolytic anemia; it affects adults, and is _________ hemolytic sickle cell disease; the hematocrit may range between _ and __%
    • chronic
    • 18-30%
  37. The life span of red blood cells normally is from _______ to _________ days, whereas in hemolytic anemia, such as sickle cell anemia, the RBC survival rate is about _______ to _______ days
    • 90-120
    • 10-15
  38. What is the acute form of sickle cell anemia called?
    sickle cell crisis
  39. What are 5 precipitating factors of sickle cell crisis?
    • may appera at any time or w/out stimuli
    • viral or bacterial infections
    • hypoxia, dehydration, sudden changes in temp
    • physical activity, extreme fatigue, acidosis
    • stress/anxiety, additional burden, trauma
  40. What are 3 signs and symptoms of sickle cell crisis (acute)?
    • self-limited, or reversible pain episodes involving extremities, head, back, chest, and abdomen
    • infactions occur in various tissues and organs
    • symptoms of seizure or stroke, or coma
  41. What are 3 steps in an acute sickle cell anemia (sickle cell crisis) emergency?
    • stop procedure
    • activate medical emergency system
    • administer oxygen
  42. What is an increase in the number and concentration of red blood cells above the normal level? Hemoglobin and hematocrit values are raised. The three general categories are relative, primary, and secondary?
  43. Which category of polycythemia is described?
    loss of plasma occurs w/out loss of RBCs
    concentration of cells increases and relative polycythemica results
    cause of fluid loss may be dehydration, diarrhea, repeated vomiting, sweating or burn
    factors such as smoking, hypertention, overweight, stress can add
  44. Which type of polycythemia results from actual increased red blood cell count and hemoglobin value? White cell and platelet counts are elevated, and blood viscosity increased affecting oxygen transport?
    primary polycythemia
  45. Which type of polycythemia is a neoplastic condition resulting from a bone disorder in which the primitive red cells or stem cells proliferate?
    polycythemia primary type
  46. Which type of polycythemia is the only form with oral signs? Identify them. (3)
    • primary polythemia
    • tongue, mucous membrane, and gingiva: deep purplish red
    • gingiva enlarged: bld on slt provocation
    • petechiae, ecchymosis, and hemotoma
  47. What are 3 factors that can contribute to secondary polycythemia?
    • hypoxia from:
    • high altitudes
    • pulmonary disease
    • heart disease
    • tobacco smoking
  48. What are the 2 main types of WBCs?
    • granulocytes: neutrophils, eosinophils, basophils
    • agranulocytes: lymphocytes, monocytes
  49. Whicy type of WBC Has three types of T cells that are involved with the delayed or cellular immune reaction?
    lymphocytes (an agranulocyte)
  50. What is the normal value of lymphocytes in blood? What will an increase of this result in? decrease?
    • normal: 20-35%
    • increase: lymphocytic leukemia, chronic infections, and viral disease
    • decrease: aplastic anemia, myelogenous leukemia, radiation
  51. Which type of WBC functions in phagocytosis, intracellular killing (especially mycobacteria, protozoa, and fungi), and mediating of immune inflammatory response? They serve as antigen presenting cells, and migrate into tissues.
    monocytes (an agranulocyte)
  52. What is the normal value of monocytes in blood? What will an increase result in? decrease?
    • normal: 2-6%
    • increase: monocytic leukemias, TB, infective endocarditis, hodgkin's disease
    • decrease: aplastic anemia
  53. Which type of cells defend the body through phagocytosis, and are the first line of defense in the body?
    neutrophils (granulocyte)
  54. What is the normal value of neutrophils in blood? What will an increase result in? decrease?
    • normal: 60-70%
    • increase: acute infections, myelogenous leukemia, poisoning erythroblastosis
    • decrease: aplastic anemia, granulocytopenia
  55. Which type of WBC is involved in allergic reactions and infections by parasites?
    eosinophils (granulocyte)
  56. What is the normal value of neutrophils in blood? What will an increase result in? Decrease?
    • normal: 1-3%
    • increase: allergic disease dermatitis, hodgkins disease, scarlet fever,
    • decrease: aplastic anemia, typhoid fever
  57. Which type of WBC functions to increase vascular permeability during inflammation, so phagocytosis cells can pass into the area?
    basophils (granulocyte)
  58. What is the normal value of basophils in blood? What will an increase result in? decrease?
    • normal: 1%
    • increase: certain chronic infections
    • decrease: aplastic anemia
  59. What is a reduction in total number of leukocytes in the blood; count under 500 per ml?
  60. What are 2 specific causes of leukopenia?
    • specific infections: HIV/AIDS, typhoid fever, influenza, malaria, measles
    • disease or intoxification of the bone marrow: chronic drug poisoning, radiation, autoimmune or drug induced immune reaction
  61. What is a rare, serious disease involving the destruction of bone marrow? Its causes relate to toxicity from drugs and chemicals, antipsychotic drugs, and autoimmune reactions?
    agranulocytosis (malignant neutropenia)
  62. What is an oral manifestation of agranulocytosis?
    ulceration and necrosis of tissue
  63. What the general types of bleeding disorders caused by? (3)
    • pathology of the blood vessel walls: fragile vessels; petechial and hemorrhage appear in mucous membrane and skin
    • Platelet deficiency or dysfunction: thrombocytopenia or plateley dysfunction
    • Disorders of coagulation: acquired disorders or hereditary disorders
  64. What type of platelet deficiency or dysfunction is a lowered number of platelets that may be caused by decreased production in the bone marrow?
  65. What will platelet dysfunction result in?
    prolonged bleeding time
  66. List 3 acquired disorders of coagulation.
    • Vitamin K defiency
    • liver disease
    • anticoagulant drug therapy
  67. How many hereditary coagulation disorders exist? List 3 examples.
    • at least 30: deficiency or abnormality of a plasma protein
    • hemophilia A: factor VIII abnormality
    • hemophilia B: factor IX abnormality
    • von Wellebrand's disease
  68. What is the normal level of blood clotting factor in circulating blood?
    platelet count: 140,000-400,000/mm3
  69. At what blood clotting factor level can spontaneous bleeding occur?
    less than 50,000/mm3
  70. Which hemophilia type is associaged with reduced amt of factor VIII?
    hemophilia A
  71. Which hemophilia type is associated with factor IX?
    hemophilia B
  72. Which type of hemophilia is characterized by prolonged bleeding time in the presence of a normal platelet count?
    von Willebrand's disease
  73. What is the most common hereditary disorder of platelet dysfunction?
    von Willebrand's disease
  74. Hemophilia A and B most often affect boys or girls? what about von Willebrand's?
    • A and B: boys
    • von Willebrand's: both
  75. What are effects of minor trauma from hemophilia?
    bld and bruising from minor trauma
  76. What is bleeding into the soft tissue of joints begins in the very young who have severe hemophilia, much swelling, pain, and incapacitation are created?
  77. true or false. an effect and long-term complication of hemophilia is that permanent joint damage can result and the pt may need splints, braces, or orthopedic surgery
  78. true or false. Pts with hemophilia may avoid brushing and flossing for fear of bld. inform pt to brush well
  79. What are 3 different screening tests to determine pts status with hemophilia?
    • PT: prothrombin time
    • aPTT: activated PTT
    • platelet count
  80. which hemophilia test is described?
    measures the status of extrinsic and common pathways of coagulation, it reflects the ability of blood lost from vessels in the area of injury to coagulate
    PT: prothrombin time
  81. Which hemophilia test is described?
    measures the status if the intrinsic and common pathways of coagulation; it reflects the ability of the blood still within the vessels in the area of injury
    activated PTT
  82. Which hemophilia test is described?
    screens for possible bleeding problems because of thrmobocytopenia; an examination of a blood smear may be requested by a physician inresponse to abnormality in blood counts
    platelet count