Micro-Test 2

Front 1

What organism is related to Agressive (early onset) periodontitis?

Back 1

-Aggregatibacter actionmycetemcomitans

Front 2

Describe Neutrophil Respiratory Burst?

Back 2

-Neutrophil metabolism is indept of O2.
-Consumes large amount of O2 when stimulated to converted to Superoxide anion and hydrogen peroxide.
-Resulting in OXIDATIVE killing.

Front 3

Defect in NADPH oxidase result in what?

Back 3

-Chronic Granulomatous Disease: inability to mount a respiratory burst.

Front 4

Describe each step that ais affect by
1. Chronic Granulomatous disease (CGD)
2. Myeloperoxidase deficient (MPOD)
3. Glycogen storage disease (GSD)

Back 4

1. CGD: NADPH oxidase
2. MPOD: MPO inhibitor (NaN3): H2O2 --> HOCl
3. GSD: O2- deficit.

Front 5

Clinical Presenation of CGD Pt?

Back 5

-Recurrent staphylococcus skin infection (10 yr old)
-Periodontal condition deteriorated suddenly, cannot be controlled by antibiotic (38 yrs old)

Front 6

Literature stated that pt with CGD have evidence of severe periodontal disease (T/F)

Back 6

False: Severity of diease consistent with age and oral hygiene
-50% of CGP is ass. with gingivitis.

Front 7

Examples of Bioactive lipids?

Back 7

-Leukotriene B4
-PAF

Front 8

Exampes of Cytokines from Neutrophil-derived Mediators?

Back 8

-IL-1, 6, 8
-TNF-Alpha
-GM-CSF, G-CSF

Front 9

Fx of Neutrophil recptors?

Back 9

-Phaygocytosis
-Modulation
-Adhesion
-Chemotaxis

Front 10

Destructive roles in Neutrophil?

Back 10

-Releasing granular enzymes (elastase)
-Releasing toxic oxygen species (O2-, H2O2
-Releasing inflammatory mediators (TNF-alpha, IL-1)

Front 11

Roles of Macrophage in Periodontal Disease in relation to LPS?

Back 11

-LPS responsive: LPS binding protein, CD14, Toll-like receptors 4 and 2.

Front 12

Example of Marcrophage Destructive mediators?

Back 12

-Synthesis of pro-inflammatory mediators (TNF-Alpha, Il-1B, IL-6, IL-8, PGE2, NO (iNOS).
-Releasing matrix metalloproteineases (MMP)

Front 13

Example Remodeling of Macrophage in Periodontal Disease?

Back 13

-Secreting PDGF, TGF-Beta

Front 14

T-cell regulate macrophage (T/F)

Back 14

True

Front 15

What is Priming?

Back 15

-A mechanis, where by dormant neutrophils acquire a state of preactivation that enables an enhanced response to be generated onace the cells are activated or cellular signals that say "amber" but not "green".

Front 16

Example of Priming agents?

Back 16

Bacterial LPS and Cytokines

Front 17

Primed neutrophil oxidative responsiveness has been found in ___, ___, ___?

Back 17

-Acute bacterial infection, bacteremia, septicemia, inflammatory bowel disease

Front 18

Elevated systemic cytokine levels in periodontal pt have been reported and enhanced neutrophil respiratory burts has also be dependently reported (T/F)

Back 18

False: Independently reported.

Front 19

Periodontopathogens examples?

Back 19

-Porphyromonas gingivalis
-Aggregatibacter actinomycetemcomitans

Front 20

How is Porphyromonas gingivalis strains resistant to phagocytosis? How do we deal with that problems.

Back 20

-Capsule
-Discrete proteases that cleave opsonins and chemotactic
-Require specific antibodies

Front 21

How can you kill Porphyromonas gingivalis?

Back 21

-Intracellular
-Oxygen dependent

Front 22

Which of the follow is Porphyromas gingivalis resistant to?

Back 22

-Lactoferrin, defensins, Other oxygen-indepedent mechanisms (Proteases)

Front 23

Aggregatibacter actinomycetemcomitans can produce human neutrophils specific leukotoxins (T/F)

Back 23

True: Host antibody responses to leukotoxin and capsule

Front 24

Describe how to kill Aggregatibacter actinomycetemcomitans?

Back 24

-Easy to phagocytized
-Sensitive to Oxygen-independent killing mechanism (Lactoferrin)
-Make catalase: but is sensitive to MPO system

Front 25

Examples of PMN dysfunctions?

Back 25

-Neutropenia
-Leukocyte Adhesion Deficiencies
-Chemotaxis deficiencies
-Lysosomal granule dysfunctions

Front 26

PMN evasives strategies of periopathogens?

Back 26

-Resistance to phagocytosis & opsonization
-Resistance to killing
-Production of leukotoxins

Front 27

PMN involvement in Pathology?

Back 27

-Recruitment & activation of Macrophage: cytokine directed PMN-priming (IL1B, TNFA, IL8)
-PMN produces in GCF (collagenase, B-Glu, LF, MPO)

Front 28

What is Mouse Chamber Model?

Back 28

-Cytology
-Monokine ass. w/ PMN influx
-IL8 analogue
-PMN activation by chamber fluid w/o Ab or C
-PMN presence w/o LTB4.

Front 29

What type of metabolism is facultative?

Back 29

-Capable of both aerobic or anaerobic metabolism

Front 30

What is difference b/t selective and differential?

Back 30

-Differential: ie sugar fermentation
-Non-selective vs. selective

Front 31

What percent is Cloiform bacteria (Enterics) in pyogenic oral infections?

Back 31

-6%

Front 32

Dental Unit water lines pathogen?

Back 32

-Pseudomonas: pioneer colonizer
-Peri-implant infections
-Need to monitor dental unit water line and regular disinfection

Front 33

What type of bacteria are well colonized in GI?

Back 33

-Strict Anaerobes

Front 34

Describe Coliform bacteria stain, enzyme production, structures and Selective media?

Back 34

-Stain: Gram - = endotoxin = LPS (O-antigen)
-Make exotoxins, hymolysins, proteases
-Flagella (H), fimbriae, pili and capsules (K)
-Selective media: MacConkey's Agar.

Front 35

Classic stimulant for inflammatory response?

Back 35

-Gram - = endotoxin = LPS (o antigen)
-Step1 : LPS + LPS binding protein --> CD14 on Monocytes,
-Step2: LPS + CD14 --> TLR 4 on Monocytes
-Step3: Activation of NFB--> Inflammatory mediator

Front 36

Growth in bile salts and dyes inhibit what?

Back 36

-Gram +s

Front 37

What are the serotypes of E. Coli?

Back 37

-O antigen CHO side chain of LPS (serogroup)
-H antigen (protein-flagellin) of flagella (serotype)
-K antigen of capsule (CHO)
-Virulence ass

Front 38

How does virotypes occur?

Back 38

-Typing based on virulence traits
-Certain serotypes more ass.

Front 39

Virotypes of E. Coli
-ETEC
-EAggEC
-EPEC
-EHEC
-EIEC

Back 39

-ETEC (toxic): attach but not invade
-EAggEC: similar to ETEC
-EPEC (pathogenic): provoke inflammation
-EHEC (hemorrhagic): kidney failure), shiga toxin
-EIEC (Invasive): invade colonic cells but don't produce Shiga-toxin

Front 40

Uropathogenic E. coli?

Back 40

-Community acquired: Uropathogenic strains (>80%), Lkebsiella, Proteus, start colonizing in colon, Urethra & Bladder --> Kidneys
-Hospital Acquired: 50% of pt w/ indwelling urinary catheter for > 5 days (septicemia)
-Hematogenous urinary tract infection.

Front 41

What is Hematogenous urinary tract infection gram stain?

Back 41

-Almost always Gram +, Descending infections

Front 42

Major cytokines released during septic shock?

Back 42

-IL1A + B
-TNF
-IL6
-IL8
-Interferon-Gamma.

Front 43

Respiratory Infection

Back 43

Respiratory Infection

Front 44

Aerotolerant Respiratory Pathogens in oral-Facial infections?

Back 44

-Streptococcus pyogenes
-Staphyloccus aureus
-Klebsiella pneumonia

Front 45

Describe Streptoccocus Pyogenes (stain, sugar, hemolysis, sensitivity)
(+, B, CN, A, B) Plus BoW Can Never Achieve B grade

Back 45

-Gram + cocci in chains
-Beta Hymolytic small white colonies
-Catalase negative (no bubbles w/ H2O2)
-Serogroup A-Lancefield typing
-Sensitive to Bacitracin (Group A disk)

Front 46

Staphlyoccous aureus (stain, sugar, hemolysis, sensitivity)
(+, B, C, SM, P) Put Billy Can SwiM Permenantly.

Back 46

-Gram + cocci in clusters
-B-hemolytic-yellow large colonies
-Catalase postive (bubbles w/ H2O2)
-Growth in salt and mannitol
-Resistant to penicillin

Front 47

Klebsiella pneumonia (stain, sugar, hemolysis, sensitivity)
(-, L, C, in M, BM) Never lack Capsule in My Blue Meth)

Back 47

-Gram - rod
-Ferment lactose
-Capsule production
-Growth in bile salts MacConkey's or Eosin Methylene Blue (EMB)

Front 48

Located of S. aureus vs S. pyogenes

Back 48

-S. aureus: resident microfloa of nose, vagina, colon
-S. pyogenes: carries, upper respiratory tract

Front 49

Disease caused by both S. aureus and S. pyogenes

Back 49

-Impetigo
-Speticemia

Front 50

Diseased caused by S. aureus and not by S. pyogenes?

Back 50

-S. aureus: food borne disease, soft tissue infections, Pnuemonia, Osteomyelitis
-S. pyogenes: Pharyngitis (rheumatic fever; kidney failure), Boils, skin abscesses, TSLS, Scarlet fever

Front 51

Describe S. pyogenes Pharyngitis?

Back 51

-Sudden onset, swollen tonsils, purulent exudate of tonsils, low-grade fever, pain mild to severe
-May cause severe pneumonia
-Rheumatic fever rate > 2% if not treated.

Front 52

Invasive Group A Streptococci?

Back 52

-Symptoms occur w/in 1-2 days
-Acute Respiratory: pain in chest, high fever, BP drop, Scarlet fever
-Wound Infection: pain, high gever, BP drop, Necrotizing lesion

Front 53

TX of Invasive Group A Streptococci?

Back 53

-Tx broken skin w/ betadyne or other good antiseptic and cover
-Tx with penicllin or Augmentin
-Early tx is impt.

Front 54

S. pyogenes is ALWAYS susceptible to penicillin (T/F)

Back 54

True
-Heart ass: penicillin or other regimen required to prevent rheumatic fever.

Front 55

Smallest free living bacteria?

Back 55

-Mycoplasma pneumonia

Front 56

Where and who does Mycoplasma pneumonia infect?

Back 56

-Respiratory mucosa: P1 adhesion binds to base of cilia on epithelia cells.
-Droplet transmission (common in children)
-Slow onset, clear to cloudy white discharge
-Last 2-5 wks
-Pas middle age or impaired health

Front 57

Mycoplasma Respiratory INfections?

Back 57

-Upper respiratory (URI): pharyngitis, rhinitis, sinusitis, Eustachian tube/middle ear infections, moves from one side to other.
-Lower respiratory (LRI): Brochitis, pneumonia (Atypical or walking pneumonia)

Front 58

Mycoplasma susceptiblity?

Back 58

-No cell wall for target (Resistant to Penicillin, cephalosporin, vancomycin)
-Drugs prevent protein synthesis
-Erythromycin 500 units QID
-Oxycycline (Vibramycin) 100 mg.

Front 59

Factors that affect pt who get Legionella pneumophila?

Back 59

-Fastidious and hard to stain
-Factors: men over 55 years, smoking, alcohol abuser
OR
-Emphysema; chronic bronchitis; diabetes; cancer/chemotherapy
-Source: water aerosols-dentul unit water lines
-Not transmissible.

Front 60

Legionallosis URI?

Back 60

-Pontiac fever
-Pharyngeal/rhinitis
-High infectivity rate
-Short lived, 2-5 days

Front 61

Legionellosis LRI?

Back 61

-Sudden onset
-Chills/fever
-Lung congestion
-Erythromycin or tetracycline

Front 62

What is Cystic Fibrosis?

Back 62

-Defective chloride transport (cystic fibrosis transmembrane conduct regulator (CFTR) gene)
-Leads to reduced aqueous phase w/ increase mucin-defective beating of cilia and reduced mechanical clearance

Front 63

About half of infectious colds are believed to be caused by rhinoviruses (piconaviridae). (T/F)

Back 63

True

Front 64

Common URI cold viruses

Back 64

-Picorna-rhinovirus
-Coronavirus
-Respiratory syncytial virus

Front 65

What affect does Rhino viral agents have?

Back 65

-Damage mucosal cells and membranes
-Provoke increased vascular permeability (kinins, histamine, iNOS)
-Lipid breakdown
-Fever/pain (PGE2, pyrogen)
-Edema (pus infection)

Front 66

Live virus can proliferate cause what?

Back 66

-Acute febriel/pain response
-Slough ciliated epithelial cells
-Edema may seal respiratory passages
-Edema or 2nd bacterial infection can kill in 3-6 days.

Front 67

Viral infection is halted by ___ secreted by mucosa, usually in ___ days

Back 67

-Interferon in 2-4 days

Front 68

Immunity (sIgA) usually responds ___ weeks.

Back 68

-2

Front 69

Viral relapse and recovery may occur before antibody response (T/F)

Back 69

True

Front 70

Recommended tx for Mucosal damage (coughing)?

Back 70

-Topical or systemic vasoconstrictors to relieve nasal congestion, analgesics to treat headache.

Front 71

Most vaccines stimulate IgA (T/F)

Back 71

False: IgG
-Nasal flu vaccine stimulates SIgA response through common mucosal immune system

Front 72

If untreated, rhinitis can lead to what?

Back 72

-Sinusitis, otitis media, bronchitis, pneumonia, or late-occuring problems such as nasal polyps and brochiectasis.

Front 73

Sinus infection occurs when?

Back 73

-Infection w/o adequate drainage = growth of resient bacteria

Front 74

Bacterial agents of Sinus RI?

Back 74

-Mycoplasma
-Hemophilus influenza
-S. pyogenes
-Branhamella catarrhalis (Neisseria)
-Streptococcus pneumonia

Front 75

Half of global population is infected wiht Mycobacterium tuberculosis (T/F)

Back 75

False: 1/3

Front 76

What is the vaccine for TB?

Back 76

-Calmette-Guerin (BCG)

Front 77

Fungal infections of Lower respiratory tracts?

Back 77

-Inhale spores or yeast
-Immunocompromised
-Blastomycosis, coccidiomycosis, cryptococcosis, histoplasmosis

Front 78

Pneumonias due to Pneumocystis carinii are particularly common in AIDS (T/F)

Back 78

True

Front 79

Cause of non-seasonal allergies

Back 79

-Chronic or recurring symptoms of nasal obstruction w/ or w/o discharge
-Food allergens
-Sensitivity test helpful

Front 80

What is SARS

Back 80

-Severe Acute Respiratory Syndrome
-Coronavirus
-Development of antibodies (>21 days)

Front 81

Symptom?

Back 81

-Mild: Asymptomatic
-Moderate: fever, cough, shortness of breath
-Severe: fever, cough, shortness of breath, hypoxia, radiographic PNEUMONIA, Respiratory distress syndrome.

Front 82

END OF ENTERIC BACTERIA

Back 82

END OF ENTERIC BACTERIA

Front 83

Methods of ID of bacteria?

Back 83

-Culture: isolation, ID and determination of antibiotic sensitivities
-DNA-DNA hybridization
-PCR
-Serological ID

Front 84

What Capnophilic and Microaerophilic?

Back 84

-Capnophilic: candle jar and or CO2 incubator
-Microaerophilic: aerobic bacteria that find atmospheric O2 toxic.

Front 85

Natural habitat of most oral bacteria?

Back 85

-Structural multi-species communit.
-Bacteria embedded in matrix w/ water channels
-Attachment - growth - ecological - maturation

Front 86

Describe Sub-g tooth surfaces

Back 86

-Low O2 tension = Good G- anaerobes
-Major site of interaction of bacteria/host tissues
-Species mix varies b/t each side

Front 87

Basic biofilms properties

Back 87

-Cooperating communities of various types of micro-organisms
-Antagonism
-Arrange in microcolonies
-Surrounded by protective matrix
-W/in microcolonies are diff environment
-Microorganism have primitive communication sys.
-Resistant to antibiotics, antimicrobials and host responses

Front 88

-Biofilms behave as a community (T/F)
-Assemblage of microorganisms: self-organize (T/F)
-Respond to environmental changes as a individual (T/F)

Back 88

-True
-True
-False: unit

Front 89

Who does microcolonines communicate with as scouts?

Back 89

-Planktonic

Front 90

What Quorum sensing?

Back 90

-Tells bacteria when to grow and when its time to go.

Front 91

What is the goals of deattaching bacteria at the surface of mature biofilms?

Back 91

-Bacteria become planktonic and find a new ome

Front 92

Saliva provide a transport medium for planktonic oral bacteria to travel and grow (T/F)

Back 92

False: For travel only not growth.

Front 93

Ecological succession

Back 93

-3rd colonizers: (Gram -): Porphyromonas gingivalis
-2nd colonizers: (Gram -): Bridge species, F. nucleatum bind to other bacteria
-1st (Gram +): Streptococcus bind pellicle proteins from saliva.

Front 94

List microbial complex in green cluster?

Back 94

-C. gingivalis, E. corrodens, S, sputigena, C. orchracea, C. concisus, A. actinomycetemcomitans serotype A

Front 95

Host Resistance Properties?

Back 95

-Innate immune defense factors
-Antibodies
-Phagocytic cells
-Epithelial integrity
-Indigenous host compatible microfloa
-Nutritional deprivation

Front 96

Host Suceptibility to Traits?

Back 96

-PMN dysfunctions (overt or subtle)
-Opsonin dysfunctions
-Hyperresponsive inflammatory response
-Anatomical
-Environmental (oral hygiene, diet)
-Tissue repair/regeneration

Front 97

Innate defense resistance of bacteria.

Back 97

-Serum
-PMN
-Oxygen tolerance
-Inactivation by proteases

Front 98

Attachment of bacteria?

Back 98

-Fimbriae
-Capsule
-Hydrophobicity
-Lectin/Protein receptors
-Unmask receptors by proteases

Front 99

Immune surveillance evasion?

Back 99

-Ig/Opsonin proteases
-Pleomorphism
-Immunomodulation
-Tissue invasion

Front 100

Criteria for determing the etiologic agents of destructive periodontal disease?

Back 100

-Animal Models
-Host response
-Association
-Virulence factors
-Elimination

Front 101

Applied criterion for Porphyromonas gingivalis

Back 101

-Ass: elevated periodontal lesions.
-Elimi: Eliminate results in successful therapy
-Host: Elevated serum Ab in periodontitis
-Virulence: Specific proteases, endotoxin, capsule, fimbriae
-Animal: mice, rats, monkeys, dogs

Front 102

Describe Porphyromonas gingivalis?

Back 102

-Virulent strains are resistants to phagocytosis: capsule, discrete proteases
-Killing: intracellular, O2 dependent
-Resistant: Lactoferrin, defensins, O2 indept. mechanisms

Front 103

Virulence factors of P. gingivalis?

Back 103

-LPS, proteases, fimbriae, hemagglutinating factors, polysaccharides capsule, collagenase, vessicles.

Front 104

Describe LPS of P. gingivalis?

Back 104

-A potent monocyte stimulation and neutrophil priming agent TLR2

Front 105

Describe Proteases of P. gingivalis?

Back 105

-Arginine gingipain (RGP) and lysine gingipain (KGP)= inflammation
-Responsible for resistance to PMN phagocytosis and non-oxygen dependent killing mechanism

Front 106

Aggregatibacter (Actinobacillus) Actinomycetemcomitans criterions?

Back 106

-Ass: can be almost pure culture from aggressive lesion
-Elimn: elimination results in successful therapy
-Host: Prcipitating antibodies to carb. Leukotoxin neutralizing Ab.
-Virulence: Leukotoxin, invasion in cell culture
-Animal: Induction of disease in gnotobiotic rats.

Front 107

Ab neutralization of virulence properties?

Back 107

-Agglutination-mech. clearance
-Masking ligand-receptor interaction (inhibit attachment)
-Opsonins
-Neutralization of proteases
-Leukotoxin neutralization
-Disrupt of biofilm.

Front 108

Bacteria in aggressive periodontitis?

Back 108

-All species (esp. red complex) are present in periodontitis found in aggressive periodontitis.
-A. actinomycetemcomitans in early onset agg. periodontitis

Front 109

Adult flora in children, suspect what?

Back 109

-Neutropenia, LAD

Front 110

Identify 6 bacterias associated WITH FAILING IMPANTS?

Back 110

P. gingivalis
Peptostreptococcus micros
Fusobacterium sp
Pseudomonas sp.
Enterobacter
E. coli

Front 111

Identify the main bacteria associated with periaplical abscesses?

Back 111

Oral streptococci
Enterococcus sp
S. aureus
Psorphyromonas sp.
P. endodontalis
Prevotella sp
Fusobacterium sp.
Spirochetes

Front 112

Identify the bacteria found in BOTH periapical abscesses and failing implants?

Back 112

Fusobacterium sp.
Porphyromonas species

Front 113

Which bacterias associated with periapical abscesses are consider BACTEROIDES?

Back 113

Porphyromonas sp.
P. endodontalis
Prevotella sp

Front 114

Most UNC pt. that comes in with enodontic infections but has NO PROGRESSIVE SWELLING/FEVER are mainly treated with what?

Back 114

Ca(OH)2, without antibiotics even if they release suppurative exudate into the canal.

Front 115

If UNC pt. comes in with FEVER/PROGRESSIVE SWELLING, what should you refer to the pt.

Back 115

Orofacial surgery

Front 116

What is the most common endodontic case found in private dentist?

Back 116

Persistent or mildly progressive periapical infection

Front 117

What is the least common endodontic case found in private dentistry?

Back 117

Swelling in the face

Front 118

Dispersed bacteria can can cause infection by traveling thru ________ or ________.

Back 118

Lymphatics
Capillaries

Front 119

Identify the bacteria with the highest percentage found in pyogenic oral infections at the school of UNC?

Back 119

Oral streptococci with 61%

Front 120

What are 4 factors related to POSTOPERATIVE INFECTION?

Back 120

size of bacterial inoculum

extent and time of surgery

presence of foreign body

state of host

Front 121

What are 3 situation in which the STATE OF THE HOST could cause postoperative infection?

Back 121

Compromised resistance

AIDS Gingivitis meaning loss of resistant against plaque bacteria

CD4 T helper lymphocytes counts are less thatn 200/mm3

Front 122

What are 7 physical conditions that contributes to progressive oral infections?

Back 122

1. Protected reservoirs
2. Particles of calculus
3. Untreated canal with necrotic pulp
4. Fragment of root tip
5. Cracked tooth
6. PMNs cannot surround bacteria
7. Co-infection with synergistic bacteria

Front 123

What are things you can do to AVOID POST TREATMENT INFECTIONS?

Back 123

1. Reduce surgical trauma
2. Reduce length of surgeries
3. Reduced debris from plaque and calculus
4. Use excellent asepsis
5. Fresh sterile saline for irrigation
6. Have pt. rinse mouth with topical disinfectant
7. Neve rblow air into cut tissue
8. Don't pull long sutures across pt. hair or clothing
9. Wipe mucosa before injection

Front 124

Pt. are often refer to the maxillofacial surgery when there are presence of what?

Back 124

Chills/Fever in past 24h

Progressive swelling

Worsening pain, malaise