Most common oral change of nutritional anemia is:

# Most common oral change of nutritional anemia is:

A. Atrophic glossitis

B. Leukoplakia

C. Lichen planus

D. Hypertrophic glossitis

The correct answer is A. Atrophic glossitis.

Glossitis is one of the more common symptoms of pernicious anemia. The patients complain of

painful and burning lingual sensations which may be so annoying that the dentist is often consulted first for local relief. The tongue is generally inflamed, often described as ‘beefy red’ in color, either in entirety or in patches scattered over the dorsum and lateral borders. In some cases, small and shallow ulcers — resembling aphthous ulcers — occur on the tongue. Characteristically, with the glossitis, glossodynia and glossopyrosis, there is gradual atrophy of the papillae of the tongue that eventuate in a smooth or ‘bald’ tongue which is often referred to as Hunter’s glossitis or Moeller’s glossitis and is similar to the ‘bald tongue of Sandwith’ seen in pellagra. Loss or distortion of taste is sometimes reported accompanying these changes. The fiery red appearance of the tongue may undergo periods of remission, but recurrent attacks are common.

Shafer 7th Edition, Page no: 763

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Cyanosis of lips is a common finding in all EXCEPT:

# Cyanosis of lips is a common finding in all EXCEPT:

A. Polycythemia

B. Sickle cell anemia

C. Iron deficiency anemia

D. Congenital heart disease

The correct answer is: C. Iron deficiency Anemia.

In general， cyanosis becomes apparent when,  the concentration of reduced hemoglobin in capillary blood exceeds 40 g/L (4 g/dL). It is the absolute，rather than the relative，quantity of reduced hemoglobin that is important in producing cyanosis. Thus, in a patient with severe anemia，the relative quantity of reduced hemoglobin in the venous blood may be very large when considered in relation to the total quantity of hemoglobin in the blood. However, since the concentration of the latter is markedly reduced, the absolute quantity of reduced hemoglobin may still be low, and， therefore， patients with severe anemia and even marked arterial desaturation may not display cyanosis. Conversely， the higher the total hemoglobin content， the greater the tendency toward cyanosis; thus， patients with marked polycythemia tend to be cyanotic at higher levels of Sao， than patients with normal hematocrit values.

CAUSES OF CYANOSIS

Central Cyanosis

1. Decreased arterial oxygen saturation

     A. Decreased atmospheric pressure- high altitude

     B. Impaired pulmonary function

          - Alveolar hypoventilation

          - Inhomogeneity in pulmonary ventilation and perfusion (perfusion of hypoventilated alveoli)

          - Impaired oxygen diffusion

     C. Anatomic shunts

         - Certain types of congenital heart disease

         - Pulmonary arteriovenous fistulas

         - Multiple small intrapulmonary shunts

    D. Hemoglobin with low affinity for oxygen

2. Hemoglobin abnormalities

    A. Methemoglobinemia-hereditary，acquired

    B. Sulfhemoglobinemia-acquired

    C. Carboxyhemoglobinemia (not true cyanosis)

Peripheral Cyanosis

A. Reduced cardiac output

B. Cold exposure

C. Redistribution of blood flow from extremities

D. Arterial obstruction

E. Venous obstruction

Ref: Harrison's 19th edition, Page 249

Dietary approaches to stop hypertension (DASH) approximately reduces systolic blood pressure by:

# Dietary approaches to stop hypertension (DASH) approximately reduces systolic blood pressure by:

a. 2-4mm Hg

b. 4-9mm Hg

c. 2-8mm Hg

d. 8-14mm Hg

The correct answer is D. 8-14 mm Hg.

Limitation of alcohol consumption will lower by 2-4mm Hg, physical activity will

reduce by 4-9mm Hg and dietary sodium reduction will lower by 2-8mm Hg. Adoption of DASH eating plan will reduce SBP by 8-14 mm Hg.

Ref: Burkett 12th ed, page number: 366

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 # Cytomegalovirus that causes severe oral ulcers is also known as:

a. HHV 5

b. HHV4

c. HHV 2

d. HHV1

The correct answer is B. HHV4

HHV 4 is also known as cytomegalovirus, HHV 5 is Epstein barr, HHV 2 is herpes

simplex virus 2 and HHV 1 is herpes simplex virus 1. 

Ref: Burkett 12th ed, page number: 59

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