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Flashcards in 1. Patient Evaluation Deck (54):
1

Patient history consists of

ID
Chief complaint
History of present illness
Past medical Hx
Ongoing medical care
Past surgical Hx
Family Hx
Social Hx
ROS (Review of systems)
Meds
Allergies

2

T/F Want to avoid oral surgery in patients receiving radiation to head/neck? Why or why not?

yes because risk of osteoradionecrosis

3

What drugs trigger malignant hyperthermia

Anesthesia gases: Halothane, Enflurane, Isoflurane, Sevoflurane, Desflurane.
Muscle relaxants: Succinylcholine.

4

T/F Family history of malignant hyperthermia is irrelevant

f- More likely to have it when it runs in the family so avoid muscle relaxants and anesthesia gases

5

Why is knowing someones social history (tobacco and alcohol use) important?

Because it tells you if they will have delayed healing

6

What does HEENT stand for

Head, eye, ear, nose and throat

7

What are symptoms of reflux/heartburn intraorally

lingual erosion of teeth
burning tongue

8

Describe the vitals of a person experiencing a thyroid storm

Sporadic vitals

9

syncope describes an issue with what system in the body

neurologic

10

What are the 6 vital signs

-Temperature
-BP
-Pulse
-Respiration
-Height
-Weight

11

What is the acronym OBESE used to determine and what does it mean

-Predictive of difficulty with mask ventilation
O= Obesity (also difficult instrumentation and oxygenation)
B=Beard- Poor seal on mask
E=Elderly
S=Snorer
E=Edentulous

12

Skin elasticity (increases/decreases) with age

decreases

13

The thyromental height is measured from

the thyroid cartilage to the most anterior aspect of the chin

14

What does the thyromental height tell us about the patient

-<50 mm associated with difficulty in airway instrumentation
-Dentofacial/craniofacial abnormalities (i.e retrognathia of mandible)

15

What other measurement can indicate issues with difficult airway instrumentation

<30 mm interincisal opening

16

Child airway is more (anterior/posterior) relative to adult airway

anterior

17

Objects get lodged in (adult/child) airway easier

child

18

What is the narrowest part of the child airway

cricoid cartilage

19

T/F Infants are obligate nose breathers

t

20

Larynx is more _ and _ in location relative to child larynx

Inferior and posterior

21

Epiglottis is bigger and floppier in (child/adult) airway

child

22

Trachea is (more/less) rigid in child compared to adult

less

23

Describe the 4 different classes of Mallampati airway classification

1= faucial pillars, soft palate and uvula visible
2= Faucial pillars and soft palate can be seen but uvula masked by base of tongue
3= Can see soft palate
4= Only hard palate seen

24

What factors relating to the neck affect an individuals airway

-Atanto-occipital and cervical range of motion
-Neck circumference (anterior fat neck)
-Tracheal anatomy
-Past surgery, radiation, injury

25

(Upper/lower) lobes of the lungs are more affected in smokers Why? Pneumonia

upper because smoke rises... pneumonia affects the lower lung lobes

26

Describe the different ASA categories

I= Normal and healthy no modification needed
II= Mild systemic disease- no limitations (smoker= ASA 2 and drinkers)
III= Severe systemic disease (activity limited but not incapacitating
IV= Severe systemic disease- constant threat to life
V= Moribund and not expected to live >24 hrs
VI= Declared brain dead and will undergo organ harvest for donation
E= Emergency operation

27

Describe anxiety

Interactive relationship between pyschological and physical signs.symptoms which arise in response to a stressor (actual or perceived)

Characterized by feelings of impending doom

28

Systemic symptoms that may arise in someone which anxiety are

-Tachycardia (palpitations)
-Tachypnea, dyspnea
-Pupillary dilitation
-Psychomotor agitation

29

Features of general anxiety disorder include

-Persistant pervasive generalized anxiety
-Anxiety is unexplainable in terms of tangible idea, object, or situation
-"Free floating" anxiety (Unable to ID triggers of anxiety)
-Impairment in social/ occupational function

30

Describe maladaptive anxiety

-Exaggerated response to stressor which is in the subconcious
-Pathologic if maladaptive and disabling or crippling
-Interferes with social/occupational functioning or health care.

31

Define phobic disorders

Irrational fear of specific object, place or situation

32

What are the three different types of phobias

-Simple phobias (Everyone has this about dentistry)
-Social phobias
-Agoraphobia (These patients will not show up and this phobia may have arised due to previous traumatic experiences)

33

Describe the difference between dental phobia (simple phobia) and dental anxiety

Dental phobia
-Irrational fear of situation/place
-May have familial componenet

Dental anxiety
-Maladaptive in nature
-F>M
-May co-exist with generalized anxiety ot other anxiety disorders
-May have familial componenet

34

What are the main etiologies of dental anxiety

-Novelty- new/unfamiliar experiences
-Uncertainty- Unknown is often source of general arousal
-Expectation- Formulated from information obtained from others or vicariously experiencing fear provoking situations accompanied by negative cognitions
-Genetics
-Neurotransmitter systems (noradrenergic, GABA, and serotonin systems in frontal lobe and limbic system)

35

Behavioral signs of dental anxiety

-Avoidance
-Posture (skeletal muscle tension)
-Activity (restlessness, talkative)
-Severe psychologic distress
-Substance abuse (Informed consent issue)

36

Physiologic features of dental anxiety

-Tremulousness
-Diaphoresis (Sweating)
-Syncope
-Lowered pain threshold
-Tachycardia (Make sure you aspirate!)
-Increased BP
-Tachypnea

37

Biochemical evidence of dental anxiety

-Increase serum catecholamines
-Increased serum ACTH and corticosteroid levels
-Increased salivary corticosteroid levels
-Increased urinary catecholamine metabolities
-Increased urinary corticosteroid metabolite levels

38

Ways to assess dental anxiety

-Simple observation
-Patient self-report
-Assessment tools

39

What population is the toughest to gauge their level of anxiety

children

40

What 4 questions are asked in the Corah Dental anxiety Scale

1. If you had to go to the dentist tomorrow how would you feel about it

2. When you are waiting in the dentist's office for your turn in the chair how do you feel

3. When you are in the chair waiting while the dentist gets the drill ready to begin working how do you feel?

4. You are in the dentist's chair to have your teeth clean. While you are waiting and the dentist is getting out the instruments which will be used to scrape around your gums how do you feel?

41

Aside from the Corah DAS what other assessment scales are available to gauge dental anxiety

-Modified child DAS (MCDAS)
-Faces version of MCDAS
-Index of dental anxiety and fear (IDAF-4C)

42

What are the claimed benefits of the Index of dental anxiety and fear scale (IDAF-4C)

-Takes multi-dimensional nature of dental anxiety and fear into account
-Asks 8 questions
-Additional modules available for phobias and stimuli

43

What cardiovascular conditions are exacerbated by anxiety

-Coronary artery disease
-Angina
-Dysrhythmias
-Cardiomyopathies
-Hypertension

44

What pulmonary disorders are exacerbated by anxiety

-Asthma
-COPD

45

What GI issues are exacerbated by anxiety

-Peptic Ulcers
-GERD

46

What neurological conditions are exacerbated by anxiety

-Cerebrovascular disease
-Seizure disorders

47

What endocrine conditions are exacerbated by anxiety

-DM
-Adrenal insufficiency
-Thyroid disease (hyperthyroic, hypothyroid, and myxedema)
-Psychologic (Generalized anxiety, panic disorder, and depression)

48

What pharmacoloigc medication should be used to treat dental anxiety

something reversible like a benzodiazepiene

49

T/F There was an improvement in dental anxiety and attendance is groups put under general anesthesia

f

50

What is iatrosedation

Any technique of anxiety reduction in which no drug administration is required (talking to the patient)

51

Describe the 4 major components of an iatrosedation interview

1. Recognition
2. Dx (determine origin of fear)
3. Education
4. Build trust and confidence

52

Management of a mildly anxious patient

-Morning appts
-Iatrosedation
-Close attention with regional analgesia and post-op pain management

53

Management of moderately anxious patient

-Evaluate coping methods
-Intra/post op analgesia
-Teach new coping skills
-Hypnosis
-Behavior therapy + pharmacosedation

54

Management of severely anxious and or phobic patient

*Multidisciplinary team approach**
Psychotherapist
-Pharmacologic therapy (anxiolytics, antidepressants, and beta blockers)
-Systematic desensitization

Dentist
-Good pain control
-Iatrosedation + pharmacosedation
-General anesthesia for most severe cases - last resort.