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Patient Care Exam 2 > 10/5: Asthma, Diabetes and Allergy > Flashcards

10/5: Asthma, Diabetes and Allergy Flashcards

1
Q

(T/F) You need to get the medical history of all patients, even if they appear healthy

A

True

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2
Q

This is a chronic inflammatory disease of the airways characterized by REVERSIBLE episodes of increased airway hyperresponsiveness

A

Asthma

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3
Q

Is Asthma reversible or irreversible episodes?

A

Reversible

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4
Q

Asthma usually has a _______ onset

A

Sudden

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5
Q

When do peak symptoms occur for asthma?

A

10-15 min

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6
Q

Inadequate treatment of asthma results in ER visits for what percentage of patients?

A

25%

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7
Q

How many people worldwide does asthma affect?

A

300 million

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8
Q

Asthma accounts for how many deaths worldwide (pre-covid)

A

1 in 250 deaths

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9
Q

Has the prevalence of asthma doubled since the 1960s in the USA?

A

Yes - from 2% to 7%

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10
Q

This is a disease that can lead to chronic obstructive pulmonary disease that involves repeated attacks

A

Asthma

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11
Q

Asthma is a disease primarily of (children or adults)

A

Children

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12
Q

What is the 2nd most common chronic disease in children?

A

Asthma

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13
Q

What is the most common chronic disease in children?

A

Caries

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14
Q

What percentages of children are affected by asthma?

A

10%

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15
Q

What percentage of adults are affected by asthma?

A

6%

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16
Q

Do females or males have a higher presence of asthma?

A

Females

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17
Q

The prevalence of asthma during childhood is higher in boys or girls?

A

Boys

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18
Q

Asthma has a slightly higher prevalence among which communities?

A

African Americans
Hispanics

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19
Q

Asthma can be triggered by what kinds of stress?

A

Emotional
Physical

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20
Q

Can asthma be triggered by allergies to food or drugs?

A

Yes

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21
Q

Can asthma be exercise-induced?

A

Yes - breathing through the mouth and inhaling colder and drier air

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22
Q

Asthma can be divided into 2 categories

A

Extrinsic
intrinsic

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23
Q

This category of asthma is allergic asthma

A

Extrinsic - pollens, dust, molds, allergic foods such as milk, fish, shellfish

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24
Q

This category of asthma is non-allergic asthma

A

Intrinsic

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25
Q

What category of asthma occurs more often in children?

A

Extrinsic

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26
Q

What drugs and chemicals can trigger extrinsic asthma?

A

Penicillin
Vaccines
Aspirin
Sulfites

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27
Q

What percent of asthmatic children outgrow extrinsic asthma by late teens or early twenties?

A

50%

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28
Q

Intrinsic asthma usually develops in adults older than

A

35

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29
Q

Psychological and physiological stress can induce what kind of asthma attack?

A

Intrinsic

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30
Q

Intrinsic asthma attacks are precipitated by what specific non-allergic factors?

A

Respiratory infection, physical exertion, environmental and air pollution

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31
Q

Psychological and physiological stress can induce what kind of asthma attack?

A

Intrinsic

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32
Q

What is the “Triad” in triad asthmatics?

A

Asthma
Nasal polyps that recur
sensitivity to aspirin and NSAIDs

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33
Q

What should you avoid if you have asthma?

A

Aspirin and NSAIDs

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34
Q

What does aspirin cause for people?

A

Bronchoconstriction in 10%
Sensitivity to aspirin in 20-40%

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35
Q

Do nasal polyps in Triad asthmaticus recur?

A

Yes

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36
Q

Do triad asthmaticus respond to bronchodilators?

A

No

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37
Q

Triad asthmaticus manifests with what 3 things?

A

Wheezing
Dyspnea
hypoxia

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38
Q

What are the symptoms of asthma?

A

(WCCIAD)
a. Wheezing and coughing
b. Cyanosis
c. Chest congestion
d. Increased blood pressure
e. Anxiety and agitation
f. Dyspnea and tachypnea

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39
Q

What is the underlying goal in the dental management of patients with asthma?

A

Prevent acute attack

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40
Q

You can help prevent asthma by getting what vaccination?

A

Pneumonia
Influenza
COVID

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41
Q

Through a good medical history, the dentist should be able to determine the ____________ of the disease

A

severity and stability

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42
Q

What should a dentist know regarding a patient with asthma?

A

Frequency/severity of attacks
Time of day of attacks (most occur at night)
Any current or past problems with asthma attacks
How are attacks usually managed
Has the patient ever received emergency care for an acute attack

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43
Q

What is the asthma risk assessment severity based on?

A

Frequency of symptoms
Impairment of lung function
Risk of attacks

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44
Q

How should you manage asthma in a dental setting?

A

Sit patient upright
Administer bronchodilator - Ventolin (improvement in 15 sec. If no improvement, administer again. Up to 3 times)
Administer epinephrine-bronchodilator and antispasmodic
Adminster oxygen if bronchodilator is unsuccessful

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45
Q

What is categorized as mild asthma?

A

Attacks <3/week
<30 min duration
Only w/ exercise or allergen
Inhaler use rare
Usually, childhood, outgrow

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46
Q

What is categorized as moderate asthma?

A

3-5 attacks/week
Last 30 min-several hours
Affects sleep
Occasional ER visits
Inhaler used more common

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47
Q

What is categorized as severe asthma?

A

Daily attacks
Use inhaler daily
May use steroids
Frequent ER visits - occasionally hospitalized
Limits daily activity

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48
Q

What is the 3rd leading cause of death in the USA?

A

Diabetes

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49
Q

What is the leading cause of blindness in the USA?

A

Diabetes

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50
Q

This is a group of metabolic syndromes resulting from low levels of the hormone insulin

A

Diabetes

51
Q

Are you hypo or hyperglycemic in diabetes mellitus?

A

Hyperglycemic

52
Q

What type of diabetes is insulin-dependent?

A

Type 1 diabetes

53
Q

What type of diabetes is more common in children and adolescents?

A

type 1 diabetes

54
Q

What cell is destroyed in both Type 1 and Type 2 diabetes?

A

Beta cells

55
Q

What does beta cell destruction lead to?

A

Absolute insulin deficienct

56
Q

What type of diabetes have an abrupt onset?

A

Type 1 diabetes

57
Q

What type of diabetes have a slow onset?

A

Type II diabetes

58
Q

What diebetes are usually seen in adults, overweight, milder?

A

Type II diabetes

59
Q

Ketoacidosis is uncommon in what type of diabetes?

A

Type II diabetes

60
Q

Are blood sugar levels more stable in type 1 and type 2 diabetes?

A

Type II diabetes

61
Q

What kind of diabetes can you get during pregnancy?

A

Gestational

62
Q

You get more stable glucose levels and calories when?

A

Morning

63
Q

What occurs in a pregnant woman with type II diabetes after childbirth?

A

Glycemic control returns to normal, but have increased risk of developing diabetes within 5-10 years

64
Q

Monitoring what is common in diabetic patients?

A

Blood pressure-hypertension

65
Q

In diabetic ketoacidosis, the body produces high levels of blood acids called

A

Ketones

66
Q

What kind of respiration patterns do you get in diabetic ketoacidosis?

A

Kussmaul’s respirations

67
Q

Diabetic ketoacidosis is rare in people with what type of diabetes?

A

Type 2

68
Q

Glucose values will be above what in diabetic ketoacidosis?

A

300 mg/dl

69
Q

What treatment is there for diabetic ketoacidosis

A

a. Fluid and electrolyte replacement
b. Insulin therapy

70
Q

In hyperglycemia, is it slow or fast onset?

A

Slow

71
Q

In hypoglycemia, is it slow or fast onset?

A

Fast

72
Q

Do you get “fruity-smelling breath” and “Kussmaul’s breathing” in hyper or hypo-glycemia?

A

Hyperglycemia

73
Q

When you think polyuria, polydipsia, or polyphagia what are you thinking of?

A

Hyperglycemia

74
Q

Mood swings, tachycardia, lethargy, and nausea are symptoms of hypoglycemia or hyperglycemia?

A

Hypoglycemia

75
Q

Your blood glucose values are what in hypoglycemia?

A

<50 mg/100 ml

76
Q

Do you get altered levels of consciousness in hypoglycemia or hyperglycemia?

A

Hypoglycemia

77
Q

What are ways to manage hypoglycemia in a conscious patient?

A

Administer 100% oxygen
Oral carbohydrates if conscious
Medical assistance

78
Q

What are ways to manage hypoglycemia in an unconscious patient?

A

Cake icing
50% dextrose (20-50ml) IV
Glucagon 1mg IM or IV
Epinephrine 1/1000 0.5 mg IM

79
Q

What is an ideal HbAlc level if you have diabetes?

A

6.5% or below

80
Q

A1c measures the average amount of sugar in your blood over the past _____ months

A

Long term glucose: 30-90 days

81
Q

If you are at risk of developing type 2 diabetes, your target HbA1C should be

A

6%

82
Q

If you have a blood glucose reading of <70mg/dl, you should consider what? And wait how long?

A

a. Consider deferring elective treatment
b. Wait 15 minutes and retest

83
Q

If you have a blood glucose reading of >200mg/dL, you should do what regarding treatment?

A

a. Defer treatment
b. Refer to physician

84
Q

If you fast (8-12 hours), your glucose level will be

A

80-130 mg/dL

85
Q

Your glucose levels 1-2 hours after a meal is

A

<180 mg/dl

86
Q

What is caused by excess insulin and occurs in three stages?

A

Insulin shock - major goal is to prevent this

87
Q

What is the most common stage of insulin shock?

A

Mild stage

88
Q

This stage of insulin shock is characterized by hunger, weakness, trembling, tachycardia, pallor, sweating, paraesthesias

A

Mild stage

89
Q

This stage is characterized as a substantial blood glucose drop, patient becomes incoherent, uncooperative, and sometimes belligerent or resistant to reason or efforts at restraint?

A

Moderate stage

90
Q

The chief danger during this stage of insulin shock is that patients may injure themselves or someone else

A

Moderate stage

91
Q

This stage of insulin shock is characterized by complete unconsciousness

A

Severe stage

92
Q

This stage of insulin stock is characterized by sweating, pallor, rapid and thready pulse, hypotension, and hypothermia

A

Severe shock

93
Q

The reaction to excessive insulin (insulin shock) can be corrected by giving the patient

A

Something sweet (cake icing) or sweetened fruit

94
Q

What is the best way of treating patients in the severe stage (unconsciousness)?

A

IV-glucose solution; glucagon or epinephrine

95
Q

What is only the earliest oral manifestation of diabetes?

A

Xerostomia

96
Q

What are manifestations of diabetes?

A

Bacterial, viral, and fungal infections (including candidiasis)
Poor wound healing
Increase incidence and severity of caries

97
Q

You can get what kind of taste from metformin in oral manifestations of diabetes?

A

Metallic

98
Q

Hyperglycemia and periodontitis are

A

Bidirectional

99
Q

Hyperglycemia affects oral health while periodontitis affects what

A

Glycemic control (increases HbA1C)

100
Q

This is an abnormal or hypersensitive response of the immune system to a substance introduced
into the body

A

allergy

101
Q

For an allergic reaction to occur, the patient must have been previously exposed to the

A

Antigen

102
Q

For an allergic reaction to occur, the patient must have been previously exposed to the antigen. The ________ exposure to the antigen causes the reaction

A

Subsequent

103
Q

When you think of Type 1 - true IgE, antibiotic, analgesic, narcotics, anesthetics, venom, what type of allergic reaction is this?

A

Rapid/anaphylactic

104
Q

This is an acute reaction involving smooth muscle of the bronchi in which antigen-IgE antibody complexes form in the surface of mast cells which causes sudden histamine release from these cells

A

Anaphylaxis

105
Q

When do most anaphylaxis occur?

A

Within one hour of taking meds

106
Q

Can you get acute respiratory compromise and cardiovascular collapse from anaphylaxis?

A

Yes

107
Q

What is the most common cause of type 1 hypersensitivity reaction?

A

Antibiotics, but recently, chemotherapy drugs

108
Q

You get capillary dilation and increased capillary permeability resulting in blushing and edema formation. Decreased venous return, decreased blood pressure, and cardiac output in this type of anaphylactic allergic reaction

A

Cardiovascular

109
Q

You get increased secretions by the mucous, lacrimal, salivary, pancreatic, gastric, and intestinal growth in this type of anaphylactic allergic reaction

A

Stimulation of secretions

110
Q

You get increased secretions by the mucous, lacrimal, salivary, pancreatic, gastric, and intestinal growth in this type of anaphylactic allergic reaction. These effects can lead to asphyxia from upper respiratory tract obstruction in this type of anaphylactic allergic reaction

A

Respiratory

111
Q

You can get urticaria-itching, hives, erythema rash, and angioedema in this type of anaphylactic allergic reaction

A

Skin

112
Q

You get bronchospasm, wheezing, respiratory distress, Angioedema to the larynx, and rhinitis in this type of anaphylactic allergic reaction

A

Respiratory

113
Q

What is management of rapid allergic reactions?

A

Position patient supine
BCLS
Oxygen
Monitor vital

114
Q

You can use what medication to manage rapid allergic reaction

A

Epinephrine (1/10,000 3.0cc IV or 1/1000 0.3cc IM/SC)
Benadryl (50 mg IV or IM)
Obtain medical assistance and transport to hospital

115
Q

What part of the thigh should be put in the epi-pen?

A

outer thigh because it has thinner tissue and less fat

116
Q

What is the shelf life for an epi pen?

A

16 months, but the FDA is allowing an additional 4 months

117
Q

How long should you hold an epi-pen injector?

A

3-10 seconds

118
Q

What are delayed allergic reactions?

A

Onset greater than one hour
usually non-life threatening
Antibiotics
Analgesics
Narcotics
Preservatives in anesthetics

119
Q

What are signs and symptoms of delayed allergic reactions?

A

Rash
Pruritus (itching)
Urticaria (hives)
Edema
Rarely- hypertension, dyspnea, coma

120
Q

What is management for a delayed allergic reaction?

A

Terminate procedure
Position patient based upon comfort
BCLS if indicated (usually not)
Benadryl 50 mg PO or IM q 4 h depending upon severity of symptoms
Continue benadryl for 24 hours after symptoms dissapear

121
Q

About ______% of self report allergies are NOT true allergies?

A

5-10

122
Q
A
123
Q
A

Patient Care Exam 2 (5 decks)

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