6. Endocrine Ds

Question 1

adrenal glands secrete what

Answer 1

cortisol, epi, NE, aldosterone, and adrenal androgens

(sex hormones and catecholamines)

Question 2

adrenal glomerulosa

Answer 2

aldosterone

Question 3

adrenal fasciculata

Answer 3

cortisol (glucocorticoid)

Question 4

adrenal reticularis

Answer 4

androgens

Question 5

NE and Epi actions

Answer 5

fight or flight - stress response

increase Bp, peripheral resistance, cardiac output

Question 6

hyperadrenalism is what

Answer 6

increase of aldosterone, cortisol, androgen, estrogen isolated or in combo

Question 7

hyperaldosteronism

Answer 7

HTN, hypokalemia, edema

Question 8

glucocorticoid xs

Answer 8

is high levels of cortisol
and the MOST COMMON

(Cushing ds and syndrome)

Question 9

CUSHINGOID memonic

Answer 9

signs and symptoms that as associated with cushing ds

C-cataracts
U- ulcers
S- striae and skin thinning
H- HTN and hirsutism
I- Immunosuppresion and infections
N- Necrosis of femoral heads
G- Glucose elevation
O- Osteoporosis and obesity
I- Impaired wound healing
D- Depression and mood changes

Question 10

cushingoid moon face is a sign of

Answer 10

cushing ds or syndrome

not necessarily specific for cushings though.

Question 11

why is cortisol used

Answer 11

it is used to decrease inflammation

Question 12

bexamethasone

betamethason are what type of drugs

Answer 12

long-acting glucocoritcoids

used for oral ulcerations ( dexamethesome)

Question 13

prednisolone

triamcinolone

methylprednisolone are what type of drugs

Answer 13

intermediate acting glucocorticoids

used topciallly (methyprednisolone)

Question 14

primary adrenal insufficiency is what

Answer 14

addisons ds
increase ACTH decrease Cortisol.

Question 15

what is this

Answer 15

cutaneous findings in addisons ( so primary adrenal insufficiency)

hyperpigmentation of skin and mucous membrance but they’re iregullarly shaped. It’s a variation of normal but could be addisons too.

hyperpigmentation and andrenal crisis do not usually ocur or are less likelly to occur in the secondary and teritary insufficiencies.

Question 16

secondary adrenal insufficiency

Answer 16

decrease of cortisol and decrease of ACTH, aldosterone is unchaged.

Question 17

tertirary adrenal insufficiency

Answer 17

most commonly a result of chronic exogenous steroid use

Question 18

impaired would healing can be a consequence of both ___ and ____

Answer 18

hyperadrenalsim and adrenal insufficiency

Question 19

signs of an adrenal crisis

Answer 19

• hypotension - monitor BP (vasopressors, pt position, fluid replacement)
• abdominal pain
• myalgia
• fever
• supplement with 100mg of hydrocoritsone and send to the ER

Question 20

3 hormones of the thyroid procedures

Answer 20

• T3
• T4
• Calcitonin

Question 21

what is a thyroid storm

Answer 21

during a hyperthyroidism event

the pts will have fever, confusion, dehydration and eventually death if left untreated. This is thyroid storm

Question 22

in hyperthyroidism you have __ free T4 and ___ TSH

Answer 22

increase free T4 and decrease TSH

Question 23

hypothyroidism is __ free T4, ___ TSH or ___ TSH

Answer 23

• decrease of free T4
• increase of TSH

or increase of TSH

Question 24

hyper- thyroid dental implications

Answer 24

increase in peridontal bone loss

increase susceptibility to caries

Question 25

hypo-thyroid dental implications

Answer 25

* delayed tooth eruption and altered bone formation * macroglossia * dysgeusia and burning mouth * salivary gland enlargment * oral lichen planus

Question 26

pts with both hyper and hypo thyroidism are more susptible to what

Answer 26

infections so tx aggresively *just do not over tx.*

Question 27

if a pt is having a thyrotoxic crisis/storm for hyperthyroidism what should you administer

Answer 27

cpr and vital signs ice or wet packs administer hydrocortisone 100 to 300 mg IV glucose Administer propylthiouracil send to ED

Question 28

if a pt is having a myxedema coma for hypothyroidism what should you administer?

Answer 28

CPR and vital signs conserve body heat - blanket administer hydrocortisone 100 to 300 mg IV saline and glucose Administer thyroxine Send to ED *myXedema with thyroXine and... hydrocortisone(the same for hyperthry)*

Question 29

should you give care to pts with uncontrolled or poorly controlled hyper or hypo thyroidism

Answer 29

no... only if it is under control. Too many risk factors of a thyrotoxic storm and/or myxedema coma

Question 30

drug interactions/side effects seen in hyperthyroidism

Answer 30

- caution w aspirin, NSAIDS (can incr. T4) - contraindicated to use ciprofloxacin because it decreases the absorption of thyroid hormone - avoid LA with epi and gingival retraction cord w epi

Question 31

drug inteactions/side effects in hypothyroidism

Answer 31

- avoid CNS depressants (narcotics, babituates, sedatives) - Cytochrome p450 inducers (phenytoin, carbamazepine, and rifampin) should be avoided bc it increases metabolism of levothyroxine.

Question 32

pancrease hormones

Answer 32

insulin glucagon somatastatin

Question 33

diabetes is due to

Answer 33

- lack of beta cell pancreatic production of insulin - results in undernourished tissues which have systemic effects.

Question 34

type 1 is due to

Answer 34

the destruction of pancreatic beta cells --\> insulin deficiency

Question 35

type 2 diabetes is due to

Answer 35

pancrease produces insulin but it is in low titers or it doesnt work properly majority of diabetics.

Question 36

order of stability of the tests for DM

Answer 36

hemoglobin A1C --\> fasting plasma glucose --\> oral glucose tolernace test

Question 37

DM oral implications

Answer 37

* xerostomia/dry mouth * oral burning (diff from burning mouth, secondary) * infections (bacterial, viral, fungal) * poor wound healing * increased caries * increased severity risk of periodontal ds

Question 38

at what HbA1c and glucose readings do we defer tx

Answer 38

HbA1c 8% or higher glucose is less than 70 or more than 200

Question 39

what are the emergency dental tx during pregnancy

Answer 39

- provided as needed - pain control and elimination of infections should be preformed, or else it stresses the mother and endargers the fetus - untx dental infections may pose a risk to the devloping fetus --\> fever and sepsis may precipitate a spontaneous abortion -

Question 40

supine hypotension syndrome

Answer 40

pregnant pt cannot lie on their back or else it will compress the inf vena cava and affect venous return too.

Question 41

which sedation should be used on a preg pts

Answer 41

- no pharmacologic sedation is preferred if ABSOLUTLEY necessary then nitrous oxide for less than 30 mins and with at least 50% oxygen.

Question 42

Which two antibiotics are contraindicated in preg pts

Answer 42

tetracycline and doxycycline CONTRINDICATED teratogenic

Question 43

what is the max permissible dose for occupational

Answer 43

1 mSv/yr avg denetal is 0.2 mSv/yr

Question 44

oral findings in a pregnant pt

Answer 44

* mild inflammation to severe overgrowth due to hormonal increase * tooth mobility may be present * pyogenic granuloma pregnancy tumor it is reacting to something irritating the tissue overgrowth.