EXAM I Pre-Operative Health Status Evaluation

Question 1

what are the 7 pieces of information that is collected during history and physical exams?

Answer 1

1. biographic data
2. chief complaint and its history
3. medical history
4. social and family medical histories
5. review of systems
6. physical examination
7. laboratory and imaging results

Question 2

___ is a term used to describe why the patient thinks he/she is here to see you, is recorded verbatim, and establishes patient’s priorities

Answer 2

chief complaint

Question 3

what type of information do you collect for history of present illness?

Answer 3

• patient is asked to describe the history of their CC
  
  • first appearance, changes since first appearance, influenced by other factors
• changes in symptoms
• descriptions of pain
  
  • date of onset, intensity, duration, location, radiation, factors that worsen and mitigate pain
• constitutional symptoms
  
  • fever, chills, lethargy, anorexia, malaise, weakness

Question 4

___ describes the information collected on the patients medical problems currently being treated, past hospitalizations, serious injuries and illnesses, medications, allergies, and use of tobacco, alcohol, or recreational drugs

Answer 4

past medical history

Question 5

what are some important health conditions to inquire about verbally or on a health questionnaire?

Answer 5

• allergies to antibiotics or local anesthetics
• bleeding disorders
• diabetes (affects healing)
• lung disease
• myocardial infarction (delay treatment for 3 months)

Question 6

___ describes gathering information not included by the patient in the past medical history (medication list can help guide this discussion), and to know the current status or symptoms of patients with a known medical diagnosis

Answer 6

review of systems

Question 7

what is the “systems” component of review of systems?

Answer 7

general, cardiovascular, pulmonary, GI, genito-urinary, neurologic, endocrine, hepatic, renal, hematologic, musculoskeletal

Question 8

what are some top questions to ask in the review of systems?

Answer 8

• do you have a history of high blood pressure, heart murmur, or rheumatic fever?
• chest pain or shortness of breath? can you walk up a flight of stairs or 1 city block without becoming short of breath?
• any history of difficulty breathing/asthma?
• stomach ulcers, reflux symptoms?
• when you cut yourself, how long does it take to stop bleeding?
• are you pregnant or taking oral contraceptives
• history of seizure, stroke, neurologic/psychological disorder?
• have you had any problems with dental treatment in the past?

Question 9

what type of information is gathered in the physical examination?

Answer 9

• vital signs
• head and neck exam
• airway exam
• systemic evaluation as necessary (pulmonary, cardiovascular, etc.)
• inspection, palpation, percussion, auscultation

Question 10

when doing a physical exam, what should you be inspecting on the head and face?

Answer 10

general shape, symmetry, hair distribution

Question 11

when doing a physical exam, what should you be inspecting on the ear?

Answer 11

normal reaction to sounds (otoscopic examination if indicated)

Question 12

when doing a physical exam, what should you be inspecting on the eyes?

Answer 12

symmetry, size, reactivity of pupil, color of sclera and conjunctiva, movement, test of vision

Question 13

when doing a physical exam, what should you be inspecting on the nose?

Answer 13

septum, mucosa, patency

Question 14

when doing a physical exam, what should you be inspecting on the neck?

Answer 14

size of thyroid gland, jugular venous distention

Question 15

when doing a physical exam, what should you be inspecting in the mouth?

Answer 15

teeth, mucosa, pharynx, lips, tonsils

Question 16

when doing a physical exam, what should you be palpating for in the temporomandibular joint?

Answer 16

crepitus, tenderness

Question 17

when doing a physical exam, what should you be palpating for in the paranasal region?

Answer 17

pain over sinuses

Question 18

when doing a physical exam, what should you be palpating in the mouth?

Answer 18

salivary glands, floor of mouth, lips, muscles of mastication

Question 19

when doing a physical exam, what should you be palpating on the neck?

Answer 19

thyroid gland size, lymph nodes

Question 20

what percussion tests should you do when performing a physical examination?

Answer 20

• paranasal - resonance over sinuses (difficult to assess)
• mouth - teeth

Question 21

when doing a physical exam, what should you auscultate?

Answer 21

• temporomandibular joing - clicks, crepitus
• neck - carotid bruits (puts patient at high risk for stroke)

Question 22

which ASA status is a normal, healthy patient?

Answer 22

ASA I

Question 23

which ASA status is a patient with mild systemic disease or significant health risk factor?

Answer 23

ASA II

Question 24

which ASA status is a patient with severe systemic disease that is not incapacitating?

Answer 24

ASA III

Question 25

which ASA status is a patient with severe systemic disease that is a constant threat to life?

Answer 25

ASA IV

Question 26

which ASA status is a moribund patient who is not expected to survive without the operation?

Answer 26

ASA V

Question 27

which ASA status is a declared brain-dead patient whose organs are being removed for donor purposes?

Answer 27

ASA VI

Question 28

what are the two absolute best strategies for managing medical emergencies?

Answer 28

preparation and prevention

Question 29

when presenting your patient to an attending on the clinic floor, what order do you present the information?

Answer 29

CC, HPI, meds, allergies, review of systemc, plan

Question 30

what steps should you take at every patients appointment, from beginning to end of the appointment? (this is the “stepwise approach”)

Answer 30

1. review medical history and radiograph (have panorex pulled up in the room)
2. patient presentation to attending
3. render treatment
4. provide post-operative instructions
5. paperwork

Question 31

what radiographs are required in order to perform an extraction on a patient?

Answer 31

PAs or panorex

BWX are insufficient, as they do not provide apical information

Question 32

a 24 year old patient presents to your office for evaluation of a painful tooth no. 17. during your history and physical examination, you discover the patient has a past medical history significant for hypertension, asthma, and smokes 1.5 packs of cigarettes per day. what ASA classification is this patient?

Answer 32

ASA II

Question 33

all of the following are included in the standard format for recording results of a history and physical except what?

past medical history

history of present illness

laboratory and imaging results

history of missed appointments

Answer 33

history of missed appointments