Adrenal/HIV/Allergy/Diabetes/Pregnancy/Thyroid

Question 1

Cortisol increases blood levels and use of —–, increases —-, and has —- actions = homeostasis

Answer 1

glucose

blood pressure

anti-inflammatory

Question 2

—- releases
•
corticotropin-releasing hormone

Answer 2

Hypothalamus

Question 3

—- first reason for releasing cortisol.

Answer 3

Surgical stress

Question 4

——- produces and secretes
•
adrenocorticotropic hormone

Answer 4

Pituitary

Question 5

—— stimulates adrenal cortex to
•
produce and release cortisol

Answer 5

ACTH

Question 6

Primary Adrenocortical Insufficiency

Answer 6

addison’s disease

Adrenal cortex destroyed or removed - Medical management
Manage the adrenal disease
Glucocorticoid replacement corresponds to normal output ~20mg/day
Hydrocortisone

Question 7

Secondary Adrenocortical Insufficiency

Answer 7

Pituitary disease or adrenals unresponsive to ACTH

Question 8

2ndary adrenocortical insufficiency - Medical management

Answer 8

Glucocorticoid replacement Hydrocortisone 10-20mg/day

Question 9

Tertiary Adrenocortical Insufficiency

Answer 9

Treat autoimmune and inflammatory diseases AND long- term immunosuppression for organ transplant and joint replacement
Sluggish hypothalamus
Regimens aimed at being therapeutic at the least dose to prevent adrenal suppression
•
•
•
Topical, locally injected, inhaled
•
not of concern
•
HPA axis regains responsiveness and functional 14d after DC of steroid

Question 10

Increased cortisol levels during and after —-

Answer 10

surgery

Question 11

Plasma cortisol peaks 2 to 10-fold between —— hours after surgery

Answer 11

4 and 10

Question 12

Cortisol level returns to baseline —– hours post-op

Answer 12

24-48

Question 13

Adrenal Crisis

Life-threatening emergency characterized by

Answer 13

Hypotensive collapse, abdominal pain, myalgia, fever

Question 14

Adrenal crisis - Immediate treatment in the ED

Answer 14

100mg hydrocortisone bolus

Fluids & electrolytes

Question 15

Primary adrenal insufficiency =

Answer 15

supplement

Question 16

Secondary adrenal insufficiency =

Answer 16

daily therapeutic dose

Question 17

Hypotension first sign of

Answer 17

acute adrenal crisis

Question 18

With acute adreanl crisis,

Answer 18

ems immediately, bls

Question 19

True allergy symptoms:

Answer 19

Urticaria Swelling

Skin rash Chest tightness Dyspnea, SOB Rhinorrhea Conjunctivitis

Question 20

Angioedema

Answer 20

Edema in deeper planes

Diffuse enlargement of lips, infraorbital tissues, larynx, tongue

Question 21

Anaphylaxis —- depression

Answer 21

respiratory and CV

Question 22

Anaphylaxis with Depressed/absentee vital sign—

Answer 22

0.3-0.5ml 1:1000 epinephrine IM Q5min and CPR prn

Question 23

Risk of stroke & CAD death —- higher in diabetics MI leading cause of death in —– diabetics

Answer 23

2-4x

Type 2

Question 24

ESRD ———-

—— more likely to acquire vs. those without diabetes Leading cause of death in those with ——diabetes

Answer 24

end stage renal disease

25x

Type 1

Question 25

HbA1c

Answer 25

Amount of sugar attached to hemoglobin

Question 26

HbA1c Indicates level of glycemic level over last ---- months Monitors patient’s progress ------ if controlled ----- is uncontrolled

Answer 26

2-3 2x/year 4x/year

Question 27

HbA1c Non-diabetic patients, Diabetic patients,

Answer 27

<6% <7%

Question 28

For type 1 diabetics - Long acting replace ---- level. Short acting covers ------

Answer 28

basal carbs.

Question 29

External Insulin Pumps for

Answer 29

Type 1

Question 30

Type 2 diabetics - Drug therapy

Answer 30

1 or more hypoglycemics +/- injectables

Question 31

Dental Treatment Concerns with Uncontrolled Diabetics

Answer 31

Infection aggressive management, strict glycemic control Poor wound healing avoid elective surgery Systemic risk HTN, CAD, stroke

Question 32

Type 1 diabetics -

Answer 32

disease responds a bit differently. Always be concerned about type 1 diabetics. Uncontrolled vs brittle - not just compliance. Some people just can’t get consistent glucose levels.

Question 33

Management of Acute Infection DDS: -------- MD: ------

Answer 33

treat odontogenic infection Extraction, I&D, antibiotics glycemic controlSliding scale insulin

Question 34

I&D:

Answer 34

Incisions and drainage

Question 35

Tx of insulin reaction

Answer 35

if conscious, sugar. if unconscious, EMS and glucagon injection - bls prn

Question 36

Preventing Insulin Shock

Answer 36

1. Instruct patients to follow normal insulin regimen and eat normally around appointment 2. Morning appointment 3. Confirm that they ate and took insulin/hypoglycemics 4. Instruct patient to notify you of symptoms during the office visit 5. Source of sugar in the office

Question 37

HIV Target cells:

Answer 37

dendritic cells, macrophages, CD4+ T cells

Question 38

Blood HIV viral load correlates with

Answer 38

risk of transmission of the virus; patients with early HIV infection are highly contagious

Question 39

Progressive depletion of CD4+ lymphocytes

Answer 39

pancytopenia | immune dysfunction

Question 40

CD4+ drops to

Answer 40

200

Question 41

Prophylaxis for opportunistic infections with

Answer 41

low CD4+ counts

Question 42

CD4+ count at time of HIV diagnosis Every-----months after

Answer 42

3-4

Question 43

Asymptomatic HIV Infection

Answer 43

Asymptomatic patients have OK CD4+ count Low viral load Normal platelets and WBCs No S/S (wouldn’t know of disease if they did not endorse)

Question 44

Asymptomatic HIV Infection - dental care

Answer 44

good to go

Question 45

Asymptomatic, HIV-Infected Patient with Decreasing CD4+ Count

Answer 45

May be developing immune suppression increased risk of infection (decreased WBCs) increased bleeding (decreased platelets) Invasive surgical procedures: obtain WBC & platelet counts

Question 46

Asymptomatic, HIV-infected patient with decreasing CD4+ count - ------- dentistry ok

Answer 46

Routine & complex restorative

Question 47

AIDS Patients (CD4+ <200) Significant ------- ------- dental care only With invasive procedures must prepare for : ------ antibiotic prophylaxis for patient with WBC <500uL ---------platelets must be >50,000 for treatment Check drug interactions with ----

Answer 47

immunosuppression Emergency care and preventive Infection Excessive bleeding ART

Question 48

Most dental drugs (prego) are

Answer 48

category C

Question 49

Prego - Analgesics:

Answer 49

Acetaminophen NO NSAIDs (ibuprofen or aspirin) Consult for narcotics

Question 50

Amount of drug excreted in milk ----- of maternal dose

Answer 50

~1-2%

Question 51

Breast feeding timing w/drug | Timing

Answer 51

Consume right after breast feeding Supplement with formula

Question 52

Thyroid hormone (thyroxine + triiodothyronine) influences Regulate ------ Regulated by a --------

Answer 52

metabolism or the way that the body uses energy feedback loop

Question 53

Secretion of Thyroid Hormone | Feedback mechanism mediated by

Answer 53

hypothalamic- pituitary-thyroid axis | •

Question 54

Hyperthyroidism | Excess

Answer 54

T3 and T4 in the blood

Question 55

Thyrotoxicosis

Answer 55

Graves’ disease (most common) | Autoimmune

Question 56

Hyperthyroidism - symptoms

Answer 56

Anxiety, fatigue, rapid HR, heat intolerance, weight loss, exopthalmous

Question 57

Antithyroid agents

Answer 57

Propylthiouracil, 18 months Radioactive iodine Surgery

Question 58

Hypothyroidism | Inadequate amount of

Answer 58

T3 and T4 | Slow physical/mental activity, sensitivity to cold, weight gain

Question 59

Hypothyroidism managed with

Answer 59

synthetic T4

Question 60

Well-Controlled Thyroid Disease can do

Answer 60

Any routine dental treatment

Question 61

Thyroid Physician consultation for assistance in management of acute infection or in anticipation of significant surgical stress Increased ----

Answer 61

metabolic demand

Question 62

----- is most common thyroid issue

Answer 62

Hypo