Behavious Management

Question 1

When do you see children

Answer 1

See at age 1

Question 2

How to classify cognitive development in kids

Answer 2

0-2y= sensory motor, pre-cooperative, sensation and motor skills
2-7y= preoperational stage, communication with symbols, gestures, work
Centration: focus on one aspect at one time
Egocentrism: assumes other people experience the world exactly the same
Animism: believe inanimate objects have human feelings and intention
7-11y= concrete-operational stage, operational and logical reasoning rather than intuitive thought
11y= formal operational stage

Question 3

Language development in children

Answer 3

Tougher to understand before 4
4-5: use adjective
5-6: fluent speech

Question 4

Physical development of children

Answer 4

Teach parents OHI

Children can brush teeth when they’re about 7 year old

Question 5

Classification of child temperament

Answer 5

Thomas chess birch
Easy (40%): routine, happy, adapts easily
Difficult (10%): irregular, negative, intense, slow to adapt- structured treatment, firm commands, confident dentist
Slow to warm up (15%): inactive, mild, negative mood, slow- longer time to adjust, more happy visits, calm dentist

Question 6

Classification of parenting styles

Answer 6

Baumrind, maccoby and martin
Authoritative: high control high warmth
Authoritarian: high control, Low warmth
Permissive: high warmth Low control
Uninvolved: Low warmth Low control

Question 7

how long does attachment last

Answer 7

form attachment to primary caregiver: 8 month to 5 years

Question 8

verbal domains of behavioural management

Answer 8

tell-show-do- describe whats going to happen, demonstrate, carry out
modelling- older siblings, flip charts, videos
distraction- keep talking about something, television

Question 9

non-verbal

Answer 9

body language- smile, reassuring touch

desensitization- repeated exposure, increase systematically, oral desensitization eg. electric tooth brush,

Question 10

rewards

Answer 10

*positive reinforcement- increasing desirable behaviour by providing wanted stimulus, physical rewards and esp verbal rewards, be specific DO NOT bribe cos bribery has to increase in size over time
negative reinforcement- increasing desirable behaviour by removing unwanted stimulus, punishment, scolding, giving contingency escape

Question 11

aversive

Answer 11

parental exclusion- (for defiant, not for separation anxiety), require parent consent and cooperation
voice control- change in tone and volume, regain control of situation, need warn parents you need to raise your voice
hand over mouth- not really done le, not used as punishment, to establish communication in a child who has lost control but parents dont like

Question 12

physical

Answer 12

active restrain- by parent or assistant, for precooperative child, knee to knee, emergency (extraction on precooperative child), a bit danger
passive restrain- device and wrap, good for autistic children, under sedation, mouth prop, (require consent)

Question 13

who made up behaviour assessment

Answer 13

Frankl

Question 14

whats the frankl scores

Answer 14

++/4: definitely positive, happy anything
+/3: cooperative, but somethings dont like, need to make a note to say what they dont like
-/2: crying but some form of ytreatment
–/1: extreme cannot

Question 15

what to do first dental visit

Answer 15

history, have plan, dont be ambitious

Question 16

pharmacological:

Answer 16

anxiolysis: minimal sedation
conscious sedation: moderate
deep sedation
general anesthesia

Question 17

anxiolysis: responsiveness, airway, spon ventilation, cardio

Answer 17

everything ok

Question 18

moderate sedation/analgesia/conscious sedation: responsiveness, airway, spon ventilation, cardio

Answer 18

purposeful response

no airway intervention

Question 19

deep sedation/analgesia: responsiveness, airway, spon ventilation, cardio

Answer 19

purposeful response following repeated or painful stimulation
may required airway intervention, may have inadequate ventilation
usually maintain CV

Question 20

GA: responsiveness, airway, spon ventilation, cardio

Answer 20

no response ever, airway intervention, inadequate ventilation, may impair CV

Question 21

drugs

Answer 21

midazolam

Question 22

sedation and dose

Answer 22

sedation not defined by specific medication or dose but by patient response

Question 23

Whats American Society of Anesthesia levels

Answer 23

low risk
I: normal healthy patient
II: patient with mild systemic disease

high risk
abnormal airway, asthma, apnea, obesity, respiratory compromise, aspiration risk, poorly controlled seizures, liver disease
III: severe systemic
IV: severe systemic constant threat to life
V: not expected to survive wo operation
VI: brain dead and organ removal

Question 24

how to classify tonsil size

Answer 24

Brodsky: 
reduces transvere section of airway
0=surgically removed
1= hidden behind tonsil pillar
2= extending to pillar
3= beyond pillar
4= midline

Question 25

classify soft palate

Answer 25

mallampati: vertical dimension, position of tongue and soft palate I/II/III/IV

Question 26

NPO status | how long to fast

Answer 26

solid and non clear liquids 6-8hour breast milk- 4 hour clear liquid- 2 hour

Question 27

nitrous oxide

Answer 27

sweet smelling, non-irritating colourless gas flow rate of 5-6L/min non less than 30% oxygen regarding at all times advantage: tolerance for longer appt, depress gag reflex, rapid onset and recovery and titratable disadvantage: lack of potency, patient breathe through nose, nausea and vomitting (tell patient to not drink/eat, dont titrate like crazy), can suppress airway reflex at 50%, *diffusion hypoxia- more soluble in blood than nitrogen, blood saturated of nitrous oxide, when you stop, nitrous fills up lungs, hypoxia, need to stop nitrous then give 100% O2

Question 28

nitrous oxide contraindications

Answer 28

severe COPD upper respiratory infection 1st trimester pregancy? bleomycin sulfate treatment (cancer drug affects folate for respiratory replicating cells) methylenetetrahydrofolate reductase deficiency (risk of developing abnormal plasma homocystein concentrations) drug related dependancies, severe otitis media, severe asthma

Question 29

hydroxyzine

Answer 29

``` gen 1 antihistamine vistaril: 25mg/5cc atarax: 10mg/5cc dose: 2-4mg/kg, max 75mg/dose onset in 30min, duration 3-6 hours, potentiates opioids, babiturates, antiemetic (anti vomiting), sedative, anti-cholinergic ```

Question 30

midazolam

Answer 30

benzodiazapine dose: oral 0.5mg/kg, nasal: 0.2mg/kg onset 20min, peak plasma level 30min, half life 1 hour 3-4x more potent than diazepam, anterograde amnesia

Question 31

diazepam

Answer 31

0.2-0.5mg/kg onsent 45min peak plasma 2hr duration 6-8 hours (no driving risk of resedation) half life 20-70hours of active metabolites give adults to take 1 hour before coming

Question 32

ketamine

Answer 32

NMDA receptor antagonist anesthesia, only in children <8 older then more vivid very hard oral 6-8mg/kg, IV 0.5-2mg/kg onset: 20-30min

Question 33

merperidine

Answer 33

``` weak opioid dose: oral 1-2mg/kg CNS/CV/resp depression onset 30min peak 1-2 hours, pulmonary complications, head trauma, seizures, hepatic renal disease ```

Question 34

max dose of LAs

Answer 34

lidocaine:

Question 35

risk of lidocaine toxicity

Answer 35

1 in 400000 biphasic effect on CNS and CVS, excitation followed by depression, CNS more sensitive than CVS, lowers seisure threshold

Question 36

malignant hypothermia

Answer 36

1:5000, 1:65000 genetic predisposition to hypermetabolic reaction in muscle after introduction of certain volatile gaseous inhalation anesthetics halothane, enflurane, isoflurane, sevoflurane tachycardia, tachypnea, skeletal muscle rigidity, sweating, dilated pupils treatment: supportive, sodium dantrolene

Question 37

whats the difference for pediatric respiration

Answer 37

higher respiratory rates 50-20 times/minutes smaller tidal volume more airway resistance, larger tongue and epiglottis significant lymphoid tissue, larger head to body size, mandible less developed most common adverse events: respiratory arrest/respiratory depression

Question 38

whats naloxone

Answer 38

reversal for opiods, IV or sublingual 0.1mg/kg, repeat after 2-3 min to max of 2mg half life 1-1.5 hours

Question 39

what is flumazenil

Answer 39

reverse benzodiazepine IV 0.02mg/kg over 15 sec, repeat every 5 min to max dose of 1mg total half life 20-30min

Question 40

whats a precordial stethoscope

Answer 40

put at neck and monitors breathing

Question 41

whats a capnography

Answer 41

how much CO2 you breathing out, but harder to use cos nasal hood, but more real time, for GA

Question 42

pulse ox

Answer 42

sigmoidal oxygen dissociation curve, so interruption to respiration is discovered later

Question 43

when can you discharge the patient

Answer 43

vital signs and airway stable oriented walk talk and head support hydrated