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Flashcards in Exam 2 Medical Emergencies Deck (191)
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1

What is the most common type of diabetes?

type 2

2

What causes type 2 diabetes?

obesity, high fat/ low fiber diets, sedentary lifestyle, heredity, and increased life span (old age).

3

What is a metabolic disorder characterized by hyperglycemia?

diabetes mellitus

4

What produces insulin in the pancreas?

beta cells

5

What diseases is characterized by the body being unable to produce sufficient insulin or the body is not able to use the insulin that is produced?

Type 2 diabetes mellitus

6

What causes an increase in type 2 diabetes?

old age, sedentary lifestyle, poor diet and exercise and obesity

7

Which disease is characterized by an absolute lack of insulin?

type 1 diabetes

8

In which type of diabetes are pancreatic beta cells within Islets of Langerhans destroyed due to immune dysfunction?

type 1 diabetes

9

Which type of diabetes requires supplemental insulin for survival?

type 1 diabetes

10

Glucose intolerance with initial onset during pregnancy is known as

gestational diabetes

11

What is the leading cause of blindness in ages 20-74?

diabetic retinopathy

12

What is diabetic retinopathy?

a complication of diabetes that affects the eyes

13

What is diabetic neuropathy?

A type of nerve damage that occurs with diabetes

14

What is diabetic nephropathy?

kidney damage that results from diabetes

15

What vascular changes are a result of diabetes?

gangrene, loss of limbs, fingers, toes, etc. and increased risk of CVA and MI

16

Name the types of diabetes tests

fasting plasma glucose test
oral glucose tolerance test
A1c
Self testing

17

How long do you have to fast when doing the fasting plasma glucose test and what are the numbered results?

12-14 hours; 100-125 pre diabetes, >125 diabetes

18

How does the oral glucose tolerance test work?

12-14 hour fast and then drink a glucose rich beverage.... two hours later have the reading 140-199 pre diabetes; >200 diabetes

19

How many diabetics are affected by neuropathy?

60-70%

20

What are the 3 types of diabetes?

Type 1 (juvenile onset, insulin dependent)
Type 2 (adult onset, non insulin dependent)
Gestational

21

What is the normal reading on a self testing glucometer?

70-180

22

What does a reading of less than 70 on a self testing glucometer indicate?

hypoglycemia

23

What does an A1c reveal?

average blood glucose over the past 3 months

24

What should the glucose reading be 2 hours after eating a meal?

less than 180

25

What should the glucose reading be after 8 hours of fasting?

130

26

What is the normal reading for A1c?

5.7

27

What is the A1c reading for prediabetes?

5.7-6.4

28

What A1c reading indicates diabetes?

6.5 (2 tests to check)

29

The FPG (fasting plasma glucose test) requires no food or drink 8 hours before the test. What are the readings for normal, prediabetes, and diabetes?

Normal- less than 100
Pre- 100-125
Diabetes- 126+

30

The OGTT (oral glucose tolerance test) which requires no food or drink for 12 hours and then a glucose drink is given has what readings for normal, prediabetes and diabetes?

Normal-less than 140
Pre-140-199
Diabetes-200+

31

True or False: Insulin needs to be refrigerated to lengthen effectiveness

True

32

For which type of diabetes can exercise and diet control be an option instead of medicine?

Type 2

33

What is Diabetic Ketoacidosis?

Sugar too high, insufficient levels in blood

34

What is hypoglycemia?

Sugar too low

35

Who is at risk for Diabetic Ketoacidosis?

newly diagnosed type 1 diabetics, alcohol and drug users, poor diet

36

Fruity breath, altered mental state and increased thirst are all indicative of what?

Diabetic Ketoacidosis

37

How is DKA (diabetic ketoacidosis) treated?

check glucose level and lower w/ insulin, contact ems

38

What is another name for severe hypoglycemia?

insulin shock

39

How many diabetics are affected by severe hypoglycemia?

30%

40

What are things that can lead to severe hypoglycemia?

missed meal, alcohol, increased exercise without adjusting insulin dosage

41

What is the first step in treating severe hypoglycemia?

Give sugar

42

What is the 15-15 rule and when should it be applied?

Give 15 grams of sugar, check in 15 minutes. If it's still below 70, repeat.

43

If a patient suffering severe hypoglycemia becomes unconscious, what is the first step taken?

contact EMS

44

The risk of hypoglycemia can be reduced 58% if body fat is reduced by

7%

45

When should a diabetic patient be scheduled?

early to mid morning, short and frequent appointments

46

What should diabetic patients remember to do before appointments?

eat

47

Where is the butterfly shaped thyroid gland located?

anterior to the trachea

48

The thyroid gland produces hormones that determine

metabolic rate and growth rate

49

Hypothyroidism is when not enough____is produced.

thyroid hormone

50

What is another name for hypothyroidism?

Myxedema

51

True or False: Myxedema causes facial swelling

True

52

What is another word for Thyrotoxicosis?

Hyperthyroidism

53

What happens when a patient has thyrotoxicosis?

Too much thyroid hormone is produced

54

True or False: When a patient has thyrotoxicosis, the eyes are very small.

False, the eyes are big and have a fixed staring expression

55

What swells on a patient with thyrotoxicosis?

neck

56

How is hypothyroidism treated?

synthetic thyroid hormone, must be taken for life

57

What is Levothyroxine?

Synthetic thyroid hormone

58

How is hyperthyrodism treated?

anti thyroid medications, ablation therapy, or surgery for removal of thyroid.

59

What is a myxedema coma?

Severe hypothyroidism leading to decreased mental status, hypothermia and slowing of function in multiple organs

60

What is a thyroid storm?

thyroid too high and heart rate, blood pressure and body temperature soar dangerously high-

61

What occurs when the body is unable to compensate for thyroid hormone deficiency due to some precipiating event and what time of year does this normally occur?

Myxedema Coma, winter

62

Hypothermia patients usually have a temperature reading of less than

95 degrees

63

For Myxedema and thyroid storm, what is the first step to take?

Contact EMS

64

What is Epistaxis?

nosebleed

65

85% of nose bleeds are: anterior or posterior

anterior

66

For whom are posterior bleeds normally found in the case of Epistaxis?

Geriatric (occurs at Woodruffs Plexus)

67

People with what condition are more likely (3 times more) to have Epistaxis?

hypertension

68

What color is posterior Epistaxis?

dark red

69

What color is anterior Epistaxis?

bright red

70

When treating Epistaxis, the patient should be seated upright with the head tilted____.

forward

71

All of the following statements are true for the treatment of Epistaxis except one. Which one is the exception?
Pinch the lower part of the nose for 10-20 minutes
Have patient breath through mouth
Apply an ice pack over the bridge of the nose
Have patient blow the nose to get rid of the blood

Have patient blow the nose-this should NEVER occur

72

Hemophilia is excessive_____

bleeding

73

How many types of hemophilia are there?

3 types: A, B, and C

74

True or False: Patients with hemophilia clott excessively

False

75

What do anticoagulants reduce?

clotting

76

What is a hematoma?

Collection of blood trapped beneath the skin

77

What is the usual casue of a hematoma?

trauma

78

Individuals are 2 to 4 times more likely to have____and 5 times more likely to have_____

heart disease, stroke

79

A normal blood glucose reading is between ___and ___mg/dL

50 and 150

80

A glucose reading below___indicates the patient is hypoglycemic

50

81

A glucose reading above___indicates that a patient is hyperglycemic

150

82

The HbA1c test reveals a patients average blood sugar level over the past_______

2-3 months

83

The drugs Humalog or Novolog are types of___

insulin

84

What type diabetes does Humalog and Novolog treat?

Type 1

85

Oral agents such as metformin, tolbutamide and glyburide (glucophage, orinase, glyburide, micronase) are prescribed to treat____

Type 2 diabetes

86

If a patient has an insulin pump, do they still need to measure glucose levels?

yes

87

What type of insulin medication is more rapidly absorbed than the injectible type?

insulin via inhalation device

88

What is happening in the body when it begins to exhale excess carbon dioxide, which results in tachypnea accompanied by an increased depth in respiration known as Kussmaul respirations or air hunger?

Diabetic ketoacidosis

89

What is a common complication in children with diabetic ketoacidosis?

cerebral edema (fluid builds around the brain)

90

True or False: The first step in treating a pt. with DKA is to determine an accurate blood glucose level.

True

91

In what diabetic emergency are pt.'s hyperglycemic and dehydrated?

hyperosmolar hyperglycemic state

92

Graves disease results in an enlarged___

thyroid gland

93

Where there are multiple nodules on an enlarged thyroid gland, what is the condition called?

nodular goiter

94

What two illnesses can thyroid medications cause?

aranulocytosis and hepatitis

95

Why is aspririn not recommended in patients experiencing a thyroid storm?

Because it can increase serum levels of T3 and T4.

96

Warfarin, aspirin, heparin, clopidogrel and prasugrel are all types of_____

anticoagulants

97

What should patients be advised to do after extractions?

No exercise for 12-24 hours
lie down with head elevated for several hours
Place gauze over the tooth socket and apply pressure for at least two hours.

98

What is the most effective way to control bleeding?

Apply pressure

99

Wrapping a tea bag with guaze and placing it on the extracted socket with pressure is recommended because it contains____

tannic acid

100

It is normal for blood to ooze out of the extraction site for ____hours.

12

101

What is the most common inherited bleeding disorder?

Von Williebrands disease (VWD)

102

What is the most common dental office emergency?

syncope

103

How can medical emergencies be prevented in the dental office?

Taking a complete and accurate medical history

104

What type of patient falls under ASA PS I?

Normal healthy patient

105

What type of patient falls under ASA PS II?

Mild systemic disease such as:
controlled type 2 diabetes
controlled epilepsy
controlled stage 1 hypertension
allergies
fearful dental patient
pregnancy

106

What type of patient falls under ASA PS III?

Severe systemic disease that limits activity but is not incapacitating such as:
stable angina
myocardial infarction longer than 6 months ago
controlled type 1 diabetes
renal failure
controlled heart failure
poorly controlled hypertension with BP >160/100 (stage 2)
morbid obesity

107

What type of patient falls under ASA PS IV?

Incapacitating systemic disease that is a constant threat to life such as:
MI or CVA within the past 6 months
unstable angina
heart failure
uncontrolled diabetes
uncontrolled epilepsy
hypertension with blood pressure >180/110
uncontrolled thyroid conditions

108

What patient falls under ASA PS V?

Moribound patient not expected to survive 24 hours with or without operation:
multiorgan failure
poorly controlled coagulopathy
Sepsis with hemodynamic istability

109

What patient falls under ASA PS VI

A declared brain dead patient who's organs are being harvested for donation

110

What is a normal pulse rate?

60-100

111

What is the normal respiration rate?

12-20

112

What is the normal blood pressure?

120/80

113

What is the normal temperature?

98.6

114

What is considered stage 1 hypertension?

130-139/80-89

115

What is considered stage 2 hypertension?

140+/90+

116

What blood pressure is considered critical?

Any systolic over 180 and diastolic over 120

117

What treatment is recommended for a severe allergic reaction?

Epinepherine

118

What size oxygen tank is recommended for use in the dental office?

Size E

119

What things should oxygen NOT be administered for?

hyperventilation, ischemic heart disease, or severe hypertension

120

What is nitroglycerin indicated for?

acute angina, myocardial infarction, heart failure

121

What does the reducing valve do an oxygen tank?

allows for the safe release of oxygen

122

What does the flow meter do on an oxygen tank?

allows the operator to determine how much oxygen the patient is receiving

123

What type of patient would a nasal cannula be recommended for and what should the setting be?

A conscious patient suffering from MI or CVA. Set between 1 and 6/L per minute

124

What type of patient should the non rebreathing face mask used on?

asthma or angina pectoris; can deliver 6-12 L per minute

125

When is the bag mask device used and what should the regulator be set at?

when the patient is in respiratiory arrest and requires complete oxygen delivery. Regulator should be set at 8-12 L/minute

126

What is noncardiac syncope?

involves situations that do not affect the heart such as seizures, orthostatic hypotension, hyperventilation and metabolic diseases

127

What is orthostatic hypotension?

At least a 20mmHG drop in BP after assuming an upright position after prolong suppine position

128

Which type of syncope is the most common form?

neurocardiac syncope-- commonly associated with pain, fear, exhaustion or illness

129

What causes cardiac syncope?

inadequate cardaic output as a result of an underlying heart disease

130

What is tachyarrhythmia?

rapid, irrelgular heart beat

131

What is bradyarrhythmia?

slow irregular heart beat

132

How is syncope treated?

If possible, pt. should be in suppine position, open the airway and assess breathing, loosen tight clothing, deliver oxygen at 4-6L/minute

133

What is the condition produced when the cardiovascular-pulmonary system fails to deliver enough oxygenated blood to body tissues to support the metabolic needs of those tissues and leads to abnormal cellular and tissue function?

shock

134

How many types of shock are there? Describe each

4 types of shock:
hypovolemic shock-MOST COMMON caused by inadequate venous return to the heart or dehydration
cardiogenic shock-destruction in tissue perforation caused by a decrease in cardiac output
distribtive- also called vasogenic shock. caused by loss of sypathetic nerve activity from the brains vasomotor center. 3 types: anaphylactic, septic, and neurogenic
obstructive-indirect heart pump failure, leading to decreased cardiac function and reduced circulation

135

What part of the eye covers the iris?

The cornea

136

What is the white part of the eye called?

sclera

137

What is the thin layer of the eye that covers the sclera and inside of eyelids?

conjunctiva

138

What types of foreign body are inorganic?

metallic and nonmetallic

139

What types of foreign body are organic?

dirt, wood, or vegetation

140

What types of foreign body are metallic?

steel, iron, lead, aluminum

141

What types of foreign body are nonmetallic?

plastic, stone, glass and other minerals

142

Which type of foreign body creates a higher chance of infections if it enters the eye?

organic

143

When a high velocity object enters the globe or orbit of the eye, what is likely?

loss of vision

144

What should the patient be instructed NOT TO DO when a foreign object enters the eye?

DO NOT RUB

145

Is loss of vision likely when a low velocity object is on the cornea?

no

146

What should be done if a foreign body becomes embedded in the eye?

do not attempt to remove, cover both eyes to limit eye movement, seek immediate care for a specialist to remove

147

What is a perioretriever?

magnetized instrument used to retrieve broken instrument tips

148

What are amphetamines?

central nervous system stimulants
dexadrine, ritalin, adderalll, meth,

149

What are the side effects of adderall?

excessive excitability, restlessness, dizziness, headache and blurred vision/ improves focus in pt.'s with ADHD

150

What are the side effects of ritalin?

rapid heartbeat, psychosis, heart failure

151

True or False: Amphetamines activate the sympathetic nervous system and result in increased heart rate, pupil dialation, bronchodilation, increased blood flow to the brain and skeletal muscles.

True

152

What type of drug users have bruxism and tooth wear due to an overall increase in energy and neuromuscaular function?

methamphetamine users

153

What type of drug users have rampant caries developing from dehydration and xerstomia and also have an increased intake of carbohydrates and high-calorie carbonated beverages?

methamphetamine users

154

What type of anesthetic should methamphetamine users NOT receive?

anesthetic agent with a vasoconstrictor

155

What will happen if a methamphetimine user recieves anesthetic with a vasoconstrictor?

myocardial ischemia and cardiac dysrhythmias

156

What are some signs and symptoms of amphetamine toxicity?

euphoria
restlessness
anxiety
agitation
confusion
seizures, possible coma or MI

157

Is it safe to give a pt. with amphetamine toxicity an emetic agent to induce vomiting? Why or why not?

No because vomiting can induce seizures

158

What are pt.'s with amphetamine toxicity given charcoal for in the hospital?

to prevent systemic absorption of the drugs

159

What was cocaine used as a local anesthetic for?

mucous membranes

160

What are the ways cocaine can be taken as a street drug?

snorted, smoked, IV or oral

161

Does cocaine have a slow onset?

No it is rapid and powerful

162

How long does it take cocaine to reach it's peak affect? How long does it last?

10-30 minutes; 1 hour (intranasal effects in 3-5 minutes after snorting)

163

What does cocaine do to the mind and body of it's users?

produces a feeling of euphoria and well being, increases cardiac bp and body temperature,

164

Palatal necrosis and perforation is common with usage of what drug?

cocaine

165

Which drug decreases the sense of smell?

cocaine

166

What are some complications of using cocaine?

Chronic sinusitis, decreased sense of smell, vasoconstriction can lead to necrosis sand ischemia of nasal septum and perforation, bruxism, increased caries due to carb intake, gingival lesions if repeatedly applied to tissues

167

Name the CNS depressants

opiods (poppies)-heroine, oxycodone, fentanyl, tramadol
barbiturates- phenobarb, sleep
benzodiaepines- diazepam (valium), versed, xanax, klonapin

168

Why are heroin users sometimes given opiods?

to counteract heroin

169

True or False, Opiate and Opioids inhibit gastrointestinal motility which lead to constipation

True

170

What drugs are uppers?

Uppers include amphetamines, methamphetamine, cocaine and khat. Pharmaceutical examples include Adderall, Ritalin and Concerta.

171

What drugs are downers?

Downers include benzodiazepines, barbiturates, GHB and flunitrazepam.

172

What drug relieves anxiety, causes CNS depression and acts as a sedative?

Barbituates

173

What RX replaced barbituates?

benzodiazepines

174

What are benzodiazepines used in the place of barbituates for?

reduction of anxiety, anticonvulsant properties, and muscle relaxant properties (versed, zanax, klonopin, ataivan, halciaon, valuim, etc.) Produces sedation, hypnosis and antianxiety

175

What are the signs and symptoms of benzodiazepine toxicity?

lethargy, slurred speech, mental confusion, coma and respiratiory arrest, usually in combination with other CNS depressants

176

What are the mild signs of barbituate toxicity? What are the severe signs of barbituate toxicity?

Mild signs: lethargy, slurred speech and rapid eyeball movement
Severe signs: hypothermia, hypotension, pulmonary edema, coma, and respiratory arrest

177

Why would Flumazenil be administered in the hospital to a patient experiencing Benzodiazepine toxicity?

act as an antidote as it counteracts the sedative effect

178

What are the 2 Options for treatment of a superficial foreiogn in the eye?

Option 1: Instruct the pt. not to rub, operator wash hands and re glove, gently pull down lower lid and have pt. look up, then direct object away using a moist cotton tip (better to let pt. remove)

Option 2:Irrigate the eye with saline or water, use the emergency eyewash station or eye cup, irrigate from medial to lateral portion of eye.

179

If an foreign body becomes embedded in the eye, is okay to try to remove it?

No, never

180

What condition often mimics CVA?

hypoglycemia

181

Left ventricular heart failure results in?

respiratory distress

182

When does RV heart failure occur?

after LV

183

Is Cyanosis a symptom of late stage heart failure?

yes

184

LV heart failure occurs before___?

RV

185

Which ventricle pumps blood out to the body?

LV

186

Which ventricle pumps blood to the lungs?

right

187

Which heart failure fills the lungs up with blood?

LV

188

What is dyspnea?

difficulty breathing

189

Is nitroglycerin recommended for patients with a stystolic pressure lower than 100mmHg?

no

190

Prominent jugular veins while seated in an upright position is indicative of?

pulmonary embolism

191

What is the most frequent etiology of heart failure?

myocardial infarction