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Final Flashcards

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1
Q

What are the hospital classifications?

A

Acute, chronic, children’s, obstetrical, mental health

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2
Q

Governance structure of the Hospital

A

Governing board, administration, medical staff, community served.

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3
Q

Hospital classifications

A

Government, non-profit, proprietary

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4
Q

Hemostasis

A

Dynamic process of blood clot formation at the site of vascular injury.

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5
Q

What are the stages of hemostasis?

A

Primary, secondary and tertiary

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6
Q

What are the phases of hemostasis?

A

Initiation and formation of the platelet plug
Propagation by the coagulation cascade
Termination by antithrombotic mechanism
Fibrinolysis

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7
Q

What are the three pathways to the coagulation cascade?

A

Intrinsic, extrinsic and common.

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8
Q

Extrinsic Coagulation

A

The “quick fix” in 10-15 seconds. Tissue Factors

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9
Q

Intrinsic Coagulation

A

Larger clot with lots of thrombin in 1-6 min. Contact Factors

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10
Q

Common Coagulation

A

Prothrombin to thrombin; fibrinogen to fibrin.

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11
Q

What are the most common laboratory assessments?

A

CBC, aPTT, PT/INR, bleeding time, TT, Platelet function/adhesion/aggregation, fibrinogen levels, Factor assays

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12
Q

What is the normal platelet level?

A

150-400k

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13
Q

What platelet count leads to spontaneous bleeding?

A

Less than 20k

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14
Q

What platelet count causes thrombocytosis?

A

More than 400k

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15
Q

What affects Bleeding Time?

A

Von Willibrands, ASA, NSAIDS

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16
Q

What does aPTT test?

A

Activated Partial Thromboplastin Time:

Intrinsic and the contact factors (XI, XII, VII, and IX) and Common (Factors II, prothrombin, V, X and I, fibrinogen).

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17
Q

What affects the aPTT?

A

Heparin, long term abx therapy, liver dz, malabsorption, cancer, infections, hemophilias, von Willebrand’s dz.

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18
Q

What does PT/INR Test?

A

Extrinsic: Tissue factor and Factor VII
Common: Factors II, V, X and fribinogen, Vitamin K dependent factors: II, VII, IX, X

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19
Q

What is a normal INR?

A

0.8-1.2

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20
Q

When is it safe to extract a single tooth?

A

If the INR is less than 3

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21
Q

Difference between aPTT and INR?

A

aPTT is intrinsic, INR is extrinsic.

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22
Q

What are thrombocytes?

A

Platelets from the bone marrow.

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23
Q

How long do thrombocytes last in circulation?

A

8-10 days.

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24
Q

What are the qualitative disorders of platelets?

A

Affecting bone marrow or liver dx, splenic sequestration, VonW dz, aspirin, NSAIDS, clopidogrel, COX 2 inhibitors, uremia.

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25
What are quantitiative disorders of platelets?
Inherited or congenital. Rare!
26
Inherited Coagulopathies
Hemophilia A, B and C
27
Acquired Coagulopathies
Liver dx, vit K deficiency or antagonists, disseminated intravascular coagulation, anticoagulant therapy.
28
Hemophilia A
Factor VIIIc deficiency
29
Hemophilia B
Christmas Disease, Factor IX deficiency
30
Hemophilia C
Stuart's disease, Factor XI deficiency
31
How many people are living with cancer at any point in time? (Cancer prevalence?)
12.5 million
32
Triad of Cancer Therapies
Surgery, radiation, chemo
33
Tumor Classification-Grade
How cells look, potential for growth rate and metastasis. | GX-G4 going from well differentiated to undifferentiated.
34
Anatomic Staging
TNM T: Size of primary tumor N: Spread to regional lymph nodes M: presence or absence of metastases.
35
Curative Chemo
Eliminate every tumor cell! The smallest detectable tumor is 1 billion cells, with a kill rate of 99.999%, only 10,000 cells left!
36
Control Chemo
Stop cancer from growing and prevent metastasis
37
Palliation Chemo
Relieve symptoms, prolong life and improve quality of life.
38
Tumor kinetics
1 billion cells is approximately 1 cm mass and is clinically detectable. Exponentially growing tumors double about 30 times before becoming detectable. Each tumor has a characteristic doubling time.
39
Chemotherapy side effects
Targets ALL fast growing cells. Bone marrow suppression. Neutropenia.
40
What is the goal of dental management pre-chemo?
Diagnose and eradicate infective potential.
41
What do you need to counsel patient on pre-chemo?
Mucositis, transient xerostomia, spontaneous hemorrhage, infections, importance of oral hygiene, non-healing and oral wound.
42
What are the chemo crises?
Spontaneous bleeding, infection, mucositis, xerostomia
43
How do you treat spontaneous bleeding from chemo?
Platelet infusion.
44
How many platelets are in a pack?
Increase of 4k-6k platelets.
45
What are the 4 R's of radiation biology?
Repair of cellular damage Reoxygenation of the tumor Redistribution within the cell cycle Repopulation of cells
46
What is the sequence of osteoradionecrosis?
Radiation Hypovascular, hypocellular, hypoxic tissue Tissue breakdown (cellular death and collagen lysis exceed synthesis and cellular replication) Chronic non-healing wound where energy, oxygen and metabolic demands clearly exceed the supply.
47
What is the significant dose for osteoradionecrosis?
More than 5k cGy;H
48
Which jaw is more at risk for osteoradionecrosis?
MN
49
Prevention of ORN
Remove 'at risk' teeth 21 days prior to XRT Consider treatment in golden window (1-6 months after XRT, pre-fibrotic phase) Adjunctive HBO treatment Don't extract post radiation
50
What are at risk teeth for ORN?
Caries, RCT or periodontal disease, especially in MN. | Know the area with the highest dose
51
What are the radiation level guidelines for treatment?
Less than 4500-normal 4500-5500- MX is normal, caution with MN More than 5500-No treatment without HBO
52
Intraoral complications from radiation
Edema, muscle trismus, erythema, mucositis, diminished taste, radiation caries, xerostomia.
53
What is the most common long term complication from radiation?
Xerostomia. 200 cgy/day x one week is 57% decrease in flow. Irreversible with doses more than 400 cGY.
54
Radiation Induced Caries
Cervical cusp tips. Different from caries not induced by radiation. From a combined affect of hyposalivation and radiation dose.
55
What is Lateral Wall Movement and what nerves are involved?
Necessary for swallowing and speech. | Vagus, facial, glossopharyngeal
56
What are the components of speech?
Respiration, phonation, neural integration, resonation, articulation, audition.
57
What is a frontal plane rotation?
After a hemimandibulectomy, MN deviates toward the defect due to the pull of the suprahyoid muscles on the residual fragment.
58
How do you treat trismus?
Early! With intervention of an exercise program.
59
Inoculation Infection.
Edema, soft tissue involvement. Determined by perforation of cortical bone in relation to muscle attachments. Infection will spread along path of least resistance.
60
Cellulitis
Indurated. Acute, painful, diffuse borders, mixed bacteria.
61
Abcess
Puss. Chronic, localized pain, fluctuant, well circumscribed, anaerobes.
62
Indications for referral to OMS?
Rapidly progressing, difficulty in breathing and swallowing, fascial space involvement, elevated temp, severe trismus, toxic appearance, compromised host, extremes of age.
63
First line of Abx?
Pen VK
64
What do you use if allergic to pen VK?
Clinda
65
What abx do you use if resistant?
Augmentum or add flagyl

Hospital Dentistry (1 decks)

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