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3rd Year BDS > GHD > Flashcards

GHD Flashcards

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1
Q

Typpes of vavular heart disease?

A

Valvular stenosis
Valvular regurg
Aortic coarctation
CHD

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2
Q

Symptoms of aortic stenosis?

A

Angina
Breathlessness on exertion
Dizziness

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3
Q

Symptoms of aortic regurg?

A

Dyspnoea
Orthoponea
Nocturnal angina

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4
Q

Symptoms of Mitral valve disease?

A

Breathlessness
Palpitations due to Atrial fibrillation
Embolisation

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5
Q

What do Apixaban, Rivaroxaban and Edoxaban target?

A

Factor X

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6
Q

What does Dabigatran target?

A

Prothrombin

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7
Q

INR for AF?

A

2-3

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8
Q

INR for Metallic heart valves?

A

2.4-4.0

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9
Q

Contraindications for NSAIDs prescription to patients?

A

Taking oral anticoagulation tablets

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10
Q

Definition of infectvive endocarditis?

A

Infection on the cardiac or vasc endo

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11
Q

Predisposing factors for infective endocarditis?

A 
Endothelium subjected to turbulent flow
Any valvular or cardiac abnormality
Prosthetic heart valves
Bacteriaemia
IVDU
Dental procedures
Surgical procedures at infected sites
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12
Q

Aetiology for infective endocarditis?

A 
Bacteria
- Streptococcus, Staphylococcus, Enterococcus, Pneumococcus, Gram-cocco-bacilli
Fungi
Mycobacteria
Rickettsiae
Chlamydia
Mycoplasma
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13
Q

Symptoms for infective endocarditis?

A 
Fever
Malaise, anorexia, weight loss
Heart failure due to acute valvular destruction
Systemic embolisation: occult 	stroke
Acute renal failure
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14
Q

How to manage a patient with infective endocarditis?

A

Good oral hygiene
Regular dental review: twice/year in high risk patients and yearly in all others
Extra care taken for procedures requiring manipulation of the gingival or peri-apical region of the teeth or perforation of the oral mucosa (including scaling and root canal procedures)

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15
Q

Prophylaxis for infective endocarditis patient before dental treatment?

A

Amoxy 3g adult 60 mins prior
Amoxy 50mg per kg for child, max 3g
Clindamycin 600mg 60 mins prior adult
Clindamycin 30mg/kg child, max 600mg

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16
Q

Types of cardiovascular disease?

A 
Ischaemic heart disease
- Angina
- Myocardial Infarction
Heart failure
Cerebrovascular disease
- Transient ischaemic attack
- Thrombotic stroke
Arrhythmias
- Atrial Fibrillation
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17
Q

Describe atherosclerosis?

A 
Damage to vessel wall 
- Smoking
- Wall stress (High BP)
Healing process
- Activation of platelets
- Inflammatory cells
- Incorporation of Cholesterol
Fibrous cap
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18
Q

Describe atherosclerosis?

A 
Damage to vessel wall 
- Smoking
- Wall stress (High BP)
Healing process
- Activation of platelets
- Inflammatory cells
- Incorporation of Cholesterol
Fibrous cap
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19
Q

Types of antiplatelet drugs and their targets?

A

Aspirin- Thromboxane A2 (COX-1)
Clopidogrel/ Ticagrelor/ Prasugrel- P2Y12 ADP receptors
(Dipyridimole- Phosphodiesterase inhibitors )
(Abcicimab fibrinogen receptor antagonists)

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20
Q

Implications of antiplatelets for dental practice?

A

Patients bleed for longer
Aim for bloodless technique
Ensure primary haemostasis obtained before patient leaves practice
Interaction with NSAIDS
- Potent COX inhibitors
- Increased bleeding Risk- particularly GI tract

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21
Q

Beta 1 receptor action?

A

Heart- SA, AV Nodes and myocardial cells.
Kidneys- reduce secretion of Renin (see ACE inhibitors)
Positive Effect- Slows heart rate and conduction (Negatively Chronotropic (and Dromotropic)), Increases Diastolic Time, Reduces BP, Protects heart from effects of Catecholamines
Negative Effects- reduces contractility (negatively Inotropic)

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22
Q

Beta 2 receptor actions?

A

Smooth muscle eg Airways, Peripheral vasculature
Skeletal Muscle
Positive Effects- Reduces tremor?!?!?
Negative Effects- potentially lethal bronchospasm in asthmatics, vasoconstriction and PVD

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22
Q

Beta 1 and Beta 2 blockers?

A 
Beta 1:
- Bisoprolol
- Atenolol
- Carvediol
- Metoprolol
Beta 1 and 2:
- Propanalol
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23
Q

Describe the renin-agiotensin-aldosterone axis?

A

Angiotensinogen produced by liver
Converted to Angiotensin I by Renin and enzyme released by the kidney in response to reduction in perfusion pressure
Angiotensin I converted into Angiotensin II by ACE and Endothelial enzyme found predominantly in the lungs
Angiotensin II acts on the adrenals leading to the release of aldosterone

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24
Function of ANG II?
Vasoconstrictor - peripheral vasc - efferemt arteriole of glom
25
Function of aldosertone?
Retain Na and H20 | Lose K in DCT
26
ACE inhibitor action and examples?
Ramipril Lisinopril Captopril Perindopril Positive effects- Reduce blood pressure, reduce afterload on heart, prevents aberrant remodelling after MI and reduces proteinuria Negative effects- reduces perfusion pressure in glomerulus, cough
27
ARBs action and examples?
Losartan and candersartan Positive effects- Reduce blood pressure, reduce afterload on heart, prevents aberrant remodelling and reduces proteinuria Negative effects- reduces perfusion pressure in glomerulus
28
Aldosterone antagonists?
Spironolactone and eplenerone Enhanced diuretic effect Never with NSAIDs
29
Ca channel blockers types?
Dihydropyridine | Non-dihydropyrdine
30
Affect of dihydropyridine and examples?
Block calcium entry into smooth muscle Less effect on myocardial pacemaking tissue Eg. Amlodipine, felodipine
31
Affect of non-dihydropyridine and examples?
``` Block calcium entry to smooth muscle Blocks calcium entry in the myocardial pacemaking tissue Slow SA node function Slow AV conduction Eg. Verapamil and Diltiazem ```
32
Dental implications for Ca channel blockers?
Gingival hypertrophy Particularly dihydropyridine Poor dental hygiene and gingival inflammation are a risk factor
33
How statins works?
Hydroxy-methyl-glutaryl Coenzyme A (HMGCoA)reductase inhibitor Rate limiting step in production of cholesterol
34
Implicaitons of statins in dental practice?
No clarithromycin for Simvastatin
35
Implicaitons for anticoagulations in the dental practice?
Interactions with antibiotics commonly used - Enhanced anticoagulant effect via inhibition cP450 eg. Clarithromycin, Azole anti fungals - Reduced anticoagulant effect via induction of cP450 eg. Rifampycin
36
Risk factors for HT?
``` Cigarette smoking Diabetes mellitus Renal disease Male 2X risk Hyperlipidaemia Previous MI or stroke ```
37
Other factors for HT aetiology?
``` Age • Genetics and family history • Environment • Weight • Alcohol intake • Race • Birth weigh - salt ```
38
Causes of 2nd HT?
Renal disease Drug Induced Pregnancy Endocrine
39
Why treat HT?
reduce cerebrovascular disease by 40-50% | – reduce MI by 16-30%
40
Defintion of Stroke?
is the sudden onset of focal neurological symptoms caused by ischaemia or haemorrhage and lasting more than 24 hours
41
Definition of TIA?
TRANSIENT ISCHAEMIC ATTACK (TIA) is the term used if the symptoms resolve within 24 hours.
42
Difference between haemorrhagic and ischaemic stroke?
Haemorrhage/blood leaks into brain tissue | Ischaemic is where a clot stops the blood supply to an area of the brain
43
Signs and symptoms of Stroke?
``` Motor (clumsy or weak limb) • Sensory (loss of feeling) • Speech: Dysarthria/Dysphasia • Neglect / visuospatial problems • Vision: loss in one eye, or hemianopia • Gaze palsy • Ataxia/ vertigo / incoordination / nystagmus ```
44
Signs and symptoms for a posterior circulation stroke?l
ataxia, vertigo incoordination, nystagmus, loss of | consciousness, cardiorespiratory control
45
Types of Strokes?
``` Brainstem stroke (brainstem) Cortical stroke (cortex) Lacunar stroke (small vessel) ```
46
Stroke mimics?
``` Migraine • Epilepsy • Structural brain lesions – SDH, Tumour, abscess • Metabolic/toxic disorders – hypoglycemia • Vestibular disorders • Psychological disorders • Demyelination • Mononeuropathy ```
47
Why Strokes happen?
Problems in the large arteries • Problems in the small arteries • Clots that come from the heart Carotid stenosis Carotid disease Cardioembolic stroke (AF) Carotid dissection - clot tears artery wall
48
Non-modifiable RF for Stroke?
Previous stroke –Being old –Being male – Having a family history
49
Modifiable RF for Stroke?
``` HT Diabetes x3 Smoking x2 Lipids Alcohol Weight ```
50
FAST?
Facial weakness Arm weakness Speech problems Time to call 999
51
Early management for stroke treatment?
``` Swallowing • Fluids and oxygen • Early therapy involvement • Good nursing care • Aspirin ```
52
TIA risk of Stroke?
``` Almost inevitable 1/2 days prior Meds to reduce chances Antiplatelets Antihypertensives Statins+Endarterectomy ```
53
Relevant patient information for exodontia?
``` Bleeding disorders. SDCEP guidance and implementation advice. Antibiotics Prophylaxis. Anticoagulants and Antiplatelets. Bisphosphonates. MRONJ ```
54
Relevant medical information fro patient for exodontia?
Head and neck radiotherapy. Chemotherapy. Liver failure. Haemophilia.
55
Name respiratory conditions?
``` Asthma and COPD Pneumonia Obstructive sleep apnoea Pulmonary Embolism Pneumothorax Lung Cancer Chronic cough Bronchiectasis Interstitial Lung Disease ```
56
Respiratory symptoms?
``` Dyspnoea (breathlesssness) Cough Sputum Haemoptysis Chest Pain Wheeze ```
57
How to assess respiraotry disease?
``` Physical examination - Pulse rate - Pulse oximeter - Respiratory rate - Listen to breathing - Lung auscultation Oxygen saturation Arterial Blood gas - pH, PO2, PCO2 Chest X-ray (CxR) Peak Flow Lung Function CT scan Bronchoscopy ```
58
Equipment for respiratory assessment in the dental practice?
Pulse oximeter | Peak flow meter
59
TI respiratory failure?
Low PO2 Normal or low PCO2 Examples include acute asthma, pneumonia
60
TII respiratory failure?
Low PO2 High PCO2 Examples include severe COPD, obesity hypoventilation syndrome
61
Symptoms for Asthma and COPD?
Airways disease Breathlessness Wheeze Cough
62
Description of Asthma?
``` reversible airflow obstruction not caused by smoking intermittent symptoms common in childhood Treat with bronchodilators (salbutamol) and corticosteroids (beclomethasone) ```
63
Description of COPD?
irreversible airflow obstruction caused by smoking continuous symptoms tends to occur in older adults
64
Symptoms of Pneuomina?
Acute illness Fever, myalgia, headache Cough, chest pain, sputum, dyspnoea May require admission to hospital May have type I respiratory failure Consolidation on CxR Treated with antibiotics, oxygen, intravenous fluids
65
Description of a Pulmonary embolism and risk factors?
``` Blood clot to the lung Typically arises in leg veins Major risk factors include - Recent major operation - Recent major trauma - Immobility - Major chronic disease e.g. cancer ```
66
Symptoms of Pulmonary embolism and treatment?
``` breathlessness chest pain haemoptysis Type I respiratory failure Near normal CxR Treated with anticoagulation e.g. warfarin, rivaroxaban, apixaban ```
67
Description of Pneumothorax?
Collapsed lung Primary (no cause) or secondary (underlying lung disease) May pres
68
Symtpoms of pneumothorax?
chest pain (sudden onset) dyspnoea clinical examination and CxR
69
Description of Chronic cough?
Cough lasting > 8 weeks
70
Causes of Chronic cough?
asthma gastro-oesophageal reflux postnasal drip
71
Description of Bronchiectasis?
Dilated, damaged airways
72
Symptoms for Bronchiectasis?
cough sputum, often copious haemoptysis
73
Description of intersitial lung disease?
Thickening, inflammation of interstitium of lung
74
Symptoms of interstitial ling disease?
dyspnoea | dry cough
75
Types of neurodegenarative disease?
Dementia Parkinson’s Motor neuron disease
76
Definition of dementia?
Progressive impairment of multiple domains of cognitive function in alert patient leading to loss of acquired skills and interference in occupational and social role
77
Common features of neurodegenarative disease?
usually late onset gradual progression neuronal loss (specific neuropathology) structural imaging often just atrophy
78
Causes of dementia?
Late onset (65+ yrs) Alzheimer’s (55%) Vascular (20%) Lewy body (20%) Others (5%) Young onset (<65 yrs) Alzheimer’s (33%) Vascular (15%) Frontotemporal (15%) Other (33%)
79
How to diagnose dementia?
History (independent witness) type of deficit, progression, risk factors, FH Examination: cognitive function, neurological, vascular Investigations routine - bloods, brain imaging
80
Dementia screening tests?
Clock drawing
81
Types of dementia?
Temporo-parietal dementia - Early memory disturbance - Language and visuospatial problems - Personality preserved until later Frontotemporal dementia - Early change in personality / behaviour - Often change in eating habits - Early dysphasia - Memory / visuospatial relatively preserved Vascular dementia - Mixed picture - Stepwise decline
82
Treatment for Alzheimer's?
Cholinesterase inhibitors (cholinergic deficit) - Donepezil, rivastigmine, galantamine - Small symptomatic improvement in cognition (wash-out) - No delay in institutionalisation NMDA antagonist (memantine)
83
Dental complications for Alzheimer's?
``` poor comprehension (consent / capacity) easily confused (strange environments / pain) poor speech ``` ``` Excess saliva (medications) Neglect of dental care ```
84
Approach for Alzheimer patients?
``` Time & explanation Best if with friend / family Calm approach Show as well as say Plan with patient early in dementia Think ahead prevention / long-term management Specialist / hospital services e.g. sedation ```
85
Diagnosis of Parkinson's disease?
Bradykinesia + ≥1 tremor, rigidity, postural instability No other cause / atypical features Slowly progressive (> 5-10 yrs) Supported by asymmetrical onset, rest tremor, response to treatment
86
Treatment for Parkinson's?
COMT inhib: entacapone tolcapone opicapone Dopamine agonists: ropinirole pramipexole rotigotine MAO-B inhib: selegiline rasagiline
87
Dental issues for Parkinson's?
``` Movement problems Dementia Swallowing Drooling Dry mouth (rarer) Dentures Deep brain stimulators: antibiotics ```
88
Parkinson's managment dentally?
``` Give time to respond (speech & action) Minimise distractions & clutter Advice – local PDS society / medic / nurse Specialist hospital Rx / sedation Speech and language therapy Saliva management Good denture care ```
89
Parkinson's managment dentally?
``` Give time to respond (speech & action) Minimise distractions & clutter Advice – local PDS society / medic / nurse Specialist hospital Rx / sedation Speech and language therapy Saliva management Good denture care ```
90
Definition of Motor Neurone Disease?
Combination of upper and lower motor neuron signs LMN = muscle fasciculations, wasting, weakness UMN = spasticity, brisk reflexes, extensor plantars No sensory involvement 10%+ have cognitive decline
91
Dental issues for Motor Neurone Disease?
dysarthria/weakness, saliva, swallow, survival
92
Other movement disorders?
Tremour | Dystonia
93
Definiton of tension headache?
Most frequent primary headache, but is NOT disabling and rarely presents to doctors
94
Symtpoms of tension hedache?
Mild, bilateral headache pressing or tightening in quality no significant associated features not aggravated by routine physical activity
95
Treat tension headache?
NSAID or paracetamol | Tricyclic antidepressant if a preventative required
96
Definition of migraine?
Most frequent DISABLING primary headache
97
Migraine treatment?
``` Lifestyle Diet: don’t miss meals, drink plenty of fluids Sleep: avoid changes in sleep patterns Regular exercise Trigger avoidance ``` Acute treatment Aspirin or NSAIDs Triptans Limit to 10 days per month (~2 days per week) to avoid the development of medication overuse headache Prophylactic treatment B-Blockers (propranolol) Anti-epileptics (Topiramate, Valproate, Gabapentin) Tricyclic antidepressants (amitriptyline, dothiepin, nortriptyline) Others
98
Definiton of chronic migarines?
Headache on ≥ 15 days per month, of which ≥ 8 days have to be migraine, for more than 3 months
99
Definition of cluster headache?
``` Pain: mainly orbital and temporal Attacks are strictly unilateral Rapid onset (max within 9 mins in 86%) Duration: 15 mins to 3 hours (majority 45-90 mins) Rapid cessation of pain ```
100
Definition of cluster headache?
``` Pain: mainly orbital and temporal Attacks are strictly unilateral Rapid onset (max within 9 mins in 86%) Duration: 15 mins to 3 hours (majority 45-90 mins) Rapid cessation of pain ```
101
symptoms of cluster headache?
Premonitory symptoms: tiredness, yawning | Associated symptoms: nausea, vomiting, photophobia, phonophobia
102
Paroxysmal hemicarnia defintion?
Pain: mainly orbital and temporal Attacks are strictly unilateral Rapid onset Duration: 2-30 mins Rapid cessation of pain
103
Neuralgia defintion?
An intense burning or stabbing pain The pain is usually brief but may be severe. Pain extends along the course of the affected nerve. Usually caused by irritation of or damage to a nerve
104
Causes of trigeminal neuralgia?
Vascular compression of the trigeminal nerve ``` Uncommon Multiple sclerosis Intracranial arteriovenous malformation Intracranial tumour Brainstem lesions ```
105
Symptoms of trigeminal neuralgia?
Unilateral maxillary or mandibular division pain > ophthalmic division Stabbing pain 5 - 10 seconds duration
106
Definition of atypical facial pain?
Pain Poorly localized featureless pain Typically involving eye, nose, cheek, temple or jaw, but can involve areas supplied by the cervical roots Continuous with no paroxysms, distinguishing it from trigeminal neuralgia No triggers
107
Definition of burning mouth syndrome?
An intraoral burning or dysaesthetic sensation, recurring daily for more than 2 hours per day over more than 3 months, without clinically evident causative lesions.
108
Symptoms of burning mouth syndrome?
Pain is usually spontaneous, but can be triggered by foods especially spicy or acidic
109
Symtpoms of sinus headache?
Purulent anterior rhinorrhoea Nasal congestion Postnasal drip Continuous facial or dental pain / pressure Cough (frequently has a night time component)
110
Definiton of thunderclap headache?
A high intensity headache reaching maximum intensity in less than 1 minute Majority peak instantaneously 1/10 actually have a subarachnoid haemorrhage
111
Eye movements and their cranial nerves?
SO4 - superior oblqiue rotates - pulles eye towards the nose LR6 - lateral rectus - moves eye laterally All others for CN III
112
Lesions that cause visual field defects?
Optic nerve - 1 sided blindness Optic chiasma - half vision in both eyes Optic radiations - variable in both eyes Occipital visual cortex - variable in both eyes
113
IVth nerve pasly definition?
Trochlear nerve innervates superior oblique Intorts depresses and abducts the globe (eye) Vertical diplopia,  tortion Diplopia worse looking down to opposite side of IVth CN palsy Can have head tilt away from affected side
114
III nerve palsy?
dilated pupil/ oculomotor abnormalities innervates levator palpebrae superioris
115
Myasthenia Gravis definition?
``` Auto-immune disorder Antibodies against acetylcholine receptor Associated with thymoma and thymic hyperplasia Pure ocular MG Generalised MG Extra-ocular Bulborespiratory muscles Limbs – proximal>distal ```
116
Treat Myasthenia Gravis?
Acetylcholinesterase inhibitors (pyridostigmine, neostigmine) Immunosuppression Steroids IV immunoglobulin, plasma exchange Azathioprine, cyclosporin, cyclophosphamide, methotrexate
117
Definition of Bell's Palsy?
right or left facial paralysis Noises sound louder on RHS or left dilated pupil in right or left eye
118
UMN vs LMN facial paralysis?
UMN: - stroke - tumour LMN: - Bell's palsy - carcoid
119
CN XII palsy definition?
Tongue deviates to side of lesion+ fasciculations + wasting
120
Causes of transient loss of consciousness?
``` Vasovagal 20% Reflex syncope 14% Cardiogenic syncope 18% Epilepsy 8% Other (provoked seizure) 2% Metabolic 4% Unknown 34% - Non-epileptic ```
121
Types of syncope?
Reflex Orthostaic Cardiogenic
122
Cardiogenic syncope symptoms?
On exertion Chest pain, palpitations, SOB Clammy/sweaty Witness account: - Suddenly went floppy - Looked grey/ashen white - Seemed to stop breathing - Unable to feel a pulse
123
Definition of epilepsy?
Epilepsy is the tendency to recurrent seizures
124
Factors which increase seizure risk?
Missed medications (most common) Sleep disturbance, fatigue Hormonal changes Drug/alcohol use, drug interactions Stress/Anxiety Photosensitivity in a small group of patients Other rarer reflex epilepsies (visual patterns, music)
125
Basic classifcaitions of seizures?
Generalised seizures | Focal seizures
126
Generalised seziure types?
``` Absence seizures Generalised tonic-clonic seizures Myoclonic seizures Juvenile myoclonic epilepsy Atonic seizures ```
127
Focal seizures types?
Simple partial seizures Complex partial seizures Secondary generalised
128
Difference between Generalised and Focal?
``` Generalised: No warning < 25 years May have history of absences and myoclonic jerks as well as GTCS e.g in juvenile myoclonic epilepsy Generalised abnormality on EEG May have family history ``` Focal: May get an “aura” Any age – cause can be any focal brain abnormality Simple partial and complex partial seizures can become secondarily generalised Focal abnormality on EEG MRI may show cause
129
Signs of a generalsied tonic clonic seizure?
Groaning sound Tonic (rigid phase) Then generalised jerking in all four limbs Eyes open Staring/ roll upwards Foaming at the mouth Jerking for a few minutes and then groggy for 15-30mins
130
Signs of an absence seizure?
Sudden arrest of activity for a few seconds Brief staring May have eye-lid fluttering
131
Signs of a complez partial seizure?
``` Sudden arrest in activity Staring blankly into space Automatisms Lip smacking Repetitive picking at clothes ```
132
Signs of status epilepticus?
Prolonged or recurrent tonic-clonic seizures persisting for more than 30 minutes with no recovery period between seizures Be wary of non-convulsive status epilepticus
133
Treatment of status epilepticus?
Midazolam: 10mg by buccal or intra-nasal route, repeated after 10mins if necessary Lorazepam: 0.07mg/kg, usually 4mg bolus repeated once after 10 mins Diazepam: 10 - 20mg iv or rectally, repeated after 15 mins if necessary
134
Signs of pseudoseizure?
May recognise stress as a trigger (even if patient doesn’t) May report signs of patient retaining awareness Tracking eye movements, still some verbalisation during episodes Movements not typical of seizures Pelvic thrusting Asynchronous movements, tremor Episodes waxing and waining
135
Causes of orthostatic syncope?
Dehydration, medication related (anti-hypertensive) | Endocrine, autonomic nervous system
136
Causes of reflex syncope?
Taking blood/medical situations | Cough, Micturation

3rd Year BDS (21 decks)

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