Human disease Flashcards
(47 cards)
1
Q
Most common causes of sepsis? 2 marks
A
UTI
Respiratory tract infection
2
Q
Mechanisms of antimicrobial resistance 4 marks
A
- Enzymatic inactivation of drug
- Modified targets for drugs
- Reduced permeability to drug
- Efflux of drug
3
Q
Do you need a MDRO test before dental check-up? 1 mark
A
- Smoking
- Diabetes
- Renal disease
- Low fitness
- Hyperlipidaemia
- Male
- Previous MI or stroke
4
Q
What are her cardiac risk factors (2)
A
Smoking and hypertension
5
Q
Diagnosis of angina and what you would do next (3)
A
- New onset presentation – puzzling pain
- Unstable angina
- Advice patient to seek medical advice.
6
Q
Define hypertension
A
Hypertension, also known as high or raised blood pressure, is a condition in which the blood vessels have persistently raised pressure. The higher the pressure, the harder the heart has to pump. (WHO)
BP 140/90 mmHg or higher is Stage 1 hypertension
7
Q
What does systolic and diastolic mean? (2) 2/2
A
- Systolic – ventricular contraction, blood pumping out of heart to rest of body, normal range is 90-120
- Diastolic – ventricular relaxation, ventricles filling, normal range is 60-80
8
Q
What is the MOA atenolol (3)
A
Atenolol is a beta blocker, blocks action of beta receptors, reduces contractility, reduces HR
Adrenergic chemicals?
9
Q
What is Von Willebrand Disease and how is it characterised? (2 marks)
A
- Congenital or inherited bleeding disorder
- Characterised by deficient or abnormal vin Willebrand factor (1)
10
Q
What should your next enquiry be about regarding the medical history once you have established that they have von Willebrand disease? (2 marks)
A
- Establish severity of disease
- Management of the disease in terms of medication or prophylaxis in the event of an episode which may cause bleeding
11
Q
What is the mode of inheritance of von Willebrand (1) and is it more prevalent in males or females or of equal prevalence (1)? (2 marks)
A
- Autosomal dominant
- Affects both males and females
12
Q
Name five clinical manifestations of von Willebrand disease? (5 marks)
A
- Mucocutaneous haemorrhage
- Gingival bleeding/brushing
- Epistaxis
- Post-surgical bleeding
- Menorrhagia
- Post-partum bleeding
- Post-trauma
13
Q
What prophylactic measures is the haematologist most likely to prescribe prior to extraction? (2 marks)
A
- vWF concentrate of DDAVP
- Tranexamic acid
14
Q
Indication + Mechanism of action of statins
A
- ACE inhibitors – inhibit ACE which prevents angiotensin I conversion to angiotensin II, which prevents reuptake of water and sodium, reducing blood volume and reducing blood pressure
- Angiotensin II antagonists (ARB) – Inhibits angiotensin II, reduces vasoconstriction
- Calcium channel blockers – blocker calcium channels in smooth muscle thus causing dilation
- Thiazide Type Diurectics -
- Antiplatelet drugs – reduce activation of platelets, inhibits thromboxane A2, cox signalling pathway or inhibits P2Y12 ADP receptors
- Novel Oral Anticoagulants (NOAC)
- Beta blockers – blocks action of beta receptors, reduces contractility, reduces HR
- Anticoagulates – vit k antagonist, inhibits factors in clotting cascade,prevents thrombin production which inhibits clot formation
- NOACs – direct thrombin inhibitor, factor Xa inhibitors, more rapid than warfarin
- Statins – reduce action of enzyme (HMGCoA) involved in production of cholesterol
15
Q
Risk factors for hypertension (smoking was not a mark)
A
- Smoking
- Diabetes
- Renal disease
- MaLE
- Hyperlipidaemia
- MI
- Stroke
- LV hypertrophym
- Low fitness
- Obesity
- Genes
- Environment (GRA – permanent aldosterone switched on)
- Age, family history, weight, alcohol, race, birth weight, Na intake
16
Q
Safe BP ranges
A
- Normal BP = <120/80
- Prehypertension = 120-139/80-89
- Stage I hypertension = 140/95mmHg or higher
- Stage II –hypertension = 160/100mmHg or higher
- Severe – 180/120mmHg or higher
- Hypertensive urgency = diastolic >120
- Don’t treat dental patients with BP over 180/110
17
Q
Unstable angina/COPD/stents/3 referrals to cardiologist in 3 years/hypotension/stomach ulcer – in for RCT
Q) What is angina?
A
Angina is chest pain caused by reduced blood flow to the heart muscles caused by a temporary obstruction of blood flow to the heart
18
Q
what is meant by stent placement (2)
A
Stent placement is where a balloon is guided through the artery to the blockage and inflated to expand the narrowed artery so blood can flow properly
19
Q
what side effects of nicorandil (1)
A
Nicorandil is a vasodilator used to treat angina, side effects include headaches, dizziness, nausea or vomiting
20
Q
COPD clinical considerations for RCT (3)
A
Woulndt use rubber dam, obstruct airway
Wouldn’t lie patient back fully
Oxygen nearby
Bronchodilators
21
Q
70 year old with ache in jaw and teeth for 2 weeks happening for 2 weeks, it is worse during exercise, similar ache in the left arm at the same time. Breathlessness and tight chest when they walk short distances, high BP, feels it is improved when they smoke and that makes them less anxious
Q) What medical condition?
A
Angina
22
Q
Difference between systolic and diastolic blood pressure?
A
Systolic – ventricular contraction, blood pumping out of heart to rest of body, normal range is 90-120
Diastolic – ventricular relaxation, ventricles filling, normal range is 60-80
22
Q
70 year old with ache in jaw and teeth for 2 weeks happening for 2 weeks, it is worse during exercise, similar ache in the left arm at the same time. Breathlessness and tight chest when they walk short distances, high BP, feels it is improved when they smoke and that makes them less anxious.
Q) Cardiac risk factors?
A
Smoking
Low fitness
Male
Older
23
Q
MOA of atenolol?
A
Beta blocker, blocks beta receptors on the heart , dilate blood vessels, reduce BP
24
70 year old with ache in jaw and teeth for 2 weeks happening for 2 weeks, it is worse during exercise, similar ache in the left arm at the same time. Breathlessness and tight chest when they walk short distances, high BP, feels it is improved when they smoke and that makes them less anxious.
Q) 5 risk factors for high BP?
Obesity, smoking, renal disease, poor diet, high cholesterol, liver disease
25
Patient with breast cancer been in the all clear for 5 years. Has been advised it has come back and needs to take IV bisphosphonates.
Other: Vit B12 deficiency (macrocytic anaemia), celiac disease, ?
Non-smoker, non-drinker
Meds: ? + ?
Q) Macrocytic/hyperchromic anaemia?
raised mean cell volume (MCV), test blood for Vit B12 and foliate, check bone marrow, Vit B12 deficiency stores deplete gradually, foliate deficiency happens quickly
26
Patient with breast cancer been in the all clear for 5 years. Has been advised it has come back and needs to take IV bisphosphonates.
Other: Vit B12 deficiency (macrocytic anaemia), celiac disease, ?
Non-smoker, non-drinker
Meds: ? + ?
Q) Microcytic/hypochromic anaemia?
Lowered MCV, lowered mean cell haemoglobin (MCH), cells are pale, smaller, test blood for serum ferritin
27
Normocytic/normochromi Anaemia?
normal MCV and MCH, anaemia caused by number of cells, reticulocyte count, low or normal = problems with bone marrow, increased = blood loss or haemolysis
28
Haemolytic anaemia?
accelerated RBC destruction, low Hb
29
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
Q) what is angina
Chest pain (1) caused due to the narrowing of arteries which do not allow oxygen to reach heart muscles (1) reduced blood flow to the heart caused by temporay obstruction
30
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
Q) What medication is usually carried by patients with angina to relieve symptoms?
GTN spray (glyceryl trinitrate) (1)
31
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
Q) How would you risk assess this patient to determine whether she is suitable to be treated in a primary care setting?
unstable angina/unprovoked attacks would move the patient into a higher risk category (1) dental anxiety may exacerbate angina symptoms (1) and influence choice, recent frequency of referral to cardiologist implies further inquiry required
32
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
33
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
Q) The patient is on a medication called Nicorandil. What might be one potential oral side effect of this medication?
(Oral) mouth ulceration (1) Nicorandil is a vasodilator medication
34
A 67-year-old female presents for a dental assessment. She is dentally anxious and is concerned about losing her teeth. Her Medical History reveals that she has unstable angina. These episodes have been provoked spontaneously. Periods of hospitalisation were required for the placement of stents 7 years ago. The patient also reports that she has been referred by her GP to the cardiologist 3 times in the last 3 years.
Additional medical history of note includes; Chronic Obstructive Pulmonary Disease (COPD), hypertension and a history of a bleeding stomach ulcer 10 years ago.
Her dental examination identifies that a root canal treatment is indicated.
Q) The patient also suffers from COPD. How might COPD complicate the dental treatment for this patient? Consider the specific treatment she requires.
Patients may be unable to be treated in supine position (1). Treatment planning may need to be monitored if there is a persistent cough/dyspnoea and lengthy complicated treatment may not be practical (1) It may be difficult to use rubber dam as patients with COPD may not tolerate the additional obstruction to breathing. (1)
35
A 50-year-old male attends your practice concerned about a broken tooth. Following your examination, you note that the mandibular left first molar (FDI 36) has been endodontically treated, but the coronal restoration has failed, and the tooth is unrestorable. Due to the presence of periapical pathology, as seen radiographically, you explain to the patient that FDI 36 requires surgical extraction. You are competent to carry out the procedure in your practice under local anaesthesia. You explain the risks and benefits of the procedure to the patient and the patient consents to the surgical removal of FDI 36 under local anaesthesia at a future date and you arrange a suitable appointment early in the day and at the beginning of the week.
Q) The patient might be taking the following medications: Warfarin, Clopidogrel, Rivaroxaban, Combination or injectable anticoagulant
Fill in the boxes on the table below by writing on the text box the number of the cell and you answer next to it.
1– anticoagulant Vitamin K Antagonist (1)
2 - keep in mind patient may bleed more than usual - an atraumatic technique used - INR needs to be less than 4 (1) (Treat without interrupting medication if INR below 4) within 24 hours (INR checked ideally no more than 24 hours before procedure) to continue with extraction (1) (may be less than 4 within 72 hours if patient has been stably anticoagulated (1)). Appointment should be scheduled earlier in the morning and earlier in the week to allow room for complications. if INR is 4 or above delay treatment or refer if urgent (1)
3 - higher risk (1)
4 - local haemostatic measures taken pack and suture (1)
5 – antiplatelet (1)
6 –treat without interrupting medication (1)
6 - patient is more likely to bleed
7 – NOAC (1) Novel Oral Anticoagulant
8 – with rivaroxaban, it is taken once a day - if taken in the evening the patient should continue medication as normal. if taken as a morning dose, pt should be told to not take it before treatment that day (1) (delay morning dose) but 4 hours after haemostasis is achieved (1) (post-treatment dose 4 hours after haemostasis has been achieved (usual time if taken in evening)
9 – talk with general medical practitioner or specialist (1)
36
A 50-year-old male attends your practice concerned about a broken tooth. Following your examination, you note that the mandibular left first molar (FDI 36) has been endodontically treated, but the coronal restoration has failed, and the tooth is unrestorable. Due to the presence of periapical pathology, as seen radiographically, you explain to the patient that FDI 36 requires surgical extraction. You are competent to carry out the procedure in your practice under local anaesthesia. You explain the risks and benefits of the procedure to the patient and the patient consents to the surgical removal of FDI 36 under local anaesthesia at a future date and you arrange a suitable appointment early in the day and at the beginning of the week.
Q) Pt returns for prep of 15 for MCC – when he arrives he is more breathless than usual. When you are prepping, the patient becomes agitated, starts breathing faster + begins to wheeze). Describe course of action you would now take, along with medical _____ available to you in the dental practice. Provide doses and method of delivery of any drugs used. (8)
Asthma attack
Symptoms
* Shortness of breath
* Incomplete sentences
* Respiratory rate >22
* Audible wheeze
* Tachycardia >100
Attach pulse oximeter, record Sp02
If they have their own inhaler with them, allow them to self administer if not get salbutamol, spacer and oxygen
Give 2 puffs salbutamol into space device and allow patient to breath normally for 1 mins
Administer O2 at 10-15l/min
If breathing has improved complete an M-DEWS2 score and monitor every 5 mins
If no improvement after 5 cycles (10 puffs) call emergency services
37
What does Zolendronic acid do, what class of drug is it, what’s it mode of action (3m)
Zolendronic acid is a bisphosphonate, inhibits bone resorption and osteoclast proliferation which may reduce bone turnover in the jaw resulting in mRONJ
38
Why are the maxillofacial bones more affected? (1m)
Maxillofacial bones have higher remodelling rates making them more prone to the effect of bisphosphonates
39
Some 47 year old woman
PC:Upper immediate denture lost for 11 21 is mobile
DH: Brushing with fluoridated toothpaste, Using floss 2-3 times week
11/21 involved in trauma leading them to be root filled and crowned.
MH: Breast cancer starting IV Zolendronic
E/O and I/O- NAD BPE 112/122
Class 2 incisal relationship
Class 1 molar relationship
Canine guidance
NWS interference on 46 lingual cusp when left excursion of mandible
Patient has had a cycle of non-surgical periodontal treatment
SH: Drinking 1X75cl of wine an evening. Has 3 children.Is unemployed.
Q) 3. Which bones are most likely to be affected and why? (2m)
Mandible alveolar bone
40
Some 47 year old woman
PC:Upper immediate denture lost for 11 21 is mobile
DH: Brushing with fluoridated toothpaste, Using floss 2-3 times week
11/21 involved in trauma leading them to be root filled and crowned.
MH: Breast cancer starting IV Zolendronic
E/O and I/O- NAD BPE 112/122
Class 2 incisal relationship
Class 1 molar relationship
Canine guidance
NWS interference on 46 lingual cusp when left excursion of mandible
Patient has had a cycle of non-surgical periodontal treatment
SH: Drinking 1X75cl of wine an evening. Has 3 children.Is unemployed.
Q) 4. What is your treatment for present and future and what do you need to tell the patient about the the oral health complications that might arise(14m)
MRONJ
41
Some 47 year old woman
PC:Upper immediate denture lost for 11 21 is mobile
DH: Brushing with fluoridated toothpaste, Using floss 2-3 times week
11/21 involved in trauma leading them to be root filled and crowned.
MH: Breast cancer starting IV Zolendronic
E/O and I/O- NAD BPE 112/122
Class 2 incisal relationship
Class 1 molar relationship
Canine guidance
NWS interference on 46 lingual cusp when left excursion of mandible
Patient has had a cycle of non-surgical periodontal treatment
SH: Drinking 1X75cl of wine an evening. Has 3 children.Is unemployed
Q) What is the risk of MRONJ and what risk category is the patient in? (3m)
depends how long the patient has been taking bisphosphonates
42
Some 47 year old woman
PC:Upper immediate denture lost for 11 21 is mobile
DH: Brushing with fluoridated toothpaste, Using floss 2-3 times week
11/21 involved in trauma leading them to be root filled and crowned.
MH: Breast cancer starting IV Zolendronic
E/O and I/O- NAD BPE 112/122
Class 2 incisal relationship
Class 1 molar relationship
Canine guidance
NWS interference on 46 lingual cusp when left excursion of mandible
Patient has had a cycle of non-surgical periodontal treatment
SH: Drinking 1X75cl of wine an evening. Has 3 children.Is unemployed.
Q) What oral health/preventive advice will you give this patient? (6)
43
Some 47 year old woman
PC:Upper immediate denture lost for 11 21 is mobile
DH: Brushing with fluoridated toothpaste, Using floss 2-3 times week
11/21 involved in trauma leading them to be root filled and crowned.
MH: Breast cancer starting IV Zolendronic
E/O and I/O- NAD BPE 112/122
Class 2 incisal relationship
Class 1 molar relationship
Canine guidance
NWS interference on 46 lingual cusp when left excursion of mandible
Patient has had a cycle of non-surgical periodontal treatment
SH: Drinking 1X75cl of wine an evening. Has 3 children.Is unemployed
Q) Taking into consideration the patient’s drug history, what are overall aims of future dental Rx? (3)
44
What is BRONJ
45
What are the signs n symptoms of BRONJ?
46
What source and name of guidance available to dentists in Scotland on management of patient’s taking bisphosphonates? (2)
