Lecture 1- Introduction Flashcards
1
Q
List how dentistry and medicine today are different (than previous years): (3)
A
- people liver longer= more elderly patients
- People receive medical treatments that would have been fatal just a few years ago
- pharmaceuticals continue to advance
2
Q
What is proportional to an increase in combinations and permutations of dental treatment?
A
- increased number of conditions
- increased complexity of conditions
- increased number of medications
3
Q
-increased number of conditions
-increased complexity of conditions
-increased number of medications
These are all proportional to an increase in:
A
combinations and permutations of dental treatment
4
Q
With the current scope of dental practice, the dentist must be more knowledgable about a wider range of:
A
medical conditions as patients receive dental treatment
5
Q
Many chronic disorders or their treatments necessitate:
A
modification of dental treatment
6
Q
What sparked the use of gloves in dentistry?
A
Hepatitis (1982)
7
Q
What sparked the use of PPE in dentistry?
A
AIDS (1990)
8
Q
What sparked the use of updated PPE and required vaccines?
A
Covid-19 (2019)
9
Q
Clinicians must practice so that the _____ of dental treatment will ______ of a medical complication occurring either during treatment or as a result of treatment
A
benefits; outweigh the risk(s)
10
Q
When considering the benefits vs. risk, a clinician must take into account:
A
- pre-operative considerations
- intra-operative considerations
- post-operative considerations
11
Q
What doctor stated “a doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment.”
A
Paul Dudley White MD (1876-1973)
(Ushered in the era of modern cardiology)
12
Q
Organized risk assessment in dental care includes:
A
- bleeding
- infection
- drug effects
- availability to tolerate care (CV-Resp-Psych)
13
Q
_____ can be applied to assess risk prior to any oral health care delivery
A
acquired data
14
Q
Acquired data can be applied to assess risk prior to any oral health care delivery using a _____ format
A
P-A,B,C,
15
Q
In the P-A,B,C format, the “P” stands for:
A
Patient evaluation
16
Q
A chief complaint may be:
A
objective or subjective
17
Q
List factors that contribute to “P” patient evaluation: (7)
A
- medical history
- medications
- social & family history
- review of systems
- history of present illness
- objective findings
- CC
18
Q
What are some adjunctive tests & procedures: (8)
A
- Anesthesia
- Histopathology
- Imaging
- Labs
- Microbiology
- Molecular biology
- Refer
- Sequencing
19
Q
Taking blood pressure is an example of:
A
organized risk assessment (P- Patient evaluation)
20
Q
Patient Evaluation includes:
- identify ALL _______
- Review _____
- Examine ______
- Review or gather _____
- Obtain ______
A
- Identify ALL medications & drugs, taken or supposed to be taken
- Review medical history, discuss relevant issues with patient
- Examine patient for signs & symptoms of diease
- Review or gather recent laboratory tests or images
- Obtain a medical consult
21
Q
When should you obtain a medical consult as part of the patient evaluation?
A
- if the patient has poorly controlled or undiagnosed problems
- if you’re uncertain about the patient’s health
22
Q
You should request a medical consult to:
A
confirm & determine level of disease activity/status
23
Q
A medical consult may be used to determine:
A
what precautions may be necessary for dental treatment
24
Q
The precautions necessary for dental treatment are often determined by the: (2)
A
- degree of dental treatment
- level of disease activity/status
25
if you are uncertain about the patients health findings you should request a consult to determine if:
an undiagnosed disease exists
26
In the P-A,B,C format, what foes the "A" stand for?
1. Antibiotics
2. Analgesics
3. Anesthesia
4. Allergies
5. Anxiety
"Al(lergies) was ANXIOUS to get ANTIBIOTICS, ANALGESICS & ANESTHESIA"
27
What should you question about the patients ALLERGIES?
Is the patient allergic to drugs or substances that may be used or prescribed?
28
What should you question about the patient ANXIETY?
Will the patient need or benefit from a sedative or anxiolytic?
29
What questions should be asked about ANTIBIOTICS?
1. Will the patient need antibiotics?
2. Is the patient taking an antibiotic?
30
What questions should be asked about ANALGESICS?
1. Is the patient taking aspirin or NSAIDs that can increase bleeding?
2. Will analgesics be needed post-treatment?
31
What question should be asked about ANESTHESIA?
Are there concerns using a local with or without epinephrine?
32
In the P-A,B,C format, what foes the "B" stand for?
1. Breathing
2. Bleeding
3. BP
33
What question should be asked in regard to BLEEDING?
Is abnormal hemostasis possible?
34
What question should be asked in regard to BREATHING?
Does the patient have difficulty breathing or is the patient's breathing fast or slow?
35
What question should be asked in regard to BLOOD PRESSURE?
Is the patient's BP well controlled or is it possible that it may increase/decrease during dental treatment?
36
In the P-A,B,C format, what foes the "C" stand for?
Chair position
37
What questions should be asked regarding CHAIR POSITINO ?
1. Can the patient tolerate a supine or horizontal position?
2. Is the patient going to have a problem being raised quickly after treatment?
38
In the P-A,B,C format, what foes the "D" stand for?
Drugs & Devices
39
What questions should be asked regarding DRUGS?
Any drug interactions, adverse effects, or allergies associated with drugs currently being taken or drugs that the dentist may prescribe or use?
40
What question should be asked regarding DEVICES?
Does the patient have prosthetic or therapeutic device that may require tailored management?
41
List some examples of prosthetic or therapeutic devices that a patient may present with: (5)
1. prosthetic heart valve
2. prosthetic joint
3. stent
4. pacemaker
5. defibrillator
42
In the P-A,B,C format, what foes the "E" stand for?
Equipment & Emergencies
43
What question should be asked regarding EQUIPMENT?
Any potential issues with the use of dental equipment?
(such as X-ray equipment, electrocautery, oxygen supply, ultrasonic cleaner, apex locator)
44
What question should be asked regarding EMERGENCY?
Are there medical emergencies that can be anticipated or prevented by modifying care?
(such as MI, stroke, asthma, uncontrolled bleeding)
45
In the P-A,B,C format, what foes the "F" stand for?
Follow-up
46
What question should be asked regarding FOLLOW-UP?
Is there any follow up care indicated?
(such as post-op analgesics, antibiotics, anxiety)
47
Post-op instructions for home care ______ and for_____ when necessary
ALWAYS; prescriptions
48
What is the simple rule that determines whether the patient should be contacted at home to assess post-treatment response?
If a local anesthetic(s) are used on a patient and there was bleeding during the appointment, the patient should be contacted that evening or the following day
49
The _____ MUST be taken for every patient who is to receive dental treatment
Medical history
50
T/F: It is okay to skip the medical history documentation if the patient is there for a follow-up
False
51
What are the two basic techniques used to obtain a medical history?
1. interview the patient (ask patient questions, record patient's verbal response - we do this at UMKC through Axium)
2. a printed questionnaire the patient fills out
52
The questions asked when taking a medical history are designed to identify or hint to medical issues that:
may affect dental treatment
53
Medical history questions are designed to identify or hint to medical issues that may affect dental treatment such as:
1. anxiety
2. cardiovascular disease
3. neurologic disorders
4. gastrointestinal diseases
5. respiratory tract diseases
6. musculoskeletal disease
7. endocrine disease
8. STD's
9. cancer & radiation treatment
54
A medical history is different from ______
Review of systems (ROS)
55
T/F: Medical history is synonymous to ROS
False- different
56
If the patient has already been diagnosed, or patient presents with information needing diagnosis this would be charted under:
Medical history
57
What is the goal for ROS?
To screen for potential new diseases
58
What type of approach is used when screening through sign and symptoms during the ROS?
Systems-based approach
59
Even if the result of your ROS findings are consistent with a particular systemic disease, you will not:
Diagnose
60
What should you do if you get findings during the ROS that are consistent with a particular systemic disease?
Referral consultation letter that expresses findings, concerns and basis for ROS
(Its the physicians role to further examine, request labs and diagnose)
61
What category would the following signs and symptoms fall under in the ROS?
- recent weight change
- fatigue
- malaise
- fever
- chills
- night sweats
General
62
What category would the following signs and symptoms fall under in the ROS?
- rashes
- lumps
- ulcers
- dryness
- pruritus (itching)
- finger clubbing
- nail changes
Dermatologic
63
What category would the following signs and symptoms fall under in the ROS?
- headaches
- dizziness
- head trauma
Head
64
What category would the following signs and symptoms fall under in the ROS?
- changes in vision & visual fields
- spots
- floaters
- diplopia
- blurriness
- dryness
- tearing
- itching
Eyes
65
What category would the following signs and symptoms fall under in the ROS?
- hearing loss
- pain
- discharge
- tinnitus
- vertigo
Ears
66
What category would the following signs and symptoms fall under in the ROS?
- stuffiness
- sneezing
- rhinorrhea
- itching
- epistaxis (nose bleeds)
- change in sense of smell
Nose/Sinuses
67
What category would the following signs and symptoms fall under in the ROS?
- bleeding or painful gums
- lesions
- dental pain
- halitosis
- altered taste
- hoarseness
- sore throat
- dysphagia
- neck swelling
Mouth/Throat/Neck
68
What category would the following signs and symptoms fall under in the ROS?
- dyspnea
- chest pain
- wheezing
- cough
- sputum
- hemoptysis
Respiratory
69
What category would the following signs and symptoms fall under in the ROS?
- chest pain
- palpitations
- orthopnea
- dyspnea on exertion
- paroxysmal nocturnal dyspnea
- peripheral edema
Cardiovascular
70
What category would the following signs and symptoms fall under in the ROS?
- appetite changes
- abdominal pain
- nausea
- vomiting
- diarrhea
- constipation
- heart burn
- belching
- bloating
- flatulence
- dysphagia
- bleeding (hematemesis, hemorrhoids, melena, hematochezia)
- jaundice
- ascites
Gastrointestinal
71
What category would the following signs and symptoms fall under in the ROS?
- Frequent urination
- Hesitant urination
- urgent urination
- incontinence
- nocturia
- dysuria
- hematuria
- abnormal genital discharge
- genital lesions
- changes in libido
Genitourinary
72
What category would the following signs and symptoms fall under in the ROS?
- polydispsia
- polyuria
- polyphagia
- heat & cold intolerance
- weight gain or loss
- excessive sweating
- thyroid enlargement or pain
Endocrine
73
What category would the following signs and symptoms fall under in the ROS?
- anemia
- easy bruising or bleeding
- lymphadenopathy
Hematologic
74
What category would the following signs and symptoms fall under in the ROS?
- arthritis
- arthralgia
- pain
- swelling
- redness
- limitations in ROM
- muscle weakness
- trauma
Musculoskeletal
75
What category would the following signs and symptoms fall under in the ROS?
- seizures
- memory loss
- loss of consciousness
- paresthesia
- anesthesia
- muscles weakness
- paralysis
Neurologic
76
What category would the following signs and symptoms fall under in the ROS?
- menopause
- menstrual changes
- dysmenorrhea
Gynecologic
77
What category would the following signs and symptoms fall under in the ROS?
- mood
- anxiety
- depression
- changes in sleep pattern
- decreased ability to concentration
Psychiatric/emotional
78
Asking this question can help you determine the patients ______
"Do you have the ability to engage in normal day-to-day activity?"
Functional capacity
79
According to functional capacity, the ability to perform common daily tasks can be expressed in:
Metabolic equivalent levels (METs)
80
METs:
Metabolic equivalent levels
81
An MET is a:
unit of oxygen consumption
82
Tells you the patients ability to tolerate exercise which is linked to patients overall health:
METs
83
A higher MET corresponds with:
better physical condition
84
1 MET =
3.5 mL of oxygen per kg of body weight per minute at rest
85
List some activities that are considered "light" in regards to MET:
(Less than 3.0 METs)
1. walking- slowly
2. sitting- using computer
3. standing- light work (cooking or washing dishes)
4. fishing- sitting
5. playing most instruments
86
List some activities that are considered "moderate" in regards to MET:
(3.0-6.0 METs)
1. walking- very brisk (4 mph)
2. cleaning- heavy (washing windows, vacuuming or mopping)
3. mowing lawn (walking power mower)
4. bicycling- light effort (10-12 mph)
5. badminton- recreational
6. tennis- doubles
87
List some activities that are considered "vigorous" in regards to MET:
(>6.0 METs)
1. walking/hiking
2. jogging (6 mph)
3. shoveling
4. carrying heavy loads
5. bicycling fast (14-16 mph)
6. basketball game
7. soccer game
8. tennis- singles
88
T/F: Asking a patient "can you walk up two flights of stairs without having to catch you breath" can indicate general cardiovascular and/or pulmonary health.
True
89
T/F: Not all "allergies" are true allergies
True
90
If a patient response "yes" when asked to a particular substance, the mandatory follow-up question should be:
"What happens?"
91
List some examples of reactions that indicate TRUE allergies: (9)
1. anaphylaxis
2. itching
3. urticaria (hives)
4. rash
5. swelling
6. wheezing
7. angioedema
8. rhinorrhea
9. tearing eyes
92
List some examples of reactions that indicate an INTOLERANCE or ADVERSE SIDE EFFECT: (5)
1. nausea
2. vomiting
3. diarrhea
4. heart palpations
5. fainting
93
Treating every patient as if they're infectious:
standar precaution
94
What STDs can have manifestations in the oral cavity:
1. Syphilis
2. Ghonorrhea
3. HIV
95
Some STDs including ________, can be transmitted to the dentist through direct contact with oral lesions or infected blood
1. HIV
2. Hep B
3. Hep C
4. Syphilis
96
T/F: Some STDs including HIV, Hep B, Hep C and Syphilis can be transmitted to the dentist through indirect contact with oral lesions of infected blood
False- only through DIRECT contact
97
The single most common STD in the US:
Chlamydia genitalia infection
(Chlamydia trachnomatis)
98
_____ & ____ are examples of steroids that are used to treat many diseases
Cortisone & Prednisone
99
Steroids are important because their use can result in ______ and the patient is unable to mount a normal response to the stress of infection or invasive dental procedure such as extraction or periodontal surgery
adrenal insufficiency
100
When patients are using steroids, and this results in adrenal insufficiency why might this be a concern as a dentist?
The patient may be unable to mount normal response to stress of infection or invasive dental procedures
101
Steroids can make a patient _____ to some degrees and can also make ____ less likely to work
immunosuppressive; antibiotics
102
The long term use of steroids cause a patient to:
stop making steroids
103
The long term use of steroids cause a patient to stop making steroids, when does this become a concern?
Cardiac crisis
104
T/F: Not every hospitalization has long term reprocussions but it may so its good to know
True
105
History of hospitalizations can provide:
Clues to past illnesses that may have current significance
106
An INDIRECT aspect of your evaluation but an effective way to identify a current condition:
History of operations & hospitalizations
107
Obtaining a history of operations and hospitalizations is considered:
An INDIRECT aspect of your evaluation
108
What questions should you ask the patient in regards to operations?
1. REASON for procedure
2. Any emergencies
3. Post-op bleeding
4. Post-op infection
5. Drug allergy
109
Caution with pregnant patients is warranted with:
1. radiography
2. drug administration
3. timing of dental treatment
110
What trimester is the safest to provide dental treatment?
Second
111
When should radiography be used for dental treatment during pregnancy?
Urgent care ONLY
112
During pregnancy ____ have changed and the patient is more susceptible to _____
endocrine systems; periodontal issues
113
Patients with a history of IV drug use are at an increased risk for diseases like:
1. Hep B
2. Hep C
3. HIV/AIDs
4. Infective endocarditis
114
For what population of patients should sedatives & narcotics be prescribed with a great deal of caution or not at all?
Patients with history of drug abuse
115
For patients with a history of drug abuse, sedatives & narcotics be prescribed with a great deal of caution or not at all, this is because:
Risk of triggering relapse
116
_____ should be avoided for cocaine & methamphetamine users
Vasoconstrictors
117
Why should vasoconstrictors be avoided for cocaine & methamphetamine users?
These agents may cause
-arrhythmias
-severe HTN
-MI
-stroke
118
When talking to about substance use, misuse and abuse, this requires a level of:
professional trust
119
What are we trying to avoid in patients with history of drug abuse/misuse?
Respiratory depression
120
Alcohol consumption is a risk factor for:
many cancers & other diseases
121
Alcohol consumption may lead to ____ which can cause many complications
liver cirrhosis
122
What should you ask the patient in regard to alcohol use?
How many standard drinks per week
123
The national institute of alcohol abuse and alcoholism came up with minimally acceptable amount of alcohol =
4 drink units per day or 8 per week (men)
3 drink units per day or 7 per week (women)
124
T/F: Men & women should not regularly exceed 12 units per week of alcohol
False- 14 units
125
Wine drinking can lead to:
1. liver toxicity
2. delayed healing
3. dementia
4. bleeding issues
126
Tobacco use poses a risk for:
many cancers and other diseases (especially oral cancer)
127
What should you ask a tobacco user?
1. type of tobacco
2. frequency of use
3. years of usage
(to establish cumulative risk, current & past)
128
T/F: Smoking tobacco is much more detrimental than chewing tobacco
True
129
Describe the parameters of the following when discussing amounts:
1. cigarettes
2. smokeless tobacco
3. hookah
4. e-cigarettes
1. packs/day
2. cans/week
3. hours/week
4. cartridges/week
130
Asking your patient about occupation, marital status, and children are examples of:
Social parameters
131
Why might we ask the patient about their occupation?
To determine environmental/occupational risk
132
Why might we ask the patient about their marital status?
To determine social support
133
Social parameters can be very personal but can effect:
patient compliance with treatment
134
Gives insight to potential disease with heritability:
Family history
135
In regards to family history, we should watch out for signs and symptoms of:
1. HTN
2. DM
3. autoimmune disease
4. cancer
5. other hereditary disease & syndromes
136
What questions may we ask the patient to get info on their family history?
1. do any disease run in your family?
2. are your parents & siblings alive and well?
3. what did your (mother/father/sibling pass of?)
137
T/F: What we do may affect the patients medications. What medications the patient takes may affect our dental treatment.
Both statements true
138
_____ is a good way to initiate the medical history
Checking the medications first
139
Give some examples of signs and symptoms of drug-related adverse effects:
1. bleeding
2. immunosuppression
3. BP
4. MRONJ
140
T/F: Patients typically list all medications including OTC drugs & herbal medicines
False
141
During the physical examination, objective findings include:
1. vital signs
2. general appearance
3. skin
4. fingers
5. nails
142
What are we checking on the head & neck examination?
1. skin
2. eyes & nose
3. ears
3. cranial nerves
5. neck examination
6. intra-oral examination
143
Vital signs include:
1. BP
2. Pulse
3. Respiratory rate
4. temperature
5. height
6. weight
144
In a dental setting, what vital signs are typically taken?
Only BP & pulse
(these are the only measured DIRECTLY)
145
Respiratory rate is taken by:
observation
146
A normal respiratory rate:
12-16 r/m
147
____ is measured when infection or systemic involvement is suspected
temperature
148
Height and weight are determined by:
asking the patient (in dental setting)
149
Vital signs are used to establish:
a baseline
150
What is the purpose of taking vital signs?
Detection of abnormality NOT diagnosis
151
The purpose of taking vital signs is for detection of an abnormality, NOT diagnosis. Diagnosis is the responsibility of:
the physician
152
Why is it important to check BP?
1. screening (you may be the first to detect)
2. monitoring (compliance/control/progression)
3. risk assessment (potential serious complications)
4. treatment modifications
153
T/F: Blood pressure is variable so multiple readings are really the most appropriate
True
154
Is blood pressure a direct or indirect measurement?
indirect
155
The blood pressure cuff should encompass ____% of the circumference of the arm. The cuff should center over the _____
80%
brachial artery
156
What happens if the blood pressure cuff is:
-too small
-too big
too small --> falsely elevated values
too big --> falsely low values
157
White coat HTN can elevate the BP by:
30 mmHg
158
If pregnant patient has a greater than or equal to increase of ____ from baseline increase in systolic BP this poses a risk for _____ and you should _____
10 mmHg; eclampsia; immediately refer
159
Blood pressure helps to identify patients at risk of:
cardiovascular disease
160
Arm position matters when taking BP. The arm should be:
Horizontal at heart level (mid-sternum)
161
When the arm position is _____ heart level, this OVER-ESTIMATES systolic and diastolic pressures
Below
(similar to cuff being too small)
162
When the arm position is _____ heart level, this UNDER-ESTIMATES systolic and diastolic pressures
Above (similar to cuff being too big)
163
_____ method of BP measurement is universally accepted
auscultation
164
Describe how to take a blood pressure:
1. BP cuff should be inflated until radial pulse disappears; then add additional 20-30 mmHg
2. Slowly turn release valve. Fall rate of needle should be around 2-3mmHg per second
3. Listen for sounds - these sounds are the systolic pressure
4. As needle continues to fall, the beat will become louder and then diminish
5. listen for weekend beats & when sounds disappear completely this = diastolic pressure
164
When taking a blood pressure, the first audible sound:
Korotkoff sounds (beating sounds)
165
The pressure point of the first audible sound (Korotkoff sounds) =
systolic pressure
166
What is the reliable index of diastolic pressure?
Point when sound disappears completely
167
How can you ensure an accurate measurement of BP?
1. Pt avoids caffeine exercise & nicotine
2. Pt empty bladder prior to measurement
3. Have patient relax for 5 min prior to measurement
4. support limb when taking BP
5. don't take BP over clothes
6. take 2-3 readings on 2-3 occasions
168
What BP range falls under the classification:
-normal:
-elevated:
-stage 1:
-stage 2:
-hypertensive crisis:
-normal: LESS THAN 120/80
-elevated: (120-129) / LESS THAN 80
-stage 1: (130-139) / (80-89)
-stage 2: GREATER THAN OR EQUAL TO 140 / 90
-hypertensive crisis: GREATER THAN OR EQUAL TO 180 / 120
169
Categorize the following BP measurement:
180/120
Hypertensive crisis
170
Categorize the following BP measurement:
120/81
elevated
171
Categorize the following BP measurement:
118/76
normal
172
Categorize the following BP measurement:
132/80
Stage 1
173
Categorize the following BP measurement:
140/ 90
Stage 2
174
When classifying a patients BP, you need:
at least 2 readings on at least 2 separate visits
175
At UMKC, we will not perform any dental care on a patient if their BP is:
Greater than or equal to 180/110 mmHg
176
180/120 is classified as a _____ by the _____ based on the 2017 guidelines
Hypertensive urgency; AHA
177
If your patient presents with 180/120 BP and is asymptomatic this requires:
urgent referral to doctor
178
If your patient presents with 180/120 BP and is symptomatic this requires:
emergency room!
179
What is the standard for assessing pulse?
Palpate carotid artery at side of trachea (the most reliable)
or
Palpate radial artery on thumb side of wrist
180
Do NOT use the _____ for pulse detection
thumb
181
Classify the following pulse ranges:
-normal:
-tachy:
-brady:
-normal: 60-100
-tachy: >100
-brady: <60
182
Abnormal pulse rate may be a sign of:
cardiovascular disorder
183
Pulse may be influenced by:
1. exorcise/conditioning
2. anemia
3. anxiety
4. drugs
5. fever
184
The normal pulse is:
a series of rhythmic beats at regular intervals
185
Irregular beats are described as:
1. irregular
2. dysrhythmic
3. arrhythmic
186
Palpate the pulse for a _____ for accuracy if a _____ is suspected
full minute; arrythmia
187
Rate and depth of breathing noted by careful observation of movement of the chest and abdomen in the quietly breathing patient:
respiration
188
Normal respiration rate in adults:
12-16 breaths/min
189
Respiratory rate in small children is ____ compared to adults
higher
190
Abnormal breathing patterns (respiration) include:
1. labored breathing
2. rapid breathing
3. irregular breathing patterns
191
Abnormal breathing patterns may be signs of:
systemic problems, especially cardiopulmonary disease
192
A common respiration finding in apprehensive patients is _____
Hyperventilation (rapid, prolonged, deep breathing or sighing)
193
A common respiration finding in apprehensive patients is hyperventilation (rapid, prolonged, deep breathing or sighing). This may result in:
lowered carbon dioxide levels
194
Rapid weight loss may be a sign of:
1. malignancy
2. diabetes
3. tuberculosis
4. neoplasm
5. other wasting disease
195
Rapid weight gain may be a sign of:
1. heart failure
2. edema
3. hypothyroidism
4. neoplasm
196
A lot can be determined by the patients health from a purposeful but:
tactful visual inspection
197
Changes in the skin & nails can be associated with systemic disease, what are some examples?
1. cyanosis
2. jaundice
3. pigmentation
4. petechia or ecchymoses
198
What can the following changes indicate in a patients skin & nails?
1. cyanosis
2. jaundice
3. pigmentation
4. petechia or ecchymoses
1. cardiac or pulmonary insufficiency
2. liver disease
3. hormonal abnormalities
4. blood dyscrasia or bleeding disorder
199
Alterations in finger nails are usually seen in:
chronic disorder
200
Alterations in finger nails is usually seen in chronic disorders such as:
1. clubbing
2. white discoloration
3. yellowing
4. splinter hemorrhages
201
The following signs on the fingernails are associated with what chronic diseases?
1. clubbing
2. white discoloration
3. yellowing
4. splinter hemorrhages
1. cardiopulmonary insufficiency
2. cirrhosis
3. malignancy
4. infective endocarditis
202
______ hand surfaces are common for actinic keratosis & basal cell carcinomas
Dorsal
203
A raised, darkly pigmented lesion with irregular borders could be:
melanoma
204
List some characteristics of melanoma:
1. darkly pigmented
2. irregular borders
3. raised
205
_____ & ____ of the face are abnormal in many syndromes & conditions
shape & symmetry
206
List some well-regarded examples of syndromes and conditions that may result in face & symmetry changes in the face:
1. Acromegaly- coarse & enlarged features
2. Cushing syndrome- moon face
3. Bell's palsey- unilateral paralysis
207
T/F: Eyes can be indicators of systemic disease and should be inspected closely. Patients wearing glasses should be asked to remove them during examination of head & neck
Both statements true
208
Involving the eyes & nose, give an example of an indicator of hyperthyroidism:
lid retraction
209
Involving the eyes & nose, give an example of an indicator of hypercholesteremia:
xanthomas of the eyelids
210
Involving the eyes & nose, give an example of an indicator of liver disease (problem metabolizing drugs):
yellowing of sclera
211
Involving the eyes & nose, give an example of an indicator of allergy or sicca syndrome:
conjunctiva reddening
212
An earlobe crease may be an indicator of:
CAD
213
Examination of the head & neck may vary in its comprehensiveness bu should include:
inspection & palpation of:
1. soft tissues of oral cavity
2. maxillofacial region
3. neck
(as well as evaluation of the cranial nerve function)
214
What do we look for when physically examining the neck?
1. normal or enlarged?
2. soft or hard?
3. mobile or fixed?
4. tender or non-tender?
215
What may be some causes of abnormal findings in the neck?
1. infections
2. goiter
3. cysts
4. massess
5. vascular deformities
216
List the groups of lymph nodes that should be palpated in a head & neck examination:
1. pre-auricular
2. post-auricular
3. tonsillar
4. submandibular
5. anterior cervical
6. posterior cervical
7. supraclavicular
217
Describe how you may want to organize the appointment for a patient with known dental anxiety:
1. short appointments
2. usually in morning
3. pre-dental treatment sedation (1hr prior to appt)
4. sedation during treatment (nitrous oxide)
5. profound local anesthesia
6. post-dental pain control
7. patient contacted the evening of the procedure
218
What type of drugs may be prescribed for to be taken 1 hour prior to treatment for an anxious patient? Give an example:
Benzodiazepines; Triazolam .25mg
219
Indications for laboratory testing in dentistry include:
1. aid in detecting suspected disease
2. screen high-risk patients for undetected disease
3. establish normal baseline values before treatment
4. address medical-legal considerations
220
Common labs a dentist may order include:
1. CBC (complete blood count with platelets & WBC differential)
2. prothrombin time
3. partial thromboplastin time
221
What measurements may be found on a CBC? Include normal values:
1. RBC: 4.2-5.9 million/mm3
2. WBC: 4-10 thousand/mm3h
3. PLT count: 150k-400l/mm3
222
The prothrombin time test is:
International normalized ratio (PT-INR)
223
What is the purpose of a prothrombin time test (PT-INR)?
Helps to determine bleeding risk & measures extrinsic & normal coagulation cascade pathways
224
What is considered a normal INR (from a PT-INR test)?
normal = 1
For patient on Coumadin = 2-3
225
What does a higher INR indicate?
Higher bleeding risk
226
P.T.T:
Partial thromboplastin time
227
PT-INR:
Prothrombin time- international normalized ratio
228
The P.T.T measures the ____ pathway
intrinsic
229
Normal range for a P.T.T=
25-38 seconds
230
aPTT is ______ and is used for _____
activated PTT; Pradaxa
231
A _____ record is a legal record
written
232
T/F: Risk is sometimes increased when treating a medically complex patient
False- ALWAYS
233
When dealing with a complex patient, plan around:
likelihood of most severe complication
234
ASA:
American Society of Anesthesiologist
235
Assign an ASA classification for the following situation:
A normal healthy patient
ASA 1
236
Assign an ASA classification for the following situation:
A patient with mild systemic disease
ASA 2
237
Assign an ASA classification for the following situation:
A patient with severe systemic disease
ASA 3
238
Assign an ASA classification for the following situation:
A patient with severe systemic disease that is a constant threat to life
ASA 4
239
Assign an ASA classification for the following situation:
A moribund patient who is not expected to survive without operation
ASA 5
240
Assign an ASA classification for the following situation:
A patient declared brain-dead whose organs are being removed for donor purposes
ASA 6
241
Higher ASA status (2-6) increases with:
increasing age
242
ASA classification that poses little or no risk during treatment:
ASA 1
243
ASA classification that poses minimal risk during treatment:
ASA 2
244
ASA classification of a patient that can walk up one flight of stairs or two level city blocks but has to stop on the way because of distress:
ASA 3
245
For ASA 3 patients, if dental care is needed, ____ & other ____ are indicated
stress reduction protocols; other treatment modifications
246
T/F: 30 days or more ago history of Myocardial infarction, cerebrovascular accident & CHF place a patient in the classification of ASA 4
False- ASA 3
247
What is the ASA classification for patient that has severe systemic disease that is a constant threat to life?
ASA 4
248
What is the ASA classification for a patient unable to walk up 1 flight of stairs or two level city blocks. Distress is present at rest.
ASA 4
249
Elective dental care should be postponed until the patient is an:
ASA 3
250
Emergency dental care for an ASA class 4 patient:
may be best in a hospital with a consultation of the patients physician team
251
What is the ASA classification, for a paten with unstable angina, MI or CVA in the last 30 days?
ASA 4
252
What is the ASA classification for:
-severe CHF
-moderate to severe COPD
-uncontrolled HTN
-uncontrolled DM
-uncontrolled epilepsy or seizure disorder
ASA 4
253
