Medical Hx Taking Flashcards
(80 cards)
1
Q
risk assessment before tx
A
- Obtain Medical Hx, Dental, family and Social Hx and risk assess
- Assess pt needs and agree with pt
- Pt valid consent for investigations and then again for Tx plan
2
Q
for anaesthetism confirm
A
- Before anaesthesia induction (sign in)
- Before skin incision (time out)
- Before pt leaves operating theatre (sign out)
3
Q
8 factors influencing outcome of healthcare procedures
A
- Health of pt
- Type of procedure
- Duration of procedure
- Degree of trauma and stress
- Degree of urgency of procedure
- Skill and experience of operator
- Skill and experience of anaesthetise
- Facilities and equipment
4
Q
5 ASA Classes
A
I
- normal healthy pt
II
- mild systemic disease (well controlled diabetes, asthma, hypertension, epilepsy, pregnancy, anxiety)
III
- severe systemic disease limiting activity but not incapacitating (frequent seizures, uncontrolled hypertension, MI, severe asthma, stroke)
IV
- incapacitating disease constant threat to life (cancer, angina, MI, arrhythmia, recent stroke)
V
- moribund pt not expected to live more that 24hours with or without Tx
5
Q
ASA I
A
normal healthy pt
6
Q
ASA II
A
mild systemic disease
(well controlled diabetes, astham, hypertension, epilepsy, pregnancy, anxiety)
7
Q
ASA III
A
severe systemic disease limiting activity but not incapacitating
(frequent seizures, uncontrolled hypertension, MI, severe asthma, stroke)
8
Q
ASA IV
A
incapacitating disease constant threat to life
(cancer, angina, MI, arrhythmia, recent stroke)
9
Q
ASA V
A
moribund pt not expected to live more than 24hours with or without Tx
10
Q
ASA is
A
American Society of Anestheiologists
11
Q
Chronic obstructive pulmonary disease
COPD
stages
A
ASA II
- cough or wheeze, well controlled
ASA III
- breathless on minimal exertion
12
Q
angina
stages
A
ASA II
- occasional use of glyceryl trinitrate (GTN)
ASA III
- regular use of GTN
- unstable angina
13
Q
asthma
stages
A
ASA II
- well controlled with inhalers
ASA III
- poorly controlled
- limiting lifestyle
14
Q
hypertension
stages
A
ASA II
- well controlled on single agent
ASA III
- poorly controlled
- multiple drugs
15
Q
diabetes
stages
A
ASA II
- well controlled
- no complications
ASA III
- poorly controlled
- complications
16
Q
ASA I
dental care modifications
A
none
17
Q
ASA II
dental care modifications
A
dental care should focus on elimination of acute infection before medical/surgical procedures (e.g. prosthetic cardiac valve)
18
Q
ASA III
dental care modifications
A
dental care should focus on elimination of acute infection and chronic disease before medical/surgical procedure (e.g. organ transplant pts)
19
Q
ASA IV
dental care modifications
A
all potential dental probelms should be corrected before medical/surgical procedure (e.g. prior to radiotherapy to head and neck)
20
Q
ASA V
dental care modifications
A
control of acute dental pain and infection only
21
Q
consent to Tx
discuss
A
- Details of diagnosis and prognosis with and without Tx
- Uncertainties
- Options
- Purposes of all components of proposed investigations and Tx
- Likely benefits and probability of success
- Adverse effects and risks of the
- Outcomes of no Tx
- Need for drains, catheters etx
- Right to change mind at any stage
- Right to second opinion
- Time of appointment or admission
- Eating/starving instructions
- Management of daily Mx
- Pre-op specific instructions
- Anaesthetic issues
- Duration of procedure and recovery time, and likely discharge date
- Post-op care
- Follow up requirements
22
Q
allergies features
A
range from urticaria to anaphylaxis
common
- latex, Iodine, Elastoplat, Drugs (LIED)
- anaesthetics
- analgesics (aspirin, codeine)
- antibiotics (penicillin)
23
Q
bleeding disorders features
A
bleeding and/ or bruising
family history?
hospital admissions?
hazard in dental surgery
24
Q
cardiorespiratory disorders features
A
wheezing, cough, dyspnoear, chest pain, swelling of ankles, palpitations, hypertension
sputum?
mobility capacity?
often contraindication to GA or CS
25
drug treatment Qs
include OTC, herbal, inhalers - all
## Footnote
interactions - with GA (IV or IH), monoamine oxidase inhibitors and antihypertensive drugs
NSAID may be hazard - anticoagulated, asthmatic, diabetic, pregnant, GI disorders, under 16yo
26
endocrine disorders features
diabetes mellitus - can collapse, irritable, lassitude, anorexia, weight loss
* **hypoglycaemic attack**
hyperthyroidism - heat intolerance, emotional lability, sweating, diarrhoea, weight loss with inc appetite, tremor, palpitations, visual disturbances
hyperadrenocarticism - weight gain and redistribution (moon face, buffalo hump) purpura
hypoadrenalism - weakness, weight loss, hypotension, pigmentation
27
fits or faints features
type? frequency? precipating factors?
28
gastrointestinal disorders features
abdominal pain, frequency and type of stool, bleeding and weigh loss
difficulty swallowing? indigestion? nausea/ vomitting? bowel habit (colour, consitency, blood, times)?
Crohns disease or coeliac disease may lead to oral complications
vomitting - erosion
29
hospital admissions and attendances
underlying health issues
reaction to GA?
30
infections features
rashes, fevers etc
follow standard SOPs
31
jaundice and liver disease features
hepatitis carrier?
prolonged bleeding
impaired drug metabolism
32
Kidney disorder features
hypertension, pallow, brusing
issues passing urine - haematuria, nocturia, polyuria, dysuria, incontinence
excretion of some drugs impaired
*tetracyclines in lower dose*
renal failure or transplant complications can have oral signs
33
prenancy features
any essential procedures involving drugs, radiography or GA should be arranged in middle trimester
periodontal issues possible
34
neurological problems features
movement disorders can disrupt operative procedures - allow time
access can be barrier to care
35
potential drugs if end in
-am
bensodiasepines
diazepam, alprazolam
36
potential drugs if end in
-ase
fibrinolytics
streptokinase
37
potential drugs if end in
- apine
- azine
antipsychotics
clozapine, carprazine
38
potential drugs if end in
-asone/one
corticosteroid
cortisone, predinolone, hydrocortisone, dexamthasone
39
potential drugs if end in
-azole
antifungals
fluconazole, clotrimazole
40
potential drugs if end in
-azosin
alpha adrenoreceptor blockers
afluzosin
41
potential drugs if end in
-cillin
penicillin
amoxicillin
42
potential drugs if end in
-cin
some antimicrobials
ofloxacin
43
potential drugs if end in
-coxib
newer non-steroidal anti-inflammatory drugs (NSAID)
celecooxib
44
potential drugs if end in
-cycline
tetracycline
45
potential drugs if end in
-dopa
antiparkinsonian agents
levodopa (dopamine receptor agonists)
46
potential drugs if end in
-dronate/dronic
bisphosphonates
alendronate, risedronate
47
potential drugs if end in
-erol
betal 2 agonists (used in asthma)
albuterol
48
potential drugs if end in
-gatran
New Oral AntiCoagulants NOACs
apixaban, dagibatran
49
potential drugs if end in
-imab/umab
monoclonal antibodies (MoAbs)
50
potential drugs if end in
-ipine
calcium channel blockers
amlodipine, felodipine
51
potential drugs if end in
-lukast
leukotriene-receptor antagonists
52
potential drugs if end in
-navir
protease inhibitors
ritonavir
53
potential drugs if end in
-nitrate
nitrates
54
potential drugs if end in
-olol
beta blockers
atenolol, bisprolol
55
potential drugs if end in
-ovir
antivirals
acyclovir
56
potential drugs if end in
-parin
heparins
57
potential drugs if end in
-prazole
protein pump inhibitors PPIs
omeprazole
58
potential drugs if end in
-pril
angiotensin-coverting enzyme inhibitors (ACEIs)
enalpril, benazepril
59
potential drugs if end in
-sartan
angiotensin-receptor anatagonists
losartan
60
potential drugs if end in
-statin
statins
fluvaststin, atrovastatin
61
potential drugs if end in
-terol
beta 2 adrenergic agonist
albuterol, levalbuterol
62
potential drugs if end in
-tidine
H2 receptor anatagonists
cimetidine, ranitidine
63
potential drugs if end in
-vudine
nucleoside reverse transcriptase inhibitors (NRTIs)
lamivudine
64
NAD
no abnoramlities detected
65
NKDA
no known drug allergies
66
plavex
trade name for
clopidrogrel
67
imp to ask about
* Bone strengthening drugs – once a year, tablet, IV or monthly – bisphosphonates
* Calcium channel blockers effect gingiva
* diabetes
* inhalers
* previous traumas
* warfarin - INR
68
oral side effect of
citalopram, fluxetine
dry mouth
69
oral side effect of
ACE inhibitors
angio-oedema
70
oral side effect of
aspirin
burn / ulcer
71
oral side effect of
nicorandil, methotrexate
ulcerations
72
oral side effect of
Nifedipine
gingival hypertrophy
| (Ca Channel blocker)
73
oral side effect of
phenytoin
gingival hypertrophy
| (anti-epileptic)
74
oral side effect of
antimalarials
pigmentation
75
oral side effect of
tetracycline
tooth staining
76
oral side effect of
CHX mouthwash
tooth staining
77
which systemic diseases commonly have oral manifestation
lichen planus
diabetes
heart disease
78
diet factos
frequncy of sugar and acid
longevity of restorations etc
79
xerostomia
dry mouth
* unpleasant for pt
* reduced buffering effect saliva
* caused by disease (sjogrens) or drugs (antidepressants)
* radiation therapy - glandualr fibrosis
* gland issues
80
4 tissues that make up periodontium
bone
cementum
PDL
gingiva
without a solid foundation tooth is deemed to fail
