Module 4 Exam 2 Flashcards
(136 cards)
1
Q
What organs does HTN have a signifcant impact on?
A
kidneys, heart, brain, eyes
2
Q
What is blood pressure in HTN?
A
- pressure against walls of artery
- blood in vessel is greater than the space available
- pumping of heart is source of pressure
3
Q
What arteries have the highest blood pressure?
A
Those that are closest to the heart
4
Q
What is systolic pressure?
A
pressure created when ventricles contract
5
Q
What is diastolic pressure/
A
pressure that exists when ventricles relax
6
Q
When do you refer a patient to their dr?
A
when BP is 160/100 or greater
7
Q
What are 3 factors that creat pressure in hypertension?
A
cardiac output
peripheral resistance
blood volume
8
Q
What does increased viscosity =
A
increased resistance
9
Q
What does a decrease in volume =
A
decreased resistance
10
Q
What does a increase in volume =
A
increased resistance
11
Q
What is the basic underylying defect in hypertension?
A
a failure in the regulation of vascular resistance
12
Q
In young adults prevalance of HTN is greater in _____ than ______ and in adults the _____ is true
A
men, women, reverse
13
Q
What is the etilogy of hypertension?
A
- increase Na intake
- genetics
- stress
- smokin
- left ventricular hypertrophy
- obesity
- excessive alcohol intake
- physical inactivity
14
Q
What is the pahophysiology of HTN?
A
- normal increase with age
- untreated decreases lifespan 10-20 years
15
Q
What does sustained HTN eventually result in?
A
aterial damage and multiple complications
renal failure, cerebrovascular accident, MI, congestive heart failure, blindness
16
Q
What are the classificationf of HTN?
A
- essential-primary-idiopathic
- Secondary
17
Q
90% of patients are diagnosed with what kind of HTN?
A
essential-primary-idiopathic
18
Q
What is secondary HTN?
A
- has existance of underlying/assiciated condition
- endocrine disorders
- neurologic disorders
- sleep apnea
19
Q
What is the most common cause of secondary HTN?
A
renal disorders
20
Q
What are the oral manifestations of HTN?
A
- xerostomia
- ulcerations
- Lichnoid reactions
21
Q
What causes xerostomia in HTN?
A
diuretics and other antihypertensive medications
22
Q
What causes ulcerations in HTN?
A
medications
23
Q
What causes lichenoid reactions in HTN?
A
thiazides, methyldopa, propraolol, labetalol
24
Q
What is methyldopia used in tx of?
A
parkinsons
25
What is the good choloesterol? bad?
HDL, LDL
26
What is the nonpharmacologic medical management of HTN?
- weight loss
- restricion of NA
- moderation of alcohol intake
- diet
- smoking cessation
- exercise
- relaxation therapy
27
What can we do in the dental office to manage HTN?
- reduce anxiety
- avoid long stressful appts
- avoid sudden changes in chair position
- eval before administering LA with vasoconstrictors
28
What is congestive heart failure?
inability of the ventricles to pump enouch blood the meet metabolic demands
29
The amound of blood recieved by the rt side should ________ that ejected by the left side
equal
30
What does heart failure most often begin with?
left ventricular failure initated by increased work load, disease of the myocardium
31
What does left ventricular failure in CHF lead to?
- hypertrophy of ventricle
- fluid accumulation in lungs
- cough
- shortness of breath
32
What is left ventricular failure often referred to as?
congestive heart failure
33
What is the most common cause of right-sided heart failure?
preceding failure of left ventricle
34
What happens in right sided heart failure?
blood backs up into peripheral veins, peripherial edema
35
What is intial right sided heart failure associated with?
congenital heart defects or emphysema
36
What is a class 1 on the NYHA Classification of CHF?
- no limitation
| - no signs or symptoms
37
What is a class 2 on the NYHA classification of CHF?
- slight limitation
| - Slight fatigue, palpitations, dypnea
38
What is a class 3 on the NYHA classification of CHF?
- marked limitation of physical activity
| - less than normal activity -->symptoms
39
What is a class 4 on the NYHA classification of CHF?
- symptoms are present at rest
| - worsen on ANY physical exertion
40
Can you use vasoconstrictors on a class 3 or 4 NYHA classification of CHF patient?
NO
41
What are signs and symptoms of heart failure?
- rapid, shallow breathing
- Cheyne-Stokes respiration
- Inspiratory rales (crackles)
- heart murmer
42
What are cheyne stokes respirations?
hyperventilation alternating with apnea during sleep
43
What are some other signs and symptoms of heart failure?
```
gallop rythym
pulsus alternans
distended neck veins
orthopnea
clubbing of fingers
cyanosis
fatigue
extercise intolerance
```
44
What is acites?
Accumulation of fluid in the peritoneal cavity
45
What is the peritoneal cavity?
space between parietal peritoneum and visceral perioteum which separate organs in the abdominal cavity
46
What is the most common cause of acites?
liver disease (portal hypertension)
47
What are some other causes of acites?
sodium and water retention (kidney failure)
| congestive heart failure
48
What is pitting edema?
pressure indentation that persists when pressure is removed
49
What is teh most common systemic cause of pitting edema?
cardiac/liver/kidneys
50
What is the most common local cause of pitting edema?
varicose veins/thrombophlebitis
51
Is there a relationship between pulmonary edema and cardiac dysfunction?
Yes
52
What are oral manifestations of CHF?
```
-infection
bleeding
petechiae
ecchymoses
Drug related: xerostomia, lichenoid lesions
```
53
What kind of dental tx is done a on a person with untreated or unconrolled CHF?
No elective dental care, physician consult recommended, ID meds
54
What kind of dental tx is done on a person with controlled CHF withno complications?
They can recieve routine dental care
55
What is the hierarchy of oxygen deprivation in heart disease?
coronary artery disease leads to ischemia which leads to infarction
56
What is coronary artery disease?
partial or complete blockage of coronary arteries, any reduction in blood supply to the heart produces a reduction in cardiac preformance
57
What isthe most common cause of coronary artery disease?
atherosclerosis/arteriosclerosis
58
What is athero/arteriosclerosis?
formation of fatty acid deposits and plaque
59
What is a thrombus?
fracture of deposit (embolus)
60
What two types of coronary artery disease?
isolated or diffuse
61
What is Ischemia?
insufficent blood supply resulting from compromised regional blood vessels
62
In ischemia cells remain alive but cannot function normally. T/F
True
63
Persistent ischemia or complete collusion of coronary artery results in what
infarction
64
What is the leading cause of death in the US?
Coronary artery disease
65
How many teenageras already have pathologic intimal thickening of the coronary arteries
1 in 6
66
What is myocardial ischemia?
decrease in 02 to the myocardium
67
How is a myocardial ischemia manifested?
brief pain- angina pectoris
Prolonged pain- myocardial infarction
suddend death
68
What are major risk factors for myocardial ischemia?
- physical inactivity
- obesity
- mental stress
- depression
69
What is the pathophysiology of myocardial ischemia?
- accumulation of lipid laden cells in blood vessels
- fibrous reaction occurs causing thickening of endothelium
- lipid laden cells rupture (LDL)
70
What happens after lipid laden cells rupture in myocardial ischemia?
- calcification of ruputured material
| - additional thickening
71
What is a fatty streak?
early benign deposit, everyone has
72
what is a fibrous plaque?
lipid-laden cells plus fibrous connective tissue
73
what is a complicated plaque?
degenerative leison consisitng of fibrin, fibrous tissue, calcium, and lipid deposits
74
what is the effect of persistent ischemia or the complete occlusion of the coronary artery?
cause infarction/death of the deprived myocardial tissue
75
What does infarction constitute in myocardial ischemia?
an often fatal heart attack
76
What is the most important symptom of myocaridal infarction?
PAIN
77
What does angina pectoris feel like?
aching, heavy, squeezing pressure or tightness in the midchest area
78
Where may the pain radiate in a myocardial infarction?
-down left or right arm
-neck
lower jaw
79
What is the prolonged pain like in an MI?
- more severe in nature
| - not relieved by vasodilators/nitroglycerin, cessation of activity
80
What are some other possible symptoms of an MI?
palpitations, syncope
81
What is stable angina?
- predictibly reproduced (walkin, stairs)
- consistent over time
- pain in releived by cessation of activity or nitroglycerin
82
How should you manage patients with stable angina or a history of MI more than 6 mo ago?
- short, morning appts, semisupine chair position
- nitroglycerin tabs available
- good pain control
83
What is a cardiac arrythmia?
any variation in the normal rythm of the heartbeat
84
What may an arrythmia be?
disturbance of rythm, rate, conduction
85
What kind of people are arrythmias found in?
healthy people and those with cardiovascular disease
86
what are some general causes of arrythmias?
- cardiovascular diseases
- pulmonary disorders
- autonominc diseases
- drug related side effects
- electrolye imbalances
87
What node is the pacemaker?
SA node
88
What is an example of AV tachycardia?
Wolff-Parkinson-WHite
89
What is Wolff-Parkinson-White?
abnormal conduction pathway between the sinus and ventricles. stimulate ventricles to contract prematurely
90
What is bradycardia?
heart rate less than 60/min
91
What is tachycardia?
heart rate greater than 100/min (at rest)
92
When does ventricular tachycardia almost always occur?
with diseased heart b/c heart is work so hard to get oxygen out
93
What is ventricular fibrillation?
irregular, chaotic activity of ventricles
94
are contractions in ventricular fibrillation effective?
no they are rapid but ineffectivwe
95
What happens if ther eis not interventin in ventricular fibrillation?
death
96
What is the most commmon form of heart disease predisposing ventricular fibrillation?
ischemic heart disease
97
What is ventricular asystole?
no pulse- defibrillation
98
What are signs and symptoms of cardiac arrythmias?
- bradycardia
- tachycardia
- palpitaions
- fatigue
- dizziness
- syncope
- angina
- CHF
- irregular rhythm
99
How are arrythmias managed medically?
medication, pacemaker, defibrillator, surgery
100
What are electromagnetic interferences in the dental field?
electro surgery, ultrasonic bath cleaners, US scalers
101
What is chronic obstructive pulmonary disease?
generalized term for pulmonary disorders characterized by chronic airflow limitation from the lungs- is not fully reversible
102
What are the most common diseases classified as COPD?
chronic bronchitis, emphysema
103
Emphysema is a problem getting air
out of lungs
104
What is the most important factor in the etiology of COPD?
cigarette smoking
105
What increases a persons risk of COPD?
-# of cigarettes and how long they have been smokin
106
What are some other causes besides smoking of COPD?
- chronic exposure to environmental pollutants
| - chronic allergies
107
What is chronic bronchitis?
-inflammation of the mucous membrane of the bronchial airways, excessive mucous production, thickened bronchiol walls, chronic cough with sputum
108
What is obstruction caused by in chronic bronchitis?
- narrowing or collapse of airways
- mucous plugs
- loss of surfactant
109
Is chronic bronchitis present on inspiration or expiration?
Both
110
What is emphysema?
enlargement of air spaces distal to terminal bronchioles, destruction of alveolar walls, loss of elastic recoil
111
is emphysema present on inspiration or expiration?
expiration
112
What are complications of emphysema?
- pulmonary hypertension
- right sided heart failure
- hypoxemia
- debilitation
- no cure
113
How should we manage a patient in the dental chair with COPD?
- semisupine or upright chari position
- no bilateral blocks
- low flow oxygen
- no rubber dam or sedatives
114
Is nitrous contraindicated in COPD?
yes, because the drug may acumulate in the tissues
115
What is asthma?
chronic inflammatory respiratory disease, associated with increased airway hyperresponsiveness
116
What do asthmatics have recurrent episodes of?
dyspnea, coughing, weezing
117
What is asthma provoked by?
-allergens
-upper respiratory infections
-exersice, cold air, stress, emotions
smoke
nervousness
118
What ist he obstruction of airflow the result of in asthma?
- bronchiol smooth muscle spasm
| - inflammation of bronchiol mucosa with mucosal hypersecretion
119
What is the etiology of asthma?
- multifactoral
| - extrinsic, intrinsic, food induced, severe, exercise induced, infections
120
WHat is extrinsic induced asthma?
most common
| triggered by allergens
121
What in intrinsic induced asthma
- no known cause
| - triggered by stress
122
WHat is drug induces asthma?
triggered by aspirin, NSAIDS
123
What is food induced asthma?
-nuts, shellfish, strawberries, peanuts, food coloring, preservatives
124
What are signs and symptoms of asthma?
- sudden onset of coughing and wheezing
- respirations difficult
- termination of attack is accompanied by a productive cough with thick mucous
125
What is mild asthma?
- symptoms only when exposed to stimulant
| - occus less than 2x week
126
What is moderate asthma?
- occurs more than twice a week
| - affects sleep and activites
127
What is severe asthma?
ongoing symptoms
limit normal activity
frequent attacks result in hospitalization
128
How should we manage patients with asthma in the dental office?
- severe asthma-consult
- N20 will eliminate stress
- LA without epi
- have pt bring inhaler
129
What is the etiology of TB?
mycobacterium tuberculosis
| contagious
130
how is TB transmitted?
infected airborne droplets of mucus or saliva (coughing, sneezing, talking)
131
How does someone get tb?
- droplets inhaled and carried to alveoli
- bacteria engulfed by macrophages and replication occurs
- 2-3 weeks after onset of infection, delayed hypersensitivity to bacteria
132
For how long after intial exposure and incubation will a person have a negative skin test?
6-8 weeks
133
what does a positive skin test mean?
a person has been infected, does not mean it is currently active
134
WHat are some non specific signs and symptoms of TB?
-cough, malaise, anorexia, weight loss, night sweats, fever
135
What groups are at a higher risk for TB?
- contact with individual with TB
- HIV
- Homeless
- Alcoholics
- prisoners
- psychiatric care facilities
- health care workers
136
What do we do with a dental patient who has TB?
only urgent care if TB is active, review how TB was treated and when did they see MD last
