OMFS Flashcards

Question

hsv - medication mx

Answer 1

Targeted Therapy Acyclovir: Used particularly for severe cases or immunocompromised patients if started within 72 hours of infection onset. Dosage: 200mg 5x/day for 5 days for adults and >2yrs old. Benefits: Decreases the duration of fever, pain, lesions, and viral shedding. Limitations: Does not change the frequency or severity of recurrent herpes simplex infections (RHSI). Additional Care Considerations Fever and Pain Management: Aim to reduce both fever and pain effectively. Prevent Secondary Infections: Critical to prevent complications. Adequate Fluid Intake: Essential to prevent dehydration. Isolation and Infection Control: Important to prevent spread during the contagious period.

Answer 2

Progression of Symptoms Incubation: 5-7 days. Prodrome: 1-2 days, with symptoms like fever, malaise, headache, nausea. Active Infection: Characterized by vesiculation and ulceration, with fever typically decreasing by the third day and symptoms reducing by the sixth day. Resolution: Symptoms generally resolve after 10-14 days.

Answer 3

1. <6/12 MI 2. <6 CVAccident 3. <6/12 CABG 4. uncontrolled HTN > 200mg/115mmHg 5. unstAble Angina pectoris 6. uncontrolled thyrotoxicosis 7. Congestive heart failure

Answer 4

1. dm on hypoglycemics 2. HTN -controlled 3. cardiac arrythmia 4. NON selective beta blockers [PROp/timolol] and digoxin for arrythmias 5. hepatic or renal failure- metabolism of amide LA and excretion is affected

Answer 5

PT 10-13 sec extrinsic pathway + common pathway [1,2,5,7, 10] I, II, VII and X

Answer 6

wbc 4500-10,000/mL platelets 150k-450k/uL; >80k major surg >50k minor surg 30k-50k routine procedure <30k defer all tx transfused 1hr before procedure and regularly to maintain at least >30k-40k range until healing occurs

Answer 7

25-35 sec intrinsic + common pathway xii xi [hemophilia c-autosom dom.] ix [hemophilia b- X-linked] viii [hemophilia a- X-linked] also monitor for heparin

Answer 8

9-13sec common pathway ability to form initial clot from fibrinogen

Answer 9

7-9mins - duration to arrest bleeding platelets and blood vessels and primary hemostasis

Answer 10

0.8-1.2 normal measure extrinsic pathway RATIO OF pt PT to standard PT for monitoring patients on warfarin therapy 2.0-3.0

Answer 11

mild >5% -rarely bleed spontaneously moderate 1-5% severe <1% -bleed spontaneously into muscle and joints at young age

Answer 12

factor viii [ ] prothrombin complex [ ] cryoprecipitate if ddvap unavailable desmopressin [ddvap]- mild hemophilia A

Answer 13

-block vit k epoxide reductase in liver also (-) vit k dependent clotting factors like ii-thrombin, vii, ix, x ; C+S -> dec clotting ability - use to tx/prevent ->DVT, Pulm embolism -> atrial fib -> post MI, cardiac valve replacement

Answer 14

stop the warfarin [long half life] oral/parenteral vit k - few doses emergency - FFP, prothrobim complex [ ]

Answer 15

nsaids/cox-2 -or , aspirin, tramadol azole antifungal - fluconazole/miconazole antibiotics - macrolides- erythr/azi/clarithromycin, tetracycline, metronidazole [ amoxy/ clindamycin is safe] “sickfaces.com group”: Sulfonamides, Isoniazid-tb, Cimetidine, Ketoconazole, Fluconazole, Alcohol (binge drinking), Ciprofloxacin, Erythromycin, Sodium valproate, Chloramphenicol, Omeprazole, Metronidazole, and Grapefruit juice are P450 inhibitors.

Answer 16

immunosuppressant like azathioprine, cyclosporine carbamezepine, rifampin, phenytoin Induction of CYP450 Enzymes: All these drugs enhance the activity of liver enzymes that metabolize warfarin. Increased Metabolism: Leads to a faster breakdown of warfarin. Reduced anticoagulant effect, requiring dose adjustments of warfarin.

Answer 17

-PT/INR required (w/in 24hrs) <2.5 -routine procedures + local measure 2.3-3 - omfs >3 defer, refer to physician if cessation of warfarin 2-3 days before- resume on evening <3 - tx >3 defer until INR controlled Requires periprocedural bridging anticoagulation- in hosp setting - cessation of warfarin start iv/sc heparin - inr 24 hr stop heparin 6-8 hrs be4 procedure

Answer 18

direct THROMBIN inbitor [oral] AFib ; post-surg thromboprophylaxis of knee/hip replacement rapid onsent ; short halft life, less interaction with food/drug; no monitoring needed

Answer 19

if major surgery, discuss to discont 1-2 days pre op 1 day post op emergency , PROthr complex [ ] / aFviii / hemodialysis reversal agent is monoclonal Ab - idaru/cizumab

Answer 20

NSAID, azole antifungal carbamezepine,

Answer 21

andexanet alfa, pcc in severe bleed

Answer 22

orally active agent act on f Xa ->preventing the formation of thrombin rapid onset 2-4 hr short half life 5-9 hrs

Answer 23

irreversible inactivation of cox1 enzyme-> suppress PG and THROMBOXANE TXA2-> (-) platelet aggregation for 7-10 days

Answer 24

irreversibly block ADP receptor (-) activation of glycoprotein IIb/IIIa pathway-->platelet aggregation for 7-10 days

Answer 25

no need to stop - if stop need stop 7-10 days pre op and recommence 3 days post op local measure and tranexamic m/w >3 teeth, multiple visits - refer omfs, kiv stop clopidogrel /ticlopidine

Answer 26

absorbable [4-6wks] gelatin sponge - pig skin act as mechanical matrix for clotting + provide structural support

Answer 27

oxidised regenerated cellulose for mechanical activation of clotting cascade, denatures blood proteins; bacteriostatic, resorable in 4-8 wks

Answer 28

antifibrinolytic ; binds to plasminogen, inactivates it and prevent conversion to plasmin and the degradation of fibrin clots 500mg tablet disolved in 10-20ml of water then rinse 10ml 4x/day for 2 days

Answer 29

careful wound debridement - curretage - granulation tissue wound compression, pressure with gauze tranexamic acid soaked gauze absorable - spongiostan /surgicel NON absorbable hemostatic agent is bone wax suturing

Answer 30

INC in blood glucose lvl dt absolute or relative def of insulin leading to CHD, CVA, ESRD, infections-> death

Answer 31

120days how much sugar there has been in your blood over the past few months....intra-day hbA1c[glycated haemoglobin]-2-3months- ideal normal <5.7% =6.5mmol/L 5.7- 6.4%=6.5-7.5mmol/L [prediabetes] >6.4% DM=7.6mmol/L poor control is 8-10% uncontrolled is >10% //>13.9mmol/L hyperglycemic >13.9mmol/L-use ketones DKA-polyuria, polydipsia, polyphagia; reduced alertness, ketonemia, ketouria

Answer 32

**Blood Vessels:** microvascular and macrovascular changes->Thickened basement membrane and impaired blood flow reduce leukocyte migration, nutrient delivery, oxygen perfusion, and waste elimination. **Host Response:** impaired immune system-Neutrophil dysfunction, poor chemotaxis-migrate to site of infection affected, and poor phagocytosis. **AGEs:** Decreased collagen and bone matrix production, increased degradation, impaired fibroblast/keratinocyte function-> abnormal cross-linking of collagen fibers, reducing the flexibility and functionality of matrix-> poor wound healing. **Macrophage Activation**: Increased cytokine secretion, prolonged to inflammation. **Neuropathy**: Reduced sensation peripheral areas, delayed recognition of injuries, worsened infections at time of tx.

Answer 33

Macrolides (erythromycin +clarithromycin) Azole antifungals Cyclosporine Statins metabolized by CYP3A4 (simvastatin, lovastatin, and atorvastatin) must not be combined with CYP3A4 inhibitors=> increases statin concentrations + risk of rhabdomyolysis!->amaged muscle tissue releases its proteins and electrolytes into the blood->damage the heart and kidneys -> permanent disability / death. also interact with warfarin

Answer 34

acute toxicity that typically resolves following discontinuation of therapy and recovery of damaged tissues, while radiation therapy can cause acute oral toxicities AND can induce permanent tissue damage, resulting in lifelong risk for the patient. The most common oral complications related to cancer therapies are **M**ucositis**, o**pportunistic infection (viral or fungal), **s**alivary gland dysfunction-viscous; **t**aste disturbance; hyposalivation/**X**eros., , and **p**ain. These complications, in turn, may lead to **d**ehydration, dysgeusia (change in **t**aste), **d**ysphagia (difficulty swallowing), and **m**alnutrition, poor **Q**OL ; **p**eriod dis-CAL and mobility + dental caries [cervical]

Answer 35

chemo and BMT/HSCT increased risk of bleeding and immunoSup. Chemo assoc with anemia related atrophy dt myelosupp. and neutropenic ulcers too and atypical facial pain -dt vinca alkaloids Chronic oral complications- secondary malignancy RT- ORN, trismus

Answer 36

prophylatic inhaler puff - beta 2 agonist= sympathomimetic=bronchodilation -salbutamol if inhaled CCs >1.5mg daily of beclomethasone then consider supplemental steroids

Answer 37

dental development, such as altered tooth development, craniofacial growth or skeletal development, especially in those children younger than 9 years of age.

Answer 38

within days ... no time

Answer 39

(type, stage, etc.), treatment approach, blood counts, and comorbid conditions. active caries, periodontal or endodontic disease, teeth requiring extraction, or other urgent dental care

Answer 40

1 teaspoon of table salt to 4 cups of water The solution can be administered either at room temperature or refrigerated, depending on patient preference. The patient is generally instructed to rinse and swish approximately 1 tablespoon of the solution and spit it out; this may be repeated as often as necessary to maintain oral comfort. Saline solution can enhance oral lubrication, directly, as well as by stimulating salivary glands to increase salivary flow. sodium bicarbonate (baking soda) may be added (1 to 2 tablespoons per 4 cups of water), if viscous saliva is present.

Answer 41

with antiresorptive agents (i.e., IV bisphosphonates, denosumab); medication-related osteonecrosis of the jaw (MRONJ).

Answer 42

(1) current or previous treatment with antiresorptive therapy alone or in combination with immune modulators or antiangiogenic agents; (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region that has persisted for more than 8 weeks; and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws.

Answer 43

necrosis .. dt obstruction of blood supply pain and purulent discharge spontaneously

Answer 44

suppression of bone turnover and remodeling by the antiresorptive agents impairs the body’s ability to repair microfractures in the maxilla and mandible

Answer 45

alveolar osteitis, OM, sinusitis, gingivitis/periodontitis, or periapical pathosis.

Answer 46

O - Older than 65 years L - Long-term or high-dose antiresorptive/antiangiogenic agents (more than 2 years) IV/oral D - Diabetes D-Dentures S - Smoking E-Exo/surgery O - Oncology patients (multiple myeloma, breast, lung cancer) P-Periodontitis

Answer 47

bisphosphonates and RANKL (receptor activator for nuclear factor-kappa B ligand) inhibitors. 2 parenteral bisphosphonates, pamidronate (Aredia®)22 and zoledronic acid (Zometa®/Reclast]), and ibandronate (Boniva) (e.g., hypercalcemia of malignancy). orally – including alendronate (Fosamax), risedronate (Actonel) Denosumab is a monoclonal antibody against RANKL, a ligand required for osteoclastic precursors to differentiate into mature osteoclasts

Answer 48

antiangiogenic agents

Answer 49

linea alba, lichen planus leukoedema-disappear with stretching white sponge nevus-hereditary no tx pv fordyce's granules OHL thrush

Answer 50

traumatic keratosis material alba- can be wiped off chemical trauma lichenoid contact reaction Carcinoma papiloma leukoplakia

Answer 51

CHX.. complex which is ineffective

Answer 52

ISH- in situ hybridization and histopathological examination

Answer 53

1. **field of cancerisation** - epith elsewhere in the area has premalignant disease and myb subclinical - **chromosomal abnormalities** in clinically normal mucosa 2. **continuous exposure of carcinogens**- tobacco smoke, spirits-alcohol, 3UV , 4SPICES- areca nuts, 5sepsis

Answer 54

not symp, not erosive - monitor / flup symp + erosive= topical CCS and kiv Antifungal if suspect fungal oppor. infection not response, CI in CCS, then topical tacrolimus / cyclosporine [ both TOPICAL CALCINEURIN -ors to (-) T cell activation] then lastly topical retinoids and PUVA -PHOTOdynamic therapy

Answer 55

HTN OLICHENOID drug reaction

Answer 56

bind to bone, bone remodeling are mostly six months of treatment cessation

Answer 57

evidence to support or refute drug holiday remains inconclusive. 3months following the last dose of DMB when the level of osteoclast inhibition is waning. It can then be reinstituted 6-8 weeks postsurgery.

Answer 58

WHO criteria for anemia Men: Hb < 13 g/dL Women: Hb < 12 g/dL Pregnant women: Hb < 11 g/dL if<10g/DL

Answer 59

Cataracts, Ulcers, Striae/Skin thinning, Hypertension/Hirsutism/Hyperglycemia, Infections, Necrosis (of the femoral head), Glucose elevation, Osteoporosis/Obesity, Immunosuppression, Depression/Diabetes. Moon facies, buffalo hump

Answer 60

*Oral Lichen Planus * Mucous Membrane Pemphigoid (MMP)* * Pemphigus Vulgaris (PV) * SLE) * DLE)

Answer 61

benign: TOM's 1. **tobacco pouch keratosis** (not true leukoplakia)- dt Smokeless tobacco -regress if not biopsy if >1month post cessation 2. **o**ral melanotic macule [2* to smoking] 3. smoker's **M**elanosis-Anterior Lab ging. 4.Nicotinic **s**tomatitis- greyish white hard palate with red spots dt inflm minor salivary glands and thermal injury in PIPE smokers **PML: SPLERO** 1. Sublingual keratosis 2. PALATAL Red-W LESIONS IN REVERSE SMOKERS*// ulcerations 3. Leukoplakia-cannot be rubbed off and cannot be characterized clinically or pathologically as any other condition. 4. Erythroplakia-Red, velvety patches; cannot be characterized as any other condition. 5. Rigidity-Oral Submucous Fibrosis: A chronic, progressive condition characterized by mucosal rigidity due to fibrosis of the submucosal tissues-> LMO. It is strongly associated with areca nut chewing (often found in some tobacco* products) and carries a high risk of malignant transformation 6 Oral sq cell Ca-> Ca

Answer 62

a. Drug history (Current/past) -Hypertension, DM (Diabetes Mellitus), Liver disease, HBV (Hepatitis B Virus), HCV c. DLE (Discoid Lupus Erythematosus) / SLE (Systemic Lupus Erythematosus) d. GVHD (Graft-Versus-Host Disease) e. Psychological state (Stress)

Answer 63

U - Ulcers (Non-healing>2/52) C - Color (White/red patches, speckled lesions, nodular white lesions=verrucous leukoplakia) A - Appearance (Exophytic: fungating, papillary, verrucous; Endophytic: rolled borders, invasive, ulcerated) N - Nodules (Indurated, fixed to tissues) B - Bleeding (Unexplained) H - Hoarseness (Chronic sore throat) E - Enlarged lymph nodes (LN involvement, B symptoms) A - Altered sensation (Paraesthesia; painless initially) R - Radiographic appearance (Moth-eaten/root resorption) D - Dysphagia (Difficulty swallowing/chewing, reduced tongue mobility-smf) T - Teeth + taste (Loose, non-healing extraction sockets; dysguesia) W - Well/ill-defined borders (Regular or ill-defined, uni- or bilateral) I - Inflammation (Swelling, poor denture fit) C - Clinical progression (Rapid changes) E - Etiology (Medical history, syphilis, HIV, familial history; social history: alcohol, tobacco;>50y male) S- lat/ventral -tongue, FOM, soft palate,gums,lining of the mouth/lower lip D- dysplasia A:Asymmetry * B: Border irregularities * C: Colour variegation * D: Diameter>6mm * E:Elevation(surface) for Malg melanoma

Answer 64

1 Avoid alcohol, spirit 2 avoid tobacco; smoke 3. use UV protection, sun 4. HPV vaccination, sex 5. maintain good oral hygiene,- prevent sepsis-candidiasis 6. manage nutrition - avoid areca nuts [spices] 7. mx -immune status.

Answer 65

both are important- to avoid hypoglycemia that is not evident in HbA1c 7% reading]

Answer 66

ABC ,Check the blood sugar level with a glucose meter (finger prick). If it is too low (below 4.0mmol/l), take a sweet drink like a fruit juice or sweets (not sugar-free) to raise the glucose level quickly. Check the blood glucose level again after 10 to 15 minutes. If it is still low, take something sweet again. It is important to seek medical attention promptly if the symptoms persist.

Answer 67

generally, early warning signs of hypoglycaemia include: 1Feeling shaky, weak, dizzy, irritable and hungry 2Having a fast heartbeat 3Headache 4Mood swings 5A staggering gait 6 trouble seeing clearly, 7feel confused, 8have a seizure or 8 LOC

Answer 68

LAs Weak bases prepared as hydrochlorides for stability and solubility. pKa of most LAs: 7.5-9.5. At physiological pH (7.4), charged forms predominate. Charged forms cannot easily penetrate cell membranes. Non-ionized forms penetrate membranes. LAs => ionized forms which block Na chnls in the nerve cells. Tissue pH and Anesthetic pKa Inflammation->inf mediators->Lower pH: Acidic environment reduces the non-ionized form of the drug. Less Effective: Fewer non-ionized molecules to penetrate the nerve. Inflammation causes vasodilation, dilute La and reduce efficacy. Necrosis: No extracellular fluid to buffer, LA remains ineffective. Tachyphylaxis: Repeated administration results in decreased response Considerations: Use regional block over local infiltration, deposit a larger volume of LA. .