Other medical problems

Question 1

After LA, edema of eyes, lips, cheeks. BP 75/59mmHg

What is shock? List the types and their causes

Answer 1

Shock:

a state of cellular and tissue hypoxia due to reduced oxygen delivery and/or increased oxygen consumption or inadequate oxygen utilization

Question 2

List the different types of shock

Answer 2

Cardiogenic

Hypovolaemic

Obstructive

Distributive (vasodilatory shock)

Anaphylactic (caused by allergic reaction)

Neurogenic (caused by damage to the nervous system)

Question 3

Explain the causes of cardiogenic shock and give an example

Answer 3

Cardiogenic
o Cause: failure of the heart to pump effectively
o E.g. myocardial infarction

Question 4

Explain the causes of Hypovolaemic shock and give an example

Answer 4

Hypovolemic
o Cause: insufficient circulating volume
o E.g. hemorrhage

Question 5

Explain the causes of Obstructive shock and give an example

Answer 5

Obstructive
o Cause: physical obstruction of the great vessels of the pulmonary or systemic circulation
o E.g. cardiac tamponade

Question 6

Explain the causes of Distributive shock and give an example

Answer 6

Distributive
o Low BP due to a dilation of blood vessels within the body
o Causes: systemic infection; severe allergic reaction; spinal cord injury
o E.g. septic shock

Question 7

Explain the pathogenesis of type I hypersensitivity

Answer 7

• B cells are stimulated to produce IgE antibodies specific to an antigen
• IgE antibodies bind to receptors on mast cells and blood basophils
• Mediators released (e.g. histamine, leukotrienes, prostaglandins, cytokines etc.)
• Vasodilation, smooth muscle spasm, leukocyte extravasation

Question 8

Discuss how you can identify patient with history of drug allergy in a dental clinic (2)

Answer 8

• Ask more questions about last time’s allergy
• Skin test
• Administer a small amount of penicillin or its breakdown products (PRE-PEN) on skin scratching or intradermal injection
• Positive result will show localized reddening, swelling, itching area
• Blood test

Question 9

1 day after extraction, fever, cough, shortness of breath and crepitation of right chest. What is the diagnosis and treatment? (2)

Answer 9

Ingestion of foreign objects. Go to hospital for surgery

Question 10

Gross abdominal distension, ankle edema & increasing dizziness

Give the likely causes (3)

Answer 10

Congestive heart failure,

Cirrhosis (e.g. liver not working, so not producing enough protein to retain fluid in the bloodstream),

kidney disease (extra fluid and sodium in your circulation may cause edema)

Question 11

Gross abdominal distention, ankle edema & increasing dizziness

b. lab investigations (2)

Answer 11

Hepatic panel
Complete blood count
Basic metabolic panel
Serum calcium and magnesium
Serum lipase 

should be routinely obtained to help rule out hepatic, pancreatic or electrolyte disorders

Question 12

Gross abdominal distention, ankle edema & increasing dizziness

c. special investigations (2)

Answer 12

CT scan

Question 13

Gross abdominal distention, ankle edema & increasing dizziness

d. management based on results of the above tests (3)

Answer 13

No answer given

Question 14

3. List five ways that you can do for the patient concerning the general medical conditions

Answer 14

• (Example with smoking; apply to different situation)
• Ask - Identify and document tobacco use status for every patient at every visit
• Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
• Assess - Is the tobacco user willing to make a quit attempt at this time?
• Assist - For the patient willing to make a quit attempt, use counselling and pharmacotherapy to help him or her quit.
• Arrange - Schedule followup contact, in person or by telephone, preferably within the first week after the quit date.

Question 15

Go to pg16 for acute asthma and allergic reaction management

Answer 15

.