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dental management > 7. hematologic ds dental managment > Flashcards

7. hematologic ds dental managment Flashcards

1
Q

CBC includes:

A
  • Hb
  • Hematocrit
  • WBC
  • Platelet
  • RBC indices
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2
Q

Hb [] in men and women

A

<13.5 g/dL in men

or

<12.0 g/dL in women

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3
Q

hematocrit in men and women

A

<41% in men

or

<36% in women

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4
Q

microlytic anemia includes

A
  • iron deficiency anemia
  • thalassemias (inherited blood disorder have less hb than normal)
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5
Q

macrocytic anemia includes

A
  • pernicious anemia
  • folate deficiency
  • B12 deficiency
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6
Q

normocytic anemia includes

A
  • hemolytic anemia
  • sickle cell anemia
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7
Q

iron deficiency anemia

category

causes

labs

A

more common in W of childbearing ages and children

category: microcytic anemia
causes: blood loss, poor iron intake, poor iron absorption, or incr. demand for iron.
labs: serum iron, ferritin, TIBC, transferrin.

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8
Q

folate deficiency

category

causes

labs

A

category: macrocytic anemias
causes: it is not stored in the boyd in large amounts, need continual dietary supply. If deficient during pregnancy it causes neural tube defects in baby.
labs: serum folate levels

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9
Q

cobalamin deficiency

A

aka b12 deficiency

category: macrocytic anemias
causes: pernicious anemia (deficiency of intrinsic factor which is necesary for b12 absorption) and nitrous oxide (irreversible inactivation of b12)
labs: serum b12

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10
Q

oral manifestations of anemia

A

atrophic glossitis with loss on tongue papillae, redness or cheilosis

mucosal pallor

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11
Q

anemia and dental management

A
  • generally tolerate routine dental tx well
  • avoid long use of nitrous oxygen exposure with b12 def pts
  • severe anemia avoid strong narcotics, defer routine dental care, use pulse oximeter and supplemental oxygen
    *
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12
Q

signs and symptoms of sickle cell anemia

A
  • jaundice, pallor
  • leg ulcers
  • cardiac failure or stroke
  • delays in growth and dev
  • pain (abdominal or bone)
  • sickle cell crisis- prolonged pain (caused by infection, high altitude, dehydration, and trauma)
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13
Q

oral manifestations in sickle cell anemia

A
  • mucosal pallor or jaundice
  • papillary atrophy
  • delayed tooth eruption
  • aseptic bone and pulpal necrosis
  • osteomyelitis
  • neuropathy
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14
Q

radiographic sickle cell anemia manifestations

A
  • INCREASED widening and decrease number of trabeculations
  • trabeculation and lamina dura seem more prominent
  • hair on end xray
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15
Q

dental managment for pts with sickle cell anemia

A
  • routine care, emphasis on good oral hygiene so do not get any infections
  • anesthetics: do not use LA with epi, avoid prilocaine, use epi 1:100,000 no stronger concentration
  • monitor O2 levels if give N2O, keep oxygen greater than 50%
  • for pain management consult primary care for opioid contract
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16
Q

aplastic anemia is due to

A

bone marrow failure resulting in pancytopenia

tx with hematopoietic cell transplant

17
Q

aplastic anemia oral manifestations

A

anemia: atrophic glossitis with loss of tongue papillae, redness or cheilosis and mucosal pallor
thrombocytopenia: petechia, spontaneous or prolonged bleeding
neutropenia: infection and ulceration due to redcution of WBC

18
Q

platelet disorders: thrombocytopenia

normal

severe

A

caused by decreased production, destruction, medications and blood loss

normal: 150,000 to 400,000

severe <50,000

19
Q

thrombocytopenia oral manifestations

A

petechia

spontaneous gingival bleeding

prolonged bleeding after procedures

20
Q

platelet disorder: von willebrand ds

A
  • misisng or defective VWF clotting protein
  • the most common inherited clotting disorder.

3 types

  • tx with DDAVP desmopressin
21
Q

von willebrand ds platelet disorder anesthetics

A

avoid block injections and have local hemostatic measures

22
Q

inherited coalgulation hemophilia

A

factor A (8) and B (9) deficiency, x linked recessive

Mild severity for: A is (6 to 30%) or b is 49%

severe is less than 1%

Tx: factor infusions, DDAVP (A)

23
Q

medication related bleeding disorders - plavix (clopidogrel)

A

an antiplatelet agent, reduces the risk of MI and stroke. Increased risk of bleeding and bruising.

24
Q

medication related bleeding disorders: plavix (clopidogrel)

A
  • its an anti platelet agent that reduces risk of MI and stroke
  • it can increase risk of bleeding and bruising
  • dental managment is to look at medication list
25
Q

medication related bleeding disorders - coumadin (warfarin)

A
  • vit k antagonist
  • side effect is bruising
  • monitor INR to keep around 2-3 need to reivew 24 h before tx
  • INR for pts with prosthetic heart vales is (3-3.5)
  • Antidote is vit k
26
Q

bleeding disorders medication related - direct oral anticoagulants (DOAC) and direct thrombin inhibitors

A
  • direct inhibitor of factor Xa and thrombin
  • class of newer anticoagulants an alt to warfarin
  • v effective
  • no lab monitoring
  • but more $
27
Q

hematologic malignancies are

A

leukemia

lymphoma

myeloma

28
Q

AML

CML

ALL

CLL

A

AML: actue myeloid leukemia

CML: chronic myeloid leukemia

ALL: acute lymphocytic leukemia

CLL: chronic lymphocytic leukemia

29
Q

oral manifestations of leukemia

A
  • leukemia infiltrate
  • spontaneous gingival bleeding
  • oral ulceration (neutropenic, ulcer, mucositis)
  • infection (viral, fungal, bacterial)
  • lymphadenopathy (chronic)
30
Q

oral manifestations of lymphoma

A
  • LAD (waldeyers ring, neck)
  • extranodal involvement with oral ulceration, localized infiltrate osteolytic radiographic lesions
  • may have infections
  • tx related is head and neck radiation.
    • can see hyposalivation, tismus and osteonecrosis bc of radiation tx.
31
Q

whats this

A

lymphoma

32
Q

risk of neutropenia and thrombocytopenia in lymphoma and leukemia

A

the risk is lower in lymphoma

33
Q

what is a myeloma

A

cancer of the plasma cells

so it prevents normal production of abs.

34
Q

oral manifestations of multiple myeloma

A
  • plasmacytoma
  • lytic bone lesions
  • infection (virla, fungal, bacterial)
    • tx related oral manifestations
35
Q

multiple myeloma dental managment

A
  • ds related managment:
    • soft tissue swelling
    • infection managment
    • pre-disphosphate exam
  • medication related
      • MJONJ includes bisphosphonate history, chlorhexisine rinses, oral gygiene, ab regimen and sequestration
36
Q

what needs to get done before a transplant is placed

A

a dental cleaning and need to be dentition stable for 12 months

37
Q

hematopoietic cell transplant

A

aka HSCT

  • lots of mucositis, bleeding and infection,
  • you have an increase risk of oral cancer

dental management (8 decks)

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