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Internal Medicine > Adrenal/HIV/Allergy/Diabetes/Pregnancy/Thyroid > Flashcards

Adrenal/HIV/Allergy/Diabetes/Pregnancy/Thyroid Flashcards

1
Q

Cortisol increases blood levels and use of —–, increases —-, and has —- actions = homeostasis

A

glucose

blood pressure

anti-inflammatory

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2
Q

—- releases
•
corticotropin-releasing hormone

A

Hypothalamus

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3
Q

—- first reason for releasing cortisol.

A

Surgical stress

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4
Q

——- produces and secretes
•
adrenocorticotropic hormone

A

Pituitary

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5
Q

—— stimulates adrenal cortex to
•
produce and release cortisol

A

ACTH

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6
Q

Primary Adrenocortical Insufficiency

A

addison’s disease

Adrenal cortex destroyed or removed - Medical management
Manage the adrenal disease
Glucocorticoid replacement corresponds to normal output ~20mg/day
Hydrocortisone

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7
Q

Secondary Adrenocortical Insufficiency

A

Pituitary disease or adrenals unresponsive to ACTH

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8
Q

2ndary adrenocortical insufficiency - Medical management

A

Glucocorticoid replacement Hydrocortisone 10-20mg/day

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9
Q

Tertiary Adrenocortical Insufficiency

A

Treat autoimmune and inflammatory diseases AND long- term immunosuppression for organ transplant and joint replacement
Sluggish hypothalamus
Regimens aimed at being therapeutic at the least dose to prevent adrenal suppression
•
•
•
Topical, locally injected, inhaled
•
not of concern
•
HPA axis regains responsiveness and functional 14d after DC of steroid

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10
Q

Increased cortisol levels during and after —-

A

surgery

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11
Q

Plasma cortisol peaks 2 to 10-fold between —— hours after surgery

A

4 and 10

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12
Q

Cortisol level returns to baseline —– hours post-op

A

24-48

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13
Q

Adrenal Crisis

Life-threatening emergency characterized by

A

Hypotensive collapse, abdominal pain, myalgia, fever

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14
Q

Adrenal crisis - Immediate treatment in the ED

A

100mg hydrocortisone bolus

Fluids & electrolytes

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15
Q

Primary adrenal insufficiency =

A

supplement

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16
Q

Secondary adrenal insufficiency =

A

daily therapeutic dose

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17
Q

Hypotension first sign of

A

acute adrenal crisis

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18
Q

With acute adreanl crisis,

A

ems immediately, bls

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19
Q

True allergy symptoms:

A

Urticaria Swelling

Skin rash Chest tightness Dyspnea, SOB Rhinorrhea Conjunctivitis

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20
Q

Angioedema

A

Edema in deeper planes

Diffuse enlargement of lips, infraorbital tissues, larynx, tongue

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21
Q

Anaphylaxis —- depression

A

respiratory and CV

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22
Q

Anaphylaxis with Depressed/absentee vital sign—

A

0.3-0.5ml 1:1000 epinephrine IM Q5min and CPR prn

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23
Q

Risk of stroke & CAD death —- higher in diabetics MI leading cause of death in —– diabetics

A

2-4x

Type 2

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24
Q

ESRD ———-

—— more likely to acquire vs. those without diabetes Leading cause of death in those with ——diabetes

A

end stage renal disease

25x

Type 1

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25
Q

HbA1c

A

Amount of sugar attached to hemoglobin

26
Q

HbA1c

Indicates level of glycemic level over last —- months
Monitors patient’s progress —— if controlled —– is uncontrolled

A

2-3

2x/year

4x/year

27
Q

HbA1c

Non-diabetic patients,
Diabetic patients,

A

<6%

<7%

28
Q

For type 1 diabetics - Long acting replace —- level. Short acting covers ——

A

basal

carbs.

29
Q

External Insulin Pumps for

A

Type 1

30
Q

Type 2 diabetics - Drug therapy

A

1 or more hypoglycemics +/- injectables

31
Q

Dental Treatment Concerns with Uncontrolled Diabetics

A

Infection
aggressive management, strict glycemic control

Poor wound healing avoid elective surgery
Systemic risk
HTN, CAD, stroke

32
Q

Type 1 diabetics -

A

disease responds a bit differently. Always be concerned about type 1 diabetics. Uncontrolled vs brittle - not just compliance. Some people just can’t get consistent glucose levels.

33
Q

Management of Acute Infection
DDS: ——–
MD: ——

A

treat odontogenic infection
Extraction, I&D, antibiotics

glycemic controlSliding scale insulin

34
Q

I&D:

A

Incisions and drainage

35
Q

Tx of insulin reaction

A

if conscious, sugar. if unconscious, EMS and glucagon injection - bls prn

36
Q

Preventing Insulin Shock

A
  1. Instruct patients to follow normal insulin regimen and eat normally around appointment
  2. Morning appointment
  3. Confirm that they ate and took insulin/hypoglycemics
  4. Instruct patient to notify you of symptoms during the office visit
  5. Source of sugar in the office
37
Q

HIV Target cells:

A

dendritic cells, macrophages, CD4+ T cells

38
Q

Blood HIV viral load correlates with

A

risk of transmission of the virus; patients with early HIV infection are highly contagious

39
Q

Progressive depletion of CD4+ lymphocytes

A

pancytopenia

immune dysfunction

40
Q

CD4+ drops to

A

200

41
Q

Prophylaxis for opportunistic infections with

A

low CD4+ counts

42
Q

CD4+ count at time of HIV diagnosis Every—–months after

A

3-4

43
Q

Asymptomatic HIV Infection

A

Asymptomatic patients have OK CD4+ count
Low viral load
Normal platelets and WBCs
No S/S (wouldn’t know of disease if they did not endorse)

44
Q

Asymptomatic HIV Infection - dental care

A

good to go

45
Q

Asymptomatic, HIV-Infected Patient with Decreasing CD4+ Count

A

May be developing immune suppression increased risk of infection (decreased WBCs)
increased bleeding (decreased platelets)
Invasive surgical procedures: obtain WBC & platelet counts

46
Q

Asymptomatic, HIV-infected patient with decreasing CD4+ count - ——- dentistry ok

A

Routine & complex restorative

47
Q

AIDS Patients (CD4+ <200)
Significant ——-
——- dental care only
With invasive procedures must prepare for :
—— antibiotic prophylaxis for patient with WBC <500uL
———platelets must be >50,000 for treatment
Check drug interactions with —-

A

immunosuppression

Emergency care and preventive

Infection

Excessive bleeding

ART

48
Q

Most dental drugs (prego) are

A

category C

49
Q

Prego - Analgesics:

A

Acetaminophen
NO NSAIDs (ibuprofen or aspirin)
Consult for narcotics

50
Q

Amount of drug excreted in milk —– of maternal dose

A

~1-2%

51
Q

Breast feeding timing w/drug

Timing

A

Consume right after breast feeding Supplement with formula

52
Q

Thyroid hormone (thyroxine + triiodothyronine) influences
Regulate ——
Regulated by a ——–

A

metabolism or the way that the body uses energy

feedback loop

53
Q

Secretion of Thyroid Hormone

Feedback mechanism mediated by

A

hypothalamic- pituitary-thyroid axis

•

54
Q

Hyperthyroidism

Excess

A

T3 and T4 in the blood

55
Q

Thyrotoxicosis

A

Graves’ disease (most common)

Autoimmune

56
Q

Hyperthyroidism - symptoms

A

Anxiety, fatigue, rapid HR, heat intolerance, weight loss, exopthalmous

57
Q

Antithyroid agents

A

Propylthiouracil, 18 months
Radioactive iodine
Surgery

58
Q

Hypothyroidism

Inadequate amount of

A

T3 and T4

Slow physical/mental activity, sensitivity to cold, weight gain

59
Q

Hypothyroidism managed with

A

synthetic T4

60
Q

Well-Controlled Thyroid Disease can do

A

Any routine dental treatment

61
Q

Thyroid
Physician consultation for assistance in management of acute infection or in anticipation of significant surgical stress
Increased —-

A

metabolic demand

62
Q

—– is most common thyroid issue

A

Hypo

Internal Medicine (12 decks)

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