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Nationwide Peds Dental Residency > Children with Special Health Care Needs > Flashcards

Children with Special Health Care Needs Flashcards

1
Q

which group of CSHCN has been reported to have fewer access to care barriers

A

Cystic fibrosis

As opposed to higher barriers in:
Craniofacial issues

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2
Q

4 nutritional concerns in CSHCN

A

Low calorie intake
High sugar intake
Increased energy needs
Food aversions
Sugary medication
Absorption issues

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3
Q

4 strategies for increasing nutrient density and food intake as healthy diet soluation and alternatives to high sugar foods

A

Cariostatic foods + cariogenic foods
Adding butter/sour cream to soup
Snack before oral hygiene
Sauce and gravy

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4
Q

Clinical recommendations for patients who are hearing impaired do NOT include:

A

Use of virtual reality wrap-around glasses as distraction technique

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5
Q

Which would be most effective in teaching oral hygiene to vision-impaired children?

A

Incorporate auditory and visual and sensory components in oral hygiene exercises

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6
Q

What is the therapeutic INR?

A

3.0

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7
Q

3 reasons why caries may be more common in children w/congenital heart disease

A

parental indulgence
less access to care
sugary medications
chronic hypoxia disturbance in ameloblastic activity leading to defects in enamel formation
fear of engaging in care leading to agitation and cyanosis

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8
Q

Long term sequelae of large, unrepaired left to right shunts?

A

congestive heart failure

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9
Q

Long term sequelae of large, unrepaired right to left shunts

A

cyanosis

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10
Q

3 orofacial clinical features of Kawasaki disease:

A

strawberry tongue
erythema
crackling lips
cervical lymphadenopathy
oral mucositis

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11
Q

2 conditions or defects considered to be cyanotic

A

Tetraology of fallot
Truncus arteriosus
Tricuspid atresia
D-transposition of great arteries

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12
Q

Bacteria that cause endocarditis

A

S. Viridans

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13
Q

Tetralogy of Fallot does not include

A

Hypoplasia of mitral valve

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14
Q

Tetralogy of Fallot does include:

A

Transposition of great aorta
Pulmonary valve stenosis
Ventricular septal defect
Right ventricular hypertrophy

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15
Q

For which dental procedure or even does the AHA (2007) recommend prophylaxis?

A

**LA for Removal of necrotic tooth

Not for:
-bleeding from trauma to the lips or oral mucosa
-removal of ortho brackets
-IAN for operative dentistry (not infected tissue)

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16
Q

When do you not give prophylaxis?

A

cardiac transplant with no valvulopathy

Yes for:
prosthetic heart valves
congenital heart defect

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17
Q

According to Wilson article in preventing Viridans Strep group IE, please list the times in which you would prescribe prophylaxis?

A

-artificial heart valve
-history of IE
-cardiac transplant
-CHD
-unrepaired or repaired within last 6 months

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18
Q

Symptoms of ASD typically appear in which period?

A

first 2 years

Not:
ages 3-4
Aged 5-8
Ages 9-10
Adolescence

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19
Q

Designed to help individuals with ASD understand and follow specified social protocol, individualized short stories..

A

Social stories

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20
Q

DSM criteria for ASD include all of these EXCEPT

A

Deficits in intellectual functioning

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21
Q

Which one is a criteria for ASD DSM-5

A

Deficits in social emotional reciprocity

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22
Q

Not a common associated comorbidity associated with ASD?

A

Cerebral Palsy

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23
Q

Which genetic disorder is NOT associated with ASD?

A

Tay-Sach’s Syndrome (brain & spinal cord- leads to blindness)

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24
Q

Which is not a major component of the D-Termined method for familiarization in the dental setting

A

Dentist does most of the training

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25
Q

The ___ model of disability entails treating the diagnosis as a problem and curing it

A

Medical

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26
Q

The new DSM-5 diagnosis of ASD includes the previous diagnoses except

A

Obsessive Compulsive Disorder

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27
Q

Features of ASD dentists should be aware of include:

A

Difficulty with tongue coordination, oral tactile sensitivities, possible food pouching

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28
Q

Three simple ways to effectively and compassionately treat a patient who self-reports ASD or sensory processing disorder on an intake form may include:

A

ask about word choices/triggers
Social stories
Have chair laid back/positioning
Ask about noise/music

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29
Q

Match the correct seizure term with its definition:

A

-clonic- alternating contraction and relaxation

30
Q

What is an atonic seizure?

A

Sudden loss of muscle tone (can be partial or complete)
May drop things or fall to the ground if standing

31
Q

Which epilepsy syndromes are more severe and typically drug resistant?

A

West (can progress into Lennox-Gastaut)
Dravet
Lennox-Gastaut

32
Q

Which seizure types are typically associated with Lennox-Gastaut syndrome?

A

Atonic, tonic, atypical absence, myoclonic, focal and generalized tonic clonic; nocturnal tonic seizures- clinically subtle, are an early clue to diagnosis

33
Q

Valproic Acid side effects-

A

Blood clotting mechanism (thrombocytopenia)

34
Q

Supplement to help prevent gingival overgrowth?

A

Folic Acid

35
Q

Most significant predictor of OSA in children is?

A

Snoring every night

36
Q

Two most common, recommended treatments of OSA for children

A

-Adenoid/Tonsil removal
-Weight reduction
-CPAP
-Tracheostomy

37
Q

**Obesity causes fat-induced restrictive lung disease which reduces all except:

A

-Respiratory Rate

Does reduce:
-Functional residual capacity
-Expiratory reserve volume
-Vital Capacity

38
Q

What are behavioral characteristics of ADHD that might affect behavioral management in a dental setting?

A

-inattentiveness
-fidgeting, squirming
-Trouble waiting
-Talking excessively
-interrupting, intruding

39
Q

What are some ways to manage the behavior of ADHD in patients in dental office?

A

-Morning appointments
-N2O
-Distraction
-Short appointments

40
Q

Classes of medication used to manage ADHD include all of the following except:

A

beta blockers

41
Q

Classes of medication used to manage ADHD do include:

A

alpha2 adrenergic agonists
atypical antipsychotics
SNRI’s
stimulants

42
Q

The prevalence of intellectual disability in children is closest to:

A

1%

43
Q

De-institutionalization of patients with intellectual disabilities in the 60’s and placing them in smaller setting or with family members led to better outcomes than during institutionalization of patients

A

-False

44
Q

-A local anesthetic available without a vasoconstrictor that is commonly used in dentistry?

A

Prilocaine- concern is methemoglobinemia

45
Q

Vasoconstrictors used in LA could theoretically have an ___ effect on the psychostimulant medications taken by children with ADHD

A

-Additive

46
Q

For children taking atypical antipsychotic medications, a dentist should:

A

-ensure the child is adequately numb before proceeding with operative tx

NOT:
-ask the patient to hold medication 24 hours before dental procedures
-Monitor blood pressure every 5 mins
-use a pulse ox to be sure the child does not experience bradycardia

47
Q

Adverse effects of stimulant medications for patients with ADHD include all except:

A

-sialorrhea

48
Q

Which fits definition of deprivation abuse, rather than neglect

A

-family who refuses to feed her child for a week because they keep bedwetting

49
Q

Name three conditions or disorders associated with self-injurious behaviors:

A

-Lesch-Nyhan
-Smith-Magenis Syndrome
-Fragile X
-Cri du Chat Syndrome
-Rett Syndrome
-Down Syndrome
-Autism Spectrum Disorders
-Visual Impairments

50
Q

You have an 8-yr old male NP from WV with no documentation in EPIC. Patient has moderate intellectual disability. Give detailed description of how to proceed with data gathering for patient:

A

-Observe the child
-Get a thorough history from patient/family

51
Q

Who is the pillow angel child?

A

Child who was given hormone suppression medication because of guardian desire to keep patient small enough to manage at an old age

52
Q

Special health care needs increases caries risk to what level?

A

Moderate

53
Q

Examples of acyanotic shunts?

A

L–>R shunts
-ASD, VSD, persistent PDA, AVSD, PFO
Can require SBE prophylaxis if turbulent blood flow persists post repair

54
Q

Examples of cyanotic shunts

A

Tetralogy of Fallot, transposition of the great arteries, tricuspid atresia, total anomalous pulmonary venous return

55
Q

What is the most common innocent murmur?

A

Still’s murmur

56
Q

What is the most common underlying condition in children for infective endocarditis?

A

congenital heart disease

57
Q

What is the most common chromosomal disorder?

A

Trisomy 21

58
Q

What are some GA specific concerns for patients with Trisomy 21?

A

Cardiac conditions
Airway abnormalities
Atlantoaxial instability

59
Q

3 factors key to D-TERMINED program

A

Eye contact (reminding to look at me)
Positional modeling (legs straight and hands on stomach for 10 seconds at a time)
Counting framework (verbally and repeatedly counting to 10 during the procedure; always completing during this time)

60
Q

What are 5 Ds of D-TERMINED program?

A

Divide the skill into small components
Demonstrate the skill
Drill the skill
Delight in Repetition
Delegate the patient to your trained auxiliary

61
Q

What are the criteria for epilepsy?

A

2+ unprovoke seizures more than 24 hrs apart or 1 unprovoked w/high probability of recurrence or diagnosis of epilepsy syndrome

62
Q

What is one of the most common concomitant diseases associated with obesity?

A

DM2

63
Q

Why is obesity a significant concern for sedation?

A

-Likelihood for adverse event of hypoxia is increased in patients that are obese due to restrictive lung disease and OSA
-dosing is based on lean body mass and total body weight - can lead to increased effects and delayed recovery

64
Q

What does SADE stand for?

A

Sensory adapted dental environment - adjustment of visual, auditory, somatosensory and tactile stimuli to address anxious behavior

65
Q

What is neglect?

A

Failure to supply ANY needs of a child

66
Q

What is abuse?

A

Deliberate and malicious withholding of needs

67
Q

Rescue meds for epilepsy

A

IN midazolam or rectal diazepam

68
Q

Key ways to prevent BRONJ in pediatric patients:

A

Comp care
Referral to OMFS
Dental surgery late in infusion cycle (allow 3 weeks of healing before next infusion)
Chlorhexidine 5 days prior and after
Suture
Abx prophy in high risk
Avoid Ortho

69
Q

Dental trama is common to patients with CP due to…

A

Class II malocclusion and lip incompetence + seizure risk high

70
Q
A

Nationwide Peds Dental Residency (9 decks)

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