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Hospital Dentistry > Final > Flashcards

Final Flashcards

1
Q

What are the hospital classifications?

A

Acute, chronic, children’s, obstetrical, mental health

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2
Q

Governance structure of the Hospital

A

Governing board, administration, medical staff, community served.

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3
Q

Hospital classifications

A

Government, non-profit, proprietary

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4
Q

Hemostasis

A

Dynamic process of blood clot formation at the site of vascular injury.

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5
Q

What are the stages of hemostasis?

A

Primary, secondary and tertiary

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6
Q

What are the phases of hemostasis?

A

Initiation and formation of the platelet plug
Propagation by the coagulation cascade
Termination by antithrombotic mechanism
Fibrinolysis

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7
Q

What are the three pathways to the coagulation cascade?

A

Intrinsic, extrinsic and common.

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8
Q

Extrinsic Coagulation

A

The “quick fix” in 10-15 seconds. Tissue Factors

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9
Q

Intrinsic Coagulation

A

Larger clot with lots of thrombin in 1-6 min. Contact Factors

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10
Q

Common Coagulation

A

Prothrombin to thrombin; fibrinogen to fibrin.

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11
Q

What are the most common laboratory assessments?

A

CBC, aPTT, PT/INR, bleeding time, TT, Platelet function/adhesion/aggregation, fibrinogen levels, Factor assays

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12
Q

What is the normal platelet level?

A

150-400k

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13
Q

What platelet count leads to spontaneous bleeding?

A

Less than 20k

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14
Q

What platelet count causes thrombocytosis?

A

More than 400k

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15
Q

What affects Bleeding Time?

A

Von Willibrands, ASA, NSAIDS

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16
Q

What does aPTT test?

A

Activated Partial Thromboplastin Time:

Intrinsic and the contact factors (XI, XII, VII, and IX) and Common (Factors II, prothrombin, V, X and I, fibrinogen).

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17
Q

What affects the aPTT?

A

Heparin, long term abx therapy, liver dz, malabsorption, cancer, infections, hemophilias, von Willebrand’s dz.

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18
Q

What does PT/INR Test?

A

Extrinsic: Tissue factor and Factor VII
Common: Factors II, V, X and fribinogen, Vitamin K dependent factors: II, VII, IX, X

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19
Q

What is a normal INR?

A

0.8-1.2

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20
Q

When is it safe to extract a single tooth?

A

If the INR is less than 3

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21
Q

Difference between aPTT and INR?

A

aPTT is intrinsic, INR is extrinsic.

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22
Q

What are thrombocytes?

A

Platelets from the bone marrow.

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23
Q

How long do thrombocytes last in circulation?

A

8-10 days.

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24
Q

What are the qualitative disorders of platelets?

A

Affecting bone marrow or liver dx, splenic sequestration, VonW dz, aspirin, NSAIDS, clopidogrel, COX 2 inhibitors, uremia.

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25
Q

What are quantitiative disorders of platelets?

A

Inherited or congenital. Rare!

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26
Q

Inherited Coagulopathies

A

Hemophilia A, B and C

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27
Q

Acquired Coagulopathies

A

Liver dx, vit K deficiency or antagonists, disseminated intravascular coagulation, anticoagulant therapy.

28
Q

Hemophilia A

A

Factor VIIIc deficiency

29
Q

Hemophilia B

A

Christmas Disease, Factor IX deficiency

30
Q

Hemophilia C

A

Stuart’s disease, Factor XI deficiency

31
Q

How many people are living with cancer at any point in time? (Cancer prevalence?)

A

12.5 million

32
Q

Triad of Cancer Therapies

A

Surgery, radiation, chemo

33
Q

Tumor Classification-Grade

A

How cells look, potential for growth rate and metastasis.

GX-G4 going from well differentiated to undifferentiated.

34
Q

Anatomic Staging

A

TNM
T: Size of primary tumor
N: Spread to regional lymph nodes
M: presence or absence of metastases.

35
Q

Curative Chemo

A

Eliminate every tumor cell! The smallest detectable tumor is 1 billion cells, with a kill rate of 99.999%, only 10,000 cells left!

36
Q

Control Chemo

A

Stop cancer from growing and prevent metastasis

37
Q

Palliation Chemo

A

Relieve symptoms, prolong life and improve quality of life.

38
Q

Tumor kinetics

A

1 billion cells is approximately 1 cm mass and is clinically detectable. Exponentially growing tumors double about 30 times before becoming detectable. Each tumor has a characteristic doubling time.

39
Q

Chemotherapy side effects

A

Targets ALL fast growing cells. Bone marrow suppression. Neutropenia.

40
Q

What is the goal of dental management pre-chemo?

A

Diagnose and eradicate infective potential.

41
Q

What do you need to counsel patient on pre-chemo?

A

Mucositis, transient xerostomia, spontaneous hemorrhage, infections, importance of oral hygiene, non-healing and oral wound.

42
Q

What are the chemo crises?

A

Spontaneous bleeding, infection, mucositis, xerostomia

43
Q

How do you treat spontaneous bleeding from chemo?

A

Platelet infusion.

44
Q

How many platelets are in a pack?

A

Increase of 4k-6k platelets.

45
Q

What are the 4 R’s of radiation biology?

A

Repair of cellular damage
Reoxygenation of the tumor
Redistribution within the cell cycle
Repopulation of cells

46
Q

What is the sequence of osteoradionecrosis?

A

Radiation
Hypovascular, hypocellular, hypoxic tissue
Tissue breakdown (cellular death and collagen lysis exceed synthesis and cellular replication)
Chronic non-healing wound where energy, oxygen and metabolic demands clearly exceed the supply.

47
Q

What is the significant dose for osteoradionecrosis?

A

More than 5k cGy;H

48
Q

Which jaw is more at risk for osteoradionecrosis?

49
Q

Prevention of ORN

A

Remove ‘at risk’ teeth 21 days prior to XRT
Consider treatment in golden window (1-6 months after XRT, pre-fibrotic phase)
Adjunctive HBO treatment
Don’t extract post radiation

50
Q

What are at risk teeth for ORN?

A

Caries, RCT or periodontal disease, especially in MN.

Know the area with the highest dose

51
Q

What are the radiation level guidelines for treatment?

A

Less than 4500-normal
4500-5500- MX is normal, caution with MN
More than 5500-No treatment without HBO

52
Q

Intraoral complications from radiation

A

Edema, muscle trismus, erythema, mucositis, diminished taste, radiation caries, xerostomia.

53
Q

What is the most common long term complication from radiation?

A

Xerostomia. 200 cgy/day x one week is 57% decrease in flow. Irreversible with doses more than 400 cGY.

54
Q

Radiation Induced Caries

A

Cervical cusp tips. Different from caries not induced by radiation. From a combined affect of hyposalivation and radiation dose.

55
Q

What is Lateral Wall Movement and what nerves are involved?

A

Necessary for swallowing and speech.

Vagus, facial, glossopharyngeal

56
Q

What are the components of speech?

A

Respiration, phonation, neural integration, resonation, articulation, audition.

57
Q

What is a frontal plane rotation?

A

After a hemimandibulectomy, MN deviates toward the defect due to the pull of the suprahyoid muscles on the residual fragment.

58
Q

How do you treat trismus?

A

Early! With intervention of an exercise program.

59
Q

Inoculation Infection.

A

Edema, soft tissue involvement. Determined by perforation of cortical bone in relation to muscle attachments. Infection will spread along path of least resistance.

60
Q

Cellulitis

A

Indurated. Acute, painful, diffuse borders, mixed bacteria.

61
Q

Abcess

A

Puss. Chronic, localized pain, fluctuant, well circumscribed, anaerobes.

62
Q

Indications for referral to OMS?

A

Rapidly progressing, difficulty in breathing and swallowing, fascial space involvement, elevated temp, severe trismus, toxic appearance, compromised host, extremes of age.

63
Q

First line of Abx?

64
Q

What do you use if allergic to pen VK?

65
Q

What abx do you use if resistant?

A

Augmentum or add flagyl

Hospital Dentistry (1 decks)

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