Final Exam Flashcards
1
Q
Plumber- vincent syndrome
A
oral cancer possible association
2
Q
How would the mucosa of Crohn’s disease look on an x-ray?
A
cobblestone appearance of mucosa
- Ilium, genetic component, granulomatous, persistent diarrhea, Malabsorption, increased GI cancer risk, treat with corticosteroids, oral lesions
- Dental aspects
- Malabsorption complications
- Corticosteroid complications
- Avoid NSAIDs
- Avoid antibiotics that cause diarrhea
- Large, linear, ragged mucosal ulcers
- “cobblestone” appearance of mucosa
- Facial and labial swelling
3
Q
Cardner’s syndrome
A
GI polyps, jaw exostoses, jaw osteomas
NO CYSTS
- : Everything in excess = excess polyps, excess bone
- colo-rectal polyps—autosomal dominant disorder.
4
Q
What blood disease is the highest risk in dentistry?
A
Hepatitis B
5
Q
What is the serological marker for successful vaccination of hepatitis B?
A
Anti - Hbs
-
HBsAg
- Acute infection – 20-120 days post-infection
- Chronic infection – 13 weeks post – jaundice
-
Anti-HBs
- Recovery and immunity
- Successful vaccination
- HBcAg – current or recent infection
-
Anti-HBc
- With anti-HBs – recovery and immunity
- Without anti-HBs – carrier/chronic hepatitis
- HBeAg: Ongoing infectivity
-
Anti-HBe
- Inactive state
- Complete recovery if HBeAg absent
- What lesion has sulfur granules? Actinomycosis
6
Q
What lesion has sulfur granules?
A
actinomycosis
7
Q
Where can we see the Koplik’s spots?
A
Measles
aka rubeola
8
Q
What is the most common physical handicap in the US?
A
cerebral palsy
9
Q
What is the fastest growing developmental disorder in the US
A
Autism
10
Q
What is the safest trimester to give dental care to pregnant women?
A
2nd trimester
11
Q
What is associated with osteogenesis imperfecta?
A
abnormal translucency
brown-purple color
abnormal wear
altered enamel-dentin interface
obliterated pulp chamber
NOT IMPACTED TEETH!!
- Clinical Features
- Usually autosomal dominant, Brittle bone -> fracture, Easy bruising, Joint Hypermobility, Cardiac complications, Blue sclera, Otosclerosis (deafness)
12
Q
What do you see on an X-ray of fibrous dysplasia?
A
ground glass appearance
Normal calcium and phosphate levels, polysialic
13
Q
What is associated with butterfly rash?
A
lupus
14
Q
Name and describe the different types of tissue grafts
A
Autograft - same person
Allograft - closely matched individual (cadaver)
Isograft - from a genetically identical individual (twin)
- Hematopoietic stem cell transplant – autologous or allogenic
- Peripheral blood / umbilical blood stem cell transplant
15
Q
How long should you wait to provide elective dentistry after a bone marrow transplant?
A
6 months
16
Q
What is the most common malignancy in humans?
A
basal cell carcinoma
17
Q
What is metabolic syndrome and its features?
A
Risk factors for ischemic heart disease, diabetes, stroke:
hypertension
insulin resistance
obesity
dyslipidemia
2x ischemic heart disease risk
5X diabetes risk
18
Q
What is the most common durg abused?
A
alcohol
19
Q
What would be the most affected activity in the elderly
A
walking
20
Q
Which of the following is a risk factor in type II diabetes mellatis
A
Hypertension
physical inactivity
obesity
average age above 40
- What would you find in Type II diabetes MD:
- Fasting blood sugar > 126 on 2 separate occasions
- HbA1C > 6.5% (Want to see people under 7 to 6.5) – 4 to 6 is normal range
- Random sugar > 200
- GTT > 200
- Signs/sx’s – polyuria/polydipsia/blurry vision
21
Q
What are the complications of poorly controlled diabetes?
A
neuropathy (peripheral)
nephropathy
retinopathy
CVD/PAD/Stroke
poor wound healing
periodontal disease - 6th complication
22
Q
What is the normal number of RBC’s?
A
4 - 5 million
23
Q
What is the normal number of platelets?
A
150,000 - 400,000
average = 200,000
24
Q
What is the most common inherited blood disorder?
A
von Willebrand’s disease
25
is hemophilia autosomal dominant, recessive or X-linked?
X - linked
26
What do you see in hemophilia?
hemarthrosis
deep muscle pain
normal INR
normal PT
**NOT NORMAL PTT = prolonged prothrombin time**
27
What can you see in DIC?
Disseminated intravascular coagulation
malignancies
acute hemolysis
bacterial sepsis
severe burns
**IT IS NOT A DISEASE**
1. Widespread activation of thrombin and plasmin mechanisms
1. Overwhelmed control mechanisms
2. Consumption of participants in hemostasis
1. Platelets
2. Coagulation proteins
1. Fibrinogen, prothrombin, factor V, factor VIII
3. Control proteins
1. Antithrombin, protein C, protein S, Plasminogen
2. May present as bleeding or thrombosis
3. Introduction of extrinsic clot promoting material
1. Malignancy, amniotic fluid, fat embolism, etc
4. Intravascular elaboration of procoagulants
1. Acute hemolytic process
2. Heparin associated thrombocytopenia
5. Vascular injury
1. Bacterial viral sepsis, hypotension
6. Uncertain mechanisms
1. Anaphylaxis, hypothermia, hepatic failure
28
What are the characteristics of anticoagulants?
Warfarin = slow onset, food interactions, drug interactions, no predictable drug effects, yes antidote
29
What are the etiologies of anemia?
pregnancies
GI blood loss
Parasitic infection
menstrual blood loss
hemolysis
decrease RBC production
genetic disposition
30
How does altitude impact anemia?
high altitude makes anemia worse
31
What are the characteristics of sickle cell anemia?
Can see hemolysis mainly
microvascular infarction
splenic infarcts
sepsis
32
Hypoproliferative anemia characteristics
1. not making enough RBC
2. low reticulocyte count
3. nutritional deficiencies: vit B12, folic acid, iron deficiency
4. Impaired iron metabolism: anemia of chronic infection
5. Impaired erythropoietin: anemia of chronic kidney function
6. aplastic anemia
33
Most common form of anemia in the US
iron deficiency anemia
34
most abused drug by dentists other than nitrous oxide?
acetaminophen with hydrocodone
35
What number do you need to prescribe controlled substances?
DEA number
36
What number should be on all prescriptions?
NPI number
37
When do you need prophylactic antibiotics?
1. If patient has a history of IE, you would need prophylactic antibiotics
2. Medically compromised patient with prosthetic joints comes in for severe dental surgery, do you immediately give prophylactic antibiotics or do you need to consult? Need to consult
3. Anything prosthetic inside the heart needs prophylactic antibiotics
4. ***_Cardiac transplant: would NOT need a prophylactic antibiotic_***
38
How long after the appointment can a patient take prophylactic antibiotics if forgotten?
up to 2 hours after appointment
39
What are the medications for TB?
RIPE - F
**Rifampin**
**Isoniazid**
**Pyrazidimide**
**Ethambutol**
**Fluoroquinones** **(moxifloxacin)**
40
What condition is it if you have wheezing sound?
asthma
41
What does it suggest if you have there is an enlargement of the left ventricle?
Shift to the left PMI = CHF
42
Which component in different mouthwashes and chewing gums can be associated with contact mucositis?
cinnamon dentifrices, mouthwashes, gum
plasma cell gingivitis
Tartar-control dentifrices with cinnamon or pyrophosphates
43
Which of the following regarding periodontal disease in elderly is true?
1. Majority of older adults have an aggressive form -False
2. Periodontal disease can be age-specific disease – False
3. Most of the older adults would not have periodontal disease - False
4. Know how periodontal disease is affected in older adults (chronic is more common in elderly)
1. **Majority** of older adults have some form of periodontal disease - result of chronic, slowly progressing lifetime disease accumulation
2. Not an age specific condition
3. Aggressive active periodontitis affects small number of elderly
44
Older patients has a denture and most probably what would you see if there is a lesion under the denture?
1. **C. albicans**
2. Traumatic Ulcers – Etiology: denture irritation
3. Epulis Fissuratum = Denture granuloma
4. Denture Stomatitis – sore mouth
45
Metabolic syndrome association/determination
1. ***_LDL_***
2. High blood pressure
3. Need to know these numbers to see which one leads to metabolic syndrome
4. **Risk factors for ischemic heart disease, diabetes, stroke**
1. **Hypertension, Insulin resistance, Obesity, Dyslipidemia**
5. Six pack
1. Waist circ Men \> 40 in Women \> 35 in
2. BP\>135/80
3. Pre Diabetic 100-125
4. High TG \> 150
5. HDL Men \< 40 Women \< 50
6. Gout/OSA (Beer)
7. FHx/HTN/Dyslipidemia – 30 50% probability
46
What is associated with hypoglycemia
tachycardia
anxiety
seizures
cardiac dysrhythmia
47
What are the differences between primary and secondary hemostasis
1. What is affected, Hemophilia A, B which factors affected **in A is VIII and B is IX**
1. **Primary hemostasis factors**: collagen, vWB, platelets, inflammatory markers
2. **Etiologies for secondary hemostasis:** heparin, VIC, hemophilia, vitamin K deficiencies
48
What are the etiologies with secondary hemostasis?
Heparin
DIC
Vitamin K deficiency
Hemophilia
**NOT THROMBOCYTOPENIA**
49
What is INR based on?
PT = extrinsic pathway
50
In hemophilia, what do you expect to see?
Hemarthrosis
deep muscle hemorrhage
normal INR
normal PT
**ABNORMAL PTT**
1. What will you see in hemophilia regarding INR, PTT, PT. Which is increased, normal or decreased
1. Prolonged PTT (partial thromboplastin time)
2. Normal PT, TT, fibrinogen, PFA-100
3. Low factor VIII or IX
51
all of the following except what would lead to indications for anti-coagulation therapy except what?
1. Would malignancy lead to anti-coagulation
2. Would venous thrombosis lead to anti-coagulation
3. Prosthetic heart valves lead to anti-coagulation
4. Ventricular fibrillation lead to anti-coagulation
1. Would malignancy lead to anti-coagulation - yes
2. Would venous thrombosis lead to anti-coagulation - yes
3. Prosthetic heart valves lead to anti-coagulation - Yes
4. Or ***_Ventricular fibrillation lead to anti-coagulation_***
5. Atrial fibrillation- Warfarin - yes
52
What are the different types of anemias?
Iron deficiency
pernicious
aplastic
hemolytic
hypoproliferative
53
Each of the following is at best a bad idea or violation except what?
1. If you prescribe medication – birth control for your spouse.
2. Prescribing same things (estrogen containing birth control) – for a colleague
3. Prescribing acetaminophen and hydrocodone for yourself
4. Taking acetaminophen with ibuprofen every 8 hours for pain. Both are OTC, do not require prescription
5. Prescribing a combination of acetaminophen and hydrocodone for someone who is not a patient of record and you have not met him
1. If you prescribe medication – birth control for your spouse. BAD!!
2. Prescribing same things (estrogen containing birth control) – for a colleague – BAD
3. Prescribing acetaminophen and hydrocodone for yourself – STILL BAD!!!
4. ***_Taking acetaminophen with ibuprofen every 8 hours for pain. Both are OTC, do not require prescription – OKAY_***
5. Prescribing a combination of acetaminophen and hydrocodone for someone who is not a patient of record and you have not met him- BAD
54
Each of the following statements regarding antibiotic prophylaxis is false except which one?
1. For patients with prosthetic joint implants, prophylactic antibiotics ALWAYS recommended
2. Patients take premedication 8-12 hours prior to the invasive dental procedure
3. Patients with IE history do NOT need prophylactic antibiotics
4. Patients who forgot to take medication can be reasonably covered by medication within 6 hours
5. If based on existing scientific data, dentist believes risks of Prophylactic antibiotics outweighs the benefits which would be in contrast to what the physician wrote? The dentist cannot outweigh what the physician says? If you are in-doubt whether to prescribe medication for a patient, need to do a consult. If afraid whether not to or to prescribe, leave the responsibility to the orthopedic surgeon for the surgeon to make the decision
1. For patients with prosthetic joint implants, prophylactic antibiotics ALWAYS recommended - false
2. Patients take premedication 8-12 hours prior to invasive dental procedure - false
3. Patients with IE history do NOT need prophylactic antibiotics – false
4. Patients who forgot to take medication can be reasonably covered by medication within 6 hours - false
5. If based on existing scientific data, dentist believes risks of Prophylactic antibiotics outweighs the benefits which would be in contrast to what the physician wrote? Dentist cannot outweigh what the physician says? If you are in doubt whether to prescribe medication for a patient, need to do a consult. If afraid whether not to or to prescribe, leave responsibility to the orthopedic surgeon for the surgeon to make the decision
6. PATIENTS WITH HEART TRANSPLANT DO NOT NEED ANTIBIOTIC PROPHYLAXIS
55
What are the dosages for antibiotic prophylaxis?
1. If a patient needs a prophylactic antibiotic, would be amoxicillin. Dose is 2000 mg, 4 tablets of 500 mg = 2000 mg
2. If patient has allergy to penicillins, would prescribe Clindamycin—600 mg (4 x 150 mg)
56
What are the characteristics of cirrhosis?
Final stage of liver disease
portal hypertension
finger clubbing
jaundice
hypercoagulability
**NOT HYPERCOAGULABILITY**
57
Which of the following heart valves would you hear the best?
mitral valve (5th intercostal space)
at the midclavicular line
58
What are the types of herpes viruses?
1. HHV - Type 1 – fever blisters, cold sores
2. HHV – Type 2 – Genital herpes
3. Varicella zoster – chicken pox, shingles
4. **Epstein-Barr Virus** – mononucleosis, **Burkitt lymphoma**, nasopharyngeal carcinoma, hairy leukoplakia (seen on tongue
5. Cytomegalovirus – retinitis
6. HHV – Type 6 – exanthum subitum
7. HHV – type 7 – roseola infantum
8. **HHV – Type 8 – Kaposi sarcoma = seen in AIDS patients!!**
1. ***_NOT HERPANGIA (CAUSED BY COXSACKIE A VIRUS)_***
59
What is Epstein-Barr virus and its associations?
1. Mononucleosis
1. Transmitted ***_by Kissing_*** (secreted in saliva)
2. Palatal petechiae
2. ***_Burkitt lymphoma_*** –non-Hodgkin lymphoma
1. African children
2. Massive mandibular swelling
3. Nasopharyngeal carcinoma – Asians
4. ***_Hairy leukoplakia – AIDS (on the tongue)_***
1. Leukoplakia does not need AIDS to be present. But HAIRY LEUKOPLAKIA IS MAINLY ONLY FOR AIDS PATIENTS!!!
60
What is less characteristic of men than women?
1. tobacco use (men)
2. suicidal rate (men)
3. Cardiovascular disease (men)
4. ***_preventive health measures (women more than men)_*** – use toothbrush, floss, doctors..
61
What medications are most common cause of osteonecrosis?
bisphosphonates and denosumab
1. 1 in 20 patients with IV ***_bisphosphonates_*** = show signs of osteonecrosis!!!
2. 1 in 1500 with oral bisphosphonates
3. Also seen with ***_denosumab_***, bevacizumab, sunitinib
62
What is the difference between primary and secondary Sjogrens sydrome?
1. F \>\> M (5% of women; 0.5% of men) – he doesn’t like to ask stats questions…
2. Middle-age
3. **Primary**
1. **Dry mouth, Dry eyes**
4. **Secondary**
1. **Dry mouth, Dry eyes**
2. ***_Rheumatoid arthritis_* or other connective tissue diseases**
5. **5% risk of lymphoma**
1. **usually MALT lymphoma**
1. **MALT lymphoma (MALToma) is a form of lymphoma involving the mucosa-associated lymphoid tissue (MALT), frequent of the stomach**
2. Usually parotid
63
What feature are associated with scleroderma?
mask-like face (mona lisa)
Constricted mouth opening (fish mouth)
Limited tongue mobility (chicken tongue)
Jaw resorption
**NOT IMPACTED TEETH!!!**
1. **FEMALES ARE 10 TIMES MORE THAN MALES**
1. Estrogen and possible silicone breast implants
2. “hard skin”
3. Localized- 1. morphea 2. linear
4. Linear – coup de sabre
5. Systemic
1. Limited, diffuse, sine
6. **Dental aspects**
1. **80% with head and neck symptoms**
2. **30% are initial signs and symptoms**
3. **Mask-like face *_(mona lisa)_***
4. **Restricted facial movements**
5. **Constricted mouth opening *_(fish mouth)_***
6. **Limited tongue *_mobility (chicken tongue)_***
7. **Jaw resorption**
1. ***_IMPACTED TEETH?? NO_***
64
What are the features of chronic renal disease?
hypertension
renal osteodystrophy
calcium excretion
increased PTH (secondary hyperparathyroidism)
giant cell lesions of bone
1. **Anatomical classification**
1. **Vascular, glomerular, tubulointerstitial, obstructive**
2. Clinical symptoms
1. Thrombocytopenia -\> purpura
2. Diminished thromboxane -\> impaired thrombin formation
3. Elevated prostacyclin -\> poor platelet aggregation
4. Defective von Willebrand factor
5. **_Hypertension_**
6. Anemia (marrow toxicity)
7. Defective phagocyte function -\> infection
8. **_Renal osteodystrophy_**
1. Phosphate retention**, _calcium excretion, Increased PTH_ (_secondary hyperparathyroidism_)**
2. **_Giant cell lesions of bone_**
3. Management
1. **Control blood pressure** – you must check BP for every patient
65
When do you proceed with dental treatments when the patient is on dialysis?
day after dialysis for dental treatment
66
What is associated with actinic keratosis
Pre-malignant
Found on skin exposed to sun
Prevented with sunscreen
Lower lip
Premalignant or precancerous
If untreated, 10% develop into SCC over 10 years
60% of SCC develop from AK
Risk factors are the same as SCC
Prevented with sunscreen and low fat diet
TX is destruction or topical immunotherapy
AKA solar keratoses, senile keratoses, or “precancers”
Occur on sun-damaged (scalp, face, tops of ears, hands)
Classic appearance: rough or gritty pink to red macule or papule with angular borders
0.1% per year turn into an invasive SCC
We don’t know which one, so we tend to treat them all
67
What is associated with atopic dermatitis (AD)
= Eczema
bacterial colonization
Xerosis (scaling)
early childhood
***_NO BLISTERING_***
_Atopic triad_: AD, Asthma, allergic rhinitis
1. A common inflammatory condition of the skin
2. Often referred to as “eczema”
3. Associated with seasonal allergies, asthma and food allergies
1. ***_Atopic triad: AD, Asthma, allergic rhinitis_***
4. “to break out; to boil over”
5. Group of dermatoses with characteristic histologic and clinical features
6. Not a diagnosis in and of itself
7. Eczema is a broad term, and treatments differ, so it is important to distinguish the “kind of eczema”
8. Prevalence
1. ***_Higher in children_*** – genetic
9. ***_NO BLISTERS_***
68
What type of allergy reaction and material can be from allergic contact dermatitis?
1. (Type IV allergy response)
1. Beauty products, latex, **glass** (NO), poison ivy, etc – read
Topical antibiotics (neomycin), Poison ivy, Bandage, Textiles, Nickel, Latex
69
What is Psoriasis?
**Arthritis (NO), Obesity, Metabolic syndromes, nail pitting, Inc/dec cancer risk?**
1. Chronic inflammatory disorder of the skin
1. Immune – mediated disease
2. Prevalence is 1 – 2 in 100
3. Present in children and adults
4. Subtypes
1. Plaque-type, guttate, psoriatic arthritis, Pustular psoriasis, Erythroderma
5. Triggers (for flares)
1. Infection, particularly streptococcus
2. Emotional or physical stress
3. Trauma
4. Certain medications – beta blockers, hydroxychloroquine, ibuprofen, many others
6. Association
1. Obesity, metabolic syndrome (high blood pressure, excess body fat (abdominal), high blood sugar, high blood pressure
2. Increased risk for cardiac morbidity and mortality in those who have psoriasis, even mild
7. Plaque (head, butt, elbows, knees), **nail bed,** guttate, palms, pustular, erythrodermic, inverse
70
What are the features of Gaucher's disease?
Most common lysosomal storage disease
common in Ashkenazic Jews
Glucocerebrosidase deficiency
Hepatosplenomegaly
Anemia
Thrombocytopenia
Honey-combed mandibular radiolucencies
Autosomal recessive
71
What are the characteristics of Amyloidosis?
Local anesthesia OK
Macroglossia
Gingival enlargement
Mucosal petechiae
**NOT ASSOCIATED WITH PAGE'S DISEASE**
1. Eosinophilic, hyaline protein
2. **Primary**
1. Immunoglobulin light chain over-production
2. Myeloma-associated
3. **Secondary**
1. **Most common type**
2. Excessive stimulation of RE system or inflammatory diseases
4. Dental Aspects
1. ***_Local anesthesia OK_***
2. ***_Macroglossia_***
3. ***_Gingival enlargement_***
4. ***_Mucosal petechiae_***
1. **Paget association? (NO)**
5. Biopsy: Stain with Congo red, view with polarized light
72
What type of cells are associated with HIV?
CD4+ helper T lymphocytes
1. most of transmission is intimate contact, blood products, needles, vertical transmission (Q: what type of cells are affected by HIV)
1. Retroviral infection of ***_CD4+ helper T lymphocytes_***
2. First noted in 1981
3. Now identified as early as 1959
4. Transmission
1. Intimate contact
1. Mainly risky sexual practices
2. Primarily heterosexual (worldwide)
3. Primarily MSM (developed countries)
2. Contaminated blood, blood products, tissue (hemophiliacs)
3. Contaminated needles (IVDUs)
4. Vertical transmission (25% of HIV + mothers)
73
What are the different types of immunoglobulins?
1. **IgA – secretory and mucosal immunity**
2. **IgD – unknown significance**
3. **IgE – allergy and parasitic diseases**
4. **IgG – bacterial infections**
5. **IgM – opsonization**
74
**What abused drug causes ischemic mucositis of the nasal septum and palate?**
Cocaine
75
Explain allergic reactions and their reaction types
1. **Anaphylaxis**
1. **Type I (IgE-mediated)**
1. Latex (rare), drugs, eg. **Penicillin**
2. Contact Allergy
1. **Type IV (cell-mediated)**
1. **Latex,** dental materials
1. 15% latex allergy and 1% general population have latex allergy
3. **Clinical Features**
1. **Type I**
1. **Rapid onset**
2. **Wheezing**, breathlessness
3. Sneezing, runny nose, itching, urticarial
4. Bronchospasm -\> hypotension -\> angioedema -\> anaphylactic shock
2. **Type IV**
1. **Slower onset**
2. **Inflammation at contact site**
76
Humoral immunity cell type
B cells
77
Cell mediated immunity cell type?
T cells
78
Explain Fordyce granules
Sebaceous glands
epithelium of cheek and vermillion boarder of lips
79
What is associated with Downs Syndrome?
1. chromosome 21, congenital, macroglossia
1. Lip and tongue fissuring, periodontal disease, bruxism, malocclusion, drooling, delayed eruption, hypodontia and microdontia, Omega-shaped palate
80
Explain Autistic spectrum disorder
1. **developmental disability with social interaction difficult = *_short and quiet visits_***
1. Developmental disability characterized by difficulties in social interaction and communication and by restricted or repetitive patterns of thought and behavior
1. ***_Communication + behavior + social functioning = ASD_***
2. Autism is the fastest-growing developmental disability, prevalence has increased by 6-15% each year from 2002 to 2010, in US 1 in 68 births, 3-4 times more common in boys, symptoms typically are recognized in the first two years of life, 46% of ASD children have above average intelligence
3. ASD Dental Aspects
1. Communication problems, mental capabilities, behavior problems, unusual responses to stimuli, unusual and unpredictable body movements, bruxism, tongue thrusting, self-injury: picking at gingival, biting lips, Pica, Poor oral hygiene, Dental caries and periodontal disease – similar to general population
4. ASD Dental Management
1. Desensitization appointment, Quiet and short visits, Routine: same dental staff, operatory, appointment time, Use a “tell-show-do” approach, minimize distractions, document your observation
81
What are pregnant women mouth sores?
Pyogenic granulomas
82
What is related with parafunctional habits?
Mandibular tori
83
All of the following can cause defective platelet function except?
1. Aspirin , Plavix , Prozac , dialantin , acetaminophen
1. Aspirin (yes), Plavix (yes), Prozac (yes), dialantin (yes), **acetaminophen (no**)
84
How long should pediatric records be kept for?
7 yrs after their 18th birthday
= till 25th birthday
85
What cranial nerve is not test during routine POE?
CN 1
86
What is the main facial difference between Bell's palsy and a stroke?
1. CN 7 is not in tact anymore for bells palsy
(forehead doesn’t wrinkle when the patient raises eyebrows, stroke it does
87
What is a list of clinical signs and symptoms in decreasing order?
differential diagnosis list
88
Which of the following is not a schedule II drug
## Footnote
a. Benzodiazepine
b. Codeine
c. Barbiturates
d. Amphetamines
e. Fentanyl
a. Benzodiazepine - IV
b. Codeine - II
c. Barbiturates - II
d. Amphetamines - II
e. Fentanyl - II
89
What is the treatment for trigeminal neuralgia?
carbamazepine (tegretol)
90
What are the 3 main causes, treatment and characteristics for burning mouth syndrome?
1. 3 main causes: vitamin deficiencies, fungal infection, dry mouth
1. Zinc will also cause BMS if deficient
2. What medication to treat? **Clonazepam (klonopin) =** antidepressant
3. Characteristics: short, sharp shooting pain
91
What type of pain is associated with trigeminal neuralgia?
Sharp shooting pain for short duration
92
What percentage of children are victims of child abuse in the head and neck?
65%
93
what are the type II diabetes mellitus risk factors
1. **Age \>40**
2. **Hypertension**
3. **Obesity**
4. **Habitual physical inactivity**
5. **Polyuria**
6. **High HbA1C (\>6.5%)**
7. **Normal range: 4-6%**
1. ***_NOT Western European race_***
94
What is perioral dermatitis?
1. **An inflammatory condition of the face**
2. **Usually made worse with fluorinated topical steroids or fluoride toothpaste**
3. **Spares vermillion border**
4. **Can involve perinasal and periocular skin**
5. **Pruritic**
6. **Tx:**
1. **Remove offending agents**
2. **Gentle, fragrance-free skin care**
3. **Topical antibiotics - metronidazole, erythromycin**
4. **Oral antibiotics - doxycycline**, minocycline (adults) and erythromycin
