Final Review Flashcards
1
Q
Who is authorized to give medical history?
A
Legal guardian
2
Q
Does a patient have a true allergy if they broke out in hives after taking penicillin?
A
Yet
3
Q
What is produced by chronic inflammation of the bronchial tubes whose edema leads to narrowing of the bronchi (can be caused by a hyperactive response or inflammatory response)?
A
Asthma
4
Q
Asthma that is twice weekly or less, and has nighttime fits twice a month or less is classified as what?
A
Mild intermittent asthma
5
Q
Asthma that is more than twice weekly but no more than once a day nighttime fits more than twice a month is classified as what?
A
Mild persistent asthma
6
Q
Asthma that has daily symptoms and nighttime more than once a week is classified as what?
A
Moderate persistent asthma
7
Q
Asthma with symptoms throughout most days and frequently at night is classified as what?
A
Severe persistent asthma
8
Q
What is a question to ask a parent when they report their child has asthma to evaluate the severity?
A
What are their night symptoms?
9
Q
What is the rescue medication for asthma that is a short-acting Beta-2 agonist?
A
Albuterol most common
10
Q
What type of asthma would a child having a Flovent (fluticasone) or Pulmicort inhaler have?
A
Severe. They are being treated with a steroid
11
Q
Spacers or a nebulizer are usually prescribed to what child demographic for asthma?
A
Young children. Nebulizer used in children 3-5 yrs old
12
Q
Identify Child’s Caries Risk assessment:
Mother/primary caregiver has active caries
Parent caregiver has low socioeconomic status
Child has >3 b/w meal sugar snacks or beverages/day
Child is put t obed w/ bottle containing natural or added sugar
Child has >1 decayed/missing/filled surfaces
Child has active white spot lesions or enamel defects
Child has elevated S. mutans level
A
High Caries Risk
13
Q
If contacts are closed on a high caries risk patient, it is the first visit, and they are only primary dentition (5 years old), what radiographs are indicated?
A
Bitewings
14
Q
What radiograph schedule is indicated for a high caries risk patient as the get on recalls, assuming they maintain a high caries risk?
A
BW every 6-12 months
Pano w/ eruption of the 1st permanent molars (6 yr molars) = early mixed dentition
15
Q
Caries Risk for a child: Child has special health care needs Child is a recent immigrant Child has plaque on teeth Patient has defective restorations Patient wearing an intraoral appliance
A
Moderate caries risk
16
Q
What radiographs are indicated for a moderate caries risk patient when on recall in the office?
A
Bitewings every 6-12 months
17
Q
What would be the treatment of choice for caries on #A on a 5 year old patient with high caries risk?
A
Stainless steel crown
18
Q
If you extract $T (primary 2nd molar) what space maintenance is indicated and why?
A
Distal shoe off #S planted into the distal of the socket of #T to guide #30 as it erupts
19
Q
If you extract #S (primary 1st Molar), what space maintenance is indicated and why?
A
Band and loop off #T to #R to hold arch space
20
Q
Why would a band and loop be indicated over a lower lingual holding arch (LLHA) for maintenance of space where #S was extracted?
A
19, #30, and anterior incisors must be erupted to do LLHA
21
Q
What is the primary dentition occlusal scheme where the terminal plane of the mandibular primary second molar is mesial to the maxillary primary second molar terminal plane?
A
Mesial step, will normally go Class I or Class III permanent occlusion
22
Q
What is the primary dentition occlusal scheme where the terminal plane of the mandibular primary second molar is distal to the terminal plane of the maxillary primary second molar?
A
Distal Step, pt will be Class II permanent occlusion
23
Q
What is a primary dentition occlusal scheme where the terminal plane of the mandibular primary second molar is distal to the terminal plane of the maxillary primary second molar?
A
Distal Step, pt will be Class II permanent occlusion
24
Q
What is the primary dentition occlusal scheme where the terminal plane of the mandibular second primary molar is even with the terminal plane of the maxillary primary molar?
A
Flush terminal plane, mostly Class I permanent
25
What is the Ideal occlusion for a 7 yr old?
Class I molar (will have permanent molars in)
2mm anterior and posterior overjet
2mm anterior overbite
Coincident dental midlines
26
An inattentive, overactive, compulsive child classified as either Inattentive, Hyperactive-Impulsive, or Combined (I'm not really sure what this question means)?
ADHD
27
What percentage of pulpotomies fail?
15%
28
what occlusal scheme do you look at once the first permanent molars are in?
Angle class
29
What space maintenance is indicated when #A (maxillary primary 2nd molar) extracted and #3 and #14 are in?
Nance or TPA
30
Do kids have a higher or lower drug requirement than adults and why?
Higher due to greater volume of distribution
31
What is a consideration as far as drug metabolism for children?
They have lower concentration of liver enzymes
32
What makes a sedation more challenging on a child?
Airway
33
What are 3 differences of pediatric airway?
1. Larynx more anterior
2. Vocal cords have anterior slant
3. Epiglottis is stiff
34
Are children small adults?
No
35
What does the high surface area to weight ratio mean for a child?
They lose heat more easily
36
Why do children desaturate faster than adults?
Smaller thorax has less expansive capacity, therefore have less functional reserve
37
What produces a minimally depressed state of consciousness but pt is still able to maintain patent airway independently and continuosly. Able to respond appropriately to physical stimulation and verbal commands
Sedation
38
Does sedation make an uncooperative child cooperative?
No
39
What are the goals of sedation?
```
Quality care
Minimize disruptive behavior
Positive psychological response
Patient welfare and safety
Physiologic state w/ safe discharge
```
40
What is the anxiolytic level of sedation where pt can respond normally to verbal commands with possible cognitive function and coordination impairment, but ventilation and cardio is unaffected?
Minimal sedation
41
What is the term for conscious sedation of drug induced depression of consciousness where pts respond purposefully to verbal commands, can expect age-appropriate behavior in conscious sedated child, e.g. crying?
Moderate sedation
42
What is the term for drug induced depression of consciousness where pt cannot easily be aroused, but responds purposefully after repeated verbal/painful stimuli. Ventilatory function may be impaired?
Deep sedation
43
What is the drug-induced loss of consciousness during which pt is not arousable even by painful stimuli, cannot maintain ventilator function?
General anesthesia
44
If doing sedation, what level of sedation should you be prepared for you?
Deeper level than intended
45
What are 5 routes of drug administration?
1. Oral
2. Rectal
3. Intramuscular
4. Inhalational
5. IV
46
What is a major disadvantage of the oral route for sedation?
Cannot titrate dose once given, so deal with the level you get
47
Child with pharyngeal space that occupies more than 50% (Brodsky III or IV?) is at increased risk of what during sedation?
Respiratory obstruction
48
What are 3 things children are more susceptible to with respect to cardiovascular function and sedation?
1. Bradycardia
2. Decreased Cardiac Output
3. Hypotension
49
What is the Brodsky class where tonsils occlude pharyngeal space <25%?
I
50
What is the Brodsky class where tonsils occlude pharyngeal space 25-50%?
II
51
What is the Brodsky class where tonsils occlude pharyngeal space 50-75%?
III
52
What is the Brodsky class where tonsils occlude pharyngeal space >75%?
IV
53
What is the risk if NPO is not followed prior to sedation?
Pulmonary
54
How close to sedation can the patient have clear liquids?
2 hours
55
How close to sedation can patient have breast milk?
4 hours
56
How close to sedation can the patient have infant formula?
6 hours
57
How close to sedation can patient have a light meal such as toast and clear liquids?
6 hours
58
Why would antihistamine be given in a sedation?
1. Aide sedation
| 2. Combat nausea (antiemetic)
59
What are sedation drug classes?
Choral hydrate
Benzodiazepines (Daizepam)
Narcotics (Meperidine)
60
What is the oral sedation success rate?
60%
61
Should a patient expect to get a sedation on their first appointment?
No. First will be consult. 2nd will be the sedation.
62
Would a patient with extensive operative needs be a good candidate for sedation and why?
No. Length of treatment might exceed time of sedation effects. Pt better served via General Anesthesia (GA)
63
What is an Inherited disorder of skeletal muscle triggered by depolarizing muscle relaxants and inhalational agents, particularly succinylcholine (paralytic for intubation). Symptoms are tachycardia, increased end tidal CO2, decreased O2 saturation, dysrhythmia, masseter rigidity?
Malignant hyperthermia
64
What are 4 stages of general anesthesia?
I – Analgesia and Amnesia
II – Dreams and delirium
III - Surgical Anesthesia
IV – Medullary paralysis
65
What is the GA Stage where Pt experiencing blurry thoughts after administration of anesthetic for GA?
Stage I analgesia and amnesia
66
What is the GA stage where pt loses consciousness, pt may appear to struggle?
Stage II dreams and delirium
67
What is the GA stage where pt has progressive loss of reflexes with gradual paralysis of muscles?
Stage III surgical anesthesia
68
What is the GA stage where pt is in the time between respiratory arrest and cardiac collapse?
Stage IV Medullary paralysis
69
What is the difference with induction of GA for pedo and adult?
Pedo give inhalational first, then start IV. Reverse in adults.
70
What is the risk of cardiac arrest with GA?
1.4/10,000
71
What inhalation has an increased risk associated so it is not used?
Halothane, we use Sevo or Desflurane
72
Patients who have or are at increased risk for a chronic physical, developmental, behavioral or emotional condition and who also require health and related services of a type or amount beyond that required by children generally?
Children with special health care needs
73
Does asthma count as a patient with special health care needs?
Yes
74
Which patients are 3 times more likely to be ill and miss school, have 3 times as many hospitalizations and 7 times as many hospital stays and take 5 times as many prescribed meds?
Special needs children
75
What is the most common unmet health care need in special needs children?
Dental care
76
Medicaid goes to what age for special needs children?
18-21 years old
77
What is the most common type of asthma?
Extrinsic (caused by allergen)
78
What are things to ask a parent about with regards to their child's asthma?
1. Triggers
2. Frequency and severity of episodes
3. Management of attacks
4. History of emergency treatment
5. Night symptoms
79
When is the best time to schedule a patient that has nocturnal asthma episodes?
Late morning
80
Can Nitrous oxide be used with a mild or moderate asthmatic?
Yes, med consult for severe asthmatic
81
What instructions should be given to an asthmatic that uses an inhaler regularly to decrease caries risk?
Rinse with water after use b/c meds have low pH and cause xerostomia
82
What is a syndrome with characteristic faces, macroglossia, CIII occlusion, openbite, mouthbreathing, microdontia, hypodontia, delayed tooth eruption, increased risk of periodontitis due to dysfunction of T-cells?
Down syndrome (Trisomy 21)
83
What are 3 considerations for Sedation of pt w/ Downs Syndrome?
1. Atlanto-axial instability
2. Bradycardia
3. Airway changes due to hypotonia
84
What is indicated if you are planning dental treatment on pt w/ Downs Syndrome who had a congenital heart defect completely repaired with a prosthetic material 5 months ago?
Antibiotic prophylaxis
85
What is the Amoxicillin prophylaxis dose?
50mg/kg (max 2 g 30-60 min prior)
86
What is the Clindomycin prophylaxis dose?
20 mg/kg (max 600 mg max 30-60 min prior)
87
What is the Azithromycin prophylaxis dose?
15 mg/kg
88
What is a spectrum of developmental disorders having significant social, communication, and behavioral challenges?
Autism spectrum disorder
89
What is the term for milder symptoms of full autistic disorder, typically with no intellectual disability?
Asperger's syndrome
90
What are some considerations for planning treatment of child with autism?
1. Tell-Show-Do (TSD)
2. Short appointments
3. Same treatment room
4. Distracters
91
What is a question to ask parent of child with autism as a guage to how they might react to dental treatment?
Whether or not they get haircuts
92
What is a neurobehavioral disorder characterized by pervasive inattention and/or hyperactivity-impulsivity which can result in significant functional impairment. Currently the most common behavioral disorder in school-age children with boys affected more than girls?
Attention deficit hyperactivity disorder (ADHD)
93
What is the criteria for diagnosis of ADHD (inattentive, hyperactive, or impulsive types)?
Six or more symptoms persisting for at least 6 months
94
Dr Berry sees what pharacotherapy for ADHD?
Nonstimulant (Atomoxetene (Strattera))
95
What is the key to ensure before treating a patient with ADHD?
Whether the patient took his or her medication (a common problem in summer months)
96
What is a behavior management tool for a patient with ADHD?
Nitrous oxide
97
What is a disorder of movement and posture as a result of injury or damage to brain motor areas more common in males, occurring in 1-2/1000 live births?
Cerebral palsy
98
Will cerebral palsy get worse as the child gets older?
No. It is non-progressive. The patient may be of normal I.Q.
99
What are 4 Cerebral Palsy types?
1. Spastic
2. Dyskinetic / Athetoid
3. Ataxic
4. Mixed
100
What is the most common cerebral palsy type (muscles are stiff due to increased muscle tone)?
Spastic Cerebral Palsy
101
What is a cerebral palsy type with uncontrolled movements either slow and writhing or rapid and jerky?
Dyskinetic / Athetoid
102
What is a erebral palsy type where pt is unable to properly balance and coordinate?
Ataxic
103
What is a cerebral palsy with multiple types, the most common being spastic-dyskinetic?
Mixed cerebral palsy
104
What is a possible cause of the bruxism associated with Cerebral Palsy?
Medications
105
Will a patient with Cerebral Palsy have more or less decayed/missing/filled surfaces on permanent teeth?
More
106
What is the term for an excess percentage of body weight due to fat that puts people at risk for many health problems?
Obesity
107
What is a measure of body weight adjusted for height as an indicator of obesity?
BMI
108
Would BMI be used for an athletic teenage male?
No
109
A BMI of 85th to 95th percentile is overweight or obese?
Overweight
110
How does the dentist aide the pediatrician?
Use each visit as a screening and counseling
111
Juice should be limited to how much per day?
2 6oz servings / day or 1/2 of the recommended fruit intake
112
Why is juice not a substitute for all fruit intake?
Juice lacks fiber of fruit
113
When should juice be consumed?
Part of a meal or with a snack. Not sipped throughout the day.
114
What is the most important teeth in the Moyer space analysis?
Mandibular incisors 23-26
115
What does a negative number in a space analysis mean?
Child has crowding
116
What is the term for the difference of the mesiodistal width between C’s, D’s, and E’s and 3’s, 4’s, 5’s (difference between the width from the M of the primary canine to the distal of the primary 2nd molar and the width from the distal of the permanent canine to the distal of the permanent second premolar)?
Leeway Space
117
How much is the Leeway space in the Mandible?
1.7mm / side 3.4 mm total
118
What dimension is measured in a smooth curve from the distal of the primary second molar to the contralateral primary second molar?
Arch perimeter
119
What is the measure of the relationship between the total mesiodistal diameters of the teeth of the dental arch and the perimeter of bone that surrounds them?
Arch perimeter
120
What are 3 parts of the space analysis?
1. Determine required space
2. Determine available space
3. Determine arch perimeter liability
121
What is the required space based on?
The greatest MD width of each of the 4 permanent mandibular incisors
122
What is the total width of mandibular permanent incisors used to predict and with what tool?
Predict the combined width of the mandibular maxillary permanent canines and premolars using Moyers probability chart
123
Available space is based off what?
MB contact of 1st permanent molar to MB contact of contralateral 1st permanent molar
124
What is a space analysis method that relys on measuring 2 unerupted premolars on radiographs and using the sum of those measurement to estimate width of permanent premolars and canines?
Hixon-Oldfather
125
Crowding of less than ___ mm per quadrant is considered within normal range?
1.0mm
126
Crowding of ____ mm or more per quadrant requires treatment?
3.5mm
127
What amount of space is required in each quadrant for every 1.0mm of leveling to be accomplished per quadrant?
0.5mm
128
A high caries risk peso patient would have what recall schedule?
Every 3 months
129
Where does a pulpotomy normally fail?
At the CEJ
130
If you pull #D-#G early, will the permanents have delayed eruption?
Yes. More bone lays down and gingiva gets more keratinized
131
If you must hold down the patient to get through the appointment, what is their Frankl score?
2
132
What are the steps of a pulpotomy?
1. Unroof pulp chamber
2. Remove coronal pulp
3. Get hemostasis
4. Place dilute (1:5) formocresol for 5 minutes, then remove
5. Pack w/ IRM or Interval
6. Restore with Stainless steel crown
133
If a pulpotomy is planned, when should stainless steel crown slices be done: before or after pulpotomy?
After pulpotomy. If do before the bleeding from the slices could interfere with telling if you get hemostasis in the pulp
134
What is the most common genetic disorder of blood?
Sickle cell anemia
135
What can induce a vaso-occlusive crisis in a patient with sickle cell anemia?
Stress, which we must try to minimize
136
Vaso-occlusive crisis in sickle-cell anemia affects what?
Large organs
137
What is the leading cause of death in sickle cell anemia?
Acute Chest Syndrome
138
What is "acute chest syndrome"?
Vaso-occlusive crisis of pulmonary vasculature characterized by new infiltrate on chest x-ray
139
What is the dosing of Amoxicillin for a child from 3 months to 40kg?
20-40 mg/kg divided doses every 6 hrs
| 25-45 mg/kg divided dosed every 8 hrs
140
What is the amoxicillin dosing of a child over 40kg or an adult?
250-500 mg every 8 hrs
| 500-875 mg every 12 hrs
141
What are the parts of a prescription?
Rx: drug name and dosage
Disp: how many, how much
Sig: instructions to pt
142
What are the most common prescription in Pedo?
Rx: Amoxicillin 400mg/5ml
Disp: 150 mL
Sig: Take 2 tsp (10mL) loading dose and take 1 tsp(5mL) three times a day for 7 days
143
What is the most common mistake in restoration of primary teeth?
Overextension of the preparation
144
If interproximal caries have broken through the marginal ridge of a primary tooth, what is the restoration of choice?
Stainless steel crown
145
Can you do a direct pulp cap on a primary tooth?
No. If you expose the pulp, do a pulpotomy and put a stainless steel crown on it.
146
What procedure includes placing a base or a liner over caries that would otherwise result in a pulp exposure?
Indirect pulp cap
147
How much root length must remain to do a pulpotomy?
2.3 root length remaining
148
If you annoy stop the pleading or if the tissue is necrotic, what treatment is indicated?
Pulpectomy
149
How much root length must remain for a pulpectomy?
At least 1/2 root length
150
What treatment is indicated on a tooth with no permanent successor, e.g. congenitally missing permanent tooth?
Pulpectomy
151
How much fluoridated toothpaste for a child under 2 yrs old?
Smear
152
What is the mg/kg 2 % Lidocaine?
4.4 mg/kg
153
What is the mg/kg 4 % Septocaine?
7 mg/kg
154
What is the BW schedule for high caries risk?
6-12 months
155
What is the BW schedule for low caries risk?
12-24 months
156
Maxillary permanent canines erupt at what age?
11-12 years old
157
Maxillary centrals erupt at what age?
7-8 years old
158
Which arch has teeth that erupt first?
Mandible ahead of maxilla
159
What are some different medications to treat disorders on the autism spectrum?
1. Hyperactivity (ritalin, concerta, catapres)
2. Repetitive behaviors (prozac)
3. Aggressive behaviors (tegretal, risperdal)
4. Delusions (Zyprexa)
160
In what primary tooth is ankylosis most often seen?
Mandibular primary molar
161
What should you do if there is a high risk of damaging the underlying permanent tooth if you extract a primary tooth?
Observe and it may resorb and migrate to the gingiva on its own.
162
What are the most commonly impacted teeth starting with most common?
Third molar > maxillary canine > second premolar > mandibular second molar > maxillary incisor
163
75% of medical emergencies in the dental office are related to what?
Stress and anxiety
164
Is a child's airway more or less reactive to infection than the adults?
More reactive
165
What is the equation to calculate normal BP?
90 mm Hg + (2 X age in years)
166
What are the three phases of preparation for emergencies?
1. Prevention
2. Early Recognition
3. Management
167
In the basic kit, what is used for anaphylaxis?
Epinephrine
168
In the basic kit, what is the histamine blocker?
Diphenhydramine HCL
169
In the basic kit, what is the vasodilator?
Nitroglycerin
170
In the basic kit, what is the bronchodilator?
Albuterol
171
In the basic kit, what is the anti hypoglycemic agent?
Sugar
172
In the basic kit, what is the thrombolytic agent?
Aspirin
173
What is the flow and O2 concentration of the nasal cannula?
2-6L/Min
| 28-44%
174
What is the flow and O2 concentration of the non-rebreather face mask?
15L/min
| 90-100%
175
What is the flow and O2 concentration of the bag valve mask / ambu bag?
15L/min
| 100%
176
How should you position a conscious patient?
In a position of comfort
177
How should you position an unconscious patient?
position to increase cerebral blood flow, supine with legs elevated, or lateral recumbent to prevent aspiration
178
How should you position a patient having a seizure?
Position them in a way to protect them
179
What are some signs of an asthma attack?
1. Expiratory wheezing
2. Cough
3. Chest tightness
180
What are some signs of respiratory obstruction?
1. Choking
2. Coughing
3. Wheezing
4. Nasal flaring
5. Cyanosis
6. Grasping throat
181
How should you treat a conscious patient with an obstructed airway?
1. Calm them and encourage them to breathe slowly
| 2. Heimlich maneuver if unable to speak, cough or breathe
182
How should you treat an unconscious patient with an obstructed airway?
1. Activate EMS
2. Position patient supine, jaw thrust, open airway and attempt rescue breathing, repeat until successful or CPR is needed
