Haematology

Question 1

What is atrial fibrillation?

Answer 1

• AF happens when electrical impulses in the atria of the heart fire irregularly
• Causes an irregular/ fast heart beat.
• Can create blood clots in the heart which may lead to stroke

Question 2

What is diabetes?

Answer 2

• Pancreas no longer able to make insulin/ body becomes insensitive to insulin causing abnormal blood glucose levels.
• Chronic high blood glucose levels associated with tissue damage and organ failure (cataracts, neuropathy)

Question 3

What are the dental implications of diabetes?

Answer 3

• Poor wound healing
• Xerostomia
• Oral dysesthesia (burning mouth syndrome)
• Periodontal disease

Question 4

What is hypertension?

Answer 4

• High blood pressure
• Can lead to heart attack/ stroke, kidney failure, vascular dementia.
• Arteries lose stretch and become narrow, easier for a thrombus to occlude lumen.

Question 5

What is frusemide?

Answer 5

• loop diuretic (for hypertension)
• decreases fluid in body

Question 6

What is metformin?

Answer 6

• Anti-hyperglycaemic drug - enhances insulin sensitivity
• Can reduce vitamin B12 levels (anaemia risk)

Question 7

What is a side effect of sulfonylureas?

Answer 7

Reduced factor VIII and reduced platelet aggregation

Question 8

How is pseudomembranous candidiasis managed?

Answer 8

• Assess risk factors - diabetic control, medications, anaemia, ill fitting denture
• Denture hygiene advice
• Antifungal medication - miconazole contraindicated with warfarin, nystatin safe to use for warfarin

Question 9

Why is joint swelling significant in haemophilia patients?

Answer 9

• Swelling is likely to be a haemarthrosis - bleeding into joint space (associated with haemophilia)
• This can cause damage to articular cartilage in joint- bone resorption and cyst formation.

Question 10

What is haemophilia A?

Answer 10

Deficiency in factor VIII (most common)

Question 11

What is haemophilia B?

Answer 11

Deficiency in factor IX

Question 12

What procedures are safe for haemophilia patients?

Answer 12

• Treatment which doesn’t require manipulation of mucosa
• ID block contraindication (articaine infil instead)

Question 13

What is DDVAP?

Answer 13

• Desmopressin
• Releases factor VIII that has been bound to endothelial cells, giving a temporary boost

Question 14

What is tranexamic acid?

Answer 14

Inhibitor of fibrinolysis (keeps clot formed)

Question 15

How are patients with severe haemophilia classed and managed?

Answer 15

<1% of factor
Recombinant factor

Question 16

Haemophilia A is a deficiency of which factor?

Answer 16

VIII

Question 17

Apixiban inhibits which factor?

Answer 17

Factor Xa

Question 18

A person with moderate haemophilia has what percentage of normal factor in their blood?

Answer 18

1-5%

Question 19

Von Willibrands type 2 is normally managed with which product to manage bleeding?

Answer 19

Factor VIII concentrate

Question 20

Augmentation of factor levels is required for which of the inherited bleeding conditions
-Moderate Haemophilia B
-Type 3 Von Willebrand’s Disease
-Mild Haemophilia A
-Type 2a Von Willebrand’s Disease
-All of the above

Answer 20

All of the above

Question 21

Takes the medication warfarin with associated blood testing every week and requires a single tooth extraction.

What is the most appropriate management strategy?

Answer 21

INR required within 24 hours

Question 22

Takes the medications aspirin and clopidogrel following a STEMI two weeks ago and requires the extraction of two asymptomatic teeth.

What is the most appropriate management strategy?

Answer 22

Delay extractions until 6 month point

Question 23

Takes the medication Rivaroxaban once a day in the morning and requires the extraction of 5 teeth at 0900 in the morning.

What is the most appropriate management strategy?

Answer 23

Delay the morning dose and take it four hours after haemostatis has been achieved

Question 24

Takes the medication Dabigatran and requires the surgical extraction of two teeth at 0900 in the morning

Most appropriate management?

Answer 24

Miss the morning dose of medication and take the evening dose as usual

Question 25

Takes the medication Apixaban and requires a single extraction

Most appropriate management?

Answer 25

Do not change drug regime

Question 26

The prothrombin time (PT) would be deranged in…

Answer 26

Liver disease or warfarin therapy

Question 27

The activated partial thromboplastin time (APTT) would be deranged in…

Answer 27

Haemophilia

Question 28

Activated partial thromboplastin time (APTT) measures…

Answer 28

• Factors V, VIII, IX, X, XI, XII
• prothrombin
• fibrinogen

Question 29

Prothrombin time (PT) measures..

Answer 29

• Factors V, VII, X
• prothrombin
• fibrinogen

Question 30

A patient with moderate haemophilia A requires factor coverage for supra-gingival scaling true or false?

Answer 30

False

Question 31

Topical miconazole for the management of oral candidosis presents a risk for patients prescribed Warfarin by potentiating bleeding.

Answer 31

True

Question 32

What kind of inheritance pattern do haemophilia A and B follow?

Answer 32

• Sex linked recessive
• Defective gene on the X chromosome - males are affected and females are the carries.
• Unusual for females to have both X chromosomes affected

Question 33

What is considered a normal INR?

Answer 33

1

Question 34

What are the important platelet count numbers?

Answer 34

• 100 to take out tooth in GDP
• 50 in hospital

Question 35

What is the INR?

Answer 35

• international normalised ratio
• prothrombin time of pt and dividing it by reference PT plasma value

Question 36

What neutrophil count is required for dental treatment?

Answer 36

• over 1 for GDP
• under is high infection risk
• consider antibiotic prophylaxis or post operative antibiotics