haematology

Question 1

histological presence of iron deficient anaemia?

Answer 1

RBC paler + smaller

Question 2

what would blood test show for iron deficient anaemia?

Answer 2

low Hb
low MCV (size of RBC)
low ferritin levels

Question 3

3 causes of iron deficient anaemia

Answer 3

1. dietary deficiency
2. malabsorption
3. blood loss - GI tract, haemorrhage

Question 4

common oral sign of iron deficient anaemia?

Answer 4

angular stomatitis

Question 5

common oral cause of B12 deficient anaemia?

Answer 5

macroglossia + smooth tongue

Question 6

histological presence of B12/folate deficient anaemia?

Answer 6

microcytic

Question 7

what would blood test show for B12/folate deficient anaemia?

Answer 7

Hb low

high MCV

Question 8

5 causes of folate deficient anaemia

Answer 8

1. dietary deficiency
2. increased requirement - pregnant
3. malabsorption e.g. coeliac
4. alcoholism
5. drugs - septrin + methotrexate

Question 9

4 causes of B12 deficient anaemia

Answer 9

1. inadequate intake
2. low gastric acid
3. intrinsic factor/antibodies against parietal cells - pernicious aneamia
4. abnormal terminal ileum

Question 10

what causes petechiae?

Answer 10

reduced platelets

ITP most commonly

Question 11

if you noticed petechiae on pts palate what would you need to be aware of?

Answer 11

pts bleed excessively

Question 12

what is an oral manifestation of acute leukimia?

Answer 12

gingival hyperplasia

Question 13

why is it important to be aware of myeloma pts as a dentist?

Answer 13

on bisphophonates

Question 14

what sort of anaemia is found in myeloma patients?

Answer 14

normocytic anaemia

Question 15

what is the WHO oral toxicity scale?

Answer 15

1. grade 1 - soreness +/- erythema
2. grade 2 - erythema, ulcers, can swallow solids
3. grade 3 - ulcers, extensive erythema, cannot swallow solids
4. can’t swallow liquids

Question 16

4 main components of blood

Answer 16

plasma
platelets
RBC
crycoprecipitate

Question 17

what is the role of collagen in haemostasis?

Answer 17

exposed when damage to vessel wall
binds to platelets or VWF
platelet plug forms

Question 18

what is the role of clotting factor X?

Answer 18

prothrombin –> thrombin

Question 19

what is the role of thrombin?

Answer 19

fibrinogen –> fibrin

Question 20

how would you manage haemophiliacs undergoing dental surgery?

Answer 20

close liaison with haemophilia centre

1. DDAVP infusion for mild haemophiliacs
2. factor VIII/IX for mod/severe
3. atraumatic as possible
4. local haemostats measure - tranexamic acid

Question 21

what is platelet count level for safe treatment?

Answer 21

> 50x10^9 /l

Question 22

how may liver disease cause bleeding problems?

Answer 22

low platelet count - caused by portal venous hypertension which is caused by liver disease

clotting factors 2, 7, 9, 10

Question 23

what is ITP?

Answer 23

immun thrombocytopenia pupura - autoimmune disease causing low platelets

Question 24

how may local haemostasis be achieved?

Answer 24

pressure
oxidised cellulose (surgical), collagen sponges + sutures
5% tranexamic acid mouthwash

Question 25

what must not be prescribed to pts who take warfarin following extraction?

Answer 25

cox-2 or NSAIDs as analgesic

Question 26

an example of a congenital vascular bleeding disorder?

Answer 26

Ehlers dans

Question 27

an example of an acquired vascular bleeding disorder?

Answer 27

chronic prednisolone use

Question 28

difference in presentation between platelet disorders + coagulation disorders?

Answer 28

coagulation - present with bruising at deeper levels

Question 29

importance of kidney disease in bleeding?

Answer 29

renal disease = impaired platelet function

Question 30

what are thrombophillias?

Answer 30

conditions causing clotting

Question 31

what is ecchymoses?

Answer 31

bruising | bleeding into subcutaneous tissue due to trauma

Question 32

what is purpura?

Answer 32

spontaneous bleeding into skin

Question 33

2 types of purpura?

Answer 33

1. petechiae - small | 2. senil purpura

Question 34

what may spider telangiectasia be a sign of?

Answer 34

liver disease

Question 35

what is haemangioma and how would you treat a pt with it?

Answer 35

dark ref pulsatile lesion along maxilla | DONT extract

Question 36

What part of clotting pathway does APTT test?

Answer 36

intrinsic

Question 37

what part of clotting pathway does PT test?

Answer 37

extrinsic + common

Question 38

what effects APTT?

Answer 38

factor deficiencies + heparin

Question 39

what effect PT?

Answer 39

warfarin + alcoholic liver disease

Question 40

how would you measure platelet count?

Answer 40

FBC

Question 41

what does TT test?

Answer 41

common pathway

Question 42

LFT showing decreased synthesis

Answer 42

albumin down factors down PT up

Question 43

LFT showing decreased excretion

Answer 43

bilirubin, alkaline phosphates + GGT up

Question 44

LFT showing hepatocyte necrosis

Answer 44

AST + ALT up

Question 45

in liver disease which anaesthetic is best used?

Answer 45

prilocaine - metabolised in lung not liver | articaine - partly metabolised in blood

Question 46

what to use to stop bleeding post extraction if bleeding is from bone?

Answer 46

bone wax

Question 47

how does tranexamic acid stop bleeding?

Answer 47

anti-fibrinolytic - stops breakdown of the clot

Question 48

2 types of cautery that can be used post op?

Answer 48

chemical | electrical - bipolar or monopolar

Question 49

how to treat urgent high INR

Answer 49

vitamin k 10mg IV or PO | life threatening - beriplex used (prothrombin complex conc from human plasma)