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Internal Med > HTN - Thyroid Disorders > Flashcards

HTN - Thyroid Disorders Flashcards

1
Q

what is the ASA classification is a pt is healthy but very anxious? what about unhealthy and cannot tolerate added stress?

A

ASA 2

ASA 3

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2
Q

what is the most common way for a patient to die?

A

premedication (should do it in-office)

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3
Q

most frequent cause of respiratory difficulty in a dental setting?

A

hyperventilation

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4
Q

S/S of respiratory distress

(inc CO2 elimination cause alkylosis

A
  • light headed
  • tingling in fingers, toes, perioral
  • caropedal spasm
  • twitches, convulsions
  • loss of consciousness
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5
Q

tx of respiratory distress

A
  • terminate procedure
  • position nearly upright
  • verbally reassure the patient
  • rebreathe CO2 rich air (small bag)
  • reschedule with better plan for anxiety
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6
Q

most common diagnosis in the US

A

hypertension

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7
Q

signs for hypertension?

A

earliest: elevated BP reading
advanced: severely elevated BP involving target organs

“silent disease” bc asymptomatic for many years

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8
Q

what is the drug therapy of HTN

A

thiazide diuretic “water pill”

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9
Q

what are the follow-up questions with HTN?

A
  • date of dx
  • typical reading
  • tx recommendations and compliance
  • any recent changes in prescribed meds
  • ever been tx in ER for symptoms
  • functional status
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10
Q

if the BP reading is very high (160/100) but they feel fine today can you procede with routine dental tx?

A

yes

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11
Q

what should we be careful of with HTN pts?

A
  • avoid gingival retraction cord
  • slow chair repositioning
  • limit epi usage
  • limit NSAID usage
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12
Q

what is the most likely cause of coronary artery disease?

A

HTN

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13
Q

does nitro work for angina relief?

A

yes for stable (good prognosis)

no for unstable (probs MI)

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14
Q

what is the tx for coronary artery disease?

A
  • reduce risk factors for CV disease
  • stress management, weight loss, excersice
  • drugs
  • revascularization
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15
Q

what are the meds that assist with coronary artery disease?

A
  • nitroglycerin (vasodilator that reduces what comes back to the heart)
  • beta-blockers
  • anti-platelet therapy
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16
Q

what are the surgical strategies to treat coronary artery disease?

A
  • angioplasty +/- stent

- bypass graft

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17
Q

bare metal stent

A

10-15% re-stenosis within 6 months

-used for pts that already have blood disorders and cant go on blood thinners

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18
Q

drug-eluting stents

A

release antiproliferative agents to inhibit re-stenosis

  • INC RISK OF THROMBOSIS FOR 1 YEAR
  • ANTI-PLATELET THERAPY (ASPIRIN or CLOPIDOGREL)
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19
Q

what are the questions to ask when dealing with coronary artery disease or angina?

A
  • date of diagnosis
  • did you bring nitro with you
  • have you had an MI
  • what resovlves your angina?
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20
Q

what is an intermediate risk pt for coronary artery disease and can you treat them?

A
  • stable angina
  • past MI (> 1 month)

yes you can do elective care but be cautious and recommend consultation with cardiologist

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21
Q

what is a major risk pt for coronary artery disease and can you treat them?

A
  • unstable angina

- recent MI (

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22
Q

how does a dentist treat a pt with stable angina or a past MI?

A
  • adequate analgesics post op
  • profound anesthesia
  • stress reduction for anxiety
  • anticipate bleeding and DO NOT prescribe anti platelets
  • give a comfortable chair position
  • avoid ultrasonic
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23
Q

what do you do if there is an emergency angina attack?

A
  • stop procedure
  • nitro (1 tab Q5 minutes up to three doses)
  • O2 via nasal cannula
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24
Q

how does a dentist treat a pt with unstable angina or recent MI?

A

same as with stable except:

-give prophylactic nitro, supplemental O2, and modest epi

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25
Q

what happens if an angina pt is NOT responding to tx during an attack?

A

activate EMS
have pt chew an aspirin
continue BLS

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26
Q

where is the fluid backup during left sided heart failure?

A

lungs (congestion)

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27
Q

where is the fluid back during right sided heart failure?

A

feet, legs, and abdomen

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28
Q

what are the 4 classes of heart failure?

A

1: no symptoms with activity
2: symptoms with activity, none at rest
3: marked limitation, symptoms with MINIMAL activity but none at rest
4: symptoms at rest and get worse with activity

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29
Q

what drugs can help manage heart failure

A
  • diuretics (less volume the heart has to pump)
  • beta blockers
  • ACE inhibitors (dilate vessels)
  • digoxin (last resort drug due to toxicity)
  • supplemental O2 at home

also heart transplant or left ventricular assist deveice

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30
Q

what is the goal of the dentist when dealing with a pt with heart failure

A

keep the CV system normal (no big shifts)

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31
Q

what follow-up questions should a dentist ask a pt with heart failure?

A
  • date of dx
  • do you regularly see your physician?
  • compliance with therapy?
  • any symptoms today?
  • —coughing wheezing, SOB.
  • —swelling in feet, ankles, legs and weight gain from fluid and m fatigue
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32
Q

how would you go about treating a pt with ASYMPTOMATIC/MILD heart failure?

A

elective tx ok

plan:

  • reduce stress/anxiety
  • may not tolerate supine position
  • avoid epi with digoxin
  • avoid NSAIDS
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33
Q

how would you go about treating a pt with SYMPTOMATIC heart failure?

A

elective care deferred
emergency care limited to non-invasive procedures
—must consult with physician

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34
Q

what is the 3rd leading cause of death in the US

A

COPD

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35
Q

what are the three causes of COPD

A
  • smoking
  • genetics
  • occupation
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36
Q

which disease of COPD involves both inspiration and expiration?

A

bronchitis

BLUE BLOATERS

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37
Q

which disease of COPD involves expiration only

A

emphysema (enlarged air spaces and loss of elastic recoil)

retain CO2 so…. PINK PUFFERS (barrel chested)

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38
Q

how do you test for COPD?

A

spirometry

measure of how much a person can exhale in one second

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39
Q

what drugs are used to medically treat COPD pts?

A
  • anticholinergics
  • inhaled steroids
  • supplemental O2
  • THEOPHYLLINE for severe cases
  • antibiotics PRN
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40
Q

can you treat a COPD pt if they have symptoms present when they walk into your operatory?
(SOB at rest, productive cough, upper respiratory infection)

A

reschedule elective tx until they are under control

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41
Q

can you treat a COPD pt if they are stable?

A

yes just dont do anything to aggravate their symptoms

  • upright or semi-supine chair position
  • dont do bilateral IAN blocks
  • NO2 ok in mild cases but avoid in severe cases (must fluch out with O2 afterwards)
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42
Q

what drugs should you AVOID when dealing with a COPD pt?

A
  • anticholinergics/antihistamines (anything that will further dry the pt out)(they will probs already be on an anticholinergic so dont give any more)
  • narcotics and barbituates (further dec respiratory drive)
  • theophylline toxicity with macrolide antibiotics and cipro
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43
Q

does asthema normally affect children or adults?

A

children (may spontaneously resolve after puberty or may progress to COPD)

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44
Q

how do you medically manage an asthma pt?

A

limit exposure to triggering agents

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45
Q

what is the drug selection for asthmatics?

A

inhaled beta 2 agonists

-if there is an attack in the office make sure you use SHORT acting beta 2 agonists (inhaler)

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46
Q

what are the indication for a sever asthma disease?

A
  • frequent exacerbations
  • exercise intolerance
  • multiple scheduled meds
  • ER visits
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47
Q

what must the dentist do differently when treating astmatics?

A
  • remind pt to take meds by doctor
  • stress/anxiety management, NO2 sedation
  • avoid triggers:
  • —-LA without vasoconstrictors
  • —-avoid aspirins and NSAIDS (ask if they tolerate these drugs)
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48
Q

what do you do if there is an asthma attack in your office?

A
  • short acting beta 2 agonist (inhaler) repeat Q20 minutes
  • epi for refractory symptoms
  • O2
  • monitor vitals
  • activate EMS PRN
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49
Q

severe prolonged asthma attack that is refractory to normal therapy and is associated with respiratory infection

can lead to exhaustion, dehydration, peripheral vascular collapse, and DEATH

A

status asthmaticus

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50
Q

what affects the chances of someone contracting TB?

A
  • number of organisms inhaled
  • immune function of individual

1/3 of the worlds population

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51
Q

most common site of the TB infection

A

lungs

alveolar macrophages ingest the bacteria and the bacteria replicate within
can become systemic

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52
Q

90% of TB pts are asymptomatic but how would you discern if someone had it?

A

positive TB skin test (measures the delayed hypersensitivity response)

lab test: 3 consecutive positive sputnum cultures

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53
Q

what does the CDC recommend for chemotherapeutic regimen for a positive TB test?

A

4 drug therapy
—-isoiazid, rifampin, ethambutol, pyrazinamide

pt will ALWAYS show a positive test even if they go through tx

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54
Q

how does a dentist proceed if a pt has clinically active, sputnum, positive TB?

A
  • NO outpatient tx
  • isolation and ventilation systems in hospital setting
  • treated like all other pts once physician confrims they are non-infectious after chemo
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55
Q

what must a pt how has tested positive for TB in the past tell you as the dentist?

A
  • dates and type of drug tx including duration

- if they had a periodic physician F/U with chest xrays

56
Q

if a pt comes in with latent TB with no clinically active disease, how do you proceed

A

routine tx with standard precautions

57
Q

what should you be cautious of with pts with TB?

A
  • tx with acetominophen

- bleeding, infection, and delayed wound healing

58
Q

for how long is a pt with a mechanical valve anticoagulated?

A

liftetime

59
Q

for how long is a pt with a bioprosthetic valve anticoagulated?

A

3 months

60
Q

how long is a drug eluting cardiac stent pt anticoagulated?

A

~1 year

61
Q

inflammation of the liver

A

hepatitis

62
Q

types of hepatitis that are infectious, self limiting, and use the fecal oral route of tramsmission?

A

A and E

63
Q

types of hepatitis that are chronic infections, develop to cirrhosis, and are transmitted via bodily fluids

A

B, C, and D

*B is worse than C
80% mortality rate

64
Q

medical tx for acute hepatits?

A
  • INTERFERON (6months to a year)
  • bed rest and fluid
  • avoid alchohol
  • avoid drugs metabolized in the liver
  • viral antigens monitored for 6 months
  • watch for signs of liver failure
65
Q

what happens if you are occupationally exposed to a person with hepatitis?

A
  • blood drawn from source and exposed person by state law

- tested for Hep B, C, and HIV

66
Q

the FIRST change in a liver that is an engorgement of hepatocytes and enlargement of the liver

A

fatty liver

67
Q

is a fatty liver reversible

A

yes

68
Q

diffuse inflammation of the liver that involves destructive cellular changes

A

alcoholic hepatitis

69
Q

is alcoholic hepatitis reversible?

A

maybe

  • ranges from reversible to fatal
  • depends on nutritional status and amount of damage
70
Q

chronic injury to the liver as an insult form ethanol that results in fibrosis and abnormal regeneration of liver architecture

A

cirrhosis

71
Q

is cirrhosis reversible?

A

no

-end of the line for alchoholic and hep pts

72
Q

what is 2/3 of cirrhosis caused by?

A

alcohol or HCV

73
Q

when dealing with a liver pt, what must a dentist do?

A
  • recognize possible liver problems

- determine the severity and consult physician (find out the cause and the severity and blood tests)

74
Q

why do liver pts have a predisposition to bleeding?

A

vitamin K deficiency bc it is stored in the liver
-check PT test

  • if they have bad bleeding issues then may not be a candidate for elective surgical procedures
  • may have to treat them in a hospital
75
Q

what medications do you have to make dosage adjustments for drugs metabolized in the liver if the pt has a compromised liver

A
  • lidocaine
  • acetaminophen
  • ibuprofen
  • antibiotics
76
Q

if a pt presents with ACTIVE hepatitis, what can you do as a dentist?

A

no routine tx, urgent care only in consultation with physician

77
Q

if a pt presents with CHRONIC hepatitis, what can you do as a dentist?

A

routine tx ok

-usually still require a physician consult

78
Q

what are the additional concerns with alchoholism?

A
  • bone marrow suppression (thrombocytopenia = inc bleeding)(platelet count must be over 50,000)
  • infection due to a loss of WBCs (give antibiotics)(at risk for aggressive cellulitis)
79
Q

where are the majority of peptic ulcers?

A

duodenum

80
Q

what is the most common cause of a peptic ulcer?

A

heliobactor pylori

  • produces a urease that hydrolyzes urea to ammonia
  • host response to ammonia causes ulcer
81
Q

what is the second most common cause of a peptic ulcer?

A

NSAIDS

-dec prostaglandin production, inhibit mucous secretion, dec mucosal blood flow (basically dry everything out)

82
Q

if ulcers are caused by NSAIDS, where are they most likely found?

A

stomach

83
Q

what are the S/S of peptic ulcers?

A
  • epigastric pain (burning/gnawing)
  • empty stomach (give them something to eat before tx)
  • relief with food milk and antacids
  • pain may radiate to the back, tarry stools
84
Q

how do you dx a peptic ulcer?

A

fiberoptic endoscopy

85
Q

what is the medical management of peptic ulcers?

A
  • treat acid (proton pump inhibitors, histamine antagonists)
  • tx infection (antibiotics)
  • eliminate risk factors (alc, NSAIDS, smoking, stress)
86
Q

as a dentist, what should you prescribe to a peptic ulcer pt?

A

acetominophen!!!

avoid NSAIDS and corticosteroids

87
Q

S/S of ulcerative colitis

A
  • diarrhea, rectal bleeding, abdominal cramps
  • fatigue, weightloss, dehydration due to malabsorption
  • 50% relapse after tx
88
Q

S/S of crohns disease?

A
  • recurrent/persistent diarrhea, abdominal pain/cramping

- annorexia or weight loss

89
Q

what is the dental management of pts with crohns or UC?

A
  • schedule appts during remissions
  • avoid anti-inflammatory drugs (use ibuprofen)
  • caution with antibiotics like clindamycin

*sulfa drugs can cause thrombocytopenia and leukopenia so do a pre op CBC to evaluate WBCs and platelets

90
Q

what bacteria is responsible for pseudomembranous colitus?

A

clostridium difficile
-caused by wide-spread antibiotics that eliminate normal gut bacteria which results in ovegrowth of this bacteria

-pseudomembranes form so it makes it so you cant absorb anything so inflammation and diarrhea happens

91
Q

what are the at risk populations for pseudomembranous colitus?

A
  • elderly
  • pts in hospitals/nursing homes
  • suppressed immune systems
  • previous pseudomembranous colitus
92
Q

what are the S/S of pseudomembranous colitus?

A
  • timing: within 4-10 days of antibiotic administration
  • diarrhea: mild to severe
  • severe dehydration, hypotension, peritonitis
93
Q

if a pt comes in with pseudomembranous colitus, what do you do as a dentist?

A
  • delay elective dental care until free of disease symptoms
  • use antibiotics only when needed

*this has never been reported with antibiotic prophylaxis for IE

94
Q

progressive loss of renal function persisting for >3 months

A

chronic kidney disease

95
Q

what are the causes of chronic kidney diease?

A
  • diabetes (37%)
  • HTN (24%)
  • chronic glomerulonephritis
  • polycystic kidney disease
96
Q

what is the principle marker of kidney damage?

A

protein via urinalysis

*also GFR

97
Q

what is a normal GFR and what is the GFR if you have kidney failure?

A

normal = >90

failure =

98
Q

what is conservative care for kidney failure pts that have a GFR still over 60

A
  • dec nitrogenous waste retention (diet modification)
  • control HTN, fluids, electrolyte imbalance
  • control diabetes
99
Q

when does a kidney pt have to go on dialysis?

A

GFR

100
Q

what are the complications of hemodyalysis?

A
  • anemia (most common)
  • dec serum calcium
  • infection of AV fistula (STAPH)(no IE prohylaxis)
  • bleeding disorders (platelets destroyed by machines)
101
Q

how does a dentist manage a pt with mild-moderate renal disease?

A

NO CONTRAINDICATIONS to routine care, but….

  • physician consult if stage 4
  • give ACETOMINOPHEN for post of analgesia (avoid nephrotoxic drugs)
102
Q

what drug should be given to renal pts for post op pain?

A

acetominophen

103
Q

how does a dentist manage a severe/hemodyalysis renal pt?

A
  • physician consult
  • tx on days btw dialysis
  • avoid nephrotoxic durgs
  • no BP cuff, no antibiotic prophy
  • if surgery is needed, must get plately count (dialysis machine destroys platelets)
104
Q

which type of diabetes is most common?

A

2

105
Q

what are the two systemic complications of diabetes?

A
  • peripheral nervous system

- vascular issues (CAD, stroke, MI)

106
Q

what is the leading cause of death in type 2 diabetics?

A

MI

107
Q

what is the leading cause of death in type one diabetics?

A

end stage renal disease

108
Q

test that measures the amount of sugar attached to hemoglobin

A

HbA1c

  • indicates level of glycemic control over the last 2-3 months
  • 2X a year if controlled
  • 4X a year if uncontrolled
109
Q

what level should the HbA1c test be for a non diabetic pt

A
110
Q

what level should the HbA1c test be for a well-controlled diabetic?

A
111
Q

how do type one diabetics manage their symptoms?

A

insulin injection

*multiple dosing throughout the day

112
Q

how do type 2 diabetics manage their symptoms?

A
  • lifestyle modificaitons
  • control risk factors for CV
  • drugs (hypoglycemics, injectables)
113
Q

what questions should you ask a diabetic pt?

A
  • type?
  • drugs?
  • what is your normal glucose value?
  • frequency of medical visits
  • timing and results of last HbA1c test?
  • frequency of insulin injections
  • any systemic complications?
114
Q

how does a dentist modify tx for controlled diabetics?

A
  • ANY ELECTIVE CARE IS OKK
  • prevention of problems causes by oral hypoglycemics or insulin
  • check glucose PRIOR to treatment (always stick them before tx)
115
Q

before an appointment, at what point do you give carbs to a controlled diabetic?

A

if glucose measurement is

116
Q

before an appointment, at what point do you absolutely defer elective tx to a controlled diabetic?

A

> 200 mg/dl

*serious risk of dental infection

117
Q

what are the stages of an insulin reaction?

A

mild
moderate
severe

118
Q

what are the symptoms of a mild insulin reaction?

A

hunger
weakness
sweating
tachycardia

119
Q

what are the symptoms of a moderate insulin reaction?

A

incoherent
uncooperative
belligerent
disorientation

*snicker’s commercial

120
Q

what are the symptoms of a severe insulin reaction?

A

unconscious
hypotensive
tachcardia

121
Q

what are the treatments of an insulin reaction?

A

mild and moderate: oral sugar (better within 5 minutes)

severe: EMS and glucagon injection

122
Q

how does a dentist prevent an insulin shock?

A
  • instruct pt to follow normal insulin regimen and eat normally around appt
  • morning appt
  • confirm that they ate and took insulin
  • instruct them to notify you if symptoms arise
  • source of sugar in the office
123
Q

what are the dental treatment risks with uncontrolled diabetics?

A
  • infection
  • poor wound healing (avoid elective perio/oral surgery)
  • systemic risk (HTN, CAD, renal disease, stroke)
124
Q

what is potentially a significant problem with uncontrolled and brittle diabetics?

A

acute odontogenic infection

-infection can lead to loss of diabetic control===> can then lead to aggressive infection

125
Q

what are the main functions of thyroid hormone?

A
  • tissue maturation
  • cell respiration
  • energy expenditure
  • all about metabolic demand
  • stress/rebuilding tissues = inc in metabolic demand
126
Q

how does someone dx a thyroid disorder?

A

LAB TESTS

  • radioactive iodine uptake
  • T3 and T4 serum concentration
  • TSH serum concentration
127
Q

what are the S/S of HYPERthyroidism?

A
  • anxiety
  • fatigue
  • rapid HR
  • heat intolerance
  • weight loss
  • exopthalmous
128
Q

what is the most common form of hyperthyroidism?

A

grave’s disease

129
Q

rare and serious complication of untreated hyperthyroidism that causes restlessness, N/V, and abdominal pain and can even lead to death

A

thyrotoxic crisis

130
Q

and inadequate amount of T3 and T4

A

HYPOthyroidism

131
Q

what are the S/S of HYPOthyroidism

A
  • slow physical/mental activity
  • sensitive to cold
  • weight gain
132
Q

what is the medical management of a pt with HYPOthyroidism?

A

synthetic preparations of LT4 (levothyroxine) and LT3 (liothyronine)

133
Q

serious complication of HYPOthyroidism that involves MYXEDEMA, bradycardia, severe hypotention and as a high mortality rate?

A

hypothyroid coma

134
Q

what is the dental management of a well-controlled thyroid diease?

A
  • ANY ROUTINE DENTAL TX

- consult physician if acute infection or in anticipation of significant surgical stress (inc metabolic demand)

135
Q

what are the potential problems in dentisty with untreated/uncontrolled thyroid problems?

A

NOT MANY

  • if they are taking meds and following up with their physician then good enough
  • ** cant do elective care though if they have not started taking their meds
136
Q

what are the potential problems for uncontrolled HYPERthyroidism?

A
  • adverse interaction with epi
  • complications secondary to underlying CV probs
  • propylthiouracil and infection/wound healing
137
Q

what are the potential problems with untreated HYPOthyroidism

A
  • exaggerated response to CNS depressants

* stick to tylenol and ibuprofen

Internal Med (3 decks)

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