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Question 1

Multiple Myeloma

Answer 1

(Plasma Cell Myeloma)

Cancer of plasma cells
* Bone resorption & replaced by bone marrow
* Amyloidosis of tongue
* Punched-out RL on skull
* Dx: Bence Jones Proteins in urine

Question 2

Multiple Myeloma: Pt Considerations

Answer 2

WBC< 2,000:
* AB prophylaxis

Platelet Count < 50,000
* Platelet Transfusion before invasive surgical procedures

Question 3

Peptic Ulcer Disease

Answer 3

Causes:
* H. Pylori (most common)
* Chronic NSAIDs

Question 4

Multiple Myeloma: Tx

Answer 4

Thalidomide:
* Inhibits TNF-a & IL-6 secretion

Bortezomib:
* Protease inhibitor

Bisphosphonates:
* Osteoclast apoptosis

Question 5

Peptic Ulcer Disease: Tx

Answer 5

Antiacids

Ranatidine:
* H2 receptor antagonist

Omeprazole:
* PPI: Proton Pump Inhibitor

Question 6

Tuberculosis

Answer 6

Cause:
* Mycobacterium Tuberculosis

Transmission:
* Droplet nuclei (air)

Latent TB:
* no growth
* asymptomatic
* Can’t spread
* Tx: Isonazid

Active TB:
* Grows
* symptomatic
* Can spread
Tx: (TRIP)
* Isonazid
* Rifampin
* Pyrazanamide
* Thembutol

Question 7

Tuberculosis: Pt Considerations

Answer 7

Active TB:
Elective–> Defer & refer

Urgent:
* Isolated Op
* Standard precautions + N95

Latent TB
* No mods

Question 8

Pregnancy Complications

Answer 8

Preeclampsia:
* High BP
* Proteinurea
* Edema
* Blurred Vision

Question 9

Pregnancy: Drug Categories

Answer 9

A: No risk
* Folic Acid
* Levothyroxine
* Isonizad

B: Usually safe
* Acetaminophen
* NSAIDs (1st & 2nd)
* Lidocaine

C: Use w/caution
* Glucocorticoids
* Epinephrine
* Nitrous Oxide (1st)

D: Avoid
* Aspirin (3rd trimester)
* NSAID (3rd trimester)
* Doxycycline
* Tetracycline (2nd/3rd)
* Diazepam/Clorazepam

X: Contraindicated
* Trazoloam
* Flurazepam

Question 10

Pregnancy: Supine Hypotensive Syndrome

Answer 10

Uterus compresses aorta & inferior vena cava

Tx: Left lateral Decubitis (Turn on left side)

Question 11

Pregnancy: Pt considerations

Answer 11

Relcine instead of supine
* Monitor BP
* Radiographs only when needed (Thyroid collar+Lead apron)

Avoid:
* elective dental care (1st & 2nd half of 3rd)
* Nitroous Oxide: (1st)
* Xs Fl: (2nd/3rd)
* NSAIDs (3rd)
* Benzodiazepines

Question 12

Pregnancy: Oral Manifestations

Answer 12

Gestational Gingivitis

Pyogenic Granuloma

Increased Caries Risk

Hypersensitive Gag Reflux

Question 13

Parasomnia

Answer 13

Sleepwalking
Night terros

Question 14

Sleep-related breathing disorders

Answer 14

Snoring
CSA
OSA

Question 15

Sleep-related movement disorders

Answer 15

Restless leg syndrome

Nocturnal Bruxism

Question 16

Circadian Rhythm Sleep-Walk disorders

Answer 16

Jet Lag
Shift work

Question 17

CSA

Answer 17

Central Sleep Apnea
* CNS Issue

Temporarily No Inspiration=Stops airflow
* Pliomyelitis
* Spincal Cord injury
* Encephalitis

Question 18

OSA

Answer 18

Obstructive Sleep Apnea

Physical obstruction=Stops airflow
* Nasopharyngeal
* Oropharyngeal
* Hypopharyngeal

Question 19

Apnea vs Hypopnea

Answer 19

Apnea:
* No airflow for at least 10 s

Hypopnea:
* Reduced airflow for at least 10 s

Question 20

Respiratory efforet related arousal (RERA)

Answer 20

Increased respiratory effect for at lest 10 s
*leads to arousal

Question 21

Apnea-Hypopnia Index (AHI)

Answer 21

(#apnea+ #hypopnea)/ Hrs of sleep

Adults:
* Mild: 5-15 episodes/hr
* moderate: 15-30
* severe: 30+

Child:
* Mild: 1-5
* Moderate: 5-10
* SeveRE: 10+

Question 22

Hepatitis

Answer 22

Liver inflammation

Causes:
* Hepatitis virus (Most common)
* Heavy alc
* some Chemical

Transmission: Contaminated-Blood Direct fEcAl-oral
* Hep A: Fecal-oral
* Hep B: contaminated blood
* Hep C: Contaminated blood
* Hep D: Direct contact + prior infeciton w/Hep B
* Hep E: Fecal oral

Question 23

Hep A

Answer 23

Vaccine

Symptomatic:
* Jaundice
* Fever

Transmission: Fecal-oral

Question 24

Hep B

Answer 24

DNA Virus:
* DANE particle

Transmission: High risk (30%)
* contaminated blood

Sympatomatic

Vaccine
* OSHA-requires vacine available to employee

Surface Antigen(HBsAg): Infectious
Surface Antibody(anti-HBs): Immunity
Core Antibody (anti-HBc): History, persistent
IgM Antibody: (IgM anti-HBc): History, temporary

Question 25

Hepatitis: Pt considerations

Answer 25

Active Hep
Elective: Defer & Refer

Urgent:
* Isolated Op
* Standard Precautions
* Minimal aerosol
* Avoid drugs metabolized in LIVER

Recovered from HEP:
* No Tx mods

Question 26

Diabetes: Pt Considerations

Answer 26

Well Controlled:
Short AM Appts
Normal Insulin & Meals before
Use glucometer before
Avoid:
* NSAIDs w/sulfonyureas
* glucocorticoids
* Levofloxacin

Poorly Controlled
Elective: Defer tx

Urgent:
* Asymptomatic: remove infection & refer to DR
* Symptomatic (Ketoacidosis): Immediate referall to ER