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Dental Management of the Medically Complex Patient > Lecture 1- Introduction > Flashcards

Lecture 1- Introduction Flashcards

1
Q

List how dentistry and medicine today are different (than previous years): (3)

A
  1. people live longer= more elderly patients
  2. people receive medical treatments for disorders that would have been fatal just a few years ago
  3. pharmaceuticals continue ot advance
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2
Q

What is proportional to an increase in combinations and permutations of dental treatment?

A
  1. increased number of conditions
  2. increased complexity of conditions
  3. increased number of medications
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3
Q
  • increased number of conditions
  • increased complexity of conditions
  • increased number of medications
    These are all proportional to an increase in:
A

combinations and permutations of dental treatments

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4
Q

The dentist must now be more knowledgable about a wider range of:

A

medical conditions (as patients receive dental treatment)

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5
Q

Many chronic disorders or their treatments necessitate:

A

modification of dental treatment

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6
Q

What sparked the use of gloves in dentistry?

A

Hepatitis (1982)

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7
Q

What sparked the use of PPE in dentistry?

A

AIDS (1990)

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8
Q

What sparked the use of updated PPE and required vaccines?

A

Covid-19 (2019)

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9
Q

Clinicians must practice so that the ___ of dental treatment will ____ of a medical complication occurring either during treatment of as a result of treatment

A

benefit; outweigh the risk(s)

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10
Q

When considering the benefit vs. risk, a clinician must take into account:

A
  1. pre-operative considerations
  2. intra-operative considerations
  3. post-operative considerations
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11
Q

What doctor stated “a doctor who cannot take a good history and a patient who cannot give one are in danger of gibing and receiving bad treatment”?

A

Paul Dudley White MD (1876-1973)

Ushered in the era of modern cardiology

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12
Q

Organized risk assessment in dental care includes:

A
  1. bleeding
  2. infection
  3. drug effects
  4. ability to tolerate care (CV-Resp-Psych)
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13
Q

_____ can be applied to assess risk prior to any oral health care delivery

A

acquired data

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14
Q

Acquired data can be applied to assess risk prior to any oral health care delivery using a ____ format

A

P- A, B, C

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15
Q

In a P-A,B, C, format, the “P” stands for:

A

Patient evaluation

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16
Q

A chief complaint may be:

A

objective or subjective

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17
Q

List factors that lead to “P” Patient evaluation: (7)

A
  1. medical history
  2. medications
  3. social and family history
  4. review of systems
  5. history of present illness
  6. objective findings
  7. CC
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18
Q

List some adjunctive tests & procedures: (8)

A
  1. Anesthesia
  2. Histopathology
  3. Imaging
  4. Labs
  5. Microbiology
  6. Molecular biology
  7. Refer
  8. Sequencing
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19
Q

Taking blood pressure is an example of:

A

P- patient evaluation

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20
Q

For patient evaluation:

  1. Identify ALL _____
  2. Review ______
  3. Examine ___
  4. Review or gather ____
  5. Obtain ___
A
  1. Identify ALL medications and drugs (taken or supposed to be taken)
  2. Review medical history (discuss relevant issues with patient)
  3. Examine patient for signs and symptoms of disease
  4. Review or gather recent lab tests or images
  5. Obtain a medical consult
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21
Q

When should you obtain a medical consult as part of the patient evaluation?

A
  1. if the patient has poorly controlled or undiagnosed problems
  2. if you’re uncertain about the patient’s health
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22
Q

You should request a medical consult to:

A

confirm determine level of disease activity/status

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23
Q

A medical condition may be used to determine:

A

what precautions may be necessary for dental treatment

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24
Q

The precautions necessary for dental treatment are often determined by the:

A
  1. degree of dental treatment
  2. level of disease/activity status
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25
Q

If you are uncertain about the patients health findings you should request a consult to determine if:

A

an undiagnosed disease exists

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26
Q

In the P- A, B, C format, what does the A stand for?

A
  1. Antibiotics
  2. Analgesics
  3. Anesthesia
  4. Allergies
  5. Anxiety

“Al(lergies) was ANXIOUS to get ANTIBIOTICS, ANALGESICS & ANESTHESIA

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27
Q

What should you question about the patient’s ALLERGIES?

A

Is the patient allergic to drugs or substances that may be used or prescribed?

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28
Q

What should you question about the patient’s ANXIETY?

A

Will the patient need or benefit from a sedative or anxiolytic?

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29
Q

What questions should be asked about ANTIBIOTICS?

A
  1. Will the patient need antibiotics?
  2. Is the patient taking an antibiotic?
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30
Q

What questions should be asked about ANALGESICS?

A
  1. Is the patient taking aspirin or NSAIDs that can increase bleeding?
  2. Will analgesics be needed post-treatment?
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31
Q

What question should be asked about ANASTHESIA?

A

Are there concerns using a local with or without epinephrine?

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32
Q

In the P-A,B, C format, what does the “B” stand for?

A
  1. breathing
  2. bleeding
  3. BP
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33
Q

What question should be asked about BLEEDING?

A

Is abnormal hemostasis possible?

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34
Q

What question should be asked about BREATHING?

A

Does the patine have difficulty breathing or is the patient’s breathing fast or slow?

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35
Q

What question should be asked about BLOOD PRESSURE?

A

Is the patient’s BP well controlled or is it possible it may increase/decrease during dental treatment?

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36
Q

In the format P-A, B, C, what does the C stand for?

A

Chair position

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37
Q

What questions should be asked regarding CHAIR POSITION?

A
  1. Can the patient tolerate a supine or horizontal position?
  2. Is the patient going to have a problem being raised quickly after treatment?
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38
Q

In the format, P-A, B, C, D, what does the D stand for?

A

Drugs & Devices

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39
Q

What questions should be asked regarding DRUGS?

A

Any drug interactions, adverse effects, or allergies associated with drugs currently being taken or drugs that the dentist may prescribe or use?

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40
Q

What question should be asked regarding DEVICES?

A
  1. Does the patient have a prosthetic or therapeutic device that may require tailored management?
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41
Q

List some examples of prosthetic or therapeutic devices that a patient may have: (5)

A
  1. prosthetic heart valve
  2. prosthetic joint
  3. stent
  4. pacemaker
  5. defibrillator
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42
Q

In the format P-A,B,C,D, E, what does the “E” stand for?

A

Equipment & Emergencies

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43
Q

What question should be asked regarding EQUIPMENT?

A
  1. Any potential issues with use of dental equipment?

(such as x-ray equipment, electrocautery, oxygen supply, ultrasonic cleaner, apex locator etc.)

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44
Q

What question should be asked regarding EMERGENCY?

A

Are there medical emergencies that can be anticipated or prevented by modifying care?

(such as MI, Stroke, Asthma, Uncontrollable bleeding)

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45
Q

In the format P-A, B, C, D, E, F, what does the “F” stand for?

A

Follow-up

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46
Q

What question should be asked regarding FOLLOW-UP?

A

Is any follow up care indicated?

(such as post-op analgesics, antibiotics, anxiety)

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47
Q

Post-op instructions for home care _____ and for ______ when necessary

A

ALWAYS; prescriptions

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48
Q

What is the “simple rule” in regards to contacting the patient post treatment?

A

If local anesthetic(s) are used on patient and there was bleeding during the appointment, the patient should be contacted that eventing or the following day

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49
Q

The _____ MUST be taken for every patient who is to receive dental treatment

A

medical history

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50
Q

T/F: It is okay to skip the medical history documentation if the patient is there for a follow-up

A

False

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51
Q

What are the two basic techniques used to obtain a medical history?

A
  1. interview the patient (we do this at UMKC & chart in axium)
  2. A printed questionnaire the patient fills out
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52
Q

Medical history questions are designed to identify or hint to medical issues that may affect dental treatment such as: (9)

A
  1. anxiety
  2. cardiovascular diseases
  3. neurologic disorders
  4. gastrointestinal diseases
  5. respiratory tract diseases
  6. musculoskeletal diseases
  7. endocrine diseases
  8. STD’s
  9. cancer & radiation treatment
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53
Q

A medical history is different from:

A

Review of Systems (ROS)

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54
Q

T/F: Medical history is synonymous to ROS

A

False- different

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55
Q

If the patient has already been diagnosed or patient presents for information needing a diagnosis this would be charted under:

A

Medical history

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56
Q

What is the goal for ROS?

A

to screen for potential new diseases

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57
Q

What type of approach is used when screening through signs and symptoms during the ROS?

A

Systems-based approach

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58
Q

Even if the result of ROS gives you findings consistent with a particular systemic disease, you will not:

A

diagnose

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59
Q

What should you do if you get findings during the ROS that are consistent with a particular systemic disease?

A

referral consultation letter that expresses findings, concerns and basis for ROS.

(It is the physicians job to further examine, request labs & diagnose)

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60
Q

What category does the following signs and symptoms fall under in the ROS?

  • recent weight changes
  • fatigue
  • malaise
  • fever
  • chills
  • night sweats
A

General

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61
Q

What category does the following signs and symptoms fall under in the ROS?

  • rashes
  • lumps
  • ulcers
  • dryness
  • pruitus (itching)
  • finger clubbing
  • nail changes
A

Dermatologic

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62
Q

What category does the following signs and symptoms fall under in the ROS?

  • headaches
  • dizziness
  • head trauma
A

Head

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63
Q

What category does the following signs and symptoms fall under in the ROS?

  • changes in vision and visual fields
  • spots
  • floaters
  • diploplia
  • blurriness
  • dryness
  • tearing
  • itching
A

Eyes

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64
Q

What category does the following signs and symptoms fall under in the ROS?

  • hearing loss
  • pain
  • discharged
  • tinnitus
  • vertigo
A

Ears

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65
Q

What category does the following signs and symptoms fall under in the ROS?

  • stuffiness
  • sneezing
  • rhinorrhea
  • itching
  • epistaxis (nose bleed)
  • changes in sense of smell
A

Nose/Sinuses

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66
Q

What category does the following signs and symptoms fall under in the ROS?

  • bleeding or painful gums
  • lesions
  • dental pain
  • halitosis
  • altered taste
  • hoarseness
  • sore throat
  • dysphagia
  • neck swelling
A

Mouth, Throat, Neck

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67
Q

What category does the following signs and symptoms fall under in the ROS?

  • dyspnea
  • chest pain
  • wheezing
  • cough
  • sputum
  • hemoptysis
A

Respiratory

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68
Q

What category does the following signs and symptoms fall under in the ROS?

  • chest pain
  • palpitations
  • orthopnea
  • dyspnea on exertion
  • paroxysmal nocturnal dyspnea
  • peripheral edema
A

Cardiovascular

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69
Q

What category does the following signs and symptoms fall under in the ROS?

  • appetite changes
  • abdominal pain
  • nausea
  • vomiting
  • diarrhea
  • constipation
  • heart burn
  • belching
  • bloating
  • flatulence
  • dysphagia
  • bleeding (hematemesis, hemorrhoids, melena, hematochezia),
  • jauncice
  • ascites
A

Gastrointestinal

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70
Q

What category does the following signs and symptoms fall under in the ROS?

  • Frequent urination
  • Hestistant urination
  • Urgent urination
  • Incontinence
  • nocturia
  • dysuria
  • hematuria
  • abnormal genital discharge
  • genital lesions
  • changes in libido
A

genitourinary

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71
Q

What category does the following signs and symptoms fall under in the ROS?

  • Polydispsia
  • Polyuria
  • polyphagia
  • heat & cold intolerance
  • weight gain or loss
  • excessive sweating
  • thyroid enlargment or pain
A

Endocrine

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72
Q

What category does the following signs and symptoms fall under in the ROS?

  • anemia
  • easy bruising or bleeding
  • lymphadenopathy
A

Hematologic

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73
Q

What category does the following signs and symptoms fall under in the ROS?

  • arthritis
  • arthalgia
  • pain
  • swelling
  • redness
  • limitations in ROM
  • muscle weakness
  • trauma
A

musculoskeletal

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74
Q

What category does the following signs and symptoms fall under in the ROS?

  • seizures
  • memory loss
  • loss of consciousness
  • parasthesia
  • anesthesia
  • muscle weakness
  • paralysis
A

Neurologic

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75
Q

What category does the following signs and symptoms fall under in the ROS?

  • menopause
  • menstrual changes
  • dysmennorhea
A

Gynecologic

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76
Q

What category does the following signs and symptoms fall under in the ROS?

  • mood
  • anxiety
  • depression
  • changes in sleep pattern
  • decreased ability to concentrate
A

psychiatric/ emotional

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77
Q

Asking this question can help you determine the patients _____.

“Do you have the ability to engage in normal day-to-day physical activity?”

A

Functional capacity

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78
Q

According to functional capacity, the ability to perform common daily tasks can be expressed in:

A

Metabolic equivalent levels (METs)

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79
Q

METs:

A

Metabolic equivalent levels

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80
Q

An MET is a:

A

unit of oxygen consumption

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81
Q

Tells you a patients ability to tolerate exercise which is linked to patients overall health:

A

METs

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82
Q

A higher MET corresponds with:

A

better physical condition

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83
Q

1 MET =

A

3.5 mL of oxygen per kg of body weight per minute at rest

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84
Q

List some activities that are considered “Light” in regards to MET:

A

(Less than 3.0 METs)
- slowly walking
- sitting using computer
- standing with light work (cooking, or washing dishes)
-fishing-sitting
- playing most instruments

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85
Q

List some activities that are considered “Moderate” in regards to MET:

A

(3.0-6.0 METs)
- brisk walk 4mph
- heavy cleaning (washing windows, vacuuming, mopping)
- mowing lawn
- bicycling (light effort)
- badminton
- tennis (doubles)

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86
Q

List some activities that are considered “Vigorous” in regards to MET:

A

(Greater than 6.0 METs)
- walking/hiking
- jogging at 6mph
- shoveling
- carrying heavy loads
- bicycling fast (14-16mph)
- basketball game
- soccer game
- tennis (singles)

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87
Q

Asking a patient, “Can you walk up two flightless of stairs without having to catch your breath” can indicate general cardiovascular and/or pulmonary health

A

True- this is just a rough guideline but helps give an idea

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88
Q

T/F: Not all allergies are true allergies

A

True

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89
Q

If a patient responds “yes” when asked if allergic to a particular substance, the mandatory follow-up question should be:

A

“what happens?”

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90
Q

List what reactions are considered TRUE ALLERGIES: (9)

A
  1. anaphylaxis
  2. itching
  3. urticaria
  4. rash
  5. swelling
  6. wheezing
  7. angioedema
  8. rhinorrhea
  9. tearing eyes
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91
Q

List what reactions are considered intolerances or adverse side effects: (5)

A
  1. nausea
  2. vomiting
  3. diarrhea
  4. heart palpitations
  5. fainting
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92
Q

Treating every patient as they’re infectious:

A

Standard Precaution

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93
Q

What STDs can have manifestations in the oral cavity?

A
  1. syphilis
  2. gonorrhea
  3. HIV
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94
Q

Some STDs including _____, can be transmitted to the dentist through direct contact with oral lesions or infected blood

A
  1. HIV
  2. Hep B
  3. Hep C
  4. Syphilis
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95
Q

T/F: Some STDs including HIV, Hep B, Hep C, and Syphilis can be transmitted to the dentist through indirect contact with oral lesions or infected blood

A

False- only through direct contact

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96
Q

The single most common STD in the us:

A

Chlamydial genitalia infection

(Chlamydia trachomatis)

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97
Q

____ & ____ are examples of steroids that are used to treat many disease

A

cortisone & prednisone

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98
Q

Steroids are important because their use can result in ____ and the patient is unable to mount a normal response to the stress of an infection or invasive dental procedure such as extractions or periodontal surgery

A

adrenal insufficiency

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99
Q

When patients are using steroids, and this results in adrenal insufficiency, why might this be a concern as a dentist?

A

The patient may be unable to mount a normal response to stress of infection or invasive dental procedures

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100
Q

Steroids can make a patient ____ to some degree and also make ___ less likely to work

A

immunosuppressive; antibiotics

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101
Q

The long term use of steroids cause a patient to:

A

stop making steroids

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102
Q

The long term use of steroids cause a patient to stop making steroids. When does this become a concern?

A

cardiac crisis

103
Q

T/F: Not every hospitalization has long term repercussions but it may so it is good to know

A

true

104
Q

History of hospitalizations can provide clues to:

A

past illnesses that may have current significance

105
Q

An INDIRECT aspect of your evaluation but an effective way to identify a current condition

A

history of operations and hospitalizations

106
Q

Obtaining a history of operations and hospitalizations is considered:

A

an INDIRECT aspect of your evaluation

107
Q

What questions should you ask your patient in regards to operations?

A
  1. REASON for the procedure
  2. Any emergencies
  3. Post-op bleeding
  4. Post-op infection
  5. Drug allergy
108
Q

Caution with pregnant patients is warranted with:

A
  1. radiography
  2. drug administration
  3. timing of dental treatment
109
Q

What trimester is the safest to provide dental treatment?

A

2nd trimester

110
Q

When should radiography be used on pregnant women?

A

urgent care only

111
Q

During pregnancy, ____ have changed and the patient is more susceptible to ____.

A

endocrine systems; periodontal issues

112
Q

Patients with a history of IV drug use are at an increased risk for diseases like:

A
  1. Hep B
  2. Hep C
  3. HIV/AIDS
  4. Infective endocarditits
113
Q

For population of patients should sedatives and narcotics be prescribed with a great deal of caution or not at all?

A

Patients with history of drug abuse

114
Q

For patients with a history of drug abuse, sedatives and narcotics be prescribed with a great deal of caution or not at all. This is because:

A

risk of triggering relapse

115
Q

____ should be avoided for cocaine and methamphetamine users

A

Vasoconstrictors

116
Q

Why should vasoconstrictors be avoided for methamphetamine and cocaine users?

A

These agents may cause:
- arrhythmias
- severe hypertension
- MI
- stroke

117
Q

When talking about substance use, misuse and abuse, this requires a level of:

A

professional trust

118
Q

What are we trying to avoid in patients. with a history of drug abuse/misuse?

A

respiratory depression

119
Q

Alcohol consumption is a risk factor for many:

A

many cancers and other diseases

120
Q

Alcohol consumption may lead to ____ which can cause many complications

A

liver cirrhosis

121
Q

What should you ask the patient in regards to alcohol use?

A

How many standard drinks per week

122
Q

The national institute of alcohol a use and alcoholism came up with minimally acceptable amount of alcohol =

A

4 drink units per day or 8 per week (men)

3 drink units per day or 7 per week (women)

123
Q

T/F: Men and women should not regularly exceed 12 units per week of alcohol

A

False- 14 units

124
Q

Wine drinking can lead to:

A
  1. liver toxicity
  2. delayed healing
  3. dementia
  4. bleeding issues
125
Q

Tobacco use poses a risk for:

A

many cancers and other diseases (especially oral cancer)

126
Q

What should you ask a tobacco user?

A
  1. type of tobacco
  2. frequency of use
  3. years of usage

(to establish cumulative risk, current and past)

127
Q

T/F: Smoking tobacco is much more detrimental than chewing tobacco

A

true

128
Q

Describe the parameters when discussing amounts of the following:

  1. Cigarettes
  2. Smokeless tobacco
  3. Hookah
  4. E-cigarettes
A
  1. Packs per day
  2. Cans per week
  3. Hours per week
  4. Cartridges per week
129
Q

Asking your patient about occupation, marital status and children are examples of:

A

social parameters

130
Q

Why might we ask the patient about their occupation?

A

to determine environmental/occupational risk

131
Q

Why might we ask the patient about their marital status?

A

To determine social support

132
Q

Social parameters can be very personal but can affect:

A

patient compliance with treatment

133
Q

gives insight to potential diseases with heritability:

A

family history

134
Q

In regards to family history, we should watch out for signs and symptoms of:

A
  1. hypertension
  2. diabetes
  3. autoimmune disease
  4. cancer
  5. other hereditary diseases and symptoms
135
Q

What questions may we ask the patient to get info on their family history?

A
  1. Do any diseases run in your family?
  2. Are your parents and siblings alive and well?
  3. What did your (mother/father/sibling) pass of?
136
Q

T/F: What we do may affect the patients medications. What medications the patient takes may affect our dental treatment.

A

Both statements true

137
Q

_____ is a good way to initiate the medical history

A

checking medications first

138
Q

Give some examples of signs and symptoms of drug-related adverse effects:

A
  1. bleeding
  2. immunosupression
  3. BP
  4. MRONJ
139
Q

T/F: Patients usually list all medications including OTC drugs and herbal medicines.

A

False

140
Q

During the physical examination objective findings include:

A
  1. vital signs
  2. general appearance
  3. skin
  4. fingers
  5. nails
141
Q

What are checking on the head and neck examination?

A
  1. skin
  2. eyes and nose
  3. ears
  4. cranial nerves
  5. neck examinait on
  6. intra-oral examination
142
Q

Vitals signs include:

A
  1. blood pressure
  2. pulse
  3. respiratory rate
  4. temp
  5. height
  6. weight
143
Q

In a dental setting, what vital signs are typically taken?

A

only BP and pulse (theses are the only ones measured DIRECTLY)

144
Q

Respiratory rate is taken by:

A

observation

145
Q

A normal respiratory rate:

A

12-16 r/m

146
Q

____ is measured when infection or systemic involvement is suspected

A

temperature

147
Q

Height and weight are determined by:

A

asking the patient (in dental setting)

148
Q

Vital signs are used to establish:

A

baseline

149
Q

What is the purpose of obtaining vital sings?

A

detection of abnormality (NOT diagnosis)

150
Q

The purpose of taking vital signs is for detection of an abnormality, and NOT diagnosis. Diagnosis is the responsibility of:

A

the physician

151
Q

Why is it important to check BP?

A
  1. screening (you may be the first to detect)
  2. monitoring (compliance/control/ progression)
  3. risk assessment (potential serious complications)
  4. treatment modifications
152
Q

T/F: Blood pressure is variable so multiple readings are really the most appropriate

A

True

153
Q

Is blood pressure a direct or indirect measurement?

A

INDIRECT

154
Q

The blood pressure cuff should encompass ___% of the circumference of the arm. The cuff should center over the ____.

A

80%; brachial artery

155
Q

What happens if the blood pressure cuff is:

  • Too small:
  • Too big:
A

Too small –> falsely elevated values
Too big –> falsely low values

156
Q

White coat HTN can elevate the BP by:

A

30 mmHg

157
Q

If pregnant pt has BP increase of ____ from baseline increase in systolic BP, this poses a risk for ____ and you should ___.

A

10mmHg; Eclampsia; immediate referral

158
Q

Blood pressure helps to identify patients at risk of:

A

cardiovascular disease

159
Q

Blood pressure helps to identify patients at risk of::

A

horizontal at heart level (mid-sternum)

160
Q

When the arm position is ____ heart level, this overestimates systolic and diastolic pressures

A

BELOW

(similar to cuff being too small)

161
Q

When the arm position is ____ heart level, this under-estimates systolic and diastolic pressures

A

ABOVE

(similar to cuff being too big)

162
Q

_____ method of BP measurement is universally accepted

A

auscultation

163
Q

Describe how to take a BP:

A
  1. BP cuff should be inflated until radio pulse disappears; then add additional 20-30 mmHG
  2. Slowly turn release valve. Fall rate of needle should ~2-3mmHg per second
  3. Listen for sounds- these sounds are the systolic pressure
  4. As the needle continues to fall, the beat will become louder and then diminish
  5. Listen for weakened beats and when sound disappears completely this = diastolic value
164
Q

First audible “beating sound” - when taking a BP:

A

Korotkoff sounds

165
Q

What is a reliable index of diastolic pressure?

A

point when sound disappears completely

166
Q

The pressure point of the first audible sounds (korotkoff sounds) =

A

systolic pressure

167
Q

How can ensure an accurate measurement of blood pressure?

A
  1. pt avoid caffeine, exercise, and nicotine
  2. pt empty bladder prior to taking BP
  3. have patient relax for 5 minutes prior to measurement
  4. support limb when taking BP
  5. don’t take BP over clothes
  6. take 2-3 readings (on 2-3 occasions)
168
Q

What BP range follows under:

Normal:
Elevated:
Stage 1:
Stage 2:
Hypertensive Crisis:

A

Normal: LESS THAN 120/80
Elevated: 120-129/ Less than 80
Stage 1: 130-139/ 80-89
Stage 2: greater than or equal to 140/90
Hypertensive Crisis: greater than or equal 180/120

169
Q

Categorize the following BP:

180/120

A

Hypertensive crisis

170
Q

Categorize the following BP:

120/81

A

Elevated

171
Q

Categorize the following BP:

118/76

A

normal

172
Q

Categorize the following BP:

132/80

A

Stage 1

173
Q

Categorize the following BP:

140/90

A

Stage 2

174
Q

When classifying a patients BP, you need:

A

atleast 2 readings on 2 visits

175
Q

At UMKC, we will not perform any dental care on a patient if their BP is:

A

Greater than or equal to: 180/110 mmHG

176
Q

180/120 is classified as a ___ by the ___ based on the 2017 guidelines

A

Hypertensive urgency; AHA

177
Q

If your patient presents with 180/120 BP and is asymptomatic, this requires:

A

urgent referral to doctor

178
Q

If your patient presents with 180/120 BP and is symptomatic, this requires:

A

Emergency Room!

179
Q

What is the standard for assessing pulse?

A

Palpate carotid artery at side of trachea (most reliable)

or

Palpate radial artery on thumb side of wrist

180
Q

Do NOT use the ___ for pulse detection

A

thumb

181
Q

Classify the following pulse ranges:

Normal:
Tachy:
Brady:

A

Normal: 60-100
Tachy: greater than 100
Brady: less than 60

182
Q

abnormal pulse rate may be a sign of:

A

CV disorder

183
Q

Pulse may be influenced by:

A
  1. exercise/conditioning
  2. anemia
  3. anxiety
  4. drugs
  5. fever
184
Q

The normal pulse is:

A

a series of rhythmic beats at regular intervals

185
Q

Irregular beats are described as:

A
  1. irregular
  2. dysrhythmic
  3. arrhythmic
186
Q

Palpate the pulse for a ____ for accuracy if an ____ is suspected

A

full min; arrhythmia

187
Q

Rate and depth of breathing noted by careful observation of movement of the chest and abdomen in the quietly breathing patient:

A

respiration

188
Q

Normal respirate rate in adults:

A

12-16 breaths/min

189
Q

Resiratory rate in small children is ___ compared to adults

A

higher

190
Q

Abnormal breathing patterns (respiration) includes:

A
  1. labored breathing
  2. rapid breathing
  3. irregular breathing patterns
191
Q

abnormal breathing patterns may be signs of:

A

systemic problems, especially cardiopulmonary disease

192
Q

A common respiration finding in apprehensive patients is ____.

A

Hyperventilation (rapid, prolonged, deep breathing or sighing)

193
Q

A common respiration finding in apprehensive patients is hyperventilation (rapid, prolonged, deep breathing or sighing). This may result in:

A

lowered carbon dioxide levels

194
Q

Rapid weight loss may be a sing of:

A
  1. malignancy
  2. diabetes
  3. tuberculosis
  4. neoplasm
  5. other wasting disease
195
Q

Rapid weight gain may be a sign of:

A
  1. heart failure
  2. edema
  3. hypothyroidism
  4. neoplasm
196
Q

A lot can be determined about a patient’s health from a purposeful but ____visual inspection

A

tactful

197
Q

Changes in the skin and nails can be associated with systemic diseases, what are some examples?

A
  1. cyanosis
  2. jaundice
  3. pigmentation
  4. petechiae or ecchymoses
198
Q

What can the following changes indicate in a patients skin and nails?

  1. cyanosis
  2. jaundice
  3. pigmentation
  4. petechiae or ecchymoses
A
  1. cardiac or pulmonary insufficiency
  2. liver disease
  3. hormonal abnormalities
  4. blood dyscrasia or bleeding disorder
199
Q

Alterations in fingernails are usually seen in:

A

chronic disorder

200
Q

Alterations in fingernails is usually seen in chronic disorders such as:

A
  1. clubbing
  2. white discoloration
  3. yellowing
  4. splinter hemorrhages
201
Q

The following signs on the fingernails are associated with what chronic diseases?

  1. clubbing
  2. white discoloration
  3. yellowing
  4. splinter hemorrhages
A
  1. cardiopulmonary insufficiency
  2. cirrhosis
  3. malignancy
  4. infective endocarditis
202
Q

_____ hand surfaces are common for actinic keratosis & basal cell carcinoma

A

dorsal

203
Q

A raised, darkly pigmented lesion with irregular borders could be a:

A

melanoma

204
Q

List some characteristics of melanoma:

A
  1. darkly pigmented
  2. irregular borders
  3. raised
205
Q

___ & ____ of the face are abnormal in many syndromes and conditions

A

shape and symmetry

206
Q

List some well regarded examples of syndromes and conditions that may result in shape and symmetry changes of the face:

A
  1. Acromegaly- coarse and enlarged features
  2. Cushing syndrome- moon face
  3. Bell’s palsy- unilateral paralysis
207
Q

T/F: Eyes can be indicators of systemic disease and should inspected closely. Patients wearing glasses should be asked to remove them during examination of head and neck.

A

Both statements true

208
Q

Involving the eyes and nose, give an examples of an indicator of hyperthyroidism:

A

lid retraction

209
Q

Involving the eyes and nose, give an examples of an indicator of hypercholesteremia

A

xanthomas of the eyelids

210
Q

Involving the eyes and nose, give an examples of an indicator of liver disease (problem metabolizing drugs):

A

yellowing of sclera

211
Q

Involving the eyes and nose, give an examples of an indicator of allergy or sicca syndrome:

A

conjunctiva reddening

212
Q

An earlobe crease may be an indicator of:

A

CAD

213
Q

Examination of the head and neck may vary in its comprehensiveness but should include:

A

inspection & palpation of:
1. soft tissues of oral cavity
2. maxillofacial region
3. neck

(as well as evaluation of the cranial nerve function)

214
Q

What do we look for when physically examining the neck?

A
  1. normal or enlarged?
  2. soft or hard?
  3. mobile or fixed?
  4. tender or non-tender?
215
Q

What may be some causes of abnormal findings in the neck?

A
  1. infections
  2. goiter
  3. cysts
  4. masses
  5. vascular deformities
216
Q

List the groups of lymph nodes that should be palpated in a head and neck examination:

A
  1. pre-auricular
  2. post-auricular
  3. tonsillar
  4. submandiublar
  5. anterior cervical
  6. posterior cervical
  7. supreclavicular
217
Q

Describe how you may want to organize an appointment for a patient with known dental anxiety:

A
  1. short appointments
  2. usually morning
  3. pre-dental treatment sedation (1hr prior to appt)
  4. sedation during treatment (nitrous oxide)
  5. profound local anesthesia
  6. post-dental pain control
  7. patient contacted the evening of the procedure
218
Q

What type of drugs may be prescribed to be taken 1 hr prior to treatment for an anxious patient? Give an example:

A

Benzodiazepine; Triazolam .25 mg

219
Q

Indications for laboratory testing in dentistry include:

A
  1. aid in detecting suspected disease
  2. screen high-risk patients for undetected disease
  3. establish normal baseline values before treatment
  4. address medical-legal considerations
220
Q

Common labs a dentist may order include:

A
  1. CBC (complete blood count with platelets & WBC differential)
  2. Prothrombin time
  3. Partial thromboplastin time
221
Q

What measurement may be found on a CBC? Include normal values:

A
  1. RBC 4.2-5.9 million/mm3
  2. WBC 4-10k/mm3h
  3. Platelet count 150k-400k/mm3
222
Q

The prothrombin time test is:

A

international normalized ratio (PT-INR)

223
Q

What is the purpose of a Prothrombin Time Test? (PT-INR)

A

Helps to determine bleeding risk & measure extrinsic and normal coagulation cascade pathways

224
Q

What is considered a normal INR (from a PT-INR test)?

A

normal =1

For a patient on Coumadin 2-3 is normal

225
Q

What does a higher INR mean?

A

higher bleeding risk

226
Q

P.T.T:

A

Partial thromboplastin time

227
Q

PT-INR:

A

Prothrombin time -international normalized ratio

228
Q

The P.T.T measures the ___ pathway

A

intrinsic

229
Q

Normal range for a P.T.T equals:

A

25-38 seconds

230
Q

aPTT is ___ and is used for:

A

activated PTT; pradaxa

231
Q

A ___ record is a legal record

A

written

232
Q

T/F: Risk is sometimes increased when treating a medically complex patient

A

False- ALWAYS

233
Q

When dealing with a complex patient, plan around:

A

likelihood of most severe complication

234
Q

ASA:

A

American Society of Anesthesiologists

235
Q

Assign an ASA classification for the following situation:

A normal healthy patient

A

ASA1

236
Q

Assign an ASA classification for the following situation:

A patient with mild systemic disease

A

ASA2

237
Q

Assign an ASA classification for the following situation:

A patient with severe systemic disease

A

ASA3

238
Q

Assign an ASA classification for the following situation:

A patient with severe systemic disease that is a constant threat to life

A

ASA4

239
Q

Assign an ASA classification for the following situation:

A moribund patient who is not expected to survive without operation

A

ASA5

240
Q

Assign an ASA classification for the following situation:

A patient declared brain-dead whose organs are being removed for donor purposes

A

ASA6

241
Q

Higher ASA status (ASA2-6) increases with:

A

increasing age

242
Q

ASA classification that poses little or no risk during treatment:

A

ASA1

243
Q

ASA classification that poses minimal risk during treatment:

A

ASA2

244
Q

ASA classification of a patient that can walk up 1 flight of stairs or 2 level city blocks but has to stop on the way because of distress:

A

ASA3

245
Q

For an ASA3 patient, if dental care is needed ____ and other ____ are indicated.

A

stress reduction protocols and other treatment modifications are indicated

246
Q

T/F: 30 or more ago history of myocardial infarction, cerebrovascular accident, and congestive heart failure place a patient in the classification of ASA4

A

False- ASA 3

247
Q

What is the ASA classification for a patient who has severe systemic disease that is a constant threat to life?

A

ASA 4

248
Q

What is the ASA classification for a patient unable to walk up 1 flight of stairs or 2 level city blocks. Distress is present at rest

A

ASA 4

249
Q

Elective dental care should be postponed until the patient is an:

A

ASA3

250
Q

Emergency dental care for an ASA Class 4 patient:

A

may be best in a hospital with a consultation with the patients physician team

251
Q

What is the ASA classification for a patient with unstable angina, MI, or CVA in the last 30 days?

A

ASA 4

252
Q

What is the ASA classification?

  • severe CHF
  • moderate to severe COPD
  • uncontrolled HTN
  • uncontrolled DM
  • uncontrolled epilepsy or seizure disorder
A

ASA 4

253
Q
A

Dental Management of the Medically Complex Patient (5 decks)

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