Management of the Medically Compromised Patient Flashcards

1
Q

What drugs might you need for syncope/vaso-vagal attack/fainting

A

Oxygen lol

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2
Q

What drugs might you need for anaphylaxis

A
  • Oxygen

- Adrenaline

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3
Q

What drugs might you need for Asthma

A
  • Oxygen
  • Salbutamol
  • Adrenaline
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4
Q

What drugs might you need for ACS (includes heart attacks etc.)

A
  • Oxygen
  • Aspirin
  • GTN
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5
Q

What drugs might you need for Epilepsy

A
  • Oxygen

- Buccolam (contains midazolam)

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6
Q

What drugs might you need for Hypoglycaemia

A
  • Oxygen

- Glucagon

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7
Q

What is the normal range in g/dL for haemoglobin

A

13-17.0g/dL

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8
Q

What is the normal range for mean cell volume in fL

A

83-101 fL

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9
Q

What is the normal range for red cell folate in umol/L

A

0.36 - 1.44 umol/L

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10
Q

What is the normal range for Vitamin B12 nmol/L

A

0.13 - 0.68 nmol/L

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11
Q

What is the normal range for WBCs per litre

A

4 - 7 x 10^9/L

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12
Q

What is the normal range for neutrophils per litre

A

2 - 7 x 10^9/L

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13
Q

What is the normal range for platelets per litre

A

150.0 - 400.0 x 10^9/L

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14
Q

What is the normal range for INR

A

0.9 - 1.1

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15
Q

What is the normal range for APPT

A

21 - 31 seconds

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16
Q

What is the normal range for TT

A

14 - 19 seconds

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17
Q

What platelet count requires a patient to have extra added platelets for major surgery

A

< 75 x 10^9/litre

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18
Q

If a patient has less than 0.5 x 10^9/litre of neutrophils, what precaution should be taken for surgeries

A

Antibiotics should be administered

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19
Q

What BMI is overweight, obese and underweight

A
Overweight = >25
Obese = > 30
Underweight = < 18
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20
Q

What problems can arise from overweight patients

A
  • Airway management and patient handling problems

- Comorbidities like CVD, Diabetes and Fatty Liver Disease

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21
Q

What problems can arise from underweight patients

A
  • Anaemia
  • Bradycardia, hypotension
  • Psychiatric disease
  • Osteoporosis
  • Reflux
  • Dental implications
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22
Q

When should you review the control of asthma in an asthma patient

A

Review it on the day of the treatment - essential

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23
Q

What drugs are there up the ladder of Respiratory treatments (mainly asthma)

A
  • Salbutamol
  • Budenoside / beclometasone
  • Formoterol
  • Theophylline
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24
Q

AY BAWS CAN I HABE DE NOTE PLEASE

A

COPD is often undiagnosed in patients

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25
Q

What HbA1c % indicates poorly controlled blood sugar

A

< 6.5% (< 48mmol/mol)
OR
>10% (>86mmol/mol)

26
Q

In what cardiac patients might you need to consider AB cover?

A
  • Previous Infective Endocarditis (IE) patients
  • Prosthetic heart valves
  • Some congenital heart defects
27
Q

What type of cover should be given if a patient is indicated to need AB cover due to cardiac conditions

A
  • Amoxil 3g PO/IV (50mg/kg in children)
    OR
  • Clindamycin 600mg PO (20mg/kg in children)
28
Q

Name some types of NOAC (Novel Oral Anti Coagulant)

A
  • Apixaban
  • Dabigatran
  • Rivaroxaban
29
Q

If a patient is taking Apixaban or Dabigatran how should they alter their drug schedules if undergoing dental treatment that involves bleeding

A
  • Miss their morning dose (pre treatment)

- Post treatment dose should be at the usual time in the evening

30
Q

If a patient is taking Rivaroxaban how should they alter their drug schedules if undergoing dental treatment that involves bleeding

A
  • If they normally take their dose in the evening then they don’t need to change anything
  • If they normally take their dose in the morning then they should delay it until 4 hours after haemostats has been achieved
31
Q

What types of bleeding and symptoms can indicate a defect in the primary haemostasis of a patient

A
  • Immediate bleeding
  • Oozing 24 hours post op unto 3 days
  • Petechiae in multiple sites
32
Q

What types of bleeding and symptoms can indicate a defect in the secondary haemostasis of a patient

A

Deep tissue bleeding

33
Q

What is especially important to go through in the MH of a haematology patient

A
  • Type of bleeding disorder e.g. haemophilia/vW disease
  • Severity of disease - % of Factor XIII
  • How dental tx managed in the past
34
Q

What is the diagnosis test for a patient with renal disease

A
  • Blood test for Creatinine, which is a breakdown of muscle metabolism
  • Higher levels of creatinine indicates a lower GFR
  • Urinalysis - Proteinurea + renal biopsy
35
Q

What are some of the signs and symptoms of a patient with renal disease

A
  • Lemon tinge to skin
  • Halitosis
  • Itchy skin
  • Hypertension
  • Anaemia
  • Peritonitis
  • Proteinurea
  • Bone pain
36
Q

What are the medical management options of Renal disease

A
  • No treatment
  • Haemodialysis
  • Peritoneal dialysis
  • Transplant
37
Q

What patient factors present risk in renal disease patients for dental treatment

A
  • Anaemia
  • Increased bleeding
  • Increased risk infection
38
Q

What GFR indicates Stage 1 of loss in renal function

A

≥90ml/min/1.73 m^2

39
Q

What GFR indicates end stage renal failure

A

<15 ml/min/1.73 m^2

40
Q

What are some of the signs and symptoms of a patient with Liver disease

A
  • Encephalopathy
  • Bleeding
  • Jaundice
  • Dry mouth/excessive thirst
  • Telangiectasia
  • Ascites
  • Gynecomastia
  • Resting tremor
  • Dupytren’s contracture
  • Hepatocellular carcinoma
41
Q

Name some immunosuppressant drugs that a transplant patient might be taking

A
  • Tacrolimus
  • Cyclosporin gingival swelling
  • Mycophenolate mofetil
  • Prednisolone
  • Monoclonal antibodies
42
Q

What are some common drugs used in the treatment of HIV

A
  • Atripla
  • Combivir
  • Kaletra
43
Q

When a patient comes in with HIV what questions are particularly important to ask

A
  • How long?
  • Medications?
  • CD4 count? Viral load?
44
Q

What CD4 levels qualify a patient to have AIDS

45
Q

At what viral load is HIV typically undetectable

46
Q

Name some typical antipsychotics used to treat some forms of psychiatric disease

A
  • Clozapine

- Haloperidol

47
Q

Name some atypical antipsychotics used to treat psychiatric disease

A
  • Olanzapine
  • Risperidone
  • Amisulpride
  • Aripiprazole
  • Quetiapine
48
Q

What complications can arise as a result of thalassaemias

A

Anaemia
Cardiomyopathy
Patients often require splenectomy

49
Q

What drugs are common in thalassaemia patients

A

Bisphosphonates

50
Q

Name some things that can precipitate sickling of cells in a patient with Sickle Cell Anaemia

A
  • Cold
  • Infection
  • Dehydration
  • Acidosis
  • Hypoxia
51
Q

Why should you avoid high doses of aspirin in SCA patients

A

Risk of inducing acidosis

52
Q

What size of tumour does T1 - T4 indicate

A
T1 = < 2cm
T2 = 2 < x < 4cm
T3 = > 4cm
T4 = Deep invasion into bone, muscle, skin, adjacent structures; massive tumour
53
Q

What does the notation of N0-N2 indicate about the nodes of an oncology patient

A
N0 = No nodes
N1 = Single, unilateral node < 3cm
N2 = Single, unilateral node   3-6cm/ multiple unilateral nodes not > 6cm
54
Q

What does M0 and M1 indicate about the state of metastases in oncology patients

A

M0 - no distant metastases

M1 - Distant metastases

55
Q

What are the general signs and symptoms of a cancer patient

A
  • Lymphadenopathy
  • Bleeding gums
  • Infections
  • Haematurea
  • Weight loss
  • Fever
  • Malaise
56
Q

What is the acronym used for the symptoms/signs of multiple myeloma what does it stand for

A
C = Calcium elevation in the blood (serum calcium > 10.5 mg/L)
R = Renal insufficiency (serum creatinine > 2mg/dL)
A = Anemia (haemoglobin < 10g/dL)
B = Lytic bone lesions or osteoporosis
57
Q

What methods of diagnosis are there for cancer

A
  • Clinical
  • MRI/CT
  • PET scans
  • Biopsies
58
Q

What methods of treatment are there for cancer patients

A
  • Chemotherapy
  • Radiotherapy
  • Surgery
  • Combination
59
Q

What drugs can lead to MRONJ

A

Zometa and Denosumab etc

Bisphosphonates carry the highest risk of this

60
Q

What are some of the treatments that are provided to patients with Stage 1 and above MRONJ

A
  • Antibacterial mouth rinse
  • Pain control
  • Antibiotic therapy
  • Debridement to relive soft tissue irritation and infection control