Medical History Flashcards
dx
diagnosis
hx
history
n/a
next appointment or not applicable
fm
full mouth
hbv
hepatitis b virus
hiv
human immunodeficiency virus
prn
as needed
bid
twice a day
tid
three times a day
qid
four times a day
pt
patient
rx
prescription
tmj
temporomandible joint
tb
tuberculosis
all patients get a medical history, even if you
appear apparently healthy
patients often don’t realize or recall the significance of this
what do you look for first?
the most common diseases
what do patients sometimes forget or fudge? (4)
oral hygiene
alcohol
smoking
drugs
make sure patients can understand your questions by
speaking at the patients level of understanding, language barriers
asthma
Is a chronic inflammatory disease of the airways characterized by reversible episodes of increased airway hyperresponsiveness resulting in recurrent episodes of dyspnea, coughing, and wheezing.
onset of asthma
sudden onset, with symptoms occurring within 10-15 minutes
inadequate treatment of asthma results in ER visits for about —% of patients
25%
Asthma affects —million people worldwide and accounts for 1 of every — deaths worldwide(pre-COVID)
300
250
In the US, asthma’s prevalence has more than doubled sine the 1960’s from -% to -% or greater. Affecting – million people
2
7
23
asthma is a disease primarily of
children
–% of children affected with asthma
10%
what is the most common chronic disease of children?
asthma
how many cases develop before age 10?
1/2
asthma affects -% of adults
6
do females or males have a higher rate of asthma?
females
although the prevalence is higher during childhood in boys
asthma occurs within all races, with a slightly higher prevalence among — and a lower prevalence among — than among other races or ethnic groups
African americans
hispanics
causes/triggers of asthma (5)
Emotional or physical stress
Allergy to foods or drugs-ingestion of nuts, shellfish, aspirin, nonsteroidal anti-inflammatory drugs (NSAID’s)
Air pollution or irritating vapors
Upper respiratory infections
Exercise induced –breathing through the mouth & inhaling colder and drier air.
what should you avoid for patients with asthma? (2)
aspirin
NSAIDs
aspirin causes bronchoconstriction in about –% of patients with asthma and sensitivity to aspirin occurs in – to –% of people with asthma who have pansinusitis and nasal polyps
10
30
40
if patients have triad asthmaticus, they may have a
very sudden and very severe asthma attack
asthma- no contraindication to (2)
nitrous oxide
valium
symptoms of asthma (6)
chest congestion wheezing and cough dyspnea and tachypnea increased blood pressure anxiety and agitation cyanosis
the underlying primary goal in dental management of patients with asthma is to prevent
an acute attack
Through a good medical history, the dentist should be able to determine the (2)
severity and stability of the disease
Frequency and severity of attacks, time of day attacks occur, most occur at
night
Any current or past problem with the
asthma attacks
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How are attacks usually
managed
Has the patient ever received emergency care for
an acute attack?
asthma prevention (5)
Get vaccinated for influenza and pneumonia (age appropriate)
Know your asthma triggers—smoke, exercise, animals
Take medication as prescribed
Risk assessment-through a good medical history. Severity is based on age, frequency of symptoms, impairment of lung function, and risk of attacks.
May want patient to take a puff from their inhaler prior to starting treatment.
management of asthma (7)
Terminate procedure Position patient-upright Calm patient Administer bronchodilator-Ventolin Administer oxygen Summon medical assistance Administer epinephrine-Bronchodilator and antispasmodic
chronic complications of diabetes (8)
blindness kidney disease nerve damage amputation cardiovascular disease (stoke, heart attack, loss of circulation in arms and legs)
diabetes is a chronic, — illness and a growing epidemic in the United States
incurable
According to the CDC, more than — (9.4%) million Americans have diabetes
30.3
— million Americans (23.8%) are undiagnosed.
7.2
– million are prediabetic.
84
diabetes is the — leading cause of death in the US (pre covid)
third
diabetes and age
Increases with age-95% are over 45 years of age
diabetes is the leading cause of — in the US
blindness
diabetes mellitus
Is a group of metabolic syndromes resulting from low levels of the hormone insulin
diabetes mellitus is characterized by a disordered metabolism of (4)
carbohydrates,
lipids,
proteins
an abnormally high blood sugar level (hyperglycemia)
the incidence of type 2 diabetes vs type 1 diabetes since 1998
2- more than doubles
1- remained stable
The long-term hyperglycemia that results from DM can lead to damage of carious organs, including the (6)
heart eyes kidneys nervous system vascular system periodontium
type 1 diabetes accounts for -% of diabetic patients
5%
type 1 diabetes is more common in
children than cults
what is absent in type 1 diabetes?
circulating insulin
what is type 1 diabetes?
autoimmune destruction of the beta cells of the pancreas
what does type 1 diabetes cause?
total insulin deficiency
onset of type 1 diabetes
abrupt onset
Persistent elevated blood glucose levels put persons at risk for
diabetes
About –% of people with prediabetes who were followed annually developed overt diabetes each year during the average 3 years of follow-up
11%
gestational
Any degree of abnormal glucose tolerance during pregnancy
how prevalent is diabetes mellitus during pregnancy
5-7%
obesity during pregnancy is a known
risk factor
After childbirth, the mother’s glycemic control usually returns to normal, but these women have an increased risk of developing diabetes within
5-10 years
Body produces high levels of blood acids called
ketones
diabetic ketoacidosis develops when
your body can’t produce enough insulin
Kussmaul’s respirations
deep and labored breathing pattern
diabetic ketoacidosis can be trigger by (2)
infection or other illness
DIABETIC KETOACIDOSIS is rare in people with
type 2
DIABETIC KETOACIDOSIS glucose levels will be above
300 mg/dL
hyperglycemia symptoms (7)
polyuria polyphagia dry, warm skin kussmauls respirations fruity breath odor rapid, weak pulse altered level of conciousness
hypoglycemia symptoms (7)
pale, moist skin weakness, dizziness shallow respirations headache altered level of conciousness onset very sudden blood glucose values <50 mg/ 100 mL
when is an appointment recommended for a patient with hypoglycemia?
after a meal or snack
many patients with diabetes are recommended to eat a meal or snack every
4-5 hours
common symptoms of an alert level include (4)
shakiness
irritability
confusion
hunger
symptoms of severe hypoglycemias include (3)
loss of consciousness
seizures
coma
management of hypoglycemia (4)
position the patient comfortable (ABC)
administer 100% oxygen
oral carbohydrates in conscious
medical assistance
management of hypoglycemia if unconscious (4)
cake icing
50% dextrose (20-50 mL) IV
glucagon 1 mg IM or IV
epinephrine 1/1000 0.5 mg IM
self test of blood sugar
perform with a blood glucose meter
tells you what your blood sugar level is at that point in time
a1c measures
the average amount of sugar in your blood over the past 2-3 months
HbA1c(Hemoglobin A1c)-monitors long term glucose control over
30-90 days
If you have diabetes an ideal HbA1c level is —% or below
6.5
if you are at risk of developing type 2 diabetes, your target HbA1c should be -%
6%
If patient doesn’t know their A1c, test the patient with a
glucometer
—mg/dL-consider deferring elective treatment or
give carbohydrates. Wait 15 minutes and retest
–mg/dL-defer elective treatment and refer to
physician
70
200
Fasting (8-12 hours) Glucose Level – to – mg/dL
80-130
1-2 hours after a meal-< —mg/dL
180
A major goal is to prevent — — (very low blood glucose). Patient skips a meal but takes their insulin
insulin shock
Patients who are treated with insulin must closely adhere to their diet. If they fail to eat in accordance with their diabetic management plan but continue to take their regular insulin injections, they may experience a
hypo-glycemic reaction caused by an excess of insulin.
Reaction or shock caused by excess insulin occurs in three well-defined stages, each more
severe and dangerous than the one preceding.
most common stage of insulin shock
mild stage
mild stage insulin shock is characterized by (6)
hunger, weakness, trembling, tachycardia, pallor, and sweating; paraesthesias may be noted on occasion
when might mild stage insulin shock occur? (3)
before meals,
during exercise,
when food has been omitted or delayed
Because blood glucose drops substantially, the patient becomes (4); judgement and orientation are defective
incoherent,
uncooperative,
and sometimes belligerent
or resistant to reason or efforts at restraint
The chief danger during moderate stage is that patients may
injure themselves or someone else.
severe stage of insulin shock
Complete unconsciousness with or without tonic or clonic muscular movements
Most of these reactions take place during sleep, after
the first two stages have gone unrecognized
May also occur after exercise or alcohol ingestion if the earlier signs have been
ignored
what may be present during serve stage insulin shock? (6)
Sweating, pallor, rapid and thready pulse, hypotension, hypothermia
how can insulin shock be corrected?
giving the patient sweetened fruit juice or anything with sugar in it (cake icing)
Patients in the severe stage (unconsciousness) are best treated with an — solution; — or — may be used for transient relief.
Iv-glucose
glucagon or epinephrine
treatment of diabetes mellitus (5)
treat uncontrolled patient only with consultation with physician
decrease insulin on day of treatment if patient will be eating less
consider chronic complications - infection
early morning appointments
good medical history
— — is commonly seen in people with diabetes and is considered a complication of diabetes.
Periodontal disease
Bidirectional — affects oral health while — affects glycemic control (increased HbA1c)
hyperglycemia
periodontitis
oral complications of diabetes (7)
Periodontal disease is commonly seen in people with diabetes and is considered a complication of diabetes
Bidirectional-hyperglycemia affects oral health while periodontitis affects glycemic control( increased HbA1c)
Xerostomia
Increased infections and poor wound healing
Burning mouth syndrome
Increased incidence and severity of gingival inflammation
Periodontal abscess.
allergy
an abnormal or hypersensitive response of the immune system to a substance introduced into the body
it is estimated that more than –% of all Americans demonstrate an allergy to some substance
25%
rapid allergy reaction (7)
Rapid onset-less than one hour Type I-true IgEmediated anaphylaxis Antibiotics Analgesics Narcotics Preservatives in anesthetics-Articaine Venom of stinging insects
type 1 hypersensitivity reactions are related to the humoral immune system (antibody-mediated immunity) and usually occur soon after
second contact with an antigen; however, many people have repeated contacts with a specific drug or material before they become allergic to it
acute reaction involving smooth muscle of the bronchi in which antigen-IgE antibody complexes form in the surface of mast cells which causes sudden histamine release from these cells. The potential end resultis acute respiratory compromise and cardiovascular collapse.
Anaphylaxis
Most anaphylaxis occur within one — of taking a medication
hour
Antibiotics are the most common cause but most recently, — — have also been shown to induce
chemotherapy drugs
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signs and symptoms of rapid allergic reaction (14)
pallor rash itching hives angio-edema hypotension dyspnea GI upset bronchospasm laryngeal edema rhinorrhea circulatory collapse dysrhythmias cardiac arrest
management of rapid allergic reaction (7)
position patient supine
BCLS
oxygen
minor vital
epinephrine (1/10,000) 3.0cc IV or epinephrine (1/1,000) 0.3 cc IM/SC
Benadryl: 50 mg IV or IM
obtain medical assistance and transport to hospital
where does epinephrine get inserted
outer thigh
Cost of epi pens: Mylan purchased the rights to EpiPen in 2007 and gradually raised the list price from $50.00 for a pen to — for a 2-pack
$800
Shelf life of epi pens was 16 months BUT the FDA is allowing an additional - months
4
The outer thigh should be used as opposed to the front of the thigh. It provides a skin area with (2)
thinner tissue and less fat
Hold the auto-injector in place for - seconds
3
delayed allergic reaction (6)
onset greater than one hour usually non-life threatening antibiotics analgesics narcotics preservatives in anesthetics
signs and symptoms of delayed allergic reaction (5)
rash pruritus (itching) urticaria (hives) edema rarely -hypotension, dyspnea, coma
management of delayed allergic reaction (5)
terminate procedure
position patient based upon comfort
BCLS if indicated (usually not)
Benadryl 50 mg PO or IM q 4 h depending upon severity of symptoms
continue Benadryl for 24 hours after symptoms disappear
about – to – % of self-reports of allergy are not true allergies
5-10%
syncope after injection of a
local anesthetic
nausea or vomiting (N/V), after ingestion of
codeine
a family history of a reaction to a specific drug typically does not increase your chance of
reacting to the same drug
