Medical History Flashcards
0
Q
Scarlet fever
A
Red rash
Untreated strep infection
1
Q
Rheumatic fever
A
Inflammatory disease Heart, skin, joints, and brain Rheumatic fever -> rheumatic fever heart disease -> heart valve complications May need pre med Beta hemolytic group a streptococcus
2
Q
Chicken pox
A
- Contagious viral infection
- Varicella-Zoster Virus
- virus lay dormant In the ganglia of sensory nerves (trigeminal and dorsal ganglions)
- latent form is Shingles (Very painful rash that breaks out unilaterally on the head, neck, or trunk)
- There are vaccinations for both Chicken Pox and Shingles. They are two separate vaccines
3
Q
German measles
A
- Acute contagious exanthematous disease
- Lymphadenopathy (enlarged lymph nodes)
4
Q
Measles
A
Acute viral infection
Koplik spots that can be found on the buccal and labial mucosa
6
Q
Mumps
A
-Acute contagious disease caused by the Paramyxovirus
-Can cause Parotitis (inflammation of the parotid gland) which can cause pain
when chewing
-can affect the testis, ovaries, prostate and mammary glands
7
Q
Whooping cough
A
bacteria- Bordetella pertussis
A high pitched cough with a whooping sound when the person breaths in
between coughs
8
Q
Hepatitis
A
- Inflammation of the liver
- Hepatitis A = fecal-oral route
- Hepatitis B = blood borne
- Hepatitis C = blood borne
- Hepatitis D = blood borne
- Hepatitis E = fecal-oral route
3. Which type of Hepatitis is a co infection of another Hepatitis? - You can’t have Hepatitis D without having Hepatitis B
4. Which types of Hepatitis have vaccines? - Hepatitis A and B have vaccines, and since you need Hepatitis B to have D, D is also considered
9
Q
Herpes
A
- Oral Herpes caused by Herpes Simplex 1 Virus
- Genital Herpes caused by Herpes Simplex 2 Virus
- stages: Prodromal, Vesicular, and Crusting
- treat at the crusting stage
- Lesions are Fluid-filled
9
Q
HIV/AIDS
A
- Human Immunodeficiency Virus
- Acquired Immune Deficiency Syndrome
2. Where is the virus found? - Bodily fluids
3. How is it transmitted? - Blood, semen, vaginal secretions, and breast milk
4. What makes HIV progress to AIDS? - The T-cell count is less than 200
5. Do you need to consult the patient’s physician? - YES = patient is immunocompromised
6. What are intraoral findings of HIV/AIDs?- Linear gingival erythematous, Kaposi sarcoma, Hairy leukoplakia
- More prone to NUG and candidiasis
10
Q
Sexually transmitted diseases (STD)
A
Examples include Syphilis, Gonorrhea, Chlamydia, Human Papillomavirus (HPV)
1. Which STD’s have oral manifestations?
-Syphilis, Ghonorrhea, and HPV
2. What are the stages of syphilis?
-Chancre
-Skin rash and intraoral mucous patches
-Gumma
3. What are the possible side effects when a mother passes syphilis to the fetus?
And what are these symptoms called?
-Hutchinson’s triad:
-Mulberry molars or notched incisors
-Blindness
-Deafness (8th nerve)
4. How is syphilis treated?
-Penicillin G / (syPhilis – Penicillin)
5. What is the bacteria that causes syphilis?
-Trepanema palladium
6. What is the bacteria that causes gonorrhea?
-Neisseria gonorrhea
11
Q
Rheumatic fever heart disease
A
-Disease of the heart resulting from Rheumatic Fever that can cause abnormalities of the heart valves because of the inflammation
12
Q
Tuberculosis
A
Tuberculosis
1. What bacteria causes TB?
-Mycobacterium tuberculosis
2. What are the symptoms?
-Persistent cough with bloody sputum, weight loss, fever, night sweats
3. What is the difference between latent and active TB?
-Latent TB is the disease which lays dormant without symptoms and is
nontransmissible
-Active TB is the infection where the bacteria is growing and patient presents
with symptoms
4. How long should treatment be postponed after standard anti-tuberculosis
therapy?
-2-3 weeks (should still consult MD)
5. Can you use the ultrasonic on a patient with TB?
-When it is inactive
6. What is a PPD test?
-Purified protein derivative test OR Mantoux Test
7. How often should we as healthcare providers be tested?
-Annually
8. What would you see in a person’s chest x-ray with the latent form?
-tubercles
9. What are the common medications used to help treat TB?
- SIREP
Streptomycin - is the antibiotic for treatment
Isoniazid (INH)
Rifampin (RIF)
Ethambutol
Pyrazinamide (PZA)
9. How long is INH therapy?
-6 months for adult
-9 months for children
-12 months for HIV infected
14
Q
Mitral valve prolapse
A
Even though current guidelines do not require physician consultation or pre-medication, the UNH Dental Hygiene Clinic requires the physician to be
consulted regarding possible pre-medication if they have taken premedication at previous UNH appointments.
-Excessive retrograde movement from the left ventricle to the aorta allowing regurgitation of blood through the mitral valve
14
Q
Infective Endocarditis
A
Infective Endocarditis (IE)
- What is IE?
- Bacterial infection of the endocardium (inner lining of the heart) - What bacteria are involved?
- streptococci and staphylococci (Streptococcus viridians) – alpha hemolytic streptococcal infection - Can a patient self-induce IE? How?
- Possibly through eating, brushing/flossing, anything being forced into sulcus
15
Q
Heart murmur
A
Even though current guidelines do not require physician consultation or pre-medication, the UNH Dental Hygiene Clinic requires the physician to be consulted regarding possible pre-medication if they have taken premedication
at previous UNH appointments.
1. What is a Heart Murmur?
-Abnormal sound generated by blood flow through the heart
2. Why are heart murmurs significant to hygienists?
-Because it may indicate other heart conditions (IE, Mitral Valve Prolapse, congenital heart defects)
16
Q
Heart Attack or Myocardial Infarction (MI)
A
- What causes heart attacks?
-Thrombus – complete blockage of blood flow (typically in atherosclerotic
artery) to the heart, causing IRREVERSABLE damage - How long does it need to be before we can treat someone who has had a MI?
-Patient’s last attack needs to be at least 6 months prior to treatment, however,
can treat if have medical clearance from physician for emergency cleaning - What are common drugs used to help prevent MI? Example?
-Anticoagulant such as Coumadin (warfarin) - Do we need to consult patient’s physician?
-YES! = Need patient’s INR if patient is on anticoagulant - What is INR? When can we treat?
-International Normalized Ration, should be less than 3.0
17
Q
Arteriosclerosis
A
Hardening of the arteries (due to loss of elasticity)
18
Q
Angina pectoris
A
- Ischemic disease causing lack of oxygen to the heart
- main cause: thrombosis in an atherosclerotic artery
2. What can precipitate an attack? - Stress, exertion, emotion, heavy meal, anxiety
3. What are the symptoms? - Burning, squeezing, or crushing tightness in the chest that radiates to the neck, shoulder, left arm, and mandible
4. Should physician by consulted? - ONLY if it is unstable
5. What drug is used to help relieve an attack? - Nitroglycerin
6. How is the drug administered during an attack? - 1 tablet sublingually every 5 minutes for up to 3 tablets (total of 15 minutes)
7. Where does the Nitroglycerin need to be during appointments? - On the counter
8. At what point do you call EMS? - After administering the second pill – but make you judgment based on ethics and safety of the patient (because 5 minutes can be a major difference to saving the patient)
9. If patient doesn’t have their Nitroglycerin, where can emergency Nitroglycerin be found? - In the first aid kit in the Resource room
10. How do you know if the nitroglycerin is working? - The patient will complain of a headache
19
Q
Atherosclerosis
A
Hardening of the coronary arteries (due to loss of elasticity)
20
Q
Hypotension
A
Low blood pressure
- What reading is considered Low Blood Pressure?
- 90/60 or less - May also increase the risk of what?
- Orthostatic Hypotension
21
Q
Hypertension
A
High blood pressure
- What can cause High Blood Pressure?
- Obesity, genetics, smoking, poor diet, medications, stress, etc. - What are the 4 classes of antihypertensive drugs?
- Angiotensin II receptor blockers (example = Lisinopril)
- Beta-blockers (example = Propranolol)
- Calcium Channel Blockers (example = Procardia)
- Diuretics (example = Lasix) - What reading does UNH terminate the appointment?
- 160/100 or higher - What reading is contraindicated for local anesthetic use?
- 200/115 or higher - What is the difference between primary and secondary?
- Primary: caused by amount of cardiac output, fluid volume, peripheral resistance
- Secondary: caused by underlying diseases (weight gain, smoking, etc)
22
Q
TIA/CVA
A
- What is the difference between a TIA and CVA?
-TIA is a Transient Ischemic Attack when there is a partial blood clot reducing
blood flow to the brain. This is considered a “mini stroke”
-CVA is a Cerebral Vascular Accident when there is a lack of oxygen to the brain
due to a thrombus or embolus - What are the symptoms of each?
-TIA symptoms include a severe headache, sudden loss of neurological function
with a quick recovery, numbness, tingling, weakness, paralysis, vision change,
trouble speaking
-Effecting one half of the body - determines what the medical emergency is
23
Q
High cholesterol
A
- What are the two types of cholesterol? Which is the good which is the bad?
- LDL (Low Density Lipoproteins) = BAD
- HDL (High Density Lipoproteins) = GOOD
- Total cholesterol should be around 200 to be healthy - What class of drugs are used to treat High Cholesterol?
- statins (ex: Lipitor)
24
Cardiac pacemaker
If the pacemaker is unshielded, use of ultrasonic is contraindicated.
1. What is the difference between a pacemaker and a defibrillator (implanted
cardioverted – defibrillator)?
-A pacemaker helps keep the beat of the heart steady
-A defibrillator shocks the heart if the heart stops
2. Do we need to obtain medical clearance?
-ONLY if the device is unshielded or patient is unaware
3. Can the ultrasonic be used?
-ONLY if the pacemaker is shielded or if medical clearance is obtained if
unshielded
25
Allergies
1. What are common things a patient may be allergic to?
| - Pollen, latex, peanut butter, drugs, bees, etc.
26
Hives/ skin rash
1. What may be used to treat someone having an allergic reaction with Hives or
Skin Rash?
-Benadryl
2. What may be used to treat someone experiencing anaphylactic shock?
-Epi-pen
27
Latex allergy
1. What follow up questions should you ask a patient if they are unsure (indications
for latex allergy)?
-Have you ever experienced swelling of the lips, tongue, or skin after a dental
visit?
-Are you allergic to avocados, kiwis, bananas, chestnuts, or papayas?
-Have you ever had a reaction after blowing up a balloon?
28
Asthma
1. What is Asthma?
-An inflammatory disease of the lungs (tracheobronchiole tubes) characterized
by reversible inflammation and narrowing of the airway
2. What could precipitate an asthma attack?
-Allergies, drugs, pregnancy, mold, infection, cold air, exercise, smoking,
chemicals, GERD, stress, etc.
3. What is a common drug an asthmatic might be using?
-Bronchodilator ex. Albuterol
-Anti-inflammatory ex. Corticosteroid, Advair discus, NSAIDs, etc.
4. What oral findings may you see with this medication?
-Enamel erosion, extrinsic tooth stain, candiasis and xerostomia
5. What should you instruct the patient to bring with them every appointment in
case of an attack?
-Their bronchodilator and put it on the counter
6. Why might a patient have an attack in a dental chair?
-If they rush to the appointment and are exerted, stress, anxiety about the
appointment, allergies, etc.
7. What should you instruct your patient to be doing after using a bronchodilator?
-To rinse their mouth with water
8. What are things to avoid giving an asthmatic patient?
-Avoid giving aspirin, no erythromycin if taking theophylline
29
Bronchitis
1. What is the difference between acute and chronic Bronchitis?
-Acute is caused by a recent infection and is resolved
-Chronic is caused by smoking and cystic fibrosis and is a long term disorder
2. What is the difference between Emphysema and Chronic Bronchitis?
-Emphysema: inflammation of alveoli
-Characteristics: barrel chest + dyspnea (labored breathing)
-Chronic Bronchitis: inflammation of bronchiole tubes causing mucous/sputum/
smokers cough
30
Emphysema
1. What is Emphysema a form of?
-COPD (Chronic Obstructive Pulmonary Disorder)
2. What is the most common cause of Emphysema?
-Smoking
3. What treatment modifications do you need to make for a patient with
Emphysema?
-The patient may not be able to be fully reclined therefore they may need to be
kept in a semi-upright or upright position during treatment. The use of anything
that can produce aerosols should be avoided (polishing, ultrasonic) depending on
the severity of the disease
4. What two things must you have to be diagnosed with COPD?
-Chronic bronchitis and Emphysema
5. How is COPD managed?
-inhaler, Advair, Cymbiort, Flovent, oxygen, prednisone
- With COPD, avoid administering local epinephrine and bilateral mandibular blocks
31
Pneumonia
-Pneumonia is fluid in the lungs causing inflammation of the lungs and shortness of breath
32
Sinus trouble
1. Why do we need to know about sinus trouble?
| - The patient may complain about pain in their maxillary molars
33
Syncope
1. What should you do if a patient is experiencing syncope?
-Put the patient in a supine position, clear their airway, administer oxygen, and
monitor vitals, use ammonia inhalants /smelling salts under the nose to wake
2. What should you do after the patient has recovered from syncope?
-Postpone treatment and do not dismiss until vitals have returned to normal
34
Convulsions/Seizures/Epilepsy
If the patient has a cerebral shunt, the physician needs to be consulted.
1. What is a seizure?
-A brain disorder in which there is a sudden discharge of electrical energy to the
brain caused by an imbalance among the neurons.
2. What is tonic clonic?
-Tonic clonic are the convulsions of a seizure
-Tonic is the contractions of the muscles
-Clonic is the relaxation of muscles
3. What may a patient experience before having a seizure?
-An aura
4. How do you manage this emergency?
-DO NOT move the patient during a seizure – keep in supine position
-Push everything away from the patient, clear their airway, do not place
anything in their mouth, TIME THE SEIZURE
-If the seizure lasts more than 5 minutes EMS should be contacted
-Let the patient rest after they wake and call someone to pick them up
-DO NOT let them drive home themselves
5. What is the seizure termed if it is lasting more than 5 minutes?
-Status epilepticus – can be life threatening!
6. What is a common medication that is used to help treat Epilepsy?
-Dilantin
-Phenytoin
-Other medications: phenobarbital and depacote
7. What is an oral manifestation of these medications?
-Gingival hyperplasia
8. What are the 3 stages of a seizure?
-Prodromal / convulsive / recovery phase
36
Hemophilia
1. What is Hemophilia?
- A blood disorder in which there is a tendency of hemorrhage (uncontrolled
bleeding) caused by not being able to clot
2. What factors are associated with Hemophilia A and Hemophilia B?
- Hemophilia A = factor VIII
- Hemophilia B = factor IX
3. Do we need to consult with the patient’s physician? Why?
- YES! = need the patient’s INR
4. What is INR?
- international normalized ratio is a calculation based on results of a PT and is used to monitor individuals who are being treated with the blood-thinning medication.
- INR should be 0.8-1.1
- PT should be 11-13 seconds
36
Anemia
Additional Follow Up Questions:
-Does the patient take iron supplements?
Competency Questions:
1. What is Anemia?
-When there is not enough Iron in the blood
2. What may Anemic patients take?
-Iron supplements
37
Delayed blood clotting
1. Do we need to consult with the patient’s physician? Why?
- YES! = need the patient’s INR
2. What is INR?
- International Normalized Ratio = records the time it takes for a patient to clot and should be between 2.0-3.0
38
Mononucleosis
1. What virus causes Mononucleosis?
- Epstein-Barr Virus
2. What are the most common and distinct symptoms of Mononucleosis?
- Swollen spleen and lymphadenopathy (swollen lymph nodes)
39
Abnormal blood count
When did the patient experience abnormal blood count?
Was it the result of a disease?
How often do they have their blood count checked?
What were their most recent lab results?
40
Leukemia
-Patient’s physician should be consulted regarding medical clearance.
Competency Questions:
1. What is Leukemia?
-Cancer of the bone marrow and blood from abnormal white blood cells
-Characterized by myelosuppresion (bone marrow suppression) and will be at an increased risk for bleeding
41
Cancer
Patient’s physician needs to be consulted if currently undergoing treatment.
If the patient has a catheter or port, then the patient’s physician needs to be
consulted regarding the need for premedication.
Prior to cancer treatment, the patient must visit the dentist to reduce infection
(14 days prior OR 21 days after)
Competency Questions:
1. What is the difference between radiation and chemotherapy?
-Radiation is therapy using x-rays, gamma rays, or charged particles
-Chemotherapy is drug therapy in the form of liquid IV, pills, shots, etc.
-Radiation can also cause osteoradionecrosis and trismus
2. What organ or gland does head and neck radiation effect and what can it cause?
-It can affect the parotid gland and can cause radiation caries and xerostomia
3. What could you recommend to cancer patient for oral hygiene / comfort?
-custom fluoride trays
-suggest drinking water
-Magic mix (kaopectate + benydryl + anesthetic) – used to treat mucositis from
radiation
4. What are the intraoral findings that you may see from radiation therapy?
-Candiasis
-Mucositis
-xerostomia
-dysgeusia (altered taste)
-Infection (general)
-Osteoradionecrosis
-Trismus: difficulty opening and closing the mouth
-Radiation caries – around cervical 1/3 of tooth
42
Tumor or growth
When did the patient have the tumor/growth?
| When did the patient have treatment?
43
Liver disease or jaundice
Is the liver disease a result of another disease or condition? (Hepatitis or Alcoholism)
44
Kidney problems
Patient’s physician should be consulted regarding the need for medical
clearance and the need for premedication.
If the patient has an indwelling catheter or port, blood pressure should be taken
on the opposite arm as the blood pressure cuff (when inflated) can cause the
catheter/port to collapse.
Competency Questions:
1. What are the functions of the kidneys?
-maintain fluid balance + excrete waste
2. If someone is on hemodialysis, what anticoagulant might they have during
treatment?
-Heparin
3. Can you treat someone who had hemodialysis the same day as an
appointment?
-No
4. Do you need to get medical clearance if someone is currently on hemodialysis?
-YES! = possible need of antibiotic premedication if they have a shunt or are
immunocompromised
5. What is the difference between hemodialysis and peritoneal dialysis?
-hemodialysis: get arteriovenous fistula inserted into arm
-Treatment: 3x weekly for 4hrs to filter blood
-will need medical clearance for port
-Takes Heparin (blood thinner); stays in blood for 3-6 hours so this is why
you can treat the patient the day after dialysis
-peritoneal dialysis: for acute failure
-Will have a catheter in abdomen – with more frequent sessions of
dialysis
-can treat this patient the day after dialysis
-may be on cyclosporine or prednison
45
Arthritis or rheumatism
1. What is arthritis?
-Arthritis is inflammation of the joints
2. What is the difference between rheumatoid arthritis and osteoarthritis?
-Rheumatoid arthritis: inflammation of the smaller joints (ex: fingers)
-Osteoarthritis: inflammation of weight bearing joints (ex: knees)
3. What is Gout and who does it mainly effect?
-A form of arthritis resulting from elevated uric acids in the blood and
deposition of crystals in joints (mainly in big toe)
-Most effects elderly men
4. What can you recommend to the patient with rheumatoid arthritis?
-Patient may have a hard time brushing so enlarge the handle
5. How is arthritis managed?
-Anti-inflammatory (NSAIDs) and corticosteroids
6. What is Lupus?
-inflammation of connective tissue
-Characteristic sing: butterfly rash on their face
46
Diabetes
If the patient doesn’t know their HbA1c and FPG readings, then the patient’s
physician needs to be consulted.
If the patient has uncontrolled diabetes, then the patient’s physician needs to
consulted.
In medical emergency, give glucose – NEVER administer insulin in case they are
having hypoglycemic reaction
Competency Questions:
1. What are the types of Diabetes?
-Type I = Juvenile Diabetes, no insulin is being produced, onset when child
-insulin dependent
-Type II = the body is producing insulin but doesn’t know how to use it,
obesity
-insulin resistant
-Type III = Gestational, during pregnancy
2. What readings do we need from the patient?
DIABETIC READING:
-FPG reading = over 126
TREATABLE READING:
-FPG = must be below 160 or need medical clearance
-HbA1c = should be less than 7
4. What are signs and symptoms of hyperglycemia?
-Polyuria (increased urination)
-Polydipsia (increased thirst)
-Polyphagia (increased hunger)
-Fruity mouth odor
5. When is the best time to schedule a diabetic patient?
-In the morning after the patient has eaten
6. Which test (HbA1c – FPG) is administered at home and which is completed in
the doctor’s office?
-HbA1c – doctor’s office (*more accurate*)
-FPG – at home test
7. What does HbA1C mean?
-Glycated hemoglobin assay
8. Where is insulin produced? Why do we care about it?
-In pancreases – beta cells of islets of Langerhans
-It controls the transport of glucose into the cells
9. Side effects of diabetics?
-infection (periodontal disease)
-neuropathy (loose sense of feeling in nerve endings
10. Examples of diabetic medications?
-insulin, Metformin, Orinase, Avandia
47
Chemical dependency
1. If someone has used Cocaine in the last 24 hours, what can you NOT administer?
- Local Anesthetics
2. If a patient was or is dependent on alcohol, what treatment modification would you need to make?
- Not using alcoholic mouth rinse for preprocedural mouth rinse
3. What will a patient’s pupils look like if they had taken heroin?
- Dilated – important to know so you don’t prescribe narcotics to these patients
4. What will a patient’s pupils look like if they had taken cocaine?
- Pinpoint – important to know so you don’t prescribe narcotics to these patients
48
Artificial implant
Patient’s physician needs to be consulted regarding the need for antibiotic
premedication.
Competency Questions:
1. How do we explain to a patient why we need medical clearance for artificial
implants?
-When we work in the mouth, it is common for there to be bleeding. The
bacteria in the mouth gets disrupted and can get into the blood stream causing
bacteremia. Bacteria like to harbor around artificial implants, shunts, screw,
pins, etc. So we need to contact your physician regarding if there is a need for
antibiotic premedication as a precautionary measure.
49
Digestive disorders
1. What is a common Digestive Disorder?
- GERD (Gastroesophageal reflux disease)
2. What is it?
- When the esophageal sphincter does not close properly and acid from the stomach rises into the esophagus and mouth
3. What is a common oral side effect of acid reflux/GERD?
- Erosion on the lingual of the anterior teeth
50
History of surgery
What type of surgery?
| When was their surgery?
51
Blood transfusion
1. What are patients at risk of having if they had a blood transfusion?
- Hepatisis C
52
History of radiation therapy
1. What can radiation therapy cause?
-Thrush, dysgeusia (altered taste), xerostomia, mucositis, fungal
infections, caries, infection, osteoradionecrosis and trismu
53
Occupational exposure to radiation
How long did the patient work with radiation?
| Did the patient wear a monitoring badge?
54
Smoke/use of tobacco
1. What are common oral manifestations of chronic smoking?
-Caries, extrinsic stain, nicotine stomatitis, halitosis (bad breath), tooth loss,
periodontal disease (know why smoking can effect periodontal disease) and
cancer
55
Pregnancy
1. When is the safest time to treat during pregnancy?
-During the second trimester – but would be for elective treatment
2. What oral manifestations are associated with pregnancy?
-Pyogenic granuloma from hormonal changes and pregnancy gingivitis
3. What do you do when the pregnant patient becomes light headed when
being treated in a supine position?
-Adjust the chair to be in a semi-supine position and instruct the patient
to lay on her left side so that the pressure of the baby is relieved off the
heart (mainly the vena cava)
56
Marked weight change
1. What is a condition on the medical history that marked weight change is
indicative of?
-Thyroid disorder, uncontrolled diabetes, heart failure, eating disorder, etc
57
Psychiatric Care
1. What is a common oral side effect of antidepressants?
- Xerostomia and bruxism
2. What are different types of psych disorders?
- Bipolar, schizophrenia, depression, anxiety, anorexia/bulimia
58
Thyroid disorder
1. What are the two types of thyroid disorders?
-Hyper- and Hypothyroidism
2. Describe each type and the signs associated with them?
-Hyperthyroidism is when the thyroid is overactive, a form of hyperthyroidism is
graves disease; can cause a goiter and the patient would be very alert,
overactive, and skinny
-Hypothyroidism is when the thyroid is underproductive, a form of
hypothyroidism is hashimoto’s disease, and the patient is very tired and can be
overweight with swelling in the joints
3. What hormone is associated with the thyroid?
-Thyroxine
4. What does the thyroid secrete? (3 things specifically)
-Calcitonin + T3 + T4
5. What element is needed for the production of the thyroid hormone?
-Iodine
6. Can the body make this element? Where do we get it?
-No we get it from our diet mainly in salt
7. What is the term for bulging eyes?
-exophthalmic
8. How is hyper and hypothyroidism treated?
-hyperthyroidism: radioactive iodine, beta blockers, anti-thyroid medication or removal
-hypothyroidism: synthroid and levothyoid
9. What does the thyroid do?
-regulates metabolism
59
Dialysis
1. What are two types of Dialysis?
- Hemodialysis and Pertinealdialysis
2. Do you need medical clearance for a patient on dialysis? Why or why not?
- YES.
- There may be a port in their arm for IV, which will need premedication OR they may have taken an anticoagulant
60
Osteoporosis
1. Who is more at risk for Osteoporosis?
-Women, underweight individuals, someone with calcium deficiency, Asians,
hormones can affect the risk of having this and menopaus
61
Anorexia
1. What are two intraoral findings you will notice on a patient with an eating disorder?
- xerostomia
62
Anxiety disorder
What some things that can cause a patient to have anxiety disorder?
- PTSD
- Bipolar
- Depression
63
Ischemic heart disease
1. What causes Ischemic heart disease?
- Not enough oxygen to the heart
2. What are 3 things that Ischemic heart disease can cause?
- Angina pectoris
- Arteriosclerosis
- Atherosclerosis
64
Antibiotic Prophylaxis
1. What would cause a patient to have to take premeds?
-Infective endocarditis
-Implants/prosthesis
-Cyanotic congenital heart defects
-Cardiac transplant
2. What happens if you find out that your patient did not take their premedication
prior to the appointment?
-There is a 2 hour window for this patient to take this medication after their
appointment
3. How long should a patient that requires premedication wait in between dental
appointments?
-9-14 days so that they do not build a resistance to the premedication
4. How long does the premedication last in the patient’s system?
-6 hours - *so you cannot treat them all day*
65
Tetralogy of Fallot
1. What is Tetralogy of Fallot?
- A cyanotic heart condition with a 4 part defect
2. What are the 4 defects caused by this disorder?
- ventricular septal defect, pulmonary stenosis (narrowing), right ventricular hypertrophy (enlargement) and malposition of the aorta
66
What is the medical term for throwing up?
Perymolosis
67
What does the pancreas secrete?
Insulin
68
What does the adrenal gland secrete?
Epinephrine, adrenalin, glucorticoids (cortisone)
69
What is the difference between a coinfection and a superinfection?
Coinfection: an injection that happens from another infection
Superinfection: an infection that occurs following an earlier infection due to
treatment
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anticoagulant
Examples: Plavix, Aspirin, Pradaxa, Warfarin (Coumadin), Heparin
Competency Questions:
1. What is it?
-Blood thinner that extends the time it takes for blood to clot
2. List some examples.
-Plavix, Aspirin, Coumadin, Heparin, Pradaxa
3. What might be a reason a patient is taking an anticoagulant?
-Heat attack prevention
4. What is our concern?
-Excessive or uncontrolled bleeding
5. What do you need from their physician?
-Need to get the INR or Pro-thrombin time
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nitroglycerine
1. What is it used for?
- To help relieve the symptoms of Angina Pectoris
2. How is it administered?
- Sublingually, one dose every 5 minutes up to 3 doses (15 minutes)
3. Where should it be during all appointments?
- On the counter
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Digitalis
1. What is it used to treat?
-Congestive Heart Failure – it will make the heart pump blood efficiently
-With congestive heart failure, it causes peripheral edema, poor venus return,
ascites (abdominal swelling), cyanosis and clubbed fingers
-position them semi-supine while treating a patient with congestive heart
failure
2. What is a common side effect that affects us as dental hygienists?
-Exaggerated gag reflux
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Anti hypertension
1. What are they used to treat?
- High Blood Pressure
2. List some examples.
- Metoprolol, Lasix, Atenolol, Diovan, Lotrel, Lisinopril, Captopril
3. What are the four classes?
- Angiotensin II receptor blockers (ex: Lisinopril)
- Beta-blockers (ex: propranolol)
- Calcium Channel Blockers (ex: Norvask, Procardia)
- Diuretics (ex: Lasix)
4. Which class can cause gingival hyperplasia?
- Calcium Channel Blocker
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Dilantin
1. What kind of medication is it?
- Antiseizure
2. What disorder does it help treat?
- Epilepsy
3. What is a common oral side effect?
- Gingival Hyperplasia
4. What is another antiseizure medication?
- Dioxan
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sulfa drugs
1. What are they used for?
-Treating urinary tract infections
2. What are examples?
Bactrim, Septra
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Chemotherapy drugs
general follow up questions
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insulin
1. What is it used to help manage?
- Diabetes Type I
2. What kinds of insulin are available?
- Oral pills, pump, or injection through a syringe
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Penicillin
1. What kind of medication is it?
- Antibiotic
2. What if someone is allergic to Penicillin and needs antibiotic premedication?
- A drug from a different class such as Clindamycin 600 mg
3. What STD can it help treat?
- Syphilis - *ONLY treated with Penicillin G*
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Antidepressants
1. What is the most common oral side effects of antidepressants?
- Bruxism and xerostomia
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Barbituates, sedative, sleeping pills
1. List some examples.
| - Ambien, Xanax, Lunesta
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Codeine
1. What kind of drug is it?
| - Pain killer
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Cortisone
1. What kind of drug is it?
-Anti-inflammatory
2. What is the concern when a patient is taking systemic steroids?
-Their immune response may be compromised
3. What is the 2:2:2 Rule?
-If the patient has taken 2 grams of corticosteroids for 2 weeks within a 2 year
period, the immune system can be compromised. This is only a concern for
surgical procedures.
4. Why do we need to worry about the 2 week rule?
-If a patient was taking corticosteroids for 2+ weeks, it can affect the adrenal
gland and the amount of steroids it naturally produces; which may require the
patient to take an additional supplement
5. If someone gets a cortisone shot, would the 2 week apply?
-No, because it is localized and is not systemic
6. What gland can make cortisone?
-Adrenal gland
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aspirin
1. What are the 4 A’s?
- Analgesic (anti-pain)
- Anti-Inflammatory
- Anti-pyretic
- Anti-coagulant
2. How many mg in a regular aspirin?
- 325 mg
3. How many mg is a baby aspirin?
- 81 mg
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anti-inflammatory
1. List some examples.
- Aspirin, Ibuprofen, Advil, Motrin, Aleve
2. What conditions would you need to take anti-inflammatory daily?
- Arthritis
- Asthma
- Crohn’s
- COPD
- Bronchitis
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oral contraceptives
1. What is our concern about oral contraceptives?
-Antibiotics can interfere with oral contraceptives and the patient should be
advised to use additional methods of birth control
2. What is a common side effect of oral contraceptives?
-Hypertension
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vitamins/supplements
1. What can be a side effect of vitamins?
| - Delayed Blood Clotting
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antihistamines
1. List examples of antihistamines.
| - Benadryl, Claritin, Zyrtec
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local anesthetics
1. What drug, if used in the past 24 hours, do we not administer local anesthetics?
- Cocaine
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bisphonates
1. What are bisphosphonates used to help treat?
- Osteoporosis
2. List some examples.
-Fosamax, Boniva, Actonel, Reclast
3. What are we concerned about?
-Osteonecrosis of the jaw
4. Why does bisphosphonates cause osteonecrosis of the jaw?
-The osteoblasts are increased (not as much osteoclasts). If there is an
extractions, there is overgrowth of the bone.
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Fen-Phen/ Redux
1. Is this drug still on the market?
- NO
2. Why is it not on the market anymore?
- Causes complications with the heart such as pulmonary hypertension
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What medications cause gingival hyperplasia
o Anti-seizure: Dilantin (also called phenytoin)
o Calcium channel blockers: Norvask, Procardia
Used to control blood pressure
o Cyclosporine
Used as an immunosuppressant
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HIPPA
- Health Insurance Portability and Accountability Act
- national standarized privacy protextion act
- confidentiality
- protection against electronic transferring of information
- right to obtain copies
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Comprehensive care
- right to all services at clinic
| - right to deny any treatment
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Learning institution form
- UNH clinic is a learning institution
| - I am a SDH under a licensed RDH
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What is the standard regimen for antibiotic premedication? What if they are
allergic?
-Amoxicillin 2g 30-60 minutes prior to treatment
-If allergic then should be prescribed a drug from a difference class such as
Clindamycin 600mg
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List 4 reasons why a patient might need premedication? *AHA Guidelines*
- Prosthesis (prosthetic valve/implant)
- Cyanotic congenital heart defect (EX: Tetralogy of Fallot)
- Infective Endocarditis (previous or current)
- Cardiac transplant
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How long do you need to wait in-between appointments for a patient who
needs antibiotic premedication? Why?
Ten days to avoid antibiotic resistance
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How long does the premedication last? Can your patient that needs premed be
scheduled for an all-day appointment?
6 hours
| no, they cannot stay all day
