Medically Complex patients Flashcards
Q268 : What causes migraine?
Etiology is unknown. A neurovascular hypothesis is that vasodilatation of cephalic and cerebral arteries causes activation of sensitized perivascular nociceptors. Genetic factors are involved.
Q269 : List patients who are at risk of developing infective endocarditis (IE) following a dental procedure?
According to the 2017 AHA/ACC updated guidelines for management of patients with valvular heart disease, prophylactic antibiotics should be considered before dental procedures that involved manipulation of gingival, periapical regions of teeth or perforation of the oral mucosa in patients with:
1-Prosthetic cardiac valves including transcatheter implanted protheses and homografts
2-Prosthetic material used for cardiac valve repair such as annuloplasty rings and chords
3-Previous IE
4-Unrepaired cyanotic congenital heart disease or repaired congenital heart disease, with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or prosthetic device.
5-Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
Q270 : what is the estimated risk of osteonecrosis of the jaw (ONJ) following surgical procedures in patient receiving an oral or IV bisphosphonates (BPs)?
According to the American Association of Oral and Maxillofacial Surgeons position paper on medication related osteonecrosis of the jaw, the estimate for the risk of bisphosphonate related osteonecrosis of the jaw (BRONJ) among patients exposed to oral BPs following tooth extraction is 0.5%. Exposure to IV BPs can increase the risk from 1.6-14.8%. The prevalence of BRONJ following surgical procedure can be directly related in the duration of which BPs were administered.
Q271 : What is the HAART protocol for AIDS treatment?
HAART stand for «Highly active antiretroviral therapy». It refers to a broad category of treatment regimens usually comprised of three or more antiretroviral drugs that are expected to reduce plasma virus levels below the limits of detection in previously untreated HIV infected patients.
Q272 : what types of pain medication and antibiotics that should not be prescribed to a patient with liver disease?
1-Anagesics:
1) Aspirin
2) Acetaminophen (Tylenol, Datril)
3) Codeine
2-Antibiotics :
1)Tetracycline
2)Metronidazole
3)Vancomycin
Q273 : What is Sickle cell anemia (SCA), How does it affect the pulp?
SCA is a genetic and systemic disease which may cause pulp necrosis without necessarily having an identifiable etiology (Kaya et al 2004). SCA causes radiographically observable differences in jaw structure, especially in the mandible. The clinical problem is directly associated with the defective RBC (red blood cells). The patients are prone to infection because the macrophages are involved in the phagocytosis of the RBC and not available for destroying bacteria. The distorted cells may also occlude the microvasculature and impede blood flow to an area. Costa et al 2013 showed almost 8 times higher incidence of pulp necrosis with SCA patients.
Q274 : Describe the cause, sign and management of Pseudomembranous Colitis?
Pseudomembranous Colitis is the overgrowth of clostridium difficile. This overgrowth results from the loss of competitive anaerobic gut bacteria, most using broad-spectrum antibiotics, such as clindamycin, but it can also result from heavy metal intoxication, sepsis, and organ failure. Management :
- Discontinue antimicrobial agent (in mild cases this may resolve).
- Treatment with antibiotics that can target this infection such as oral metronidazole (500mg q6h for 7-10 days) or Vancomycin.
- Pseudomembranous colitis recurs in as many as 20% of people who have been treated.
Q275 : What is the characteristic presentation of patients with vitamin D deficiency (Rickets)?
Clinically:
1)Frontal bossing
2)Bowing of legs
3)Short enlarged wrists and ankles
Dentally:
1)Hypoplastic/hypocalcified enamel
2)Gingival swelling
3)Radiographic enlargement of the pulp chambers with wide root canals, short roots and loss of lamina dura.
Q276 : How to manage an angina attack in the dental office?
a) Call 911
b ) Administer nitroglycerin tablets sublingual (0.4 mg tablet) or spray. If pain is not relieved 10 minutes after the initial dose, repeat nitroglycerin
c) Administration of oxygen
d) Monitor vital signs. In a conscious patient, chest pain lasting more than 10 minutes must be assumed to be due to unstable angina or myocardial infarct. If at any time the patient becomes unresponsive, no normal breathing, and no palpable pulse consider the diagnosis of cardiac arrest and immediate start CPR.
Q277 : How can endodontic treatment be affected by diabetes?
Diabetic patients are generally more prone to infection. (Fouad and Burleson 2003) suggested that patients with diabetes who are treated endodontically should be assessed carefully and be treated with effective antimicrobial root canal regimens, particularly in cases with preoperative lesions as they have more prone to develop flare ups and have a reduced success rate. It should be noted, however that the diabetic status of these patients (controlled or uncontrolled) was not assessed in this study. In a one-year outcome study by (Arya et al 2017) showed that diabetic patients with HBA1c level > 6,5% had higher PAI scores compared to non-diabetic patients suggesting that diabetes may have negative impact on periapical healing. Possibility of later healing should be considered in these cases. It has been showed by (Azim et al 2016), that healing may be delayed in patient with medical conditions that affects the immune system, such as diabetes. In a systematic review by (Tiburcio-Machado et al 2017) they showed that there was a trend among the published studies to converge on a positive association between diabetes and a larger number of periapical lesions. However, the literature to date is still scarce and incipient, and the evidence for such an association is not yet conductive.
Q278 : What is the mechanism of action of tramadol?
μ-opioid agonist and serotonin and nor-adrenaline reuptake inhibitor.
Q279: Which antibiotics are safe to prescribed to pregnant patient?
Penicillin and clindamycin are generally safe. Avoid tetracycline.
Q280 : what are the characteristics of hyperparathyroidism?
Primary-caused by adenoma (80%), carcinoma of the parathyroid or PTH release from ectopic malignant tumor. Treatment–surgical removal of parathyroid.
Secondary–caused by chronic kidney disease, Vit D deficiency, calcium malabsorption states (Ca, phosphate, K). Treatment–renal dialysis or transplant.
Classic signs:
-Ectopic calcifications
–kidney stones
-Bone lesions
-Lytic lesions (brown tumors=central giant cell granuloma)
-Ground glass appearance with decreased trabeculation
-Loss of lamina dura
-Vague abdominal pain, bone pain, fatigue, weakness
-Emotional liability, psychoses
Q281 : Describe the signs and symptoms of a thyroid crisis (Thyrotoxic crisis)? and how to manage?
Signs:
-Restlessness
-Tachycardia
-Tremor
-Sweating
-Coma and death
Management:
-Cool the patient with cool towels
-Give O2
-Inject hydrocortisone
-Monitor vital signs
-CPR if needed
Q282 : which of the following pain medicaments should be considered for female patients during their pregnancy? Acetaminophen (Tylenol), Aspirin, Ibuprofen (Advil Motrin),Tramadol
Acetaminophen (Tylenol) : BONNE REPONSE
Tylenol should be the pain medication of choice for pregnant patients as it has the lowest risk according to the ADA, over the entire pregnancy period. Ibuprofen can be considered but only during the first two trimesters.
