Medicine/Anesthesia Flashcards
2% lidcaine with 1:100k epi
Limiting amount for lidocaine?
Limiting amount for epi?
Which of the two is the limiting factor for a 130 lb patient?
Max # of cartridge’s?
Lido: 3.3 mg/lb (7 mg/kg)
Epi: 0.2 mg
For 140 lb pt, 12 cartridge lido and 11 cartridge epi, so limiting factor is epinephrine (11 cartridge).
What are symptoms of local anesthesia systemic toxicity? (10)
Tinnitus, metallic taste, circumoral numbness, altered mental status, slurred speech, hypotension, bradycardia, seizures, ventricular arrhythmias, and cardiac arrest
How should you manage local anaesthetic systemic toxicity?
- Activate EMS
- Ensure adequate oxygenation
- If IV established (can treat cardiac aspects, seizures, bradycardia,
- Partoid, submand, and sublingual glands contribute what percent of saliva?
- Normal daily production?
- Which gland contributors to resting (unstimulated) saliva?
- Which gland contributes to stimulated?
- What gland contributes to both (but at low rates)?
- 90%
- 0.5 and 1.5 liters
- Submandibular
- Parotid gland
- Sublingual
- Parotid: Produces mainly serous or mucous, nerve?
- Submandibular
- Sublingual
- Parotid: Serous (via Stenton’s duct) - watery, enzyme-rich, and contains amylase. Lacks mucous acini. Glossopharyngeal (IX)
- Submandibular: Mixed (mostly serous, some mucous) - Contains amylase, mucins, lysozyme (Facial (VII))
- Sublingual: Mixed (mostly mucous, some serous) - thick due to mucins. (Facial (VII))
Which systemtic diseases lead to systemic salivary gland hypofunction / xerostomia?
Sjogren syndrome, rheumatoid arthritis, systemic lupus erythematosus, and head & neck cancer therapy
- Lidocaine is what type of anesthetic?
- What’s the mechanism of action?
- What’s an example of the alternate type of anesthetic used in dental?
- What’s difference between lidocaine and articaine? (Hint: what “ring” does articaine have)
- Amide (not ester)
- Blocks nerve signals that send pain to the brain
a. Binds to sodium channels
b. Prevents sodium flow
c. Turns off nerves - Ester (benzocaine)
- Articaine has faster onset and a thiophrine ring that can penetrate tissue and bone better
What are examples of abrasives in toothpaste? (5)
- Calcium carbonate
- Calcium phosphate dihydrate
- Alumina
- Silica
- Sodium bicarbonate
Exposed root-surface cementum and dentin are abraded at rates __ and __ times the rate of enamel?
35 and 25, respectively
25% Aluminum chloride mechanism of action?
Does it interfere with PVS or bonding?
Vasoconstriction and coagulation of proteins, leading to hemostasis
No does not
Ferric sulfate mechanism of action?
Does it interfere with VPS or bonding? How?
Reacts with blood proteins to form ferric ion-protein complex
Yes, interferes with bonding and VPS. The ferric ions can inhibit polymerization
HPV is a strong marker for what kind of carcinoma?
Lymph nodes. HPV is a strong marker for adenocarcinomas
Esophageal adenocarcinoma (EAC) is one of the fastest growing cancers in the western world. EAC has been associated with high-risk human papillomavirus and has been shown to grant a positive prognosis in EAC. In some human papillomavirus (HPV) driven malignancies (e.g., cervical and head and neck tumors), associated lymph nodes with a high viral load suggest metastatic lymph node involvement. Therefore, HPV is a potential marker of micro-metastases. This review highlights the importance of investigating HPV in lymph node metastasis of EAC based on data derived from other HPV driven malignancies.
Significant percentages for Eagle’s Syndrome
4% general population
4-10% symptomatic
50% bilateral, but just unilateral symptoms
80% have relief of symptoms after styloidectomy
What does the carotid artery calcification indicate the patient is at higher risk of?
Does the Swedish article recommend Pano as a screening tool?
Did the Swedish article say that panoramic are important for CVD?
Some say it is a marker of atherosclerosis - risk of Stroke or MI. The presence of the calcification places her “at risk” of CVD per the American Heart Association.
No, negative finding does not indicate vascular health. Some plaques are not calcified or may be below pano field.
Yes, there is high specificity (90%) of CAC in PR when compared to ultrasound.
How is the physician treating your patient’s carotid artery calcification?
Due to the patient’s relatively low risk, the patient’s labs are being actively monitored year to year. Her lipid levels and blood pressure are of particular attention. She has regular exercise, a low BMI, blood pressure within normal limits, does not smoke, eats healthily, no sleep apnea or reported depression, no family history, and has low diabetes risk, so she does not need to make many lifestyle changes. More so, this has changed how she approaches her annual medical appointments.
She has not begun menopause yet, but the hormonal changes associated can result in inflammation, worse cholesterol, and higher blood pressure.
CVD is leading cause of death in women (20%), only 56% of women are aware of that. Women are typically diagnosed ten years later than men.
How does aspirin play into MI and stroke prevention?
It inhibits platelet synthesis of thromboxane A2.
How do statins play into MI and stroke prevention?
It lowers LDL cholesterol levels. Below 100 mg/dl is recommended (70 mg/dl for high risk).
HMG-CoA reductase inhibitors
On the panoramic, what anatomy contains the calcification?
Bifurcation of carotid artery into internal and external carotid. Near region of C3/C4 vertebrae.
What did U Tennessee 2024 paper conclude about Carotid artery calcification and certain risk factors?
Significant correlation between CAC and hypertension, hyperlipidemia, cerebrovascular accident, coronary artery disease, DMFT
What did Rula (UMD)’s review on calcified head-and-neck atheroma conclude that subjects with combined atheroma lesions are at higher risk for disease-wise? (3)
What percent of CBCT’s reviewed had a calcified atheroma?
Higher in males/females? Young/old?
Higher risk for cardiovascular disease, hyperlipediemia, hypertension
30% of CBCT’s presented.
Higher in males and older.
Five most common Antibiotics
Can you list them all with their MOA?
- Amoxicillin (inhibits cell wall synthesis)
- Amox w/ Clavulanate (beta-lactamase inhibitor (augmentin) - Broad spectrum
- Clindamycin (targets anaerobic bacteria, inhibits protein synthesis) - risk of c. Dif diarrhea
- Metronidazole (targets anaerobic bacteria, disrupts DNA)
- Azithromycin/Clarithromycin (inhibits bacteria protein synthesis)
What are common doses for Amox, Amox + clavulanate, clindamycin, metronidazole, and azithromycin?
- 500 mg every 8 hours or 2 g loading dose (2 to 7 days)
- 500 mg every 8 hours
- Clinda: 150-450 mg every 6-8
- Metronidazole - 500 mg every 8 hours (often combined w/ amex)
- Azithro: 500 mg first day, then 250 daily for four more days
How is GERD managed by your patient?
She avoid tomatoes, citrus, and fried foods.
Her physician does not have her take any daily proton pump inhibitors or histamine blockers
What are typical symptoms of GERD?
What lifestyle habits factor into GERD?
What diagnostic tests (if necessary) can be performed?
Presence of typical symptoms (heartburn, pain in chest, difficulty swallowing, chronic cough, sensation of a lump in throat, hoarseness)
Diet, smoking, weight gain, alcohol consumption factor into it
Dx Tests:
1. Upper endoscopy
2. Ambulatory (BRAVO) 24 hr PH probe test
3. Barium swallow
4. Esophageal manometry
How does estradiol affect the skin?
Estradiol can stimulate melanocyte activity and blood vessel dilation. In general, any fluctuations in estrogen can contribute to acne or other temporary conditions.
How many forms of estrogen are there?
What is the most potent and abundant form of estrogen during a woman’s reproductive years?
What is the goal of hormone therapy (prescribed estrogen)?
- Estrone (E1), Estradiol (E2), and Estriol (E3)
- Most potent/abundant: Estradiol (E2). It plays a vital role in menstrual cycle, development of female secondary sexual characteristics, bone health, and other bodily functions.
- Goal is to alleviate menopausal symptoms and improve quality of life.
How does chronic alcoholism affect dental treatment?
- Risk of oral cancer
- Xerostomia
- Drinks can be high in sugar and lead to caries
- Tooth erosion if acidic
Increased risk of head and neck cancer associated with what virus?
Which cancer?
HPV 16
Oral squamous cell (94% of oral cancers)
Warning signs of Oral Cancer (12)
- an ulceration in the mouth that does not heal (most common symptom)
- an area of leukoplakia (white in color) or erythoplakia (red in color) on the gingiva, tongue, tonsil, or oral mucosa that persists
- a lump or thickening in the cheek
- a sore throat or globus sensation (feeling that something is caught in the throat)
- difficulty chewing with or without dysphagia
- increasing trismus and or decreasing tongue mobility
- sensory changes in the tongue or other oral structures
- swelling of edentulous areas that cause dentures to fit poorly or become uncomfortable
- increasing tooth mobility or pain associated with the teeth or jaw
- voice changes
- a lump or mass in the neck
- weight loss
Seven factors of a thoroughly made oral cancer screening
- palpate the lymph nodes in the neck and under the mandible
- visually inspect and palpate the cheeks and lips
- visually inspect the gingival tissues
- pull the tongue forward to evaluate the posterior dorsal and ventral surfaces
- visually inspect and palpate the palate
- visually inspect the tonsillar and oropharyngeal areas
- visually inspect and palpate the floor of the mouth
