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Neurological and special senses dentally relevant questions Flashcards

1
Q

What anti-thrombotic medication is used?

A

Antiplatelet –> aspirin, clopidogrel, dipyramidamole
Antocoagulation –> wafarin
DOACs –> dabigatran, apixaban, rivaroxaban

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2
Q

What is the scale used to diagnose a stroke?

A

Rosier scale

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3
Q

What are the dental aspects to be aware of with a stroke?

A 
OH
Denture fitting problems 
Reduced airway protection, gag reflex 
Medications being taken 
Avoid adrenaline in LAs - hypertension risk
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4
Q

What are the 3 D’s of speech?

A

Dysarthia –> difficult articulating speech (slurred)
Dysphonia –> loss of voice (hoarse)
Dysphasia –> loss of cerebral language skills

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5
Q

What is the difference and parts of the brain that cause 1.receptive and 2.expressive/motor dysphasia?

A
  1. Patient can not comprehend - Wernike’s

2. Patient can not form words/sentences - Broca’s

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6
Q

What is the neurological assessment of ACVPU?

A

Rapid assessment:

  • Alert
  • Confusion (new onset)
  • Voice (response)
  • Pain (response)
  • Unresponsive
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7
Q

What is the Glasgow Coma Scale used for? and whats its scale?

A

Assess neuro condition - response with eye, response to verbal and pain
Scale from 3-15 (3 dead –> 15 fully alert)

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8
Q

What is conductive and sensory neural deafness?

A

Conductive –> air not transported through war (due to wax?)

Sensory neural –> mediated by CN VIII

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9
Q

What is the rinne test used for?

A

Can test conductive deafness when bone conduction is greater than air conduction with a vibrating tuning fork

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10
Q

What is the weber test used for and how does it work?

A

Tuning fork in the middle of the back of the head
Conductive deafness = sound same side as problem
Sensory neural deafness = sound from opposite side

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11
Q

What is Otitis externa?

A

Painful ear infection with serous discharge, can have swelling which can block ear canal

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12
Q

What is the treatment for otitis externa?

A

Gentamicin and steroid ear drops

If not working, might be fungal, therefore use anti-fungal

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13
Q

What is another name for Glue ear?

A

Otitis media

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14
Q

What is otitis media?

A

When the eustachian tube blocks (between middle ear and oropharynx) cause pain/pyrexia/hearing loss, usually from an ascending URTI, can become chronic infection with effusion

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15
Q

Why do ear infections need to be managed quickly?

A

Can track up to the brain or back to the mastoid

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16
Q

What is acoustic neuroma? and what symptoms can present?

A

Rare tumour of vestibulocochlear N

Unilateral deafness, facial palsy due to proximity to facial N

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17
Q

What dental pain can arise from earache?

A

TMD

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18
Q

How can glaucoma lead to optic N damage?

A

Increased intraocular pressure

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19
Q

How can a dentist identify temporal arteritis?

A

Patient complaining of headache and visual problems
Temporal A enlarged (especially unilateral)
MEDICAL EMERGENCY

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20
Q

What are the triad symptoms of Bechet’s disease?

A

Oral ulceration
Genital ulceration
Uveitis

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21
Q

What is the treatment of Bechet’s disease? And who should you not give this certain treatment to?

A

Immunosuppression, IV methylprednisolone, oral steroids, azathioprine, cyclosporin
Never give steroids if diabetic, osteoporosis, undiagnosed red eye

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22
Q

If patient has orbital cellulitis, what dental disease could this be caused by?

A

Could be due to sub periosteal abscess formed due to tooth infection

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23
Q

What is Ramsay hunt? What causes it? What tx?

A

Herpes zoster on the geniculate ganglion
Associated with nerve palsy and can not close eye properly
Treatment IV aciclovir

24
Q

What 5 tests can be used to test CN II?

A

Optic nerve

Visual acuity, pupillary reflexes, visual fields, colour vision, fundoscopy

25
What tests can be used to test CN V?
Sensory - sensation in all 3 divisions | Motor - open against resistance and jaw jerk
26
What tests can be used to test CN VII?
Motor of each branch - raise eyebrows, close eyes, puff nose Taste Schimer test - lacrimal test
27
What tests can be used to test CN IX and X?
``` Gag reflex Voice Cough Puff checks Swallow ```
28
What tests can be used to test CN XI?
Shoulder shrug - trapezius | Head turn - SCM
29
What can anti-convulsant medication treat?
Epilepsy Neuralgia Neuropathic pain
30
What is the difference between generalised 1.motor and 2.non-motor epilespy?
1. Body moves in own way with no control, tonic-clonic seizures (LOC, m. contract, jerk) 2. Stop and stare or repetitive movements (e.g. lip smacking)
31
What is the difference between generalised and focal epilepsy?
Generalised - affects both sides of the brain | Focal - develops in 1 side of the brain
32
What is focal epilepsy?
Aware of seizure, confused, emotional changes
33
What are some first line anti-convulsant drugs?
Phenytoin/carbamazepine --> block na and ca channels Na valporate Gabapetin and pregablin BZDs
34
What is status epilepticus? What is its best treatment?
Fits always happen, rapid firing of nerves, rapid movements | Best treatment = BZDs
35
What is MoA of anti-convulsants?
Inhibit rapid repetitive firing that characterises seizures by inhibiting ion channels or enhancing GABA mediated neurones Decrease neuro inflammation for pain Decrease central trigeminal activation
36
What drug is used to treat trigeminal neuralgia? and what doses are given
Carbamazepine 100-200mg 1/day Then can slowly increase to TDS, max 1600mg
37
What body interactions can occur with carbamazepine?
Steven-johnsons - rashes/ulcers Blood dyscrasis - decreased WBC therefore decreased immunity Liver disorder - bruising/ yellow skin
38
What is the general impact of anti-convulsant drugs on dental treatment?
Have haematological effects: anaemia, decreased WBCs, decreased platelets Therefore need to know if patient has normal blood tests
39
What is seen in patient on phenytoin, dentally?
Gingival overgrowth Root shortening/resorption Hypercementosis Can have teratogenic effect cleft lip and palate
40
What is seen in patient on carbamezapine, dentally?
Xerostomia Glossitis Oral ulceration Can have teratogenic effect cleft lip and palate
41
What is the pathology of parkinsons disease?
Loss of dopaminergic neurones of substania nigra Presence of Lewy bodies and neurites within neurones Therefore decreased dopamine and increased ACh
42
What are the effects of dopaminergic drugs on mouth and perioral structures?
``` Dry mouth Taste disturbance Stomatitis Oral ulceration Head ache Dyskinesias ```
43
When to treat a patient on dopaminergic medication?
When patient is in ON time: medications working (treatment within 60-90 mins of meds), therefore good for dental treatment Morning often better and shorter appointments Not good in OFF time: medications not working, more tremor and decreased movement
44
What is the dental side effect of anti-muscarinic drugs?
Dry mouth
45
What is the function of fluoxetine?
Blocks serotonin reuptake, increases availability, increases mood
46
What types of antipsychotic drugs are there?
1st and 2nd generation
47
What is the drug interaction of alcohol and BZDs?
Increased sedation
48
What is the drug interaction of erythromycin and antipsychotics?
Ventricular arrhythmias --> asystole --> cardiac arrest
49
What is the drug interaction of SSRIs and TCAs?
Ventricular arrhythmias
50
What is the dental relevance of patients of antipsychotics?
Xerostomia | Postural hypotension
51
What is the MoA of antidepressants?
To increase monoamine
52
What types of antidepressants are there?
SSRIs, SNRIs (selective noradrenaline), TCAs, MAOIs (monoamine oxidase inhibitors)
53
What interaction occurs between SSRI and SNRI?
Serotonin syndrome
54
What dental use can be used for SSRI?
Burning mouth syndrome
55
What dental side effects do most antidepressants cause?
Postural hypotension and xerostomia

Human Diseases (17 decks)

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