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BOARDs > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

When is antibiotic prophylaxis recommended?

A
  1. Previous hx of infective endocarditis
  2. Prosthetic heart valve or heart valve repair w/prosthetic material
  3. Heart transplant w/valvular regurgitation
  4. Reapired congenital heart defect w/residual shunts or valvular regurgitation
  5. Unrepaired cyanotic heart diseases

Peds:
* completely repaired congenital heart defect w/prosthetic material–>Antibiotics for 1st 6 months after sx.

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2
Q

When scenarios should antibiotic prophylaxis be used?

A

Dental Procedures:
* Manipulation of gingival tissue or periapical region or perforation of oral mucosa
* ext, cleaning, SRP, biopsy, sutures, probing

Severely immunocompromised states:
* HIV w/CDR < 200
* AIDs related opportunistic infection
* Bone marrow or organ transplant
* Neutropenia
* Cancer chemotherapy
* Hx of H&N radiation
* RA w/prednisone>10mg/day
* SCID
* Autoimmune disease (SLE, juvenile arthritis)

Hyperglycemic states (Uncontrolled diabetes)
* Hba1c> 8%
* Random blood glucose > 200 mg/dL

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3
Q

HTN Categories

A

Stage 1: 1 medication
Stage 2: 2 meds from different drug classes
Hypertensive crisis: Hospitalization if signs of organ damage

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4
Q

Oral Manifestations of HTN

A

Dry mouth, taste changes and ulcerations related to HTN meds

Gingival Hyperplasia

ANgioedema

Gingival Bleeding

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5
Q

Diabetes Mellitus

A

Leads to High blood glucose
* body cannot produce or react to insulin
* Polydipsia (thirsty), Polyphagia (hungry), and polyuria (urinate a lot)

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6
Q

Diabetes Insipidus

A

Kidneys can’t retain water
* can’t produce or react to ADH
* Polydipsia, polyuria

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7
Q

Type 1 Diabetes

A
  • Juvenile onset
  • insulin dependent (Autoimmune- Kills b cells that make insulin)
  • Insulin Deficiency
  • Ketone Breath
  • No way to prevent
  • All cases require insulin injections
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8
Q

Type 2 Diabetes

A
  • Adult onset
  • non-insulin dependent
  • Insulin Resistance
  • Most cases can be prevented
  • Late stage cases require insulin injections
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9
Q

Blood Glucose Measurement

A

Measures glucose conc. in a blood sample

Varies throughout the day

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10
Q

HbA1c measurement

A

Measures glycosylated hemoglobin

Stable for 3 months
* life cycle of blood cell

want under 7%

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11
Q

Diabetic vs Prediabetic vs Normal:
* A1c Test
* Fasting Blood sugar test
* Glucose Tolerance Test

A
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12
Q

Medications used for Type 1 diabetes

A

Insulin
* rapid Acting: Lispro, Aspart, Glulisine
* Short acting: Human insulin
* Intermediate acting: NPH
* Long-acting: Determir, glargine

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13
Q

Medications used for Type 2 Diabetes

A

Sulfonylurea: 30 mins b4 meals
Biguanide: Taken w/ meals

DP4 inhibitor: -liptan
Thiazolidinedione: -litazone
SGLT3 inhibitor: Liflozin

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14
Q

Hypoglycemia

A

COLD AND CLAMMY NEED SOME CANDY
TIRED:
* Tachycardia
* Irritability
* Restlessness
* Excessive Hunger
* Diaphoresis (Sweating)

Blood sugar < 70 mg/dL

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15
Q

Hyperglycemia

A

HOT AND DRY SUGAR HIGH
SINFUL:
* Sweet breath (ketone breath)
* Increased Thirst
* Nausea & Vomitting
* Frequent
* Urination (Polyuria)
* Loss of clear vision

Fasting Blood sugar >/= 126 or
Post-prandial >/= 200

Can lead to life threatening complications:
* Diabetic ketoacidosis
* Hyperosmolar hyperglycemic state

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16
Q

Patient with diabetes is undergoing general anesthesia. what do you do?

A

Severe diabetes should not if possible

Well controlled can but recommend:
* Fasting at midnight
* use only 1/2 insulin dose

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17
Q

ASA Classification

A
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18
Q

CPR Checklist

A

5 A’s
1. Appraise scene safety
2. Assess responsiveness
3. Alert for Help
4. Assess Breathing & Pulse
5. Activate EMS

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19
Q

CPR Compressions

A

30
* lower half of sternum b/w nipples
* 2 inches
* 100-120 compression per min

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20
Q

CPR Airway

A

Head tilt-chin lift
* if trauma=jaw thrust

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21
Q

CPR: Breathing

A

2 breaths

22
Q

AED

A

Automated External Defibrillator
* Stop an abnorally beating heart
* attach pads to UR & LL of chest
* over 8 y.o=adult pads

Witnessed Cardiac arrest: Use AED ON ARRIVAL
Unwitnessed Cardiac arrest: Use AED after 5 cycles/2 mins of CPR
* Cardiac arrest=no pulse + Abnormal breathing

23
Q

Cardiac Arrest + Respiratory Arrest

A

Respiratory arrest:
* pulse
* Abnormal breathing

Cardiac Arrest:
* no pulse
* Abnormal breathing

24
Q

Child/Infant CPR:

A

Pulse:
* Child/Adult=Carotid
* Baby=Brachial

Start CPR immediately if unwitnessed collapse

Small children: 1 hand
Infant: 2 fingers
compress: 1/3 depth of chest

15 compressions for every 2 breaths if 2 rescuers

25
Q

Rescue Breating

A

Do if–>Pulse + Abnormal breathing (Respiratory arrest)

K I D: 1 breath every 3 seconds

A D U L T: 1 breath every 5 seconds

26
Q

Choking/Foreign Body Obstruction

A

IF CONSCIOUS:
Encourage coughing
* Can’t cough, but conscious=abdominal thrusts- b/w xiphoid process & navel
* Infants: 5 back slaps then 5 chest thrusts

IF UNCONSCOUS:
* Check mouth before breaths
* CPR

27
Q

How long can the brain survive w/o oxygen?

A

6 mins

28
Q

Nitrous Oxide: Indications vs Contraindications

A

Indications:
* Dental ANxiety
* Gag Reflex
* Asthma

Contraindications:
* COPD
* Nasal Obstruction
* Multiple Sclerosis
* Pregnant (1st trimester especially)
* Otitis Media
* Sickle Cell Disease

29
Q

Supplemental Oxygen: Indications vs Contraindications

A

Indications:
* COPD
* Asthma

Contraindications:
* Bleomycin
* Paraquat poisoning (toxic herbicide)

30
Q

Steroids:

A
  • Derived from Cholesterol
  • Glucocorticoids=cortisol
31
Q

Cushing Syndrome

A

HIGH CORTISOL levels

Endogenous: Due to benign tumor
* Primary: Increased cortisol at adrenal cortex
* Secondary: Increased ACTH at anterior pituitary
* Tertiary: Increased CRH at hypothalamus

Exogenous: Due to taking too many glucocorticoids
* Rule of 2s: 20 mgs of exogenous cortisol + for 2 weeks + within last 2 years==>Suspect: suprresion of adrenal cortex & Possible Crisis
* 20 mg hyrocoritsone=5 mg prednisone=0.75 dexamethasone

Symptoms:
* Moon facies: round, red, and fulll f ace
* Bufallo hump: fat b/w shoulders

32
Q

Addison’s Disease

A

Low CORTISOL Levels

Endogenous: due to immune-mediated tissue destruction
* Primary: Decrease cortisol at adrenal cortex
* Secondary: Decreased ACTH at anterior pituitary
* Tertiary: Decreased CRG at hypothalamus

SYmptoms:
* Hyperpigmentation: Bronzing, brown macules on lips/mucosa

33
Q

Addisonian Crisis

A

Aka Acute Adrenal Insufficiency/Adreanl Crisis

Corticosteroids are critcally Low

stress leads to Hypovolemic shock (Severe fluid loss=heart unable to pump blood)

Activate EMS
* Apply ice packs
* monitor vital signs
* * Start IV Saline (to help w/hypovoemia)
* GIVE IV HYDROCORTISONE

34
Q

Bisphosphonates

A

Prevent bone resorption by Osteoclasts apoptosis
* increase bone density
* slows tooth movement
* impairs bone healing
* may lead to osteonecrosis

35
Q

Bisphosphonates are used in what conditions?

A
  • Osteoporosis
  • Pagets disease
  • Multiple myeloma
  • Metastatic bone lesions of various cancers
36
Q

Bisphosphonate Medications

A

-Dronate

37
Q

Medication-Related Osteonecrosis of the Jaws (MRONJ)

A

Medication: Bisphosphonate, denosumab

Osteonecrosis: Dead bone

Posterior Mandible

38
Q

What gives you a higher risk and severity for MRONJ?

A

Higher Dose
more frequent administration
Longer duration
IV administartion

39
Q

Diagnosis criteria for MRONJ

A

Current or previous tx w/a medication

Exposed bone>8 weeks

No hx of radiation therapy to the jaws (ORNJ)

40
Q

What are the phases of Hemostasis

A
  1. Vascular
  2. Platelet=primary hemostasis
  3. Coagulation=Secondary Hemostasis
  4. Fibrinolytic (plasmin cuts fibrin mesh and dissolves clot)
41
Q

Platelet Disorders

A

Von Willebrand Diseases
Thrombocytopenia

42
Q

COPD: Patient Considerations

A
43
Q

COPD Medications

A
44
Q

Asthma: Patient Considerations

A
45
Q

Asthma Medications

A
46
Q

MRONJ: Patient Considerations
* Risk of MRONJ
* Active infection

A

d

47
Q

Antiplatelet Medications

A

Aspirin
Clopidorel
Abciximab

48
Q

Anticoagulants

A
49
Q

Substance Abuse

A

Recurrent use of a substance over the past 12 months w/subsequent adverse consequences

*Disrupts dopamine circuits in the brain

50
Q

Dependence

A

uncontrollable need for a substance despite adverse consequences

51
Q

Tolerance

A

Need for increased amount of a substance to get desired effect

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