Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Tim's Cards > Oral Medicine V - Brennan's Bespoken Bane > Flashcards

Oral Medicine V - Brennan's Bespoken Bane Flashcards

1
Q

Dyskinesias affect the jaw

Levodopa

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the ideal pre-Tx drug regimen for Parkinson’s pts?

A

Take meds 60-90 minutes prior to appt

*peak response period

**also, brief visits

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Palpitations:

A

A-fib

atrial fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

An estimated 2.6 million Americans have A-fib, number is increasing, and is responsible for ______% of all Strokes

A

15-20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

4 comorbidities to A-fib

A

Coronary artery disease

CHF

Diabetes

Thyrotoxicosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

3 Therapies for A-fib

A

Meds (Antithrombotics, combo, alternative)

Cardioversion

Ablation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

New Comparative Study, Tx of CVA can be safely administered w/in what time period?

As long as what?

A

A few weeks of CVA

Kept under optimal medical surveillance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Most common Inherited Clotting Disorder:

A

Hemophilia A

(1 in 5,000 male births)

Hemophilia B

(1 in 30,000 male births)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Hemophilia A is a Factor ___ deficiency (80%)

Hemophilia B is a Factor _____ deficiency (13%)

6% is a factor ____ deficiency

A

Factor VIII

Factor IX

Factor XI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Vitamin K rich foods are

A

Green

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

If you lack one coagulating factor it is…

If you lack multiple coagulating factors it is….

A

Inherited disorder

Acquired disorder

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

4 Vitamin K factors made in the LIVER:

A

II

VII

IX

X

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Factor XII, XI, IX

Factor VII

A

Intrinsic system/Tissue Factor pathway

Extrinsic system/Contact pathway

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

3 lab tests for Coagulation Disorders

A

aPTT - Activated Partial Thromboplastin Time

PT - Prothrombin Time

Platelet Count

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

aPTT tests the ______ system. What 4 factors?

PT tests the _______ system. What 5 factors?

Platelet Count deals w/ primary _____

A

Intrinsic VIII, IX, XI, XII

Extrinsic VII, V, X, prothrombin II, fibrinogen I

Hemostasis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Some pts might not be forthcoming about bleeding disorders - what is an important question to ask?

A

Do you bleed or bruise easily?

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

5 Uses for Warfarin

*what 2 have higher anticoagulation and higher risk of morbidity

A

Prosthetic Heart valves

Hx deep venous thrombosis

MI

Stroke

Atrial Fibrillation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What INR and PT levels would you not worry about (discontinuation not necessary for minor OS)

A

INR < 3.5

PT < 20 seconds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Primary concern for pts on Warfarin:

Physician Consult?

Recourse for excessive bleeding:

Post Op:

A

Hemostasis

Order/review lab values - perioperative change likely

GelFoam/thrombin, bone wax, Amicar/Tranexamic acid rinses

Acetominophen/codeine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

PT < 20 seconds, INR < 3.5
These measurements should be takend w/in _____

You can make changes to anticoagulation therapy

A

24 hrs

False

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

3 Issues w/ Warfarin:

A

Narrow therapeutic window

Frequent monitoring

Food/Drug interactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What consumables increase the effects of Warfarin?

What decreases?

A

Wine, cranberries

Green, Vitamin K rich foods

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Pain med interactions w/ Warfarin:

Abx interactions:

A

ASA, NSAIDS, Acetaminophen

Tetracycline, ampicillin, amoxicillin/clavulanic acid (augmentin)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What Abx should you take w/ pt on Warfarin? (2)

A

Pen V or Clindamycin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

T/F

Lit supports altering anticoagulant regimen prior to dental procedures and surgery

A

False

*go by 3.5 rule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Clinical judgement, experience, training, and accessibility to appropriate bleeding management strategies are all important components in any treatment decision

A

Frame and put on wall

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

3 Antiplatelet agents:

A

ASA (and NSAIDS)

Ticlid

Plavix

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Antiplatelets are used primarily for prophylaxis of:

Secondary prevention of adverse ________

in pts with Hx of _______, _______, and ______

A

Coronary Thrombosis

Thromboembolic events

Coronary thrombosis, Stroke, Unstable Angina

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Do NOT mix up coagulation factors w/ Anti-Platelets - What does INR measure?

A

Coagulation (warfarin)

NOT platelets (ASA, etc)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Best test for ASA platelet effect is PFA 100 or Ivy bleeding time

Not a problem unless Bleeding time is greater than ______

A

True

20 minutes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

NSAIDS will increase bleeding time how?

Generally you must wait 3 half lives (w/ wide variance between drugs)

A

Antiplatelet

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

6 ways to increase clinical risk of bleeding through antiplatelet activity:

A

ASA

NSAIDS

EtOH

Age

Liver disease

existing coagulopathies

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Clinical recommendation for pts on Antiplatelet therapies:

A

Little/No indication to interrupt antiplatelet drugs for dental procedures

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

It is not necessary to interrupt low dose aspirin therapy for simple dental extractions

A

True

*really any ASA dose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Drug Eluting Stents (DES) is often clopidogrel, plavix, etc and when combined with ASA…

A

Decreases cardiac events after stenting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

DES, premature discontinuation of antiplatelet therapy greatly increases the risk of what 3 things?

A

Stent Thrombosis

MI

Death

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

DES usually has ASA/Plavix dual Tx for how long after Stent placed?

Postpone Elective surgery for how long?

If surgery cannot be deferred, what do?

A

12 months

12 months

continue ASA perioperatively

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

3 reasons for Warfarin replacement drugs:

A

Wide therapeutic index

Few Drug/Food interactions

Predictable anticoagulant response at fixed doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

3 new oral Anticoagulants (Warfarin replacements)

A

Dabigatran

Rivaroxaban

Apixaban

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

New oral Anticoagulants (Xarelto, etc) have what major flaw

A

No reversal agent

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

What is the reversal agent for Warfarin?

New drugs?

A

Vitamin K

nothing

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

If pt taking new Anticoagulants, what 3 lab tests do you need prior to surgery?

A

aPTT

TT

anti-factor Xa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Warfarin acts on what 4 clotting factors:

Unfractioned Heparin on what 2:

Rivaroxaban (and Apixaban):

Dabigatran:

A

VIIa, IXa, Xa, Thrombin

Xa, Thrombin

Xa

Thrombin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

2 new drugs act on Factor X:

1 new acts on Factor II (Thrombin):

A

Rivaroxaban, Apixaban

Dabigatran

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

T/F

It does not appear Dabigatran discontinuation is necessary (if renal function, etc ok)

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Type 1 diabetics have a deficiency of insulin secondary to destruction of what cells?

Type II is either faulty receptors to insulin or antibodies to those insulin receptors or insulin itself

In either case, what is the result?

A

Beta cells

True

Hyperglycemic State

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

Hyperglycemia, short term polyphagia, polyuria, polydipsia, ketoacitosis/hyperosmotic coma

What is the long-term consequence?

A

Microangiopathy

*and deposition, delayed healing, infection

48
Q

Diabetes Diagnosis, blood Glucose:

HbA1c must be what in well-controlled diabetics:

A

> 126 mg/100mL

<7%

49
Q

Xerostomia, Infection, poor wound healing, increased perio/caries, etc

A

Diabetes

50
Q

There is a significant bleeding risk in Diabetes

A

False

51
Q

Epinepherine concern in Diabetes:

A

epi in LA increases blood Glucose

52
Q

Well-controlled diabetics can tolerate dental care _____

If cardiac complications…

A

normally

precautions

53
Q

Diabetes: Morning appts, pts eat normally. Have what to monitor?

What in case of hypoglycemia?

A

Glucometer

fast-acting carbs

54
Q

In uncontrolled diabetes, provide what care only?

A

Emergency

55
Q

Controlled diabetics Abx

Uncontrolled:

A

like everybody else

heightened risk for Infection (Use post-op Abx)

56
Q

Normal thyroid feels…

Enlarged feels…

A

rubbery

soft

57
Q

If untreated Hyperthyroidism, avoid…

If untreated Hypothyroidism, avoid…

A

Epi

CNS depressants

58
Q

Hydrocortisone (100-300 mg), CPR, IV glucose Tx for crisis in both Hyper and HypoThyroid

A

True

59
Q

In well-controlled thyroid disease, Tx infections normally

A

True

60
Q

Osteoporosis of alveolar bone, caries, etc

Cretinism, enlarged tongue, etc

Pain to ear, jaw, occiput, dysphagia, enlarged, firm nodular, and tender thyroid

A

Thyrotoxosis

Hypothyroidism

Thyroiditis

61
Q

Possible labe tests for organ transplantation Bleeding time:

liver disease:

renal disease:

A

platelet count, WBC count, hematocrit

AST, ALT, alkaline phosphatase, PT, bilirubin

creatinine, BUN, specific gravity urine, proteins in urine, hematocrit, WBC, pTT

62
Q

3 important factors in Dentistry to consider in pts w/ transplants:

A

bleeding

infection

build-up drugs/toxic metabolites (liver/kidney)

63
Q

Oral signs of Immunosuppression include HSV, apthous, CMV, candidiasis…

A

Mucositis

64
Q

Bone Marrow suppression drug that Increases chance for infection:

affects liver/kidney, causes gingival hyperplasia

A

Azathiprine

Cyclosporine

65
Q

Avoid dental care Tx for how long after a Transplant?

A

6 months

66
Q

Pre-transplant Tx

A

Med consult

prophy Abx, other mods, labs

67
Q

4 Drugs to Increase Interval/Change after Organ Transplant

A

Acetaminophen

Penicillin V

Cephalexin

Tetracycline (or Doxy)

68
Q

If Abx prophylaxis, give what ideally?

plus…

If allergic?

or Impenem, dosage:

Can’t take orally:

plus…

What shouldn’t be used in Organ Transplant pts b/c of acute Liver Toxicity?

A

Amoxicillin, 2g orally 1 hr prior

500 mg oral 1 hr prior

Vancomycin, 1g IV infused slowly over 1 hr prior

1g IV infused 1hr infused slowly prior

Apicillin, 2g IV 1 hr prior

metronidazole 500 mg IV 1 hr prior

Clindamycin

69
Q

Transplant issues, anticoagulation via meds, rejection

Stress - may need steroid supplementation if adrenal suppression

Mucositis, viral infection, aphthous, etc

A

True

70
Q

Blood Glc reading = 65

A

Tx w/ fast acting carbs

71
Q

Post-op Abx in Diabetes:

A

only for Uncontrolled

72
Q

Uncontrolled Diabetic Cardiac Guidelines:

A

None

*no subset here, follow Cardiac Guidelines

73
Q

Fasting Glucose threshold for Diabetes:

A

126 mg/100 mL

74
Q

If pt on ASA, what lab test prior to Extraction?

A

None

*nothing for Anti-platelets!!!

75
Q

Warfarin affects what clotting factors (number and name):

A

VIIa (tissue factor)
IXa
Xa
IIa (Thrombin)

76
Q

Extrinsic, Tissue Factor pathway, what Factor?

A

VII

77
Q

Med Consult during Chemo?

Postpone when Platelets below…

or Neutrophils below…

A

Always

50,000

1,000 mm3

78
Q

Tx of Uncontrolled Diabetics when?

A

only during Emergency

79
Q

Parkinson’s, take meds - minuted prior and keep brief

A

60-90 minutes prior

80
Q

Old research on stroke, wait….

New research, Tx w/in ____ as long as surveilled

A

6 months

a few weeks

81
Q

4 Vitamin K dependent factors:

A

II, VII, IX, X

*warfarin

82
Q

Clotting factor II:

IIa:

I:

Ia:

A

Prothrombin

Thrombin

Fibrinogen

Fibrin

83
Q

If on Warfarin, INR <

PT <

Should be measured w/in

A

3.5

20 sec

24 hrs

84
Q

New drug, Thrombin inhibitor:

3 Factor Xa inhibitors:

A

Dabigatran (Pradaxa)

Rivaroxaban, Apixaban, Edoxaban

85
Q

2 Abx ok to use w/ Warfarin:

A

PenV

Clindamycin

86
Q

Asthma, instruct pt to bring Inhaler, consider _____ if severe.

Emergency, use…

A

pulse ox during Tx

Ventolin/Proventil (short acting beta 2 adrenergic)

87
Q

COPD 4 clinical considerations:

A

Stability of pt

chair position

avoid Rubber Dam

Low-flow supplemental Oxygen

88
Q

Almost everyone w/ Asthma has what Drug Allergy?

A

ASA

89
Q

Chronic Bronchitis, chronic cough w/ sputum production for what time period?

A

3 consecutive months

2 successive years

90
Q

Hypercapnea

A

too much CO2 (COPD)

91
Q

Theophylline:

A

COPD (Stevens-Johnson syndrome)

92
Q

Unstable COPD pt (below 91% Oxygen) must have what 2 mods?

A

Upright

Pulse ox

93
Q

Stable COPD, ok to use diazepam

must be upright

A

True

True

94
Q

Early stage tumors:

Advanced stage:

A

surgery

chemoradiotherapy

95
Q

Pre-cancer oral health exam should be done when?

A

1 month prior cancer Tx

96
Q

Common radiation side-effect

A

Trismus

*difficulty opening

97
Q

Radiation Therapy, dental procedures should be done how long prior?

If ortho bands

fabricate…

Endo in field:

Endo out of field:

avoid removables, fabricate dentures _____ post surgery/radiation

A

10-14 (idally 21) to heal

remove

custom gel-applicator

Extract, no re-treats

RCT can be done

3-4 months

98
Q

If chemo, ask Oncologist cancer, stage, palliative/curative, prognosis

blood:

clotting factors:

Tx schedule (so safe dental Tx can be delivered)

A

True

CBC, neutrophil, platelet

if invasive

true

99
Q

If possible, all dental Tx should be done ___ prior to Chemo

Extractions should be done how long prior ideally?

minimum?

A

1 week

3 weeks

10-14 days

100
Q

When do you need a Med Consult if pt on Chemo?

A

Always

*even prophys

101
Q

If pt on Chemo, when would you postpone Tx? (2 cases)

A

platelet count < 50,000

neutrophil count < 1,000

102
Q

When would you schedule a Chemo pt?

A

17-20 days post Tx (when they feel best)

103
Q

Hematopoietic stem cell transplantation:

A

Intentional destruction of Marrow

stem cell transplant

104
Q

3 types of Hematopeitic Stem cell transplants

A

Autologous (own cells)

Allogenic (own species)

Syngeneic (identical twin)

105
Q

HSCT similar guidelines to Chemo

A

True

106
Q

HSCT, delay elective procedures for how long?

Greatest risk of complications:

A

1 year

100 days

107
Q

*180 days autologous, 365 allogeneic for standard care

A

True

108
Q

Painful, ulcerative oral complication of Radiation

A

Oral Mucositis

109
Q

Mucositis, xerostomia, candidiasis, osteoradionecrosis,

Trismus

A

Radiation

110
Q

Mucositis, ural ulceration, anemia, thrombocytopenia, infection, neurotoxicity, osteonecrosis of the jaw, xerostomia

A

Chemotherapy

111
Q

Anticonvulsants can modify the pathologic process and decrease orofacial pain

A

True

112
Q

HSCT prevalence of Oral Complications:

A

80%

*severe immunosuppression

113
Q

GVHD manifests orally as atrophy, erythema, white striations, plaques (similar to lichen planus), xerostomia, taste changes, formation of mucoceles, and mucosal sclerosis

A

True

114
Q

If neutrophil count is below 50,000, what is needed

A

Abx prophylaxis

115
Q

All procedures 1 week prior to chemo

17-20 days post

A

True

116
Q

If Controlled Diabetes what might you need to do prior to Tx

A

current HbA1c

Tim's Cards (140 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions