paeds medical tutorials Flashcards
1
Q
how can you reassure a parent that your practice is prepared for a child with autism
A
- reassure that you have experience of treating children with ASD
- find out about experience of child
- get parent to complete ASD questionnaire
- send her a social story for your practice to prepare son
- detail what will happen on day of examination
2
Q
what are the 3 main issues for autistic patients
A
- difficulties with communication and language
- difficulties in forming relationship with other people
- a limited pattern of behaviour and obsessive resistance to small changes in familiar surroundings
3
Q
what can be some difficulties treating autistic patients
A
- reduced ability to communicate therefore can be difficult to let patient know what you re doing
- can be difficult to establish rapport
4
Q
what are some characteristics of patients with ASD
A
- Poor social relating,
- poor play skills,
- gaze aversion,
- difficulty with open ended language tasks,
- distractibility,
- attention deficits,
- special interest fixation and obsessions (numbers, letters, colours, train timetables etc),
- heightened sensory input,
- repetitive behaviours,
- extreme resistance to invasion of personal space or being hurried,
- failure to use facial expression and body language to interpret others.
5
Q
what can be a problem with the dental environment for patients with ASD
A
- new with lots of strange noises, sounds and smells
6
Q
how can you modify your behaviour and communication style to help facilitate dental exam for patients with ASD
A
- use specific language, less general chat, short sentences
- be aware of how you describe things = take things very literally
- tell-show-do should be short clear commands
- use verbal praise and rewards
- avoid contact where possible
- be aware of self-injurious behaviour
7
Q
what are some techniques to help acclimatise and make ASD patients feel more comfortable
A
- several short visits to familiarise them
- gradual slow exposure
- short appointments
- same designated appointment should be scheduled
- picture books and cards are useful
8
Q
why do ASD patients tend to present with worse dental decay
A
- often have a higher pain tolerance
9
Q
what is OraNurse
A
- taste free toothpaste
- good for ASD patients
- 1350ppm
10
Q
what are some methods ASD patients use to communicate
A
- PECS
- Makaton
11
Q
how can you establish pain for patients with ASD
A
- ask if sleeping pattern is different than normal, rather than if they are staying awake
12
Q
what is tetralogy of fallot
A
- CHD
- cyanotic CHD
- hole in wall between two ventricles
- narrowing of pulmonary valve
- enlargement of aorta
- muscular wall of lower right chamber of heart thicker then normal
13
Q
what is a CHD
A
- structural defect or condition affecting the heart, which develops in utero, before baby is born
14
Q
how are CHD’s categorised
A
- into cyanotic or non-cyanotic
15
Q
what are cyanotic cardiac degects
A
- deoxygenated blood bypasses the lungs and enters the systemic circulation, or a mixture of oxygenated and deoxygenated blood circulates
- causes low levels of oxygen in the blood
16
Q
what are non-cyanotic cardiac defects
A
- occur when blood is shunted from left side of heart to the right through a structural defect in the septum
- oxygen levels remain normal
17
Q
what does blood shunting from left to right cause
A
- creates more pressure on right and can create hypertrophy
- increase blood flow to lungs and can cause damage to the lungs because of increased pressure
18
Q
what sort of medications can impact dental treatment
A
- diuretics
- digoxin
- vasodilators
- anticoagulants
19
Q
who would you consult for patients with CHD if unsure how to treat htem
A
- consultant cardiologist
- local paediatric dentistry department at the children’s hospital
20
Q
what is infective endocarditis
A
- an infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect
- more common on damaged heart valves
21
Q
what pathogen often causes IE
A
- streptococcus veridans
22
Q
what is mural endocardium
A
- any part of the endocardium apart from the heart valves
23
Q
what patients are most at risk of developing IE
A
- adults and children with structural cardiac defects at risk of developing IE
- acquired valvular heart disease with stenosis or regurgitation
- hypertrophic cardiomyopathy
- previous IE
- CHD
- valve replacement
- cyanotic congenital cardiac defects are most at risk
24
Q
what is the guidelines for antibiotic prophylaxis
A
- antibiotic prophylaxis is not recommended routinely for people undergoing dental procedures
- only given for invasive procedures and for this who require special consideration = prosthetic valve, previous IE, CHD
25
what are the two ways in which IE can present
- acute = takes place over days
| - subacute = occurs more gradually, over weeks or months
26
what are the clinical symptoms of IE
- temp >38
- shortness of breath on exertion
- fatigue
- muscle and joint pains
- unexplained weight loss
- flu-like symptoms
- pale skin
- heart murmur
27
what is finger clubbing
- enlargement of ends of digits
28
what age can you prescribe 2800ppm toothpaste
- from age of 10
29
at what age can you give 5000ppm
- from age 16
30
why do cardiac patients need to be treatment planned more radically
- need to treatment plan differently because of the risk that infection can cause
- won't do any hall crowns or pulp treatment of primary teeth
31
why are children with CCD a priority group for prevention of dental disease
- increased risk of IE
- risk of bacteraemia from dental infections and treatment
- dental decay may delay cardiac surgery
32
what type of CHD are more commonly seen in adults
- acquired
33
what are blue babies
- right to left shunt
- de-oxygenated blood mixes with oxygenated then goes to systemic circulation
- most commonly seen in lips and oral mucosa = because it is so thin
34
why do those with cyanotic CHD have tachycardia
- to compensate for less oxygen in the body
| - needs of tissues not being met so brain makes heart beat faster to compensate
35
what is polycythaemia
- increased RBC
| - can damage liver which is involved in haemostasis
36
what are the 3 layers of the heart
- pericardium = outer
- myocardium = middle
- endocardium = inner
37
what are the 4 valves of the heart
- tricuspid valve = between right atria and ventricle
- bicuspid valve - between left atria and ventricle
- pulmonary valve = right
- aortic valve = left
38
when id CHD often picked up
20 week scan so parents are aware before baby is born
39
what are some cyanotic CHD
- tetralogy of fallot
- transposition of great arteries
- complete atrioventricular septal defect
- tricuspid atresia
- pulmonary atresia
40
what are some acyanotic CHD
- ventricular septal defect
- atrial septal defect
- patent ductus arteriosus
- pulmonary stenosis
- aortic stenosis
- coartication of aorta
41
what are dental considerations for CHD
- risk of bleeding
- risk of IE
- risk of GA
- active dental disease may delay cardiac surgery
42
what is leukaemia
- cancer of the white blood cells
- normally WBC are made in bone marrow and develop, repair and reproduce themselves in an orderly and controlled way
- in leukaemia, process gets out of control and cells do not mature so don't work well
43
what are the 4 types of leukaemia
- acute myeloid leukaemia = AML
- acute lymphoblastic leukaemia = ALL
- chronic myeloid leukaemia = CML
- chronic lymphocytic leukaemia = CLL
44
how is ALL treated
- chemotherapy is the main treatment
| - 3 stages = induction, consolidation and maintenance
45
what is the induction stage of ALL treatment
- involves intensive treatment, aimed at destroying as many leukaemia cells as possible and is usually started within days of being diagnosed
- lasts 4 to 6 weeks
- bone marrow sample is taken at the end of induction treatment to confirm whether or not child still has leukaemia
46
what is the consolidation and CNS treatment of ALL treatment
- aimed at maintaining remission and preventing spread of leukaemia cells into the brain and spinal cord
- CNS treatment involves performing lumbar puncture and injecting methotrexate into spinal fluid
47
what stage is between consolidation and maintenance
- interim maintenance
| - more drugs given to try to keep leukaemia in remission
48
what is the maintenance treatment of ALL
- lasts for 2 years from start of interim maintenance
- 3 years for girls and 2 for boys
- child takes daily and weekly tablets
49
what is bone marrow transplantation used for in ALL
- needed by a minority of patients and is used for children with ALL that is likely to come back
50
what are the short term affects of chemotherapy
- cytotoxic = mucositis and deceased salivary gland function
- haemorrhagic = due to bone marrow suppression, can result in petechiae and gingival bleeding
- infectious = due to bone marrow suppression, viral, bacterial and fungal
- neurological = trismus and jaw pain
51
what are the long term effects of chemotherapy
- tooth agenesis
- microdontia
- crown hypoplasia
- disturbed root formation
- effect will be on teeth mineralising during chemotherapy
52
if a child with ALL has dental caries what treatment would you need to do
- radical treatment
| - need to remove any potential sources of infection
