Patient Care Exam II Flashcards by Annabella Moody

Diagnosis

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History

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N/a

Next appointment or not applicable

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Full mouth

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HBV

Hepatitis B virus

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HIV

Human immunodeficiency virus

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Prn

As needed

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Bid

Twice a day

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Tid

Three times a day

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Qid

Four times a day

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Patient

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Prescription

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TMJ

Temporomandible joint

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Tuberculosis

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Chronic inflammatory disease of the airway characterized by reversible episodes of increased airway hyperresponsivness resulting in recurrent episodes of dyspnea, coughing and wheezing

Asthma

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Describe the episodes of asthma

Reversible

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Asthma is characterized by reversible episodes of increased airway ______ resulting in asthmatic symptoms

Hyperresponsiveness

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Coughing, dyspnea and wheezing are characteristic of

Asthma

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Chronic inflammatory disease of airway

Asthma

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Describe onset of asthmatic episode

Sudden onset

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When do peak symptoms occur within an asthma attack

10-15 minutes

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Inadequate treatment of asthma result in:

ER visits for ~25% of patients

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Asthma is disease primarily found in

Children

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Percentage of children affected by asthma

10%

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Second most common chronic disease of children

Asthma

Most common chronic disease of children

Dental caries

In adults the prevalence of asthma is highest in ______ In childhood the prevalence of asthma is highest in ____

Female Boys

Although asthma affects all races what two races have a slightly higher prevalence of asthma

African American Hispanic

List the causes/triggers of asthma (6):

- Emotion/physical stress - Allergy to foods - Allergy to drugs - Air polution/irritating vapors - Upper respiratory infections - Exercise induced

What foods are common allergens that lead to asthma attacks

Nuts Shelfish

What drugs can commonly cause asthma attacks

Aspirin NSAIDs

Exercise induced asthmatic episodes are caused by what two factors:

Breathing through mouth Inhaling colder/drier air

Define whether this is extrinsic or intrinsic asthma: Allergic asthma

Extrinsic

Define whether this is extrinsic or intrinsic asthma: Non-allergic asthma

Intrinsic

Define whether this is extrinsic or intrinsic asthma: Occurs more often in children

Extrinsic

Define whether this is extrinsic or intrinsic asthma: Usually develops in adults older than 35

Intrinsic

Define whether this is extrinsic or intrinsic asthma: Triggered by specific allergens such as pollens, dust, molds, allergenic foods such as milk, fish and shellfish

Extrinsic

Define whether this is extrinsic or intrinsic asthma: Asthmatic episode brought on by drugs and chemicals such Penicillin, Vaccines, Aspirin and sulfites

Extrinsic

Define whether this is extrinsic or intrinsic asthma: Type of asthma in which 50% of children outgrow by late teens or early twenties

Extrinsic

Define whether this is extrinsic or intrinsic asthma: Attacks are precipitated by non-allergic factors, respiratory infection, physical exertion, environmental & air pollution

Intrinsic

Define whether this is extrinsic or intrinsic asthma: Asthma attack induced by psychological and physiological stress

Intrinsic

Triad asthmatic may also be termed:

Samter’s triad Aspirin-Exacerbated-Respiratory disease AERD

Percentage of individuals with asthma develop triad asthmaticus

Small percentage

Asthmatic patients that may have a sudden and severe asthmatic attack

Triad asthmaticus

Triad asthmaticus manifest with:

Wheezing Dyspnea Hypoxia

Triad asthmatics do not responds to:

Bronchodilators

Due to triad asthmatics not responding to bronchodilators it is considered:

A true medical emergency

What is the triad in triad asthmaticus:

Asthma Recurrent nasal polyps Sensitivity to aspirin and NSAIDs

Aspirin & NSAIDs should be avoided in some patients because it can cause:

Bronchoconstriction in about 10% of asthmatic patients with aspirin/NSAIDs sensitivity

Bronchoconstriction from NSAIDs/Aspirin occurs in around ______ of asthmatics who have ____ and _____

30-40% who have pansinusitis & nasal polyps

Describe reactions between asthmatics and nitrous oxide and Valium

No contraindications

Define symptoms of an asthmatic attack (9):

1- chest congestion 2- wheezing 3- cough 4- dyspnea 5- tachypnea 6- elevated BP 7- anxiety 8- agitation 9- cyanosis

Difficulty breathing

Dyspnea

Abnormal, rapid breathing

Tachypnea

Blueish discoloration due to decrease blood & oxygen circulation

Cyanosis

Primary goal in asthmatic patients

Prevent an acute asthma at attack with management

In order to prevent an asthmatic attack in a patient, a provider should:

Utilize medical history

Regarding asthmatic patients, what should a provider be sure to know regarding the patient prior to treatment (4):

1- frequency & severity of attacks 2- know any current or past problems with asthma 3- how attacks are managed 4- if the patient has ever received emergency care for an acute attack

To prevent asthma attacks, patients should get vaccinated against ____ & ____

Influenza & Pneumonia

In order to avoid attacks, asthmatic patients should know:

Their triggers

It is important or asthmatic patients to take their _____ as _____ in order to help prevent an asthma attack

Medication as prescribed

______ is important through a good medical history in asthmatics

Risk assessment

Prior to treatment it is a good idea to have an asthmatic patient to:

Take a puff from their inhaler

Complex, chronic, incurable illness, and a growing epidemic in the US

Diabetes

Disease characterized by a high blood glucose

Diabetes

What is the third leading cause of death in the US

Diabetes

Disease that increases with age- ____ of affected are over the age of ___

Diabetes 95% 45

Leading cause of blindness in the US

Diabetes

Diabetes is characterized by a group of _____ resulting from:

Metabolic disease Low levels of hormone insulin

Diabetes is characterized by a disordered metabolisms of:

Carbohydrates, lipids & proteins

Abnormally high blood sugar level

Hyperglycemia

The prevalence of Type-II diabetes has:

Doubled over time

The prevalence of Type-I diabetes has:

Remained stable

long term effects hyperglycemia

Damage to various organs

What organs can be damaged due to the long term affects of hyperglycemia

Heart Eyes Kidneys Nervous system Vascular system Periodontum

Type I or Type II Insulin-dependent diabetes Mellitus

Type I

Type I or Type II About 5% of diabetic patients, more common in children

Type I

Type I or Type II Diabetes characterized by beta-cell destruction leading to absolute insulin deficiency

Type I

Beta cell destruction usually leads to

Absolute insulin deficecy

Type I or Type II Typically an abrupt onset

Type I

Type I or Type II Non-insulin dependent

Type II

Type I or Type II Milder form of diabetes, usually seen in adults

Type II

Type I or Type II Diabetes characterized by the individual being overweight or obsess

Type II

Type I or Type II Diabetes in which the clinical onset is is slow

Type II

In what form of diabetes are blood sugar levels more stable

Type II

________ is uncommon in type II diabetics

Ketoacidosis

Any degree of abnormal glucose tolerance during pregnancy

Gestational diabetes

Gestational diabetes occurs in _____ percent of pregnant women during pregnancy

5-7%

A risk factor for gestational diabetes

Obesity during pregnancy

Following childbirth the mothers glycemic control usually:

Returns back to normal

Women who develop gestational diabetes have an increased risk for:

Developing diabetes within 5-10 years

Body produces high levels of blood acids called ketones

Diabetic ketoacidosis

Diabetic ketoacidosis occurs when the body:

Can’t produce enough insulin

Deep labored breathing pattern characteristic of diabetic ketoacidosis

Kussmaul’s respiration

Diabetic ketoacidosis can be triggered by:

Infection or other illness

Diabetic ketoacidosis rarely occurs in:

Type II diabetes

Treatment of diabetic ketoacidosis

Fluid & electrolyte replacement Insulin therapy

Unlike in ketoacidosis, symptoms develop slower over several days in _______

Hyperglycemia

In hyperglycemia, the longer blood sugar levels are elevated, the:

More serious symptoms may become

Symptoms of hyperglycemia include (8):

1- polyurina 2- polydipsia 3- polyphagia 4- dry warm skin 5- Kussmaul’s respiration 6- Fruity breath 7- Rapid, weak pulse 8- altered level of consciousness

Excessive urination

Polyuria

Abnormally great thirst

Polydipsia

Excessive eating

Polyphagia

Sudden onset of low blood glucose

Hypoglycemia

Symptoms of hypoglycemia include:

1- lethargy 2- changes in mood 3- nausea 4- tachycardia 5- hypertension 6- anxiety 7- sweating 8- pale, moist skin 9- weakness 10-dizziness 11- shallow respiration 12- headache 13- altered level of consciousness

Blood glucose level of hypoglycemia:

Less than 50mg/100ml

Regarding hypoglycemia management: An appointment should be scheduled:

After a meal or snack

Regarding hypoglycemia management: Many patients with diabetes are recommended to eat a meal or snack every:

4-5 hours

Common symptoms of an alert level of hypoglycemia:

Shakiness Irritability Confusion Hunger

Symptoms of severe hypoglycemia:

Loss of consciousness Seizures Coma

To manage hypoglycemia in the office: Position the patient:

Comfortably- ABC

To manage hypoglycemia in the office: If necessary, the patient might require:

Administration of 100% oxygen

To manage hypoglycemia in the office: If the patient is conscious:

Oral carbohydrates

To manage hypoglycemia in the office: If the patient is unconscious what glucose options may be given:

Cake icing 50% dextrose IV Glucagon 1mg Epinephrine 1/1000 (0.5 Mg IM)

Self-test performed with a blood glucose meter, revealing what the blood sugar level is at that point in time:

Blood sugar level

Measures the average amount of sugar in the blood over the past 2-3 months

A1C

A1C measures the blood glucose average over a period of:

2-3 motnhs

What is HbA1c:

Hemaglobin-A1C Monitors long term glucose control over 30-90 days

Consider deferring elective treatment or give carbohydrates & wait 15 minutes and retest if the blood glucose level is:

Less than 70 mg/dL

Defer elective treatment and refer to a physician if the blood glucose level is:

Greater than 200 mg/dL

What should a blood glucose level be after fasting for 8-12 hours

80-130 mg/dL

1-2 hours following a meal, the blood glucose level should be:

Less than 180 mg/dL

If a patient skips a meal but takes their insulin there is a chance that what may occur:

Insulin-shock

Stage of insulin shock that is most common

Mild stage

Stage of insulin shocks characterized by hunger, weakness, trembling, tachycardia, pallor, sweating; paresthesia may be noted on occasion

Mild stage

Stage of insulin shock that may occur before meals, during exercise, or when food has been omitted or delayed

Mild stage

Stage of insulin shock that occurs when blood glucose drops substantially, the patient becomes incoherent, uncooperative & sometimes belligerent or resistant to reason or efforts at restraint

Moderate stage

In the moderate stage of insulin shock, _____ & ____ are defective

Judgement & orientation

Stage of insulin shock characterized by unconsciousness with or without tonic or clonic muscular movements

Severe stage

In the severe stage of insulin shock, most of the reactions take place in _____ after the first two stages have gone unrecognized

sleep

During the severe stage of insulin shock, what symptoms may present:

Sweating Pallor Rapid and thready pulse Hypotension Hypothermia

Xerostomia

Dry mouth

One of the earliest oral manifestations of diabetes

Xerostomia

Bacterial, viral and fungal infections are all:

Oral manifestations of diabetes

In diabetic patients, their may be an increased incidence or severity of:

Caries

Burning mouth syndrome is characteristic of:

Diabetes

The diabetic drug Metformin, may cause:

Metallic taste

Periodontal disease is an oral complication of:

Diabetes

Bidirectional-hyperglycemia affects ______ while periodontitis affect ______

Oral health Glycemic control

Increased incidence and severity of gingival inflammation may be associated with:

Diabetes

Diabetes can cause a ______ abscess

Periodontal

An abnormal or hypersensitive response of the immune system to a substance introduced into the body

Allergy

For an allergic reaction to occur, the patient must have been previously exposed to the:

Antigen

The previous exposure to the antigen in an allergic response is considered _________ The subsequent exposure to the antigen that causes the reaction is considered _____

Sensitizing dose Challenge dose

What type of allergic reaction is characterized by: Rapid onset- less than one hour

Rapid/Anaphylactic

What type of allergic reaction is characterized by: Type I- True IgE-mediated

Rapid/Anaphylactic

What type of allergic reaction is characterized by: Reaction to antibiotics, analgesics, and narcotics

Both rapid/anaphylactic and delayed

What type of allergic reaction is characterized by: Reaction to anesthetics such as Septocaine/Articaine & Esters

Rapid/Anaphylactic

What type of allergic reaction is characterized by: Reaction to the venom of stinging insects

Rapid/Anaphylactic

What type of allergic reaction is characterized by: Onset greater than one hour

Delayed

What type of allergic reaction is characterized by: Usually, non-life threatening

Delayed

What type of allergic reaction is characterized by: Reaction to the preservatives in anesthetics

Delayed

Describe what occurs in the cardiovascular system due to anaphylactic allergic reactions (7):

Capillary dilation Increased capillary permeability Blushing Edema Decreased venous return Decreased BP Decreased cardiac output

What secretion are increased during an anaphylactic allergic response (6):

Increased secretions by the mucous, lacrimal, salivary, pancreatic, gastric, & intestinal glands

Describe the respiratory effects of an anaphylactic allergic reaction:

Asphyxia from upper respiratory tract obstruction

Reaction related to the humoral immune system and usually occur soon after second contact with an antigen

Type I hypersensitivity reaction

In a type I hypersensitivity reaction, many people have repeated contacts with a specific drug or material:

Before they become allergic to it

An acute reaction involving smooth muscle of the bronchi in which antigen-IgE antibody complexes form in the surface of mast cells which causes sudden histamine release from these cells

Anaphylaxis

In anaphylaxis ____ cells release ____

Mast cells Histamine

What antigen-antibody complex is involved in anaphylaxis

Antigen—IgE antibody complexes

What are the most common causes of anaphylaxis

Antibiotics Chemo drugs

The symptoms of an anaphylactic response present in what order:

Skin > eyes, nose, GI > respiratory > cardiovascular

Management of a patient in anaphylaxis includes positioning the patient in a:

Supine position

In addition to placing the patient in a supine position if in anaphylaxis, what other steps should be taken:

1- BCLS 2- Oxygen 3- Monitor vitals 4- Epinephrine 5- Benadryl

In a delayed allergic reaction the common symptoms and signs may include (4):

Rash Pruritis (itching) Urticaria (hives) Edema

In a delayed allergic reaction, the more uncommon symptoms and signs include (3):

Hypotension Dyspnea Coma

In a delayed allergic reaction, the procedure should be ____, the patient should be placed in a _____ , _____ should be given if indicated and _____ should be given every _____ hours

1- terminated 2- comfortable position 3- BCLS 4- Benadryl 50 mg 5- four hours

What are the four risk factors for cardiovascular disease:

1- heredity 2- sec 3- race 4- age

The hereditary component of cardiovascular disease make sup for _____ of risk

30%

People with parents or siblings affected by ____ are at risk for development of the disease at a younger age

Coronary atherosclerotic

______ develop heart disease ten years earlier, however _____ catch up

Men, women (post-menopausal)

Race that is at a heightened risk of cardiovascular diseases (primarily due to hypertension)

African americans

The majority of people who die from coronary artery disease:

Age 65 or older

Extreme fatigue, constant dizziness or light-headedness, fast HR (more than 100 BPM), new irregular heart beat, chest pain or discomfort, difficulty breathing, nausea, cold sweats, and edema are all warning signs of

Heart disease

Major risk factors for heart disease include (7):

1- smoking 2- diabetes 3- cholesterol 4- hypertension 5- obesity 6- sleep apnea 7- family history

Minor risk factors of heart disease (3):

1- excessive alcohol use 2- stress 3- age

What is the single most-modifiable risk for heart disease:

Smoking

Narrowing or obstruction- typically within an aortic valve

Stenosis

Stenosis can be caused by:

Rheumatic fever Calcification of valve Congenital abnormalities

Breathing that is difficult, labored or uncomfortable- usually due to COPD or asthma

Dyspnea

Difficulty breathing when lying down

Orthopena

Causes of orthopena may include (4):

1- heart failure 2- COPD 3- Panic disorder 4- sleep apnea

Decreased or blocked blood flow to the heart due to plaque build-up

Coronary artery disease (CAD)

The leading cause of morbidity and mortality in patients with diabetes

Coronary artery disease

If you have diabetes you are twice as likely to have:

Heart disease or stroke

The longer you have diabetes, the more likely you are to have:

Heart disease

Progressive clogging of the arteries usually medium muscular arteries or large elastic arteries

Atherosclerosis

______ can lead to thrombosis, infarction, ischemic lesions of brain, heart and extremities

Atherosclerosis

What are the major risk factors of atherosclerosis (2):

1- elevation in serum lipids 2- increased BP

Systolic BP is commonly related to:

Cardiovascular disease

Chest pain usually brief, resulting from temporary ischemia of the myocardium

Angina pectoris

______ is common along with angina pectoris

Hyperventilation

Least common form of angina pectoris

Acute MI

The chest pain of angina pectoris is described as:

Aching, heavy, squeezing, tightness in the middle of the chest

The pain associated with angina is ____ and can radiate out into:

Brief Left/right arm, neck/mandible

The pain of angina is caused by:

Blood supply to the cardiac muscle is insufficient for oxygen demand

Pain that is predictable, reproducible, unchanging and consistent over time. Pain is typically precipitated by physical effort such as walking or climbing stairs but can occur with eating or stress

Stable angina

In stable angina, the pain is relieved by:

1- cessation of the precipitating activity 2- rest 3- nitroglycerin

Individuals that experience stable angina, typically have underlying:

Coronary artery disease (CAD)

Defined as new-onset pain, increasing in frequency and/or intensity, and is predicated by less effort than before; can also occur at rest

Unstable angina

Type of angina in which the pain is not readily relieved by nitroglycerin

Ustable

The key feature of unstable angina is:

Changing character (increasing intensity, frequency or pattern)

Sublingual tablets used to treat episodes of angina in people who have coronary heart disease

Nitroglycerin

Drug that can be used just before activities that may cause episodes of angina as preventative measure:

Nitroglycerin

During an MI, women display:

Different symptoms than men

Common MI symptoms in women:

Fatigue & Dyspnea

Common MI symptoms in men:

Chest pain

Development of chest pain, sometimes manifested as crushing, squeezing or heavy feeling, that is more severe than with angina, and lasting longer than 15 minutes and not relieved by nitroglycerin

Myocardial infarction

Cyanosis, pale or ashen appearance; weakness, cold sweat, nausea vomiting, air hunger and sense of impending death, and irregular pulse are all characteristic of:

Myocardial infarction

The intially symptoms of a myocardial infarction may progress to:

Cardiac arrest

If a patient has history of heart attack and it has been less than 8 weeks out:

No elective dental treatment

If a patient has a history of a heart attack and it has been more than 8 weeks since:

Elective dental treatment possible- need to obtain a medical consultation

Congestive heart failure usually occurs at:

Older than 65 years

Congestive heart failure results from any structural or functional cardiac disorder that:

Impairs the ability of the ventricle to fill or eject with blood

Fatigue & Weakness Ankle swelling (edema) Clubbing of the digits Syncope Angina Breathing difficulties Increased urination at night Are all characteristic of:

Congestive heart failure (CHF)

The respiratory symptoms of congestive heart failure include:

Dyspnea, orthopnea, sleep apnea

As a dentist, what should you ask your patient if aware if their CHF status:

How many pillows do you sleep with at night

A general term for pulmonary disorders characterized by chronic air flow limitation from the lungs that is not fully reversible

Chronic obstructive pulmonary disease

Chronic bronchitis and emphysema are both examples of:

Chronic obstructive pulmonary disease

Chronic inflammation of the bronchi that produces excessive tracheobronchial mucus production and a persistent cough with sputum for at least three months and in at least two consecutive years in a patient whom other cause of productive chronic cough can be excluded

Chronic bronchitis

Permanent enlargement of the air spaces in the lungs that is accompanied by destruction of the air space (alveolar) walls without obvious fibrosis

Emphysema

When would the use of oxygen be indicated and at what dose:

Almost any emergency 100% inhalation

When would the use of epinephrine be indicated and at what dose

Anaphylaxis Asthma unresponsive to Albuterol/Salbutamol 1:1000 (1mg/ml) auto-injector 0.3 mg/ml EpiPen 0.15 mg/ml EpiPen Jr

When would th ease of nitroglycerin be indicated and at what dose:

Angina pain 0.4 mg sublingual every 3-5 minutes

When would the use of Diphenhydramine be indicated and at what dose:

Allergic reactions 1mg/kg IM/IV (Maximum of 50 mg)

When would the use of albuterol/salbutamol be indicated and at what dose:

Asthmatic bronchospasm 2 puffs (repeat as needed)

When the use of Aspirin be indicated and at what dose:

Myocardial infarction 81mg chewable tablet

When would the use of glucose be indicated and at what dose:

Hypoglycemia (patient unconscious) 37.5 mg (repeat as needed)

When would the use of Atropine web indicated and at what dose

Clinically significant bradycardia 0.5 mg IV or IM

When would the use of hydrocortisone be indicated and at what dose

Adrenal insufficiency recurrent anaphylaxis 100 mg IV or IM (mixed with 3-5 ml of sterile water)

When would the use of morphine or nitrous oxide be indicated and at what dose

Angina pain unresponsive to nitroglycerin; Titration 2 mg IV, 5 mg IM Around 35% N2O inhalation

When would the use of Naloxone be indicated and at what dose

Reversal of Opioid overdose 0.1 mg/kg up to 2mg IV or IM

When would the use of Lorazepam or Midazolam be indicated and at what dose

Status epilepticus 4 mg IM or IV 5 mg IM or IV

When would the use of Flumazenil be indicated and at what dose

Benzodiazepine overdose 0.01 mg/kg at 1 minute intervals up to 1 mg IV or IM

Identify the risk factors for rheumatic fever (3):

1- usually some form of strep throat as a child (5-15 years old) 2- autoimmune condition 3- Group A, B-hemolytic strep

Rheumatic fever can affect many _____ tissues

Connective

Rheumatic fever affecting the heart valves

Rheumatic heart disease

What can occur in the joints of patients with rheumatic fever

Inflammation

In rheumatic fever, uncontrolled movements of the brain can present- these are called

Chorea

Broad pink patches of skin are present in patients with:

Rheumatic fever

A disease dealing with primary adrenal insufficiency

Addison’s disease

Disease caused by the progressive destruction of the adrenal cortex

Addison’s disease

Addison’s disease- the progressive destruction of the adrenal cortex is usually due to:

Autoimmune disease Chronic infections diseases

TB, HIV, Cytomegalovirus infections, and fungal infections are all chronic infectious diseases that can lead to:

Addison’s disease

The inability to increase cortisol production with stress (tired-fatigue, weak, Orthostatic hypotension, poor healing, inability to tolerate stress, increased infections)

Adrenal insufficiency- Addison’s disease

Refers to a condition caused by excessive cortisol in the body, the most common cause is the use of steroid drugs

Cushing syndrome

Cushing syndrome is a sign of:

Steroid imbalance

Moon face, gingival lesions, easy bruising, abdominal striae are all signs of:

Steroid imbalance

Weight gain, fatty tissue deposit, thinning hair, acne and decreased healing are all signs of:

Steroid imbalance

Missed appointments, specific odor of breath, enlargement of the parotid glands and spider angiomas are all signs of:

Alcohol abuse

Reduction in the oxygen carrying capacity of blood

Anemia

Anemia is the _____ condition in the US

Most common blood

Anemia is usually associated with a decreased number of:

Circulating RBCs

Who does anemia affect more

Females

Four types of anemia

1- iron 2- folate 3- hemolytic 4- sickle cell

Pallor, fatigue, low BP, SOB and rapid heart rate are all signs of:

Anemia

What are the oral signs of anemia

Smooth, burning red tongue, bleeding gums, deflated healing, increased infection

Almalgam restorations are higher than the surrounding enamel is a sign of:

Bulimia

Enamel erosion from acidic chemicals (lingual on anterior teeth)

Perimyolysis

Test used to detect bleeding disorders or excessive common disorders; measure how quickly your blood clots

PT test

Patient PT / Control PT x ISI

INR

Low INR indications:

Patient can be at risk for a blood clot

High INR indicated tat the patient could experience:

Bleeding issues

Typically INR for a patient on blood thinners INR in individuals that are not on blood thinner

2-3 1.1 or below