Patient Evaluation

Question 1

Daily blood glucose check correlation to Hb1Ac

Answer 1

• 6% 125
• add 30 to each % increase

Question 2

INR 1-5

Answer 2

• INR 1- normal healthy pt
• INR 2- atrial fibrilation target
• INR 3- Mechanical heart valve
• INR 4- Risk of uncontrolled bleeding
• INR 5- Uncontrolled bleeding
• Ideal INR 2-3
• Heart valve patients should be btw 2.5-3

Question 3

Normal WBC count

Answer 3

4,400-11,000/ mL

Question 4

Normal hematocrit for female and male

Answer 4

• Female 35.9-44.6%
• Male 41.5-50.4%

Question 5

Creatinine Normal levels

Rised creatinine levels indicate

Answer 5

• Normal 0.6-1.2 mg/dL
• Elevated creatinine means impaired kidney function

Question 6

Blood Urea Nitrogen normal

Tells you

Answer 6

• 8-23 mg/dL
• Tells how well the kidney and liver are working

Question 7

Glucose fasting

Answer 7

70-110 mg/dL

Question 8

Pre-medication protocol for IE

Answer 8

• Single dose 30-60 mins before procedure
  
  • Amoxicillin 2g adult
  • Amoxiciliin 50mg/kg children
• Allergic to penicillin
  
  • Cephalexin/ CLindamycin 2g
  • Axithromycin/Clarithromycin 500-600mg

Question 9

Hypertensive range

Dental considerations

Answer 9

• 140/90 hypertensive
• >160/100 but <180/100
  
  • Intraoperative BP monitoring
• Max of 40 mcg epinephrine in single session
  
  • 2 carpules of 1:100,000

Question 10

How to calculate Pulse Pressure and MAP

BP 172/98

Answer 10

• PP= diastolic-systolic
  
  • >60 risk for cardio disease
    
    • 172-98= 74
• MAP= diastolic + 1/3PP
  
  • 70-110 Normal
    
    • 93 - 25=123

Question 11

When is steroid supplementation indicated

Regimen for diff stress

Answer 11

• pts with adrenal insufficiency
• Minor stress
  
  • Prescription is higher than 7.5mg, dbl dose that day
• Moderate stress
  
  • 10-15mg prednisone for 1-2days then taper off
• Major stress
  
  • 20-25mg prednisone 1-2 days then taper off
• Medrol dose pack 21 4 mg pills for 6 days

Question 12

What is ACTH Stimulation test and when is it indicated

Answer 12

• Measures how well adrenal glands respond to ACTH
• Associated with adrenal insufficiency
  
  • Addisons
  • Cushings

Question 13

Dental management for those on Hemodialysis

Answer 13

• tx day after dialysis
• consult physician about AB prophylaxis
• BP monitored
• Potential for bleeding problems, screen bleeding disorders, platelet count, hemotocrit, hemoglobin, anemia status
• Primary intention
• Consider steroid supp if on steroids

Question 14

Dental precautions for uncontrolled hyperthyroidism

Answer 14

avoid epinephrine in anesthetic, gingival packing cord, means to control bleeding