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Oral and Maxillofacial Surgery > Problems Relating to Certain Systemic Conditions > Flashcards

Problems Relating to Certain Systemic Conditions Flashcards

1
Q

What are the components of the surgical sieve?

A 
VITAMIN DIC
V - vascular
I - inflammatory
T - traumatic 
A - autoimmune
M - metabolic
I - infection
N - neoplastic
D - degenerative
I - idiopathic
C - congenital
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2
Q

Is LA safe to use in pregnancy?

A

Yes.

The hormonal mechanism shields the uterus from smooth muscle activators.

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3
Q

What is the biggest danger to a foetus in GA?

A

Anoxia (total depletion of oxygen levels).
Most likely to occur in 3rd trimester as vital capacity of mother’s lungs is decreased and oxygen supply to foetus decreases.

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4
Q

When is the optimum time for a GA in pregnancy

A

2nd trimester

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5
Q

When is the most common time for spontaneous abortion to occur?

A

1st trimester

Increased risk of teratogenic drug effects also.

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6
Q

How would you manage a patient with hyperthyroidism?

A
  • OS or use of LA with adrenaline may precipitate thyroid crisis
  • Delay surgery until GP gives go ahead.
  • GA may be preferable to LA as less upsetting
  • Sedation is contraindicated
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7
Q

What are the causes of adrenal insufficiency?

A 
Primary:
Addison's - autoimmune breakdown of adrenal glands
Secondary:
Long term corticosteroids 
OR
Tumour of pituitary - reduces ACTH
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8
Q

What drugs are prescribed for cortisol and aldosterone replacement?

A

Hydrocortisone

Fludrocortisone

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9
Q

What are the symptoms of adrenal crisis?

A 
Postural hypotension
Weakness
Vomiting
Nausea
Fatigue
Hypoglycaemia
Tachycardia
Weak pulse
LoC
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10
Q

What are the guidelines for steroid cover with regard to adrenal insufficiency?

A

NICE Guidelines:
Pts taking 10mg/day prednisolone (or have done in the last 6 months) should be considered.

  • Minor dental procedures: no cover
  • Medium procedures under LA e.g. RCT: double hydrocortisone dose (up to 20mg) 1 hour before and for 24 hours after
  • Major procedures under LA/GA e.g. XTN: 100mg hydrocortisone IM just before surgery, double dose for 24 hours after
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11
Q

How is the immediate management in adrenal crisis?

A

Crisis = BP below 25% of diastolic

100mg hydrocortisone (IV or IM) alongside saline drip

Adult: 100mg
Child 6+: 50-100mg
Child 1-5: 50mg
Child <1 year: 25mg

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12
Q

Name 3 complications of diabetes mellitus.

A
  1. Diabetic ketoacidosis (Type 1): high blood sugar (really dehydrated) so cell sugar is low and body breaks down ketone bodies instead
  2. Hyperosmolar hyperglycaemic state (Type 2): not as severe as pts have more insulin. Ketone bodies are not broken down

Tx for above: hospital for IV fluids and electrolytes

  1. Hyperglycaemia (both types): symptoms - tremor, anxiety, dry mouth, sweating, hunger, confusion, slurring words, convulsion, LoC

Tx: sugar drink/gel
If LoC: 1mg glucagon IM

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13
Q

How would you manage a patient with diabetes?

A
  • LA with adrenaline is SAFE to use
  • Offer AM appt if possible, ensuring they’ve had breakfast
  • Severe diabetics having longer procedures require GKI (glucose, potassium and insulin infusion)
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14
Q

What are the two types of angioedema?

A
  1. Hereditary - exaggerated response to minor trauma shared by family members
    - due to lack of C1 esterase inhibitor; no complement cascade initiation
    - administration of fresh frozen plasma provides this inhibitor
    - spontaneous angioedematous attacks treated with steroids
  2. Non-hereditary - allergic response to food, drugs, emotional responses
    - if acute reaction occurs treat for anaphylaxis
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15
Q

What is angina?

A

Occurs when partial occlusion of vessels due to atherosclerosis

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16
Q

What are the symptoms of angina?

A

Central, crushing chest pain

Radiates to mandible/arm

17
Q

How is angina treated?

A
  • Place pt upright
  • GTN spray under tongue; 2 sprays every 3 mins
  • Only repeat once, then begin Tx for MI
  • Deliver oxygen 15 l/min CD cylinder
18
Q

How should you manage a pt clinically who suffers from angina?

A
  • Take a full history
  • Use LA without adrenaline if unstable: prilocaine
  • Max 2 cartridges of LA w/adrenaline if stable
  • Ensure they have GTN with them
  • Ensure GTN is in emergency drugs box
  • Consider sedation
19
Q

What is a myocardial infarction?

A

Complete occlusion of coronary arteries by thrombosis, causing ischaemia of the heart muscle

20
Q

What are the symptoms of MI?

A

Same as angina

Plus - nausea and vomiting

21
Q

How would you manage a pt experiencing MI?

A
  • Make pt comfortable
  • 300mg aspirin to chew
  • Oxygen administered 15 l/min
  • Ring 999
22
Q

What is infective endocartitis?

A

Infection of the mural endocardium on the heart valves as a result of bacteraemia

23
Q

What are the risk factors for IE?

A
  • Congenital heart disease
  • Prosthetic heart valve
  • Tetralogy of fallot
  • Previous IE
  • Rheumatic heart disease
  • Huntington’s chorea
24
Q

Would you provide antibiotic cover in a pt with IE?

A

Not routinely given
Liase with specialist
Weigh up risk vs benefit

Stress GOOD OH!
Warn of symptoms:
- Malaise and fever
- Flu symptoms
- SoB
- Chest pain when breathing
25
Q

What is leukaemia?

A

Increased numbers of abnormal or immature leukocytes

26
Q

How should you manage a pt with leukaemia?

A

ALL forms of leukaemia are a contraindication to ANY form of OS

  • Always liase with haematologist
  • Require FBC before XTN
  • Adopt a conservative approach to Tx until in remission
  • Higher susceptibility to infection
27
Q

What are the 3 stages of clot formation?

A
  1. Contraction of blood vessel walls
  2. Plugging of small deficiencies by platelets
  3. Clotting of the blood
28
Q

What can cause prolonged bleeding time?

A
  • Vascular damage prevents the arrest by contraction of cut vessel walls
  • Platelet abnormalities where there is ineffective plugging of small deficiencies
29
Q

What are the 2 kinds of platelet abnormalities?

A
  1. Thrombocytopaenic purpura - low platelt count e.g. leukaemia

<100 x 10 9/L - use local haemostatic measures
<50 x 10 9/L - do not treat

  1. Thrombocythaemic purpura - platelet count is raised (related to polycythaemia - raised RBC count)
30
Q

What factor is insufficient in Haemophilia A?

A

Factor VIII - males only

31
Q

What coagulation disorder is also known as Xmas disease?

A

Haemophilia B - Factor IX insufficiency

Males only

32
Q

What should you check in patients treated with anticoagulant drugs?

A

INR - should be less than 4

Clot may be stabilised with Surgicel (oxidise cellulose)

33
Q

What are some oral presentations of HIV/AIDS?

A
  • Oral candidosis
  • Oral hairy leukoplakia
  • Kaposi’s sarcoma
34
Q

What classification is used to assess the fitness of patients before surgery under RA/GA?

A

ASA Classification
I - normal, healthy individual
II - mild systemic disease that doesn’t limit activity
III - severe systemic disease that isn’t incapacitating
IV - Incapacitating systemic disease; life-threatening
V - Moribund

Oral and Maxillofacial Surgery (2 decks)

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