Brainscape's Knowledge GenomeTM

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


See full index

BDS3 - Paediatrics > The Impact of Medically Compromising Conditions > Flashcards

The Impact of Medically Compromising Conditions Flashcards

1
Q

what are the 2 types of congenital heart disease

A

○ Cyanotic

○ Acyanotic

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

give examples of cyanotic congenital heart disease

A

§ Fallot tetralogy

§ Transposition great arteries TGA

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

give examples of acyanotic congenital heart disease

A 
§ Ventricular Septal Defect
§ Patent Ductus Arteriosus
§ PS
§ ASD
§ Coarctation of Aorta
§ Atrial Septal Defects
§ VSD,PDA,PS,ASD,CoA,AS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

what is the aetiology of congenital cardiovascular disease

A

○ Maternal rubella

○ Maternal diabetes

○ Maternal drugs – alcohol, phenytoin

○ Foetal chromosomal abnormality- Down syndrome

○ Foetal inborn errors of metabolism and connective tissue disorder-Williams syndrome

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

how does congenital heart disease affect dental treatment

A

• Importance of good oral hygiene in preventing infective endocarditis

• Follow NICE Guidelines
○ Any doubt consult cardiologist

  • Anticoagulant medication
  • Treatment under sedation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

what should you not say to a patient with Down’s syndrome

A

○ Suffers from OR is a victim of Down’s Syndrome

○ A Down’s baby / person / child

○ Retarded / mentally handicapped / backward / mental disability

○ Disease / illness / handicap

○ The risk of a baby having Down’s syndrome (in relation to pre-natal screening and probability assessments)

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

what should you say to a patient with Down’s syndrome

A

○ Has Down’s Syndrome

○ A person / baby / child with Down’s syndrome or who has Down’s syndrome

○ Learning disability

○ Condition OR genetic condition

○ The chance of a baby having Down’s syndrome

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

what are clinical features of Down’s syndrome

A
  • Congenital heart lesions in 50% - ASD,VSD AV canal
  • Duodenal atresia
  • Atlantoaxial instability
  • Umbilical hernia +/- absence of a rib

• Immunological defects affecting skin, GIT, RespTracts
○ eg. periodontal destruction seen in mouth

  • ALL 20x more common
  • Increased risk hypothyroidism and Alzheimers
  • Classical Clinical features
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what are oral manifestations seen in Down’s syndrome

A

• Mouth
○ small, open lip posture

• Tongue
○ protrusive , fissured tongue. Circumvallate papilae may be enlarged and filiform absent

• Lips
○ thick, dry, fissured

• Occlusion
○ AOB, post x-bite,Class III

• Palate
○ high. Bifid uvula and CLP more common

• Teeth
○ eruption delayed, hypodontia, microdontia, hypoplasia, low caries incidence.

• Periodontium
○ immunological defect of white cell chemotaxis may cause severe early onset disease.

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

what is the oral and dental management of patient’s with Down’s syndrome

A
  • Preventive protocol
  • OH- modify toothbrush handle or electric?
  • Advice about oral hygiene reiterated in congenital heart disease
  • Treat under LA if compliance allows
  • Chlorhexidine gel or mouthwash specifically for periodontal disease
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what is the impact of Down’s syndrome

A
  • Development (like all children they benefit from high expectations, social inclusion is key).
  • Speech and Language – delayed speech, easy read resources
  • Motor skills
  • Social Development
  • Memory skills
  • Education-Most benefit from being in mainstream school, everyone will have some degree of learning disability.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

how can asthma affect dental treatment

A
  • Excess mucus production
  • Inflammation of epithelial lining of airways
  • Increased bronchial smooth muscle tone
  • Anxiety and stress can precipitate
  • Asthma medication side effects
  • Adrenal suppression
  • Avoid aspirin and other NSAID’s such as Ibuprofen or Diclofenac for pain relief
  • Allergy to penicillin more common
  • IS (mild/mod) rather than IV sedatives (resp failure)
  • GA risk
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

how can GA affect respiratory conditions

A

• Mild
○ ASA II
○ outpatient GA

• Moderate
○ ASA III
○ inpatient GA

• Severe
○ ASA IV
○ inpatient GA

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

what are oral impacts of asthma

A
  • Inhaled corticosteroids ?
  • Inhaled beta-2 agonists
  • Palatal erosion

• Acidic inhalers
○ not proven

• Dryness of mouth
○ increased intake of acidic beverages

• Laxity of lower oesophageal sphincter
○ reflux of gastric acid

• Chronic cough at night
reflux of gastric acid

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

what can be said about asthmatics

A

Asthmatics are atopic individuals and may have other allergies.
Eg. nuts, latex, drugs.

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

what is the impact of asthma in nursery and childcare

A

○ Asthma policy (most children not diagnosed until around 5 years)
○ Avoidance of triggers (animal fur/smoke/pollen)
○ Individual healthcare plans in place

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

what is the impact of asthma at primary school

A

○ Asthma action plan (diagnosis, typical symptoms, ask for help, tummy ache, go silent??)
○ Communication (how serious -3 children die every year)
○ Where will reliever inhaler be kept (often blue)

Asthma UK

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

what is the impact of asthma at secondary school

A

○ Encourage your child to take more control
○ You and your child meet with school (school nurse, sports teacher)
○ Asthma action plan (discuss)
○ The autumn term (rise in children rushed to hospital)

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

what is the impact of asthma with exercise

A

As normal but be prepared with asthma action plan on fridge, your phone and their phone.

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

what is the impact of asthma with travel

A

Weather, altitude, physical activity, air travel, accommodation

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

how does cystic fibrosis arise

A

• Autosomal recessive long arm chr 7
○ Exocrine system affected in respiratory system (thick mucous) and digestive tract (lack of pancreatic lipases)
Diabetes, Liver cirrhosis, Reproductive problems with age

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

what bacteria are common in recurrent chest infections in patients with cystic fibrosis

A

P.aeruginosa and S.aureus

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

what are oral manifestations of cystic fibrosis

A
  • Saliva - thickened
  • Caries may be reduced (? Higher salivary ammonia)
  • Higher calculus levels
  • Lower plaque and gingival disease
  • Enamel defects
  • Delayed eruption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is the dental management of cystic fibrosis

A
  • GA risk
  • Diabetes and Liver disease
  • Sedation contraindicated – resp failure
  • Diet advice (high sugar intake)
  • Sugar free liquid antibiotics
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

what can cystic fibrosis impact

A
  • Nutrition
  • Treatment
  • Travel
  • Physiotherapy
  • School
  • Higher education
  • Transition
  • Fertility and Pregnancy
  • CF at work
  • Cross Infection
  • Transplant
  • Combination therapies
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

what are the treatment modalities for childhood cancer

A
  • Chemotherapy - C/T
  • Radiotherapy - R/T
  • Surgery
  • High dose therapy with bone marrow rescue - BMT
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

what are the general side effects of chemotherapy

A
  • Bone marrow suppression: Hb, WCC, PLT
  • Immunosuppression
  • Anorexia
  • Nausea and vomiting
  • Gut mucosal damage
  • Alopecia
28
Q

what are acute complications of childhood cancer

A
  • oral mucosa
  • haemorrhage
  • infection
  • saliva
  • sialadenitis
  • taste loss
  • dysphagia
  • oral flora
  • gingiva
  • tooth sensitivity
  • tooth mobility
  • toothache, headache, bone pain
  • trismus
  • soft palate
  • dry lips
  • halitosis cacogeusia
  • glossitis
  • parasthesia
  • GvHD
29
Q

when do ulcers usually occur after radiotherapy treatment

A

Onset 12-15 days after R/T

30
Q

when do ulcers usually occur after chemotherapy treatment

A

onset 3-10 days after C/T

31
Q

in cancer, where is mucositits usually localised

A

Mucositis often localised to oropharynx

32
Q

what do stomatitis develop as

A

Stomatitis develops as burning which within 1-3 days develops into ulceration

33
Q

what supportive treatment can be given to a child with ulceration and mucositis

A

○ Sodium Bicarb – 2 hourly
○ Gelclair- 2 hourly
○ Biotene (Oral Balance)mouthrinse – 2 hourly
○ Difflam mouthrinse or spray – 2 hourly
○ Lignocaine 2% solution/ice lolly-b4 meals/2hrly
○ Benzocaine 20% flavoured gel – b4 meals
○ Orabase+/- corticosteroid –between meals
○ Tetracycline oral suspension –1min spat out QDS

34
Q

what does biotene mouthwash and toothpaste do

A

• Moisturises oral mucosal cells
• Antibacterial effect of proteins
• Reinforces antibacterial activity of saliva
• Contains Xylitol which inhibits bacteria
• Triple enzyme formula: lysozyme;
○ lactoperoxidase; lactoferrin.
• Contains fluoride, glucose oxidase, aloe vera

can be used to treat ulceration and mucositis

35
Q

what can chemotherapy or bone marrow transplant cause

A

○ Anaemia
○ Thrombocytopenia
○ Leucopenia

36
Q

when can spontaneous gingival haemorrhage occurs

A

Spontaneous gingival haemorrhage when platelets < 20-30 x 109/L

37
Q

how are haemorrhages managed

A
  • Eliminate hard foods
  • Smooth sharp cusps and fillings
  • Never use salicylates for pain
  • Platelet count > 80 (40-100) x 109/L for all injections, extractions, deep scaling.
  • Time treatment to normal platelet count
  • Do not neglect
  • Liaise with physician
38
Q

what oral infections can chemotherapy cause

A 
• Leucopenia
• Inhibition of antibody responses
• Block of the mononuclear phase of inflammation
• Abolition of delayed hypersensitivity
• Oral infections:
	○ Viral, Fungal, bacterial
39
Q

what is the treatment for a viral oral infection

A

Viral (H.Simplex)
○ Acyclovir 5% cream 5xday5days
○ Acyclovir 400mg/10ml 5xday5days
○ ( under 2 yrs ½ dose)

40
Q

what is the treatment for a bacterial oral infection

A

Bacterial – G-ve bacilli
○ systemic antibiotics
○ lozenges with polymixin,
○ tobramicin

41
Q

what is the treatment for a fungal oral infection

A 
○ Candida
• nystatin 100,000units 5mls QDS
• miconazole gel 25mg/ml 5ml QDS
• fluconazole 50mg/ml. 50mg caps OD
• itraconazole, ketoconazole

○ Aspergillus
• systemic antifungal

○ Phagomycosis
• systemic antifungal

42
Q

is chronic renal failure more common congenitally or acquired

A

Congenital and familial more common than acquired

43
Q

what is the impact of renal disease

A

• Coping with feeding problems

• Some babies and children with Chronic Kidney Disease (CKD) struggle with feeding or eating.
○ Children are more likely to be happy feeders if they sense that their parent is calm and relaxed.

• You may wish to talk to someone – a family member, friend or healthcare professional – to help manage your anxiety away from your child.
○ This will help you to stay calm and in control, without leaving you feeling that you will raise your voice or force feed your child.

• More about coping with feeding problems

• Feeding devices
○ Some babies and children cannot eat and drink the amount they need for their growth and development.
○ If needed, they can be fed through a tube.
○ All or some of their nutrition – and water and medicines, if needed – can be given through a nasogastric tube, a gastrostomy tube or gastrostomy button.

44
Q

what oral findings are associated with chronic renal failure

A
  • Excessive plaque accumulation
  • Gingivitis & bleeding
  • Gingival overgrowth
  • Enamel hypoplasia
  • Some develop periodontitis
  • Osseous changes
  • Pulp obliteration
  • Pallour, petechiae, ecchymosis
  • Uraemic stomatitis
  • Reduced caries
45
Q

what dental considerations are there with chronic renal failure

A
  • Bleeding tendencies and haemostasis
  • Treatment: day after dialysis
  • Infections can be poorly controlled
  • Signs of inflammation can be masked
  • Increased risk blood borne viral infections
  • Osseous lesions may be seen jaws; lamina dura thinning, osteolytic lesions, giant cell lesions.
46
Q

what dental aspects need to be considered with chronic renal failure

A
  • Local anaesthetic ok but consider bleeding issues
  • Inhalational sedation ok
  • IV sedation – careful of veins, midazolam less risk thrombophlebitis
  • Careful management for general anaesthetic
  • Consider underlying diseases such as hypertension, diabetes & SLE
47
Q

what medical treatment is given to patients with chronic renal failure

A
  • Benzylpenicillin potassium content, neurotoxicity.
  • Give lower doses of penicillin’s (except flucloxacillin & phenoxymethyl pen), metronidazole and cephaloridine to avoid toxicity CNS
  • Erythromycin, cloxacillin & fucidin normal dose
  • Care with tetracyclines – doxycycline & minocycline ok within usual dental constraints
  • Consider antimicrobial prophylaxis for surgery
  • Consult renal physician
48
Q

when is a renal transplant carried out and why

A
  • Due to chronic renal failure
  • From 2 years old onwards
  • Graft survival 85% after 2 years (5)
  • Life long immuno-suppression
  • Prevention of T-cell allo-immune rejection
  • Usually with corticosteroid plus steroid sparing drug
  • Careful pre-op dental assessment
  • Removed sources infection
  • Maximal preventive efforts
  • Defer elective treatment 6/12 after surgery
  • Consider antibiotic prophylaxis within that time
  • Renal graft survival 5 years 70% (2)
  • Patient survival 1 year post transplant 95-98% (2)
49
Q

what needs to be considered about dental treatment with a renal transplant

A
  • Consult paediatric nephrologist
  • Ask about graft function & degree of suppression
  • Modify drug dosage according to degree renal function
  • Prednisolone regimen – consider steroid cover
  • Frequent dental recall for preventive care
  • Consider change to tacrolimus from cyclosporin (less gingival overgrowth)
50
Q

what are early clinical features of diabetes mellitus

A 
• Classic Triad of symptoms
○ Polyuria (produce abnormally large volumes of urine)
	§ (Frequent need for toilet)
○ Polydipsia (great thirst)
○ Recent weight loss
  • Pruritus
  • Weakness
  • Fatigue
  • Polyphagia
  • Constipation
  • Mental confusion
  • Acetone breathe
51
Q

what are late clinical features of diabetes mellitus if they are undiagnosed

A
  • Vomiting, nausea, abdominal pain
  • Renal dysfunction
  • Hyperventilation – metabolic acidosis
  • Dehydration
  • Hypovolaemia
  • Pasasthesia(extremities)
  • Dysaesthesia
  • Gastrointestinal neuropathy
  • Muscle wasting
  • Shock
  • Coma
52
Q

what are oral manifestations of diabetes mellitus

A
  • Reduced salivary flow
  • Xerostomia
  • Burning mouth/tongue
  • Candidal infection
  • Altered taste
  • Progressive periodontitis
  • Dental caries
  • Oral neuropathies
  • Parotid enlargement
  • Sialosis
  • Delayed wound healing
53
Q

what are the features of a hypo coma in a patient with diabetes mellitus

A
  • Mood change, irritability
  • Strong bounding pulse
  • Nausea and stomach ache
  • Hunger
  • Shaking, tingling around mouth
  • Increased gastric motility
  • Hypothermia
  • Disorientation
  • blurred vision
  • Lethargy
  • slurred speech
  • Sweaty skin
54
Q

what are the features of a hyper coma in a patient with diabetes mellitus

A
  • Weak pulse
  • Rapid deep breathing (Kussmaul’s respiration)
  • Dry skin
  • Acetone breath
  • Increased frequency of micturition (to want to urinate)
  • Thirst
  • Severe hypotension
  • Abdominal pain and vomiting
  • Loss of consciousness (diabetic coma)
55
Q

what is GI

A

Glycaemic Index (GI) is a ranking of carbohydrate-containing foods based on the overall effect on blood glucose levels

56
Q

how can diabetes be managed

A
  • Support from other people
  • (Parents, siblings, extended family) who looks out for signs of hypo/hyper
  • Taking control: set goals (HbA1c)
  • carb count and insulin adjustment
  • Health eating
  • Recording test results
  • Being vigilant for infection (examine your feet)
  • Know the sick day rule
  • Eeffect stress/infection/temp
  • Wear identification in case of emergency
  • Getting active and staying active
  • Affect of alcohol on sugar levels
57
Q

how can hypos be stopped with physical activity

A

○ You could reduce your dose of insulin and increase the amount of food you eat beforehand. Talk to your nurse or doctor about this.

○ Check your blood glucose before, and after activity, and maybe during the activity as well.

○ Changing your injection sites may help.

○ Always keep something sugary nearby, such as glucose tablets, in case you feel hypo.

58
Q

what is the cause of primary epilepsy

A

Primary

no cause found

59
Q

what is the cause of secondary epilepsy

A

○ first year
§ Congenital
§ Birth trauma

○ later
§ Meningitis
§ Encephalitis
§ RTA

60
Q

what is self management of epilepsy

A

• Self-management of epilepsy includes everything you do that helps you manage your seizures and their effects on your daily life.
○ It doesn’t mean you manage epilepsy all by yourself.

• To manage seizures, you’ll need to work together with your health care team and your family.
○ Everyone on your epilepsy team has a different role:

• Your doctor and health care team diagnose and recommend treatment for your seizures.

• You and your family bring your voices and experiences to the team.
○ Information you have helps your doctor make the right diagnosis, recommend tests or treatments, and refer you to other doctors or resources that may help you.

• You’re the one who has to live with your seizures, today and every day.
○ How epilepsy affects you and your family will influence your doctor’s recommendations and your choices.

61
Q

how can you reduce the risk of seizures

A
  • One good way of making life safer is to do everything you can to not have seizures.
  • Here are some ways to keep seizures to a minimum.
  • If you know there are things that trigger your seizures, try to avoid them
  • Find ways to deal with stress, when you can’t avoid it altogether.
  • Try to have regular sleeping patterns.
  • Don’t forget to take your epilepsy medicine.
  • Never run out of your epilepsy medicine.
62
Q

what are common emotional problems associated with epilepsy

A

○ Anxiety
○ depression
○ low self-esteem
○ a lack of confidence

Children show emotional distress in different ways from adults.
Mood swings, irritability and frequent temper outbursts can be signs of anxiety or stress, especially in young or developmentally delayed children.

63
Q

what injuries can be caused by an epilepsy fit

A

○ Soft tissue laceration of tongue or buccal mucosa
○ Facial fractures
○ Trauma to teeth
○ TMJ dislocation

64
Q

what injuries can be caused by drug therapy

A

○ Gingival hyperplasia
○ Recurrent aphthous like ulceration
○ Anomalous development – small teeth, delayed eruption
○ Cervical lymphadenopathy

65
Q

what is the dental and oral management of epilepsy

A
  • Prevent pain
  • Prevent infection
  • Treat any trauma due to fits
  • Try to retain natural teeth
• Seizure:
○ Recovery position
○ Diazepam up to 10mg
○ Oxygen
○ Call ambulance
66
Q

what are congenital coagulation defects

A

○ Haemophilia A
○ Haemophilia B
○ Von Willebrands Disease
○ Single clotting factors eg. XI and XII

67
Q

what are acquired coagulation defects

A 
○ Vit K deficiency(liver disease)
○ Clotting antibodies
○ Stored blood transfusions
○ Anticoagulant drugs eg. warfarin
○ DIC-Diffuse Intravascular Clotting eg.meningococcal septicaemia

BDS3 - Paediatrics (20 decks)

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