Therapeutics and effects management Flashcards
What is a good system for taking a history?
- PCO
- HPC - chronology is important
- PMH - systems; pt often tertiary referral; prev. XLA; bleeding
- DH
- SH - often overlooked; includes drugs, alcohol, smoking; liver function
- FH
- NKDA?
What are the first few steps when history taking: before the actual history?
- Introduce yourself
- Ask permission!
- Explain what you propose to do
- Acquire consent for action
What are the important chronological points for the HPC (history of presenting complaint)?
- Described in patient’s own words
- Get timeline
- Other clinicians
- Previous investigations
- Patient’s own thoughts and disposition!
What are the seven important questions to ask for the history of lesion?
- When did you notice it?
- Were there any predisposing events?
- Why did these events occur?
- Has it changed?
- How does it bother you?
- Are there any other lumps?
- What investigations/treatments have you had in the past for this lesion?
What are some questions to gain the history of an ulcer?
- Is this part of a recurrent pattern of ulceration?
- Is this an isolated ulcer?
What are some important questions necessary to obtain a drug history?
- List all the medication the pt is currently taking
- List important drugs that have previously been taken
- Doses and durations of tx
- Over-the-counter medications
- Drug allergies (also state if none)
When you are inspecting a pt where should you look?
The entire head and neck region
How should you palpate a pt?
- Palpate from behind
- Are their any painful areas?
- Use bimanual palpation
Give some examples of variations in normal oral anatomy.
- Fordyce spots
- Tori
What characteristics of an ulcer should you examine?
- Base
- Firmness
- Edge
- Painful response
- Local tissues
- Regional lymph nodes
What are two examples of histopathological investigations?
- Histopathology
- Direct immunofluorescence
What information does a full blood count provide?
Haemoglobin (Hb); mean cell volume (MCV); lymphocyte count; neutrophil count; platelet count
What are the oral manifestations of anaemia?
- Atrophic glossitis
- Angular cheilitis
- Apthous-like ulceration
- Dysaesthesia
What is atrophic glossitis and give an example of when it can manifest?
AKA Bald tongue, smooth tongue: a condition characterised by a smooth glossy tongue that is often tender/painful caused by complete atrophy of the lingual papillae (depapillation). Dorsal surface can be affected totally or in patches and may be associated with a burning sensation.
What is angular cheilitis?
Inflammation of one or both corners of the mouth - cheilitis is inflammation of the lips.
What is aphthous-like ulceration?
Idiopathic ulcers that cannot be defined as present due to an underlying cause - their definition can change if systemic disease is found.
What is dysaesthesia?
Abnormal sensation.
What information does a prothrombin time (PT) coagulation blood test provide?
- Warfarin Rx (receipt)
- Liver disease
What information does an activated partial thromboplastin time (APTT) coagulation blood test provide?
It is used to test for defects of the clotting system e.g. heparin therapy
Why is it important to notice and question submucosal bleeding?
Indications of pt health/medication etc
What biochemical blood tests can be performed?
- Liver function test
- Random blood glucose
- Haematinic assays
- CRP
What immunological test can be performed?
- Autoantibodies
- Immunoglobulin levels
- Electrophoresis
- Complement levels
What are some microbiological investigations for infection? Direct lesional sampling and serum based assays.
Direct lesional:
- Swab for culture and sensitivity
- Swab for PCR
- Tissue biopsy
Serum based assays:
- Serology
What is hairy leukoplakia? What can it be caused by? What is a diagnostic factor? Is it benign?
White area of keratosis on the tongue with a corrugated or hairy appearance. Can be caused by Epstein-Barr virus, smoking and occurs usually in people who are immunocompromised. The white lesion cannot be scraped off (firmly attached to underlying mucosa); benign; usually used to diagnose underlying problems.
