General Medicine

Question 1

What are the cornerstone of medical evaluation?

Answer 1

1. History taking
2. Examination
3. Special investigation

Question 2

Why is rheumatic fever something we should worry about?

Answer 2

In some instances, rheumatic heart diseases may be exacerbated by increased bacteremia during certain dental procedures

Question 3

What are some of common conditions should we worry about in terms of the cardiovascular disease section of the medical history?

Answer 3

1. Heart failure
2. Acute Myocardial Infraction
3. Hypertension - high blood pressure
4. Congenital Heart Disease - bacterial endocarditis
5. Arrhythmias - related to heart failure and blood thinners

Question 4

What is important aspects to assist a patient with general stress?

Answer 4

1. Open communication about fears and concerns
2. Short appoitment
3. Mornign appoitment
4. Ensure profound local anaesthesia
5. Need to provide adequate post-operative pain control
6. Post-procedure telephone call

Question 5

What are some of common conditions should we worry about in terms of the blood disorders section of the medical history?

Answer 5

1. Inherited bleeding disorders - haemophilia
2. Anaemia
3. Leukemia or blood dyscrasias
4. Blood thinners

Question 6

What are some of common conditions should we worry about in terms of the respiratory tract disease section of the medical history?

Answer 6

1. Asthma
2. Chronic obstructive airways disease
3. Tuberculosis
4. Sleep apnea or sleep disordered breathing

Question 7

What are some of common conditions should we worry about in terms of the neurological disorders disease section of the medical history?

Answer 7

1. Stroke
2. Epilepsy, seizures and convulsions
3. Behavioral/psychiatric disorders

Question 8

What are some of common conditions should we worry about in terms of the endocrine disease section of the medical history?

Answer 8

1. Diabetes - type I and type II
2. Thyroid disease - uncontrolled hyperthyroidism and stress sensativity

Question 9

What are some of common conditions should we worry about in terms of the genitourinary tract disease section of the medical history?

Answer 9

1. Kidney disease - abnormal drug metabolism
2. Sexually transmitted disease - HIV, Hep b and C

Question 10

What are some of common conditions should we worry about in terms of the muscuskeletal disease section of the medical history?

Answer 10

1. Arthritis - relating to TMJ and use of NSAIDS
2. Prosthetic joints

Question 11

What are some of the other conditions to look out for when conducting a thorough medical history?

Answer 11

1. Tobacco and alcohol use
2. Drug addiction and substance abuse
3. Cancer treatment
4. Use of steroids
5. Pregnancy
6. Previous operations or hospitalisations

Question 12

What is considered to be normal blood pressure?

Answer 12

Any blood pressure where the systolic (first reading) is below 120 and diastolic (second reading) is below 80 e.g. 119/79

Question 13

What is INR?

Answer 13

International Normal Rate is a test that identifies potential blood clotting issues by comparing them to an international norm (with 1 being norm and everything above is considered to be worst clotting = more bleeding)

Question 14

What are the basic drugs and equipment that should be available at every dental practice required by law?

Answer 14

Drugs:
1. Oxygen
2. Adrenaline
3. Glucose
4. Bronchodilator
5. Aspirin
6. Hydrocortisone

Equipment:
1. Blood pressure monitor
2. Glucose monitor
3. Pulse oximeter
4. Automated external defibrillators
5. Laryngeal airways

Question 15

What is syncope, what’s it’s causes and how do we manage it?

Answer 15

Syncope - transient self-limiting loss of consciousness. The onset is rapid and spontaneous and complete. Has presyncope phase of light-headed, nauseated, anxious and pale.

The underlying mechanism - cerebral hypoperfusion - i.e. low oxygen levels

Causes:
Vasovagal
Orthostatic
Cardiac dysrhythmias
Cardiac disease

Managmenet:

1. Stop treatment
2. Lie the patient down
3. Support airway by removing all object for the mouth
4. Measure the patient’s blood pressure and heart rate
5. If the patient does not regain consciousness - call 000 begin DRSABCD

Question 16

What are coronary ischaemia syndromes?

Answer 16

They are syndromes that result from coronary artery obstruction.

The main two that we should worry about are:

1. Angina - cuases by temporary myocardial infraction from demand for more blood flow. It typically present as crushing central chest pain, radiating to left arm, neck of jaw
2. Acute myocardial infraction - should be suspected if chest pain is unrelieved by nitroglycerin

Question 17

What is the protocol of action if you suspect the patient having coronary ischaemia syndromes in chair?

Answer 17

1. Stop treatment
2. Measure: blood pressure, heart rate and pulse oximetry
3. Assess consciousness
4. To relieve symptoms use glyceryl as instructed, call the registered nurse

If patient reports pain to be THE WORST EVER DO:
1. Call 000
2. Give glyceryl to a patient with previous history of angina
3. Give aspiring 300 mg orally
4. Measure: blood pressure, heart rate and pulse oximetry
5. Start supplemental oxygen - call registered nurse
6. Provide reassurance
7. If patient loses consciousness - start DRSABCD protocol

Question 18

What is cardiac arrest, what are signs and causes, what is the management of the patient?

Answer 18

Cardiac arrest is the stop of heart function.

Signs: no pulse, loss of consciousnes and respiration

Causes: ventricular tachycardia, ventricular fibrillation, asystole

Managment:
1. Stop dental treatment
2. Call 000
3. DRSABCD

Question 19

What are the different severity of an asthma attack?

Answer 19

1. Moderate/mild: Saturation level of oxygen in blood abover 94%
2. Severe: Oxygen saturation of 90-94%
   Life-threatning: oxygen saturation of less than 90%

Question 20

What is the management of mild or moderate asthma?

Answer 20

1. 4 puffs of slabutamol inhaler, 1 puff at a time, shaken before each puff
2. Ask the patient to take 4 breaths in and out of the spacer after each puff
3. Wait 4 minutes
4. If no imporvement - repeate
5. If no improvement again - define this as a sever or life-threatening attack

Question 21

What is the management of sever or life threatening asthma attack?

Answer 21

1. Call 000
2. Start oxygen and airway support
3. Salbutamol - 12 puffs for 6+ years, 6 puffs for less than 6 year olds
4. 1 puff at a time, 4 breaths in between
5. When waiting for help - perform the protocol every 20 minutes
6. If patient is worsening - continuously administer salbutamol

Question 22

What are the signs of partial airway obstruction?

Answer 22

1. Wheeze
2. Stridor (noisy inspiration
3. Laboured breathing
4. Coughing spasms
5. Cyanosis

Question 23

What are the signs of complete obstruction of the airways?

Answer 23

1. Inability to breath, speak, cry or cough
2. Agitation, gripping of the throat
3. Cyanosis
4. Bulging of the neck veins
5. rapid development of respiratory failure
6. Loss of consciousness

Question 24

What are the steps of management if an inhaled object appears to have fallen down the oropharynx?

Answer 24

1. Stop dental treatment
2. Check for object location
3. If not found, put the patient into an upright position
4. Refer the patient for further medical assessment

Question 25

What are the steps of management if the patient is conscious with signs of airway obstruction?

Answer 25

1. Call 000 2. Reassure the patient and ask them to relax, breete deeply and try to dislodge the object by coughing 3. If coughing is ineffective - give upto 5 back blows between the shoulder blades - check between each hit 4. If the back blows dont work, do 5 chest thrust similar to CPR 5. Continue until assistance arrives

Question 26

What are the steps of management if the patient is unconscious with signs of airway obstruction?

Answer 26

1. Call 000 2. Inspect the back of the throat for foreign object 3. Start DRSABCD 4. Consider performing cricothyroidotomy 5. DO NOT DO THE HEIMLICH MANOEURVE

Question 27

What are the sings and symptoms of stroke?

Answer 27

1. Transient loss of consciousness 2. Difficulty of moving one side of the body 3. Confusion 4. Difficulty speaking

Question 28

What are the steps to managing a patient with a stroke?

Answer 28

1. Stop dental treatment 2. Call 000 3. Measure: blood pressure, heart rate and pulse oximetry 4. Start oxygen and airway support 5. Monitor vital signs

Question 29

What is the management of seizures?

Answer 29

If history of epilepsy or seisures is present - please use a bite block on the patient 1. Stop dental treatment 2. Ensure patient is not in danger 3. Turn the patient to the side 4. Avoid restrainning 5. Wait until seizure stops 6. Maintain airways 7. Assess the patient 8. If still unconscious, call 000 and maintain airways

Question 30

What to do if you given the patient a partial paralysis of priocular muscles because of the injection intro the parotid plexus?

Answer 30

1. Stop administratioe patchn of local anaesthetic 2. Explain what happened 3. Tell the patient to not rub their eye 4. Close the eye with an eye patch 5. Keep the patient under observation until the ability to blink starts to return 6. Advise patient not to drive 7. Phone the patient in 12 hours and make sure the issue resolved - if not refer for extra medical care

Question 31

How to manage a person with hypoglycaemia?

Answer 31

1. Stop dental treatment 2. Give 15 g of glucose or a similar drink or food 3. Measure blood glucose - if does not return to normal - repeat the dose 4. If after 3 doses normal blood sugar not returned - call for help 5. If unconscious call 000 than DRSABCD

Question 32

How to manage a person with hyperglycaemia?

Answer 32

Call 000

Question 33

When does an addisonian crisis occur and how to manage it?

Answer 33

Usually occurs in patient with hyperthyroidism or use of corticosteroids 6-12 hours after surgica; stress Managment: 1. Call 000 2. Give hydrocortisone 200 mg 3. Think about GIVING MORE STEROID BEFORE PROCEDURES

Question 34

What is step by step management of mild urticaria or angiodema?

Answer 34

1. Stop dental treatment 2. Remove or stop administration of the allergen 3. Recommend oral anti-histamine

Question 35

What is step by step management of extensive urticaria or angiodema ro swelling involving eyelids, lips or tongue?

Answer 35

1. Stop dental treatment 2. Remove or stop administarion of the allergen 3. Refer for urgent medical attention; systemic corticosteroids may be indicated

Question 36

What is step by step urticaria or angiodema with associated hypotension and evidence of anaphylaxis?

Answer 36

1. Stop dental treatment 2. Remove or stop administration of the allergen 3. Call 000 4. Give intramuscular injection of adrenaline

Question 37

What is the step by step management of a patient with anaphylaxis?

Answer 37

1. Stop dental treatment 2. Remove or stop administration of the allergen 3. Lie patient flat 4. Give an intramuscular injection of adrenaline 5. Call 000 6. Start supplemental oxygen and airway support if needed 7. DRABCD 8. Repeat adrenaline every 5 minutes

Question 38

What are the 5 most common and important cardiovascular diseases we should know about?

Answer 38

1. Congestive heart failure 2. Ischaemic Heart disease 3. Cardiac arrhythmias 4. Venous thrombosis 5. Infective endocarditis

Question 39

What is congestive heart failure, what is the aetiology and clinical features?

Answer 39

Definition: it is the inability of the heart, working at normal pressure, to pump enoughblood to meet the oxygen requirements of the body. Results from many diseases Aetiology: mostly results from myocardial infreaction Clinical features: tachycardia, neck vein distension, hepatic enlargement

Question 40

What are potential ways to treat congestive heart failure?

Answer 40

1. Treatment of systolic dysfunction with digoxin 2. Reducing after-load on the heart with vasodilators like ACE inhibitors 3. Reducing pre-load with diuretics and sodium restriction

Question 41

What is atherosclerotic coronary artery disease, what is the aetiology and clinical features?

Answer 41

Definition: it is the focal narrowing of the coronary arteries as a result of the proliferation of smooth muscle cells and deposition of fats, The basic lesion is known as plaque. Aetiology: the response to injury theory 1. Some injurious stimulus causes enodthelial damage - the chemical released during the damage cause proliferation of smooth muscle and migration of macrophages into the vessel wall - the damaged endothelium becomes more permeable to lipid and cholersterol into the intima 2. These changes result in plaque formation, which becomes more disrupted leadin to platelets being activated and thrombus formation resulting in worsening obstructions Clinical features: 1. Angina pectoris - chest pain or pressure caused by myocardial ischaemia 2. Myocardial infraction - necrosis of myocardial tissue

Question 42

What are potential ways to treat angina?

Answer 42

1. Non-pharmalogical - standard lifestyle changes 2. Revascularization - coronary artery bypass grafting or other surgeries 3. Pharmacological treatment - beta blocker, nitrates, calcium channel blockers or other Important to know that treatment for unstable angina patient can not be treated - please talk to the cardiologist. If it is healthy - it is just important to tak ethat and potential medication into account. Timing is key in treatment - really stop and think about signs and sympotms of MI vs angina and get the to the hospital

Question 43

What is atherosclerotic cardiac arrhythmias, what is the aetiology and clinical features?

Answer 43

Definition: refers to any variation in the normal heartbeat, includes disturbances of rhythm, rate or the conduction pattern of the heart Aetiology: 1. Atrial tachycardia (popular treatment is oral anticoagulants): 1. Regular - Sonus tachycardia: physiological increase in the sinus rate above 100 bpm. Secondary to a disease process 2. Irregular - Atrial fibrilation: Irregurlarly irregular atrial rythm. Causes include stress, fever, MI 2. Ventricular tachycardias: 1. Regular - ventricular tachycardia: regular rhythm that occurs paroxysmally and exceeds 120 bpm. If sustained is a life threatening and leads to ventricular fibrilation - cardiac arrest 2. Ventricula fibrillation: is a characterised by disordered contraction of the ventricles and therefore no cardiac output. Death unless conversion to an effective rhythm is accomplished.

Question 44

What is atherosclerotic venous thrombosis (deep venous thrombosis), what is the aetiology, predisposing factors and clinical features?

Answer 44

Definition: DVT occurs when a blood clot forms in the lower extremities or the pelvic veins. The exact aetiology in unknown. Thrombi can become pulmonary emboli, this tendency is pronounced for clots above the politeal fossa. Predisposing factors: varicose veins, immobilisation Clinical features: Unilateral leg pain and swelling, tenderness, increase in the circumference

Question 45

What are potential ways to treat DVT?

Answer 45

1. Anticoagulants 2. Rapid mobilisation, foot exercises and anti-thrombus stockings

Question 46

What is infective endocarditis, what is the aetiology, predisposing factors and clinical features?

Answer 46

Definition: Infective endocarditis, also called bacterial endocarditis, is an infection caused by bacteria that enter the bloodstream and settle in the heart lining, a heart valve or a blood vessel. IE is uncommon, but people with some heart conditions have a greater risk of developing it. Predisposing factors: 1. Prosthetic cardiac valves 2. Previous infective endocarditis 3. Some congenital hear diseases 4. Cardiac transplantation with subsequent development of cardiac valvulopathy 5. Rheumatic heart disease Dental procedures could induce harmful bacteremia - please contact the cardiologist for their needed anti-biotics

Question 47

What are the most common antibiotics used for prophylaxis?

Answer 47

1. Amoxicillin 2g 1 hour before procedure 2. Clindamycin 600mg 1 hour before procedure

Question 48

What are some of the important information that needs to be considered when treating a patient with congestive heart failure?

Answer 48

1. Patient wit heart failure may have difficulty breathing thus may not tolerate a supone chair position 2. Underlying condition causing heart failure may need special consideration 3. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected

Question 49

What are some of the important information that needs to be considered when treating a patient with ischaemic heart disease (angina)?

Answer 49

1. Need to reduce the stress and anxiety 2. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected 3. Patient taking aspirin may have excessive bleeding 4. Patient who had coronary artery bypass graft may require antibiotics

Question 50

What are some of the important information that needs to be considered when treating a patient with ischaemic heart disease (myocardial infraction)?

Answer 50

1. Need to reduce the stress and anxiety 2. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected 3. Patient taking aspirin may have excessive bleeding 4. Patient who had coronary artery bypass graft may require antibiotics 5. Patient may have some degree of heart failure 6. If patient has a pacemaker, some dental equipment may potentially cause electromagnetic interference Remember of having INR of less than 3.5 and speak to the cardiologist

Question 51

What are some of the important information that needs to be considered when treating a patient with cardiac arrhythmias?

Answer 51

1. Need to reduce the stress and anxiety 2. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected 3. Patient taking aspirin or warfarin may have excessive bleeding 4. Patient who had coronary artery bypass graft may require antibiotics 5. If patient has a pacemaker, some dental equipment may potentially cause electromagnetic interference 6. Patient with preexisting arrhythmia are at an increased risk of serious complications such as angina, MI and other Remember of having INR of less than 3.5 and speak to the cardiologist

Question 52

What are some of the important information that needs to be considered when treating a patient with infective endocarditis?

Answer 52

1. Dental procedures that involve the manipulation of gingival tissue or periapical region of teeth or perforation of the oral mucosa can produce a bacteremia 2. Patient with mechanical prosthetic heart valves may have excessive bleeding following invasive dental procedures as the result of anticoagulant therapy. Please contact cardiologist as some procedures may require anti-bacterial prophylaxis

Question 53

What are some of the important information that needs to be considered when treating a patient with hypertension?

Answer 53

1. Routine dental delivery to patients with uncontrolled hypertension could result in a serious outcome such an angina and myocardial infraction 2. Stress and anxiety for dental visits may increase blood pressure 3. Patient taking none selective beta blockers - need to consider the amount of epinephrine injected 4. Some anti-hypertensive drugs can cause oral lesion or oral dryness and can predispose patient to orthostatic hypotension.

Question 54

What is chronic obstructive pulmonary diseases?

Answer 54

It is a set of lung diseas that limit airflow and is not fully reversible. COPD patient report they are hungry for air.

Question 55

What are the two most common cause of COPD?

Answer 55

1. Chronic bronchitis - chronic inflammation and excess mucus (blue bloater) - difficulty breathing 2. Emphysema - damage to the small, sac-like units of the lung that deliver oxygen into the lung and remove carbon dioxide (pink puffer) - none-efficient respiratory function Man difference: bronchitis produces mucus and a lot

Question 56

What is the pathophysiology of COPD?

Answer 56

1. First should be an irritant - like cigarette smoke 2. Irritant cause direct damage to the epithelial lining of the airways causing fibrosis of the said airways and damage to the cilia of the lungs 3. There is alveolar wall destruction to to inflammation 4. There is also mucus hersecretion from the goblet cells

Question 57

What are the clinical signs and symptoms of COPD?

Answer 57

Symptoms: 1. Chronic cough with expectoration (mucus) - mostly associated with bronchitis 2. Shortness of breath 3. Wheezing 4. Chest tightness Signs: 1. Tachypnea 2. Active use of accessory muscles 3. Barrel-shaped chest 4.Prolonged expiration - due to dead air retained within the chest 5.Rhonchi

Question 58

What is the treatment for COPD?

Answer 58

1. Smoking cessation 2. Medication - bronchodilators. steroids and anti-biotics 3. Treatments - avoidance of allergens. exercise and breathing exercise

Question 59

What are some of the important information that needs to be considered when treating a patient with COPD?

Answer 59

1. Avoid treating if upper respiratory infection is present 2. Treat in upright chair position 3. Avoid rubber dam in sever disease 4. Use pulse oximetry in severe disease 5. Avoid nitrous oxide/oxygen inhalation sedation with sever COPD - in order to not reduce the respiratory drive 6. Avoid using narcoticts - in order to not reduce the respiratory drive 7. Consider using steroids before the appoitment

Question 60

What is asthma?

Answer 60

Asthma is an inflammation in the airways which makes the muscles in the airways constrict. This causes the airways to narrow. The symptoms tend to come and go and vary in severity from time to time. Treatment is to reduce inflammation and to open up airways usually works well.

Question 61

What is related to sever asthma?

Answer 61

Frequent hospitalisation due to asthmatic attacks

Question 62

What do we need to know about asthma?

Answer 62

1. Identify and assess by history of astham - severity, irritants and levels of control are essential 2. Ask the patient to bring their current medication 3. Avoid NSAIDS and aspirin as they have an impact on inflammatory mediators and make asthma worst 4. Patients taking chronic corticosteroid medications over the long term may require supplementation in a stressful situation like a dental procedure 5. Provide stress free environment 6. Recognise signs and symptoms of an asthmatic attacks: - Inability to finish a sentence in one breath - Ineffectiveness of bronchodilators - Tachycardia - Accessory muscle usage - Tachypnea - Sweating profusely

Question 63

What is tuberculosis?

Answer 63

It is a human disease caused by mycobacterium tuberculosis. It is spread by inhalation of infected droplets. Long development period. Inflammatory and granulomatous response that result in pulmonary and systemic disease.

Question 64

What is an important aspect to understand about tuberculosis?

Answer 64

It is a high infectious disease thus if you see a patient with persistent cough, previous hospitalisation and they are from susceptible countries - might need to go to the infectious disease specialist.

Question 65

What treatment can we give to a patient with active tuberculosis?

Answer 65

Only emergency care, in the infectious disease word, isolated

Question 66

What treatment can we give to a patient with previous history of tuberculosis?

Answer 66

Thorough history is important - contact their respiratory physician about the stage of their disease and procautions that they need. If patient is confirmed free of disease than patient is safe to be treated as normal.

Question 67

What is the difference about snoring and sleep apnoe?

Answer 67

Snoring and sleep apnoe are related concepts but are different pathologically.

Question 68

What are the two main types of sleep apnoe?

Answer 68

1. Obstructive sleep apnea 2. Central Sleep Apnea - lack of breathing as a result of lack of CNS respiratory drive

Question 69

What is snoring?

Answer 69

It is a result from the vibration of soft tissues of the upper airway, primarily through inspiration. It occurs without abnormal ventilation.

Question 70

What is UARS?

Answer 70

Upper airways resistance syndrome - is a clinical entity midway between snoring and OSA. Occurs with snoring and associated with complaints of daytime sleepiness and fragmentation of sleep with some increased ventilatory effort.

Question 71

What is obstructive sleep apnea?

Answer 71

It is a clinical condition that result in loud snoring and excess daytime sleepiness with complete cessation of breathing (apnea) or significantly decreased ventilation (hypopnea) due to airway obstruction during sleep.

Question 72

What is the pathology of sleep related diseases?

Answer 72

Primary cause is anatomically narrowed upper airways combined with pharyngeal dilator muscle collapsibility. The process of airways assessment is the following: 1. Nasal cavity 2. Nasopharynx 3. Oropharynx

Question 73

What is the normal sleep cycle?

Answer 73

Normal sleep occurs in 2 phases: non-rapid eye movement (NREM) and rapid eye movement (REM). Patterns can be measured by an EEG and presence of eye movement

Question 74

What are the classifications of obstructive sleep apnea and how does it relate to sleep?

Answer 74

OSA depends on the degree and duration of obstruction, hypoxia, anoxia and hypercarbia. OSA leads to arousal and transition to a lighter stages of sleep making the sleep fragmented. Due to the lighter sleep, the restorative benefits of sleep are not achieved leading to cognitive and physiologic abnormalities.

Question 75

What are 5 symptoms of OSA?

Answer 75

1. Loud snoring 2. Frequent wake-up 3. Low concentration 4. Poor work performance 5. Poor short term memory

Question 76

What are some of the potential way to manage OSA?

Answer 76

1. General measures - weight loss, exercise, nsala decongestants 2. Positive airway pressure machine 3. Oral appliances 4. Upper airway surgery - Powell-Riley protocol - ENT and maxilofacial surgery

Question 77

What is the purpose of the mandible advancement device?

Answer 77

The main purpose is to protrude the mandible forward (and the tongue) in order to reduce the airway restriction. Some association with TMD.

Question 78

What are some of the basic facts we need to know about the patients cancer diagnosis?

Answer 78

1. Have a basic understanding of cancer progression 2. Basic knowledge of treatment modalities 3. Understanding the various locations in which patient receive therapy 4. Hvae basic understanding of cancer outcomes

Question 79

What is cancer?

Answer 79

Cancer is uncontrolled growth of aberrant neoplastic cells. It is often a destructive invasion of tissues by direct extension and spread to distant sites by metastasis via blood, lymph or serosal surfaces. Uncontrolled proliferation of cell results in cancer but also neovascularisation of those cells is essential.

Question 80

What is the normal pathway of progression for an oral cancer?

Answer 80

1. Normal epithelium 2. Leukpplakia that does not go away when wiped - hyperproliferative epithelium 3. Epithelium dysplasia 4. Oral cancer - carcinoma

Question 81

What is the difference between incision biopsy and excitional biopsy?

Answer 81

1. Incisional - small section of a lesion taken 2. Ecsitional - all of the lesion is taken

Question 82

What is the clinical presentation of a case or potential carcinoma?

Answer 82

1. Change in surface colour of the lesion 2. A lump or palpable mass 3. Altered organ function 4. Symptoms - pain and paraesthesia

Question 83

What are the steps to management of carcinomas?

Answer 83

1. History taking 2. Examination 3. Extra investigation - blood tests, x-rays etc 4. Referral to cancer center 5. Medical intervention

Question 84

What are the 4 stages of cancer?

Answer 84

Stage I - localised and contained to the organ (T1 N0 M0) Stage II - regional and nearby structures (T2 N0 M0) Stage III - extensive beyond the regional site (T3 N1 M0) Stage IV - widely dissaminated (any T N1 M1)

Question 85

What is the difference between a cancerous lymph-node and a node during an infection?

Answer 85

Cancerous 1. Fixed 2. Enlarged 3. Rubbery and hard 4. None-tender During an infection: 1. Can be rolled 2. Enlarged 3. Kinda soft

Question 86

How to deal with an oral cancer?

Answer 86

1. Do a biopsy 2. Do CT scan 3. Talk to the patient and provide information - good to ask a patient to bring someone else

Question 87

What role do you have in treating a patient with oral cancer?

Answer 87

1. Basic pretreatment oral evaluation 2. Rule out oral disease that may worsen during cancer therapy 3. Provide baseline for comparison and monitoring of sequelae of radiation and chemotherapy damage 4. Detect metastatic lesions 5. Minimize oral discomfort during cancer therapy

Question 88

What are some considerations for a patient who has undergone radiotherapy for cancer in a context of tooth extraction?

Answer 88

They are at a high risk of osteoradionecrosis of the jaw. It is a good idea to refer them to a head and neck surgeon.

Question 89

What are sexually Transmitted Diseases?

Answer 89

STD's are infections that are spread from person to person through intimate sexual contact. They are very easily spread thus they can be quite dangerous.

Question 90

How are STD's spread?

Answer 90

1. Sexual intercourse 2. Oral-genital contact 3. IV drug 4. Congenitally transmitted

Question 91

What are the incrubale STDs?

Answer 91

1. HIV/AIDS 2. HPV 3. Hep B 4. Genital Herpes

Question 92

What is syphilis and what are it's common transmission?

Answer 92

It is an STD that is caused by the treponema pallidum bacteria. known as a "great imitator" it is able to imitate many different diseases. Main modes of transition: 1. Sexual 2. Trans-placental 3. Percutaneous following contact 4. Blood transfusion The dosage of exposure needs to be great and latent stages of syphilis may cause neural damage.

Question 93

What is an oral manifestation of gonorrhoea?

Answer 93

An ulcer in the back of the mouth

Question 94

What are some of the common oral manifestations of HIV infection?

Answer 94

1. Oral candidiasis 2. Herpes simplex virus lesions - Kaposi's circoma

Question 95

What are some of the common oral manifestations of HPV infection?

Answer 95

Condyloma accuminatum - please send to oral surgeon

Question 96

What is coagulation?

Answer 96

Coagulation of the process of blood clotting, which is used to heal an injured blood vessel.

Question 97

What is involved in haemostasis?

Answer 97

Haemostasis involves: 1. Vascular constriction 2. Platelet plugging 3. A fibrin mesh forming

Question 98

What is the important aspects of history that might indicate a bleeding problem?

Answer 98

1. Spontaneous bleeding from gingiva 2. Spontaneous nasal bleeding 3. Family history 4. Drugs history - anticoagulants - woferin 5. Viral infections 6. Liver disease 7. Cardiac disease

Question 99

What are some of the signs you can note during examination that may indicate a haematological problem?

Answer 99

1. Multiple purpurae of the skin 2. Bleeding wounds 3. Haematomas 4. Swollen joint 5. Liver disease signs and symptoms 6. Cardiac disease

Question 100

What are the 4 main pre-operative tests that may be ordered for a patient with bleeding problems?

Answer 100

1. Bleeding time BT - platelet function test 2. Activated partial thromboplastin time APPT - evaluation of the intrinsic coagulation pathway 3. International normalised ration - INR - meaasurenment the extrinsic patway (1.0 is normal_ - please contact the cardiologist reagarding this 4. Platelet count - quatify platelet function (normal range 150k-450k)

Question 101

What are the most important bleeding disorders that we need to know?

Answer 101

1. Coagulation factor deficiencies: - Hemophilia A and B -von Willebrand's disease - Vitamin K deficiency due to warfari use 2. Platalet disorder: - Idiopathic -leukemia - Drug-induced - think aspirin 3. Vascular diosder: -Scurvy

Question 102

What are the two types of coagulation factor deficiencies?

Answer 102

1.Congenital: -Hemophilia A and B -Von Willebrand's disease 2.Acquired -Liver disease -Vitamin K deficiency due to warfarin use -Disseminated intramuscular coagulation

Question 103

What is haemophilia A?

Answer 103

It is a deficiency clottin factor VIII or anti-haemolytic factor inherited X-linked recessive trait found in males. Symptoms: delayed bleeding, deep haematoma, spontaneous gingival bleeding Management: Increase factor VIII levels by replacing the factor or by inhibiting fibrinolysis. For dental extraction - email or talk to a haematologist for prescription of factor VIII replacement before the procedure and discuss additional platelet function increases, like desmopressin.

Question 104

What is haemophilia B?

Answer 104

It is a deficiency clottin factor IX. Symptoms: delayed bleeding, deep haematoma, spontaneous gingival bleeding Management: Increase factor IX levels by replacing the factor or by inhibiting fibrinolysis. For dental extraction - email or talk to a haematologist for prescription of factor VIII replacement before the procedure and discuss additional platelet function increases, like desmopressin.

Question 105

What is Von Willebrand's disease?

Answer 105

It is the most common hereditary coagulation disorder. It is not sex linked. Treatment is desmopressin and factor VIII concentrates in sever cases.

Question 106

What are some of the systemic diseases that cause coagulopathies?

Answer 106

1. Renal failure 2. Hepatic failure 3. Bone marrow

Question 107

What are platelet disorders?

Answer 107

They can be hereditary or acquired and may be due to decreased platalet production, excess consumption or altered function. Platalets must be greater than 50k. Treatment: Usually a replacement therapy 30 minutes prior to the procedure is enough for the patient. Idiopathic thrombocytopenic papura, an acquired platelet disorder, may require the use of oral steroid 7-10 days prior.

Question 108

What is tranexamic acid?

Answer 108

It is compound that is used to decrease bleeding by supporting the formed blood clot be decreasing the production of blood clot destroying enzymes.

Question 109

What are the four principal function of the urinary system?

Answer 109

1. Excretory - excretion of water products and drugs in the urine 2. Regulatory - regulation of the volume and the osmotic pressure of the blood 3. Andocrine - kidneys produce several hormones that regulate blood pressure and production of red blood cells 4. Metabolic - the kidney activated vitamin D which results in bone formation. In addition, the kidney is the major site for catabolism of important proteins such as insulin and parathyroid hormones

Question 110

What are the parts of the renal system?

Answer 110

1. Kidneys 2. Ureters 3. Bladder 4. Urethra

Question 111

What is a basic unit of the kidney?

Answer 111

The basic unit of the kidney is the nephron. They are millions of nephron per kidney.

Question 112

What are the parts of the nephron?

Answer 112

1. Glomerulus 2. Bowmans capsule 3.Proximal tubule 4. Distal tubule 5. Loop of henle 6. Collecting duct

Question 113

What are renal disease?

Answer 113

They are different disorders that impact the renal system? The two distinct types of renal diseases are the acute renal unsufficiencies and chronic renal failure. Common diseases: Diabetes mellitus, arterial hypertension and other

Question 114

What is chronic renal disease?

Answer 114

It is a progressive and irreversible decline in renal function associated with reduced glomerular filtration rate. GFR is measured using a creatinine clearance test. CRD is the renal disease that manifests oral consequences most frequently. Treatment for CRD: 1. Dietry changes 2. Correction of systemic complication 3. Dialysis 4. Renal transplant

Question 115

What is, generally, the first step of the parthenogenesis of kidney disease?

Answer 115

A reduction in the nephron number.

Question 116

What are the oral consequences of kidney disease?

Answer 116

1. Greater bleeding tendency due to reduction in platalets 2. Hypertension due to extra blood volume 3.Anaemia 4.Drug intolerance - antibiotic and analgesics 5. Increased susceptibility to infections 6. Halitosis, burning sensation int eh mouth, uremic stomatitis, periodontal disease 7. Xerostomia 8. Impared healing Please consider collaborating with a nephrologis

Question 117

What are the steps to the dental management of a person who is on haemodialysis?

Answer 117

1. Consultation with nephrologist 2. Platelet dysfunction and anaemia resulting in bleeding tendency should be discussed 3. Heparin anticoagulation can be given to patient who is on haemodialysis - thus maybe try to do a procedure on another day 4. Avoid compression on the arm with the vascular access 5. Do not presribe some drugs - check with MIMS or consult with the renal specialist 6. Look out for renal osteodystrophy - there is weaker bone with those patients so extra care need to be taken care when performing surgery

Question 118

What are the steps to the dental management of a person who had a kidney transplant?

Answer 118

1. Consultation with nephrologist 2. Platelet dysfunction and anaemia resulting in bleeding tendency should be discussed 3. Risk of adrenal crisis if they are teated with long standing corticosteroid therapy: morning appoitment and consider the need of supplemental steroids 4. Immunosuppression may require antibiotic prophylaxis prior to invasive dental procedures 5. Disturbances in removal of drugs: care is needed prior to prescribing analgesia or antibiotics 6. Gingival overgrowth as result of immunosuppressive drugs such as cyclosporin - also consider medication interactions If anything beyond a clean is needed - please consider sending them to a specialist such a special needs dentist or a OMFS.

Question 119

What information do we need to know about a patient with known diabetes?

Answer 119

1. History of diabetes detection: -Are you diabetic? -What medications do you take for your diabetes? -Are you treated by a doctor? 2. Establishment of severity of disease and degree of control? -When were you first diagnosed as diabetic? -What was the level of your las HbA1C sample?

Question 120

What are the types of diabetes?

Answer 120

Type I - related to beta cell destruction and insulin deficiency Type II - related to insulin resistance Diabetets relating to pancreatic disease - cancers of the pancreas or others Gestational - diabetes relating to pregnancy

Question 121

What are the steps to dental management of a diabetic patient?

Answer 121

1. Maximise blood glucose control - always tell the patient to go to the G 2. Treat infections - due to the reduced immune function and healing - oral rinses, incision and drainage, extraction, antibiotics and other

Question 122

What oral manifestations of diabetes?

Answer 122

Diabetes mostly affects the peripheral vascular tissue of the oral cavity 1. Accelerated periodontal diseases 2. Gingival proliferations 3. Periodontal abcesses 4.Xerostomia 5. Poor healing 6. Infections 7. Oral ulcerations an candidiasis 8. Numbness, burning and pain in oral tissues

Question 123

What is the main reason for death in cocaine users?

Answer 123

Deaths usually occur as a result of cardiac stimulation, increase in blood pressure and arrhythmia. Thus it is not recommended to use adrenaline containing LA within 48 hours after last dose of cocaine

Question 124

What are some of the cautions that we may have for a patient with regular cannabis use?

Answer 124

1. Xerostomia 2. Oral cancer 3. Anxiety exacerbation 4. Vasoactive effect It is recommended that patienr stay off marijuana for at least 1 week before LA with adrenaline. Might need to use adrenaline free LA.

Question 125

What are some of the cautions that we may have for a patient with regular use of methamphetamine?

Answer 125

1. Cardiovascular effect like arrhythmias 2. Stroke 3. Bruxism and clenching 4. Xerostomia 5. Meth mouth - rampant caries These patient should be in close recall and the LA containing adrenaline should be avoided at least 24 hours after meth use.

Question 126

Wht should be your general approach of managing a person of a general medical complication in the dental chair?

Answer 126

Consider 1. Time of day for appointment 2. Duration of the appointment 3. Positioning of the patient 4. Pre-procedure preparation/action plan - e.g. ask the patient to bring their medication 5. Use of local anaesthetics 6. Medications - contraindications, toxicities, interaction 7. Caries risk 8. Perio risk 9. Xerostomia

Question 127

How would you quickly assess the patients severity of COPD asthma?

Answer 127

1. If they are managed situational by an inhaler - they are probably okay 2. If they take medication - this may be a little more sus 3. If they have been hospitalised - maybe consult with tutor

Question 128

How does the diabetes damage the body?

Answer 128

Higher Blood glucose leads to advanced glycosylated end products (AGE) and free radicals which damage tissues - mostly on two levels Microvascular damage - think perio Macrovascular - think coronary artery disease and renal disease