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107 Cards in this Set
- Front
- Back
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How did patients respond when asked what they liked about their dentist?
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1. interpersonal caring
2. professionalism 3. good communication |
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What is the term for: "to go against a patient's autonomy to do more good than the decision of the patient"
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Paternalism
(must get a 2nd opinion and document) |
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What is the term for: "letting the patients know the treatment options, the prognosis of proposed treatment alternative options, so the patient should always be considered competent until evidence to the contrary"?
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Informed consent
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What brings you in today?
Can you describe your typical diet? These are examples of what type of questions |
Open ended questions
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Sure. Please go on. I see.
These are examples of what: |
Facilitation/probe
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Are you currently taking any prescription medications? are examples of what kind of questions
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Closed-ended question
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Does the pain come on every few minutes, every hour, every week, or every month?
These are examples of what type of questions |
Laundry list question
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What type of listening addresses the emotional component of the patient's illness or difficulty?
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Empathic listening
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What type of listening uses brief responses, body language, & facial expressions?
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Active listening
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What type of listening includes clarifying or summarizing what patient has said?
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Reflective listening
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How much time is needed to be successfully empathetic as a physician?
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3 minutes
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What is the best way to be persuasive?
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Appeal to interests and/or consequences
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What is the mortality w/infective carditis?
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10-80%
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What common microbial agents involved in infective endocarditis had the largest % involvement?
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Viridans strep = 55%
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What common microbial agents involved in infective endocarditis had the 2nd largest % involvement?
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Staph aureus & epidermis = 30%
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If you are unable to take oral medication, what kind of antibiotics do you perscribe?
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Cefazolin 1.0 gm IM or IV 30 min prior to procedure
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If you are unable to take oral medication & are allergic to penicillins, what kind of antibiotics do you perscribe
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Cefazolin 1.0 gm IM or IV 30 min prior to procedure
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What is included in the extra-oral exam?
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Head: TMJ, lymph nodes, salivary glands, bones, ears, eyes, perioral tissues
Neck: lymph nodes, structures of the midline, skin |
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What is true about the progress notes in the charting?
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If it is not recorded in the progress notes, it didn't happen
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How do you help calm an anxious patient?
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1. Provide the patient with a sense of control
2. Acknowledge their experience 3. Use brief cognitive-behavioral interventions 4. Continually assess level of anxiety |
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How is anxiety treated?
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1. Psycho therapy
2. Drug therapy 3. Behavoiral therapy |
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What are some axiolytics?
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diazepam- valium
lorazepam- ativan |
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What are some sedative hypnotics?
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triazolam- halcion
flurazepam- dalmane |
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What is the key to behavioral management, when dealing with anxiety?
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Effective communication
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When is oral sedation given for anxiety?
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night prior
prior to appt |
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How long must symptoms persist before diagnosising depression?
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2 weeks
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What is major depression or mixed states that occur at different times in the patient or a mixture of symtoms occurring at the same time?
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Bipolar disorder
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What are lithium, abilify, & tegretol used as?
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Mood Stabilizers
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What are zoloft, wellbutrin, & paxil used for?
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Antidepressants
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What are some oral signs of mood disorders?
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1. Abrasion- excessive brushing
2. Gingival injury- excessive flossing 3. Xerostomia- drug side effect |
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What should you do about anesthetics regarding patients on mood disorder drugs?
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Limit local anesthetic to 2 cartriges of 1:100,000 LA w/epinephrine
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What are some physical complaints of alcohol use?
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1. frequent injuries
2. abdominal pain 3. nausea, vomitting |
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What are the 4 questions you should ask when assessing alcohol use/abuse?****
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CAGE
1. Cut down/control- have you ever purposefully tried to cut down on drinking? 2. Annoyed or angry- have you ever felt annoyed at someone who commented on your drinking? 3. Guilt- have you ever felt guilty about drinking? 4. Eye opener- have you ever had a drink in the morning to steady the shakes? |
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What is the primary cognitive disorder of dimentia?
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Alzheimer's disease (it's reversible)
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What are some systemic diseases that can cause dementia?
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1. acid-base disturbances
2. hypoglycemia 3. stroke |
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Where do you report abuse?
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Department of health & human services
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What are common medical conditions involving the GI tract?
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1. Peptic Ulcer Disease
2. Inflammatory Bowel Disease (Crohn's disease & ulcerative colitis) 3. Pseudomembranaous Colitis |
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What acid blocking drugs decrease the metabolism of certain dental drugs?
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1. Diazepam
2. Lidocaine 3. Tricyclic antidepressats 4. May require dosage adjustment |
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How should you taper your treatment when dealing with GI disorders?
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Avoid perscribing ASA & NSAIDS
(Consider patient risk factors for GI bleeding & provide lowest dose for effect) Consider analgesics instead (tylenol, etc) |
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What are signs of jaundice?
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yellow skin & conjunctiva
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What causes accumulation of fluids & cirrhosis?
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tender swollen liver
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what causes accumulation of fluid due to blockage in the portal circulation?
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peripheral edema
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What causes accumulation of fluid in abdomen due to blocked portal circulation?
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Ascites
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What causes confusion, coma due to accumulation of waste?
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Hepatic encephalopathy
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What causes arteriovenous anastomoses?
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spider angiomas
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What causes blotchy erythema caused by vasodilation?
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Palmar erythema
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What causes impaired conjugation of bilirubin?
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bilirubinemia
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What can the effects of alcohol on the liver enzyme induction & CNS effects require in dental treatment?
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increased amounts of local anesthetic or additional axiolytic medication
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Which antibiotics should you avoid in severe liver disease?
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Metronidazole
Vancomycin |
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What LA should limit dose if severe liver dx, or if bleeding abnormalities?
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Aspirin
Ibuprofen |
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What LA should limit dose if severe liver dx, encephalopathy, or when taken w/alcohol?
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Demerol
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What is the most common form of infectious hepatitis?
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Acute viral hepatitis
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Which type of hepatitis makes up the majority of cases?
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HAV fecal-oral
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What are the 3 phases of acute illness in hepatitis?
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1. Prodromal-ab pain, nausea
2. Icteric phase- jaundice, hepatomegaly, splenomegaly 3. Convalescent phase- symptoms disappear, but hepatomegaly & abnormal liver function may persist |
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How long is the recovery from hepatitis?
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months
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Is medical history enough to confirm that a patient does not have hepatitis?
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no your medical Hx may not tell you the complete story
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What are some examples of neurologic disease?
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1. epilepsy
2. CVA 3. TIA 4. headaches 5. paralysis |
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What are the drugs phenytoin (dilantin), carbamzepine (tegretol), & valproic acid used to treat and how do they work?
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Seizures
They elevate the seizure threshold of motor cortex neurons |
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What is an oral side effect of seizure medications?
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gingival hyperplasia (42%)
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What do you use to manage grand mal seizures?
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Ligated mouth prop & ask pt to inform you if they have an aura
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What is the 3rd most common cause of death in the US?
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CVA
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What is a REVERSIBLE TEMPORARY interruption in blood supply to localized areas of the brain?
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TIA
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What medications could CVA patients be on that would require monitoring of status prior to surgical procedures?
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Coumadin/Warfarin
antiplatlet drugs |
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What is the most important aspect to managing parkinson's disease patients during treatment?
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Protect the airway. Don't lay patient supine when placing restorations.
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What bacteria cause Prosthetic joint infections?
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Mostly Staphylococcus
viridans strep peptostrep |
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Should you premedicate antibiotics to (most) pts with prosthetic joint replacement?
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NO
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Regarding joint disease, when should you prescribe antibiotic premedication?
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Immunocomprimised pts (SLE, RA)
Type I diabetics 1st 2 yrs following joint replacement Previous prosthetic joint infections malnourishment hemophilia |
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Who is cephalexin, cephadine, or amoxicillin premedicating for?
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Pts not allergic to penicillin
2 g orally 1 hr before procedure |
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Who is cefazolin or ampicillin used to premedicate for?
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Pts NOT allergic to penicillin & unable to take oral medication
Cefazolin 1 g or ampicillin 2 g IM or IV 1 hr before dental procedure |
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Who is clyndamycin used to premedicate for?
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Pts allergic to penicillin
600 mg clindamycin orally/IV 1 hr before the dental procedure |
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What does a butterfly rash indicate?
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SLE
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What is normal fasting blood sugar glucose?
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Normal: 70-100 mg/dl
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Do type II patients in good control w/o complications require alteration of dental treatment?
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NO
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What are important questions to ask diabetes patients?
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Do you take medications for your diabetes?
Did you eat breakfast? Did you take your insulin/medication? What is the Hgb A1C? Have you been hospitalized in the last year for your diabetes? When did you last see your physician? |
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What cause weakness, tremor, can progress to unconsciousness?
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Hypoglycemia due to type I diabetes
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Why should you NOT use LA with epinephrine in untreated hyperthyroid patients?
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Hypertension
Tachycardia Dysrhythmia |
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Should you consider Ab prophylaxis w/patients receiving dialysis?
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YES
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What should you avoid doing when treating patients receiving dialysis?
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Avoid taking BP or placing IV in the arm w/arteriovenus shunt (A-V shunt)
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What are diseases of RBC's?
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Anemia
Polycythemia |
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What are diseases of WBC's?
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Leukocytosis
Leukopenia Myeloproliferative ds |
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When should patients have complete head & neck exams?
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every 6 months
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What does SOAP stand for?
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Subjective- what pt tells you
Objective- exam, charting, documentation Assessment- diagnosis Plan |
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What factors can raise body temp?
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exercise
infection ovulation inflammatory disorders hyperthyroidism |
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What is the normal respiratory rate for adults?
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16-20/min
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What is the normal respiratory rate for children?
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24-28/min
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What is the normal respiratory rate for infants?
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up to 44/min
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What could interfere with pacemakers?
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sonic scalers, but not since 8-10 yrs ago
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Dr. Baden had a patient not feeling well. checked pulse and it was irregular. Patient reported esophageal reflux, jaw & chest pain, at risk for heart attack. What should you do?
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Need to administer aspirin and get to the ER
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What value is used to classify the degree of hypertension?
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whichever figure is msot out of range
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What are some psych drugs that may cause hypotension?
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Antidepressants
MOA inhibitors |
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What is the ASA classification for:
1. No abnormalities 2. All body systems appear in good health 3. Physiologically able to tolerate stress of routine dental care, no risk of serious complications 4. little to no anxiety 5. is capable of walking up one flight of stairs or 2 level city blocks w/o distress 6. no modifications needed |
ASA 1 Risk status classification for pts scheduled to go under anesthesia
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What is the ASA classification for:
1. mild systemic disease (controlled) or health w/more extreme anxiety of dental care 2. less tolerant, but still little risk during tx 3. proceed w/caution 4. capable of walking up one flight of stairs or 2 level city blocks, but will have to stop after from distress 5. possible minor modifications needed 6. examples: a. well controlled type II diabetes, epilepsy, asthma, hypo & hyperthyroid disease b. ASA 1 w/respiratory infection c. healthy pregnant women, pt w/drug allergies d. BP: 140-159/90-94 |
ASA 2
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What is the ASA classification for:
1. severe systemic disease limiting activity, bu not incapacitating 2. at rest does not exhibit signs and symptoms of distress, but does so when stressed physiologically 3. proceed w/caution 4. pt at greater risk of medical event during tx 5. able to walk up one flight of stairs or 2 level city blocks, but will have to stop en route from distress 6. May need tx modifications and medical consult 7. examples a. stable angina pectoris b. status post-MI and stroke c. well controlled type 1 diabetics d. CHF w/ankle edema & orthopnea e. exercise induced asthma f. COPD g. not well controlled epilepsy h. symptomatic hyper- & hypothyroid disease i. BP: 160-199/95-114 |
ASA 3
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What is the ASA classification for:
1. incapacitating disease that is a constant threat to life 2. severe medical illness that is of primary concern 3. elective dental tx should be postponed 4. unable to walk up one flight of stairs or 2 city blocks w/o distress 5. distress at rest 6. examples a. unstable angina b. MI & stroke within 6 mo c. uncontrolled epilepsy d. severe CHF or COPD e. BP: >200/115 |
ASA 4
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What is the ASA classification for:
1. pt expected to live 24 hrs 2. palliative tx may be necessary 3. Tx only in acute care setting 4. a. end stage renal, liver disease, infectious disease b. terminal cancer |
ASA V
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What are the stages of change?
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1. precontemplation: unaware of problem, or can be aware but has no intention of change
2. contemplation: thinking about changing, but ambivalent 3. preparation ready to change, making a plan, experiment w/new behaviors 4. action: taking action 5. maintenance: keeping on track, relapse |
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What are the normal glucose levels?
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80-120
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What are the fasting glucose levels?
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70-100
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hypoglycemic level
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<40
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What is normal/good control of A1C?
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<7
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What is a poor control value for A1C?
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9-20
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What is the prothrombin time (blood coagulation) effects of coumadin?
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PT = 10-12 sec
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What is normal value for partial thromboplastin time?
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<35 PTT
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What is normal INR?
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INR = 1.0
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What range of INR indicates warfarin use but still ok to treat?
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INR = 2-3
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What is the INR acceptable value for mechanical heart valve?
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2.5-3.5
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What is a normal platlet count value?
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140,000-400,000
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