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166 Cards in this Set
- Front
- Back
Gingival Curettage
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remove soft tissue ling of perio pocket, leaving only gingival connective tissue lining (AA of Perio statement)
|
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Does gingival curettage promote more long JE attachment than SRP alone?
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no (AA of Perio statement)
|
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What can be used for gingival curettage?
|
Curette
Sodium Sulfite Phenol camphor antiformin (can damage CT) sodium hypochlorite Ultrasonic Dental Laser |
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What can cause an overhang?
|
Improper placement of matrix
Improper manipulation of restorative materials Carving errors lack of improper restorative finishing technique (overhang handout on BB 387) |
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Margination (what we are learning right now)
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overhang removal (overhang handout on BB)
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What be used for margination (OH removal)
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Hand instruments (curet, amalgam files, knives, chisels, and finishing strips)
Conventional High Speed Handpiece (limited to accessible areas, flame tipped scaler insert available with water spray) Ultrasonic Devices Slow speed motor driven handpieces (wedge shaped abrasive tips) (overhang handout on BB) |
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Is pre-med necessary for OH removal?
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Yes (overhang handout on BB, p. 388)
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Contraindications of OH removal
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Open Contact
Open Margins Extensive in Size (greater than 1/2 embrasure space) (overhang handout on BB 388) |
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Type I overhang classification
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Light catch with explorer, easily removed with hand instruments
(overhang handout on BB 388) |
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Type II overhang classification
|
moderate, definite catch with explorer, material extends beyond cavosurface, visible radiographically
removed by directional handpiece system ultrasonics handheld instruments (overhang handout on BB 388) |
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Type III overhang classification
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Gross overhang
Requires replacement One half of the embrasure is filled (overhang handout on BB 388) |
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What is the suggested sequence for removal of amalgam restorations?
|
1. Remove bulk excess in provimal area. Use shaving strokes starting at the base and exterior surface of the material. Work from the most apical portion of overhang to contact.
2. Make smooth between tooth and material 3. maintain anatomy. Watch angulation of instruments! (overhang handout on BB 389) |
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OH removal: Burs
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Diamond or finishing: used for large excess of amalgam where access permits without damage to surrounding structures
overhang handout on BB 389) |
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OH removal: Files
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Working files: Removal of bulk, proximal surfaces
Finishing Files: refinement of cavosurface margin overhang handout on BB 389) |
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OH removal: Gold Knives
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Proximal surfaces
B and L surfaces Gingival cavosurface margins Moderate to slight excess of amalgam overhang handout on BB 389) |
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OH removal: Curets
|
shave or smooth amalgam surface
area specific or univerals used (overhang handout on BB 389) |
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OH removal: Cuttle Discs
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accessible surfaces on F and L
refine and smooth amalgam surfaces on proximals (overhang handout on BB 389) |
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OH removal: Abrasive Strips (finishing)
|
proximal surfaces
smooth cavosurface margin on proximal smooth amalgam surfaces on proximal (overhang handout on BB 389) |
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OH removal: Dental Tape and Pumice
|
proximal surgaces to check contact and smoothness. Use floss in conjunction with pumice to make smooth
(overhang handout on BB 389) |
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OH removal: Explorer and Dental Floss
|
check smoothness
(overhang handout on BB 389) |
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What is unique about the Burnett Power Tip?
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slim diameter ultrasonic tip that withstands higher power setting and more lateral pressure than conventional.
Used for smoothing OH of amalgam |
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An extended shank Gracey curet has a _____ working end and a lower shank that is 3 mm ________ than the lower shank of standard area specific curet
|
An extended shank Gracey curet has THINNER (by 10%) working end and a lower shank that is 3 mm LONGER than the lower shank of standard area specific curet
p.485,488 NG |
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A miniature gracey curet has a ____, ____ working end and a _____ lower shank compared with the design of a standard Gracey curet.
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A miniature gracey curet has a SHORTER (by 1/2), THINNER (by 10 %) working end and a LONGER lower shank compared with the design of a standard Gracey curet.
p.485 NG |
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Standard area specific curets are meant to instrument in pockets ___mm or less.
|
4 mm or less
p.485 NG |
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There are no 17/18 curets in either extended shank or mini. Why?
|
The standard Gracey 17/18 has logner shank length and shorter, slightly thinned working end
p.487 NG |
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Design of After Five and Gracey 3+ pocket curets differ from standard Gracey how?
|
1. lower shank 3 mm +
2. Working end 10% thinner p.488 NG |
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What general four places are mini gracies designed to work best?
|
Narrow pockets of 4mm in depth
1. root branches 2. midlines of anterior roots 3. root concavities 4. furcation areas p.489 NG |
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Vision Curvette Miniature Curets have a ______ and more ________ working end. The shank design differs ____
|
Vision Curvette Miniature Curets have a SHORTER and more CURVED (60-70 degree) working end in comparison to standard area specific gracie. The shank design differs:
1. extended lower shank in 11/12 and 13/14 2. lower shank two bands indicate 5 and 10 mm p.490 NG |
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How is a modified intraoral fulcrum different from a split fulcrum?
|
Middle and ring finger contact near middle knuckle region. In split, there is NO contact
p.514 NG |
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Cross Arch fulcrum vs. opposite arch fulcrum
|
Cross arch--fulcrum on opposite side of the SAME arch
Opposite arch--fulcrum on opposite ARCH (mand vs. max) |
|
Who is at the highest risk for OSA (obstructive sleep apnea)
a. men b. women |
a. MEN (Little 129)
|
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What is a polysomnography?
|
an overnight sleep study. A technician records activities during sleep.
|
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electroencephalogram
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a test done that monitors brain waves (for sleep study) (little 129)
|
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electro-oculogram
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monitors eye movements (for sleep study, Little 129)
|
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electromyogram
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monitors jaw muscular activity and leg movements (for sleep study, Little 129)
|
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Split night study
|
Start the night with a polysomnography and if they are able to make a diagnosis early in the night, they try applying positive airway pressure (Little 129)
|
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What index is used to determine severity of OSA?
|
Apnea Hypopnea Index (AHI)--add all apneas in the night with all hypopneas and divide total number of hours slept
or Respiratory Disturbance Index (RDI)--same, but respiratory effort related arousals are added too. Diagnosis made if higher than 5 per hour w/symptoms. 0-5 normal 5-15 mild 15-30 mod 30+ severe (129-131 Little) |
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Apnea
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cessation or near complete cessation of airflow for at least 10 seconds (Little 130)
|
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Hypopnea
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greater than 30% reduction in airflow compared with baseline with greater than 4% O2 desaturation (Little 130)
|
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Sleep Latency Test
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tests ability to fall asleep (Little 131)
|
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Maintenance of Wakefulness Test
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assess ability to stay awak (Little 131)
|
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The American Academy of Sleep Medicine has these guidelines for the use of oral appliances in the treatment of patients with snoring and OSA
|
•patients with primary snoring
• mild to mod OSA who wont use CPAP, don't respond, or aren't appropriate for CPAP • severe OSA failed an initial trial of CPAP |
|
what is the most common surgery performed for the treatment of obstructive sleep apnea?
|
uvulopalatopharyngoplasty (little 134)
|
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What is the most common cause of OSA in children?
|
adenotonsillary hypertrophy, so adenotonsillectomy is curative in 75-100% of cases! (little 135)
|
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At what point is care contraindicated with clients who have obstructive sleep apnea?
|
patients with OSA may undergo any necessary dental treatment (little DM-13)
|
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Oral Manifestations of obstructive sleep apnea
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large tongue
long soft palate long uvula redundant parapharyngeal tissues large tonsils retrusive mandible (Little DM-12) |
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What does obstructive sleep apnea increase risk for ?
|
hypertension
stroke arrhythmia myocardial infarction diabetes (little DM-12) |
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What is the most effective treatment for obstructive sleep apnea?
|
weight loss
|
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T or F. alcohol, sedatives or muscle relaxors should be avoided before bed time in clients with obstructive sleep apnea
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True
|
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Complications of Snoring
|
Headaches
Hard to concentrate Fatigue Poor work performance Bothering Partner (class lecture) |
|
Side Effects of Oral Appliances
|
TMJ pain
Muscular Pain Tooth Pain Hypersalivation Crepitus Xerostomia Gingival irriation Abnormal Occlusion in the morning |
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T or F Adrenal glands are endocrine glands
|
True p. 236
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T or F the adrenal medulla functions as a sympathetic ganglion and secretes catecholamines
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True p. 236
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T or F Glucocorticoids, mineralcorticoids and androgens are all derives from cholesterol, share a common molecular nucleus, and are manufactured by the adrenal cortex
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True p. 236
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What is Aldosterone
|
regulates physiologic levels of sodium and potassium
mineralocorticoid The predominant hormone of the zona glomerulosa p. 236-237 |
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T or F Cortisol is a mineralocorticoid
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False, it the primary glucocorticoid
p. 236 |
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Cortisol is responsible for...
|
regulate carb, fat or protein metablolism
maintain homeostasis during physical or emotional stress insulin antagonist increasing blood levels and peripheral use of glucose p. 236 |
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How is secretion of cortisol regulated?
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the hypothalmuc pituitart adrenal axis p. 236
CNS > circadium rhythm in response to stress>hypothalmus>release CRH>produce ACTH (in anterior pituitary)>adrenal cortex>cortisol > inhibits CRH and ACTH p. 236 |
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What is the most common type of adrenocortical overproduction?
a. Cushing's Disease b. Addison's Disease |
a. Cushing's Disease, caused by glucocorticoid excess
|
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What is primary adrenocortical insufficiency?
a. Cushing's Disease b. Addison's Disease |
addison's disease
p.238 |
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T or F. Adrenal insufficiency occurs in 40-60 persons per 1 million aduls
|
True p. 238
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T or F Primary adrenocortical insufficiency is about 5 times more common than secondary adrenal insufficiency
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False, 2ndary is more common than primary. p.238
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Primary adrenocortical insufficiency is caused by progressive destruction of the adrenal cortex and/or
a. autoimmune b. hemorrhage c. sepsis d. infectious disease e. malignancy f. adrenalectomy g. drugs h. all of the above |
h. all of the above could cause primary adrenocortical insufficiency p. 238
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T or F Clinical evidence of adrenocortical insufficiency arises only after 50% of the adrenal cortices have been destroyed.
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False, 90%!!! p. 238
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Lack of cortisol causes
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impaired metabbolism of glucose, fat, progtein
hypotension increased ACTH secretion Impaired fluid excretion excessive pigmentation inability to tolerate stress |
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Aldosterone deficiency results in
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inability to conserve sodium and eliminate potassium and hydrogen ions (leading to hypovolemia, heperkalemia and acidosis)
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T or F Secondary adrenocortical insufficiency is more common than primary. It results from hypothalamic or pituitary disease, administration of exogenous corticosteroids or administration of specific drugs.
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Both True 239-240
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T or F The production of aldosterone is NOT effected by administration of corticosteroids. Why or Why not?
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True-- It is not dependant upon ACTH, which is not produced because of the increased levels of administered corticosteroids. p.240
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What dose of declomethasone diproprionate or budesonide in adults is considered the cutoff point indicating that adrenal suppression is probable?
a. 100-200 mg/day b. 500-1000mg/day c. 1000-1500 mg/day d. 1500-2000 mg/day |
c. 1000-1500 mg/day p.240
|
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What is the following medical emergency and what can occur if not treated rapidly?
sunken eyes, profuse sweating, hypotension, weak pulse, cyanosis, nausea, vomiting, weakness, headache, dehydration, fever, dyspnea, myalgias, arthralgia, hyponatremia, eosinophilia after being in a stressful situation |
adrenal crisis
if not treated rapidly, hypothermia, severe hypotension, hypoglycemia and circulatory collapse that can result in death p. 240 |
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Adrenal crisis is typically more serious in a client with which type of adrenal insufficiency?
a. primary b. secondary |
a. primary because in a secondary adrenal crisis, there is NOT an absense of aldosterone p. 241
|
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T or F Androgen-related (hyperadrenalism) disorders are rare and primarily affect reproductive organs
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True p.241
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T or F Mineralcorticoid excess is known as Cushing Syndrome and is associated with hypertension, hyperkalemia and depedant edema
|
First False
Mineralcorticoid excess is primary aldosteronism. Second, however, is true. p.241 |
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What do these symptoms represent?
Weight Gain Round or mood-shaped face Buffalo Hump on upper back abdominal striae hypertension hirsutism acne |
cushing syndrome--glucocorticoid excess.
May also cause glucose intolerance, heart failure, osteoporosis, bone fractures, impaired healing, psychiatric disorders. p.241 |
|
Which of the following is NOT an increased risk of long-term steroid use?
a. insomnia b. peptic ulceration c. cataract formation d. glaucoma e. growth suppression f. abnormal cuticle discoloration g. delayed wound healing |
f. abnormal cuticle discoloration
p.241 |
|
Where can cortisol be detected?
|
urine, plasma, saliva
most sensitive in saliva p.241 |
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T or F. Cortisol values may be altered by circadiuan rhythm, diet and stress.
|
True. p.241
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A positive screening cortisol screening test should be followed by provocative tests of the HPA axis to detect hyper or hypo adrenalism. These tests include...
|
synthetic ACTH stimulation test---most reliable for adrenal hypofunction, directly evaluates level of adrenal reserve. + means adrenal function
CRH test-- differentiates ACTH dependant form from ACTH independant dexamethasone suppression test-- screen for adrenal hyperfunction, specificity issues (false + and -) p. 241 |
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What are the two primary needs of the addison patient?
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1. management of adrenal disease
2. hormonal replacement therapy p. 241 |
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For what therapeutic properties are steroids prescribed for (speaking of non-endrocrine disorders)
|
anti-inflammatory effects and immunosuppressive properties
p. 242 |
|
Hydrocortisone 20mg/day
prednisone 5mg/day dexathasone 0.5 mg/day |
yup p. 242
|
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T or F Midazolam administration reduces stress associated with oral surgery
|
true 242
|
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What is done for adrenal crisis?
|
IV injection of glucocorticoid (100mg bolus) and fluid and electrolyte replacement. p.243
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Are clients with hyperadrenalism at an increased risk for periodontal disease?
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Yes, because osteoporosis is related to bone lose and fracture. This consideration should be included in the treatment plan
|
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Because of the increased risk of peptic ulceration in clients with hyperadrenalism should not use WHAT post op analgesics?
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Aspirin or NSAIDS p. 243
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T or F past or present history of TB, histoplasmosis, or HIV increases risk for adrenal disease
|
true 243
|
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To determine if a client needs hormone supplementation for moderate or severe surgical procedures, what test/s should be done?
|
ACTH stimulation test p. 243
|
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T or F Adrenal insufficiency is prevented with circulating levels of flucocorticoids are about 65 mg of hydrocortisone equivalent per day
|
FALSE, 25 mg per day. This is evuivalent to about 6mg of predisone p.244
|
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What represents hypotension?
|
systolic 100 mm Hg/ diastolic 60mmHg
|
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What is the proper patient positioning for a client that is hypotensive?
|
Head LOWER than feet
fluid replacement administer vasopressors distinguish between signs of adrenal dysfunction vs hypoglycemia |
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What is a common oral complication of primary adrenal insufficiency?
a. leukedema b. diffuse or brown focal macular pigmentation of oral mucous membranes c. large oral ulcerations |
b. diffuse or brown focal macular pigmentation of oral mucous membranes
p.245 |
|
Physical signs of anoretic patient
|
failure to maintain normal body weight
15% below normal fear of gaining weight distorted body image pale skin bruising easily (P&G Eating Disorders) |
|
Medical complications with anorexia nervosa
|
amenorrhea
bradycardia hypothermia low potassium hypotension (P&G Eating Disorders) |
|
Which is the most common of the eating disorders?
|
Bulimia nervosa
(P&G Eating Disorders) |
|
Characterized by indulging in recurrent binges of highly caloric, sweet or high carbohydrate foods followed by purging
a. Anorexia Nervosa b. Bulimia Nervosa c. |
b. bulimia nervosa 4-20% of college aged women may be related
|
|
T or F Purging in bulimia nervosa can be done through vigorous exercise.
|
TRUE Also, laxatives, diuretics, or self vomiting
(P&G Eating Disorders) |
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T or F An anorexic or Bulimic patient can be underweight, normal weight or overweight.
|
False, Anorexic patients are usually underweight while bulimic can be ANY weight
|
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Physical signs of bulimia
|
darkness under the eyes
damages cuticles scarred and or calloused knuckles red eyes headaches weekly fluctuations in weight of 5 to 10 pounds (P&G Eating Disorders) |
|
Medical complications associated with bulimia include
|
dehydration
potassium imbalance gastric distension gastric ruptures GI bleeding cardiac arrythmias constipation (P&G Eating Disorders) |
|
T or F The ultimate medical complication with anorexia or bulimia is death.
|
true
(P&G Eating Disorders) |
|
Lanugo
|
downy hair growth may that may appear on the vermillion border of the lips, lower border of the mandible and extremities seen in anorexia nervosa
(P&G Eating Disorders) |
|
Perimolysis
|
enamel erosion
(P&G Eating Disorders) |
|
Oral signs of anorexia
|
Lanugo
Skin dry and flaky and appear orange Petechia may also be present enlarged parotid gland angular cheilitis lymphadenopathy (P&G Eating Disorders) |
|
Oral signs of bulimia
|
Perimolysis, facial erosion smooth and dished out present in person has been purging for a long time, linguals, increased dental caries,
dehydration oralpharyngeal area may be red or bleed enlarged parotid gland angular cheilitis lymphadenopathy |
|
Why is a bulimic client at an increased risk for caries?
a. a diet that included large amounts of sugars and carbs b. from the stomach acid in the mouth c. decreased salivary flow d. all of the above |
d. all of the above
(P&G Eating Disorders) |
|
A few signs of ______ that may be seen in a health history include:
heart disorders dehydration bruising easily blood chemistry problems |
eating disorders
(P&G Eating Disorders) |
|
T or F A bulimic individual should be told NOT to brush immediately after purging but can rinse with tap water.
|
First is true
Second is false, rinsing with tap water could decrease the buffering capacity of the saliva (P&G Eating Disorders) |
|
Peptic Ulcer
|
well defined break in the GI mucosa greater than 3 mm in diameter resulting from host response to HElicobacter pylori.
(little chp 12) |
|
T or F Peptic ulcers develop principally in regions of the GI tract that are proximal to the acid/pepsin secretions.
|
TRUE (little chp 12) The first portion of duodenum most common in western pop and gastric ulcers more frequenct in asia. Upper ujunum rarely involved
|
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T or F Peptic ulcer disease usually is chronic and focal
|
True (little chp 12)
|
|
The incidence of peptic ulceration has declined since 1950. What did the book discuss as possible reasons why?
|
• decreased cigarette and aspirin use
• increased use of veggie oils • better sanitation (little chp 12) |
|
Who is at a higher risk than the general population for getting peptic ulcers?
|
• first degree relatives of those who have them
• Smoke and heavily drinke • Type O blood • hyperparathyroidism and conditions with increased gastrin levels (renal dialysis, Zollinger-Ellison syndrome, mastocytosis) • NSAID for more than 1 month (little chp 12) |
|
T or F Peptic ulcers are rarely seen in children. When they are, it is usually due to poor sanitation in third world countries.
|
First is true, second is FALSE
Its most often associated with an underlying systemic illness like severe burn or major trauma (little chp 12) |
|
Etiological factors for peptic ulcers
|
• H pylori
• NSAID use • acid hypersecretion • cigarette smoking • distress (psychological or physical) • Cytomegalovirus (rare, in HIV + patients) |
|
T or F Helicobacter pylori is microaerophilic, gram-negative, sprial shaped bacillus
|
TRUE (little p.163)
|
|
Why are NSAIDS associated with peptic ulcers?
|
directly damage mucosa
reduce mucosal prostaglandin production inhibit mucous secretion (little p.163) |
|
In relation to peptic ulcers...
In a properly functioning body, what normally provides protection against acid breakdown? |
Mucosal resistance
Mucous and prostoglandin production blood flow bicarbonate secretion ion-carrier exchange Antibacterial proteins like lysozyme, lactoferrin, interferon, defensin/cryptdin (little p. 163) |
|
T or F Alcohol and NSAIDS are directly injurious to gastric mucosa
|
TRUE little p. 165
|
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T or F H. pylori is a known cause of acid hypersecretion.
|
FALSE, no correlation exists (little p. 165)
|
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T or F. H. Pylori is able to injure the stomach mucosa alone.
|
FALSE, it has the ability to cause inflammation but it is most likely the host response that causes the mucosal breakdown (little p. 165)
|
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When does discomfort of duodenal ulcer typically happen? Gastric?
|
duodenal: on an empty stomach 90 min to 3 hours after eating (can awake someone from sleep) p.165
Gastric: unpredicatable, may get it from eating |
|
What is a BAD sign that an ulcer has penetrated deeper?
|
Changes in character of pain..
loss of antacid relief pain radiating to the back p. 165 |
|
Test used to diagnose a peptic ulcer
|
fiberoptic endoscopy
Urea breath tests --measure presence of bug before and after treatment Serology (past or current infection, cant document eradication of bug) or H.pylori stool antigen tests less commonly used p.165 |
|
What three types of drugs are considered first line therapy ("triple") for peptic ulcers
|
at least two antibiotics and one antisecretory drug
|
|
Specifically, what is the first line therapy for peptic ulcers?
|
Propton pump inhibitor (or ranitidine bismuth citrate) twice daily PLUS
Clarithromycin 500 mg twice daily PLUS Amoxicillin 1000 mg twice daily or metronidazole 500 mg twice daily P.167 |
|
How long does therapy (meds) last for peptic ulcers?
|
10 days to 2 weeks
|
|
What is the second line therapy for peptic ulcers?
|
Quadruple therapy subsalicylate proton pump inhibitor twice daily, bismuth subsalicylate/subcitrate 120 mg 4x daily plus metronidazole 500 mg twice daily, tetracycline 500 mg 4 times daily
p. 167 |
|
When should a med consult be done with a client who has circled peptic ulcers on the health history?
|
when there are symptoms of active disease (p. 167)
|
|
Which of the following should be prescribed to a client with peptic ulcers (or history of peptic ulcers) for pain?
a. acetaminophen b. aspirin c. NSAIDS |
a. Acetaminophen only, the others should be avoided because they can irritated the GI epithelium
p. 167 |
|
T or F. A client with peptic ulcers should be instructed to take antibiotics or dietary supplements 2 hours before or after antacids are ingested.
|
TRUE, because the antacid impair absorption of those things p.167
|
|
T or F H. Pylori is found in dental plaque. Good oral hygiene and periodic scaling should be discussed with clients with peptic ulcers
|
TRUE p. 168
|
|
Inflammatory Bowel Disease
|
subcategories are ulcerative colitis and Crohns disease. Distinguished by site and extent of tissue involvment. p.169
|
|
T or F. Crohns disease is a mucosal disease that is limited to the large intenstine and rectum. In contast, ulcerative colitis is transmural process (affectes entire wall of bowel) and may produce patchy ulcerations on any point from mouth to anus.
|
FALSE, they are opposite p.169
|
|
Inflammatory Bowel Disease most commonly found in
|
Jew and whites
US and Europe Young adulthood (20-40 yrs) Crohns: female ulcerative colitis: m=f |
|
Ulerative colitis and Crohns disease are inflammatory diseases of unknown cause thought to be associated with.....
a. immune disfunction in response to environmental factors b. infection and destruction of tissue from bacterial infection |
a. (little chp. 12)
|
|
The three main symptoms of ulcerative colitis
|
1. attacks of diarrhea
2. rectal bleeding or bloody diarrhea 3. abdominal crams |
|
T or F Patients with Crohns disease do not typically require operation but long standing colonic crohns disease increases risk for colorectal cancer.
|
First false
Second true p. 170 |
|
Extraintestinal manifestations of Ulcerative Colitis
|
Dehyrdation
Fatigue weight Loss Fever arthritis erythem nodosum growth failure eye disorders (little chp. 12) |
|
Crohns disease initial manifestations
|
Persistent diarrhea
abdominal cramps anorexia weight loss THEN comes... fever, malaise, arthritis, uveitis, malabsorption features (little chp. 12) |
|
First line drugs for IBD
|
Anti inflammatory (sulfasalazine, corticosteroids...etc) (little chp. 12)
|
|
Second line drugs for IBD
|
Immunosuppressive and antibiotics (little chp. 12)
|
|
Third line drugs for IBD
|
monoclonal antibody against TNF ad surgery. (little chp. 12)
|
|
Sulfasalazine
|
Anti-inflammatory, administered 4g/day for active mild to moderate IBD at 1g/day during remission.
(may cause nausea head ache fever arthralgia, rash anemia agranulocytosis cholestatic hepatitis in 1/3 of patients) (little chp. 12) |
|
What supplements are usually recommended during sulfasalazine use?
|
Folic acid or iron (little chp. 12)
|
|
T or F Corticosteroids and sulfasalazine is used to induce remission in patients moderately to severely ill with IBD
|
TRUE
(steroids not for maintenance) |
|
Corticosteroid use is typically for ______ in IBD
a. maintenance in moderate to severe IBD b. mild disease c. short term use to induce remission d. long term use |
c. short term use to induce remission
p.171 |
|
What is Methotrexate? Adverse Effects?
|
immunomodulator used for severe disease in IBD (specificially Crohns disease) when it is refractory to all other treatments and for maintaining remission.
Prolonged use causes hepatotoxicity and pneaumonitis (also very expensive) |
|
In a med consult what should be asked if your client has IBD and is taking Methotrexate?
|
• ask about the patients breathing capacity.
• Ask for review of liver enzymes • Blood studies and coagulation studies need to be done too |
|
T or F Development of a fever in a client taking immunosuppressants with IBD should be cause for referal to physician
|
TRUE only if the cause of the fever is unexplainable or unknown. p. 172
|
|
T or F Routine care is not contraindicated for clients in any stage of IBD
|
FALSE, only urgent care during acute exacerbations p. 172
|
|
How can you assess the severity of IBD?
|
temperatue
number of diarrheal bowl movements per day if stool is bloody p.172 |
|
T or F Oral ulcerations may manifest in clients with IBD and Pyostomatitis vegetans can also be seen specifically in clients with Crohns disease.
|
TRUE p. 172
|
|
T or F Oral lesions in ulcerative colitis and crohns disease resolve when the GI state is medically controlled
|
TRUE p. 173
|
|
What distinguishes between apthous ulcers and ulcers seen as manifestations of IBD?
|
IBD ulcers are granular and may have irregular margins p. 172
|
|
Pseudomembranous colitis
|
severe and fatal resulting from overgrowth of Clostridium difficile due to loss of competative anaerobic gut bacteria p.173
|
|
Most common nosocomial infection of the GI tract
|
Pseudomembranous colitis p.173
|
|
Pseudomembranous colitis most common in
|
elderly, hospitalized patients, tube fed, infected with HIV p.173
(no gender distinction, young children rare) |
|
C difficile is
a. aerobic b. gram-negative c. anaerobic d. gram positive e. sporeforming rod |
a. gram-positive
c. anaerobic e. rod Overgrowth causes pseudomembranous colitis p. 173 |
|
What might be suspected:
After initiating clindamycin (ampicillin or amoxicillin), the client developed diarrhea(watery, loose or even bloody), dehydration, abdominal cramps and tenderness and fever. |
refer this client IMMEDIATELY, they could have Pseudomembranous colitis. These symptoms typically show 4-10 days after initiation of oral antibiotic but could show in 1-8 p. 174
|
|
Oral complications in Pseudomembranous colitis
|
systemic antibiotics could cause candidiasis p. 175
|
|
Diagnostic Triad for Anorexia Nervosa
|
body weight 85% less than expected
intense fear of weighht gain disturbance in body image |
|
T or F An enlarged parotid gland may be seen in clients with eating disorders
|
TRUE p. 499
|
|
T or F the prognosis is better for bulimia nervosa than anorexia nervosa.
|
False, opposite p.500
|
|
Which bug is associated with Peptic Ulcers?
a. h. pylori b. p. gingivallis c. c. difficile c. h. pylori |
a. h. pylori
(chp 12) |
|
How often should blood pressure be taken on a client with hyperadrenalism?
|
It should be monitored throughout the appointment (243)
|
|
Which bug is associated with Pseudomembranous colitis?
a. h. pylori b. p. gingivallis c. c. difficile |
c. c. difficile
(chp 12) |