Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
44 Cards in this Set
- Front
- Back
|
Medical Risk Assessmenti s the collection and evaluation of essential data from of four sources:
|
1. Medical History:
Includes drugs & medications 2. Physical examination Vital signs Visual assessment of face, head, neck, gait, body positioning, other 3. Laboratory tests, if indicated. 4. Medical consultation MD, DDS, specialist, pharmacist |
|
|
American Society of Anesthesiologists Risk Assessment Scale
|
ASA I: No overt systemic condition
Routine office care ASA II: Mild to moderate systemic condition(s) with significant risk factor(s), medically stable Minor modifications Stress reduction ASA III: Severe systemic condition(s) that limits physical activity, medically fragile but not debilitating Medical consultation Modified office care Stress reduction ASA IV: debilitating systemic condition(s) that immobilizes and is a constant threat to life Medical consultation Hospital care Strict modification ASA V: moribund patient not expected to live 24 hours Emergency care only in a hospital |
|
|
Any healthy individual who experiences extreme fear of dental treatment is classified as ASA level ___
|
2
|
|
|
ASA level 2
|
patient should be able to walk two city blocks at a fast pace or climb two flights of stairs without becoming SOB or experiencing any discomfort
|
|
|
the most common significant adverse events in the perioperative period.
|
Morbidity and mortality from cardiac complications
|
|
|
Major risk factors identified by ACC/AHA to consider before treatment
|
1. Unstable CHD
Angina, MI < 30 days 2. Symptomatic CHF Unable to perform limited physical activity w/o chest pain, SOB 3. Significant arrhythmias Heart block, ventricular arrhythmias, symptomatic bradycardia 4. Severe valvular disease Severe aortic stenosis, symptomatic mitral valve stenosis |
|
|
Intermediate risk factors identified by ACC/AHA
|
1. History of CHD
Angina, previous MI, angioplasty, CABG 2. History of CHF 3. History of cerebrovascular disease CVA, TIA 4. IDDM Type 1 diabetes 5. Renal insufficiency Serum creatinine > 2.0 mg/dL |
|
|
If __ or more intermediate risk factors are present; defer elective procedures until cleared by patient’s physician
|
3
|
|
|
Minor risk factors identified by ACC/AHA
|
1. Advanced age > 70
2. Abnormal ECG LV hypertrophy, left BBB, ST-T abnormalities 3. Rhythm other than sinus 4. Uncontrolled hypertension >180/110 |
|
|
Use of Epinephrine in Patients With CV Disease
|
Benefits:
Decreases bleeding Decreases absorption of LA Increases duration of LA Potential Risks: Tachycardia Increased BP Dose related Palpitations Apprehension |
|
|
Avoid epinephrine for patients with these conditions
|
Unstable angina
Recent MI Past Hx of MI and still symptomatic (chest pains, etc) Significant arrhythmias Advanced heart failure Recent stroke Uncontrolled hypertension >180/>110 |
|
|
What drugs should not be used for 24 hours after cocaine use?
|
Vasoconstrictors
|
|
|
Elevated WBC count
|
WBC > 1,000 cells/mm3
|
|
|
Elevated platelet count
|
> 100,000 cells/mm3
|
|
|
Cardiac risk factors:
|
• Family history of IHD
• Smoking • Diabetes • Inactivity • Previous MI • Age and Gender • Hypertension • Obesity • Peripheral or Cardiac disease |
|
|
hypertension
|
a consistent recording of systolic blood pressure of 140 mm Hg or greater, diastolic blood pressure of 90 mm Hg or greater, or taking antihypertensive medication.
|
|
|
Primary or essential hypertension is a multifactorial disease but most hypertensives seem to have at least one of the following mechanisms involved:
|
An inability to handle sodium appropriately in comparison to normotensive patients
Overactivity and overstimulation of the sympathetic/adrenergic nervous system A defect in the handling of intracellular calcium in vascular smooth muscle, thereby giving more vasoconstriction in hypertensives versus normotensives |
|
|
JNC VI: BP Classifications
|
- Normal: <120/80
- High Early: Sys:120-139/80-89 - Stage 1 Hypertension: 140-159/90-99 - Stage 2 Hypertension: >160/100 |
|
|
Pharmacologic therapy for Treatment of Hypertension
|
a diuretic, usually a thiazide
a beta-adrenergic blocker or other adrenergic blocker an angiotensin-converting enzyme inhibitor a calcium-channel blocker |
|
|
Prevalence of Diabetes in the US
|
7.3% of adults
Half are undiagnosed > 20 million with impaired glucose tolerance |
|
|
Diagnostic Criteria for diabetes
|
ADA
Fasting glucose ≥ 126mg/dl x2 + symptoms, glucose >200mg/dl WHO Fasting glucose ≥140mg/dl Random or pp glucose ≥200mg/dl |
|
|
Metabolic Syndrome
|
- Impaired fasting glucose
≥ 110 mg/dl - Hypertension ≥ 130/85 mm Hg - Triglycerides ≥ 150 mg/dl - Low HDL < 40 mg/dl men; < 50 mg/dl women - Abdominal obesity Waist circumference ≥ 102 cm men; ≥88 cm women |
|
|
Complications of diabetes
|
- Microvascular
Nephropathy Retinopathy - Neurologic Altered Salivary secretion - Immune Increased risk of infection - Macrovascular Heart attacks Brain attack (stroke) - Periodontal disease |
|
|
Possible Mechanisms of Diabetic Complications
|
Advanced glycosylation end products (accelerated ‘aging’)
Accumulation of sorbitol via the polyol pathway Increased protein kinase C Genetic susceptibility |
|
|
Glucose binds irreversibly to Hb, thus Hb A1c levels directly correlate to...
|
blood glucose levels
|
|
|
Etiology of Periodontal disease in DM
|
Inflammation
Vascular changes Altered oral microflora Abnormal collagen metabolism Elevated Matrix Metalloproteinases Suppressed bone remodeling |
|
|
Hypoglycemia signs/symptoms
|
Sweats
Shakes Headache Hunger Tachycardia Mental confusion Syncope Seizure |
|
|
Hyperglycemia signs/symptoms
|
Poly’s
Behavior change Tachycardia Rapid, deep breathing Hot, dry skin Acetone breath |
|
|
The new guidelines recommend that only individuals who are at the highest risk of an
adverse outcome from IE receive antibiotic prophylaxis, and they include: |
1. Prosthetic cardiac valve
2. Previous infective endocarditis 3. Congenital heart disease 4. Cardiac transplantation recipients who develop cardiac valvulopathy |
|
|
SYMPTOMS OF PULMONARY DISEASE
|
COUGH
DYSPNEA CHEST PAIN HEMOPTYSIS |
|
|
MOST COMMON CAUSE of HEMOPTYSIS
|
ACUTE BRONCHITIS
|
|
|
CHRONIC BRONCHITIS
|
Cough characterized by mucous production for most days of the week to three months of the year for two consecutive years.
|
|
|
EMPHYSEMA
|
A condition of the lung characterized by permanent enlargement of the airspaces distal to the terminal bronchioles accompanied by destruction of alveolar walls but without evidence of fibrosis
|
|
|
ASTHMA TRIGGERS
|
Allergies
Aspirin Nonsteroidal antiinflammatory agents Emotions Infections Exercise Environmental changes – cold air |
|
|
ASTHMA TREATMENT
|
Bronchodilators
a. beta sympathomimetics 1. long acting 2. short acting b. theophylline preparations c. anticholinergics Anti-inflammatory agents a. steroids |
|
|
GI disease that has the largest effect on the oral cavity
|
gastric reflux.
|
|
|
The most common condition in post-menopausal women that may present as a potential medical risk
|
hypothyroidism
|
|
|
PT
|
Prothrombin time - monitors effects of Coumadin
|
|
|
PTT
|
partial thromboplastin time - monitors effects of heparin
|
|
|
standard WBC counts
|
o Total WBC: 4,000 – 11,000 cell/mm^3
o Neutrophils: 3,000-6,000 (30-70%) - Antibiotic prophylaxis is indicated with neutrophils <500 o Lymphocytes: 1,500- 4,000 (20-50%) o Monocytes: 200-900 (1-12%) o Eosinophils: 100-700 (0-3%) o Basophils: 20-50 (0-1%) o Platelet count: 150,000- 400,000 mm^3 • <20,000 may see spontaneous bleeding |
|
|
activated partial thromboplasin time (aPTT)
|
• crude test of hemostasis; measure of platelet function – how well platelets interact with blood vessel walls to form blood clots
• used most often to detect qualitative defects of platelets |
|
|
Anti-HCV
|
hepatitis antibody- marker of infection, because you never clear the infection anyone who has this antibody has Hep. C
|
|
|
CD4 count diagnostic of AIDS
|
<200 cells/uL
|
|
|
Hutchinson’s triad
|
It is a common pattern of presentation for congenital syphilis, and consists of three phenomena:
1. interstitial keratitis, 2. Hutchinson incisors, and 3. eighth nerve deafness |
