Oral Surg Final

Front 1

Bleeding labs: list 4

Back 1

CBC/platelet count
Bleeding times
PT/INR
PTT

Front 2

Bleeding time (BT) is prolonged by what drugs:
Is is significant?

Back 2

ASA, NSAIDS

NOT Clinically significant but statistically is

Front 3

Can prolonged bleeding time presdict severe surgical bleeding?

Back 3

NO

Front 4

T/F Bleeding time is useful in predicting bleeding.

Back 4

Fasle

Front 5

List the factors involved in the extrinsic pathway

Back 5

I, II, V, VII X

Front 6

List the vit K dependent factors

Back 6

II, IV XI X

Front 7

Extrinsic pathway can be affected by all of the following idseases/drugs:

Back 7

Coumadin/proloned use of broad spectrum antibiotic; liver disease, drug use, leukemia, lymphoma, alcoholism, malabsorption syndrome

Front 8

If have a problem with EXRINSIC pathway, may have prolonged ___
Choices; BT, PT, PTT, CBC/platelet

Back 8

PT and aPTT

Front 9

Prothrombine time is associated with the __ pathway

Back 9

Extrinsic

Front 10

INR stands for what, and what is the WHO sttandardization

Back 10

International normalized ratio
INR=1

Front 11

__ is a measurement of responsiveness of a give thromboplastin to reduction of Vit. K-dependent factors compared to the international reference (takes into account the severity of the varous reagents)

Back 11

ISI

Front 12

Intrinsic pathway is associted with what factors:

Back 12

VII, IV, X, XI, V prothrombin and fibrinogen

Front 13

__ is associated with the intrinsic pathway

Back 13

aPTT

Front 14

for aPTT you will get a normal value when at least __% of factor available

Back 14

70%

Front 15

Intrinsic pathway is affected by __ drugs and __ conditions

Back 15

Heparin, lonterm antibiotic
Liver disease, malabsorption, cancers, infections, hemophilias, Von willebrands disease

Front 16

aPTT is used to monitor __therapy

Back 16

Heparin

Front 17

Which factor is the most sensitive and has a half life of 5 hours

Back 17

VII

Front 18

What is the normal range for platelets?
Diagnosis of thrombocotopenial w/ what count?
At a count of 50,000 what can you expect?
How about 10,000-20,000

Back 18

100,000-400,000
penia= <100,000
50,000= moderate bleeding but controable after surgery
10,000=spontaneous bleeding

Front 19

What is the term for too many platelets (above 400,000)

Back 19

thrombocytosis

Front 20

What is the most common inherited blood disorder

Back 20

Von Willebrands

Front 21

Von willebrands (aka factor ___ ) disease is characterized by prolonged __ and normal __; and is normally produce by __ cells in is necessary for normal platelet function

Back 21

VIII
prolonged BT, normal aPTT

Front 22

Mosts cases of VWD are __ (mild, moderate, severe) and tmt is __

Back 22

mild
dDAVP

Front 23

Aspring IRREVERSIBLY interferes w. conversion of platelet __ to __ by acetylating COX; COX recovers in __ days
Minimal effect on bleeding slighly incr __ but no eefect on __

Back 23

AA to thromboxane A2
4-7 days
prolonged BT no effect PT/aPTT

Front 24

NSAIDS act by REVERSIBLY acytylating COX and effecs last __

Back 24

6 hrs

Front 25

Plavix is a __ receptor blocker and inhibits __; is a __ inhibitor (rev/irrev)
Cardiac sent protocal=

Back 25

ADP
platelet aggregation
IRREVERSIBLE
ASA+ Plavix

Front 26

COX2 inhibitors (__) not a concern in theory b/c __ mediates antiplatelet effect but actually increased __

Back 26

Celebrex
cardiac complications

Front 27

Antiplatelet drugs abcixmab, anagrelide etc are __ receptor agaonists and prevent binding of __ to receptor-more potent than ASA
but have shown to exhibit __ in several trials

Back 27

Glycoprotein IIb/IIIa
Fibrinogen
Excessive bleeding

Front 28

Asprin will react normally to collagen and thrombin but __ will only act normally to HIGH concentrations of collagen/thrombin

Back 28

Clopidogrel

Front 29

__- results from end stage renal disease and impares platelet funtion, prolonged __ and is only partially corrected with dialysis. what happens if you give asprin

Back 29

Uremia
Prolonged BT
Markedly prolonged BT

Front 30

Hemophilia A is a deficiency in factor __; most common in __ form (mild, moderate severe)
TMT:__

Back 30

VIIIc
Severe
Human recombinant factor VIIIc

Front 31

__ is the most common recessive bleeding disorder

Back 31

Hemophilia A

Front 32

Factor VIII deficiency is caterorized as;
Sever= less than __% of normal
Mod.= __-__%
Mild: __-__%

Back 32

less than 1%
1-4%
5-50%

Front 33

Hemophilia B aka __ is deficiency of factor __

Back 33

Christmas
IX

Front 34

Hemophelia C aka __ is deficiency of factor __

Back 34

Stuarts
XI

Front 35

In liver disease all factors except __ (which is produced in endothelial cells is affected and resluts in prolonged __

Back 35

VIII
PT/aPTT

Front 36

Vitamin K deficiecy affects factors __ and reslus b.c malabsorption, malnutrition and alcoholism

Back 36

II VII IX X

Front 37

Anti-coagulant therapy
Coumadin=__ and is a competitve inhibitor of __; onset takes about __ hours and last for __ days; carried in blood by __

Back 37

Warfarin Sodium
Vit K
48 hours
2-10 days
Albumin

Front 38

Name antagonisits of coumadin

Back 38

Vit k, whole blood, fresh plasma

Front 39

Herparin (used as in-patient) potentiates action of __ and inactivates __; prevents conversion of __ to __
Onset: _
Duration:__

Back 39

Antithrombin II
thrombin, IX X XI XII
fibrinogen to fibrin
10-20 min
4-6 hrs

Front 40

Antagonist of heparin

Back 40

perotamine sulfate

Front 41

Low molecular weight heparin is given at home but mujst ge given for up to __ wks, less/more serious complications then with heparin

Back 41

4 wks
less

Front 42

When treating ___ condiditons need MD consult

Back 42

when on coumadin, thrombocytopenia, hemophilia A and B, VWFD

Front 43

Local measure to be taken use __surgical technigue: incluseds

Back 43

Atraumatic: clean incisiion, gentle management of soft tissue, remove areas of sharp bone and granulation tissue, inspect carefully for bleeders,lido w/ epi, can use gelfoam, tension sutures, post-op analgesia, NO risnsing 48 hours, liquid diet 48-72 hrs

Front 44

Local measures to stop bleeding include:

Back 44

Pressure!, mechanical adjuvants, cauery, hemostatic agents, cold packs

Front 45

__is always the first repsonse when bleeding

Back 45

Pressure-use damp gauze

Front 46

Ex. of mechancial adjuvants to stop bleeding

Back 46

Primary closure, surgical sents, soft tissue bleed=clamp/ligate, bone=crush foramen w. hemostat, bone wax

Front 47

Use cautery only when __ because of potential for __

Back 47

a specific bleeder noted
osteonecrosis

Front 48

Ex. of hemostatic agenst

Back 48

Gelfoam, topical thrombin, surgicel, absorbalbe collagen

Front 49

Gelfoam is and absorbable __ that have platelets that disintegrate at release __; resorb in __ wks, don't use when?
Advantages: (2)

Back 49

gelatin spone
thromboplastin
4-6 wks
When have infection
Common and least expensive

Front 50

Topical trombin bypasses __ and conberts __ to __, can be used with gelfoam

Back 50

coagulation cascade
fibrinogen to fibrin

Front 51

Surgicel is oxidized regenerated __ (plant based), Adv-can be __
Absorption can occur in __ days, DO NOT MOISTEN and only use amount needed;

Back 51

Cellulose
bactericidal
7-14

Front 52

__ can be enhanced by thrombin while __ is not

Back 52

Gelfoam
Surgicel

Front 53

Absorbable collagen promotes __ and Adv is excellent __ and __
But mj disadvantage is __
Ex.:

Back 53

platelett aggregation
adhearance to wound and well tolerated
Expensive
Avitene, Collaplug, Collatape

Front 54

not sure if i'm still in

Back 54

in

Front 55

T/F Fibrin sealant is dreived from bonvine thombin

Back 55

fasle-used to be now human

Front 56

Ttranexamic acid fomes a reversible complex w/ lysine site on __, and hase decreased use of factor concentrates in extractions by 80%, contraindicated in __ __ and __ and also may have __ has a side effect

Back 56

Plasminogen
SAH, color blindness and DIC
bad taste/GI upset

Front 57

__ aka __ is associated w/ SHORT term correction of BT's but doesn't work in in all patients and is TMT of choice when short term prevention of bleeding is necessary

Back 57

DDVAP/desmopressin

Front 58

DDAVP onset in __ hrs and duraction __ hours

Back 58

1 hr
4-24 hrs

Front 59

Cold packs- cause __ and decrease __; How do you apply it? and when?

Back 59

vasoconstriction and decreases edema
20min on 20 off 6-8 hrs after procedure

Front 60

When dealing w/ a pt on coumadin, may either partailly stop or completely stop or substitute w/ __; what test do we need b/4 treating

Back 60

Heparin
INR

Front 61

Write a MD consult for pt on coumadin

Back 61

Pt presents w/ __ and requires __(type of surgery) Pt is presently on coumadin. Please adjust PT/INR as ncessesary (eg will accept PT/INR <2.5) Will use additinal local measures for hemostasis. Require PT/INR lab morning of or w/i 24 hrs of surgical appt.

Front 62

Partial cessation of coumadin follows a __day withdrawl protocol
Comoplete a __day

Back 62

2-3-keeps duration of anticoagulation to a minimum

4-5-v.risky and overused

Front 63

What is the MC cancer of head/neck

Back 63

laryngeal

Front 64

MC oral cancer

Back 64

SCC

Front 65

T/F SCC is detectible w/ self exam

Back 65

yes

Front 66

Prognosis and survival correlate w/ __

Back 66

Stage

Front 67

List risk factors of oral cancer

Back 67

Alcohol, tocacco smoking, tobacco chewing, plummer vinsion syndrom, immunosupression, radiation, HPV

Front 68

Name some symptoms of oral cancer

Back 68

loose teeth, trismus, numbness, pain, dysphagia, halitosis

Front 69

Which is more malignant: red or white lesions

Back 69

Red (25% are malignant)

Front 70

List some commonly affected sites of oral cancer:

Back 70

lateral border of tongue, retromolar trigone, FOM, soft palate, gingiva, salivary glands

Front 71

TNM staging of oral cancer stands for:
T=
M=
N=

Back 71

Tumor Node Metastasis
T=size of tumor
N=numer and location of nodes
M= involves scans and other blood work

Front 72

Different Sizes of tumor
TIS=
TX=
T1=
T2=
T3=
T4=

Back 72

TIS=carcinoma in situ
TX=priamry tumor cant be assesed
T1= <2cm
T2=>2 and <4 cm
T3=>4
T4-massive w/ deep invasion of other tissues

Front 73

Nodal
Nx=
NO=
N1=
N2=
N3=

Back 73

Nx=neck nodes can't be assesed
NO=no involved nodes
N1=single ipsilateral invovled node <3cm
N2=" " <3cm or multiple nodes none >6
N3=single massive node or bilateral nodes or contralateral nodes
N3=

Front 74

Metastatic Disease
Mx=
Mo=
M1=

Back 74

MX=can't asses distant metastases
MO-no distant metastases
M1= distant metastasis present

Front 75

__ is the gold standard in cancer diagnosis-requres scalpel, LA and suture
___-potential for false negatives
__-primarily for lymph nodes/glands, high degress of false negatives

Back 75

Surgical incisional biopsy
Brush biopsy
Aspirational biopsy

Front 76

Only TMT in early stages is __ and __

Back 76

XRT or surgery

Front 77

__ make up 90% of oral malignancies for which XRT is used and requires high does of __ when most other cancers require __

Back 77

SCC
>60 GY
<50 GY

Front 78

__ minimize tissue exposure to radiation

Back 78

Portals

Front 79

__ is a mainstay of high stange H&N tmt and __ cells are the most vulnerable but other cells may b injured

Back 79

radiation therapy
neoplastic

Front 80

RT is done __ times weekly for __ wks and side effect are evident w/i __ wkds and are dose dependanct

Back 80

5x
6 weeks
1-2 weeks

Front 81

List some short term effects of RT to oral mucosa:
Long term:

Back 81

Short: erythema, mucositis, tast change, friable, easlily injured
Long: HHH-hypocellular, hypovascular, hypoxic, submucosa fibrosis, easier ulcerated, delayed healing

Front 82

__-painful erythema on soft palate, tonsillary pillars, buccal mcosa etc; develops after __, ..subsides __

Back 82

Irradiation mucositis

after 1 week
after 2-3 weks after complete tmt

Front 83

After RT may end up with radiation caries due to __ or __

Back 83

Xerostomia
Changes in oral flora

Front 84

Problems to bone are most serious after __ so it is chonic and progressive-will NOT GET BETTER; __ healing after trauma

Back 84

4 months
delayed to no healing

Front 85

Before and after RT: dental exam every __ mo; may need to perscibe what differnt tmt?

Back 85

2-3 mo
Fluoride trays, chlohexidine rinse daily, Piocarpine (to help slaiva flow), saliva substuitute, if have mucositis may need to give visous lido, benadryl mylanta etc

Front 86

Prior to XRT-
What teeth should be extracted?
When should they be extracted?
If don't get them extracted b/4 give RT can you extract after>

Back 86

All questionable teeth but full bony can be left in place
Opitmal time 3 wks b/4
Have a 4 month window AFTER tmt complete

Front 87

Dental mgmt DURING RT:

Back 87

Pallitive only-NO EXTRACTIONS
ie pulpotomy and ectomy, Incsion/drainage, pain meds, antibiotics

Front 88

At what dose will you see osteoradionecrosis

Back 88

possible at 50-60 but for sure if over 60 gy

Front 89

TMT for osteoradionecrosis

Back 89

hyperbaric oxygen chamber (HBO)

Front 90

If placing implants and have had dose of >45 gy then what condisderation should you have

Back 90

HBO before place implants

Front 91

MGMT after RT:
__ mo recall
__ for rest of life
_- procedures prn
__ can be done after mucositis has cleared
If mucosititis has cleard and w.i 4 mo then can do __ but if need this after 4 mo and/or had a dose of 60 gy what consideration must you take

Back 91

3 mo recall
Fluoride
restorative
Pros consult
Minor surgical procedures/minor pre pros prn
HBO therapy

Front 92

If have carious teeth after RT may want to avoid __ and __ may be difficult, __ is last resort

Back 92

crowns (hard to monitor decay
Endo (fibrous pulp)
exodontia

Front 93

Dentures after RT
__ more common and may lead of ORN
__ is impt
__ may be needed if there has been loss of bone in resection

Back 93

Soft tissue ulcerations
even force distribution
Specifically modified dentures

Front 94

T/F dental implants are contraindicated and cannot intergrate after RT

Back 94

False-can but fail at greater rate

Front 95

Should allow __ mo for integration of implants after RT

Back 95

6 mo

Front 96

T/F implants may offer the ONLY practical solution to overcoming post-surgical anatomic deformities

Back 96

True

Front 97

Ossteoradionecrosis is MC in __ and most worrisome at doses over __;

Back 97

mandible
60 gy

Front 98

T/F Antibiotics is a tmt for ORN

Back 98

Fasle-just prevents spread or secondary infection

Front 99

__ is administration of 100% o2 in a pressure chamber and causes __ to happen to damaged tissue

Back 99

HBO
increased oxygen and neovascualr grwoth

Front 100

Protocal for HBO: __ dives for exodontia and __ after-problem is may not be avialable

Back 100

20-30 before
10 after

Front 101

During chemo __ is common sequella; __ is also common but reverses after tmt stoped; also increase __

Back 101

Myelosupression
Stomatitis
opportunistic infections

Front 102

Mylesoupression common sequela: __ __ __ and__ but usually recover by __ wks

Back 102

leukopenia, nutropenia, thrombocytopeina, anemai
3 weeks

Front 103

__ is responsible for 70% of deaths if myelosuppressed patiens

Back 103

Systemic infections-so treat aggressively if see signs of infection

Front 104

MGMT during chemo:
Always need __
Defer tmt if WBC< __ or platelets <__and give __ and __ prn but can treat in routine matter if numbers above these-IF BELOW ___
Treat problems prior to chemo if possible

Back 104

Need MD/oncologis consult,
2000 50,000
If below-pallative tmt only
antibiotics and cholohexidine

Front 105

T/F Like RT cannot treat pt during chemo

Back 105

False-can treat b/t rounds but coordinate w/ MD

Front 106

List some symptms of ONJ caused by bisphosphonates:

Back 106

Soft tissue swelling, drainiage, loose teeth, non-healing exposed bone, pain

Front 107

3 characteristics of ONJ:

Back 107

Current/previous bisphosontae tx, exosed oral bone (more than 8 wks), no history of RT to jaws)

Front 108

Risk of ONJ is greater w/ IV or oral use

Back 108

IV (.8-`1%)

Front 109

bisphosphonates have __ yr half life and pricipitating factor for ONJ is _-

Back 109

10 yrs
trauma

Front 110

T/F TMT for ORN is same as ONJ

Back 110

Fasle-may actually exacerbate it

Front 111

Bisphoshonates bind to __ killing them; areas to be concerned about when using IV bisphophonates

Back 111

osteoclasts
areas of thin overlying mucosa

Front 112

TMT of pts on IV bisphosphonates:
Prior to IV therapy
Post IV therapy

Back 112

Pre-similar to RT (extract questionable, smooth sharp edges)
Post-AVOID implants, EXT is LAST resort

Front 113

T/F discontinuing oral bisphosontate therapy elimintaes risk of ONJ

Back 113

Fasle- so when need to extract only pull 1 first assess healing before doing multiple

Front 114

T/F Elective oral surgery is contraindicated in pts on oral bisphosphonates

Back 114

False

Front 115

1)How to you treat pts <3 yrs after PO bisph.?
2)How about >3 rst or <3 yrs + steroids?

Back 115

1)No alteration/delay in surgical tx
2) Stop bisphosphonates 3 mo prior and hold for 3 mo after

Front 116

Staging of ONJ
Stage 1 ENB:
Stage 2 ENB
Stage3 ENB:

Back 116

1: asynpt, no infection
2:pain and infection
3: pain and infection + 1 or more: pathological fracture, fisula, osteolysis to inferior border

Front 117

TMT of
Stage 1 ENB
Sage 2 ENB
Stage 3 ENB

Back 117

1: no surg, cholohexidine
2: cholohexidine, antibiotics
3: surgical depridement, resection w/ antibiotics

Front 118

Est ONJ tmt protocol..what are the objectives?

Back 118

Eliminate pain, control infectionand minimize progression

Front 119

T/F When have ONJ you should NEVER extract teeth because it will exacerbate the est. necrotic process

Back 119

Fasle-it is unlikely ext will cause more problem but NO ELECTIVE surgery

Front 120

T/F there is no short term benefit of discontinuing IV bisphosphonates but in the long term may stabilize ONJ sites, and decrease symtoms

Back 120

True

Front 121

T/F Discontinuing oral bisphos has been assoc w/ clinical improvement but at 6-12 mo sponteous sequestration may occur

Back 121

True

Front 122

T/F you do not need an MD consult for a pt on ORAL bisphosphonates

Back 122

False

Front 123

For diabetes- a positive fasting plasma glucose test is 2 occalsions of BS over __ (when normal is __)

Back 123

126 mg/dl
80-100 mg/dl

Front 124

Positive 2 hr porstprandial test is when glucose is greater than __

Back 124

200 mg/dl

Front 125

__-considered the best overall indicator of diabetic control; indicates mean glusce levels over __ days

Back 125

HbA1c
60

Front 126

Normal BS for diabetic thoughout day is __ and acceptible level is __ for surgery

Back 126

80-140 mg/dl
<200 mg.dl

Front 127

Normal HBA1c is __; good control __; fair control __

Back 127

5
<7
7-9

Front 128

Which type of diabetes exhibits ketoacidosis

Back 128

Type 1

Front 129

Typcial reading for Type 1 diabtic experiencing hyperglycemia __
Type 2

Back 129

250-800
>600 and up to 1000

Front 130

Mild hypoglycemia=__ mg/dl (symotms)
Moderate=
Severe=

Back 130

60-70 mg/dl-shakes, irritable, tachy
50-60 confusion
40-50 or less-coma

Front 131

TMT of mild-moderate hypoglycema:
Severe:

Back 131

M/M= 10-15 gm of carbs roally
Severe= 50% glucose IV (25 gm total but give 12 first) or glucagon IM

Front 132

Hyperglycemia results b/c __ cells are hyperactive to epi levels

Back 132

pancreatic alpha cells

Front 133

What questions to ask diabetic

Back 133

What meds are you on?
Do you monitor your bs? What was last reading
Do you get low often?
Do you know your symptoms? What are they?
Have you ever had to go to the hospital for a bs control issue?

Front 134

T/F b4 you do surgery on a diabetic you should have a MD consult

Back 134

true

Front 135

T/F Oral hypoglcemic agents should be stopped day of surgery

Back 135

True

Front 136

If pt is taking insulin and in for surgery how should you manage them

Back 136

1/2 of usual morning dose, D5W drip and monitor bs

Front 137

What main thing should you consider when pt is or has been taking steriods?

Back 137

Are they adrenaly suppressed and need supplemental steroids

Front 138

T/F Steroids decrease blood glucose levels

Back 138

False-elevate

Front 139

Steroids are necessary for 2 things..what are they

Back 139

Increase blood glucose through glucagon and catechol
Vascular scmooth muscle contraction

Front 140

Why/What is steroids most often prescribed for?

Back 140

As an anitinflammatory

Front 141

What is the rule of 2's as it pertains to steroids

Back 141

20 mg prednisone or its equivalen
for 2 weeks or more
w/i last 2 years

Front 142

What is the most postent steroid and which is the lease potent

Back 142

Most=dexemathasone
Least=cortisol

Front 143

Besides the rule of 2's what other condtions may you need to prescibe steroids for to preven adrenal insufficiency

Back 143

Receiving bed time dose for more than a few weeks
Any pt w/ Cushings
Possilbe alternate day therapy (but not used often **note not same as alternate day therapy when tapering off drug)

Front 144

What is the pre-op mgm of ppl on steroids

Back 144

Double dose for day of
Prednisone 30-40 mg or equivalent (decardon 6-8 mg)
If in doubt give boost of steroid

Front 145

What is the 3x3 rule as it applies to steroids

Back 145

3x the nomral dose for 3 days

Front 146

Symptoms of adrenal crisis

Back 146

Dizziness, profound weakness, sweating, hypotension, tachycardia, abdominal pain, nausea, vomiting LOC

Front 147

How to you treat a pt you suspect is going into adrenal crisis

Back 147

1. Call 911
goal is to treat hypoteniosn/cortisol deficienty
2. Large volume (2-3L) of NS or D5NS as quickly as posible
3. IV decardon 4-6 mg

Front 148

T/F ppl on stroids are at a decreased risk of infection

Back 148

Fasle-increased

Front 149

T/F NSAIDS is fine to take when on steroids

Back 149

Fasle-increase GI symptoms (ulcer, GI bleed)

Front 150

Cushings syndrome is characterized by:

Back 150

Fatty deposition (moon face, bufflo hump, suparclavicular fossa fat), muscle wasting, easliybrused, poor wound healing

Front 151

T/F Elective surgery is fine for hyperthyroid pts but NOT hypothyroid pts

Back 151

False-it isn't ok for either