Oral Surgery Test 1

Front 1

1 MET is equal to ___

Back 1

resting oxygen uptake in sitting position-oxygen it would require to take care of yourself

Front 2

Increased risk w/ patient unable to meet __ MET demand during normal activity

Back 2

4 MET

Front 3

4 METs is appoximately equal to the oxygent it would take to ___

Back 3

walk up a flight of stairs or a hill

Front 4

Acute MI w/i __ days w/ evidence of important ischemic risk

Back 4

7 days

Front 5

Recent MI w/i __ days with evendence

Back 5

8-20

Front 6

Cardiovascular Risk factors: high, moderate or minor

Severe angina

Back 6

High

Front 7

Cardiovascular Risk factors: high, moderate or minor

Significant arrhythmia

Back 7

High

Front 8

Cardiovascular Risk factors: high, moderate or minor

Decompensated CHF

Back 8

High

Front 9

Cardiovascular Risk factors: high, moderate or minor

Severe heart valve disease (aortic stenosis)

Back 9

High

Front 10

Cardiovascular Risk factors: high, moderate or minor

Mild angina (CCS I or II)

Back 10

Moderate

Front 11

Cardiovascular Risk factors: high, moderate or minor

Compenstated or prior history of CHF

Back 11

Moderate

Front 12

Cardiovascular Risk factors: high, moderate or minor

DM especially insulin depend.

Back 12

Moderate

Front 13

Cardiovascular Risk factors: high, moderate or minor

Reduced renal function

Back 13

Moderate

Front 14

Cardiovascular Risk factors: high, moderate or minor

Advanced age

Back 14

Minor

Front 15

Cardiovascular Risk factors: high, moderate or minor

Abnormal ECG

Back 15

Minor

Front 16

Cardiovascular Risk factors: high, moderate or minor

Low functional capacity (MET)

Back 16

Minor

Front 17

Cardiovascular Risk factors: high, moderate or minor

History of stroke

Back 17

Minor

Front 18

Cardiovascular Risk factors: high, moderate or minor

Uncontrolled hypertension

Back 18

Minor

Front 19

___- results from an 75-80% occlusion of vessles or increased oxygen demand or both

Back 19

Angina

Front 20

__ angina- chronic unchanged pattern, induced by physical activity/stress, relieved by SL or Nitro

Back 20

Stable

Front 21

__ angina-chronic change in pattern, new onset (occur at rest) less responsive to nitro

Back 21

Unstabe

Front 22

Mngmt of Stabe angina- ASA__, limit vasoconstrictor to __; consider sedation

Back 22

ASA III
40mcg

Front 23

Mngmt of Unstable angina- ASA__, NOT a canditate for elective surgery so limit tmt to __; consult with patients MD

Back 23

ASA IV
Rx with analgesics and antibiotics

Front 24

Hear dies after __ minutes of oxygen deprivation

Back 24

30 minutes

Front 25

Death from MI is usually due to __

Back 25

V fib

Front 26

Normal ejection fraction (measurement of strenght of heart) is about __%; EF<__% is impared pumping action

Back 26

60%

50%

Front 27

TMT of MI patient
If pt ahs been evaluated and has NO residual myocardium risk for continued ischemia then elective dental tmt can be done as early as __ post MI

Back 27

6 weeks

Front 28

> 6 mo post MI should be categorized as ASA __

Back 28

ASA III

Front 29

Anti-arrhythmic drug classified by channel they block
Cl I-___
Cl II-___
Cl III-___
Cl IV-___

Back 29

I-primarly sodium channels
II- beta blocker
III-potassium channels
IV-calcium channel blocker

Front 30

Atria tachycardia-__ bpm
usually caused by __ or __

Back 30

120-180

Front 31

Meds for atrial tachycardia
__- increased vagal tone to AV node
__-decrease sympathetic activation of AV node
__-slow AV nodal conduction
__-because these pts are at increased risk of systemic emboli

Back 31

Digoxin
Beta blockers
Amiodarolline
Anticoagulants (coumadin)

Front 32

The most common arrhythmia is __; only worrisome if unifocal with __ bmp or if ___

Back 32

PVC (premature ventricular contraction)
>5 BPM or multifocal

Front 33

___-rate of about 150 bpm, results in significant hemodynamic compromise
__-total chaotic ventr. rhythm, immediate attention needed

Back 33

V tach

V fib

Front 34

Arrhythmia Risk: Negligible, Moderate, Significant

Atrial arrhythmia/PVC-no meds

Back 34

Negligible

Front 35

Arrhythmia Risk: Negligible, Moderate, Significant

Healthy, asymptomatic pt with bradycardia

Back 35

Negligible

Front 36

Arrhythmia Risk: Negligible, Moderate, Significant

Atrial Arrhythmia-chronic meds

Back 36

MOderate

Front 37

Arrhythmia Risk: Negligible, Moderate, Significant

Pt w/ pacemaker

Back 37

Moderate

Front 38

Arrhythmia Risk: Negligible, Moderate, Significant

Ventricualr arrhythmia-chronic meds

Back 38

Significant

Front 39

TMT of pt with blood pressure >180/ >110
ASA___
TMT: ___

Back 39

ASAIII

may recieve tmt- stress reduction (Nitrous or IV) treat at your comfort level

Front 40

Local anesthesia is/is not contraindicated in pts with hypertension

Back 40

are NOT
but use with caution

Front 41

Max dose of epi for cardiac pts ___
Max dose for normal pt

Back 41

0.04 mg (40 mcg) w/i a 30 minute period w/ all but severe CHD
0.2mg (200mcg)

Front 42

Alpha 1 or 2 Beta 1 or 2:

Constricts vasc. smooth muscle-vasoconstriction leads to increased periperal vascular resistance leased to increased BP

Back 42

Alpha 1

Front 43

Alpha 1 or 2 Beta 1 or 2:

Inhibits release of NE

Back 43

Alpha 2

Front 44

Alpha 1 or 2 Beta 1 or 2:

Increase HR and strength or contraction

Back 44

Beta 1

Front 45

Alpha 1 or 2 Beta 1 or 2:

Dilate smooth muscles of BV's and airway

Back 45

Beta 2

Front 46

Selective beta blockers block__ (beta 1 or 2)

Back 46

Beta 1

Front 47

TMT of pt w/ BP >210/>120
ASA __ Stage __
TMT that can be done: __

Back 47

IV Stage 4
TMT: no elective tmt, control BP prior to emergency care, refer immediately to family MD or ER

Front 48

Difference b/t stroke and TIA is __

Back 48

TIA symptoms disappear after 24 hours

Front 49

Stroke pts are on __ to prevent further occurances

Back 49

Anticoagulants and antiplatelet (plavix and aspirin)

Front 50

Do stent pts need antibiotic prophy?
Bare metal sent(BMS) pts are places on __ therapy (Rx and duration)
Drug eluting sents on __ therapy

Back 50

Prophy-?? consult physician
BMS-ASA and plavix for 1 mo minimum-1 year ideal
DES-ASA and plavix for 1 year minimum

Front 51

Most artificial vavles are __ (mechanical or bioprosthetic) and are _(mitral or atrial)__ valves

Back 51

mechanical
Mitral

Front 52

2 main concerns of Vavle replcement pts for dentists are __ and __

Back 52

Endocartitis prophylaxis
Antithrombotic therapy
Mechanical-NEEDS both coumadin and ASA
Bioprosthetic-ASA, or possible ASA and coumadin for high risk pateints

Front 53

TMT of pt with CHF
Compensated CHF-
Uncompensated CHF-

Back 53

Compensated-treat with any necessary modification
Uncompensated- defer tmt

Front 54

Ex Class II Beta blocker

Back 54

Propranolol

Front 55

Ex. Beta 1 selective beta blocker

Back 55

Metoprolol

Front 56

ex Betal blocker with alpha blocking activity

Back 56

Coreg

Front 57

ex. Alpha 1 blocker

Back 57

Prazosin

Front 58

Alpha2-Adrenergic Agonist

Back 58

Clonidine

Front 59

Ex. Ace Inhibitor

Back 59

Lesinopril

Front 60

Ex. Angiotensisn II receptor blocker

Back 60

Cozaar

Front 61

Ex. Calcium channel blocker

Back 61

Norvasc

Front 62

Ex. Antiarrhythmic agent Class IV

Back 62

Digoxin

Front 63

__-cesation of breathing
__-difficult or labored breathing
__-deficient oxygenation of blood

Back 63

Apnea
Dyspnea
Hypoxemia

Front 64

__-deficiency of oxygen reaching tissues
__-excess of CO2 in blood

Back 64

hypoxia
Hypercapnia

Front 65

__ drug of choice in treating asthmatics
__-drug used for prophylactic in exercised induced or acute exacerbations

Back 65

Inhaled corticosteroids

Beta2-adrenergic bronchodilatiors

Front 66

Triad of asthma

Back 66

Cough
Weezing
Dyspnea

Front 67

Stepped Approach for TMT of Asthma:
Step 1 __ for mild
Step 2__- for moderate
Step 3 __-for moderate
Step 4__-for severe

Back 67

1- B2 agonist
2-Inhaled steroids
3- B2 + inhaled+long acting broncholilators
4- all of step 3+ oral corticosteroids

Front 68

Conscious sedation is/is not contridiacted for asthma patients-becareful with __ and __ type drugs

Back 68

Is not
Barbituates and narcotics

Front 69

COPD is characterized by __-if don't have this then not COPD

Back 69

airflow obstruction

Front 70

Patients w/ COPD may be on __-if used with ertythrocmycin may lead to toxic levels leading to arrhythmia and convulsions

Back 70

Theophylline

Front 71

T/F There are some medications that have been proven to alder the decline in lung function that is the hallmark of COPD

Back 71

False

Front 72

__-mainstay therapy in COPD

Back 72

Bronchodilators

Front 73

Drugs for COPD therapy
__-short acting prn, long acting if short acting inadequate
__
__-effects only modest and toxicity is a concern
May also use __ (either inhaled or systemic) or a combination of this and long acting beta2 agonists

Back 73

B2 agonist
Anticholinergics
Theophylline
Corticosteroids

Front 74

Regardless of hypercapnia-it is essential to treat hypoxia-optimal O2 sat is __-any more than this risk hypercapnia and do little to reduce hhypoxia

Back 74

88-93%

Front 75

Skeletal muscle can withstand __minutes of hypoxia whereas the brain can only withstand __

Back 75

30
4-6

Front 76

__ and __ can lead to hypercapnia

Back 76

CNS depression
Rapid shallow breathing

Front 77

Hypercapnia is present in __(early/Late)__ stage of COPD

Back 77

Late

Front 78

__-most common tmt for sleep apnea; mj concern in dentistry and sleep apnea comes when __

Back 78

CPAP machine

PT desires sedation-only should be lightly sedated

Front 79

__-final breakdown product of protein by the liverand chief nitrogenous constituent of urine
Its excretion inc/dec in kidney failure

Back 79

Urea

Decreased

Front 80

__-intoxication caused by the body's accumulation of metabolic byproducts taht are normally excreted by healthy kidneys

Back 80

Uremia

Front 81

TMT for Uremia includes:

Back 81

Dialysis, protein restricted diet, careful management of acid-base balance and calcium/folate supplements

Front 82

Uremic bleeding in CRF (chronic renal failure) is predominately a __ dysfunction partly because of excess production of __

Back 82

Platelet- aggregation and adhesion decreased
Nitric oxide

Front 83

__-crystalline substace that combines readily with phosphate called __-this combo serves as a source of high energy phosphate relased in the __ phase of muscle contraction

Back 83

Creatine
Phsophocreatine
anaerobic

Front 84

__-the decomposition product of the metabolism of phsphocreatine; inc/dec quantities found in renal failure

Back 84

Creatinine
Increased

Front 85

__ is a common way of measuring GFR
in women should be about__
In men about __

Back 85

Plasma creatinine concentration(creatinine clearance) Clcr
women= 95 +/- 20
men= 120 +/- 25

Front 86

Clcr and Tylenol
Clcr 10-50 ml/min-Administer every __hours
Clcr <10 administer every __ hours

Back 86

6
8

Front 87

__-metaboism involving nucleic acids, present in nuclei of cells, in which they are combined with proteins to form nucleoproteins

Back 87

purine metabolism

Front 88

purines are the end producs of nucleoprotein digestion and are catabolized into __ which is excreated by kidneys, excess leads to gout

Back 88

Uric Acid

Front 89

__-enzyme produced by the kidney that splits angiotensinogen to form __ which is converted to __-stimulates vasoconstriction and secretion of __

Back 89

Renin
Angiotensin I to Angiotensin II
Aldosterone

Front 90

__ produced by kidneys causes a rise in RBC production, reduced amounts of this leads to __

Back 90

Erythropoietin
Anemia

Front 91

__ is used to treat anemia esp in patients with renal or bone marrow failure but __ is a common side effect

Back 91

Synthetic erythropoietin
Hypertension

Front 92

__-nitrogen in the blood in the form of urea, the metabolic product of the breakdown of amino acids used for energy production
Nomral conc. is __

Back 92

Blood urea nitrogen (BUN)
8-18mg/dl

Front 93

BUN inc/dec in presence of decreased renal function, dehydration, upper GI bleed, or tmt w/ steroids/tetracycline

Back 93

Increased

Front 94

Pt w/ BUN= __ would have moderate insufficiency and with __ would have plt abnomral w/ bleeding

Back 94

50 mg/dL

>50 mg/dL

Front 95

TMT of bleeding Kidney pt
Mild platelet interference-use__
More severe-coordinate w/ pts MD and __ used

Back 95

Local measures-gelfoam, suture over-sew
DDAVP(desmopressin)-taken 30 min before procedure

Front 96

2 Types of Dialysis
__ and __-requires vascular access

Back 96

Continuous ambulatory peritoneal dialysis (CAPD)
Hemodialysis (HD)

Front 97

Hemodialysis is done usually every 2-3 days and __ is used so blood does not clot in dialysis -make appt day after dialysis

Back 97

Heparin

Front 98

Antibiotic prophylaxis and Dialysis-Answer Y or N
CAPD-__
HD by hative AV fistula-__
HD by synthetic graft-__
HD by indwelling catheter-__

Back 98

Yes
no
Yes
Yes

Front 99

List of drugs OK to use w/ kidney pt's

Back 99

Tylenol-w/caution
Codeine, oxycodone, hydrocodone
Pen, cephalsporins, clinda, metron, doxycycline
Fentanyl
Propofol
Benzo's and Versed

Front 100

Drugs NOT OK to use w/ kidney pt

Back 100

Meperidien
Propoxyphene
ASA
Tetracycline
NSAIDS

Front 101

__-the pathological changes in the liver of extensive fibrosis

Back 101

Cirrhosis

Front 102

Chirrhosis char are all of the following except (may be more than 1): jaundice, fluid retention, wasting, coagulopathy, fever, altered mental status, High BP, GI bleeding

Back 102

fever, high BP

Front 103

TMT of a pt with acitve hepatocellular disease- __
Ex of active hepatocellular disease - ___

Back 103

Defer until active infection resolves-palliative tmt only

Acute viral hepatitis

Front 104

TMT of pt with crhonic infective state of liver disease-___

Back 104

Medical consult-beware pt may be on tmt that affect hemoglobin/hematocrit as well as induce leukopenia/thrombocytopenia

Front 105

Clotting factors ____ are produced in liver, all of which are Vit K dependant except __
lab values of these effect __-usually increased if levels of these are decreased

Back 105

II, V VII, IX, X

V
Prothrombin time

Front 106

Decreased albumin produced by liver means what for drugs?

Back 106

Increased unbound active drugs

Front 107

TMT of bleeding problem w/ liver disease-__

Back 107

MD consult, Fresh frozen plasma, if <50,000 then platelet transfustion

Front 108

Fibrosis associated with deceased blood flow to most distal areas where you find __-v. imp in metabolizing many drugs

Back 108

Cytochrome P450 (CYP)

Front 109

Decreased levels of CYP mean __ half life of certain drugs

Back 109

Prolonged

Front 110

Hep A B C D or E

Oral fecal route

Back 110

A and E

Front 111

Hep A B C D or E

No chronic carrier state, develop lifetime immunity

Back 111

A and E

Front 112

Hep A B C D or E

Usually perentral route, highly infectious

Back 112

B

Front 113

Hep A B C D or E

Usually blood exposure-one of the leading cause of cirrhosis

Back 113

C

Front 114

Hep A B C D or E

No vaccine and little immunity that is not effective

Back 114

C

Front 115

Hep A B C D or E

Need to co-infection w/ hep B

Back 115

D

Front 116

Most commmon drugs used in dental practive metabloized by liver

Back 116

Xylocaine, Carbocaine, Marcaine, Aspirin, Acetominophen, ibuprofen, codeine, meperidine, Benzo's

Front 117

90% of acetominophen is converted in liver to __ and __ conjugates; the other 10% is converted by __ to __-very toxic but is rapidly conjugated w/ __ to form __ and __ compounds which are exctreted in urine.

Back 117

Sulfate and glucuronide
CYP450 to NAPQI
hepatic glutathione forming cysteine and mercaptate

Front 118

When hepatic gluthione are depleated by about __%- liver toxicity occurs

Back 118

70

Front 119

Can liver pts use acetominophen?

Back 119

Yes-but in a limited low dose-avoid chronic use