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45 Cards in this Set

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mx/mn position, insufficient width, length/projection, loss of retroglottic & upper airway space results in ____ in theory
this is hypothesis of sleep apnea
sleep apnea corrected via
correction of mx/mn position increases space & sucessfuly treats obstructive sleep apnea
T/F

sleep apnea & obstructive sleep apnea are synonymous
False
poor concentration, inappropriate sleep & 10 more are symptoms of sleep apnea?
poor memory, increased irritability, chronic fatigue, decreased libido, some depression, claustrophobia, rapid sleep onset, avoidance of social events, awakening w/ a headache, and sweating in sleep
OSA associated with
gender?
diet?
other?
male
Age
Obese
Alcohol/Tobacco
Consequences of OSA?

(daily & more long term)
daytime sleepiness

arthrosclerotic-hypoxic sequelae
Sleep apnea is mediated from 2 different sources. what are they?

hint: one is airway obstruction
1. airway obstruction

2. CNS mediated
central vs. obstructive vs. mixed sleep apnea. what's the frequency %?
1% Central

14% Mixed

84% Obstructive

perhaps understatement of CNS
SA is multifactorial. 6 items listed, 2 include lifestyle, cardiac, list others
primary CNS
Upper airway
cardiac
pulmonary
substances
lifestyle
Central Sleep Apnea - conditions that contribute to chronic anoxia, such as CHF, pickwickian synd., A-V malformations (septal defects) & what?
pulmonary fibrosis

CHF, pickwickian syndrome
A-V (heart), pulmonary fibrosis
COPD role maybe?
conditions that cause chronic CO2 retention such as pulmonary cemphysema may also be the cause.
disease of CNS that depressed repiratory center effects SA. includes poliomyelitis, chronic drug/alcohol use, viral emcephalitits residual damage and ___ tumors & MS
CNS sleep apnea
polio
drug/alcohol
viruses (encephalitis)
brainstem tumors
MS
if someone is a blue bloater it's
a. cor pulmonale
b. cyanosis
c. OSA
blue bloater
- cor pulmonale
- cyanosis
it's sleep apnea, but not OSA
can tonsils cause sleep apnea?
greatly enlarged tonsils and adenoids can cause obstructive sleep apnea
difference between oral soft tissue Mallampati scores
grade 1 - wide open
grade 2 - open
grade 3 - hard/soft palate
grade 4 - palate
OSA in sleep, airway obstruction on blood levels.
arousal in sleep?
blood co2 levels rise, o2 levels fall
breathing resumes with a gasp, briefly arousal to open airway and restore blood gases
suggested Tx often (simple daily Tx)?
generalized exercising and stretching
COPD role maybe?
conditions that cause chronic CO2 retention such as pulmonary cemphysema may also be the cause.
disease of CNS that depressed repiratory center effects SA. includes poliomyelitis, chronic drug/alcohol use, viral emcephalitits residual damage and ___ tumors & MS
CNS sleep apnea
polio
drug/alcohol
viruses (encephalitis)
brainstem tumors
MS
if someone is a blue bloater it's
a. cor pulmonale
b. cyanosis
c. OSA
blue bloater
- cor pulmonale
- cyanosis
it's sleep apnea, but not OSA
can tonsils cause sleep apnea?
greatly enlarged tonsils and adenoids can cause obstructive sleep apnea
difference between oral soft tissue Mallampati scores
grade 1 - wide open
grade 2 - open
grade 3 - hard/soft palate
grade 4 - palate
OSA in sleep, airway obstruction on blood levels.
arousal in sleep?
blood co2 levels rise, o2 levels fall
breathing resumes with a gasp, briefly arousal to open airway and restore blood gases
suggested Tx often (simple daily Tx)?
generalized exercising and stretching
OSA cycle, p 12
p12
hypothyroid - 2%
mild hypothyroid - ?
hyperthyroid - ?
mild hyperthyroidism - ?

.2%, .1-.6%, 5-17%. match
hypothyroid - 2%
mild hypothyroid - 5-7%
hyperthyroid - .2%
mild hyperthyroidism - .1-0.6%
p.9 thyroid
p.9 thyroid
these are signs of what?:
weakness, fatigue, cold intolerance, dry/cold/yellow skin, thick tongue, weight gain and Bradycardia
thyroid hypofxn: hypothyroidism :

weakness, fatigue, cold intolerance, dry/cold/yellow skin, thick tongue, weight gain and Bradycardia
hyperthyroid, what will you see clinically?
exophthalmos

also: tremors, sweating, heat intolerance, warm/thin/soft skin, weight loss, tachycardia
if out of control

hypothyroidism leads to?

hyperthyroidism leads to?
hypo --> MYXEDEMA COMA

hyper --> THYROID STORM
emergency management of myxedema coma or hypothyroid storm. 5 steps
1. stop dental tx
2. position supine, elevate legs
3. BLS, airway, breathing, circulation
4. EMS, IV established, administer Oxygen
5. transport to hospital
cardia emergencies
part 1

age 10+, heart disease is #1 killer
average wait from symptoms of cardiac event to help is?
__% via private transport.
X will die, X will never reach hospital alive
average wait from symptoms of cardiac event to help is TWO HOURS
50% via private transport.
500,000 will die, 300,000 will never reach hospital alive

total: 1,500,000 individual events
chest pain

acute coronary syndrome can be one of 2 things:
unstable angina
or
Myocardial infarction
difference b/w angina and MI
angina - brief periods of occlusion would likely cause unstable angina (at rest)
MI - protracted episodes could result in nontransmural or transmural infarction
what do i got?
subeternal squeezing/burning pain "heavy weight" "indigestion", sudden onset w/ exertion or emotion.
radiates to shoulder, face, left arm
- subsides w/ rest or nitroglycerin
these are clinical manifistations of Angina Pectoris
angina pectoris, has some precipitating factors; name 3
1. physical activity, 2. hot/humid room 3. cold weather, 4. large meals, 5. emotional stress, 6. caffeine ingestion, 7. fever/anemia 8. cigarette smoking, 9. smog 10. high altitudes
how to assess a pt with hx of angina, as about ... 1.2.3.
stable v. unstable angina
1. exercise tolerance
2. nature of angina
3. NTG effectiveness
what shows Consistent...
1. frequency of angina
2. type of discomfort
3. location of pain
4. precipitating factors
5. response to NTG
these are all signs of

Stable Angina Pectoris
if you see clinically ...
1. angina of recent onset, by minimal exertion
2. increasingly severe/prolonged/frequent angina in pt w/ relatively stable, exertional angina
3. angina both at rest & minimal exertion
these are 3 clinical criteria of

UNSTABLE ANGINA PECTORIS
angina in the dental chair goes from Anxiety/fear/pain -->X --> Chest Pain. what's X
Anxiety/fear/pain - release of catecholamines (EPI) - increases BP/HR/contraction - increases myocardial oxygen demand - mycardial ischemia - chest pain
angina pectoris management. ask, is this your typical angina?
also ask about
this your typical angina?
location?
radiation?
severity? other?
response to NTG?
manage\angina pectoris:
position upright, BLS/vitals, hx?, Nitroglycerine .3-0.6mg SL, oxygen, repeat q3-5'; total 3 doses, then ...
discharge or hospital? Tx? if no response?
if hx of angina pectoris - discharge, treat - no problem
if no hx - hospital. assume cardiac in origin
if no response --> 3 doses & Tx as MI
pt comes in & high BP, hx of angina, uses nitroglycerin, before tx do anything different?
few minutes before injection use nitroglycerin as prophylactic
what group careful to use nitroglycerin with?
folks with ED drugs in system
(interaction dangerous)
people who are allergic