FSBGD MCQ Study Questions 2001

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FSBGD WRITTEN BOARD QUESTION STUDY GUIDE 2000 1. According to the July 1997 American Heart Association recommendations, which of the following require antibiotic prophylaxis for invasive dental treatment? 1. 2. 3. 4. 5. Organic heart murmur with regurgitation Cardiac pacemakers Isolated secundum atrial septal defect Previous history of endocarditis Most artificial joint patients a. b. c. d. e. 1,4 2,5 1,3,4 1,4,5 1,3,4,5 Endocarditis prophylaxis is not recommended for: (1) isolated secundum atr
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  FSBGD WRITTEN BOARD QUESTION STUDY GUIDE 2000 1.   According to the July 1997 American Heart Association recommendations, which of the followingrequire antibiotic prophylaxis for invasive dental treatment?1.   Organic heart murmur with regurgitation2.   Cardiac pacemakers3.   Isolated secundum atrial septal defect4.   Previous history of endocarditis5.   Most artificial joint patientsa.   1,4b.   2,5c.   1,3,4d.   1,4,5e.   1,3,4,5Endocarditis prophylaxis is not recommended for: (1) isolated secundum atrial septal defect; (2) surgicalrepair of atrial septal defect; ventricular septal defect, or patent ductus arteriosus (without residua beyond6 months); (3) previous coronary artery bypass graft surgery; (4) mitral valve prolapse without valvarregurgitation; (5) physiologic, functional, or innocent heart murmurs; (6) previous Kawasaki diseasewithout valvar dysfunction; (7) previous rheumatic fever without valvar dysfunction; and (8) cardiacpacemakers (intravascular and epicardial) and implanted defibrillators.JADA, Vol, 128, August 1997. pp 1142-1151.An expert panel of dentists, orthopaedic surgeons, and infectious disease specialists, performed athorough review of all available data to determine the need for antibiotic prophylaxis to preventhamatogenous prosthetic joint infections in dental patients who have undergone total joint arthroplasties.The result is a report adopted by both organizations as an advisory statement. Conclusion: Antibioticprophylaxis is not indicated for dental patients with pins, plates and screws, nor is it routinely indicatedfor most dental patients with total joint replacements.Patients at potential increased risk of hematogenous total joint infection include: Immunocompromsied / immunosuppressed patients such as (a) patients with disease-, drug-, or radiation-inducedimmunosuppression; (b) patients with inflammatory arthropathies such as rheumatoid arthritis andsystemic lupus erythematosus. Other patients at increased risk include (a) type I diabetics; (b) patientswith previous prosthetic joint infections; (c) malnourished patients; and (d) hemophilic patients.JADA, Vol. 128, July 1997. pp 1004-1008.The correct answer is: A. 1,42. Which of the following groups of drugs has the greatest potential for diverse side effects when they arebeing administered to a patient undergoing local anesthesia with a vasoconstrictor?a.   Anticoagulantsb.   tranquilizersc.   mono-amine oxidase inhibitorsd.   barbituratese.   analgesicsAlthough the potential for interactions involving local anesthetics is great, clinical manifestations appearinfrequently and only when very large doses are used or when unusual patient factors are present. Muchmore likely to occur are interactions between various drugs and the vasoconstrictors employed during  local anesthesia. Despite statements to the contrary, local anesthetics containing epinephrine may be usedwithout special reservation in patients taking monoamine oxidase inhibitors..Of the vasoconstrictorscurrently added to local anesthetic solutions, phenylephrine is contraindicated with concomitant MAOtherapy.Vasoconstrictor- added to slow the absorption of the local anesthetic. This results in (a) increased depthand duration of anesthesia, (b) reduced toxicity of the local anesthesia, and (c) improved hemostasis atlocal site. Epinephrine, in concentrations of 4 to 20 ug/ml (1:250,000 to 1:50,000) is the most frequentlyemployed agent, but levonordefrin, norepinephrine, and phenylephrine are also used.Pharmacology and therapeutics for dentistry, Neidle, Kroegerand Yagiela 1980, pp 263-283.The following paper discusses vasoconstrictors and drug interaction. The author rates each druginteraction from 1-(major problem established )to 5-(minor or unlikely). The following all have ratingsof 1.Tricyclic Antidepressants – May modify cardiovascular response to vasoconstrictors.B-Adrenergic Antagonists – May cause bradycardia leading to cardiac arrest.General Anesthetics – Enhances the dysrhythmogenic potential of adrenergic drugs.Cocaine – Prevents active re-uptake of norepinephrine therefore potentiates the effect of adrenergicvasoconstrictors.Yagiela HA Adverse drug interactions in dental practices: interactions associated with vasoconstrictors(Part V). JADA, 130:701-709, 1999.Considering all of the potential adverse reactions of epinephrine use, it is essential that the clinician makeevery effort to minimize epinephrine administration, obtain an adequate medical history, and minimizestress. The maximum recommended dose of epinephrine for a healthy adult is 0.2 milligrams, while forthe patient with cardiovascular disease, it is 0.04 milligrams. In cases where the use of a vasoconstrictor isabsolutely contraindicated (hyperthyroidism and pheochromocytoma), and agent such as 3% mepivacainewithout a vasoconstrictor should be used.Oral Med Handout – Assessment of Adverse Reactions to Local AnestheticsThe correct answer is C.3. A patient presents with fractures of the maxillae, orbits and ethmoid bones. This midface trauma canbe classified as:a.   Pyramidal fractureb.   Horizontal fracturec.   Leforte 1d.   Leforte 2e.   Leforte 3The LeFort I fracture frequently results from the application of horizontal force to the maxilla, whichseparates the maxilla from the pterygoid plates and nasal and zygomatic structures. This type of traumamay separate the maxilla in one piece from other structures, split the palate, or fragment the maxilla.Forces that are applied in a more superior direction frequently result in LeFort II fractures, which is theseparation of the maxilla and the attached nasal complex from the orbital and zygomatic structure. ALeFort III fracture results when horizontal forces are applied at a level superior enough to separate thenaso-orbital ethmoid complex, the zygomas, and the maxilla from the cranial base, which results in a so-called craniofacial separation.Peterson, L.J., et al, Contemporary Oral and Maxillofacial Surgery , 1998, Mosby  A horizontal fracture (LeFort I) is one in which the body of the maxilla is separated from the base of theskull above the level of the palate and below the attachment of the zygomatic process. It results in afreely movable upper jaw. The pyramidal fracture (LeFort II) is one that has vertical fractures throughthe facial aspects of the maxillae and extends upward to the nasal and ethmoid bones. It usually extendsthrough the maxillary antra. One malar bone may be involved.Kruger, G.O., Textbook of Oral and Maxillofacial Surgery , 1984, MosbyThe correct answer is e. Leforte 3.4. Traumatic tattoos can be minimized or corrected by all of the following except:a.   Use of high pressure lavageb.   Minimal use of saline irrigationc.   Use of a dermabraderd.   Use of soap and water and vigorous scrubbinge.   Removal of oily substances by acetoneAbrasions are often produced by trauma that allows dirt, cinders, or other debris to be ground into thetissue. If allowed to remain in the wound, a traumatic tattoo will result. These particles should beremoved by mechanical cleansing. They should be cleansed with one of the detergent soaps and thenisolated with sterile towels. A local anesthetic is then injected and the involved area is meticuloulsyscrubbed with a detergent soap on sterile gauze. Frequent irrigation of the field with sterile saline solutionaids in washing the particles form the wound. The use of an electric dermabrader for the removal of largeareas of imbedded particles has been recommended. The procedure is tedious and time consuming, butremoval of these particles is extremely important.The correct answer is E.Kruger, G.O., Textbook of Oral and Maxillofacial Surgery , 1984, Mosby5. A shift to the left in the patient’s WBC means a _____ in the number of ________.a.   decrease; neutrophilsb.   increase; immature neutrophilsc.   decrease; immature leucocytesd.   increase; mature leucocytese.   increase; eosinophilsAnswer: b. increase in number of immature neutrophilsNormal FindingsTotal WBCs:Adult/child>2 years: 5000-10,000/mm 3 or 5-10.0 x 10 9  /L (SI units)Differential countNeutrophils: 55% to 70%Lymphocytes: 20% to 40%Monocytes: 2% to 8%Eosinophils: 1% to 4%Basophils: 0.5% to 1.0%   The WBC count has two components. One is a count of the total number of WBCs (leukocytes) in 1 mm 3 of peripheral venous blood. The other component, the differential count, measures the percentage of each type of leukocyte present in the same specimen. An increase in the percentage of one type of   leukocyte means a decrease in the percentage of another. Neutrophils and lymphocytes make up 75% to90% of the total leukocytes. These leukocyte types may be identified easily by their morphology on avenous blood smear. The total leukocyte count has a wide range of normal values, but many diseasesmay induce abnormal values. An increased total WBC count (leukocytosis) usually indicates infection,inflammation, tissue necrosis, or leukemic neoplasia. Trauma or stress, either emotional or physical, mayincrease the WBC count. Leukopenia (i.e., a decreased WBC count) occurs in many forms of bonemarrow failure (e.g., following antineoplastic chemotherapy or radiation therapy, marrow infiltrativediseases, overwhelming infections, dietary deficiencies, and autoimmune diseases). The major functionof the WBC’s is to fight infection and react against foreign bodies or tissues. Five types of WBC’s mayeasily be identified on a routine blood smear. These cells, in order of frequency, include neutrophils,lymphocytes, monocytes, cosinophils, and basophilsl. All these WBC’s arise from the same “pluripotent”stem cell within the bone marrow as the red blood cell (RBC) does. Beyond this srcin, however, eachcell line differentiates separately. Most mature WBC’s are then deposited into the circulating blood.Polymorphonuclear neutrophils are produced in 7 to 14 days and exist in the circulation for only 6 hours.The primary function of the neutrophil is phagocytosis (killing and digestion of bacterialmicroorganisms). Acute bacterial infections and trauma stimulate neutrophil production, resulting in anincreased WBC count. Often, when neutrophil production is stimulated, early immature forms of neutrophils enter the circulation. These immature forms are called band or stab cells. This process,referred to as a “shift to the left” in WBC production, is indicative of an ongoing acute bacterial infection.Lymphocytes are divided into two types: T cells and B cells. T cells are primarily involved with cellular-type immune reactions, whereas B cells participate in humoral immunity (antibody production). Theprimary function of the lymphocytes is fighting chronic bacterial infection and acute viral infections. Thedifferential count does not separate the T and B cells but rather counts the combination of the two  Monocytes are phagocytic cells capable of fighting bacteria in a way very similar to that of the neutrophil.Monocytes can be produced more rapidly, however, and can spend a longer time in the circulation thanthe neutrophils.  Basophils , and especially eosinophils , are involved in the allergic reaction. Parasitic infestations also arecapable of stimulating the production of these cells.6. A patient is taking coumadin. Which blood study do you use todetermine his status for surgery?a.   WBC and differentialb.   Platelet countc.   PTd.   PTTe.   Both b and ca. WBC and differential - White Blood Cell Count - normal - 4,500 - 11,000 /mm3 Leukocyctosis is >11,000/mm3 Differential WBC Count - Estimation of percentage of each cell type/mm3Normal - neutrophils 50-60% lymphocytes 20-30% monocytes 3-7% eosinophils 3% basophils <1%b. Platelet count -may have adequate number of platelets, but they may be nonfunctional due toaspirin or motrin use. Bleeding time will reflect problems with both the number and quallity of platelets. Normal value - 140,000 to 400,000 platelets/mm3 Bleedings Problems - < 50,000platelets/mm3c. PT - PT test is often used by physicians to monitor anticoagulant therapy i.e. coumadin. Coumarinis a Vit K antagonist (Vitamin K is necessary for the final activation of factors II, VII, IX and X),interferes with fibrin formation and is used to prevent thrombus development and extension.
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