Exam Flashcards

Question

What are the key characteristics of **status asthmaticus**?

Answer 1

* Hypoxemia * Hypercarbia * Secondary respiratory failure ## Footnote This condition requires immediate medical attention.

Answer 2

* Quick-relief (rescue/reliever) medications * Long-term control (controller) medications ## Footnote Quick-relief medications are taken when symptoms are present, while long-term control medications are taken daily.

Answer 3

Albuterol ## Footnote This is a short-acting inhaled sympathomimetic (beta-2-selective agonist) bronchodilator.

Answer 4

* Beclomethasone * Budesonide * Triamcinolone * Ciclesonide * Flunisolide * Fluticasone * Mometasone ## Footnote ICS are preferred for long-term control of asthma and can be administered via metered-dose inhaler.

Answer 5

* Prednisone * Methylprednisolone ## Footnote These are used for long-term control of airway inflammation.

Answer 6

* Formoterol * Salmeterol ## Footnote LABAs are used for long-term control of asthma.

Answer 7

Theophylline (narrow toxic-therapeutic range, BE CAREFUL) ## Footnote Methylxanthines are used as bronchodilators in asthma treatment.

Answer 8

* Cromolyn sodium * Nedocromil sodium ## Footnote These medications help prevent asthma symptoms by stabilizing mast cells.

Answer 9

Leukotriene receptor antagonist; Montelukast sodium (Singulair) ## Footnote LTRAs are used for long-term control of asthma.

Answer 10

* Omalizumab (Xolair) * Mepolizumab (Nucala) * Reslizumab (Cinqair) * Dupilumab (Dubixent) * Benralizumab (Fasenra) ## Footnote These treatments target specific pathways in asthma management.

Answer 11

FALSE ## Footnote Medications can be intraoral or inhaled.

Answer 12

Your asthma may not be controlled as well as it could be ## Footnote This score is part of an assessment to evaluate asthma control.

Answer 13

Dental treatment risk assessment and dental management precautions ## Footnote It involves treatment modifications based on the patient's health status.

Answer 14

Bring to appointment and be readily available ## Footnote This ensures the patient has access to their medication during the appointment.

Answer 15

* Pollens * Dusts * Odors * Exercise * Stress * Drugs (especially aspirin & NSAIDs) ## Footnote These factors can trigger an asthma attack in susceptible patients.

Answer 16

* Benzodiazepine * Nitrous ## Footnote The use of nitrous can usually be used safely and effectively in patients with mild to moderate asthma.

Answer 17

* Aspirin * NSAIDs ## Footnote This is particularly important for patients with asthma along with nasal polyps or a history of angioedema.

Answer 18

Opioids ## Footnote Opioids should be avoided in patients who report a history of asthma exacerbation with their use.

Answer 19

Local anesthetic containing vasoconstrictors ## Footnote This is also contraindicated in severe asthmatics dependent on systemic steroids due to an increased risk of sulfite allergy.

Answer 20

Adrenal suppression and immunosuppression ## Footnote This is an important consideration in the management of asthma patients.

Answer 21

Pulse oximeter ## Footnote Normal SaO2 levels are 97-100%, while levels below 91% indicate impaired oxygen exchange and the need for intervention.

Answer 22

* Erythromycin * Clarithromycin ## Footnote These antibiotics can cause elevated levels of methylxanthine (theophylline), resulting in toxicity.

Answer 23

No specific contraindications ## Footnote Rubber dams can be used safely in patients with asthma.

Answer 24

Chronic Obstructive Pulmonary Disease ## Footnote COPD is an umbrella term typically referring to a mixture of chronic bronchitis and emphysema.

Answer 25

* Excessive secretion of bronchial mucus * Obstruction of small airways * Productive cough for 3 months or more in 2 consecutive years ## Footnote Chronic bronchitis is characterized by inflammation and irritation of the bronchial tubes.

Answer 26

* Loss of lung elasticity * Destruction of lung parenchyma ## Footnote Emphysema leads to difficulty in breathing due to the loss of alveolar structure.

Answer 27

TRUE ## Footnote Symptoms typically emerge as the disease progresses.

Answer 28

Fifth or sixth decade of life ## Footnote Patients often complain of excessive cough, sputum production, and shortness of breath.

Answer 29

* Cyanosis * Chronic productive cough * Tachypnea * Tachycardia * Fatigue * Persistent and progressive dyspnea ## Footnote Dyspnea is the major cause of disability in COPD.

Answer 30

Inversely ## Footnote A lower FEV1 indicates more severe dyspnea.

Answer 31

Pursed-lip breathing ## Footnote This technique helps to improve ventilation and reduce shortness of breath.

Answer 32

* Hyperinflation * Increased anteroposterior diameter (barrel chest) * Protruding abdomen ## Footnote These abnormalities reflect changes in lung function and structure.

Answer 33

Hyperinflation of the lungs ## Footnote This reflects loss of lung elastic recoil and limitation of expiratory flow.

Answer 34

* Viral infections (e.g., rhinovirus, RSV, coronavirus, influenza) * Air pollution ## Footnote Acute exacerbations are more common in winter months.

Answer 35

* Pneumonia * Pulmonary hypertension * Congestive heart failure/cor pulmonale * Chronic respiratory failure ## Footnote These complications can significantly impact the quality of life.

Answer 36

* Pulmonary embolism * Pneumothorax * Lobar atelectasis * Pleural effusion * Arrhythmias ## Footnote These conditions can complicate the management of COPD.

Answer 37

* Reduction of risk factors (influenza vaccine) * Short-acting bronchodilator as needed ## Footnote These measures aim to manage mild obstruction effectively.

Answer 38

* Reduction of risk factors (influenza vaccine) * Short-acting bronchodilator as needed * Long-acting bronchodilator * Cardiopulmonary rehabilitation ## Footnote These treatments help manage moderate obstruction and improve patient outcomes.

Answer 39

* Reduction of risk factors (influenza vaccine) * Short-acting bronchodilator * Long-acting bronchodilator as needed * Cardiopulmonary rehabilitation * Inhaled corticosteroids if repeated exacerbations ## Footnote These interventions are crucial for managing severe obstruction.

Answer 40

* Reduction of risk factors (influenza vaccine) * Short-acting bronchodilator as needed * Long-acting bronchodilator * Cardiopulmonary rehabilitation * Inhaled corticosteroids if repeated exacerbations * Long-term oxygen therapy * Consider surgical options such as lung volume reduction surgery ## Footnote This grade requires comprehensive management strategies due to the severity of the condition.

Answer 41

Encourage smoking cessation ## Footnote Smoking cessation is critical for improving outcomes in COPD patients.

Answer 42

* At rest (PaCO2 < 56 mmHg or SaO2 ≤ 88% for 6 minutes) * On exertion (SaO2 ≤ 87% for at least 1 minute during a 6-minute walk) * Nocturnal use (SaO2 ≤ 89% for > 20% of the night) ## Footnote Oxygen therapy is essential for managing hypoxemia in COPD patients.

Answer 43

* Short-acting bronchodilators * Long-acting bronchodilators ## Footnote These bronchodilators help relieve symptoms and improve airflow.

Answer 44

For moderate to severe COPD ## Footnote Corticosteroids help reduce inflammation and manage exacerbations.

Answer 45

* S. pneumoniae * H. influenzae * M. catarrhalis ## Footnote These pathogens are frequently involved in exacerbations of COPD.

Answer 46

* Prophylactic measure in patients with frequent exacerbations of chronic bronchitis * To treat an acute episode of bronchitis ## Footnote Antibiotics are critical in managing infections in COPD patients.

Answer 47

To manage and alleviate symptoms ## Footnote This includes various therapeutic approaches to improve patient outcomes.

Answer 48

Treatment of certain lung diseases ## Footnote It helps in managing conditions like COPD.

Answer 49

* Graded aerobic physical exercise programs * Training of inspiratory muscles * Pursed-lip breathing ## Footnote These exercises aim to improve respiratory function and overall fitness.

Answer 50

* Lung transplant * Lung volume reduction surgery * Bullectomy ## Footnote Surgical options are considered in severe cases of COPD.

Answer 51

* Decreased PaO2 (45-60 mmHg) * Elevated PaCO2 (50-60 mmHg) * Elevated hematocrit and hemoglobin ## Footnote These tests help in assessing the severity of chronic bronchitis.

Answer 52

* Normal to slightly decreased PaO2 (60-75 mmHg) * Normal PaCO2 unless FEV1 < 1 L * Usually normal hematocrit and hemoglobin (12-15 mg/dL) ## Footnote These findings help differentiate emphysema from other lung conditions.

Answer 53

It generally precedes CO2 retention and hypercapnia ## Footnote This is a critical aspect of respiratory failure in COPD.

Answer 54

Worsening lung function ## Footnote FEV1 is a key measure in assessing the severity of obstructive lung diseases.

Answer 55

Severity of the patient’s airflow limitation ## Footnote This classification helps in assessing the severity of COPD.

Answer 56

* Spirometry tests still normal (FEV1/FVC ≥ 70%, FEV1 ≥ 80% predicted) * Asymptomatic smoker or ex-smoker * Chronic cough and sputum production ## Footnote Patients in this grade do not exhibit symptoms but may have risk factors.

Answer 57

* FEV1/FVC < 70% * FEV1 ≥ 80% predicted * Shortness of breath with strenuous exercise * Usually chronic cough and sputum production ## Footnote Patients may not be aware that lung function is abnormal.

Answer 58

* FEV1/FVC < 70% * FEV1 between 50-79% of predicted * Shortness of breath causing slower walking than peers * Typically the stage when patients seek medical attention ## Footnote Patients often experience dyspnea on exertion or exacerbations.

Answer 59

* FEV1/FVC < 70% * FEV1 between 30-49% of predicted * Increased shortness of breath * Repeated exacerbations impacting quality of life ## Footnote This grade indicates significant impairment and frequent exacerbations.

Answer 60

Post-bronchodilator FEV1 ## Footnote FEV1 is the forced expiratory volume in one second, a key measure in assessing lung function.

Answer 61

Very severe COPD ## Footnote Defined by FEV1/FVC < 70% with FEV1 < 30% of predicted value or presence of chronic respiratory failure.

Answer 62

* Respiratory failure * PaO2 < 60 mmHg * PaCO2 > 50 mmHg ## Footnote These signs indicate severe complications associated with COPD.

Answer 63

0-40 points ## Footnote A score >10 indicates that COPD symptoms may not be under optimum management.

Answer 64

VERY BAD ## Footnote Scores are used to assess the severity of COPD symptoms.

Answer 65

* Group A: low exacerbation risk / low symptoms * Group B: low exacerbation risk / high symptoms * Group C: high exacerbation risk / low symptoms * Group D: high exacerbation risk / high symptoms ## Footnote These classifications help in managing COPD treatment strategies.

Answer 66

Med consult needed ## Footnote Indicates that the patient's COPD symptoms may require further evaluation and management.

Answer 67

* Severity of symptoms (CAT assessment) * History of moderate and severe exacerbations * Recent pulmonary function tests (PFTs)/spirometry results ## Footnote This assessment is crucial for effective dental treatment risk assessment.

Answer 68

Severity of clinical COPD symptoms ## Footnote Indicated by their CAT and mMRC scores.

Answer 69

I to III ## Footnote Treatment should be avoided in patients who have Gold Grade IV or ASA IV.

Answer 70

Semi supine or upright chair position ## Footnote This modification is necessary based on the severity of the patient's COPD.

Answer 71

local anesthetics containing vasoconstrictors ## Footnote This is important for ensuring patient safety during dental procedures.

Answer 72

emphysema ## Footnote Caution is necessary due to potential respiratory complications.

Answer 73

low-dose opioids ## Footnote This treatment can help manage symptoms effectively.

Answer 74

respiratory events ## Footnote Monitoring is crucial to prevent complications.

Answer 75

pulse oximeter ## Footnote This device helps monitor oxygen saturation levels.

Answer 76

rubber dam ## Footnote This could complicate the treatment process for these patients.

Answer 77

Acute flu-like syndrome lasting 10-14 days ## Footnote More than 50% of patients experience this syndrome.

Answer 78

* Reduce HIV-associated morbidity and prolong survival * Restore and preserve immunologic function * Maximal and durable suppression of plasma HIV viral load * Prevent HIV transmission ## Footnote These goals guide treatment strategies for HIV patients.

Answer 79

Every 3 months until suppressed for at least 1 year ## Footnote After 1 year of consistent suppression, monitoring can be performed every 6 months.

Answer 80

CD4 cell counts usually increase ## Footnote CD4 counts are recommended every 6 months until above 250mm^3 for at least 1 year with viral suppression.

Answer 81

FALSE ## Footnote CD4 counts need not be measured unless ART failure occurs.

Answer 82

To detect if ART is failing ## Footnote Virologic failure is defined as HIV RNA level above 200 copies/mL on at least 2 consecutive measurements.

Answer 83

HIV RNA level above 200 copies/mL on at least 2 consecutive measurements ## Footnote This indicates that ART is not effectively controlling the virus.

Answer 84

Usually show antibodies by 6th month of infection ## Footnote Altered ratio of CD4+/CD8+ lymphocytes, decrease in total lymphocytes, thrombocytopenia, anemia.

Answer 85

Every 3-4 months ## Footnote This monitoring is crucial for assessing immune function in HIV patients.

Answer 86

90% sensitive ## Footnote However, it has a high rate of false-positive results.

Answer 87

Detection ranges from 40-750K ## Footnote Greatest viral load is the first 3 months after initial infection.

Answer 88

* Candidiasis * Angular cheilitis * Linear gingival erythema * ANUG * ANUP * Kaposi sarcoma * Enlarged parotid glands * Xerostomia * Recurrent aphthous or herpetic ulcers * Papilloma * Oral hairy leukoplakia ## Footnote These manifestations indicate virologic failure and require careful management.

Answer 89

Above 200/mm^3 ## Footnote This level indicates sufficient immune function for safe dental treatment.

Answer 90

Below 50 copies/mL ## Footnote This indicates effective viral suppression.

Answer 91

When absolute neutrophil count is below 500/mm^3 ## Footnote This helps prevent infections during dental procedures.

Answer 92

At least 50,000/mm^3 ## Footnote This helps minimize the risk of excessive bleeding.

Answer 93

Greater than 1.7 ## Footnote Elevated AST and ALT levels indicate potential liver issues.

Answer 94

FALSE ## Footnote Patients with INR greater than 1.7 should not receive invasive dental treatment.

Answer 95

Prevention of infection and excessive bleeding ## Footnote This is crucial for patients with severe immunosuppression, neutropenia, and thrombocytopenia.

Answer 96

Because they could interact with drugs ## Footnote This is important to avoid adverse effects and ensure effective treatment.

Answer 97

Life long blood transfusion ## Footnote Patients with beta thalassemia need regular blood transfusions to manage their condition.

Answer 98

Occasionally or never ## Footnote Unlike beta thalassemia, patients with sickle cell disease may not need frequent transfusions.

Answer 99

* Inherited condition * Sickle RBCs that don’t carry as much oxygen * Obstruction of blood vessels * Rapid RBC death ## Footnote This leads to vaso-occlusive events due to ischemic tissues and hemolysis of RBCs.

Answer 100

Vaso-occlusive crisis ## Footnote This crisis produces ischemia manifested by acute pain, tenderness, fever, tachycardia, and anxiety.

Answer 101

* Sudden pain * Tenderness * Fever * Tachycardia * Anxiety ## Footnote The pain can last several hours to days and affect any body part.

Answer 102

* Pallor and jaundice in oral tissues * Increased erythropoietic activity * Decreased trabeculations * Generalized osteoporosis * Delayed eruption of teeth * Increased periodontal disease ## Footnote Dental radiographic findings may include changes due to bone marrow hyperplasia.

Answer 103

* Management of vaso-occlusive crisis * Management of chronic pain syndromes * Management of chronic hemolytic anemia * Prevention and treatment of infections * Management of complications and organ damage * Prevention of stroke * Detection and treatment of pulmonary hypertension ## Footnote These goals aim to improve the quality of life for patients with SCD.

Answer 104

Opioids (morphine) ## Footnote Morphine is preferred for managing severe pain associated with crises.

Answer 105

* Penicillin V 125 mg PO bid by age 2 months * Increased to 250 mg bid by age 3 * Can be discontinued after age 5 unless splenectomy has occurred ## Footnote This prophylaxis helps prevent infections in vulnerable patients.

Answer 106

* Decrease frequency of painful episodes * Reduce acute chest syndrome * Reduce transfusions * Increase production of HbF ## Footnote Hydroxyurea slows the production of HbS, which is beneficial for patients.

Answer 107

* Acute chest syndrome * Stroke * Myocardial infarctions * Renal failure * Avascular necrosis of the hip * Risk of osteomyelitis ## Footnote These complications can significantly impact patient health and longevity.

Answer 108

Screening of newborns for Sickle Cell Disease ## Footnote This test helps identify infants at risk for SCD early in life.

Answer 109

* Presence of HbS * Absence of HbA * Increased levels of HbF ## Footnote This test is crucial for diagnosing Sickle Cell Disease.

Answer 110

FALSE ## Footnote There are no contraindications for routine dental care under local anesthesia during non-crisis periods.

Answer 111

Prilocaine ## Footnote Prilocaine poses an increased risk of methemoglobinemia in these patients.

Answer 112

* Surgical dental treatment * Treatment under general anesthesia * Status post splenectomy * History of previous infections ## Footnote These factors increase the risk of infections, warranting prophylactic antibiotics.

Answer 113

At least 50% oxygen concentration ## Footnote This ensures adequate oxygenation during sedation.

Answer 114

10 g/dL ## Footnote General anesthesia is not recommended below this hemoglobin level due to increased risks.

Answer 115

Inherited deficiency in synthesis of b-globin chain of hemoglobin ## Footnote It creates abnormal hemoglobins that are functionally inadequate and is the homozygous form.

Answer 116

Between 6-24 months ## Footnote Symptoms include failure to thrive, weakness, jaundice, and enlarged spleen and liver.

Answer 117

* Chipmunk facies * Skeletal class II malocclusion with anterior open bite * Maxillary hypertrophy * Frontal bossing * Depression of nasal bridge * Dental arch morphologic changes ## Footnote These changes are due to compensatory hypertrophy of erythroid marrow.

Answer 118

* Enlarged bone marrow spaces * Reduced trabeculations * Absence of inferior alveolar canal * Small maxillary sinuses * Attenuated lamina dura * Reduced thickness of inferior mandibular cortex * Thick skull cortex with 'hair on end' appearance ## Footnote These findings result from increased hematopoiesis.

Answer 119

* Lifelong blood transfusions * Iron chelation therapy * Splenectomy if needed * Allogeneic bone marrow transplantation as a potential cure ## Footnote Iron chelator drugs include deferoxamine, deferasirox, and luspatercept.

Answer 120

FALSE ## Footnote Medical consult is needed, but there are no contraindications for routine dental care.

Answer 121

Increased infection risk during surgical dental treatment ## Footnote Consideration is needed for patients status post splenectomy.

Answer 122

* Infants due to unsupplemented milk diets * Women during reproductive years due to heavy menstrual periods * Pregnant women ## Footnote It is particularly prevalent in toddlers aged 1-2 years and females aged 12-49 years.

Answer 123

Asymptomatic ## Footnote Severe symptoms include fatigue, weakness, and skin pallor.

Answer 124

* Fatigue * Weakness * Skin pallor * Conjunctival pallor * Irritability * Decreased concentration * Shortness of breath * Brittle, fragile fingernails * Koilonychia * Headache (frontal) * Decreased appetite (mostly in children) * Pica * Plummer-Vinson syndrome ## Footnote Dysphagia symptoms of PVS are caused by a weblike structure in the cervical esophagus.

Answer 125

* Angular cheilitis * Atrophic glossitis * Generalized mucosal atrophy ## Footnote These signs indicate the oral manifestations of iron deficiency.

Answer 126

Oral ferrous sulfate, 325 mg (1, 2, or 3 times a day) ## Footnote Transfusion of packed RBCs is indicated in patients with severe symptomatic anemia.

Answer 127

* RBC count and indices * Serum iron * Serum ferritin * Serum transferrin * Total iron-binding capacity (TIBC) ## Footnote The first detectable abnormality is a decrease in serum ferritin.

Answer 128

* Low serum ferritin level * Increased RBC distribution width (>15) * Low mean corpuscular volume * Low mean corpuscular hemoglobin * Increased total iron-binding capacity (TIBC) * Low serum iron ## Footnote These abnormalities indicate hypochromic microcytic anemia.

Answer 129

TRUE ## Footnote Routine care should be deferred if Hgb is <11 g/dL with symptoms like shortness of breath or tachycardia.

Answer 130

Narcotic analgesics with strong respiratory depressant properties ## Footnote These patients have an increased risk for ischemic heart disease.

Answer 131

Physician consultation ## Footnote This is crucial to assess the risks associated with low hemoglobin levels.

Answer 132

Megaloblastic anemia with autoantibodies against intrinsic factor and gastric parietal cells ## Footnote Characterized by very large but very few RBCs.

Answer 133

* Weakness * Sore tongue * Paresthesias ## Footnote Symptoms may vary with the stage of the disease.

Answer 134

* Anorexia and weight loss (50%) * Impaired memory * Depression * Gait and balance disturbances * Peripheral nerve paresthesias * Generalized weakness ## Footnote These symptoms indicate a progression of the disease.

Answer 135

* Sore, burning sensation of the tongue, lips, buccal mucosa * Focal patchy areas of oral mucosal erythema and atrophy ## Footnote The tongue exhibits mucosal erythema and atrophy in 50-60% of patients.

Answer 136

* Parenteral vitamin B12 (cyanocobalamin or hydroxocobalamin), 1000 mcg/month * Intranasal cyanocobalamin, 500 mcg/week ## Footnote Treatment is essential for managing the condition.

Answer 137

* CBC and peripheral blood smear * Serum cobalamin levels * Intrinsic factor antibodies * Serum folic acid assay * Serum methylmalonic acid and homocysteine levels ## Footnote These tests help confirm the diagnosis and rule out other conditions.

Answer 138

Cobalamin absorption by assessing increased urine radioactivity after an oral dose of radioactive cobalamin ## Footnote IT IS NO LONGER USED OR AVAILABLE IN MOST MEDICAL CENTERS.

Answer 139

Nitrous oxide sedation ## Footnote This is due to potential complications associated with the condition.

Answer 140

If hemoglobin (Hgb) levels are ≥ 11 g/dL and asymptomatic ## Footnote Routine care should be deferred if Hgb is <11 g/dL with symptoms like shortness of breath.

Answer 141

Narcotic analgesics with strong respiratory depressant properties ## Footnote This is to prevent exacerbating respiratory issues.

Answer 142

Increased risk for ischemic heart disease ## Footnote Physician consultation prior to surgical treatment is recommended.

Answer 143

* Angular chelitis * Atrophic glossitis * Glossodynia * Generalized mucosal atrophy ## Footnote These oral findings indicate the impact of iron deficiency on mucosal health.

Answer 144

< 12 mcg/L ## Footnote This level is considered highly reliable for diagnosing iron deficiency anemia.

Answer 145

< 30 mcg/dL ## Footnote A decline in serum iron values is a key indicator of iron deficiency.

Answer 146

Elevated ## Footnote Elevated transferrin levels lead to a transferrin saturation of < 15%.

Answer 147

Elevated ## Footnote This elevation is associated with low iron availability in the body.

Answer 148

> 15 ## Footnote An increased RBC distribution width indicates variability in red blood cell size.

Answer 149

Low ## Footnote Low mean corpuscular hemoglobin is characteristic of iron deficiency anemia.

Answer 150

Hypochromic microcytic anemia ## Footnote This type of anemia is characterized by smaller and paler red blood cells.

Answer 151

* Jaundice in oral tissues * Increased erythropoietic activity * Increased widening and decreased numbers of trabeculations * Generalized osteoporosis * Trabeculae may appear as horizontal rows or 'stepladder' * More dense and distinct lamina dura * Areas of sclerotic bone * Ischemic necrosis in the mandible * Peripheral neuropathy (mental nerve paresthesia) * Delayed eruption of teeth * Dental hypoplasia * Increased periodontal disease ## Footnote These manifestations are due to bone marrow hyperplasia and vaso-occlusive events.

Answer 152

Acute chest syndrome ## Footnote Symptoms include dyspnea, chest pain, fever, leukocytosis, and pulmonary infiltrate.

Answer 153

* Infarctions * Autosplenectomy * Impaired immune function * Life-threatening infections (Streptococcus pneumonia, Haemophilus influenzae) ## Footnote These complications can occur within the first 18 to 36 months of life.

Answer 154

TRUE ## Footnote This is due to enhanced platelet function, activation of the coagulation cascade, and impaired fibrinolysis.

Answer 155

* Glomerulopathy (early in life) * 30% have renal insufficiency (older than 40) * 5-18% may progress to chronic renal failure ## Footnote Renal complications can develop as the patient ages.

Answer 156

Avascular necrosis of the hip ## Footnote This condition can lead to significant pain and mobility issues.

Answer 157

* Salmonella * Staphylococcal aureus ## Footnote These bacteria are commonly linked to osteomyelitis in affected patients.

Answer 158

Med consult! ## Footnote A medical consultation is essential to assess the patient's condition before dental treatment.

Answer 159

Oral infection can precipitate a vaso-occlusive crisis ## Footnote Preventative measures include oral hygiene instruction (OHI) to minimize infection risk.

Answer 160

No contraindications for routine dental care under local anesthesia with inhalational sedation (Nitrous) ## Footnote Local anesthetic agents with vasoconstrictors are generally safe.

Answer 161

Prilocaine ## Footnote The use of prilocaine is unwarranted in patients with sickle cell disease.

Answer 162

Controversial ## Footnote There is no clear consensus or guidance on the use of prophylactic antibiotics.

Answer 163

* Surgical dental treatment (extractions) * Treatment under general anesthesia * Status postsplenectomy * History of previous infections (osteomyelitis) ## Footnote These factors indicate a higher risk of infection.

Answer 164

Treat quickly → I + D, heat, high doses of antibiotics, pulpectomy, extraction ## Footnote Prompt treatment is crucial to prevent complications.

Answer 165

Low risk: outpatient setting ## Footnote Simple procedures can typically be performed safely in an outpatient environment.

Answer 166

Use for short periods, at least 50% oxygen concentration ## Footnote Ensuring adequate oxygen concentration is important for safety.

Answer 167

* Non-salicylate NSAIDs * Opioid/APAP analgesics * Proper hydration ## Footnote Pain management may be challenging due to the patient's condition.

Answer 168

Moderate or high risk ## Footnote Patients with higher risk factors should be treated in a hospital setting.

Answer 169

Extreme caution ## Footnote IV sedation should be approached with care due to potential complications.

Answer 170

When Hb level falls < 10 g/dL ## Footnote Low hemoglobin levels increase the risk of complications during anesthesia.

Answer 171

* Non-restorable due to any reason * Periodontal pocket depths > 5 mm * Gingival margin apical to the CEJ by 2 mm or greater * Furcation score of 2 or higher * Mobility score of 1 or higher * Active abscess that persists or recurs after treatment * Partially erupted third molars with history of pericoronitis * Radiographic evidence of periapical inflammation ## Footnote Exception: an asymptomatic endodontically treated tooth with stable but persistent periapical radiolucency.

Answer 172

At least 5 days ## Footnote This timing helps to minimize complications related to dental extractions during chemotherapy.

Answer 173

At least 7 days ## Footnote This timing is crucial to ensure patient safety and reduce the risk of infection.

Answer 174

At least 3 weeks ## Footnote This allows adequate healing time before starting head and neck radiation therapy.

Answer 175

At least 2 weeks ## Footnote This is the minimum recommended timeframe to avoid complications.

Answer 176

> 60,000/mm3 ## Footnote No intervention is necessary for patients with a platelet count above this threshold.

Answer 177

Platelet transfusions are optional for non-invasive treatment ## Footnote Consider administering preoperatively and 24 hours after surgical treatment, utilizing adjunctive hemostatic techniques to control bleeding.

Answer 178

Platelets should be transfused 1 hour before procedure ## Footnote The goal is to maintain platelet counts > 30,000 to 40,000/mm3 until initial healing has occurred.

Answer 179

* Microfibrillar collagen * Topical thrombin * Aminocaproic acid ## Footnote Aminocaproic acid may help stabilize nondurable clots, and surgical sites should be monitored carefully.

Answer 180

No prophylactic antibiotics needed ## Footnote None

Answer 181

Low Risk: Use American Heart Association (AHA) prophylactic antibiotic recommendations ## Footnote Clinical judgment is critical: If infection is present or unclear, more aggressive antibiotic therapy may be indicated.

Answer 182

* Use amikacin 150 mg/m2 IV 1 hour pre-surgery * Then ticarcillin 75 mg/kg IV ½ hour pre-surgery * Repeat both 6 hours post-operatively ## Footnote If organisms are known or suspected, appropriate adjustments should be based on antibiotic sensitivity testing.

Answer 183

* Craniofacial deformities * Dental anomalies ## Footnote These complications are especially common in children receiving high-dose chemotherapy, particularly if treated before age 12 and especially if younger than 6.

Answer 184

* Abnormal tooth formation * Delayed eruption of teeth * Shortened root length ## Footnote These anomalies can significantly impact oral health and development.

Answer 185

* After completion of chemotherapy * After 2-year remission * After risk of relapse is decreased * When not using immunosuppressive drugs ## Footnote The timing of treatment is not fully established and varies based on individual circumstances.

Answer 186

TRUE ## Footnote This is an important consideration in the management of oral health for these patients.

Answer 187

A medical consult ## Footnote This is crucial for ensuring the patient's safety and appropriate dental care during cancer treatment.

Answer 188

* Type * Stage ## Footnote Understanding the diagnosis helps in planning dental care appropriately.

Answer 189

* Anticipated date of any surgery * Start date of any chemotherapy (CT) * Head/Neck radiotherapy (HNRT) * Anticipated plan and dose of any HNRT ## Footnote This information is essential for coordinating dental treatment with cancer therapies.

Answer 190

* CBC with differential & platelet count * PT/INR ## Footnote These tests provide important information about the patient's blood health before dental procedures.

Answer 191

* Zoledronic acid/zoledronate (Zometa) * Pamidronate * Angiogenesis inhibitors (bevacizumab, sunitinib, sorafenib) * RANKL inhibitors (denosumab) ## Footnote Identifying these drugs is critical for assessing the risk of medication-related osteonecrosis of the jaw (MRONJ).

Answer 192

* Oral evaluation * Discuss with patient TIMING * OHI and patient education * Dietary counseling * Calculus removal, prophylaxis and fluoride treatment * Elimination of all oral sources of irritation and infection * Specific considerations for children ## Footnote Each component aims to minimize complications and prepare the patient for cancer treatment.

Answer 193

* Ruling out existing oral disease * Provide a baseline for monitoring complications * Minimize oral discomfort * Detect oral/maxillofacial metastatic lesions ## Footnote This evaluation is crucial for ensuring the patient's oral health before starting cancer therapy.

Answer 194

At least 1 month before the start of cancer treatment ## Footnote This allows for adequate healing from any required invasive oral procedures.

Answer 195

Patients should be informed about the types of oral toxicities they might expect ## Footnote This education helps patients recognize complications and know when to contact their dentist.

Answer 196

* Encourage non-cariogenic diet * Avoid spicy, acidic, salty, dry, coarse, rough foods ## Footnote These foods might cause discomfort and exacerbate oral mucositis.

Answer 197

* Calculus removal * Prophylaxis * Fluoride treatment ## Footnote These procedures help maintain oral health and prevent complications during treatment.

Answer 198

* Extract mobile primary teeth * Evaluate gingival opercula for surgical removal * Remove orthodontic bands and brackets ## Footnote These actions help prevent complications related to dental issues during cancer treatment.

Answer 199

* Pain * Orofacial fistulas + suppuration * Exposed necrotic bone * Pathological mandibular fracture * Xerostomia ## Footnote These symptoms indicate the presence of osteoradionecrosis, which is a serious condition following radiation therapy.

Answer 200

Exposed, non-vital bone in the jaw persisting longer than 3 months in the absence of cancer recurrence ## Footnote ORNJ typically follows high-dose radiation therapy and results from radiation-induced damage.

Answer 201

* Persistent pain * Cortical perforation * Orofacial fistulas * Suppuration * Ulceration of mucosal surfaces * Pathologic fractures ## Footnote These presentations are especially common in the mandible.

Answer 202

Ill-defined radiolucent areas on x-rays, sometimes with radiopaque areas ## Footnote This indicates dead bone beginning to separate from living tissue.

Answer 203

* Higher radiation doses increase risk, especially above 50–60 Gy * Risk persists for life ## Footnote Modern radiotherapy techniques aim to reduce ORNJ risk by controlling dose volumes directed at the mandible.

Answer 204

* History of oral trauma * Dental procedures (e.g., tooth extraction) after radiation therapy ## Footnote Dentists should consult the radiation oncologist if uncertain about the radiation dose.

Answer 205

* Pre-existing periodontal disease * Use of vasoconstrictors * Reduced local blood flow ## Footnote These factors can worsen ischemic changes and increase the risk of ORNJ.

Answer 206

* Tobacco use * Alcohol use ## Footnote These habits impair tissue healing and increase the risk of complications.

Answer 207

Increased risk in patients receiving both chemotherapy and radiation ## Footnote Findings regarding this relationship vary.

Answer 208

Increased risk for carotid artery atheroma in patients with head/neck radiation over 45 Gy ## Footnote This may lead to stroke risk and warrant a referral for medical evaluation.

Answer 209

* Bone Modifying agents (BMAs) * Antiangiogenic Agents (AAs) ## Footnote BMAs include bisphosphonates and anti-RANKL agents, while AAs include anti-VEGFs and tyrosine kinase inhibitors.

Answer 210

Zoledronate ## Footnote Bisphosphonates can remain in the system for a long time after administration.

Answer 211

Denosumab ## Footnote This agent is used in the management of osteoradionecrosis.

Answer 212

* Hyperbaric oxygen therapy * Medications like pentoxifylline and tocopherol (Vitamin E) ## Footnote There is controversy regarding the effectiveness of these measures.

Answer 213

Always seek a consult from the patient’s radiation oncologist ## Footnote This is essential to assess ORNJ risk.

Answer 214

30% ## Footnote Regular head, neck, and intraoral exams are necessary for monitoring recurrence or new cancers.

Answer 215

1.8% ## Footnote This percentage indicates the risk associated with specific radiation doses.

Answer 216

9% ## Footnote This highlights the increased risk with higher radiation doses.

Answer 217

TRUE ## Footnote Procedures like tooth extractions and periodontal surgery can elevate the risk.

Answer 218

* Trauma to bone or mucosa * Pre-existing dental conditions ## Footnote These factors contribute to the likelihood of developing ORN.

Answer 219

* Periodontal disease * Periapical pathology ## Footnote Ongoing inflammation and potential for infection are key concerns.

Answer 220

* Bone-modifying agents (BMAs) * Antiangiogenic agents * Immune modulators ## Footnote These medications can affect bone healing and increase susceptibility.

Answer 221

Mandible ## Footnote Although ORN can develop in either jaw, the mandible is more frequently impacted.

Answer 222

* Osteoporosis ## Footnote Patients on BMAs and RANKL inhibitors face additional risks due to medication effects.

Answer 223

ORN ## Footnote Immunosuppressed patients are at higher risk for complications.

Answer 224

Tobacco Use ## Footnote Tobacco use is a known risk factor for various health complications, including ORN.

Answer 225

Inform patients about ORN risk and obtain written consent outlining potential benefits, risks, and alternatives ## Footnote This ensures patients are aware of the risks associated with the procedure.

Answer 226

* Removing the clinical crown of a non-restorable tooth * Performing endodontic treatment on the remaining roots ## Footnote These options are less invasive and may reduce the risk of ORN.

Answer 227

Schedule surgery 3–4 months after the last dose of RANKL inhibitors ## Footnote Medication can be resumed 6–8 weeks post-surgery.

Answer 228

* Perisurgical hyperbaric oxygen * Vitamin E * Pentoxifylline ## Footnote These measures may help improve healing and reduce complications.

Answer 229

* Use conservative extraction techniques * Smooth sharp bony edges post-extraction ## Footnote These techniques aid in primary tissue closure and promote healing.

Answer 230

Conduct extractions per quadrant, observing each site for adequate healing before proceeding ## Footnote This approach helps ensure that healing is sufficient before additional procedures.

Answer 231

* Penicillin VK (500 mg every 6 hours) * Amoxicillin (500 mg) + Metronidazole (500 mg every 8 hours) * Alternatives for Penicillin Allergic Patients: Levofloxacin (500–750 mg every 24 hours) or Doxycycline (100 mg every 12 hours) ## Footnote Antibiotics can help prevent infections in high-risk patients undergoing surgery.

Answer 232

0.12% chlorhexidine solution twice daily for 4–8 weeks ## Footnote This helps reduce infection risk in exposed or healing bone.

Answer 233

Applicable to patients receiving chemotherapy expected to result in severe immunosuppression ## Footnote Especially for chemotherapy used for myeloablative conditioning prior to allogeneic bone marrow or stem cell transplant.

Answer 234

* Non-restorable due to any reason, including fractured crown * Only roots remaining * Periodontal depth (PD) >5mm * Gingival margin apical to the CEJ by 2mm or greater * Furcation score of 2 or higher * Mobility score of 1 or higher * Active abscess that persists or recurs after treatment ## Footnote These indicators help determine the necessity of tooth extraction in patients undergoing specific treatments.

Answer 235

An asymptomatic, endodontically treated tooth with stable but persistent periapical radiolucency ## Footnote This indicates that not all periapical radiolucencies are indicative of active disease.

Answer 236

Extraction ## Footnote This guideline emphasizes the importance of successful treatment outcomes in endodontics.

Answer 237

At least 1 month before ## Footnote This allows sufficient time to assess treatment success before the initiation of CT/HNRT.

Answer 238

Symptomatic non-vital permanent teeth ## Footnote Timing is crucial for evaluating treatment success before further interventions.

Answer 239

A history of pericoronitis ## Footnote This condition can complicate the management of third molars.

Answer 240

* Osteoporosis * Cancer * Osteopenia * Paget’s disease of bone * Osteogenesis imperfecta ## Footnote Cancer includes hypercalcemia of malignancy, bone metastasis-related skeletal events, solid tumors (breast, prostate, lung), and lytic lesions (e.g., multiple myeloma).

Answer 241

* Hypercalcemia of malignancy * Bone metastasis-related skeletal events * Solid tumors (breast, prostate, lung) * Lytic lesions (e.g., multiple myeloma) ## Footnote These cancers are associated with increased risk of bone complications.

Answer 242

Medication-Related Osteonecrosis of the Jaws (MRONJ) ## Footnote It is a debilitating condition associated with anti-resorptive BMAs, including bisphosphonates, RANKL inhibitors, and sclerostin inhibitors.

Answer 243

* Cancer-specific survival benefits remain controversial * Improve quality of life * Integrate into bone with a half-life of 10–12 years * Effects persist for 40+ years ## Footnote MRONJ risk is higher with high-dose BP therapy in cancer.

Answer 244

<5% (2–20x higher than placebo) ## Footnote Breast cancer patients on 4 mg zoledronate every 4 weeks showed MRONJ incidence rates at 1, 2, and 3 years were 0.5%, 1.2%, and 1.4%.

Answer 245

* Significantly lower compared to cancer patients * IV zoledronate (5 mg/year): <0.02% * Oral BPs: <0.05% * No significant MRONJ increase for up to 9 years ## Footnote This indicates a much lower risk for osteoporosis patients compared to cancer patients.

Answer 246

* Fully humanized antibody targeting RANKL * Not indicated for multiple myeloma * Does not bind to bone * Shorter half-life (25.4 days) * MRONJ risk 0–6.9% ## Footnote Risk increases with longer exposure in osteoporosis treatment.

Answer 247

* Anti-angiogenic medications (e.g., Bevacizumab, Sunitinib) * Sclerostin inhibitors (e.g., romosozumab) * Fusion proteins (e.g., aflibercept) * mTOR inhibitors (e.g., everolimus) * Radiopharmaceuticals (e.g., radium 223) * Selective estrogen receptor modulators (e.g., raloxifene) * Immunosuppressants (e.g., methotrexate, corticosteroids) ## Footnote These medications disrupt angiogenesis signaling and are associated with increased MRONJ risk.

Answer 248

* Urgency and timing less critical for osteoporosis than for cancer * Optimize dental health * Patient education on MRONJ risks and symptoms ## Footnote Stress oral hygiene, regular dental visits, and smoking cessation.

Answer 249

* Tooth pain * Dull aching pain in the jaw * Tooth mobility * Mucosal swelling ## Footnote These symptoms indicate potential complications associated with MRONJ.

Answer 250

TRUE ## Footnote Tooth mobility is one of the signs indicating possible MRONJ.

Answer 251

medication-related osteonecrosis of the jaws (MRONJ) ## Footnote This symptom is part of the clinical presentation of MRONJ.

Answer 252

* Patients taking bisphosphonates * Patients with cancer * Patients undergoing dental procedures * Patients with poor oral hygiene ## Footnote These factors can elevate the risk of developing MRONJ.

Answer 253

Syndrome with disordered carbohydrate metabolism and inappropriate hyperglycemia due to either a deficiency of insulin secretion or a combination of insulin resistance and inadequate insulin secretion ## Footnote DM is characterized by high blood sugar levels.

Answer 254

Pancreatic islet beta cell destruction predominantly by an autoimmune process ## Footnote T1DM is also known as juvenile-onset diabetes mellitus or insulin-dependent diabetes mellitus.

Answer 255

* Hyperglycemia with little or no endogenous insulin secretion * Abrupt onset with marked polyuria, polydipsia, polyphagia, weight loss, and fatigue * Prone to diabetic ketoacidosis (DKA) ## Footnote DKA can lead to dangerous complications including blood acidity and dehydration.

Answer 256

A dangerous condition caused by the blood becoming acidic, leading to electrolyte imbalance and dehydration ## Footnote Patients may present for treatment during an initial episode of DKA.

Answer 257

A phase of polyuria, polydipsia, and weight loss that may precede DKA by days to months, commonly noted for 2 to 4 weeks before onset of DKA ## Footnote This phase indicates the early signs of T1DM.

Answer 258

Peaks in the middle of the first decade and again at the time of growth acceleration in adolescence ## Footnote This indicates critical periods for the onset of T1DM.

Answer 259

Increased urination as a consequence of osmotic diuresis secondary to sustained hyperglycemia ## Footnote Results in loss of glucose as well as free water and electrolytes in the urine.

Answer 260

Thirst due to dehydration from polyuria ## Footnote It is a common symptom in diabetes.

Answer 261

Weight loss despite normal or increased appetite ## Footnote Initially due to depletion of water, glycogen, and triglycerides; later, reduced muscle mass occurs.

Answer 262

Loss of subcutaneous fat and muscle wasting ## Footnote These features are common when T1DM develops sub-acutely.

Answer 263

Decreased plasma volume ## Footnote This condition can lead to dizziness or fainting when standing up.

Answer 264

Temporary dysfunction of peripheral sensory nerves ## Footnote This can result in sensations like tingling or numbness.

Answer 265

Hyperosmolar state ## Footnote This condition can affect visual acuity.

Answer 266

Patients remain relatively alert ## Footnote Sufficient water intake is maintained during this time.

Answer 267

Stupor or even coma may occur ## Footnote Dehydration progresses and compensatory mechanisms become inadequate.

Answer 268

Fruity breath odor of acetone ## Footnote This is a common sign in diabetic ketoacidosis.

Answer 269

>6.5% ## Footnote This value is useful for screening and diagnosis.

Answer 270

>126 mg/dL ## Footnote This test requires no caloric intake for at least 8 hours.

Answer 271

>200 mg/dL, 2 hours after a 75g glucose load ## Footnote This test measures how well the body processes sugar.

Answer 272

Casual plasma glucose >200 mg/dL ## Footnote This indicates high blood sugar levels.

Answer 273

* Fasting plasma glucose = 100 to 125 mg/dL * 2 hour plasma glucose = 140 to 199 mg/dL * HbA1c = 5.7-6.4% ## Footnote These levels indicate glucose levels higher than normal but not high enough for a diabetes diagnosis.

Answer 274

Lifelong treatment with insulin ## Footnote Self-monitoring blood glucose (SMBG) is particularly useful.

Answer 275

At least 2x a year ## Footnote Quarterly for patients whose therapy has changed or who are not meeting glycemic goals.

Answer 276

Targets are individualized ## Footnote This allows for personalized treatment plans.

Answer 277

<7% ## Footnote Less stringent control (HbA1C >7.5) may be reasonable for elderly patients with limited life expectancy.

Answer 278

ASA III ## Footnote This includes both T1DM and T2DM patients.

Answer 279

Have patient eat to avoid hypoglycemia ## Footnote This is crucial to prevent insulin reactions.

Answer 280

* Defer elective dental treatment * Have patient take hypoglycemic drug (insulin) if appropriate ## Footnote High BG levels indicate a need for caution.

Answer 281

Inform someone immediately ## Footnote This is important for safety during dental procedures.

Answer 282

Approximately 15 grams ## Footnote This helps manage hypoglycemia effectively.

Answer 283

* Poorly controlled diabetes: HbA1c >9% or fasting blood glucose >200 mg/dL * Brittle diabetes ## Footnote These conditions increase the risk of post-operative infections.

Answer 284

ASA IV ## Footnote Elective, invasive dental treatment should usually be deferred.

Answer 285

* Xerostomia * Periodontal Disease * Oral Fungal Infections (candidiasis) ## Footnote These complications can significantly affect oral health.

Answer 286

* Hyperglycemia * Diabetic Ketoacidosis ## Footnote These conditions require careful management in diabetic patients.

Answer 287

DKA ## Footnote Patients with T2DM can develop DKA, but it is less common and less severe.

Answer 288

* Uncontrolled metabolism of foods * Inability to metabolize ketones rapidly * Failure to compensate for decreased pH ## Footnote DKA occurs when the body cannot manage ketone production and pH balance.

Answer 289

>250 mg/dL ## Footnote DKA is often precipitated by infection.

Answer 290

* Excessive thirst * Frequent urination * Nausea * Headache ## Footnote Progressive symptoms may include abdominal pain, vomiting, fatigue, fruity-smelling breath, rapid breathing, confusion, and diarrhea.

Answer 291

* IV fluids for rehydration * Insulin therapy to reduce blood glucose * Electrolyte replacement, especially potassium ## Footnote Insulin treatment can lower blood potassium levels.

Answer 292

TRUE ## Footnote Severe cases can lead to coma or death if left untreated.

Answer 293

A diabetic-related complication marked by severe hyperglycemia and absence of significant ketoacidosis ## Footnote HHS is also known as hyperosmolar, hyperglycemia, non-ketotic coma (HHNC).

Answer 294

30% ## Footnote 50% present with impaired consciousness.

Answer 295

* Weakness * Polyuria * Polydipsia * Orthostatic hypotension ## Footnote HHS does not present with fruity breath or hyperventilation.

Answer 296

Hypoglycemia ## Footnote It often arises from insufficient food intake following insulin administration or over-administration of insulin.

Answer 297

Significantly increases the risk of post-operative infections ## Footnote This is a critical concern for patients with T1DM.

Answer 298

* Insulin resistance * Defect in compensatory insulin secretion ## Footnote T2DM is also known as adult-onset diabetes mellitus or non-insulin-dependent diabetes mellitus.

Answer 299

Overt abnormalities of glucose homeostasis ## Footnote This includes fasting hyperglycemia and/or carbohydrate intolerance.

Answer 300

FALSE ## Footnote Unlike patients with T1DM, patients with T2DM are not absolutely dependent on insulin.

Answer 301

Retention of endogenous insulin secretory capabilities ## Footnote This occurs in the basal state.

Answer 302

Marked resistance or insensitivity to metabolic actions of insulin due to decreased insulin receptors ## Footnote This includes both endogenous and exogenous insulin.

Answer 303

Failure of post-receptor coupling at insulin receptor and of intracellular insulin action ## Footnote This contributes significantly to the overall insulin resistance.

Answer 304

4 to 7 years ## Footnote This phase can lead to a delay in diagnosis.

Answer 305

More than 90% ## Footnote T2DM is the most common form of diabetes.

Answer 306

40 years or older ## Footnote The prevalence of T2DM increases with age.

Answer 307

TRUE ## Footnote This trend indicates a growing concern for younger populations.

Answer 308

* Increased urination (polyuria) * Increased thirst (polydipsia) * Insidious onset of hyperglycemia * Neuropathic or cardiovascular complications * Chronic skin infections * Generalized pruritus * Symptoms of chronic candida vulvovaginitis * Frequent acute urinary tract infections ## Footnote Many patients may be asymptomatic initially, especially if they are obese.

Answer 309

Approximately 80-90% ## Footnote Obesity is defined as weight greater than 130% of desirable body weight.

Answer 310

* Upper segment of the body * Abdomen * Chest * Neck * Face ## Footnote These fat deposits are often associated with obesity in T2DM.

Answer 311

* Polyhydramnios * Preeclampsia * Unexplained fetal loss ## Footnote These conditions are associated with pregnancy complications.

Answer 312

>6.5% ## Footnote This value is useful for screening and diagnosis due to its reliability.

Answer 313

>126 mg/dL ## Footnote This should be confirmed with repeat testing on a different day.

Answer 314

>200 mg/dL, 2 hours after a 75g glucose load ## Footnote For pregnant women, a 100g glucose load is used.

Answer 315

>200 mg/dL ## Footnote This is one of the criteria for diagnosing diabetes.

Answer 316

pre-diabetes ## Footnote This condition is also referred to as impaired glucose tolerance.

Answer 317

100 to 125 mg/dL ## Footnote This range is used to identify individuals at risk for developing diabetes.

Answer 318

140 to 199 mg/dL ## Footnote This is another criterion for identifying pre-diabetes.

Answer 319

5.7-6.4% ## Footnote This range helps in assessing the risk of developing diabetes.

Answer 320

* Oral antihyperglycemic agents * Insulin * Injectable agents other than insulin ## Footnote Oral antihyperglycemic agents include various classes such as biguanides, secretagogues, GLP-1 agonists, SGLT2 inhibitors, DPP-4 inhibitors, thiazolidinediones, alpha-glucosidase inhibitors, meglitinides, and bile-acid sequestrants.

Answer 321

* Biguanides: metformin (Glucophage) * Secretagogues (sulfonylureas) * GLP-1 agonist * SGLT2 inhibitors * DPP-4 inhibitors * Thiazolidinediones * Alpha-glucosidase inhibitors * Meglitinides * Bile-acid sequestrant ## Footnote These agents are used to manage blood glucose levels in patients with T2DM.

Answer 322

* Severity of fasting hyperglycemia * Presence of symptoms * Obesity * Patient’s age * Motivation * Coexistence of other diseases ## Footnote These factors help tailor the treatment approach to individual patient needs.

Answer 323

* At least 2 times a year * Quarterly for patients whose therapy has changed or who are not meeting glycemic goals ## Footnote Regular monitoring of HbA1c helps assess long-term glucose control.

Answer 324

Target HbA1c <7% ## Footnote Less stringent control (HbA1C >7.5) may be reasonable for elderly patients with limited life expectancy.

Answer 325

* All dental procedures can usually be performed * No special precautions needed unless complications of diabetes are present * Check patients BG prior to treatment ## Footnote Ensuring adequate caloric intake is important when patients are on hypoglycemic drugs.

Answer 326

Have patient eat to avoid hypoglycemia ## Footnote Monitoring blood glucose is crucial before dental treatment.

Answer 327

Elective, invasive dental treatment should usually be deferred ## Footnote Only essential (Emergency) dental treatment should be offered to these patients.

Answer 328

FALSE ## Footnote There is no clear or compelling evidence that justifies the use of prophylactic antibiotics in these cases.

Answer 329

True ## Footnote This emphasizes the importance of managing diabetes mellitus (DM) in dental care.

Answer 330

* Xerostomia * Periodontal Disease * Caries * Oral Fungal Infections * Oral Lesions * Diabetic Neuropathy ## Footnote These complications can significantly affect oral health in diabetic patients.

Answer 331

* Hyperglycemia * Diabetic Ketoacidosis (DKA) * Hyperosmolar Hyperglycemia Syndrome/State (HHS) * Hypoglycemia * Increased risk for infections ## Footnote These complications can lead to serious health issues if not managed properly.

Answer 332

TRUE ## Footnote Patients with T2DM can develop DKA, but it is less common and less severe.

Answer 333

Inability to metabolize ketones rapidly and failure to compensate for decreased pH via renal and respiratory mechanisms ## Footnote DKA occurs with persistently high blood glucose >250mg/dL and is often precipitated by infection.

Answer 334

* Severe hyperglycemia * Extreme hypertonic dehydration * Absence of significant ketoacidosis ## Footnote Patients may present in coma (30%) or with impaired consciousness (50%).

Answer 335

Hypoglycemia ## Footnote It often arises from insufficient food intake following insulin administration, exercise without sufficient intake, or over-administration of insulin.

Answer 336

* Polyuria * Polydipsia * Polyphagia ## Footnote These symptoms are often accompanied by rapid weight loss and enuresis in children.

Answer 337

An autoimmune reaction that destroys stomach cells responsible for producing intrinsic factor ## Footnote This factor is necessary for vitamin B12 absorption, and its deficiency leads to symptoms seen in the classic triad.

Answer 338

* Weakness * Sore tongue * Paresthesias ## Footnote These symptoms often develop as the condition progresses.

Answer 339

asymptomatic ## Footnote Symptoms typically progress to the classic triad as the condition worsens.

Answer 340

Adrenal Crisis ## Footnote This condition requires careful management, especially in stressful situations.

Answer 341

* Type of adrenal insufficiency * Level and type of stress ## Footnote These factors determine the need for corticosteroid supplementation in patients.

Answer 342

* Patients with primary adrenal failure due to Addison’s disease * Patients with congenital adrenal hyperplasia * Patients with secondary adrenal insufficiency due to hypopituitarism ## Footnote This recommendation applies only during surgery or in the management of dental or systemic infections.

Answer 343

FALSE ## Footnote Routine (non-surgical) dental procedures do not stimulate cortisol production at levels comparable to surgery.

Answer 344

Addison’s disease, congenital adrenal hyperplasia, or hypopituitarism ## Footnote This is crucial for managing stress during surgical procedures.

Answer 345

* Memory loss * Confusion * Difficulty with language * Impaired judgment * Diminished problem-solving abilities ## Footnote These initial signs indicate the onset of cognitive decline.

Answer 346

* Severe impairment in daily tasks * Mood instability * Disorientation * Motor coordination issues ## Footnote These symptoms reflect the advanced stages of the disease.

Answer 347

* Higher prevalence of dry mouth * Increased risk of mucosal lesions * Candidiasis * Significant plaque and calculus buildup * Periodontal disease * Smooth surface (root) and coronal caries ## Footnote Advanced stages also increase the risk for aspiration pneumonia due to poor oral and swallowing function.

Answer 348

* Antipsychotics * Antidepressants * Anxiolytics ## Footnote These medications can cause xerostomia, increasing the risk for dental caries and oral infections.

Answer 349

* Agranulocytosis * Leukopenia * Thrombocytopenia * Movement disorders (dystonia, dyskinesia) ## Footnote These effects can impact facial and oral muscles.

Answer 350

TRUE ## Footnote As patients progressively lose the ability to manage their own hygiene, family support becomes essential.

Answer 351

* Cognitive tests * Imaging (MRI, CT) ## Footnote These methods assess brain structure and rule out other conditions.

Answer 352

ASA II ## Footnote This classification applies when patients are stable and cooperative.

Answer 353

* ASA III * ASA IV ## Footnote These classifications apply to patients who have difficulty cooperating or significant comorbidities.

Answer 354

* Preventive treatments * Restorative treatments ## Footnote Care should be provided while the patient can still cooperate.

Answer 355

* Avoid complex prostheses * Minimize xerostomia-exacerbating medications * Implement behavioral management strategies ## Footnote These precautions help manage the unique challenges faced by late-stage patients.

Answer 356

Increased risk of aspiration pneumonia ## Footnote This necessitates diligent oral hygiene.

Answer 357

Caries and oral infections ## Footnote Antipsychotic and anxiolytic drugs commonly lead to dry mouth.

Answer 358

Resistance to routine oral care ## Footnote This underscores the need for caregiver assistance.

Answer 359

Candidiasis ## Footnote These conditions are exacerbated by poor hygiene and medication side effects.

Answer 360

A seizure causing loss of consciousness and violent muscle contractions ## Footnote Previously known as a grand mal seizure.

Answer 361

* Tonic Phase: Stiffening of muscles and loss of consciousness (10–20 seconds) * Clonic Phase: Rhythmic jerking movements of the limbs (1–2 minutes) * Postictal State: Confusion, drowsiness, muscle soreness, headache ## Footnote These phases describe the progression of a tonic-clonic seizure.

Answer 362

* Tongue lacerations * Fractured teeth * Injuries from falls ## Footnote Patients are at high risk of oral trauma during seizures.

Answer 363

* Phenytoin * Carbamazepine * Valproate ## Footnote These medications are commonly prescribed to manage seizures.

Answer 364

To diagnose epilepsy and confirm seizure type ## Footnote EEGs are crucial for understanding seizure activity.

Answer 365

Controlled seizures on medication, without recent episodes ## Footnote This classification suggests a lower risk during dental procedures.

Answer 366

* Use a semi-reclined chair position * Use mouth props to prevent oral trauma * Be aware of phenytoin-associated gingival hyperplasia ## Footnote These precautions help minimize risks during dental procedures.

Answer 367

TRUE ## Footnote Proper management of seizures allows for routine dental care.

Answer 368

Gingival hyperplasia ## Footnote This condition necessitates enhanced oral hygiene and regular periodontal care.

Answer 369

short, calm appointments ## Footnote Reducing stress can help prevent seizure triggers.

Answer 370

Confusion, drowsiness, muscle soreness, headache ## Footnote This state occurs after the seizure has ended.

Answer 371

* Vagus nerve stimulation * Resection of the epileptic focus ## Footnote These options are explored when medications fail to control seizures.

Answer 372

To address potential injuries such as fractured teeth and soft tissue trauma ## Footnote Regular check-ups help manage the increased risk of oral trauma.

Answer 373

An acute liver infection caused by an ssRNA flavivirus ## Footnote It is the most common chronic blood-borne infection in the U.S.

Answer 374

* 1a * 1b * 2 * 3 * 4 * 5 * 6 ## Footnote Genotypes 1a and 1b are the most common in the U.S.

Answer 375

Parenteral transmission ## Footnote Injecting drug use is the main source of transmission.

Answer 376

80–90% ## Footnote Only 10–20% experience symptoms such as jaundice, abdominal pain, anorexia, and malaise.

Answer 377

* Jaundice * Abdominal pain * Anorexia * Malaise ## Footnote Symptoms usually develop 7–8 weeks post-infection.

Answer 378

* Cirrhosis * Liver failure * Hepatocellular carcinoma ## Footnote Approximately 80–90% of infections progress to chronic hepatitis.

Answer 379

Presence indicates chronic infection ## Footnote Diagnosis can be challenging in immunosuppressed patients.

Answer 380

Sustained virologic response (SVR) ## Footnote Achieved in >95% of cases with Direct-Acting Antivirals (DAAs).

Answer 381

* Ledipasvir/sofosbuvir * Elbasvir/grazoprevir ## Footnote Treatment options vary based on genotype, cirrhosis presence, and prior treatment attempts.

Answer 382

Confirms active infection and measures viral load ## Footnote Used for monitoring treatment effectiveness.

Answer 383

* Fibrosis * Degree of inflammation and necrosis ## Footnote Not necessary for diagnosis but helpful for grading severity.

Answer 384

Stable, chronic HCV without significant liver dysfunction ## Footnote Patients may receive routine dental care.

Answer 385

Defer elective dental care until symptoms resolve ## Footnote Stable chronic HCV patients without significant liver dysfunction may receive routine care.

Answer 386

FALSE ## Footnote Reinfection is possible even after achieving SVR.

Answer 387

Leading cause of hepatocellular carcinoma ## Footnote Especially in patients with cirrhosis, older age, or prolonged infection duration.

Answer 388

Morning sickness ## Footnote Patients should rinse with water after vomiting instead of brushing immediately to protect enamel.

Answer 389

Supine Hypotension Syndrome ## Footnote Patients should be positioned on their left side to alleviate this condition.

Answer 390

* Lidocaine with epinephrine * Prilocaine ## Footnote These are classified as Category B.

Answer 391

* Penicillins * Erythromycin (not estolate form) * Cephalosporins * Metronidazole * Clindamycin ## Footnote Tetracyclines are contraindicated, including doxycycline.

Answer 392

Acetaminophen ## Footnote NSAIDs and aspirin should be avoided, and opioids should be used sparingly.

Answer 393

TRUE ## Footnote Anxiolytics and sedation medications like zaleplon and zolpidem should also be avoided.

Answer 394

<140/90 mm Hg ## Footnote Blood pressure monitoring is recommended at each visit.

Answer 395

ASA II ## Footnote This classification helps assess dental treatment risk.

Answer 396

During the second trimester (12–26 weeks) or early third trimester (>26 weeks) ## Footnote Complex treatments should generally be postponed until after delivery.

Answer 397

Prevent pregnancy-related gingivitis or periodontitis ## Footnote Advise meticulous oral hygiene and recommend dental cleanings.

Answer 398

Nitrous oxide ## Footnote Oxygen should be administered to avoid fetal hypoxia.

Answer 399

The patient’s due (delivery) date ## Footnote Also identify any previous high-risk pregnancies or complications.

Answer 400

* Routine radiographs are contraindicated * Use only when essential for care ## Footnote Information should not be obtainable by other means.

Answer 401

* Birth defects * Poor fetal growth * Stillbirth * Preterm delivery * Adverse respiratory effects ## Footnote Consult the patient’s physician before prescribing opioids.

Answer 402

Scarring of liver leading to portal hypertension ## Footnote End stage liver disease characterized by transformation of liver into regenerative parenchymal nodules surrounded by fibrous bands.

Answer 403

* Compensated: No symptoms * Decompensated: Demonstrate symptoms ## Footnote Compensated cirrhosis shows no clinical signs, while decompensated cirrhosis presents various symptoms.

Answer 404

* Hepatic cell dysfunction * Portal hypertension * Portosystemic shunting ## Footnote These features are critical in understanding the impact of cirrhosis on the body.

Answer 405

* Jaundice * Ecchymosis * Palmar erythema * Spider angiomas * Pruritus * Hepatomegaly * Splenomegaly * Abdominal ascites * Edema * Weakness and weight loss * Anorexia * Fetor hepaticus ## Footnote These symptoms reflect the systemic effects of liver dysfunction.

Answer 406

Low platelet count ## Footnote A low platelet count is a key indicator in the setting of chronic liver disease.

Answer 407

Liver Biopsy ## Footnote It provides definitive evidence of cirrhosis and its severity.

Answer 408

* Avoid aspirin and NSAIDs * Beta-blockers * Diuretics * Lactulose and rifaximin * Anticoagulants * Antiviral medications * Ursodeoxycholic acid * Albumin * Vitamin K ## Footnote These medications help manage symptoms and prevent complications associated with cirrhosis.

Answer 409

* Lifestyle modifications * Dietary changes * Paracentesis * Endoscopic therapies * Transjugular intrahepatic portosystemic shunt (TIPS) * Liver transplantation ## Footnote These interventions aim to improve quality of life and manage the disease.

Answer 410

TRUE ## Footnote ASA III classification allows for in-office procedures if there are no clinical symptoms.

Answer 411

* Serum ALT and AST greater than 4 times normal * Serum bilirubin elevated above 2 mg/dL * Serum albumin less than 3.5 g/dL * Ascites or encephalopathy * Platelet count less than 50,000 * INR greater than 1.7 ## Footnote ASA IV indicates decompensated cirrhosis and requires hospital settings for invasive dental treatment.

Answer 412

* Crohn disease * Ulcerative colitis ## Footnote These conditions are characterized by chronic inflammation of the gastrointestinal tract.

Answer 413

* Chronic abdominal pain * Persistent or nocturnal diarrhea * Nausea * Vomiting * Bowel obstructions ## Footnote Abdominal pain is often localized in the lower right quadrant.

Answer 414

* Fever * Fatigue * Weight loss * Night sweats * Growth and development delays in children ## Footnote These signs are frequent and can indicate severe disease.

Answer 415

* Perianal disease (abscesses, fistulas) * Joint pain and swelling * Erythema nodosum * Hepatosplenomegaly * Finger clubbing ## Footnote These manifestations can occur due to chronic inflammation.

Answer 416

* Swelling of the face, lips, and gingiva * Angular cheilitis * Cobblestoning of the oral mucosa * Deep linear ulcerations in the buccal vestibule * Polypoid mucosal tags * Macrocheilia * Aphthous Stomatitis ## Footnote Oral manifestations may precede GI symptoms in up to 60% of cases.

Answer 417

* Frequent, bloody diarrhea with mucus * Urgency * Tenesmus * Pain in the lower left quadrant ## Footnote Symptoms are particularly pronounced if limited to the rectosigmoid colon.

Answer 418

* Fever * Weight loss * Higher risk of colon cancer in longstanding cases ## Footnote Systemic signs are typically less severe than in Crohn's disease.

Answer 419

* Aphthous-like lesions * Pyostomatitis Vegetans (raised, erythematous projections) * “Snail track” fissures * Cobblestoning ## Footnote Oral lesions often present before GI symptoms or flare-ups.

Answer 420

* Corticosteroids * Immunosuppressants (Azathioprine, mercaptopurine, methotrexate) * TNF inhibitors (infliximab, adalimumab) * Antibiotics (metronidazole, ciprofloxacin) * Nutritional supplementation ## Footnote These medications help manage inflammation and control symptoms.

Answer 421

* Surgical interventions for strictures, abscesses, or fistulas * Psychotherapy for stress management ## Footnote Surgery may be necessary in advanced cases.

Answer 422

* Colectomy if medication is ineffective * Possible ileostomy if total colectomy is performed ## Footnote Colectomy can be curative for Ulcerative Colitis.

Answer 423

* Decreased hemoglobin and hematocrit * Electrolyte imbalances * Low albumin levels * Vitamin B12 and folate deficiency * Elevated inflammatory markers (CRP, ESR) * Elevated INR ## Footnote These indicators help assess disease activity and nutritional status.

Answer 424

* Colonoscopy * MRI * CT enterography * Capsule endoscopy ## Footnote These techniques help visualize the small intestine and confirm diagnosis.

Answer 425

* ASA II: Controlled, mild cases * ASA III: Severe or poorly controlled IBD ## Footnote This classification helps assess the risk for dental interventions.

Answer 426

* Stress reduction (shorter appointments, sedation) * Oral lesion management (biopsy, topical corticosteroids) * Medication-specific considerations (adrenal suppression, infection risk) ## Footnote These considerations help minimize complications during dental treatment.

Answer 427

* Emphasize oral hygiene * Corticosteroid therapy during symptomatic phases * Perioperative antibiotics for invasive procedures ## Footnote Close monitoring is essential for patients on immunosuppressants.

Answer 428

* Surgical excision for symptomatic lesions * Systemic control often resolves oral lesions * Topical steroids as needed ## Footnote Similar considerations for invasive procedures as in Crohn's.

Answer 429

Inability to effectively filter metabolic waste, regulate electrolyte and acid-base balance, control body fluid volume, reabsorb proteins, and secrete essential hormones ## Footnote Also known as Chronic Renal Failure (CRF).

Answer 430

Less than 60 mL/min for 3 months or longer ## Footnote GFR is a key indicator of kidney function.

Answer 431

* Toxic condition due to azotemia * Electrolyte abnormalities * Anemia * Systemic complications related to waste accumulation ## Footnote Uremia is symptomatic when GFR is around 5–10% of normal.

Answer 432

* Anemia due to decreased EPO * Mild to moderate thrombocytopenia ## Footnote Thrombocytopenia increases the risk of infection.

Answer 433

* Leading cause of morbidity and mortality * Hyperkalemia * Hypertension * Hyperlipidemia and atherosclerosis ## Footnote These complications arise due to sodium and fluid retention.

Answer 434

* Decreased calcitriol synthesis * Increased PTH * Hyperparathyroidism * Osteitis cystica fibrosa * Osteomalacia and osteosclerosis ## Footnote These changes lead to increased bone resorption and marrow fibrosis.

Answer 435

* Tooth erosion * NUG and NUP * Uremic fetor * Petechiae and ecchymosis * Xerostomia * Triad of osseous changes ## Footnote Triad includes thinning of lamina dura, demineralized bones, and radiolucent jaw lesions.

Answer 436

* Dietary management * Blood pressure control * Anemia management * Hyperphosphatemia treatment * Metabolic acidosis treatment * Hyperlipidemia management ## Footnote Specific treatments vary based on the stage of kidney disease.

Answer 437

Glomerular Filtration Rate (GFR) ## Footnote Reduced GFR indicates severity and progression of CKD.

Answer 438

* Uremic symptoms * Fluid overload unresponsive to diuretics * Refractory hyperkalemia * Severe metabolic acidosis * Neurological symptoms ## Footnote Typically started when serum creatinine reaches about 10 mg/dL.

Answer 439

* Hemodialysis * Peritoneal dialysis ## Footnote Each type has its own advantages and complications.

Answer 440

Arteriovenous (AV) Fistula ## Footnote It is preferred due to longer durability but requires a delay before use.

Answer 441

* Peritonitis * Cloudy dialysate with >100 white cells per microliter ## Footnote Often caused by Staphylococcus aureus.

Answer 442

* Hyperkalemia * Infection (sepsis) ## Footnote Mortality rates from infection can be up to 300 times that of the general population.

Answer 443

Approximately one-third to one-half of ESRD patients qualify ## Footnote Donor sources include cadaveric and living related donors.

Answer 444

* Corticosteroids * Azathioprine * Cyclosporine ## Footnote Essential to prevent rejection of the transplanted kidney.

Answer 445

systemic disease that is a constant threat to life ## Footnote This classification reflects the high risk associated with any dental intervention.

Answer 446

Excessive, uncontrollable, requires no external stimulus, resulting in physical, emotional, behavioral, and cognitive changes ## Footnote Anxiety is a natural adaptation but becomes a disorder when it exceeds normal levels.

Answer 447

* Chronic, generalized anxiety * Episodic, panic-like anxiety ## Footnote These patterns describe the different ways anxiety can manifest.

Answer 448

* Most frequently encountered psychiatric condition in the general population * Simple phobia is the most common anxiety disorder * Panic disorder is the most common in individuals seeking treatment ## Footnote Anxiety disorders are widespread and affect many individuals.

Answer 449

* Sympathetic activation: Increased heart rate, sweating, dilated pupils, muscle tension * Parasympathetic activation: Urinary frequency, episodic diarrhea ## Footnote These responses mirror those of fear and involve the autonomic nervous system.

Answer 450

* Sense of impending disaster without an apparent source * Minimal or prominent physical symptoms (e.g., tachycardia, palpitations, chest pain) ## Footnote Symptoms can vary in intensity and presentation.

Answer 451

* Agoraphobia: Fear of distressing symptoms when leaving home * Social phobia: Fear of embarrassment in social settings * Specific phobias: Fear of specific stimuli (e.g., spiders, heights) ## Footnote Each type of phobia has unique triggers and manifestations.

Answer 452

* Sudden, overwhelming feelings of terror * Symptoms: dyspnea, palpitations, dizziness, faintness, trembling, sweating, choking, flushes or chills, numbness, tingling, chest pain ## Footnote Repeated panic attacks can indicate panic disorder.

Answer 453

Significant disability and distress ## Footnote GAD can severely impact daily functioning.

Answer 454

* Psychotherapy (often in severe cases) ## Footnote Psychological treatments aim to address the underlying issues contributing to anxiety.

Answer 455

* Cognitive approaches * Biofeedback * Hypnosis * Relaxation Imaging * Desensitization * Flooding ## Footnote These treatments focus on changing behavior and responses to anxiety.

Answer 456

* Tricyclic Antidepressants (TCAs) * Selective Serotonin Reuptake Inhibitors (SSRIs) * Monoamine Oxidase Inhibitors (MAOIs) * Benzodiazepines * Antihistamines * Beta-blockers * Sedative-hypnotics ## Footnote Medications can help manage symptoms of anxiety.

Answer 457

Combination of therapies ## Footnote Most patients benefit from integrating multiple treatment modalities.

Answer 458

* Episodes of uncontrolled eating (binging) * Compensatory behaviors to prevent weight gain (self-induced vomiting, use of diuretics or laxatives, strict dieting, excessive exercise) ## Footnote Bulimia involves cycles of binging followed by actions to avoid weight gain.

Answer 459

* Weight loss of at least 15% below expected body weight * Intense fear of weight gain * Strict dietary habits that prevent weight gain * Distorted perception of body weight and shape ## Footnote Anorexia is characterized by extreme weight loss and a distorted body image.

Answer 460

* Weight criteria: 85% or less of ideal body weight * Amenorrhea (absence of menstruation) * High risk of electrolyte imbalances leading to sudden death from ventricular tachyarrhythmias ## Footnote These presentations highlight the severe health risks associated with anorexia.

Answer 461

* Binge eating without major weight gain * Signs of purging behaviors (vomiting, laxatives, diuretics) * Obsessive-compulsive behavior * Antisocial actions or self-harm ## Footnote Individuals with bulimia are typically at normal or above-normal weight.

Answer 462

* Erosion on teeth consistent with stomach acid exposure * Referral for medical diagnosis and treatment is necessary ## Footnote Dentists may detect bulimia through dental erosion, prompting further evaluation.

Answer 463

* Approximately 40% of anorexic patients exhibit bulimic behaviors * Signs of dental erosion may be present * Young patients with significant weight loss should be approached about possible self-starvation ## Footnote Parents should be informed if applicable, especially if no other medical cause is apparent.

Answer 464

Can reach 20%, primarily due to cardiac arrest and suicide ## Footnote This highlights the severe risks associated with the disorder.

Answer 465

* Requires an interdisciplinary team (mental health clinicians, dieticians, medical doctors) * Evaluation includes tests (CBC, electrolyte panel, ECG, etc.) * Primarily treated with nutritional rehabilitation and psychotherapy; hospitalization may be necessary ## Footnote Pharmacotherapy is generally not the first line of treatment.

Answer 466

* Managed with nutritional rehabilitation * Psychotherapy * Pharmacotherapy when needed, typically on an outpatient basis ## Footnote This approach focuses on addressing both the psychological and physical aspects of the disorder.

Answer 467

* Manage dental effects of chronic vomiting (erosion) * Address diet-related caries * Postpone complex restorative treatments until binging and purging cycles are controlled ## Footnote Full-coverage restorations may be necessary, but complex restorations risk failure if vomiting recurs.

Answer 468

TRUE ## Footnote Understanding the likelihood of relapse is crucial for effective dental management.

Answer 469

A persistent sad, empty, or irritable mood, along with somatic and cognitive changes that impair the ability to function ## Footnote Symptoms must persist for at least two weeks for an MDD diagnosis.

Answer 470

* More common in women * Highest among older adults, then those aged 30-40 * Rarely begins before puberty ## Footnote Approximately one-third of those with depression may require hospitalization.

Answer 471

* Pervasive low mood * Reduced interest in activities * Significant weight changes * Sleep disturbances (insomnia or hypersomnia) ## Footnote Untreated, an episode of MDD can last 8-9 months.

Answer 472

TRUE ## Footnote This duration is crucial for the diagnosis of MDD.

Answer 473

* Alcoholism * Drug abuse * Social isolation * Elderly males * Terminal illness * Untreated mental health disorders * Previous suicide attempts * Recent diagnosis of a serious illness * Recent loss * Retirement ## Footnote These factors significantly elevate the risk of suicide in individuals with MDD.

Answer 474

Selective serotonin reuptake inhibitor (SSRI), such as citalopram ## Footnote SSRIs are commonly prescribed for managing MDD.

Answer 475

* Struggles with oral hygiene * Reduced salivary flow * Complaints of dry mouth (xerostomia) ## Footnote Xerostomia can increase the risk for rampant caries and periodontitis.

Answer 476

* Rampant Caries * Periodontitis ## Footnote Xerostomia is often worsened by antidepressant side effects.

Answer 477

* Glossodynia (burning mouth) * Various facial pain syndromes * Temporomandibular joint (TMJ) disorders * Bruxism ## Footnote These complaints can affect the quality of life for individuals with MDD.

Answer 478

* Xerostomia * Stomatitis * Glossitis * Sialadenitis * Gingivitis * Edema * Tooth discoloration ## Footnote Antidepressants, antipsychotics, and mood stabilizers frequently cause these side effects.

Answer 479

Bruxism ## Footnote This side effect can further complicate dental health in patients with MDD.

Answer 480

* Bipolar I * Bipolar II ## Footnote Bipolar I is characterized by episodes of mania, while Bipolar II includes episodes of hypomania and major depression.

Answer 481

Characterized by episodes of mania and possibly major depression or mixed states ## Footnote A depressive episode is not required for diagnosis.

Answer 482

Defined by episodes of hypomania and a required episode of major depression ## Footnote Hypomania is a milder form of mania.

Answer 483

* Inflated self-esteem or grandiosity * Decreased need for sleep * Excessive talkativeness, rapid or loud speech * Flight of ideas, distractibility * Psychomotor agitation and involvement in high-risk pleasurable activities ## Footnote These symptoms indicate a period of elevated, expansive, or irritable mood.

Answer 484

* Euphoric or 'high' mood * Poor judgment * Potential for financial and legal issues * Increased risk of drug and alcohol abuse ## Footnote These behaviors can lead to significant life challenges.

Answer 485

Upon a single manic episode, even without a depressive episode ## Footnote This is a key diagnostic criterion.

Answer 486

Requires both hypomania and a depressive episode ## Footnote This distinguishes it from Bipolar I.

Answer 487

* Men experience more frequent manic episodes * Women tend to have more depressive episodes ## Footnote This highlights the differing presentations of the disorder.

Answer 488

* Episode durations decrease * Cycle frequency increases with age ## Footnote This emphasizes the importance of treatment.

Answer 489

* Lithium Carbonate * Anticonvulsants (e.g., Valproic Acid, Carbamazepine) ## Footnote These medications help manage mood swings.

Answer 490

* Xerostomia (dry mouth) * Dysgeusia (altered taste) * Increased cravings for carbohydrates ## Footnote These side effects can impact patient compliance.

Answer 491

* Xerostomia * Glossitis * Blood disorders (e.g., leukopenia, anemia) * Increased risk of thrombocytopenia at high doses ## Footnote These side effects may require special considerations in dental procedures.

Answer 492

Effective treatment for manic episodes when medication is insufficient ## Footnote ECT can be a crucial option for severe cases.

Answer 493

* Xerostomia increases caries risk * Carbohydrate cravings may contribute to higher caries risk * Blood dyscrasias may require special consideration during dental procedures ## Footnote These factors are important for dental health management.

Answer 494

Characterized by abnormalities in several domains, including: * Delusions * Hallucinations * Disorganized thinking and speech * Grossly disorganized or abnormal motor behavior * Negative symptoms ## Footnote Negative symptoms include lack of typical mental function in thinking, behavior, and perception.

Answer 495

* Delusions * Hallucinations ## Footnote These symptoms are characterized by the presence of abnormal thoughts or perceptions.

Answer 496

* Withdrawal * Reduced emotional expression (affective flattening) * Alogia (reduced speech content) * Avolition (lack of motivation) ## Footnote These symptoms reflect a decrease in normal functions.

Answer 497

At least **two** symptoms ## Footnote Symptoms include hallucinations, delusions, disorganized speech or behavior, catatonic behavior, and negative symptoms.

Answer 498

A state where a person appears awake but doesn't respond to their environment or other people ## Footnote This is one of the symptoms required for diagnosis.

Answer 499

* Formal Thought Disorder * Disorder of Thought Content ## Footnote Formal Thought Disorder impacts relationships and associations in language, while Disorder of Thought Content involves the development of delusions.

Answer 500

* Auditory * Visual * Tactile * Olfactory * Gustatory ## Footnote Hallucinations are perceptual disturbances that can affect any of the senses.

Answer 501

* Drug abuse disorders * Alcohol abuse disorders ## Footnote These disorders are frequently associated with schizophrenia.

Answer 502

* Eye gouging * Pushing objects into the ear canal * Lip or cheek biting * Tongue biting * Burning oral tissues with cigarettes ## Footnote These behaviors can pose significant risks to the patient's health.

Answer 503

* Dystonia * Dyskinesia * Tardive Dyskinesia ## Footnote These side effects may cause jaw spasms, TMJ dislocation, and impaired gag reflex.

Answer 504

* Agranulocytosis * Leukopenia * Thrombocytopenia ## Footnote Clozapine is known to cause these blood disorders.

Answer 505

Routine dental care should only be provided if the patient is under proper medical management for schizophrenia ## Footnote Even under management, these patients may pose challenges for dental treatment.

Answer 506

Characterized by re-experiencing a traumatic event and decreased responsiveness or avoidance of reminders of the trauma ## Footnote Diagnosis is made if symptoms persist for one month or longer following the traumatic event.

Answer 507

* Hyperarousal * Heightened startle reactions * Intrusive thoughts * Illusions * Overgeneralized associations with the traumatic event * Sleep disturbances (e.g., nightmares) * Impulsivity * Difficulty concentrating * Hyper-alertness ## Footnote Symptoms may sometimes emerge after a delay, leading to later-onset PTSD.

Answer 508

TRUE ## Footnote This condition is referred to as later-onset PTSD.

Answer 509

* Behavioral approaches * Psychological approaches * Pharmacological approaches ## Footnote Prognosis improves with early symptom onset after the traumatic event and prompt initiation of therapy.

Answer 510

Some patients may view dental professionals as authority figures, associating treatment with a sense of lost control ## Footnote This is particularly relevant for veterans and other patients with PTSD.

Answer 511

* Potential carriers of HBV * Potential carriers of HCV * Potential carriers of HIV ## Footnote Heavy drinkers may also have increased risks of infection, bleeding, delayed healing, and altered drug metabolism.

Answer 512

If informed consent is not secured ## Footnote This emphasizes the importance of obtaining consent before treatment.

Answer 513

Patients may neglect oral hygiene, increasing their risk for dental issues ## Footnote Common issues include caries, periodontal disease, and pericoronitis.

Answer 514

* Atypical facial pain * Glossodynia * TMJ disorders * Bruxism ## Footnote These complaints highlight the need for tailored dental care for PTSD patients.

Answer 515

* Disclosure of Information * Voluntariness of Decision * Competence to Make Decisions ## Footnote These principles ensure that patients are fully informed and able to make decisions regarding their treatment.

Answer 516

Explicitly provided by the patient, either verbally or in writing ## Footnote This type of consent is crucial for ensuring patients understand their treatment options.

Answer 517

Consent inferred from the patient’s actions, gestures, or circumstances ## Footnote Examples include unconscious patients implying consent for emergency treatment.

Answer 518

* Diagnosis, if known * Nature, purpose, and expected outcome of treatment * Potential risks, complications, and benefits * Alternative options with costs and insurance coverage * Consequences of not proceeding * Reasons for the recommended treatment plan ## Footnote Patients must receive detailed information to make informed decisions.

Answer 519

The patient’s decision must be made freely, without pressure or coercion ## Footnote This principle protects the patient's autonomy in making healthcare choices.

Answer 520

Patients must be mentally capable of understanding and reasoning about their treatment options ## Footnote Competency can fluctuate and may need reassessment throughout treatment.

Answer 521

* Ability to recall information * Reasoning about choices ## Footnote Questions may include understanding the condition and proposed treatment.

Answer 522

* Lower-risk, high-benefit treatments require a lower threshold * Complex, high-risk treatments require a higher level of competence ## Footnote This ensures patients can adequately understand the risks and benefits associated with their treatment.

Answer 523

Compression of the inferior vena cava by the enlarged uterus ## Footnote This compression reduces venous return to the heart, leading to decreased cardiac output.

Answer 524

From the middle of the second trimester onward ## Footnote This is due to the increasing size of the uterus.

Answer 525

* Pallor * Dizziness or lightheadedness * Hypotension * Sweating * Nausea * Increased heart rate (tachycardia) ## Footnote Symptoms are often relieved by changing the patient’s position.

Answer 526

Move the patient from a supine to a left lateral position ## Footnote This adjustment relieves pressure on the vena cava and usually resolves symptoms promptly.

Answer 527

* Monitor vital signs * Administer supplemental oxygen if symptoms persist ## Footnote Checking blood pressure and heart rate is essential.

Answer 528

Always position pregnant patients with a slight tilt or left lateral positioning ## Footnote This is especially important from the second trimester onward.

Answer 529

thyroid storm ## Footnote It is an acute medical emergency associated with untreated or poorly treated thyrotoxicosis.

Answer 530

high ## Footnote Thyrotoxic crisis is an extreme form of thyrotoxicosis (hyperthyroidism).

Answer 531

T4 ## Footnote Thyroxine regulates metabolism, heart and digestive function, brain development, bone health, and muscle control.

Answer 532

* Fever (may exceed 104F) * Restlessness * Tachycardia * Atrial fibrillation * Pulmonary edema * Tremor * Sweating * Stupor * Coma and death if untreated ## Footnote These symptoms can be precipitated by physiologic stress.

Answer 533

* Infection * Surgery * Trauma * Emotional stress * Cardiovascular disease * Systemic illness * Diabetic ketoacidosis * Vigorous palpation of the thyroid ## Footnote These factors can trigger a thyrotoxic crisis in patients with poorly treated or untreated thyrotoxicosis.

Answer 534

Block thyroxine synthesis ## Footnote This can be achieved using propylthiouracil (PTU) 150mg PO/NG q.6.h.

Answer 535

saturated solution of potassium iodide [SSKI] 3 to 5 drops PO/NG q.8.h ## Footnote This helps in managing the acute symptoms of thyrotoxic crisis.

Answer 536

* Dexamethasone 2mg PO/NG q.6.h (blocks T4 conversion) * Propranolol 1 to 2mg IV q.15min.prn (beta-blockade) ## Footnote These medications help mitigate the effects of excess thyroid hormone.

Answer 537

* Acetaminophen * Ice packs * Hypothermia blankets ## Footnote Aspirin should NOT be used in this scenario.

Answer 538

* Oxygen * Digitalis * Diuretics ## Footnote These treatments help manage heart failure symptoms associated with thyrotoxic crisis.

Answer 539

IV fluids (hyper-tonic glucose) ## Footnote Rehydration is crucial in managing the patient's condition.

Answer 540

100mg IV q.8.h ## Footnote There is little scientific justification for this treatment.

Answer 541

Hypoglycemia ## Footnote Often arises from insufficient food intake following insulin administration, exercise without food, over administration of insulin, sulfonylureas, or meglitinides, or the presence of infection or other disease.

Answer 542

* Weakness * Dizziness * Tingling * Difficulty concentrating * Blurred vision * Confusion * Changes in consciousness * Seizure * Coma ## Footnote These symptoms result from depriving the brain of its primary fuel, glucose.

Answer 543

* Tremulousness * Tachycardia * Palpitations * Anxiety ## Footnote These symptoms are a response to low blood glucose levels.

Answer 544

* Diaphoresis * Hunger * Paresthesias ## Footnote These symptoms occur due to the body's response to low glucose levels.

Answer 545

BG <54mg/dL ## Footnote Neuroglycopenic symptoms begin to occur and require immediate action to resolve the hypoglycemic event.

Answer 546

Severe event requiring assistance for recovery ## Footnote Characterized by altered mental and/or physical function.

Answer 547

Myxedema Coma ## Footnote A severe, life-threatening complication of advanced hypothyroidism.

Answer 548

Hypothyroidism slows everything down ## Footnote It highlights the clinical presentation of myxedematous crisis.

Answer 549

* Exposure to cold * Infections * Trauma * Surgery * CNS depressants (opioids, sedatives) ## Footnote These factors can trigger a myxedematous crisis.

Answer 550

* Bradycardia * Severe hypotension * Impaired mentation * Hypothermia * Hyponatremia * Hypoglycemia ## Footnote These symptoms indicate significant metabolic suppression.

Answer 551

Activate EMS ## Footnote Rapid hospital intervention is crucial due to high mortality rates.

Answer 552

* Oxygen via mask * Monitor vital signs * Blood pressure support * Prevent hypothermia ## Footnote These measures are essential to stabilize the patient.

Answer 553

100-300 mg intramuscularly ## Footnote This supports adrenal function and reduces stress on the body.

Answer 554

Dextrose ## Footnote This supports brain function and prevents seizures.

Answer 555

Intubation ## Footnote This is required for ventilatory support in severe cases.

Answer 556

Administer intravenous levothyroxine ## Footnote This helps stabilize thyroid function.

Answer 557

High levels of biologically active thyroid hormones (T3 and T4) due to an overactive thyroid gland ## Footnote Hyperthyroidism is often confused with thyrotoxicosis, which encompasses all causes of excess thyroid hormone.

Answer 558

A broader term encompassing all causes of excess thyroid hormone, regardless of origin ## Footnote It includes conditions like hyperthyroidism.

Answer 559

* Nervousness * Restlessness * Sweating * Heat intolerance * Palpitations * Tachycardia * Dyspnea * Fatigue * Weakness * Weight loss * Increased appetite ## Footnote These symptoms can significantly impact quality of life.

Answer 560

* Goiter (enlarged thyroid with bruit) * Ophthalmopathy: Chemosis, conjunctivitis, proptosis, optic nerve compression, corneal drying ## Footnote Grave's Disease is an autoimmune disorder that leads to hyperthyroidism.

Answer 561

* Tremor * Warm/moist skin * Emotional lability * Hyperreflexia * Fine hair * Onycholysis * Rare cases of heart failure ## Footnote These signs can vary in presentation among individuals.

Answer 562

* Elevated serum T3, T4, free thyroxine * Suppressed TSH (except in rare cases) * Hypercalcemia * Increased alkaline phosphatase * Anemia * Decreased granulocytes ## Footnote These tests help confirm the diagnosis and assess the severity of the condition.

Answer 563

* MRI of orbits (preferred) * CT * Ultrasound ## Footnote These imaging techniques help visualize the extent of ocular involvement.

Answer 564

Provide symptomatic relief without affecting thyroid hormone levels ## Footnote Commonly used beta-blockers include propranolol.

Answer 565

Inhibit thyroid hormone synthesis; associated with high rates of recurrent hyperthyroidism ## Footnote Examples include methimazole and PTU.

Answer 566

Destroys overactive thyroid tissue; not suitable for pregnant patients ## Footnote It is an effective treatment option for many patients.

Answer 567

* Risk of corneal ulceration * Vision loss * Optic nerve compression * Corneal drying * Downward and outward expansion of eye ## Footnote These complications can be severe and require prompt management.

Answer 568

* Sinus tachycardia * Atrial fibrillation ## Footnote Atrial fibrillation can sometimes be a primary manifestation of hyperthyroidism.

Answer 569

Acute emergency with high mortality in untreated or poorly managed patients ## Footnote It requires immediate medical intervention.

Answer 570

* Increased risk of caries * Accelerated periodontal disease * Extra-glandular thyroid enlargement * Osteoporosis in jaws * Accelerated dental eruption * Burning mouth syndrome ## Footnote These findings can complicate dental management.

Answer 571

* Salivary gland dysfunction * Parotid swelling * Pain * Taste loss * Recurrent sialadenitis * Hyposalivation * Xerostomia ## Footnote These side effects can significantly affect a patient's quality of life.

Answer 572

* Elevated risk of thyrotoxic crisis * Possible cardiac complications * Caution with catecholamine-containing local anesthetics ## Footnote Stress or vigorous thyroid palpation can exacerbate these risks.

Answer 573

* History of thyroid treatments * Symptoms of hyperthyroidism * CVD * Recent normal TSH levels ## Footnote This assessment is crucial for safe dental management.

Answer 574

* Stress reduction * Intraoperative monitoring * Pharmacologic considerations ## Footnote Short, morning appointments and adequate local anesthesia are recommended.

Answer 575

Active infection with HBV and that the patient is infectious ## Footnote HBsAg appears before symptoms, peaks during symptomatic disease, and typically declines to undetectable levels within approximately 12 weeks.

Answer 576

After acute infection resolves; provide lifelong immunity ## Footnote Anti-HBs indicate immunity from either past infection or vaccination.

Answer 577

Active viral replication and ongoing infection ## Footnote Persistent HBeAg indicates heightened infectiousness and potential progression to chronic hepatitis.

Answer 578

Reduced infectivity and resolution of acute infection ## Footnote The presence of anti-HBe usually marks a declining or resolving infection.

Answer 579

Recent or acute HBV infection ## Footnote IgM anti-HBc helps distinguish acute from chronic HBV.

Answer 580

Anti-HCV (Antibody to HCV) via Enzyme-Linked Immunoassay (EIA) ## Footnote Generally detects positive results around 9 weeks post-exposure.

Answer 581

Active, potentially transmissible infection ## Footnote HCV RNA presence indicates that the patient is infectious.

Answer 582

Tends to respond better to antiviral treatments ## Footnote Viral load measurement does not correlate directly with hepatitis severity.

Answer 583

Symptomatic presentation and either anti-HCV or new anti-HCV detection ## Footnote Testing for HCV RNA is helpful as it appears before anti-HCV, confirming active infection.

Answer 584

Presence of anti-HCV and elevated ALT/AST levels over six months ## Footnote Most chronic patients are infectious, as nearly all will show detectable HCV RNA.

Answer 585

Assessing liver damage severity ## Footnote It is not essential for HCV diagnosis.

Answer 586

Non-invasive blood test for assessing fibrosis and necroinflammatory activity ## Footnote It uses biochemical markers and AI.

Answer 587

What type of cancer and what stages ## Footnote Understanding the specific cancer type and its stage is crucial for treatment planning.

Answer 588

* Surgery date * Start date of chemotherapy * Head and neck radiotherapy * Dosage of HNRT ## Footnote This information helps coordinate dental care with ongoing cancer treatments.

Answer 589

CBC, differential + platelet count, PT/INR ## Footnote Assessing hematologic status is essential to ensure the patient can safely undergo dental procedures.

Answer 590

* Bisphosphonates (e.g., Zoledronic acid/zoledronate, pamidronate) * Angiogenesis inhibitors (e.g., Bevacizumab, Sunitinib, Sorafenib) * RANKL inhibitors (e.g., Denosumab - XGEVA) ## Footnote These medications can significantly affect dental treatment and patient safety.

Answer 591

About 2nd week ## Footnote HNRT induced mucositis shows symptoms like erythema and ulceration by week 5.

Answer 592

40% incidence ## Footnote Onset occurs between the 5th to 10th day and resolves 7-14 days post treatment.

Answer 593

70-80% incidence ## Footnote Onset occurs on the 3rd or 4th day and resolves 14-18 days post treatment.

Answer 594

About 2nd week ## Footnote This condition is a common finding in patients receiving chemotherapy.

Answer 595

About 2nd week ## Footnote More frequent and severe in HNRT, lasting 3-4 months.

Answer 596

Zinc ## Footnote Chemotherapy-related dysgeusia resolves within a few days after the last dose.

Answer 597

About 1 week ## Footnote Doses higher than 26 Gy can cause permanent loss of function.

Answer 598

* Radiation caries * Xerostomia * Mucositis * Cheilitis * Glossitis ## Footnote Severe hypo salivation is more common with HNRT.

Answer 599

About 1 week ## Footnote It occurs due to myelosuppressive effects of chemotherapy on bone marrow.

Answer 600

Below 10,000 to 20,000 / mm3 ## Footnote Platelet count is generally not a good predictor for bleeding risk.

Answer 601

Decalcification, dental decay, tooth disintegration ## Footnote Unlikely to result in tooth damage with radiation doses less than 30 Gy.

Answer 602

* Pulpal pain * Teeth sensitivity ## Footnote More common in the molar region and can be bilateral.

Answer 603

Delayed onset ## Footnote Risk remains throughout the patient's life, especially higher if concurrent CT and HNRT were received.

Answer 604

1.8% ## Footnote The incidence increases to 9% for doses greater than 70 Gy.

Answer 605

Trismus ## Footnote It may require physical therapy to resolve.

Answer 606

Increased risk after treatment ## Footnote Detected by panoramic radiography at a neck irradiation dose of 45 Gy.

Answer 607

* Deficient mandible * Shortened root length * Abnormal tooth formation * Enamel dysplasia ## Footnote These alterations have a delayed onset.

Answer 608

Low platelet count ## Footnote Commonly experienced by patients receiving chemotherapy.

Answer 609

Low white blood cell count ## Footnote Often occurs in patients undergoing chemotherapy.

Answer 610

60,000+ ## Footnote This is considered a safe level for patients.

Answer 611

30-60,000 ## Footnote This range indicates that treatment may proceed with caution.

Answer 612

Less than 30,000 ## Footnote Critical for ensuring patient safety during procedures.

Answer 613

2000+ ## Footnote Indicates sufficient immune response to prevent infection.

Answer 614

1000 - 2000 ## Footnote AHA prophylactic recommendations apply in this range.

Answer 615

Less than 1000 ## Footnote Indicates a high risk of infection.

Answer 616

Amikacin 150 mg 1 hour before surgery ## Footnote Helps prevent infections in at-risk patients.

Answer 617

75 mg half hour pre-surgery ## Footnote Used as a prophylactic measure.

Answer 618

* Pain * Orofacial fistulas + suppuration * Exposed necrotic bone * Pathological mandibular fracture * Xerostomia ## Footnote These symptoms indicate severe complications following radiation therapy.

Answer 619

Exposed, non-vital bone in the jaw persisting longer than 3 months in absence of cancer recurrence ## Footnote Typically follows high-dose radiation therapy.

Answer 620

Radiation-induced damage leading to hypocellularity, hypovascularity, and ischemia of the bone ## Footnote Often starts with soft tissue necrosis.

Answer 621

* Persistent pain * Cortical perforation * Orofacial fistulas * Suppuration * Ulceration * Pathologic fractures ## Footnote These signs indicate advanced stages of the condition.

Answer 622

* Ill-defined radiolucent areas * Radiopaque areas as dead bone separates ## Footnote These signs are visible on x-rays.

Answer 623

Higher than 50–60 Gy ## Footnote Risk persists for life after high doses.

Answer 624

* Tobacco use * Alcohol use ## Footnote These factors impair tissue healing.

Answer 625

* Bone Modifying agents (BMAs) * Antiangiogenic Agents (AAs) ## Footnote These classes help manage the condition.

Answer 626

Zoledronate ## Footnote A key medication in managing bone health.

Answer 627

Denosumab ## Footnote Used to manage bone-related conditions.

Answer 628

* Hyperbaric oxygen therapy * Pentoxifylline * Tocopherol (Vitamin E) ## Footnote Controversial effectiveness prior to invasive dental work.

Answer 629

30% ## Footnote Indicates the need for regular monitoring in head and neck cancer survivors.

Answer 630

Chronic graft versus host disease (GVHD) ## Footnote The transferred cells recognize alloantigens in the host.

Answer 631

Allogeneic bone marrow or stem cell transplantation ## Footnote It may also rarely follow transplantation of solid organs rich in lymphoid cells, such as the liver.

Answer 632

Immunocompetent T-cells in donor marrow recognize recipient’s HLA antigens as foreign ## Footnote Both CD4+ and CD8+ T-cells from the donor tissue recognize and attack host tissues.

Answer 633

Within 100 days (median: 2 to 3 weeks) ## Footnote Any organ may be affected, with major manifestations in the liver, skin, and gut.

Answer 634

* Generalized rash and mucosal ulcerations (skin) * Jaundice (destruction of small bile ducts) * Bloody diarrhea (mucosal ulceration of the gut) ## Footnote These manifestations result from epithelial cell necrosis.

Answer 635

* Viral infections * CMV * EBV ## Footnote Immunodeficiency frequently accompanies GVHD.

Answer 636

100 days or more ## Footnote It may follow the acute syndrome or occur insidiously.

Answer 637

* Extensive cutaneous injury * Destruction of skin appendages * Fibrosis of the dermis * Cholestatic jaundice (chronic liver disease) ## Footnote Resembles systemic sclerosis.

Answer 638

* Involution of the thymus * Depletion of lymphocytes in lymph nodes ## Footnote Leads to a profoundly weakened immune response.

Answer 639

80% ## Footnote Oral symptoms cause significant morbidity.

Answer 640

* Mucosal erythema * Lichen-planus-like changes (reticular, erosive/ulcerative) * Hyperkeratosis or leukoplakia * Decreased salivary gland function and dry mouth complaints * Mucoceles * Sclerotic restriction of mouth opening * Taste disturbances ## Footnote Symptoms resemble those of several autoimmune conditions.

Answer 641

Approximately 16 times the risk ## Footnote Patients should be evaluated at least twice a year.

Answer 642

At least 2 months following the last dose of zoledronate (Reclast) and at least 2 months before the next dose of Reclast ## Footnote Zoledronate is administered once a year and inhibits osteoclast-mediated bone resorption.

Answer 643

3 to 4 months following the last dose of denosumab (Prolia) ## Footnote Denosumab is given every six months and inhibits osteoclasts by targeting RANKL.

Answer 644

Bisphosphonate ## Footnote It is administered once a year and helps strengthen bones by inhibiting osteoclast-mediated bone resorption.

Answer 645

Monoclonal antibody ## Footnote It is given every six months and inhibits osteoclasts by targeting RANKL.

Answer 646

TRUE ## Footnote MRONJ stands for medication-related osteonecrosis of the jaw, which is a risk associated with these medications.

Answer 647

Once a year ## Footnote It is used for the treatment of osteoporosis or osteopenia.

Answer 648

Every six months ## Footnote It is used to help prevent osteoporosis.

Answer 649

Dry mouth, commonly seen due to extracellular fluid depletion and decreased saliva production ## Footnote Results in lower levels of salivary calcium, phosphate, and fluoride, and elevated salivary glucose.

Answer 650

* Xerostomia * Increased susceptibility to infections * Delayed wound healing * Higher incidence and severity of dental caries * Gingivitis and periodontal disease * Periapical abscess ## Footnote These complications arise due to various factors including altered immune responses and high glucose concentrations in saliva.

Answer 651

TRUE ## Footnote This includes bacterial, viral, and fungal infections, such as candidiasis, linked to altered immune responses and high glucose levels.

Answer 652

Slower healing of oral tissues ## Footnote This can complicate recovery after dental procedures.

Answer 653

Increases risk of dental caries ## Footnote Particularly in cases of poor glycemic control.

Answer 654

Periapical abscess ## Footnote This condition is more likely to occur in patients with poorly controlled diabetes.

Answer 655

Increased severity of periodontal disease ## Footnote Due to enhanced inflammatory response and compromised wound healing.

Answer 656

Primarily occurs in T1DM but can also develop in T2DM ## Footnote DKA results from the body’s inability to metabolize ketones as quickly as they are produced, causing acid buildup.

Answer 657

>250 mg/dL ## Footnote DKA often arises with blood glucose levels above this threshold, often precipitated by infection.

Answer 658

* Headache * Flushed face * Fatigue * Hunger * Confusion * Nausea * Vomiting * Abdominal pain * Diarrhea * Kussmaul respirations * 'Fruity' breath * Hypotension * Polydipsia * Polyphagia * Possible loss of consciousness ## Footnote These symptoms indicate severe metabolic derangement.

Answer 659

* Determine and address the cause * Correct hyperglycemia (insulin) * Reestablish electrolyte levels * Correct dehydration (IV fluids and insulin) ## Footnote Treatment focuses on stabilizing the patient and correcting metabolic imbalances.

Answer 660

Extreme hyperglycemia (>600 mg/dL) with severe dehydration and no significant ketoacidosis ## Footnote HHS is seen mainly in T2DM and can be triggered by acute illness.

Answer 661

* Weakness * Polyuria * Polydipsia (often for several days) * Normal BP but significant orthostatic hypotension * Altered mental status * Coma (in severe cases) ## Footnote HHS has a mortality rate of 30-60% in severe cases.

Answer 662

* Insulin * Fluid replacement ## Footnote Treatment focuses on correcting hyperglycemia and rehydrating the patient.

Answer 663

Hypoglycemia ## Footnote Often due to insufficient food intake following insulin administration, exercise without food intake, or excessive insulin.

Answer 664

* Tremulousness * Tachycardia * Palpitations * Anxiety ## Footnote These symptoms are catecholamine-mediated and indicate the need for immediate intervention.

Answer 665

* Weakness * Dizziness * Tingling * Blurred vision * Confusion * Behavioral changes * Potentially seizures or coma ## Footnote Level 3 Hypoglycemia is a severe event requiring assistance from another person.

Answer 666

Impair immune function by affecting neutrophil activity, phagocytosis, cytokine production, and oxidative stress ## Footnote This leads to an increased risk for infections.

Answer 667

* Skin infections * Tuberculosis (TB) * Pneumonia * Pyelonephritis ## Footnote These infections contribute to mortality in 5% of DM patients.

Answer 668

Impair wound healing due to poor collagen formation and weakened wound tensile strength ## Footnote Improved glucose control aids wound healing and reduces post-operative complications.

Answer 669

A clinical syndrome due to accumulation of waste products in the blood ## Footnote Symptoms include gastrointestinal, systemic, neurological, cardiovascular, and dermatological manifestations.

Answer 670

* Nausea * Vomiting * Anorexia ## Footnote These symptoms arise from the accumulation of waste products in the blood.

Answer 671

* Fatigue * Weakness ## Footnote These symptoms reflect the overall impact of waste accumulation on the body.

Answer 672

* Confusion * Impaired cognition * Seizures ## Footnote Neurological symptoms can significantly affect the patient's quality of life.

Answer 673

* Pericarditis * Pleuritis ## Footnote These conditions can arise due to the effects of waste accumulation on the cardiovascular system.

Answer 674

* Pruritus * Uremic frost ## Footnote Uremic frost refers to crystallized urea on the skin.

Answer 675

Final stage of chronic kidney disease with severe loss of kidney function ## Footnote Key clinical features include hematologic, cardiovascular, metabolic, bone and mineral, neurological, gastrointestinal, and dermatological symptoms.

Answer 676

* Anemia ## Footnote Anemia in ESRD is due to reduced erythropoietin production by the kidneys.

Answer 677

* Hypertension * Cardiovascular disease ## Footnote These conditions are common due to the effects of kidney failure on the cardiovascular system.

Answer 678

* Fluid and electrolyte imbalances * Metabolic acidosis ## Footnote These metabolic disturbances can lead to serious health complications.

Answer 679

* Renal osteodystrophy * Bone pain * Fractures ## Footnote These disorders arise from disrupted calcium, phosphorus, and parathyroid hormone levels.

Answer 680

* Neuropathy * Muscle cramps * Sleep disturbances ## Footnote Neurological issues can significantly impact the quality of life for ESRD patients.

Answer 681

* Anorexia * Nausea * Vomiting ## Footnote These symptoms can lead to further complications in ESRD patients.

Answer 682

* Pruritus ## Footnote Persistent itching is a common and distressing symptom in ESRD.

Answer 683

* Sexual dysfunction * Depression * Anxiety ## Footnote Psychological complications are frequently experienced by ESRD patients.

Answer 684

* Heart failure * Coronary artery disease * Arrhythmias ## Footnote ESRD significantly increases the risk of these cardiovascular issues.

Answer 685

* Renal osteodystrophy * Bone pain * Increased fracture risk ## Footnote These disorders are due to disrupted calcium, phosphorus, and parathyroid hormone levels.

Answer 686

* Peripheral neuropathy * Restless leg syndrome * Cognitive impairment ## Footnote Neurological complications can severely affect daily functioning.

Answer 687

* Hyperkalemia * Hyponatremia * Volume overload ## Footnote These imbalances can lead to serious health issues.

Answer 688

TRUE ## Footnote Persistent itching is a distressing symptom experienced by many ESRD patients.

Answer 689

* Increased risk of infections, such as peritonitis in those on peritoneal dialysis ## Footnote ESRD patients have a compromised immune system, increasing their susceptibility to infections.

Answer 690

* Depression * Anxiety * Sleep disturbances ## Footnote Psychological health is a significant concern for patients with ESRD.

Answer 691

* Bacterial endocarditis * Endarteritis ## Footnote Hemodialysis patients with intravascular access devices are at higher risk for these infections, but antibiotic prophylaxis is not typically needed unless an abscess is being incised and drained.

Answer 692

* Blood pressure cuffs * IV medications ## Footnote These should not be used in the arm that has the vascular access site, usually an arteriovenous fistula or graft.

Answer 693

On the day of dialysis, especially within the first 4 hours after the session ## Footnote Bleeding risk is heightened due to heparin administered during dialysis. Ideally, schedule treatment for later in the day or the morning after dialysis.

Answer 694

Platelet defects ## Footnote Prolonged bleeding is primarily due to platelet defects rather than heparin from dialysis, which typically does not cause clinically significant bleeding issues with routine dental procedures.

Answer 695

Protamine sulfate ## Footnote This should be pending approval from the patient's physician.

Answer 696

* Hepatitis B * Hepatitis C * HIV ## Footnote Hemodialysis patients have a higher risk of these infections. Screen before treatment or treat the patient as potentially infectious.

Answer 697

* Erythropoiesis-Stimulating Agents (ESAs): Epoetin alfa, darbepoetin alfa * Iron Supplements: IV options (Iron sucrose, ferric gluconate, ferric carboxymaltose); Oral options (Ferrous sulfate, ferrous gluconate, ferrous fumarate) ## Footnote ESAs stimulate bone marrow to produce red blood cells; iron supplements treat iron deficiency often accompanying anemia in ESRD patients on dialysis.

Answer 698

Stimulate the bone marrow to produce red blood cells ## Footnote Addresses the decreased erythropoietin production in ESRD.

Answer 699

* Vitamin D Analogues: Calcitriol, paricalcitol, doxercalciferol * Calcimimetics: Cinacalcet * Calcium Supplements: Calcium carbonate, calcium acetate ## Footnote These drugs help regulate calcium and phosphate metabolism and manage hyperparathyroidism.

Answer 700

Increase intestinal absorption of calcium and lower PTH levels ## Footnote Helps regulate calcium and phosphate metabolism.

Answer 701

* Calcium-Based Binders: Calcium acetate, calcium carbonate * Non-Calcium-Based Binders: Sevelamer carbonate, sevelamer hydrochloride, lanthanum carbonate * Iron-Based Binders: Ferric citrate, sucroferric oxyhydroxide ## Footnote Phosphate binders reduce the absorption of phosphate from food in the gastrointestinal tract.

Answer 702

Reduce the absorption of phosphate from food in the gastrointestinal tract ## Footnote Helps control serum phosphate levels.

Answer 703

Sodium Bicarbonate ## Footnote Used to raise blood bicarbonate levels, commonly administered in tablet or powder form.

Answer 704

* ACE inhibitors: Lisinopril * ARBs: Losartan * Beta-blockers: Metoprolol * Calcium channel blockers: Amlodipine * Diuretics: Thiazide or loop diuretics (e.g., furosemide) ## Footnote These drugs help control blood pressure and manage volume overload due to decreased kidney function.

Answer 705

Manage elevated cholesterol and reduce cardiovascular risk ## Footnote Statins like atorvastatin and rosuvastatin are used due to the high cardiovascular risk in ESRD patients.

Answer 706

No need for antibiotic prophylaxis in hemodialysis patients with intravascular access devices except if an abscess is being incised and drained ## Footnote Concerns for patients at increased risk for bacterial endocarditis and endarteritis.

Answer 707

* Reduce inflammation * Suppress immunity ## Footnote Corticosteroids are used to manage various medical conditions by targeting inflammation and immune responses.

Answer 708

Endocrine disorders ## Footnote This therapy is necessary when the body cannot produce enough of its own corticosteroids.

Answer 709

Addison's disease ## Footnote Addison's disease is a disorder where the adrenal glands do not produce enough hormones.

Answer 710

anti-inflammatory and immunosuppressant ## Footnote These properties help manage chronic inflammatory responses and tissue damage.

Answer 711

* Reduce tissue responses to inflammation * Inhibit accumulation of inflammatory cells ## Footnote These effects help alleviate symptoms associated with inflammation.

Answer 712

Balancing benefits with potential adverse effects ## Footnote Long-term use of corticosteroids can lead to significant side effects.

Answer 713

FALSE ## Footnote Corticosteroids are considered palliative, aimed at relieving symptoms rather than curing the underlying condition.

Answer 714

Decrease T-lymphocyte concentrations ## Footnote This effect helps modify immune responses and reduce cell-mediated reactions.

Answer 715

* Prostaglandins * Leukotrienes ## Footnote These mediators are involved in the inflammatory response.

Answer 716

* Macrophages * Lymphocytes ## Footnote This inhibition helps reduce inflammation and tissue damage.

Answer 717

basement ## Footnote This action helps lower complement and immunoglobulin levels.

Answer 718

Suppression via a negative feedback mechanism ## Footnote This suppression affects the production of corticosteroids and androgens in the adrenal cortex.

Answer 719

Development of adrenal unresponsiveness and potential adrenal insufficiency ## Footnote Recovery time depends on the duration of corticosteroid therapy, dosage, frequency, and specific corticosteroid characteristics.

Answer 720

FALSE ## Footnote Higher doses and divided daily doses are more suppressive compared to a single daily dose.

Answer 721

Clinically significant suppression of the HPA axis is rarely a problem ## Footnote Patients can withdraw from steroids suddenly with no risk of adrenal insufficiency.

Answer 722

Administering on alternate days ## Footnote This regimen mimics the normal diurnal pattern of corticosteroid secretion.

Answer 723

* Fluid and Electrolyte Disturbances * Musculoskeletal Effects * Gastrointestinal Effects * Dermatologic Effects * Metabolic Effects * Neurologic Effects * Metabolic/Endocrine Effects * Ophthalmic Effects ## Footnote These effects can arise due to the anti-inflammatory and immunosuppressive properties of corticosteroids.

Answer 724

* Sodium retention * Fluid retention * Potassium loss * Hypokalemic alkalosis * Hypertension ## Footnote These disturbances can lead to congestive heart failure in susceptible patients.

Answer 725

* Muscle weakness (steroid myopathy) * Loss of muscle mass * Osteoporosis * Vertebral compression fractures * Aseptic necrosis of femoral and humeral heads * Pathological fractures of long bones ## Footnote These effects can significantly impact mobility and quality of life.

Answer 726

* Peptic ulcers * Possible perforation and hemorrhage * Pancreatitis * Abdominal distension * Ulcerative esophagitis ## Footnote Statistically significant for hospitalized patients, not for those in ambulatory care.

Answer 727

* Impaired wound healing * Thin fragile skin (epithelial atrophy) * Petechiae and ecchymoses * Facial erythema * Increased sweating ## Footnote These effects can lead to increased vulnerability to skin injuries.

Answer 728

* Idiopathic intracranial hypertension * Papilledema * Convulsions * Vertigo * Headaches ## Footnote Psychological derangements may also arise, including mood swings and severe depression.

Answer 729

* Menstrual irregularities * Cushingoid state * Secondary adrenocortical and pituitary unresponsiveness * Suppression of growth in children * Decreased carbohydrate tolerance * Elevated blood glucose levels * Exacerbation of diabetes mellitus ## Footnote Up to 40% prevalence of diabetes mellitus reported in patients undergoing long-term corticosteroid treatment.

Answer 730

* Posterior subcapsular cataracts * Increased intraocular pressure * Glaucoma * Exophthalmos ## Footnote These conditions can lead to significant visual impairment.

Answer 731

NO ## Footnote Patients taking corticosteroids do not have a significantly higher risk of post-operative infection compared to other patients.

Answer 732

* Atraumatic techniques * Aseptic techniques ## Footnote Employing these techniques is crucial for minimizing infection risk.

Answer 733

If corticosteroids might mask signs of inflammation ## Footnote This is typically recommended until sufficient wound healing has occurred, usually within 7-10 days.

Answer 734

7-10 days ## Footnote This duration is recommended until sufficient wound healing has occurred.

Answer 735

No ## Footnote There are no routine laboratory tests that can accurately indicate or assess an increased risk for infection in patients taking chronic systemic corticosteroids.

Answer 736

* Individual Variability * Lack of Specific Biomarkers * Inconsistent Evidence ## Footnote These reasons highlight the complexity of assessing infection risk in patients taking corticosteroids.

Answer 737

FALSE ## Footnote There are no specific biomarkers or laboratory tests that directly correlate with the infection risk associated with corticosteroid use.

Answer 738

Corticosteroids can impair immune function ## Footnote However, this impairment does not consistently translate to a measurable increase in infection risk.

Answer 739

infection risk ## Footnote This highlights the challenges in assessing infection risk in these patients.

Answer 740

Between 3-4am ## Footnote This timing is significant for understanding asthma symptoms and management.

Answer 741

Classification of asthma ## Footnote This approach helps in understanding the baseline severity of the condition.

Answer 742

With treatment ## Footnote This assessment provides insight into the effectiveness of the current management plan.

Answer 743

Eosinophil activity ## Footnote This test helps evaluate therapeutic effectiveness in asthma management.

Answer 744

TRUE ## Footnote Antihistamines can thicken mucus, potentially exacerbating asthma symptoms.

Answer 745

By GOLD ## Footnote GOLD criteria provide a standardized approach to assess the severity of COPD.

Answer 746

CAT test ## Footnote The CAT test evaluates the impact of COPD on a patient's health status.

Answer 747

Comorbid CHF ## Footnote This indicates that other health issues can influence COPD assessments.

Answer 748

No contraindications unless hx. of intrinsic asthma ## Footnote Intrinsic asthma may be exacerbated by dry, cold air.

Answer 749

Antibiotic susceptibility for TB treatment ## Footnote This test is important for determining effective treatment options for tuberculosis.

Answer 750

Low risk ## Footnote The risk of ORNJ increases with higher radiation doses.

Answer 751

Moderate risk, especially with local trauma ## Footnote Higher doses increase the risk of vascular and bone damage.

Answer 752

High risk due to vascular and bone damage ## Footnote The risk continues to escalate with increasing doses.

Answer 753

Very high risk, with significant potential for necrosis ## Footnote This level of radiation poses severe risks to jaw health.

Answer 754

Low risk of permanent damage; some recovery possible ## Footnote Parotid glands are primary saliva producers for unstimulated flow.

Answer 755

Moderate risk; partial recovery may occur over time ## Footnote Damage increases with higher radiation doses.

Answer 756

High risk of significant damage and permanent xerostomia ## Footnote Severe damage to salivary function is likely.

Answer 757

Severe and typically irreversible damage to salivary function ## Footnote This level of radiation greatly affects saliva production.

Answer 758

Reduced function; recovery is limited ## Footnote Submandibular glands are secondary saliva producers.

Answer 759

High risk of permanent dysfunction ## Footnote Higher doses lead to significant loss of gland function.

Answer 760

Almost complete loss of function ## Footnote Severe damage occurs at this level of radiation.

Answer 761

Sensitive to doses >10 Gy, with gradual loss of mucosal lubrication ## Footnote This can lead to complications such as radiation caries.

Answer 762

Low risk: Minimal direct damage to dental hard tissues ## Footnote Caries risk is mostly due to reduced salivary flow if nearby salivary glands are affected.

Answer 763

Moderate risk: Teeth begin to show structural changes ## Footnote Enamel cracking and reduced mineralization increase susceptibility to caries.

Answer 764

High risk: Significant alterations in enamel and dentin composition ## Footnote This leads to rapid and severe decay, especially combined with xerostomia.

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