Baker's Exam 3: Baker's Exam 3: Disease State Parameters

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kmaher
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122098
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Baker's Exam 3: Baker's Exam 3: Disease State Parameters
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2011-12-09 01:54:43
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Dental Therapeutics
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Disease State Parameters
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  1. What are the guidelines for the diagnosis HTN?
    • Normal: SBP= <120 & DBP= <80
    • PreHTN: SBP= 120-139 & DBP= 80-89
    • HTN Stage 1: SBP= 140-159 & DBP= 90-99
    • HTN Stage 2: SBP= =or>160 & DBP= =or>100
  2. What are the guidelines for Class 1 heart failure? How is this Class managed?
    • No limitation of physical activity
    • No dypnea, fatigue or palpitations w/ordinary activity
    • *Provide routine care
  3. What are the guidelines for class 2 HF? How is this class managed?
    • Slight limitation of physical activity
    • Fatigue, palpitations and dyspnea w/ordinary physical activity but comfortable at rest
    • *Elective care OK and recommend consult w/physician
  4. What are the guidelines for Class 3 HF? How is this class managed?
    • Marked limitation of activity
    • Less than ordinary physical activity results in symptoms but comfortable at rest
    • *AVOID elective care; if tx necessary consult physician and consider referral to specian pt care setting; avoid vasoconstrictors
  5. What are the guidelines for Class 4 HF? How is this class managed?
    • Symptoms present at rest and any physical activity exacerbates the symptoms
    • *AVOID elective care; if tx necessary consult physician and consider referral to specian pt care setting; avoid vasoconstrictors
  6. What are the guidelines for the diagnosis of Diabetes?
    • Normal: Fasting Blood Glc = <110 & Post prandial = <140
    • Impaired Glc Met: Fasting Blood Glc = 110-125 & Post prandial =140-199
    • DM: Fasting Blood Glc = >or=126 & Post prandial = 200+
  7. What are the DSM IV Diagnosis guidelines for Depression (MDD)?
    • One of the following: Depressed mood or loss of interest OR Diminished sense of pleasure
    • + 4 for the 7 following: Wt or appetite change, Sleep disorder on most days, Change in psychomoter, Fatigue/Dec energy, Feelings of guilt/worthlessness, Dec concentration/decisiveness, Suicidal ideation or attemp
  8. The physical presentation of Depression: A SAD FACES
    A-Appetite

    • S-Sleep
    • A-Anhedonia
    • D-Depressed mood

    • F-Fatigue
    • A-Agitation
    • C-Concentration
    • E-Esteem
    • S-Suicidal
  9. What are the stages of asthma - intermittent or persistent
    • Intermittent: Symptoms <or= 2day/wk, no nighttime awakenings, use of B2 ag to control symptoms <or= 2days/wk, no interferences with normal activity
    • Persistent (Mild): Symptoms > 2day/wk, nighttime awakenings 1-2X/mo, use of B2 ag to control symptoms > 2days/wk not daily, minor interferences with normal activity
    • Persistent (Moderate): Symptoms daily, nighttime awakenings 3-4X/mo, use of B2 ag to control symptoms daily, some interferences with normal activity
    • Persistent (Severe): Symptom throughout day, nighttime awakenings >1x/wk, use of B2 ag to control symptoms several times/day, extreme interferences with normal activity
  10. What are conditions that can be triggered/worsened by stress and/or pain?
    • HTN
    • Angina
    • Cardiac Arrhythmia
    • Epilepsy
    • Asthma
  11. What are the most common types of Epilepsy?
    • (Most to least common)
    • Complex partial
    • Generalized tonic-clonic
    • Simple partial
    • Other generalized
    • Unknown partial
    • Absence (Petit mal)
    • Myoclonic
    • Unclassified
  12. Epilepsy as a medical emergency: Initial assessment
    • Hx,physical
    • Blood tests: CBC, Electrolytes, Glc, Ca, Mg, Phosphate, hepatic and renal function
    • Lumbar puncture (if meningitis or encephalitis suspected)
    • Blood or urine screen for drugs
    • EEF
    • CT or MR brain scan
  13. Epilepsy as a medical emergency: Common causes (infancy and childhood)
    • Prenatal or birth injury
    • Inborn error of metabolism
    • Congenital malformation
  14. Epilepsy as a medical emergency: Common causes (childhood and adolescence)
    • Idiopathic/genetic syndrome
    • CNS infection
    • Trauma
  15. Epilepsy as a medical emergency: Common causes (adolescence and young adult)
    • Head trauma
    • Drug intoxication and withdrawal (Seizure not epilepsy)
  16. Epilepsy as a medical emergency: Common causes (Older adult)
    • Stroke
    • Brain tumor
    • Acute metabolic disturbance (seizures not epilepsy)
    • Neuordegenerative
  17. Epilepsy as a medical emergency: when is it status epilepticus?
    More than 10 min of continuous seizure activity OR 2+ sequential seizures w/o full recovery b/w seizures
  18. Characterize SUDEP
    • sudden, unexpected death in a patient with epilepsy where the postpartem exam does not reveal a toxicologic or anatomic cause of death w/ or w/o evidence of seizure and excluding SE.
    • Risk of sudden death in epilepsy pts 24X gen pop.
    • Risk factors: hx and # of GTCS, freq seizures, subtherapeutic AED levels, young adults, long epilepsy duration, IQ<70
  19. Differentiate b/w syncope and seizure: before spell
    (C)=common
    (R)=Rare
    • Trigger: Sycope (C)/Seizure(R)
    • Sweating & Nausea: Syncope (C)/Seizure(R)
    • Aura(deja vu, smell) or unilat symptoms: Syncope(R)/Seizure(C)
  20. Differentiate b/w syncope and seizure: during spell
    (C)=common
    (R)=Rare
    • Pallor: Syncope(C)/Seizure(R)
    • Cyanosis: Syncope(R)/Seizure(C)
    • Loss of consciousness: Syncope(<20sec)/Seizure(>60sec)
    • Automatisms: Syncope(Occasional)/Seizure(C)
    • Lat. Tongue biting: Syncope(R)/Seizure(Occasional)
    • Frothing/hyper-salivation: Syncope(R)/Seizure(C)
    • Movements: Syncope(few clonic or myclonic jerks)/Seizure(Prolonged tonic phase-rhythmic clonic mvmts)
    • Durations: Syncope(<15sec)/Seizure(30-120sec)
  21. Differentiate b/w syncope and seizure: after spell
    (C)=common
    (R)=Rare
    • Confusion/Disorientation: Syncope(R<30sec)/Seizure(C sev +mins)
    • Diffuse myalgias: Syncope(R,brief, shoulders/chest)/Seizures(C, hr-days)
    • Creatine kinase elevation: Syncope(R)/Seizure(C)
  22. Characteristics of Partial: Simple Partial Seizures
    • W/somatosensory or special sensory symptoms
    • W/motor signs
    • W/autonomic symptoms or signs
    • W/psychic or experiential symptoms
  23. Characteristics of Partial: Complex Partial Seizures
    • Impaired consciousness
    • Clinical manifestations vary: presence and nature of aura, automatisms, other motor activity
    • Duration: <2min
  24. Characteristics of Partial: Secondarily Generalized Seizures
    • Begins focally w/ or w/o focal neurological symptoms
    • Variable symmetry, intensity, and duration of tonic (stiffening) and clonic (jerking) phases
    • Duration: 1-3 min
    • Postical confusion, somnolence, w/ or w/o transient focal deficit
  25. Characteristics of Generalized: Typical Absence Seizures (Petit mal)
    • Brief staring spells w/impairment of awareness
    • Duration: 3-20 sec
    • Sudden onset and sudden resolution
    • Often provoked by hyperventilation
    • Onset usually b/w 4-14 yrs old
    • Often resolved by 18 yrs
    • Normal development and intelligence
  26. Characteristics of Generalized: Atypical Absence Seizures (Petit mal)
    • Brief staring spells w/variably reduced responsiveness
    • 5-30 sec
    • Gradual onset and resolution
    • Gen not provoked by hyperventilation
    • Onset >6 yrs
    • Often in children w/global cognitive impairment
  27. Characteristics of Generalized: Myoclonic Seizures
    Brief, shock-like jerk of a muscle or group of muscles
  28. Characteristics of Generalized: Atonic Seizures
    • Sudden loss of postural tone (Severe:fall vs. Mild:head nod or jaw drop)
    • Consciousness usually impaired
    • Duration: Seconds, rarely >1min
  29. Characteristics of Generalized: Tonic Seizures
    • Symmetric, tonic muscle contraction of extremities w/tonic flexion of waist and neck
    • Duration: 2-20 sec
  30. Characteristics of Generalized: Tonic-Clonic Seizures
    • Assoc w/loss of consciousness and post-ictal confusion/lethargy
    • Duration: 30-120 sec
    • Tonic Phase: Stiffening and fall, often assoc w/ictal cry
    • Clonic Phase: Rhythmic extremity jerking
  31. What are the benchmarks of good asthma contol?
    • No coughing or wheezing
    • No SOB or rapid breathing
    • No waking up at night
    • Normal physical activities
    • No school absences due to asthma
    • No missed time from work for parent or caregiver
  32. Indication of a severe asthma attack.
    • Breathless at rest
    • Hunched forward
    • Speaks in words rather than complete sentences
    • Agitated
    • Peak flow rate less than 60% of normal

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