CMCP Final Review Questions and Correct Answers

ASA 1- healthy pt w/ no systemic disease 2- II - pt w/ mild systemic disease 3- III - pt w/ systemic disease that affects their quality of life but not entirely incapacitating 4- IV - pt with systemic disease that is largely incapacitating (DO NOT SEE THEM IN CLINIC) 5- V - pt w/ systemic disease that is not expected to survive next 24 hrs Vital Signs pulse: 60-100 bpm blood pressure: diastolic- < 90, systolic- <120 Respirations: 12-20 Temp: 98 degrees F or 36 degrees C Premed, uses, regime, when to use MEDICAL HISTORY SHOULD BE REVIEWED @ BEGINNING OF EACH APPT *if premed is needed, suspicion of an undiagnosed condition, abnormal vital signs History of excessive bleeding, anticoagulation/antiplatelet therapy (blood thinners), HIV/AIDS (include a t-cell count), immunosuppressive therapy, radiation therapy within 6 months, hepatitis carrier, organ transplant, cancer/leukemia, chemo within 6 months, joint replacement. Endocarditis, bacteria, most common valve lesions, when to premed. Antibiotic Cross resistance? Infective endocarditis: •Disease caused by microbial infection of the heart valves or endocardium usually associate w/ congenital or acquired cardiac defects (BE or BEA) **bacteria is the causative factor streptococci - approximately 90% Staphylococci- IV drug users candidial - yeast infections Iatrogenic valve damage: caused by certain Migraine medications & appetite suppressants (phen fen) Prosthetic valve endocarditis- infection of prosthetic heart valves -usually valvular, MITRAL VALVE is the most affected. (aortic, mitral, then bicuspid valves) When to pre-med- Prosthetic cardiac valve, previous IE, Congenital heart disease, cardiac transplant Emergency Drug kit, Uses, Contraindications Midazolam (anticonvulsant), Albuterol (bronchodilator), epinephrine (epi pen), diphenhydramine (antihistamine), Aspirin, Nitroglycerin (angina), Morphine (heart attack)(NOT IN CLINIC KIT), ammonia capsules (syncope) Most common congenital heart defects Tetralogy of fallot- most common of the congenital cardiac defect that causes cyanosis. Ventricular septal defect- most common heart lesion Reasons Risk factors Med Emer Increased Increased number if older patients, Medical advances making ppl live longer, longer appointments, increased drug use Med History how often reviewed, types MED HISTORY REVIEWED EVERY APPOINTMENT!!! Types: medical history form, interview, physical exam Types of questionnaires- system oriented, disease oriented, symptom oriented, culture oriented Causes for gingival enlargement hyperplasia Leukemia, cyclosporine, Calcium channel blockers cause gingival hyperplasia Drug/ vs allergic reactions Adverse drug reactions- more frequently encountered Pharmalogic encounter (85%) Allergic reactions- Basic defense system mechanisms such as skin, and lining of nasal passages, dont block the antigen from entering the system (15%) S+S hyperventilation tightness in chest, suffocating feeling, dizzy, tachycardia, palpitations, shortness of breath S+S hypotension drugs to treat Dizziness or lightheadedness.Nausea.Fainting (syncope)Dehydration and unusual thirst.Dehydration can sometimes cause blood pressure to drop. However, dehydration does not always cause low blood pressure. ...Lack of concentration.Blurred vision.Cold, clammy, pale skin. prevent hypotension (low bp) by gradually changing pt's position throughout treatment NO NITROGLYCERIN S+S hypertension drugs to treat early symptoms: elevated bp readings, vision changes (narrowing on retinal arterioles), occipital headache, dizziness, ringing in ears (tinnitus), fatigue, coldness in legs advanced symptoms: rupture & hemorrhage of retinal arterioles, papilledema, left ventricle hypertrophy, proteinuria, congestive heart failure, angina, renal failure, dementia, encephalopathy (damage to brain) risk factors: older age (atherosclerosis), blacks > whites > Hispanics > Asians, less educated, more common in women than men (older population)