| Signs children may show when ill | Non specific
Behaviour change
Poor feeding
Anorexia
Failure to thrive
Screaming episodes
fever
Specific
Acute stridor
Wheeze
Non-blanching rash
Swollen face/lips |
| Chronically unwell children may have faltering growth due to | Developmental delay
Chronic inflammatory disease
Connective tissue
Bowel disease
Illness
Diabetes
Atopic disease |
| Oval gray roofed vesicles on the hands feet mouth and buttocks may indicate | Hand foot and mouth disease |
| What could the following symptoms indicate
Refuses to eat
Maculopapular rash noted over body
Characteristic enanthem
osterior mouth
Soft palate, uvula, tonsillar pillars
Age
3-10 years old
Caused by cocksackie | herpangina |
| How is herpangina different to herpes stomatitits | Herpes stomatitis is full mouth including gingivae |
| What disease could the following symptoms indicate
12 hours of sore throat, vomiting, headache
Appearance of widespread rash
Strawberry tongue
Rash
Usually appears fist on the enck and face
Clear unaffected area around mouth
Like sandpaper
Tongue
Thick, white coating that peels after four or five days – strawberry appearance
Cause – Group A streptococcus | Scarlet fever give penicillin |
| What could the following symtoms indicate
Increased weakness
Admitted to ITU and died
It causes URT illness, with a sore throat and a high grade fever
Get a pseudo-membrane of the tonsils, pharynx and nose which leads to difficulties breathing
toxin release leading to paralysis of the respiratory muscles | Diptheria |
| what do the following symptoms indicate and what can the long term affect of this disease be
3 day history of fever, vomiting, and drowsiness. Not feeding
Non-blanching rash present | meningococcal disease |
| Abuse categories | Neglect, physical, emotional and sexual abuse |
| What to document in suspected abuse | The sequence and timing of symptoms
The evolution of features over time
Possible explanations and contributing factors
Inconsistencies and delays in seeking help should be noted |
| E.g. of some thrombolytics | Thrombolytics
Streptokinase
tPA |
| Assesing bleeding risk | Ask if any non prescribed drugs, assess treatment bleeding liklihood and assess whether condition is lifelong or time limited |
| How long does aspirin last | 7-10 days i.e. platelet lifespan |
| Clopidogrel works by? and lasts how long | Inhibitint ATP formation in platelets so will work until platelets die and are replaced |
| If dual antiplatelet therapy may have a greater increase in affect | Consult haemologist before tx. |
| Heparin indicates that complex dental procedures should be | Avoided |
| Heparin can be used for what type of therapy | bridging |
| How are low molecular weight heparins administered | Subcutaneously used prophy for DVT and acute chronic conditions etc.. |
| warfarin half life | 3 days |
| When is a higher INR e.g. 3.5 okay | Mechanic heart valves |
| Adverse affects of warfarin | Bleeding (from anywhere!)
Skin rashes
Alopecia
Diarrhoea, skin necrosis, jaundice
Bleeding peptic ulcer
Subconjunctival haemorrhage |
| What drugs interact with warfarin | Aspirin – AVOID high dose, even low doses increase bleeding risk
NSAIDS – Increased risk of GI Bleed
Opioids – not usually a problem ( but tramadol increases effect of warfarin)
Paracetamol – not usually a problem (prolonged regular use may increase effect of warfarin) |
| Why do some antiobiotics affect warfarin | Interact with PK enzyme |
| What herbal remedies can inhibit warfarin | St johns wort, (ginseng and feverfew can also affect) |
| What should you do when carrying out a procedure on a warfarin patient | Check INR 72 hrs before 24 if unstable and book for early in the day and week |
| What is thrombocytoponeia | Low platelet count |
| Warfarin reversal | VITAMIN K
5 mg I.V (major bleed)
1-3mg I.V. (minor bleed)
Fresh frozen plasma (FFP)
Clotting factor replacements (dried prothrombin complex) |
| Common antidiabetic drugs | Metformin |
| Dental implications of diabetes | Increased risk of infection (eg dental root abscess or post op infections) BUT infection itself can also worsen diabetic control/blood sugars
Poor Healing (eg post procedure) |
| What do mineralcorticoids do | Control BP |
| What do glucocorticoids do | Involved in anti inflammatory activity |
| Corticosteroids in dentistry | Topical corticosteroid therapy used for some forms of oral ulceration
E.g. Betamethasone soluble tablets (Betnesol®) dissolved in water used as mouthwash
Hydrocortisone oromucosal tablets (dissolved next to affected area) used in recurrent apthous ulceration and erosive lichenoid lesions |
| Indication for steroid tx | Asthma/ COPD
Inflammatory arthritis eg Rheumatoid
Connective tissue disorders
Immunosuppression |
| What could these symtoms indicate
ABDOMINAL PAIN
NAUSEA
VOMITING
CONFUSION
FEVER
HYPOTENSION
LOSS OF CONCIOUSNESS
DEHYDRATION
WEAKNESS
HYPOVOLAEMIC SHOCK
HYPOGLYCAEMIA
HYPERKALAEMIA
COMA
DEATH | Adrenal crisis |
| Dosage for oral surgery when on steroids | Take usual daily dose
Double dose one hour prior to surgery & continue double dose for first post-op day |
| In major dental procedures | Managed in secondary care
Intramuscular or IV hydrocortisone pre-op
Double oral dose of corticosteroids for 24 hours post op |
