N502 H/A exam 1

bronchopony

"99" normally muffled and indistinct across chest wall -abnormal if clearly heard lobar consolidation from pneumonia

Other times antibiotic prophyaxis is recommended for dental procedures

Vascular grafts (less than 6 months old) Arteriovenous hemodialysis shunts Neurosurgical shunts (dependent on type) Indwelling vascular catheters According to 2015 AAOS-ADA clinical practice guidelines, "for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection."

hypothyroidism

fatigue, lethargy, weight gain with anorexia, dry coarse skin, cold intolerance, swelling of hands, feet, face, constipation, weakness, muscle cramps, arthralgia, paresthesia, impaired memory, poor hearing dry coarse cool skin, yellow skin, nonpitting myxedema, hair loss, periorbital myxedema low pitch speech Dec systolic, ins diastolic BP bradycardia hypothermia Dec intensity of heart sounds Prolonged relaxation during ankle reflex impaired memory somnolence mixed hearing loss peripheral neuropathy carpal tunnel

dull percussion sound

fluid or solid tissue replaces air containing lung ex. pneumonia

Which of the following dental procedures does NOT requires antibiotic prophylaxis for individuals at high risk of bacterial endocarditis? Routine fillings Post-operative suture removal Dental cleaning Fluoride treatments Orthodontic appliance adjustment

fluoride

frontal sinuses maxillary sinuses

forehead cheeks

screening questions: anxiety

have you been feeling nervous, anxious or on edge? Have you been unable to stop or control worrying? Have you had an anxiety attach, suddenly feeling fear or panic?

Screening questions: Depression

have you felt down, depressed, hopeless? have you felt little to no interest/pleasure in doing things? Have you had trouble falling or staying asleep or sleeping too much? Have you been feeling bad about yourself or that youre a failure or let your family down? have you felt tired or had little energy have you had poor appetite or over eating have you had trouble concentrating have you been moving or speaking slowly or so fidgety or restless that others have noticed? have you had thoughts that you would be better off dead or had thoughts of harming yourself in any way?

ear nose concerning sx

hearing loss earache, ear discharge ringing ears dizziness, vertigo nasal discharge/congestion nosebleeds

S1 and S2

heart sounds as heart valves close

Hyperresonant to percussion

hyperinflated lungs of COPD, large pneumothorax

light illumination for estimating depth of anterior chamber

if light source illuminates entire eye w/o shadow = deep chamber if light source only illuminates proximal side and casts a shadow = iris bowed foreward

PMI

impulse located the L border of the heart found at 5th intercostal space or just medial to left midclavicular line or 7-9 cm lateral to midsternal line

Gingivitis

inflammation of the gingiva without destruction of the periodontal ligament or bone, which distinguishes it from periodontitis.

Bronchiovesicular breath sounds

insp and exp about equal in length, at times separated by silent interval

pupil exam

inspect size, symmetry, light reaction, near/far reaction

chest tube insertion

intercostal space between 4th and 5th rib

Thoracentesis position

intercostal space between 7 & 8th rib just medial to tip of scapula

pruritis

itching

plaque

larger flatter solid skin elevation > 1 cm ex. psoriasis, granuloma annulare

S4

left ventricular end diastolic stiffness which decreases compliance

steps of optic exam

locate optic disc bring optic disc into focus, sould be sharpest focus at 0 if pt does not have refractive errors (myopia, negative ; hyperopia, plus) inspect optic disc inspect fovea and macula

erosins

loss of epidermal or mucosal epithelium

tracheal breath sounds

loud harsh sounds heard over trachea in neck

bronchial breath sounds

louder, harsher, higher pitch silent gap between insp and exp exp longer than insp

Which of the following factors reduces the risk for caries in adults? Low socioeconomic status Existing tooth restoration A vegetarian diet Decreased salivary flow Low sugar diet

low sugar diet

bases of lungs

lowermost portions of lungs

silent chest

minimal air movement

S2

mitral and tricuspid valves

seborrheic keratosis

multiple 5mm to 2 cm tan to brown, oval, stuck on, flat topped, verrucous plaques on the abdomen, following skin tension lines

social determinants of health

neighborhood & built environment economic stability (food, employment, poverty) education social and community context health and health care

hyperthyroidism

nervousness, weight loss despite inclreased PO intake, excess sweating, heat intolerance, palpitations, frequent BMs, tremor, proximal muscle weakness warm smooth moist skin, exophthalmos, lid lag Inc systolic and dec diastolic BP tachycardia, afib hyperdynamic cardiac pulsation with accentuated so tremor and proximal muscle weakness

neologism

new invented or distorted word schizo, psychotic d/o, aphasia

ecchymosis

nonblanchable larger area of purpura

petechia

nonblanchable punctate foci of hemorrhage

purpura

nonblanchable raised and palpable

air conduction

normal first phase in the hearing pathway

describing skin lesions

number, size, color, shape, texture, primary lesion, location, and configuration

vertebral line

overlies the spinous processes of the vertebrae

palpate for tactile fremitus

palpable vibrations transmitted through bronchopulm tree to chest wall as pt speaks, normally symmetric normally more prominent in intrascapular region use ball of paml and have pt repeat "99" decreased/absent when voice is higher pitched or soft or when there is presence of thick chest wall, obstructed bronchus, COPD, pleural effusion, fibrosis, pneumothorax, or tumor

perversion

persistent repetition of words or ideas schizo, psychotic d/o

to locate findings on the chest

place finger in hollow curve of suprasternal notch move down 5 cm to horizotal bony ridge where manubrium joins body of sternum (sternal angle, angle of louis) adjacent to the angle is the 2nd rib use fingers to "walk down" and count each rib on an oblique line

abnormal high level of dullness in lung

pleural effusion, atelectasis, phrenic nerve paralysis

what procedures is prophylaxis for bacterial endocarditis not recommended

procedures that occur above the gum line Routine fillings Periodontal procedures if bleeding not anticipated Simple root canal treatment Rubber dam placement Suture removal Removable appliance placement Oral impressions Fluoride treatments Oral radiographs Orthodontic appliance adjustment Shedding of primary teeth

pectoriloquy

pt whisper 99 or 1-2-3, voice heard faintly or indistinctly if at all

Otoscope Exam of Tympanic Membrane

pull auricle up and back in adults direct otoscope down and foreawrd

How would you best manage the oral finding noted in the photo below? (HAIRY TONGUE) Biopsy Referral to oral surgeon Treat with topical antibiotics Regular tongue brushing

regular brushing

echolalia

repetition of words or phrases of others schozi & manic d/o

right lung vs left lung

right lung has 3 lobes, left has 2 to accommodate the heart

Which of the following is an abnormal tooth change not explained by aging alone? Gingival recession Root caries Yellowing of teeth Wearing away of teeth with exposed dentin

root caries

optic disc

round yellow orange structure with all arteries and veins flowing in and out of it blind spot

triangle of safety

safe position of chest tube insertion marked by lateral border of pec major anteriorly, lateral border of lat dorsi posteriorly, and nipple line (4-5th intercostal space) inferiorly

Mediastinal crunch (Hamman's sign)

series of precordial crackles synchronous with heart beat, not respiration due to mediastinal emphysema (pneumomediastinum)

vellus hair vs terminal hair

short fine inconspicuous relatively unpigmented hair vs coarser thicker more conspicuous and pigmented hair (eg. scalp & eyebrows)

light reasction

should be seen slightly nasal to center of pupils and similar on both sides

cover unconver test

show slight or latent muscle imbalance

A complete oral examination includes an assessment of each of the following EXCEPT: Temporomandibular joint (TMJ) Cervical nodes Palpation of the floor of the mouth Sinuses Skin around the mouth

sinuses

wheezes, rhonchi

sinusoidal, musical, prolonged like dashes in time

vesicle

small circumscribed elevation of epidermis containing clear fluid < 1 cm ex. herpes, acute allergic contact dermatitis, some autoimmune blistering

bulla

small circumscribed elevation of epidermis containing clear fluid > 1 cm ex classic autoimmune dx, pemphigus vulgaris, bullous pemphigoid

papule

small, solid skin elevation < 1 cm

visual acuity

snellen chart expressed as 2 numbers 20/nn = 20 ft away from chart / number normal person could read from 20/200 = normal eye could read that letter from 200 ft away 20/20 = normal eye

vesicular breath sounds

soft and low pitched, heard on insp and continue without pause into exp insp longer than exp

nodule

solid, round or oval elevated lesion 1 cm or more in diameter extends deeper into skin layers ex. cyst, lipoma, fibroma

common or concerning sx throat and mouth

sore throat bleeding gums hoarseness bad breath (halitoases)

incoherence

speech that is incomprehensible because it is illogical, lack of meaningful connections, abrupt changes in topics, disordered grammar or word use

EOMsassess for

strabismus, nystagmus, lid lag

blocking

sudden interruption of speech in midsentence before idea is completed losing the thought occurs in normal people, may be striking in schizophrenia

resp distress

tachypnea cyanosis or pallor audible sounds of breathing accessory muscle use \chest shape - AP diameter to lateral diameter = 0.7-0.9 normally

derailment loose associations

tangenital speech with shifting topics that are loosely connected or unrelated pt unaware of lack of association schizo, manic, other psychotic disorders

whisper voice test

tests auditory or gross hearing whisper combo of numbers and letters while standing an arms length behind the pt so they cannot read your lips occlude opposite ear if they correctly repeat at least 1 of 3 combos, they pass the screening test

epidermis dermis

thin, avascular, keratinized dense vascularized layer of interconnecting collagen and elastic fibers

test chest expansion/excursion

thumbs at level of 10th rib with fingers loosely grasping and parallel to lateral rib cage, have pt inhale and exhale deeply, watch distance between fingers move apart and feel for range and symmetry

Which of the following has been implicated in the development of recurrent aphthous ulcers? Trauma Vitamin C deficiency Sickle Cell Anemia Herpes simplex virus infection

trauma

common concerning sxs eyes

vision changes: blurred vision, loss of vision, Floaters, Flashes of light eye pain redness tearing double vision/diplopia

rash

widespread eruption of lesions

clanging

word choice based on sound, not meaning, includes nonsense rhymes and puns people with schozophrenia o manic disorders look at my eyes and nose, wise eyes and rosey nose, two to one, the ayes have it

All of the following are needed by a primary care clinician to conduct a thorough oral exam on an adult EXCEPT? An exam light to illuminate key features in the mouth Tongue depressors to lift the lip and retract the cheek A mouth mirror to view the lingual surfaces of teeth Gauze pad to grasp the tongue

A mouth mirror to view the lingual surfaces of teeth

A caregiver asks you how many teeth her 3 year old child should have. What is the most appropriate response? 20 22 24 28

20

needle decompression

2nd intercostal space at the midclavicular line

What is a full complement of adult teeth? 26 28 30 32

32

well placed ET tube

4th rib

At what age do teeth typically begin to emerge in children? Before 6 months of age 6-15 months of age 15-21 months of age 21-27 months of age

6-15 mo

pallor = cyanosis = jaundice =

= anemia = decreased O2 supply = increased bili

Mrs. Pederson is a 74 year old who presents for a routine blood pressure follow up visit. Her blood pressure is well controlled, but on review of systems she reports dry mouth of several years duration that has acutely worsened over the past 2 months. She quit smoking after she developed thyroid cancer that required surgery and neck radiation for cure. She has been drinking more water than usual, but it only improves her symptoms for a few minutes. She drinks wine with dinner and sometimes before bed for insomnia. On physical examination this is the appearance of her tongue (Pic: normal, dry). All of the following are likely contributing to Mrs. Pederson's xerostomia (the sensation of dry mouth) except: A. Aging process B. antiHTN meds C. alcohol use D. head/neck radiation E. sedative medications

A. Aging process aging alone is not a predisposing factor to xerostomia(dry mouth)

What is the most appropriate initial management for the patient in the photo below? (Angular cheilitis) Treat with topical antifungals Refer to dermatology Biopsy Treat with oral antibiotics Treat with topical antiviral medication

Treat with topical antifungals

Two months later Tanya returns with similar complaints. She has developed recurrent painful month sores that resemble her previous lesions. The lesions have been present for almost 2 weeks. In the past, her pain was minimal, but she now reports that it has become painful to eat, drink and speak. She has tried over the counter mouth rinses without much improvement. Which of the following is the most appropriate next step in management? A. Refer Tanya to an oral surgeon for biopsy of her lesion. B. Prescribe Thalidomide. C. Prescribe topical steroids. D. Prescribe an antiviral medication.

C.

Which clinical finding distinguishes periodontitis from gingivitis? Inflammation of the gums White discoloration of the permanent teeth Enlarged pockets at the gum base Gingival hypertrophy

Enlarged pockets at the gum base

James, a 57-year-old man, presents to the community clinic to establish care. He complains of a loose tooth and oral pain. He reports a history of hypertension and type 2 diabetes. He takes lisinopril and metformin. Laboratory tests and examination findings demonstrate that he is in poor glycemic control with his current medication regimen. You are a member of a health care team that works collaboratively to provide James with appropriate and timely oral health care. Which of the following behaviors best exemplifies the mutual respect and trust that are foundational to interprofessional collaborative practice? A. Inform the patient that diabetes has no direct effect on his oral health, but seeing a dietician is important to help control his diabetes. B. Involve dental and primary care providers in the management of James' oral health. C. Explain to James that a dentist will take care of his teeth but will not be involved in his overall health care. D. Explain to the patient that poorly-controlled diabetes leads to conditions that are very expensive for the health care system.

B

Yadira is a one year old girl who visits your office for her routine well child visit. After advising her parents about the importance of brushing twice daily, taking her fluoride supplement (her town has non-fluoridated water) and making an appointment to see their dentist soon, you prepare to perform an oral exam. Yadira is experiencing some age-appropriate stranger anxiety and does not want to let you look in her mouth. Which of the following approaches would most increase your chance of success with Yadira's oral examination? A. Have Mom force Yadira's mouth open if she is resisting. B. Use the knee to knee position for the examination. C. Use a papoose board to restrain her. D. Use a mouth mirror to pry the mouth open. E. Abandon the exam if Yadira cries excessively as the gums can become very erythematous leading to over-diagnosis of gingivitis.

B

You are the primary care physician caring for Grace, a 79-year-old woman, who is a resident in a long-term care facility. You are a board certified internist with a Certificate of Added Qualification in Geriatric Medicine. Grace has a history of moderate dementia and right-sided hemiplegia from a stroke at age 68. You are new to the practice and are seeing Grace for the first time. The nursing team leader of Grace's floor has listed "oral care" as one of three primary concerns of her family, along with choking on solid foods and poor sleep. Which behavior best exemplifies the mutual respect and trust that are foundational to interprofessional collaborative practice? A. Acknowledge that it is not always possible in a long-term care facility to examine the patient in a non-private setting. B. Acknowledge the importance of the patients' interests. C. Recognize that individual and cultural differences that are characteristic of patients do not influence the care of those patients in an institutional setting. D. Understand that elderly patients, particularly those with comorbidities such as dementia, have a shorter life expectancy and therefore do not require routine attention to oral care.

B

Mr. Green responds "no" when asked about whether he smokes cigarettes. However, on further inquiry, he acknowledges that he uses smokeless tobacco on a daily basis. As you prepare to perform an oral examination, which of the following choices best describes the supplies and equipment you will require to perform an adequate examination? A. Gloves and a small piece of gauze B. Gloves, a small piece of gauze and a tongue blade C. Gloves, a small piece of gauze, a tongue blade and a mouth mirror D. Gloves, a small piece of gauze, a tongue blade, a mouth mirror, and a dedicated examination chair with a headrest.

B.

Which of the following is true regarding Recurrent Aphthous Ulcers (RAU)? A. These lesions commonly present as a single painful ulcer that resolves after two months. B. RAUs have been associated with vitamin deficiencies. C. Most lesions require immediate treatment with topical steroids. D. These lesions typically occur on keratinized mucosal surfaces such as the gingival and hard palates.

B. some predisposing factors have been associated. These include a family history, smoking, vitamin deficiencies (Vitamin B12, folate, and iron), and systemic illness such as Behcet's, Celiac disease and HIV. Stress, local trauma and smoking have also been associated with RAU

Mrs. Pederson's active medical problems include Hypertension, Type 2 Diabetes Mellitus, and Glaucoma. Her past history is remarkable for treated thyroid cancer, seasonal allergies, and intermittent insomnia. She smoked when she was younger, but quit 30 years ago. She is widowed and a retired administrative assistant. She enjoys a glass of wine about five times a week with dinner and walks daily for exercise. Her medications include: lisinopril/HCTZ 10/25 mg orally once daily metformin 1000 mg orally twice daily aspirin 81 mg orally once daily zolpidem 10 mg orally at bedtime approximately twice per week diphenhydramine 25 mg orally as needed for allergy symptoms in the spring and fall latanoprost ophthalmic drops daily (topical prostaglandin analog for closed angle glaucoma treatment) Based on the information provided above, which of the following scenarios would most likely contribute to Mrs. Pederson's xerostomia? A. She began regularly using lemon candy drops to improve the smell of her breath. B. She has been taking zolpidem nightly for worsening insomnia following the recent death of her favorite cousin. C. She had a recent upper respiratory infection and sore throat. D. Due to the onset of winter she has not required any diphenhydramine for her allergies in the past 2 months. E. She has stopped drinking wine with dinner recently due to problems with heartburn.

B. zolpidem is a sedative which can worsen xerostomia

Which of the following patients require bacterial endocarditis antibiotic prophylaxis? A 26-year-old woman with mitral valve prolapse undergoing routine teeth cleaning with no anticipated bleeding. A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction. A 16-year-old boy with a ventricular septal defect completely repaired in infancy who requires extraction of an impacted wisdom tooth. A 32-year-old man who had bacterial endocarditis 5 years ago who is undergoing orthodontic appliance adjustment.

B.A 64-year-old man with a prosthetic mitral valve who is undergoing a tooth extraction

During the initial visit with James, you perform an oral health history. You determine that he has not had consistent access to quality health care and has only seen dental providers for acute problems. Additionally, he reports eating frequent sugary snacks and brushing his teeth infrequently. These factors place him at high risk for oral disease. Which of the following behaviors best exemplifies the acknowledgement of roles and responsibilities of participating members of the healthcare team? A. Seek solutions to the patients' oral health needs that primarily involve medical professionals, as to avoid interprofessional conflicts. B. Remind your staff that the patient centered medical home must be the anchor for any meaningful interprofessional work. C. Explain your role and responsibilities and how you will work as part of a team to provide the best possible care for your patient. D. Do as much as you can for James first before involving other members of the healthcare team.

C

Mrs. Pederson reduces her alcohol intake and stops taking diphenhydramine and zolpidem. She understands the need for her antihypertensive and diabetic medications and will continue to take those as directed. After these changes her dry mouth improves to some degree, but is still symptomatic. She inquires what else she can do to improve her symptoms. Which of the following interventions would be contraindicated for Mrs. Pederson? A. Use of an over-the-counter saliva substitute B. Sucking sugarless candy during the day to promote saliva production C. Starting cevimeline in an effort to increase saliva production D. Switching to an electric toothbrush from a traditional one E. Avoiding sugary and caffeinated drinks

C. Cevimeline and pilocarpine increases the flow of saliva through stimulation of muscarinic cholinergic receptors, and are commonly used in patients with Sjogrens Syndrome. While potentially helpful, their use is contraindicated in patients such as Mrs. Pederson with angle closure Glaucoma. Other potential side effects of these agents include headache, nausea, diaphoresis, rhinitis, abdominal pain, and vomiting.

most protruding process when neck is flexed forward

C7 vertebra (possibly also T1)

Tanya is a 10 year old female who presents to your office with a painful mouth sore that has been present for three days. The sore developed spontaneously and has not changed since its appearance. Six months ago, she noticed similar sores that resolved spontaneously after two weeks. She denies fever or systemic symptoms. Your oral exam reveals the following: What is the most likely cause of Tanya's oral lesion? A. Primary oral herpes B. Gingival trauma C. Coxsackie virus D. Aphthous ulcer

D

You perform an oral examination and encounter severe gingival recession and several loose teeth. You note that Grace has significant xerostomia. You determine that Grace requires the urgent intervention of her dentist, who, after your call, agrees to see her in a few days. You also feel there would be benefit from the involvement of a social worker as a member of her health care team. You notify the nursing home social worker using the flag system in your EMR and ask the nursing team leader to communicate this plan with the patient's family. Which behavior best exemplifies effective communication among participating members of the healthcare team? A. Encourage use of paper-based forms of communication between team members. B. Use proper dental terminology when referring to any of the patient's oral health concerns, regardless of their medical background. C. Explain that you will arrange for a dentist to take care of the patient's mouth and that you will take care of all the other health concerns. D. Encourage the social worker on the team to share ideas and opinions regarding the patients' care.

D

During the initial visit with Grace, you perform a thorough medical history including an oral health history. You determine that even though Grace has hemiplegia and dementia that prevents her from adequately caring for her own teeth, she has had excellent oral care, provided by a trained clinical assistant. She was seen by a dentist 8 months ago (6 months after being admitted to this facility). At that time the dentist recommended that she increase her brushing frequency, use fluoride gel on the exposed roots that had been developing, and return in 3 months for a recheck to document changes in her oral health. Which behavior best exemplifies effective teamwork among participating members of the healthcare team? A. Inform the team you will be making all the dental related decisions for Grace in the future. B. Acknowledging that there is a shortage of dental professionals in this setting, so unfortunately, future evaluations by the dentist will be eliminated. C. Encourage dental health professionals to oversee all aspects of care relating directly to the oral health of the patient. D. Develop consensus among team members around ethical principles involved in the care of patients with dementia and physical disability.

D.

Mr. Green, a 52-year old male, presents to your office for his annual evaluation. As part of that visit, you plan to perform a comprehensive physical examination. Which one of the following statements describes the appropriate decision making process as to whether or not to include an intraoral examination as part of today's visit? A. If he has seen his dentist within the last 6 months, there is no need to examine his oral cavity. B. If he has not seen his dentist within the last 6 months, an open-mouth observational examination is adequate. C. If he does not smoke cigarettes, his risk of oral cancer can be assumed to be very low, so an oral examination is not necessary. D. If he smokes cigarettes, he is at increased risk for both lip and intraoral cancer, so a careful examination is necessary.

D.

You perform an oral examination and encounter the following. You determine that James requires the urgent intervention of a dentist for gingivitis and periodontitis. Which behavior best exemplifies effective communication among participating members of the healthcare team? A. Encourage patient to establish care by a dentist and return to the clinic for medical treatment, as needed. B. Be available to discuss concerns with dental providers involved in the patients' medical care if they choose to contact you. C. Discuss your medical findings and opinions to dental providers involved in James' care only if he requests that you do so. D. Encourage dental providers to share ideas and opinions regarding the patients' care.

D.

On examination, you identify this white lesion on the floor of Mr. Green's mouth: National Institute of Health Which of the following statements is NOT correct about this white lesion? A. The differential diagnosis includes cancer, pre-cancer as well as benign conditions such as oral candidiasis. B. This lesion should be biopsied promptly to rule out pre-cancer and cancer. C. This lesion is likely to coincide with the area that the patient "parks" his smokeless tobacco. D. Treatment with an antifungal agent is an appropriate first step in the evaluation and management of this condition. E. If a white lesion in the mouth cannot be wiped off with gauze, the likelihood of pre-cancer or cancer should be strongly considered.

D. This patient has an intraoral white lesion and uses smokeless tobacco. Pre-cancer or cancer is at the top of the differential diagnosis. Therefore, prompt biopsy, rather than treatment for oral candidiasis is the best initial step. Such biopsies can be readily performed using local and/or topical anesthesia. Bleeding can be controlled with a topical hemostatic agent or a suture.

Using the knee to knee exam, Yadira is much more cooperative. You are able visualize the entire mouth using your gloved fingers and a tongue blade. You have a student working with you who has never seen such a thorough oral examination before. She asks you to explain what you are looking for. Important elements of a thorough well child oral exam for children between 6 months and three years old include all of the following EXCEPT: A. Tooth eruption sequence B. Developmental defects C. Tongue D. Signs of tooth malformation from thumb sucking E. Assessment of oral hygiene

D. Thumb sucking does not lead to tooth malformation. It is therefore not part of a thorough infant/toddler oral exam. If a child continues to suck their thumb beyond age 4, it may contribute to misalignment (malocclusion) of the teeth. Counseling about persistent thumb sucking and pacifier use and their potential adverse effect on the dental outcomes should be part of routine care.

what procedures is prophylaxis for bacterial endocarditis required

Dental Cleaning Tooth extractions Periodontal procedures if bleeding anticipated Scaling and root planing Reimplantation of avulsed teeth Root canal treatment beyond the apex Initial placement of orthodontic bands (not brackets) Intraosseous or intraligamentary injections

When examining the mouth of a 9-month old child, which of the following is a reason for early referral to see a dentist? The child has only 4 incisors Developmental tooth defects are present Molars are not present Canines are not present

Developmental tooth defects are present

Your next patient is Peter, a 61 year old man with Trisomy 21 (Down Syndrome). He is cared for by his elderly mother and requires a great deal of care especially recently since he began to develop Alzheimer's Dementia. He has a full upper denture because all of upper teeth were extracted second to rampant caries. His caregiver is concerned one of his remaining lower teeth may be hurting him as he holds his jaw and refuses to eat solid foods. She asks you to examine his mouth and advise her on what to do next. She adds that she tries very hard to keep his teeth clean but it is difficult due to lack of understanding and cooperation on his part. Which of the following is true about performing an oral examination on Peter? A. Removing his denture is not necessary since he has no remaining upper teeth. B. Recruiting extra staff to help hold Peter down when he resists will make his examination more accurate and easier. C. You do not need to do the examination. You can refer Peter to a local general dentist to do it. D. All of the above E. None of the above

E.

When performing the "knee-to-knee" oral exam on a young child, in what position should the child start? Facing the examiner Standing up Sitting on the exam table Facing the caregiver

Facing the caregiver

Which of the following is the least common site for the development of oral cancer? The tongue Floor of mouth Hard palate Lower lip

Hard palate

You are performing an oral exam on a 21-year old patient who has been using smokeless tobacco for 4 years. Which part of this patient's oral cavity is especially important for you to examine? Sun-exposed areas of the cheeks Inner aspect of the lips and cheeks Discoloration or pitting of the teeth Plaque build-up along the gum line Posterior pharynx

Inner aspect of the lips and cheeks

PMI > 2.5

LVH, HTN, dilated cardiomyopathy

weber test

Lateralization of sound sound lateralizes to impaired ear; suspect unilateral conductive hearing loss tuning fork on top of head

STOP-bang

OSA assessment snore tired observed falling asleep during day high blood pressure BMI>35 Age>50 neck circumference>40cm gender male

dextrocardia

PMI located on R heart displaced to the right

Oral cancer is most common in which area of the mouth? Hard palate Top of tongue Inside of cheek Posterolateral surface of tongue

Posterolateral surface of tongue

what medical conditions is prophylaxis for bacterial endocarditis required

Prosthetic heart valves, including homografts and allografts Previous bacterial endocarditis Congenital heart disease: Unrepaired Partially repaired with residual defects Completely repaired (first six months only) Posttransplant valvulopathy

common concerning resp issues

SOB, dyspnea, wheezing cough blood streaked sputum (hemoptysis) chest pain daytime sleepiness, snoring, disordered sleep

circumstantiality

Speech that is delayed in reaching the point and contains excessive or irrelevant details some points may have meaningful connection, but are not part of the initial point many people without mental disorders do this may also occur in people with obsessions

Which of the following statements concerning xerostomia, or dry mouth, is NOT true? Xerostomia is caused by a decrease in the production of saliva. Xerostomia can cause a burning sensation, change in taste, and difficulty swallowing. Medications can contribute to the development of xerostomia. Xerostomia increases risk for the development of caries. Xerostomia is rarely a problem for patients wearing complete dentures.

Xerostomia is rarely a problem for patients wearing complete dentures.

pustule

a small circumscribed elevation of the epidermis containing purulent fluid ex. bacterial infection, folliculitis

Supraclavicular

above clavicle

apex of lung

above clavicle

S3

abrupt deceleration of inflow across mitral valve

crackles / rales

adventitious sound intermittent, nonmusical, brief

flight of ideas

almost continuous flow of accelerated speech with abrupt changes from one topic tothe next, changes may be based on understandable associations, plays on words, or distracting stimuli, but ideas are not well connected manic moods

abnormality of thought content

anxiety, compulsion, delusion, depersonalization, derealization, obsessions, phobias

common/concerning mental/behavioral symptoms

anxiety, excessive worrying depressed mood memory problems medically unexplained symptoms

S1

aortic and pulmonic valve

apices of lungs

apex uppermost portion

Visual field of eyes

area seen by the eye when it looks at a central point limited by brows above, cheeks below, and nose medially lac of retinal receptors at optic disc produces oval blind spot in normal field of each eye (15 degrees temporal to line of gaze)

egophany

ask pt to say EEE, if it sounds like A

pseudoisochromatic plates

assess color vision

ABCD method

asymmetry, border irregular, color variation, diameter > 6mm, evolving rapidly, elevation, firm, growth over several weeks screening moles for melanoma

auscultation

before beginning, have pt cough to clear mild atelectasis or airway mucous use diaphragm first, ladder pattern, one full breath in each location listen directly in skin, clothes, hairs, etc can cause confusing crackling sounds

infraclavicular

below clavicle

infrascapular

below the scapula

interscapular

between scapulae

bone coduction

bypasses middle and external ear, used for testing purposes

mid sternal line

drops vertically along sternum

midclavicular line

drops vertically from midpoint of clavicle

anterior axillary line

drops vertically from the anterior axillary fold

posterior axillary line

drops vertically from the posterior axillary fold

wheal

circumscribed raised lesion consisting of dermal edema aka hives, urticaria lasts < 24 hrs

macule

circumscribed, flat area of color change < 1cm may be hyper or hypopigmented ex. freckles, flat moles, port wine stains, rickettsia infection rubella, measles

patch

circumscribed, flat area of color change > 1cm

pleural friction rub

coarse grating biphasic sounds heard primarily during exp

Herpes labialis

cold sores tx: topical antiviral

rinne test

compares air conduction to bone conduction place base on mastoid bone behind ear level with canal when pt no longer can hear, turn it and place prongs close to ear canal asif pt can hear the vibration

What constitutes a tooth's outer layer? Enamel Dentin Pulp Cementum

enamel

info gathering order

establish the agenda invite pt story gather info about pts perspective of illness ID and respond to pts cues gather info by exploring biomedical perspective gather important background info

percussion of thorax/lungs

establish whether underlying tissue is air filled, fluid filled, or consolidated hyperextend middle finger of L hand, press distal interphalangeal joint firmly on lung/chest surface, position right forearm close to pt with hand cocked upward use sharp quick relaxed wrist motion to strike your own finger with the R middle finger tip, not the pad, remove the striking finger quickly to avoid dampening the vibration caused Use ladder like pattern healthy lungs are resonant

confabulation

fabrication of facts/events in response to questions the act of filling in memory gaps korsakoff syndrome or alcoholism

ulcers

deeper loss of epidermis and upper dermis

Delirium vs Dementia

delirium is ACUTE onset dementia is chronic, long term, gradual loss

tuning fork tests

determines conductive vs sensorineural loss

primary lesion

develop as direct result of and are most characteristic of a disease

ophthalmoscopic exam

do not dilate eyes in primary HC setting darken room focus wheel = 0 diopter ophthalmoscope in R hand, use R eye to examine R eye and L hand, L eye, to examine L eye hold ophthalmoscope firmly braced against your own orbit medially with handle tilted laterally 20 degrees pt instructed to look up slightly over your shoulder and pick a point on the wall to stare at place self 15 in away and at 15 degree angle lateral to pts field of vision place thumb of opposite hand against pts eyebrow to steady your examining hand may need to decrease brightness for pt comfort

midaxillary line

drops down from the apex of the axilla

scapular line

drops from the inferior angle of the scapula