Avoiding Suggestive Questions

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Questions and Answers

What does a higher INR indicate about blood clotting?

Blood does not clot at all

Blood clots more quickly than desired

Blood clots more slowly than desired (correct)

Blood clots normally

Which vitamin K-dependent clotting factors are most sensitive according to PT?

Factors VIII and IX

Factors I and III

Factors V, VIII, and XII

Factors II, VII, and X (correct)

In which scenario is antibiotic prophylaxis NOT typically recommended?

Patients with implantable cardiac devices (correct)

Patients with prosthetic materials

Patients with dental procedures

Patients with a history of endocarditis

What device is used for measuring INR and allows self-monitoring?

CoaguChek Signup and view all the answers

What is the preferred reporting method for Prothrombin Time results?

International Normalized Ratio (INR) Signup and view all the answers

Which statement is correct regarding antibiotic prophylaxis before dental treatment?

It is not recommended for most patients Signup and view all the answers

How long before an invasive procedure must the INR test be taken?

48 hours or less Signup and view all the answers

Which valve is most commonly affected by infections?

Mitral valve Signup and view all the answers

What is the primary use of rFVIIa (NovoSeven RT) in patients with inhibitors?

To stop spontaneous bleeding and prevent excessive bleeding during surgeries Signup and view all the answers

What is the recommended IV dosage of Desmopressin (DDAVP) for a patient preparing for a procedure?

0.3 mcg in 100 mL saline infused over 30 minutes Signup and view all the answers

Why is a test dose of DDAVP administered before a procedure?

To verify adequate rise in F-VIII levels Signup and view all the answers

What should be the minimum time interval between the test dose of DDAVP and the surgical procedure?

1 week Signup and view all the answers

In patients with moderate to severe F-VIII deficiency without inhibitors, what is required before invasive dental procedures?

F-VIII replacement therapy Signup and view all the answers

What role does e-aminocaproic acid (EACA) play for patients with mild Hemophilia A?

It stabilizes blood clots when combined with DDAVP Signup and view all the answers

In patients with moderate to severe F-VIII deficiency with inhibitors, what is the suggested treatment before dental procedures?

rFVIIa (NovoSeven RT) before the procedure Signup and view all the answers

What is the typical peak effect timing for the nasal spray administration of Desmopressin (DDAVP)?

60-90 minutes after administration Signup and view all the answers

What is the primary clinical presentation of a ruptured cerebral vascular aneurysm?

Sudden severe headache Signup and view all the answers

Which treatment is NOT part of the medical management for unruptured cerebral vascular aneurysms?

Endovascular coiling Signup and view all the answers

What should be considered when performing dental procedures on patients using dual antiplatelet therapy?

Adjunctive local hemostatic methods are recommended. Signup and view all the answers

Which of the following conditions is NOT considered a high-risk factor for thromboembolic events?

Recent hip replacement surgery Signup and view all the answers

What is a common sign of a Transient Ischemic Attack (TIA)?

Complete recovery within 1-24 hours Signup and view all the answers

What is the impact of low-dose ASA combined with other antiplatelet drugs on bleeding during dental treatments?

Has no impact on the amount and duration of bleeding Signup and view all the answers

Which of the following is a first-line pharmacologic treatment for TIA?

Aspirin Signup and view all the answers

Which of these antiplatelet drugs is classified as a Protease-activated receptor-1 (PAR-1) antagonist?

Vorapaxar Signup and view all the answers

What should be avoided during dental treatment for patients with cerebral vascular conditions?

Prolonged appointments Signup and view all the answers

When treating a patient with chronic kidney disease, what additional precaution should be taken during dental procedures?

Use of adjunctive local hemostatic methods is advised. Signup and view all the answers

Which of the following factors influences the treatment of unruptured aneurysms?

Size Signup and view all the answers

Which symptom is associated with both a TIA and a stroke?

Ipsilateral monocular visual disturbances Signup and view all the answers

Which of the following is NOT a major category of cardiovascular drugs mentioned in the content?

Antidepressants Signup and view all the answers

For patients undergoing tooth extraction with recent stroke or TIA, what is the recommended approach?

Consider the patient's bleeding risk and implement local hemostatic methods. Signup and view all the answers

What is an important dental consideration for patients on anticoagulant therapy?

Assess bleeding risk Signup and view all the answers

Which class of patients should be classified under high-risk for thromboembolic events due to mechanical heart valves?

Patients with all mechanical mitral valves Signup and view all the answers

Which type of question typically provides the answer within its structure?

Suggestive questions Signup and view all the answers

What information is primarily included in the Biographic Information section of a patient’s medical history?

Patient's date and place of birth Signup and view all the answers

Which aspect does the Chief Complaint best represent in a patient's medical history?

A summarization of patient's reasons for seeking care Signup and view all the answers

What should be assessed in the Source and Reliability section of a patient's medical history?

The patient's reliability in providing accurate information Signup and view all the answers

Which question type does NOT lead the respondent toward a specific type of answer?

Direct questions Signup and view all the answers

What critical details should be included in the History of the Present Illness section?

Timeframes and factors related to the chief complaint Signup and view all the answers

Which type of question is considered problematic as it suggests the expected answer?

Leading questions Signup and view all the answers

What should the Pain Assessment section evaluate about a patient's experience?

Duration, location, intensity, and factors affecting the pain Signup and view all the answers

Study Notes

Question Types to Avoid

Suggestive Questions: Lead the respondent towards a specific answer.
Example of Suggestive: “Do you feel the pain in your left arm when you get it in your chest?”
Better Alternative: “When you get the pain in your chest, do you notice it anywhere else?”
Leading Questions: Imply the answer the interviewer is seeking.
Example of Leading: “You haven’t used any recreational drugs, have you?”
Better Alternative: “Do you use recreational drugs?”

Medical History Sections

Source and Reliability: Includes identifying information (age, gender) and reliability assessment of the source.
Biographic Information: Captures date/place of birth, sex, race, ethnic background, and gender identity.
Chief Complaint: Patient's own words summarizing the reason for seeking care.
History of Present Illness: Details recent health changes relating to the chief complaint (what, when, how, etc.).
Pain Assessment: Evaluates pain condition, including location, intensity, duration, and aggravating/alleviating factors.
General State of Health: Patient’s perception of health and recent physical exams.
Past Medical History: Summary of childhood/adult illnesses, significant conditions, and treatments.
Current Medications: List of medications currently being taken by the patient.
Allergies: Documented patient allergies.
Psychosocial History: Patient's social history impacting health.
Health Maintenance: Records preventive care received.
Occupational and Environmental History: Job history and relevant exposures.
Diet, Sleep Patterns, and Family History: Assessment of dietary habits, sleep quality, and medical history of relatives.

INR and Coagulation Tests

INR (International Normalized Ratio): Measures blood clotting speed; ranges indicate slow (high INR) or fast (low INR) clotting.
PT (Prothrombin Time): Commonly used to gauge the effectiveness of anticoagulant therapy like warfarin.
CoaguChek Device: Allows patients to self-monitor INR with minimal blood sample, providing quick results.
Prosthetic Patients: AB prophylaxis not routinely needed for patients with certain medical devices like cardiac pacemakers.

Antibiotic Prophylaxis Considerations

No Evidence of Benefit: AB prophylaxis is not recommended for most dental procedures in patients with specific cardiac devices.
Dentists and Prophylaxis Requests: Can decline unnecessary requests for AB if no medical rationale exists.

Hemophilia Management

rFVIIa (NovoSeven RT): Used primarily for patients with inhibitors; recommended dosage is 70-90 mcg/kg.
Desmopressin (DDAVP): Stimulates release of F-VIII, useful for mild Hemophilia A; available in IV and nasal spray form.
EACA/Tranexamic Acid: Can be used alongside DDAVP for stabilizing clots in mild Hemophilia A patients.
Management for Severe Deficiency: Requires F-VIII replacement or rFVIIa administration prior to dental procedures.

Bleeding Risk Assessment

NSAIDs and Dental Procedures: Generally safe for invasive work; dual antiplatelet therapy may increase bleeding risk.
Vorapaxar and Other Antiplatelet Drugs: Important considerations when assessing cardiovascular health.

Dental Treatment Guidelines

Hypertension: Understanding ASA classification is crucial for managing treatment risks relative to blood pressure.

Thromboembolic Event Risks

High-risk Factors: Identify recent DVT/PE, mechanical heart valves, high CHA₂DS₂VASc scores, and other specific conditions.

Cerebral Vascular Aneurysms

Clinical Presentation: Often asymptomatic; rupture leads to severe headache, neck stiffness, and altered consciousness.
Management Approaches: Surgical intervention or endovascular coiling for ruptured cases; medical management for unruptured cases aims to reduce rupture risk.
Dental Considerations: Evaluate bleeding risk in patients on anticoagulants and avoid excessive strain during treatment.

Stroke and TIA Management

Transient Ischemic Attack (TIA): Symptoms resolve within 24 hours; present with visual disturbances and motor/sensory dysfunction.
First-line Pharmacologic Treatment: Aspirin or clopidogrel for secondary prevention.
Surgical Intervention: Consideration for patients with carotid artery-related TIA.

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Description

This quiz highlights the types of questions that should be avoided, particularly in sensitive scenarios like medical inquiries. It contrasts suggestive questions with more neutral alternatives to emphasize the importance of unbiased questioning. Improve your questioning skills by identifying the right approach.