HIV Testing and Thyroid Disorders
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Questions and Answers

What is the primary purpose of the enzyme-linked immunosorbent assay (ELISA) in HIV testing?

  • Detect a general antibody response to HIV (correct)
  • Detect specific HIV proteins
  • Indicate the stage of HIV infection
  • Detect the presence of HIV mRNA

    • What is the recommended steroid dosage for a patient currently on steroids who is expected to experience post-op pain?

  • Double the daily dose on the day of the procedure and the next day (correct)
  • No steroids administered at all
  • Regular dose on day of procedure only
  • Half the normal dose on the day of the procedure

    • What indicates that a patient is considered HIV positive based on testing?

  • One positive PCR and one positive Western blot
  • One positive ELISA and one positive Western blot
  • Only positive PCR results
  • Two positive ELISA and one consecutive Western blot (correct)

    • Which hormone does the thyroid gland NOT produce?

    <p>Insulin</p> Signup and view all the answers

    What CD4 count is considered normal for adults?

    <p>600 cells/mm3 or higher</p> Signup and view all the answers

    What condition is characterized by a deficiency of thyroid hormones leading to physical and mental development issues in infants?

    <p>Cretinism</p> Signup and view all the answers

    What does a CD4:CD8 ratio that is low indicate?

    <p>Immune suppression</p> Signup and view all the answers

    What should be done if a patient has stopped regular steroid usage for more than two weeks before a surgical procedure?

    <p>No steroid supplementation is needed</p> Signup and view all the answers

    Which statement is true regarding the p24 antigen and antibodies in HIV testing?

    <p>p24 antigen indicates active viral replication</p> Signup and view all the answers

    What is a potential consequence of a heart transplant recipient being on immunosuppressive drugs?

    <p>Increased susceptibility to infections</p> Signup and view all the answers

    What triggers the production of T3 and T4 in the thyroid gland?

    <p>Release of TSH from the anterior pituitary</p> Signup and view all the answers

    Which of the following is a sign of congestive heart failure?

    <p>Elevated veins</p> Signup and view all the answers

    What should be done if a patient has an artificial graft placed less than 6 months prior to an invasive dental procedure?

    <p>Prophylactic antibiotic coverage is recommended</p> Signup and view all the answers

    Which condition is associated with hypertension in terms of complications?

    <p>Renal failure and myocardial infarction</p> Signup and view all the answers

    What is a side effect of antihypertensive drugs that affects oral health?

    <p>Gingival hyperplasia</p> Signup and view all the answers

    Which of the following factors would increase the risk of congenital heart disease?

    <p>Gross obesity</p> Signup and view all the answers

    Which symptom is specifically linked with left-sided heart failure?

    <p>Paroxysmal nocturnal dyspnea</p> Signup and view all the answers

    Which lifestyle factor increases the risk for coronary heart disease (CHD)?

    <p>Nicotine use</p> Signup and view all the answers

    What percentage of diabetics seen by dental healthcare workers are typically Type 2?

    <p>90%</p> Signup and view all the answers

    Which type of diabetes is characterized by requiring insulin for management?

    <p>Type 1</p> Signup and view all the answers

    Which of the following complications is most serious and associated with diabetes?

    <p>Ketoacidosis</p> Signup and view all the answers

    Which symptom is commonly associated with both Type 1 and Type 2 diabetes?

    <p>Increased thirst</p> Signup and view all the answers

    What is the typical age of onset for Type 1 diabetes?

    <p>15 years</p> Signup and view all the answers

    What is the primary treatment for managing hyperglycemia in diabetics?

    <p>Administer insulin</p> Signup and view all the answers

    Which of the following is a common oral finding in poorly controlled diabetes?

    <p>Increased gingivitis</p> Signup and view all the answers

    In cases of hypoglycemia, what is a recommended immediate action if the patient is conscious?

    <p>Give oral glucose</p> Signup and view all the answers

    What factor influences the likelihood of developing complications such as nephropathy in diabetes?

    <p>Control of blood glucose levels</p> Signup and view all the answers

    Which insulin type has an onset time of 1/4 hour?

    <p>Regular</p> Signup and view all the answers

    What is the primary reason dental offices are prohibited from refusing treatment based on a patient's HIV status?

    <p>To comply with the Disabilities Act</p> Signup and view all the answers

    Which of the following statements correctly describes the principles regarding patient referrals for dental care?

    <p>Patient referrals should not consider HIV status</p> Signup and view all the answers

    What should be acquired before releasing any HIV-related information from dental records?

    <p>A written release from the patient</p> Signup and view all the answers

    What is the median incubation period for HIV infection before signs of AIDS appear?

    <p>10 years</p> Signup and view all the answers

    Which of the following correctly states a mode of transmission for HIV among adults?

    <p>Heterosexual and homosexual intercourse</p> Signup and view all the answers

    Which of the following conditions is specifically associated with HIV infection?

    <p>Major opportunistic infections</p> Signup and view all the answers

    As of the end of 2002, which Caribbean country had the highest estimated number of individuals living with HIV?

    <p>Haiti</p> Signup and view all the answers

    Which of the following represents the main concern for dental healthcare workers regarding current diseases?

    <p>Multiple drug-resistant tuberculosis</p> Signup and view all the answers

    Which of the following is a common precipitating factor for seizures?

    <p>Skipping meals</p> Signup and view all the answers

    What does a negative EEG indicate in the context of seizures?

    <p>Seizures may still be present</p> Signup and view all the answers

    Which medication is commonly associated with gingival hyperplasia as a side effect?

    <p>Phenytoin</p> Signup and view all the answers

    In which condition is ptosis a common early sign?

    <p>Myasthenia Gravis</p> Signup and view all the answers

    What is the recommended positioning for a patient experiencing uncontrolled seizure activity?

    <p>On their side to minimize aspiration</p> Signup and view all the answers

    Which of the following medications is considered an anticholinergic used for drooling control?

    <p>Cogentin</p> Signup and view all the answers

    What critical step should be taken if a patient exhibits multiple seizures lasting 30 minutes?

    <p>Provide slow IV or IM Diazepam</p> Signup and view all the answers

    What is a common reason for xerostomia in individuals taking antidepressants?

    <p>Anti-cholinergic effects</p> Signup and view all the answers

    What should be avoided when treating patients with CNS depression during dental care?

    <p>Sedatives</p> Signup and view all the answers

    What type of tremors do patients with Parkinson’s Disease typically experience?

    <p>Tremors at rest</p> Signup and view all the answers

    What is the primary characteristic of Multiple Sclerosis?

    <p>De-myelinated plaques in the CNS</p> Signup and view all the answers

    Which type of depression is characterized by a lack of personal hygiene and withdrawal?

    <p>Major depression</p> Signup and view all the answers

    What is a common concern during dental treatment for patients with Myasthenia Gravis?

    <p>Respiratory depression</p> Signup and view all the answers

    Which heart condition does NOT require antibiotic prophylaxis for infective endocarditis?

    <p>Atrial septal defect</p> Signup and view all the answers

    What is a common early clinical presentation of infective endocarditis?

    <p>Fever</p> Signup and view all the answers

    Which systemic manifestation is associated with infective endocarditis?

    <p>Roth's spots</p> Signup and view all the answers

    Which laboratory finding is NOT used in the diagnosis of infective endocarditis?

    <p>Elevated creatinine levels</p> Signup and view all the answers

    What treatment regimen is typically used for infective endocarditis?

    <p>Penicillin and streptomycin</p> Signup and view all the answers

    Which patient group listed does require antibiotic prophylaxis for certain procedures?

    <p>Patients with a prosthetic heart valve</p> Signup and view all the answers

    What describes Osler's nodes commonly seen in infective endocarditis?

    <p>Tender pink-red painful lumps in finger and toe pads</p> Signup and view all the answers

    What is the reported fatality rate for untreated infective endocarditis?

    <p>20-70%</p> Signup and view all the answers

    Which heart condition requires antibiotic prophylaxis due to an increased risk of bacteremia?

    <p>Ventricular septal defect</p> Signup and view all the answers

    What management consideration should be taken for a patient with prosthetic valve disease before an invasive dental procedure?

    <p>Withdraw anticoagulants for 2 days prior</p> Signup and view all the answers

    Which of the following is NOT a recommended strategy to manage a patient with angina pectoris during dental treatment?

    <p>Routine elective dental care</p> Signup and view all the answers

    What condition is suggested by the presence of a murmur related to a patent ductus arteriosus?

    <p>Another type of congenital heart disease</p> Signup and view all the answers

    Which cardiac condition implies the presence of advanced arteriosclerosis and may require medication before dental procedures?

    <p>Angina pectoris</p> Signup and view all the answers

    For patients with Marfan syndrome, which cardiac risk should be closely monitored?

    <p>Aortic aneurysm rupture</p> Signup and view all the answers

    What is a critical step that dental healthcare workers must take for patients on anticoagulant therapy?

    <p>Withdraw anticoagulants before invasive procedures</p> Signup and view all the answers

    What should dental healthcare workers be particularly cautious about in patients with a history of infective endocarditis?

    <p>Antibiotic prophylaxis is necessary when treating them</p> Signup and view all the answers

    What is the implication of a CD4 count below 200 cells/mm3 in an adult?

    <p>Increased risk of opportunistic infections</p> Signup and view all the answers

    What is the primary role of the Western blot test in HIV testing?

    <p>Identifies specific antibodies against HIV proteins</p> Signup and view all the answers

    Which statement is true regarding pre- and post-test counseling in HIV testing procedures?

    <p>It is mandatory for all patients undergoing testing.</p> Signup and view all the answers

    What does a low CD4:CD8 ratio signify in a patient's immune profile?

    <p>Immune suppression</p> Signup and view all the answers

    In what situation can involuntary testing of a patient’s blood for HIV occur?

    <p>If court ordered due to specific circumstances</p> Signup and view all the answers

    What is the primary method for managing Type 2 diabetes?

    <p>Diet, exercise, and oral hypoglycemic medications</p> Signup and view all the answers

    At what age is Type 1 diabetes most commonly diagnosed?

    <p>Teenage years</p> Signup and view all the answers

    Which diabetes-related complication is the most serious?

    <p>Ketoacidosis</p> Signup and view all the answers

    What symptom is least commonly associated with diabetes?

    <p>Silvery skin</p> Signup and view all the answers

    Which type of diabetes generally requires insulin for management?

    <p>Type 1</p> Signup and view all the answers

    What means of evaluating a diabetic patient is most helpful in determining their management and compliance?

    <p>History of emergency room visits for diabetes-related issues</p> Signup and view all the answers

    Which complication is most strongly associated with an increased need for dialysis in diabetic patients?

    <p>Nephropathy</p> Signup and view all the answers

    What is the characteristic breath odor associated with hyperglycemia?

    <p>Acetone</p> Signup and view all the answers

    What type of oral finding is commonly seen in poorly controlled diabetes patients?

    <p>Increased cavities and gingivitis</p> Signup and view all the answers

    What is the best initial action for a conscious patient experiencing hypoglycemia?

    <p>Provide oral glucose</p> Signup and view all the answers

    What is necessary to prevent airway obstruction during dental procedures for patients with hemophilia?

    <p>Factor V111 must be replaced before local anesthesia</p> Signup and view all the answers

    What oral manifestation is commonly seen in patients with polycythemia vera?

    <p>Petechia on the mucosa</p> Signup and view all the answers

    Which platelet disorder is indicated by a platelet count of less than 25,000 mm3?

    <p>Thromboctopenia with spontaneous hemorrhage</p> Signup and view all the answers

    Which condition is considered a cause of thrombocytopenia?

    <p>Cancer chemotherapy</p> Signup and view all the answers

    What is the appropriate management for a patient with thrombocytopenia before invasive procedures?

    <p>Platelet transfusion if count is below 50,000 mm3</p> Signup and view all the answers

    Which test primarily assesses the intrinsic pathway of coagulation?

    <p>Activated Partial Thromboplastin Time (APTT)</p> Signup and view all the answers

    What is a clinical sign of status asthmaticus?

    <p>Prolonged wheezing with decreased oxygenation</p> Signup and view all the answers

    What is the typical treatment approach during a severe asthmatic attack?

    <p>Deliver oxygen and use inhalation sympathomimetics</p> Signup and view all the answers

    Which finding is associated with significant risk status in asthma patients during dental appointments?

    <p>Symptomatic state at time of dental appointment</p> Signup and view all the answers

    What is an essential preemptive strategy to prevent asthma attacks in a clinical setting?

    <p>Ensure good rapport and minimize stress</p> Signup and view all the answers

    What oral finding may indicate early signs of thrombocytopenia?

    <p>Purplish-red mucosa</p> Signup and view all the answers

    Which medication is likely to affect platelet function and needs to be reported during medical history screening?

    <p>NSAIDs like Aspirin</p> Signup and view all the answers

    In a patient with a recent prescription of radioactive phosphorus, which test is especially important before dental treatments?

    <p>Complete blood count</p> Signup and view all the answers

    What is a notable challenge in managing bleeding disorders during dental treatment?

    <p>Patients are commonly unaware of their condition</p> Signup and view all the answers

    What is a common oral manifestation of severe hypothyroidism due to hypo-pituitarism?

    <p>Delayed eruption</p> Signup and view all the answers

    Which symptom is characteristic of acromegaly in adults?

    <p>Prognathism</p> Signup and view all the answers

    What oral manifestation is associated with primary systemic amyloidosis?

    <p>Hemorrhagic bullae on tongue</p> Signup and view all the answers

    Which condition is characterized by an enzyme deficiency leading to yellow pigmentation of skin and oral manifestations?

    <p>Gaucher Disease</p> Signup and view all the answers

    What is the primary enzyme deficiency associated with Morquio syndrome?

    <p>Galactosamine-6-sulphatase</p> Signup and view all the answers

    Which oral manifestation is commonly seen in children suffering from protein malnutrition, such as Kwashiorkor?

    <p>Angular cheilitis</p> Signup and view all the answers

    In cases of vitamin A deficiency, which oral manifestation is typically noted?

    <p>Increased keratinization of oral mucosa</p> Signup and view all the answers

    Which condition is represented by 'foam-cells in dental pulp' as an oral manifestation?

    <p>Niemann-Pick Disease</p> Signup and view all the answers

    What dental feature is commonly associated with Morquio syndrome?

    <p>Marked enamel hypoplasia</p> Signup and view all the answers

    What oral finding is associated with systemic amyloidosis affecting the salivary glands?

    <p>Altered taste and smell</p> Signup and view all the answers

    Study Notes

    Essentials of Medicine for Dentistry

    • Presented by Dr. Doryck L. Boyd, DDS, Oral & Maxillofacial Pathologist, Associate Professor
    • Focuses on cardiovascular diseases and their management in dental practice.

    Cardiovascular Disease

    • Dental patients may present with a confirmed history of cardiovascular disease (CVD) or signs/symptoms of CVD.
    • Cardiac emergencies can arise during dental procedures.
    • Dental Health Care Workers (DHCWs) must be prepared to manage these situations.

    General Critical Management Guidelines

    • Increased morbidity & mortality is a concern with undiagnosed CVD.
    • Closely observe patients for signs/symptoms of CVD.
    • Be aware of medication duration, dose, and potential side effects & interactions.
    • Maintain close communication with the patient's physician.
    • Prevent infection.
    • Schedule early morning appointments to minimize stress.
    • Lower stress leads to lower blood pressure.
    • Safe levels of local anesthetic (LA) + epinephrine must be used.
    • Aspirate to prevent injecting LA into blood vessels

    Known Cardiac Patients

    • Congenital heart defects like ventricular septal defect, idiopathic hypertrophic subaortic stenosis, bicuspid aortic valve complex HD (outflow), patent ductus arteriosus murmur, pulmonary stenosis, tetralogy of Fallot (outflow obstruction → decreased oxygen), Marfan syndrome, and cortication of aorta.
    • Increased risk of bacteremia → endocarditis.
    • Antibiotic prophylaxis is required.
    • Marfan's syndrome: Congestive heart failure, aortic aneurysm rupture → death; in 2/3 of cases.
    • Turner's syndrome (in women): Aortic complications.
    • Tetralogy of Fallot: Usually corrected before dental treatment.

    Acquired Cardiac Disease

    • Mitral valve prolapse
    • Degenerative heart disease
    • Rheumatic valvular disease
    • Asymmetric septal hypertrophy
    • Syphilitic aortic valve disease
    • Endocarditis
    • Medical referral for current status
    • Antibiotic prophylaxis for a history of infective endocarditis only.

    Prosthetic Valve Disease

    • Very high risk for infective carditis
    • Anticoagulant therapy requires special precautions if invasive procedures are performed → bleeding
    • Contact your physician; withdraw anticoagulant for 2 days prior to treatment.

    Angina Pectoris

    • Implies advanced arteriosclerosis.
    • Premedicate with anti-anginal or sedative medications prior to stressful procedures.
    • Hypotension after general anesthesia → myocardial infarction.
    • Routine dental care for stable cases in recent months.
    • Avoid elective care with unstable angina.
    • Caution with dose of LA + epinephrine and aspirate while injecting.
    • Schedule short morning appointments.
    • Minimize stress.
    • Monitor blood pressure & heart rate.
    • Immediate medical attention should be available.

    Recent MI (within 6 Months)

    • Implies advanced arteriosclerosis.
    • Written consultation with physician is recommended.
    • Stress → re-infarction.
    • Anticoagulant or aspirin may be required.
    • Require recovery period → elective dentistry (3–6 months).
    • Minimum LA + epinephrine.
    • Schedule short, stress-less morning appointments.
    • Monitor vital signs.
    • Medical help nearby.

    MI over 6 Months & Endocarditis

    • Written consultation with physician is advisable.
    • Stress → re-infarction.
    • Anticoagulant or aspirin therapy may be required.
    • Elective dental treatment with limited epinephrine.
    • Ensure good pain control → less stress
    • IV drug abusers have a high risk of recurrent endocarditis.

    Arrhythmias (Abnormal Heart Beat/Rate)

    • Most patients need no change in routine dental care.
    • Effective anxiety control may be required; especially in advanced cases.
    • Advanced cases → CVA (e.g., blindness, irregular speech, decreased limb sensitivity, hemiplegia)
    • Stress or hypoxia (e.g., gauze, rubber dam) → increased arrhythmia.
    • Limit epinephrine
    • Monitor potassium levels if on diuretics.

    Pacemaker & Congested Heart Failure

    • Pacemaker: May imply a history of bradycardia (slow heart beat); Avoid external electromagnetic devices (electro-surgical units are the highest risk).
    • Congested heart failure: Implies advanced heart disease, HBP, CHD, myopathy, valvular disease → high risk of mortality; May result in excessive metabolic demand.

    Congested Heart Disease

    • Medications and side effects can complicate dental treatment (e.g., diuretics & digitalis → nausea + vomiting).
    • Avoid triggering gag reflex.
    • Reduce stress. Stress increases workload on the heart.
    • Treat the patient in a reclining chair position. Prone position to pulmonary congestion if retained in supine position for too long.

    Heart Transplant Recipient

    • Dental infections should be treated before a transplant.
    • A medical consultation is a must.
    • Patients may be on immunosuppressive drugs for life → increased susceptibility to infections.
    • Cyclosporine → gingival hyperplasia
    • Drug-induced xerostomia → increased caries + PDD & candidiasis.

    Other Heart Defects

    • Arterio-arterial or arterio-venous fistula → endocarditis
    • Streptococccus viridans pericarditis may follow invasive dental treatment
    • Artificial grafts with prosthetic material can be a site for hematogenous implantation of bacteria post invasive dental treatment. Prophylactic coverage if graft placed less than 6 months.

    Hypertension

    • Accelerates atherosclerosis → CHF + CVA
    • Cardiovascular complications increase with age if BP is high.
    • Renal failure & MI possible
    • Minimal use of epinephrine
    • Side effects of anti-hypertensive drug → postural hypotension, confusion, depression, xerostomia, loss of libido, angioedema, gingival enlargement.
    • Compliance with medications is often a problem.
    • Elective dental Rx deferred if BP not controlled.
    • Classification of blood pressure (in adults over 18 years). The table with the categories and their ranges are included below. Note: The table of ranges is not included in the current dataset.

    Cardiac Disease Signs & Considerations

    • Gross obesity → risk for Coronary Heart Disease (CHD).
    • Nicotine/alcohol → risk for CHD
    • Xanthelasma → Hypercholesterolemia → CHD
    • Elevated veins → Congested Heart Failure
    • Clubbed fingers → congenital heart disease → CHD
    • Nail cyanosis → CHD
    • Swollen ankles → Right side Heart Failure
    • Heart Murmur → Valvular disease, Hypertention, Congested Heart Disease (CHD), Atrial fibrillation.
    • Abnormal BP → Hypertention, Congested Heart Failure
    • Irregular pulse → atrial fibrillation.
    • Chest tightness, Pain → Myocardial ischemia, Left side HF, Congested Heart Failure
    • Dyspnea, SOB → Left side HF, Congested Heart Failure, CHD
    • Orthopnea, SOB recumbent → LSHF, CHD
    • Paroxysmal nocturnal dyspnea → LSHF, CHD
    • Severe cramping, claudication → Atherosclerosis
    • Xerostomia → Side effects of antihypertensive medications
    • Orthostatic hypotension → side effects of antihypertensive medications
    • Impotence → side effects of antihypertensive medications
    • Depression → side effects of antihypertensive medications
    • Headache
    • Visual blurring → dizziness, lightheadedness

    Emergency Cardiac Patient

    • Familiarity of classical signs & symptoms of cardiac distress, and appropriate management is essential.
    • Treatment of emergencies not within the scope of a Dental Health Care Worker (DHCW).
    • Angina pectoris: Definition is a clinical term referring to brief paroxysmal thoracic pain and moderate intensity. The pain comes from ischemic heart disease.

    Angina Pectoris (cont)

    • Etiology: Coronary arteriosclerosis or more than 1 major coronary artery → transient myocardial oxygen demand > available oxygen supply.
    • Clinical presentation: Effort or stress related substernal pressure, tightness or discomfort may radiate to the left shoulder, medial surface arm, jaw, throat, or neck.

    Angina Pectoris (Emergency Treatment)

    • Stop dental Rx, confirm the diagnosis, and eliminate precipitating factors.
    • Calmly reassure and make the patient comfortable.
    • Admin vasodilator (nitroglycerine 0.4 mg tabs sublingual). Repeat every 5 minutes up to 3 times (prn).
    • Administer oxygen (2–4 liters/minute).
    • Record vital signs
    • If attack continues, call for help, start IV, and summon medical assistance to transport the patient to the ER.

    Myocardial Infarction (MI)

    • Definition: Irreversible myocardial damage resulting from prolonged ischemic injury.
    • Etiology: Coronary artery atherosclerosis & thrombolytic vascular occlusion.
    • Clinical Presentation: Severe prolonged substernal or chest pain radiating to either arm or mandible. Nausea, vomiting, sense of impending doom. Denial, insistence upon gastric distress.

    Myocardial Infarction (Emergency Treatment)

    • Reaffirm diagnosis.
    • Summon medical assistance (926-5721)
    • Administer nitroglycerin 0.4 mg sublingually
    • Administer crushed aspirin (325 mg) if not allergic.
    • Administer oxygen (2–4 liters/minute low).
    • Start IV, administer analgesic (morphine 250 mg) and repeat as necessary (prnq 10 minutes).
    • Monitor and record vital signs.
    • Prepare to start CPR.

    Cardiac Arrest

    • Definition: Sudden cessation of cardiac function with disappearance of arterial BP, indicating ventricular fibrillation, tachycardia or ventricular standstill.
    • Etiology: Myopathy or advanced atherosclerosis; coronary artery disease.
    • Clinical Presentation: Mostly respiratory arrest precedes cardiac arrest. No pulse, BP, or heart beat; seizures are common.

    Cardiac Arrest (Emergency Treatment)

    • BLS (Basic Life Support).
    • Recognize unconsciousness & confirm diagnosis.
    • Summon medical assistance & initiate CPR with patient on a flat surface
    • Open airway, check for breathing.
    • Ventilate with 2 long breaths (1–1.5 seconds each).
    • Check carotid pulse (lateral neck) and initiate external chest compressions (5:1 or 15:2).
    • Arrange for defibrillation ASAP.
    • Start IV, transport to ER.

    ... (Remainder of the notes remain the same)

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    This quiz covers key concepts related to HIV testing using ELISA and aspects of thyroid function. It includes questions about HIV positivity indicators, steroid usage, and hormone production. Additionally, it addresses conditions related to hormonal imbalances and their implications.

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