Upto what levels of systolic and diastolic blood pressures ambulatory oral surgical care can be safely given?

# Upto what levels of systolic and diastolic blood pressures ambulatory oral surgical care can be safely given?

A. Systolic 120 and diastolic 80 mm of Hg

B. Systolic 140 and diastolic 90 mm of Hg

C. Systolic 160 and diastolic 100 mm of Hg

D. Systolic 200 and diastolic 110 mm of Hg

The correct answer is D. Systolic 200 and diastolic 110 mm of Hg.

Mild or moderate hypertension  (i.e., systolic pressure <200 mm Hg or diastolic pressure <110 mm Hg) is usually not a problem in the performance of  ambulatory oral surgical care, as long as the patient is not having  signs or symptoms of end-organ involvement secondary to the elevated blood pressure. Care of the poorly controlled hypertensive patient includes use of an anxiety-reduction protocol and monitoring of vital signs. 

Epinephrine-containing local anesthetics should be used cautiously; after surgery, patients should be advised to seek medical care for their hypertension. Elective oral surgery for patients with severe hypertension (i.e., systolic pressure of ≥200 mm Hg or diastolic pressure of ≥110 mm Hg) should be postponed until the pressure is better controlled. Emergency oral surgery in severely hypertensive patients should be performed in a well-controlled environment or in the hospital so that the patient can be carefully monitored during surgery and acute blood pressure control can be subsequently arranged.

Ref: Contemporary Oral and Maxillofacial Surgery, 7th Edition, Hupp, Tucker, Ellis, Page 13

End organ damage in case of hypertensive patients could be any one of the following. Signs and symptoms for each of these should be evaluated prior to surgical care. 

 

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Most difficult to diagnose:

 # Which is most difficult to diagnose?

A. Necrosed pulp

B. Internal resorption

C. Chronic pulpitis

D. Acute apical abscess

The correct answer is C. Chronic pulpitis.

Both necrotic pulp and chronic pulpitis are difficult to diagnose and can show varied symptoms. 

Chronic pulpitis can be differentiated by its history of clinical symptoms. 

Chronic pulpitis under a crown restoration is most difficult to diagnose. 

This question is a direct pick from NBDE and the answer is Chronic Pulpitis. 

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Stunned pulp is:

 # Stunned pulp is:

A. Stunning appearance on radiograph

B. Does not respond to vitality tests 6-8 weeks after trauma

C. Necrosed pulp

D. Hyperaemic pulp

The correct answer is B. Does not respond to vitality tests 6-8 weeks after trauma.

Diagnosis of traumatized tooth:

- Diagnosis is made from the patient's history, visual examination, radiographs, electric pulp test, and the thermal test. Following fracture of the root, the reaction to tests of pulp vitality may be negative for as long as 6-8 weeks; that is, the pulp is stunned.

- A stunned tooth due to injury responds within 6 weeks. If it does not respond after that, pulp may be undergoing necrotic changes.

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Feature of chronic extravascular hemolysis

 # Which one of the following is a feature of chronic extravascular hemolysis? 

a. Raised serum conjugated bilirubin 

b. Low reticulocyte count 

c. Hypocellular bone marrow 

d. Gall stones

The correct answer is D. Gall stones.

Hemolytic anemia is a form of anemia due to hemolysis, the abnormal breakdown of red blood cells (RBCs), either in the blood vessels (intravascular hemolysis) or elsewhere in the human body (extravascular). This most commonly occurs within the spleen, but also can occur in the reticuloendothelial system or mechanically (prosthetic valve damage). Hemolytic anemia accounts for 5% of all existing anemias.  It has numerous possible consequences, ranging from general symptoms to life-threatening systemic effects. The general classification of hemolytic anemia is either intrinsic or extrinsic. Treatment depends on the type and cause of the hemolytic anemia.

Symptoms of hemolytic anemia are similar to other forms of anemia (fatigue and shortness of breath), but in addition, the breakdown of red cells leads to jaundice and increases the risk of particular long-term complications, such as gallstones and pulmonary hypertension. 

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Iron absorption will be increased in:

 # Iron absorption will be increased in: 

a. Pregnancy 

b. Chronic inflammation 

c. Iron overload 

d. Phosphates

The correct answer is A. Pregnancy.

Factors that increase iron absorption from GI tracts are:

• Dietary factors

• Increased heme iron (particularly in meat)

• Ferrous iron salts

• GI factors

         – Acid pH

• Increased requirement:

         – Iron deficiency

         – Increased erythropoiesis

         – Pregnancy

         – Hypoxia

Factors that decrease iron absorption are:

• Ferric iron salts

• Malabsorption

• Proximal bowel resection

• Presence of oxalates, phytates and phosphates in diet

• Inflammatory disorders (due to increased hepcidin level)

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First stage of iron deficiency:

 # Which is the first stage of iron deficiency? 

a. Negative iron balance 

b. Decreased iron stores 

c. Decrease MCV 

d. Decrease in Hemoglobin

The correct answer is A. Negative Iron Balance.

“Negative iron balance” describes a state in which body iron content is decreasing, secondary to relative decreases in iron intake and/or relative increases in iron losses. Over time, negative iron balance can progress to functional and absolute iron deficiency and anemia.

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Earliest recognizable change in RBC morphology:

 # Which of the following is earliest recognizable change in RBC morphology in case of iron deficiency? 

a. Hypochromia 

b. Anisocytosis 

c. Target cells 

d. Poikilocytosis

The correct answer is B. Anisocytosis. 

Anisocytosis is the medical term for having red blood cells (RBCs) that are unequal in size. Normally, a person’s RBCs should all be roughly the same size.

Anisocytosis is usually caused by another medical condition called anemia. It may also be caused other blood diseases or by certain drugs used to treat cancer. For this reason, the presence of anisocytosis is often helpful in diagnosing blood disorders like anemia.

Treatment for anisocytosis depends on the cause. The condition isn’t dangerous on its own, but it does indicate an underlying problem with the RBCs.

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