Questions based on emmergency medicine!! Answers needed

[pallavi rakesh]

I thought this would help out everyone also!!! Your inputs is highly appreciated.

thanks,
pallavi

1. Following administration of a local anesthetic agent, the patient displays irregular breathing, muscle rigidity, uncontrolled body movement and pallor. Blood pressure readings remain stable. The patient is most likely experiencing
1. cardiac arrest
2. hyperventilation
3. respiratory arrest
4. cerebral vascular accident


1. A rather sudden onset of sweating, nervousness, tremor and loss of consciousness in a diabetic patient suggests
1. diabetic coma
2. ketoacidosis
3. insulin shock
4. hyperglycemia
5. hypoinsulation

2. The most frequent cause of syncope is associated with local anesthesia is
1. hypotension
2. hypertension
3. hyperglycemia
4. hypoglycemia

3. Alleviating a patient's fears of dental treatment will aid in preventing each of the following EXCEPT
1. angina
2. heart attack
3. anaphylaxis
4. hyperventilation
5. epileptic seizure

4. During prophylaxis, a patient experiences sudden loss of breath, labored breathing, cold clammy skin and pain radiating to the left shoulder and arm. Which of the following is most likely?
1. A stroke
2. Coronary occlusion
3. Anaphylactic shock
4. Cerebral hemorrhage
5. Subacute bacterial endocarditis

5. A patient suddenly exhibits a blank gaze followed by spastic contractions of facial muscles. These symptoms most likely indicate the onset of
1. anaphylactic shock
2. epileptic seizure
3. Bell's palsy
4. Diabetic coma
5. Syncope

6. A patient who suffered a coronary thrombosis several years ago returns for a recall appointment. During root planing procedures, profuse hemorrhage fails to subside. This bleeding is most probably caused by which of the following medications?
1. Steroids
2. Vitamin k
3. Amyl nitrate
4. Dicumarol
5. Thiazides

7.During a dental procedure, the patient faints. Immediate treatment should be to
1. inject epinephrine intravenously
2. administer aromatic spirits of ammonia
3. lower the patient's head and elevate his legs
4. administer a CNS stimulant, such as caffeine, by subcutaneous injection

8. In an emergency situation, a patient is not breathing, but has a carotid pulse. Which of the following procedures should be performed?
(a) Check pulse frequently
(b) Give oxygen therapy initially
(c) Give cardiopulmonary resuscitation (CPR)
(d) Give mouth to mouth resuscitation

1. (a), (b) and (c)
2. (a) and (d)
3. (b) and (c) only
4. (d) only

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[KAJALKIRAN]

ok here are my answers to these questions....any disputes, battles are welcome, as am sure it will only benefit everyone out here.....
ps: there are actually 9 questions in all and ill stick to the numbers as given in the qstns..
1. respiratory arrest

1. insulin shock

2. hypotension

3. anaphylaxis

4. coronary occlusion

5. bell's palsy

6. dicumoral

7. lower the patient's head and elevate his legs

8. (a) and (d)

thanks rakesh, it was fun answering these qstns

 

[pallavi rakesh]

Kajal that was very quick, hope they are all correct, waiting to see if others have different opinions.

This site has answers for eveything, you guys rock.

thanks once more

take care
pallavi

 

[mib]

Hi,

I think K'Kiran has most of them right except #5 which I think is epileptic seizure, to be specific, petite mal seizure and I am not too sure about #1.
Do let me know if I am wrong.
Good questions, pallavi.

 

[dentaldoc]

I agree with kajal for the answers are these part 2 questions?

Now I really feel the interaction between the forum members that's the spirit guys! keep it up. thanks to pallavi

 

[KAJALKIRAN]

hey guys thanx! taht is inspiring..especially since my exam is fast approaching...
well i may be wrong in 1 0r 2 (hope not!! ) but mibs ..am pretty sure of answer 5 ...it is bell's palsy;
remember bell's sign? and the spastic contractions of facial muscles? well petit mal epilepsy is a seizure like condition seen generally seen in people below 16 years of age and NOT NECESSARILY have the facial spasms..while in contrast, the bell's palsy has this eye sign as a remarkable and characteristic sign......

 

[pallavi rakesh]

I will go with kiran for the 5th question. My only uncertanity is with the 1st one.

I wish others also have some thing to share. Let the questions roll... such interaction with make us remmember things better.

thanks
pallavi

 

[elementz]

I back Kajal's answers to the questions too.Good for you Kajal.
Answering questions like this is interesting and lots of fun. Posts like this sure help give our brain cells the needed oiling! we should have more such posts.
All the best to all of you taking up part-2 soon.

 

[toothlord]

Originally posted by pallavi rakesh
I thought this would help out everyone also!!! Your inputs is highly appreciated.

thanks,
pallavi

1. Following administration of a local anesthetic agent, the patient displays irregular breathing, muscle rigidity, uncontrolled body movement and pallor. Blood pressure readings remain stable. The patient is most likely experiencing
1. cardiac arrest
2. hyperventilation
3. respiratory arrest
4. cerebral vascular accident


1. A rather sudden onset of sweating, nervousness, tremor and loss of consciousness in a diabetic patient suggests
1. diabetic coma
2. ketoacidosis
3. insulin shock
4. hyperglycemia
5. hypoinsulation

2. The most frequent cause of syncope is associated with local anesthesia is
1. hypotension
2. hypertension
3. hyperglycemia
4. hypoglycemia

3. Alleviating a patient's fears of dental treatment will aid in preventing each of the following EXCEPT
1. angina
2. heart attack
3. anaphylaxis
4. hyperventilation
5. epileptic seizure

4. During prophylaxis, a patient experiences sudden loss of breath, labored breathing, cold clammy skin and pain radiating to the left shoulder and arm. Which of the following is most likely?
1. A stroke
2. Coronary occlusion
3. Anaphylactic shock
4. Cerebral hemorrhage
5. Subacute bacterial endocarditis

5. A patient suddenly exhibits a blank gaze followed by spastic contractions of facial muscles. These symptoms most likely indicate the onset of
1. anaphylactic shock
2. epileptic seizure
3. Bell's palsy
4. Diabetic coma
5. Syncope

6. A patient who suffered a coronary thrombosis several years ago returns for a recall appointment. During root planing procedures, profuse hemorrhage fails to subside. This bleeding is most probably caused by which of the following medications?
1. Steroids
2. Vitamin k
3. Amyl nitrate
4. Dicumarol
5. Thiazides

7.During a dental procedure, the patient faints. Immediate treatment should be to
1. inject epinephrine intravenously
2. administer aromatic spirits of ammonia
3. lower the patient's head and elevate his legs
4. administer a CNS stimulant, such as caffeine, by subcutaneous injection

8. In an emergency situation, a patient is not breathing, but has a carotid pulse. Which of the following procedures should be performed?
(a) Check pulse frequently
(b) Give oxygen therapy initially
(c) Give cardiopulmonary resuscitation (CPR)
(d) Give mouth to mouth resuscitation

1. (a), (b) and (c)
2. (a) and (d)
3. (b) and (c) only
4. (d) only

1.2
1.3
2.1
3.3
4.2
5.5
6.4
7.3
8.2

iam not sure about number 4 and 5

 

[pinktooth]

Hi Folks,
I agree with Kajal's answers mostly except:
Fifth question.
I think the answer is Epilepsy.In Bells palsy the eyelids do not close on one side(mostly) and thus they do not give a blank gaze.
I think you should just check it out again.

 

[pinktooth]

Hi Folks,
I did some research and found 'Blank expression' written clearly againg petit mal epilepsy

Symptoms of Petit mal seizures
List of symptoms of Petit mal seizures: The list of symptoms mentioned in various sources for Petit mal seizures includes:

Onset of petit mal seizures:
Brief loss of response
Temporary lack of awareness
Blank expression
Apparent "spacing out"
Muscle movements
Facial expression changes
Duration of petit mal seizures usually brief
Recovery after petit mal seizure:
Resumes previous activity without impairment
No apparent awareness of the episode

 

[pinktooth]

And I think the answer for question number one is hyperventilation

 

[smiledentist]

Great work guys!!

this is certainly helping all those in the process of part 2 at any stage of prep!!

smiledentist

 

[KAJALKIRAN]

thanks pinktooth for answer number 5.....i was so much into think of only craniofacial neuro lesions....this is real good piece of knowledge to me.....
coming to qstn no.1 , i thought of hyperventilation too, but remember hyperventilation is accompanied by hypotension and the question specificaly states that the BP remains stable, which generally occcurs in resp arrest, and also resp arrest can be one of the adverse affects of LA.
correct me if this is not true.....

 

[DentalSupremo]

Pinktooth is correct. Also, the keyword for answering question #5 is "suddenly"

 

[nondentist]

1st question: Hyperventilation. Symptoms described are typical for hyperventilation.
Systemic side effects of local anaesthetic can be due to excitation of the CNS or Vasodilation and cardiac suppression.
(bradycardia, heart block, and possibly cardiac arrest. Hypotension). Symptoms described in the question are supporting the CNS excitation which causes hyperventilation ,rather than cardiac depression.
Kajal: hyperventilation causes the vasodilatation mainly of the cranial vessels. Thats the reason treatment of cerebral edema and acute brain herniation is hyperventilation. It usually doesn?t cause systemic hypotension.

Qustion 5: epileptic seizure. You can?t think about bells palsy here. Bells palsy is paralysis of facial muscles not contraction of the muscles.

 

[shilpi]

in question 8 why checking pulse frequently and giving oxygen not correct answers(even if initially)

 

[dentaldoc]

Originally posted by shilpi
in question 8 why checking pulse frequently and giving oxygen not correct answers(even if initially)

I guess oxygen administration can be done if mouth to mouth.... is not helping..is that true?

 

[organic]

question 8 is one of those strange questions in part 2 that I don't think is clear enough


8. In an emergency situation, a patient is not breathing, but has a carotid pulse. Which of the following procedures should be performed?
(a) Check pulse frequently
(b) Give oxygen therapy initially
(c) Give cardiopulmonary resuscitation (CPR)
(d) Give mouth to mouth resuscitation

1. (a), (b) and (c)
2. (a) and (d)
3. (b) and (c) only
4. (d) only

first follow the ABC protocol,
A- airway, check patient if he/she has any foreign object in the mouth/throat. Any obstruction.
B- Breathing-- checking breathing sound -- NO breathing
C- circulation-- carotid pulse for adult-- with a pulse

ONLY rescuing breathing is necessary

with mask or mouth ot mouth, one breath every 5 seconds ( 12 times per minute)
check pulse from time to time to maintain C valid

I think (b) is wrong only because it is mentioned that O2 is needed"initially" -- incorrect

you can't give too much oxygen to someone who is not breathing!

a pressurized oxygen tank hooked to mask is even better.

If you are a single rescuer, you'd find that using a mask with short fingers and small hands like mine is VERY difficult. Mouth- to - mouth is easier in the case

(c) actually implies to the compression portion of CPR, not including breathing

 

[toothlord]

for the 1st qustion usually carbopedal spasm or convultions accompanied hyperventilation not respiratory arrest.
for the 5th qustion its so vague and there isent enough information therefore everyone has different interpretations,syncopre which is my answer is accompanied by convultions and cerebral hypoxia which may lead to mydriasis which =blank gaze.
regarding the 5th question i think giving oxygen is a propable choice though not included.
nice to hear from you dental supremo its been a long time.

 

[pinktooth]

Hi toothlord,
during syncope there might be mydriasis but the eyelids are CLOSED..personal experience too!!

 

[pinktooth]

Originally posted by KAJALKIRAN
thanks pinktooth for answer number 5.....i was so much into think of only craniofacial neuro lesions....this is real good piece of knowledge to me.....
coming to qstn no.1 , i thought of hyperventilation too, but remember hyperventilation is accompanied by hypotension and the question specificaly states that the BP remains stable, which generally occcurs in resp arrest, and also resp arrest can be one of the adverse affects of LA.
correct me if this is not true.....

Hi Kajal,
In questions and cases of complications( of anaesthesia or extraction) you should always rule out the commoner ones first.
Hyperventilation is a commoner reaction than respiratory arrest.
I would like to back my answer with nondentists explaination.

 

[pinktooth]

Hey nice thread..someone please post more questions

 

[toothmail]

i agree with pinktooth. the answer to q. 5 is epilepsy specifically petit mal which is characterized by a blank stare and brief loss of consciousness or cessation of activity. these seizures are also termed absence seizures.

this must be differentiated from syncope where the eyes remain closed although on opening the eyes to examine there might be mydriasis.