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Case #1 (Questions 1-15)
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B
Your patient has had a Transient Ischemic Attack (TIA) 8 months ago. What is a TIA?
A transient ischemic attack (TIA) happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage. Some people call a TIA a mini-stroke, because the symptoms are those of a stroke but don’t last long.
A TIA is a warning: it means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 or other emergency services right away. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.
Symptoms of a TIA are the same as symptoms of a stroke. But symptoms of a TIA don’t last very long. Most of the time, they go away in 10 to 20 minutes. They may include:
• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. The clot can block blood flow to part of the brain. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. After the clot dissolves, blood flow returns, and the symptoms go away.
Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a “low-flow” TIA. It is not as common as other types.
Your doctor will do tests to look at your heart and blood vessels. You may need:
Tests that show pictures of your brain and blood vessels, such as a CT scan, an MRI, a magnetic resonance angiogram (MRA), or an angiogram.
A test that uses sound to check your blood flow (Doppler ultrasound).
An echocardiogram (echo) to check your heart’s shape and its blood flow.
An electrocardiogram (EKG, ECG) to measure your heart rhythm.
Blood tests, including a complete blood count and a fasting blood test to check for problems that could be causing your symptoms.
Your doctor will also check to see if something else caused your symptoms.
A transient ischemic attack (TIA) happens when blood flow to part of the brain is blocked or reduced, often by a blood clot. After a short time, blood flows again and the symptoms go away. With a stroke, the blood flow stays blocked, and the brain has permanent damage. Some people call a TIA a mini-stroke, because the symptoms are those of a stroke but don’t last long.
A TIA is a warning: it means you are likely to have a stroke in the future. If you think you are having a TIA, call 911 or other emergency services right away. Early treatment can help prevent a stroke. If you think you have had a TIA but your symptoms have gone away, you still need to call your doctor right away.
Symptoms of a TIA are the same as symptoms of a stroke. But symptoms of a TIA don’t last very long. Most of the time, they go away in 10 to 20 minutes. They may include:
• Sudden numbness, tingling, weakness, or loss of movement in your face, arm, or leg, especially on only one side of your body.
• Sudden vision changes.
• Sudden trouble speaking.
• Sudden confusion or trouble understanding simple statements.
• Sudden problems with walking or balance.
A blood clot is the most common cause of a TIA. Blood clots can be the result of hardening of the arteries (atherosclerosis), heart attack, or abnormal heart rhythms. The clot can block blood flow to part of the brain. Brain cells are affected within seconds of the blockage. That causes symptoms in the parts of the body controlled by those cells. After the clot dissolves, blood flow returns, and the symptoms go away.
Sometimes a TIA is caused by a sharp drop in blood pressure that reduces blood flow to the brain. This is called a “low-flow” TIA. It is not as common as other types.
Your doctor will do tests to look at your heart and blood vessels. You may need:
Tests that show pictures of your brain and blood vessels, such as a CT scan, an MRI, a magnetic resonance angiogram (MRA), or an angiogram.
A test that uses sound to check your blood flow (Doppler ultrasound).
An echocardiogram (echo) to check your heart’s shape and its blood flow.
An electrocardiogram (EKG, ECG) to measure your heart rhythm.
Blood tests, including a complete blood count and a fasting blood test to check for problems that could be causing your symptoms.
Your doctor will also check to see if something else caused your symptoms.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
Your patient is taking Plavix following his TIA. What type of medication is Plavix?
Drug Class | Drug Names |
Anticoagulant* |
|
Antiplatelet agents* |
|
Target-specific oral anticoagulants** |
|
Antiplatelet agents inhibit platelet aggregation and prevent formation of the platelet plug. Platelet plug forms in places of vascular injury to stop bleeding, and it can also cause pathological atherosclerosis and thrombosis.
There are two classes of antiplatelet agents: glycoprotein platelet inhibitors and platelet aggregation inhibitors. These drugs work by different mechanisms to inhibit platelet function.
Antiplatelet agents are used as treatment and prophylaxis in patients who have had myocardial infarctions or are at a high risk of other thromboembolic disorders such as stroke.
Drug Class | Drug Names |
Anticoagulant* |
|
Antiplatelet agents* |
|
Target-specific oral anticoagulants** |
|
Antiplatelet agents inhibit platelet aggregation and prevent formation of the platelet plug. Platelet plug forms in places of vascular injury to stop bleeding, and it can also cause pathological atherosclerosis and thrombosis.
There are two classes of antiplatelet agents: glycoprotein platelet inhibitors and platelet aggregation inhibitors. These drugs work by different mechanisms to inhibit platelet function.
Antiplatelet agents are used as treatment and prophylaxis in patients who have had myocardial infarctions or are at a high risk of other thromboembolic disorders such as stroke.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
How long should you defer elective dental care following a TIA?
Defer Elective Dental Care
Avoid elective care for 6 months after a stroke or TIA (“mini” stroke).
Provide only urgent dental care during the first 6 months after a stroke or TIA.
Case #1 (Questions 1-15)
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Case #1 (Questions 1-15)
All of the following are true concerning local anesthetic precautions for post TIA patients EXCEPT one. Which one is the EXCEPTION?
Local Anesthetic Precautions
Use vasoconstrictors with caution. Increased risk for adverse outcomes.
Rare possibility of increased risk of a hypertensive episode followed by bradycardia in patients taking nonselective beta-blockers (e.g., propranolol).
Recommendation:
*Consider limiting epinephrine to 0.04 mg (2 cartridges of 1:100,000 or 4 cartridges of 1:200,000 epinephrine) and levonordefrin to 0.2 mg.
*Monitor blood pressure and heart rate preoperatively and 5 minutes after injection. Should not treat if systolic BP > 180 mm Hg or if diastolic BP > 110 mm Hg.
*If multiple quadrants are being treated, the timing of the injections should be spread out (wait 5 minutes before re-administering and monitor patient).
*Avoid: 1:50,000 concentrations of epinephrine in dental anesthetic and epinephrine-impregnated retraction cord.
Local Anesthetic Precautions
Use vasoconstrictors with caution. Increased risk for adverse outcomes.
Rare possibility of increased risk of a hypertensive episode followed by bradycardia in patients taking nonselective beta-blockers (e.g., propranolol).
Recommendation:
*Consider limiting epinephrine to 0.04 mg (2 cartridges of 1:100,000 or 4 cartridges of 1:200,000 epinephrine) and levonordefrin to 0.2 mg.
*Monitor blood pressure and heart rate preoperatively and 5 minutes after injection. Should not treat if systolic BP > 180 mm Hg or if diastolic BP > 110 mm Hg.
*If multiple quadrants are being treated, the timing of the injections should be spread out (wait 5 minutes before re-administering and monitor patient).
*Avoid: 1:50,000 concentrations of epinephrine in dental anesthetic and epinephrine-impregnated retraction cord.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
There are four warning sign events associated with a stroke. Which one is not associated with a stroke?
Stroke (cerebrovascular accident) is a serious and often fatal neurologic event characterized by the rapid appearance (usually over minutes) of a focal deficit of brain function.
Pathophysiology: Of patients presenting with a stroke, 85% will have sustained a cerebral infarction due to inadequate blood flow to part of the brain, and the remainder will have had an intracerebral hemorrhage. If a stroke is not fatal, the survivor is often debilitated in motor function and/or speech.
Warning signs: Four events are associated with a stroke:
1. The transient ischemic attack (TIA), a “mini” stroke that can last less than 10 minutes;
2. Reversible ischemic neurological deficit that can last 24 hours before eventual recovery occurs;
3. Stroke-in-evolution; and
4. The complete stroke.
Strokes happen usually as a complication of another disease (e.g., arrhythmia, carotid artery stenosis/plaque rupture), which should be addressed by the dentist.
Stroke (cerebrovascular accident) is a serious and often fatal neurologic event characterized by the rapid appearance (usually over minutes) of a focal deficit of brain function.
Pathophysiology: Of patients presenting with a stroke, 85% will have sustained a cerebral infarction due to inadequate blood flow to part of the brain, and the remainder will have had an intracerebral hemorrhage. If a stroke is not fatal, the survivor is often debilitated in motor function and/or speech.
Warning signs: Four events are associated with a stroke:
1. The transient ischemic attack (TIA), a “mini” stroke that can last less than 10 minutes;
2. Reversible ischemic neurological deficit that can last 24 hours before eventual recovery occurs;
3. Stroke-in-evolution; and
4. The complete stroke.
Strokes happen usually as a complication of another disease (e.g., arrhythmia, carotid artery stenosis/plaque rupture), which should be addressed by the dentist.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
Your patient complains that the left side of his jaw hurts when he wakes up in the morning. Which of the following is most likely the cause of his problem?
Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.
Causes: People can clench and grind without being aware of it. It can happen during both the day and night, although sleep-related bruxism is often a bigger problem because it is harder to control.
There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms.
Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:
• How much stress you are under
• How long and tightly you clench and grind
• Whether your teeth are misaligned
• Your posture
• Your ability to relax
• Your diet
• Your sleeping habits
Symptoms: Clenching the teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).
Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners.
Symptoms of bruxism include:
• Anxiety, stress, and tension
• Depression
• Earache (due in part because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
• Eating disorders
• Headache
• Muscle tenderness, especially in the morning
• Hot, cold, or sweet sensitivity in the teeth
• Insomnia
• Sore or painful jaw
Bruxism is when you clench (tightly hold your top and bottom teeth together) or grind (slide your teeth back and forth over each other) your teeth.
Causes: People can clench and grind without being aware of it. It can happen during both the day and night, although sleep-related bruxism is often a bigger problem because it is harder to control.
There is some disagreement about the cause of bruxism. Daily stress may be the trigger in many people. Some people probably clench their teeth and never feel symptoms.
Factors that influence whether or not bruxism causes pain and other problems will vary from person to person. They may include:
• How much stress you are under
• How long and tightly you clench and grind
• Whether your teeth are misaligned
• Your posture
• Your ability to relax
• Your diet
• Your sleeping habits
Symptoms: Clenching the teeth puts pressure on the muscles, tissues, and other structures around your jaw. The symptoms can cause temporomandibular joint problems (TMJ).
Grinding can wear down your teeth. It can be noisy enough at night to bother sleeping partners.
Symptoms of bruxism include:
• Anxiety, stress, and tension
• Depression
• Earache (due in part because the structures of the temporomandibular joint are very close to the ear canal, and because you can feel pain in a different location than its source; this is called referred pain)
• Eating disorders
• Headache
• Muscle tenderness, especially in the morning
• Hot, cold, or sweet sensitivity in the teeth
• Insomnia
• Sore or painful jaw
Case #1 (Questions 1-15)
A
B
Case #1 (Questions 1-15)
All of the following are self-care therapies your patient can do himself that may reduce the pain he is having in the morning EXCEPT one. Which one is the EXCEPTION?
Treatment: The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.
The following self-care steps may help relieve pain:
• Apply ice or wet heat to sore jaw muscles. Either option can help.
• Avoid eating hard foods like nuts, candies, and steak.
• Avoid chewing gum.
• Drink plenty of water every day.
• Get plenty of sleep.
• Learn physical therapy stretching exercises to help restore the action of the muscles and joints on each side of the head to get back to normal.
• Massage the muscles of the neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout the head and face
• Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
• Try to reduce your daily stress and learn relaxation techniques.
To prevent damage to the teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.
A well-fitting splint should help reduce clenching. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.
There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn’t work, another may.
A splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.
After splint therapy, orthodontic adjustment of the bite pattern may help some people. Surgery should be considered a last resort.
Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.
In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.
Treatment: The goals of treatment are to reduce pain, prevent permanent damage to the teeth, and reduce clenching as much as possible.
The following self-care steps may help relieve pain:
• Apply ice or wet heat to sore jaw muscles. Either option can help.
• Avoid eating hard foods like nuts, candies, and steak.
• Avoid chewing gum.
• Drink plenty of water every day.
• Get plenty of sleep.
• Learn physical therapy stretching exercises to help restore the action of the muscles and joints on each side of the head to get back to normal.
• Massage the muscles of the neck, shoulders, and face. Look for small, painful nodules called trigger points that can cause pain throughout the head and face
• Relax your face and jaw muscles throughout the day. The goal is to make facial relaxation a habit.
• Try to reduce your daily stress and learn relaxation techniques.
To prevent damage to the teeth, mouth guards or appliances (splints) are often used to treat teeth grinding, clenching, and TMJ disorders. A splint may help protect the teeth from the pressure of clenching.
A well-fitting splint should help reduce clenching. However, some people find that the symptoms go away as long as they use the splint, but pain returns when they stop. The splint may also not work as well over time.
There are many types of splints. Some fit over the top teeth, some on the bottom. They may be designed to keep your jaw in a more relaxed position or provide some other function. If one type doesn’t work, another may.
A splint called the NTI-tss fits over just the front teeth. The idea is to keep all of your back teeth (molars) completely separated, under the theory that most clenching is done on these back teeth. With the NTI, the only contact is between the splint and a bottom front tooth.
After splint therapy, orthodontic adjustment of the bite pattern may help some people. Surgery should be considered a last resort.
Finally, there have been many approaches to try to help people unlearn their clenching behaviors. These are more successful for daytime clenching.
In some people, just relaxing and modifying daytime behavior is enough to reduce nighttime bruxism. Methods to directly modify nighttime clenching have not been well studied. They include biofeedback devices, self-hypnosis, and other alternative therapies.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
In the radiograph B, what is the anatomical anomaly that the red arrows are pointing at which might make endodontic therapy more difficult?
Endolith (pulp stone)
A calcified body found in the pulp chamber of a tooth; may be composed of irregular dentin (true denticle) or due to ectopic calcification of pulp tissue (false denticle)
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
What is the anatomical structure that the red arrow is pointing to in radiograph A?
The maxillary sinus is one of the four paranasal sinuses, which are sinuses located near the nose. The maxillary sinus is the largest of the paranasal sinuses. The two maxillary sinuses are located below the cheeks, above the teeth and on the sides of the nose.
The maxillary sinuses are shaped like a pyramid and each contain three cavities, which point sideways, inwards, and downwards. The sinuses are small air-filled holes found in the bones of the face. They reduce skull weight, produce mucus, and affect the tone quality of a person’s voice.
The maxillary sinus drains into the nose through a hole called the ostia. When the ostia becomes clogged, sinusitis can occur. The ostia of the maxillary sinus often clog because the ostia are located near the top of the maxillary sinus, thus making proper drainage difficult.
Maxillary sinusitis or an infection of the maxillary sinus can have the following symptoms: fever, pain or pressure in face near the cheekbones, toothache, and runny nose. Sinusitis is the most common of maxillary sinus illnesses and is usually treated with prescription antibiotics.
The maxillary sinus is one of the four paranasal sinuses, which are sinuses located near the nose. The maxillary sinus is the largest of the paranasal sinuses. The two maxillary sinuses are located below the cheeks, above the teeth and on the sides of the nose.
The maxillary sinuses are shaped like a pyramid and each contain three cavities, which point sideways, inwards, and downwards. The sinuses are small air-filled holes found in the bones of the face. They reduce skull weight, produce mucus, and affect the tone quality of a person’s voice.
The maxillary sinus drains into the nose through a hole called the ostia. When the ostia becomes clogged, sinusitis can occur. The ostia of the maxillary sinus often clog because the ostia are located near the top of the maxillary sinus, thus making proper drainage difficult.
Maxillary sinusitis or an infection of the maxillary sinus can have the following symptoms: fever, pain or pressure in face near the cheekbones, toothache, and runny nose. Sinusitis is the most common of maxillary sinus illnesses and is usually treated with prescription antibiotics.
Case #1 (Questions 1-15)
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Case #1 (Questions 1-15)
Your patient has indicated that he is no longer eligible to donate blood due to his tattoos. All of the following infectious diseases are at risk of transmission during the tattoo procedure EXCEPT one. Which one is the EXCEPTION?
Tattooing carries several medical risks, including the transmission of infectious diseases. We review the published literature on the transmission of hepatitis B virus, human immunodeficiency virus, Treponema pallidum, papillomavirus, Mycobacterium tuberculosis, and other organisms by tattooing. Education, through public health measures, should promote the prevention of infectious disease transmission. Particular populations who could benefit from education include prisoners, individuals involved with correctional facilities, youths, military personnel, and health care providers coming in contact with populations at risk for tattoos.
Trichinellosis (trichinosis) is a disease caused by parasitic roundworms (nematodes) that can infect and damage body tissues. Nematodes are a major division of the helminth family of parasitic worms (for example, Trichinella spiralis). When ingested, these parasitic worms can pass through the intestinal tract to invade other tissues, such as muscle, where they persist. Trichinosis is also termed trichiniasis, or trichinelliasis.
Tattooing carries several medical risks, including the transmission of infectious diseases. We review the published literature on the transmission of hepatitis B virus, human immunodeficiency virus, Treponema pallidum, papillomavirus, Mycobacterium tuberculosis, and other organisms by tattooing. Education, through public health measures, should promote the prevention of infectious disease transmission. Particular populations who could benefit from education include prisoners, individuals involved with correctional facilities, youths, military personnel, and health care providers coming in contact with populations at risk for tattoos.
Trichinellosis (trichinosis) is a disease caused by parasitic roundworms (nematodes) that can infect and damage body tissues. Nematodes are a major division of the helminth family of parasitic worms (for example, Trichinella spiralis). When ingested, these parasitic worms can pass through the intestinal tract to invade other tissues, such as muscle, where they persist. Trichinosis is also termed trichiniasis, or trichinelliasis.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
Which of the following has been linked to Monster Energy drinks?
Monster Energy drinks are full of numerous ingredients that promise to increase endurance, create lasting energy and improve concentration. The effects of the beverage will vary from person to person. One can contains two servings and consuming the entire can may have adverse health effects on your body, so limit your consumption of Monster Energy drinks and be aware of the serving size. Follow up with your physician if you believe you are suffering from negative side effects.
Elevated Blood Pressure: High blood pressure, also known as hypertension, puts your body at risk for numerous additional illnesses. Having high blood pressure can harden your arteries, strain your kidneys and cause permanent damage to your heart. Information provided by the University of California states that intakes of more than 100 mg of caffeine per day can increase your risk of hypertension. Monster Energy drinks contain about 80 mg of caffeine per serving, or 160 mg per can. Severe side effects can occur after you consume 400 mg of caffeine in one day.
Sleeplessness: The high sugar and caffeine content in Monster Energy drinks can keep you wired for hours and cause you to lose sleep. Medline Plus reports that caffeine is absorbed by your body quickly and distributed through the bloodstream. From this point it quickly accesses your brain. This can cause the caffeine to have an effect for hours after you drink it. Monster also contains additional ingredients such as carnitine, guarana, ginseng and taurine. Each of these ingredients are believed to increase your energy which may be disruptive to you before bedtime. Do not consume Monster Energy drinks after lunchtime to avoid complications when trying to fall asleep.
Arrhythmia: The high caffeine content in Monster Energy drinks can also cause an arrhythmia in your body. Arrhythmia occurs when you feel a fluttering in your chest or rapid heartbeat. In a healthy adult, these symptoms should be temporary and disappear on their own. You may also experience chest pain, restlessness, dizziness or shortness of breath, as reported by MayoClinic.com.
Increased urination: Excessive caffeine consumption can also speed up your digestive tract which can cause you to urinate more frequently. Not only is this unpleasant, but it can also make you become dehydrated very quickly. The University of California attributes increased urination with caffeine consumption greater than 400 mg per day. If you are looking for energy, better concentration or increased endurance from Monster Energy drinks, drink water as well to avoid dehydration.
Monster Energy drinks are full of numerous ingredients that promise to increase endurance, create lasting energy and improve concentration. The effects of the beverage will vary from person to person. One can contains two servings and consuming the entire can may have adverse health effects on your body, so limit your consumption of Monster Energy drinks and be aware of the serving size. Follow up with your physician if you believe you are suffering from negative side effects.
Elevated Blood Pressure: High blood pressure, also known as hypertension, puts your body at risk for numerous additional illnesses. Having high blood pressure can harden your arteries, strain your kidneys and cause permanent damage to your heart. Information provided by the University of California states that intakes of more than 100 mg of caffeine per day can increase your risk of hypertension. Monster Energy drinks contain about 80 mg of caffeine per serving, or 160 mg per can. Severe side effects can occur after you consume 400 mg of caffeine in one day.
Sleeplessness: The high sugar and caffeine content in Monster Energy drinks can keep you wired for hours and cause you to lose sleep. Medline Plus reports that caffeine is absorbed by your body quickly and distributed through the bloodstream. From this point it quickly accesses your brain. This can cause the caffeine to have an effect for hours after you drink it. Monster also contains additional ingredients such as carnitine, guarana, ginseng and taurine. Each of these ingredients are believed to increase your energy which may be disruptive to you before bedtime. Do not consume Monster Energy drinks after lunchtime to avoid complications when trying to fall asleep.
Arrhythmia: The high caffeine content in Monster Energy drinks can also cause an arrhythmia in your body. Arrhythmia occurs when you feel a fluttering in your chest or rapid heartbeat. In a healthy adult, these symptoms should be temporary and disappear on their own. You may also experience chest pain, restlessness, dizziness or shortness of breath, as reported by MayoClinic.com.
Increased urination: Excessive caffeine consumption can also speed up your digestive tract which can cause you to urinate more frequently. Not only is this unpleasant, but it can also make you become dehydrated very quickly. The University of California attributes increased urination with caffeine consumption greater than 400 mg per day. If you are looking for energy, better concentration or increased endurance from Monster Energy drinks, drink water as well to avoid dehydration.
Case #1 (Questions 1-15)
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Case #1 (Questions 1-15)
The average 8 ounce cup of brewed coffee contains more caffeine than an 8 ounce serving of a Monster Energy drink.
An 8 ounce serving of a Monster Energy drink contains roughly the same amount of caffeine as found in a 1.9 ounce 5-hour Energy (Extra Strength) drink.
Monster Energy, the drink blamed in a lawsuit for the death of a 14-year-old girl and cited in five deaths reported to the FDA, has 92 milligrams of caffeine per 8-ounce serving. That’s about mid-range for the energy drinks tested. 5-hour Energy (Extra Strength) has a whopping 242 milligrams of caffeine in a 1.9 ounce serving….Yikes!
In a normal 8 ounce cup of brewed coffee there is between 95-200 milligrams and in the single serve varieties (Keurig, etc.) it varies from 75-150 milligrams.
Monster Energy, the drink blamed in a lawsuit for the death of a 14-year-old girl and cited in five deaths reported to the FDA, has 92 milligrams of caffeine per 8-ounce serving. That’s about mid-range for the energy drinks tested. 5-hour Energy (Extra Strength) has a whopping 242 milligrams of caffeine in a 1.9 ounce serving….Yikes!
In a normal 8 ounce cup of brewed coffee there is between 95-200 milligrams and in the single serve varieties (Keurig, etc.) it varies from 75-150 milligrams.
Case #1 (Questions 1-15)
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B
Case #1 (Questions 1-15)
All of the following are migraine symptoms that Imitrex helps to relieve EXCEPT one. Which one is the EXCEPTION?
Sumatriptan (Imitrex) is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, and sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Sumatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.
Sumatriptan does not prevent future migraines or lessen how often you get migraine attacks.
How to use Imitrex
Read the Patient Information Leaflet if available from your pharmacist before you start taking sumatriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor, at the first sign of a migraine. The dosage is based on your medical condition and response to treatment. If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, you may take another dose at least two hours after the first dose. Do not take more than 200 milligrams in a 24-hour period.
This medication may also be used as a backup for sumatriptan injection. If your symptoms are only partly relieved or your headache comes back, you may take a dose of sumatriptan by mouth at least two hours after the injection, up to a maximum of 100 milligrams in a 24-hour period.
If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking sumatriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.
Overuse of drugs to treat sudden migraine attacks can sometimes lead to worsening of headache (medication overuse headache) or rebound headache. Therefore, do not use this medication more often or for longer than prescribed. Tell your doctor if you need to use this medication more often, if the medication is not working as well, or if you have more frequent or worse headaches. Your doctor may need to change your medication and/or add another medication to help prevent headaches.
Sumatriptan (Imitrex) is used to treat migraines. It helps to relieve headache, pain, and other migraine symptoms (including nausea, vomiting, and sensitivity to light/sound). Prompt treatment helps you return to your normal routine and may decrease your need for other pain medications. Sumatriptan belongs to a class of drugs known as triptans. It affects a certain natural substance (serotonin) that causes narrowing of blood vessels in the brain. It may also relieve pain by affecting certain nerves in the brain.
Sumatriptan does not prevent future migraines or lessen how often you get migraine attacks.
How to use Imitrex
Read the Patient Information Leaflet if available from your pharmacist before you start taking sumatriptan and each time you get a refill. If you have any questions, ask your doctor or pharmacist.
Take this medication by mouth with or without food as directed by your doctor, at the first sign of a migraine. The dosage is based on your medical condition and response to treatment. If there is no improvement in your symptoms, do not take more doses of this medication before talking to your doctor. If your symptoms are only partly relieved, or if your headache comes back, you may take another dose at least two hours after the first dose. Do not take more than 200 milligrams in a 24-hour period.
This medication may also be used as a backup for sumatriptan injection. If your symptoms are only partly relieved or your headache comes back, you may take a dose of sumatriptan by mouth at least two hours after the injection, up to a maximum of 100 milligrams in a 24-hour period.
If you have a higher risk for heart problems (see Precautions), your doctor may perform a heart exam before you start taking sumatriptan. He/she may also direct you to take your first dose of this medication in the office/clinic to monitor for serious side effects (such as chest pain). Talk to your doctor for details.
Overuse of drugs to treat sudden migraine attacks can sometimes lead to worsening of headache (medication overuse headache) or rebound headache. Therefore, do not use this medication more often or for longer than prescribed. Tell your doctor if you need to use this medication more often, if the medication is not working as well, or if you have more frequent or worse headaches. Your doctor may need to change your medication and/or add another medication to help prevent headaches.
Case #1 (Questions 1-15)
A
B
Case #1 (Questions 1-15)
The periodontal probe is inserted along the long axis of the tooth into the pocket with gentle pressure, approximately 25 grams of force, until resistance is met, because in a healthy site, the tip of the probe stops within the junctional epithelium.
A periodontal pocket is a pathologic space between a tooth and pocket wall and its depth measured from the gingival margin to the clinical attachment level.
The depth of a periodontal pocket is measured by using a calibrated periodontal probe.
The periodontal probe is inserted along the long axis of the tooth into the pocket with gentle pressure – approximately 25 grams of force – until resistance is met.
In a healthy site, the tip of the probe stops within the junctional epithelium.
In a diseased site the probe penetrates into connective tissue.
The clinical probing depth is always greater than the histologic sulcus or pocket depth
Among examiners or from one time point to another, probing accuracy is only within ± 1 mm.
A periodontal pocket is a pathologic space between a tooth and pocket wall and its depth measured from the gingival margin to the clinical attachment level.
The depth of a periodontal pocket is measured by using a calibrated periodontal probe.
The periodontal probe is inserted along the long axis of the tooth into the pocket with gentle pressure – approximately 25 grams of force – until resistance is met.
In a healthy site, the tip of the probe stops within the junctional epithelium.
In a diseased site the probe penetrates into connective tissue.
The clinical probing depth is always greater than the histologic sulcus or pocket depth
Among examiners or from one time point to another, probing accuracy is only within ± 1 mm.
Case #1 (Questions 1-15)
A
B
Case #1 (Questions 1-15)
Which of the following lesions is not associated with HPV?
HPV is a DNA virus that has a tropism for epithelial cells and is found in normal oral mucosa.
Squamous papilloma is a subtype associated with HPV 6 and 11- contains koilocytic cell
Verruca vulgaris is a subtype associated with HPV 2 and 6 – contains koilocytic cell
Condyloma accuminatum is a subtype associated with HPV 6 and 11 – contains koilocytes
Benign migratory glossitis is of an unknown etiology. Possibly associated with stress, hormone imbalance.
Focal epithelial hyperplasia is a subtype associated with HPV 13 and 32 – multiple papillary or sessile lesions
HPV is a DNA virus that has a tropism for epithelial cells and is found in normal oral mucosa.
Squamous papilloma is a subtype associated with HPV 6 and 11- contains koilocytic cell
Verruca vulgaris is a subtype associated with HPV 2 and 6 – contains koilocytic cell
Condyloma accuminatum is a subtype associated with HPV 6 and 11 – contains koilocytes
Benign migratory glossitis is of an unknown etiology. Possibly associated with stress, hormone imbalance.
Focal epithelial hyperplasia is a subtype associated with HPV 13 and 32 – multiple papillary or sessile lesions
Case #1 (Questions 1-15)
A
B