Case Studies Test Answers – Flashcards

Your 1:00 oral prophylaxis patient is a 79-year-old male retired service salesman. He is in fair health and suffered from a previous myocardial infarction four years ago. You take his vital signs and find the following: pulse is 102 bpm, respiration is 22 rpm and exaggerated, blood pressure is 150/98 mmHg. What can be concluded from these vital signs?

Your 2:00 patient is a 62-year-old postal and is new to your practice. His history indicates daily intake His history indicates daily intake of hypertension medications, but he states that he does not like to take them due to the side effects. Other than the hypertension, his medical history is negative. His blood pressure is 188/112 mmHg, pulse rate 86 and respiration rate is 16. What is the medical significance of the information stated by the patient and the recorded blood pressure?

Your third patient this morning, a 52-year-old male, was seen last week for an initial examination. He has not received dental or dental hygiene care in approximately seven years. At his visit last week it was determined that he has class III periodontitis and moderate to heavy calculus deposits and requires four quadrants of periodontal debridement with anesthesia. The patient reluctantly agreed to this treatment plan and today is five minutes late for his 10:00 a.m. appointment to begin debridement of the mandibular right quadrant. You greet David in the reception area and accompany him to the operatory, review his medical history and perform an intra/extra oral examination and find no significant findings or contraindications to treatment. His vital signs are within normal limits although slightly elevated, which you attribute to his anxiety (pulse 88, respirations 16, blood pressure 138/88). Reviewing his personal oral hygiene seems to place him at ease. You prepared the anesthetic syringe prior to his arrival and approach him with the topical anesthetic on a cotton tipped applicator.You notice that he has become quite pale and the hairs on his arms are standing up. He is beginning to sweat profusely and frequently yawns. You ask him if he is feeling well and he states that he is fine, just a little nervous and a bit dizzy. You pick up the syringe and notice that he has lost consciousness.

Your first patient after lunch is a 21-year-old, normally healthy, female who is in your office for her initial examination. While reviewing the medical history she informs you that yesterday she had an automobile accident in which her airbag deployed. She was sent to the ER where she was treated for minor cuts and abrasions and released. Today she presents with the following symptoms: increased blood pressure of 150/98, increased pulse rate of 92 that is weak and thready, pale skin, and she seems somewhat confused and is becoming less coherent as time goes on. Beth reports that she has had some pain in her abdominal area since the accident. From what condition do you think your patient might be suffering?

Your 34-year-old female patient is scheduled for her first periodontal debridement appointment. She is a fairly new patient to your office having been seen last week for her initial examination. The patient informs you that this is not an experience she enjoys, since she has had unpleasant dental experiences in the past. Her medical history is negative, but today she seems unusually anxious and complains of being dizzy and lightheaded. Her vital signs are elevated (pulse 84, respiration 18, blood pressure 120/78), but still within the normal range so you begin treatment. Following the anesthetic injection you begin the debridement procedure and she begins to breathe quite rapidly and deeply. She cannot seem to catch her breath and complains of a tingling feeling in her face, particularly around her mouth. You notice that the fingers on her hands are beginning to tense and curl. Her skin is pale, moist, and cool. From what emergency do you suspect she is suffering?

Your patient, a 15-year-old female, comes into the office for her six month check-up, accompanied by several of her friends. From past visits and from the medical history update, you know that she is under treatment for a seizure disorder and that she had a tonic-clonic seizure about a month ago. She informs you that her seizures seem to occur more frequently around her menstrual cycle, which she is experiencing presently. She answers your questions with a somewhat irritable attitude and indicates that she has taken her medication (400 mg carbamazepine [Tegretol] bid). She states that she does not want to discuss her medical problems any further. Her oral hygiene is poor and you start to reinforce brushing instructions when she states she has a bad headache. Her body becomes rigid and she starts having convulsions. What do you do?

Your patient is a 65-year-old black male who reports a history of hypertension, usually 160/110. He smokes two packs of cigarettes per day and has a drink or two with dinner to calm his nerves. He takes cardizem for his hypertension and his medical history states that he suffers from atrial fibrillation. He informs you that three days ago he was not feeling very well and had some vertigo, mild blurred vision and some weakness in his left arm. The symptoms only lasted about 40 minutes so he did not call his physician. You take his blood pressure and find that it is 186/124 and his pulse rate is 90 beats per minute.Leroy begins to complain of an acute headache, dizziness, loss of vision in one eye, and a tingling feeling on his right side. You notice that his speech is slurred and his breathing is labored at a rate of 12 per minute. He remains conscious. From what emergency do you suspect he is suffering?

Your patient is a 55-year-old accountant. Upon completion of his medical/dental history you note that he presents with the following vital signs: blood pressure 132/88, respiration rate of 20 breaths/min and pulse rate of 80 bpm. He reports that his present health is "fair." You note that the patient has a heart disorder for which he takes 120mg of diltiazem daily, 20mg of atorvastatin calcium daily, 81mg of aspirin daily and nitrostat as needed. He smokes 20 cigarettes daily and has done so for 35 years. Upon further questioning, he discloses that he has chest pain about once a week, particularly during physical exertion and periods of stress. He tells you that he is a little tense at the thought of you "scraping" under his gums and he has postponed dental care due to fear of the dentist. Suddenly he has severe, crushing pain in his chest, left arm, and shoulder. He is having difficulty breathing, his skin is pale and clammy, and he is clutching his fist to his chest.

Your patient is a 58-year-old retired nurse. She indicates on her medical history that she suffered an acute myocardial infarction two years ago. She also states that she has swelling in her ankles and feet, especially after being on her feet all day. She has difficulty breathing with physical exertion and she needs to prop her head up with pillows to sleep at night. She is taking hydrochlorothiazide daily and sublingual nitroglycerin spray as necessary. She has not had any dental care in 15 years and is very anxious about her dental hygiene appointment today. Shortly after you begin your dental hygiene treatment, she appears very agitated and is experiencing significant difficulty breathing. She is gasping for air and her lips are becoming cyanotic. From what emergency do you suspect she is suffering?

Your 72-year-old male patient is scheduled for his six month recall dental hygiene appointment for which he is a year overdue. He had a pacemaker placed nine months ago due to consistent bradycardia. He has been coming to your office for a number of years, however, due to the length of time since his last dental hygiene care appointment he has moderate deposits on his teeth and you decide that the ultrasonic scaler would be easier for both you and the patient. You begin the procedure and suddenly the patient begins to complain of chest pain, dyspnea, dizziness, and is constantly hiccoughing. You take his pulse and it is very slow and weak at 50 beats per minute, his blood pressure is 108/72. What is happening to this patient?

Your patient is scheduled for a routine check-up and prophylaxis. He is seven years old and has been a patient in the practice since he was five. There are no significant findings on his medical history, however he admits to becoming short of breath at times. You notice that he is very apprehensive in the waiting room. He tells his mom that he is afraid to go into the treatment room. After alleviating his fears, he accompanies you into the operatory. Once seated, you notice that his breathing is beginning to become labored and a wheezing noise can be heard upon expiration. His respiration rate is 22 breaths per minute. From what condition do you suspect Pedro is suffering?

Your 1:00 p.m. patient, is an 80-year-old female. You are attempting to recement a temporary crown that came off over the weekend. The crown slips out of your wet gloves and has entered your patient's throat. She places her hands to her neck, is aggressively coughing, and is having difficulty breathing. What should you do?

Your patient is a 50-year-old female in good health except for her prosthetic hip replacement, for which she must be premedicated with 2.0 gm of amoxicillin prior to dental hygiene treatment. She arrives early stating that she has forgotten to take her antibiotic. Since you keep a supply of amoxicillin in your office, you dispense the appropriate dosage. She is sitting in the reception area waiting the required one hour prior to treatment. About 10 minutes later she begins to complain of a scratchy throat and is beginning to itch all over and is exhibiting hives on her arms and face. She requests a glass of water and is trying to catch her breath. Her symptoms are worsening. Her lips and eyes are beginning to swell. She is pale and exhibiting severe dyspnea. You take her blood pressure and it is extremely low: 70/40, her pulse is bradypneic at 60 beats per minute. From what emergency do you suspect she is suffering?

Your patient is a 29-year-old male disc jockey in good health. His medical history reveals that he is a controlled Type 1 diabetic who takes insulin daily. He is late for his 8:00 a.m. appointment stating that he did a gig last night and overslept. You begin the intra/extra oral examination prior to the oral prophylaxis and notice he is salivating profusely. You ask him where he is & his response is confused & irrational. You take his vital signs & find a bounding pulse & shallow respirations. He is conscious. From what emergency do you suspect Jeff is suffering?

Your mid-afternoon patient is a 56-year-old female who explains that she is a severe dental phobic & other than her initial examination a week ago has not had dental hygiene care for 16 years. She is scheduled for one quadrant of periodontal debridement with local anesthetics. While reviewing her medical history you notice that she reports that she has Addison's disease & takes 30 mg of hydrocortisone daily. As you are preparing for treatment your patient states that she is nauseous & not feeling well. You take her pulse & she is tachypneic with a pulse rate of 118 beats/minute & it's thready. Her respiration rate is 34 breaths/minute & she is quite hypotensive with a blood pressure of 78/54. From what medical emergency is your patient suffering?

Your second patient on this January day in your Vermont dental office is a 78-year-old male in fair health. His medical history reveals that he has hypothyroidism & is supposed to take Synthroid daily before breakfast. He informs you that he is on a fixed income & could not afford the medication for the past 2 months. He also informs you that he has just recovered from a bout of pneumonia. His voice seems rather hoarse & you notice that his skin is dry, scaly & cool to the touch. His hair is coarse & sparse. He seems much more confused & apathetic than at his previous appointments, but you assume that it is due to his age. You take his pulse & find that he is bradycardic with a pulse rate of 50. His BP is 122/98. His respiration rate is 12 breaths/minute & they are weak. You decide to take his temperature as he is complaining of being cold & you find he is hypothermic with a body temperature of 95°F. When you begin the intraoral examination, you notice that his tongue is quite enlarged. Due to his vital signs you decide to postpone dental hygiene treatment as you suspect the patient is suffering a medical emergency which requires immediate attention by a physician. Which medical emergency do you suspect?