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P1. Cellulits is a common infection in patients with poorly controlled diabetes

mellitus.

What are the factors that favor this type of infection in diabetics in the lower

extrimities? Impairment of the immune system, Neuropathy(sensory) , peripheral

vascular disease ,poor glycemic control , impairment of blood circulation in the

legs leading to diabetic foot/foot ulcers.

What are the most common pathogens causing this type of infection?

taphylococci and streptococci

P!. "t is important to monitor glycemic control in diabetic patients. Which of the

following is of value to assess long term #!$% months& control?

a& 'ody mass index

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 b& (asting and postprandial blood glucose

c& )lycosylated haemoglobin * 1 C

P%. P. +uring management of a diabetic patient with dental illness, explain the best

 practie measures you should tae regarding the following?

-istory taing

$its important to tae a good medical history and assess glycemic control at the initial

appointment.

$as the patient about recent blood glucose levels and freuency of hypoglycemic

episodes.

$*ntidiabetic medications#dosage and time of administration&should be determined

0iming of visit appointment

"n general,morning appointments are advisable as endogenous cortisol levels are

generally higher at this time+iet

  important to ensure that patient has eaten normally and taen medications as usual

 2evel of glycemic control

 $measuring blood glucose level before any procedure .

$Patients with low glucose levels# 345mg/dl& tae oral carbohydrate before treatment.

$Patients with elevated glucose levels tae medical consultation.

P6. Comment on the color of the sin

What are the causes of this abnormality?

Pallor of the sin of the hand #left&in relation to normal hand colour#right& ,with blac

 pigmentation at finger tips that may be resulted from smoing.

$anemia

$hypoglycemia

$emotional shoc 

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P7. Comment on the color of the scelera

8ention the causes of this abnormality/

$9ellow sclera that may be accompanied with yellow sin and mucous membranes,because of increased levels of serum bilirubin as in :aundice.

$ Causes for condition;

Pre hepatic and Post hepatic

-epatocellular; hemolysis

g$<$p

hyperbilirubinia

P<. * 7< year old man, with long standing history of diabetes mellitus. +escribe this

lesion in the right foot. =xplain the factors that favour this ind of in:ury.

$+iabetic deep right foot ulcer#well$defined deep punched out ulcer on the right foot

surrounded with red and blac area&

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(actors;

$Peripheral neuropathy

$venous insufficiency

$Peripheral vascular diseases

$poor glycemic control$peripheral arterial occlusive disease.

P4. +escribe changes in a a patient with truncal obesity. 2ist % diseases that cause this

disorder 

 patient who have body mass index of %5 or more and in which the fat is primarily

stored around the trun of the body. 0hose who have truncal obesity suffer from

serious health conditions .

1$cushings syndrome

!$hypothyroidism

%$growh hormone deficiency.

P.> * !7 year old male patient presented to the outpatient clinic. -is height is 1>! cmwhile his weight was < ilogram. Calculate his body mass index, Categori@e this

 patient according to this value.

What are the causes of dar urine?

Aninary tract infection

Baundice

-epatitis

2iver cirrhosis+ehydration

)all bladder stones

+rugs, hemolysis

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P. +escribe this abnormality found in the lower part of the oesphagus during upper

gastrointestinal endoscopy.

#dilated blood vessels become enlarged and loo swollen&

=sophageal arices # seuel of liver cell failure&

P15. -ow can you diagnose hepatic encephalopathy in a cirrhotic patient visiting your

office?

$blood test and liver test

$C0 ad 8D" scan

$==) specific wave

P11. -ow can you manage a 66 year old male patient with *ddidons disease who

was on maintainance replacement therapy with hydrocortisone !7 mg daily and

 presenting to you for surgical tooth extraction.

#1& increased administration of glucocorticoids #steroid prep&, 155 mg

#!& systemic antibiotic therapy

#%& anxiety control

What are the symptoms you should assess for !6 hours after surgery?8onitor electrolytes and blood pressure post$operatively for all procedures reuiring

in:ected steroid cover. "f the patient becomes hypotensive, drowsy or peripherally

shut down, administer 155mg hydrocortisone i/v or i/m

immediately. administer bolus hydrocortisone over a minimum of 15 minutes to

 prevent vascular damage.

http;//www.addisons.org.u/comms/publications/surgicalguidelines$colour.pdf 

 p1!. Patients who have hyperthyroidism have increased levels of anxiety, and stress

or surgery can trigger a thyrotoxic crisis. =pinephrine is contraindicated, and elective

dental care should be deferred for patients who have hyperthyroidism and exhibitsigns or symptoms of thyrotoxicosis.

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+escribe the clinical manifestations of hyperthyroidism?

E udden weight loss,

E Palpitations due to rapid heartbeat regular or irregular 

E "ncreased appetiteE Fervousness, anxiety and irritability

E 0remor G usually a fine

E weating

E Changes in menstrual patterns

E "ncreased sensitivity to heat

E +iarrhea

E )oiter  

E (atigue, muscle weaness

E +ifficulty sleeping

E in thinning

E (ine, brittle hair