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Medical Emergencies · single question

How should you proceed with this patient who shows undiagnosed Addison-type features and needs an extraction?

  1. Refer to a physician for medical evaluation before surgery
  2. Proceed with the extraction immediately, no precautions
  3. Tell her the findings are unrelated to dentistry
  4. Prescribe antibiotics and extract the same day
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Correct answer: A. Refer to a physician for medical evaluation before surgery

  • A. Correct. A patient with suspected, UNMANAGED adrenal insufficiency is at risk of an adrenal (Addisonian) crisis under the stress of surgery. She must be medically evaluated/stabilized (and may need steroid supplementation) before an elective extraction.
  • B. Operating on an unstabilized adrenal-insufficient patient risks a life-threatening crisis (hypotension, shock).
  • C. Systemic signs that affect surgical safety are very much the dentist's concern.
  • D. Antibiotics do not address the adrenal risk, and same-day surgery is premature.

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