DSE OSCE EXAM QUESTIONS WITH COMPLETE
SOLUTIONS
41-yo |woman, |pregnant; |prev |rheumatic |fever |with |heart |murmur |(no |valvular |abnormality); |
allergy |to |penicillin. |Positive |history |of |infective |endocarditis. |Does |she |need |to |pre |med?
- |yes
- |no
yes
- |on |my |exam, |this |patient |had |a |previous |history |of |infective |endocarditis. |Pre-med |IS |
indicated
Pre-med |options |for |pregnant |woman |w/hx |of |infective |endocarditis |and |penicillin |allergy
- |amoxicillin
- |cephalexin
- |clarithromycin
- |ciproflaxacin
*clarithromycin* |
I |may |not |be |correct, |the |correct |option |may |be |cephalexin. |however |I |chose |clarithromycin |
due |to |penicillin |allergy, |cross |reaction |with |cephalosporins, |and |since
|clindamycin/erythromycin/azthromycin |were |not |options. |Ciproflaxacin |is |contraindicated |in |
pregnancy. |article |for |reference |
What |procedure |can |a |dentist |perform |without |consulting |MD |if |a |patient |is |currently |taking |
bisphosphonates?
- |endo |therapy
- |prophy |and |scaling
- |extraction
- |occlusal |restoration
*occlusal |restoration*
although |the |main |HELL |NO |is |extraction, |completing |endo |therapy |increases |risk |if |the |apex |is
|compromised/damaged |during |therapy. |I |teetered |on |prophy |and |scaling, |but |since |it |did |not |
,specify |supragingival, |decided |that |the |risk |of |scaling |can |negatively |affect |the |periosteum |of |a
|bisphosphanate |patient. |ADA |recommendations:
Pregnant |person |afraid |of |needles |- |stress |management |by |putting |patient |in |what |position |
when |in |your |chair |(BEFORE |they |even |get |to |the |point |of |passing |out)?
- |supply |oxygen
- |place |in |Trendelenburg
- |make |patient |sit |up |straight
- |tell |them |to |suck |it |up |buttercup
place |her |in |Trendelburg |position
6 |months |pregnant |had |bleeding |gums |and |mobile |teeth, |how |should |they |be |treated?
- |immediate |extractions
- |do |not |treat |until |baby |is |born
- |conservative |debridement
- |immediate |endo
conservative |debridement
.- |pregnancy |gingivitis: |important |to |do |ScRP |(and |stress |good |oral |hygiene) |to |prevent |plaque |
growth. |The |plaque |can |enter |blood |stream |and |stimulate |patient's |immune |system |to |
produce |prostaglandins, |which |can |trigger |uterine |contraction |leading |to |early |labor, |
premature |birth, |and |a |small |baby.
Pregnant |lady |with |a |diastema |in |between |#8 |and |#9 |with |deep |probing |depth |and |class |1 |
mobility |on |8 |and |9. |What |is |the |reason |for |diastema?
- |chronic |periodontitis
- |distal |drift
- |normal |during |pregnancy
chronic |perio
- |increased |incidence |of |periodontal |disease |during |pregnancy |=> |must |emphasize |good |oral |
hygiene, |and |remove |all |their |plaque |so |it |doesn't |lead |to |premature |birth |/ |low |birth |weight
Permanent |staining |as |a |result |of |tetracyline; |did |this |happen?
- |During |development |(as |fetus)
- |0-5yrs
- |5-10 |yrs
- |10-15 |yrs
age |0-5 |years
,- |remember |that |PERMANENT |dentition |does |not |begin |calcification |until |birth
Pentobarbital |(Nembutal) |and |Secobarbital |(Seconal) |are |what |type |of |drugs?
- |benzodiazepines
- |NSAIDS
- |barbituates
- |atypical |antipsychotic
barbituates
- |used |primarily |evening |BEFORE |appointment
A |patient |has |an |allergic |reaction |to |a |barbiturate, |how |do |you |treat?
- |epinephrine
- |diphenhydramine
- |send |to |ER
benadryl |(diphenhydramine)
A |patient |is |on |a |steroidal |medication. |What |information |do |you |need |to |obtain |before |
treating |them?
- |dose |and |pharmacy |that |filled |the |RX
- |duration |of |prescription
- |both |dose |and |duration
*dose |and |duration*
- |"The |rule |of |twos": |Ask |whether |the |patient |is |currently |on |steroids |or |has |been |on |
corticosteroids |for |2 |weeks |or |longer |within |the |past |2 |years. |You |must |go |back |2 |years |in |the |
history |because |it |can |take |2 |weeks |to |2 |years |for |the |adrenal |glands |to |bounce |back |to |
normal |function.
What |is |the |most |important |factor |when |calculation |medication |dosage |for |a |child
- |age
- |weight
- |gender
- |height
weight
A |patient |is |confirmed |to |have |trisomy |21. |What |are |you |initially |concerned |about?
- |congenital |heart |defect
- |Cushings
- |cerebrovascular |accident
, congenital |heart |defects
Consider |cardiac |status |and |posibility |of |pre-medication:
- |atrioventricular |septal |defect, |patent |ductus |arteriosus, |Tetralogy |of |Fallot
A |patient |has |recently |had |a |stroke. |What |is |your |first |concern?
- |when |was |their |last |cleaning
- |are |they |on |anticoagulants
- |current |blood |pressure
Are |they |on |anticoagulants
- |Stroke |patients |could |be |on |blood |thinners, |such |as |aspirin, |dipyradamole |(Persan- |tine), |
clopidogrol |(Plavix), |or |Coumadin, |postrecovery. |Prior |to |major |surgery, |always |consult |with |
the |patient's |physician |to |determine |whether |and |when |the |blood |thinners |can |be |stopped |
and |subsequently |restarted.
What |is |the |main |symptom |that |differentiates |anaphylaxis |from |syncope?
- |bronchoconstriction
- |clammy |skin |and |pallor
- |nausea, |vomiting
Bronchoconstriction
- |Anaphyalxis: |intense |itching, |hives, |flushing |over |the |face |and |chest. |Rhinitis, |conjunctivitis, |
nausea, |vomiting, |abdominal |cramps, |and |perspiration. |Palpitation, |tachycardia, |sub- |sternal |
tightness, |coughing, |wheezing, |and |dyspnea. |BP |drops |rapidly |and |loss |of |consciousness |or |
cardiac |arrest |can |occur |in |severe |cases.
-Syncope: |fight |or |flight |response. |Anxiety, |tachycardia, |perspiration, |light-headedness, |and |
blurred |vision |are |commonly |experienced.
The |Enzyme |Linked |Immune |Absorbent |Assay |(ELISA) |Test |- |a |negative |response |for |a |person |
who |had |needle |stick |means |what?
- |the |patient |definitely |has |an |HIV |infection
- |the |patient |has |antibodies |to |HIV-1 |present
- |the |patient |definitely |does |not |have |an |HIV |infection
- |the |patient |has |no |antibodies |to |HIV-1 |present.
*the |patient |does |not |have |HIV |antibodies*
- |consider |that |false |negatives |are |a |thing, |life |happens. |We |cannot |definitively |say |they |do |
not |have |HIV,but |we |can |say |that |no |Ab |were |detected.
SOLUTIONS
41-yo |woman, |pregnant; |prev |rheumatic |fever |with |heart |murmur |(no |valvular |abnormality); |
allergy |to |penicillin. |Positive |history |of |infective |endocarditis. |Does |she |need |to |pre |med?
- |yes
- |no
yes
- |on |my |exam, |this |patient |had |a |previous |history |of |infective |endocarditis. |Pre-med |IS |
indicated
Pre-med |options |for |pregnant |woman |w/hx |of |infective |endocarditis |and |penicillin |allergy
- |amoxicillin
- |cephalexin
- |clarithromycin
- |ciproflaxacin
*clarithromycin* |
I |may |not |be |correct, |the |correct |option |may |be |cephalexin. |however |I |chose |clarithromycin |
due |to |penicillin |allergy, |cross |reaction |with |cephalosporins, |and |since
|clindamycin/erythromycin/azthromycin |were |not |options. |Ciproflaxacin |is |contraindicated |in |
pregnancy. |article |for |reference |
What |procedure |can |a |dentist |perform |without |consulting |MD |if |a |patient |is |currently |taking |
bisphosphonates?
- |endo |therapy
- |prophy |and |scaling
- |extraction
- |occlusal |restoration
*occlusal |restoration*
although |the |main |HELL |NO |is |extraction, |completing |endo |therapy |increases |risk |if |the |apex |is
|compromised/damaged |during |therapy. |I |teetered |on |prophy |and |scaling, |but |since |it |did |not |
,specify |supragingival, |decided |that |the |risk |of |scaling |can |negatively |affect |the |periosteum |of |a
|bisphosphanate |patient. |ADA |recommendations:
Pregnant |person |afraid |of |needles |- |stress |management |by |putting |patient |in |what |position |
when |in |your |chair |(BEFORE |they |even |get |to |the |point |of |passing |out)?
- |supply |oxygen
- |place |in |Trendelenburg
- |make |patient |sit |up |straight
- |tell |them |to |suck |it |up |buttercup
place |her |in |Trendelburg |position
6 |months |pregnant |had |bleeding |gums |and |mobile |teeth, |how |should |they |be |treated?
- |immediate |extractions
- |do |not |treat |until |baby |is |born
- |conservative |debridement
- |immediate |endo
conservative |debridement
.- |pregnancy |gingivitis: |important |to |do |ScRP |(and |stress |good |oral |hygiene) |to |prevent |plaque |
growth. |The |plaque |can |enter |blood |stream |and |stimulate |patient's |immune |system |to |
produce |prostaglandins, |which |can |trigger |uterine |contraction |leading |to |early |labor, |
premature |birth, |and |a |small |baby.
Pregnant |lady |with |a |diastema |in |between |#8 |and |#9 |with |deep |probing |depth |and |class |1 |
mobility |on |8 |and |9. |What |is |the |reason |for |diastema?
- |chronic |periodontitis
- |distal |drift
- |normal |during |pregnancy
chronic |perio
- |increased |incidence |of |periodontal |disease |during |pregnancy |=> |must |emphasize |good |oral |
hygiene, |and |remove |all |their |plaque |so |it |doesn't |lead |to |premature |birth |/ |low |birth |weight
Permanent |staining |as |a |result |of |tetracyline; |did |this |happen?
- |During |development |(as |fetus)
- |0-5yrs
- |5-10 |yrs
- |10-15 |yrs
age |0-5 |years
,- |remember |that |PERMANENT |dentition |does |not |begin |calcification |until |birth
Pentobarbital |(Nembutal) |and |Secobarbital |(Seconal) |are |what |type |of |drugs?
- |benzodiazepines
- |NSAIDS
- |barbituates
- |atypical |antipsychotic
barbituates
- |used |primarily |evening |BEFORE |appointment
A |patient |has |an |allergic |reaction |to |a |barbiturate, |how |do |you |treat?
- |epinephrine
- |diphenhydramine
- |send |to |ER
benadryl |(diphenhydramine)
A |patient |is |on |a |steroidal |medication. |What |information |do |you |need |to |obtain |before |
treating |them?
- |dose |and |pharmacy |that |filled |the |RX
- |duration |of |prescription
- |both |dose |and |duration
*dose |and |duration*
- |"The |rule |of |twos": |Ask |whether |the |patient |is |currently |on |steroids |or |has |been |on |
corticosteroids |for |2 |weeks |or |longer |within |the |past |2 |years. |You |must |go |back |2 |years |in |the |
history |because |it |can |take |2 |weeks |to |2 |years |for |the |adrenal |glands |to |bounce |back |to |
normal |function.
What |is |the |most |important |factor |when |calculation |medication |dosage |for |a |child
- |age
- |weight
- |gender
- |height
weight
A |patient |is |confirmed |to |have |trisomy |21. |What |are |you |initially |concerned |about?
- |congenital |heart |defect
- |Cushings
- |cerebrovascular |accident
, congenital |heart |defects
Consider |cardiac |status |and |posibility |of |pre-medication:
- |atrioventricular |septal |defect, |patent |ductus |arteriosus, |Tetralogy |of |Fallot
A |patient |has |recently |had |a |stroke. |What |is |your |first |concern?
- |when |was |their |last |cleaning
- |are |they |on |anticoagulants
- |current |blood |pressure
Are |they |on |anticoagulants
- |Stroke |patients |could |be |on |blood |thinners, |such |as |aspirin, |dipyradamole |(Persan- |tine), |
clopidogrol |(Plavix), |or |Coumadin, |postrecovery. |Prior |to |major |surgery, |always |consult |with |
the |patient's |physician |to |determine |whether |and |when |the |blood |thinners |can |be |stopped |
and |subsequently |restarted.
What |is |the |main |symptom |that |differentiates |anaphylaxis |from |syncope?
- |bronchoconstriction
- |clammy |skin |and |pallor
- |nausea, |vomiting
Bronchoconstriction
- |Anaphyalxis: |intense |itching, |hives, |flushing |over |the |face |and |chest. |Rhinitis, |conjunctivitis, |
nausea, |vomiting, |abdominal |cramps, |and |perspiration. |Palpitation, |tachycardia, |sub- |sternal |
tightness, |coughing, |wheezing, |and |dyspnea. |BP |drops |rapidly |and |loss |of |consciousness |or |
cardiac |arrest |can |occur |in |severe |cases.
-Syncope: |fight |or |flight |response. |Anxiety, |tachycardia, |perspiration, |light-headedness, |and |
blurred |vision |are |commonly |experienced.
The |Enzyme |Linked |Immune |Absorbent |Assay |(ELISA) |Test |- |a |negative |response |for |a |person |
who |had |needle |stick |means |what?
- |the |patient |definitely |has |an |HIV |infection
- |the |patient |has |antibodies |to |HIV-1 |present
- |the |patient |definitely |does |not |have |an |HIV |infection
- |the |patient |has |no |antibodies |to |HIV-1 |present.
*the |patient |does |not |have |HIV |antibodies*
- |consider |that |false |negatives |are |a |thing, |life |happens. |We |cannot |definitively |say |they |do |
not |have |HIV,but |we |can |say |that |no |Ab |were |detected.
