Diagnostic Skills Exam OSCE (DSE OSCE) - 2022
Pre-Med required for? Correct Answer: - Prosthetic heart valves, or prosthetic material used for cardiac
valve repair.
- Hx of infective endocarditis
- cyonotic heart disease
- valve regurgitation w. heart thingys (even if has transplant or was repaired already)
[According to limited data, infective endocarditis appears to be more common in heart transplant
recipients than in the general population; the risk of infective endocarditis is highest in the first 6
months after transplant because of endothelial disruption, high-intensity immunosuppressive therapy,
frequent central venous catheter access, and frequent endomyocardial biopsies]
5 month old preggers with rheumatic fever and heart murmer: pre med?
a. yes
b. no
(remembered) Correct Answer: b
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)?
(remembered) Correct Answer: place her in trundelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava) => must prevent this
in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, prefera-bly to the left side,
to displace the uterus away from the inferior vena cava. The patient can also be placed in a sitting
position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth? How should they be treated?
(remembered) Correct Answer: conservative debridement is what other person answered.
- pregnancy gingivitis: It is SO important to do ScRP (and stress good oral hygeine) to prevent plaque
growth. The plaque can enter blood stream and stimuate 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?
,(remembered) Correct Answer: 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 / small baby.
Permanent dentition with tetracycline staining, when did this happen?
(remembered) Correct Answer: Patient ingested tetracycline when they were between 0 and 5 years
old
• Pentobarbital (Nembutal)
• Secobarbital (Seconal)
are what kind of drugs? Correct Answer: barbiturates - Both pentobarbital (Nembutal) and secobarbital
(Seconal) are used primarily on the evening before the dental appointment.
Barbiturates - how should an allergic reaction be treated?
(remembered) Correct Answer: Benadryl -> if its a mild-moderate allergy.
- When a patient experiences a milder form of anaphylactic reaction, the drug or prepara- tion that
caused a reaction is discontinued and the patient is given diphenhydramine (Benadryl), 25-50 mg/tablet
PO q6h for 48-72 hr.
Steroids - whats most important information you need to get from your patient when you find out they
are on steroids.. before even thinking about treating them?
(remembered) Correct Answer: duration and dosage.
- "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.
Patients _____ is the most important thing for calculating medication dosage for a child.
a. age
b. weight
c. gender
d. height
(remembered) Correct Answer: b
Biggest concern with down syndrome?
, he thought Congenital Heart Defects.
- Trisomy 21 are at increased risk of cardiac defects, true.
- early onset periodontal disease IS MOST SIGNIFICANT ORAL HEALTH PROBLEM; they have a lower
prevalence of dental caries though.
Consider prescribing Chlorhexidine or other antimicrobial agents for daily use.
- When treating, consider patient's cardiac status and need for premedication (medical consult may be
indicated).
(remebered) Correct Answer:
Patient just had a stroke. What do you need to worry about?
(remembered) Correct Answer: if they are on anti-coagulants (blood thinners).
- 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.
- . Following a CVA that required significant hospitalization, routine dental treatment must be delayed by
6 months.
- Routine dental treatment should be delayed by 3 months if the post-CVA recovery was uneventful and
the patient was admitted overnight just for observation.
- Avoid epinephrine containing LAs during the first 6 months of dental treatment. Subsequent use of
epinephrine depends on the patient's prognosis. Epinephrine containing LAs can be used starting 1 year
after the stroke, when the patient demonstrates progressive improvement of the CVA and absence of
TIAs.
What is the difference in anaphylaxis vs syncope?
(remembered) Correct Answer: anaphylaxis has wheezing and
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: fright and 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?
Pre-Med required for? Correct Answer: - Prosthetic heart valves, or prosthetic material used for cardiac
valve repair.
- Hx of infective endocarditis
- cyonotic heart disease
- valve regurgitation w. heart thingys (even if has transplant or was repaired already)
[According to limited data, infective endocarditis appears to be more common in heart transplant
recipients than in the general population; the risk of infective endocarditis is highest in the first 6
months after transplant because of endothelial disruption, high-intensity immunosuppressive therapy,
frequent central venous catheter access, and frequent endomyocardial biopsies]
5 month old preggers with rheumatic fever and heart murmer: pre med?
a. yes
b. no
(remembered) Correct Answer: b
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)?
(remembered) Correct Answer: place her in trundelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava) => must prevent this
in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, prefera-bly to the left side,
to displace the uterus away from the inferior vena cava. The patient can also be placed in a sitting
position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth? How should they be treated?
(remembered) Correct Answer: conservative debridement is what other person answered.
- pregnancy gingivitis: It is SO important to do ScRP (and stress good oral hygeine) to prevent plaque
growth. The plaque can enter blood stream and stimuate 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?
,(remembered) Correct Answer: 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 / small baby.
Permanent dentition with tetracycline staining, when did this happen?
(remembered) Correct Answer: Patient ingested tetracycline when they were between 0 and 5 years
old
• Pentobarbital (Nembutal)
• Secobarbital (Seconal)
are what kind of drugs? Correct Answer: barbiturates - Both pentobarbital (Nembutal) and secobarbital
(Seconal) are used primarily on the evening before the dental appointment.
Barbiturates - how should an allergic reaction be treated?
(remembered) Correct Answer: Benadryl -> if its a mild-moderate allergy.
- When a patient experiences a milder form of anaphylactic reaction, the drug or prepara- tion that
caused a reaction is discontinued and the patient is given diphenhydramine (Benadryl), 25-50 mg/tablet
PO q6h for 48-72 hr.
Steroids - whats most important information you need to get from your patient when you find out they
are on steroids.. before even thinking about treating them?
(remembered) Correct Answer: duration and dosage.
- "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.
Patients _____ is the most important thing for calculating medication dosage for a child.
a. age
b. weight
c. gender
d. height
(remembered) Correct Answer: b
Biggest concern with down syndrome?
, he thought Congenital Heart Defects.
- Trisomy 21 are at increased risk of cardiac defects, true.
- early onset periodontal disease IS MOST SIGNIFICANT ORAL HEALTH PROBLEM; they have a lower
prevalence of dental caries though.
Consider prescribing Chlorhexidine or other antimicrobial agents for daily use.
- When treating, consider patient's cardiac status and need for premedication (medical consult may be
indicated).
(remebered) Correct Answer:
Patient just had a stroke. What do you need to worry about?
(remembered) Correct Answer: if they are on anti-coagulants (blood thinners).
- 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.
- . Following a CVA that required significant hospitalization, routine dental treatment must be delayed by
6 months.
- Routine dental treatment should be delayed by 3 months if the post-CVA recovery was uneventful and
the patient was admitted overnight just for observation.
- Avoid epinephrine containing LAs during the first 6 months of dental treatment. Subsequent use of
epinephrine depends on the patient's prognosis. Epinephrine containing LAs can be used starting 1 year
after the stroke, when the patient demonstrates progressive improvement of the CVA and absence of
TIAs.
What is the difference in anaphylaxis vs syncope?
(remembered) Correct Answer: anaphylaxis has wheezing and
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: fright and 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?
