Diagnostic Skills Exam OSCE (DSE OSCE) – 2022
What are the ADA recommendations for when pre-med is required -Ans>>- prosthetic cardiac valves,
including transcatheter-implanted prostheses and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
--any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or
adjacent to the site of a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
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 -Ans>>yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective endocarditis.
Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin -Ans>>*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 https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-
and-pregnancy/
What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration -Ans>>*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:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations%20for%20Treatment
%20of%20Patients%20on%20Bisphosphon.pdf
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 -Ans>>place her in Trendelburg 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, preferably 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?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo -Ans>>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 -Ans>>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 -Ans>>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 -Ans>>barbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER -Ans>>benadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway, treatment may differ...
but this was not indicated in the question stem. However, I did not have answer choices that reflected
this scenario nor was it addressed in the question stem
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 -Ans>>*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 -Ans>>weight
, A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident -Ans>>congenital heart defects; however, early onset periodontal disease
is a significant oral health issue, but this was not an answer for those who have had this question.
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 -Ans>>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.- . 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 main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor
- nausea, vomiting -Ans>>Anaphylaxis is accompanied by wheezing, 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?
- 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. -Ans>>*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.
14 year old presents with inflamed gingiva. Bloodwork indicates abnormal RBC, WBC, and platelets.
Diagnosis?
- normal 14 year old
- hypothyroidism
- leukemia
- anemia -Ans>>leukemia --> high WBC, lymphadenopathy, painful gingiva. Don't forget that WBC can
be elevated OR decreased in leukemia! Gingival hypertrophy is a common sign/symptom
Stem indicates patient has recently taken medications, which one likely caused the rash present on
their arm?
- Acetamiophen
- Barbituates
- Penicillin
- diphenhydramine -Ans>>Penicillin allergy
- hives is a common response to penicillin allergies
What are the ADA recommendations for when pre-med is required -Ans>>- prosthetic cardiac valves,
including transcatheter-implanted prostheses and homografts
- prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords
- a history of infective endocarditis
- a cardiac transplanta with valve regurgitation due to a structurally abnormal valve
- the following congenital (present from birth) heart disease
--unrepaired cyanotic congenital heart disease, including palliative shunts and conduits
--any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or
adjacent to the site of a prosthetic patch or a prosthetic device
**ADA website**
https://www.ada.org/en/member-center/oral-health-topics/antibiotic-prophylaxis
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 -Ans>>yes
- REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective endocarditis.
Pre-med IS indicated
- many of the OSCE quizlets say no....
Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy
- amoxicillin
- cephalexin
- clarithromycin
- ciproflaxacin -Ans>>*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 https://www.parents.com/pregnancy/my-body/is-it-safe/antibiotics-
and-pregnancy/
What procedure can a dentist perform without consulting MD if a patient is currently taking
bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration -Ans>>*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:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations%20for%20Treatment
%20of%20Patients%20on%20Bisphosphon.pdf
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 -Ans>>place her in Trendelburg 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, preferably 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?
- immediate extractions
- do not treat until baby is born
- conservative debridement
- immediate endo -Ans>>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 -Ans>>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 -Ans>>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 -Ans>>barbituates
- used primarily evening BEFORE appointment
A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine
- diphenhydramine
- send to ER -Ans>>benadryl (diphenhydramine)
- And discontinuation of the drug. Obviously if there are concerns with airway, treatment may differ...
but this was not indicated in the question stem. However, I did not have answer choices that reflected
this scenario nor was it addressed in the question stem
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 -Ans>>*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 -Ans>>weight
, A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident -Ans>>congenital heart defects; however, early onset periodontal disease
is a significant oral health issue, but this was not an answer for those who have had this question.
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 -Ans>>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.- . 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 main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor
- nausea, vomiting -Ans>>Anaphylaxis is accompanied by wheezing, 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?
- 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. -Ans>>*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.
14 year old presents with inflamed gingiva. Bloodwork indicates abnormal RBC, WBC, and platelets.
Diagnosis?
- normal 14 year old
- hypothyroidism
- leukemia
- anemia -Ans>>leukemia --> high WBC, lymphadenopathy, painful gingiva. Don't forget that WBC can
be elevated OR decreased in leukemia! Gingival hypertrophy is a common sign/symptom
Stem indicates patient has recently taken medications, which one likely caused the rash present on
their arm?
- Acetamiophen
- Barbituates
- Penicillin
- diphenhydramine -Ans>>Penicillin allergy
- hives is a common response to penicillin allergies
