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DIAGNOSTIC SKILLS EXAM OSCE (DSE OSCE)
QUESTIONS & ANSWERS
1. Pre-Med required for?: - 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]
2. 5 month old preggers with rheumatic fever and heart murmer: pre med?
a. yes
b. no
(remembered): b
3. 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): 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.
4. 6 months pregnant had bleeding gums and mobile teeth? How should they
be treated? (remembered): 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
HEALTH
gh.
nts for
2 years in the history because it can take 2 weeks to 2 years for the adrenal glands to bounce back to normal function.
10. Patients is the most important thing for calculating medication
dosage for a child.
a. age
b. weight
c. gender
d. height
(remembered): b
11. 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 PROBLEM; they have a lower prevalence of dental caries thou Consider prescribing Chlorhexidine or other antimicrobial age use. - When treating, consider patient's cardiac status and need for premedication (medical consult may be indicated). (remebered):
12. Patient just had a stroke. What do you need to worry about?
(remembered): if they are on anti-coagulants (blood thinners).
- Stroke patients could be on blood thinners, such as aspirin, dipyradamole (Per- san- 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.
13. What is the difference in anaphylaxis vs syncope?
(remembered): 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-head- edness, and blurred vision are commonly experienced.
14. The Enzyme Linked Immune Absorbent Assay (ELISA) Test - a negative
response for a person who had needle stick means what?
a. the patient definitely has an HIV infection
b. the patient has antibodies to HIV-1 present
c. the patient definitely does not have an HIV infection
d. the patient has no antibodies to HIV-1 present.
(remembered): patient had no Abs present was answer.
- The ELISA Test is "reactive" when it detects antibodies to HIV-1. Once positive, the blood is tested again to confirm that indeed the ELISA Test is positive.
- Western Blot Test is more specific test. It determines size of antigens in the test kit binding to the antibodies. Blood showing a positive ELISA is subjected to the Western Blot Test. Thus, the Western Blot Test is a confirmatory testing for HIV infection. A positive Western Blot Test confirms that the patient has the HIV infection.
missing teeth
22. Mucocele treatment?
a. Prescribe corticosteroids
b. Excise it and adjacent gland should be excised to prevent recurrence
c. Must be biopsied for definitive diagnosis
d. Anti-fungal medications
(remembered): b "Excise with salivary gland remnants"
- May be self-limiting or require local excision.
- on lower lip from trauma. history of increasing and decreasing in size.
23. Mucocele - on lower lip from trauma.:
24. Patient presents with Jaundice. Answer the following questions:
(1) Which of the following do you think they probably have?
a. Cirrhosis
b. Hepatitis A
c. Hepatitis C
(2) They currently are jaundiced. What is the proper thing to do?
a. Start with the examination and complete a thorough diagnostic assess-
ment.
b. Tell the patient to immediately go to the emergency room.
c. Tell the patient to come back for treatment in 1 week, and you cannot treat
them now. (remembered): (1) B - Jaundice is common in HepA (in B its like 60% of them, and in C its really rare) (2) c - this was on remembered questions.You can treat hepA patients after 1 week. called it jaundice.
25. Ectodermal Dysplasia - was given symptoms of no hair and
(remembered):
26. Perncious Anemia:
a. Is associated with an autoimmune destruction of the parietal cells in the
stomach.
b. Is caused by acute or chronic blood loss.
c. Both A and B: a - parietal cells make intrinsic facor, which is required to absorb
vitamin B12 from food.
27. what does intrinsic factor do?
(remembered): required to absorb vitamin B12 from food
28. Pernicious anemia - whats it caused by?
a. Decrease in intrinsic factor, which is required to absorb vitamin B12 from
food.
b. Chronic use of aspirin, NSAIDs, or corticosteroids.
c. A variant of hemoglobin A called hemoglobin S
d. Destruction of red blood cells
(remembered): a
- The Shilling's test is performed to evaluate vitamin B12 absorption, and it is most commonly used to evaluate patients having pernicious anemia.
29. What is hemolytic anemia?
a. An autoimmune destruction of the parietal cells in the stomach.
b. A genetic defect in which there is a variant of hemoglobin A called
hemoglobin S
c. A condition in which red blood cells are destroyed and removed from the
bloodstream before their normal lifespan is over
d. A condition in which folic acid is deficient and the patient presents with
neurologic symptoms. (remembered): c. ALSO know about Folate deficiency - neurologic symptoms!
30. Hereditary Telegnastia is associated with...
(remembered): d - they give an eye picture and ask what dental findings should you see
38. If they give you a picture of eyes and ask what dental findings you expect
to see - whats the answer?: dentinogenesis imperfecta (blue sclera is the eye pic)
39. All of the following are Hyperthyroid symptoms except?
a. fatigue
b. exopthalamus
c. tachycardia
d. tremor of extremities
(remembered): a
40. Large space (diastema) between #11 and #12. What do you do?
a. place implant
b. removable partial denture
c. fixed partial denture (bridge)
d. do nothing
(remembered): d - "leave it alone"
41. What is the greatest problem (disadvantage) with resin bonded bridges
(Maryland Bridge)?
a. staining
b. debonding
c. fracture
d. less tooth reduction
(remembered): b
42. Gutta percha is made out of?
a. barium salts
b. zinc oxide
c. silicate dioxide
d. graliam prema: b
43. Drug that increase the concentration of lidocaine in the blood?
a. Prozac
b. Asprin
c. Propanalol: c
44. Advantage of a maryland bridge?
a. staining
b. debonding
c. fracture
d. less tooth reduction: d
45. The minimal axial reduction for crowns is?
a. 0.5mm
b. 1.0mm
c. 1.5mm
d. 2.0mm
(remembered): c
- i think they are talking about PFM here: Metal coping: 0.3 - 0.5 mm & Porcelain: 0.7 - 1.0 mm
46. Best initial treatment for Maxillary oroantro fistula?
a. antibiotics
b. irrigation
c. pack with gauze
d. two of the above: d - antibiotics and irrigation
47. Drug taken for arthritis?
a. Propranolol
b. Benadryl
c. Naproxene
d. Aleve: c
48. In order to improve gingival health, what must you do to temporary
crown?
ooth
structure.
a. maximal taper
b. minimal taper
(tufts material): b - you want the taper, but you want to conserve t
55. What is the maximum amount of unsupported porcelain allowed? ("Min-
imum thickness for porcelain") (remembered): 2mm
56. The most important treatment for ANUG is?
a. antibiotics: chlorohexidine rinse
b. debridement
c. patient understanding the importance of oral hygeine
d. explaining to the patient the link between oral health and systemic health
(remembered): b
57. What is Gingivectomy used for?
a. gingival hyertrophy
b. gingival hyperplasia
c. gingival recession
d. hemostasis
(remembered): b
58. What is the treatment for a patient with a liver clot?
a. prescribe antibiotics
b. irrigate
c. apply pressure then re-assess
d. two of the above
(remembered): Irrigate, apply pressure, reassess
(liver clot-unstable and often large, friable clot commonly forming in mucous membranes. Usually lead to excessive bleeding and abnormal wound healing.)
59. Picture of Upper and lower complete arch crowns. What is wrong?
(remembered): impingement on gums/gums health
60. Patient presents with pain on swallowing when wearing their denture.
What is wrong? (rememered): - overextension of lingual flange, one person said
- In tufts lecture, difficulty swallowing is associated with excessive VDO.
61. Patient presents with space in between 3rd molar and premolar, with
class II mobility. How should you treat?
a. fixed partial denture
b. removable partial denture
c. implant prosthesis
d. full denture
(remembered): Implant
62. Grade III or IV furcation involvement, Miller class III mobility; the tooth
can't be maintained with adequate plaque control by the clinician or by the patient. What would be the prognosis for this tooth?
a. questionable
b. good
c. poor
d. hopeless: d
63. Patient missing #2 and #3. #1 has Class III mobility and furcation involve-
ment. What would be the optimal treatment plan?
a. Fixed bridge from #1 to
b. Place two implant-supported crowns for #2, #3; Frequent recall visits to
re-evaluate #1.
c. Extract #1 and place implants for #2, or #2 and #3.
d. maxillary posterior
mandible
e. two of the above
(remembered): "Either mandibular posterior or anterior" (i think ant. better though according to what tufts lectures say bc it has more cortical than the posterior mandible)
68. What is the best long term prognosis for an implant?
a. mandibular anterior
b. mandibular posterior
c. maxillary anterior
d. maxillary posterior
e. two of the above
(remembered): "Either mandibular posterior or anterior"
69. Worst cement for deep restoration?
a. Glass Ionomer
b. Zinc Phosphate
c. Composite Resin
d. RMGI
(remembered): b
70. Zinc phosphate is the worst cement for what type of restoration?
a. Class V
b. Deep Caries
c. Shallow Caries
(remembered): b - pulpal irritation
71. BW xray of amalgam restoration. Patient complained of pain when pro-
voked by hot or cold. What is wrong? (remembered): Deep amalgam filling (/restoration)
b. weekly
c. bi-weekly
d. annually
(remembered): b
78. Ortho case - what was the most important thing they did in maxillary
arch?
a. close the upper and lower diastema
b. align the teeth for future restorative procedures
c. adjust the occlusion for patient comfort
d. promote the movement of the mandibular teeth
(remembered): Align the teeth for future restorative procedures (Not close upper and lower diastema)
79. What pain reliever do you give to a patient who has kidney disease?
a. Asprin
b. Acetaminophen
c. Morphine
d. Naproxen
(remembered): b
80. Picture of surveyor. Asked what we were looking at?
(remembered): space for guideplane
81. What is the major complications of Phelobitis?
a. Atrial Fibrilation
b. Pulmonary Embolism
c. Peripheral Neuropathy
d. Myocardial Infarction
(remembered): pulmonary embolism
82. Patient complaining of space in between teeth after SRP, why?
a. Removal of some of tooth structure during ScRP
b. Tooth movement is normal following ScRP
c. Reduction in edematous tissue condition following ScRP
d. The cause in unknown
(remembered): reduction in edema
83. 1-2 mm of reduction in probing depth after performing SRP. What caused
this? (remembered): long junctional epithelium
84. If a patient has a shunt on the left arm where do you take BP?
a. wrist
b. right arm
c. neck
d. finger
(remembered): right arm -- "Pt's on dialysis, where do you take their BP? Not on the side where the shunt was placed for dialysis"
85. Picture of #10 and #11 lingual surface, what is wrong with the gingiva?
(remembered): Edema - enlargement of marginal and interproximal gingival tis- sues, Smooth shiny surface and loss of stippling, diffuse redness.
86. Space in between #29 and #30 in a very old patient with no #31 or
and barely occluding with #3. This is due to what / why is this happening?
