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DSE OSCE QUESTIONS & ANSWERS
1. What are the ADA recommendations for when pre-med is required: - pros-
thetic cardiac valves, including transcatheter-implanted prostheses and homo- grafts
- 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
2. 41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvu-
lar abnormality); allergy to penicillin. Positive history of infective endocardi- tis. Does she need to pre med?
- yes - no: 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....
3. 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 https://www.parents.com/preg- nancy/my-body/is-it-safe/antibiotics-and-pregnancy/
4. What procedure can a dentist perform without consulting MD if a patient
is currently taking bisphosphonates?
- endo therapy - prophy and scaling - extraction
- 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.
7. 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
8. 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
9. Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of
drugs?
- benzodiazepines - NSAIDS - barbituates - atypical antipsychotic: barbituates
- used primarily evening BEFORE appointment
10. A patient has an allergic reaction to a barbiturate, how do you treat?
- epinephrine - diphenhydramine - send to ER: 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
11. A patient is on a steroidal medication. What information do you need to
obtain before treating them?
- congenital heart defect - Cushings - cerebrovascular accident: congenital heart defects; however, early onset pe- riodontal 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
14. 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 (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.
15. What is the main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor - nausea, vomiting: Anaphylaxis is accompanied by wheezing, bronchoconstric- tion
- 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.
16. 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
20. Drugs that may have increased chance of periodontal destruction
- "-statin" - "-olol" - "-ipril" - Amlodipine: I put Amlodipine (gingival hyperplasia,
- statins have actually been shown to improve periodontal treatment outcomes due to the osteoblastic activity induced https://www.intechopen.com/books/oral-diseases/adverse-effects-of-medica- tions-on-periodontal-tissues
21. Pt presents with white lesion, lateral anterior tongue. History of trauma
(continuously biting it, ect). Resembled a papillary lesion.
- papilloma - fibroma - squamous cell carcinoma: Use your best judgement. History of trauma leads
to fibroma diagnosis; but medical history may lead to papilloma. If described as "cauliflower" assume papilloma!
22. Pt has a history of multiple odontomas. What syndrome is suspected?
- Addison's disease - ectodermal dysplasia - Gardner's syndrome - Cushing's syndrome: Gardner's Syndrome
23. What is the treatment for a mucocele?
- corticosteroids - excision with local glands - biopsy - antifungal medication: cut. it. out. seriously, exorcise the demon (mucocele)!
24. Identify:
- mucocele - ranula - fibroma - papilloma - thermal injury - SCC - cold sore (herpes): - mucocele - bluish, swollen salivary gland
- ranula - mucocele but on the floor of the mouth
been present for an extended time (my question stem mentioned several months). SCC is more common on the lower lip vs upper lip.
26. A patient was diagnosed with Hepatitis A, presentation of jaundice. How
soon can you treat?
- 1 day - 1 week - 1 month - 1 year: 1 week
27. Patient presents with jaundice. Name three possible causes?: cirrhosis
Hep A Hep C
28. Pt presents with missing teeth and no hair. What is the likely medical
condition?
- Gardner's disease - ectodermal dysplasia - trisomy 21 - Paget's syndrome: Ectodermal dysplasia
29. Pernicious anemia is associated with:
- autoimmune destruction of parietal cells in stomach - acute, chronic blood loss - both: remember that pernicious anemia is associated with intrinsic factor from parietal cells, which is required to absorb B12 from food
30. What does intrinsic factor do?
- allows iron to bind to hemoglobin - prevents destruction on RBCs - required for absorption of vit B12 from food: Required for the absorption of vitamin B12 from food
31. Another version Pernicious anemia is caused by:
- Decrease in intrinsic factor (required for absorption of B12) - Chronic use of aspirin, NSAIDs, corticosteroids - A variant of hemoglobin A (called hemoglobin S) - Destruction of RBCs: decrease in intrinsic factor
- Schilling's test to evaluate B12 absorption; most commonly used to eval pts w/pernicious anemia
32. What is hemolytic anemia?
- autoimmune destruction of parietal cells in stomach - genetic defect, includes variant of hemoglobin A (called hemoglobin S)
bous
crowns
teeth
- yellow or brown discoloration
- teeth prone to damage, breakage
- sensitive teeth
- open bite malocclusion
- minimal to no enamel visible radiographically
37. Diagnose dentinogenesis imperfecta radiographically: - bul
- cervical constriction
- thin roots
- early obliteration of root canals and pulp chambers
38. Once thought to be associated with BLUE SCLERA and multiple bone
fractures
- hemolytic anemia - grave's disease
pernicious anemia
dentinogenesis imperfecta: dentinogenesis imperfecta
- question stem refers to a picture of blue sclera
39. All of the following are symptoms of hyperthyroidism except:
- fatigue - exopthalamus - tachycardia - tremor of extremities: fatigue is NOT a symptom symptoms include: nervousness, anxiety and irritability. hyperactivity - you may find it hard to stay still and have a lot of nervous energy. mood swings. difficulty sleeping. feeling tired all the time. sensitivity to heat. muscle weakness. diarrhoea.
40. Large space (diastema) between #11 and #12. What do you do?
- place implant - removable partial denture - fixed partial denture (bridge) - do nothing: let it be, let it be! let be, let it be... seriously, if it ain't broke, don't fix it.
41. The greatest disadvantage of resin bonded bridges?
- staining
- https://journals.sagepub.com/doi/abs/10.1177/074880689801500302? journal- Code=acsa
44. What is an advantage of a Maryland bridge?
- staining - debonding - fracture - less tooth reduction: less tooth reduction
45. Prep guidelines for PFM crowns: anterior vs posterior
- axial - occlusal/incisal: Anterior:
- labial: 1.5mm
- lingual: 1mm
- incisal: 2mm Posterior:
- axial: 1.5mm
- nonfunctional cusp: 2mm
- functional cusp: 2.5mm
46. Minimum height for posterior crown preps
- 1-2mm
- 2-3mm
- 3-4mm
- 4-5mm: 3-4mm
- a short clinical crown is defined as a tooth with <2mm of sound opposing parallel walls remaining after occlusal and axial reduction https://meridian.allenpress.com/operative-dentistry/article/41/6/666/194406/ Pre- molar-Axial-Wall-Height-Effect-on-CAD-CAM-Crown
47. Best initial treatment for maxillary oroantral fistula?
- antibiotics - irrigation - gauze pack - two of the above: two fo the above: antibiotics and irrigation
48. Medication taken for arthritis?
- propranolol - benadryl - naproxen - aleve: naproxen
