MCQs Flashcards
. Which of the following is not an exception to confidentiality?
a. Disclosure with patient’s consent
b. Disclosure within healthcare team
c. Disclosure to patient’s partner
d. Disclosure in connection with legal proceedings
C - disclosure to patient’s partner
Which of these is NOT a provision of the Mental Capacity Act 2005 that must be adhered to when a dentist makes a decision on behalf of an incapacitated adult?
a. Presume capacity in the first instance
b. Support decision making
c. Respect wise decisions
d. Promote best interests
A - respect wise decisions
Which one of the following words is NOT part of the 3 A’s of Anxiety?
a. Ask
b. Assess
c. Acknowledge
d. Address
B - assess
What was made from the mental capacity act 2005 that gives us guidance on capacity?
a. Code of Capacity
b. Code of Consent
c. Code of Practice
d. Code of Honour
B - code of consent
- What does Gillick competence concern?
a. Children
b. Adults
c. Elderly
d. Everyone
A - children
If a child was born before the 1st of December 2003, who has responsibility for them if their parents are divorced/ unmarried?
a. Both Parents
b. Mother
c. Father
d. Whoever they live with
B - mother
What are the five principles of the mental capacity act?
Presumption of capacity Individuals being supported to make own decisions Unwise decisions Best interests Less restrictive options
What are the components of anxiety and an example? (4 marks)
Physical - breathlessness, palpitations, sweating
Cognitive - inability to concentrate, poor memory function
Behavioural - avoidance, disruption, escape
What are the four factors implicated due to traumatic experience?
Patient - no dental care, delayed tx, more restorative work
Dentist - missed appointments, higher levels of stress, financial problems
18 month infant comes to see you with complicated crown fracture to upper lip. What 7 factors would you ask when taking a history?
- Attended with?
- C/O
- HPC - When
- Where
- How
- Lost teeth – fragments
- Concussion/ Amnesia/ Vomiting?
- Prev Trauma?
- Past MH
- Any associated injuries
What 8 things may lead to think child has suffered a non-accidental injury?
- Delay in presentation
- Withdrawn child
- Abnormal parent-child interaction
- Inconsistent Hx
- 50% lesions in Oro-Facial region
- Bizaare lesions in odd sites
- Fraenum tears / bite marks
- 10% burns
Define confidentiality and the main principles
The commitment/ duty to the patient to protect their information
- Patient’s right to privacy
- Practical necessity for condition of trust
Recognised exceptions to duty of confidentiality: GDC
- Disclosure with the patient’s consent
- must understand what, why and likely consequences - Disclosure within health care team (‘need to know’ basis)
- pt’s refusal must be respected - Disclosure without consent in pt’s medical interests
- pt too ill to ask
- consulting pt would cause them harm - Disclosure in interest of others
- Disclosure in connection with legal proceedings
- Disclosure in accordance with statutory requirements
- Disclosure for the purposes of clinical teaching, research or audit
Steps of answering a question regarding ethics
- What is the issue (e.g. confidentiality)
- Define the issue
- What is the specific concern in this case?
- What would you do about this problem?
Types of negligence
Covers 3 areas:
1. Duty of care - assumed all the time for dentists
2. Breach of duty
3. Damage due to breach of duty
Can be fault of diagnosis, treatment or consent
If there is an emergency beyond your scope of practice what should you do?
- Stop
- Tell pt
- Temporarily patch up
4, Urgent referral
Tests for negligence
Bolam: in relation to diagnosis or tx
-what any reasonable dentist would do
Montgomery: in relation to consent
-speak to pt
-all known risks of procedure that any normal pt would want to know; material risks
-also other risks that individual pt might want to know e.g. how many needles to phobic pt
Financial compensation in relation to negligence
Isn’t punitive in UK - have to prove in worse off state than before, then given money to get back to starting point
Components of consent
Based on autonomy
- Information
- Capacity
- Voluntary: feels free to choose
- Patient must make the decision
Principles of Mental Capacity Act 2005
Do minimum tx possible if pt is unable to consent and in immediate danger
- Presumption of capacity
- Support to make own decisions
- Respect unwise decisions
- Promote best interests
- Less restrictive options
What to do if patient is drunk and leaves hospital before tx
- Call when they have sobered up
- Ask him to come back in/make new appointment
- If this doesn’t work, call his GP
- this is a breach of confidentiality but your concern for his health should justify this breach
- let GP know that he may need future care
- this is NOT to ask GP to persuade him to be treated
Test for cacacity
Understand info
Retain info
Weigh up info
Communicate info
When can’t a patient consent?
Life of death situation Public health affair by law Minor/ pt who lacks capacity Harm to get consent Mental Health Act part 4
Test for Gillick competence
Understand
- treatment details
- failure of treatment
- alternative to treatment proposed
- consequences of doing nothing
What would you do if your patient is choking?
Mild: encourage them to cough
Severe: Lean patient forward, 5 back blows between shoulder blades with heel of hand, check if blockage has cleared, if not give up to 5 abdominal thrusts
How long to acid etch for?
35% phosphoric acid
40s for fresh enamel
20s for milled or burred enamel
PRR steps
LA and rubber dam advisable
Suspect areas of fissures explored with high speed diamond - only enough to gain access
Caries removed
Leave undermined enamel in situ!!! As bis-GMA virtually restores strength of tooth
Line cavity with CaOH, etch, wash, dry, bond, fill
Seal fissures with fissure sealant
Best way to achieve initial rapport with a patient
Greets patient and obtains patient’s name
Introduces self and clarifies role
Demonstrates interest and respect, attends to patient’s physical comfort
For how many anxious patients was fear named as the main barrier to treatment?
45%
Medical and social model of disability
Medical: disability is functional limitation which is biologically or physiologically determined
Social: institutional/ societal oppression which disables those who have impairments through attitudinal or structural barriers
-medicine is part of the problem as it puts people in a box so they can get the resources they need
Causes of dental anxiety
Learning -classical conditioning: traumatic/ negative experiences -observational: friends, family, media Uncertainty, "fear of the unknown" -lack of control -inadequate information -pain Personality -of pt: generalised anxiety, neuroticism -of dentist: impersonal, uncaring, disinterested, poor communication skills
