Mock OSCEs Flashcards
what are the 5As you need to do when trying to refer someone for smoking cessation
ask
advise
assess
assist
arrange
what questions should you ask for the Ask section of 5As
do you smoke
what do you smoke
how often do you smoke
how long have you smoked
why do you smoke
do you have kids in the house
what should you tell the patient with regards to advising about smoking cessation
smoking is harmful to general health
smoking is detrimental to oral health
money and bad breath problems
how would you assess a pt’s willingness to quit
ask - are you interested in giving up now, any motivations to quit, have you tried to quit in the past, if so why not successful
how do you assist a patient to stop smoking
ask them if they want help from local smoking cessation services
4 x more likely to quit
nicotine replacement therapy
where should you signpost patient to if they would like to quit
pharmacy
GP
Quit your way Scotland
what would a patient with orbitozygomatic fracture present with
lacerations
nasal bleeding/ deviation/ patency
facial asymmetry
limited mandibular movement
how would you examine a patient for orbitozygomatic fracture
palpation of zygoma bilaterally
examine sensation of infra-orbital region - upper lip, lateral nose and lower eyelid
eye exam - pupillary reaction to light, ask if double vision, eyeball mobility assessment
how would you manage a patient with orbitozygomatic fracture in practice
urgent phone call to OMFS at A&E for urgent referral
surgical management - ORIF if symptomatic (diplopia/asymmetry/enophthalmos)
conservative management - if displaced, asymptomatic or more than 1 month old
how would you assess a patient for XLA who is taking warfarin
ask about INR level
ask if pt knows their INR
ask when INR was last taken
ask to see patient’s INR book
ask if INR is stable
how would you tell a patient in pain that is taking warfarin that the tooth cannot be XLA’s today
due to high risk of bleeding because of your medication (warfarin) your INR values are above the recommended level for safe extractions
how long before an extraction should a patient taking warfarin’s INR levels be checked
ideally within 24 hours, can be 72 hours if stable
stable = INR < 4 for last 3 months
what questions are asked on a BBV screen after sharps injury
have you ever been diagnosed with HIV/ hep B/C
have you ever injected drugs
have you ever had sex with another man
have you had sex with someone outside of europe, canada, USA, australia or New Zealand
have you had a piercing or tattoo done by unlicensed artist in UK or other country
what type of drug is alendronic acid
bisphosphonate
what is the action of bisphosphonate drugs
they reduce the turnover of bone
they accumulate in sites of high bone turnover
what is the relevance of bisphosphonates to dentistry (4)
risk of poor wound healing following XLA
need to remove any teeth of poor prognosis prior to starting bisphosphonates
important to prevent tooth loss in future
reduced turnover of bone and reduced vascularity can lead to death of bone - osteonecrosis - specifically MRONJ
what are the 6 handpiece safety checks
back cap checked - grip and turn anticlockwise
bur security checked - suitable force applied to remove bur
bur rotated laterally with fingers - attempts to spin but
attempts to move bur laterally - pushes bur from side to side
tension applied to handpiece when fitted to coupling
handpiece sound tested whilst running - run for 5 seconds at least
how would you treat an enamel dentine fracture with pulp exposure in a tooth with immature apex
pulpotomy
LA
rubber dam
remove enamel and dentine covering pulp chamber - remove coronal pulp
irrigate with saline
get bleeding to stop with cotton wool soaked saline
place MTA or ZOE
place composite restoration
what is the aim of pulpotomy
partial removal of pulp
aim to keep undamaged pulp tissue alive
so the tooth stays alive and continues to grow
what tests are required before pulpotomy
sensibility - test the affected tooth and adjacent teeth
this is so long term monitoring can occur
what is the SPIKES model
For breaking bad news
setting - sit down at level with patient
perception - is pt aware of what is going to be discussed
information - inform pt you have results
knowledge - give a warning phrase, give them the information and let it sink in
empathy - ‘i am deeply sorry to break this to you’
summary - repeat news
what is post op instructions for fluoride application
soft diet for rest of day
no dark coloured foods
dont eat/ drink for 1 hour
how is fluoride overdose treated
5mg/kg - milk
5-15mg/kg - ipecac syrup, milk, possible referral
more than 15mg/kg - hospital referral
what advice would you give to manage denture induced stomatitis
palate brushing daily
cleaning denture - brush at meals with denture cream and non-abrasive denture cream and soak in chlorhexidine mouuthwash for 15 mins 2x daily
leave denture out at night
what may patients with chronic OAF complain of
fluids from nose
speech and signing of nasal quality
problems playing wind instruments
problems smoking or using a straw
bad taste
sinusitis type symptoms
what is OAC
an acute communication between maxillary air sinus and oral cavity
what is OAF
chronic communication between maxillary sinus and oral cavity which has healed by epithelialising forming a sinus and a permanent communication
how is an OAF treated
excise sinus tract/ fistula - removing epithelium
buccal advancement flap
amoxicilling 500mg TID 7 days
post operative instructions following OAF diagnosis
avoid blowing nose or stifiling sneeze by pinching nose
steam or menthol inhalations
avoid using straw
refrain from smoking
what is primary herpetic gingivostomatitis
contagious primary infection caused by herpes simplex virus
self limiting - disappears in 7-10 days
most often occurs in small children and usually first exposure child has to herpes virus
how does primary herpetic gingivostomatitis present
blisters on tongue, cheeks, gum, lips and roof of mouth
after blisters pop ulcers will form
high fever, difficulty swallowing, drooling and swelling
dehydration can occur
treatment for primary herpetic gingivostomatitis
push fluid intake
analgesia to control pain and fever
bed rest
clean teeth with damp cotton wool
use dilute chlorhexidine to swab gums
aciclovir recommended if very severe or pt is immunocompromised - 200mg tablets 1 tablet five times daily for 5 days
what are the crown prep principles
ideal taper 6 degrees
retentive groove/ slots
bevel functional cusps
two plane buccal reduction
smooth prep margin at gingival margin
when is a denture reline carried out
when fitting surface of denture inadequate but denture otherwise okay (occlusal plane/ OVD/ profile)
how do you take a reline impression
take functional impression using light-body PVS using denture as tray
functional = get pt to bite down as PVS sets
how do you carry out a tooth trial
check denture extension, support and retention
inform pt trial denture will be looser due to wax instead of acrylic
speech
aesthetics
mark post dam on cast
what are the five headings for treatment planning
immediate - pain
initial - HPT, removal of non-symptomatic teeth of poor prognosis, NCTSL management, caries management, endodontic tx
re-evaluation - perio tx
re-construction - dentures, bridgework ect
maintenance - perio, NCTSL
how would you explain tx to an 8 year old patient who has had an EDP # on 11
the tooth has fractured in a way that has affected all 3 structures of the tooth, and has affected the nerve of the tooth
we will need to do tests on injured and adjacent teeth to see if the nerve is alive
treatment will be pulpotomy due to large exposure of nerve
explain the procedure of a pulpotomy
involves partial removal of the pulp (nerve tissue) to keep undamaged pulp tissue alive so it can continue to grow
- LA injection
- rubber dam
- drilling to remove pulp tissue and leave good tissue
dressing - setting CaOH or MTA
restoration - composite
how would you treat a hypoglycaemic medical emergency
signs - patient is pale, shaky, sweaty, clammy, dizzy, confused, blurred vision, loss of consciousness
if conscious and cooperative - administer oral glucose 10-20g or sugary drink
if unconscious/ uncooperative - 1mg IM glucagon injection and oral glucose when regain consciousness
reassess - ABCDE
call ambulance - location, number and describe pt condition
what is the IM technique for administering glucagon
inject diluting solution in vial with glucagon powder
swirl to mix - do not shake or will foam up
syringe solution back to syringe
use Z-track technique to inject to thigh or bicep
- spread skin, advance needle in skin at 90 degrees, aspirate, inject 30 seconds, pull out and release tension
how would you manage an epileptic seizure
sings - loss of consciousness, uncontrollable muscle spasms, drooling, falls rigid (tonic), sharp jerky movements (clonic), hypotension, hypoxia, loss of airway tone
ABCDE assessment
do not try to restrain pt
ensure pt not at risk of injury
secure airway
administer 100% oxygen 15l/min
if fit >5mins administer midazolam 2ml oromucosal solution 5mg/ml to buccal cavity
repeat after 5 minutes id not worked
when would you refer a patient who has had an epileptic fit to hospital
first seizure
seizure is atypical
injury was caused
difficult to monitor patient
what is the NHS complaints procedure (7 steps)
- acknowledge complaint and provide patient with practice complaint procedure
- inform the dental defence organisation if you require advice
- inform the patient of timescales and stages involved
- acknowledge complaint in writing, by email or telephone as soon as you receive it 3 working days maximum but ideally within 24 hours
- early resolution 5 working days
- investigation 20 working days for issues that have not been resolved in the early resolution stage
- independent external review ombudsman for issues that have not been resolved
what are treatment options for a 20 year old patient with class III malocclusion
accept and monitor
intercept with URA - procline uppers
growth modification (not applicable) - reverse twin block
camouflage - accept underlying skeletal pattern but move teeth to hide it
orthognathic surgery with combined ortho
how long is a tooth monitored for after placing an indirect pulp cap
3 months and if vital and asymptomatic the provisional restoration should be removed and definitive restoration placed
if symptomatic then RCT required
