OSCE 2016 Flashcards
What type of hand hygiene would you perform when the patient first comes into the surgery?
Hygienic handwash
Soap and water.
Demonstrate the six steps for hand hygiene
1- Palm to palm 2- Right palm over left dorsum and left palm over right dorsum. 3- Palm to palm, fingers interlaced. 4- Backs of fingers to opposing palms with fingers interlocked. 5- Rotational rubbing of right thumb clasped in left palm, then vice versa. 6- Rotational rubbing, backwards and forwards with clasped fingers of hand in left palm then vice versa.
What PPE would you wear after carrying out hand hygiene?
Mask, apron, visor, gloves
What are the areas of primary support in the maxilla and mandible for pros?
Palate and maxillary tuberosity and rugae (secondary)
Retromolar pads and buccal shelf
What are the post-op instructions after Ex of 36.
Rest up after
No smoking or drinking for 24hrs
Do not explore the socket
Will experience numbness but don’t worry is normal
May experience pain also but take paracetamol, if the pain does get worse then indicates possible infection so see a dentist.
Swelling is normal
Bleeding should be minimal when leaving but the instruction of biting down on damp gauze should be given. If this doesn’t stop it then call NHS 24.
stitches should dissolve after 7-10days unless told otherwise
Do not rinse mouth for first day
What are the 5As for smoking cessation?
Ask Access Advise Assist Arrange to follow up
What are the 3A’s for smoking cessation?
Ask - record the smoking status with various questions
Advise - Patient on the personal health benefits
Act - on the patient’s response, refer to the pharmacy, NRT and track care etc
An actor with radiating chest pain, and left arm pain after climbing up the stairs but the pain is relieved upon rest? Diagnosis
Stable angina
What LA is safe for a pregnant person?
Lignocaine
What is the gold standard for moisture control?
Dental dam
Other benefits of dental dam apart from moisture control?
Patient protection from debris
Improved access and visibility
Increased efficiency
Infection control
Demonstrate the aids you would use for good moisture control for a FS?
Use dry guards
Cotton wool roll (don’t forget to change after washing the etch off)
Ask nurse to place saliva ejector
What are the numbers put in front of Adams pliers?
64 Adam’s pliers
65 are the coil formers
What are Adam clasps used for?
Retention
When taking a pain history what is the acronym you would use and what does it stand for?
SOCRATES Site Onset Character Radiate Associated symptoms Time Exacerbating factors Severity
What differentiates stable angina from unstable angina?
Stable angina, the chest pain is relieved when resting.
How does an MI differentiate from angina?
The pain is more severe and persistent, isn’t relieved by rest.
Is also a complete blockage in the heart as opposed to a partial blockage
In a medical emergency, how would you treat stable angina?
GTN spray sub lingually 400micrograms
oxygen 15L/min
What are all the different medical emergency medications that you will need to know about? (7)
Only stunning Men are actually getting girls Oxygen Salbutamol Midazolam Adrenaline Aspirin GTN spray Glucagon
Tx for an MI?
Crush up 300mg of aspirin allow it to absorb into oral mucosa then call an ambulance.
oxygen also
Describe symptoms of a patient presenting with reversible pulpitis.
Pt will have pain upon stimulus to hot or cold but that sharp pain will only last 10-15 s before going away. (A delta fibres)
Inflammation of the pulp will return to normal once the source is removed (caries)
Describe symptoms of a patient presenting with irreversible pulpitis.
Dull aching pain that is spawntaneous.
Can keep the pt up at night and worse when lying down.
Apon stimulus to hot, cold and sweet the pain can then linger for minutes up to hours.
THe inflammation of the pulp will not be resolved by removal of the source, therefore RCT or Ex required.
Talk through how you would set up a needle for LA Ex of 26.
Check the batch number and expiration date.
Would set up the needle with ultra safety plus system for a infiltration
25mm needle, apply topical if needed.
Aspirate and give 2/3 of cart to the buccal side
Then rest for palatal.
Double click sheath down and dispose in correct sharps bin and LA bin.
What type of LA ingredients or LA should be avoided for pt with heart problems?
High amounts of adrenaline
Why is adrenaline added to LA?
As it acts as a potent vasoconstrictor which maximises the time the LA is in that area, meaning you don’t need to give such high dosages for the same effect.
What type of LA should be given to pregnant pt’s?
Lidocaine
Avoid bupivacaine
What are the 3 types of handwashing?
Social
Hygenic must use alcohol gel after
Surgical
How would you go about giving a radiographic report?
Say what type of radiograph What teeth are present Is it satisfactory or not Apices Bone levels Caries Any fillings, crowns and RCT
Eruption order for permenant and primary teeth?
ABDCE
U- 61245378
L- 61234578
Name all of the forceps.
Upper straight/universal, premolar, molar L +R, Bayonets, Root
Lower straight, molar, root, cowhorn
Name all of the elevators
Couplands
Warwick James
Cryers
What is the difference between a Coupland and a luxator?
Couplands are round and smooth whereas luxators are sharp and are used to break the PDL before Ex
What is the standing position for Ex of teeth?
Stand behind the pt for only Ex of lower right , the rest stand in front of the pt.
What would you write on the lab card for complete denture stage 1? Primary to special trays?
Please pour up primary impressions in 50:50 dental stone/plaster
Make special light cured trays with 3mm upper spacer for alginate and 2mm for silicone and polyether.
For lowers 0.5mm spacer
And an extra oral handle
What would you write on the lab card for complete denture stage 2? special trays to Jaw reg?
Please pour up secondary impressions in 100% dental stone and construct upper and lower wax record blocks on a shellac base to record the occlusal relationship.
What would you write on the lab card for complete denture stage 3? Jaw reg to tooth trail.
Please mount casts on semi-adjustable articulator using the jaw reg provided.
Then with the shade and mould set teeth for tooth trial
What would you write on the lab card for complete denture stage 4? Tooth trial to delivery?
Finished
Please prepare post dam to distance marked on casts.
Please create a finished heat-cured acrylic denture.
If you’re not happy with the tooth trail instead of going to delivery what can you do?
Re-trial
Write an ortho lab prescription card to correct an anterior crossbite.
Please construct URA to correct the anterior crossbite. A - Z-spring 0.5mm HSSW on 21 R - 14,24,16,26 Adam clasps 0.7mm HSSW A - fine as one tooth B - Self cured PMMA and FPBP
If you’re not happy with the tooth trail instead of going to delivery what can you do?
Re-trial
Write an ortho lab prescription card to correct a posterior crossbite.
Please construct URA to correct the posterior crossbite. A - mid palatal screw R - 14,24,16,26 Adam clasps 0.7mm HSSW A - tick and cross B - Self cure PMMA with FPBP
Write an ortho lab prescription card to move the canine posteriorly (retracting).
Please construct URA to move canines posteriorly.
A - 13,23 palatal finger spring 0.5mm HSSW with guard
R - 11,21 Southend clasp and 16,26 Adams clasp with 0.7mm HSSW
A - fine
B - Self cure PMMA
Write an ortho lab prescription card to move the canine palatally.
Please construct URA to move canines palatally.
A - Buccal canine retractor on 13,23 with 0.5mm HSSW and 0.5mm tubing.
R - 11,21 Southend clasp and 16,26 Adams clasp with 0.7mm HSSW
A - fine
B - Self cure PMMA
Write an ortho lab prescription card to correct overbite and move canines palatally.
Correcting Overbite & Moving canines palatally
A: 3|3 buccal canine retractors 0.5mm HSSW & 0.5mm tubing – strength & rigidity
R: Adams clasp 0.7mm HSSW 6|6 Southend clasp 0.7 HSSW 1|1
A: …..
B: Self cure PMMA
FABP for 6.5mmm O/J = 9.5mm FABP
What are the 5 parts to an Adams claps?
The bridge The arrowhead the flyover the leg the tag
Tx for ANUG?
Give pt OHI Gentle debridement under LA 0.2% chlorhexidine mouthwash for 7 days Smoking cessation and advised rest. If systemic then can give AB Metronizole 400mg 3x daily for 3 days Or amoxicillin 500mg 3x daily for 3 days
What are some predisposing factors for ANUG?
Smoking Drinking Poor OH High levels of stress Lack of rest Persistent gingivitis
What are the stages for BLS?
DRSABC Danger Response - shout and shake the patient Shout - for help call 999 Airway - is it clear Breathing - Are they breathing, listen and look Circulation - can you feel a pulse If not too all of these need to call 999 and start compressions immediately.
What are the compression rate for BLS and the ratio to ventilations?
120/min
30/2 breaths
What are the 8 hand scalers and their function?
Mini sickle - supra anywhere in the mouth Columbia - supra and sub anywhere in the mouth Grey gracey - anteriors Green gracey - posteriors Orange gracey - mesial Blue gracey - distal Yellow hoe - buccal and lingual Red hoe - mesial and distal
What are the seating positions for hand scaling?
7 o’clock for lower anterior
9 o’clock for buccal 44-48, 14-18 and lingual of 34-38
11 o’clock for the rest
What post-operative instructions would you give a pt after Ex of a tooth?
Rest
No smoking drinking for 24hrs
Avoid exploring the socket
Take paracetamol before LA wears off to reduce pain
Do not rinse the area until the next day but do then rinse with warm salty water
avoid hot food and eating on that side for 24hrs
Brush as normal
If you have any bleeding after, bite down on some damp gauze and maintain pressure for 15mins if the bleeding doesn’t stop then call NHS 24 or 111
What kind of instructions would you give a new denture pt in terms of denture hygiene and their denture?
Instruct them to wear as much as possible and that it will take time for the muscles to get used to it.
Advise of pain but if really sore to come back in.
Take out at night and clean with warm soapy water
What other solutions can be good for cleaning dentures and why?
Alkaline hypochlorites Superior cleaning properties Dissolution of plaque Removes stains Bactericidal and fungicidal properties
What are some downsides of using alkaline hypochlorites as a denture cleaning solution?
Can bleach the denture
Corrode CoCr
Leave a lasting taste
What are corticosteroids? and what can they be used for?
They are human-made steroid hormones that are used to reduce the inflammatory response from the body.
Used to treat eczema, arthritis etc
What is ledermix and what can it be used for?
It is an antibiotic and steroid medicament used to treat and reduce inflammation of inflamed pulps and slow down resorption after traumatic injuries.
What type of material is Riva?
GI
What type of material is vitrebond and Relyx?
RMGI
What type of mateiral is Dycal?
Setting CaOH
What are 3 uses of NS CaOH?
Direct pulp capping
Lining material for deep cavities
Indirect pulp capping procedures with carious dentine
What makes S CaOH a good RCT, intracanal medicament?
It eliminates any remaining microbes after chemomechanical preparation is complete
What makes S CaOH good for pulp capping?
Preserves vitality of the pulp with no inflammatory response
Stimulates the formation of a mineralised tissue barrier.
What does LIMBO stand in relation to tooth trail?
Lip support - making sure the record block isn’t too bulky and lips can get all the way around. NLA should be 90 degrees.
Incisal level - parallel to the interpupillary line and also must not be too low
Midline - incisal frenum
Buccal corridor - Buccal gap when smiling
Occlusal plane - Flat and parallel to the ATL
The contour of the occlusal rim is marked to show the flat area of the ridge. Why is this?
To show the technician where the teeth should be set along the alveolar ridge.
In the neutral zone.
When giving adrenaline, what type of technique is used to administer and wherein the body is it given?
Z track technique
In the leg
If blood appears in the syringe when giving adrenaline what should you do?
Go 1mm deeper
What effect does adrenaline have on the peripheral and central parts of the body?
Its a potent peripheral vasoconstrictor and a potent central vasodilator
For someone in anaphylaxis shock what dose of adrenaline should be given and then how often should you repeat it? (adult)
0.5mg (1 in 1000 0.5ml) This should be done every 5mins at different sites.
Explain some advice you would give to a pt after a review of their diet diary?
Identify any hidden sugars, flavoured water, sugar medications
Sweets only at mealtimes
reduce the frequency of sugar attacks
Milk and water to drink
Watch out for low pH drinks like diet coke as can cause erosion.
What is the residual alveolar ridge?
The remaining ridge is left after the loss of Ex of teeth.
It is important for the setting of posterior teeth.
Vitrebonnd is a lining material, what are the main contents of it?
Fluroaluminosilicate glass powder
What dose and type of oxygen and oxygen mask do you give to a pt in an emergency?
15L/min
non-rebreathable mask
What dose of salbutamol is given to a pt having an asthma attack?
100 micrograms
What dose of midazolam is given to a pt having continuous or prolonged seizures?
10mg
What dose of adrenaline is given to someone in anaphylaxis?
0.5mg or (1 in 1000 0.5ml)
What dose of aspirin is given to someone with suspected MI and how is it administered?
300mg of crushed aspirin so can be absorbed in the oral mucosa
What dose of GTN spray is used for someone with suspected angina?
400 micrograms
What dose of glucagon is used for someone in a hypo?
1mg IM
What are the 3 main causes of anaemia?
Blood loss
Destruction of RBC
Faulty production of RBC
Describe iron deficiency anaemia and how it looks on blood results?
Body doesnt have enough iron to therefore make enough RBC.
Low RBC count, low Hg, Hct, MCV and ferritin levels.
Describe Pernicious anaemia and how it looks on blood results?
The body cannot use vit B12 to produce RBC
Low vit B12 levels and low level of RBC
Describe aplastic anaemia and how it looks on blood results?
The body stops producing enough blood cells.
Meaning low levels of platelets, WBC and RBC
Describe haemolytic anaemia and how it looks on blood results?
When the body destroys blood cells within the body faster than they are being made.
Results in low levels of Hg
Describe sickle cell anaemia and how it looks on blood results?
This is damage to the Hg within the RBS and results in chronic low levels of oxygen
Describe thalassemia and how it looks on blood results?
Less Hg than normal
Results in low levels of Hg
What instruments are present in a CONS kit?
Probe (explorer)
mirror
BPE (CPITN probe)
Tweezers
In terms RPD what does RPI stand for and when would you use one?
RPI Rest (on the mesial side) Proximal plate I Bar Used for abutment teeth with long free end saddles.
Give an example of everything involved in the prescription of a partial denture lab card?
Must include drawing with design.
Then any modification that needs to be made must be stated, like rest seats and composite for undercuts.
Support - rests for free end saddles on the mesial aspect.
Retention can have occlusally approaching clasps engaging certain undercuts. As well as gingivally approaching clasps
Reciprocation claps to stabilise the tooth
Then the type of connector, lingual bar, plate etc
Explain how the Kennedy classification system works?
1 - bilateral free end saddle 2 - unilateral free end saddle 3 - bounded saddle 4 - Anterior saddle then any additional saddles count as a modification
Explain how the Craddock classification works?
1 - tooth-borne
2 - mucosal borne
3 - Both tooth and mucosal borne
What is the ratio of liquid to powder when mixing GI?
Liquid 2 - powder 1
What is the smile line also referred to as?
high lip line
What is the function of the periotome instrument?
Used for atraumatic Ex, to minimise damage to soft tissues and the alveolar plate
What is the concentration of F in mouthwash?
225ppm
But some online say 450ppm
What is the minimum possible lethal dose of fluoride?
5mg/kg of body weight