OSCE Medical History Flashcards
What follow up questions would you ask if the pt says they have :
angina
does the pain come only after physical activity or can it happen spontaneously at
rest? When
was the last time you had angina? When was the last time you saw your GP about this
condition? What treatment are you taking for it? Have you brought your GTN spray with you
today? For unstable angina, ensure that dental care is carried out in a suitable facility
(perhaps refer to secondary dental care), or postpone treatment until after you have liased
with the clinician.
What follow up questions would you ask if the pt says they have :
Myocardial infarction:
when did you have your MI? what medication have you been taking
since? Did previous heart issues e.g. angina prior to the MI? Do you smoke? Postpone
elective treatment till 3-6 months later. Note that for patients with cardiac failure, do not lie flat
(they may have pulmonary oedema and so may have orthopnea).
What follow up questions would you ask if the pt says they have :
Diabetes
what type? What treatment are you taking for it (note complications of hypo
drugs)? Would you say the diabetes is well controlled? Have you eaten today? Have you
taken your medication after eating (if no, how long ago did they eat?)? Do you have your
medication on you? Do
you have a sugary snack or drink with you? Do you have your glucose record book with you (if not,
inform patient that you will need to contact their doctor to find out exactly how well controlled their
diabetes is)? Implications: Some procedures require fasting (e.g. XGA) – for fast procedures = ‘fast
and check’: omit morning insulin/medication, do procedure, then give a late breakfast with normal
medication. Monitor glucose before and after. For long procedures you’d need to give IV GKI infusion.
What follow up questions would you ask if the pt says they have :
Hepatitis A-E
when were you diagnosed as having it? Have you been to the doctor to get
blood tests since? (f they’ve had HepB antigens for more than 6 months, they’ve got chronic
hepatitis). Do you bruise easily? Any history of drug intolerance? Implications: If liver isn’t
working optimally then LA metabolism may be impaired; opt to use prilocaine or articaine
which are partially metabolized in the lungs and plasma respectively and which therefore
lessen the metabolic burden on the liver. Alternatively, use Lidocaine but limit the dose to 2-3
cartridges. Avoid IDB, but if unavoidable then you have to inform the patient that bleeding into
the muscle may stiffen the jaw for a few days, but reassure them that this is only temporary.
Liase with GP/hepatologist to discern severity of liver disease: if severe, patient may need to
be referred to secondary dental care to receive FFP transfusion peri-opertively to replace any
clotting factor deficiencies the patient may have. If patient says it’s fine for you to treat them
then bare in mind that you will have to secure local haemostasis e.g. suturing, backing with
resorptive dressings e.g. surgical/gelaticel, etc.
What follow up questions would you ask if the pt says they have :
Haemophilia A/B
are you registered to a haemophiliac centre? Do you have your green
haemorrhagic states card with you (the contact details of the centre can be found on this)?
Complications: Lack of factor 8/9 can cause excessive bleeding in procedures such as XLA.
Patients with mild haemophilia A may require DDAVP (synthetic analogue of vasopressin)
infusion pre- operatively. Severe haemophiliacs will require factor replacement therapy. Avoid
LA regional blocks when possible, secure local haemostasis as with Hepatitis, and prescribe
4.8% tranexamic acid mouthwash – take 4 times daily per day for 2 days.
What follow up questions would you ask if the pt says they have :
Asthma
how severe would you say your asthma is? what triggers the asthma? when was
your last attack? how is your asthma being treated/managed? Do you have your inhaler with
you? Clinical relevance: avoid using Duraphat fluoride varnish; use Profluorid instead. Also,
patients who inhale corticosteroids e.g. beclometasone can get oral candidiasis and
hoarseness of voice. Advise gargling water after inhaltion or using a spacer can help reduce
these symptoms.
What follow up questions would you ask if the pt says they have :
Adrenal Insufficiency
questions to ask: How long have you been diagnosed with this?
When was the last time you had an addisonian crisis? When was the last time you saw your
GP? Was your GP happy with the way your Addison’s disease was being controlled? What
treatment are you taking for it? dental treatment can cause physiological stress; it’s
recommended by the Resuscitation Council UK guidelines that some patients, especially
those with Addison’s disease, have prophylactic cover: for simple LA procedure e.g. fillings,
monitor blood pressure and if it drops below 25% diastolic 100- 200mg IV hydrocortisone (you
may need to refer them to secondary dental care. For major LA procedure – double patient’s
dose of steroid medication one hour prior to surgery; they will have to remain at this elevated
dose for 24 hours after the procedure. Procedures under GA – IV hydrocortisone (100-
200mg) one hour before surgery.
What follow up questions would you ask if the pt says they have :
High blood pressure
2) low blood pressure
Do you know the measurements for your blood pressure? (liase with
doctor before performing treatment to check if it’s okay to treat), drugs etc.
2) same questions as above; may get orthostatic hypotension (bring them
up from the dental chair slowly)
