What are the ADA recommendations for when pre-med is required
- prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts
- ... [Show More] 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
41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular abnormality); allergy to penicillin. Positive history of infective endocarditis. 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....
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/pregnancy/my-body/is-it-safe/antibiotics-and-pregnancy/
What procedure can a dentist perform without consulting MD if a patient is currently taking bisphosphonates?
- endo therapy
- prophy and scaling
- extraction
- occlusal restoration
occlusal restoration
although the main HELL NO is extraction, completing endo therapy increases risk if the apex is compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not specify supragingival, decided that the risk of scaling can negatively affect the periosteum of a bisphosphanate patient. ADA recommendations:
http://www.centreoms.com/admin/storage/news/ADA%20Recommendations%20for%20Treatment%20of%20Patients%20on%20Bisphosphon.pdf
Pregnant person afraid of needles - stress management by putting patient in what position when in your chair (BEFORE they even get to the point of passing out)?
- supply oxygen
- place in Trendelenburg
- make patient sit up straight
- tell them to suck it up buttercup
place her in Trendelburg position.
- supine hypotension in 3rd trimester usually occurs (bc compression Inf vena cava) => must prevent this in dental chair bc it can cause patient to pass out.
- Best preventative treatment for supine hypotension is to turn the patient, preferably to the left side, to displace the uterus away from the inferior vena cava. The patient can also be placed in a sitting position with the knees flexed.
6 months pregnant had bleeding gums and mobile teeth, how should they be treated?
- immediate extractions
- do not treat until baby is born
- 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.
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
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
Pentobarbital (Nembutal) and Secobarbital (Seconal) are what type of drugs?
- benzodiazepines
- NSAIDS
- barbituates
- atypical antipsychotic
barbituates
- used primarily evening BEFORE appointment
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
A patient is on a steroidal medication. What information do you need to obtain before treating them?
- dose and pharmacy that filled the RX
- duration of prescription
- both dose and duration
dose and duration
- "The rule of twos": Ask whether the patient is currently on steroids or has been on corticosteroids for 2 weeks or longer within the past 2 years. You must go back 2 years in the history because it can take 2 weeks to 2 years for the adrenal glands to bounce back to normal function.
What is the most important factor when calculation medication dosage for a child
- age
- weight
- gender
- height
weight
A patient is confirmed to have trisomy 21. What are you initially concerned about?
- congenital heart defect
- Cushings
- cerebrovascular accident
congenital heart defects; however, early onset periodontal 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
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 (Persan- 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.
What is the main symptom that differentiates anaphylaxis from syncope?
- bronchoconstriction
- clammy skin and pallor
- nausea, vomiting
Anaphylaxis is accompanied by wheezing, bronchoconstriction
- 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-headedness, and blurred vision are commonly experienced.
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
- the patient has no antibodies to HIV-1 present.
the patient does not have HIV antibodies
- consider that false negatives are a thing, life happens. We cannot definitively say they do not have HIV,but we can say that no Ab were detected.
14 year old presents with inflamed gingiva. Bloodwork indicates abnormal RBC, WBC, and platelets. Diagnosis?
- normal 14 year old
- hypothyroidism
- leukemia
- anemia
leukemia --> high WBC, lymphadenopathy, painful gingiva. Don't forget that WBC can be elevated OR decreased in leukemia! Gingival hypertrophy is a common sign/symptom
Stem indicates patient has recently taken medications, which one likely caused the rash present on their arm?
- Acetamiophen
- Barbituates
- Penicillin
- diphenhydramine
Penicillin allergy
- hives is a common response to penicillin allergies
Name the drugs that induce hyperplasia
calcium channel blockers, cyclosporines, anticonvulsants, immunosuppressants
- nifedipine, amlodipine, phenytoin, sodium valproate, phenobarbitone, ethosuximide
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-medications-on-periodontal-tissues
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!
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
- colorectal polyposis
What is the treatment for a mucocele?
- corticosteroids
- excision with local glands
- biopsy
- antifungal medication
cut. it. out. seriously, exorcise the demon (mucocele)!
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
- fibroma - benign scar-like reaction to constant irritation/trauma
- papilloma - wartlike lesion; likely positive hx of HPV
- thermal injury - hx of hot food/drink; sudden occurence
- SCC - shallow, ulcerated lesion
- cold sore (herpes)
image
Pt presents with shallow ulcerated lesion on the lower lip that has been present for several months. Has been a farmer for several years. Likely diagnosis?
- squamous cell carcinoma
- traumatic burn
- apthous ulcer
- mucocele
Squamous cell carcinoma
- ALWAYS pay attention to medical history. Knowing that he is a farmer, you know that he spends the majority of his time in the sun; also knowing that the lesion has been present for an extended time (my question stem mentioned several months). SCC is more common on the lower lip vs upper lip.
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
Patient presents with jaundice. Name three possible causes?
cirrhosis
Hep A
Hep C
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
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
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
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
What is hemolytic anemia?
- autoimmune destruction of parietal cells in stomach
- genetic defect, includes variant of hemoglobin A (called hemoglobin S)
- RBCs destroyed, removed from bloodstream before normal lifespan is over
- Folic acid is deficient, patient presents w/neurologic symptoms
destruction of RBCs (think about it. hemo (RBC) lytic (destroy))
Hereditary Hemorrhagic Telangiectasia is associated with:
- B12 deficiency
- Pernicious anemia
- Iron deficiency
- hypertension
Iron deficiency
"Iron deficiency anemia"
Pt presents, upset with look of with canine and premolar area; spotted (pick up stains), pits and grooves on outer surface of teeth. Likely diagnosis
- hypoplasia
- hyperplasia
- abfraction
- erosion
hypoplasia; consider that fact it is localized, likely not related to systemic disease
Several spots with yellowish concave areas in cervical 1/3rd of anterior teeth. Likely cause?
- erosion
- abfraction
- hypoplasia
- hyperplasia
Facial erosion due to acidic beverages
Diagnose amelogenesis imperfecta radiographically
- smaller than normal teeth
- yellow or brown discoloration
- teeth prone to damage, breakage
- sensitive teeth
- open bite malocclusion
- minimal to no enamel visible radiographically
Diagnose dentinogenesis imperfecta radiographically
- bulbous crowns
- cervical constriction
- thin roots
- early obliteration of root canals and pulp chambers
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
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.
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.
The greatest disadvantage of resin bonded bridges?
- staining
- debonding
- fracture
- less tooth reduction
debonding [Show Less]
