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OSCE > Medical History Taking > Flashcards

Medical History Taking Flashcards

1
Q

ORDER

A 
introduce
presenting complaint 
history of presenting complaint 
med history 
dental history 
social history 
family history 
conclude
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2
Q

SOCRATES

A 
site
onset
characteristic 
radiation
associated symptoms 
time 
exacerbating factors 
severity
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3
Q

MED HISTROY ORDER

A 
heart 
lungs 
stomach 
endocrine 
musco-skeletal
bleeding disorders 
nuero - fits / faints 
meds
hosp/surgery 
allergies
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4
Q

DRUGS OF NOTE FOR DENTIST

A

anticoag - warfarin NOACS - for extractions
antiplatelets - clopidogrel / aspirin
bisphosphonates - taken for osteoporosis - link to osteonecrosis of the jaw
steroids - taken if asthmatic - lead to adrenal crisis

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5
Q

STEPS WHEN SOMEONE HAS ANGINA

A

make sure they have their GTN spray - encourage them to use it before appointment
manage their stress as this is what can bring on angina attack
jaw pain radiating to neck is jsut their angina
aspirin

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6
Q

STEPS WHEN PATIENTS HAS PCI /CABG

A

any stress causes them greater effect as they have reduced cardiac muscle
stent = extra care of mouth as avoid getting perio - push prevention
antiplatelets
aspirin cant be stopped if they are stented

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7
Q

DENTAL LINK TO ANGIOTENSIN INHIBITORS / B BLOCKERS

A

lichenoid reaction - whitening around ulceration

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8
Q

DENTAL LINK TO ANTIPLATELTS / ANTICOAG

A

extended bleeding time - extractions

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9
Q

DENTAL LINK TO CALCIUM CHANNEL BLOCKERS

A

gingival hyperplasia - overgrowth of gum tissue

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10
Q

STEPS WHEN PATEINT HAS HEART FAILURE

A

dont use B blockers
dont lie flat as causes shortness of breath
drug absorption issues

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11
Q

STEPS WHEN PATIENT HAS INFECTIVE ENDOCARDITIS

A

prevent
avoid piercings
antibiotic prophylaxis before treatment - antibiotic resistance though - need informed consent
mouth bacteria link to infective endocarditis

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12
Q

STEPS WEHN PATIENT HAS A PACEMAKER

A

avoid equipment generating electromagnetic feild - induction/ultrasonic scaler

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13
Q

WHAT IS ANAEMIA

A

low Hb

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14
Q

CAUSES OF ANAEMIA

A 
cant make haem 
cant make globin chains 
inflammatory disease
reduced RBC - bone marrow cant make
bleeding such as GIT
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15
Q

WHAT DO MICROCYTIC RBC INDICATE

A

small

Fe/thalassemia

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16
Q

WHAT DO MACROCYTIC RBC INDICATE

A

large

vit B12 / folate / retics

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17
Q

WHAT DO NORMOCYTIC RBC INDICATE

A

normal size but reduced Hb in blood

18
Q

WHAT DO HYPOCHROMIC RBC INDICATE

A

paler due to less Hb

19
Q

HAEMATINICS

A

needed to make haem
Fe
folate
vit b12

20
Q

HAEMOGLOBINOPATHIES

A

failure of globin chain production
thalassemia = genetic mutation of globin
sickle cell anaemia = abnormal globin chains that only work in normal standard O2 enviro

21
Q

STEPS WHEN PATIENT HAS ANAEMIA

A

figure out if its caused by sickle cell - as need o2 capacity for general anaesthetic
deficiency cause can =
mucosal atrophy
candidisis
recurrent oral ulceration
sensory changes
if you see a mucosal disease - check their haematinics

22
Q

WHICH DISEASES REDUCE COAGULATION ABILITY

A

haemophilia a / b

von willibrands disease

23
Q

STEPS TO TAKE IF PATIENT IS MILD / CARRIER OF DECREASED COAGULATION

A 
refer to hosp for 
extractions 
surgery 
LA - IDB , lingual infil
review at haemophilia centre every 2 years
observe for 2-3 hours after extraction
24
Q

STEPS WITH A DENTATE PATIENT WITH DECREASED COAGULATION

A

treat in hosp for extraction, surgery, lingual infil, IDB

review overnight after extraction

25
Q

STEPS WITH A EDENTULOUS PATIENT WITH DECREASED COAGULATION

A

treat in GDP

26
Q

WHICH PROCEUDRES NEED SPECIAL CARE WHEN A PATIENT HAS AN INHERITED BLEEDING DISORDER

A

extraction
surgery
perio surgery
biopsy

27
Q

WHAT IS INR

A

international normalised rario

28
Q

STEPS WHEN PATIENT IS ON WARFARIN

A

don’t do treatment there - get INR checked first 72 hours before
should be 2-4
local haemostatic measures
NSAIDS/antibiotics increase INR

29
Q

STEPS WHEN PATIENT ON NOACS

A

treat early in day / week
limit inital treatment to asses degree of bleeding
high risk procedure = miss morn dose - 1 a day - have after / 2 a day = have only 1 after that day
local haemostatic measures
NSAIDS prolong action

30
Q

STEPS WHEN PATIENT IS ON ANTIPLATELET ANTITHROMBINS

A

aspirin = dont stop, local haemo measures
aspirin + 1 / 1 = dont stop, local haemo measures and expect prolonged bleeding
2 = discuss w doc to stop 1 week prior / refer to hosp
good post op instruction with emergency contact details

31
Q

STEPS WHEN SOMEONE HAS COPD

A

dont lie them flat - obstructs airways
might need O2 = interferes
they might be using inhaled steroids at high dose = candida risk = rinse / space divider
no oxygen

32
Q

STEPS WHEN SOMEONE HAS COELIAC DISEASE

A

dont give them meds with gluten

33
Q

STEPS WHEN SOMEONE HAS CROHNS DISEASE

A

look out for steroidal meds = cause candida

oral presentaiton

34
Q

WHICH MEDS CAN CAUSE ORAL INFECTIONS

A

steroids

35
Q

STEPS WHEN SOMEONE HAS OROFACIAL GRANULOMATOSIS

A

odema of mouth and face

check if they have crohns this is a presentation of it

36
Q

STEPS WHEN SOMEONE HAS LIVER FAILURE

A

liase with physician - use INR 1.1-1.3
think about which drugs / doses as they have lesser ability of metabolising
LA okay as done in plasma
paracetamol is safest analgesic
reduced plasma proteins = less drug binding (effect)

37
Q

STEPS WHEN SOMEONE HAS RENAL DISEASE

A

check drug prescription with physician
oppurtunisic infections
dry mouth / taste disturbance
bleeding tendencies

38
Q

EFFECTS WHEN SOMEONE HAS CHRONIC RENAL FAILURE

A

growth in child slow = eruption delayed
secondary anaemia effects
white patches

39
Q

STEPS WHEN SOMEONE IS ON RENAL DIALYSIS

A

treat day after dialysis
check drugs with physician - need to be able to be removed
dont treat if transplant is near

40
Q

STEPS WHEN SOMEONE HAS A RENAL TRANSPLANT

A

be suspicous of oral lesions as they are at a higher cancer risk
prednisolone = bad

41
Q

STEPS TO TAKE WHEN SOMEONE HAS THYROID DYSFUNCTION

A

goitre detectable
hyper = pain anxiety
hypo = avoid sedatives

42
Q

STEPS WEHN SOMEONE HAS DIABETES

A

be aware of effect of dental treatment on their food intake / their normal routine / glucose alternative if cant eat
poor wound healing
infection risk
hypoglycaemia

OSCE (14 decks)

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