Mock OSCEs

Question 1

what are the 5As you need to do when trying to refer someone for smoking cessation

Answer 1

ask
advise
assess
assist
arrange

Question 2

what questions should you ask for the Ask section of 5As

Answer 2

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

Question 3

what should you tell the patient with regards to advising about smoking cessation

Answer 3

smoking is harmful to general health
smoking is detrimental to oral health
money and bad breath problems

Question 4

how would you assess a pt’s willingness to quit

Answer 4

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

Question 5

how do you assist a patient to stop smoking

Answer 5

ask them if they want help from local smoking cessation services
4 x more likely to quit
nicotine replacement therapy

Question 6

where should you signpost patient to if they would like to quit

Answer 6

pharmacy
GP
Quit your way Scotland

Question 7

what would a patient with orbitozygomatic fracture present with

Answer 7

lacerations
nasal bleeding/ deviation/ patency
facial asymmetry
limited mandibular movement

Question 8

how would you examine a patient for orbitozygomatic fracture

Answer 8

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

Question 9

how would you manage a patient with orbitozygomatic fracture in practice

Answer 9

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

Question 10

how would you assess a patient for XLA who is taking warfarin

Answer 10

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

Question 11

how would you tell a patient in pain that is taking warfarin that the tooth cannot be XLA’s today

Answer 11

due to high risk of bleeding because of your medication (warfarin) your INR values are above the recommended level for safe extractions

Question 12

how long before an extraction should a patient taking warfarin’s INR levels be checked

Answer 12

ideally within 24 hours, can be 72 hours if stable
stable = INR < 4 for last 3 months

Question 13

what questions are asked on a BBV screen after sharps injury

Answer 13

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

Question 14

what type of drug is alendronic acid

Answer 14

bisphosphonate

Question 15

what is the action of bisphosphonate drugs

Answer 15

they reduce the turnover of bone
they accumulate in sites of high bone turnover

Question 16

what is the relevance of bisphosphonates to dentistry (4)

Answer 16

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

Question 17

what are the 6 handpiece safety checks

Answer 17

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

Question 18

how would you treat an enamel dentine fracture with pulp exposure in a tooth with immature apex

Answer 18

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

Question 19

what is the aim of pulpotomy

Answer 19

partial removal of pulp
aim to keep undamaged pulp tissue alive
so the tooth stays alive and continues to grow

Question 20

what tests are required before pulpotomy

Answer 20

sensibility - test the affected tooth and adjacent teeth
this is so long term monitoring can occur

Question 21

what is the SPIKES model

Answer 21

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

Question 22

what is post op instructions for fluoride application

Answer 22

soft diet for rest of day
no dark coloured foods
dont eat/ drink for 1 hour

Question 23

how is fluoride overdose treated

Answer 23

5mg/kg - milk
5-15mg/kg - ipecac syrup, milk, possible referral
more than 15mg/kg - hospital referral

Question 24

what advice would you give to manage denture induced stomatitis

Answer 24

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

Question 25

what may patients with chronic OAF complain of

Answer 25

fluids from nose speech and signing of nasal quality problems playing wind instruments problems smoking or using a straw bad taste sinusitis type symptoms

Question 26

what is OAC

Answer 26

an acute communication between maxillary air sinus and oral cavity

Question 27

what is OAF

Answer 27

chronic communication between maxillary sinus and oral cavity which has healed by epithelialising forming a sinus and a permanent communication

Question 28

how is an OAF treated

Answer 28

excise sinus tract/ fistula - removing epithelium buccal advancement flap amoxicilling 500mg TID 7 days

Question 28

post operative instructions following OAF diagnosis

Answer 28

avoid blowing nose or stifiling sneeze by pinching nose steam or menthol inhalations avoid using straw refrain from smoking

Question 28

what is primary herpetic gingivostomatitis

Answer 28

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

Question 29

how does primary herpetic gingivostomatitis present

Answer 29

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

Question 30

treatment for primary herpetic gingivostomatitis

Answer 30

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

Question 31

what are the crown prep principles

Answer 31

ideal taper 6 degrees retentive groove/ slots bevel functional cusps two plane buccal reduction smooth prep margin at gingival margin

Question 32

when is a denture reline carried out

Answer 32

when fitting surface of denture inadequate but denture otherwise okay (occlusal plane/ OVD/ profile)

Question 33

how do you take a reline impression

Answer 33

take functional impression using light-body PVS using denture as tray functional = get pt to bite down as PVS sets

Question 34

how do you carry out a tooth trial

Answer 34

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

Question 35

what are the five headings for treatment planning

Answer 35

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

Question 36

how would you explain tx to an 8 year old patient who has had an EDP # on 11

Answer 36

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

Question 37

explain the procedure of a pulpotomy

Answer 37

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

Question 38

how would you treat a hypoglycaemic medical emergency

Answer 38

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

Question 39

what is the IM technique for administering glucagon

Answer 39

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

Question 40

how would you manage an epileptic seizure

Answer 40

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

Question 41

when would you refer a patient who has had an epileptic fit to hospital

Answer 41

first seizure seizure is atypical injury was caused difficult to monitor patient

Question 42

what is the NHS complaints procedure (7 steps)

Answer 42

- 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

Question 43

what are treatment options for a 20 year old patient with class III malocclusion

Answer 43

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

Question 44

how long is a tooth monitored for after placing an indirect pulp cap

Answer 44

3 months and if vital and asymptomatic the provisional restoration should be removed and definitive restoration placed if symptomatic then RCT required