Osce q's batch 1 4-5 Flashcards
(103 cards)
1
Q
What are the signs and symptoms of hypoglycaemia?
A
* Shaking/trembling * Confusion *Aggitation *Slurring of speech * Headache *Sweating * Headache *Sweating *Aggressive behaviour *Increase in heart rate *Increase in respiratory rate
2
Q
What actions should be taken in a case of hypoglycaemia?
A
*Reassure the patient.
*Carry out A-E assessment on patient.
*Administer up to 3 glucose tablets in the early stages where the patient is responsive, co-operative and their gag reflex still intact.
*Administer oxygen, 15 litres per minute.
*If the patient becomes unconscious dial 999 *Administer glucagon by IM on the outer aspect of the thigh (1mg adults, 0.5mg children)
*Where patient regains consciousness, administer oral glucose
3
Q
What are the signs and symptoms of syncope?
A
*Light headed. *Dizzy *Nausea *Pale *Slow heart rate *Loss of consciousness
4
Q
What actions should be taken in the event of syncope?
A
*Raise patients legs above their head
*Loosen tight clothing, keep the patient cool and ventilate the room
*Administer oxygen at 15 litres per minute
*Assess and reassure the patient
5
Q
What are the signs and symptoms of a severe acute asthma attack?
A
*Inability to complete a sentence in one breath.
*Increased heart rate.
*Increased respiratory rate.
*Audible wheeze.
6
Q
What actions should be taken in the case of a severe acute asthma attack?
A
*Reassure patient.
*Carry out A-E assessment
*Call 999
*Administer salbutamol inhaler via a spacer device for up to ten activations
*Repeat as needed.
*Administer oxygen at 15 litres per minute
*Ensure patient is in a comfortable position
*Continue to reassure and assess the patient
7
Q
What are the signs and symptoms of a cardiac emergency/ myocardial infarction?
A
*Chest pain
*Pain in neck, jaw, back, shoulders, arms
*Indigestion
*Shortness of breath
*Pale skin, sweating, clammy
*Nausea, vomiting
*Weak pulse
8
Q
What actions should be taken in the event of a cardiac emergency?
A
*Reassure the patient
*Carry out A-E assessment
*Ensure they are sitting and resting
*Administer two activations of GTN spray sublingually (400/800 micrograms)
*Give oxygen at 15 litres per minute
*If no improvement, dial 999
*Administer 300mg aspirin, chewed or crushed. Do not give with water
*Continually assess and reassure patient
9
Q
What are the signs and symptoms of a seizure?
A
*Vagueness
*Sudden loss of consciousness
*Patient becomes rigid and cyanosed
*Jerking movements of the limbs
*Urinary incontinence
*Frothing at the mouth
10
Q
what are the signs and symptoms of anaphylaxis?
A
*Flushing
*Sweating
*Nausea and abdominal pain
*Possible rash
*Swelling of soft tissues
*Swelling of throat and tongue
*Wheezing
*Difficulty breathing
*Increased heart rate
11
Q
Kennedy class I
A
Bilateral free end saddle
12
Q
Kennedy class II
A
Unilateral free end saddle
13
Q
Kennedy class III
A
Bounded saddle
14
Q
Kennedy class IV
A
Anterior bounded saddle crossing midline
15
Q
When taking a pain history, what does SOCRATES stand for?
A
-Site - Onset -Character -Radiation -Association -Time course -Exacerbating/relieving factors -Severity
16
Q
Describe previously initiated RCT
A
-tooth has been previously treated by partial endodontic therapy such as pulpotomy/pulpectomy -depending on the level of therapy, the tooth may or may not respond to pulp testing modalities
17
Q
List some common extraction complications
A
- Fracture of tooth/root.
- Fracture of alveolar bone
- Fracture of tuberosity.
- OAC
- Damage to IAN
- Bleeding
- Dislocation of TMJ
- Damage to adjacent teeth/restorations
- Pain
- Swelling
- Bleeding
- Bruising
- Dry socket (alveolar osteitis)
- Sequestrum
- Infection
18
Q
What advice should a patient be given regarding post extraction pain?
A
Expect some post op pain, this is normal. Take painkillers before LA wears off. Take 1-3 days then as and when required. If pain is getting worse after 3-4 days, contact the practice for further advice.
19
Q
What advice should be given to a patient with trismus/limited mouth opening?
A
- Monitor, may take several weeks to resolve.
- Gentle mouth opening exercises/wooden spatula/tismus screw
- Symptoms should settle over a couple of weeks, if it affects eating or lasts longer than two weeks, further advice should be sought.
- Swelling can be especially evident two days post op. If it gets worse or there is concern of infection, further advice should be sought.
- Bruising can occur and varies person to person but this is normal
20
Q
What advice should be given to a patient regarding post op bleeding at home?
A
Roll up a damp tissue/gauze and bite firmly for 20-30 mins. If bleeding persists, repeat for one hour. If still bleeding, contact the practice or out of hours. If bleeding will not stop and patient cannot attend emergency appointment, they should attend their local a+e
21
Q
List some haemostatic agents
A
- LA containing adrenaline
- Oxidised regenerated cellulose - surgicel - framework for clot formation. Take care in lower 8 region as it is acidic and can cause damage to IAN.
- Gelatin sponge - absorbable/meshwork for clot formation
- Thrombin liquid and powder
- Fibrin foam
22
Q
What is the management of a dry socket (alveolar osteitis)
A
- BIP; bismuth subnitrate and iodoform pack. Antiseptic and astringent.
- Alvogyl - mixture of LA and antiseptic
- Advice on alalgesia and HSMW
23
Q
What is the best method of obtaining a pain history?
A
SOCRATES
Site - where
Onset - when
Character - sharp/throbbing
Radiates
Associated - systemic
Time - how long
Exacerbating
Severity
24
Q
In paediatric caries prevention, how do you encourage behaviour change?
A
- Explore current habits. Seek permission. Open questions. Affirmations. Reflective listening. Summarising. Elicit change talk.
- Educational intervention - improve knowledge and skills
- Action planning - set time, date and place to start
- Encourage habit formation
- Repeat at each recall
25
What toothbrushing advice should be offered to paediatric patients at their exams?
| In brackets - enhanced
- Once per year (or each recall) remind to brush thoroughly twice daily, including last thing at night
- Use age appropriate amount and concentration of F (script?)
- Spit dont rinse
- Supervise brushing
- Demo toothbrushing annually (each recall)
- Action plan/habit stacking
- Advise brushing on eruption of first tooth.
- use short scrubbing motion
- Use timer/watch/app for 2+ minutes
- Wait 30 minutes after acidic food to brush
- Highlight brushing technique for PE teeth
- Recommend aids such as toothbrushing/sticker charts, timers, disclosing tablets
- Offer free toothbrush/toothpaste
26
What diet advice should be offered to paediatric patients?
- Advise on benefits of healthy diet
- Limit consumption of food/drink containing sugar. Restrict to meal times.
- Drink only water or milk between meals
- Snack on lower sugar foods; veg, breadsticks, oatcakes, cheese, some fruit
- Nothing but milk/water in baby bottle
- Nothing to eat/drink after brushing at night
- Beware of hidden sugars
- Beware of acid content
27
When should an orthodontic exam be carried out?
\*brief exam at around aged 9 \*comprehensive exam when premolars and canines erupt (11-12 years) \*when older patients first present \*if a malocclusion develops later in life
28
What is ideal occlusion?
anatomically perfect arrangement of teeth
29
what is normal occlusion?
acceptable variation from the ideal
30
Class I incisor relationship
lower incisors occlude with or lie immediately below cingulum of upper incisors
31
Class II incisor relationship
lower incisor edges lie posterior to cingulum of upper incisors div 1 - max centrals are upright or proclined, OJ increased div 2 - max centrals retroclined, OJ usually decreased, may be increased
32
Class III incisor relationship
lower incisors lie anterior to cingulum of upper incisors, OJ is decreased or reversed
33
What are balancing extractions and compensating extractions?
balancing - extraction of same/adjacent tooth on the opposite side of the same arch - preserves symmetry compensating - extract of occluding tooth on the opposing arch. stops over eruption
34
What information would you give a patient who has jsut been given their removable appliance?
1. non compliance with significantly increase your treatment time 2. it will feel big, you will salivate more and you will find it hard to talk. practice and these will aleviate 3. wear is 24/7 except contact sports and swimming. clean after meals with toothbrush over filled sink 4. if it breaks, come back 5. some discomfort initially is to be expected - it means it is working. this will reduce 6. emergency contact details
35
What are some risks of orthodontic treatment?
- root resorption - relapse - failure to complete treatment - treatment failure - devitalising of tooth - pain - trauma from components - decalcification of tooth
36
What special tests are required for an orthodontic diagnosis?
\*study models
\*Radiographs (OPT, lateral cephalogram)
\*Photos
\*Sensibility tests
\*cone beam CT scan
37
Where is the ideal meeting point of the FMPA?
external occipital protuberance
38
What are the eruption dates for the
6's
1's
2's
6's - 6 yo
1's - 7 yo
2's - 8 yo
39
For CN exam, how do you test CN 1 (Olfactory?)
Ask the patient if they have experienced any changes with their sense of smell.
40
What are the three possible scores in a modified plaque score?
```
2 = visible plaque without use of a probe
1 = no visible plaque but a probe skimmed over tooth surface reveals plaque
0 = no plaque
```
All scores are added together to give a total, which is then divided by the maximum plaque score possible (36)
41
What is the purpose of grading periodontal disease and what are the three grades?
Grading indicates the progression of bone loss.
Grade A - slow - less than half patients age
Grade B - moderate half to equal to patients age
Grade C - rapid - greater than patients age
42
In bridgework define abutment
A tooth which serves as an attachment for a bridge
43
In bridgework define pontic
The artificial tooth which is suspended from the abutment tooth/teeth
44
How should the assessment of facial trauma/zygomatic fracture be approached?
Exam, diagnosis, indicate further investications
- E/O exam; lacerations. Nasal bleeding/deviation/patency (by obstructing each nostril). Palpation of zygoma bilaterally from behind the patient. Assymetry? Limitation of mandibular movement? Examine sensation of infra-orbital region (upper lip, lateral nose, over eyelid). Examine eye; periorbital ecchymosis, subconjunctival haemorrhage. Vision assessment - pupillary reaction to light, ask if presence of double vision. Assess eyeball mobility.
- I/O features; tenderness of zygomatic buttress. Bruising/swelling/haematoma. Occlusal derangement and step deformitites. Lacerations (especially gingivae), loose/# teeth. Anaesthesia/parasthesia of teeth.
- Further investigations; radiographs (occlusal maxillary. CT. CBCT). Identify fracture on radiograph
- Diagnose ie zygomatic fracture
- Management; urgent phone to OMFS unit or A+E for advice/referral. Surgical - ORIF or conservative if displaced, asymptomatic or greater than one month
45
A patient presents with toothache in tooth 26. It's unrestorable and requires XLA. Pt is on warfarin. How to approach this?
- Introduce yourself.
- Gather info about patients coagulation status. INR; when was it last checked, what was the value, do you have your INR record book?
- give patient detailed and valid explanation as to why tooth cannot be extracted today. Ie due to high risk of bleeding, as a result of warfarin, values are above the recommended levels for safe extraction
- Reference SDCEP; INR shoud ideally be checked within 24 hours, 72 hours if stable (INR has been <4 for 3 months) Proceed without interuppting meds is <4.
- Appropriately convince pt not to have ext today
- Address patients pain; offer advice on analgesia, extirpate/dress tooth
- Ask if patient understands and if they have any questions
46
How should you complete a handpiece safety check?
- Back cap checked. Gripped and turned anti-clockwise.
- Bur security checked. Suitable force applied to remove bur.
- Tension applied to handpieve when fitted to coupling. Assess if handpiece is attached safely.
- Bur rotated with finger, rolls along finger.
- Attempt to move bur laterally, push bur side to side a few times.
- Handpiece sound tested when running. Run for >5 seconds and observe movement/sound
47
50 year old male presented for HPT 3/12 ago. 35 is tender and swollen. 8mm pocket distally. Pt is systemically well, normal body temp. Provide diagnosis, special investigations etc.
Request PA radiograph and sensibility testing.
If EPT response is positive and PA shows PAP, highlight swelling, there is a pocket with pus. On the radiograph, we can see bone loss.
Diagnosis is perio abscess.
Tx includes debridement, irrigating the pocket, HSMW
No ABs needed as localised infection and no systemic symptoms
48
A two yo child attends for fluoride varnish. Parent has concerns over why it's needed, flouride toxicity and OHI.
Reassure parent. Minimally invasive. Tooth is dried and fluoride is painted on. It protects teeth by promoting remineralisation and preventing demineralisation.
Contraindicated in severe asthma (hospitalised in last 12 months). Allergy to colophony. Colophonly free can be used if needed.
Post op - don't eat or drink for at least one hour. Soft diet for the rest of the day and avoid fluoride supplements.
Very small risk of fluoride toxicity.
5mg/kg - milk
5-15mg/kg ipecak syrup/milk, refer
15mg/kg+ hosp referral
1500ppmF contains 3mg/g fluoride. Child would need to eat entire tube
49
Discuss Tx options for Class iii occlusion in a 20 yo patient
- Accept and monitor
- Intercept with URA to procline uppers (may not be possible at this age)
- Functional appliance (reverse twinblock, RME and protraction headgear) (may not be possible at this age.
- Camoflage with fixed appliances. Accept skeletal base and move teeth with fixed ortho to disguise (procline uppers and retrocline lowers) Usually with XLA of upper and lower premolars.
- Discuss risks of fixed ortho (decalcification, root resorption, relapse, gingival recession, devitalisation)
- Orthognathic surgery combined with ortho. Surgical manipulation of mandible/maxilla to produce optimal aesthetics/function
Multidisciplinary team with careful planning. Involves pre and post surgery ortho totaling approx 3 years.
50
What factors put a patient at higher risk of developing MRONJ?
- Previous diagnosis
- Pt is taking anti-resorptive or anti-angiogenic drugs for cancer management
- Pt has taken bisposphonates for 5 years or longer
51
You overhear a nurse bad-mouthing a patient to a colleague in a public place in the surgery. They refer to them in a derogatory manner and joke about potentially posting this on social media. The patient and family are easily identifiable from the information discussed as well. Discuss this issue with your nurse.
- Introduce yourself and ask the nurse if it's ok to talk 'do you have a minute for a chat>'
- State the facts of the situation; what, when, where, how?
- Ask nurse for their account of the situation.
- 'unfortunately there were remarks made publicly and talk of posting on social media. Can you tell me what happened/was said?'
- Explain the issue to the nurse and why it is unacceptable 'I appreciate there was no harm intended, but it's not acceptable to say things publicly about a patient, or post on social media'
'As the GDC standards state, it's our obligation to work to the patients best interests and protect their information. Speaking in a public area can breach confidentiality. The patients are recognisable from the post, this is not protecting them. In their position, how would you feel if you saw your information on social media?'
- 'This does not provide the public with confidence in you, the practice or the profession. The practice could be in question and the GDC could be informed of this in the future'
Options; if there's a post on social media - delete it immediately. Apologise to the patient, if the patient has left, invite them back for a formal apology.
Inform the nurse that this can't happen again.
Ask/advise - it would be good to raise awareness on confidentiality and the use of social media. Would you be willing to attend a CPD course?
If problem repeats - seek advice from more senior staff
Record and document the conversation
52
Nursing Bottle Caries (6 mins)
Concerned mother with 2 year old in pain. Take a brief pain history then photo of decayed 52-62 (upper incisors) provided. Explain diagnosis to parent, prevention and management options (GA).
- Take a pain history (socrates)
- Is bottle given at bedtime? whats in the bottle?
- Look at photos to establish pattern of decay (lower incisors protected by tongue)
Advise
- sippy cup replacing bottle from 6 mon
- No feeding at night
- No on demand BF
- No sweetened milk/soy
- Milk and water only between meals
- sugar free drinks and medicines
- Advise on snacks
- TBI; help/do for child. 2 x daily. nothing to eat/drink after brushing. Spit don't rinse.
Management;
- If in pain XGA. Discuss risks
- GIC remaining teeth and review if no pain
- Fluoride varnish and sups
53
What actions should be taken in the event of anaphylaxis?
\*Reassure the patient
\*Carry out A-E assessment
\*Dial 999 for ambulance
\*Administer oxygen at 15 litres per minute
\*Raise patients legs to help restore their BP
\*If symptoms are life threatening, administer IM injection of adrenaline into outer aspect of thigh
\*Can be repeated after 5 minutes on opposite thigh
\*0.5ml adults, 0.3ml 6-12years, 0.15ml 6mo-6yr
\*Continue to assess and reassure patient
54
Craddocks class I
Tooth borne
55
Craddocks class II
Mucosal borne
56
What actions should be taken in the event of a seizure?
\*Ensure the area is safe
\*Do not restrain, support the head if possible.
\*Suction in the buccal sulcus may be helpful
\*Don't place anything between the patients teeth
\*Make a note of the time
\*If the seizure ceases within 3 minutes, place patient in lateral position and administer oxygen at 15 litres per minute and continually assess the patient
\*If seizure approaches 5 mins dial 999
\*If seizure is prolonged (5 mins) or recurrent administer Midazolam buccally
\*10mg adult
7.5mg 5-10 years
5mg 1-5 years
57
Craddocks class III
Combination of tooth and mucosal borne
58
What 2 areas of primary support are on the maxilla?
- Hard palate and residual ridge
59
You expose a pinpoint pulp exposure when doing a cavity prep on an asymptomatic tooth. How should this be addressed?
* Explain to the pt what has happened and that a pulp cap is required
* Explain risk of future RCT if symptoms occur
* Ensure tooth is asymptomatic, no pain history, pulp exposure is small and surrounding dentine is hard.
* Dam should have been placed prior to exposure
* Cavity cleaned with sterile saline and blotted dry with CWP
* Cover exposure with setting CaOH (dycal) and line with RMGI (vitrebond)
* Complete restoration
* KUO to monitor vitality.
* RCT if symptoms
60
Assume dam has been fitted and pulp has been exposed during cavity prep, there is still caries present. How to address this?
* Extirpate - pulpectomy
* Remove coronal pulp tissue with sterile spoon excavator. Irrigate with saline and dry.
* Discuss with pt XLA or RCT required
* Temporise with odontopaste/ledermix (AB/steroid) ahead of XLA/RCT
* CWP and GIC
61
What are the recommended limits of alcohol consumption?
| Give some stats
No more than 14 units of alcohol per week with some alcohol free days.
Bottle of wine 9-10 units
Pint 2.5 units
Spirits 1 unit (small shot)
62
In removable prosthodontics, what is the minimum data that should be recorded onto the record block?
- OVD; the distance between the jaws with the teeth in occlusion
- centre line;
- occlusal plane; the central occlusal plane indicates where the incisal level of the tooth will be
- High lip line
- Canine line; line extended from the inner canthus of the eye
- Arch form (width-lip support)
63
What are some general features that should be present on a definitive impression?
- ensure the denture bearing areas are covered
- ensure there is a good functional sulcus present
- ensure there is good surface detail with no air blows
64
What information should be on a lab prescription?
| denture requirements
Saddles - teeth to be replaced
Support - How occlusal load is managed. ie occlusal/cingulum rests. Place mesial of tooth - furthest from saddle
Retention - clasps. Triangular pattern. Clasp axis then 90o to that. Premolars and forward gingivally approaching i bar. Molars occlusally approaching c clasp.
Major connector. Upper palatal plate or ring connector. Lower lingual bar.
65
List what can be used and how cold and heat sensibility testing is carried out
Frozen carbon dioxide (-78degrees), ethyl chloride or refrigerant spray can be used Cold sensibility testing tests the hydrodynamic forces. -dry and isolate the tooth - test close to the pulp horn Heat tests can be carried out using hot GP and vaseline or hot water and dental dam
66
What features should be present on a maxillary definitive impression?
- coverage of maxillary tuberosity
- coverage of hamular notch
- extension anterior to the vibrating line for post dam
- functional depth and width of sulcus to create a good peripheral seal and ensure the hard palate and residual ridge are functional for primary support
67
What indicates the posterior border of the maxillary denture?
- The post dam which should sit 1-2mm anterior of the vibrating
line between the junction of the hard and soft palate.
- The maxillary denture should be at the level of the Hamular
notch to produce a good posterior seal which is located
between the distal surface of the tuberosity and the Hamular
process of the medial pterygoid plate of the maxilla.
68
Describe surveying a cast
| Points to remember if OSCE question
'Tripod' with graphite. 3 lines on base of model, labelled PD (path of displacement). Make sure occlusal plane is flat.
Repeat with model angled differently to reduce undercuts and repeat in different colour. Label PI (path of insertion)
69
What are examiners looking for in an OSCE
| things to remember for easy grades
- Introduce yourself.
- Take a relevant history
- Recognise patients concerns
- Recognise time constraints on Tx
- Give clear explanation of treatment options
- Give patient an opportunity to ask questions, confirm their understanding
- Give risks vs benefits and potential costs
- Discuss further investigations
- discuss need for referral
- Use socretes when taking a pain history
70
How would you carry out a systematic endodontic exam?
- extra oral - intra oral - STE - intra oral swelling -sinus tract -palpitation -percussion -mobility -perio exam
71
What are the risks of excessive/regular alcohol consumption?
Regular drinking increases risk of oral, throat, breast, bowel and liver cancer.
The more you consume, the higher your risk
Smoking in combination with drinking increases your cancer risk 5 fold
72
What are normal RBC count?
Men 4.32-5.72
Women 3.90-5.03
million per mm3 of blood
73
What are normal haemolglobin (Hb) ranges?
men 13.5 - 17.5
women 12 - 15.5
g/dL
74
What lymph nodes should be examined in suspected oral cancer cases?
- Lymph from all areas of the head and neck eventually drains into the deep cervical lymph nodes. (Internal jugular vein below SCM)
- Submental nodes, just inside inferior border of the mandible drain lymph from the tip of the tongue and FoM, lower incisor region. Empty into jugulo-omohyoid node.
- For tongue lesion - palpate submental and submandibular nodes. Will eventually drain to deep cervical lymph nodes infront of SCM and behind SCM above clavicle.
75
What needs to be carried out/established with a patient who presents with facial trauma?
| Before physical exam
- Immediate emergency assessment. ABCDE
- Did the patient lose consciousness?
- When did the injury occur?
- How did the injury occur? The type of force that caused the injury can influence nature of fracture. Object that created wound can indicate left over debris (glass) and infection risk
- Associated symptoms; changes to vision, breathing, occlusion
- Social history; safeguarding concern? Lifestyle that will affect Tx? Drugs/alcohol?
76
What is the recommended volume and concentration of fluoride toothpaste?
Under 3 years - smear of TP
Over 3 years - pea size TP
1000-1500ppmF standard
1350-1500ppmF enhanced
2800ppmF 10+ years enhanced
77
Give the Britisd standards institute classification of incisor relationships
\*Class I - the lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper central incisors \*Class II - the lower incisor edges lie posterior to the cingulum plateau of the upper incisors - Division I; the upper incisors are proclined or are of average inclination and there is an INCREASE IN OVERJET - Division II; the UPPER CENTRAL INCISORS ARE RETROCLINED. The OJ is usually minimal or may be increased \*Class III - lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The OJ is reduced or reversed
78
How do you monitor the eruption of canines?
palpation from 9/10 look at inclination of 2s mobility of cs colour of cs
79
Describe the AP class III relationship
mandible in front of maxilla
80
What is an increased FMPA?
Frankfort mandibular plane angle
increased if premature meeting point
81
What is a decreased FMPA?
Frankfort mandibular plane angle
decreased if delayed meeting point
82
Clinically speaking, what is the upper anterior face height and lower anterior face height?
Upper; glabella to base of nose
\*Lower; base of nose to inferior aspect of chin
\*Average ratio of LAFH to TAFH 50%
83
What are some causes of high RBC
Smoking and high altitude
Congenital heart disease
Renal cell carcinoma
Pulmonary fibrosis
Polycythemia
84
In a blood panel, what is haematocrit (Hct)?
It is the percentage of RBCs and inticates if there are too many or too few
85
What is the normal value for haematocrit panel?
men 38.8-50%
women 34.9-44.5%
86
What can a low haematocrit value indicate?
Anaemia, Leukemia, Haemorrhage, bone marrow failure, vit/mineral deficiency
87
What can high-macrocytic MCV mean?
Vit B12 and or folate deficiency, haemolytic anaemia, chronic liver disease, alcoholism, aplastic anaemia, hypothyroidism
88
What are the six options of treatment in orthodontics?
1) Accept malocclusions
2) Extractions only
3) URA
4) Functional appliances
5) Fixed appliances
6) complex treatment involving orthodontics and restorative treatment or orthodontics and orthognatic surgery
89
What does the hierarchial scale MOCDO stand for?
Missing teeth
Overjet
Crossbite
Displacement of contact points
Overbites
90
What features should be present on a mandibular definitive impression?
- coverage of pear shaped pad and buccal shelf
- retromolar pad and extension into the linual pouch should occur
- functional width and depth of the sulcus
- ensure there is an area of primary support of the buccal shelf and retromolar pad
91
Describe how an electric pulp test is carried out and how it works
- electric current used to stimulate sensory nerves -primarily A-delta fast conducting fibres -unmyelinated C-fibres may or may not respond -teeth are dried and isolated -probe is placed near the pulp horn -a conducting medium is used such as tooth paste -the circut is complete, current slowly increased until there is a response A negative response is a reliable indicator unreliable in teeth with an open apex
92
Describe normal apical tissues
-not TTP -radiographically, the lamina dura surrounding the root is intact and the PDL space is uniform -comparitive testing for percussion should always begin with normal teeth as a baseline
93
For CN exam, how do you test CN 9 and 10 (glossopharyngeal and vagus)
Inspect soft palate and uvula when pt says 'ahhh'
Ask pt to cough
Ask about gag reflex
94
For CN exam, how do you test CN 11 (accessory nerve?)
Test trapezius and SCM
Get pt to shrug and turn head against pressure
95
How is the extent of periodontal disease recorded?
- Localised - less than 30% of teeth
- Generalised - greater than 30% of teeth
- Molar incisor pattern
96
Describe pulpal necrosis
(pulpal diagnosis)
-diagnostic category indicating death of the pulp, necessitating RCT -non responsive to pulp testing and is asymptomatic -could be non responsive due to calcification, recent trauma or an unknown reason -does not by itself cause apical periodontitis -TTP or radiographic evidence of osseous breakdown
97
What is the mean corpuscular volume (MCV)
The average size of a single RBC and is usally 80-95 fL
98
What can low-microcytic MCV mean?
Iron deficiency, thalassemia, sideroblastic anaemia, malignancy
99
In the management of mandibular fractures, describe internal fixation
Plates and screws to fixate fractured segments together
100
Describe type 1 recession
Gingival recession with no loss of interproximal attachment. Interproximal CEJ is clinically not detectable at both mesial and distal aspects of the tooth
101
Describe type 2 recession
Gingival recession associated with interproximal LOA. The amount of LOA is less than or equal to the buccal attachment loss.
102
A patient presents with a post crown on a tooth that has not been RCT's. There is lingual caries but is asymptomatic. Give Tx options and pros/cons for each
First, introduce yourself.
LEAVE/KUO
- may remain asymptomatic but can't tell how long for.
- Risk of infections, abscess, tooth breakdown, root fracture, pain, loss of tooth, decay below bone.
REMOVE CROWN/CARIES
- May be able to restore with new crown
- Removes risk of post removal
- Doesn't address that there is no endo, risk of PAP, difficulty removing crown, tooth ma be deemed unrestorable.
REMOVE POST AND CORE, RCT AND REPLACE
- Risk of root fracture requiring XLA. Referral to endo specialist
- Several appts
- General risks of endo Tx
EXTRACTION
- Single appt but looth lost
- Give options of replacement - none, bridge, denture, implant
Discuss pts decision and ask if they have questions.
Use photos/radiographs if they're there
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How should smoking cessation advice be offered? What information will the actor be looking for?
ASK What do you smoke? How long have you smoked for? How many cigs per day? How quickly after waking do you have your first cig? Does anyone else in the house/family smoke?
ADVISE Smoking is harmful for general health (cardiovascular and respiritory). Detrimental to oral health - risk of tooth loss, reduced ability to heal, staining, perio disease, oral cancer. Personal such as cost/smell
ASSESS motivation to quit. Interested in quitting? Any past attempts? How many? What worked/didn't work?
ASSIST offer referral/sign post. Champix, gum, patches, lozenges.
Ecigs; newish, don't fully know side effects. Likely less harmful than tobacco. Don't vape around children. Maintains habit and culture of smoking.
ARRANGE/REFER Those interested to pharmacy/stop smoking services. Can self refer. Run by NHS staff and trained advisors. Arrange follow up
Actor is looking for non-judgemental, easy to understand advice, listening, good eye contact, open body language
