DSE OSCE - PT 2

What is the best location for an implant? a. mandibular anterior b. mandibular posterior c. maxillary anterior d. maxillary posterior e. two of the above (remembered)

"Either mandibular posterior or anterior mandible"

What is the best long term prognosis for an implant? a. mandibular anterior b. mandibular posterior c. maxillary anterior d. maxillary posterior e. two of the above (remembered)

"Either mandibular posterior or anterior"

Patient *presents* with Jaundice. Answer the following questions: (1) Which of the following do you think they probably have? a. Cirrhosis b. Hepatitis A c. Hepatitis C (2) They currently are jaundiced. What is the proper thing to do? a. Start with the examination and complete a thorough diagnostic assessment. b. Tell the patient to immediately go to the emergency room. c. Tell the patient to come back for treatment in 1 week, and you cannot treat them now. (remembered)

(1) B - Jaundice is common in HepA (in B its like 60% of them, and in C its really rare) (2) c - this was on remembered questions. You can treat hepA patients after 1 week. called it jaundice.

Pre-Med required for?

- Prosthetic heart valves, or prosthetic material used for cardiac valve repair. - Hx of infective endocarditis - cyonotic heart disease - valve regurgitation w. heart thingys (even if has transplant or was repaired already) [According to limited data, infective endocarditis appears to be more common in heart transplant recipients than in the general population; the risk of infective endocarditis is highest in the first 6 months after transplant because of endothelial disruption, high-intensity immunosuppressive therapy, frequent central venous catheter access, and frequent endomyocardial biopsies]

Patient presents with pain on swallowing when wearing their denture. What is wrong? (rememered)

- overextension of lingual flange

Ortho case - what was the most important thing they did in maxillary arch? a. close the upper and lower diastema b. align the teeth for future restorative procedures c. adjust the occlusion for patient comfort d. promote the movement of the mandibular teeth (remembered)

Align the teeth for future restorative procedures (Not close upper and lower diastema)

Patient presents with space in between 3rd molar and premolar, with class II mobility. How should you treat? a. fixed partial denture b. removable partial denture c. implant prosthesis d. full denture (remembered)

Implant

What is the treatment for a patient with a liver clot? a. prescribe antibiotics b. irrigate c. apply pressure then re-assess d. two of the above (remembered)

Irrigate, apply pressure, reassess (liver clot-unstable and often large, friable clot commonly forming in mucous membranes. Usually lead to excessive bleeding and abnormal wound healing.)

BW xray of amalgam restoration. Patient complained of pain when provoked by hot or cold. What is wrong? (remembered)

Deep amalgam filling (/restoration)

Picture of #10 and #11 lingual surface, what is wrong with the gingiva? (remembered)

Edema - enlargement of marginal and interproximal gingival tissues, Smooth shiny surface and loss of stippling, diffuse redness.

Patient missing #2 and #3. #1 has Class III mobility and furcation involvement. What would be the optimal treatment plan? a. Fixed bridge from #1 to #4 b. Place two implant-supported crowns for #2, #3; Frequent recall visits to re-evaluate #1. c. Extract #1 and place implants for #2, or #2 and #3. (remembered)

Extract #1 and implant for #3 or #2and #3 (#1 prognosis is hopeless)

Hereditary Telangiectasia is associated with... a. B12 deficiency b. Pernicious Anemia c. Iron Deficiency d. Hypertension (remembered)

Fe deficiency (Iron deficiency Anemia)

Permanent dentition with tetracycline staining, when did this happen? (remembered)

Patient ingested tetracycline when they were between 0 and 5 years old

Patient with purple lesions on palate and said they had similar lesions on their body too. What is the most probable cause? a. Surge Weber b. Erthyema Multiforme c. HIV d. Malignant Melanoma (remembered)

HIV - Kaposi Sarcoma

Picture of the bottom of the tongue with multiple white lesions. Stated that the patient had complaint of sore gums and tongue, he had a fever of 101 degrees. Most likely diagnosis? a. Primary Herpetic Stomatitis b. Secondary Herpetic Stomatitis c. Herpangia d. Recurrent Ampthous Stomatitis (remembered)

Primary Herpetic Stomatitis . (herpes on attached gingiva) - treat with Palliative care

What disease will effect wearing complete dentures the most? a. Leukemia b. Leukoplakia c. Sjogrens Syndrome (Xerostomia) d. Squamous Cell Carcinoma (remembered)

Sjorgens syndrome (xerostomia)

All of the following are Hyperthyroid symptoms except? a. fatigue b. exopthalamus c. tachycardia d. tremor of extremities (remembered)

a

colorectal polyposis a. gardner syndrome b. gorlin syndrome

a

Pernicious anemia - whats it caused by? a. Decrease in intrinsic factor, which is required to absorb vitamin B12 from food. b. Chronic use of aspirin, NSAIDs, or corticosteroids. c. A variant of hemoglobin A called hemoglobin S d. Destruction of red blood cells (remembered)

a - The Shilling's test is performed to evaluate vitamin B12 absorption, and it is most commonly used to evaluate patients having pernicious anemia.

multiple odontomas a. gardner syndrome b. gorlin syndrome (remembered)

a (Gardner's Syndrome (colorectal polyposis))

Perncious Anemia: a. Is associated with an autoimmune destruction of the parietal cells in the stomach. b. Is caused by acute or chronic blood loss. c. Both A and B

a - parietal cells make intrinsic facor, which is required to absorb vitamin B12 from food.

Facial erosion on teeth due to? (given image) (remembered)

acidic beverages

What is the difference in anaphylaxis vs syncope? (remembered)

anaphylaxis has wheezing and 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.

5 month old preggers with rheumatic fever and heart murmer: pre med? a. yes b. no (remembered)

b

Gingival edema is caused by? a. aerobic bacteria b. anaerobic bacteria c. forces (remembered)

b

Gutta percha is made out of? a. barium salts b. zinc oxide c. silicate dioxide d. graliam prema

b

How often does OSHA make you check the autoclave? a. daily b. weekly c. bi-weekly d. annually (remembered)

b

Patients _____ is the most important thing for calculating medication dosage for a child. a. age b. weight c. gender d. height (remembered)

b

The most important treatment for ANUG is? a. antibiotics: chlorohexidine rinse b. debridement c. patient understanding the importance of oral hygeine d. explaining to the patient the link between oral health and systemic health (remembered)

b

What is Gingivectomy used for? a. gingival hyertrophy b. gingival hyperplasia c. gingival recession d. hemostasis (remembered)

b

What is the greatest problem (disadvantage) with resin bonded bridges (Maryland Bridge)? a. staining b. debonding c. fracture d. less tooth reduction (remembered)

b

What is the major reason for periodontal flaps? a. Visualization of bone quality b. Access of Instrumentation c. Greater surface field to work on d. Increased primary wound healing (remembered)

b

What pain reliever do you give to a patient who has kidney disease? a. Asprin b. Acetaminophen c. Morphine d. Naproxen (remembered)

b

Worst cement for deep restoration? a. Glass Ionomer b. Zinc Phosphate c. Composite Resin d. RMGI (remembered)

b

X-rays show many well demarcated PARL's - Next step? a. initiate root canal therapy b. perform pulp testing c. incision and drainage d. extract

b

Mucocele treatment? a. Prescribe corticosteroids b. Excise it and adjacent gland should be excised to prevent recurrence c. Must be biopsied for definitive diagnosis d. Anti-fungal medications (remembered)

b "Excise with salivary gland remnants" - May be self-limiting or require local excision. - on lower lip from trauma. history of increasing and decreasing in size.

Post crown cementation sensitivity is due to? a. inadequate cement b. microleakage c. too much cement d. reaction to crown material (remembered)

b (marginal defects and gaps caused by polymerization shrinkage during placement)

Treatment of Primary Herpetic Stomatitis? a. Antibiotics b. Palliative c. Do nothing d. Antifungals (remembered)

b - Palliative care is medical care provided by physicians, nurses and social workers that specializes in the relief of the pain, symptoms and stress of serious illness.

Principles of tooth preparation - it should be your goal to prepare the tooth with: a. maximal taper b. minimal taper (tufts material)

b - you want the taper, but you want to conserve tooth structure.

Zinc phosphate is the worst cement for what type of restoration? a. Class V b. Deep Caries c. Shallow Caries (remembered)

b - zinc phosphate is a pulpal irritant

• Pentobarbital (Nembutal) • Secobarbital (Seconal) are what kind of drugs?

barbiturates - Both pentobarbital (Nembutal) and secobarbital (Seconal) are used primarily on the evening before the dental appointment.

Drug taken for arthritis? a. Propranolol b. Benadryl c. Naproxene d. Aleve

c

Drug that increase the concentration of lidocaine in the blood? a. Prozac b. Asprin c. Propanalol

c

Panoramic xray with radioPACITY underneath the mandibular incisors, asked what is it? a. odontoma b. impacted incisor c. supernumerary tooth d. osteoma (remembered)

c

Precision attachments not good for what type of patient? a. With poor ridge adaptment b. With flabby tissue c. With low dexterity d. With high esthetic demand (remembered)

c

Surgical stent fits the gums but the immediate denture doesn't fit, what do you do? a. re-construct the surgical stent b. re-construct the immediate denture c. relieve it until it seats (remembered)

c

The minimal axial reduction for crowns is? a. 0.5mm b. 1.0mm c. 1.5mm d. 2.0mm (remembered)

c - i think they are talking about PFM here: Metal coping: 0.3 - 0.5 mm & Porcelain: 0.7 - 1.0 mm

Ceramic restorations should have similar _______ to the adjacent natural teeth to have a good esthetic outcome. a. hue b. chroma c. value (tufts material)

c (value is most important part of the shade components) - value is the brightness.

Leave periodontal pack in for how long? a. 24 hours b. 3 days c. 1 week d. 3 months (remembered)

c - periodontal pack is just a periodntal dressing used to promote wound healing following periodontal flap surgery.

Lesion in the mouth that heals with a scar? a. Primary Herpes Labialis b. Minor Ampthous Ulcer c. Major Ampthous Ulcer d. Recurrent Herpes Stomatitis (remembered)

c major ampthous ulcer (minor heal without a scar)

What is hemolytic anemia? a. An autoimmune destruction of the parietal cells in the stomach. b. A genetic defect in which there is a variant of hemoglobin A called hemoglobin S c. A condition in which red blood cells are destroyed and removed from the bloodstream before their normal lifespan is over d. A condition in which folic acid is deficient and the patient presents with neurologic symptoms. (remembered)

c. ALSO know about Folate deficiency - neurologic symptoms!

What is a characteristic of a major connector of a denture? a. Provide relief b. Does not act as a support element c. Rigidity d. Stability (remembered)

c. must be rigid to transmit force equally to all areas and structures

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? (remembered)

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 / small baby.

6 months pregnant had bleeding gums and mobile teeth? How should they be treated? (remembered)

conservative debridement is what other person answered. - pregnancy gingivitis: It is SO important to do ScRP (and stress good oral hygeine) to prevent plaque growth. The plaque can enter blood stream and stimuate patient's immune system to produce prostaglandins, which can trigger uterine contraction leading to early labor, premature birth, and a small baby.

Advantage of a maryland bridge? a. staining b. debonding c. fracture d. less tooth reduction

d

Grade III or IV furcation involvement, Miller class III mobility; the tooth can't be maintained with adequate plaque control by the clinician or by the patient. What would be the prognosis for this tooth? a. questionable b. good c. poor d. hopeless

d

PFM crown - whats the occlusal reduction? a. 0.5mm b. 1.0mm c. 1.5mm d. 2.0mm (remembered

d

Large space (diastema) between #11 and #12. What do you do? a. place implant b. removable partial denture c. fixed partial denture (bridge) d. do nothing (remembered)

d - "leave it alone"

What is the worst location for an implant? a. mandibular anterior b. mandibular posterior c. maxillary anterior d. maxillary posterior e. two of the above (remembered)

d - T4 bone. Strongest bone is found in anterior mandible

Best initial treatment for Maxillary oroantro fistula? a. antibiotics b. irrigation c. pack with gauze d. two of the above

d - antibiotics and irrigation

Once thought to be associated with BLUE SCLERA and multiple bone fractures a. hemolytic anemia b. grave's disease c. pernicious anemia d. dentinogenesis imperfecta (remembered)

d - they give an eye picture and ask what dental findings should you see

Before you re-line a complete denture you must first establish? a. anterior guidance b. maximum intercuspal position c. posterior occlusion d. centric relation (remembered)

d. centric relation

If they give you a picture of eyes and ask what dental findings you expect to see - whats the answer?

dentinogenesis imperfecta (blue sclera is the eye pic)

Steroids - whats most important information you need to get from your patient when you find out they are on steroids.. before even thinking about treating them? (remembered)

duration and dosage. - "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.

Cyclosporine - side effect you need to know?

gingival hyperplasia (cyclosporine is an Immunodepressant used in transplant patients. )

Patient just had a stroke. What do you need to worry about? (remembered)

if they are on anti-coagulants (blood thinners). - 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.

Picture of Upper and lower complete arch crowns. What is wrong? (remembered)

impingement on gums/gums health

**Advantage of under contoured temporary crowns? a. allows adequate material to resist occlusal forces b. improves health of gingival tissues c. saves the patient money

improves health of gingival tissues

1-2 mm of reduction in probing depth after performing SRP. What caused this? (remembered)

long junctional epithelium

cauliflower lesion on tongue is? (remembered)

papilloma

If you cannot pick a color for crown, what should you choose? Answer: Something with ____ shade saturation, and ______ gray. a. higher, more b. lower, less c. higher, less d. lower, more (remembered)

something with LOWER shade saturation and less gray

Picture of surveyor. Asked what we were looking at? (remembered)

space for guideplane

What is the maximum amount of unsupported porcelain allowed? ("Minimum thickness for porcelain") (remembered)

2mm

In order to preserve biological width, you want the crown margin to be ___mm above the alveolar crest. (tufts material)

2mm above crest. And in case of crown lengthening, 3mm from the bone.

Crown on #9 needs to be replaced. What measurement is correct? (remembered)

2mm occlusal reduction

Barbiturates - how should an allergic reaction be treated? (remembered)

Benadryl -> if its a mild-moderate allergy. - When a patient experiences a milder form of anaphylactic reaction, the drug or prepara- tion that caused a reaction is discontinued and the patient is given diphenhydramine (Benadryl), 25-50 mg/tablet PO q6h for 48-72 hr.

Lichen planus present on the tongue that was asymptomatic, what is the treatment? a. Antifungal b. Corticosteroids c. Antibacterial d. Chlorohexidine Rinse (remembered)

Corticosteroids (nothing was not an option)

14 y.o. patient with inflamed gingiva. Given normal ranges and then the patient's abnormal numbers for RBC, WBC, and platelets. What is wrong? (remembered)

Leukemia because high WBC, sore lymph nodes, and painful gums - note: WBC can be high or low for leukemia. - Gingival hypertrophy is common with leukemia.

What drug causes gingival hyperplasia? (remembered)

Nifedipine, Cyclosporine, Phenytoin (Dilantin) - It is best to schedule hygiene recall every 3-4 months to control the hyperplasia.

Space in between #29 and #30 in a very old patient with no #31 or #32 and barely occluding with #3. This is due to what / why is this happening? (remembered)

No occlusion, or mesial drifting premolars

In order to improve gingival health, what must you do to temporary crown? a. overcontour b. undercontour (remembered)

Under contour (bulbous crowns are not good for gingiva)

The Enzyme Linked Immune Absorbent Assay (ELISA) Test - a negative response for a person who had needle stick means what? a. the patient definitely has an HIV infection b. the patient has antibodies to HIV-1 present c. the patient definitely does not have an HIV infection d. the patient has no antibodies to HIV-1 present. (remembered)

patient had no Abs present was answer. - The ELISA Test is "reactive" when it detects antibodies to HIV-1. Once positive, the blood is tested again to confirm that indeed the ELISA Test is positive. - Western Blot Test is more specific test. It determines size of antigens in the test kit binding to the antibodies. Blood showing a positive ELISA is subjected to the Western Blot Test. Thus, the Western Blot Test is a confirmatory testing for HIV infection. A positive Western Blot Test confirms that the patient has the HIV infection.

Arm rash - what drug caused it? (remembered)

penicillin allergy is answer

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)? (remembered)

place her in trundelburg 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, prefera-bly 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.

What is the major complications of Phelobitis? a. Atrial Fibrilation b. Pulmonary Embolism c. Peripheral Neuropathy d. Myocardial Infarction (remembered)

pulmonary embolism

Patient complaining of space in between teeth after SRP, why? a. Removal of some of tooth structure during ScRP b. Tooth movement is normal following ScRP c. Reduction in edematous tissue condition following ScRP d. The cause in unknown (remembered)

reduction in edema

Maxillary tori in denture patient. What do you do before making a new denture? (remembered)

remove tori

what does intrinsic factor do? (remembered)

required to absorb vitamin B12 from food

If a patient has a shunt on the left arm where do you take BP? a. wrist b. right arm c. neck d. finger (remembered)

right arm -- "Pt's on dialysis, where do you take their BP? Not on the side where the shunt was placed for dialysis"