DSE OSCE - 2024
ADA Recommendations for Antibiotic Prophylaxis
Pre-medication is required for:
- Prosthetic cardiac valves: including transcatheter-implanted prostheses and homografts.
- Prosthetic material used for cardiac valve repair (e.g., annuloplasty rings, chords).
- History of infective endocarditis.
- Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
- Congenital heart diseases, including:
- Unrepaired cyanotic congenital heart disease (including palliative shunts and conduits).
- Any repaired congenital heart defect with residual issues at the site of or adjacent to a prosthetic
patch/device.
Source: [ADA Guidelines on Antibiotic Prophylaxis](https://www.ada.org/en/member-center/oral-
health-topics/antibiotic-prophylaxis)
Clinical Cases and Scenarios
1. Pregnant Patient with History of Infective Endocarditis:
- Pre-med indicated? ✔️ Yes.
- Recommended pre-med options considering penicillin allergy: ✔️ Clarithromycin (notably,
cephalexin could also be considered, but avoid ciproflaxacin as it is contraindicated in pregnancy).
2. Dentist Procedures in Bisphosphonate Patients:
- Can a dentist perform without consulting MD? ✔️ Occlusal restoration is acceptable.
- Extraction increases risk, as does endo therapy if compromised.
3. Management of Anxiety in a Pregnant Patient:
- Position during stress (before passing out)? ✔️ Place in Trendelenburg position to help prevent
supine hypotension in the third trimester.
,4. Management of Pregnancy-Related Gum Issues:
- How to treat bleeding gums and mobile teeth in a pregnant woman? ✔️ Conservative debridement
(avoid extractions).
5. Diastema in Pregnant Patient:
- Likely Reason: ✔️ Chronic periodontitis (address periodontal health to avoid complications).
Medical Knowledge and Clinical Pharmacology
6. Tetracycline Staining Timing:
- Permanent staining occurs at age: ✔️ 0-5 years (during enamel development).
7. Drug Identification:
- Pentobarbital and Secobarbital Type: ✔️ Barbiturates.
8. Treatment of Barbiturate Allergy:
- How to treat allergic reaction? ✔️ Diphenhydramine (Benadryl) is appropriate.
9. Steroid User Information Needed Before Treatment:
- What to inquire about? ✔️ Both dose and duration of steroid use.
10. Child Medication Dosage Calculation:
- Most important factor? ✔️ Weight (preferred over age, gender, height).
Patient Conditions and Considerations
11. Trisomy 21 Concerns:
- Initial concern? ✔️ Congenital heart defects (common in patients with Down syndrome).
,12. Post-Stroke Concerns:
- First concern after stroke? ✔️ Are they on anticoagulants?
13. Anaphylaxis vs. Syncope Symptoms:
- Main symptom differentiating: ✔️ Bronchoconstriction (anaphylaxis includes difficulty breathing).
14. ELISA Test Result Interpretation:
- Negative response indicates: ✔️ The patient does not have HIV antibodies.
15. Leukemia Signs in 14-Year-Old:
- Likely diagnosis with abnormal blood cells: ✔️ Leukemia (high WBC, painful gingiva).
16. Drug-Induced Hyperplasia Agents:
- ✔️ Calcium channel blockers, Cyclosporines, Anticonvulsants.
Oral Lesions and Conditions
17. Identifying Oral Lesions:
- Characteristics:
- Mucocele: Bluish, swollen salivary gland.
- Ranula: Mucocele under the tongue.
- Fibroma: Granulation tissue response to irritation.
- Papilloma: Wart-like due to HPV.
- Thermal Injury: From hot food/drink.
- SCC: Ulcerated and persistent lesions.
- Cold Sore (Herpes): Recurrent vesicular lesions.
, 18. Ectodermal Dysplasia Symptoms:
- Presentation Includes: ✔️ Missing teeth and no hair.
19. Pernicious Anemia Explanation:
- Associated with what? ✔️ Autoimmune destruction of parietal cells leading to B12 deficiency.
20. Hemolytic Anemia Definition:
- Characterized by: ✔️ Destruction of RBCs before their normal lifespan is over.
21. Hereditary Hemorrhagic Telangiectasia:
- Associated with: ✔️ 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
ADA Recommendations for Antibiotic Prophylaxis
Pre-medication is required for:
- Prosthetic cardiac valves: including transcatheter-implanted prostheses and homografts.
- Prosthetic material used for cardiac valve repair (e.g., annuloplasty rings, chords).
- History of infective endocarditis.
- Cardiac transplant with valve regurgitation due to a structurally abnormal valve.
- Congenital heart diseases, including:
- Unrepaired cyanotic congenital heart disease (including palliative shunts and conduits).
- Any repaired congenital heart defect with residual issues at the site of or adjacent to a prosthetic
patch/device.
Source: [ADA Guidelines on Antibiotic Prophylaxis](https://www.ada.org/en/member-center/oral-
health-topics/antibiotic-prophylaxis)
Clinical Cases and Scenarios
1. Pregnant Patient with History of Infective Endocarditis:
- Pre-med indicated? ✔️ Yes.
- Recommended pre-med options considering penicillin allergy: ✔️ Clarithromycin (notably,
cephalexin could also be considered, but avoid ciproflaxacin as it is contraindicated in pregnancy).
2. Dentist Procedures in Bisphosphonate Patients:
- Can a dentist perform without consulting MD? ✔️ Occlusal restoration is acceptable.
- Extraction increases risk, as does endo therapy if compromised.
3. Management of Anxiety in a Pregnant Patient:
- Position during stress (before passing out)? ✔️ Place in Trendelenburg position to help prevent
supine hypotension in the third trimester.
,4. Management of Pregnancy-Related Gum Issues:
- How to treat bleeding gums and mobile teeth in a pregnant woman? ✔️ Conservative debridement
(avoid extractions).
5. Diastema in Pregnant Patient:
- Likely Reason: ✔️ Chronic periodontitis (address periodontal health to avoid complications).
Medical Knowledge and Clinical Pharmacology
6. Tetracycline Staining Timing:
- Permanent staining occurs at age: ✔️ 0-5 years (during enamel development).
7. Drug Identification:
- Pentobarbital and Secobarbital Type: ✔️ Barbiturates.
8. Treatment of Barbiturate Allergy:
- How to treat allergic reaction? ✔️ Diphenhydramine (Benadryl) is appropriate.
9. Steroid User Information Needed Before Treatment:
- What to inquire about? ✔️ Both dose and duration of steroid use.
10. Child Medication Dosage Calculation:
- Most important factor? ✔️ Weight (preferred over age, gender, height).
Patient Conditions and Considerations
11. Trisomy 21 Concerns:
- Initial concern? ✔️ Congenital heart defects (common in patients with Down syndrome).
,12. Post-Stroke Concerns:
- First concern after stroke? ✔️ Are they on anticoagulants?
13. Anaphylaxis vs. Syncope Symptoms:
- Main symptom differentiating: ✔️ Bronchoconstriction (anaphylaxis includes difficulty breathing).
14. ELISA Test Result Interpretation:
- Negative response indicates: ✔️ The patient does not have HIV antibodies.
15. Leukemia Signs in 14-Year-Old:
- Likely diagnosis with abnormal blood cells: ✔️ Leukemia (high WBC, painful gingiva).
16. Drug-Induced Hyperplasia Agents:
- ✔️ Calcium channel blockers, Cyclosporines, Anticonvulsants.
Oral Lesions and Conditions
17. Identifying Oral Lesions:
- Characteristics:
- Mucocele: Bluish, swollen salivary gland.
- Ranula: Mucocele under the tongue.
- Fibroma: Granulation tissue response to irritation.
- Papilloma: Wart-like due to HPV.
- Thermal Injury: From hot food/drink.
- SCC: Ulcerated and persistent lesions.
- Cold Sore (Herpes): Recurrent vesicular lesions.
, 18. Ectodermal Dysplasia Symptoms:
- Presentation Includes: ✔️ Missing teeth and no hair.
19. Pernicious Anemia Explanation:
- Associated with what? ✔️ Autoimmune destruction of parietal cells leading to B12 deficiency.
20. Hemolytic Anemia Definition:
- Characterized by: ✔️ Destruction of RBCs before their normal lifespan is over.
21. Hereditary Hemorrhagic Telangiectasia:
- Associated with: ✔️ 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
