DSE OSCE 2022 Exam

What are the ADA recommendations for when pre-med is required - - prosthetic cardiac valves, including transcatheter-implanted prostheses and homografts - prosthetic material used for cardiac valve repair, such as annuloplasty rings and chords - a history of infective endocarditis - a cardiac transplanta with valve regurgitation due to a structurally abnormal valve - the following congenital (present from birth) heart disease --unrepaired cyanotic congenital heart disease, including palliative shunts and conduits --any repaired congenital heart defect with residual shunts or valvular regurgitation at the site of or adjacent to the site of a prosthetic patch or a prosthetic device **ADA website** 41-yo woman, pregnant; prev rheumatic fever with heart murmur (no valvular abnormality); allergy to penicillin. Positive history of infective endocarditis. Does she need to pre med? - yes - no - yes - REVIEW HEALTH HISTORY - on my exam, this patient had a previous history of infective endocarditis. Pre-med IS indicated - many of the OSCE quizlets say no.... Pre-med options for pregnant woman w/hx of infective endocarditis and penicillin allergy - amoxicillin - cephalexin - clarithromycin - ciproflaxacin - *clarithromycin* I may not be correct, the correct option may be cephalexin. however I chose clarithromycin due to penicillin allergy, cross reaction with cephalosporins, and since clindamycin/erythromycin/azthromycin were not options. Ciproflaxacin is contraindicated in pregnancy. article for reference What procedure can a dentist perform without consulting MD if a patient is currently taking bisphosphonates? - endo therapy - prophy and scaling - extraction - occlusal restoration - *occlusal restoration* although the main HELL NO is extraction, completing endo therapy increases risk if the apex is compromised/damaged during therapy. I teetered on prophy and scaling, but since it did not specify supragingival, decided that the risk of scaling can negatively affect the periosteum of a bisphosphanate patient. ADA recommendations: 0Treatment%20of%20Patients%20on%20B 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)? - supply oxygen - place in Trendelenburg - make patient sit up straight - tell them to suck it up buttercup - place her in Trendelburg 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, preferably 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. 6 months pregnant had bleeding gums and mobile teeth, how shou