DSE OSCE – 2021 (170 QAs CORRECTLY ANSWERED)

What are the ADA recommendations for when pre-med is required - ANSWER >>> - 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 - ANSWER >>> 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 - ANSWER >>> *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 - ANSWER >>> *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: 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 - ANSWER >>> 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