Medical OSCE Quiz - glucose, bisphosphonates, INR

You must make sure you carry out ICE for all patients. What does ICE stand for? I - [blank_start]Introduce[blank_end] C - [blank_start]Consent[blank_end] E - [blank_start]Expose[blank_end]

What is blood glucose measured in on a glucometer (in the UK!)

What is the normal range of capillary blood glucose in mmol/L in an ADULT before a meal?

What is the normal blood glucose level in an adult without diabetes, in mmol/L, around 2 hours after eating?

You are gaining consent to take someone's blood glucose measurement. 1. [blank_start]introduce[blank_end] yourself 2. Explain you are going to take a [blank_start]blood glucose[blank_end] measurement 3. Explain that you do this to ensure the [blank_start]levels[blank_end] of blood glucose are [blank_start]normal[blank_end] so as to prevent [blank_start]complications[blank_end] during [blank_start]dental[blank_end] treatment 4. This will also give a better [blank_start]understanding[blank_end] of how well your blood glucose is [blank_start]controlled[blank_end] 5. Can I [blank_start]proceed[blank_end]?

What is the normal blood glucose level of a type 1 diabetic adult ON WAKING

What is the normal blood glucose level of a type 1 diabetic adult BEFORE MEALS

What is the normal blood glucose level of a type 1 diabetic adult 90 minutes AFTER meals?

What is the normal blood glucose level of a TYPE 2 diabetic adult BEFORE meals?

What is the normal blood glucose level of a TYPE 2 diabetic adult two hours AFTER meals?

The stages of carrying out a blood glucose measurement are as follows: 1. ICE ([blank_start]Introduce[blank_end], [blank_start]consent[blank_end], [blank_start]explain[blank_end]) 2. Cross infection - [blank_start]wash[blank_end] hands 3. Prepare equipment - [blank_start]pricking[blank_end] device, [blank_start]glucometer[blank_end] strip (check expiry date), and the [blank_start]glucometer[blank_end]. 4. Place [blank_start]strip[blank_end] in the machine - do not touch area where [blank_start]blood[blank_end] will be placed. 5. Ask patient to [blank_start]wash[blank_end] their hands - so their finger is [blank_start]clean[blank_end] 6. Place [blank_start]pricking[blank_end] device at chosen site and click 7. Dispose of device in the [blank_start]sharps bin[blank_end] 8. [blank_start]Massage[blank_end] the finger to get a [blank_start]drop[blank_end] of blood 9. Place test strip on blood droplet. Do not [blank_start]smear[blank_end] or [blank_start]spread[blank_end] the blood 10. Glucometer will generate a reading 11. Press [blank_start]cotton wool[blank_end] on to puncture wound until bleeding has [blank_start]stopped[blank_end] - possibly place a [blank_start]plaster[blank_end] 12. [blank_start]Wash[blank_end] hands, tidy up 13. Check patient is [blank_start]comfortable[blank_end] 14. Write [blank_start]record[blank_end] of measurement in notes.

Label the test strip using the drop down menus

What is the correct term for BRONJ now? Answer: [blank_start]MRONJ[blank_end]

What does the acronym MRONJ stand for? [blank_start]Medication[blank_end] [blank_start]related[blank_end] [blank_start]osteonecrosis[blank_end] of the [blank_start]jaw[blank_end]

Which of the following drugs are true about bisphosphonates? (select all that apply)

How long must necrotic bone persist in the maxilla or mandible to be classified as MRONJ?

True or false? MRONJ is rare in patients taking bisphosphonates

True or false? Bisphosphonates are used to treat some cancers

True or false? MRONJ is only truly MRONJ if the patient has no history of radiation therapy to the jaw?

True or false? Bisphosphonates are never prescribed as a preventative measure

True or false? MRONJ patients should never be treated in primary care.

During a medical history, you should ensure you ask about [blank_start]past[blank_end], current, or possible [blank_start]future[blank_end] use of bisphosphonates. Bisphosphonates are often prescribed for non-malignant conditions such as: - O[blank_start]steoporosis[blank_end] - P[blank_start]aget's[blank_end] disease - O[blank_start]steogenesis[blank_end] imperfect - F[blank_start]ibrous[blank_end] d[blank_start]ysplasia[blank_end] and some malignant conditions such as: - [blank_start]Multiple[blank_end] myeloma - B[blank_start]reast[blank_end] cancer - P[blank_start]rostate[blank_end] cancer - Metastatis bony lesions

Symptoms of MRONJ often include: - [blank_start]Delayed[blank_end] healing following extraction or oral surgery - P[blank_start]ain[blank_end] - Soft tissue [blank_start]infection[blank_end] - Sw[blank_start]elling[blank_end] - P[blank_start]araesthesia[blank_end] - [blank_start]Exposed[blank_end] bone - N[blank_start]umbness[blank_end]

Check all things you must advise a patient taking bisphosphonates during, and before, dental treatment

True or false? Carrying out dental treatment prior to a course of bisphosphonate therapy is contraindicated and will increase risk of MRONJ

How might bisphosphonates improve a patient's medical state?

Which of these is the correct term for death of bone?

True or false? A patient on bisphosphonate therapy for management of osteoporosis is at high risk of MRONJ

Are patients on IV bisphosphonates at a higher or lower risk of developing MRONJ?

Patients at high risk of developing MRONJ have one or more of the following factors − previous [blank_start]diagnosis[blank_end] of BONJ; − taking a bisphosphonate as part of the management of a [blank_start]malignant[blank_end] condition; − other non-[blank_start]malignant[blank_end] systemic condition affecting [blank_start]bone[blank_end] (e.g. Paget’s disease); − under the care of a [blank_start]specialist[blank_end] for a [blank_start]rare[blank_end] medical condition (e.g. [blank_start]osteogenesis[blank_end] imperfecta); − concurrent use of systemic [blank_start]corticosteroids[blank_end] or other [blank_start]immunosuppressants[blank_end]; − coagulopathy, chemotherapy or radiotherapy.

True or false: MRONJ risk is temporarily reduced by the patient ceasing their bisphosphonate therapy prior to dental treatment.

True or false? bisphosphonate drugs can remain in the skeletal tissues for years.

The anticoagulant treatment record is more commonly known as the...?

True or false: Patients on warfarin therapy should be advised against taking ibuprofen and aspirin

What should a patient's INR be prior to commencing dental treatment with a bleeding risk?

You are seeing a lady who is about to have dental treatment. She is on warfarin therapy. - You should ask [blank_start]why[blank_end] she was [blank_start]prescribed[blank_end] warfarin - You should look at their anticoagulant therapy record ([blank_start]yellow[blank_end] book) - You need to ensure her [blank_start]INR[blank_end] has been measured [blank_start]recently[blank_end] and that measurements are under control with no [blank_start]fluctuations[blank_end] - [blank_start]Paracetamol[blank_end] can be taken for pain relief - You can place [blank_start]sutures[blank_end] to control bleeding if necessary - She should [blank_start]not[blank_end] stop taking her warfarin before treatment - Risk of [blank_start]thrombosis[blank_end] is greater than the risk of [blank_start]bleeding[blank_end]