Overseas Registration Exam (ORE) Human Disease, Pharmacology and Therapeutics Syllabus

Human Disease, Pharmacology and Therapeutics syllabus — full chapter and topic list

Expand any chapter to see its topics and sub-topics. This is the whole examinable outline for Human Disease, Pharmacology and Therapeutics in Overseas Registration Exam (ORE), not a summary of it.

1. 1

   Medical History and Risk Assessment

   3 topics

   • Structured History Taking and the ASA Classification
   • Identifying the Medically Compromised Patient
   • Liaison with Medical Practitioners and Referral
2. 2

   Systemic Disease and Dental Implications

   5 topics

   • Cardiovascular Disease
     • Hypertension, ischaemic heart disease and arrhythmias
     • Anticoagulants, antiplatelets and bleeding risk
   • Endocrine and Metabolic Disorders
     • Diabetes mellitus and glycaemic control
     • Thyroid, adrenal and steroid-treated patients
   • Respiratory and Renal Disease
     • Asthma and COPD considerations
     • Renal failure, dialysis and drug dosing
   • Haematological Disorders and Bleeding Diatheses
   • Neurological, Hepatic and Immunological Conditions
3. 3

   Pharmacology and Prescribing

   4 topics

   • Principles of Pharmacokinetics and Pharmacodynamics
   • Drugs Used in Dentistry
     • Analgesics and the WHO analgesic ladder
     • Antimicrobials, antifungals and antivirals
     • Sedatives and emergency drugs
   • Safe and Legal Prescribing
     • The Dental Practitioners' Formulary and BNF
     • Controlled drugs legislation and record keeping
   • Drug Interactions and Adverse Reactions
4. 4

   Pain and Anxiety Control

   3 topics

   • Local Anaesthesia
     • Agents, techniques and maximum safe doses
     • Failure, complications and management
   • Conscious Sedation
     • Inhalation sedation with nitrous oxide
     • Intravenous midazolam and patient monitoring
   • General Anaesthesia: Indications and Referral

Human Disease, Pharmacology and Therapeutics flashcards for Overseas Registration Exam (ORE)

22 of 52 cards from the Human Disease, Pharmacology and Therapeutics deck — real questions with worked answers.

1. What does the ASA Physical Status Classification System assess, and how many grades does it have?

   It is a system (American Society of Anesthesiologists) used to assess a patient's pre-operative physical/medical fitness for anaesthesia or treatment. It has 6 grades (ASA I to VI), with an 'E' suffix added for emergency procedures.

2. Define ASA I to ASA III in the ASA Physical Status Classification.

   ASA I: a normal healthy patient. ASA II: a patient with mild systemic disease (e.g. well-controlled diabetes, mild asthma, smoker). ASA III: a patient with severe systemic disease that is not incapacitating (e.g. poorly controlled diabetes, stable angina).

3. Define ASA IV, V and VI in the ASA Physical Status Classification.

   ASA IV: severe systemic disease that is a constant threat to life (e.g. unstable angina, recent MI). ASA V: a moribund patient not expected to survive 24 hours without the operation. ASA VI: a declared brain-dead patient whose organs are being removed for donation.

4. What are the key components of a structured dental/medical history (the mnemonic order)?

   Presenting complaint (PC); history of presenting complaint (HPC); past medical history (PMH); past dental history (PDH); drug/medication history; family history; social history (smoking, alcohol, occupation); and a systems review.

5. What features in a patient's history should raise suspicion that they are 'medically compromised'?

   Multiple regular medications, recent hospital admission, breathlessness/chest pain on exertion, uncontrolled chronic disease, recent surgery, bleeding tendencies, immunosuppression, and reduced exercise tolerance (e.g. inability to climb a flight of stairs without stopping).

6. What information should a dental referral letter to a medical practitioner contain?

   Patient identification details, the reason for referral, a clear specific question being asked, relevant dental findings and proposed treatment, the patient's current medications and medical history as known, and the referrer's contact details and urgency.

7. Why might a dentist liaise with a patient's GP or physician before treatment?

   To confirm or clarify the medical history and current medications, assess control of systemic disease, obtain advice on anticoagulant/antiplatelet management, check fitness for sedation/GA, arrange antibiotic or steroid cover, and confirm safety of prescribing.

8. What is the recommended management of a patient on warfarin requiring a dental extraction, including the INR threshold?

   Do not routinely interrupt warfarin. Check the INR ideally within 24 hours (up to 72 hours if stable) before surgery; proceed with local measures if INR is below 4.0. Use local haemostatic measures (sutures, oxidised cellulose, tranexamic acid mouthwash).

9. For a patient with stable angina, what precautions should be taken during dental treatment?

   Ensure the patient brings their GTN spray, keep appointments short and stress-free, provide good local anaesthesia, treat in a semi-reclined position, and have GTN available. Consider treating later in the morning. Avoid elective treatment if angina is unstable.

10. What is the current guidance on antibiotic prophylaxis for infective endocarditis in dental patients (NICE)?

    NICE does not recommend routine antibiotic prophylaxis solely to prevent infective endocarditis for dental procedures, but it may be considered for people at increased risk after discussion with the cardiologist/patient. Good oral hygiene is emphasised as more important.

11. How long should elective dental treatment ideally be deferred after a myocardial infarction, and why?

    Elective treatment should be deferred for at least 6 months (some sources say 3-6 months) after an MI, because the risk of re-infarction and arrhythmia is highest in this period.

12. What is the maximum recommended dose of adrenaline-containing local anaesthetic in a patient with significant cardiovascular disease?

    Limit adrenaline (epinephrine) to about 0.04 mg total (roughly 2 cartridges of 2% lidocaine with 1:80,000 adrenaline). Use careful aspiration and slow injection to avoid intravascular delivery and a sympathetic surge.

13. What are the signs and emergency management of a hypoglycaemic episode in the dental chair?

    Signs: sweating, shaking, confusion, slurred speech, aggression, then loss of consciousness. Management: if conscious give 15-20 g fast-acting oral glucose; if unconscious give 1 mg IM glucagon or IV glucose, and call for emergency help.

14. Which is the more immediate dental emergency in a diabetic patient: hypoglycaemia or hyperglycaemia, and why?

    Hypoglycaemia, because it develops rapidly and can cause loss of consciousness, seizures and brain damage within minutes. Hyperglycaemia (and ketoacidosis) develops over hours to days and is less of an acute chairside emergency.

15. What is an Addisonian (adrenal) crisis and how is it managed in the dental setting?

    An acute deficiency of cortisol, often precipitated by stress in a patient on long-term steroids or with Addison's disease. Signs: hypotension, collapse, pallor. Management: lay flat, give 100 mg IV/IM hydrocortisone, call emergency services, give oxygen.

16. What precaution may be needed for a patient on long-term corticosteroids undergoing a stressful dental procedure?

    They may have adrenal suppression and be unable to mount a stress response, so steroid cover may be considered for major procedures to prevent an adrenal crisis (though routine doubling for minor dentistry is now often not required—assess stress level).

17. Why must elective dental treatment for hyperthyroid patients be deferred until they are euthyroid?

    Because stress and adrenaline can precipitate a thyrotoxic crisis (thyroid storm) — a life-threatening state of tachycardia, hyperthermia, arrhythmia and collapse. Adrenaline-containing LA should be used cautiously in uncontrolled hyperthyroidism.

18. What dental management considerations apply to an asthmatic patient?

    Ensure they bring their inhaler (salbutamol), assess severity/control, avoid known triggers, avoid NSAIDs and aspirin in NSAID-sensitive asthmatics, minimise stress, and be cautious with sedatives that depress respiration.

19. What is the immediate management of an acute asthma attack in the dental surgery?

    Stop treatment, sit the patient upright, give salbutamol 2 puffs via spacer (repeat as needed), give high-flow oxygen, reassure, and if no improvement or severe, call emergency services and consider repeated salbutamol/nebuliser.

20. Why should certain drugs be dose-adjusted or avoided in patients with chronic kidney disease?

    Because reduced renal clearance leads to accumulation and toxicity of renally-excreted drugs (e.g. NSAIDs, some antibiotics). NSAIDs can worsen renal function, and drug doses/intervals may need adjustment based on eGFR.

21. What dental precautions apply to a patient on renal dialysis (haemodialysis)?

    Treat on the day after dialysis (not the same day) when the patient is least uraemic and heparin has worn off; avoid nephrotoxic drugs; be aware of bleeding tendency, anaemia, hypertension and risk of hepatitis/bloodborne infection.

22. What is a bleeding diathesis, and name three examples relevant to dentistry.

    A bleeding diathesis is an increased tendency to bleed due to a defect in haemostasis. Examples: haemophilia A (factor VIII deficiency), haemophilia B (factor IX deficiency), von Willebrand disease, and thrombocytopenia.

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