Overseas Registration Exam (ORE) Prevention, Public Health and Medical Emergencies Flashcards

24 sample cards from the Prevention, Public Health and Medical Emergencies deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Name the stages of the Transtheoretical (Stages of Change) model used in behaviour change.

   Precontemplation, Contemplation, Preparation, Action, Maintenance (and Relapse). Interventions are matched to the patient's stage to support movement toward sustained behaviour change.

2. What are 'SMART' goals in oral health behaviour change?

   Specific, Measurable, Achievable, Relevant and Time-bound. Setting SMART goals with the patient improves the likelihood that agreed changes (e.g. reducing sugary snacks) are actually adopted and sustained.

3. Define decontamination and list its three component processes in order.

   Decontamination is the combination of processes that renders a reusable item safe for further use/handling. The processes are: 1. Cleaning (removal of visible soil/bioburden), 2. Disinfection (reduction of viable microorganisms), 3. Sterilisation (destruction of all microorganisms including spores). Cleaning must always precede sterilisation.

4. State the standard steam (autoclave) sterilisation parameters for dental instruments.

   Saturated steam under pressure: typically $134\text{–}137\,^{\circ}\text{C}$ at $\approx 2.1\ \text{bar}$ for a minimum holding time of $3$ minutes; an alternative cycle is $121\,^{\circ}\text{C}$ at $\approx 1.1\ \text{bar}$ for $15$ minutes.

5. Differentiate type N and type B (vacuum) autoclaves.

   Type N (non-vacuum/downward displacement) sterilises only solid, unwrapped, non-lumened instruments. Type B (vacuum/porous-load) uses active air removal and can sterilise wrapped, hollow and lumened/cannulated instruments, allowing storage of pouched sterile items.

6. In Spaulding's classification, what are critical, semi-critical and non-critical items?

   Critical = items entering sterile tissue or the vascular system (e.g. surgical instruments, scalers) — require sterilisation. Semi-critical = contact mucous membranes or non-intact skin (e.g. mirrors, handpieces) — require sterilisation or high-level disinfection. Non-critical = contact intact skin only (e.g. BP cuff) — require cleaning/low-level disinfection.

7. List the components of standard (universal) precautions in dentistry.

   Hand hygiene; appropriate PPE; safe handling and disposal of sharps; environmental cleaning and decontamination of surfaces/equipment; respiratory hygiene/cough etiquette; safe management of clinical waste, linen and blood/body-fluid spillages. They are applied to ALL patients regardless of known infection status.

8. What are the WHO 'Five Moments for Hand Hygiene'?

   1. Before touching a patient, 2. Before a clean/aseptic procedure, 3. After body-fluid exposure risk, 4. After touching a patient, 5. After touching the patient's surroundings.

9. What is the correct sequence for donning and doffing PPE?

   Donning: gown/apron → mask/respirator → eye protection → gloves. Doffing (most contaminated first): gloves → eye protection → gown/apron → mask/respirator, performing hand hygiene after removal (and between steps as needed).

10. How is clinical (hazardous infectious) waste segregated by colour in UK dental practice?

    Orange bags = infectious clinical waste (treated/incinerated). Yellow = infectious waste requiring incineration (e.g. medicinal/anatomical contaminated). Yellow sharps bin (orange lid) = non-medicinally contaminated sharps; yellow lid = sharps contaminated with medicines; purple lid = cytotoxic/cytostatic. Black/clear = domestic (offensive yellow-black 'tiger' = non-infectious offensive).

11. State the key sharps-safety rules to prevent inoculation injury.

    Do not re-sheathe needles by hand (use single-handed scoop or a re-sheathing device); never bend/break needles; dispose of sharps at the point of use into a designated puncture-resistant sharps bin; fill bins to the marked line only; the person who used the sharp is responsible for its disposal.

12. List the main blood-borne viruses of occupational concern and their relative transmission risk after a needlestick from a positive source.

    Hepatitis B (HBV) — highest risk, up to ~30% if e-antigen positive and recipient unvaccinated; Hepatitis C (HCV) — approximately 3%; HIV — approximately 0.3% after percutaneous exposure.

13. Outline the immediate first-aid and management steps after a sharps/needlestick injury.

    Encourage the wound to bleed (do not suck), wash with running water and soap (do not scrub); irrigate exposed mucosa/eyes with water/saline; report to the responsible person and occupational health; perform a risk assessment of the source; consider PEP (especially for HIV within ideally 1 hour), check/boost HBV status, and arrange baseline and follow-up serology.

14. What HBV protection should dental clinical staff have, and what indicates immunity?

    They should be vaccinated against hepatitis B (and ideally be 'EPP-cleared'). An anti-HBs (surface antibody) titre $\geq 100\ \text{mIU/mL}$ indicates an adequate response; $10\text{–}100$ is a poor responder needing a booster; $< 10\ \text{mIU/mL}$ is a non-responder requiring investigation and possibly HBIG after exposure.

15. What does the ABCDE approach to the acutely unwell patient stand for?

    A = Airway, B = Breathing, C = Circulation, D = Disability (neurological status, e.g. AVPU/GCS and blood glucose), E = Exposure (examine for other clues while preventing heat loss). Assess and treat life-threatening problems in order before moving on.

16. How do you recognise and manage a vasovagal syncope (simple faint) in the dental chair?

    Recognition: pre-syncope pallor, sweating, nausea, slow weak pulse, then loss of consciousness. Management: lay the patient flat and raise the legs to restore cerebral perfusion, ensure a clear airway, give oxygen, loosen tight clothing; recovery is usually rapid — consider glucose if delayed.

17. Describe the recognition and emergency management of acute anaphylaxis.

    Recognition: rapid onset of Airway/Breathing/Circulation problems (stridor, wheeze, hypotension) with skin changes (urticaria, angioedema) after an allergen. Management: ABCDE, remove trigger, give IM adrenaline $0.5\ \text{mg}$ ($0.5\ \text{mL}$ of $1{:}1000$) into the anterolateral thigh, high-flow oxygen, lie flat with legs raised, call 999/2222, repeat adrenaline after 5 minutes if no improvement.

18. What is the adult basic life support sequence and the CPR ratio?

    Ensure safety, check response, open airway, check for normal breathing (no more than 10 s); if absent, call for help/999 and AED, start chest compressions. Give 30 compressions to 2 rescuer breaths ($30{:}2$), compressions at a depth of $5\text{–}6\ \text{cm}$ and a rate of $100\text{–}120$ per minute.

19. In adult cardiac arrest, which rhythms are shockable, and where does adrenaline fit?

    Shockable rhythms: ventricular fibrillation (VF) and pulseless ventricular tachycardia (pVT) — defibrillate immediately. Non-shockable: pulseless electrical activity (PEA) and asystole. Adrenaline $1\ \text{mg}$ IV/IO is given immediately in non-shockable rhythms, and after the 3rd shock in shockable rhythms, then repeated every $3\text{–}5$ minutes.

20. List the emergency drugs that must be available in a UK dental practice (Resuscitation Council/DBOH).

    Oxygen; adrenaline $1{:}1000$ (1 mg/mL) IM; aspirin $300\ \text{mg}$ (dispersible); glyceryl trinitrate (GTN) spray; salbutamol inhaler; glucagon $1\ \text{mg}$ IM; oral glucose (e.g. GlucoGel) / glucose tablets; midazolam (buccal/oromucosal $10\ \text{mg}$ or IM) for prolonged seizures.

21. What essential emergency equipment must a dental practice keep for resuscitation?

    Portable oxygen cylinder with pressure-reduction valve and flowmeter; oxygen masks (non-rebreathe) and tubing; self-inflating bag-valve-mask with reservoir (adult/child); oropharyngeal (Guedel) airways of assorted sizes; pocket mask with oxygen port; portable suction with wide-bore aspirator (Yankauer); spacer device for inhalers; and an automated external defibrillator (AED) with pads.

22. How is a hypoglycaemic emergency managed in a conscious versus an unconscious dental patient?

    Conscious and able to swallow: give fast-acting oral glucose (e.g. glucose drink/gel, $15\text{–}20\ \text{g}$), repeat in 10–15 min if needed, then a longer-acting carbohydrate. Unconscious/unable to swallow: protect airway, give oxygen, administer glucagon $1\ \text{mg}$ IM and call 999; if IV access available, give IV glucose.

23. What is the emergency drug management of an acute asthma attack in the dental surgery?

    Sit the patient upright, give high-flow oxygen, and administer salbutamol via inhaler with a spacer — 2 puffs, repeated up to $4\text{–}6$ (or up to 10) puffs every 10 minutes. If no response, life-threatening features, or worsening, call 999 and continue salbutamol pending paramedics.

24. Describe immediate management of suspected acute myocardial infarction / angina in the chair.

    Stop treatment, sit the patient up, reassure. For angina give sublingual GTN spray and oxygen if hypoxic; if pain persists after GTN or MI is suspected, call 999, give a single dose of aspirin $300\ \text{mg}$ chewed (if not contraindicated), monitor ABCDE and be prepared for cardiac arrest/BLS.

What this deck covers

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