ORE Part 2 Patient Management

Question 1

A patient with severe dental anxiety refuses treatment despite being in pain. What is the most appropriate initial approach?

Accepted Answer

Use cognitive behavioural techniques, discuss sedation options, and develop a graded treatment plan

Answer

A patient-centred approach involves acknowledging the patient's anxiety, using evidence-based psychological techniques (CBT, relaxation, Tell-Show-Do), discussing conscious sedation options (inhalation or IV), and developing a graded exposure plan starting with less invasive procedures. Forcing treatment violates autonomy and is ethically unacceptable.

Question 2

According to GDC Standards for the Dental Team, which principle requires dentists to always put patients' interests first?

Accepted Answer

Principle 1: Put patients' interests first

Answer

GDC Principle 1 states 'Put patients' interests first.' This overarching principle underpins all clinical decision-making and professional conduct. It encompasses providing appropriate care, acting in the patient's best interest even when it conflicts with personal or financial interests, and maintaining trust in the profession.

Question 3

What constitutes valid consent for dental treatment in the UK?

Accepted Answer

The patient having capacity, being informed of all material risks and alternatives, and consenting voluntarily without coercion

Answer

Valid consent requires three elements: (1) the patient must have capacity to understand and retain the information, (2) they must be informed of the nature, purpose, risks, benefits, and alternatives to the proposed treatment (Montgomery v Lanarkshire, 2015), and (3) consent must be given voluntarily without duress. A signed form alone does not constitute valid consent.

Question 4

A patient collapses in the dental chair with chest pain radiating to the left arm and jaw. After calling 999, what is the immediate management while awaiting the ambulance?

Accepted Answer

Sit the patient upright, give aspirin 300mg to chew, and GTN spray if available and BP adequate

Answer

The signs suggest acute myocardial infarction. After calling 999, sit the patient in a comfortable position (often upright or semi-recumbent), give 300mg aspirin to chew (unless allergic), administer GTN spray sublingually if the systolic BP is above 90mmHg, and provide supplemental oxygen if SpO2 is below 94%. Monitor and be prepared to commence CPR if the patient arrests.

Question 5

Under the Mental Capacity Act 2005, how should treatment decisions be made for an adult patient who lacks capacity?

Accepted Answer

A best interests decision is made considering the patient's past wishes, values, and involving relevant people in the decision

Answer

Under the Mental Capacity Act 2005, when a patient lacks capacity, decisions must be made in their 'best interests.' This involves considering the patient's past and present wishes, feelings, beliefs and values; consulting with family, carers, and any appointed lasting power of attorney; and choosing the least restrictive option. Next of kin do not have automatic legal authority to consent.

ORE Part 2 Practice Test

ORE Part 2 Practice Test

ORE Part 2 Patient Management