PREPARATION FOR POSTING OS / PAEDS

PNEUMONICS:

Oh
Oh
Oh
To
Take
A
Family
Vacation (Vestibulocochlear / Auditory)
Go
Vegas
And
Hawaii
KNOW HOW TO CLERK PATIENT follow SOCRATES (will be easy)
S - Site (kat mana sakit)
1. take pt CURRENT c/o & history O - Onset (bila start kena, masa mula mula
jadi)
- for facial cellulitis C - Character of pain (dull/aching/throbbing,
i- since when / recent injury continuous, spontaneous)
ii- how long it takes to swelling R - Radiation (ada sakit smpai ke kepala? or
iii- eat anything / meds taken ? tempat lain)
iv- inflammation : warmness , redness, painful , A - Associated pain (time makan sakit ?
v- lymphadenopathy numbness ke, gigit ke)
vi- medical condition T - Timing (siang ke malam, time makan ke
vii- excessive drooling minum, berapa lama sakit (min/hour)
viii- pus discharged E - Exaberting/relieving factor (ada ambik
ix- blackened skin ? painkiller or hilang sendiri)
x- dysphagia (difficulty in swallowing) S - Severity (pain score)
xi- odynophagia (painful swallowing)
xii- SOB = Shortness of breath (difficult to breath) pneumonic for swelling (to describe)
xiii- describe swelling
- mobility Pupil Only Play Tennis
- shape
- surface P - Position
- edge O - Overlying skin
- consistency P - Pulsation
- depth T - Tenderness
- localized / diffuse
- firm / not
- tender on palpation ?
- size (measurement)
- temperature
xiv- fever ?
- since when ?
xv- if vomit (describe what pt vomit : mix with blood , saliva, food)

BP = Blood pressure
PR = Pulse rate
RR = Respiratory rate
SPO2 = peripheral capillary oxygen saturation (precentage of oxygenated blood)
- normal : 94% to 99%
Temp = body temperature
P/S = Pain score
GM = Glucose meter
WBCH =

- dental pain (follow socrates)

i. site of pain
ii. pain’s nature & pain scale
iii- pain radiate ?
iv- timing
- sudden/ gradual
- for how many days / weeks / months
- on and off / continuous
- during biting / eating / drinking / spontaneous
v- relieving factor (took painkiller or not)
vii- bad taste ?
- MVA = Motor Vehicle Accident (trauma case)
What do you need to write
i. mva between what and what in the card (LP-8)
- car with motorcycle ? 1) C/O
- passenger or driver 2) HOPC
- rider or pillion rider 3) G/C
- car hit car ? 4) Habit (if ada)
- car hit wall ? 5) PMH
6) PDH (if ada)
ii. GCS (Glasglow Coma Scale) 7) O/E ( E/O & I/O)
8) IX (if ada)
9) Diagnosis
10) Mx today
12) Rx (if ada)
13) Tx plan: TCA ......

#if posting OS, mx dulu

baru tx plan

iii. LOC (Level Of Consciousness)

- conscious 3A ( awake , alert , aware )
- awake = not sleep
- alert = able to pay attention
- aware = understanding of oneself

- sub-conscious ( not fully aware )

- un-conscious ( sedated , not awake , not aware , not alert )

iv- Pain Scale

- from 0 to 10

3. G/C (general condition)

i- ambulatory (can walk or not)
ii- accompanied by ? mother / daughter
iii- on wheelchair or not
iv- comfortable or not
v- cooperative or not

4. Habit
- smoking ?
- bruxism ?
5. PMH (Past Medical History)
i- NKMI = no known medical illness
ii- NKDA = no known drug allergies
- if ada allergy , tanya kalau makan , apa jadi (complications)
iii- history of hospitallization (if ada: masuk ED or ward)
iv- undergone any surgery ?
v- HT = hypertension (if DBP more than 100, cant do extraction)
vi- DM = diabetes mellitus
vii- Angina / chronic rheumatic heart disease / DVT / heart attack / Stent ?
viii- on any medication (list the meds)
ix- take aspirin (clopidogrel) / warfarin (coumadin ) / OHA (oral hypoglycemic agent)
- anticoagulant / antiplatelet ?
-
x- asthma ? (ada inhaler? what colour? kalau masuk hospital (ED OR ward)
xi- gastritis ? (cannot give NSAIDS because will make gastric ulcer)
xii- pregnant ?
xiii- pacemaker ?
xiv- pulmonary embolism ?
xv- family history ?
xvi-

6. PDH (Past Dental History)

i- hx of difficult extraction
ii- post-complication of extraction ?

7. O/E (on examination )

E/O (extra-oral)
i- test 9 eye movement (restricted eye movement / not) for trauma

ii- vision intact / not

iii- diplopia / not
iv- periorbital hematoma/ bruise or not
v- presence of STI (Soft Tissue Injury) at face , chin , nose or not
vi- palpate face : presence of deformity step or not
- superior orbital
- inferior orbital
- medial & lateral border of orbital
- zygoma
vii- face symmetrical
viii- facial swelling or not
ix- lymphadenopathy
x- ENT bleeding ?
- if there’s any ent bleeding especially thru ear
- perhaps there’s a brain injury involved (need CT scan of brain)
xi- TMJ - NAD , no clicking , no deviation of jaw
xii- mouth opening restricted or not (measure by using ruler in mm from which teeth)
xiii- wound of face healed or not (type of wound kena tahu) laceration / abrasion / puncture
xiv- suture intact or not
xv- able to do lateral excursion or not ? pain or not?
I/O (intra-oral)
i- # = fracture of maxilla (Check facial stability by grasping teeth and hard palate and gently pushing back
and forth then up and down, feeling for movement or instability of midface )
ii- # of mandible (Palpate mandible for tenderness, swelling, and step-off along its symphysis, body, angle,
and coronoid process anterior to the ear canal)
iii- occlusion intact or not
iv- tongue ?
v-
vi- presence of sublingual hematoma or not
vii- STI on labial mucosa / lip or not
viii- wound healed or not
ix- suture intact or not
x- any dental trauma (tooth fractured: complicated crown / uncomplicated crown fractured / concussion)
xi- tooth mobility ?
xii- any swelling
xiii- OH good / poor
xiv- buccal / gingival mucosa / floor of mouth
8. I/X (investigation) = xray
i- PA or OPG taken ? on which tooth ?
ii- interpretation of radiograph
- radiolucencies / radiopacities of enamel or dentin or pulp
- one root / 2 roots , separated / fused ?
- lesion circumscribed ? multilocular or separated ?

iii- know 7 sign of proximity (for impacted tooth )

 iv- fracture maxilla / mandible

9. Diagnosis

10. Mx today (management today)

11. Rx (medical prescription)

i- painkiller
- T. paracetamol 1gm x bds/tds/prn x 5/7
- T. mefenemic acid 500mg x tds/prn x 5/7
- (for kids under 12) Syrup paracetamol (weight x 15mg) x tds x 5/7
- T. Ibuprofen 400mg x tds/prn x 5/7
- T. Trimadol 50mg x tds/prn x 5/7

ii- antibiotics
- C. amoxicillin 500mg x tds x 5/7
- C. metronidazole 400mg x tds x 5/7
- (for kids under 12) Syrup amoxicillin (weight x 15mg) x tds x 5/7
- C. Augmentin
-

12. tx plan: TCA (to come again) for review / sr / filling / scaling ?
KNOW HOW TO PRESENT A CASE

A case of age/ race / gender ( ♂ or ♀ ) referred from where / came with complaint of _____________________ .
ikut step cam kat atas tadi (know how to clerk pt)

p/s : be confident :)

STUDY BEFORE POSTING

1. cranial nerve
2. anatomy of head and neck
- what pass thru the parotid gland
-
3. mandible fracture
- bilateral condyle fracture
- symphysis of mandible fracture
4. maxilla facture
- le fort
5. orthognathic surgery
6. Surgical removal of impacted tooth
- coronectomy
- risk of surgical removal of impacted tooth
= high chance of parasthesia ( numbness TEMPORARY :2% , numbness PERMANENT 0.2% )
- complication
7. Ameloblastoma
8. medically compromised
- mrsa
- management of diabetic pt
- gastritis
- retro virus disease
9. Cyst
- dentigerous cyst
- radicular cyst
10. SCC
11. ABG (alveolar bone graft) = cleft lip & palate
12. closed redution & open reduction
13. alveoloplasty
14. facial cellulitis
15. suture technique (indication , when to use)
- simple interrupt
- simple continuous interrupt
- figure 8
16. types of wound
17. TMJ Pain Dysfunction
18. SOCRATES
19. characteristics of swelling
20. biphosphonate ?
21. high risk pt
22. facial nerve & bell palsy (upper motor neuron vs lower motor neuron)
23. differential diagnosis : epulis
24. Osteoradionecrosis
25. lichen planus