TUFTS Patient Management

1.
Number of individuals having a disease at a given time (# of cases)
frequency
2.
Proportion or percentage of individuals having a disease at a given time (#cases/population)
prevalence
3.
Rate of new cases of disease per time (#cases/population/time) i.e.: the change in prevalence
Incidence
4.
Incidence of a specific disease
morbidity
5.
Rate of deaths resulting from a specific disease (#deaths secondary to disease of interest/#total deaths)
mortality
6.
ratio of births to a tota population (birth rate)
natality
7.
#births/#death per year. It reflects a population’s change in size
birth-death ratio
8.
A study which randomly assigns subjects to either a control treatment or test treatment group and follows the groups through time.
Randomized control study
9.
When is a randomized controlled study indicated as a “blind” study?
when participents are unaware which GROUP they are assigned to
10.
when is a randomized controlled study indicated as a “double-blind” study?
if BOTH the examiners and the subjects are unaware which group they are assigned to
11.
Individual dosen’t have the disease but the test reports he/she does
false positive
12.
individual has the disease which the test confirms
true positive
13.
individual has the disease but the test reports he/she does not.
false negative
14.
Individual dosen’t have the disease which the test confirms.
true negative
15.
Proportion of truly diseased persons who are identified by a screening test as being diseased (measures “how good” a test is at correctly identifying truly diseased person)
sensitivity
16.
Proportion of truly non-diseased persons who are so identified by a screening test (measures “how good” a test is at correctly identifying non-diseased persons)
specificity
17.
Quantifies the amount of debris and/or calculus found on the six surfaces of preselected teeth
Simplified Oral Hygeine Index (SOH-I)
18.
Approximates plaque thickness at all four gingival margin surfaces of each tooth
Plaque index (of Silness and Loe)
19.
Assesses the color, consistency, and BOP of gingiva to quantify the severity of gingivitis
Gingival Index (of Silness and Loe)
20.
Similar to gingival index except increased emphasis on whether or not gingiva bleeds on probing
Sulcus bleeding index
21.
Assesses the presence of absence of gingivitis in ares of the papillary, marginal, and attached gingiva
Papillary, marginal, and attached gingival (PMA) Indexi
22.
Quantifies the status of both gingiva and alveolar bone for each tooth, but places greater emphasis on alveolar bone resporption
Periodontal Index
23.
t/f: The periodontal index is a reversible index?
true!
24.
What are the 4 types of irreversible indices?
DMFT, DMFS, deft, defs
25.
Quatifies how the permenet dentition has been affected by caries?
Decayed, missingm or filled teeth (DMFT)
26.
A more detailed index than DMFT, as it quantifies how each tooth surface has been affected by caries.
Decayed, missing, filled surfaces (DMFS) index
27.
____ and ______ serve as the greatest indicators for a patients pain level.
eyes and eyebrows
28.
What is the principle nonverbal component?
eyes (gaze)
29.
t/f: It is more ethical and cost effective to prevent disease rather than to treat it
true
30.
“How have you been?” would be classified as which type of question?
Facilitating
31.
“How many times do you brush your teeth a day?” Is what type of question?
Leading
32.
t/F: Anxiety stems from an external origin?
FALSE: Fear comes from an external origin. Anxiety is from an unknown or unrecognized origin.
33.
What are the fundamental principles of public health?
Prevention of disease and promotion of health through an organized community
34.
How do managed care organizations (MCOs) control health care costs?
by placing limits on provider’s fees and providing treatment guidlines
35.
What are two types of managed care?
Health maintenance organizations (HMOs) and Preferred provider organizations (PPOs)
36.
In _____ Third party payers contract a network of providers to provide discounted services for their members. Providers contract with this third party in hopes of getting more patients, therefore agree to provide the discounted services to their members.
HMOs
37.
What is the main difference between a PPO and a HMO?
Unlike HMOs, PPOs will reimburse members who receive care by a non-PPO contracted provider albeit at a reduced rate
38.
____ prefer their members to use contracted providers, but still reimburse care rendered from non-contracted providers
PPOs
39.
What are the three ways that providers are reimbursed by third-party payers?
Capitation, Usual customary and reasonable (UCR) fee, or a fee schedule (table of allowences)
40.
Providers reimbursed via _______ receive a set amount for each patient each month regardless of care rendered
capitation
41.
Providers reimbursed by ________ have a consensus of the usual fee providers charge in a geographic area for a specific service.
Usual, customary and reasonable fee (UCR)
42.
Providers reimbursed via _______ have patients pay the difference between the provider’s fee and the amount the insurance company covers
Fee schedule (table of allowances)
43.
What are the 6 routes of pathogen transmission?
Droplet, Airborne, Vector-borne, Indirect, Direct, Fecal-oral (First Aid pneumonic: DAVID Failed the pathogen transmission quiz)
44.
What disease prompted the CDC to instigate a Standard (Universal) Precaution in 1985 with the goal to prevent occupational transmission of infectious disease while providing care?
HIV
45.
What is the percentage of risk for getting HCV?
1.8% (HBV=6-30%; HIV: .3%)
46.
Which form of Hepatitis has the greatest Viral load?
HBV> HCV>HIV
47.
Prior latex exposure can cause what type of reaction?
Delayed hypersensitivity reaction (type4) secondary to chemicals used in gloves
48.
t/f: atopic individuals are at risk for hypersensitivity reactions but those with seasonal allergies are not
true
49.
what kind of gloves are recommended when handling hazardous chemicals or cleaning dental office
nitrile or heavy duty utility gloves
50.
What is the requirement of filtration for face masks?
>95% effective at filtering small particle aerosols (1-3um)
51.
What are acceptable types of barriers to protect items and surfaces?
impervious-backed paper, aluminum foil or plastic covers
52.
When placing barriers you should wear gloves.
False. You should take down all barriers with gloves, then de-glove, wash hands and replace with new barriers
53.
What are the most common mode of pathogen transmission?
HANDS!
54.
T/F: Handwashing with soap and water exhibits bacteriocidal and static effects
false. It simply REDUCES bacterial counts
55.
What is a type of bacteriostatic antiseptic hand wash?
Triclosan
56.
What is a bacteriocidal AND bacteriostatic antiseptic hand wash?
Chlorhexidine gluconate
57.
t/f: All alcohol-based hand rubs are bacteriostatic, sporicidal, and fungicidal
FALSE: They are sporicidal and fungicidal BUT they are bacterioCIDAL … not static
58.
What kind of hand wash eliminates all microorganisms on hands and is long-lasting
surgical antisepsis
59.
when should healthcare workers wash their hands?
When dirty, after touching something dirty, before AND after gloving
60.
What is the most common adverse epithelial reaction?
Irritant Contact Dermatitis. This occurs in 20-30% of health care workers. Dry, itchy, irritated areas on skin around the contact area. Associated with frequent hand washing, residual powder on hands, harsh antiseptic agents. NOT ALLERGIC REACTION
61.
_______ is a type 4 reaction due to contact with a chemical allergen. Reaction is usually localized and occurs over a 12-48 hr period
Allergic contact dermatitis
62.
What is the most important step in sterilization?
PRE-CLEANING! This means the pHYSICAL removal of debris. If visible debris or organic matter is not removed, it can interfere with the sterilization process
63.
What are four forms of automated cleaning (pre-sterilization)?
Ultrasonic cleaner: removes debris by cavitation. SAFEST &MOST EFFECTIVE METHOD of cleaning
-Instrument washer: removes residue on instruments which ensures safe handling for packaging

-Washer-Disinfector: low level disinfection by using high temp cycle

-Manual: instruments soaked in detergent. prevents drying of patients material
64.
What is the safest and most effective method of cleaning (prior to sterilization)?
Ultrasonic cleaner
65.
use of a chemical procedure to destroy the majority of pathogenic microorganisms, but DOES NOT destroy bacterial spores
Disinfection
66.
What is better for disinfectants? Pump or spray? water or alcohol based?
Pump> aerosol spray

Water-based> alcohol based
67.
______: Treatment of water to reduce microbial levels to public health approved levels
sanitation
68.
______ are items that enter sterile body tissues or vascular system (ie: surgical instruments) that require sterilization
critical items
69.
_____ items that contact mucous membranes (dental instruments) that require a high level of disinfection.
Semi-critical items
70.
Items that contact intact skin (dental operator, wheelchairs) require intermediate level of disinfection, whereas items that contacted environmental surface (walls, floors) require low levels of disinfection.
Non critical items
71.
________ destruction is regarded as the benchmark for effective disinfection?
M. tuberculosis
72.
T/F: Intermediate-level disinfection, such as a chlorine compound or alcohol, is suitable to destroy M. tuberculosis.
TRUE
73.
Quaternary ammonium compounds, alcohols, chlorine compounds, iodophors and phenolics are all types of what disinfection process?
intermediate-level disinfection. Suitable for: M. tuberculosis, vegetative bacteria, most viruses and most fungi (not spores)
74.
What antimicrobial methods do not dull or corrode metal instruments?
Dry heat, unsaturated chemical vapor
75.
What is the difference between Dry heat and rapid heat transfer?
Rapid heat transfer has higher temps and controlled air flow(forced air) within the chamber providing shorter cycles
76.
What are the chemicals that are used in unsaturated chemical vapor disinfection process?
alcohol, formaldehyde, ketone , acetone and water rather than distilled wated to produce a sterilizing vapor
77.
______ irreversibly inactivates DNA and proteins. It is a toxic, flammable, highly penetrative gas used for sterilization of plastic, rubber and other heat-sensitive items. (10-16 hrs)
Ethylene-oxide gas
78.
What is the most effective skin antiseptic?
Iodine!
79.
Preparations which combine iodine and a solubilizing agent are considered _________ such as Betadine
Iodophors
80.
t/f: Iodophors can penetrate the wax and outer lipid layers of mycobacteria
true
81.
What are two peroxides that have oxidizing agents that are microcidal ?
Hydrogen peroxide and peracetic acid
82.
______ compounds oxidizes free sulfydryl groups rendering bacteria and most viruses inactive
Chlorine
83.
What is the mechanism of quaternary ammonium compounds?
Disrupt cell membranes via amphipathic interaction. These cationic detergent are widely used for skin antiseptics because they are effective against gram-positive bacteria
84.
How do anionic surface-acting materials work?
Facilitate mechanical removal of microbes by decreasing the surface tension on the skin surface
85.
A nitrocellulose filter with a pore size of ___um restricts all bacteria
0.22
86.
What is the temp and cycle for unsaturated chemical vapor?
270 (132), 20-40 min, 20psi
87.
Dry heat takes how long and at what temp?
320 (160) for 2 hours OR

340 (171) for 1 hour
88.
How long does the rapid heat transfer take?
375 (191F) FOR 6 MIN unWRAPPED OR 12MIN WRAPPED
89.
What is the minimum temperature required to annhilate all microbes?
250 (121)
90.
Who dictates what volume of blood or other bodily fluids can be discharged into sanitary sewer systems?
state and local regulations
91.
What are three ways to reduce an exposure risk?
1)Technology based engineering controls (self-shearing needles, retractable scapulas)
2) Behavior based work practice controls (scoop technique)
3)Appropriate personal protective equipment
92.
Waterlines used during patient care must be discharged for at least ______ after each patient
20 seconds
93.
Dentists are to render competent and timely care in an effort to benefit the patient. This is an example of which ethical principle
Beneficence
94.
Dentists are to treat patients according to the patien’t desires and protect patients’ confidentiality. What ethical principle is this?
Autonomy
95.
Dentists are to keep skills and knowledge up-to-date and practice within their limits in order to protect the patient from harm. Which ethical principle is this?
Non-maleficence
96.
Dentists are to deal justly with patients, colleagues and society. This ethical principle is called:
Justice
97.
Dentists are to be honest, trustworthy, communicating truthfully and without deception. This is called
veracity
98.
______ is the theory and philosophy of law
Jurisprudence
99.
Child abuse most commonly occurs in children under the age of:
3
100.
t/f: Dentists ARE included in the Good Samaritan Law in ALL states
FALSE
101.
What does the good samaritan law ensure?
that health care providers are protected from lawsuit while renderinf emergent are in accidents (provided that care rendered does not demonstrate gross negligence)
102.
t/f: Dentists are legally obligated to immediately notify designated state agencies upon observation of domestic violence or suspected abuse
true
103.
T/F: Persons with HIV and AIDS are NOT protected under the americans with disabilities act
false. they are
104.
Where are the majority of domestic violence injuries seen?
face
105.
T/F: PRR’s and sealants are NOT taken into account for caries indices
true. These are two of the common problems with using these indices. Along with: they can be invalid in older adults and they are not related to the number of teeth at risk or age
106.
The gingival index is based solely on a ordinal scale
False: It is based on a nominal scale. Nominal data is based on coding. Giving a number to indicate a characterisitc. In this case a 0=normal tissues. Although numbers are being delt with it is not an ordinal scale because you cannot infer any statistical data from the average of those numbers.
107.
What are the CPITN treatment needs?
Code 0= no treatment required
Code 1 & 2= Scale and polish/ remove overhangs/ OHI
Code 3= Scale & polish, remove overhangs, OHI root planing, complex tx
Code 4= Attachment level chartin, S&P, OHI, rootplaning, surgery/complex treatments
108.
What kind of data does the CPITN collect?
Nominal?
109.
What is the major disadvantage to using the Simplified Oral Hygeine Index?
Lack of sensitivity
110.
Data from US national surveys of adults indicate that _________ have a significantly higher CORONAL DFS as compared to other races. HOWEVER, the amount of UNTREATED coronal caries is higher in:
caucasians; blacks
111.
What is the prevalent race for root surface caries?
Identical for caucasians and blacks
112.
How many US adults have subgingival calculus?
1/2-2/3
113.
Cancers of the ____ and oral cavity account for about 2/3 of all new oral and pharyngeal cancers
lip
114.
______ Have a much higher incidence of lip cancer but _____ show the highest incidence for oral and pharyngeal cancer
whites, blacks
115.
t/f: women have higher survival rates for oral cancer than men with the exception of lip cancer
true
116.
what are the three components of the ADA code
1) principle of ethics
2) code of professional conduct
3)advisory options
117.
A patient thinks you are a horrible dentist and leaves to go to another office. Her account is not yet paid but she requests to have her xrays sent to the new office. What ethical principle is expressed here and can you refuse to send the xrays?
Autonomy. Under this principle it is the patients right to a copy of their X-rays graciously or at a small cost REGRDLESS of whether they have paid their remaining balance in full
118.
What are the components to the materials section of a scientific article?
sampling, measurement, experimental design, statistical analytical procedures
119.
positively skewed distributions have a relatively ____ number of low scores and a _____ number of very high scores
high, low
120.
Negatively skewed distributions have a very ____ number of high scores and a _____ number or low scores
high, low
121.
A peak in distributions is called a
mode. Such as bimodal distribution
122.
_____ is a method of scertaining the way individual values are located around the mean
variance
123.
The larger the variance, the _______ the data items are spread about the mean value
more widely
124.
____ measures the typical or average deviation from the mean
Standard deviation (equal to the square root of the varience)
125.
if p<.05 you _____ the null hypothesis indicating that your results are ______ significant
reject, statistically
126.
a _________ provides a mathematical model of linear relationship between a dependent (outcome variable) and two or more independent or predictor variables
multiple regression
127.
this test measures the association between teo categorical variables. It is used for the comparison of groups when the data are expressed as counts or proportions
chi-square test
128.
this test is used to analyze the statistical difference between two means
t test
129.
If an investigator wants to compare the proportion of caries-free children living in a district whose water supply is F to the proportion of caries-free children living in a non-F district, which test should you use?
chi-square
130.
If you wanted to find out the statistical difference between the treatment and control groups or groups receiving treatment A vs Tx B what test should you use?
t-test
131.
the _____ of a test is determined by its ability to show which individuals have the disease in question and which do not
validity
132.
what is the reliability of a test equal to?
repeatability and reproducability of a test
133.
sensitivity=
(true positive / (TP+FN)) X 100%
134.
Specificity =
(TN/ (TN+FP)) X 100%
135.
T/f: OSHA regulates the transportation of waste from a dental facility?
FALSE: The EPA (Enviornmental Protection aGENCY) Does this
136.
What are the components of OSHA’s Bloodborne Pathogens Standard (BPS) plan?
exposure determinations, an exposure control plan, engineering and work practice controls, training of employees assisting or providing direct care, as well as those who clean operators, instruments and gowns
137.
which section of the methods of compliance part of the BPS describes the devices, instruments, and materials used to prevent bb pathogen exposure?
engineering controls
138.
_____ consists of large, visible particles of 50um or larger than fall within 3 feet of the patients mouht
spatter
139.
____ consists of droplets that approach or exceed 50um. Settles in air after 10-15min
mist
140.
How large are aerosols?
5-50um
141.
If the noise level of an operatory reaches ___dB and a frequency of _______cps, protective measures ahould be taken
85; 30-4800
142.
For dental waterlines, the goal is to provide water with less than ____ CFUs
200
143.
t/f: MSDS’s are distributed through OSHA
False. They come from the materials manufacturer
144.
What are the meanings of the four colors that are used by the nATIONAL fIRE protection Association?
Blue: health hazard
rED: FIRE HAZARD
Yellow: reactivity or stability of a chemical
white: required PPE when using
145.
_____ is a hybrid D-HMO, a delivery system that combines the risk sharing of an HMO with fee-for-service reimbursement. In this plan, dentists are collectively at risk, as opposed to D-HMOs where they are individually at risk. The dentist is paid on a fee-for-service basis and is at risk if the payout exceeds the premium
Dental Individual Practice Association (D-IPA)
146.
The ____ model usually has one or more dental officed that use salaried dentists
Staff
147.
The _____ model uses multiple dental officed in various location and it the most common method of delivering dental benefits in managed dental care.
network
148.
The _____ model has beneficiaries that habe a limited choice of offices where they can go to to obtain dental care.
Closed
149.
With which dental management care plans is the closed model most often associated with?
HMO/ PPO
150.
Under which federal laws are states required to offer comprehensive dental services to children and what is the name of the program?
Under federal medicaid laws. Early periodic screening diagnostic and treatment program
151.
States are required to provide dental examinations to children no later than ___ and to treat comprehensively any oral problems identified
3
152.
t/f: the EPSDT requires that states take action to provide provision of information, transportation and scheduling assistance
true
153.
t/f: Medicaid adult dental coverage is optional and states vary widely in the dental benefits made available to adults
true
154.
T/F: Medicare does not cover dental care, ever.
False, they do it the dental services are directly related to the treatment of a medical condition (ex: extraction of teeth prior to chemo therapy)
155.
what are three listening techniques?
paraphrasing, interpretation and preparation
156.
what are the four components of nonverbal communication?
continuous, automatic, rich and subtle
157.
Instead of “giving advice” to a patient, what is a better way for a patient to make a decision?
provide them with info abd education so that they make their own informed decision
158.
What is behavior motivation influenced by?
perceived susceptibility (to disease or problem), severity of the consequences, perceived costs and benefits, cues to action
159.
which behavior model asserts that a person is more likely to engage in good oral preventative health care because he/she believes that they are susceptible to oral health problems?
health belief model
160.
What are the 6 components of the Stages of Change Model?
1) Pre-contemplation – Patient denies problem and its importance
2) Contemplation – Patient is open to talk, read, or think about problem.
3) Preperation – Knows that change is needed and begins to form commitment
4) Action
5) Maintanence
6) Relapse

161.
In this theory, behavioral modification is influenced by cognitive factors and the social environment.
Social cognitive theory
162.
Which behavioral model is most often used to illustrate the effectiveness of oral health care education?
The social cognitive theory
163.
A patient experiences a discomfort from a particulate lodged between her teeth. She chooses to floss because of this and as a result experiences relief. What belief/behavior model was employed?
Behavior theory (ABC) MODEL
164.
Giving a child an extra chore to do because they refused to brush their teeth is an exampl of what type of conditioning?
Operant.= positive punishment (aka: adversive conditioning)
165.
the removal of a positive stimulus in order to decrease an undesirable behavior is called what?
negative punishment
166.
creating small doable steps, followed by praise for successfully completing these steps, toward achieving a target behavior is called:
shaping
167.
A patient always shows up 20 min late to their appointment. You eventually decide that it is best for her to reschedule for a different day due to her lateness. What behavior tactic are you using?
Extinction
168.
A patient of yours feels compelled to bite her nails throughout your procedure. You ask her to wear gloves so that she can diminish her urge to bite her fingernails. What behavior strategy are you using?
incompatible behavior/stimulus control
169.
wHAT ARE THE 5 STAGES OF MOTIVATIONAL INTERVIEWING?
1) Express Empathy
2) Develop discrepancy
3) Avoid argumentation
4) roll with resistence
5) support self-efficacy
170.
What are some skills that can be used to increase treatment compliance with an anxious patient?
provide information before preceding, use hand signals, tell-show-do, time structuring, acknowledge their experience (don’t ignore their anxiety!), use brief cognitive-behavioral interventions, continually assess their anxiety level, use special considerations with pedo anxiety
171.
what are some brief cognitive behavioral interventions that can be used for anxious patients?
deep breathing, muscle relaxation, guided imagry, hypnosis, behavior rehearsals, flooding, systematic desensitization, biofeedback, cognitive coping, use praise, distraction
172.
_______ are a cognitive method that involved providing patients with an opportunity to practice coping strategies which experienceing a simulated procedure or part of a procedure
behavioral rehersals
173.
What is flooding?
an intense and prolonged exposure to a feared stimulus while useing coping skills
174.
wHAT IS BIOFEEDBACK?
Teaching one to have control over his or her physiological arousal through the use of auditory/visual monitoring arousal level
175.
_____ is when assisting patients in changinf their thinking about something to a more adaptive or realistic thinking style. Ex: changing “i cant do this” to “this may be difficult for me, but i did ok last time.”
cognitive coping reframing
176.
______ a dorsal spine mechanism that can control the flow or signals from noxious stimuli from the periphery to the brain.
Gate control theory
177.
t/f: the gate control theory accounts for cognitive and emotional factors
FALSE
178.
Why are anxious patients more likely to report pain than fearful patients?
Fear is a response to a stressor intitially causing a release of endorphins from the pituitary, resulting in an analgesic effect. However, ultimately, pain thresholds are reduced and anxious patients are more likely to report pain or discomfort for a number of reasons. (hypervigilence, muscle tension, cognitive misattribution of danger, conditioning, catastrophic thinking, perceived lack of control
179.
What is an ongoing assessment tool that is utilized in children for pain management?
Wong-Baker Faces Pain rating scale
180.
t/f: distraction is the best form of pain management when a patient is extremely anxious and hypervigilant
false. it is the least effective measure
181.
Minors under the age of 18 can give implied consent
true. they just cant give informed consent
182.
When can a minor (under 18) give informed consent?
1) has graduated from HS
2) Is or has been married
3) is or has been pregnant
4) is responsible for his/her own welfare and is living independently from parents control/support
5) emanicipated minor can also give consent to treatment of his/her child
183.
t/f: fact witnesses can charge for their services
false.
184.
expert testimony
consists of statements made by credible sources who have professional or other in-depth knowledge of a topic
-increases audience member’s acceptance of your claims
185.
You have started treatment on a patient but that patient has had several no-shows since that appointment, You decide to disconinue the patient without letting her know. What ethical principle have you violated
non-maleficence
186.
A dentist notices that a female patient has bruises on her face and decides to not report anything. wHAT ETHICAL PRINCIPLE is the dentist violating?
beneficence
187.
Expert testimony is an example of what ethical principle?
justice
188.
A dentist accepts a “rebate” . what ethical principle has he violated?
justice
189.
When a dentist increases a fee to a patient soley because the patient is covered under a dental benefits plan what is this called? what ethical principle is violated?
overbilling; veracity
190.
______ is the fee for a patient without dental benefits shall be considered a dentist’s full fee. tHIS IS THE FEE that should be represented to all benefit carriers regardless of any negotiated fee discount
fee differential (veracity)
191.
a dentist who accepts a third party payment under a copayment plan as a payment in full without disclosing to the third party that the patients payment portion will not be collected, is engaged in: __________. This is a violation of what ethical principle?
overbilling, veracity

 

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