Avoiding Suggestive Questions

Question Types to Avoid

• Suggestive Questions: Lead the respondent towards a specific answer.
• Example of Suggestive: “Do you feel the pain in your left arm when you get it in your chest?”
• Better Alternative: “When you get the pain in your chest, do you notice it anywhere else?”
• Leading Questions: Imply the answer the interviewer is seeking.
• Example of Leading: “You haven’t used any recreational drugs, have you?”
• Better Alternative: “Do you use recreational drugs?”

Medical History Sections

• Source and Reliability: Includes identifying information (age, gender) and reliability assessment of the source.
• Biographic Information: Captures date/place of birth, sex, race, ethnic background, and gender identity.
• Chief Complaint: Patient's own words summarizing the reason for seeking care.
• History of Present Illness: Details recent health changes relating to the chief complaint (what, when, how, etc.).
• Pain Assessment: Evaluates pain condition, including location, intensity, duration, and aggravating/alleviating factors.
• General State of Health: Patient’s perception of health and recent physical exams.
• Past Medical History: Summary of childhood/adult illnesses, significant conditions, and treatments.
• Current Medications: List of medications currently being taken by the patient.
• Allergies: Documented patient allergies.
• Psychosocial History: Patient's social history impacting health.
• Health Maintenance: Records preventive care received.
• Occupational and Environmental History: Job history and relevant exposures.
• Diet, Sleep Patterns, and Family History: Assessment of dietary habits, sleep quality, and medical history of relatives.

INR and Coagulation Tests

• INR (International Normalized Ratio): Measures blood clotting speed; ranges indicate slow (high INR) or fast (low INR) clotting.
• PT (Prothrombin Time): Commonly used to gauge the effectiveness of anticoagulant therapy like warfarin.
• CoaguChek Device: Allows patients to self-monitor INR with minimal blood sample, providing quick results.
• Prosthetic Patients: AB prophylaxis not routinely needed for patients with certain medical devices like cardiac pacemakers.

Antibiotic Prophylaxis Considerations

• No Evidence of Benefit: AB prophylaxis is not recommended for most dental procedures in patients with specific cardiac devices.
• Dentists and Prophylaxis Requests: Can decline unnecessary requests for AB if no medical rationale exists.

Hemophilia Management

• rFVIIa (NovoSeven RT): Used primarily for patients with inhibitors; recommended dosage is 70-90 mcg/kg.
• Desmopressin (DDAVP): Stimulates release of F-VIII, useful for mild Hemophilia A; available in IV and nasal spray form.
• EACA/Tranexamic Acid: Can be used alongside DDAVP for stabilizing clots in mild Hemophilia A patients.
• Management for Severe Deficiency: Requires F-VIII replacement or rFVIIa administration prior to dental procedures.

Bleeding Risk Assessment

• NSAIDs and Dental Procedures: Generally safe for invasive work; dual antiplatelet therapy may increase bleeding risk.
• Vorapaxar and Other Antiplatelet Drugs: Important considerations when assessing cardiovascular health.

Dental Treatment Guidelines

• Hypertension: Understanding ASA classification is crucial for managing treatment risks relative to blood pressure.

Thromboembolic Event Risks

• High-risk Factors: Identify recent DVT/PE, mechanical heart valves, high CHA₂DS₂VASc scores, and other specific conditions.

Cerebral Vascular Aneurysms

• Clinical Presentation: Often asymptomatic; rupture leads to severe headache, neck stiffness, and altered consciousness.
• Management Approaches: Surgical intervention or endovascular coiling for ruptured cases; medical management for unruptured cases aims to reduce rupture risk.
• Dental Considerations: Evaluate bleeding risk in patients on anticoagulants and avoid excessive strain during treatment.

Stroke and TIA Management

• Transient Ischemic Attack (TIA): Symptoms resolve within 24 hours; present with visual disturbances and motor/sensory dysfunction.
• First-line Pharmacologic Treatment: Aspirin or clopidogrel for secondary prevention.
• Surgical Intervention: Consideration for patients with carotid artery-related TIA.

This quiz highlights the types of questions that should be avoided, particularly in sensitive scenarios like medical inquiries. It contrasts suggestive questions with more neutral alternatives to emphasize the importance of unbiased questioning. Improve your questioning skills by identifying the right approach.