ABSCESS : Types and Methods of Treatment

An abscess is a cavity filled with pus and lined by a pyogenic membrane. There are three varieties of abscess :

  • Pyogenic abscess (commonest)
  • Pyaemic abscess
  • Cold abscess

Sometimes, the abscess cavity persists, which becomes firm and contains sterile pus. The firmness is due to thickness of its wall. This is known as 'antibioma'. This is due to continuous administration of antibiotics. The lump may even be hard, when it may mimic a carcinomatous lump.

Basic principle of treatment of an abscess is:

  • to drain the pus
  • to send the pus for culture and sensitivity test, and
  • to give proper antibiotic
Drainage of a pus can be obtained by free incision or by Hilton's method. Hilton's method is chosen when there are plenty of important structures like nerves and vessels around the abscess cavity, which are liable to be injured. 

Incision should be made parallel to important structures like nerves and vessels, while the muscle should be incised along the line of the fibers.

Counter incision : When the most prominent part is not the most dependent part, complete drainage of the pus is not possible with single incision. So, counter incision is required at the most dependent part to facilitate the drainage by gravity.

A corrugated rubber drain is usually used for drainage of an abscess cavity. When counter incision is used, the drain extends from the first incision to the counter incision.

Pyaemic Abscess : In this condition, multiple abscesses develop from infected emboli in pyaemia. Pyaemia is a condition characterized by formation of secondary foci of suppuration in various parts of the body. These foci are caused by lodgement of septic emboli formed as a result of  breaking up of an infected thrombus.

Pyaemia  is also seen in acute appendicitis when the infective emboli pass in to the portal venous system and cause portal vein pyaemia. (forming multiple pyaemic liver abscesses) 


Bacteremia Vs Septicemia : 
Bacteremia is the condition in which bacteria circulate in the blood stream. The organisms are usually very rapidly destroyed.
Septicemia is the development of certain clinical manifestations due to liberations of toxins by the bacteria in the blood stream. The manifestations include pyrexia, rigors, hypotension, petechial hemorrhages, etc. In absence of  systemic disease, B hemolytic streptococci. 


Toxaemia : Condition in which toxins, either chemical or bacterial blood circulate in the blood stream

Cold Abscess: This abscess is cold and non reacting in nature. It does not produce hot and painful abscess as seen in pyogenic abscess. It is almost always a sequel of tubercular infection anywhere in the body, commonly in the lymph nodes, bone and joint. Caseation of the lymph nodes forms the cold abscess. The commonest sites are the neck and axilla.

Once the diagnosis is established, full antitubercular regime should be started. An incision should not be made on a cold abscess for drainage, as it almost always invites secondary infection and forms a persistent sinus. Aspiration may be attempted through the normal surrounding skin and not the most prominent and most dependent part as this will innvariably cause sinus formation.

BPKIHS Anatomy Past Questions for MBBS and BDS Second Year - Basic Sciences : Central Nervous System

Anatomy
2016
1. Draw a well-labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2. Write down the blood supply of internal capsule with suitable diagram. 5
3. Mention the blood vessels forming the Circle of Willis along with a diagram. 5
4. Name the lobes of the cerebral cortex. Name the functional areas & the functions related to any one lobe of the cerebral cortex.  5
5. Write a short note on: 2x5=10
a. Medial Medullary Syndrome
b. Nuclei of thalamus

2015
1. Draw a well-labeled diagram of T.S. of midbrain at the level of the superior colliculus. 5
2. Draw a well-labeled diagram of T.S. of spinal cord showing ascending and descending tracts. 5
3. Draw a labeled histological diagram of cerebrum.5
4. Mention nuclei of thalamus with suitable diagram. 5
5. Draw a labeled diagram of Circle of Willis. 5
6. Draw a labeled diagram of the floor of the fourth ventricle. 5

2014
1. Draw a labeled diagram of blood supply of spinal cord. 5
2. Draw a labeled diagram of T.S. of medulla at the level of secondary decussation. 5
3. Enumerate the structures present on the floor of the fourth ventricle with suitable diagram. 5
4. What is corpus callosum? Illustrate with the help of a diagram the different lobe of the cerebral hemisphere. 5
5. Draw a labeled diagram of the circle of Willis. 5
6. Mention the arterial supply of internal capsule. 5
2013
1. Draw a well-labeled diagram of the floor of the fourth ventricle. 5
2. Write blood supply of Internal Capsule. 5
3. Write about Medial lemniscus. 5
4. Write about the White matter of cerebrum. 5
5. Write about the Lateral Medullary Syndrome. 5
6. Draw a labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5

2012
1. Draw a labeled diagram of the floor of the 4th ventricle. What is neurobiotaxis? 5
2. Name the nuclei of the cerebellum with the phylogenetic origin and draw a labeled diagram of these nuclei. 4+1=5
3. With well-labeled diagram write briefly about the floor of the fourth ventricle. 5
4. What are the structures present in the floor of 4th ventricle? 2.5
5. Write the venous drainage of the cerebrum. 2.5
6. Draw a labeled diagram of Circle of Willis. 5
7. What are the functions of Broadman’s areas 39 and 40? Where are they located? 5

2011
1. Write briefly on: 3x5=15
a. Lateral spinothalamic tract.
b. Red Nucleus.
c. Lateral medullary syndrome

2. Enumerate the deep cerebellar nuclei and write the features of the cerebellar syndrome. 2+3=5
3. Illustrate with a labeled diagram the:
a. Arterial supply of superolateral surface of the cerebrum. 5
b. Structures at the floor of 4th ventricle. 5


Inspirational Story : Struggle is necessary for Success

A man found a cocoon of a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through that little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no further.


Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily. But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened! In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.
What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.

Sometimes struggles are exactly what we need in our life. If we were allowed to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been. And we could never fly.

Transform your greatest weakness into your greatest strength

Weakness to Strength

There was once a 10 year old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training, the master had taught him only one move.

“Sensei,” the boy finally said, “shouldn’t I be learning more moves?”

“This is the only move you know, but this is the only move you’ll ever need to know,” the sensei replied.

Not quite understanding, but believing in his teacher, the boy kept training.
Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match.
Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a timeout. He was about to stop the match when the sensei intervened.

“No,” the sensei insisted, “Let him continue.”

Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.

On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind.

“Sensei, how did I win the tournament with only one move?”

“You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. Second, the only known defense for that move is for your opponent to grab your left arm.”

The boy’s biggest weakness had become his biggest strength.

Gas Gangrene

  • Gas gangrene is a rapid spreading infective gangrene of the muscles characterized by collection of gas in the muscles and subcutaneous tissue. It is also called "Clostridial myonecrosis".
  • Gas Gangrene is most likely to develop in wounds where there has been extensive laceration or devitalization of muscle mass with gross contamination of the wound by soil and other foreign bodies.
  • Clostridial organisms can be divided into two groups - namely Saccharolytic and Proteolytic. Of the Saccharolytic group of anaerobes, Clostridium perfringes (Cl. welchii) plays the main part in gas gangrene. 
  • Other organisms that cause gas gangrene are Clostridium oedematiens, Clostridium septicum, Clostridium histolyticum, and Clostridium bifermentans.
  •  Two important factors necessary for the formation of gas gangrene include :
  1. Entry of Clostridial organisms, particularly Clostridium perfringes (Cl. welchii), and 
  2. Anaerobic conditions within the wound
  • Diabetes and other occlusive arterial diseases predispose to gas gangrene.
  • The various exotoxins produced by these organisms (particularly Clostridium welchii) are:
Alpha toxin (Lecithinase) Is  hemolytic, and splits lecithin to phosphocholine and diglyceride.
Collagenase Is a proteinase and breaks down collagen
Hyaluronidase Breaks down hyaluronic acid
Theta toxin Is hemolytic, lethal and necrotic
Leucocidin Kills the leucocytes

  • Clostridial invasion affects the whole of the involved muscle from origin to insertion producing a foul smelling necrosis of the muscle which becomes dull red to green and ultimately black in appearance.
  • The muscle becomes green to black due to the action of the sulphurated hydrogen on iron liberated from broken down muscle hemoglobin. The gas is chiefly hydrogen, being odorless in the beginning, but soon it becomes fetid due to the liberation of sulphurated hydrogen (H2S), ammonia and volatile gases.

TYPES OF GAS GANGRENE
Clostridial cellulitis Crepitant infection involving necrotic tissue, but healthy muscle is not involved and is characterized by foul smelling, seropurulent infection of  a wound.
Single muscle type Limited to one muscle only
Group type Limited to one group of muscles, eg. extensors of the thigh
Massive type Involves almost whole muscle mass of one limb
Fulminating type Spreads very rapidly even beyond the limb, associated with intense toxemia

  • The most characteristic feature of gas gangrene is profuse discharge of brownish, foul smelling fluid between the sutures and the presence of crepitus due to presence of gas in the muscle and subcutaneous tissue.
  • The first prophylactic step in the prevention of gas gangrene wound is excision or debridement in which all the devitalized tissues, blood clots, dead and damaged muscles and foreign bodies should be removed.

What is Gastric lavage ?

Gastric lavage, also commonly called stomach pumping or gastric irrigation, is the process of cleaning out the contents of the stomach. It has been used for over 200 years as a means of eliminating poisons from the stomach. Gastric lavage involves the passage of a tube (such as an Ewald tube) via the mouth or nose down into the stomach followed by sequential administration and removal of small volumes of liquid.

- Useful within three hours after ingestion of the poison

PROCEDURE FOR GASTRIC LAVAGE

  • A stomach tube (Ewald's tube or Boa's tube) or ordinary, soft, noncollapsible  rubber tube of length 1.5 meter and diameter 1 cm with a glass funnel attached on one end and a mark at 50 cm from the other end (which should be rounded with lateral openings) is used
  • Denture must be removed and mouth gag should be placed
  • Patient should be in left lateral position or head hanging over the edge of the bed and face supported by assistant.
  • The end is lubricated with olive oil or glycerine and is slowly passed into mouth and through the pharynx and oesophagus into the stomach till the 50 cm marking.
  • About 1/4th liter of lukewarm water should be passed through the funnel held high above the patient's head
  • When funnel is empty, compress the tube below the funnel between finger and thumb and lower it below the level of stomach. the contents will be emptied by siphoning action when the pressure is released.
  • This first stomach contents should be preserved for chemical analysis.


Gastric lavage can be done with:
- water
- 1:5000 Potassium Permanganate (KMnO4)
- 5 % Sodium Bicarbonate (NaHCO3)
- 4 % Tannic acid
- 1 % Sodium or potassium iodide
- 0.9 % saline

Repeat the wash with 1/2 liter suitable solution till clear and odorless fluid comes out.

CONTRAINDICATIONS OF GASTRIC LAVAGE: 
Absolute Contraindication:
Corrosive poisoning except for carbolic acid

Relative Contraindication:
i. Convulsant poisoning
ii. Comatose patient
iii. Volatile poison
iv. upper GIT disease
v. Patient with marked hypothermia and hemorrhagic diathesis



MCQs on Diseases of Salivary Glands and Thyroid Glands - General Surgery MCQs Part 2


# What is Ranula ?
A. Retention cyst of sublingual gland
B. Retention cyst of submandibular gland
C. Extravasation cyst of sublingual glands
D. Extravasation cyst of submandibular glands

# The parotid duct is known as:
A. Wharton's duct
B. Stenson's duct
C. Duct of Santorini
D. Duct of Wirsung

# Nerve, which lies in association to Wharton's duct is:
A. Hypoglossal
B. Lingual
C. Facial
D. Spinal Accessory

# During parotid surgery, injury to the nerve, which results in Frey's syndrome is :
A. Auriculotemporal nerve
B. Great auricular nerve
C. Mandibular nerve
D. Buccal nerve

# The nerve sacrificed in parotid surgery is:
A. Auriculotemporal
B. Facial
C. Buccal
D. Cervicofacial

# In a 3 year old child, which of the following is the most common cyst located in the midline of the neck ?
A. Thyroglossal cyst
B. Bronchial cyst
C. Lymphangiocele
D. Cystic Hygroma

# Chronic lymphocytic thyroiditis refers to:
A. Tuberculous Thyroiditis
B. Hashimoto's thyroiditis
C. Dequervein's theme
D. Riedel's pharmoaclogy

# In Hashimoto's disease, serum antibodies are mainly against:
A. Thyroid Follicles
B. Thyronine
C. Thyroglobulin
D. Iodine

# Thyroglossal cyst may occasionally give rise to _________ carcinoma.
A. papillary
B. Medullary
C. Anaplastic
D. Follicular

# The folowing statements about thyroglossal cysts are true, EXCEPT :
A. Frequent cause of anterior midline neck masses in the first decade of life
B. The cyst is located within 2 cm of the midline
C. Incision and drainage is the treatment of choice
D. The swelling moves upwards on protrusion of the tongue

# Prophylactic thyroidectomy is indicated in:
A. Papillary carcinoma of thyroid
B. Follicular carcinoma of thyroid
C. Medullary carcinoma of thyroid
D. Malignant lymphoma
# A patient has wide eyes, nervousness, raised systolic BP and weight loss. Most probable diagnosis is:
A. Hypothyroidism
B. Hyperthyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism

# Thyroglossal fistula is :
A. Congenital
B. Acquired
C. Hereditary
D. Discharges blood

# The most common cause of hypoparathroidism after thyroidectomy is :
A. Removal
B. Vascular injury
C. Hypertrophy
D. Malignancy

# The commonest cause of hypercalcemia in a patient with known cancer is:
A. Ectopic parathormone production
B. Direct destruction of the bone by tumor cells
C. High levels of vitamin D
D. Production of parathormone like substance

# A patient presents with swelling in the neck following a thyroidectomy. What is most likely resulting complication?
A. Respiratory obstruction
B. Recurrent laryngeal nerve palsy
C. Hypovolemia
D. Hypocalcemia

# In retrosternal goiter, the most common presenting feature is:
A. Dysphagia
B. Stridor
C. Dyspnoea
D. Superior venacaval syndrome

# Screening method for medullary carcinoma thyroid is:
A. Serum calcitonin
B. Serum calcium
C. Serum alkaline phosphatase
D. Serum acid phosphatase

# Carcinoma thyroid with blood borne metastasis is:
A. Follicular
B. Papillary
C. Mixed
D. Anaplastic

# Lateral aberrant thyroid refers to:
A. Congenital thyroid abnormality
B. Metastatic foci from primary in thyroid
C. Struma ovarii
D. Lingual thyroid

# A patient has pituitary tumor and pheochromocytoma and a thyroid nodule. Which carcinoma is most likely to occur ?
A. Follicular
B. Medullary
C. Papillary
D. Anaplastic

# NOT a feature of de Quervain's disease:
A. Autoimmune in etiology
B. Increased ESR
C. Tends to regress spontaneously
D. Painful and associated with enlargement of thyroid

# Treatment of thyroid storm includes all, EXCEPT :
A. Propranolol
B. Radioactive iodine
C. Hydrocortisone
D. Lugol's iodine

# In case of hypothyroidism, which investigation is most informative and most commonly used ?
A. Serum TSH level
B. Serum T3, T4 level
C. Serum Calcitonin assay
D. Serum TRH assay

# Patient after thyroid surgery presents with perioral paraesthesia, serum calcium level is 7 mg/dL. What will be the best management ?
A. Oral Vit D3
B. Oral vit D3 and Ca
C. IV calcium gluconate
D. Oral calcium
# Therapy of choice for diffuse toxic goiter in a patient over 45 years is :
A. Surgery
B. Antithyroid drugs
C. Radio iodine
D. Antithyroid drugs first followed by surgery

# What percentage of cold thyroid nodules are malignant ?
A. 70 - 80 %
B. 50 - 60 %
C. 40 - 50 %
D. 10 - 20 %

# Absolute indication for surgery in hyperparathyroidism is :
A. Serum calcium < 2.85 mmol/lit
B. Increased bone density
C. Urinary Tract calculi
D. Patient more than 50 years of age

# The commonest thyroid malignancy is:
A. Anaplastic
B. Follicular
C. Papillary
D. Medullary

# Treatment of choice for mixed parotid tumor is :
A. Enucleation
B. Superficial parotidectomy
C. Radical parotidectomy
D. Radiation

# Which of the following is the most common complication of radioiodine treatment of Grave's disease ?
A. Thyroid storm
B. Subacute thyroiditis
C. Thyroid cancer
D. Hypothyroidism

# Which one of the following nerves is not encountered during submandibular gland resection ?
A. Lingual nerve
B. Hypoglossal nerve
C. Accessory nerve
D. Marginal mandibular nerve

# First investigation for solitary thyroid nodules is:
A. Thyroid scan
B. CT scan
C. MRI
D. FNAC

# A patient is wide eyed, very nervous with increased systolic pressure, increased pulse rate, fine skin and hair and loss of body weight. He is probably suffering from ?
A. Hypothyroidism
B. Hyperthyroidism
C. Hyperpituitarism
D. Hyperparathyroidism

# Which is more dangerous after a thyroidectomy resulting in acute respiratory distress ?
A. Damage to external laryngeal nerve
B. Unilateral complete damage to recurrent laryngeal nerve
C. Unilateral partial damage to recurrent laryngeal nerve
D. Bilateral partial section of recurrent laryngeal nerve
# Causes for primary hyperparathyroidism:
A. Parathyroid carcinoma
B. Renal failure
C. Rickets
D. Malabsorption

# All of the following are features of hyperthyroidism EXCEPT :
A. Thin person
B. Decreased waist:hip ratio
C. Excessive sleep
D. Increased muscular activity

# The following are true of primary thyrotoxicosis EXCEPT:
A. Tremors
B. Warm extremities
C. Diarrhea
D. Intolerance to cold

# Which one of the following feature is not associated with primary hyperparathyroidism ?
A. Giant cell tumor
B. Sharply defined radiolucencies of maxilla and mandible
C. Partial loss of lamina dura
D. Hypercementosis

# Treatment of choice in cold nodule of thyroid :
A. Subtotal thyroidectomy
B. I-131
C. Hemithyroidectomy
D. Excision of Nodule

# Thyroid carrcinoma with pulsating vascular skeletal metastasis is:
A. Follicular
B. Anaplastic
C. Medullary
D. Papillary

# Pleomorphic adenomas arising from the minor salivary glands can be treated with :
A. Local excision with 2 mm margin
B. Local excision with 5 mm margin
C. Radiotherapy
D. Chemotherapy

# Which of the following statements is true regarding thyroglobulin?
A. It is a specific marker for anaplastic carcinoma
B. Elevation after complete therapy suggests recurrence in well-differentiated thyroid malignancies
C. Preoperative elevation always suggests thyroidal disease
D. Intra operative estimation from thyroid veins is very useful for prognosis

# "Thyroid storm" is treated by following EXCEPT:
A. Aspirin for Hyperpyrexia
B. Propranolol
C. Dehydration is corrected
D. Sodium iodide

# Cricothyroidotomy is contraindicated in:
A. Age below 5 years
B. Age between 15-20 years
C. Age between 20-30 years
D. Age between 30-40 years

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MCQs on Diseases of Salivary Glands and Thyroid Glands - General Surgery MCQs


 Click HERE to view all our MCQ Topics.
# Which is the most common cause of hypothyroidism ?
A. Multinodular goitre
B. Lymphoma of thyroid
C. Autoimmune thyroiditis
D. Reidel's thyroiditis

# The treatment of anaplastic carcinoma of thyroid is :
A. Total thyroidectomy
B. Palliative radiotherapy
C. Radioactive idoine
D. Tracheostomy

# The histopathologic feature of medullary carcinoma of thyroid is :
A. Anaplasia
B. Mitotic figures
C. Psammoma bodies
D. Amyloid stroma

# The most common level of thyroglossal cyst is :
A. Lingual
B. Infra-lingual
C. Supra-hyoid
D. Infra-hyoid

# All the following are seen in thyrotoxicosis except:
A. Tremor
B. Increased temperature
C. Slow pulse rate
D. Exophthalmos

# The cyst that moves by protruding the tongue is:
A. Thyroglossal cyst
B. Median rhomboid cyst
C. Ranula
D. Tracheal cyst

# A 45 year old woman has a nodule in the neck which moves during swallowing. The nodule most probably is attached to :
A. Thyroid
B. Larynx
C. Oesophagus
D. Pharynx

# Thyroglossal fistula is :
A. Lined by squamous epithelium
B. Causes a bulge in the neck
C. Inflammatory lesion
D. Precancerous lesion

# Symptoms of hyperthyroidism include:
A. Intolerance to cold
B. Decreased appetite
C. Weight gain
D. Palpitations

# Symptoms of hypothyroidism include :
A. Intolerance to heat
B. Diarrhoea
C. Loss of weight
D. Menstrual disturbance

# FNAC (Fine needle aspiration cytology) can diagnose all the following except:
A. Papillary carcinoma of thyroid
B. Follicular carcinoma of thyroid
C. Anaplastic carcinoma of thyroid
D. Medullary carcinoma of thyroid

# Thyroglosal cyst is most often located:
A. Near hyoid bone
B. At the base of the tongue
C. Submandibular
D. Opposite cricoid cartilage
# Retrosternal goiter :
A. Causes stridor
B. Obtains its blood supply from thoracic vessels
C. Characteristically malignant
D. Must be removed by thoracotomy

# Hashimoto's disease is :
A. Agranulomatous thyroiditis
B. An autoimmune thyroiditis
C. Fibrous thytoiditis
D. A viral infection of the thyroid gland
E. None of the above

# A patient with increased metabolic rate, hyperthyroidism, goiter and have deposits of calcium in capsule of thyroid, It can be due to:
A. Follicular carcinoma of thyroid
B. Medullary carcinoma of thyroid
C. De Quervain's thyroiditis
D. Riedel's thyroiditis

# Tachycardia, nervousness, intolerance to heat and exophthalmos is seen in:
A. Hyperthyroidism
B. Hypothyroidism
C. Hyperparathyroidism
D. Hypoparathyroidism

# Sistrunk's operation is done for:
A. Thyroglossal cyst
B. Thyroglossal fistula
C. Both of the above
D. None of the above

# Follicular carcinoma of thyroid is best treated by :
A. Hemithyroidectomy
B. Near total thyroidectomy
C. Sub total thyroidectomy
D. Radiotherapy alone

# Which of the following is true for thyrotoxicosis ?
A. In Grave's disease, antibodies are formed to TSH receptors which results in excessive thyroxine secretion
B. Hashimoto's thyroiditis occurs in young males
C. In primary hypothyroidism, decreased TSH levels are seen.
D. In Grave's Disease, no antibodies are formed to TSH receptors which result in decreased thyroxine secretion

# The origin of thyroglossal duct is:
A. Foramen caceum
B. Tuburculum impar
C. Rathke's pouch
D. Rosenmiller's fossa

# A cold nodule in thyroid on thyroid scintiscan mean:
A. Nodule which is cold
B. Hyperactive nodule
C. Nodule which is nonfunctioning and malignant
D. Nodule which has no signs of inflammation

# The only reason for operating in case of thyroiditis is:
A. To prevent cancerous degeneration
B. For relief of pain in neck and ear
C. To overcome pressure on trachea or oesophagus
D. To cure the toxic reaction

# The carcinoma of thyroid associated with hypocalcemia is :
A. Papillary cancer
B. Medullary cancer
C. Follicular cancer
D. Anaplastic cancer

# Toxic adenoma on scanning appear as:
A. Hot nodule
B. cold nodule
C. Warm nodule
D. Neutral

# Thyroid carcinoma :
A. is often associated with hypothyroidism
B. often producess hyperthyroidism
C. is usually euthyroid
D. occurs in toxic nodules

# All of the following regarding papillary carcinoma thyroid are true except:
A. Multicentric origin
B. Secondary to lymph nodes
C. Slowly growing
D. Bony metastasis in early age

# Commonest thyroid malignancy is :
A. Medullary carcinoma
B. Follicular adenoma
C. Anaplastic carcinoma
D. Papillary carcinoma
# Lymph node metastasis is commonest in:
A. Follicular
B. Papillary
C. Anaplastic
D. Medullary

# Orphan Annie eyed nuclei is the characteristic histologic appearance seen in:
A. Papillary carcinoma thyroid
B. Follicular carcinoma thyroid
C. Medullary carcnoma thyroid
D. Hashimoto's thyroiditis

# Therapy of choice for diffuse toxic goiter in a patient over 45 years is :
A. Surgery
B. Antithyroid drugs
C. Radio iodine
D. Antithyroid drugs first followed by surgery

# Thyroglossal fistula develops due to:
A. Developmental anomaly
B. Injury
C. Incomplete removal of thyroglossal cyst
D. Inflammatory disorder

# Most common cause of Hypercalcemic crisis is:
A. Parathyroid adenoma
B. Parathyroid hyperplasia
C. Carcinoma breast
D. Paget's disease

# A patient has hypocalcemia which was the result of a surgical complication. Which operation could it possibly have been?
A. Nephrectomy
B. Thyroidectomy
C. Gastrectomy
D. Vocal cord tumor biopsy

# Hyperparathyroidism is characterized by the following except:
A. Generalised osteoporosis
B. Renal calculi
C. Hypercalcemia
D. Osteosclerosis

# After thyroidectomy, patient developed stridor within 2 hours. All are likely cause of stridor except:
A. Hypocalcemia
B. Recurrent laryngeal nerve palsy
C. Laryngomalacia
D. Wound hematoma

# A ranula is a :
A. type of epulis
B. Sublingual thyroid
C. Thyroglossal cyst
D. Cystic swelling in the floor of the mouth
# Mickulicz's disease is :
A. an inflammatory disease
B. neoplastic disease
C. an autoimmune disease
D. Viral infection

# A condition of the mouth which increases the caries activity in the oral cavity is :
A. Xerostomia
B. Hairy tongue
C. Fissured tongue
D. Watery saliva

# Reduction in flow of the saliva is not generally seen in:
A. elderly diabetics
B. patients undergoing radiation therapy
C. patients suffering from parkinsonism
D. patients on phenothiazine drugs

# Adenoid cystic carcinoma is also known as:
A. Cylindroma
B. Pindborg tumor
C. Warthins tumor
D. Pleomorphic adenoma

# Anatomical structure injured in excision of ranula is :
A. Lingual vein
B. Lingual artery
C. Submandibular duct
D. Parotid duct

# Stones are maximum in:
A. Parotid gland
B. Submandibular gland
C. Pancreas
D. Sublingual gland

# All are seen in Sjogren's syndrome except :
A. Positive antinuclear factor
B. Decreased immunoglobulins
C. Raised ESR
D. Positive Rheumatoid factor

# Parotid tumor which spreads perineurally is:
A. Mucoepidermoid carcinoma
B. Epidermoid carcinoma
C. Carcinoma in pleomorphic adenoma
D. Adenoid cystic carcinoma

# Treatment of submandibular salivary gland duct calculi is :
A. Excision of submandibular gland
B. Opening of the duct at the frenulum
C. Opening of the duct and removal of calculus
D. Excision of gland and duct

# Sjogren's syndrome is associated with:
A. Rheumatoid arthritis
B. SLE
C. Scleroderma
D. All of the above

# The commonest parotid tumor is :
A. Pleomorphic adenoma
B. Warthins tumor
C. Adenoid carcinoma
D. None of the above

# Adenolymphoma refers to :
A. Warthin's tumor
B. Pleomorphic adenoma
C. Adenocarcinoma
D. Adenocystic carcinoma

# In submandibular gland surgery, the nerve least likely to be injured is:
A. Inferior alveolar nerve
B. Lingual nerve
C. Hypoglossal nerve
D. Mandibular branch of facial nerve

# In case of parotid swelling, the diagnostic procedure of choice is:
A. FNAC
B. Superficial Parotidectomy
C. Enucleation
D. Excision biopsy

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Common Lesions showing Multilocular Radiolucency

A good dentist should have keen knowledge and expertise to make an accurate diagnosis based on the radiographical image of various conditions. It is often said that "The eyes do not see what the brain doesn't know." That is absolutely correct. We must have a good knowledge about the condition, its clinical presentations and radiological appearance in our mind to make an accurate diagnosis.

Common lesions which show multilocular radiolucency are:

  • Ameloblastoma
  • Odontogenic keratocyst
  • Odontogenic Myxoma
  • Central Giant Cell Granuloma
  • Central Hemangioma
  • Aneurysmal bone cyst
  • Cherubism

1. Ameloblastoma
- Soap bubble or honeycombed appearance
- Most common in 3rd molar- ramus area
- Notching is seen in advancing end of tumor
- Root resorption and displacement of adjacent teeth is seen
- Rarely causes perforation

2. Odontogenic Keratocyst
- Soap bubble appearance
- No expansion of cortical plates, because the lesion grows anteroposteriorly

3. Odontogenic myxoma
- Exclusively seen in Jaws, only in tooth-bearing portions
- angular or tennis racket or honeycomb appearance
- May be found in association with an impacted tooth

4. Central giant cell granuloma
- It is a reactive process, but not a neoplasm
- Soap bubble or honeycomb appearance
- a characteristic feature is that the septa are perpendicular to the periphery of the lesion and notching is seen corresponding to outline where septa arise.

5. Central hemangioma
- soap bubble appearance
- Swelling of Jaws, gingival bleeding through sulcus is seen
- " Pumping action " is a characteristic clinical feature. If tooth in the region of the tumor is pushed into the tumor, it will be rebound back to the original.

6. Aneurysmal bone cyst
- history of trauma, the cyst is reactive process  secondary to trauma
- honeycomb or soap bubble appearance
- frank blood on aspiration
- pseudocyst
- multinucleated giant cells are seen histologically

7. Cherubism
- seen at 2-6 years of age with a familial history
- When maxilla is involved, the skin over it is stretched with pulling of skin below eyes. The sclera is visible giving "angelic look" or "eyes towards heaven".
- Multiple unerupted teeth are seen which appear to be floating in cyst-like spaces.

MCQs in Anatomy - Basic General Anatomy : Skeletal System / Osteology


 Click HERE to view all our MCQ Topics.
# Bregma is the name given to the junction of the :
A. Coronal and sagittal sutures
B. Frontal bone with the nasal bone
C. Lambdoid and sagittal sutures
D. Two parietal bones

# 'Pterion' is :
A. is a point of articulation of four skull bones
B. is a point where 'bregma' and 'lambda' meet
C. it is the region of the anterolateral fontannele merge
D. lies deep to the zygomatic arch



# Lateral part of middle cranial fossa and posterior cranial fossa are divided by :
A. Petrous temporal bone
B. Crista galli
C. Transverse groove
D. Sphenoid bone

# The maxilla articulates with all of the following bones, except one. Identify the exception.
A. Frontal
B. Zygomatic
C. Palatine
D. Temporal

# Highest point on skull :
A. Pterion
B. Pogonion
C. Lambda
D. Vertex

# Which of the following structures is not present on the internal surface of the mandible ?
A. Genial Tubercle
B. Mylohyoid ridge
C. Lingula
D. Mental foramen

# Among all the following foramens in the base of the skull, which is the most posteriorly present?
A. Foramen spinosum
B. Foramen rotundum
C. Foramen lacerum
D. Foramen ovale

# Mental foramen is located :
A. Between roots of premolars
B. Between roots of molars
C. Near canine
D. Between incisors

# The palatine bone furnishes the link between :
A. Maxilla and the sphenoid bone
B. Sphenoid and the ethmoid bone
C. Sphenoid and the vomer
D. None of the above

# Lingula gives attachment to :
A. Upper medial incisor
B. Sphenomandibular ligament
C. Temporomandibular ligament
D. All

# Number of bones in adult skull are :
A. 18
B. 20
C. 22
D. 40

# The point where the parieto mastoid, occipito mastoid, and the lambdoid sutures meet is :
A. Pterion
B. Obelion
C. Asterion
D. Bregma

# Which of the following is the unpaired bone of facial skeleton ?
A. Nasal
B. Lacrimal
C. Inferior nasal conchae
D. Vomer

# Foramen magnum transmits all except : (Two answers correct )
A. Vertebral artery
B. Spinal branch 10th nerve
C. Spinal cord
D. Vertebral venous plexus

# Structure passing through foramen spinosum is :
A. Accessory meningeal artery
B. Middle meningeal artery
C. Mandibular nerve
D. Maxillary nerve

# Foramen caecum is seen in:
A. Ethmoid bone
B. Tongue
C. Sphenoid
D. A and B
# Bone better described as 'bat with extended wings' is :
A. Ethmoid
B. Sphenoid
C. Nasal
D. Mandible

# All of the following features of skull of a newborn are true except :
A. Diploe not formed
B. Styloid process has not fused with rest of the temporal bone
C. Anterior fontanelle open
D. Mastoid process is of adult size

# Suprameatal triangle externally represents :
A. Transverse sinus
B. Promontory of middle ear
C. Internal acoustic meatus
D. Mastoid antrum

# Anterior limit of infratemporal fossa is :
A. Lateral pterygoid plate
B. Maxillary posterior wall
C. Pterygomaxillary fissure
D. Mastoid process

# Which of the following muscles originates from the zygomatic process off the maxilla ?
A. Middle temporal
B. Lateral pterygoid
C. Superficial layer of masseter
D. Posterior portion of the buccinator

# Muscle, which pulls the disk of TMJ downward :
A. Lateral pterygoid
B. Medial pterygoid
C. Digastric
D. Mylohyoid

# Foramen transversarium transmits :
A. Inferior jugular vein
B. Inferior petrosal sinus
C. Sigmoid sinus
D. Vertebral artery

# Structures passing through foramen ovale :
A. Emissary vein
B. Mandibular nerve
C. Trigeminal nerve
D. A and B

# Which of the following is present in the posterior cranial fossa in a five year old child ?
A. Foramen rotundum
B. Foramen lacerum
C. Jugular foramen
D. Foramen spinosum

# Which structure passes through infra orbital fissures ?
A. Superior ophthalmic vein
B. Ophthalmic artery
C. Trochlear nerve
D. Zygomatic nerve

# Which of the following does not pass through superior orbital fissure ?
A. Occulomotor nerve
B. Optic nerve
C. Ophthalmic division of the trigeminal
D. Trochlear nerve

# Which vertebra has the most prominent spine ?
A. C2
B. C7
C. T10
D. L2

# Accessory meningeal artery enters cranial cavity through :
A. Foramen lacerum
B. Foramen rotundum
C. Foramen spinosum
D. Foramen ovale

# Mental spine provide attachment to :
A. Genioglossus
B. Anterior and posterior bellies of digastric
C. Mylohyoid
D. Superior constrictor of pharynx

# Following foramina are found in greater wing of sphenoid except :
A. Foramen rotundum
B. Canaliculus innominatus
C. Foramen spinosum
D. Optic canal

# The first costochondral joint is a :
A. Fibrous joint
B. Synovial joint
C. Fimosis
D. Synarthrosis

# The typical cervical differs from thoracic vertebra in that it:
A. has a triangular body
B. has a foramen transversarium
C. Superior articular facet directed backwards and upwards
D. has a large vertebral body

# The joint between the atlas and axis :
A.is Synovial
B. is closely related to the first cervical nerves
C. allows rotation of the head
D. is supported by the alar ligaments

# Joint between two bony surfaces linked by cartilage in the plane of body is called :
A. Syndesmosis
B. Symphysis
C. Synchondrosis
D. Suture

# Which out of the following bones ossify first ?
A. Mandible
B. Nasal bone
C. Vomer
D. Occipital

# The type of suture represented by sagittal suture of the cranial vault is :
A. Serrate
B. Denticulate
C. Squamous
D. Plane

# Which of the following is the weakest part of the orbit ?
A. Medial wall
B. Lateral wall
C. Floor of the orbit
D. Roof of the orbit

# The hyoid bone lies in the midline at the front of the neck at the level of the :
A. Third cervical vertebra
B. Fourth cervical vertebra
C. Fifth cervical vertebra
D. Seventh cervical vertebra

# The orbital opening is somewhat:
A. Quadrangular
B. Oval
C. Oblong
D. Circular

# Mandibular fossa is a part of :
A. Mandible bone
B. Maxilla bone
C. Sphenoid bone
D. Temporal bone
# Which of the following is located medial to the third molar at the junction of the maxilla and the horizontal plate of the palatine bone ?
A. Posterior nasal spine
B. Mylohyoid line
C. Pterygoid hamulus
D. Greater palatine foramen

# All of the following canals open on the posterior wall of the pterygopalatine fossa EXCEPT :
A. Greater palatine canal
B. Foramen rotundum
C. Pterygoid canal
D. Palatovaginal canal

# All of the following are pneumatic bones except :
A. Mastoid
B. Mandible
C. Maxilla
D. Ethmoid

# What is the number of bones a neonate has in the skeleton ?
A. 270
B. 250
C. 230
D. 206

# Deepest layer of deep cervical fascia is :
A. Prevertebral
B. Carotid sheath
C. Pretracheal
D. Temporal

# Not a part of Ethmoid bone is:
A. Inferior turbinate
B. Agar nasi cells
C. Uncinate process
D. Crista galli

# A dome shaped skull is known as :
A. Brachy-cephaly
B. Oxy-cephaly
C. Scapho-cephaly
D. Rhombo-encephaly

# The suture between the two halves of the frontal bone is :
A. Metopic
B. Symphysis
C. Mendosal
D. Coronal


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