17th FEB 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal
5th year BDS
IX Semester Internal Assessment, February 2019
Paper - IV 

Time - 1 Hour 20 minutes
 Total Marks: 60
Maximum Marks - 30
1. Write a note on embryological aspects specific to cleft lip and palate.   (4)

2. Discuss briefly on different types of dislocation and enumerate the surgical procedures for the management of chronic recurrent temporomandibular joint dislocation. (3+3=6)

3. Mention the difference between the ridge extension and ridge augmentation procedure based on their indication. Describe any one ridge extension procedure. (1+4=5)

4. Write down the regimen for antibiotic prophylaxis for infective endocarditis and enlist the cardiac conditions requiring infective endocarditis prophylaxis. (2+4=6)

5. Write a note on the measures to be considered after exposure to a known case of HIV patient following needle-stick injury during tooth extraction. (4)

6. Describe the flap design for transalveolar extraction of impacted mandibular third molar correlating with the principles of flap design. (5)


Maximum Marks: 30
I. A 11 year-old patient reported to Maxillofacial clinic with a history of fall from a tree four days ago. There is no history of vomiting, seizure, loss of consciousness, but has a history of ear bleed from right ear. On examination, extraorally there is a sutured chin laceration with appreciable preauricular swelling present bilaterally. 

Intraoral examination reveals an anterior open bite due to premature gagging of occlusion. Maxilla appears to be normal. On opening the mouth, the midline is normal. 
Q1. State the term used to best define this fracture. (2)
Q2. Enlist two radiograph that can aid to diagnosis in this case. (2)
Q3. Enlist the indications for surgical intervention for this kind of fracture. (5)
Q4. Name two incisions that can be used to surgically approach this kind of fracture. (2)
Q5. Name the major complication that can occur if the patient is inappropriately treated with closed method and briefly discuss its etiopathophysiology. (1+3=4)

II.  A 26 year-old gentleman with a history of type -II diabetes mellitus was planned for extraction of 28 under local anesthesia. While during the procedure, the patient suddenly reports feeling uncomfortable, feeling warm, and then loses his consciousness. His wife who was accompanying him reports that he had taken his regular dose of hypoglycemic but missed his breakfast due to rush for the appointment. 
Q6. Enlist four causes for loss of consciousness. (2)
Q7. Discuss the management strategy for this patient. (4)
Q8. Discuss the management protocol to be employed for this medical condition to prevent such unwanted incidence from happening. (5)
Q9. Discuss the pathophysiology of syncope. (4)

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