Dentosphere : World of Dentistry: 2023

Kennedy classification is determined by: 2079 Lok sewa aayog

# Kennedy classification is determined by:

(A) the most anterior tooth missing

(B) the first tooth to be lost

(D) the most posterior tooth missing

The correct answer is D. the most posterior tooth missing.

Kennedy classification is determined by the most posterior tooth missing on both sides of the arch. Therefore, the correct option is (D) the most posterior tooth missing.

The Kennedy classification system is used to classify partially edentulous arches (i.e., arches with missing teeth) for the purpose of designing removable partial dentures. The classification is based on the location and extent of the edentulous spaces, and it takes into account the position of the remaining natural teeth and their strategic importance in supporting the prosthesis. The classification has four main categories (Class I, II, III, and IV), each of which is further divided into subcategories based on the specific edentulous spaces present in the arch.

The objective of full mouth rehabilitation is:

# The objective of full mouth rehabilitation is:

(A) to treat periodontal conditions

(B) to minimize undue destructive stress to the tissues

(D) to bring in proper occlusion

The correct answer is D. To bring in proper occlusion.

The objective of full mouth rehabilitation is to bring in proper occlusion, which means achieving a balanced and stable relationship between the upper and lower teeth and the temporomandibular joints (TMJs). Therefore, the correct option is (D) to bring in proper occlusion.

While treating periodontal conditions, minimizing undue destructive stress to the tissues, and replacing lost teeth may be important components of a full mouth rehabilitation plan, the ultimate goal is to achieve proper occlusion.

Which of the cells most commonly found in granuloma? Lok Sewa 2079

# Which of the cells most commonly found in granuloma?

(A) Lymphocytes

(B) Giant cells

(D) Neutrophils

The correct answer is B. Giant cells.

The cell most commonly found in granuloma is giant cells. A granuloma is a type of inflammation that occurs in response to chronic infection or inflammation. It is characterized by the accumulation of immune cells such as macrophages, lymphocytes, and giant cells, which are often surrounded by a rim of fibrous tissue. Giant cells are formed by the fusion of macrophages and are a characteristic feature of granulomas. They are often multinucleated and can be identified by their large size and distinctive appearance under the microscope. Lymphocytes are also commonly found in granulomas, but giant cells are the most characteristic cell type. Mast cells and neutrophils are less commonly found in granulomas.

The carotid body is a: Lok Sewa Aayog 2079

# The carotid body is a:

(A) pressure receptor

(B) pH receptor

(D) chemo receptor

The correct answer is D. Chemo receptor.

The carotid body is a chemoreceptor. It is a small cluster of specialized cells located near the bifurcation of the common carotid artery in the neck. The carotid body senses changes in the levels of oxygen, carbon dioxide, and pH in the blood and sends this information to the brainstem, where it is used to regulate breathing rate and other physiological responses. The carotid body is an important component of the body's homeostatic control mechanisms, helping to ensure that oxygen levels in the blood are maintained within a narrow range.

The suture that maintains strength for longest time is: Lok Sewa Aayog 2079

# The suture that maintains strength for longest time is:

(A) Dexon

(B) Vicryl

(D) Chromic catgut

The correct answer is C. PDS.

The suture that maintains strength for the longest time is PDS (Polydioxanone). PDS is a synthetic absorbable suture that is gradually broken down by hydrolysis and is intended to be absorbed by the body over a period of approximately 6 months. In comparison, Vicryl (Polyglactin 910) and Dexon (Polyglycolic acid) are also absorbable sutures, but they typically maintain their strength for a period of 4 to 6 weeks and 4 to 6 months, respectively. Chromic catgut is a natural absorbable suture that is made from purified collagen fibers derived from the serosal layer of sheep intestines. Its strength retention is about 14 to 21 days.

Which among the following is elevated in hemophilia A? Lok Sewa Aayog 2079

# Which among the following is elevated in hemophilia A?

(A) PT

(B) CT

(D) PT and APTT

The correct answer is C. APTT.

PT (prothrombin time) is typically normal in hemophilia A. Hemophilia A is a genetic disorder that affects the coagulation system, specifically the clotting factor VIII. PT measures the extrinsic pathway of coagulation, which is not affected in hemophilia A. Instead, hemophilia A patients typically have a prolonged activated partial thromboplastin time (aPTT), which measures the intrinsic pathway of coagulation.

Radioisotopes are used in the following techniques, except: Lok Sewa Aayog 2079

# Radioisotopes are used in the following techniques, except:

(A) Mass spectroscopy

(B) RIA

(D) Sequencing of nucleic acid

The correct answer is C. ELISA.

Radioisotopes were commonly used in ELISA (Enzyme-Linked Immunosorbent Assay) in the past, but they are no longer commonly used due to safety concerns and advances in technology.

In the past, radioactive isotopes such as iodine-125 and tritium were used to label antibodies or antigens in ELISA. These isotopes emit radiation that can be detected and measured to quantify the amount of labeled molecule in a sample. However, the use of radioisotopes poses risks to laboratory personnel and the environment due to the potential for radiation exposure.

Today, non-radioactive labeling methods such as fluorescent dyes or enzymes are more commonly used in ELISA. These methods are safer and more convenient, and they can provide similar sensitivity and specificity as radioisotope-based assays.

2079 Chaitra Lok Sewa Aayog 8th Level Dental Surgeon Question First Paper Key B

1. Most accepted theory for the conduction of pain is:

(A) gate control theory

(B) specificity theory

(D) none of the above

2. For a patient suffering from cirrhosis of liver, the safest group of LA is:

(A) general anesthesia

(B) ester group

(D) amide group

3. The site of action of the local anesthetic agent is on:

(A) perinum

(B) axonium

(D) epineurium

4. Which is the most potent topical anesthetic?

(A) Benzocaine

(B) Tetracaine

(D) Prilocaine

5. Local anesthetic agent is absolutely contraindicated in:

(A) hyperthyroidism

(B) bronchial asthma

(D) hypertension

6. The deficiency of which of the following does not affect on tooth development?

(A) Vitamin A

(B) Vitamin D

(D) Vitamin K

7. Pindborg tumour arises from:

(A) basal layer of cells

(B) stratum intermedium

(D) dental lamina

8. Pinpoint hemorrhage of less than 1 cm diameter are known as:

(A) petechiae

(B) echymoses

(D) pustules

9. Precancerous potential in plummer vinson syndrome may be due to change in the epithelium like:

(A) atrophy

(B) hypertrophy

(D) juxta epithelial hyalinization

10. One of the common side effects of dilantin sodium therapy seen in oral cavity is:

(A) stains on teeth

(B) hairy tongue

(D) gingival recession

11. Palatal lesion with multinodular appearance with a red spot seen in centre is:

(A) Smoker's palate

(B) Leukoplakia

(D) Erythroplakia

12. Radiographic view for diagnosing horizontally favorable and unfavorable fractures of mandible is best seen in:

(A) OPG

(B) Lateral oblique view

(D) Transpharyngeal

13. The facial aspect of an intraoral film is determined by the:

(A) anatomic landmarks

(B) concavity of the embossed dot

(D) curvature of the arch

14. Sunburst appearance in the radiograph is seen in:

(A) osteofibroma

(B) osteoporosis

(D) osteosarcoma

15. Radioisotopes are used in the following techniques, except:

(A) Mass spectroscopy

(B) RIA

(D) Sequencing of nucleic acid

16. The ugly duckling stage is seen at the age of:

(A) 6-7 yrs

(B) 9-10 yrs

(D) 12-14 yrs

17. Average leeway space available in each half of the maxilla is approximately:

(A) 0.9 mm

(B) 2.9 mm

(D) 6.9 mm

18. Backward path of mandibular closure is seen in:

(A) Class II Div 2

(B) Class I

(D) Class III

19. What is the sequence of extraction in Dewel's Method of Serial Extraction?

(A) CD4

(B) C4D

(D) DC4

20. Enlow V principle of growth is found in:

(A) maxilla

(B) cranial base

(D) basal cranium

21. According to Carey's analysis 2nd premolar is to be extracted if the discrepancy is:

(A) less than 2.5 mm

(B) 2.5 to 5 mm

(D) more than 7.5 mm

22. During orthodontic movement of maxillary central incisor center of relation is present at apex, it shows:

(A) controlled tipping

(B) uncontrolled tipping

(D) intrusion

23. The maxilla develops by:

(A) endochondral bone formation

(B) intramembranous bone formation

(D) direct apposition

24. Commonest teeth involved in transposition are:

(A) maxillary central incisors and lateral incisors

(B) maxillary canine and first premolar

(D) maxillary canine and lateral incisor

25. Greatest amount of growth of cranium occurs by:

(A) birth to 5 years

(B) 5-6 years

(D) 7-8 years

26. Best material for duplicating cast is:

(A) agar-agar

(B) alginate

(D) plaster of paris

27. Hardness number which does not depend on the ductility of metal:

(A) KHN

(B) VHN

(D) BHN

28. KHN value of amalgam is:

(A) 90

(B) 343

(D) 450

29. Dominant color of an object is known as:

(A) shade

(B) chroma

(D) value

30. The main resin constituent of polishable composite resin is:

(A) polymethyl methacrylate

(B) polycarbonate

(D) dimethacrylate

31. Setting expansion of dental stone is:

(A) 0.01%-0.1%

(B) 0.06%-0.12%

(D) 0.05%-0.5%

32. The role of stearic acid in impression compound:

(A) acts as a plasticizer

(B) acts as an accelerator

(D) acts as a filler

33. Hardness of which of the following abrasives is maximum:

(A) sand

(B) emery

(D) silicon carbide

34. Polymer-monomer proportion of polymethyl acrylate is:

(A) 3:1 by volume

(B) 2:1 by weight

(D) none of the above

35. Dental wax patterns should be invested as soon as possible in order to minimize change in dimensions caused by:

(A) reduced flow

(B) water absorption

(D) relaxation of internal stress

36. Pit and fissure caries is seen in: (Question Asked with wrong options, this is corrected)

a) Class I

b) Class I compound

c) Class II

d) Class II compound

37. According to Black's classification, caries on lingual pits of maxillary central incisors are:

(A) Class I

(B) Class II

(D) Class IV

38. The function of dentin conditioner is:

(A) it thinly coats collagen fibrils with resin

(B) it thickly coats collagen fibrils with resin

(D) it removes the smear layer

39. Major factor determining the efficiency of the bur is:

(A) taper angle

(B) spiral angle

(D) head diameter

40. Direct pulp capping is indicated in:

(A) no pulpal exposure

(B) symptomatic pin point pulpal exposure

(D) asymptomatic irreversible pulpitis

41. The primary gutta percha cone must fill the canal wall tightly in the:

(A) apical third

(B) middle third

(D) entire canal

42. The purpose of root canal sealer is to:

(A) seal the tubular of dentines

(B) stimulate healing in periapical region

(D) fill the space between solid core material and pulp canal walls

43. Endodontic retreatment:

(A) is as technically challenging as original treatment

(B) has poorer prognosis than original treatment

(D) has different objectives than primary treatment

44. Composite resins are not usually recommended for restoration of class II cavities because of excessive:

(A) occlusal wear

(B) marginal fracture

(D) isthmus fracture

45. A casting is maintained in position under masticatory load primarily by virtue of:

(A) cement seal

(B) retention and resistance form

(D) all of the above

46. Average root surface area of maxillary first molar is:

(A) 433

(B) 431

(D) 400

47. Hinge axis located with the help of:

(A) ear rods

(B) maxilla mandibular vertical relation

(D) orbital pointer

48. Pontic should be:

(A) convex buccolingually

(B) convex mesiodistally

(D) concave mesiodistally

49. Vertical dimension at rest (VDR) is:

(A) changes throughout life

(B) remains constant for particular individual

(D)similar to the freeway space

50. Objective of full mouth rehabilitation is:

(A) to treat periodontal conditions

(B) to minimize undue destructive stress to the tissues

(D) to bring in proper occlusion

51. Kennedy classification is determined by:

(A) the most anterior tooth missing

(B) the first tooth to be lost

(D) the most posterior tooth missing

52. The position of the upper occlusal rim in the articulator is adjusted by :

(A) arbitrary means

(B) using face-bow

(D) adjusting the incisal pin

53. A sprue in a wax pattern show be placed:

(A) at right angle

(B) at acute angle

(D) depends on types of wax pattern

54. Thickness of the die spacer should be:

(A) 10-20 micrometer

(B) 20-40 micrometer

(D) 66-80 micrometer

55. The secondary peripheral seal area of mandibular complete denture is the:

(A) labial border

(B) buccal border

(D) anterior lingual border

56. Pocket elimination and increase in width of attached gingiva is obtained by:

(A) modified Widman's flap

(B) apically displaced flap

(D) papilla preservation flap

57. Principal cell type of periodontal ligament is:

(A) fibroblasts

(B) osteoblasts

(D) cementoblasts

58. Periodontal flap surgery is most difficult in:

(A) incisors (facially)

(B) incisors (lingually)

(D) 2nd molars (distally)

59. The brushing technique recommended for patients with periodontal disease is:

(A) scrub technique

(B) sulcular technique

(D) circular technique

60. What is the length of junctional epithelium?

(A) 0.25-1.35 mm

(B) 0.2-1 mm

(D) 1-3 mm

61. Of the following form bacterial species, which is least likely to be found in plaque?

(A) Actinomyces viscosus

(B) Streptococcus mutans

(D) Streptococcus sanguinis

62. All are 3rd generation probe, except:

(A) TPS probe

(B) Toronto automated probe

(D) Florida probe

63. Trauma from occlusion in the absence of inflammation causes:

(A) irreversible changes in periodontium

(B) no changes in periodontium

(D) only reversible changes in periodontium

64. Which PERIO electronic device is used to measure GCF?

(A) periotron

(B) periocol

(D) periotest

65. Tunneling is indicated in which grade of furcation?

(A) Grade I

(B) Grade II

(D) Grade IV

66. Early eruption of teeth is associated with:

(A) hypopituitarism

(B) hyperthyroidism

(D) hyperparathyroidism

67. In a case of rampant caries, the ideal procedure to perform in the first visit is:

(A) diet control instructions

(B) topical fluoride application

(D) oral hygiene instruction

68. Forcep contraindicated in deciduous teeth extraction is:

(A) root forcep

(B) bayonet forcep

(D) contra-angled forcep

69. The difference between the amount of space needed for the permanent incisors to erupt and the space available for them is called:

(A) primate space

(B) leeway space

(D) incisor liability

70. A 10 year old child, has a mid crown fracture of maxillary central incisor. The treatment of choice is:

(A) formocresol pulpotomy

(B) conventional root canal treatment

(D) depends on radiographic finding

71. The concept which views health as "absence of disease" is called:

(A) biomedical concept

(B) ecological concept

(D) holistic concept

72. Which of the following is a measure of dispersion in statistics?

(A)Mean

(B) P value

(D) Rates

73. The headquarter of UNICEF is at:

(A)Geneva

(B) New York

(D) Munich

74. Standard deviation and variance is a measure of:

(A) dispersion

(B) distribution

(D) cumulation

75. Percentage of fluoride used in iontophoresis is:

(A) 1%

(B) 2%

(D) 8%

76. Addison's disease is due to:

(A) chronic insufficiency of adrenal cortex

(B) chronic insufficiency of adrenal medulla

(D) hypofunction of thyroid gland

77. Spontaneous bleeding usually seen with a platelet count of:

(A) less than 50000/cubic mm

(B) 5000-75000/cubic mm

(D) 100000-150000/cubic mm

78. Acetone breaths is feature of:

(A) liver disease

(B) sinusitis

(D) diabetes mellitus

79. The appropriate test which shows lack of intrinsic factor in Vitamin B12 deficiency is:

(A) full blood count

(B) schilling's test

(D) ferritin

80. Which among the following is elevated in hemophilia A?

(A) PT

(B) CT

(D) PT and APTT

81. Which of the following drug is used in the treatment of hyperkalemia in acute renal failure?

(A) Amiloride

(B) Amlodipine

(D) Insulin

82. The suture that maintains strength for longest time is:

(A) Dexon

(B) Vicryl

(D) Chromic catgut

83. Most common primary bone tumor is:

(A) Osteosarcoma

(B) Multiple myeloma

(D) Ewing's sarcoma

84. The carotid body is a:

(A) pressure receptor

(B) pH receptor

(D) chemo receptor

85. A punched out edge is characteristic of which type of ulcer?

(A) Tuberculosis

(B) Rodent ulcer

(D) Nonspecific ulcer

86. Which form of actinomycosis is most common?

(A) Faciocervical

(B) Thorax

(D) Spleen

87. Nasopharyngeal carcinoma mostly arises from:

(A) roof

(B) posterior wall

(D) fossa of Rosenmuller

88. The excessive formation of scar tissue is called:

(A) fibroma

(B) myxoma

(D) keloid

89. Which of the cells most commonly found in granuloma?

(A) Lymphocytes

(B) Giant cells

(D) Neutrophils

90. Long term effect of radiotherapy to oral mucosa is characterized by:

(A) epithelium becomes more keratinized

(B) sub mucosa becomes highly vascular

(D) no sub mucosal fibrosis

91. A multilocular cyst of the jaw is more likely:

(A) dental cyst

(B) dentigerous cyst

(D) simple bone cyst

92. "Onion peel" radiographic appearance is seen in:

(A) Ewing's sarcoma

(B) Pagets disease

(D) Osteogenesis imperfecta

93. Which one of following type of nevi do not occur in oral cavity?

(A) Intradermal

(B) Junctional

(D) Blue nevus

94. Odontolithiasis is better known as:

(A) plaque

(B) calculus

(D) caries

95. The chemical disintegration of enamel is referred to as:

(A) abrasion

(B) attrition

(D) hypoplasia

96. Fracture of condyle causes:

(A)deviation to affected side

(B) deviation to opposite side

(D) normal functioning

97. According to "fusion theory", cleft lip occurs due to failure of:

(A) fusion of median nasal process with maxillary process

(B) fusion of median nasal process and lateral nasal process

(D) fusion of median nasal process

98. Pain of dry socket is experienced on:

(A) 1st day after extraction

(B) 2nd day after extraction

(D) after 7 days

99. Submandibular space infection may arise from:

(A) infections originating from the mandibular premolars

(B) infection from the sublingual salivary gland

(D) infection originating from middle third of the tongue, posterior part of the floor of the mouth, maxillary teeth, cheek, maxillary sinus and palate

100. The straight elevator works on which principle?

(A)wedge principle

(B) wheel and axle principle

(D) apical force principle

Lok sewa Aayog Dental Surgeon Eighth Level Second Paper Question 2079/12/04

Full Marks: 100 Time : 3 hours

Subject - Dentistry

SECTION A 20 Marks

1. How does hemophilia impact dental treatment and what precautions should be taken by dental surgeon to ensure the safety of patients with hemophilia? Discuss. 4+6=10

2. Classify fibro-osseous lesions. Discuss in detail about Paget's disease of bone. 10

SECTION B 30 Marks

3. A patient comes with the swelling of the left side of face due to carious lower first molar; which space is involved by the infection? Write about the boundaries and treatment of the buccal space infection. Also state on Gow Gates technique. 2+5+3=10

4. Describe briefly various intraoral radiographic techniques. But among them, write in detail about bite wing radiography. 5+5=10

5. Explain in detail on nonvital bleaching with note on the various bleaching agents and its mechanism. 10

SECTION C 30 Marks

6. Describe oral habits. Elucidate in detail about tongue thrusting habit. 5+5=10

7. What are the advantages and disadvantages of using glass ionomer as a restorative material in dentistry? And, in what situations is it most commonly used? Elaborate. 4+6=10

8. State pontic in fixed partial dentures. Discuss on the selection of pontics in clinical practice. 10

SECTION D 20 Marks

9. Mention different techniques to whiten discolored tooth. Discuss about walking bleach technique. 2+8=10

10. Suggest different possible public health strategies with justifications to improve oral health of population in rural areas of Nepal. 10

THE END

A young patient has white thickening of buccal mucosa since birth and it also occurs in nose and esophagus. Most likely diagnosis is:

# A young patient has white thickening of buccal mucosa since birth and it also occurs in nose and esophagus. Most likely diagnosis is:

a. accumulation of fordyces granules

b. chronic hyperplastic candidiasis

c. white sponge nevus

d. porokeratosis

The correct answer is C. White sponge nevus.

This mucosal abnormality is congenital in many instances. In other cases, it does not appear until

infancy, childhood, or even adolescence, by which time it has generally reached the full extent of its severity. The oral lesions may be widespread, often involving the cheeks, palate, gingiva, floor of the mouth, and portions of the tongue. The mucosa appears thickened and folded or corrugated with a soft or spongy texture and a peculiar white opalescent hue. There is sometimes a minimal amount of folding present. Ragged white areas may also be present which can be removed sometimes by gentle rubbing without any ensuing bleeding.

Organ involvement of SLE is in:

# Organ involvement of SLE is in:

a. kidney and Lungs

b. kidney and heart

c. lungs and heart

d. heart and spleen

The correct answer is B. Kidney and heart.

Systemic lupus erythematosus is a serious cutaneous-systemic disorder which characteristically manifests repeated remissions and exacerbations. This disease has its peak age of onset at about 30 years in females but about 40 years in males. The disease may occur in childhood as reported by Jacobs. Prevalence rates are higher in females than in males. A female-to-male ratio of approximately 2 : 1 occurs before puberty, and a ratio of 4 : 1 occurs after puberty.

The generalized manifestations of the systemic disease are referable to the involvement of various organs, including the kidney and heart. In the kidney, fibrinoid thickening of glomerular capillaries occurs, producing the characteristic ‘wire loops,’ which may be sufficient to result in renal insufficiency. The heart may suffer from an atypical endocarditis involving the valves, as well as fibrinoid degeneration of the epicardium and myocardium. The widespread tissue involvement and the nature of the lesions have led to the inclusion of this disease in that group known as the ‘collagen diseases,’ which also includes rheumatic fever, rheumatoid arthritis, polyarteritis nodosa, scleroderma and dermatomyositis.

Prodromal symptom of OSMF:

# Prodromal symptom of OSMF:

a. hypersalivation

b. dryness of mouth

c. both of the above

d. none of the above

The correct answer is C. Both of the above.

Prodromal Symptoms (Early OSF):

This includes a burning sensation in the mouth when consuming spicy food, appearance of blisters especially on the palate, ulcerations or recurrent generalized inflammation of the oral mucosa,

excessive salivation, defective gustatory sensation and dryness of the mouth. There are periods of exacerbation manifested by the appearance of small vesicles in the cheek and palate. The intervals between such exacerbation vary from three months to one year. Focal vascular dilatations manifest

clinically as petechiae in the early stages of the disease. This may be part of a vascular response due to hypersensitivity of the oral mucosa towards some external irritant like arecanut products. Petechiae are observed in about 22% of OSF cases (Rajendran, 1994), mostly on the tongue followed by the labial and buccal mucosa with no sign of blood dyscrasias or systemic disorders. Pain in areas where submucosal fibrotic bands are developing when palpated is a useful clinical test. Histologically, they revealed a slightly hyperplastic epithelium, sometimes atrophic with numerous dilated and blood-filled capillaries juxtaepithelially. The inflammatory cells seen are mainly lymphocytes, plasma cells and occasional eosinophils. The presence together of large numbers of lymphocytes and fibroblasts as well as plasma cells in moderate numbers, suggests the importance of a sustained lymphocytic infiltration in the maintenance of the tissue reaction in OSF.

Pathergy test is done in:

# Pathergy test is done in:

a. bechet syndrome

b. senear usher syndrome

c. weber cockayna syndrome

d. epidermolysis bullosa

The correct answer is: A. Bechet syndrome.

Pathergy phenomenon has been well known to dermatologists since it was first described in 1937 by Blobner as a state of altered tissue reactivity in response to minor trauma. The pathergy test is a nonspecific hypersensitivity skin reaction induced by needle prick that is performed to look for evidence of this phenomenon. Pathergy lesions are generally manifested clinically by erythematous induration at the location of skin trauma, which may remain as papules or progress to sterile pustules. Although the precise mechanism of pathergy has not yet been entirely elucidated, the skin injury by needle prick in patients exhibiting pathergy is thought to trigger a cutaneous inflammatory response that is exaggerated and more prominent than that seen in normal skin. An increased release of cytokines from cells in the dermis or epidermis is implicated in this aberrant reaction, which results in the perivascular infiltrates that are characteristically observed on histopathologic studies. While pathergy has been reported in numerous diseases, pathergy testing is primarily used in the diagnosis of Behcet Disease (BD).

Which of the following is not a characteristic of Paterson-brown-kelly syndrome?

# Which of the following is not a characteristic of Paterson-brown-kelly syndrome?

a. koilonychia

b. dysphagia

c. iron deficiency anemia

d. none of the above

The correct answer is D. None of the above.

Iron Deficiency Anemia and Plummer-Vinson Syndrome

(Paterson-Brown-Kelly syndrome, Paterson-Kelly syndrome, sideropenic dysphagia)

Iron deficiency is an exceedingly prevalent form of anemia, particularly in females. Iron deficiency is the most prevalent single deficiency state on a worldwide basis. It has been estimated that between 5 and 30% of women in the United States are iron deficient, while in some parts of the world, this may reach 50% . Men are only rarely affected.

While an iron-deficiency anemia may occur at any age, the Plummer-Vinson syndrome occurs chiefly in women in the fourth and fifth decades of life. Presenting symptoms of the anemia and the syndrome

are cracks or fissures at the corners of the mouth (angular cheilitis), a lemon-tinted pallor of the skin, a smooth, red, painful tongue (glossitis) with atrophy of the filiform and later the fungiform papillae, and dysphagia limited to solid food resulting from an esophageal stricture or web. These oral findings are reminiscent of those seen in pernicious anemia. The mucous membranes of the oral cavity and esophagus are atrophic and show loss of normal keratinization. Koilonychia (spoon-shaped fingernails) or nails that are brittle and break easily have been reported in many patients; splenomegaly has also been reported in 20–30% of the cases.

Osteogenesis imperfecta:

# Osteogenesis imperfecta:

a. Is a sex linked disorder of bones that develop in cartilage

b. Manifests with blue sclera which are pathognomonic of this disease

c. May be associated with deafness

d. Has associations with amelogenesis imperfecta

The correct answer is B. Manifests with blue sclera which are pathognomonic of this disease.

A second characteristic clinical feature of osteogenesis imperfecta is the occurrence of pale blue sclerae. The sclerae are abnormally thin, and for this reason the pigmented choroid shows through and produces the bluish color. However, the appearance of blue sclera is not confined to this disease since it may also be seen in osteopetrosis, fetal rickets, Turner syndrome, Paget’s disease, Marfan syndrome, and Ehlers-

Danlos syndrome, as well as in normal infants. While the blue sclerae are a prominent sign in this disease, they are not invariably present. In a series of 42 patients reported by Bauze and his associates, 12 of the patients had white sclerae, and these were generally found in the older patients with the more severe disease and earlier onset of fractures.

Radiographic finding in Pindborg tumor:

# Radiographic finding in Pindborg tumor:

a. Sun-burst appearance

b. Onion-peel appearance

c. Driven-snow appearance

d. Cherry-blossom appearance

The correct answer is C. Driven snow appearance.

A calcifying epithelial odontogenic tumor (Pindborg tumor) may show considerable radiographic variation. In some cases, the lesion appears as either a diffuse or a well-circumscribed unilocular radiolucent area, while in other cases there may appear to be a combined pattern of radiolucency and radiopacity with many small, irregular bony trabeculae traversing the radiolucent area in many directions, producing a multilocular or honeycomb pattern. Scattered flecks of calcification throughout the radiolucency have given rise to the descriptive term of a ‘driven snow’ appearance. In some instances, the lesion is totally radiolucent and is in association with an impacted tooth, thus leading to a mistaken clinical diagnosis of a dentigerous cyst.

The cyst with the highest recurrence rate is:

# The cyst with the highest recurrence rate is:

A. Keratocyst

B. Periapical cyst

C. Nasoalveolar cyst

D. Globulomaxillary cyst

The correct answer is A. Keratocyst.

In 1967, Toller suggested that the OKC may best be regarded as a benign neoplasm rather than a conventional cyst based on its clinical behavior. The WHO has reclassified the lesion as a tumor based on several factors, that formed the basis of this decision.

Behavior: The KOT is locally destructive and has a high recurrence rate.

Histopathology: The basal epithelial layer of KOT shows proliferation and budding into the underlying connective tissue in the form of daughter cysts and mitotic figures are frequently found in the suprabasal layers of the lesional epithelium.

Dentigerous cyst is suspected if the follicular space is more than:

# Dentigerous cyst is suspected if the follicular space is more than:

a. 2-3 mm

b. 3-4 mm

C. 1-2 mm

d. More than 5 mm

The correct answer is D. More than 5 mm.

One of the most difficult differential diagnoses to make is between a small dentigerous cyst and a hyperplastic follicle. A cyst should be considered with any evidence of tooth displacement or considerable expansion of the involved bone. The size of the normal follicular space is 2 to 3 mm. If the follicular space exceeds 5 mm, a dentigerous cyst is more likely. If uncertainty remains, the region should be reexamined in 4 to 6 months to detect any increase in size or any influence on surrounding structures characteristic of cysts.

Reference: Oral radiology Principles and Interpretation, 7th Edition Stuart C. White, Michael J. Pharoah

Which one of the following conditons is least likely to be associated with an increased risk of oral cancer?

# Which one of the following conditons is least likely to be associated with an increased risk of oral cancer?

a. Actinic Cheilosis

b. Erythroplakia

c. Leukoedema

d. Leukoplakia

The correct answer is C. Leukoedema.

Leukoedema is a white and veil‐like alteration of the oral mucosa that is merely considered a normal variant. The condition is often encountered bilaterally in the buccal mucosa and sometimes at the borders of the tongue. Leukoedema is less clinically evident after stretching the mucosa, but reappears after this manipulation is discontinued.

Reference: Burket's Oral Medicine

Disadvantages of using a GRID is:

# Disadvantages of using a GRID is:

a. Increased patient exposure

b. Decreased Patient exposure

c. Increased fogging of the film

d. Increased secondary radiation

The correct answer is A. Increased patient exposure.

Although radiographic grids reduce scattered radiation and improve contrast and resolution, they result

in higher patient exposure. Cephalometry does not require the use of grids. However, grids could improve the radiographic appearance of fine structures, such as trabecular architecture, and aid in the diagnosis of disease.

Reference: Oral radiology Principles and Interpretation, 7th Edition Stuart C. White, Michael J. Pharoah

The maximum penetration among the following is seen with which ray:

# The maximum penetration among the following is seen with which ray:

a. Alpha

b. Beta

c. Gamma

d. Electron Beam

The correct answer is C. Gamma.

Gamma (γ) rays originate in the nuclei of radioactive atoms. They typically have greater energy than x rays. In contrast, x rays are produced outside the nucleus and result from the interaction of electrons with large atomic nuclei in x-ray machines. The higher energy types of radiation in the electromagnetic spectrum— ultraviolet rays, x rays, and γ rays—are capable of ionizing matter. Some properties of electromagnetic radiation are best explained by quantum theory, whereas others are most successfully described by wave theory.

PGCEE MDS 2022: The most unwanted side effect seen with Herbst appliance is:

# The most unwanted side effect seen with Herbst appliance is:

A. Lower incisor proclination

B. Frequent breakage of the appliance

C. Downward rotation of palate

D. Mandible rotate anticlockwise

The correct answer is A. Lower incisor proclination.

The most unwanted side effects seen with Herbst appliance are:

- More chance of labial tipping as well as proclination of mandibular incisors

- Retrusion of maxillary incisors

Reference: Pancherz H. Treatment of Class II malocclusions by jumping the bite with the Herbst appliance. A cephalometric investigation. Am J Orthod. 1979;76(4):423–442.

Salivary gland stone most commonly involves:

# Salivary gland stone most commonly involves:

a. sublingual gland

b. Submandibular gland

c. Parotid gland

d. Lingual glands

The correct answer is B. Submandibular gland.

Sialoliths (salivary calculi or salivary stones) are calcified organic masses that form within the secretory system of the salivary glands. Although the exact mechanism of sialolith formation has not been established, it has been proposed that microcalculi are frequently formed in salivary ducts during periods of secretory inactivity.

Sialoliths occur most commonly in the submandibular glands (80–90%), followed by the parotid (5–15%) and sublingual (2–5%) glands, and only very rarely occur in the minor salivary glands. Spontaneous secretion in the minor and sublingual salivary glands may provide continuous salivary flow, thereby preventing stasis.

The higher rate of sialolith formation in the submandibular glands is due to: (1) the torturous course of Wharton’s duct; (2) the higher calcium and phosphate levels of the secretions contained within; (3) the dependent position of the submandibular glands which leaves them prone to stasis; and (4) the increased mucoid nature of the secretion. In addition, since the submandibular and parotid glands’ secretion is dependent on nervous stimulation, in its absence, secretory inactivity increases the risk of stone development.

Lab test for patient on warfarin

# A patient on warfarin sodium following myocardial infarction reports for an oral surgical procedure. Which one of the following laboratory tests should be preferred to ascertain the fitness?

a. Prothrombin time

b. Torniquet time

c. clotting time

d. bleeding time

The correct answer is A. Prothrombin time.

The PT and INR tests measure the time it takes for blood to clot by forming thrombin. They evaluate the extrinsic and common coagulation pathways, screening for the presence or absence of fibrinogen (F I), prothrombin (F II), and F V, F VII, and F X. The normal range of PT is approximately 11–13 seconds. Because of individual laboratory reagent variability and the desire to be able to reliably compare the PT from one laboratory with that from another, the PT test is commonly reported with the INR. The INR, introduced by the World Health Organization in 1983, is the ratio of PT that adjusts for the sensitivity of the thromboplastin reagents, such that a normal coagulation profile is reported as an INR of 1.0, and higher values indicate abnormal coagulation. Its most common use is to measure the effects of VKAs and reduction of the vitamin K–dependent F II, F VII, F IX, and F X. It is not effective for hemophilias A and B, since it does not measure F VIII or F IX. Although most patients on VKAs are monitored by monthly venous blood draws and laboratory analysis, the CoaguChek system allows Clinical Laboratory Improvements Amendments (CLIA)-waived point-of-care PT/INR testing of fingerstick blood in physicians’ and dentists’ offices.

Bremsstrahlung refers to:

# Bremsstrahlung refers to:

a. the primary source of X-rays from an X-ray tube

b. Characteristic radiation emitted when an electron is displaced from the outer shell of a tungsten atom in the target

c. the electromagnetic spectrum

d. particulate radiation

The correct answer is: A. a. the primary source of X-rays from an X-ray tube.

BREMSSTRAHLUNG RADIATION: The sudden stopping or slowing of high-speed electrons by tungsten nuclei in the target produces bremsstrahlung photons, the primary source of radiation from an x-ray tube. (Bremsstrahlung means “braking radiation” in German.)

Multiple punched out radiolucencies is a feature of:

# Multiple punched-out radiolucencies is a feature of:

a. Multiple Myeloma

b. Thalassemia

c. Fibrous Dysplasia

d. Ewing's Sarcoma

The correct answer is A. Multiple myeloma.

The periphery of multiple myeloma lesions is well-defined but not corticated; it lacks any sign of bone reaction. The lesions have been described as appearing “punched out.” However, many appear ragged and even infiltrative. Some lesions have an oval or cystic shape. Untreated or aggressive areas of destruction may become confluent, giving the appearance of multilocularity.

Bleeding time is prolonged in:

# Bleeding time is prolonged in:

A. Hemophilia

B. Von willebrand disease

C. Telangiectasia

D. Henoch Schonlein purpura

The correct answer is B. Von Willebrand disease.

Von Willebrand disease (VWD) is the most common hereditary blood-clotting disorder in humans. An acquired form can sometimes result from other medical conditions. It arises from a deficiency in the quality or quantity of von Willebrand factor (VWF), a multimeric protein that is required for platelet adhesion. It is known to affect several breeds of dogs as well as humans. The three forms of VWD are hereditary, acquired, and pseudo or platelet type. The three types of hereditary VWD are VWD type 1, VWD type 2, and VWD type 3. Type 2 contains various subtypes. Platelet type VWD is also an inherited condition.

The various types of VWD present with varying degrees of bleeding tendency, usually in the form of easy bruising, nosebleeds, and bleeding gums. Women may experience heavy menstrual periods and blood loss during childbirth.

Severe internal bleeding and bleeding into joints are uncommon in all but the most severe type, VWD type 3.

Hair-on-end appearance in a skull roentgenogram is seen in:

# " Hair-on-end" appearance in a skull roentgenogram is seen in:

a. Fibrous dysplasia

b. Thalassemia

c. Garre's Osteomyelitis

d. Paget's Disease

The correct answer is B. Thalassemia.

Similar to sickle cell anemia, the features of thalassemia generally result from hyperplasia of the ineffective bone marrow and its subsequent failure to produce normal red blood cells. However, these changes are usually more severe than with other anemias. There is a generalized radiolucency of the long bones with cortical thinning. In the skull, the diploic space exhibits marked thickening, especially in the frontal region. The skull also shows a generalized granular appearance, and occasionally a “hair-on-end” effect may develop.

Vesicles rupture at followed by pseudo membrane formation on a 3 year old child

# A 3 year old patient has extensive vesicles on lip, tongue, oral mucous membrane. After 2-4 days vesicles rupture at followed by pseudo membrane formation and also some dermal lesions are seen. What will be the diagnosis?

a. Herpetic stomatitis

b. Erythema multiforme

c. ANUG

d. Steven-Johnson Syndrome

The correct answer is B. Erythema multiforme.

Erythema multiforme (EM) is acute, self‐limited, inflammatory mucocutaneous disease that manifests on the skin and often oral mucosa, although other mucosal surfaces, such as the genitalia, may also be involved. It represents a hypersensitivity reaction to infectious agents (majority of cases) or medications. In general, EM is classified as EM minor if there is less than 10% of skin involvement and there is minimal to no mucous membrane involvement, whereas EM major has more extensive but still characteristic skin involvement, with the oral mucosa and other mucous membranes affected.

Three inherent characteristics of a radiographic film:

# Three inherent characteristics of a radiographic film:

a. density, distortion, contrast

b. sharpness, contrast, density

c. definition, sharpness, penumbra

d. distortion, detail, sharpness

The correct answer is: B. Sharpness, contrast, density.

Image quality describes the subjective judgment by the clinician of the overall appearance of a radiograph. It combines the features of density, contrast, latitude, sharpness, resolution, and perhaps other parameters.

Use of intensifying screen is:

# Use of intensifying screen is:

a. to decrease scattered radiation

b. to decrease patient radiation

c. to increase contrast

d. to increase number of photons striking the anode filament

The correct answer is B. To decrease patient radiation.

The presence of intensifying screens creates an image receptor system that is 10 to 60 times more sensitive to x-rays than the film alone. Consequently, the use of intensifying screens substantially reduces the dose of x radiation to the patient. Intensifying screens are used with films for virtually all extraoral radiography, including panoramic, cephalometric, and skull projections.

Digital radiography differs from conventional in:

# Digital radiography differs from conventional in:

a. X-rays not used

b. Rays other than X-rays are used

c. Radiation receptors are different

d. No hard copy is formed

The correct answer is C. Radiation receptors are different.

Digital image receptors encompass numerous different technologies and come in many different sizes and shapes. Numerous different and sometimes confusing names are in use to identify these receptors in medicine and dentistry. The most useful distinction is that between two main technologies: (1) solid-state technology and (2) photostimulable phosphor (PSP) technology. Although solid-state detectors can be subdivided further, these detectors have in common certain physical properties and the ability to generate a digital image in the computer without any other external device.

In medicine, the use of solid-state detectors is referred to as digital radiography. In dentistry, intraoral solid-state detectors are often called sensors. The other main technology, PSP, consists of a phosphor-coated plate in which a latent image is formed after x-ray exposure. The latent image is converted to a digital image by a scanning device through stimulation by laser light. This technology is sometimes referred to as storage phosphor on the basis of the notion that the image information is temporarily stored within the phosphor. Other times the term image plates is used to differentiate them from film and solid-state detectors. The use of PSP plates in medical radiology is referred to as computed radiography.

Tzanck smear test is used in the diagnosis of:

# Tzanck smear test is used in the diagnosis of :

a. Pemphigus

b. ANUG

c. Aphthous disease

d. Lichen planus

The correct answer is A. Pemphigus.

Pemphigus as an entity is characterized microscopically by the formation of a vesicle or bulla entirely intraepithelially, just above the basal layer producing the distinctive suprabasilar ‘split’. Prevesicular edema appears to weaken this junction, and the intercellular bridges between the epithelial cells disappear. This results in loss of cohesiveness or acantholysis, and because of this, clumps of epithelial cells are often found lying free within the vesicular space. These have been called ‘Tzanck cells’ and are characterized particularly by degenerative changes which include swelling of the nuclei and hyperchromatic staining. These changes are particularly obvious in cytologic smears taken from early, freshly opened vesicles.

A flat, circumscribed discoloration of skin or mucosa that may vary in size and shape is referred to as:

# A flat, circumscribed discoloration of skin or mucosa that may vary in size and shape is referred to as:

a. epulis

b. macule

c. nodule

d papule

The correct answer is B. Macule.

Macules: These are lesions that are flush with the adjacent mucosa and that are noticeable because of their difference in color from normal skin or mucosa. They may be red due to increased vascularity or inflammation, or pigmented due to the presence of melanin, hemosiderin, and foreign material (including the breakdown products of medications). A good example in the oral cavity is the melanotic macule.

Papules: These are lesions raised above the mucosal surface that are smaller than 1.0 cm in diameter (some use 0.5 cm for oral mucosal lesions). They may be slightly domed, or flat‐topped. Papules are seen in a wide variety of diseases, such as the yellow‐white papules of pseudomembranous candidiasis.

Plaques: These are raised lesions that are greater than 1 cm in diameter; they are essentially large papules.

Nodules: These lesions are present within the deep mucosa. The lesions may also protrude above the mucosa forming a characteristic dome‐shaped structure. A good example of an oral mucosal nodule is the irritation fibroma.

Vesicles: These are small blisters containing clear fluid that are less than 1 cm in diameter.

Bullae: These are elevated blisters containing clear fluid that are greater than 1 cm in diameter.

Erosions: These are red lesions often caused by the rupture of vesicles or bullae, or trauma and are generally moist on the skin. However, they may also result from thinning or atrophy of the epithelium in inflammatory diseases such as lichen planus. These should not be mistaken for ulcers, which are covered with fibrin and are yellow.

Pustules: These are blisters containing purulent material and appear yellow.

Ulcers: These are well‐circumscribed, sometimes depressed lesions with an epithelial defect that is covered by a fibrin membrane, resulting in a yellow‐white appearance. A good example is an aphthous ulcer.

Purpura: These are reddish to purple discolorations caused by blood from vessels leaking into the connective tissue. These lesions do not blanch when pressure is applied and are classified by size as petechiae (less than 0.3 cm), purpura (0.4–0.9 cm), or ecchymoses (greater than 1 cm).

Bismuth intoxication is manifested as:

# Bismuth intoxication is manifested as:

a. Pigmentation in areas of inflammation

b. Burtonian line

c. Gingiva

d. Blackish line in the mucosa

The correct answer is D. Blackish line in the mucosa.

Oral Manifestations: Bismuth pigmentation of the oral mucosa, particularly of the gingiva and buccal mucosa, is the most common oral feature of bismuth therapy and is reported to occur in a high proportion of patients receiving preparations containing the metal.

The pigmentation appears as a ‘bismuth line’, a thin blue-black line in the marginal gingiva which is sometimes confined to the gingival papilla. There may also be the same type of pigmentation of the buccal mucosa, the lips, the ventral surface of the tongue, or in any localized area of inflammation such as around partially erupted third molars or around the periphery of an ulcer as an anachoretic phenomenon.

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