In a leukemic patient, bleeding does not stop because:

 # In a leukemic patient, bleeding does not stop because:

A. Decreased platelet count 

B. Increased WBC count

C. Decreased calcium level

D. Decrease in coagulation level

The correct answer is A. Decreased Platelet Count

The sign and symptoms of acute leukemia result from either bone marrow suppression or infiltration

of leukemic cells into organs tissues. These changes cause anemia, thrombocytopenia and a decrease in

neutrophils. Thrombocytopenia causes spontaneous bleeding such as petechiae, ecchymoses, epistaxis,

melena. It may necessary to perform surgery on patients with platelet counts in the range of 25,000

because of the difficulty in achieving platelet levels due to circulating platelet antibodies.

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Diamond Blackfan anemia is characterized by:

 # Diamond Blackfan anemia is characterized by:

A. Inherited thrombocytopenia 

B. Inherited leucopenia

C. Erythroid aplasia

D. All of the above

The correct answer is C. Erythroid aplasia.

Diamond–Blackfan anemia (DBA) is a congenital erythroid aplasia that usually presents in infancy. DBA causes low red blood cell counts (anemia), without substantially affecting the other blood components (the platelets and the white blood cells), which are usually normal. This is in contrast to Shwachman–Bodian–Diamond syndrome, in which the bone marrow defect results primarily in neutropenia, and Fanconi anemia, where all cell lines are affected resulting in pancytopenia.

First noted by Hugh W. Josephs in 1936, the condition is however named for the pediatricians Louis K. Diamond and Kenneth Blackfan, who described congenital hypoplastic anemia in 1938. 

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Reduction of flow of saliva is not generally seen in:

# Reduction of flow of saliva is not generally seen in:

A. Elderly diabetes

B. Patient undergoing radiation

C. Patient suffering from parkinsonism

D. Patient of Phenothiazine drugs

The correct answer is C. Patient suffering from Parkinsonism.

Xerostomia : It is the subjective clinical condition of less than normal amount of saliva. It is dryness of mouth, which is a clinical manifestation of salivary gland dysfunction.

Causes:

- Radiation induced

- Pharmacologically induced xerostomia—there are about 500 drugs which can cause xerostomia. The classes of drugs which cause xerostomia include anticonvulsants, antiemetics, antihistaminics, anti-hypertensives and antispasmodics. The mode of action for decreased salivary flow is generally related to the para-sympathetic activity, usually an antimuscarine effect.

- Smoking, Mouth breathing

- Developmental—developmental abnormalities of salivary glands, tumors, autoimmune states and certain diseases which affect afferent or efferent portions of neural transmission reflex

- Systemic alternations resulting in xerostomia 

• Nutritional—certain deficiency states like pernicious anemia, iron deficiency anemia and deficiency of

vitamin A and hormones can cause xerostomia.

• Fluid loss—fluid loss associated with hemorrhage, sweating, diarrhea, vomiting.

• Diabetes mellitus—it is associated with xerostomia.

• Sjögren syndrome—xerostomia is also common in Sjögren syndrome.

• Other disease—systemic diseases, which are accompanied by high temperature and dehydration, usually result in diminished salivation. Xerostomia may also be found in HIV infection, sarcoidosis, and graft versus host resistance.

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Marked reduction in the amount of dentin, widening of predentin layer, presence of large areas of interglobular dentin and irregular pattern of dentin

# Which of the following condition shows marked reduction in the amount of dentin, widening of predentin layer, presence of large areas of interglobular dentin and irregular pattern of dentin?

A. Hypocalcified dentin

B. Regional odontodysplasia

C. Dentin dysplasia

D. Dentinogenesis imperfecta

The correct answer is B. Regional odontodysplasia.

The most characteristic features of Regional odontodysplasia are the marked reduction in the amount of dentin, the widening of the predentin layer, the presence of large areas of interglobular dentin, and an irregular tubular pattern of dentin.

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Dentigerous cyst is likely to cause:

# Dentigerous cyst is likely to cause:

A. Ameloblastoma

B. Fibrosarcoma

C. Adenocarcinoma

D. All of the above

The correct answer is A. Ameloblastoma.

Several relatively serious potential complications exist stemming from the dentigerous cyst, besides simply the possibility of recurrence following incomplete surgical removal. These include:

􀁏 The development of an ameloblastoma either from the lining epithelium or from rests of odontogenic epithelium in the wall of the cyst.

􀁏 The development of epidermoid carcinoma from the same two sources of epithelium.

􀁏 The development of a mucoepidermoid carcinoma, basically a malignant salivary gland tumor, from the lining epithelium of the dentigerous cyst which contains mucus secreting cells, or at least cells with this potential, most commonly seen in dentigerous cysts associated with impacted mandibular third molars.

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Cancer which most commonly metastasizes to jaw bone is:

# Cancer which most commonly metastasizes to jaw bone is:

A. Breast

B. Prostatic

C. Lung

D. Kidney

The correct answer is A. Breast

Metastasis to the jaw bones mainly occurs in the posterior region of the mandible, ramus, and the condyle, which are rich in red bone marrow. Metastasis to the maxilla is rare and comprises one-fifth of all metastatic tumors to the jawbones.[1] The male-to-female ratio is almost equal with a ratio of 1:1.1. The mean age of patients is 45 years.[2] The primary focus in women is usually located in the breasts, reproductive organs, thyroid gland, and kidneys, whereas in men it is in the lungs, prostate, kidneys, bones, large intestine, and suprarenal glands.[3,4,5] Metastases to the jaw bones almost originate from infraclavicular regions. The diffusion through Batson's venous system is the principal process of the oral cavity metastasis.[6] Histologically, the primary foci are usually carcinomas, and among them adenocarcinomas are more common. Adenocarcinoma is usually a metastasis from the breasts in women or from the lungs, alimentary canal, or prostate in men. 

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References: 

1. Antunes AA, Antunes AP. Gnathic bone metastasis: A retrospective study of 10 cases. Braz J Otorhinolaryngol. 2008;74:561–5. [PubMed] [Google Scholar]

2.  Singh H, Kumar P, Nirwan A, Kaur R. Possible pathogenetic mechanisms and overview of metastatic tumours to the oral cavity. Internet J Oncol 8 [Google Scholar]

3. Friedrich RE, Abadi M. Distant metastases and malignant cellular neoplasms encountered in the oral and maxillofacial region: Analysis of 92 patients treated at a single institution. Anticancer Res. 2010;30:1843–8. [PubMed] [Google Scholar]

4. Kaugars GE, Svirsky JA. Lung malignancies metastatic to the oral cavity. Oral Surg Oral Med Oral Pathol. 1981;51:179–86. [PubMed] [Google Scholar]

5. Shin SJ, Roh JL, Choi SH, Nam SY, Kim SY, Kim SB, et al. Metastatic carcinomas to the oral cavity and oropharynx. Korean J Pathol. 2012;46:266–71. [PMC free article] [PubMed] [Google Scholar]

6. Batson OV. The function of the vertebral veins and their role in the spread of metastases. 1940. Clin Orthop Relat Res. 1995:4–9. [PubMed] [Google Scholar]

In trauma or surgery which of the following fluids should be avoided?

 # In trauma or surgery which of the following fluids should be avoided?

A. 5% Dextrose

B. Isotonic saline

C. Ringer lactate

D. Blood

The correct answer is B. Isotonic saline.

Hypovolemic shock due to hemorrhage results in cellular anaerobic metabolism and lactic acidosis. This acidosis leads to decreased function of the coagulation proteases, resulting in coagulopathy

and further haemorrhage.  Underperfused muscle is unable to generate heat and hypothermia ensues. Coagulation functions poorly at low temperatures and there is further haemorrhage, further hypoperfusion and worsening acidosis and hypothermia. These three factors result in a downward spiral leading to physiological exhaustion and death. 

Intravenous blood and fluids are cold and exacerbate hypothermia. Further heat is lost by opening body cavities during surgery. Surgery usually leads to further bleeding and many crystalloid

fluids are themselves acidic (e.g. normal saline has a pH of 6.7). 

So, identification and stoppage of hemorrhage should be done immediately and physiological exhaustion from coagulopathy, acidosis and hypothermia should be avoided or limited. 

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