A 70 year old patient comes with complaint of headache, nausea, tenderness over temporal region, diagnosis is:

 # A 70 year old patient comes with complaint of headache, nausea, tenderness over temporal region, diagnosis is? 

A. Aneurysmal arterial dilatation with sub-intimal inflammation 

B. Granulomatous inflammation with giant cell arteritis

C. Luminol thrombosis 

D. Acute organizing thrombus formation

The correct answer is B. Granulomatous inflammation with giant cell arteritis.

Temporal arteritis is to be suspected in an elderly patient presenting with headache, visual symptoms (blindness), fever, malaise, weakness, pain and tenderness over temporal artery (thick cord like sensation) and a raised ESR. 

Temporal (giant cell) arteritis is an inflammatory disorder of arteries that frequently involves the extracranial carotid circulation. The average age of onset is 70 years (elderly), and women account for 65% of cases. About half of patients with untreated temporal arteritis develop blindness due to involvement of the ophthalmic artery and its branches. lschemic optic neuropathy induced by giant cell arteritis (granulomatous inflammation) is the major cause of rapidly developing bilateral blindness in patients >60 years. 

Typical presenting symptoms include headache, polymyalgia rheumatica jaw claudication, fever, and weight loss. Headache is the dominant symptom and often appears in association with malaise and muscle aches. Head pain may be unilateral or bilateral and is located temporally in 50% of patients but may involve any and all aspects of the cranium. Pain usually appears gradually over a few hours before peak intensity is reached; occasionally, it is explosive in onset. 

The erythrocyte sedimentation rate (ESR) is often, though not always, elevated; a normal ESR does not exclude giant cell arteritis. A temporal artery biopsy followed by immediate treatment with prednisone (glucocorticoids) 80 mg daily for the first 4-6 weeks should be initiated when clinical suspicion is high. 

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The assessment or measurement of the quality of care and the implementation of any necessary changes to either maintain or improve the quality of care rendered is:

 # The assessment or measurement of the quality of care and the implementation of any necessary changes to either maintain or improve the quality of care rendered is: 

A. Quality Assessment 

B. Quality Assurance 

C. Quality Planning 

D. Guidelines 

The correct answer is B. Quality Assurance.

The ADA defines quality assessment as 'the measure of the quality of care provided in a particular setting'. 

Quality assurance in turn is defined as 'the assessment or measurement of the quality of care and the implementation of any necessary changes to either maintain or improve the quality of care rendered'.

The difference in these definitions is important: Quality assessment is limited to the appraisal of whether or not standards of quality have been met, whereas quality assurance includes the additional dimension of action to take corrective steps if needed to improve the situation. 

Collagen turnover rate in the gingiva is:

 # Collagen turnover rate in the gingiva is:

A. lower than that in the periodontal ligament

B. Higher than that in the periodontal ligament

C. Equal to that in the periodontal ligament

D. Very less as collagen fibrils are mature cell components

The correct answer is A. Lower than that in the periodontal ligament.

Overall, collagen turnover rate in the gingiva is lower than that in the periodontal ligament. Slow gingival fiber turnover may result from the lowered functional stress on this tissue as the transseptal fibers function in a manner similar to tendons, providing firm anchorage of the tooth. Remodeling and regeneration of gingival epithelium can also be slow. This is evidenced by the appearance of a red patch in the soft tissue region away from which a tooth is moved, which is caused by exposure of tissues underneath the epithelium.