Malignant involvement of lymph nodes

# Which  is  the  preferred  method  of  biopsy  in  case  of  a  malignant  involvement  of  lymph  node? 

a. Fine needle  aspiration 

b. Incisional  biopsy

c. Excisional biopsy 

d. No  biopsy

The correct answer is A. Fine needle aspiration.

Fine-needle aspiration (FNA) is a diagnostic procedure used to investigate lumps or masses. In this technique, a thin (23–25 gauge (0.52 to 0.64 mm outer diameter)), hollow needle is inserted into the mass for sampling of cells that, after being stained, are examined under a microscope (biopsy). The sampling and biopsy considered together are called fine-needle aspiration biopsy (FNAB) or fine-needle aspiration cytology (FNAC) (the latter to emphasize that any aspiration biopsy involves cytopathology, not histopathology). Fine-needle aspiration biopsies are very safe minor surgical procedures. Often, a major surgical (excisional or open) biopsy can be avoided by performing a needle aspiration biopsy instead, eliminating the need for hospitalization. In 1981, the first fine-needle aspiration biopsy in the United States was done at Maimonides Medical Center. Today, this procedure is widely used in the diagnosis of cancer and inflammatory conditions.

Aspiration is safer and far less traumatic than an open biopsy; complications beyond bruising and soreness are rare. However, the few problematic cells can be too few (inconclusive) or missed entirely (a false negative).

This type of sampling is performed for one of two reasons:

- A biopsy is performed on a lump or a tissue mass when its nature is in question.

- For known tumors, this biopsy is performed to assess the effect of treatment or to obtain tissue for special studies.

When the lump can be felt, the biopsy is usually performed by a cytopathologist or a surgeon. In this case, the procedure is usually short and simple. Otherwise, it may be performed by an interventional radiologist, a doctor with training in performing such biopsies under x-ray or ultrasound guidance. In this case, the procedure may require more extensive preparation and take more time to perform.

Also, fine-needle aspiration is the main method used for chorionic villus sampling, as well as for many types of body fluid sampling.

It is also used for ultrasound-guided aspiration of breast abscess, of breast cysts, and of seromas.

Pulp stem cells are:

 # The pulp stem cells are:

A. Pluripotent in nature

B. Totipotent in nature

C. Multipotent in nature

D. None of the above

The correct answer is A. Pluripotent in nature.

Pulpal stem cells are pluripotent in nature.

The stem cells were shown to undergo proliferation and migrate to the site of injured odontoblasts and produce dentin.

Generalized Anxiety Disorder Treatment

 # A young man of 24 years is suffering from Generalized Anxiety Disorder; which drug may be preferred for his problem?

a. Zolpidem

b. Buspirone

c. Midazolam

d. Triazolam

e. Phenobarbital

The correct answer is B. Buspirone.

Buspirone is the first azapirone, a new class of antianxiety drugs, distinctly different from

Benzodiazepines. 

Buspirone: 

• Does not produce significant sedation or cognitive/functional impairment.

• Does not interact with BZD receptor or modify GABAergic transmission.

• Does not produce tolerance or physical dependence.

• Does not suppress BZD or barbiturate withdrawal syndrome.

• Has no muscle relaxant or anticonvulsant activity.

Buspirone relieves mild-to-moderate generalized anxiety, but is ineffective in severe cases, in those showing panic reaction and in OCD.

Though most patients on buspirone remain alert, those operating machinery/motor vehicles should be cautioned.

Dose: 5–15 mg OD–TDS:

Anemia of chronic disease

# Which of the following is a feature of anemia of chronic disease ?

A.Increased red cell protoporphyrin

B.Hypoproliferative marrow

C.Normal or increased serum ferritin

D.All of the above

The correct answer is D. All of the above. 

Features of anemia of chronic disease are a low serum iron, increased red cell protoporphyrin, hypoproliferative marrow, transferrin saturation of 15 - 20%, & normal or increased serum ferritin.

Ref: Harrison’s 18th edition, Page 849.

Pediatric Dentistry MCQs - Child Behavior Management

# The main areas of concern in diagnosis and treatment planning for the child are:
A. Oral medical problems
B. Dental caries and restorative dentistry
C. Occlusion and craniofacial growth and development
D. All of the above

# Pedodontic triangle is given by:
A. Mischer
B. McDonanld
C. Finn
D. Wright

# Place of the child in the pedodontic treatment triangle is:
A. At the base
B. In the centre
C. At the apex
D. None of the above 

Paradoxical excitement in children

 # Which of the following can result in paradoxical excitement in children?

 A. Morphine

 B. Phenobarbitone

 C. Nitrous oxide

 D. Amphetamine

The correct answer is B. Phenobarbitone.

A paradoxical reaction or paradoxical effect is an effect of medical treatment,usually a drug, opposite to the effect which would normally be expected. Paradoxical excitement is caused by barbiturates which also includes secobarbital. 

Reported to occur in approximately 3% of patients. In susceptible individuals,benzodiazepine treatment might increase anxiety,aggressiveness, agitation, loss of  impulse control, talkativeness, violent behavior, and even convulsions. 

Before sedating a child

 # Before sedating a child:

A. Not essential to take the consent

B. Essential to take the written consent

C. Needed to consult the pediatrician

D. Essential for the parents to be present

The correct answer is D. Essential for the parents to be present.

Before sedating a normal child it is important to take informed consent, and have the parents present during procedure.

A child with previous medical history however requires consulting with the child's physician.