Raw erythematous areas with bleeding spots on a boy with juvenile diabetes mellitus

 # A 9 year old boy visited OPD for soreness in the mouth. He had history of juvenile diabetes mellitus and was on insulin therapy. On intraoral examination, a large white scrapable lesion was noted on the soft palate. Raw erythematous areas with bleeding spots were seen after scraping the lesion. What is the most likely diagnosis to be?

A. Diphtheria

B. Oral Thrush

C. White Spongy Nevus

D. Vincent’s stomatitis

E. Chronic Hyperplastic Candidiasis

The correct answer is B. Oral Thrush

Oral thrush (pseudomembranous candidiasis) is the most likely diagnosis, characterized by white, creamy plaques on mucosal surfaces like the soft palate that scrape off easily, revealing underlying erythematous, raw tissue prone to bleeding—directly matching the presentation. Juvenile diabetes mellitus predisposes to this via hyperglycemia impairing immune response and promoting Candida albicans overgrowth, common in children on insulin. Diagnosis is clinical, confirmed by microscopy if needed (hyphae in KOH prep). Treatment involves topical antifungals (e.g., nystatin suspension) and glycemic control; systemic options if refractory. Other options are less fitting: diphtheria involves adherent gray membranes with systemic toxicity; white spongy nevus is non-scrapable and hereditary; Vincent’s stomatitis targets interdental gingiva with necrosis; chronic hyperplastic candidiasis forms adherent, non-scrapable plaques.

Which of the following is an accessory cusp found on a mandibular molar?

 # Which of the following is an accessory cusp found on a mandibular molar?

A. Protostylid

B. Cusp of Carabelli

C. Dens Evaginatus

D. Paramolar cusp

The correct answer is A. Protostylid

The protostylid is a supernumerary accessory cusp located on the mesiobuccal surface of mandibular molars, often appearing as a pit, groove, or distinct tubercle that can vary in expression from mild to pronounced. In contrast, the cusp of Carabelli (option B) is an accessory feature on the mesiolingual surface of maxillary first molars; dens evaginatus (option C) typically presents as an occlusal tubercle on premolars (especially mandibular second premolars), though it can rarely affect molars; and the paramolar cusp (option D), also known as Bolk's cusp, is primarily an extra tubercle on the buccal surface of maxillary molars. 

Three days after the onset of myocardial infarction which enzyme level has the best predictive value?

 # Three days after the onset of myocardial infarction which enzyme level has the best predictive value?

A. Serum CPK

B. Serum LDH

C. Serum SGOT

D. Serum SGPT

The correct answer is B. Serum LDH

Lactate dehydrogenase (LDH) levels rise 12-24 hours after myocardial infarction (MI), peak at 48-72 hours (around day 3), and remain elevated for 7-14 days, providing the highest diagnostic sensitivity and predictive value for confirming MI at this late stage. In contrast, creatine phosphokinase (CPK) peaks early (12-24 hours) and normalizes by day 3, making it less useful then; serum glutamic-oxaloacetic transaminase (SGOT/AST) peaks at 24-48 hours and declines by day 3-4; and serum glutamic-pyruvic transaminase (SGPT/ALT) is primarily liver-specific with minimal cardiac relevance. The LDH-1 isoenzyme is particularly specific for cardiac tissue damage.

Which of the following is an occupational disease of dentist?

 # Which of the following is an occupational disease of dentist?

A. Syphilis

B. HIV

C. HBV

D. All of the above

The correct answer is D. All of the above

Dentists face occupational risks from bloodborne pathogens due to exposure via needlestick injuries, cuts, splashes, or aerosols during procedures. HBV (hepatitis B virus) is highly transmissible and a major concern, with vaccination recommended. HIV (human immunodeficiency virus) has lower infectivity but remains a risk. Syphilis (Treponema pallidum) can spread through contact with infectious oral lesions or blood. OSHA and CDC guidelines classify all three as occupational hazards for dental professionals, emphasizing universal precautions, PPE, and post-exposure protocols to mitigate transmission.

Ideal period for surgical correction of maxilla and mandible:

 # Ideal period for surgical correction of maxilla and mandible:

A. Early growth spurts

B. Mid growth spurts

C. Late growth spurts

D. After cessation of growth spurts

The correct answer is D. After cessation of growth spurts.

Orthognathic surgery for correcting maxillary and mandibular discrepancies is ideally performed after skeletal growth has ceased to minimize postoperative relapse due to residual growth. This typically occurs in late adolescence or early adulthood (around 16-18 years for females and 18-21 years for males), once pubertal growth spurts are complete and facial bones have stabilized. Earlier interventions during active growth phases (options A-C) risk instability and require potential revisions. Preoperative orthodontics (12-18 months) aligns teeth for optimal surgical outcomes, followed by postoperative orthodontics for refinement. 

2 month baby having ulceration of tongue

 # Mother presents with a 2 month old baby having ulceration of tongue in relation to erupted tooth in mandibular incisor region. Treatment: 

A. Extraction

B. Prescribe local anesthetic gel

C. Radiograph to confirm presence of deciduous tooth followed by rounding of incisal edges

D. Counsel mother and recall

The correct answer is C. Radiograph to confirm presence of deciduous tooth followed by rounding of incisal edges

This case likely involves Riga-Fede disease, a traumatic ulceration of the tongue caused by the sharp incisal edges of a natal or neonatal tooth (typically a mandibular primary central incisor) in an infant. At 2 months old, tooth eruption is premature, so confirming it's a deciduous tooth via radiograph is essential to rule out anomalies like supernumerary teeth. The primary treatment is conservative: smoothing or rounding the incisal edges to eliminate the trauma source, allowing the ulcer to heal spontaneously (often within 1-4 weeks). Extraction (option A) is reserved for highly mobile teeth or severe feeding interference, not routine here. Local anesthetic gel (option B) offers only temporary symptom relief without addressing the cause. Counseling and recall (option D) suit asymptomatic cases but not active ulceration. Follow-up is recommended post-treatment to monitor healing and eruption.

In comparison with the permanent mandibular canine, the permanent maxillary canine in the same mouth:

 # In comparison with the permanent mandibular canine, the permanent maxillary canine in the same mouth:

a) Has a shorter root

b) Is wider mesiodistally

c) Is narrower mesiodistally

d) Has a less pronounced cingulum

The correct answer is b) Is wider mesiodistally

The permanent maxillary canine is wider mesiodistally than the permanent mandibular canine in the same mouth, with typical crown measurements of about 7.5 mm for the maxillary canine compared to 7.0 mm for the mandibular canine. In contrast, the maxillary canine has a longer root (around 17 mm versus 16.5 mm for the mandibular), and its cingulum is more developed and prominent on the lingual surface than the mandibular canine's.