Obstructive sleep apnea syndrome (OSAS) often results in all of the following except:

 # Obstructive sleep apnea syndrome (OSAS) often results in all of the following except: 

A. Excessive daytime sleepiness 

B. Aggressive behavior 

C. Personality changes 

D. Depression 

The correct answer is B. Aggressive behavior.

Signs and symptoms

Generally, symptoms of OSA begin insidiously and are often present for years before the patient is referred for evaluation.

Nocturnal symptoms may include the following:

• Snoring, usually loud, habitual, and bothersome to others
• Witnessed apneas, which often interrupt the snoring and end with a snort
• Gasping and choking sensations that arouse the patient from sleep, though in a very low proportion relative to the number of apneas they experience
• Nocturia
• Insomnia; restless sleep, with patients often experiencing frequent arousals and tossing or turning during the night

Daytime symptoms may include the following:

• Nonrestorative sleep (ie, “waking up as tired as when they went to bed”)
• Morning headache, dry or sore throat
• Excessive daytime sleepiness that usually begins during quiet activities (eg, reading, watching television); as the severity worsens, patients begin to feel sleepy during activities that generally require alertness (eg, school, work, driving)
• Daytime fatigue/tiredness
• Cognitive deficits; memory and intellectual impairment (short-term memory, concentration)
• Decreased vigilance
• Morning confusion
• Personality and mood changes, including depression and anxiety
• Sexual dysfunction, including impotence and decreased libido
• Gastroesophageal reflux
• Hypertension

Reference: https://emedicine.medscape.com/article/295807-overview

The most common mandibular surgical osteotomy to advance the mandible is:

 # The most common mandibular surgical osteotomy to advance the mandible is ____. 

A. Le Fort I osteotomy 

B. Segmental maxillary osteotomy 

C. Bilateral sagittal split osteotomy 

D. Intraoral vertical ramus osteotomy 

The correct answer is C. Bilateral sagittal split osteotomy.

Bilateral sagittal split osteotomy (BSSO) is one of the most commonly performed and versatile mandibular procedures. It can be used for backward or forward correction of the mandible in isolation or in combination with a maxillary osteotomy. It is usually performed while the patient is under general anaesthesia. It was originally described by Trauner and Obwegeser in 1957. The procedure has since undergone numerous modifications, including those by Dalpont, Hunsuck, Bell and Epker.

Even when there are large advancements, bone grafting is rarely required because of the long bony interface between the two fragments. Indications for BSSO include mandibular advancement, setback and correction of asymmetry. It is contraindicated in ramus hypoplasia, narrow lateral to medial ramus thickness and severe asymmetries.

Ref: An Introduction to Oral and Maxillofacial Surgery SECOND EDITION, David A. Mitchell, Page 306

Distraction osteogenesis is preferred over a traditional osteotomy:

 # Distraction osteogenesis is preferred over a traditional osteotomy: 

A. When a large advancement is needed 

B. When a small advancement is needed 

C. When exacted interdigitation of the occlusion is needed 

D. When the treatment needs to be done in a very short period of time 

The correct answer is A.  When a large advancement is needed.

Distraction osteogenesis is preferred over traditional osteotomies when large skeletal movements are required and the associated soft tissue cannot adapt to the acute changes and stretching that results. Larger movements may be at increased risk of some relapse; this is particularly true in a patient with a cleft palate, where there is significant soft tissue scarring from previous surgeries.

At which of the following locations are perikymata usually found?

 # At which of the following locations are perikymata usually found?

a. Cervix of the crown.

b. Apex of the root.

c. Cusp tips.

d. Deposited throughout the crown.

The correct answer is A. Cervix of the crown.

Perikymata are transverse, wave-like grooves, believed to be the external manifestations of the striae of Retzius. They are continuous around a tooth and usually lie parallel to each other and to the cementoenamel junction. Ordinarily there are about 30 perikymata per millimeter in the region of the cementoenamel junction, and their concentration gradually decreases to about 10 per millimeter near the occlusal or incisal edge of a surface. Their course usually is fairly regular, but in the cervical region it may be quite irregular. The terms perikymata and imbrication lines are used without distinction to the surface structures of ridges or grooves. To avoid confusion in the usage of these terms it has been suggested that the terms perikymata or imbrication lines be suffixed by the words ridge or crest to denote elevations and the terms groove or furrow to denote depressions, as for example, perikymata ridge.

Reference: Orban's 13th Edition Page no 58

Bones that are small, irregularly shaped, and found along sutures are called

 # Bones that are small, irregularly shaped, and found along sutures are called 

a. Parietal. 

b. Wormian. 

c. Temporal. 

d. Zygomatic. 

The correct answer is B. Wormian bone.

Wormian bones, also known as intrasutural bones or sutural bones, are extra bone pieces that can occur within a suture (joint) in the skull. These are irregular isolated bones that can appear in addition to the usual centres of ossification of the skull and, although unusual, are not rare. They occur most frequently in the course of the lambdoid suture, which is more tortuous than other sutures. They are also occasionally seen within the sagittal and coronal sutures. A large wormian bone at lambda is often called an Inca bone (Os Incae), due to the relatively high frequency of occurrence in Peruvian mummies. Another specific Wormian bone, the pterion ossicle, sometimes exists between the sphenoidal angle of the parietal bone and the great wing of the sphenoid bone. They tend to vary in size and can be found on either side of the skull. Usually, not more than several are found in a single individual, but more than one hundred have been once found in the skull of a hydrocephalic adult.

Wormian bones are a marker for some diseases and important in the primary diagnosis of brittle bone disease: osteogenesis imperfecta.

Wormian bones may also be seen in:

• Pycnodysostosis
• Osteogenesis imperfecta
• Rickets
• "Kinky-hair" Menke's syndrome
• Cleidocranial dysostosis
• Hypothyroidism and hypophosphatasia
• Otopalatodigital syndrome
• Primary acro-osteolysis
• Down syndrome

Which certification is required for dentists that provide general anesthesia?

 # Which certification is required for dentists that provide general anesthesia? 

a. Basic life support (BLS). 

b. Emergency medical training (EMT). 

c. Cardiopulmonary resuscitation (CPR). 

d. Advanced cardiac life support (ACLS). 

The correct answer is D. Advanced cardiac life support (ACLS).

Dentists that provide general anesthesia must be certifed in ACLS for their licensure; BLS certifcation is inadequate. Many states mandate, and the current standard of care necessitates, certifcation in ACLS training for dentists providing general anesthesia. 

ACLS:

For healthcare professionals who either direct or participate in the management of cardiopulmonary arrest or other cardiovascular emergencies and for personnel in emergency response

What does this course teach?

• Basic life support skills, including effective chest compressions, use of a bag-mask device, and use of an AED
• Recognition and early management of respiratory and cardiac arrest
• Recognition and early management of peri-arrest conditions such as symptomatic bradycardia
• Airway management
• Related pharmacology
• Management of ACS and stroke
• Effective communication as a member and leader of a resuscitation team

Which of the following is a property of biofilms and is of clinical signifcance?

 Which of the following is a property of biofilms and is of clinical signifcance?

a. Facilitate stain formation.

b. Increase sensitivity to antibiotics.

c. Extremely tolerant of antimicrobial agents.

d. Enhance the development of halitosis.

The correct answer is C. Extremely tolerant of antimicrobial agents.

The term biofilm describes relatively undefinable microbial community associated with a tooth surface or any other hard non-shedding material. Biofilms are ubiquitous and are found in oral cavity, the bottom of boats and docks, inside pipes, rocks in streams, catheters, hip and voice prosthesis and contact lenses.

Biofilm bacteria exhibit stronger resistance (1000 to 1500 times) to biocides and antimicrobial agents than do their planktonic counterpart. Following hypothesis may help to explain the increased resistance to antimicrobials.

1. The exopolysaccharide of the biofilm matrix may inhibit the diffusion of antimicrobial agents.

2. The physiological differences among biofilm bacteria leave only a part of biofilm bacteria susceptible to growth dependent antibiotics.

3. The genetic changes occurring in transition from planktonic to biofilm bacteria make the biofilm bacteria insensitive to various biocides and antimicrobial agents.

4. Slower rate of growth of organisms due the nutrient limitation may also contribute to the resistance to antimicrobial agents by biofilm bacteria. 

5. Extracellular enzymes such as β–lactamase, formaldehyde dehydrogenase become concentrated in extracellular matrix, thus inactivating some antibiotics.

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Herpes simplex type 1 virus can be transmitted in dentistry by which of the following?

 # Herpes simplex type 1 virus can be transmitted in dentistry by which of the following? 

a. Sharps injury. 

b. Contact with skin. 

c. Inhalation of infected droplets. 

d. Contact of infected material with skin or eyes 

The correct answer is D. Contact of infected material with skin or eyes.

It is estimated that out of the 80 known herpes viruses, at least eight are known to infect human beings. The herpes viruses that are known to cause infection in humans are herpes simplex virus (HSV 1 and 2), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein-Barr virus (EBV), human herpes virus 6 (HHV-6), human herpes virus 7 (HHV-7) and human herpes virus 8 (HHV-8). These viruses are usually transmitted from host to host by direct contact or through saliva and genital secretions. Herpes viruses are shed in the saliva of asymptomatic hosts.

Which of the following structures are closely related in time of development and sometimes have related malformations?

 # Which of the following structures are closely related in time of development and sometimes have related malformations? 

a. Ear and tongue. 

b. Palate and tongue. 

c. Palate and face. 

d. Face and ears. 

The correct answer is C. Palate and Face.

The human face develops early in gestation, during the fourth through seventh weeks, and the palatal processes begin to close during the eighth week. These two structures are closely related in time of development and sometimes have related malformations. 

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The condition involved with an unerupted tooth or impacted tooth is:

 # The condition involved with an unerupted tooth or impacted tooth is:

A. Dentigerous cyst

B. Mural ameloblastoma

C. Adenomatoid odontogenic tumor

D. All of the above

The correct answer is D. All of the above.

Dentigerous cyst is always associated initially with the crown of an impacted, embedded or unerupted tooth. A dentigerous cyst may also be found enclosing a complex compound odontoma or involving a supernumerary tooth. The most common sites of this cyst are the mandibular and maxillary third molar and maxillary cuspid areas.

Adenomatoid Odontogenic Tumors are seen in a rather narrow age range, between 5 and 30 years, with most cases appearing in the second decade. Females are more commonly affected than males. Lesions often appear in the anterior portion of the jaws, more often in the anterior maxilla, generally in association with the crowns of impacted teeth. 

HSV-2 virus resides in:

 # HSV-2 virus resides in:

A. Basal ganglia

B. Stellate ganglia

C. Lumbosacral ganglion

D. Otic ganglion

The correct answer is C. Lumbosacral region.

It is now well established that the HSV does not remain latent at the site of the original infection in the skin or oral mucosa. Instead, the virus reaches nerve ganglia supplying the affected areas, presumably along nerve pathways, and remains latent there until reactivated. The usual ganglia involved are the trigeminal for HSV-1 and the lumbosacral for HSV-2. Viral DNA can be demonstrated in these ganglia. Unfortunately, this incorporation of viral DNA into host DNA ensures a lifelong infection beyond the reach of antibody, cell mediated immune responses or chemotherapy.

The tongue of a patient deviates to one side whenever he sticks his tongue out. The cranial nerve that may be damaged is:

 # The tongue of a patient deviates to one side whenever he sticks his tongue out. The cranial nerve that may be damaged is:

A. Trigeminal nerve

B. Vagus nerve

C. Facial nerve

D. Hypoglossal nerve

The correct answer is D. Hypoglossal nerve.

HYPOGLOSSAL NERVE

Hypoglossal nerve is the twelfth cranial nerve. It supplies the muscles of the tongue. The hypoglossal nerve is tested clinically by asking the patient to protrude his/her tongue. Normally, the tongue is protruded straight forwards. If the nerve is paralysed, the tongue deviates to the paralysed side. 

Which of these is a pseudocyst?

 # Which of these is a pseudocyst?

A. Nasolabial cyst

B. Globulomaxillary cyst

C. Traumatic cyst

D. Radicular cyst

The correct answer is C. Traumatic cyst.

Traumatic cyst is also called as Solitary bone cyst, hemorrhagic cyst, extravasation cyst, unicameral bone cyst, simple bone cyst, idiopathic bone cavity. The traumatic cyst is a pseudo cyst (lacks an epithelial lining) and an uncommon lesion comprises about 1% of all jaw cysts. It occurs in other bones of the skeleton as well.