Dressler syndrome is a complication of:

 # Dressler syndrome is a complication of:

A. Hypertension

B. Pericarditis

C. Mitral stenosis

D. Myocardial infarction

The correct answer is D. Myocardial infarction.

Dressler syndrome is a secondary form of pericarditis that occurs in the setting of injury to the heart or the pericardium (the outer lining of the heart). It consists of fever, pleuritic pain, pericarditis and/or a pericardial effusion.

Dressler syndrome is also known as postmyocardial infarction syndrome and the term is sometimes used to refer to post-pericardiotomy pericarditis.

It was first characterized by William Dressler at Maimonides Medical Center in 1956.

Beyron point is located at:

 # Beyron point is located at:

A. 13 mm anterior to posterior margin of tragus on a line from center of tragus to outer canthus 

B. 11 mm anterior to posterior margin of tragus on a line from parallel to and 7 mm below FHP 

C. 10 mm anterior to posterior margin of tragus on a line from center of tragus to outer canthus 

D. 13 mm anterior to tragus on a line from base of tragus to outer canthus 

The correct answer is A.  13 mm anterior to posterior margin of tragus on a line from center of tragus to outer canthus. 

The first step in placing a face bow is to locate the hinge axis on the skin on the each side of the patients face. One frequently recommended method is to position the condyle rods on a line extending from the counter canthus of the eye to the top of the tragus of the ear and approximately 13 mm in front of the external auditory meatus is called Beyron Point.This placement generally locates the rods within 5mm of the true center of the opening axis of the jaws. The imaginary line joining the two Beyron points is an approximate hinge axis. 

Dens evaginatus is most commonly found in:

 # Dens evaginatus is most commonly found in:

A. Premolar

B. Lateral incisor

C. Canine

D. Molar

The correct answer is A. Premolar.

Dens evaginatus or leong's premolar or evaginated odontome or occlusal tuberculated premolar is a developmental condition that appears as an accessory cusp or a globule of enamel between the buccal and lingual cusps of premolars, unilaterally or bilaterally, though it had been known to rarely occur on molars, cuspids and incisors.

Which of the following lesions/conditions is not caused by virus?

 # Which of the following lesions/conditions is not caused by virus?

A. Koplik’s spots

B. Herpetiform ulcers

C. Herpes labialis

D. Ramsay-Hunt syndrome

The correct answer is B. Herpetiform ulcers.

Koplik's spots are seen in the buccal mucosa in patients with measles, which is an infection caused by paramyxovirus. Herpes labialis is caused by the herpes simplex virus and Ramsay-Hunt syndrome is due to herpes zoster of the geniculate ganglion. Herpetiform ulcers are a type of aphthous ulcer and are not caused by a virus. Lyme disease is caused by Borrelia burgdorferi, a spirochaetal bacterium, and is spread via ticks. 

Which of the following does not cause oral cancer in children?

 # Which of the following does not cause oral cancer in children?

A. Herpes simplex

B. Epstein barr

C. Cytomegalovirus

D. Varicella zoster

The correct answer is D. Varicella zoster.

HSV has been possibly associated with hit and run mechanism in oral cancer causation. Epstein barr virus causes African jaw lymphoma, CMV possibly is associated with Kaposi's sarcoma. Hence Herpes zoster is the best option. 

Osteoblastic secondaries are present in which carcinoma?

 # Osteoblastic secondaries are present in which carcinoma?

A. Carcinoma lung

B. Carcinoma breast

C. Carcinoma urinary bladder

D. Carcinoma prostate

The correct answer is D. Carcinoma prostate.

Although most of such metastases produce osteolytic lesions and thus appear as a radiolucency, certain tumors produce osteoblastic lesions or lesions and are most often associated with carcinoma of the prostate, and occasionally, of the breast and lung. 

Most common complication of mumps is:

 # Most common complication of mumps is:

A. Myocarditis

B. Orchitis

C. Uveitis

D. Conjunctivitis

The correct answer is B. Orchitis.

Mumps is characterized by triad of pathological involvement- epidemic parotitis, orchitis-oophoritis, and pancreatitis. Meningoencephalitis, epididymitis, and encephalitis are other complications of mumps. When mumps involves adult male, orchitis is a great danger. Involvement of pancreas causes an increase in serum lipase enzyme.

PGCEE MDS 2022: Sicca complex is associated with:

 # Sicca complex is associated with:

A. Primary Sjogren’s syndrome

B. Secondary Sjogren’s syndrome

C. Peutz Jeghers syndrome

D. Plummer Vinson Syndrome

The correct answer is A. Primary Sjogren's syndrome.

Primary Sjogren's syndrome (Sicca complex)

- When the disease affects only salivary and lacrimal glands without other co-existing systemic autoimmune diseases, it is called primary Sjogren's syndrome or Sicca complex. Primary Sjogren's syndrome is also referred to as "sicca syndrome" in which dry mouth (xerostomia) and dry eyes (xerophthalmia or keratoconjunctivitis sicca) are the principal features. 

Secondary Sjogren's syndrome 

Secondary sjogren's syndrome characteristically has xerostomia, xerophthalmia and an associated autoimmune connective tissue disease, usually the rheumatoid arthritis, SLE, scleroderma, polyarteritis nodosa etc. Patients with sicca complex and Sjogren's syndrome have sera antisalivary duct antibody. In addition, They are found to be associated with the HLA system, specifically HLA-DR3 and HLA-B8 which are associated with primary form of the disease and HLA-DRw52 is seen to be associated with both the forms of Sjogren's syndrome. 

Mobility of teeth in carcinoma of maxillary sinus is due to involvement of

 # Mobility of teeth in carcinoma of maxillary sinus is due to involvement of ___________ by tumor.

A. Anterior wall of the sinus

B. Posterior wall of the sinus

C. Roof of the sinus

D. Floor of the sinus

The correct answer is D. Floor of the sinus.

The clinical features of the neoplasm depend on the direction of spread of the neoplasm or the involvement of the surrounding structures. The floor of the sinus is associated with oral structures like mobility of teeth. Medial wall involvement causes nasal obstruction. Superior wall involvement produces displacement of the eyes. Lateral wall involvement produces bulging of the cheek. 

Flumazenil can reverse the action of:

 # Flumazenil can reverse the action of:

A. Fentanyl

B. Propofol

C. Ketamine

D. Midazolam

The correct answer is D. Midazolam.

Flumazenil is a benzodiazepine (BZD) antagonist. It competes with benzodiazepine agonists and inverse agonists for the benzodiazepine receptor and reverses their depressant or stimulant effects respectively. Flumazenil abolishes the hypnogenic, psychomotor, cognitive and EEG effects of benzodiazepines. Among the options provided, Midazolam is a benzodiazepine. 

Uses: 

• To reverse benzodiazepine anaesthesia 

• Benzodiazepine overdose 

Jannetta procedure is done in:

 # Jannetta procedure is done in:

A. Bell’s palsy

B. Trigeminal neuralgia

C. Herpes Zoster

D. Paresthesias

The correct answer is B. Trigeminal neuralgia.

Microvascular decompression (MVD), also known as the Jannetta procedure, is a neurosurgical procedure used to treat trigeminal neuralgia (along with other cranial nerve neuralgias) a pain syndrome characterized by severe episodes of intense facial pain, and hemifacial spasm. The procedure is also used experimentally to treat tinnitus and vertigo caused by vascular compression on the vestibulocochlear nerve.

Angle between Frankfort horizontal plane and occlusal plane is:

 # Angle between FH plane and Occlusal plane is:

A. 1 degree

B. 10 degrees

C. 27 degrees

D. Parallel to each other

The correct answer is B. 10 degrees.

This is from Down's analysis. The cant measures the slope of occlusal plane to the Frankfort horizontal plane. When the anterior part of plane is lower than the posterior, the angle would be positive. Large positive angles are found in Class II facial patterns. A long mandibular ramus also tends to decrease this angle. The mean value is +9.3° with a range of +1.5° to +9.3°. 

Under metabolic conditions associated with a high rate of fatty acid oxidation, liver produces

 # Under metabolic conditions associated with a high rate of fatty acid oxidation, liver produces:

A. Glutamate

B. Acetoacetate

C. Cholesterol

D. Glycine

The correct answer is B. Acetoacetate.

- The ketone body formation occurs primarily due to non-availability of carbohydrates to the tissues and excessive utilization of fatty acids to meet the energy requirements of the cells. 

- Acetone, Acetoacetate and Beta-hydroxybutyrate are the ketone bodies. 

- Glucagon stimulates ketogenesis whereas insulin inhibits ketogenesis. 

Delhi boil refers to:

 # Delhi boil refers to:

A. Solar keratosis

B. Malignant pustule

C. Leishmania Tropica

D. Venereal ulcer

The correct answer is C. Leishmania Tropica.

Cutaneous leishmaniasis (also known as oriental sore, tropical sore, chiclero ulcer, chiclero's ulcer or Aleppo boil) are sores resulting from a tropical infection by protozoa of the genus Leishmania which are spread by sandflies. Delhi boil is a chronic inflammatory disease, most commonly met with in India, especially towards the end of the wet season. The common staphylococcal skin infections- Furunculosis of the external auditory meatus is extremely painful, as the skin is attached to the underlying cartilage, and swelling is accompanied by considerable tension. 

Vacancy for Dental Surgeon and Dental Hygienist Jobs in Nepal - Vacancy for Dentists and Dental Hygienists - NMC registered Dental Surgeons and NHPC registered Dental Hygienists

1. Dentist

Apply Before: 31st January 2023

Basic Job Information

No. of Vacancy/s : 1

Apply Before(Deadline) : Jan. 31, 2023

Job Specification

Education Level : Bachelor in Dental Surgery (BDS)

Experience Required : More than 2 years

Dentist

Himalayan Trust Nepal (HTN) is hiring a qualified Dentist to work at Namche Dental Clinic located in Namche Bazar Solukhumbu. The clinic is supported by the American Himalayan Foundation and managed by HTN in partnership with the Namche Dental Clinic Management Committee.

Job responsibility: This position holder is responsible to provide dental health services to local residents and visitors.

Qualification: BDS degree with a license from Nepal Medical Council and minimum work experience of 2 years with good written and verbal communication in English and Nepali. A good level of physical fitness to live and work at a high altitude is preferred.

Gross salary: Rs. 90,000/month including tax. The clinic operates only 9 months a year, but the job holder will get 12 months' salary. Food and accommodation will be provided.

Contract period: Initial one-year contract and will be renewed annually. Starting Date: 1 March 2023

Application Deadline: 31 January 2023

Interview Date: 8 February 2023 (for short-listed candidates only)

Please keep visiting this page for latest vacancies for Dental surgeons and Dental hygienists available in Nepal.

CLICK THIS LINK TO FILL UP A FORM FOR YOUR VACANCY ANNOUNCEMENT NOTICE

Histologically, presence of numerous mast cells is diagnostic feature of:

 # Histologically, presence of numerous mast cells is diagnostic feature of:

a. Fibroma

b. Neurofibroma

c. Traumatic neuroma

d. Malignant Peripheral Nerve Sheath Tumor

The correct answer is B. Neurofibroma.

Solitary and multiple neurofibromas have the same microscopic features. They contain spindle-shaped

cells, with fusiform or wavy nuclei found in a delicate connective tissue matrix; this matrix may be notably myxoid in character. Lesions may be well circumscribed or may blend into surrounding connective tissue. Mast cells are characteristically scattered throughout the lesion. A histologic subtype

known as plexiform neurofibroma is regarded as highly characteristic of neurofibromatosis. In this variety, a collagen matrix supports extensive interlacing masses of nerve tissue. Small axons may be seen among the proliferating Schwann cells and perineural cells.

Mandible is the common site for Ameloblastoma due to:

 # Mandible is the common site for Ameloblastoma due to:

a. SMO mutation

b. BRAF mutation

c. p53 mutation

d. SH3BP2 mutation

The correct answer is B. BRAF mutation.

Mutations in the oncogenes BRAF (kinase signaling pathway) in mandibular tumors and SMO (hedgehog signaling pathway) in maxillary tumors have been discovered in a large proportion of

ameloblastomas. Drugs developed to inhibit the mutated proteins of these genes may have a role in the future treatment of ameloblastomas. Mutations of the p53 gene do not appear to play a role in the development and growth of ameloblastoma; a role for ameloblastin protein has been identified, although it is not specific to ameloblastoma.

Addison's disease is due to:

 # Addison's disease is due to:

a. Chronic insufficiency of adrenal cortex

b. Chronic insufficiency of adrenal medulla

c. Insufficiency of pancreas

d. Hypofunction of thyroid gland

The correct answer is A. Chronic insufficiency of adrenal cortex.

Addison's disease, also known as primary adrenal insufficiency, is a rare long-term endocrine disorder characterized by inadequate production of the steroid hormones cortisol and aldosterone by the two outer layers of the cells of the adrenal glands (adrenal cortex), causing adrenal insufficiency. Symptoms generally come on slowly and insidiously and may include abdominal pain and gastrointestinal abnormalities, weakness, and weight loss. Darkening of the skin in certain areas may also occur. Under certain circumstances, an adrenal crisis may occur with low blood pressure, vomiting, lower back pain, and loss of consciousness. Mood changes may also occur. Rapid onset of symptoms indicates acute adrenal failure which is a serious and emergent condition. An adrenal crisis can be triggered by stress, such as from an injury, surgery, or infection. 

The mitochondrial enzyme involved in the metabolism of clopidogrel and proton pump inhibitors is:

 # The mitochondrial enzyme involved in the metabolism of clopidogrel and proton pump inhibitors is:

a. CYP 2A

b. CYP 2B

c. CYP 2C19

d. CYP 2C20

The correct answer is C. CYP 2C19.

Like ticlopidine, clopidogrel is also a prodrug. About 50% of the ingested dose is absorbed, and

only a fraction of this is slowly activated in liver by CYP2C19, while the rest is inactivated by other enzymes. It is a slow acting drug; antiplatelet action takes about 4 hours to start and develops over days. Since CYP2C19, exhibits genetic polymorphism, the activation of clopidogrel and consequently its antiplatelet action shows high interindividual variability. Some patients are nonresponsive. Omeprazole, an inhibitor of CYP2C19, reduces metabolic activation of clopidogrel and its antiplatelet action. However, like ticlopidine, the action of clopidogrel lasts 5–7 days due to irreversible blockade of platelet P2Y12 receptors. 

Reference: KD Tripathi's Essentials of Medical Pharmacology

Tooth affected with dentinogenesis imperfecta are generally of which shape

 # Tooth affected with dentinogenesis imperfecta are generally of which shape?

A. Tulip

B. Conical

C. Shell

D. Ovoid

The correct answer is A. Tulip.

Aberration in chromosome 4 (loci4q21.3) is associated with Dentinogenesis imperfecta. It encodes dentin specific sialophospho protein (DSPP) gene. Deficiency of sialoprotein is also suggested as a causative factor for Dentinogenesis imperfecta. Tooth affected with dentinogenesis imperfecta are generally tulip shaped. 

Brittle bone syndrome is caused by:

 # Brittle bone syndrome is caused by:

A. Improper synthesis of procollagen 

B. Polymerisation of collagen 

C. Increase osteoclastic activity 

D Increase fibroblastic activity 

The correct answer is A. Improper synthesis of procollagen.

Osteogenesis imperfecta, also known as Brittle Bone Disease, or 'Lobstein syndrome' is disorder of congenital bone fragility caused by mutations in the genes that codify for type I procollagen. This deficiency arises from an amino acid substitution of glycine to bulkier amino acids in the collagen triple helix structure. If the body does not destroy the improper collagen, the relationship between the collagen fibrils and hydroxyapatite crystals to form bone is altered causing brittleness. The following 4 types of osteogenesis imperfecta have been reported. Type I -mild form, type II -extremely severe, type III -severe, type IV -undefined. These partly depend on the genetic subtype. Type I and IV are the most common forms of osteogenesis imperfecta. 

Goldenhar syndrome is:

 Goldenhar syndrome is:

A. Facial deformity, auricular abnormalities and vertebral deformity 

B. Facial deformity, auricular abnormalities, vertebral deformity and genital lesion 

C. Facial and auricular abnormalities only 

D. Auricular abnormalities only 

The correct answer is A. Facial deformity, auricular abnormalities and vertebral deformity.

Goldenhar syndrome or oculoauriculovertebral dysplasia is caused by abnormality in the vascular supply of the head. Hemifacial microsomia is second most common craniofacial anomaly, causing reduced growth and development of one half of the face. The mandible, maxilla, zygoma, external & middle ear, hyoid bone, parotid gland, 5th & 7th nerves, musculature and other soft tissues. When hemifacial microsomia is associated with vertebral abnormalities and epibulbar dermoids, it is known as Goldenhar syndrome. 

Cooley’s Anemia is also known as:

 # Cooley’s Anemia is also known as:

A. Sickle cell anemia

B. Alpha thalassemia

C. Beta thalassemia

D. Aplastic anemia

The correct answer is C. Beta Thalassemia.

Beta thalassaemia aka Thalassaemia major, Cooleys's anaemia: Beta-thalassaemia is inherited as an autosomal recessive pattern (homozygous). It is due to a mutation in the gene that causes either cause a total absence of beta-globin chain synthesis denoted as beta mutation or a reduced amount of beta-globin chain production denoted as beta mutation. Beta-thalassaemia major or Cooley's anaemia is the most severe form seen in individuals with a homozygous condition. These patients are severely anaemic and are transfusion dependent. 

Herald spots are seen in:

 # Herald spot is seen in:

A. Psoriasis

B. Erythema multiforme

C. Pityriasis rosea

D. Pemphigus 

The correct answer is C. Pityriasis rosea.

Pityriasis rosea is a common benign papulosquamous disease causing acute skin eruption of unknown etiology, often considered to be a viral exanthema. 

It is characterised by the appearance of superficial light red macules or papules, either generalised over most of the skin surface or localised to thighs, trunk, axillae or groin.

The individual exanthematous lesions are ovoid, with long axis parallel to the natural lines of cleavage of the skin, covered by thin, silvery scale. The generalised outbreak is preceded by primary lesion or herald spot, 7-10 days previously, that appears as bright red spot, 3-4 cm in diameter. 

Ketone bodies are normally synthesized from:

  # Ketone bodies are normally synthesized from:

A. Acetyl coA

B. Glucose

C. Glycerol

D. Acetone

The correct answer is: A. Acetyl coA.

Acetoacetic acid, O-hydroxybutyric acid and acetone are collectively called ketone bodies or acetone bodies, and the process of their formation is known as ketogenesis. Only the acetoacetic acid and acetone are the true ketones, while /3-hydroxybutyrate does not possess a keto group. The main site of ketogenesis is the liver. They are major fuel source of brain during prolonged starvation.

 Hydroxybutyryl-CoA and aceto acetyl-CoA are normally produced in penultimate step of beta oxidation. Aceto aceyl-CoA may also be formed from two molecules of acetyl-CoA. The synthesis of ketone bodies occur in liver in the mitochondrial matrix. Acetyl CoA, formed by oxidation of fatty acids, pyruvate and some other amino acids are the precursors for ketone bodies. HMG-CoA synthase is the regulatory enzyme in synthesis of ketone bodies. 

Which of the following is the most common developmental cyst?

  # Which of the following is the most common developmental cyst?

A. Nasopalatine cyst

B. Nasoalveolar cyst

C. Globulomaxillary cyst

D. Median palatal cyst

The correct answer is A. Nasopalatine cyst.

Nasopalatine duct cyst/Nasopalatine canal cyst/ Incisive canal cyst is most common non-odontogenic cyst. Its location is peculiar and specific in that it affects the midline anterior maxilla. 

Option B nasoalveolar cyst is a rare fissural cyst that arise at the junction of globular process, the lateral nasal process and the maxillary process. 

Option C globulomaxillary cyst is found within the bone at the junction of the globular portion of the medial nasal process, maxillary process, the globule maxillary fissure, usually between the maxillary lateral incisor and cuspid teeth. 

Condyloma acuminatum is associated with:

  # Condyloma acuminatum is associated with:

A. HPV

B. HHV 8

C. CMV

D. EBV

The correct answer is A. HPV.

Approximately 90% of condylomata acuminata are related to HPV types 6 and 11. These 2 types are the least likely to have a neoplastic potential. It is characterised by transmissible, autoinoculable soft pink nodules which proliferate and coalesce rapidly to form diffuse papillomatous clusters or as papillomatous, bulbous masses of varying sizes. Topical podophyllin may be used or surgical excision may be needed to treat the lesion. 

The term poikilokaryosis refers to :

 # The term poikilokaryosis refers to :

A. Alteration of nuclear cytoplasmic ratio

B. large, prominent nucleii

C. division of nuclei without division of cytoplasm

D. loss of polarity and disorientation of cells

The correct answer is C. Division of nuclei without division of cytoplasm.

Criteria for diagnosis of epithelial dysplasia in carcinoma include: 

• Increased abnormal mitoses 

• Individual cell keratinisation 

• Epithelial pearls in the spinous layer 

• Alterations in nuclear Cytoplasmic ratio 

• Loss of polarity and disorientation of cells 

• Hyper chromatism 

• Large nucleoli 

• Dyskaryosis or nuclear atypism including giant nuclei. 

• Poikilokarynosis or division of nuclei without division of cytoplasm 

• Basilar hyperplasia Individual cell keratinisation and epithelial pearl formation is absent in carcinoma in situ or intra epithelial carcinoma. 

Which is a premalignant lesion?

 # Which is a premalignant lesion?

A. Oral submucous fibrosis

B. Syphilitic glossitis

C. Erythroplakia

D. Lichen planus

The correct answer is C. Erythroplakia.

Premalignant lesion according to WHO (1978) is defined as a morphologically altered tissue in which cancer is more likely to occur than its apparently normal counterpart. Examples include leukoplakia, erythroplakia, carcinoma in situ. 

Precancerous condition is a generalised state associated with a significantly increased risk of cancer. These include siderophenic dysphagia, submucous fibrosis, lichen planus, syphilitic glossitis. 

Anomaly of chromosome 8q12 with slow growing mass on the left cheek in front of ear lobule

 # A patient presents with a slow growing mass on the left cheek in front of ear lobule. A sample is sent for gene analysis and cytogenic analysis reveals anomaly of chromosome 8q12. What is the diagnosis?

A. Mucoepidermoid carcinoma

B. Adenoid cystic carcinoma

C. Acinic cell carcinoma

D. Pleomorphic adenoma

The correct answer is D. Pleomorphic adenoma.

The cytogenetic abnormality of chromosome 8q12 is clearly indicative of Pleomorphic adenoma. 

Pleiomorphic adenoma is most commonly seen in the Parotid gland. 

PLEOMORPHIC ADENOMA 

• Synonym: Mixed tumor. 

• Histogenesis: Following are the possible origins: - Myoepithelial cell - Intercalated duct reserve cell 

• It is the most common tumor of salivary gland cell. - Constitutes > 50% of all salivary gland tumors. - Constitutes 90% of all benign salivary gland tumors. 

• It contains cells of pleomorphic origin (can differentiate into epithelial- ductal/ non-ductal and mesenchymal cells-chondral, myxoid, osseous cells) 

• Genetics: PLAG1 (Pleomorphic Adenoma gene) mapped to chromosome 8q12 may be responsible for pleomorphic adenoma. 

• Clinical features: - Benign tumor; It is a mixed tumor i.e., composed of both ductal and myoepithelial cells (as against monomorphic adenomas that are composed of only one cell type). - Parotid is the most common site overall; intraorally, palate is the most common site.

Oral surgery retractor with V shaped notch is:

 # Oral surgery retractor with V shaped notch is:

A. Obwegeser retractor

B. Langenbeck retractor

C. Minnesota retractor

D. Austin retractor

The correct answer is A. Obwegeser retractor.

Obwegeser Coronoid/ Ramus Retractor: 

• The retractor is similar to the Langenbeck's retractor except that the edge of the retracting blade is forked, forming a 'V' shaped notch, so as to engage the anterior border of the ramus of the mandible and aid in good tissue retraction. 

• Uses: - To retract the soft tissues along the anterior border of the ramus during sagittal split or ramus osteotomy - To retract the tissues from the anterior border of the ramus during coronoidectomy procedures. 

Langenbeck's Retractor:

 It has a long handle and an 'L' shaped blade. This retractor is most commonly used in oral surgery. It is available in different sizes with various blade widths. The instrument can be single or double ended. It is used to retract the soft tissues, incision edges, to allow view of the deeper structures. 

Austin's Retractor: It is a short right-angled retractor used for retracting the cheek, tongue and the mucoperiosteal flaps. 

‘Choking off’ phenomenon takes place after application of:

 # ‘Choking off’ phenomenon takes place after application of:

A. APF

B. NaF

C. SnF2

D. Amine Fluoride

The correct answer is B. NaF.

Choking off phenomenon is seen with the application of sodium fluoride varnish.

Neutral Sodium Fluoride 

• Fluoride concentration = 9200 ppm 

• Formed by dissolving 20 gms NaF in 1 Litre of water in a plastic bottle 

• Knutson technique: used for NaF application - Clean and dry teeth and isolate the field - Apply 2% NaF over teeth with cotton bud/applicator. Allow the solution to dry for 3-4 minutes - Application is repeated at 2nd, 3rd and 4th week at an interval of 1 week each. These applications are not preceded by Scaling. - The four-visit procedure is recommended for age groups 3, 7, 11, 13 years coinciding with eruption of different dentitions 

• Mechanism of action - NaF applied to tooth surface reacts with tooth calcium to form CaF2 - As CaF2 develops, it impedes further penetration of fluoride into hydroxyapatite. This is called "Choking off" phenomenon. It is because of this phenomenon, repeated application of NaF should be done only after 4 minutes. - The CaF2 reacts with hydroxyapatite to slowly release fluoride and thus is caries inhibitory. 

• Advantages: 

- NaF is stable when kept in plastic containers. NaF reacts with glass 

- Taste is well acceptable by patient 

- Does not discolour tooth structure 

- Procedure indicated only at specific ages and not every year application 

• Disadvantages: - At the index age, 4 visits to the dentist are mandatory in that year. 

Raloxifene is used in the treatment of:

 # Raloxifene is used in the treatment of:

A. Renal osteodystrophy

B. Post menopausal osteoporosis

C. Chronic renal failure

D. Chronic osteomyelitis

The correct answer is B. Post menopausal osteoporosis. 

Raloxifene is used by women to prevent and treat bone loss (osteoporosis) after menopause. 

Raloxifene belongs to a group of drugs called Selective Estrogen Receptor Modulators (SERMs). It is a Second- generation agent. 

The principal use of Raloxifene is in the management of Post-menopausal Osteoporosis. It is also useful in Hormone sensitive Breast cancer (both prevention and treatment). 

It is important to remember that SERMs are partial Estrogen receptor antagonists. Raloxifene inhibits the estrogen receptors in breast while stimulates those in Bone marrow. Thus, it has tissue selective action which reduces the toxicity. Like Tamoxifen, it also lowers LDL cholesterol and thus has a favorable lipid profile. Side effects include hot flushes and calf pain (like Tamoxifen, but less incidence and severity). 

In contrast, Tamoxifen is a Pure Estrogen Receptor antagonist (1st Generation SERM). It causes significant side effects including Intravascular clotting, post-menopause like symptoms, hot flushes, calf pain, uterine bleeding, Uterine Carcinoma and Polyps. Its current use is limited to Management of Estrogen Sensitive Breast cancer. 

Third-generation drug, Bazedoxifene, has also been developed to treat osteoporosis and has similar effects to that of raloxifene. 

Apart from Raloxifene, Bisphosphonates, calcium supplements and Vitamin D supplements are used for management of post-menopausal Osteoporosis. 

Which of the following acts as an astringent?

 # Which of the following acts as an astringent?

A. Thymol

B. Glycerin

C. Zinc chloride

D. Liquoron

The correct answer is C. Zinc chloride.

Zinc chloride is a commonly known astringent used in various ways as in with retraction cords, gum paints and for management of oral ulcers. 

• Astringents : These are substances that act by precipitating proteins on the superficial layer of mucosa and make it mechanically stronger. Examples are alum or aluminum potassium sulfate (KAl (SO4)2), A1C13 and zinc chloride (ZnC12) 

• Styptics: These are concentrated forms of astringents, which cause superficial and local coagulation. Examples are ferric chloride and ferric sulfate (Fe2 (SO4)3) 

• A1C13 and ferrous sulfate are preferred astringents among dentists because of minimum tissue damage. 

• Because of the caustic action of zinc chloride on the oral tissues, it is not the preferred chemical for gingival retraction although it is still used for management of oral ulcers. 

Which of the following is an opsonin?

 # Which of the following is an opsonin?

A. C3b

B. C3a

C. IgG

D. IgA

The correct answer is A. C3b.

Opsonization is the process of increasing ability for phagocytosis of foreign body. In opsonisation, opsonin antibodies attach to the bacteria and facilitate the phagocytosis of that bacterium. 

Different types of opsonins: 

• Antibodies- IgM and IgG 

• Complement proteins- C3b, C4b 

• Circulating proteins- Pentraxins, collectins, and ficolins 

Origin of tongue muscles:

 # Origin of tongue muscles:

A. Occipital myotome

B. First pharyngeal swellings

C. Lateral lingual swellings

D. Pre optic myotomes muscles

The correct answer is A. Occipital myotome.

All muscles of tongue both intrinsic and extrinsic except palatoglossus are derived from the four occipital myotomes and are supplied by 12th cranial nerve (which is formed by fusion of pre cervical nerves) and the palatoglossus is supplied by vagus nerve. The occipital myotomes migrate into the developing tongue (contributed by 1st to 3rd pharyngeal arches) in the floor of mouth. Muscles develop from occipital myotomes supplied by hypoglossal nerve. 

The characteristic alarm clock headache is a feature of:

 # The characteristic alarm clock headache is a feature of:

A. Auriculotemporal neuralgia

B. Trigeminal neuralgia

C. Sphenopalatine neuralgia

D. Glossopharyngeal neuralgia

The correct answer is C. Sphenopalatine neuralgia.

Sphenopalatine neuralgia / Lower half Headache / Sluder's headache / Horton's syndrome

• Described by Sudian, who concluded the involvement of Vidian nerve. 

• Pain is thought to be generated at the level of pericarotid or cavernous sinus complex. 

• Characterized by unilateral paroxysms of pain in the region of eyes; the maxilla, the ear and mastoid, and beneath the zygoma. 

• There is no trigger zone. 

• Unfortunately, the attacks develop regularly, usually atleast once a day, over a prolonged period of time. 

• Interestingly in some patients, the onset occurs at exactly the same time of day, because of which it is referred to as alarm clock headache 

Application of fluoride varnish after luting a crown has which of the following beneficial action?

 # Application of fluoride varnish after luting a crown has which of the following beneficial action?

A. Removes fluorides from enamel

B. Reduces the peripheral seal

C. Provides desensitizing action

D. Allows dissolution of marginal cement

The correct answer is C. Provides desensitizing action.

Fluoride applied after crown cementation has the benefit of reducing the decalcification in the area and helps to seal the tubules which may be open at the cervical tooth margin. This provides for additional desensitizing action. 

For maxillary expansion, HYRAX uses a force of:

 # For maxillary expansion, HYRAX uses a force of:

A. 2 to 3 pounds

B. 10 to 20 pounds

C. >25 pounds

D. >50 pounds

The correct answer is B. 10 to 20 pounds.

Hyrax (Hygienic Rapid Expander): 

• It is a fixed tooth borne rapid maxillary expansion appliance. 

• The Hyrax Expander is essentially a non-spring-loaded jackscrew with an all wire frame. The main advantage of this expander is that it does not irritate the palatal mucosa and is easy to keep clean. 

• It is capable of providing sutural separation of 11 mm within a very short period of wear and a maximum of 13 mm can also be achieved. Each activation of the screw produces approximately 0.2 mm of lateral expansion and it is activated from front to back. 

• Fixed appliances like Hyrax or Haas, apply forces about 3 to 10 pounds, which can reach up to 20 pounds in daily activation 

• Rapid maxillary expansion appliances uses 10-20 pounds force, whereas slow arch expansion uses 2-4 pounds. 

Earliest marker of renal damage in a known case of diabetes mellitus is:

 # Earliest marker of renal damage in a known case of diabetes mellitus is:

A. Microalbuminuria

B. Glycosuria

C. Increased serum creatinine

D. Increased serum urea

The correct answer is A. Microalbuminuria. 

Microalbuminuria refers to the urinary excretion of small amounts of albumin. The consistent presence

of albumin in the urine is abnormal and is clinically important in identifying the very early stages of glomerular disease, as occurs in conditions like diabetic nephropathy. Because significant renal damage

has already taken place before standard dipstick tests become positive, patients with diabetes mellitus should be screened regularly for microalbuminuria. Persistent microalbuminuria has also been associated with an increased risk of atherosclerosis and cardiovascular  mortality but neither the mechanism of proteinuria nor an explanation for this association has been established.

Osteomyelitis in early stage on radiograph appear as:

 # Osteomyelitis in early stage on radiograph appear as:

A. Blurring of trabeculae

B. Dense radiopaque areas

C. Radiolucent foci

D. Formation of sequestrum

The correct answer is A. Blurring of trabeculae. 

Osteomyelitis is defined as inflammation of bone and its bone marrow. Acute osteomyelitis progresses rapidly and demonstrates limited radiographic evidence until 1-2 weeks. The earliest change noticed is fuzziness and indistinct trabeculae. Chronic osteomyelitis appears as moth eaten radiolucencies in the bone, along with appearance of radiopaque sequestrum. 

In pantomograph, if patient chin is placed anterior to the focal trough, the structures appears to be:

 # In pantomograph, if patient chin is placed anterior to the focal trough, the structures appears to be:

A. Blurred and diminished

B. Blurred and magnified

C. Either magnified or diminished

D. Only blurred

The correct answer is A. Blurred and diminished.

Anatomic structures present within the focal trough are well defined on panoramic radiographers. If the chin is placed anterior to the focal trough, the structures appear to be blurred and diminished. If the chin is placed posterior to the focal trough, structures appear blurred and magnified. 

Ball in hand appearance is seen in:

 # Ball in hand appearance is seen in:

A. Sialadenosis

B. Benign tumor of salivary gland

C. Sialadenitis

D. Sjogren’s syndrome

The correct answer is B. Benign tumor of salivary gland.

Benign tumors may present as low-intensity (dark) or high-intensity (light) tissue signals on MRI, although the relative intensity of the signal may indicate the presence of lipid, vascular, or fibrous

tissues. Sialography may suggest a space-occupying mass when the ducts are compressed or smoothly displaced around the lesion (the “ball-in-hand” appearance).

Ulcers on palate, splenomegaly and lymphadenopathy with positive heterophile agglutination test

 # A 20-year-old female reports with ulcers on palate, splenomegaly and lymphadenopathy. Serum examination reveals positive heterophile agglutination test. What is the diagnosis? 

A. Rickettsia 

B. Measles 

C. Infectious Mononucleosis 

D. Chicken pox 

The correct answer is C. Infectious mononucleosis.

INFECTIOUS MONONUCLEOSIS 

• It is also called Glandular fever, kissing disease.

Clinical features: 

• Age: Children or young adults with peak incidence 15-20 yrs. In children, most cases are asymptomatic. 

• Fever, sore throat, headache, chills, nausea, vomiting, lymphadenopathy & hepatosplenomegaly are present. 

• Cervical lymph nodes are usually the 1st to exhibit enlargement. 

Oral manifestation: 

• Acute gingivitis & stomatitis present. 

• White grey membrane formation on various areas of oral & pharyngeal mucosa occurs. 

• Palatal Petechiae are often diagnostic. 

- Pin-point in size. 

- Present especially on soft palate & its junction with hard palate. 

- May help as an early diagnostic sign. 

Lab findings: 

• +ve Paul Bunnel test (Heterophile 'Ab' test) 

- Characteristic & pathognomonic of disease

- Heterophile 'Ab' titre increased up to 1: 4096 

• Atypical lymphocytosis: More than 50% lymphocytosis of which > 10% atypical 

• Thrombocytopenia 

• Antibodies to EBV present 

• Normal ESR 

Oedema may be caused by any of the following EXCEPT:

 # Oedema may be caused by any of the following EXCEPT :

A. An increase in the plasma protein concentration 

B. An increase in the capillary hydrostatic pressure 

C. An increase in the capillary permeability 

D Lymphatic obstruction 

The correct answer is A. An increase in the plasma protein concentration.

Oedema is accumulation of fluid in the interstitial tissue spaces and serous cavities.

Causes of oedema 

• Decreased plasma oncotic pressure 

• Increased capillary hydrostatic pressure 

• Increased capillary permeability 

• Lymphatic obstruction 

• Tissue factors (increased oncotic pressure of interstitial fluid, and decreased tissue tension) 

• Sodium and water retention. 

Passivating layer on alloy is dissolved completely by:

 # Passivating layer on alloy is dissolved completely by:

A. Basic acid

B. Borax

C. Potassium fluoride

D. Graphite

The correct answer is C. Potassium fluoride. 

# Aluminum, chromium, and titanium have high affinity for oxygen and they form protective oxide film, which prevents further oxidation and corrosion. This is called passivation. For soldering these alloys, the passivating film should be dissolved. Potassium fluoride used as a flux dissolves passivating film so that the solder can wet the parts. 

# Flux is a compound applied to metal surfaces that dissolves or prevents the formation of oxides and other undesirable substances that may reduce the quality or strength of a soldered or brazed area. 

# There are three types of fluxes according to their primary purpose: - 

Type I: Surface protection- covers the metal surface and prevents access to oxygen so that no oxides can form. 

Type II: Reducing agent- reduces any oxides present and exposes clean metal. 

Type III: Solvent- dissolves any oxides present and carries them away. 

Fluxes for use with noble metal alloys are generally based on boric acid, boric anhydride, and borax. Chromium oxides that form on base metal alloys are more stable and fluoride containing fluxes are used as solvents to dissolve chromium, nickel, and cobalt oxides. 

In long surgical procedure intubation method is:

 # In long surgical procedure intubation method is: 

A. Nasotracheal tube with cuff 

B. LMA 

C. Nasotracheal tube without cuff 

D. Endotracheal tube 

The correct answer is A. Nasotracheal tube with cuff.

LMA (laryngeal mask airway) is used mostly in situations of emergency and by non-anaesthesiologists. Endotracheal tube is commonly used method during general anaesthesia. For prolonged surgeries especially facio-maxillary surgeries nasaltracheal or Orotracheal intubation especially with cuff is used.

Best way to monitor perfusion of free flap:

 # Best way to monitor perfusion of free flap: 

A. Pulse oximeter 

B. Laser Doppler velocimetry 

C. Prick test 

D. Flourescin & dermoflourometer 

The correct answer is: C. Prick Test.

 During the postoperative phase, the flap is closely monitored for signs of compromised perfusion. Flaps are best assessed by inspection. Clinical monitoring is the current gold standard for assessing free flaps. Dermal bleeding or prick test is used to assess the colour of the blood within the flap circulation. Also scalpel mark on the flap can also be used to assess the colour of the blood.

Many high-end techniques are described in literature to monitor free flaps such as: 

• Serial fluorometry

• Plethysmography

• Laser doppler flow-metry

Reference: [Steel and Marran's head and neck surgery 4th ed 137]

Pulsating varicose vein is due to:

 # Pulsating varicose vein is due to 

A. Arterio venous fistula 

B. Sapheno femoral incompetence 

C. Deep vein thrombosis 

D. Abdominal tumour 

The correct answer is A. Arteriovenous fistula.

Communication between an artery and adjacent vein leads to arteriovenous aneurysm or arteriovenous fistula. When an arteriovenous fistula is created surgically, this is called iatrogenic arteriovenous fistula. For Renal dialysis,iatrogenic fistula is mostly used in the wrist or in the ankle and such temporary arteriovenous fistula is known as Cimino fistula. Presence of a pulsating thrill over the site of the lesion is quite characteristic, particularly if the lesion is located near the surface. If a finger is pressed on the artery proximal to the fistula,there will be slowing of pulse rate and rise in the diastolic pressure. This is known as Branham's sign.

Ref: S. Das Manual of Surgery, 3rd ed 194