What is the highest safe dose of adrenaline that can be given to a patient with angina pectoris?

 # What is the highest safe dose of adrenaline that can be given to a patient with angina pectoris?

A. 0.02 mg

B. 0.4 mg

C. 0.2 mg

D. 0.04 mg

The correct answer is D. 0.04 mg.

For a patient with clinically significant cardiovascular disease, such as angina pectoris, the American Heart Association (AHA) and the American Dental Association (ADA) recommend limiting the dose of epinephrine (adrenaline) to a "cardiac dose."

Scientific Rationale and Evidence

In healthy patients, the maximum recommended dose of epinephrine is generally 0.2 mg (equivalent to approximately 11 cartridges of 1:100,000 epinephrine). However, in patients with ischemic heart disease or unstable angina, the exogenous administration of adrenaline can trigger adverse hemodynamic effects.

Adrenaline acts on alpha and beta receptors, leading to:

• Increased Myocardial Oxygen Demand: Due to positive inotropic (contractility) and chronotropic (heart rate) effects.

• Potential Ischemia: In a patient with narrowed coronary arteries (angina), the inability of the coronary blood flow to meet this increased oxygen demand can precipitate a myocardial infarction or severe arrhythmia.

Which cephalometric characteristic is most commonly found in adult patients with repaired unilateral cleft lip and palate?

 # Which cephalometric characteristic is most commonly found in adult patients with repaired unilateral cleft lip and palate?

A. Maxillary prognathism

B. Increased midface height

C. Maxillary retrusion and Class III tendency

D. Mandibular retrognathism

The correct answer is C. Maxillary retrusion and Class III tendency.

Reasoning

Adult patients with repaired unilateral cleft lip and palate (UCLP) typically exhibit a specific craniofacial morphology due to the restrictive effects of primary surgical repairs (particularly palatoplasty) on maxillary growth.

• Maxillary Retrusion: The formation of scar tissue from surgical repair inhibits the anteroposterior and transverse growth of the maxilla. This is the most consistent and prominent cephalometric characteristic.

• Class III Skeletal Pattern: Because the mandible generally usually exhibits normal growth potential (though it may be slightly retrognathic or rotated), the deficient maxilla results in a relative mandibular prognathism, creating a skeletal Class III relationship (ANB angle reduction or inversion).

• Vertical Dimensions: While midface height can be affected, the reduced anterior face height or vertical maxillary deficiency is more common than increased midface height, often contributing to a "closed" bite tendency or requiring surgical advancement that includes vertical lengthening.

Why other options are incorrect:

• A. Maxillary prognathism: The maxilla is typically hypoplastic (underdeveloped), not prognathic.

• B. Increased midface height: The midface is usually vertically deficient (hypoplastic).

• D. Mandibular retrognathism: While the mandible may sometimes be slightly smaller or rotated, the defining characteristic of the Class III appearance is the maxillary deficiency, not the mandibular position. The mandible often appears prognathic relative to the retrusive maxilla.

Which member of the cleft team is primarily responsible for assessing velopharyngeal competence?

 # Which member of the cleft team is primarily responsible for assessing velopharyngeal competence?

A. Orthodontist

B. Plastic Surgeon

C. Speech-Language Pathologist

D. Otolaryngologist

The correct answer is C. Speech-Language Pathologist.

Reasoning

While the cleft palate team functions physically as a unit, the primary responsibility for assessing velopharyngeal competence (the ability of the soft palate and pharyngeal walls to separate the oral and nasal cavities during speech) lies with the Speech-Language Pathologist (SLP).

• Speech-Language Pathologist: Conducts perceptual assessments of speech (listening for hypernasality and nasal air emission) and instrumental assessments (such as nasometry). They are often the primary provider to identify velopharyngeal insufficiency (VPI) before referring for surgical or prosthetic management.

• Plastic Surgeon: Performs the surgical repair (pharyngoplasty or flap surgery) based on the assessment but relies heavily on the SLP's data regarding function.

• Orthodontist: Manages malocclusion and dentofacial growth. While maxillary advancement can affect velopharyngeal function, the orthodontist does not primarily assess the competence mechanism itself.

• Otolaryngologist (ENT): Primarily assesses and manages hearing (eustachian tube dysfunction/otitis media) and airway obstruction, rather than velopharyngeal competence for speech.

According to the ACPA standards, what is the minimum frequency for a comprehensive team evaluation for a child with a cleft?

# According to the ACPA standards, what is the minimum frequency for a comprehensive team evaluation for a child with a cleft? 

A. Every six months

B. Annually

C. Every two years

D. Every five years

Based on the ACPA (American Cleft Palate-Craniofacial Association) standards, specifically the Parameters for Evaluation and Treatment of Patients with Cleft Lip/Palate or Other Craniofacial Anomalies, the correct answer is:

B. Annually

Reasoning

The ACPA standards state that children with cleft lip and/or palate require longitudinal follow-up. While specific specialists (such as speech-language pathologists or orthodontists) may see the patient more frequently depending on treatment needs, the comprehensive interdisciplinary team evaluation must be performed at least annually.

• Infancy to 4 Years: Evaluations are typically more frequent (often every 6 months or annually) to monitor feeding, growth, speech development, and hearing.

• School Age to Maturity: Comprehensive team evaluations are recommended at least annually to coordinate phases of care (such as bone grafting, orthodontics, and secondary surgeries) and to monitor facial growth and psychosocial well-being.

The minimum frequency is designed to ensure that no developmental issues (speech, hearing, dental, or skeletal) are missed during the child's growth periods. 

MDS Orthodontics Assertion and Reason Questions - Biologic Basis of Orthodontic Tooth Movement

Orthodontics Finals Prep

Biologic Basis of Tooth Movement

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MCQs on Community Survey and Family Case Study - Public Health Dentistry - Community Dentistry

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MCQs on Concept of Health and Attitude Towards Illness - Community Dentistry - Public Health Dentistry

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