5th year BDS IX Semester February 2019 - ORAL AND MAXILLOFACIAL SURGERY, BPKIHS

17th FEB 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

5th year BDS

IX Semester Internal Assessment, February 2019

Paper - IV 

(ORAL & MAXILLOFACIAL SURGERY)

Time - 1 Hour 20 minutes

 Total Marks: 60

SHORT ANSWER QUESTIONS

SECTION - 'A'

Maximum Marks - 30

1. Write a note on embryological aspects specific to cleft lip and palate.   (4)

2. Discuss briefly on different types of dislocation and enumerate the surgical procedures for the management of chronic recurrent temporomandibular joint dislocation. (3+3=6)

3. Mention the difference between the ridge extension and ridge augmentation procedure based on their indication. Describe any one ridge extension procedure. (1+4=5)

4. Write down the regimen for antibiotic prophylaxis for infective endocarditis and enlist the cardiac conditions requiring infective endocarditis prophylaxis. (2+4=6)

5. Write a note on the measures to be considered after exposure to a known case of HIV patient following needle-stick injury during tooth extraction. (4)

6. Describe the flap design for transalveolar extraction of impacted mandibular third molar correlating with the principles of flap design. (5)

SECTION 'B'

MODIFIED ESSAY QUESTIONS

Maximum Marks: 30

I. A 11 year-old patient reported to Maxillofacial clinic with a history of fall from a tree four days ago. There is no history of vomiting, seizure, loss of consciousness, but has a history of ear bleed from right ear. On examination, extraorally there is a sutured chin laceration with appreciable preauricular swelling present bilaterally. 

Intraoral examination reveals an anterior open bite due to premature gagging of occlusion. Maxilla appears to be normal. On opening the mouth, the midline is normal. 
Q1. State the term used to best define this fracture. (2)
Q2. Enlist two radiograph that can aid to diagnosis in this case. (2)
Q3. Enlist the indications for surgical intervention for this kind of fracture. (5)
Q4. Name two incisions that can be used to surgically approach this kind of fracture. (2)
Q5. Name the major complication that can occur if the patient is inappropriately treated with closed method and briefly discuss its etiopathophysiology. (1+3=4)

II.  A 26 year-old gentleman with a history of type -II diabetes mellitus was planned for extraction of 28 under local anesthesia. While during the procedure, the patient suddenly reports feeling uncomfortable, feeling warm, and then loses his consciousness. His wife who was accompanying him reports that he had taken his regular dose of hypoglycemic but missed his breakfast due to rush for the appointment. 
Q6. Enlist four causes for loss of consciousness. (2)
Q7. Discuss the management strategy for this patient. (4)
Q8. Discuss the management protocol to be employed for this medical condition to prevent such unwanted incidence from happening. (5)
Q9. Discuss the pathophysiology of syncope. (4)

***

5th year BDS IX Semester February 2019 - CONSERVATIVE DENTISTRY AND ENDODONTICS, BPKIHS

15th FEB 2019

B.P. Koirala Institute of Health Sciences, Dharan, Nepal

5th year BDS

IX Semester Internal Assessment, February 2019

Paper - III 

(CONSERVATIVE DENTISTRY AND ENDODONTICS)

Time - 1 Hour 20 minutes

 Total Marks: 60

SHORT ANSWER QUESTIONS

SECTION - 'A'

Maximum Marks - 30

1.  Discuss Gingival Marginal Trimmer with its number, use, and way to identify the sides.   (5)

2. Discuss the component present in 5th generation Bonding agent, Hybrid layer and ways to get a better Hybrid layer. (5)

3. Discuss the management of mercury pertaining to environmental issues using a flow chart. (5)

4. Write briefly about lateral condensation. (5)

5. What is crown down preparation of the root canal? (5)

6. What Precautions are to be taken to prevent ledging and apical transportation of root canals?
(5)

SECTION 'B'

MODIFIED ESSAY QUESTIONS

Maximum Marks: 30

I. A 42-year female patient visited dental OPD with severe spontaneous pain in the right upper back region of mouth for 5 days. Patient avoided chewing food from right side due to pain for several months.
Q1. Enlist the several causes of intraoral pain. (3)

Upon examination, there was poor oral hygiene, bleeding on probing, carious lesion in 15,16,17. IOPAR revealed dental caries in 15, deep dental caries approximating pulp in 16,17. 
Q2. Describe the investigation process to diagnose the case. (3)
Q3. Mention the diagnosis of the case. (2)
Q4. Outline the treatment plan. (2)

Prompt diagnosis and removal of the reservoir of infection are important for treatment of endodontic infections. 
Q5. Explain the crown down pressureless technique with its advantages for root canal shaping. (5)

II. Mr. Subash Limbu, 18-year male from Dharan-7, came to the Department of Conservative Dentistry and Endodontics with the chief complaint of decayed tooth on the left lower jaw region. He noticed a blackish discoloration on the chewing surface of left lower first molar yesterday evening during brushing and being a British Army aspirant, he didn't wan't to take any chances. So, today, he showed up for a checkup. After brief history, general examination was carried out. 
Q6. Outline the method for oral examination. (2)

On examination, the dentist noticed white spots over upper anterior teeth, and features associated with increased caries risk.
Q7. Mention the method for diagnosing a white spot. (2)
Q8. Describe the clinical examination findings associated with increased caries risk. (5)
Q9. Outline the treatment strategies in caries prevention program. (5)
Q10. Best measures for preventing both caries and periodontal disease are? (1)

***

#MCQ 21 - During the Master cone fitting procedure in the endodontic treatment of a patient's tooth, the patient says he has a "sharp shooting pain in the same tooth that ached earlier". What should be your response and why?

#MCQ 21- During the Master cone fitting procedure in the endodontic treatment of a patient's tooth, the patient says he has a "sharp shooting pain in the same tooth that ached earlier". What should be your response and why?

A. Continue with obturation, the anesthetic is simply wearing off
B. Continue with obturation, this is a normal complaint during this part of the procedure
C. Consider looking for an accessory canal and re-filing, there is likely pulpal tissue that has not been properly debrided
D. Irrigate further, the Sodium Hypochlorite should take care of this problem
E. Temporize the tooth and obturate at a later date

Answer: C. Consider looking for an accessory canal and re-filing, there is likely pulpal tissue that has not been properly debrided

This indicates inadequate debridement, as a pulpless tooth should not respond to any stimuli.
The most important consideration before filling a root canal is proper cleaning (debridement)and shaping (instrumenting) of the canal. Once the canal is obturated, any organisms
that have entered the periapical tissues from the canal are eliminated by the natural defenses
of the body.

CLICK HERE TO VIEW  ALL MCQS

Dentosphere Gems - Must Know Points in Oral Surgery

MOST COMMON:

1. The most common cause of anemia is iron deficiency due to decreased intake of essential compounds, viz. vitamin B1, B6, B12, iron, vitamin C.

2. The most commonly used Bard Parker Blade handle in oral surgery is no. 3.

3. Lagenbeck's retractor is the most commonly used retractor in oral surgery.

4. There are three work principles applicable to the elevators, viz. Lever principle, Wedge principle and Wheel and axle principle. Lever principle is the most commonly used principle.

5. The half circle curved needles are the most commonly used needles in oral surgical procedures.

6. Vicryl plus antibacterial suture is the world’s first and only antibacterial suture, which offers protection against bacterial colonization of the suture. It contains Triclosan which is a broad spectrum antibacterial agent and effective against the most common pathogens associated with surgical site infections.

7. Interrupted Suture is the most commonly used Suture.

8. Tetracyclines are the most common antibiotics responsible for causing superinfection, because they cause marked suppression of the normal intestinal flora.

9. The dentigerous cyst is the most common type of developmental odontogenic cyst, making up about 20 percent of all epithelium lined cysts of the jaws.

#MCQ 20 - Gingival Extension for a restoration should be:

#20 - Gingival Extension for a restoration should be:
A. At the gingival crest
B. At least 1 mm above the alveolar crest
C. At least 3 mm above the alveolar crest
D. Doesn't have any relation with the alveolar crest height

Answer: C. At least 3 mm above the alveolar crest
In a proper restoration, gingival margin of restoration should be at least 1 mm occlusal to the free marginal gingiva. Also, the free gingiva is approximately 2 mm coronal to the alveolar crest. So, margin of restoration should be 2mm (biological width) + 1 mm (distance away from free gingival margin) = 3 mm away from the alveolar crest.

CLICK HERE TO VIEW  ALL MCQS

Oral Surgery Past Questions

NOTE: These are real exam questions from BPKIHS, Dharan Nepal compiled by students and handed over to juniors throughout the history. In fact these are generational gems to students. If you find any mistakes, suggest corrections and help make it errorfree. Don't be mean, share with your fellow mates too. Because, you are having access to it here because someone cared to collect these and share for you people. So, Thank the friend who shared this to you and, share with 3 of your best friends. Pay-It-Forward. :)

CLICK HERE TO VIEW OTHER SUBJECTS' PAST QUESTIONS

1. What is impaction? Indication of Extraction of impacted teeth.
2. Ameloblastoma: etiopathogenesis, C/F, T/t.
3. Favourable and unfavourable #s. Principles of # T/t.
4. Trigeminal neuralgia. Etiology, C/F, T/t.
5. MPDS: predisposing factors, C/F, T/t.
6. Chronic pyogenic and suppurative osteomyelitis: Pathogenesis and treatment.
7. Dry socket: definition and causes.
8. Oroantral communication: cause, treatment.
9. Radicular cyst: Diagnosis, treatment.
10. Mx of patient on aspirin for Xn.
11. Merit/demerit of bur, chisel and mallet.
12. GowGates technique.
13. I for open extraction. Describe the flaps for the same.
14. Actinomycosis.
15. LA: classification, composition with fxn of each, MOA, complications.
16. Technique, landmark, S/S: IAN, PSA, Infraorbital.
17. Boundaries: pterygomandibular space, submandibular space.
18. Mx of anaphylaxis.
19. Ankylosis: classification, T/t, etiology.
20. Classification: Impacted canine, midface #.
21. Marsupialization of cystic lesion.



22. Oroantral fistula : etiology, complication, Mx.
23. Principles of surgery.
24. Extraction: I, CI, complication.
25. Describe areas supplied by IAN, long buccal, lingual, GP, PSA, NP, incisive, mental, infraorbital.
26. 38,48 Xn : Contarindication
27. SN: WAR line, Peterson’s difficulty index, causes of tooth impaction, heart disease needing prophylaxis, radicular cyst, nerve injury, adenocystic carcinoma, teeth and fracture lines, cavernous sinus thrombosis and its management, shift cone technique.
28. Precaution and Complication of surgery in HTN, asthmatics, diabetes.
29. GCS
30. X-ray used for mand/max #.
31. Branches of V2 and V3 and their innervation.
32. MoM, muscles attached to mandible.
33. Investigation of bleeding disorder.
34. Etiology of cleft.
35. Boundaries and content of infratemporal fossa.
36. C/F of U/L subcondylar dislocated #
37. Fracture healing.
38. Branches of external carotid, max artery, facial artery.
39. Tongue: muscles, nerve supply, lymph drainage.
40. Shock: hypovolemic, anaphylactic.
41. Space infections that cause trismus.
42. Spaces infected by lower 2nd molar.
43. Investigations and Mx of cystic lesions (also their enlargement)
44. Mandibular #: Classification and X-ray.
45. Different types of flap with design.
46. C/F, radiofeature, Mx: CGCG, ameloblastic fibroma, dry socket.
47. Etiology, C/F, Mx of pterygomandibular abscess.
48. C/F, Investigation and Mx of hemangioma.
49. Causes of non-healing fractures.
50. Possible complication of 16,26 Xn.
51. Open Vs closed reduction of mand #.
52. Define sterilization. Describe one.
53. Complication LeFort I osteotomy.
54. Methods of treating LeFort I #.
55. Superficial Vs deep temporal space.
56. Gillie’s temporal approach.
57. Branches of V.
58. Face- blood supply.
59. Facial palsy.
60. Indication of tracheostomy in OMFS.
61. CSF rhinorrhea and its Dx.
62. Complication of #.
63. Mention principles of elevators.
64. T/t options for Trigem N.
65. Classification of impacted teeth.



66. Three technique to block IAN.
67. Sequetrum vs involucrum.
68. Name 3 surgical approach to TMJ.
69. Normal flora of oral cavity and skin.
70. Describe line of # in LeFort # with diagram.
71. Enucleation vs marsupialization.
72. Space for 3rd molar.
73. Classify condylar #.
74. C/F and Mx of OAF..
75. Classify sutures. Describe different sutures with diagram.
76. MEQ: U/L TMJ ankylosis. – Dx and Mx. – cause, classification and pathophysiology. – Surgical Mx. – Approach to mandible. – Material used for interpositional arthroplasty and describe.
77. MEQ: LeFort I # with zygomatic complex #. –Dx. –X-ray. – Mx. Open vs closed reduction. –Gunning splint.
78. 5 lesion associated with impacted teeth. –Factors causing Xn easy and difficult.
79. Complication due to Xn of 36,46.
80. Allergic rxn, anaphylaxis due to LA: –Dx. –Mx. Prevention.
81. Ameloblastoma: histological variants, mode of t/t, radiological findings.
82. Extracranial course and branches of V3.
83. LeFort II#: GCS, C/F, X-ray.
84. Bleeding socket for 7 days: cause, investigation, Mx.
85. Case of dentigerous cyst: confirming Dx, describe enucleation and marsupialization.
86. Pt with severe pain, limited mouth opening. OPG revealed carious lesion: Primary Mx, Define Ludwig’s angina, Mx and complication Ludwig’s angina.
87. Syncope: pathophysiology, S/S, Mx.
88. 28 yrs old B/l condylar #: Investigation and Mx.
89. Zygomatic complex #: X-ray, C/F, indication for open reduction.
90. A 60 yrs old man comes in denal clinic for Xn of tooth. Previous h/o prosthetic valve replacement. 6 mnths back. List the preoperative preparation of this case. He developed intense chest pain and radiated to left shoulder : Mx.
91. Methods of treating LeFort I 3.
92. Causes of postoperative bleeding.

93. Face: blood supply.
94. Facial palsy.
95. Neuroparesis.
96. Define #. Mention causes of non-healing socket.
97. Mention the C/F of U/L subcondylar dislocated #.
98. X-ray for mand #.
99. SN: teeth and # line.
100. Define Ludwig’s angina, tt, C/F.
101. Define Xn. Flaps in open Xn with diagrams.
102. Define cyst. Mention a cyst without epithelial lining.
103. Dx of cyst, how ?
104. D/D of periapical radiolucency.
105. C/F and Mx of B/L TMJ ankylosis.
106. How to identify and manage anaphylactic rxn to LA ?
107. Buccinator muscle.
108. Osteology of midface.
109. Orthognathic surgery.
110. Ascending palatine branch of max artery.
111. Hypoglycemic shock.
112. Complications of LeFort I osteotomy.
113. Pharmacology of LA.
114. History taking. Method of drainage of submandibular and pterygomandibular space abscess.
115. Theories and MOA of LA. Describe specific receptor theory.
116. Patient on warfarin, Mx.
117. ORN : etio, C/F, Tt.
118. OKC – types, histological classification and its significance, recurrence and prevention, C/F, T/t.
119. Referred pain ?
120. Asthma Mx ?
121. Liver disease patient Mx.
122. Mx of seizures, thyroid, alcoholics.
123. PEP.
124. Indication of antimicrobials in OMFS.
125. Frey’s syndrome, etio, S/S, tt.
126. Silhoutte/PG tumor
127. Syncope vs drug overdose.
128. Central lymph nodes.
129. Inner/outer waldeyer’s ring.
130. Internal derangement.
131. CSF vs nasal secretion vs blood.
132. Birn’s hypothesis.
133. Pyogenic OM.
134. Ideal properties of LA.
135. BLS.
136. MOA of Nimesulide, Ibuprofen, Aspirin, Penicillin, cephalosporins.
137. Describe Kazanjian’s technique in vestibuloplasty.
138. Describe Caldwell-Luc operation.
139. Causes for post-traumatic diplopia.
140. Indications for sagittal split osteotomy.
141. I/CI of adrenaline.
142. Some incisions to middle third #.
143. Define dislocation.
144. Absolute/relative indications for open reduction of condylar #.
145. Mx of avulsed tooth.
146. Tt of Ellis V #.
147. Principles of suturing.
148. Tissue reaction to suture.
149. C/F of Guerin #, pyramidal #, unilateral and bilateral TMJ ankylosis.
150. Etiology of oral cancer. TNM classification and staging.



151. Define pain and methods to control pain.
152. Mention theories of pain and action of LA.
153. Local and systemic complications of LA.
154. Types of vasoconstrictors used in dentistry.
155. Indications of vestibuloplasty.
156. Classify antibiotic.
157. Complex odontoma, pleomorphic adenoma.
158. Warphe’s difficulty index.

Prosthodontics Past Questions

Prosthodontics Past Questions

NOTE: These are real exam questions from BPKIHS, Dharan Nepal compiled by students and handed over to juniors throughout the history. In fact these are generational gems to students. If you find any mistakes, suggest corrections and help make it errorfree. Don't be mean, share with your fellow mates too. Because, you are having access to it here because someone cared to collect these and share for you people. So, Thank the friend who shared this to you and, share with 3 of your best friends. Pay-It-Forward. :)

CLICK HERE TO VIEW OTHER SUBJECTS' PAST QUESTIONS

1. Lower bilateral edentulous area missing 567.
a. Classify.
b. Which major connector, why?
c. Which clasp assembly, why ?
d. Color coding for above.
e. Methods of impression making, explain.
2. CD patient with DM on medication has bony spicules and high frenal attachment.
a. T/t plan
b. Method of increasing width of residual ridge.
c. Steps of CD.
d. Post-insertion instructions.
3. A cast moddel of a patient was studied and:
a. Missing 35, 36, 37, 38, 46, 47 with 48 present.
b. Supraerupted 24, 25, 26.
c. Buccally placed 28
d. Classification ?
e. Figure with denture prosthesis ?
f. Needs for surveying ?

4. Ill-fitting denture worn 1 yr back. O/E, traumatic ulcers in denture-bearing area, xerostomia.
a. List the conditions of the ill-fitting dentures.
b. Investigatins to be done.
c. Mx.
5. 40 yr old lady with missing max lateral incisors. O/E, midline diastema. Pt is smoker and diabetic.
a. Different Tt modalities, justify one.
b. Which modality not indicated for above mentioned case ?
c. Steps of Tt plan.
6. 50yrs, all-dentulous maxilla, edentulous mandible.
a. Different types of Tt modalities and prognosis.
b. Types and techniques of jaw relation.
c. Difficulties during fabrication of denture.
7. Mandibular bilateral posterior edentulism, supraerupted upper teeth.
a. Classification.
b. Causes of reduced interarch space.
c. Tt plan.
8. Betelnut chewer edentulous patient.
a. Various Tt modalities.
b. Procedures for treatment plan.
c. Troublesome factors during Tt.

9. 25 yrs lady with proclined max teeth, discoloured all teeth with flakes on surface.
a. Appropriate Tt plan.
b. Various prosthodontic options.
c. Procedure of Tt for best prosthetic option.
10. Kennedy/Applegate.
11. Clasp assembly.
12. Requirement of clasp design.
13. Components of RPD.
14. Major connectors, definition and requirement.
15. Max major connector : special requirement.
16. Types of max and mand major connectors.
17. Minor connectors: defn and types.
18. Types of rest, retainer.
19. Factors influencing magnitude of stress transmitted to abutment tooth.
20. Surveyor : defn, parts, figure, types, purpose and objective.



21. Factors influencing path of insertion.
22. Impression technique.
23. Vestibuloplasty
24. Jaw augmentation involving denture bearing area.
25. 1o, 2o, stress bearing area, limiting area, relief area.
26. Jaw relation – types.
27. Types of face bow, parts.
28. Define centric relation, methods to record.
29. Classification of articulators.
30. PPS: defn, significance, how to record.
31. Selection of teeth.
32. Mouth preparation.
33. Define retention and stability. Factors affecting retention.
34. SN: Eccentric relation, fluid wax technique.
35. Justify the implementation of jaw relation in prosthetic rehabilitation.
36. Importance of TRY-IN.
37. Balanced occlusion.Factors determining occlusion.
38. SN: Biological width.
39. Stress breaker.
40. Influence of systemic factors on RRR and Mx.
41. Aspects of aging wrt oral cavity.
42. Principles of impression making.
43. Periodontal consideration in impression making of FPD.
44. Define CR, CO.

45. C/C
a. Max intercuspation and CO.
b. Mucompressive and mucostatic technique.

46. I/CI of lingual plate.
47. Classify dental implants.
48. SN: definitive obturator, steps and design.
49. Define pontic, classify. SN: Modified ridge lap.
50. Finish line configuration
51. Gingival retraction method.
52. Provisional restoration
53. Surveyor: uses and sequence in surveying.
54. Missing 34, 36
a. Define Ante’s law.
b. Define pier abutment.
c. Pontic indicated and why ?
d. Key and keyway figure.
e. Is it necessary in this case, why ?

55. Missing 22
a. Tt plan
b. Best option.
c. Investigations.

56. Classification of muscle attachment of soft palate. Velopharyngeal mechanism.



57. Classification, parts, limitation, recent advancement of semi adjustable articulator.
58. SN: resin bonded prosthesis, bonding technique.
59. Types, I/CI of implants.
60. 50 yrs old. Upper incisors missing, flabby ridge. O/E, resorbed ridge.
a. Tt option
b. Tt plan.
c. Impression technique.
61. Abused tissue and Mx.