# Dose adjustment of all of the following drugs will be required in patient with severe liver cirrhosis EXCEPT:

# Dose adjustment of all of the  following drugs will be required in a patient with severe liver cirrhosis EXCEPT:
a) Lorazepam
b) Theophylline
c) Paracetamol
d) Metronidazole

The correct answer is A. Lorazepam.

PHARMACOKINETICS

Most of the BZDS are metabolized in the liver to produce active products (thus long duration of action). Active metabolites may result in cumulative effects. After metabolism, these are conjugated

and are excreted via kidney. Estazolam, lorazepam, oxazepam, temazepam and triazolam are directly conjugated without metabolism to active products. These drugs are thus short-acting and do not

accumulate on repeated administration. Further these drugs can be safely administered in liver failure and in elderly because these are conjugated directly without undergoing metabolism in the liver.

(Mnemonics: @ TO-LET; Short-acting drugs are Triazolam, Oxazepam, Lorazepam, Estazolam and Temazepam,). Compounds with shorter half life are favored in patients with sleep-onset insomnia whereas longer acting BZDS are favored in patients with day time anxiety.

Adverse effects

Benzodiazepines are much safer than barbiturates (less chances of respiratory depression and coma) and also have less abuse potential. However, these drugs can also impair learning and memory

Flunitrazepam is a tasteless BZD and is implicated as a date rape drug due to its propensity to cause dose dependent amnesic effects.

Benzodiazepine Antagonist

Flumazenil is the substance that acts as competitive antagonist at BZD receptor. It blocks the depressant action of benzodiazepine, zolpidem and zaleplon as well as the convulsant action of inverse agonist (like B-carotene).  It is administered i.v. for the treatment of BZD poisoning (specitie antidote) and can also be used to reverse BZD anaesthesia.

# Of the following local anesthetics, which has intrinsic vasoconstrictive action? (MAN -97)

# Of the following local anesthetics, which has intrinsic vasoconstrictive action? (MAN -97)
a) Cocaine
b) Procaine
c) Xylocaine
d) Bupivacaine

The correct answer is : A. Cocaine

All local anaesthetics except cocaine are synthetic compounds and they are vasodilating in nature. Cocaine is a natural local anaesthetic agent and causes local vasoconstriction.

 (Cocaine increases the vasoconstrictive action of adrenaline. If LA with adrenaline is given risk of death is more in cocaine abusers. So they are known as  'walking time bombs.'

Which of the following is the preferred local anesthetic technique for hemophilics? (MAN -01)

# Which of the following is the preferred local anesthetic technique for hemophilics? (MAN -01)
a) Nerve block
b) Supraperiosteal
c) Intraligamentary
d) Field block

The correct answer is C. Intraligamentary.

 In hemophilics to avoid complications,  Intraligamentary  (an intraosseous technique) method of local infiltration technique is preferred. In this technique, the solution is deposited in depth of gingival sulcus. The needle should be inserted apically into the bone until resistance is met.

# Which of the following may least be used as an abutment: (PGI -2K)

# Which of the following may least be used as an abutment: (PGI -2K)
a) Tooth with minimum crown
b) Tooth with short tapered crown and conical roots
c) Rotated and tipped tooth
d) Pulp treated tooth

The correct answer is: B. b) Tooth with short tapered crown and conical roots

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# Epitheloid cells are seen in all of the following except (MAN -02):

# Epitheloid cells are seen in all of the following except (MAN -02):
a) Tuberculosis
b) Granulation tissue
c) Syphilis
d) Sarcoidosis

The correct answer is : B. Granulation Tissue

Epitheloid cells are a collection of modified macrophages present in granuloma. Granulomas occur in Tuberculosis, Leprosy, syphilis, Actinomycosis, Sarcoidosis, etc.

# The wetting of an adherent surface by an adhesive is related to: (AIPG-01)

# The wetting of an adherent surface by an adhesive is related to:
(AIPG-01)
A. Surface texture of the adherent
B. Surface energy of the adherent
C. Nature of the adherent that is crystalline or amorphous
D. Surface tension of the adherent

The correct answer is B. Surface energy of the adherent.

The property of wetting and adhesions are directly related to surface energy of adhesives. Substances with low surface energy like teflon are often used to prevent the adhesion of films to a surface. Metals because of their high surface energy, interact vigorouslywith liquid adhesives.

The surface energy of many restorative materials is higher when compared to that of tooth. So, there is greater tendency for the surface and margins of restorations to accumulate debris. This property will explain the relatively high incidence of marginal caries seen around dental restorations.

What is Proportional Limit?

# The proportional limit is defined as:
A. The maximum stress in a structure
B. The minimum force required to cause a structure to break
C. The maximum stress that can be induced without permanent deformation
D. The maximum elongation under tension that
 can be measured before failure

The correct answer is C. The maximum stress that can be induced without permanent deformation.

Stresses above proportional limit cause plastic deformation. This stress is called yield strength or proof stress. It  is the greatest stress, produced in a material such that stress is directly proportional to the strain. 

Phillip's Science of Dental Materials, 12th ed. Page no 57.