Ludwig's angina involves infection of:

# Ludwig's angina is a severe and spreading infection that involves the:
A. Submental and sublingual spaces only
B. Submandibular, submental, and sublingual spaces unilaterally
C. Submandibular and sublingual spaces only
D. Submandibular, submental, and sublingual spaces bilaterally

The correct answer is: D. Submandibular, submental, and sublingual spaces bilaterally

Ludwig's angina often results from an odontogenic infection. As a result, the bacteriology of theses infections generally involves oral flora, particularly anaerobes. Other recognized etiologies of Ludwig's angina include poor oral hygiene, IV drug abuse, trauma, and tonsillitis.

It is characterized by:

• Rapid onset

• The three facial spaces are involved bilaterally

• Board-like swelling of floor of the mouth and no fluctuance is present

• Typical "open-mouthed" appearance

• Elevation of the tongue

• Drooling. trismus, and fever

• Difficulty eating, swallowing, breathing

• Tachycardia, increased respiration rate

• Can lead to glottal edema; asphyxiation

Airway management, massive antibiotic coverage (IV), and surgical incision and drainage are the mainstays of treatment.

Very important: The most serious complication of Ludwig's angina is edema of the glottis (which is a slit-like opening between the true vocal cords).

Epithelioid cells and giant cells are derived from

# Epithelioid cells and giant cells are derived from macrophages and are important in the development of:
A. Initial inflammation
B. Granulomatous inflammation
C. Acute inflammation
D. Subacute inflammation

The correct answer is B. Granulomatous inflammation.

Granulomatous inflammation is a subtype of chronic inflammation and is characterized by granulomas, which are nodular collections of specialized macrophages referred to as epithelioid cells. A rim of lymphocytes usually surrounds granulomas. Granulomas are produced by multinucleated giant cells (Langerhans giant cells and foreign body giant cells). All the other cell types characteristic of chronic inflammation, including plasma cells, eosinophils, and fibroblasts, may also be associated with granulomas.

Note: Granulomatous inflammation is characteristically associated with areas of caseous necrosis produced by infectious agents, particularly Mycobacterium tuberculosis.

• Tuberculosis: caused by the inhalation of Mycobacte1ium tuberculosis. Oral non-healing chronic ulcers follow lung infection. Important: Characterized by caseating granulomas with multinucleated giant cells (Langerhans giant cells and foreign body giant cells).

Etiologic agents associated with granulomatous inflammation:

• Infectious agents

- TB and leprosy, which are mycobacterial diseases

- Fungal infections (blastomycosis, histoplasmosis, and coccidioidomycosis)

- Spirochetes (Treponema pallidum, which causes syphilis)

- Cat scratch disease (caused by an unnamed gram-negative organism)

• Foreign material (e.g., suture or talc)

• Sarcoidosis (unknown etiology; it is non-necrotizing)

• Crohn's disease (it is non-caseating)

Hepatitis found only in patients with acute or chronic episodes of Hepatitis B

# Which type of Hepatitis is found only in patients with acute or chronic episodes of Hepatitis B?
A. Hepatitis C
B. Hepatitis D
C. Hepatitis E
D. Hepatitis A

The correct answer is B. Hepatitis D, this virus causes "serum" or long-incubation hepatitis

The Hepatitis B virus (HBV) is a double-stranded DNA virus with worldwide distribution, transmitted by parenteral and sexual contact. Risk factors include multiple sexual partners, intravenous drug abuse, and receipt of blood products. Its incubation period is 40 to 100 days, and it can be recovered from all body fluids, most importantly, blood, breast milk, and amniotic fluid. The signs and symptoms are similar to hepatitis A (leve1; abdominal pain, nausea, etc.) but there is a longer incubation period (6-8 weeks). The symptoms are slower in developing but are of a longer duration. Most patients recover fully, however, some develop chronic liver disease.

Previously, viral hepatitis that was not caused by the type A or type B virus was called "non-A, non-B hepatitis." Recently three more viruses have been identified that cause some of these non-A, non-B infections.

These new viruses include:

• Hepatitis C: is a serum hepatitis that is caused by a virus antigenically different from Hepatitis viruses A and B. Most cases of post-transfusion hepatitides are of this type. It is usually much milder than A or B but is otherwise clinically indistinguishable from them. There is a higher incidence of chronic disease (chronic hepatitis), cirrhosis, and hepatocellular carcinoma. Note: Hepatitis C is now the most common reason for liver transplantation in the U.S.

• Hepatitis D: is found only in patients with acute or chronic episodes of Hepatitis B, and it makes the Hepatitis B infection more severe. Drug addicts are at relatively high risk.

• Hepatitis E: is transmitted enterically, much like Hepatitis A. It causes occasional epidemics similar to those caused by Hepatitis A. So far these epidemics have occurred only in underdeveloped countries.

Disease associated with a decreased incidence of dental caries

# Which of the following diseases is associated with a decrease in caries?
A. Sjogren's syndrome
B. Cystic fibrosis
C. Cerebral palsy
D. Down syndrome

The correct answer is B. Cystic fibrosis.

** Important: There is a significantly reduced caries rate in patients with cystic fibrosis. This is probably the result of alterations in saliva and the long-term use of antibiotics. Cystic fibrosis is a congenital metabolic disorder that causes the exocrine glands (which are glands that secrete fluids into a duct) to produce abnormal secretions, resulting in several symptoms, the most important of which affect the digestive tract and the lungs. In some glands, such as the pancreas and those in the intestines, the secretions are thick or solid {an excessively viscous mucous) and may block the gland completely. The mucous producing glands in the airways of the lungs produce abnormal secretions that clog the airways and allow bacteria to multiply. The sweat glands secrete fluids that have high sodium and chloride content. Note: The staining of the teeth is most likely due to the fact

that patients with cystic fibrosis are usually subjected to large amounts of tetracyclines during childhood.

Symptoms of CF include:

• Poor growth despite a good appetite

• Malabsorption and foul, bulky stools: steatorrhea

• Chronic bronchitis (COPD) with cough

• Recurrent pneumonia: respiratory infections

• Clubbing of fingers and toes

• Barrel-chested appearance