Pyogenic granuloma represents an over-exuberant tissue reaction to some known stimuli or injuries. The term pyogenic granuloma is somewhat a misnomer since the condition is not associated with pus formation.
CLINICAL FEATURES
Age: occurs at an early age.
Sex: seen more frequently in females.
Site: mostly occurs in relation to the gingiva, however on rare occasions, other mucosal sites may be involved.
PRESENTATION
• The lesion appears as a small, pedunculated or sessile, painless, soft, lobulated growth on the gingiva
• Labial surface of the gingiva is more frequently affected than the lingual surface.
• The lesion is often ulcerated and bleeds profusely, either upon provocation or spontaneously.
• The ulcerated area of the lesion is often covered by a yellow fibrinous membrane.
• The rate of growth of the lesion is very rapid and its maximum size could be up to 1 cm in
diameter
•Untreated lesion of pyogenic granuloma undergoes fibrosis due to decreased vascularity and in such cases it appears small, firm with little tendency to bleed. This lesion is called “fibroepithelial polyp”
• Similar lesions appearing on the gingival tissue of pregnant women are known as “pregnancy tumor”.
HISTOPATHOLOGY
• Histologically, the lesion is composed of lobular masses of hyperplastic granulation tissue, containing multiple proliferating fibroblasts, many blood capillaries and a variable number of chronic inflammatory cells.
• The lesion is a vascular one and it occurs due to the proliferation of the endothelial cells.
• The overlying epithelium is thin and ulcerated, and in most of the cases the underlying
connective tissue shows intercellular edema.
• Areas of hemorrhage and hemosiderin pigmentation are often seen within the connective tissue stroma.
TREATMENT
Pyogenic granuloma is treated by surgical excision.
Oral Biology Past Question - 2nd Year BDS BPKIHS March 2016
Time: 2 Hours Total Marks: 125
1. Mention five points of difference between cellular and acellular cementum. - 5
2. Mention five points of difference between primary and permanent pulp tissues. - 5
3. Define Crest of Curvature. Describe the Crest of Curvature of a maxillary canine from all four aspects with a neat labeled diagram. - 2+4 = 6
4. Describe six points of difference between primary and permanent human dentition. - 6
5. Describe the labial aspect of the permanent mandibular right lateral incisor. - 6
6. List and discuss the functions of dental pulp. - 6
7. Mention the different types of the cementoenamel junction and discuss the formation of any one. - 6
8. Discuss the phenomenon of formation of Hunter-Schreger band. - 6
9. Describe late bell stage of amelogenesis with suitable diagram. - 4+3 = 7
10. List the transitory structures formed during the development of teeth and describe any one. - 7
11. Discuss the development of periodontal ligament fibers. - 7
12. Discuss the formation of the root of the permanent mandibular central incisor. - 7
13. Describe the process of modulation in amelogenesis with suitable diagrams. - 7
14. Discuss the keyhole pattern of enamel. - 7
15. Discuss reciprocal induction in context to the development of teeth. -7
16. Discuss in detail the anatomy of the permanent maxillary right central incisor. -10
17. WRITE SHORT NOTES ON: (3*5 = 15)
a. Perikymata
b. Prismless enamel
c. Intermediate plexus
d. Neural crest cells
e. Plexus of Rashkow
18. Define the following. (1*5 = 5)
a. Fossa
b. Ridge
c. Lobe
d. Cingulum
e. Point angle
1. Mention five points of difference between cellular and acellular cementum. - 5
2. Mention five points of difference between primary and permanent pulp tissues. - 5
3. Define Crest of Curvature. Describe the Crest of Curvature of a maxillary canine from all four aspects with a neat labeled diagram. - 2+4 = 6
4. Describe six points of difference between primary and permanent human dentition. - 6
5. Describe the labial aspect of the permanent mandibular right lateral incisor. - 6
6. List and discuss the functions of dental pulp. - 6
7. Mention the different types of the cementoenamel junction and discuss the formation of any one. - 6
8. Discuss the phenomenon of formation of Hunter-Schreger band. - 6
9. Describe late bell stage of amelogenesis with suitable diagram. - 4+3 = 7
10. List the transitory structures formed during the development of teeth and describe any one. - 7
11. Discuss the development of periodontal ligament fibers. - 7
12. Discuss the formation of the root of the permanent mandibular central incisor. - 7
13. Describe the process of modulation in amelogenesis with suitable diagrams. - 7
14. Discuss the keyhole pattern of enamel. - 7
15. Discuss reciprocal induction in context to the development of teeth. -7
16. Discuss in detail the anatomy of the permanent maxillary right central incisor. -10
17. WRITE SHORT NOTES ON: (3*5 = 15)
a. Perikymata
b. Prismless enamel
c. Intermediate plexus
d. Neural crest cells
e. Plexus of Rashkow
18. Define the following. (1*5 = 5)
a. Fossa
b. Ridge
c. Lobe
d. Cingulum
e. Point angle
ABSCESS : Types and Methods of Treatment
An abscess is a cavity filled with pus and lined by a pyogenic membrane. There are three varieties of abscess :
Sometimes, the abscess cavity persists, which becomes firm and contains sterile pus. The firmness is due to thickness of its wall. This is known as 'antibioma'. This is due to continuous administration of antibiotics. The lump may even be hard, when it may mimic a carcinomatous lump.
Basic principle of treatment of an abscess is:
Bacteremia Vs Septicemia :
- Pyogenic abscess (commonest)
- Pyaemic abscess
- Cold abscess
Sometimes, the abscess cavity persists, which becomes firm and contains sterile pus. The firmness is due to thickness of its wall. This is known as 'antibioma'. This is due to continuous administration of antibiotics. The lump may even be hard, when it may mimic a carcinomatous lump.
Basic principle of treatment of an abscess is:
- to drain the pus
- to send the pus for culture and sensitivity test, and
- to give proper antibiotic
Drainage of a pus can be obtained by free incision or by Hilton's method. Hilton's method is chosen when there are plenty of important structures like nerves and vessels around the abscess cavity, which are liable to be injured.
Incision should be made parallel to important structures like nerves and vessels, while the muscle should be incised along the line of the fibers.
Counter incision : When the most prominent part is not the most dependent part, complete drainage of the pus is not possible with single incision. So, counter incision is required at the most dependent part to facilitate the drainage by gravity.
A corrugated rubber drain is usually used for drainage of an abscess cavity. When counter incision is used, the drain extends from the first incision to the counter incision.
Pyaemic Abscess : In this condition, multiple abscesses develop from infected emboli in pyaemia. Pyaemia is a condition characterized by formation of secondary foci of suppuration in various parts of the body. These foci are caused by lodgement of septic emboli formed as a result of breaking up of an infected thrombus.
Pyaemia is also seen in acute appendicitis when the infective emboli pass in to the portal venous system and cause portal vein pyaemia. (forming multiple pyaemic liver abscesses)
Bacteremia Vs Septicemia :
Bacteremia is the condition in which bacteria circulate in the blood stream. The organisms are usually very rapidly destroyed.
Septicemia is the development of certain clinical manifestations due to liberations of toxins by the bacteria in the blood stream. The manifestations include pyrexia, rigors, hypotension, petechial hemorrhages, etc. In absence of systemic disease, B hemolytic streptococci.
Toxaemia : Condition in which toxins, either chemical or bacterial blood circulate in the blood stream
Cold Abscess: This abscess is cold and non reacting in nature. It does not produce hot and painful abscess as seen in pyogenic abscess. It is almost always a sequel of tubercular infection anywhere in the body, commonly in the lymph nodes, bone and joint. Caseation of the lymph nodes forms the cold abscess. The commonest sites are the neck and axilla.
Once the diagnosis is established, full antitubercular regime should be started. An incision should not be made on a cold abscess for drainage, as it almost always invites secondary infection and forms a persistent sinus. Aspiration may be attempted through the normal surrounding skin and not the most prominent and most dependent part as this will innvariably cause sinus formation.
Once the diagnosis is established, full antitubercular regime should be started. An incision should not be made on a cold abscess for drainage, as it almost always invites secondary infection and forms a persistent sinus. Aspiration may be attempted through the normal surrounding skin and not the most prominent and most dependent part as this will innvariably cause sinus formation.
BPKIHS Anatomy Past Questions for MBBS and BDS Second Year - Basic Sciences : Central Nervous System
Anatomy
2016
1. Draw a well-labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2. Write down the blood supply of internal capsule with suitable diagram. 5
3. Mention the blood vessels forming the Circle of Willis along with a diagram. 5
4. Name the lobes of the cerebral cortex. Name the functional areas & the functions related to any one lobe of the cerebral cortex. 5
5. Write a short note on: 2x5=10
a. Medial Medullary Syndrome
b. Nuclei of thalamus
2015
1. Draw a well-labeled diagram of T.S. of midbrain at the level of the superior colliculus. 5
2. Draw a well-labeled diagram of T.S. of spinal cord showing ascending and descending tracts. 5
3. Draw a labeled histological diagram of cerebrum.5
4. Mention nuclei of thalamus with suitable diagram. 5
5. Draw a labeled diagram of Circle of Willis. 5
6. Draw a labeled diagram of the floor of the fourth ventricle. 5
2014
1. Draw a labeled diagram of blood supply of spinal cord. 5
2. Draw a labeled diagram of T.S. of medulla at the level of secondary decussation. 5
3. Enumerate the structures present on the floor of the fourth ventricle with suitable diagram. 5
4. What is corpus callosum? Illustrate with the help of a diagram the different lobe of the cerebral hemisphere. 5
5. Draw a labeled diagram of the circle of Willis. 5
6. Mention the arterial supply of internal capsule. 5
2013
1. Draw a well-labeled diagram of the floor of the fourth ventricle. 5
2. Write blood supply of Internal Capsule. 5
3. Write about Medial lemniscus. 5
4. Write about the White matter of cerebrum. 5
5. Write about the Lateral Medullary Syndrome. 5
6. Draw a labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2012
1. Draw a labeled diagram of the floor of the 4th ventricle. What is neurobiotaxis? 5
2. Name the nuclei of the cerebellum with the phylogenetic origin and draw a labeled diagram of these nuclei. 4+1=5
3. With well-labeled diagram write briefly about the floor of the fourth ventricle. 5
4. What are the structures present in the floor of 4th ventricle? 2.5
5. Write the venous drainage of the cerebrum. 2.5
6. Draw a labeled diagram of Circle of Willis. 5
7. What are the functions of Broadman’s areas 39 and 40? Where are they located? 5
2011
1. Write briefly on: 3x5=15
a. Lateral spinothalamic tract.
b. Red Nucleus.
c. Lateral medullary syndrome
2. Enumerate the deep cerebellar nuclei and write the features of the cerebellar syndrome. 2+3=5
3. Illustrate with a labeled diagram the:
a. Arterial supply of superolateral surface of the cerebrum. 5
b. Structures at the floor of 4th ventricle. 5
2016
1. Draw a well-labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2. Write down the blood supply of internal capsule with suitable diagram. 5
3. Mention the blood vessels forming the Circle of Willis along with a diagram. 5
4. Name the lobes of the cerebral cortex. Name the functional areas & the functions related to any one lobe of the cerebral cortex. 5
5. Write a short note on: 2x5=10
a. Medial Medullary Syndrome
b. Nuclei of thalamus
2015
1. Draw a well-labeled diagram of T.S. of midbrain at the level of the superior colliculus. 5
2. Draw a well-labeled diagram of T.S. of spinal cord showing ascending and descending tracts. 5
3. Draw a labeled histological diagram of cerebrum.5
4. Mention nuclei of thalamus with suitable diagram. 5
5. Draw a labeled diagram of Circle of Willis. 5
6. Draw a labeled diagram of the floor of the fourth ventricle. 5
2014
1. Draw a labeled diagram of blood supply of spinal cord. 5
2. Draw a labeled diagram of T.S. of medulla at the level of secondary decussation. 5
3. Enumerate the structures present on the floor of the fourth ventricle with suitable diagram. 5
4. What is corpus callosum? Illustrate with the help of a diagram the different lobe of the cerebral hemisphere. 5
5. Draw a labeled diagram of the circle of Willis. 5
6. Mention the arterial supply of internal capsule. 5
2013
1. Draw a well-labeled diagram of the floor of the fourth ventricle. 5
2. Write blood supply of Internal Capsule. 5
3. Write about Medial lemniscus. 5
4. Write about the White matter of cerebrum. 5
5. Write about the Lateral Medullary Syndrome. 5
6. Draw a labeled diagram of the transverse section of midbrain at the level of the superior colliculus. 5
2012
1. Draw a labeled diagram of the floor of the 4th ventricle. What is neurobiotaxis? 5
2. Name the nuclei of the cerebellum with the phylogenetic origin and draw a labeled diagram of these nuclei. 4+1=5
3. With well-labeled diagram write briefly about the floor of the fourth ventricle. 5
4. What are the structures present in the floor of 4th ventricle? 2.5
5. Write the venous drainage of the cerebrum. 2.5
6. Draw a labeled diagram of Circle of Willis. 5
7. What are the functions of Broadman’s areas 39 and 40? Where are they located? 5
2011
1. Write briefly on: 3x5=15
a. Lateral spinothalamic tract.
b. Red Nucleus.
c. Lateral medullary syndrome
2. Enumerate the deep cerebellar nuclei and write the features of the cerebellar syndrome. 2+3=5
3. Illustrate with a labeled diagram the:
a. Arterial supply of superolateral surface of the cerebrum. 5
b. Structures at the floor of 4th ventricle. 5
Inspirational Story : Struggle is necessary for Success
A man found a cocoon of a butterfly. One day a small opening appeared, he sat and watched the butterfly for several hours as it struggled to force its body through that little hole. Then it seemed to stop making any progress. It appeared as if it had gotten as far as it could and it could go no further.
Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily. But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened! In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.
What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.
Sometimes struggles are exactly what we need in our life. If we were allowed to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been. And we could never fly.
Then the man decided to help the butterfly, so he took a pair of scissors and snipped off the remaining bit of the cocoon. The butterfly then emerged easily. But it had a swollen body and small, shriveled wings. The man continued to watch the butterfly because he expected that, at any moment, the wings would enlarge and expand to be able to support the body, which would contract in time. Neither happened! In fact, the butterfly spent the rest of its life crawling around with a swollen body and shriveled wings. It never was able to fly.
What the man in his kindness and haste did not understand was that the restricting cocoon and the struggle required for the butterfly to get through the tiny opening were nature’s way of forcing fluid from the body of the butterfly into its wings so that it would be ready for flight once it achieved its freedom from the cocoon.
Sometimes struggles are exactly what we need in our life. If we were allowed to go through our life without any obstacles, it would cripple us. We would not be as strong as what we could have been. And we could never fly.
Transform your greatest weakness into your greatest strength
Weakness to Strength
There was once a 10 year old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training, the master had taught him only one move.
“Sensei,” the boy finally said, “shouldn’t I be learning more moves?”
“This is the only move you know, but this is the only move you’ll ever need to know,” the sensei replied.
Not quite understanding, but believing in his teacher, the boy kept training.
Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match.
Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a timeout. He was about to stop the match when the sensei intervened.
“No,” the sensei insisted, “Let him continue.”
Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.
On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind.
“Sensei, how did I win the tournament with only one move?”
“You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. Second, the only known defense for that move is for your opponent to grab your left arm.”
The boy’s biggest weakness had become his biggest strength.
There was once a 10 year old boy who decided to study judo despite the fact that he had lost his left arm in a devastating car accident. The boy began lessons with an old Japanese judo master. The boy was doing well, so he couldn’t understand why, after three months of training, the master had taught him only one move.
“Sensei,” the boy finally said, “shouldn’t I be learning more moves?”
“This is the only move you know, but this is the only move you’ll ever need to know,” the sensei replied.
Not quite understanding, but believing in his teacher, the boy kept training.
Several months later, the sensei took the boy to his first tournament. Surprising himself, the boy easily won his first two matches. The third match proved to be more difficult, but after some time, his opponent became impatient and charged; the boy deftly used his one move to win the match.
Still amazed by his success, the boy was now in the finals. This time, his opponent was bigger, stronger, and more experienced. For a while, the boy appeared to be overmatched. Concerned that the boy might get hurt, the referee called a timeout. He was about to stop the match when the sensei intervened.
“No,” the sensei insisted, “Let him continue.”
Soon after the match resumed, his opponent made a critical mistake: he dropped his guard. Instantly, the boy used his move to pin him. The boy had won the match and the tournament. He was the champion.
On the way home, the boy and sensei reviewed every move in each and every match. Then the boy summoned the courage to ask what was really on his mind.
“Sensei, how did I win the tournament with only one move?”
“You won for two reasons,” the sensei answered. “First, you’ve almost mastered one of the most difficult throws in all of judo. Second, the only known defense for that move is for your opponent to grab your left arm.”
The boy’s biggest weakness had become his biggest strength.
Gas Gangrene
- Gas gangrene is a rapid spreading infective gangrene of the muscles characterized by collection of gas in the muscles and subcutaneous tissue. It is also called "Clostridial myonecrosis".
- Gas Gangrene is most likely to develop in wounds where there has been extensive laceration or devitalization of muscle mass with gross contamination of the wound by soil and other foreign bodies.
- Clostridial organisms can be divided into two groups - namely Saccharolytic and Proteolytic. Of the Saccharolytic group of anaerobes, Clostridium perfringes (Cl. welchii) plays the main part in gas gangrene.
- Other organisms that cause gas gangrene are Clostridium oedematiens, Clostridium septicum, Clostridium histolyticum, and Clostridium bifermentans.
- Two important factors necessary for the formation of gas gangrene include :
- Entry of Clostridial organisms, particularly Clostridium perfringes (Cl. welchii), and
- Anaerobic conditions within the wound
- Diabetes and other occlusive arterial diseases predispose to gas gangrene.
- The various exotoxins produced by these organisms (particularly Clostridium welchii) are:
| Alpha toxin (Lecithinase) | Is hemolytic, and splits lecithin to phosphocholine and diglyceride. |
| Collagenase | Is a proteinase and breaks down collagen |
| Hyaluronidase | Breaks down hyaluronic acid |
| Theta toxin | Is hemolytic, lethal and necrotic |
| Leucocidin | Kills the leucocytes |
- Clostridial invasion affects the whole of the involved muscle from origin to insertion producing a foul smelling necrosis of the muscle which becomes dull red to green and ultimately black in appearance.
- The muscle becomes green to black due to the action of the sulphurated hydrogen on iron liberated from broken down muscle hemoglobin. The gas is chiefly hydrogen, being odorless in the beginning, but soon it becomes fetid due to the liberation of sulphurated hydrogen (H2S), ammonia and volatile gases.
TYPES OF GAS GANGRENE
| Clostridial cellulitis | Crepitant infection involving necrotic tissue, but healthy muscle is not involved and is characterized by foul smelling, seropurulent infection of a wound. |
| Single muscle type | Limited to one muscle only |
| Group type | Limited to one group of muscles, eg. extensors of the thigh |
| Massive type | Involves almost whole muscle mass of one limb |
| Fulminating type | Spreads very rapidly even beyond the limb, associated with intense toxemia |
- The most characteristic feature of gas gangrene is profuse discharge of brownish, foul smelling fluid between the sutures and the presence of crepitus due to presence of gas in the muscle and subcutaneous tissue.
- The first prophylactic step in the prevention of gas gangrene wound is excision or debridement in which all the devitalized tissues, blood clots, dead and damaged muscles and foreign bodies should be removed.
Subscribe to:
Posts (Atom)