Oral Medicine and Radiology COMS, Teaching Hospital, Bharatpur IV year BDS Send Up Exam 2019

COLLEGE OF MEDICAL SCIENCES. TEACHING HOSPITAL BHARATPUR

          Dec-Jan 2019-2020

Level: IV BDS                                                                                                                            Exam: Send up

Subject: Oral Medicine                                                                                                              Time: 2 hr. 30 mins.
Date 4/11/2019                                                                                                                          Full marks: 50

INSTRUCTIONS TO THE CANDIDATE

• Write brief, relevant and legible answers
• Illustrate your answer with a well labeled diagrams wherever required. 
• All questions are compulsory. 

SECTION 'B' [25Marks]

1.A 40 year old male patient visited the department with a chief complaint of pain and swelling in right side below the ear and behind the angle of the mandible. Patient gives a history of increased pain while eating food which subsides after meals. On clinical examination, there is pus discharge from a point in right buccal mucosa opposite to maxillary 2nd molar. 

Give the provisional diagnosis and discuss it in detail.               [2+4=6]

2. Define pain. Discuss in-detail about gate control theory.        [1+4=5]

3. Discuss in detail about radiotherapy. Mention the advantages and disadvantages of radiotherapy when compared with a surgical option.                                           [3+2=5]

4. Write short notes on: [3*3=9]

• Oral thrush
• Treatment of aphthous ulcers
• Corticosteroids in dentistry

SECTION "C" [25 Marks]

5. Discuss the image characteristics in detail.                              [6]
6. What is a bitewing radiograph? Give the advantages, disadvantages, indications, and uses of bitewing radiographs.      [1+4 =5]

7. Describe in detail the methods to reduce x-ray hazards.    [5]

8. Write short notes on :               [3x3=9]

• PA skull view
• Braking radiation
• Composition of fixing solution

Most common bone cancer:

# The most common bone cancer is (AlIMS 94, AIPG 99)
a) Osteosarcoma
b) Metastatic bone cancer
c) Multiple myeloma
d) Squamous cell carcinoma

The correct answer is: B. Metastatic bone cancer.

Metastatic cancers are most common cancers in bone. Multiple myeloma is the common primary bone tumor, whereas the common inherent bone cell tumor is osteogenic sarcoma or osteosarcoma.

Bifid ribs and Falx Cerebri Calcification

# Bifid ribs, multiple radiolucent lesions of the jaws, multiple basal cell nevi and falx ceribri calcification are found in (Man 98, 97)
a) Basal cell nevus syndrome
b) Sturge weber syndrome
c) Horner syndrome
d) Hereditary internal polyposis

The correct answer is A. Basal cell nevus syndrome.

Basal cell nevus syndrome is also called as Gorlin Goltz syndrome.

Horner's syndrome is characterized by miosis, ptosis and anhidrosis over face due to interruption of sudomotor and vasomotor control.

Hereditary intestinal polyposis is seen in Peutz-Jeghers syndrome.

Most aggresive odontogenic tumor

# Which of the following tumors is most aggressive? (AIPG 91, AIIMS2004)
a) Ameloblastoma
b) Odontoma
c) Odontogenic myxoma
d) Fibrocarcinoma

The answer is C. Odontogenic myxoma

ODONTOGENIC MYXOMAS

Aggressive, intraosseous neoplasms derived from embryonic odontogenic mesenchyme probably arise from the dental papilla or follicular mesenchyme. Nearly all lesions are found in the tooth bearing areas of maxillary and mandibular bone.

Mandibular lesions are commonly found in the premolar-molar area. The lesions often produce multilocular radiolucency with a "soap bubble' or "honey comb" appearance in the bone.

Thin and extremely delicate septa of bone are often seen to course through the radiolucent area and produce a "spider- web" like or "tennis racket" like appearance.

 (Ref: Shafer's Textbook of oral pathology 7h ed., p 299)

Type II Diabetes Causes

# Obesity, genetic profile, and aging all contribute to the development of Type II diabetes. Of the following, which is the most important additive factor for these three conditions in the development of Type II diabetes?

A. elevated hepatic ketogenesis
B. elevated pancreatic glucagon secretion
C. impaired renal clearance of glucose
D. muscle resistance to insulin

Answer: D - Muscle resistance to insulin is the most important additive factor for these three conditions in the development of Type II diabetes. The progressive loss of skeletal muscle sensitivity to insulin leads to increased rates of visceral cell lipolysis and pancreatic beta-cell compensation.

Parasympathetic Cranial nerves

# # All of cranial nerve have parasympathetic outflow except :
A. 5th nerve
B. 7th nerve
C. 3rd neve
D. 9th nerve

The correct answer is A. 5th nerve

Cranial nerves having parasympathetic now are 3,7,9 and 10.

Preganglionic parasympathetic neuron cell bodies are located in certain cranial nerve nuclei of the brain stem and in the grey matter of the second to fourth sacral segments of the spinal cord. Efferent fibres, which are myelinated, emerge from the CNS only in cranial nerves III, VII, IX, and X and in the second to fourth sacral spinal nerves. Preganglionic parasympathetic neurons are cholinergic. 

The only cranial nerve which arises on the dorsal aspect   -       Trochlear

The cranial nerve with longest intracranial coarse              -        Abducent

The cranial nerve with longest coarse                                 -       Vagus

The cranial nerve involved in raised intracranial tension   -       Abducent nerve

Cranial nerve carrying parasympathetic fibres                      -       3,7,9,10

Commonest cranial nerve affected in spinal anesthesia     -       Abducent nerve

Cranial nerve involved in Bell's palsy                                 -       VII Nerve

Cranial nerve involved in Ramsay Hunt Syndrome             -       VII nerve

Cranial nerve arising from the pons                                    -     V, VI, VII, VII nerves

Pure sensory nerves                                                          -       1,2,8

Branchiomeric nerves                                                       -       5.7.9,10,11

Referred pain in Orofacial region:

# ___________most often refer pain to the temporal region,
while _________most often refer pain the ear.
A. Maxillary second premolars, mandibular molars
B. Maxillary molars, mandibular molars
C.  Maxillary second premolars, mandibular premolars
D. Maxillary molars, mandibular premolars

The correct answer is A. Maxillary second premolars, mandibular molars.

If careful diagnosis does not reveal the affected tooth, other teeth and related anatomic structures

become suspect. Pulpitis in one tooth may cause pain in other areas - the pain is referred.

Site of Pain Referral                             Pulp of Tooth Causing Pain

Forehead region                                    Maxillary incisors

Nasolabial area                                      Maxillary canines. premolars

Temporal region                                     Maxillary second premolars

Ear. angle of jaw, or posterior                 Mandibular molars

regions of neck

Mental region of mandible                        Mandibular incisors, canines. and premolars

Zygomatic, parietal, and occipital              Maxillary molars

regions of head

Opposing quadrant or to other                      Maxillary and mandibular molars

teeth in the same quadrant

Important: The nerve endings of cranial nerves VII, IX, and X are widely distributed within the subnucleus caudalis of the trigeminal (V) nerve. A profuse intermingling of these nerve fibers creates the potential for the referral of dental pain to many sites.

Orofacial pain can be the clinical manifestation of a variety of diseases involving the head and neck region. The cause of the pain must be differentiated between odontogenic and nonodontogenic.

Characteristics of nonodontogenic involvement:

• Episodic pain with pain-free remissions

• Trigger points

• Pain travels and crosses the midline of the face

• Pain that surfaces with increasing stress

• Pain that is seasonal or cyclic

• Pain accompanied by paresthesia