Seizure in the dental clinic

# Which of the following is true concerning a young epileptic who has a grand mal seizure in the dental office?
A. It is generally fatal
B. It is best treated by injecting insulin
C. They generally recover if restrained from self-injury and oxygen is maintained
D. It can be prevented with antibiotics

 The correct answer is C. They generally recover if restrained from self-injury and oxygen is maintained

Of the multiple types of seizures, the tonic-clonic (grand mal) type is the most frightening and the one that most often requires treatment. Grand mal seizures are manifested in four phases: the prodromal phase, the aura, the convulsive (ictal) phase, and the postictal phase.

The prodromal phase consists of subtle changes that may occur over minutes to hours. It is usually not clinically evident to the clinician or the patient. The aura is a neurologic experience that the patient goes through immediately prior to the seizure. It is specifically related to trigger areas of the brain in which seizure activity begins. It may consist of a taste, a smell, a hallucination, motor activity, or other symptoms. As the CNS discharge becomes generalized, the ictal phase begins. The patient loses consciousness, falls to the floor, and tonic, rigid skeletal muscle contraction ensues. This usually lasts 1 to 3 minutes.

As this phase ends, the muscles relax and movement stops. A significant degree of CNS depression is usually present during this postictal phase, and it may result in respiratory depression. Management of the seizure consists of gentle restraint and positioning of the patient in order to prevent self-injury, ensuring adequate ventilation, and supportive care, as indicated, in the postictal phase, especially airway management. Single seizures do not require drug therapy because they are self-limiting.

Important: Should the ictal phase last longer than 5 minutes or if seizures continue to develop with little time between them, a condition called status epilepticus has developed. This may be a life-threatening medical emergency. This condition is best treated with intravenous diazepam, and transport should be arranged to take the patient to the hospital.

Oral manifestation of Achondroplasia

 # An outstanding oral manifestation of achondroplasia is:

A. Rampant caries

B. Periodontal disease

C. Overcrowding of teeth

D. Supernumerary teeth

The correct answer is C. Overcrowding of teeth.

Achondroplasia is the most common form of short-limb dwarfism. It occurs in all races and with equal frequency in males and females. An individual with achondroplasia has a disproportionate short stature -- the head is large and the arms and legs are short when compared to the trunk length. Other signs are a prominent forehead and a depressed bridge of the nose. Many of these children die during the first year of life. Deficient growth in the cranial base is evident in many children that survive.

Important: The maxilla may be small with the resultant crowding of the teeth.

Note: A Class III malocclusion is very common.

Remember: The oral manifestations of the following disorders in children:

• Gigantism: enlarged tongue, mandibular prognathism, teeth are usually tipped to the buccal or lingual side, owing to enlargement of the tongue. Roots may be longer than normal.

• Pituitary dwarfism: the eruption rate and the shedding of the teeth are delayed, clinical crowns appear smaller as do the roots of the teeth, the dental arch as a whole is smaller causing malocclusion, and the mandible is underdeveloped.

Iron content in each ml of blood

 # Each milliliter of red cells contain how much elemental iron ?

A. 1 mg

B. 2 mg

C. 3 mg

D. 4 mg

The correct answer is A. 1 mg.

Each milliliter of red cells contains 1 mg of elemental iron.

Ref: Harrison’s 18th Ed. 845

Flexural strength

# The term "flexural strength" describes a material with the ability do which of the following?
A. Be visually detectable in radiographs
B. Sustain deformation without permanent change in
size or shape
C. Resist fracture during bending
D. Resist the propagation of a crack

The correct answer is C. Resist fracture during bending. 

Flexural strength is the ability of a material

to resist fracture while bending and is also

known as modulus of rupture, bend

strength, or fracture strength.

The transverse bending test is most

frequently employed to evaluate the flexural strength of a material using a 3-point flexural test technique.

The flexural strength gives the highest

stress experienced within the material at its

moment of rupture.

The significance of flexural strength is

commonly expressed in class V cervical

restorations.

Low tensile and high compressive strength

# A material with a low tensile strength and high compressive strength can be described as which of the following?
A. Ductile
B. Malleable
C. Resilient
D. Brittle
E. Tough

The correct answer is D. Brittle. 

Brittle materials can be hard solid materials

that can withstand heavy compression but

not tension.

Brittle materials exhibit low tensile strength and may fracture or break instead of being deformed when under tensile stress.

Ductile materials exhibit high tensile

strength and low compressive strength,

making them capable of being drawn into

wires.

Excessive segmentation of nucleus of neutrophils

# Excessive segmentation of nucleus of neutrophils is a manifestation of ?
A. Folate or vitamin B12 deficiency
B. Iron deficiency
C. Thalassemia
D. Repeated blood transfusion

The correct answer is: A. Folate or vitamin B12 deficiency.

Nucleus of neutrophils normally contains up to four segments. Excessive segmentation (>5

nuclear lobes) is seen in folate or vitamin B12 deficiency & congenital neutropenia syndrome of

warts, hypogammaglobulinemia, infections & myelokathexis (WHIM).

Ref: Harrison’s 18th Ed. 473

Contraindication for splenectomy

# Which out of the following is a contraindication for splenectomy ?
A. Iatrogenic splenic rupture
B. Thrombocytopenia
C. Presence of bone marrow failure
D. Hairy cell leukemia

The correct answer is C. Presence of bone marrow failure.

The only contraindication to splenectomy is the presence of marrow failure, in which the

enlarged spleen is the only source of hematopoietic tissue.

Ref: Harrison’s 18th Ed. 471