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The first heart sound is loud in all of the following EXCEPT

 # The first heart sound is loud in all of the following EXCEPT:
 A. Mitral stenosis
B. Short PR interval
C. Tachycardia
D. Mitral valve calcification




The correct answer is D. Mitral valve calcification.

The intensity of the first sound is primarily related to the position of the atrioventricular valves at the onset of ventricular systole.

The first sound is usually louder in subjects with a short PQ interval than in those with a long PQ interval.

Loud first heart sound: is seen in mitral stenosis, left atrial myxoma, conditions that increase myocardial contractility, including hyperadrenergic states (e.g. exercise, anxiety, anemia, fever, pregnancy, and thyrotoxicosis) and in patients with thin chest walls. 

A loud first heart sound is a hallmark of hemodynamically significant mitral stenosis. Mobile but stiff mitral leaflets produce a loud S1 unless the leaflets are heavily calcified. The main reason for the increase in the intensity of S1 in these conditions is the increased rate of pressure development in the ventricles. 

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Instrument of choice for biomechanical preparation in fine root canals of double curved canals is

 # Instrument of choice for biomechanical preparation in fine root canals of double curved canals is:
 A. H file
B. K flex file
C. Unifile
D. Reamer


The correct answer is A. H file.

H file or S file is also used for finishing coronal third of root canal. It is also used for biomechanical preparation of fine canals. Used for flaring the fine and double curved root canals and is used in McSpadden compaction technique.



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Triangular instruments while cutting canals will have to rotate how much to complete one turn?

 # Triangular instruments while cutting canals will have to rotate _______ to complete one turn.
A. ¼ turn
B. ½ turn
C. 1/3 turn
D. Full turn




The correct answer is C. 1/3 turn.

The triangular shaft requires a one-third (120 degrees) rotation of the instrument to complete a cutting circle of the root. For cutting action in a canal, a traingular shaft instrument requires 1/3 turn. These cutting points are at 120 degrees to each other and they move simultaneously. So, a 1/3 turn or 120 degree turn will bring about a complete cuttting circle. 



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The best instrument for cutting dentin is:

 # The best instrument for cutting dentin is:
A. Reamer
B. File
C. Broach
D. Explorer



The correct answer is A. Reamer.

Reamer contains sharp cutting edges that are spaced further apart than the file and therefore it is engaged in dentin more rapidly and readily facilitates dentin removal.

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In which region are chief cells located in the gastric gland?

 # Chief cells are located in gastric gland in the region?
 A. Fundus
 B. Isthmus
C. Neck
D. Equally spread



The correct answer is A. Fundus.

Gastric gland is composed of three types of cells:
A. Mucous neck cells - secrete mainly mucus but also some pepsinogen
B. Peptic/chief cells - Secrete pepsinogen in body and fundus
C. Parietal/Oxyntic cells- Secrete hydrochloric acid and intrinsic factor


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Oral pain, erythematous gingival tissues, blunted papillae spontaneous gingival bleeding, and no attachment loss

 # A 19 year old patient presents with oral pain, erythematous gingival tissues, blunted papillae spontaneous gingival bleeding, and no attachment loss. There is also a pseudomembrane covering the gingiva. Which of the following is the diagnosis for this patient?
A. Plaque associated gingivitis
B. Necrotizing ulcerative gingivitis
C. Aggressive periodontitis
D. Chronic periodontitis
E. Necrotizing ulcerative periodontitis





The correct answer is B. Necrotozing ulcerative gingivitis.

Necrotizing ulcerative gingivitis and periodontitis usually occurs
because of the predominance of the anaerobic fusobacteria and
spirochetes within the oral cavity, specifically underneath the gingiva.

This is a case of Necrotizing ulcerative gingivitis (NUG) NOT
necrotizing ulcerative periodontitis (NUP) because the patient is not
experiencing bone loss.

Debridement of the affected gingiva with an adjunctive prescription
of chlorhexidine 0.12 % rise will help stop the progression of
necrotizing ulcerative disease.

Acute necrotizing gingivitis signs/ symptoms:
  1. Pain
  2. Interproximal necrosis of the papilla (Blunting of papilla)
  3. Bleeding gingiva
  4. Fetid odor
  5. Low-grade fever
  6. Pseudomembrane

Acute necrotizing gingivitis risk factors:
  1. Poor oral hygiene
  2. Smoking
  3. Malnutrition
  4. Fatigue
  5. Stress
  6. Immunocompromised patients


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Strongest indication for splinting

 # Which of the following patient conditions is the strongest indication for splinting?
A. Mobility with a unilateral shift from centric relation to centric occlusion
B. Mobility with discomfort
C. Presence of diastemas
D. Primary occlusal trauma



The correct answer is B. Mobility with discomfort.

Unstable teeth that cannot maintain normal position during centric occlusion need additional support to maintain position and therefore must be splinted to the adjacent teeth.

Presence of a diastema does not necessarily require splinting except when the diastema is caused by the movement of teeth due a periodontally compromised status.

Primary occlusal trauma can be resolved once the cause of trauma
is removed.

Discomfort associated with tooth mobility may:
• Be due to other periodontal conditions
• Be due to pulpal conditions
• NOT be a direct indication alone for splinting therapy


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