Medication required preoperatively for a patient with mitral valve replacement

 # Which of the following medication is required preoperatively for a patient with mitral valve replacement?

A. Ampicillin

B. Cloxacillin

C. Benzathine penicillin

D. Procaine penicillin

The correct answer is: A. Ampicillin. 

Cardiac Conditions Associated with the Highest Risk of Adverse Outcome from Endocarditis for Which Prophylaxis with Dental Procedures Is Recommended

• Prosthetic cardiac valve

• Previous infective endocarditis

• Congenital heart disease (CHD)*

-Unrepaired cyanotic CHD, including palliative shunts and conduits

- Completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first 6 months after the procedure†

- Repaired CHD with residual defects at the site or adjacent to the site of a prosthetic patch or prosthetic device (which inhibit endothelialization)

• Cardiac transplant recipients who have cardiac valvulopathy

*Except for the conditions listed above, antibiotic prophylaxis is no longer recommended for any other form of CHD.

†Prophylaxis is recommended because endothelialization of prosthetic material occurs within 6 months after the procedure.

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The CAT in pediatric dentistry is:

 # The CAT in pediatric dentistry is:

A. Caries activity test

B. Caries Advancement Test

C. Caries risk assessment tool

D. Child Aptitude Test

The correct answer is: C. Caries risk assessment tool.

The American Academy of Pediatric Dentistry (AAPD) recognizes that caries-risk assessment and management protocols, also called care pathways, can assist clinicians with decisions regarding treatment based upon child’s age, caries risk, and patient compliance and are essential elements of contemporary clinical care for infants, children, and adolescents. These recommendations are intended to educate healthcare providers and other interested parties on the assessment of caries risk in contemporary pediatric dentistry and aid in clinical decision-making regarding evidence- and risk-based diagnostic, fluoride, dietary, and restorative protocols.

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A stone present in salivary duct leads to:

 # A stone present in salivary duct leads to:

A. Hyperplasia of salivary gland

B. Hyperplasia of salivary duct

C. Dysplasia of salivary gland

D. Metaplasia of salivary duct

The correct answer is D. Metaplasia of salivary duct.

The duct associated with sialolithiasis exhibits squamous, oncocytic or mucus cell metaplasia.

- Periductal inflammation may also be seen. 

Sialolith is most common in submandibular glands. The main composition of sialoliths found in salivary glands is Calcium phosphate - 75%.

The higher rate of sialolith formation (80-90% of cases) occur in submandibular gland due to:

- Tortuous course of Wharton's duct.

- Higher calcium and phosphate levels

- The saliva from this gland is secreted into oral cavity through ducts against gravity that make them more prone to stasis

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Treatment of recurrent ranula is:

 # Treatment of recurrent ranula is:

A. Incision

B. Excision

C. Excision with adjacent glands

D. Marsupialization

The correct answer is: C. Excision with adjacent glands.

Treatment for recurrent ranula is enucleation of mucocele involving mucous gland and surrounding tissue.

Large ranulas can be best treated by marsupialization whereas the recurrent ranulas are best treated by sublingual gland excision. 

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Most common cause of mucocele is:

 # Most common cause of mucocele is:

A. Rupture of a salivary duct

B. Partial or complete compression of the salivary acini

C. Inflammatory changes in the glandular interstitial tissue

D. Partial or complete obstruction of the salivary duct by calculus

The correct answer is: A. Rupture of a salivary duct

Mucoceles often have been classified as:

(1) an extravasation mucocele, - mostly originates due to rupture of salivary duct following trauma that results in pooling of saliva and consequent swelling.

(2) a retention mucocele (or true retention cyst) - true retention cyst, arises due to obstruction of the duct by sialoliths (salivary duct stones)

The extravasation type is far more common than the retention type.

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High content of cholesterol is present in:

 # High content of cholesterol is present in:

A. Coconut oil

B. Egg yolk

C. Hydrogenated fat

D. Ghee (Unsaturated)

The correct answer is B. Egg yolk.

Cholesterol is exclusively found in animals and is the most abundant animal sterol. It is a major component of cell membranes and lipoproteins.

Elevation of serum cholesterol beyond 200 mg/dL increases the risk of atherosclerosis and coronary heart diseases. 

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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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