Earliest radiographic sign of osteomyelitis

 # The earliest radiographic sign of osteomyelitis is:

A. Solitary or multiple small radiolucent areas

B. Increased granular radiopacity

C. Blurring of trabecular outlines

D. Formation of sequestrum appearing as radiopaque patches

The correct answer is C. Blurring of Trabecular outlines.

Radiographic Features

Radiodensity—about 10 days after acute infection, the density of trabeculae will be decreased, with blurred and fuzzy. For the radiographs to reveal any changes, there must be a loss of from 30 to 60% in the calcium content.

Trabecular pattern—the earliest radiographic change is that trabeculae in the involved area are thin, of poor density and slightly unsharp or blurred. The trabeculae soon lose their continuity as well as the little density present. Individual trabeculae become fuzzy and indistinct.

Ref: Textbook of Oral Medicine, 2nd Edition, Anil Govindrao Ghom

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Treatment of Fordyce's granule

 # If one of your patient is having Fordyce’s granules in his buccal mucosa, what will be your line of treatment?

A. Excision

B. No treatment needed

C. Topical application of steroids

D. Surgery followed by radiotherapy

The correct answer is B. No treatment needed. 

Ref: Shafer's Textbook of Oral Pathology, page no. 25. These glands are innocuous, have no clinical or functional significance, and require no treatment. However, very rarely a benign sebaceous gland adenoma may develop from these intraoral structures.

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Anhidrotic ectodermal dysplasia affects:

 # A known case of anhidrotic ectodermal dysplasia is brought to hospital for treatment. Which area of the body do you find mostly affected in this case?

A. Spleen

B. Skin or ectoderm

C. Kidney

D. Thyroid gland

The correct answer is B. Skin or Ectoderm. 

The most commonly occurring ectodermal dysplasia is called as ‘hereditary hypohidrotic

(anhidrotic) ectodermal dysplasia’. This shows X-linked inheritance. 

Sex—males are affected more frequently than females.

Appearance—it is characterized by hypotrichosis, hypohydrosis and anhidrosis with saddle nose appearance.

Hairs—the hair of scalp and eyebrows tend to be fine, scanty and blond.

Frontal bosses- supraorbital and frontal bosses are pronounced.

Heat intolerance—skin is often dry, soft, smooth and scaly with partial or complete absence of sweat glands. Such patient cannot perspire and they usually suffer from hyperpyrexia and inability to endure warm temperature. 

Sibling appearance—facial appearance of these individual resemble to each other, enough to be mistaken for siblings.

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Nikolsky’s sign is a feature of:

 # Nikolsky’s sign is a feature of:

A. Lichen planus

B. Pemphigus

C. Herpes simplex

D. Lupus erythematosus

The correct answer is B. Pemphigus.

Nikolsky’s sign: It was named after Pytor Vasilyenich Nikolsky who was the first to describe this finding. On applying gentle mechanical pressure (e.g. blowing air or applying pressure with a mirror handle) on affected tissue will result in the formation of a lesion. Nikolsky’s sign is seen both in the skin and oral mucosa. It is seen in pemphigus, paraneoplastic pemphigus, mucous membrane pemphigoid, epidermolysis bullosa, linear IgA bullous disease, lupus erythematosus, graft-versus-host disease and toxic epidermal necrolysis.

Ref: Textbook of Oral Medicine, Oral Diagnosis and Oral Radiology,Ongole and Praveen, 2nd Edition, Page no. 235

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All are risk factors EXCEPT:

 # All are risk factors EXCEPT:

A. Tobacco smoking

B. Microbial tooth deposit

C. Diabetes

D. Bleeding on probing

The correct answer is D. Bleeding on Probing.

Categories of Risk Elements for Periodontal Disease

Risk Factors

Tobacco smoking

Diabetes

Pathogenic bacteria

Microbial tooth deposits

Risk Determinants/Background Characteristics

Genetic factors

Age

Gender

Socioeconomic status

Stress

Risk Indicators

HIV/AIDS

Osteoporosis

Infrequent dental visits

Risk Markers/Predictors

Previous history of periodontal disease

Bleeding on probing

Ref: Carranza's Clinical Periodontology, 12th Edition, page 392

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Pain on swallowing or turning the head

 # The pain on swallowing or turning the head associated with elongated styloid process is known as:

A. Tic douloureux

B. Gorham syndrome

C. Costen syndrome

D. Eagle’s syndrome

The correct answer is D. Eagle's syndrome.

Eagle’s syndrome. This syndrome consists of either elongation of the styloid process or ossification of the stylohyoid ligament causing dysphagia, sore throat, otalgia, glossodynia, headache, vague orofacial pain or pain along the distribution of the internal and external carotid arteries. Probably the most consistent symptom is pharyngeal pain. It is common for the difficulty to arise following tonsillectomy, presumably from fibrous tissue that forms and is stretched and rubbed over the elongated styloid process.

Ref: Shafer's Textbook of Oral pathology, 7th Edition, Page no. 862

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Which of the following is also known as trench mouth?

 # Which of the following is also known as trench mouth?

A. Noma

B. ANUG

C. Herpes gingivostomatitis

D. Herpes zoster

The correct answer is B. ANUG

Necrotizing ulcerative gingivitis frequently occurs in an epidemic pattern, sweeping through groups of

persons in close contact, especially those living under similar conditions. This was especially apparent during World War I, when the Allied troops suffered severely from the disease. It was here that the term ‘trench mouth’ originated, since the disease was especially prevalent among the troops in the trenches. Similar sporadic outbreaks also occurred during World War II.

Ref: Shafer's Textbook of Oral Pathology, 7th Edition, Page No. 396

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