Most common oral change of nutritional anemia is:

# Most common oral change of nutritional anemia is:

A. Atrophic glossitis

B. Leukoplakia

C. Lichen planus

D. Hypertrophic glossitis

The correct answer is A. Atrophic glossitis.

Glossitis is one of the more common symptoms of pernicious anemia. The patients complain of

painful and burning lingual sensations which may be so annoying that the dentist is often consulted first for local relief. The tongue is generally inflamed, often described as ‘beefy red’ in color, either in entirety or in patches scattered over the dorsum and lateral borders. In some cases, small and shallow ulcers — resembling aphthous ulcers — occur on the tongue. Characteristically, with the glossitis, glossodynia and glossopyrosis, there is gradual atrophy of the papillae of the tongue that eventuate in a smooth or ‘bald’ tongue which is often referred to as Hunter’s glossitis or Moeller’s glossitis and is similar to the ‘bald tongue of Sandwith’ seen in pellagra. Loss or distortion of taste is sometimes reported accompanying these changes. The fiery red appearance of the tongue may undergo periods of remission, but recurrent attacks are common.

Shafer 7th Edition, Page no: 763

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Cyanosis of lips is a common finding in all EXCEPT:

# Cyanosis of lips is a common finding in all EXCEPT:

A. Polycythemia

B. Sickle cell anemia

C. Iron deficiency anemia

D. Congenital heart disease

The correct answer is: C. Iron deficiency Anemia.

In general， cyanosis becomes apparent when,  the concentration of reduced hemoglobin in capillary blood exceeds 40 g/L (4 g/dL). It is the absolute，rather than the relative，quantity of reduced hemoglobin that is important in producing cyanosis. Thus, in a patient with severe anemia，the relative quantity of reduced hemoglobin in the venous blood may be very large when considered in relation to the total quantity of hemoglobin in the blood. However, since the concentration of the latter is markedly reduced, the absolute quantity of reduced hemoglobin may still be low, and， therefore， patients with severe anemia and even marked arterial desaturation may not display cyanosis. Conversely， the higher the total hemoglobin content， the greater the tendency toward cyanosis; thus， patients with marked polycythemia tend to be cyanotic at higher levels of Sao， than patients with normal hematocrit values.

CAUSES OF CYANOSIS

Central Cyanosis

1. Decreased arterial oxygen saturation

     A. Decreased atmospheric pressure- high altitude

     B. Impaired pulmonary function

          - Alveolar hypoventilation

          - Inhomogeneity in pulmonary ventilation and perfusion (perfusion of hypoventilated alveoli)

          - Impaired oxygen diffusion

     C. Anatomic shunts

         - Certain types of congenital heart disease

         - Pulmonary arteriovenous fistulas

         - Multiple small intrapulmonary shunts

    D. Hemoglobin with low affinity for oxygen

2. Hemoglobin abnormalities

    A. Methemoglobinemia-hereditary，acquired

    B. Sulfhemoglobinemia-acquired

    C. Carboxyhemoglobinemia (not true cyanosis)

Peripheral Cyanosis

A. Reduced cardiac output

B. Cold exposure

C. Redistribution of blood flow from extremities

D. Arterial obstruction

E. Venous obstruction

Ref: Harrison's 19th edition, Page 249

Dietary approaches to stop hypertension (DASH) approximately reduces systolic blood pressure by:

# Dietary approaches to stop hypertension (DASH) approximately reduces systolic blood pressure by:

a. 2-4mm Hg

b. 4-9mm Hg

c. 2-8mm Hg

d. 8-14mm Hg

The correct answer is D. 8-14 mm Hg.

Limitation of alcohol consumption will lower by 2-4mm Hg, physical activity will

reduce by 4-9mm Hg and dietary sodium reduction will lower by 2-8mm Hg. Adoption of DASH eating plan will reduce SBP by 8-14 mm Hg.

Ref: Burkett 12th ed, page number: 366

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 # Cytomegalovirus that causes severe oral ulcers is also known as:

a. HHV 5

b. HHV4

c. HHV 2

d. HHV1

The correct answer is B. HHV4

HHV 4 is also known as cytomegalovirus, HHV 5 is Epstein barr, HHV 2 is herpes

simplex virus 2 and HHV 1 is herpes simplex virus 1. 

Ref: Burkett 12th ed, page number: 59

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A patient with mitral valve replacement will require which of the following preoperatively

# A patient with mitral valve replacement  will require which of the following preoperatively?

A. Benzathine Penicillin

B. Tetracycline

C. Procaine penicillin

D. Vibramycin

 

The correct answer is A. Benzathine Penicillin.

Benzathine and procaine penicillins are formulated to delay absorption, resulting in prolonged blood and tissue concentrations. A single intramuscular injection of 1.2 million units of benzathine penicillin maintains serum levels above 0.02 mcg/mL for 10 days, sufficient to treat β-hemolytic streptococcal infection. After 3 weeks, levels still exceed 0.003 mcg/mL, which is enough to prevent β-hemolytic streptococcal infection. A 600,000 unit dose of procaine penicillin yields peak concentrations of 1–2 mcg/mL and clinically useful concentrations for 12–24 hours after a single intramuscular injection.

Reference: Basic and Clinical Pharmacology, 13th Edition, Katzung, Page 773

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Petechial hemorrhage is characteristic of which of the following condition

 # Petechial hemorrhage is characteristic of which of the following condition?

A. Agranulocytosis

B. Neutropenia

 C. Pernicious anemia

 D. Thrombocytopenic purpura

The correct answer is D. Thrombocytopenic purpura.

Petechial purpura is minor bleeding into the dermis that is flat and non-blanching. Petechiae are typically found in patients with thrombocytopenia or platelet dysfunction. Palpable purpura occurs in vasculitis. Ecchymosis, or bruising, is more extensive bleeding into deeper layers of the skin. The

lesions are initially dark red or purple but become yellow as haemoglobin is degraded.

Reference: Davidson's Principles and Practice of Medicine, 22nd Edition, Page No. 1007

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Bacteria found in gingivitis are localized in:

 # Bacteria found in gingivitis are localized in:

A. Connective tissue fibres

B. Gingival Sulcus

C. Alveolar bone

D. Periodontal ligament

The correct answer is B. Gingival sulcus.

The pathologic changes of gingivitis are associated with the presence of oral microorganisms attached to the tooth and perhaps in or near the gingival sulcus.

Reference: Carranza's Clinical Periodontology, 12th Edition, Page no: 219

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