Ulcers on palate, splenomegaly and lymphadenopathy with positive heterophile agglutination test

 # A 20-year-old female reports with ulcers on palate, splenomegaly and lymphadenopathy. Serum examination reveals positive heterophile agglutination test. What is the diagnosis? 

A. Rickettsia 

B. Measles 

C. Infectious Mononucleosis 

D. Chicken pox 

The correct answer is C. Infectious mononucleosis.

INFECTIOUS MONONUCLEOSIS 

• It is also called Glandular fever, kissing disease.

Clinical features: 

• Age: Children or young adults with peak incidence 15-20 yrs. In children, most cases are asymptomatic. 

• Fever, sore throat, headache, chills, nausea, vomiting, lymphadenopathy & hepatosplenomegaly are present. 

• Cervical lymph nodes are usually the 1st to exhibit enlargement. 

Oral manifestation: 

• Acute gingivitis & stomatitis present. 

• White grey membrane formation on various areas of oral & pharyngeal mucosa occurs. 

• Palatal Petechiae are often diagnostic. 

- Pin-point in size. 

- Present especially on soft palate & its junction with hard palate. 

- May help as an early diagnostic sign. 

Lab findings: 

• +ve Paul Bunnel test (Heterophile 'Ab' test) 

- Characteristic & pathognomonic of disease

- Heterophile 'Ab' titre increased up to 1: 4096 

• Atypical lymphocytosis: More than 50% lymphocytosis of which > 10% atypical 

• Thrombocytopenia 

• Antibodies to EBV present 

• Normal ESR 

Oedema may be caused by any of the following EXCEPT:

 # Oedema may be caused by any of the following EXCEPT :

A. An increase in the plasma protein concentration 

B. An increase in the capillary hydrostatic pressure 

C. An increase in the capillary permeability 

D Lymphatic obstruction 

The correct answer is A. An increase in the plasma protein concentration.

Oedema is accumulation of fluid in the interstitial tissue spaces and serous cavities.

Causes of oedema 

• Decreased plasma oncotic pressure 

• Increased capillary hydrostatic pressure 

• Increased capillary permeability 

• Lymphatic obstruction 

• Tissue factors (increased oncotic pressure of interstitial fluid, and decreased tissue tension) 

• Sodium and water retention. 

Passivating layer on alloy is dissolved completely by:

 # Passivating layer on alloy is dissolved completely by:

A. Basic acid

B. Borax

C. Potassium fluoride

D. Graphite

The correct answer is C. Potassium fluoride. 

# Aluminum, chromium, and titanium have high affinity for oxygen and they form protective oxide film, which prevents further oxidation and corrosion. This is called passivation. For soldering these alloys, the passivating film should be dissolved. Potassium fluoride used as a flux dissolves passivating film so that the solder can wet the parts. 

# Flux is a compound applied to metal surfaces that dissolves or prevents the formation of oxides and other undesirable substances that may reduce the quality or strength of a soldered or brazed area. 

# There are three types of fluxes according to their primary purpose: - 

Type I: Surface protection- covers the metal surface and prevents access to oxygen so that no oxides can form. 

Type II: Reducing agent- reduces any oxides present and exposes clean metal. 

Type III: Solvent- dissolves any oxides present and carries them away. 

Fluxes for use with noble metal alloys are generally based on boric acid, boric anhydride, and borax. Chromium oxides that form on base metal alloys are more stable and fluoride containing fluxes are used as solvents to dissolve chromium, nickel, and cobalt oxides. 

In long surgical procedure intubation method is:

 # In long surgical procedure intubation method is: 

A. Nasotracheal tube with cuff 

B. LMA 

C. Nasotracheal tube without cuff 

D. Endotracheal tube 

The correct answer is A. Nasotracheal tube with cuff.

LMA (laryngeal mask airway) is used mostly in situations of emergency and by non-anaesthesiologists. Endotracheal tube is commonly used method during general anaesthesia. For prolonged surgeries especially facio-maxillary surgeries nasaltracheal or Orotracheal intubation especially with cuff is used.

Best way to monitor perfusion of free flap:

 # Best way to monitor perfusion of free flap: 

A. Pulse oximeter 

B. Laser Doppler velocimetry 

C. Prick test 

D. Flourescin & dermoflourometer 

The correct answer is: C. Prick Test.

 During the postoperative phase, the flap is closely monitored for signs of compromised perfusion. Flaps are best assessed by inspection. Clinical monitoring is the current gold standard for assessing free flaps. Dermal bleeding or prick test is used to assess the colour of the blood within the flap circulation. Also scalpel mark on the flap can also be used to assess the colour of the blood.

Many high-end techniques are described in literature to monitor free flaps such as: 

• Serial fluorometry

• Plethysmography

• Laser doppler flow-metry

Reference: [Steel and Marran's head and neck surgery 4th ed 137]

Pulsating varicose vein is due to:

 # Pulsating varicose vein is due to 

A. Arterio venous fistula 

B. Sapheno femoral incompetence 

C. Deep vein thrombosis 

D. Abdominal tumour 

The correct answer is A. Arteriovenous fistula.

Communication between an artery and adjacent vein leads to arteriovenous aneurysm or arteriovenous fistula. When an arteriovenous fistula is created surgically, this is called iatrogenic arteriovenous fistula. For Renal dialysis,iatrogenic fistula is mostly used in the wrist or in the ankle and such temporary arteriovenous fistula is known as Cimino fistula. Presence of a pulsating thrill over the site of the lesion is quite characteristic, particularly if the lesion is located near the surface. If a finger is pressed on the artery proximal to the fistula,there will be slowing of pulse rate and rise in the diastolic pressure. This is known as Branham's sign.

Ref: S. Das Manual of Surgery, 3rd ed 194

Auspitz’s sign is characteristic of

 # Auspitz’s sign is characteristic of 

A. Lichen planus 

B. White sponge nevus 

C. Erythema multiforme 

D. Psoriasis 

The correct answer is D. Psoriasis.

Psoriasis of the skin is characterized by the occurrence of small, sharply delineated, dry papules, each

covered by a delicate silvery scale which has been described as resembling a thin layer of mica. If the deep scales are removed, one or more tiny bleeding points are disclosed, a characteristic feature termed Auspitz’s sign. After removal of the scale the surface of the skin is red and dusky in appearance.

Reference: Shafer's Textbook of Oral Pathology