PGCEE MDS 2022: In winter's WAR line, Amber line represents the:

 # In winter's WAR line, Amber line represents the:

a) Relative depth of the III molar

b) Point of application of the elevator

c) Bone level covering the impacted tooth

d) Axial inclination of the impacted tooth relative to Second molar

The correct answer is C. Bone level covering the impacted tooth.

Winter's lines include 3 imaginary lines that are drawn on the radiographs.

• White line

• Amber line

• Red line

White Line: It is drawn touching the occlusal surfaces of 1st and 2nd molars and is extended posteriorly over the 3rd molar region. It indicates the difference in occlusal level of 2nd and 3rd molars.

Amber Line: It is drawn from the crest of interdental bone between 1st and 2nd molars and extends posteriorly distal to 3rd molar or to the ascending ramus. It indicates the amount of alveolar bone covering the impacted tooth and the portion of tooth that is not covered by the bone.

Red line: It is drawn perpendicular from the amber line to an imaginary point of application of elevator.

It indicates the depth of the tooth in the bone and the difficulty encountered in removing of the tooth.

PGCEE MDS 2022: Gracey’s curette no 15/16 is used for:

 # Gracey’s curette no 15/16 is used for:

A. Anterior teeth

B. Premolars

C. Mesial surface of posterior teeth

D. Distal surface of posterior teeth

The correct answer is C. Mesial surface of posterior teeth. 

Double-ended Gracey curettes are paired in the following manner:

Gracey #1-2 and 3-4: Anterior teeth

Gracey #5-6: Anterior teeth and premolars

Gracey #7-8 and 9-10: Posterior teeth: facial and lingual

Gracey #11-12: Posterior teeth: mesial

Gracey #13-14: Posterior teeth: distal 

Recent additions to the Gracey curette set have been the Gracey #15-16 and 17-18. The Gracey #15-16 is a modification of the standard #11-12 and is designed for the mesial surfaces of posterior teeth. It consists of a Gracey #11-12 blade combined with the more acutely angled #13-14 shank. When the clinician is using an intraoral finger rest, it is often difficult to position the lower shank of the Gracey #11-12 so that it is parallel with the mesial surfaces of the posterior teeth, especially on the mandibular molars. The new shank angulation of the Gracey #15-16 allows better adaptation to posterior mesial surfaces from a front position with intraoral rests. If alternative fulcrums, such as extraoral or opposite-arch rests, are used, the Gracey #11-12 works well and the new #15-16 is not essential.

PGCEE MDS 2022: Jug handle view is another name for:

 # Jug handle view is another name for:

a. occipitomental view 

b. submentovertex view 

c. lateral cephalogram 

d. lateral oblique view

The correct answer is B. Submentovertex view.

Submentovertex projection or jug handle view: 

 The image receptor is positioned parallel to the patient’s transverse plane and perpendicular to the midsagittal and coronal planes. To achieve this position, the patient’s neck is extended as far backward as possible, with the canthomeatal line forming a 10-degree angle with the image receptor.

PGCEE MDS 2022: Treatment of mushroom poisoning :

 # Treatment of mushroom poisoning :

A. Atropine

B. Pilocarpine

C. Adrenaline

D. Quinidine

The correct answer is A. Atropine.

A mixture of signs and symptoms can occur with muscarinic poisoning from medications or mushrooms. Manifestations may vary even among persons who ingested mushrooms grown in the same patch and gathered at the same time. Confusion can occur if mushroom poisoning is attributed to a suspected species rather than to the toxin suggested by signs and symptoms. Accurate diagnosis depends on clinical suspicion and recognition of muscarinic manifestations, notably diaphoresis, salivation, bladder cramping, diarrhea, and difficulty with visual accommodation. Muscarinic toxicity due to medications necessitates an adjustment in drug dosage. In mushroom poisoning that produces primarily muscarinic effects, atropine is the treatment of choice. 

PGCEE MDS 2022: Collum angle is seen in:

 # Collum angle is seen in:

a) Class I bimaxillary protrusion

b) Class II div 1

c) Class II div 2 

d) Class III

The correct answer is C. Class II div 2.

The angle which is formed by the intersection of the long axes of the crown and root angulation is called Collum angle. It is decreased in Class II Div 2 cases. Due to this reason the crown appears to be lingual from the long axis of the roots in class II div 2 cases. Collum angle has been confused with interincisal angle. Interincisal angle is decreased in Class II div 1 and increased in class II div 2.

PGCEE MDS 2022 : Most suitable antiarrhythmic drug for counteracting ventricular extrasystoles due to digoxin toxicity

 # The most suitable antiarrhythmic drug for counteracting ventricular extrasystoles due to digoxin toxicity is :

A. Lignocaine

B. Quinidine

C. Verapamil

D. Amiodarone

The correct answer is A. Lignocaine.

The primary treatment of digoxin toxicity is digoxin immune fab, which is an antibody made up of anti-digoxin immunoglobulin fragments. This antidote has been shown to be highly effective in treating life-threatening signs of digoxin toxicity such as hyperkalemia, hemodynamic instability, and arrhythmias. Fab dose can be determined by two different methods. First method is based on the amount of digoxin ingested whereas the second method is based on the serum digoxin concentration and the weight of the person.

Other treatment that may be used to treat life-threatening arrhythmias until Fab is acquired are magnesium, phenytoin, and lidocaine. Magnesium suppresses digoxin-induced ventricular arrhythmias while phenytoin and lidocaine suppresses digoxin-induced ventricular automaticity and delay afterdepolarizations without depressing AV conduction. In the case of an abnormally slow heart rate (bradyarrhythmias), Atropine, catecholamines (isoprenaline or salbutamol), and/or temporary cardiac pacing can be used.

USES OF LIDOCAINE

Lidocaine is safe if given by slow i.v. injection; is used to suppress VT and prevent VF. It is ineffective in atrial arrhythmias. Because of rapidly developing and titratable action it is a good drug in the emergency setting, e.g. arrhythmias following acute MI or during cardiac surgery. In acute MI, i.v. infusion of lidocaine can prevent VF, but a metaanalysis has shown that it fails to improve survival; may even increase short term mortality. Therefore, lidocaine is no longer administered prophylactically to all MI patients, but may be used in selected cases, and to treat ventricular arrhythmias when they occur. Efficacy of lidocaine in chronic ventricular arrhythmia is poor, but it suppresses VT due to digitalis toxicity, for which it is used because it does not worsen A-V block.

PGCEE MDS 2022: Least invasive way to treat the fracture of edentulous mandible is:

 # Least invasive way to treat the fracture of edentulous mandible is:

A. External splint fixation

B. Open reduction with transosseous wire ligation

C. Percutaneous intramedullary pinning

D. Gunning splint

The correct answer is D. Gunning Splint.

Treating edentulous mandibular fracture is difficult in elderly patients due to compromised medical condition of the patient and various contraindications for the surgical approach. The complication rate of infection or malunion is higher compared to fractures in younger, dentulous patients. For such conditions, ‘Gunning splint’ is a better option as it provides close reduction and stabilization of mandibular fracture, thus improving the prognosis.

A Gunning splint is a type of orthopedic splint that can be used to immobilize and support the mandible. It is typically made of a rigid material, such as metal or plastic, and is shaped to fit around the mandible. The splint is named after William Gunning, who is credited with developing the design in the 19th century. Gunning splints are typically used to treat injuries or conditions that affect the mandible, such as fractures, sprains, or strains. They are also used to support and stabilize the mandible following surgery. The splint is typically attached to the mandible using wires or bands that are passed through holes in the splint and secured to the teeth or gums. The splint is then tightened to hold the mandible in place.