Recent advancement to treat Bupivacaine's cardiac toxicity

 # Bupivacaine is known to cause rapid and resistant cardiac toxicity when administered in high concentrations and volumes. What is the recent advancement to treat its cardiac toxicity?

A. Buffered local anesthetics

B. Addition of mannitol to local anesthetic solution

C. Use of lipid emulsions to reverse the cardiotoxicity of local anesthetics

D. Addition of another anesthetic to bupivacaine

The correct answer is C. Use of lipid emulsions to reverse the cardiotoxicity of local anesthetics.

Cardiovascular collapse from accidental local anesthetic toxicity is rare but the long-acting amide local anesthetics bupivacaine, levobupivacaine, and ropivacaine have differential cardiac toxicity, but all are capable of causing death with accidental overdose. In recent times, the discovery that lipid emulsion may improve the chance of successful resuscitation has led to recommendations that it should be available in every location where regional anesthesia is performed. 

Best method of intubation in patient undergoing treatment for oral surgery under GA is:

 # Best method of intubation in patient undergoing treatment for oral surgery under GA is:

A. LMA

B. Orotacheal tube

C. Laryngeal mask airway

D. Naso-endotube

The correct answer is D. Naso-endotube.

Solution: 

The sine qua non for intubation since the twentieth for general anesthesia patients is pharyngeal laryngoscopy and oral intubation. But here the question is about oral surgery treatment. In such cases, nasal intubation is often preferred in patients for unrestricted direct access to the mouth and pharynx regions.  In cases where the direct intubation cannot be done, blind methods such as combitube, LMA can be used. They however interfere with oral surgical procedures. 

If the question is asked about maxillofacial injuries in general then the answer is oral intubation. If the question is about oral surgical procedures, the answer is nasal intubation. 

Which of the following is not a feature of torus mandibularis?

 # Which of the following is not a feature of torus mandibularis?

A. Common in mongoloids

B. Present on the lingual surface of mandible below the mylohyoid line

C. Usually bilateral

D. May or may not be associated with torus palatinus

The correct answer is B. Present on the lingual surface of mandible below the mylohyoid line.

The torus mandibularis is an exostosis or outgrowth of bone found on the lingual surface of the mandible. This growth on the lingual surface of the mandible occurs above the mylohyoid line, usually opposite the bicuspid teeth. Although the mandibular tori are usually bilateral, they are seen as a unilateral condition in about 20% of the cases. Both unilateral and bilateral protuberances may be single or multiple, and they are frequently visible on dental periapical radiographs. There is no correlation in the frequency of simultaneous occurrence of torus palatinus and torus mandibularis, according to the

studies of Kolas and coworkers, suggesting that the two conditions are not related. Suzuki and Sakai reported a highly significant correlation in the frequency of simultaneous occurrence of the two tori, however. 

Gardner syndrome does not include:

 # Gardner syndrome does not include:

A. Osteomas

B. Epidermoid cysts

C. Osteosarcoma

D. Impacted permanent teeth

The correct answer is C. Osteosarcoma.

Gardner syndrome is also characterized by the occurrence of multiple impacted supernumerary teeth. This syndrome consists of: 

1. multiple polyposis of the large intestine,

2. Osteomas of the bones, including long bones, skull, and jaws,

3. Multiple epidermoid or sebaceous cysts of the skin, particularly on the scalp and back,

4. Occasional occurrence of desmoid tumors, and

5. Impacted supernumerary and permanent teeth 

Osteosarcoma is not a feature of Gardner Syndrome.

The most important diagnostic test to differentiate between an acute periapical abscess and a phoenix abscess is: PGCEE MDS 2022

 # The most important diagnostic test to differentiate between an acute periapical abscess and a phoenix abscess is: 

a) Pulp testing

b) Radiographs

c) History

d) Percussion

The correct answer is B. Radiographs.

Phoenix abscess is an acute inflammatory reaction superimposed on an existing chronic lesion, such as a cyst or granuloma. The exacerbation of a chronic lesion is most commonly associated with the initiation of root canal therapy in a completely asymptomatic tooth. In such a tooth, radiographs show well-defined periradicular lesions.

The deciduous tooth which does not have a resemblance to any other teeth is: PGCEE MDS 2022

 # The deciduous tooth which does not have a resemblance to any other teeth is:

a) Maxillary first molar 

b) Mandibular first molar

c) Maxillary 2nd molar 

d) Mandibular canine

The correct answer is B. Mandibular first molar.

The deciduous mandibular first molar is unique in that it has a crown form unlike that of any permanent tooth. It does, however, have two strong roots, one mesial and one distal—an arrangement similar to that of a mandibular permanent molar. These two primary teeth, the maxillary and mandibular first molars, differ from any teeth in the permanent set when crown forms are compared, in particular.

The microorganism most commonly cultured from a chronic bilateral ulcer at the corner of the mouth: PGCEE MDS 2022

 # The microorganism most commonly cultured from a chronic bilateral ulcer at the corner of the mouth:

a) Mucor 

b) Candida

c) Treponema 

d) Aspergillus

The correct answer is B. Candida. 

Angular cheilitis (AC) is inflammation of one or both corners of the mouth. Often the corners are red with skin breakdown and crusting. It can also be itchy or painful. The condition can last for days to years. Angular cheilitis is a type of cheilitis (inflammation of the lips).

Angular cheilitis can be caused by infection, irritation, or allergies. Infections include fungi such as Candida albicans and bacteria such as Staph. aureus. Irritants include poorly fitting dentures, licking the lips or drooling, mouth breathing resulting in a dry mouth, sun exposure, overclosure of the mouth, smoking, and minor trauma. Allergies may include substances like toothpaste, makeup, and food. Often a number of factors are involved. Other factors may include poor nutrition or poor immune function. Diagnosis may be helped by testing for infections and patch testing for allergies.