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BDS THIRD PROFESSIONAL EXAMINATION - GENERAL MEDICINE MODEL QUESTIONS

1. A fifty-year-old man presents in the emergency ward with central chest pain. On examination, his blood pressure is 90/60 mmHg and his pulse is 106 per minute. He is pale and sweating profusely. The most likely diagnosis is: 
a) Esophagitis. 
b) Myocardial infarction. 
c) Pericarditis. 
d) Pleural effusion. 
e) Pneumothorax. 

Key: b 
Ref: Myocardial Infarction (591) Davidson's Principles and Practice of Medicine. 

2. A thirty-five-year-old man presents in a clinic with history of chronic productive cough that is worse in the morning and brought on by changes in posture. Sputum is copious and yellow. The most likely diagnosis in this patient is: 
a) Bronchial asthma. 
b) Bronchiectasis. 
c) Bronchogenic carcinoma. 
d) Chronic bronchitis. 
e) Pulmonary tuberculosis. 

Key: b 
Ref: Bronchiectasis (Page 684) Davidson's Principles and Practice of Medicine. 

3. A twenty-year-old girl is taking anti-tuberculosis treatment. She presents in eye outdoor with visual complaints. The most likely cause of her symptoms is side effect of: 
a) Isoniazid. 
b) Rifampicin. 
c) Ethambutol. 
d) Pyrazinamide. 
e) Streptomycin. 

Key: c 
Ref: Adverse Reaction of First Line Anti Tuberculosis Drugs (Page 702) Davidson's Principles and Practice of Medicine. 

For extraoral maxillary nerve block, the target area is:

 # For extraoral maxillary nerve block, the target area is:
A. Anterior to lateral pterygoid plate
B. Posterior to lateral pterygoid plate
C. Pterygomandibular fossa
D. Pterygomandibular fissure


The correct answer is A. Anterior to the lateral pterygoid plate. 

In the extraoral technique for maxillary nerve block, the needle is directed anteriorly to the lateral pterygoid plate into the pterygopalatine fossa. The midpoint of the zygomatic process is located and depression in its inferior surface is marked. The needle is inserted perpendicular to the median sagittal plane until the needle point gently contacts the lateral pterygoid plate. 

How much reduction in strength and toughness in endodontically treated molars is attributed to changes in collagen cross-linking and dehydration of dentin?

 # How much reduction in strength and toughness in endodontically treated molars is attributed to changes in collagen cross-linking and dehydration of dentin?
A. 5 %
B. 14 %
C. 21 %
D. 60 %


The correct answer is B. 14 %.

There is almost a 14 % reduction in toughness in endodontically treated molars compared with vital dentin due to changes in collagen cross-linking and dehydration of dentin. 

Ref: Cohen 10th Edition , Page 462

Stimulation of trigeminal nerve during gap arthroplasty surgery causes?

 # Stimulation of trigeminal nerve during gap arthroplasty surgery causes?
A. Paroxysmal atrial tachycardia
B. Ventricular tachycardia
C. Bradycardia
D. Torsades de pointes


The correct answer is C. Bradycardia.

Trigeminocardiac Reflex (TCR) 
■ This basically means that stimulation of the trigeminal nerve causes vagally mediated bradycardia, which, in severe cases may even cause asystole. 
■ The trigeminocardiac reflex is the sudden-onset of dysrhythmia and hypotension during manipulation of any of the branches of the trigeminal nerve. The trigeminal nerve and cardioinhibitory vagus nerve constitute the afferent and efferent pathway in the reflex arc. 
■ In pediatric patients, the sympathetic nervous system is not fully developed, giving the parasympathetic nervous system greater control and increased tone. A severe and sudden bradycardia can often be the result of this parasympathetic hypertonia or "increased vagal tone " 
■ It is important to note that the incidence is inversely proportional to age with a sharp decline in incidence for children over the age of 3. 
■ Oculocardiac reflex (Aschner phenomenon) is a type of TCR due to stimulation of the ocular division of the trigeminal nerve. 



Aspiring to be an Orthodontist? Know These Things - WHAT AFTER MDS?

 Orthodontists are dental specialists who focus on correcting misaligned teeth and jaws. They have a variety of treatment options available to help improve the alignment of teeth and jaws. Here are some of the different treatment procedures an orthodontist can perform:

Braces: Traditional braces consist of metal brackets, wires, and bands that are attached to the teeth to apply pressure and gradually move them into their correct position.

Invisalign: This is a clear aligner treatment that uses a series of custom-made, clear plastic aligners that are virtually invisible when worn.

Retainers: After braces or Invisalign treatment, retainers are often used to help maintain the new alignment of the teeth.

Palatal expanders: These are used to widen the upper jaw to create more space for teeth to grow in or to help correct bite problems.

Jaw surgery: In some cases, orthodontic treatment alone may not be enough to correct severe jaw discrepancies, and orthognathic surgery may be recommended.

Space maintainers: These are used to hold space for permanent teeth when primary teeth are lost prematurely.




Headgear: This is a removable appliance that is worn outside the mouth to apply pressure to the teeth and help correct bite problems.

Lingual braces: These are similar to traditional braces, but they are placed on the back of the teeth, making them virtually invisible.

Damon braces: These are self-ligating braces that use a sliding mechanism instead of elastics to hold the wire in place, which can lead to fewer office visits and shorter treatment times.

Clear braces: These are similar to traditional braces but use clear or tooth-colored brackets and wires to make them less noticeable.

The specific treatment plan recommended by an orthodontist will depend on the patient's individual needs and the severity of their orthodontic problems.

After completing a Master of Dental Surgery (MDS) in Orthodontics, there are various career options available. Some of them are:

Orthodontist in private practice: Many orthodontists start their own private practice and offer services such as braces, Invisalign, retainers, and other orthodontic treatments.

Academician/Teaching: After MDS, one can choose to teach and train future dentists and orthodontists as a professor, lecturer or a teaching assistant in dental colleges or universities.

Researcher: After MDS, one can choose to pursue a career in research, working in research institutions or universities, investigating new technologies, materials, and techniques in orthodontics.

Corporate dentistry: Many corporations that operate dental clinics and chains hire orthodontists to provide specialized orthodontic care to their patients.

Consultant Orthodontist: One can choose to work as a consultant orthodontist in hospitals and clinics.

Clinical Director: One can take up the role of a clinical director for an orthodontic department in a hospital or a dental clinic.

Orthodontic Advisor: One can work as an orthodontic advisor to dental insurance companies, government health programs, and dental technology companies.

International volunteering: Orthodontists can also volunteer their services in developing countries or disaster-stricken areas.

The choice of career will depend on individual interests, strengths, and goals.

House Brackman Scale is used for evaluation of which nerve function?

 # House Brackman Scale is used for evaluation of which nerve function? 
A. Facial 
B. Trigeminal 
C. Optic 
D. Hypoglossal 



The correct answer is A. Facial.

House-Brackmann facial paralysis scale
Grade                      Impairment

I                              Normal

II                            Mild dysfunction (slight weakness, normal symmetry at rest)

III                         Moderate dysfunction (obvious but not disfiguring weakness with synkinesis, normal symmetry at rest)  Complete eye closure w/ maximal effort, good forehead movement

IV                         Moderately severe dysfunction (obvious and disfiguring asymmetry, significant synkinesis)  Incomplete eye closure, moderate forehead movement

V                          Severe dysfunction (barely perceptible motion)

VI                         Total paralysis (no movement)

 
*Please note: This scale is used to evaluate facial paralysis at the nerve trunk, and is not a descriptive scale to describe an injury to specific distal facial nerve branches.

Spontaneous nystagmus
First degree: nystagmus on gaze toward the quick component
Second degree: nystagmus on gaze toward the quick component and on straight gaze
Third degree: nystagmus in all directions of gaze

References:

1. House JW, Brackmann DE. Facial nerve grading system. Otolaryngol Head Neck Surg. Apr 1985;93(2):146-7

2nd Year BDS Unit 3 Internal Assessment Examination, Paper IIIA Oral Biology BPKIHS PAST Question

 B.P. KOIRALA INSTITUTE OF HEALTH SCIENCES, DHARAN, NEPAL
2nd Year BDS, Unit 3
Internal Assessment Examination, 20th March 2017
Paper IIIA
Oral Biology
Time: 2 hours                                                                                         Total Marks: 125


SHORT ANSWER QUESTIONS
1. Enumerate the developmental stages of teeth, and describe the cap stage in detail with a well-labelled diagram. (2+5=7)
2. Enumerate the theories of pain transmission in dentin, and discuss the most popular theory. (3+4=7)
3. Draw a well-labelled diagram of dental pulp histology, and enumerate the functions of the dental pulp. (5+2=7)
4. Describe the arrangement of principal fibers of periodontal ligaments with a neat and well labelled diagram. (5+2=7)
5. Describe the phases of tooth modulation with suitable diagrams. (4+3=7)
6. Describe the phenomenon of formation of interglobular dentin with a neat and well labelled diagram. (4+3=7)
7. Describe the morphological changes in the life cycle of odontoblasts with suitable diagrams. (4+3=7)
8. Describe the role of Hertwig's epithelial root sheath in the formation of root.   (7)
9. Describe the different types of cementoenamel junction with a neat and well labelled diagram. (7)
10. Classify the alveolar bone according to functional adaptation with  a suitable diagram. (4+2=6)
11. Describe the formation of pulp stone and classify it. (6) 
12. Describe the labial aspect of permanent maxillary right central incisor. (6)
13. Enlist the fate of dental lamina. (6)
14. Compare the difference between the permanent mandibular central and lateral incisor in six points. (6)