Perspiration and redness of the cheek and ear after eating

 # A 58-year-old woman underwent left superficial parotidectomy for a pleomorphic adenoma 2 years ago. She presents with complaints of occasional perspiration and redness of the left cheek and ear after eating. Which of the following nerves is the most likely source of these complaints? 

A. Great auricular

B. Frontal branch of the facial nerve

C. Auriculotemporal

D. Lingual

The correct answer is C. Auriculotemporal.

The auriculotemporal syndrome is an unusual phenomenon, which arises as a result of damage to the auriculotemporal nerve and subsequent reinnervation of sweat glands by parasympathetic salivary fibers.

The patient typically exhibits flushing and sweating of the involved side of the face, chiefly in the temporal area, during eating. The severity of this sweating may often be increased by tart foods. Of further interest is the fact that profuse sweating may be evoked by the parenteral administration of pilocarpine or eliminated by the administration of atropine or by a procaine block of the auriculotemporal nerve.

Reference: Shafer's Textbook of Oral Pathology, 7th Edition.

The diameter of the tip of a periodontal probe is:

 # The diameter of the tip of a periodontal probe is:

A. 0.25 mm

B. 0.5 mm

C. 0.75 mm

D. 1 mm

The correct answer is B. 0.5 mm.

Periodontal probes are used to measure the depth of pockets and to determine their configuration. The typical probe is a tapered, rodlike instrument calibrated in millimeters, with a blunt, rounded tip. There are several other designs with various millimeter calibrations. The World Health Organization (WHO) probe has millimeter markings and a small, round ball at the tip. Ideally, these probes are thin, and the shank is angled to allow easy insertion into the pocket. Furcation areas can best be evaluated with the curved, blunt Nabers probe. When measuring a pocket, the probe is inserted with a firm, gentle pressure to the bottom of the pocket. The shank should be aligned with the long axis of the tooth surface to be probed. Several measurements are made to determine the level of attachment along the surface of the tooth.

Reference: Carranza's Clinical Periodontology 12th edition.

Which of the following may create gingival deformities that require gingivoplasty to eliminate the defects?

 # Which of the following may create gingival deformities that require gingivoplasty to eliminate the defects?

A. Erosive linchen planus 

B. Desquamative gingivitis 

C. Acute herpetic gingivostomatitis 

D. Necrotising ulcerative gingivitis 

The correct answer is D. Necrotising ulcerative gingivitis.

■ Shelf-like gingival margins after healing may result in plaque accumulation. 

■ The gingiva is reshaped with periodontal knife or with electrosurgery. This process of eliminating the defects by reshaping is called as gingivoplasty. 

■ Gingival deformities are seen in gingival disease:  (Asked in AIIMS 1999) (ANUG) 

Surgical procedure for severe tissue destruction in ANUG infection is:  (Asked in COMED 2011) (Reshaping the gingiva, Gingivoplasty) 

Site of Antidiuretic hormone (ADH) action is:

 # Site of Antidiuretic hormone (ADH) action is:

A. Proximal tubule

B. Loop of Henle

C. Vasa recta

D. Collecting tubule

The correct answer is D. Collecting tubule.

Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travels down the axon terminating in the posterior pituitary, and is released from vesicles into the circulation in response to extracellular fluid hypertonicity (hyperosmolality). AVP has two primary functions. First, it increases the amount of solute-free water reabsorbed back into the circulation from the filtrate in the kidney tubules of the nephrons. Second, AVP constricts arterioles, which increases peripheral vascular resistance and raises arterial blood pressure.

Acute increase of sodium absorption across the ascending loop of Henle. This adds to the countercurrent multiplication which aids in proper water reabsorption later in the distal tubule and collecting duct.

Pyruvate dehydrogenase complex contains all EXCEPT:

 # Pyruvate dehydrogenase complex contains all EXCEPT:

A. Biotin

B. NAD

C. FAD

D. Co-A

The correct answer is A. Biotin.

Pyruvate dehydrogenase complex (PDC) is a complex of three enzymes that converts pyruvate into acetyl-CoA by a process called pyruvate decarboxylation. Acetyl-CoA may then be used in the citric acid cycle to carry out cellular respiration, and this complex links the glycolysis metabolic pathway to the citric acid cycle. Pyruvate decarboxylation is also known as the "pyruvate dehydrogenase reaction" because it also involves the oxidation of pyruvate.

The enzymes involved in PDC are Pyruvate dehydrogenase (E1), Dihydrolipoyl transacetylase (E2), and Dihydrolipoyl dehydrogenase (E3). The cofactors involved are: TPP (thiamine pyrophosphate), magnesium, lipoate, coenzyme A, FAD and NAD+. 

Reference: https://en.wikipedia.org/wiki/Pyruvate_dehydrogenase_complex

The benign neoplasm of ‘brown fat’ noted in oral/pharyngeal region is:

 # The benign neoplasm of ‘brown fat’ noted in oral/pharyngeal region is:

A. Lipoma

B. Hibernoma

C. Teratoma

D. Brown tumor

The correct answer is B. Hibernoma. 

Hibernomas are uncommon neoplasms of brown adipose tissue. The most frequent sites of occurrence include the thigh, shoulder, and back. Less common myxoid and spindle cell hibernoma variants are likely to be located in the posterior neck and shoulder. Hibernomas are benign lipomatous neoplasms and have no potential for malignant transformation.  Hibernomas contain brown fat, and the name was coined about the presence of brown fat in hibernating animals. First described by Merkel 1906, these tumors are similar to lipomas in clinical behavior but have unique imaging and histopathologic features. Hibernomas generally present in young adults with a mean age of 38. In summary, these tumors are:

• Composed of brown fat
• Represent benign neoplasms
• Generally well-circumscribed masses
• Generally are small in size
• Exhibit slow growth
• Histopathologically composed of brown fat cells
• Chief differential diagnosis include well-differentiated liposarcomas (WDLS)
• Most often involve the thigh, trunk, and chest.
• Rare locations seen in less than 10% of cases include retroperitoneal, thorax, and intraabdominal regions.
• Fewer than 20% are intramuscular in location.

Reference: Tafti D, Cecava ND. Hibernoma. [Updated 2023 May 22]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK570579/

SNA angle describes the relationship of the:

 # SNA angle describes the relationship of the:

A. Maxilla to the cranial base

B. Mandible to the cranial base

C. Maxilla to mandible

D. Maxilla to the upper incisors

The correct answer is A. Maxilla to the cranial base. 

SNA: the angle between the sella/nasion plane and the nasion/A plane (normal value at the end of growth 82 ± 2°). This angle assesses the antero-posterior position of the maxilla relative to the upper cranial structures.