In a trauma patient with intraoral bleeding, best way to secure airway is:

 # In a trauma patient with intraoral bleeding, best way to secure airway is:

A. Awake blind intubation

B. Awake fibreoptic intubation

C. Tracheostomy

D. Cricothyroidotomy

The correct answer is:

D. Cricothyroidotomy

Explanation:

In a trauma patient with intraoral bleeding, maintaining a secure airway is critical because blood in the oral cavity can obstruct visualization and aspiration can compromise the airway. Here's why cricothyroidotomy is the best option in this scenario:

1. Challenges with intubation in intraoral bleeding:

• Awake blind intubation (Option A) is highly unreliable due to the inability to visualize the airway and the presence of blood.
• Awake fibreoptic intubation (Option B) may not be feasible in this case because the blood obstructs the fibreoptic scope's view, making the procedure very difficult. 
• Although performing fiber-optic intubation under local anesthesia for achieving successful endotracheal intubation is one of the recommended methods in situations where airway management is difficult, the use of FOB (fiber-optic bronchoscope) is somewhat impractical in patients with maxillofacial trauma. Blood, vomitus, and secretions in the patient’s airway may preclude vision by fiber-optic instruments, and accomplish ing effective local anesthesia in the injured regions is difficult. Furthermore, the patient’s cooperation is essential for such an approach, and this cooperation is not easy to obtain in the trauma patient.

2. Tracheostomy (Option C):

   • While a tracheostomy can secure the airway, it is a more complex and time-consuming procedure than a cricothyroidotomy, making it less ideal in an emergency setting.

3. Cricothyroidotomy (Option D):

   • It is the fastest and most effective way to secure an airway in a patient with significant oral bleeding.
   • It bypasses the upper airway and oral cavity entirely, preventing further complications from blood aspiration.
   • Cricothyroidotomy is generally the procedure of choice in emergency situations where intubation is not feasible or has failed.

Summary:

In an emergency involving trauma with significant intraoral bleeding, cricothyroidotomy is the best and most practical approach for quickly securing the airway and ensuring the patient's survival.

Patients with organ transplants are most frequently infected with:

 # Patients with organ transplants are most frequently infected with:

A. Hepatitis A

B. Hepatitis B

C. CMV

D. EBV

The correct answer is:

C. CMV (Cytomegalovirus)

Explanation:

Cytomegalovirus (CMV) is the most common opportunistic infection in patients with organ transplants. This is because immunosuppressive therapy, which is necessary to prevent organ rejection, compromises the immune system, making the patient more vulnerable to infections.

CMV in transplant patients:

It can cause severe complications, including fever, gastrointestinal disease, pneumonitis, hepatitis, and graft rejection.

Reactivation of latent CMV or primary infection (from donor tissue or environmental exposure) is common.

Other options:

Hepatitis A: Rarely an issue in transplant patients since it does not become chronic and typically resolves without major complications.

Hepatitis B: Can cause complications in transplant patients, but it is less frequent than CMV. Pre-transplant screening and antiviral prophylaxis help manage the risk.

EBV (Epstein-Barr Virus): Can cause post-transplant lymphoproliferative disorder (PTLD), but it is less common than CMV.

In summary, CMV is the most frequent and clinically significant infection in transplant patients.

Which of the following hormones increase the sensitivity of heart to epinephrine?

 # Which of the following hormones increase the sensitivity of heart to epinephrine?

A. Parathyroid

B. Insulin

C. Thyroid

D. Glucagon

The correct answer is:

C. Thyroid

Explanation:

Thyroid hormones (primarily T3 and T4) increase the sensitivity of the heart to catecholamines, including epinephrine. This effect is due to:

• Increased β-adrenergic receptor density: Thyroid hormones upregulate the expression of β-adrenergic receptors in the heart, enhancing responsiveness to epinephrine and norepinephrine.
• Increased myocardial contractility and heart rate: By amplifying the effects of catecholamines, thyroid hormones contribute to increased cardiac output and sympathetic tone.

Other options:

• A. Parathyroid hormone (PTH): This hormone regulates calcium and phosphate metabolism, with no direct role in cardiac sensitivity to epinephrine.
• B. Insulin: While insulin affects glucose metabolism and has some cardiovascular effects, it does not directly increase heart sensitivity to epinephrine.
• D. Glucagon: Glucagon has some inotropic and chronotropic effects on the heart, but it does not enhance the heart's sensitivity to epinephrine.

Thyroid hormones play a key role in modulating the cardiovascular system, particularly through their interaction with catecholamines.

Most common cause of multiple fetal anomalies is:

 # Most common cause of multiple fetal anomalies is:

A. Syphilis

B. Tetracycline

C. Rubella

D. Rubeola

The correct answer is C. Rubella.

The correct answer is:

C. Rubella

Explanation:

Rubella, especially when contracted during the first trimester of pregnancy, is a significant cause of multiple fetal anomalies. This is due to its teratogenic effects, which can result in congenital rubella syndrome (CRS). The anomalies caused by CRS can include:

• Cardiac defects (e.g., patent ductus arteriosus, pulmonary artery stenosis)
• Ocular defects (e.g., cataracts, retinopathy, glaucoma)
• Auditory defects (e.g., sensorineural hearing loss)
• Neurological defects (e.g., microcephaly, developmental delays)

Other options:

• A. Syphilis: Can cause congenital syphilis with specific anomalies (e.g., skeletal deformities, Hutchinson teeth), but it is not the most common cause of multiple fetal anomalies.
• B. Tetracycline: Causes specific anomalies, mainly involving dental staining and hypoplasia, not a wide range of fetal anomalies.
• D. Rubeola (measles): While it can cause complications in pregnancy, it is less associated with multiple fetal anomalies compared to rubella.

Rubella is particularly significant due to its potential to cause a broad spectrum of anomalies when maternal infection occurs early in pregnancy.

Mean diameter of inferior alveolar nerve is:

 # Mean diameter of inferior alveolar nerve is:

A. 10 mm

B. 4.7 mm

C. 8 mm

D. 1.7 mm

The correct answer is B. 4.7 mm.

The inferior alveolar nerve is a branch of the mandibular nerve (the third division of the trigeminal nerve), responsible for providing sensory innervation to the lower teeth, chin, and lower lip. Its diameter is significant in clinical practices like dental anesthesia, nerve preservation during surgeries, and implant placement.

• The mean diameter of 4.7 mm reflects the nerve's size as it travels through the mandibular canal.

Inferior Alveolar – exits the mental foramen as the mental nerve and continues as the incisive nerve.

● The nerve to mylohyoid is a motor and sensory branch of the inferior alveolar nerve

● The nerve to anterior belly of the digastric muscle is a motor branch of the inferior alveolar nerve

Molar relation in primary dentition is determined by:

 # Molar relation in primary dentition is determined by:

A. Mesiobuccal cusp of maxillary first molar

B. Buccal groove of mandibular first molar

C. Distal surface of maxillary and mandibular second molar

D. Distal surface of maxillary and mandibular first molar

The correct answer is:

C. Distal surface of maxillary and mandibular second molar

Explanation:

In primary dentition, the molar relationship is determined by the alignment of the distal surfaces of the maxillary and mandibular second molars. This is used to describe the primary occlusion as either:

Flush terminal plane: The distal surfaces of the second molars are aligned in a straight plane.

Mesial step: The mandibular second molar’s distal surface is mesial to the maxillary second molar’s distal surface.

Distal step: The mandibular second molar’s distal surface is distal to the maxillary second molar’s distal surface.

These relationships are important because they influence the development of the permanent molar occlusion.

Clinical sign that is always positive in bone fracture is:

 # Clinical sign that is always positive in bone fracture is:

A. Crepitus

B. Tenderness

C. Abnormal mobility

D. All of the above

The correct answer is:

B. Tenderness

Explanation:
Tenderness is always present in fractures, as it reflects localized periosteal irritation and soft tissue damage.

Other signs, such as:

• Crepitus and abnormal mobility, may not be present in minor or incomplete fractures. These are typically seen in displaced or severe fractures but are not universal findings.