1. Hygienist performing prophylactics and tears the area distal to MX 2nd M.

- what artery is damaged ® greater palatine artery (if palatal), buccal (if vestibiular)
- what would you do? ® stop and reschedule patient, inform patient and continue…

2. 40-year-old woman came from the beach, had trauma to body of mandible and side of the eye. A stab wound was found on
lower back, 12 cm deep to the left of T4 vertebra. She is dead.
- what organ was hit/stabbed? ® lung / aorta
- Mallory bodies in the liver, what does that indicate? ® hepatocellular carcinoma, alcoholic hepatitis…
- lingual surface of MX teeth show erosion, but lower teeth don’t – what does that indicate? ® bulimia
- she had an epithelial lined tract opening from dorsal surface of the tongue on the ventral surface, what is it? ® healing after
surgery, bacterial infection, cancer…
- hematoma of the mandible from… ® trauma

Similar testlet about wound around L1 ® organ damaged would be kidney.

Mallory bodies (alcoholic hyaline): alcoholic hepatitis, composed of intermediate filaments

 3. Woman complaining of teeth sensitivity to heat. Dry, sore mouth, white patches on tongue, wearing a partial maxillary
denture for 9 years.
- name of the fibers of sensitivity? ® A delta fibers, C fibers
- location in brain/brain center? ® hypothalamus, pars interpolaris
- erythema on the palate, under denture - cause? ® denture stomatitis, candida…

Afferent fibers in dental pulp:

• Large, myelinated A delta fibers:
o Form plexus of Raschkow (beneath the cell rich zone), loose their myelination, go to cell-free zone, form
subodontoplastic plexus, proceed to predentin
o Quick, sharp, momentary pain – ends with removal of the stimulus
o Pulpodentinal complex = A delta fibers + odontoblastic cell layer
• Small, unmyelinated C fibers:
o Distributed throught the pulp
o Stimulated by hot liquids/foods
o Burning, aching, throbbing pain
o When it dominates ® irreversible local tissue damage
o ­ threshold of stimulation
o True nociceptive fibers

The spinothalamic tract is the main pathway associated with pain and temperature perception. The spinothalamic tract (also known
as anterolateral system or the ventrolateral system) is a sensory pathway from the skin to the thalamus. From the ventral posterolateral
nucleus in the thalamus, sensory information is relayed upward to the somatosensory cortex of the postcentral gyrus.

The spinal nucleus is composed of three subnuclei:

- subnucleus oralis (pars oralis)
- subnucleus caudalis (pars caudalis)
- subnucleus interpolaris (pars interpolaris)
The subnucleus oralis is associated with the transmission of discriminative (fine) tactile sense from the orofacial region, and is
continuous with the principal sensory nucleus of V. The subnucleus interpolaris is also associated with the transmission of tactile sense,
as well as dental pain, whereas the subnucleus caudalis is associated with the transmission of nociception and thermal sensations from
the head.

4. Woman with Parkinson’s came to the clinic with her husband, had distal caries on maxillary molar.
- out of all the symptoms of Parkinson's, which symptom is not important to dental treatment? ® rapid eye blinking, tremor,
muscle rigidity, loss of automatic movements…
- while working, the patient moved, and the dentist injured her near the cheek. Which artery was injured and caused
bleeding? ® buccal artery of maxillary artery, labial artery of ECA, facial artery of ECA…
- what’s the first important thing to do after the patient starts to bleed? ® stop the bleeding, call an oral surgeon, call her
husband, inform the patient…

5. Male patient with HIV, TB & slowly growing ulcer medial to the MX 1st molar. It is slowly growing, filled with lymphoid tissue
(infiltration of aplastic lymphoid tissue).
- which nerve is used to anaesthetize palatal mucosa of MX 1st molar? ® greater palatine nerve, posterior superior alveolar
nerve, infraorbital nerve
- what is the cause of the lesion? ® EBV, Kaposi’s Sarcoma, Herpes Simplex, CMV, non-Hodgkin’s lymphoma
- patient had a submandibular swelling (?) ® miliary TB
- root and canal morphology of MX 1st molar ® 2 roots & 2 canals, 3 R & 3 C, 3 R & 2 C, 2 R & 3 C
- HIV virus is: ssDNA, dsDNA, ssRNA, dsRNA

Kaposi’s sarcoma: lesions of the oral cavity occur in about 1/3 of patients with AIDS-associated KS. Hard palate lesions are MC. These
flat, red or purple plaques, either focal or diffuse, may be completely asymptomatic and easily overlooked. In other patients, however,
larger nodular lesions involving the hard or soft palate, or both, may become exophytic and ulcerated, and may bleed. Other oral sites
of KS involvement: gingiva, tongue, uvula, tonsils, pharynx, and trachea. These lesions may interfere with eating and speaking, cause
tooth loss, or compromise the airways.

Lymphomas are malignant neoplasm of the lymphocyte cell lines. They are mainly classified as either Hodgkin’s or non-Hodgkin’s
lymphoma (NHL). NHL comprises a heterogeneous group of lymphoid neoplasm with a spectrum of behavior ranging from relatively
indolent to highly aggressive and potentially fatal. Only extranodal presentation of Hodgkin’s disease is rare; among NHL’s lymphomas,
extranodal presentations are relatively common. Typical locations for extranodal NHLs are the stomach, bowel, lung, orbital tissue,
sinuses, thyroid, tonsil, salivary glands, breast, testis and kidney. Waldeyer’s ring is mainly second to the gastrointestinal tract in the
incidence of extranodal NHL, but primary lymphomas of the oral cavity are uncommon. The oral cavity, including the palate, gingiva,
tongue, buccal mucosa, floor of the mouth, and lips is the primary site of approximately 2% of all extranodal lymphomas.
Nonimmunosuppressed patients of any age can be affected, however, most patients are middle-aged to older adults, with male
preponderance. In the group of HIV-infected individuals, patients with lymphoma are almost all men, who are overall younger. Patients
complain of localized or diffuse soft tissue swelling, pain, mucosal ulceration or discoloration, paresthesias, aneshesia, and loosening
of teeth. Among nonimmunosuppressed patients, the most common type is diffuse large B-cell lymphoma, but mantle cell lymphoma,
marginal zone B-cell lymphoma, Burkitt’s lymphomalymphomablastic lymphoma, peripheral T-cell lymphoma and anaplastic large cell
lymphoma also occur.
The most common clinical appearance of NHL in the mouth is a nonhealing, painless ulceration. NHL can affect both bony and soft oral
tissue, with the most frequent localization being the palate and the mandible. However, it is rare to find extranodal NHLs in the gingiva.

6. A girl with SLE

- which is the main outcome? ® proteinuria
- she has RF factor positive too is that abnormal? ®
- the cause of the burning of the mouth ® Sjogren’s disease
- ESR elevated due to… ® autoimmune disease

Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired,
and a red rash which is MC on the face. Often there are periods of illness (flares) and periods of remission.
The cause of SLE is not clear. It is thought to involve genetics + environmental factors. Female sex hormones, sunlight, smoking, vitamin
D deficiency, and certain infections, are also believed to increase the risk. The mechanism involves an immune response by
autoantibodies against a person's own tissues. These are most commonly anti-nuclear antibodies and they result in inflammation.
There are a number of other kinds of lupus erythematosus including discoid lupus erythematosus, neonatal lupus, and subacute
cutaneous lupus erythematosus.
SLE significantly increases the risk of cardiovascular disease with this being the MC cause of death. Women of childbearing age are
affected about 9x more often than men. Those of African, Caribbean, and Chinese descent are at higher risk than white people.
For the purpose of identifying people for clinical studies, a person has SLE if any 4 out of 11 symptoms are present simultaneously or
serially on two separate occasions.
• Malar rash (cheeks)
• Discoid rash (red, scaly patches on skin that cause scarring)
• Serositis: pleurisy (membrane around the lungs) or pericarditis (membrane around the heart)
• Oral or nasopharyngeal ulcers
• Arthritis: two or more peripheral joints, with tenderness, swelling, or effusion
• Photosensitivity (exposure to ultraviolet light causes rash, or other symptoms of SLE flareups)
• Blood: hemolytic anemia, leukopenia (WBC<4000/µl), lymphopenia (<1500/µl), low platelet count (<100.000/µl) in the
absence of offending drug
• Hypocomplementemia: due to either consumption of C3 and C4 by immune complex-induced inflammation or to congenitally
complement deficiency
• Renal disorder: more than 0.5 g/day of protein in urine or cellular casts seen in urine under a microscope
• Antinuclear antibody test +
• Immunologic disorder: positive anti-Smith, anti-ds DNA, antiphospholipid antibody and/or false positive serological test for
syphilis
• Presence of anti-ss DNA in 70% of cases (though also + with rheumatic disease and healthy persons
• neurologic disorder: seizures or psychosis
Other than the ACR criteria, people with lupus may also have:
• fever (over 100 °F/ 37.7 °C)
• extreme fatigue
• hair loss
• fingers turning white and/or blue when cold (Raynaud's phenomenon)

Other than in rheumatoid arthritis, RF may also be elevated in: SLE, Sjögren's syndrome, interstitial pulmonary fibrosis, hepatitis B,
chronic liver disease and chronic hepatitis, primary biliary cirrhosis, infectious mononucleosis and any chronic viral infection, bacterial
endocarditis, leprosy, sarcoidosis, tuberculosis, syphilis, visceral leishmaniasis, malaria, leukemia, dermatomyositis, systemic sclerosis,
after vaccination/transfusion in normal individuals.
 7. Patient with gag reflex.
- what nerve stimulates that? ® afferent (sensory) IX & efferent (motor) X

8. Gun shot, entered from side of the head and exit left from insertion of SCM. Another gun shot on left T7/T8.
- what bone effected on exit ® temporal (where SCM originates)
- the patient will have hemothorax due to rupture of arch of aorta ® 1st T, 2nd F (the arch of the aorta is at T3/T4)
- hemothorax due to… ® pleural effusion (blood in the pleural cavity)
- what lobe of the lung is affected? ® inferior lobe of left lung
- the patient has previous scar in midline between SCM, what surgery has he had done before ® thyroidectomy (horizontal)

9. Alzhimer Disease: about 15 questions in this testlet, relating to tooth restoration and dental anatomy.

Symptoms Difficulty in remembering recent events, language problems, disorientation, mood swings
Usual onset Over 65 years old
Duration Long term
Causes Poorly understood: B-amyloid plaques (disrupt signaling between neurons, can cause inflammation) +
neurofibrillary tangles (intracellular, made out of tau proteins)
Risk factors Genetics, head injuries, depression, hypertension
Diagnostic method Based on symptoms and cognitive testing after ruling out other possible causes
Similar conditions Normal aging
Medication Acetylcholinesterase inhibitors, NMDA receptor antagonists (small benefit)
Prognosis Life expectancy 3–9 years

MC cause of dementia: Alzheimer Disease

It is a neurodegenerative disease = loss of neurons, especially in the cortex.
Amyloid precursos protein (APP): helps the neuron grow and repair after the injury; get used, is broken down and recycled. In AD the
protein forms B-amyloid plaques and can cause amyloid angiopathy affecting the blood vessels of the brain (®hemorrhage).
In AD the gyri get narrower, the succi get wider and the ventricles get larger.
AD: sporadic or familial.
SPORADIC: 90-95% of cases, ­ with age, gene: APO E4
FAMILLIAL: early onset, fast progression, genes: PSEN-1 (14) & PSEN-2 (1)
Down syndrome ­­­ risk of AD (APP gene was found on chromosome 21 = they have 2).

10. 17-year-old sexually active female, taking contraceptives, complaining of pain in one of her teeth.
- what is the mechanism of action of oral contraceptives? ® act on LH (inhibits LH surge), FSH, and androgens

11. Alcoholic patient, divorced, comes to the clinic for restoration. You smell alcohol from her mouth.
- what u will do? ® planned treatment, send her home with an assistant

12. Parkinson disease: 52-year-old woman comes to the office with her husband. During the treatment doctor notices, that her
husband is not in the office.
- what will you do? ® emergency call, continue treatment.
 13. Woman who had pain on her right upper side. No evidence of caries, no radiolucency. Just instant pain to touch of the face
and pain with light touch of the mucosa. Pain while chewing and talking, it also can be spontaneous and wakes her up at
night.
- what is the cause of her pain? ® sinus infection, deep caries, broken root, trigeminal neuralgia

Trigeminal neuralgia (TN or TGN) is a chronic pain disorder that affects the trigeminal nerve. There are two main types: typical
and atypical. The typical form results in episodes of severe, sudden, shock-like pain in one side of the face that lasts for seconds to a
few minutes. Groups of these episodes can occur over a few hours. The atypical form results in a constant burning pain that is less
severe. Episodes may be triggered by any touch to the face. Both forms may occur in the same person. It is one of the most painful
conditions and can result in depression. The exact cause is unclear but believed to involve loss of the myelin around the trigeminal
nerve. This may occur due to compression from a blood vessel as the nerve exits the brain stem, multiple sclerosis, stroke, or trauma.
Less common causes include a tumor or arteriovenous malformation. Diagnosis is typically based on the symptoms after ruling out
other possible causes such as postherpetic neuralgia. Treatment includes medication or surgery. The anticonvulsant carbamazepine or
oxcarbazepine is the usual initial treatment and is effective in about 80% of people. Other options include lamotrigine, baclofen,
gabapentin, and pimozide. Amitriptyline may help with the pain but opioids are not usually effective in the typical form. In those who
do not improve or become resistant to other measures, a number of types of surgery may be tried. It is estimated that 1 in 8,000 people
develop trigeminal neuralgia a year. It usually begins in people over 50 years old, but can occur at any age. Women are more commonly
affected than men. TN is characterized by episodes of severe facial pain along the trigeminal nerve divisions. The trigeminal nerve is a
paired cranial nerve that has three major branches: the ophthalmic nerve (V1), the maxillary nerve (V2), and the mandibular nerve
(V3). One, two, or all three branches of the nerve may be affected. Trigeminal neuralgia most commonly involves the middle branch
(the maxillary nerve or V2) and lower branch (mandibular nerve or V3) of the trigeminal nerve. An individual attack usually lasts from
a few seconds to several minutes or hours, but these can repeat for hours with very short intervals between attacks. In other instances,
only 4-10 attacks are experienced daily. The episodes of intense pain may occur paroxysmally. To describe the pain sensation, people
often describe a trigger area on the face so sensitive that touching or even air currents can trigger an episode; however, in many people,
the pain is generated spontaneously without any apparent stimulation. It affects lifestyle as it can be triggered by common activities
such as eating, talking, shaving and brushing teeth. The wind, chewing, and talking can aggravate the condition in many patients. The
attacks are said by those affected to feel like stabbing electric shocks, burning, sharp, pressing, crushing, exploding or shooting pain
that becomes intractable. The pain also tends to occur in cycles with remissions lasting months or even years. 1–6% of cases occur on
both sides of the face but extremely rare for both to be affected at the same time. Rapid spreading of the pain, bilateral involvement
or simultaneous participation with other major nerve trunks (such as Painful Tic Convulsif of nerves V & VII or occurrence of symptoms
in the V and IX nerves) may suggest a systemic cause. Systemic causes could include multiple sclerosis or expanding cranial tumors. TN
needs to be distinguished from other forms of unilateral pain which are related to damage to the trigeminal nerve by trauma to the
face or dental treatments. This is often termed painful trigeminal neuropathy or post-traumatic neuropathy as some sensory changes
can be noted e.g. decrease in pain sensation or temperature. This is important as different care pathways are used. Trigeminal pain
can also occur after an attack of herpes zoster, and post-herpetic neuralgia has the same manifestations as in other parts of the body.
Trigeminal deafferentation pain (TDP), also termed anesthesia dolorosa, is from intentional damage to a trigeminal nerve following
attempts to surgically fix a nerve problem. This pain is usually constant with a burning sensation and numbness. TDP is very difficult to
treat as further surgeries are usually ineffective and possibly detrimental to the person.

14. You make an ejection for treating a maxillary molar. The patient comes in the next day with a hematoma.
- what could you have hit? ® pterygoid plexus
- epidural hematoma is in ® temporal area (overlying dura, damage to middle meningeal a.)
- posterior hard palate is innervated by? ® greater palatine n.
- which part of the lateral pterygoid muscle protrudes the mandible? ® inferior head
- the superior head of the lateral pterygoid... ® stabilizes the articular disk during clenching (power stroke)

The posterior superior alveolar (PSA) nerve block targets the posterior superior nerve in the infratemporal fossa. It is accomplished by
depositing the anesthetic agent along the posterior surface of the maxilla. The needle must be advanced medially, superiorly and
posteriorly at a 45-degree angle to the maxillary occlusal plane to reach the infratemporal fossa. The improperly placed posterior
superior alveolar nerve block can result in various complications. The hematoma formation due to trauma to the pterygoid plexus of
veins is one of the most common complications. A very uncommon and rare complication of Bell's palsy can result due to improper
placement of the needle into the inferior part of the parotid gland resulting to the trauma of the cervicofacial division of the facial
nerve. This along with trauma of the lateral and medial pterygoid muscles could result in trismus.
15. A 10-year-old boy was found dead with a broken jaw deviating to the right, had bruising on the side of his face and was bite
by a rattle snake on the lateral side of his forearm.
- which muscle of the jaw was injured? ® right lateral pterygoid
- lateral side of the forearm is innervated by… ® radial n.
- the optimal muscle to close the mouth is ® masseter

16. Patient presents with xerostomia (dry mouth), keratoconjunctivitis (dry eyes) & other autoimmune disorders.
- what do they most likely have? Sjogren’s syndrome
- drinking a lot of water will… ® decrease levels of ADH

17. Patient is getting engaged with a pigmented lesion on his nose. He also has a lump medial to the right body of the mandible,
extraorally.
- what is the type of skin cancer? ® malignant melanoma, basal cell carcinoma
- what could be the lump? ® submandibular lymph node
- which muscle does not make up the triangle that contains the swelling? ® sternocleidomastoid m.

The submandibular lymph nodes are in the submandibular triangle.

18. Fat kid in high school was advised by a counselor to get blood glucose checked. Results came back as 11% glycosylated
hemoglobin.
- what is his diagnosis? ® diabetes type II
- what are the cells that control his blood glucose called? ® beta cells

Normal: 4-5.9%, anything ­ 7% is considered diabetic.

Diabetes type II does not destroy beta cells.
 19. Depressed female is taking antidepressant medication, lots of other things wrong with her.
- what causes pain in her mouth? ® burning mouth syndrome
- Gardener's syndrome? ® familial colorectal polyposis

Parameter Usual findings in burning mouth syndrome.

Site Usually bilaterally located on the tongue or less commonly the palate, lips or lower alveolar mucosa
Onset Pain is chronic, and rarely spontaneously remits
Character Burning, scalded or tingling. Sometimes the sensation is described as 'discomfort', 'tender', 'raw' and
'annoying' rather than pain or burning.
Associations Possibly subjective xerostomia, dysgeusia (altered taste), thirst, headaches, chronic back
pain, irritable bowel syndrome, dysmenorrhea, anxiety, decreased appetite, depression
Time course Pain upon waking and throughout day, less commonly other patterns.
Exacerbating/Relieving Possible exacerbating factors include tension, fatigue, speaking, and hot, acidic or spicy foods. Possible
factors relieving factors include sleeping, cold, distraction, and alcohol. The pain is often relieved by eating and
drinking (unlike pain caused by organic lesions or neuralgia) or when the person's attention is occupied.
Temporary relief while eating is described as "almost pathognomonic" by the IASP. Pain is not often
relieved by systemic analgesics, but can sometimes be relieved by topical anesthetics.
Severity Moderate to severe, rated 5-8 out of 10, similar in intensity to toothache
Effect on sleep May not disturb sleep, or may change sleep patterns, e.g. insomnia
Previous treatment Often multiple consultations and unsuccessful attempts at dental and/or medical treatment

Gardner syndrome, also known as Gardner's syndrome or familial colorectal polyposis, is an autosomal dominant form of polyposis
characterized by the presence of multiple polyps in the colon together with tumors outside the colon (osteomas of the skull, thyroid
cancer, epidermoid cysts, fibromas, as well as the occurrence of desmoid tumors in approximately 15% of affected individuals).

20. Lady has polymyalgia rheumatic, osteoarthritis, TMJ pain.

- what type of disease? ® autoimmune, inflammatory condition degenerative disease
- which of the following is not associated? ® splenomegaly, losing weight, ­ 40 years old
- what is the cause of pain in the TMJ? ® degeneration due to osteoarthritis

Polymyalgia rheumatica (PMR) is a syndrome with pain or stiffness, usually in the neck, shoulders, upper arms, and hips, but which
may occur all over the body. The pain can be very sudden or can occur gradually over a period. Most people with PMR wake up in the
morning with pain in their muscles; however, cases have occurred in which the person has developed the pain during the evenings or
has pain and stiffness all day long. People who have polymyalgia rheumatica may also have temporal arteritis, an inflammation of
blood vessels in the face which can cause blindness if not treated quickly. The pain and stiffness can result in a lowered quality of life
and can lead to depression.

The classic symptoms include:

• Pain and stiffness (moderate to severe) in the neck, shoulders, upper arms, thighs, and hips, which inhibits activity, especially
in the morning/after sleeping. Pain can also occur in the groin area and in the buttocks. The pain can be limited to one of these
areas as well. It is a disease of the "girdles" meaning shoulder girdle or pelvic girdle.
• Fatigue and lack of appetite (® weight loss)
• Anemia
• An overall feeling of illness or flu-like symptoms, weakness and sometimes exhaustion
• Low-grade (mild) fever or abnormal temperature is sometimes present

About 15% of people who are diagnosed with polymyalgia rheumatica also have temporal arteritis, and about 50% of people with
temporal arteritis have polymyalgia rheumatica. Some symptoms of temporal arteritis include headaches, scalp tenderness, jaw or
facial soreness, distorted vision, or aching in the limbs caused by decreased blood flow, and fatigue.
 21. Lady with pain in MX 1st molar, R side.
- what nerve would you inject? ® PSA & MSA
- if you plan an amalgam up to the central pit what part of the tooth must be considered to build up in carving? ® oblique
ridge, buccal groove, lingual groove, cusp of Carabelli.

22. Patient had an infection, she was prescribed antibiotics. Days later she came back to the office, telling the doctor she wasn’t
going to take more meds and requested a full extraction. On the other hand, the doctor said she needs to have a RCT (root
canal) done to save the tooth. Ethical questions.
- what will you do? ® do the extraction, refuse to do the extraction

Autonomy!

23. Same testlet, the patient was 3/4 beer drinker with multicolored tongue. Oral hygienist was performing scaling and cut the
mucosa on left upper molar moving to the midline.
- what artery will show blood outflow here? ® greater palatine
- what will you do after the dental hygienist reports to you, will you fire her? ® no, you mention it to the patient and tell him
about the suture

24. A lady had an accident few days before now, she comes to you with the complaint of loose teeth (both MX central incisors),
she has black pigmentation around her left eye.
- which fibers were not responsible for the teeth to become loose ® interradicular (not present in anteriors)
- what can be the reason for radiolucency between the teeth? ® periapical abscess, maxillary suture or foramina of the
nasopalatine canals
- what is it called that is formed around her eye? ® periorbital ecchymosis (raccoon eyes)
- what can be time her accident has happened ® 2days / 7days / 14 days / 30 days?

In the beginning - red color

within 5 days - bluish purple/black
5-10days - green/yellow
10-14 days - yellow brown/ light brown
 25. A 30-year-old lady has ulcers on the palate, gingiva, tongue, buccal mucosa, labial mucosa + bleeding; erythema of the oral
cavity. History of surgery to remove cystic ovaries 3 years ago. Decay of MX 1st molar. Biopsy of gingival ulcer and surrounding
tissue was taken.
- what could be the diagnosis? ® erythema multiforme, herpetic ulcers…
- what epithelium is a normal surrounding epithelium of the biopsy material? ® keratinized, stratified squamous epithelium
- what cells are seen in the superior of the ulcer? Cells could be dead and dying inflammatory cells / fibrous tissue exudate
- X-ray of the MX 1st molar, radiolucency is seen over teeth, what could it be? ® carious tooth or periapical problem
- she had her cystic ovary removed, what is that procedure called? ® oophorectomy

Removal of the uterus: hysterectomy

Removal of fallopian tubes: salpingectomy
An oophorectomy may be performed for:
• a tubo-ovarian abscess — a pus-filled pocket involving a fallopian tube and an ovary
• ovarian cancer
• endometriosis
• benign ovarian tumors or cysts
• reducing the risk of ovarian cancer or breast cancer in those at increased risk
• ovarian torsion — the twisting of an ovary

26. Woman found dead, description about her body.

- blood in her nose because of what? ® epistaxis
- overgrowth in the vagina, causes? ® leiomyoma
- lateral shift in spine? ® scoliosis

27. A boy was found dead with a broken jaw deviating to the right, had bruising on the side of his face and was bite by a rattle
snake on the lateral side of his forearm.
- sensations from the left face and teeth are interpreted in? ® right parietal lobe
- deviation to right, damage to ® right lateral pterygoid
- fractured condyle, mandibular will deviate to… ® injured site
- what will u find in the site of injury? ® coagulative necrosis

Snake venom causes hemolysis and muscular necrosis at site of injury/bite.

- what bone will you find in the lateral side of the forearm? ® radial nerve
- which nerve on the forearm is prone to damage? ® radial nerve
- all of these are used to recognize the patient, except… ® teeth, DNA, mitochondrial RNA, skull suture
- you found lateral supraorbital hemorrhage, what is the bone and the artery damaged? ® supraorbital a. and frontal bone
- patient had fluorosis, where do u expect to see it? ® teeth (dentin and enamel) and long bones
- lower canine has erupted, but the upper hasn’t yet – how old is the boy? ® 9-10 years old
- hematoma on the lateral rim, supraorbital injury: which artery? ® middle meningeal artery

28. Woman with hysterectomy performed 20 years ago and hypothyroidism, takes medication for her condition.
- what overdose of hypothyroidism drug won’t cause? – tachycardia, ­ TSH, hyperthermia

Overdose of hypothyroidism drug will lead to: tachycardia and hyperthermia

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other
surrounding structures.
29. SLE patient, his condition has now become systemic.
- why is there an increase in the level of Rhematoid Factor?

Increase in rheumatoid factor (RF) shows presence of SLE, and also other diseases like rheumatoid arthritis, and it is formed
due to antibodies formation against inflammation. The higher the level of RF the greater the probability of destructive articular
disease.

- what will an increase in ESR (Erythrocyte Sedimentation Rate) tell you about the patient? ® level of inflammation

If there is an inflammation, the RBCs fall more rapidly, so the level of ESR is high – it is a non-specific sign of inflammation. In
SLE patients, the ESR may be elevated with active disease or with concomitant infection. It is a non-specific inflammatory
marker that is useful for monitoring disease flares and therapeutic response to treatment.

30. An old woman, mentally compromised, allergic to tomatoes. She has 5-year-old hip fracture. She takes the medication for
mental issues & antihistamines. She has a painful ulcer on palate from the past 2 days, it aggravates as she eats. Gingival
bleeding is present when probed. Biopsy was done for the ulcer.
- what is the reason for gingival hyperplasia? ® medicines, vitamin deficiency, trauma
- what is the reason for the ulcer? ® drugs, trauma from the food, mental issues
- what is the type of bone in the fractured site at this moment? ® remodeled, woven, trabeculae
- what is the epithelium adjacent to biopsy? ® parakeratinized, orthokeratinized, non-keratinized
- what is the epithelium of the ulcer? ® parakeratinized, orthokeratinized, non-keratinized
- which nerve anesthesia for biopsy? ® PSA, GP, MSA

31. An 80-year-old female with a history of cardiovascular disease presents with a complaint of pain under her complete dentures
when biting. She has worn them for 15 years, but seldom removes or cleans them. Removal of the dentures reveals diffuse
erythema of underlying mucosal tissue. Bone resorption is noted from detectable reduction in height of the alveolar ridges
due to the ill-fitting denture.
- the bone resorption in elderly patients with low dietary calcium is enhanced by which of the following hormones? ® insulin,
estrogen, aldosterone, thyroid stimulating hormone, parathyroid hormone
- administration of a local anesthetic with epinephrine will MOST likely produce which of the following cardiovascular effects?
® ­ heart rate, ¯ heart rate, ­ diastolic blood pressure, ¯ systolic blood pressure

32. Woman present with traumatic ulcer (“my mouth hurts”). Refer pain from three days ago. Multiple ulcers, 1-2 mm on the
gingiva, palate and tongue. Bilateral lymphadenopathy.
- biopsy was done, what is the epithelium called next to the ulcer? ® orthokeratinized, parakeratinized, squamos keratinized

Palate ® orthokeratinized
Gingiva ® parakeratinized

- what is her most likely diagnosis: herpes, aphthous

- if it is a traumatic ulcer, what cusps would most likely cause it? ® buccal cusps
- she is given a mouth guard, what position do we put her mandible to prevent this from happening again? ® protrusion,
retruded, maximum intercuspation

33. A young woman with hyperthyroidism was referred to her dentist for a dental check before a scheduled thyroid surgery.
Previously she went to her gynecologist thinking that she was pregnant, because her period didn't appear, she started to
become tense and started grinding her teeth. She thought it was the stress and the pregnancy. Her pregnancy test was
negative and the gynecologist noticed a lumpy appearance of her thyroid. After blood tests, it turns out that she has Graves’
disease.
- what is the standard feature of the hormones in hyperthyroidism? ® ¯ TSH & ­ T3, T4
- what type of disease is Grave’s disease? ® autoimmune
- why is TSH decreased? ® I chose antibodies against the TSH receptors of the Thyroid cells.
- what symptoms would you expect? ® I took Exophtalmus
- all hormones are present in her pre-pregnancy state except… ® hCG
- after thyroid surgery she got tetany symptoms and cramps, why? ® accidental removal of the Parathydoid
- in what position would her dentist adjust her mouthguard, so she stops grinding her teeth? (ICP)
 Graves’ disease (toxic diffuse goiter is an autoimmune disease that affects the thyroid. It frequently results in and is the MC
cause of hyperthyroidism. It also often results in an enlarged thyroid. Signs and symptoms of hyperthyroidism may include irritability,
muscle weakness, sleeping problems, a fast heartbeat, poor tolerance of heat, diarrhea, and unintentional weight loss. Other symptoms
may include thickening of the skin on the shins, known as pretibial myxedema, and eye bulging, a condition caused by Graves'
ophthalmopathy. About 25 to 80% of people with the condition develop eye problems.
Symptoms Enlarged thyroid, irritability, muscle weakness, sleeping problems, fast heartbeat, poor
tolerance of heat
Complications Graves' ophthalmopathy
Causes Unknown
Risk factors Family history, other autoimmune diseases
Diagnostic method Blood tests, radioiodine uptake
Treatment Radioiodine therapy, medications, thyroid surgery
Frequency 0.5% (males), 3% (females)

34. Cambodian girl, 16 years old, with TB and pain in her MX 1st molar.
- PPD test is positive in all except… ® T. leprae
- what nerve has to be anesthesised? ® ASA, MSA, PSA, MSA + PSA
- if RCT will be necessary, how many root canals do you expect & where? ® 4 root canals = 1P, 2MB, 1DB
- what should the dentist do about her TB? ® treat her tooth immediately, wait until TB is healed, treat her in a clinic with
universal infectious equipment, treat her in a special hospital isolation
- what should the dentist do since neither the girl, nor her parents speak English? ® use translators or interpreters

35. 32 year-old male. Physical education teacher with t. I diabetes mellitus, diagnosed at the age of 3.
- he started to be physically active and didn't need that much Insulin anymore. How do you call this
phenomenon? ® ­ sensitivity of the cells’ receptors to insulin

36. Obese, hypertensive man, 65 years old, on antihypertension medication, aspirin, non-compliant. He has severe periodontitis
and #14 and #15 have to be extracted.
- what receptors do the antihypertensive medication work on? ® beta-1 blockers, vasodilators
- why would he bleed? ® aspirin interferes with blood’s clotting action
- exact MOA of aspirin? ® reduces platelets aggregation, inhibits COX pathway.

Ability to suppress the production of prostaglandins and thromboxanes is due to its irreversible inactivation of the
cyclooxygenase (COX) enzyme. Ibuprofen, NSAIDs inhibit them too. Aspirin has an inhibition effect on both COX 1 and 2.

- in his condition, Sharpey’s fibers would attach everywhere except? ® cellular, acellular cementum, bone

In the teeth, Sharpey's fibres are the terminal ends of principal fibres (of the periodontal ligament) that insert into the
cementum and into the periosteum of the alveolar bone. A study on rats suggests that the three-dimensional structure of Sharpey's
fibres intensifies the continuity between the periodontal ligament fibre and the alveolar bone (tooth socket), and acts as a buffer
medium against stress. Sharpey's fibres in the primary acellular cementum are mineralized fully; those in cellular cementum and bone
are mineralized only partially at their periphery.
In this case, the bone is lower than normal, so acellular cementum has no attachment to the bone ® there’s no Sharpey’s
fibers!