CLINICAL SCIENCES

f
Bhatia s
Dentogist
M C Q s in

DENTISTRY
with explanatory answers
Fourth Edition

By
Nanda Kishore Patteta (MDS) O R T H O D O N T I C S
Government Dental College
Bangalore

JAYPEEBROTHERS
MEDICAL PUBLISHERS (P) LTD
New Delhi
 ORAL AND MAXILLOFACIAL
SURGERY
Maxillofacial Injuries

B. Examining level of chlorides

1. A patient with maxillofacial injuries should be
C. Drying the discharge on a piece of cloth
carried in:
D. Examining the level of proteins
A. Supine position B. Lateral position
C. Prone position D. Sitting position 8. Placing a nasal pack during nasal bleeding and
2. A patient with maxillofacial injuries should be C S F leak carry the danger of:
carried in a supine position only when there is: A. Fracture of ethmoidal plates
A. Spinal, cervical injury B. Redirecting the CSF to oropharynx
B. Bilateral parasymphysis fracture C. Meningitis
C. Unconsciousness D. Redirecting C S F to orbit
D. Excessive mobility of fractured maxilla 9. A patient with maxillofacial injury complains of
regurgitation, absence of gag reflex and weake-
3. Tongue-tie is indicated in:
ning of voice, he may have:
A. Bilateral parasymphysis fracture
A. Laryngeal trauma
B. Unconscious patient
C. Chin has been destroyed in gunshot B. Injury to middle cranial fossa
C. These symptoms are due to acute pain
D. All of the above
D. Paralysis of IX N
4. Immediate management of nasal bleed in facial
10. The crystalloid which should be given first, after
injuries is:
maxillofacial trauma:
A. Reduction of nasal bones manually
A. Normal saline
B. Paraffin gauze packing
B. 5% dextrose
C. Positioning the patient in supine position
C. Ringer's lactate
D. Positioning the patient in prone position
D. 10% dextrose
5. Glasgow Coma Scale is used: 11. Hypovolumic shock develops after loss of:
A. To ascertain motor responsiveness
A. 10% blood
B. Verbal responsiveness B. 20% blood
C. Eye response C. 30% blood
D. To ascertain level of consciousness D. 40% blood
6. Examination of pupils is of paramount impor- 12. Facial wounds can be c o n s i d e r e d for primar\
tance in maxillofacial injuries because it indi- closure when they report within:
cates: A. 24 hrs B . 72 hrs
A. Trauma to brain C. 36 hrs D. 48 hrs
B. Trauma to optic tract
C. Progress of patient after trauma 13. T h e most important step in suturing l a c e r s : - ;
D. All of the above lip:
7. T h e m e t h o d c o m m o n l y used to d i f f e r e n t i a t e A. Apposition of muscular layer
B. Apposition of vermilion border
nasal discharge from C S F in fracture of middle
C. Apposition of mucosal layer
third of face:
D. All of the above
A. Examining level of glucose
2 Dentogist: MCQs in Dentistry—Clinical Sciences

14. F a i l u r e of p r i m a r y s u t u r i n g o c c u r s in facial B. Fracture anterior cranial fossa

C. Fracture middle cranial fossa
wounds when:
D. 'Fracture nasoethmoid
A. Fine silk has not been used
B. Catgut has been used 22. T h e d i f f e r e n t i a t i n g feature o f b l e e d i n g due
C. Dead space develops in black eye and that due to fracture of orbit is/
D. Continuous suturing is done are:
15. A patient presents with lateral subconjunctival A. Circumorbital ecchymosis in black eye deve-
haemorrhage. Infraorbital step and diplopia on lops rapidly
right side with inability to open mouth, he can B. Posterior limit of subconjunctival haemor-
be having: rhage cannot be seen in black eye
A. Fracture subcondylar right side C. Posterior limit of subconjunctival haemor-
B. Fracture zygoma right side rhage can be seen in black eve
C. Fracture he Fort II right side D. None of the above
D. Fracture of floor of the orbit 23. T h e typical 'cracked pot' sound on percussion of
16. A patient p r e s e n t s w i t h b i l a t e r a l infraorbital upper teeth is indicative of fracture:
step, p a r a e s t h e s i a on left c h e e k r e g i o n , with A. Le Fort I B. Le Fort II
posterior gagging, and m o b i l i t y o f m a x i l l a r y C. Le Fort III D. All of the above
complex at nasal b o n e s , it indicates: 24. Guerin type fracture is same as fracture:
A. Bilateral fracture zygoma A. Le Fort I
B. Bilateral fracture Le Fort II B. Le Fort II
C. Fracture zygoma left side with bilateral Le C. Suprazygomatic
Fort II D. Le Fort III
D. Fracture bilateral subcondylar and fracture 25. In Le Fort I fracture infraorbital rim is:
zygoma left side A. Bilaterally involved
1". Diplopia would result if fracture line around B. Not involved
zygomatio-frontal suture passes: C. Involved medially
A. Below the Whitnall's tubercle D. May or may not be involved
B. Above the Whitnall's tubercle
26. ' M o o n face' appearance is not present in frac-
C. Through zygomatico-fronta-1 suture
ture:
D. Tearing the periosteum of orbital surface of
A. Le Fort I
zygomatic bone
B. Le Fort II
18. A patient complains of diplopia following frac- C. Zygomatic complex
ture zygoma, this is because of: D. Le Fort III
A. Fracture of orbital floor
27. Ecchymosis at zygomatic buttress would indi-
B. Entrapment of medial rectus
cate fracture:
C. Entrapment of superior oblique
A. Le Fort I B. Le Fort II
D. All of the above
C. Zygoma D. All of the above
Q
1 . Traumatic telecanthus is associated with: 28. 'Dish face' deformity commonly seen with frac-
A. Bilateral Le Fort II fracture tures of middle third of face is because of:
B. Nasoethmoidal injury A. Posterior and downward movement of ma) i I i
C. Fracture nasal bones B. Anterior and forward movement of maxilla
D. Bilateral fracture zygoma with enophthalmos C. Anterior and downward movement of ~ a
20. Guerin sign is presence of: D. Nasal complex fracture
A. Ecchymosis at mastoid area 29. On palpation there is a step at bilateral i r r n -
B. Ecchymosis at greater palatine foramen area o r b i t a l m a r g i n s and m o b i l i t y of midface i
C. Ecchymosis in zygomatic butress area detectable at nasal bridge a possible d i a ; - -
D. Ecchymosis in sublingual area would be fracture:
21. Battle's sign is associated with: A. Le Fort I B. Le Fort II
A. Fracture zygoma C. Le Fort III D. Le Fort III and n
 Oral and Maxillofacial Surgery 3

30. There is tenderness at ZF suture, with hooding 37. In replanting an avulsed tooth:
of eyes and step at zygomatic arches with distur- A. It should be thoroughly made sterile
bed occlusion, a possible diagnosis would be: B. Root filling with apicoectomy should be done
A. Fracture zygoma and zygomatic arch C. There is failure due to external root resorption
B. Fracture zygoma with paralysis of III nerve D. All of the above
causing hooding 38. High rate of fractures at canine region of mandi-
C. Fracture Le Fort II and fracture zygoma b l e is due to:
D. Fracture Le Fort III A. Change of direction of forces occurring here
31. On moving the maxilla b i m a n u a l l y , movement B. Long canine root
is felt at ZF suture area in a case of middle third C. Lower border is thin in this area
fracture of face, it is indicative of fracture: D. Alveolus is thin in this area
A. Le Fort I
39. Pathognomonic sign of fracture mandible is:
B. Le Fort II
A. Deranged occlusion
C. Le Fort III
B. Tenderness and swelling at site
D. Zygoma
C. Sublingual haematoma
32. S t e p and m o b i l i t y at i n f r a o r b i t a l margin and D. Inability to open mouth
step at ZF region would indicate fracture:
40. Fracture of coronoid process can occur due to:
A. Le Fort III and Le Fort II
A. Trauma at chin region
B. Le Fort II and zygoma
B. Trauma from posterior region
C. Le Fort III and zygoma
C. Reflex muscular contraction
D. None of the above
D. Lateral trauma.
33. Fracture Le Fort II involves the following bones:
4 1 . Respiratory embarrassment can occur in fracture:
A. Frontal process of maxilla, nasal, lacrimal
B. Frontal process of maxilla, lacrimal ethmoidal A. Angle
B . Parasymphysis
C. Frontal maxilla and nasal
C. Bilateral parasymphysis
D. Maxilla, frontal process of zygoma, nasal and
D. Bilateral subcondylar
lacrimal
42. A patient reported with deviation of j a w to the
34. A patient presents with open bite on left side
right s i d e on o p e n i n g and b l e e d i n g from the
and with tenderness at nasal bones, it could be
right ear, is a typical picture of:
fracture:
A. Left-subcondylar fracture
A. Unilateral Le Fort I on right side
B. Right-subcondylar fracture
B. Subcondylar on left side and zygoma on right
C. Right-subcondylar with fracture of anterior
side
cranial fossa
C. Le Fort II on right side
D. None of the above
D. Zygoma on right side and subcondylar on
43. A p a t i e n t w i t h b i l a t e r a l s u b c o n d y l a r fracture
right side
presents with:
35. In a crown-root fracture of the tooth, if fracture
A. Inability to open mouth
is not below alveolar bone and pulp is not expo-
B. On opening mandible moves forward
sed the tooth should be:
C. Anterior open bite
A. Endodontically restored
D. Closed bite
B. Extracted
C. Only jacket crown given 44. T h e term vertical in 'vertical favourable' frac-
D. Observed for 3-6 weeks tures connotes:
A. The fracture line running in vertical direction
36. If there is root fracture in apical third of tooth
B. The displacement of fracture is in vertical
without mobility:
plane
A. Tooth should be extracted
C. The direction of view of the observer is in
B. Treated endodontically
vertical direction
C. No treatment and periodic review
D. None of the above D. Fracture can be reduced vertically
4 Dentogist: MCQs in Dentistry—Clinical Sciences

52. A 3 2 - y e a r - o l d f e m a l e p a t i e n t reported with

45. A horizontally unfavourable fracture of angle of
b i l a t e r a l s u b c o n d y l a r fracture with anterior
mandible runs from:'
open bite, the treatment would constitute:
A. Lingual plate anteriorly backward through
A. IMF for 6 weeks
buccal plate posteriorly
B. Distraction with rubber stoppers and anterior
B. Upper border downward and forward
traction followed by IMF for 4-6 weeks
C. Upper border downward and backward
D. None of the above C. IMF for 4 weeks
D. Distraction with rubber stoppers and poste-
46. Best radiograph for fractures of middle third of
rior traction followed by IMF for 4-6 weeks
face:
53. W h i l e doing- c i r c u m - m a n d i b u l a r wiring there
A. Submentovertex
are chances of injuring:
B. Reverse Towne's view
A. Facial nerve
C. OPG
B. Facial artery, vein
D. Occipitomental view
C. Epiglottis
47. To find if fracture of angle m a n d i b l e is verti- D. Lingual nerve
cally favourable or unfavourable the radiograph 54. T h e s u b m a n d i b u l a r i n c i s i o n for approaching
advised: a n g l e fracture i s p l a c e d one finger breadth
A. PA view mandible below the lower border of mandible:
B. Lateral oblique 30° mandible A. To keep the incision line masked
C. Occipitomental view B. To prevent injury to facial vessels
D. Lateral oblique 15° mandible C. To prevent injury to marginal mandibular
nerve
48. Submentovertex view is an ideal view for diag-
D. Access becomes easy
nosing fracture of:
A. Zygoma 55. If fracture angle result following extraction of
B. Zygomatic arch mandibular impacted 3rd molar the immediate
C. Horizontal fracture of mandible treatment should be:
D. Nasoethmoid region A. IMF only
B. Bone plating (under GA)
49. There is absolute indication for extraction of a
C. Superior border transosseous wiring and
tooth which is present in the fracture line when
IMF
there is:
D. Transosseous wiring at the lower border and
A. Longitudinal fracture of tooth involving the
IMF
root
56. In old p a t i e n t s , open r e d u c t i o n and fixation
B. Infected fracture line
should be done with great care to:
C. Dislocation of tooth from its socket
D. All of the above A. Prevent iatrogenic fracture of atrophic mandi-
50. Gunning type splints are used when patient is: ble
B. Detach minimum of periosteum
A. Edentulous in one j a w
C. Prevent dislocation of condyle
B. Edentulous in both jaws
D. None of the above
C. When vertical relation is not known
/ D. All of the above 57. W a l s h a m ' s forceps are used for:
A. Disimpaction of maxilla
51. A 7-year old boy presented with fracture of left
B. Reduction of maxilla fractures
subcondylar region with occlusion undisturbed,
C. Reduction of fracture nasal bones
- the treatment would b e :
D. Ash septal force
A. Immobilisation for 7 days
B. Immobilisation for 14 days with intermittent 58. Following are the examples of rigid fixation:
active opening A. Lateral frontal suspension
B. Extraskeletal pin fixation
C. No immobilisation with restricted mouth
C. Bone plating
opening for 10 days
D. B and C
D. No immobilisation and active movement
 Oral and Maxillofacial Surgery 5

66. In a fracture of m a n d i b l e at the angle-region the

59. Indirect reduction of fracture z y g o m a can be
placement of screws in proximal segment is in:
done by:
A. Sagittal plane
A. Gillies approach
B. Horizontal plane
B. Intraoral approach
C. Such a close relation to teeth that injury to
C. Percutaneous approach
D. All of the above molar invariably occurs
D. No relation to teeth
60. To fix a zygomatic fracture by open reduction
67. To prevent injury to the apices of the teeth in
following sites have to approached:
m a n d i b l e , the placement of miniplate is:
A. Zygomatic, frontal and infraorbital
B. Infraorbital and zygomaticotemporal A. At the lower border of mandible
B. At a distance; twice the height of the clinical
C. A and B
crown below the alveolar crest
D. Zygomaticofrontal, zygomatic prominence
C. Below the inferior alveolar canal
and, floor of orbit
D. Not possible since alveolar bone bears the
BONE PLATING apices of the teeth
68. T h e m o s t c o m m o n l y injured tooth during the
6 1 . T h e mini-boneplate system is a: p l a c e m e n t o f m i n i p l a t e for the fracture o f
A. Compressive bone plating system m a n d i b l e in anterior region may be:
B. Monocortical system
A. Central incisor
C. Bicortical system
B. Lateral incisor
D. None of the above
C. Canine
62. The best and most effective position (in mandi- D. 1st premolar
ble) of miniplate as proved by various experi-
69. In a fracture of symphysis region in the mandi-
mental studies is:
ble:
A. Lower border of mandible
A. Subapical and lower border plates should be
B. Buccoalveolar region
fixed simultaneously
C. Linguoalveolar region
D. At a height midway between superior alveo- B. Subapical plate should be fixed first followed
lar region and lower border of mandible by lower border plate
C. L o w e r b o r d e r plate should be fixed first
63. The minimum number of miniplates required in
followed by subapical plate
fractures anterior to canine in mandible is:
D. None of the above
A. No plate is required since anterior region
70. In fractures of m a n d i b l e in elderly patients,
develops less amount of tension forces than in
fixation of plate is:
molar region
A. Submucosal
B. Only one plate as in molar region
B . Supraperiosteal
C. Two plates
C. Subperiosteal
D. Three plates
D. None of the above
64. M i n i m u m n u m b e r of screws required for fixa- 7 1 . T h e contraindication to miniplate along the line
tion of miniplate are: of osteosynthesis would be:
A. One screw on each side of fracture site A. A comminuted fracture
B. Two screws on each side of fracture site B. An infected fracture site
C. Three screws on each side of fracture site C. A fracture in 10-year-old
D. Two screws in smaller fragment and three D. When more than one fracture site exists in
screws in larger fragment
mandible
65. The optimum length of screw, for fixation of
72. Stress shielding effect is seen in:
plate in mandible is:
A. Miniplating
A. 2 mm
B. Compression bone plating
B. 3 mm
C. Lag screw
C. 4 mm
D. Transosseous wiring
D. 6 mm
6 Dentogist: MCOs in Dentistry—Clinical Sciences

73. During compression b o n e plating which type of 77. Epiphora results due to:
healing would not be observed: A. Blockage of lacrimal gland canaliculi
A. Contact healing B. Blockage of nasolacrimal duct
B. Gap healing C. Overactivity of lacrimal glands
C. Primary healing D. Evulsion of palpebral conjunctiva
D. Secondary healing 78. T h e m o s t c o m m o n site o f m a n d i b l e , w h i c h
74. T h e s p h e r i c a l g l i d i n g p r i n c i p l e is a feature shows non union or delayed union after I M F is:
of: A. Angle B. Body
A. Miniplates B. Luhr plating C. Symphysis D. Ramus
C. ASIF plating D. Lag screws 79. Acceptable treatment modality for fracture man-
75. In Luhr system of plating, the two individual dible in 8-year old is:
compression screws m o v e through: A. Transosseous wiring since IMF cannot be done
A. 1 mm B . 1.6 mm B. IMF for 3 weeks
C. 3.2 mm D. 4 mm C. Circum-mandibular splinting
D. AO bone plating.
76. T h e w h o l e o f m i d d l e third o f face can b e
approached by: 80. Risdon wiring is indicated for:
A. Infraorbital incisions A. Body fracture
B. Bicoronal flap B. Angle fracture
C. Alkayat and Bramley approach C. Symphysis fracture
D. Transconjunctival approach D. Subcondylar fracture

Answers
1 B. Such a patient usually has bleeding, CSF rhinor-
rhoea and d r o o l i n g saliva. Lateral position
allows easy outward flow of these thus pre-,
venting aspiration in unconscious patient and
blocking of respiratory tract in other patients.
Prone position though equally effective poses
problem in respiration and abdominal pressure.
In A, D chances of aspiration, and respiratory
blockage are high.
2 A. No movement of neck, spinal area should be
made, rather such patient should be carried with
a neck collar. In all other conditions patient
should be carried in lateral position.
3 D. In all these conditions tongue falls back due to
loss of its attachment via genioglossus muscle in
(B) due to loss of control of the tongue, causing
respiratory embarrassment.
4 B. With all other m a n o e u v r e s b l e e d i n g would
continue and even increase.
5 D. It is used to mark the level of unconsciousness
by means of ascertaining A,B,C.
6 D. Pupils have a direct relation with physiological
status of the brain.
In concussion: Pupils are dilated and equal in
size, react to light.
In subdural haematoma: Pupils first constrict
and then dilate and become nonreacting to light.
As patient progresses pupils attain normal size
and normal reaction.
7 C. Though all the methods can be used but easy,
quick tentative result can be achieved by (C).
8 C. Most important complication with this method,
if pack left for longer duration of time.
9 B. The IX, X, XI nerve leaves jugular foramen in
m i d d l e cranial fossa. IX, X nerve supply
pharynx, palate. Any trauma, haematoma in this
area can cause compression of these nerves.
10 C. The choice of crystalloid is based on the solution
having high osmotic value. This maintains fluid
in the vascular compartment. (Since after such
trauma hypovolumic shock may be precipitated).
Normal saline, 5% dextrose, 10%, dextrose all
are isotonic and fluid moves away in cells again
m a k i n g v a s c u l a r compartment hypovolumic
resulting in hypovolumic shock.
11 D.
12 A. If more than 24 hours-delayed primary closure
or secondary healing should be considered. By
this time oedema and infection would have set
in and primary suturing would fail.

13 D. Any structure s h o u l d be sutured in layers,
otherwise dehiscence, ugly scar or depression
would remain.
14 C. Failure of suturing occurs in
a. Infection
b. Tight suturing
c. Haemorrhage not controlled
d. Dead space left behind
e. Layer wise suturing not done.
15 B. Classical signs of fracture zygoma
i. Step at ZF suture area, infraorbital margin
and zygomatico temporal area
ii. Inability to open mouth because displaced
zygoma interferes with forward movement of
coronoid
iii. Paraesthesia of infraorbital nerve
iv. Diplopia (see answers 17, 18)
v. Dimple at prominence of zygoma (see answers
16, 18).
16 B. Classical signs of Le Fort II fracture
i. Step at bilateral infraorbital and zygomatic
buttress area
u.
Paraesthesia m a y / m a y not be present at
in. infraorbital nerve regions
The maxillary complex moves as one unit at
i v . frontonasal area
Posterior gagging, as maxilla moves down-
ward and backward at 45° incline plane of
base of skull.
17 B. The eyeball is supported by the Lockwood sus-
pensory ligament. This is attached to Whitnall's
tubercle on orbital surface of zygoma and lacri-
mal bone m e d i a l l y . W h e n z y g o m a fractures
above the Whitnall's tubercle in zygomatico-
facial region the suspensory ligament m o v e s
d o w n w a r d t h e r e b y c h a n g i n g level of pupil
resulting in diplopia.
18 A. Diplopia following fracture z y g o m a results
because of
i. Fractured orbital floor and h e r n i a t i o n of
orbital fat —> e n o p h t h a l m o s , c h a n g e in
pupillary level
ii. E n t r a p m e n t of lateral rectus in fractured
zygomaticofacial region—>diplopia on medial
gaze
iii. Entrapment of inferior rectus in orbital floor
—^diplopia on superior gaze. These entraped
muscles interfere with normal movement of
the eyeball resulting in diplopia while looking
on side o p p o s i t e to functioning of these
muscles
Oral and Maxillofacial Surgery 7
iv. Due to loss of support of Lockwood suspen-
sory ligament (see answer 17).
Fracture lines of zygoma donot pass (B) and
(C).
19 B. I n c r e a s e in d i s t a n c e b e t w e e n medial canthi
occurs in fracture of nasoethmoid and fracture
Le Fort III, because in both fractures, there is
splaying of nasal and ethmoid bones.
20 B. Indicative of fracture palate
A. Indicative of fracture at middle cranial fossa
known as Battle's sign.
C. I n d i c a t i v e of fractures Le Fort I, II and
fracture zygoma
D. Pathognomonic of fracture mandible.
21 C. T h i s is b e c a u s e b l o o d / C S F leaks down to
mastoid area from injured petrous temporal
along with C S F otorrhoea.
Fracture of anterior cranial fossa and that of
nasoethmoid result in C S F rhinorrhoea.
22 C.
23 D. This is d u e to d i s j u n c t i o n of maxilla from
cranium and reverberation in maxillary sinuses.
24 A. LF I Guerin or subzygomatic fracture
LF II Pyramidal or subzygomatic fracture
LF III Craniofacial disjunction or suprazygo-
matic fracture.
25 B . LF I fracture line runs horizontally above all
maxillary teeth at level of floor of nose.
LF II runs p y r a m e d i a l l y from nasal bone —>
frontal process of maxilla —* lacrimal bone —>
infraorbital margin—^zygomatic buttress—>
move backward above maxillary tuberosity.
26 C. ' M o o n face' deformity or ballooning of face
occurs d u e to o e d e m a following fracture of
m a x i l l a . W h i c h is w i d e s p r e a d and diffuse,
giving the typical appearance.
27 D. All these fracture lines pass below the zygomatic
buttress.
28 A. Fractured maxilla moves downward and back-
ward on plane of base of skull giving concave
dish-shaped appearance of face.
29 B. In LF I nasal bridge and infraorbital margins are
not involved. In LF III infraorbital margins are
not involved (see answer 30).
30 D. LF III fracture line runs from nasofrontal region
—> lacrimal bone—> ethmoid bone—>around optic
canal—> j u m p s infraorbital fissure—^greater
wing of sphenoid—>ZF suture, along with this,
fractures the zygomatic arches on both sides.
Hooding of eyes occurs because whole of middle
3rd of face moves down and eyeballs also move
down causing hooding of upper eyelid.
 8 Dentogist: MCQs in Dentistry—Clinical Sciences
31 C. This movement is pathognomonic of LF III frac-
tures along with its movement at nasofrontal
area. This fracture causes complete disjunction
of middle 3rd of face at these two points and
therefore, the movements are felt at these areas.
32 B. LF III w o u l d not i n v o l v e ( I O M ) infraorbital
margins, nor there would be movement at infra-
orbital margin.
33 A. E t h m o i d is i n v o l v e d in LF III and fracture
zygoma.
34 C. In unilateral fracture LF II the half maxilla moves
down causing open bite on contralateral side,
with steps at infraorbital m a r g i n and nasal
bones.
Fracture z y g o m a w o u l d p r e v e n t opening of
mouth, unilateral subcondylar fracture would
not h a v e a t e n d e n c y for open bite, but on
opening mandible moves to the affected side.
35 C. If tooth has a crown root fracture then it would
require extraction unless the root part of the
fracture is not below the level of the alveolar
bone. If pulp is e x p o s e d : post c r o w n if n o t
exposed: simple jacket crown should be given.
36 C. Whereas if root fracture is in the coronal two-
third of the root the crown, root and fractured
apical portion should be removed.
37 C. When replanting a tooth no attempt should be
made to sterilize the tooth, but should be washed
with n o r m a l saline. All a t t e m p t s should be
aimed at maintaining the vitality of the perio-
dontal membrane or cemenfum. In apicoectomy,
etc handling of tooth damages the periodontal
m e m b r a n e and no better prognosis has been
seen with this. Outer limit of reimplantation
from time of avulsion is 48 hours.
38 B. Long canine roots and i m p a c t e d 3rd molars
make the bone in the respected areas weak.
Whereas the forces of impactare concentrated at
s u b c o n d y l a r n e c k region. T h e r e f o r e rate of
fracture is high in
Subcondylar 33.4% and
C a n i n e / B o d y 33.6%.
39 C. Though all signs are indicative of injury but
sublingual h a e m a t o m a is p a t h o g n o m o n i c of
fracture of mandible.
40 C. Coronoid process is such a deep structure with
surrounding temporalis attachment on its ante-
rior and medial surface that direct traumatic
force w o u l d rarely cause its fracture. But if
mandible chin is hit in open position, reflex
contracture of temporalis muscle causing reflex
fracture of coronoid.
41 C. Because a t t a c h m e n t of genioglossus is laxed
and support of tongue is altered in this fracture,
therefore tongue falls back blocking respiration.
42 B. B l e e d i n g from ear occurs because displaced
fractured condyle tears the external auditory
meatus.
43 C. C l a s s i c a l p i c t u r e of anterior open bite is in
bilateral subcondylar fracture.
44 C. It is the direction of view which marks the angle
fracture. If looking from above it is vertical if
looking from side it is horizontal (see answer 45).
45 C. A. Vertically unfavourable fracture
B. Horizontally favourable fracture.
46 D. Submentovertex is for zygomatic arches
Reverse Town's view is for subcondylar region.
47 A. Lateral oblique 30° for horizontal favourable and
unfavourable fractures of angle
Lateral oblique 15° for ramus and body of man-
dible!.
48 B. This is known as jug-handle view best to show
zygomatic arches.
For zygoma-occipitomental view
Horizontal placement of mandibular fracture-
Lateral oblique 39°
Nasoethmoid Occipitomental
True lateral face
CT scan.
49 D. In other cases tooth should be retained
50 D.
51 D. In subcondylar fractures in children less than 14
years of age;
If occlusion' is disturbed slightly or occlusion is
n o r m a l — n o i m m o b i l i z a t i o n is required and
active m o v e m e n t should be instituted to pre-
vent reankylosis.
If occlusion is grossly deranged IMF for 10 days
and then active movement should be instituted
(Row and Williams).
52 B. Anterior open bite cannot be corrected by simple
IMF and distraction stoppers should be placed
with anterior traction with elastics.
53 B. The posterior wires are placed in region of 1st
molars. While passing these on buccal aspect of
m a n d i b l e the facial v e s s e l s may be injured
leading to bleeding haematoma formation.
54 C. Such a incision is below the marginal mandi-
bular nerve a branch of facial nerve, thereby it
is not injured.
55 C. Simple superior borders or peralveolar wiring in
wall of socket of 3rd molar and IMF is sufficient
to reduce and fix such a fracture.

56 B. The blood supply of mandible in old patients is
principally from the p e r i o s t e u m . E x t e n s i v e
manipulation of periosteum around fracture
segments can result in necrosis of bone.
57 C.
58 C. The only method of rigid fixation is bone plating.
All other methods have some degree of move-
ment in areas of fixation, therefore are called
semirigid indirect fixations.
59 D. Indirect method is one is which the fracture site
is not opened but fracture is reduced from a
distant site
Gillies via Temporal approach
Intraoral via Buccal approach
Percutaneous via Zygomatic
prominence.
60 C. The fracture of zygoma can usually be fixed by
open reduction and fixation at (A and B).
61 B . Miniplates were first introduced by Michele ettal
and were developed into a practical method by
C h a m p y et al. T h e y a d v i s e d a m o n o c o r t i c a l
system which is like tension banding. It is not a
compressive system of plating.
62 C. During the function of the mandible the tension
forces are generated at the superior border and
compressive forces at inferior border. The most
favourable spot for fixation is where the mus-
c u l a r l y d e t e r m i n e d t e n s i l e s t r e s s e s are the
greatest.
Linguoalveolar region is the most desirable site
for fixation of plate. But the buccal side is more
favoured because of extensive compact layer of
bone.
63 C. The fracture in symphyseal and parasymphyseal
region requires two plates for fixation. This is
to overcome the torsional forces developed in
anterior region besides the tension forces. Two
plates are found to be adequate to control these
forces.
64 B . M i n i m u m n u m b e r of screws on long-side of
fracture site are two. T h e l o n g - c o m m i n u t e d
fractures may require 3 or m o r e s c r e w s for
fixation. Screws lesser than 2 do not provide
adequate stability.
65 C.
The average thickness of the buccal cortex is 3.5
mm, the 4 mm length of the screw is adequate
for proper screw-bone contact. More over the
minimum distance between the inferior alveolar
nerve and the outer cortex is 4 mm, the length
66 A of 4 mm is safe.
In fractures of the angle of mandible, the plate
is placed in the proximal fragment medial to the
Oral and Maxillofacial Surgery 9
external oblique ridge. It is bent over the surface
and the proximal screws are placed in a nearly
sagittal direction.
67 B. Miniplates are placed along the alveolar border.
Positioning the miniplate at lower border and
below the inferior alveolar canal is not desired.
To prevent injury to the apices of the teeth, the
plate is placed at a distance of twice the height
of clinical crown from the alveolar crest.
68 C. Canine m a y be injured by the screw during
fixation of subapical plate in anterior region.
69 C. It is recommended that lower border plate be
fixed first and the subapical plate be fixed later.
In this way it is easier to avoid the tendency to
develop diastasis at the lower border due to
action of masticatory muscles.
70 B. In e l d e r l y p a t i e n t s , the blood supply to the
mandible is m a i n l y through periosteal blood
supply. The calibre of inferior alveolar vessels
is also reduced. So while raising a mucoperio-
steal flap, the blood supply is compromised.
D i s s e c t i o n and fixation are advised supra-
periosteally.
71 C. The need for miniplate should be assessed criti-
cally in children on account of possible damage
to the-tooth germs. Though miniplates are also
debatable in infected fractures but recent results
suggest good efficiency even in such cases. The
fixation of c o m m i n u t e d fractures requires
screws more than two on either side of fracture
line to provide stability. More than one fracture
site can definitely be treated by miniplates.
72 B. A cancellisation or a loss of bone substance
below the site of plate fixation is called as stress
shielding effect. Such condition is observed only
after compression plating when the complete
loading is borne by the plate and no functional
stimulation of bone occurs.
73 D. Primary healing is a characteristic of compres-
sion plating. Secondary healing which requires
callus formation and then endochondral ossifi-
cation is a feature of non-rigid fixations. When
two fractured segments are compressed against
each other, jagged fractured ends meet at few
points of contact known as contact-posts. These
posts bear the compressive forces and are the
sites of direct lamellar bone healing called as
contact h e a l i n g . M i n u t e gaps exist between
these contact posts. Lamellar bone is deposited
into these gaps. This is called gap healing. Both,
the gap healing and contact healing are parts of
primary healing.
10 Dentogist: MCQs in Dentistry—Clinical Sciences
74 C. The spherical gliding principle is a feature of
ASIF system of bone plating. The head of the
screw is like a hemispherical ball. When screws
are tightened the interfragmentary pressure is
built up because of gliding holes in plates (see
answer 75).
75 B. In Luhr system, two central holes in the plate
close to the fracture line are eccentric in shape,
with smaller hole diameters away from fracture
site. The inner edges are bevelled at an angle of
45° corresponding to the conical head of the
screw. Drilling is done in the small diameter of
screw hole and after the final phase of screw
insertion the conical heads are pulled into the
largest diameter of eccentric holes. In this way,
two screws move towards each other indivi-
dually by 1.6 mm and together by 3.2 mm.
76 B. Infraorbital for infraorbital margins Alkayat and
Bramley for TMJ
Transconjunctival for infraorbital margin bico-
Fascial Spaces and Infections
1. Fascial spaces are filled by:
A. Loose connective tissue
B. Elastic fibres
C. Loose adipose tissue
D. Dead space
2. The characteristic features of infection of masti-
cator space is:
A. Swelling
B. Draining pus intraorally
C. Trismus
D. High grade fever
3. The infections of masticator space do not enter
into neck because:
A. The fascia is tenaciously adherent to mylo-
hyoid line
B. The fascia is firmly adherent to periosteum of
lower border of mandible
C. Before it reaches the neck it follows path of
least resistance to open extraorally or intra-
orally
D. M a s t i c a t o r s p a c e is n o t c o n t i n u o u s with
spaces in neck
4. The infection of masticator space can spread to
(except):
A. Temporal pouches
ronal for z y g o m a , nasoethmoid nasofrontal,
nasal bones, zygomatic arches and TMJ.
77 B. In maxillofacial injuries at times nasolacrimal duct
is severed or its opening is closed. Therefore tears
are not drained into inferior meatus via
nasolacrimal duct. These tears fall from lower
eyelids and condition is known as epiphora
78 C. Because the blood supply is minimal and bone
is highly dense. Therefore delayed union occurs
and if fixation is not proper non-union of
symphysis fracture results quite commonly.
79 C. The b o n e is fragile and elastic, transosseous
wiring results in tearing through bone.
Bone plating may injure developing tooth buds
with the screws.
Simple IMF cannot be done as teeth have not
fully erupted or are in the phase of shedding
therefore w i r e s cannot be tightened around
these teeth.
80 C.
B. Lateral pharyngeal space
C. Sublingual space
D. Submandibular space
5. Swellings of masticator space and lateral phary-
ngeal space are similar. T h e distinctive diffe-
rence is that masticator space infection:
A. Is of dental origin
B. Is not pushed towards the midline
C. Is more diffuse and visible from outside
D. Has a tendency to spread to temporal
pouches
6. I n c i s i o n and d r a i n a g e of m a s t i c a t o r space
should be attemped:
A. At region anterior to masseter muscle
B. Intraorally from buccal sulcus
C. Extraorally in subangular region
D. From pterygomandibular raphe
7. I n f e c t i o n s from m a n d i b u l a r 1st molar would
travel to:
A. Submandibular space
B. Sublingual space
C. Masticator space
D. Digastric space
 Oral and Maxillofacial Surgery 11

15. Infections which travel from masticator space to

8. T h e major structures present in the submandi-
parotid space are very painful because:
bular space are:
A. Facial nerve is irritated
A. Deep part of submandibular gland, branches
B. The capsule of parotid does not give way for
of facial artery, lingual nerve
the developing infection to spread
B. Superficial part of s u b m a n d i b u l a r gland,
C. Auriculotemporal nerve is irritated by infec-
branches of facial artery and lingual nerve
C. Superficial part of s u b m a n d i b u l a r gland, tion
branches of facial artery, mylohyoid nerve D. None of the above
16. W h i l e g i v i n g a i n f e r i o r alveolar nerve b l o c k ,
D. S u b m a n d i b u l a r duct, lingual nerve and
infection is transposed to:
hypoglossal nerve
A. Pterygopalatine fossa
9. In Ludwig's angina the classical sign is:
B. Pterygomandibular space
A. T o n g u e is r a i s e d and falls b a c k c a u s i n g C. Submandibular space
respiratory embarrassment D. Masticator space
B. That submandibular sublingual and submen-
17. While giving posterior superior alveolar nerve
tal spaces are involved though tongue may
block, infection m a y be instituted into:
not be raised
A. Pterygomandibular space
C. That submandibular, sublingual and sub-
B. Infratemporal fossa
mental spaces are involved bilaterally
C. Temporal pouches
D. Board-like brawny induration of mandible
D. Pterygopalatine fossa
with tongue falling back and causing respi-
ratory embarrassment 18. A patient, presented with ophthalmoplegia and
s i g n s of m e n i n g i t i s after extraction of upper
10. I n L u d w i g ' s a n g i n a the i n c i s i o n s h o u l d b e
central incisor, could be diagnosed as due to:
placed deep uptill:
A. Tumour of pituitary
A. Mylohyoid muscle
B. Tuberculous meningitis
B. Anterior belly of digastric
C. Cavernous sinus thrombosis
C. Geniohyoid
D. No relation
D. Mucous membrane of floor of mouth
19. T h e d i a g n o s t i c sign/s w h i c h Eagelton charac-
1 1 . I n f e c t i o n s o f lateral p h a r y n g e a l s p a c e travel
terised for cavernous sinus thrombosis is/are:
usually from: A. Known site of infection
A. Temporal pouches B. Paresis of III, IV, VI nerves
B. Masticator space C. Proptosis of eye and (B)
C. Sublingual space D. All of the above
D. None of the above
20. Dissecting subperiosteal abscess develops:
12. Infections of lateral pharyngeal space are life
A. Immediately after 3rd molar extraction on
theratening because they carry dangers of:
lingual side
A. Thrombosis of rjV B. Erosion of ICA
B. Several weeks later and distant to site of 3rd
C. Oedema of larynx D. All of the above
molar extraction
13. I n f e c t i o n s from lateral p h a r y n g e a l s p a c e can C. In association of post extraction infection in
transverse to: buccal area of extracted 3rd molar
A. Anterior mediastinum D.
W h e n e x t e n s i v e dissection is done while
B. Middle mediastinum extracting an impacted tooth
C. Posterior mediastinum 21. An acute alveolar abscess should be treated with:
D. Only superior mediastinum A. First antibiotics for three days and then
14. Infections from s u b m a n d i b u l a r space and sub- incision and drainage
mental space usually transverse to: B. Incision and drainage with broad spectrum
A. Anterior mediastinum antibiotic
B. Middle mediastinum C.
Broad spectrum antibiotics and analgecis
C. Posterior mediastinum D.
Antibiotics and proteolytic drugs as chymo-
D. Only superior mediastinum trypsin
12 Dentogist: MCQs in Dentistry—Clinical Sciences

22. Osteomyelitis begins as an inflammation of: 28. Treatment of chronic osteomyelitis consists of:
A. Cortical bone A. Culture sensitivity and prolonged antibiotic
B. Periosteum therapy
C. Medullary bone B. Culture sensitivity with antibiotic therapv and
D. Periosteum and inner cortex hyperbaric oxygen therapy
C. S e q u e s t r e c t o m y , surgical exploration and
23. Which of the following conditions are suscep-
prolonged antibiotic therapy after culture
tible to osteomyelitis:
sensitivity
A. Paget's disease
D. Sequestrectomy, antibiotics after sensitivity
B. Fibrous dysplasia
and hydrocortisone therapy
C. Radiation
D. All of the above 29. Saucerisation as a surgical treatment for osteo-
myelitis connotes:
24. Osteomyelitis is more common in:
A. C o m p l e t e removal of decaved bone with
A. Maxilla
primary closure of wound
B. Mandible
B. Trimming or excision of margins of necrotic
C. Zygoma
bone overlying focus of osteomyelitis and
D. Nasal complex
allowing secondary healing
25. Osteomyelitis is caused most commonly by: C. Creating a saucer shaped defect by excision of
A. Streptococcus the defect with primary closure
B. Staphylococcus D. None of the above
C. M. tuberculosis
30. In treating osteomyelitis with hyperbaric oxygen:
D. E. coli
A. 3 0 % oxygen is used at 1 arm
26. In osteomyelitis how m u c h b o n e should have B. 7 0 % oxygen is used at 2 arm
b e e n destroyed b e f o r e it m a n i f e s t s radiologi- C. 100% oxygen is used at 3 arm
cally: D. 8 0 % oxygen is used at 2 atm
A. 10-12%
3 1 . A 40-year old patient presented with multiple
B. 15% extraoral sinuses with yellowish discharge and
C. 30-60% with history of intermittent remission after anti-
D. 8 0 % biotics treatment two months ago. The disease
27. Moth eaten appearance so characteristically seen s t a r t e d after e x t r a c t i o n o f 2nd m a n d i b u l a r
in radiographs of osteomyelitis is due to: premolar. It is suggestive of:
A. Presence of sequestrum A. Tubercular osteomyelitis
B. Enlargement of medullary spaces B. Actinomycosis
C. Reduced medullary spaces C. Subperiosteal Garres osteomyelitis
D. Narrowing of Volkmann's canals D. Dissecting subperiorteal abscess

Answers
1 A. posterior m e d i a s t i n u m in thorax. But direct
2 C. Though all features are present as seen with spread usually does not occur.
other infections. But the irritation of masseter 4 D. Masticator space is bounded by the pterygomas-
setric sling encompassed in superficial and deep
and medial pterygoid due to infection causes
layer of investing layer of deep cervical fascia.
severe trismus.
Which is tenaciously adherent to lower border
3 B. The investing layer of deep fascia of neck forms
and houses body of mandible, with its perio-
a collar of the neck. It is firmly adherent to
steum. The tenacious adherence to periosteum
periosteum of lower border of mandible thus
prevents the spread of infection interiorly to
preventing the spread. Though they can spread
submandibular space. But infection can travel to
to lateral pharyngeal space which can spread
sublingual space or submandibular space.
infection to superior mediastinum in neck to
 Oral and Maxillofacial Surgery 13

rior m e d i a s t i n u m w h e r e a s infections from

5 B. Masticator space s w e l l i n g s are m a s k e d by
submental region travel to pretracheal region to
masseter. Are present more anteriorly. Whereas
anterior mediastinum.
lateral pharyngeal space infection is posteriorly 14 A. S u b m a n d i b l e space—^sublingual space—> sub-
placed with characteristic shifting of palatine
mental space—>superior mediastinum—>anterior
tonsil to midline.
mediastinum.
6 C. Though it can be done by all means but ideal is
15 B. The investing layer to deep cervical fascia splits
(C). Since trismus is acute and intraoral method
to enclose submandibular and parotid salivary
is really difficult. With subangular incision one
glands. This is firmly adherent to capsule of
can directly reach the pus pocket of masticator
gland. Any infection of the glands cannot swell
space and allow dependent drainage.
out and resulting pressure causes acute pain.
7 B. The apices of 1st molar are present superior to
16 B. The injecting needle transverses through this
the attachment of mylohyoid muscle. Above the
space.
mylohyoid lies sublingual space and below it lies
17 B. Infection due to this infection would travel to:
submandibular space. Whereas apices of 2nd
Infratemporal fossa
and 3rd molars lie b e l o w the attachments of
'i Pterygopalatine fossa
mylohyoid muscle therefore infections from
I' Pterygomandibular fossa
these teeth travel to submandibular space.
i Temporal fossa.
8 C. Structures in submandibular space
18 C. Infection from m i d d l e part of upper face
i. Superficial part of submandibular gland
(premaxilla and nose) can travel in a retrograde
ii. Branches of facial artery
direction to cavernous sinus. The veins of this
iii. Mylohyoid nerve and vessels
d a n g e r o u s area are valveless and allow
Structures in sublingual space
retrograde infection in form of cavernous sinus
i. Deep part of submandibular gland (CS) thrombosis which is characterised by:
ii. Submandibular duct i. Ophthalmoplegia 6 since III, IV, VI cranial
iii. Lingual and hypoglossal nerve nerves are present in relation to (CS).
iv. Branches of lingual artery ii. Meningitis
9 C. Classical signs of Ludwig's angina iii. Proptosis due to increased venous pressure in
i. Submandibular, sublingual and submental spa- superior and inferior veins of the orbit.
ces are bilaterally involved 19 D.
ii. Tongue is raised 20 B. This is a typical subperiosteal infection, it occurs
iii. Brawny induration several weeks after an apparently uneventful
Tongue does not fall back, but since it is raised healing of a mandibular third molar extraction.
and has swelling at its base, the oropharyngeal The swelling may be present as far forward as
1st molar or 2nd bicuspid.
isthmus decreases in size causing respiratory
21 B. If antibiotics are given first for few days and
e m b a r r a s s m e n t and later l a r y n g e a l oedema
incision/drainage not done an abscess usually
causing respiratory embarrassment.
develops into an indurated hard swelling known
10 D. To reach sublingual space the incision has to be
as an antibioma. This would take 2 / 3 months to
deep uptill the mucous membrane. Sublingual
resolve. Therefore incision/drainage should be
space (which has also to be drained) is bounded
done first then broad spectrum antibiotic should
superiorly by mucous membrane, inferiorly by
be started and when culture sensitivity report is
mylohyoid, medially by geniohyoid and genio-
available the specific drug should be given.
glossus and laterally by mandible.
22 C. Osteomyelitis is an inflammatory condition of
11 B. J u s t medial to m a s t i c a t o r s p a c e lies lateral
bone that begins as an infection of the medullary
pharyngeal space whereas other infections have
c a v i t y and h a v e r s i a n s y s t e m . It extends to
to first travel to masticator space and then reach involve the periosteum of the affected area.
lateral pharyngeal space. 23 D. Conditions which alter the vascularity of bone
12 D. T h e major s t r u c t u r e s present in lateral
predispose to the onset of osteomyelitis. In all
pharyngeal space are the carotid sheath with its
conditions the vascularity of bone is compro-
IJV, vagus and ICA. Moreover infection of this
mised.
space rapidly spreads to larynx.
24 B. Osteomyelitis is more common in bones which
13 C. Infections from lateral and posterior pharyngeal
have extensive medullary bone and rich blood
space travel to superior mediastinum to poste-
14 Dentogist: MCQs in Dentistry—Clinical Sciences

supply. Maxilla, zygoma and nasal bones have
relative paucity of medullary tissue, therefore
infection is not enclosed in the bone cavity. Even
if it occurs it permits dissipation of oedema and
pus into soft tissues surrounding them. Whereas
mandible is relatively richer in medullary bone,
therefore osteomyelitis is more common.
25 B .
26 C.
27 B. Moth eaten appearance is characteristically seen
in radiograph. Occurs due to enlargement of
medullar spaces and widening of Volkmann's
canals, secondary to destruction, lysis and repla-
cement of granulation tissue.
28 C. In chronic osteomyelitis extensive sequestrum is
formed with involucrums. Therefore only pro-
longed antibiotic therapy, with/without hyper-
baric oxygen therapy does not help. Hydrocor-
tisone should never be given as it further lowers
down the immunity of the individual, surgery is
imminent.
29 B. The foci of infection in osteomyelitis is embed-
ded deeply. Therefore a saucer-shaped defect is
created by trimming or excision of margins of
necrotic bone overlying the focus. Curettage is
done and cavity is packed with antibiotic gauze
and allowed to heal by secondary intension.
30 C. Hyperbaric oxygen is used as 100% 0, with 2
atm pressure for treatment of osteomyelitis.
31 B. A typical picture of actinomyecetes
i. History of dental extraction
ii. Multiple extraoral draining sinuses
iii. History of remission and healing
iv. Yellow coloured discharge.

Diseases of TMJ, Max. Sinus, Cranial Nerves and

Salivary Glands
The treatment of unilateral T M J ankylosis in a 5. In surgical management of T M J ankylosis, one
8-year-old child would be: can encounter excessive bleeding from:
A. Simple gap arthroplasty A. Inferior alveolar artery
B. Condylectomy B. Internal maxillary artery
C. Gap arthroplasty with costochondral grafting C. Pterygoid plexus of veins
D. High condylotomy with costochondral grafting D. All of the above
The ideal surgical approach to T M J ankylosis is: 6. In unilateral T M J ankylosis the chin is deviated
A. Endaural to:
B. Submandibular A. The affected side
C. Postauricular B. The contralateral side
D. Preauricular C. No deviation seen
Interposition of temporal muscle and fascia in D. Side where growth is occurring
treatment of T M J ankylosis is advocated:
7. In a bilateral T M J ankylosis case the chin would
A. To prevent reankylosis
be deviated to:
B. To prevent erosion of glenoid fossa due to
A. Side of intense ankylosis
movement of ramal end
B. Side where more movement is present
C. To provide soft pad for easy movement of
C. No deviation
ramal end
D. None of the above
D. None of the above
W h i c h of the following is/are cause/s of T M J 8. D a u t r e y p r o c e d u r e is a t r e a t m e n t m o d a l i t y
ankylosis? for:
A. Trauma A. TMJ clicking
B. Middle ear infection B. TMJ dislocation
C. Rheumatoid arthritis C. TMJ arthritis
D. All of the above D. TMJ ankylosis
 Oral and Maxillofacial Surgery 15

9. A patient complains of pain in TMJ area on mas- C. Dautrey procedure

D. All of the above
tication, his m u s c l e s of mastication are tender
and an audible click is there, these features are 16. A patient of M P D S with typical psychosomatic
characteristic of: aetiology should be prescribed:
A. MPDS A. Carbamethaxamol
B. Traumatic subluxation B . Diazepam
C. Rheumatoid arthritis C. Fomentation and cold compresses
D. Rheumatic arthritis D. All of the above
10. T h e hypertonic s a l i n e or sclerosing solution is 17. Berger's flap for O A F closure utilises a:
used for conservative management of T M J sub- A. Palatal flap
luxation and d i s l o c a t i o n . T h e s e injections are B. Buccal flap
given: C. Only a mucosal mobilisation
A. In superior compartment D. None of the above
B. In inferior compartment 18. A palatal flap has high success rate in manage-
C. Paracapsular ment o f O A F because:
D. In the articular disc A. Abundance of tissue
11. In T M J o s t e o a r t h r i t i s w h i c h m e d i c a m e n t is B. Branch of palatal artery is also mobilised
injected in T M J ? C. It is resistant to infection
A. Sodium morrhuate D. Of fatty layer there are less chances of tear
B. Hydrocortisone 19. If nasal antrostomy is planned after O A F closure
C. Sodium salicylate opening should be made in:
D. Hypertonic saline A. Middle meatus
12. Myofacial pain d y s f u n c t i o n s y n d r o m e can be B. Inferior meatus above nasal floor level
precipitated by: C. Inferior meatus at nasal floor level
A. High filling or malocclusion D. Just above middle concha
B. Psychogenic factors 20. O A F should never be closed if:
C. Bruxism A. Palatal muscosa is deficient
D. All of the above B. Signs of infection are present
13. Arthroscopy is a technique by which: C. Opening is too large
A. The inside of joint can be seen from outside D. Patient is to have a complete denture
but for treatment open surgery is required 2 1 . If on removing a tooth, one realises that a large
B. The inside of joint can be seen and operated
O A F has b e e n formed:
from outside, without any open surgery
A. Immediate primary closure should be done
C. Dye is injected into the joint and serial
B. Closure should be done after 7 days
radiographs are taken to see movement of
C. The sinus should be irrigated, lavaged for 2 / 3
disc in the joint
days then closed
D. Dye is injected into the joint and outline of
joint cavity is delineated to see any bony D. None of the above.
erosion spur formation, etc. 22. Nasal decongestants are prescribed in manage-
ment of O A F to:
14. A patient who reports with B/L dislocation of
A. Allow drainage
T M J should be managed: B. Shrink antral lining
A. Manually without LA C. Prevent infection
B. Manually with LA D. Make breathing easier
C. Under GA only 23. Sialoangiectasis denotes:
D. Surgically under GA A. Salivary gland and duct system as vastly
15. T h e management of recurrent T M J dislocation dilated
is: B. A sialolith is present
C. A stricture in duct is present
A. High condylotomy
D. Chronic inflammation of salivary gland
B. Eminectomy
16 Dentogist: MCQs in Dentistry—Clinical Sciences

24. The treatment of parotid abscess is: C. Facial artery, facial vein, hypoglossal nerve
A. Antibiotics only only
B. Dilation of duct and (A) D. Facial artery, facial vein, marginal mandibular
C. Incision parallel to facial nerve branches and branch of facial nerve only
drainage with (A) 28. T h e e a r l y m a n i f e s t a t i o n of s i a l a d e n i t i s on a
D. Fomentation with (A) sialogram is:
25. T h e s t o n e i n a n t e r i o r s u b m a n d i b u l a r s a l i v a r y A. Terminal acini are dilated
gland duct s h o u l d b e r e m o v e d b y p l a c i n g the B. The acinar system is dilated
incision: C. The ductal system is dilated
A. Medial to plica sublingualis D. Constriction of ductal and acinar system
B. Lateral to plica sublingualis
C. Never in anterior region 29. Warthin's tumour is:
D. Just superficially in 2nd-3rd molar region A. Malignant parotid tumour
B. Benign submandibular tumour
26. Once the stone in s u b m a n d i b u l a r salivary gland
C. Benign parotid tumour
duct has been identified the i n c i s i o n should be
D. Any tumour of salivary glands which can be
placed:
benign or malignant
A. Longitudinally and duct sutured
B. Transversely and duct sutured 30. Mucoepidermoid tumour is:
C. Longitudinally and surgical wound closed A. Malignant
without suturing the duct B. Benign
D. T r a n s v e r s e l y and s u r g i c a l w o u n d closed C. Squamous cell tumour of salivary gland
without suturing the duct D. S a m e as adenocarcinoma
27. W h i l e r e m o v i n g a s u b m a n d i b u l a r gland one 3 1 . Cylindroma:
encounters: A. Is malignant tumour
A. Facial artery, facial vein, cervical branch of B. Is slow growing but metastasises
facial nerve and lingual nerve C. Shows extensive invasion
B. Facial artery, facial vein, cervical branch of D. All of the above
facial nerve only

Answers
1 C. In a 8-year-old child, unilateral ankylosis would
have caused marked asymmetry of face. This
occurs due to damage of growth centre and loss
of function. To take care of this residual defor-
mity, a costochondral graft is placed in which the
cartilage acts as a growth centre and compen-
sates by growth of this area. This surgery results
in achieving gradual symmetrical growth.
Only gap arthroplasty or (B) or (D) lacks this
advantage.
2 D. Preauricular incision has the advantage
.1. Aesthetic incision line-covered in hair, sha-
dow of ear
2. Better access
3. Better control of bleeding
4. Easy to master.
3 A. Basic principles of treatment of TMJ ankylosis
are
1. Achieve function: by gap arthroplasty
2. To p r e v e n t relapse: by interposing s o m e
material such as muscle, fascia, costochondral
graft, etc in gap so created by gap arthroplasty
procedure
3. To c o m p e n s a t e for residual deformity by
growth of interposed costochondral graft
4. To obtain balanced functional occlusion by
orthodontic treatment
5. To obtain facial harmony by orthognathic
surgery.
4 D. Rate of incidence
Trauma > middle ear infection > rheumatoid
arthritis.
5 D. T h o u g h m o s t c o m m o n l y internal maxillary
artery has been considered to be the cause of
such bleeding. To prevent injury to this artery
d u r i n g T M J s u r g e r y a safe side retractor is
always placed medial to neck of mandible.

Due to deformed anatomy of mandible lately it
has been postulated that bleeding can occur from
any of these vessels.
6 A. The growth fails to occur on the side of ankylosis
whereas n o r m a l g r o w t h is o c c u r r i n g on the
contralateral side which pushes the chin to the
side of ankylosis.
7 C. In bilateral TMJ ankylosis case there would be
no deviation of chin as g r o w t h is retarded
equally on both the sides. But marked retrogenia
and retrognathia would be there resulting in
classical bird face of 'shrew mouth' deformity.
8 B. W h e n there o c c u r s r e c u r r e n t d i s l o c a t i o n of
mandibular condyle, any of the following could
be carried out surgically:
a. Dautrey procedure
b. Eminectomy
c. High condylotomy
(B) and (C) are methods which remove the bony
interference thus allowing easy gliding in or out
of glenoid fossa. N o w dislocation becomes self
reducing.
In Dautrey procedure the zygomatic arch is
sectioned and pushed down in front of condyle.
This prevents the dislocation to occur.
9 A. MPDS is characterised by
M Muscle tenderness
P Pain on function in T M J
D Dysfunction of disc (clicking)
10 C. Dislocation or subluxation can occur if capsule
has become lax. Therefore these solutions are
injected paracapsular to bring about fibrosis of
capsule thus checking its laxity.
11 B .
12 D. MPDS is a psycosomatic disorder and occurs in
a cyclic manner
High filling—>TMJ pain—^muscle spasm—> mouth
opening —>pain. Tension (Psycogenic)—>bruxism
—» muscle overacting —> spasm -» mouth opening
—> pain.
13 B. TMJ arthroscope as name suggests is an instru-
ment which can see inside the joint. To this is
added an armamentarium by which various soft
tissue surgeries can be done in TMJ.
14 B. T h o u g h by classical m e t h o d of p u s h i n g the
c o n d y l e d o w n w a r d and chin u p w a r d the
operator can reduce TMJ dislocation. But better
would be to inject LA in muscles/tissues around
TMJ. Since dislocation occurs due to spasm of
depressor group of muscle therefore LA breaks
this spasm and dislocation reduces on its own.
15 D. See answer 8.
Oral and Maxillofacial Surgery 17
16 D. Carbamethexamol—A muscle relaxant to break
spasm of muscle
Diazepam—(for psycologic factor) sedation
Analgesic—Relief of pain
Fomentation—Increases blood supply to muscle
therefore helps in checking spasm (vasodilation
removes lactic acid, etc.).
Cold compresses m a k e area numb and allow
muscles to function allowing stretching which
also helps to break spasm.
17 B . Mucoperiosteal mobilization from buccal tissue.
18 B . Palatal flap whenever used for closure of OAF,
should include a b r a n c h of greater palatine
artery. A vascular flap has very less chances ot
failure.
19 C. The principle of nasal antrostomy is to allow
drainage from sinus to occur in nose. If opening
is above the level of nasal floor, drainage would
not be complete.
20 B . If infection in sinus is present, OAF should never
be closed as failure is bound to occur. Patient
should be given antibiotics and antral lavage
should be done regularly.
In all other events surgery can be done by other
means such as by using tongue flap, etc.
21 A. Only signs of infection should make one defer
the surgery for closure.
22 B . Shrinkage of lining prevents oedema of lining
and thus healing is better and infection control-
led earlier. But nasal decongestants directly do
not do so.
23 A. Sialoangiectasis or dilation of salivary acinoduc-
tal system can occur due to infection, sialolithia-
sis, stricture, etc.
24 C.
This is known as Hilton's method of treating
25 A, parotid abscess.
The lingual nerve has a characteristic relation
with submandibular duct. In posterior region it
lies laterally and superiorly, therefore for pos-
terior stone the incision is more laterally and
superficially. In anterior region the nerve runs
beneath the duct to reach medially and lies deep.
Therefore the typical approach to the stone (A)
26 C is carried out.
If placed transversely the duct never recanalises.
T h e r e f o r e i n c i s i o n is l o n g i t u d i n a l and not
sutured and it canalises again. If duct is sutured
27 A. there are chances of stricture formation.
28 A. Acinar system is dilated in chronic sialadinitis
Ductal system is dilated distal to stricture or a
sialolith
18 Dentogist: MCQs in Dentistry—Clinical Sciences

Only in atrophy of gland constriction of acino- 31 D. C y l i n d r o m a is a a d e n o c a r c i n o m a . It is slow

ductal system is seen.
29 C. Warthin's tumour or papillary cystadenoma
l y m p h o m a t o s u m is a b e n i g n slow g r o w i n g
tumour and occurs anywhere in or near parotid
gland.
30 A. M u c o e p i d e r m o i d t u m o u r s are m a l i g n a n t
tumours involving ductal and acinar structures
growing as compared to other carcinomatous
adenomas. It has high propensity for recurrence
and extensive invasion, with local destruction
with mild histologic changes. Due to all these it
differs from adenocarcinoma which is rapid
growing and show metastasis rather than local
destruction.

Cysts and Tumours of Oral Cavity

1. The swelling of bone usually seen with a cyst is 6. To obtain better informative radiographic view oi
due to: a cyst which has eroded the cortex considerably:
A. Ballooning of cortical plates A. Exposure time should be reduced
B. New subperiosteal deposition B. Exposure time should be increased
C. Soft tissue reactive swelling C. Voltage should be increased
D. Milliampere should be increased
D. Cortical plates being reabsorbed and cystic
lining causes the swelling 7. Partsch operation is same as:
A. Marsupialisation
2. In an otherwise a s y m p t o m a t i c cystic swelling
B. Decompression with enucleation
there is sudden neurapraxia in inferior alveolar
C. Only enucleation
nerve region it can be due to:
D. Enucleation with marsupialisation
A. Infection of cyst
8. Fissural cysts should be ideally treated by enu-
B. Expansion of periosteum due to cyst
cleation because:
C. Neuritis
A. The cysts are smaller in size
D. Neuralgia
B. They never enlarge to a size where enuclea-
3. A patient presents with a non vital and swelling tion cannot be done
in the labial sulcus. On aspiration straw colou- C. The bone does not always regenerate from
red fluid is present a tentative diagnosis would margins and fissural areas
be: D. M a r s u p i a l i s a t i o n w o u l d leave the cavities
A. Nasopalatine cyst open and these areas are more susceptible to
B. Solitary bone cyst infection
C. Keratocyst 9. B o h n ' s nodules are:
D. Periapical periodontal cyst A. Cystic swellings in neonates
4. With infected large cyst the adjoining teeth give B. Cysts associated with soft palate
a negative vital response, it is: C. Cysts of gingiva in growing children
A. Non reversible D. Warts on the tongue
B. Reversible after decompression 10. T h e choice of treatment for keratocyst should be:
C. Extraction of the teeth is a must A. Marsupialisation
D. None of the above B. Marsupialisation with secondary closure
C. Enucleation
5. In following situations an artefact may simulate
D. Marsupialisation with primary closure
a cystic lesion (except in):
A. R a d i o l u c e n t area in p e r i a p i c a l region of 1 1 . T h e high recurrence rate of keratocysts is incri-
central incisors minated to:
B. Radiolucent area apical to mandibular pre- A. Its fragile thin lining
molars B. Presence of daughter cysts in the cyst:; linir ;
C. Radiolucent area apical to maxillary canines C. Presence of daughter cysts in the c a r s . E
D. Radiolucent area in ramus of the mandible the cyst
below sigmoid notch D. All of the above
 Oral and Maxillofacial Surgery 19

12. T h e protein content of periapical and dentige- 19. If d u r i n g e n u c l e a t i o n of a cyst the apices of
adjacent normal teeth become exposed:
rous cysts is:
A. R e t r o g r a d e filling should be done with
A. 5-11 g m / d l
calcium hydroxide
B. Less than that of serum
B. They should be treated endodontically with
C. More than that of serum
apicoectomy
D. Less than 4 g m / d l C. Dressing and secondary closure should be
13. The window for marsupialisation shows maxi- done-
D. If vital they should be observed for three
mum contracture when:
months
A. It consists of sulcus mucosa supported by
loose connective tissue 20. O n e o f the m a i n r e a s o n s for b r e a k - d o w n o f
suture line after primary closure is:
B. It consists of sulcus mucosa with firm perio-
A. Dead space
steal bed loosely adherent to bone
B. Haematoma formation
C. It consists of mucoperiosteum firmly adherent
C. Saliva seepage
to underlying bone D. Retaining adjacent teeth
D. Cyst is large
21. T h e b e s t material to be packed in large bonv
14. C o m p l e t e e n u c l e a t i o n of cyst in palatal area cavity after enucleation of cyst is:
carries danger of: A. Allogenic bone
A. Excessive bleeding from nasopalatine artery B. Hydroxy apatite crystals
B. Severing of nasopalatine nerve C. Autogenic medullary bone chips
C. Tear of nasal mucosa D. Autogenic cortical pieces
D. Alteration of speech 22. Cysts from the following teeth usually expand
15. In cysts of m a x i l l a i n v o l v i n g m a x i l l a r y sinus palatally (except):
marsupialisation pack should be changed from: A. Maxillary lateral incisors
A. Nasal antrostomy B. Roots of maxillary premolars
C. Upper molars
B. Caldwell Luc operation
D. Upper central incisors
C. Palatal opening
D. From tooth socket 23. An early stage cementoma may be erroneously
diagnosed as a periapical cyst but for the:
16. In a 48-year old patient the treatment of denti- A. Position of lesion
gerous cyst w i t h i m p a c t e d m o l a r l y i n g near B. Vitality of tooth
lower border of mandible, would be: C. Radiopacity of the margin
A. Enucleation with primary closure and IMF D. Age of the patient
B. Marsupialisation with extraction of molar 24. Lateral developmental periodontal cyst is typi-
C. Marsupialisation with I M F cally present:
D. Enucleation with secondary closure A. In relation to vital teeth
B. In relation to submental space
17. In w h i c h of the s i t u a t i o n / s the cystic l i n i n g
C. In relation to pulpless maxillary teeth only
would have become thick and adherent? D. Supernumerary non vital teeth
A. Infection
B. Already decompressed earlier 25. Eruption cysts should be treated:
A. Immediately with enucleation
C. Tooth has been extracted without treating the
B. By marsupialisation
cyst C. With no active treatment
D. All of the above D. With antibiotics.
18. D u r i n g e n u c l e a t i o n the i n c i s i o n s h o u l d b e
26. T h e protein content of keratocyst is found to be:
placed on:
A. < 4 g m / d l
A. Firm bony base
B. >6 gm/dl
B. Mucosa only C. Equal to serum protein
C. Cystic lining D. More than serum protein
D. Cystic capsule
20 Dentogist: MCOs in Dentistry—Clinical Sciences

Z~. Treatment of keratocyst is: 33. Traumatic b o n e cyst is also known as:
A. Marsupialisation A. Solitary bone cyst
B. Enucleation B. Plaemorrhagic bone cyst
C. Excision C. Static cyst
D. Enucleation with secondary closure D. A and B

23. A 36-year-old patient presented with an asymp- 34. Stafne's b o n e cyst is a:

tomatic swelling on left side of b o d y of mandi- A. True cyst
ble, radiograph shows small radiopaque specks B. Bony depression above inferior alveolar canal
within the bone cavity and on aspiration straw C. Bony depression below inferior alveolar canal
colored fluid was present. It is a typical picture D. Radiolucent area below inferior alveolar canal
of: 35. The static b o n e cyst should be treated by:
A. Amaeloblastic adenomatoid tumour A. Enucleation
B. Calcifying epithelial odontogenic cyst B. Marsupialisation
C. Keratocyst C. No active treatment
D. Cystic odontoma D. Exploration and closure
29. A 26-year-old male patient presented with mul- 36. An example of retention cyst is:
tiple keratocysts, basal cell carcinoma on right A. Mucocele B. Ranula
cheek and dyskeratosis with bifid rib. Diagnosis C. Dermoid cyst D. Branchial cyst
would constitute:
37. Mucocele should be treated by:
A. Gorlin's cyst
A. Marsupialisation
B. Gorlin's syndrome
B. Enucleation of cyst
C. Marfan's syndrome
C. Enucleation of the cyst and the minor salivary
D. Pierre Robin syndrome
gland
30. G l o b u l o m a x i l l a r y cyst o c c u p i e s b o n y r e g i o n D. Decompression only
between:
38. T r a u m a to the e x c r e t o r y ducts of s u b l i n g u a l
A. Maxillary central incisor and lateral incisor
salivary glands causes:
B. Maxillary lateral incisor and canine
A. Ranula
C. Maxillary canine and premolar
B . Mucocele
D. 1st and 2nd premolar of maxilla
C. Solitary cyst
3 1 . A 18-year-old b o y p r e s e n t e d with s w e l l i n g in D. Sialolithiasis
labial sulcus, difficulty in breathing, skiagram
39. Following cysts occur on lateral side of neck:
shows no radiolucent lesion of the bone and on
A. Dermoid cyst B. Thyroglossal cyst
aspiration straw coloured fluid was present. It
C. Branchial cyst D. Epidermoid cyst
could be:
A. Medial palatine cyst 40. A patient presented with a small cystic swelling
B. Nasoalveolar cyst in a n t e r i o r r e g i o n of n e c k w h i c h moved on
C. Nasal polyp s w a l l o w i n g and on p r o t r u s i o n of tongue, it
D. Nasopalative duct cyst could be:
32. A patient 14 years of age presented with swel- A. Dermoid cyst
ling on right mandible, the adjacent teeth were B. Thyroglossal cyst
vital. R a d i o l o g i c a l l y t h e r e w a s a n e x t e n s i v e C. Epidermoid cyst
radiolucent lesion with scalloped margin exten- D. Branchial cyst
ding b e t w e e n the roots and l a m i n a dura was 41. A 33-year old patient reported with an extensive
intact. On aspiration g o l d e n y e l l o w coloured a m e l o b l a s t o m a o f m a n d i b l e but the l o w e r
fluid was p r e s e n t , a t e n t a t i v e d i a g n o s i s can border was not involved, the treatment should
be: be:
A. Aneurysmal bone cyst A. Curettage
B. Haemorrhagic bone cyst B. En-block resection
C. Stafne's bone cyst C. Segmental resection
D. Static bone cyst D. Hemimandibulectomy
 Oral and Maxillofacial Surgery 21

42. The recommended treatment modality for Pind- C. Down syndrome

borg's tumour is: D. Pierre Robin syndrome
A. Curettage 49. A 3 5 - y e a r old p a t i e n t with history of trauma
B. Enucleation complained of intermittent pain in (right) man-
C. Excision/resection dible with areas of paraesthesia. X-ray picture
D. Marsupialisation with secondary closure revealed a radiolucent area extending into the
43. Adenoameloblastoma should be managed by: inferior alveolar canal, on aspiration no fluid/
A. Enucleation gas was present, one can suspect:
B. En-block resection A. Haemorrhagic bone cyst
B. Aneurysmal bone cyst
C. Segmental resection
C. Traumatic neuroma
D. Hemi/partial mandibulectomy.
D. None of the above
44. W h e n p e r f o r m i n g c u r e t t a g e in a g g r e s s i v e
50. Incision for removal of a palatal torus should be
tumours such as a m e l o b l a s t o m a or Pindborg's
placed:
tumour, one should:
A. In the midline
A. Not sacrifice vital structures present in the
B. Paramedian
area
C. From crevices of teeth
B. Sacrifice the vital structures present in the
D. As an envelope flap
area
C. Both tumours are not aggressive 5 1 . F o l l o w i n g m e t h o d / m e t h o d s can b e used for
D. None of the above treating oral leukoplakia:
A. Excision B. Cryotherapy
45. The surgical management of Brown's tumour of C. Fulguration D. All of the above
mandible is:
52. Treatment of pyogenic granuloma consists of:
A. En-block resection
A. Antibiotics and analgesics
B. Segmental resection
B. Excision with removal of teeth
C. Parathyroidectomy
C. Excision without removal of teeth
D. No treatment
D. None of the above
46. A patient presented w i t h a radiolucent lesion
53. P e r i p h e r a l g i a n t c e l l g r a n u l o m a s h o u l d b e
and biopsy report s h o w s giant cells the lesion
treated by:
could be:
A. En-block resection
A. Giant cell granuloma
B. Excision with removal of teeth
B. Brown rumour
C. Excision without removal of teeth
C. Cherubism D. Segmental resection
D. All of the above
54. If after extracting a m a n d i b u l a r tooth, one en-
47. A 8-year old b o y p r e s e n t e d w i t h b i l a t e r a l
counters bleeding due to an underlying haeman-
swelling of mandible which was asymptomatic
gioma the first step in treatment would be:
and s l o w l y p r o g r e s s i v e i n n a t u r e , r a d i o l o g i c
A. Carotid artery ligation
picture had extensive bilateral multilocular
B. Inferior alveolar artery ligation
r a d i o l u c e n c i e s in p o s t e r i o r m a n d i b u l a r angle
C. Replacing the tooth in the socket
and body, this is a characteristic picture of:
D. Pressure packing
A. Hand-Schuller-Christian disease
B. Letterer-Siwe disease 55. Chondromas are:
A. Radiosensitive
C. Cherubism
B . Radiopaque
D. Eosinophilic granuloma
C. Radioresistant
45. A hypertensive patient having cafe au lait spots, D. Only present in condylar area
hypoplastic maxilla a n d s i g n s of mental defi-
56. T h e management of ossifying fibroma consists of:
c i e n c y p r e s e n t e d w i t h a soft t i s s u e m a s s on
b u c c a l m u c o s a , this s h o u l d i n c i t e surgeon to A. En-block resection
B . Curettage/enucleation
investigate for:
C. Segmental resection
A. Neurofibromatosis
D. Cryotherapy
B. Neunlemmoma
 22 Dentogist: MCOs in Dentistry—Clinical Sciences
57. A 14-year old f e m a l e p a t i e n t p r e s e n t e d with
swelling on (right) side of face in maxillozygo-
matic area. T h e s w e l l i n g has b e e n slowly pro-
gressive in nature, r a d i o g r a p h s h o w s diffuse
radiopaque mass involving maxillary sinus and
zygoma, with a typical ' g r o u n d g l a s s ' appea-
rance this is a characteristic picture of:
A. Osteoma
B. Ossifying fibroma
C. Fibrous dysplasia
D. Osteosarcoma
Answers
1 B. As the cyst increases in size, the periosteum is
stimulated to form a layer of new bone and it is
this subperiosteal deposition which alters the
outline of the affected portion of the jaw and
produces a curved enlargement.
2 A. Whenever a cyst is present adjacent to a nerve
it has chances of compressing the nerve. But this
occurs quite late in stage. Sudden neurapraxia is
seen when cyst gets infected. T h e increased
pressure due to pus a c c u m u l a t i o n in sac is
responsible for this.
3 D. In all other cysts teeth are usually vital.
4 B. As mentioned in (answer 2) the increased pressure
due to pus accumulation causes neurapraxia. Thus
giving a negative vital response. After decompres-
sion vital response is positive.
5 D. a. Incisive foramen
b. Mental foramen
c. Infraorbital foramen.
6 A. Because X-rays have to pass thin cortical plate.
7 A. Marsupialisation, decompression and Partsch's
methods aim at same method of treatment.
8 C. Marsupialisation aims at regeneration of bone
from the cavity. In fissural cysts the bone, at
times fails to grow and regenerate from margins
and fissural areas and dead space does not fill
up.
9 A. Gingival cysts of neonates are known as Bonn's
nodules. They appear as discrete white swellings
and can be single or multiple. T h e y rupture
spontaneously.
10 C. Keratocyst has high recurrence rate because of
presence of satellite or daughter cysts in the
epithelial lining or capsule of the cyst. With
m a r s u p i a l i s a t i o n these d a u g h t e r cysts have
tendency to form new cysts.
58. T h e r e c o m m e n d e d treatment for fibrous dys-
plasia is:
A. Curettage for contouring
B. Resection en-block
C. Radiotherapy
D. Excision
59. T h e tumours w h i c h are poorly differentiated
are:
A. Radiosensitive B. Radioresistant
C. Radioatropic D. Radiorefractive
11 D. B e c a u s e of its fragile thin lining there are
chances of tear during enucleation and small
pieces of epithelium may be left behind, which
have cystic potential.
"12 A. Equal to mean protein level of serum.
(D) Keratocysts are characterised by protein
content being less.than 4 g m / d l .
13 A. Contracture or closure of this opening can occur,
whenever the margins of window are not sup-
ported by mucoperiosteum firmly attached to
u n d e r l y i n g b o n e . C o n t r a c t u r e would be
maximum in (A) > (B) > (C). Contracture size of
cyst really does not matter.
14 C. In these cysts the palatal bone is usually very thin
and while enucleating there are great chances of
tear of nasal m u c o s a . Bleeding is usually
encountered from greater palatine artery. During
curettage the nasopalatine nerves are flushed
with the palate and not damaged in the canal. If
flap has been sutured back speech is not altered.
15 A. The basic principle in this is to allow growth of
nasal e p i t h e l i u m which is similar to antra!
epithelium rather than to allow growth of oral
epithelium (B,C,D) which is stratified squamous.
If normal epithelium fails to grow the oroantral
opening never closes or takes very long time.
16 C. The p r o x i m i t y of 3rd molar near the lower
border with cyst in angle/body region precludes
to pathological fracture of mandible. Treatment
of choice would be (C). After some bone has
formed then molar can be removed and dressing
with IMF should be continued. Whereas A,B,D
would have a chance of pathological fracture.
17 D. Any intervention such as A,B,C, cause thicken-
ing of cystic lining. Which becomes tenaciously
adherent to surrounding tissues.

18 A. Suture line should a l w a y s be supported by
healthy bone otherwise chance of opening up of
wound is high. Therefore incision should be
planned accordingly.
19 D. Since teeth were not involved in the cyst and
inadvertent exposure of apices had occured they
should be observed. Preference should be given
to maintain vitality of the teeth. If enucleation
removes the cystic lining completely there is no
need for (C).
20 B. If haemostasis is not achieved during closure,
increased pressure due to increase in haema-
toma leads to breakage of suture apposition.
Empty dead space does not lead to this unless
infected or filled with haematoma.
21 C. Cortical bone would not h a v e the osteogenic
potential and are susceptible to infection.
22 D. Due to inclination of apical thirds of all the other
teeth.
2.3 B. Periapical cysts are associated with non-vital
teeth.
24 A. Lateral d e v e l o p m e n t a l periodontal cysts are
associated with vital teeth, and has a predilec-
tion for mandibular third molar. Whereas lateral
periodontal cysts are associated with non-vital
pulps.
25 C. Eruption cysts occur in soft tissue overlying an
erupting tooth, they spontaneously rupture or
rupture from masticatory trauma.
26 A. Typical for keratocysts. All other cysts have
protein content 5-11 g m / d l .
27 C. These cysts often penetrate the cortex as well,
therefore excision of the cyst containing bone
block is indicated or enucleation and cauteri-
sation of bed of cyst should be done otherwise
recurrence can occur.
28 B. The radiographic picture is characteristic of (A)
and (D) but presence of straw coloured fluid
indicates (B).
29 B.
30 B.
31 B. It is a soft tissue cyst therefore no radiographic
finding was there. Though a soft tissue shadow
can at times be appreciated. Nasoalveolar cyst
is also known as nasolabial cyst. Nasal polyp is
not a cyst others (A) and (D) have typical radio-
lucencies in anterior palatine area.
32 B. Though it is difficult to differentiate (A) and (B)
but scalloped picture of radiolucency around
apex of teeth is typical of (B). (C) and (D) are
same and are due to a depression in the bone
below the inferior alveolar canal and is just a
radiographic finding.
Oral and Maxillofacial Surgery 23
33 D. I laemorrhagic or traumatic bone cyst does not
show any epithelial living therefore is not consi-
dered a true cyst. To differentiate it from other
true cysts, it is specifically known as solitary
bone cyst.
34 C, D.
35 C. Static bone cyst or Stafne's bone cyst is a non-
pathological entity.
36 B. In strict term, r a n u l a o t h e r w i s e ranula and
mucocele are at times grouped as mucoceles
only. Retention cysts are lined by epithelium
whereas extravasation lesions is devoid of a
definitive epithelial lining, e.g. mucocele.
37 C. Attempts to enucleate a mucocele are generally
doomed to a failure because of its continuity
with the duct of minor salivary gland, as the
connective tissue sac refills again.
38 A. Ranula: Sublingual salivary gland
Mucocele: Minor salivary gland.
39 C. The branchial cyst is located superficially in
lateral aspect of neck, in close proximity to angle
anterior to sternocleidomastoid muscle.
All other three c y s t s are c o m m o n l y seen in
midline of the neck.
40 B. Thyroglossal cyst is present anywhere along
the tract of thyroglossal duct extending from
foramen cecum to thyroid gland. Classically the
cyst moves during swallowing or on protrusion
of the tongue.
41 B. Curettage is no more considered as the treatment
of choice, as recurrence rate is very high with
these tumours. When tumor does not infiltrate
the lower border, excision or en-block resection
should be treatment of choice. But when lower
border is also involved then depending on extent
of tumour segmental resection or
hemimandibulectomy should be carried out.
42 C. It is also an aggressive tumour, with known,
high r e c u r r e n c e with c o n s e r v a t i v e surgery.
Secondly it is not a capsulated tumour therefore
enucleation is not possible.
43 A. A d e n o a m e l o b l a s t o m a as compared to amelo-
blastoma is a capsulated tumour thus can be
managed by simple enucleation.
4 4 B . T h e s e t u m o u r s h a v e infiltrative tendencies
therefore it is recommended that vital structures
as inferior alveolar nerve in area of tumour
should be sacrificed when curettage is consi-
dered as treatment of choice.
45 C. Brown t u m o u r is a giant cell tumour which
occurs in hyperparathyroidism. 'Brown' name is
derived from brown colour of hemosiderin seen
in h i s t o l o g i c a l s e c t i o n s . P a r a t h y r o i d e c t o m y
24 Dentogist: MCOs in Dentistry—Clinical Sciences
usually leads to spontaneous healing of oral
Brown tumours.
46 D. Typical giant cell lesions.
47 C. Characteristic picture of cherubism.
48 A. Pathognomonic clinical features of neurofibro-
matosis.
49 C. When a nerve is traumatised or crushed during
trauma its proximal end proliferates and most of
the times, the nerve regenerates. At times it fails
to form complete conduit but instead forms a
nodule known as the traumatic neuroma presen-
ting the above said features.
Haemorrhagic bone cyst is usually asympto-
matic, having characteristic scalloped shape and
filled with golden coloured fluid though air may
be there. Aneurysmal bone cyst is blood filled.
50 A. Paramedian or other incision makes it difficult
to raise the mucoperiosteal flap and there are
high chances of its being perforated or torn.
51 D.
52 C. Pyogenic granuloma should be excised without
extracting the teeth as it does not have its origin
from dental structures.
53 B. Peripheral giant cell granuloma is supposed to
be associated with the periodontal ligament and
Exodontia
1. The elevators used in exodontia are functionally:
A. Class I levers only
B. Class I and II levers
C. Class III levers only
D. Only wedge-shaped
2. Exodontia elevators are based on principle of:
A. Levers
B. Wedge
C. Wheel and axle
D. All of the above
3. W h i l e removing m a n d i b u l a r 3rd molar w h i c h
part of bone should be used as f* fulcrum?
A. Lingual cortical bone
B. Mesial inter-radicular bone
C. Buccal alveolar bone
D. Distal surface of adjacent crown
4. Mechanical advantage would be maximum for
an elevator when:
A. Effort arm is greater than resistance arm
B. Resistance arm is greater than effort arm
thus associated teeth should be extracted along
with excision to prevent recurrence.
54 C. Till the tooth rests in its socket the bleeding can
be checked until definitive therapy is instituted.
55 C. Radioresistant and liable to undergo malignant
changes. They can arise from symphysis, coro-
noid, p r e m a x i l l a r y areas, along with the
condylar areas.
56 B. Ossifying fibroma is an encapsulated tumour
therefore it can be completely enucleated or
curetted.
57 C. C l a s s i c a l c l i n i c a l p i c t u r e with characteristic
'ground glass' radiographic picture of fibrous
dysplasia.
58 A. Fibrous dysplasia is a diffuse lesion involving
extensive bony structure extending from maxilla,
zygoma, maxillary sinus and at times the temporal
b o n e . T h e r e f o r e excision or resection is not
possible. Secondly it is supposed to be a self-
limiting disease process. Therefore curettage to
the extent of obtaining harmonious facial con-
touring is the recommended treatment.
59 A. Poorly differentiated tumours have high mitotic
activity and their genetic material is susceptible
to radiation, thus more sensitive.
C. When fulcrum is in the centre
D. When fulcrum is near the point of effort
5. W h e n m a x i l l a r y l a t e r a l i n c i s o r has to be
extracted the first m o v e m e n t of forcep should
be:
A. Labially then apically
B. Palatally then apically
C. Labially or palatally
D. Apically then palatally
6. Mead forceps are used for extraction of:
A. Maxillary molars
B. • Mandibular incisors
C. Maxillary canines
D. Maxillary premolars
7. To extract mandibular premolars the first move-
ment of forceps should be:
A. Apical and labial
B. Apical and lingual
C. Apical and mesial
D. Labial and no apical movement
 Oral and Maxillofacial Surgery 25

8. When maxillary and mandibular teeth are to be C. Be removed by splitting the tooth
extracted simultaneously the order of extraction D. None of the above
should be: 14. W h i c h type of m a n d i b u l a r impactions are most
A. Maxillary teeth followed by mandibular teeth c o m m o n l y a s s o c i a t e d w i t h ' a p i c a l n o t c h ' for-
B. Mandibular teeth followed by maxillary teeth mation:
C. It does not matter which teeth are removed A. Mesioangular
first B . Distoangular
D. For anterior region mandibular first and for C. Vertical
posterior region maxillary first D . A and B
9. W h e n s i m u l t a n e o u s e x t r a c t i o n s h a v e to be 15. T h e d i s a d v a n t a g e of lingual split t e c h n i q u e is/
carried out in one maxillary segment the order of are:
extraction should be: A. Injury to lingual nerve
A. Incisors, canine, premolars, molars B. Opening up of facial spaces on lingual side
B. 3rd molar, second molar, 2nd premolar, 1st and floor of mouth
molar, 1st premolar, incisors, canine C. Chances of dislodging tooth or root in sub-
C. Molars, premolars, canine, incisors lingual space
D. Molars, premolars, incisors, canine. D. All of the above
10. T h e S t o b i s m e t h o d of extraction is indicated 16. The basic advantage of lingual split technique for
when: extraction of m a n d i b u l a r impacted teeth is/are:
A. Two adjacent teeth have to be removed A. Bone loss is minimal
B. When central incisor is to be extracted B. Easy and quick method
C. When isolated molar is to be extracted and C. Tissue trauma is minimal
adjacent teeth are absent D. All of the above
D. Upper and l o w e r 3rd molars h a v e to be 17. Lateral trepanation technique of Bowdler Henry
extracted simultaneously is indicated for:
11. 'White line' described by G e o r g e Winter is a line A. Extraction of impacted canines
drawn: B. Removal of impacted premolars
A. Along occlusal surfaces of erupted mandi- C. Removal of partially formed unerupted third
bular molars extending to impacted third molars
molar region D. T r e a t i n g d e n t i g e r o u s cysts with enclosed
B. From crest of bone lying distal to third molar third molars
to crest of the interdental septum between 1st 18. The chisel should be used with:
and 2nd molar A. Bevel towards the bone which is to be saved
C. From perpendicular to 'amber line' B. Bevel towards the bone which is to be sacri-
D. From perpendicular to 'red line'
ficed
12. ' R e d L i n e ' as d e s c r i b e d by G e o r g e W i n t e r is C. Bevel direction is not important
demarcated as a line: D. Flat surface parallel to direction of grains of
A. Drawn from bone distal to third molar to crest bone
of the interdental septum between 1st and 2nd 19. While m a k i n g vertical incision for flap for man-
molar dibular third molar impactions one can injure:
B. Which is a p e r p e n d i c u l a r dropped from A. Buccal pad of fat
'amber line' to point of application of elevator B. Branches of lingual nerve
C. W h i c h is a p e r p e n d i c u l a r d r o p p e d from C. Branches of facial nerve
'white line' to point of application of elevator D. Branches of facial artery/vein
D. None of the above
20. Dry socket c o m m o n l y occurs after:
13. If in a m e s i o a n g u l a r m a n d i b u l a r i m p a c t i o n
A. 24 hours
there is 'apical notch' visible on a radiograph the
B. 2 days
tooth should:
C. 3-4 days
A. Not be removed
D. 10-15 days
B. Be removed by lingual split technique
26 Dentogist: MCQs in Dentistry—Clinical Sciences
2 1 . The treatment of localised osteitis is:
A. Debridement, curettage and sedative packing
B. Curettage, irrigation and sedative packing
C. Irrigation and sedative packing
D. None of the above
22. In case of extraction of maxillary molars if maxil-
lary tuberosity also fractures, the fractured bone:
A. Should be removed
B. Should be replaced and allowed to heal by
secondary intention
C. Should be replaced and retained by primary
suturing of soft tissues
Answers
1 B. Elevators used in exodontia are based on princi-
ples of:
(i) Levers Class I and Class II
(ii) Wedge
(iii) Pulley
(iv) Wheel and Axle
2 D.
3 C. The elevator should always be placed between
the tooth and alveolar bone and alveolar bone
should be used as fulcrum. Adjacent teeth and
lingual cortical plate should never be used as
fulcrum.
4 A. To obtain maximum mechanical advantage the
fulcrum should be near the point of resistance
and effort arm should be longer than resistance
arm (principle of class I levers).
5 D. The first movement of forceps should be always
apical. Except lateral incisors all other maxillary
teeth are then moved buccally. Lateral incisors
because of typical palatal inclination are moved
apically and then palatally rather than labially.
6 B. Mead forcep is ideal for extraction of mandi-
bular teeth.
7 B. In mandible the m o v e m e n t of forceps is first
apical for all teeth. Then labial for anteriors and
lingual for posteriors.
8 A. According to Archer maxillary teeth should be
extracted first because:
A. Early action of LA in maxilla is there.
B. The debris, etc. does not fall once maxillary
molars have been removed and packs have been
placed thus allowing clean field for mandible.
9 B. Archer suggests that the 1st maxillary molar and
D. Should be fixed by transosseous wiring or
bone plating
23. T h e c o m p l i c a t i o n of u s i n g air rotor at 30,000
R p m for impacted molars is:
A. Necrosis of bone B. Dehiscence
C. Tissue laceration D. Emphysema
24. T h e most important suture while closing Ward's
incision for impacted mandibular third molar is:
A. Suturing of vertical limb
B. Suturing of retromolar limb
C. Suture of area immediately distal to 2nd molar
D. None of the above
canine are key pillars of maxilla and most firm
teeth of the arch. Once their adjacent teeth are
r e m o v e d they can be easily luxated and
extracted rather than when these are tried to be
removed first.
10 A. Especially for lower premolars.
11 A. George Winter had described three imaginary
lines to be drawn on an IOPA for impacted
mandibular molars.
i. White line (A)
ii. Amber line (B)
iii. Red line (See Q. 12).
12 B .
13 C. Whenever an 'apical notch' is present it is usually
present on lingual aspect therefore lingual split
should be avoided as lingual removal of tooth
may injure the n e r v e . Splitting the tooth and
delivering it buccally is the ideal choice.
14 D. Both mesioangular and distoangular impactions
can be associated with an 'apical notch'.
15 D. Lingual split technique was given by Sir William
Kelsey Fry and is popular in Great Britain and
in people who are trained there.
16 D. There is a thin plate of bone on lingual side of
impacted mandibular molar. Splitting of this
plate d e l i v e r s the tooth easily and quickly.
M o r e o v e r buccal s h e l f area is saved and
preserved for future denture fabrication.
17 C. Bowdler Flenry advocated trepanation of buccal
bone lateral to partially formed unerupted third
molars and then their removal, This method pre-
serves bone collar distal to erupted 2nd molar.
18 B.
 Oral and Maxillofacial Surgery 27

19 D. A long deep incision anterior to masseter muscle
can at times injure facial artery/vein.
20 C.
21 C. It has been advocated that below the nonvital
necrotic bone of alveolus (in dry socket) healthy
bone is forming. Which in time denudes the
superficial necrotic tissue and healing proceeds
to completion. Curettage should not be done as
it prolongs the period of healing.
22 C. By this method healing usually occurs. To aid in
fixing, a cold cure acrylic splint can be fixed.
Transosseous wiring or bone plating are not
feasible, moreover simple method as (C) can
achieve equally good results.
23 D.
24 C. A distal pocket can form in 2nd molar region if
this suture is not in the right position.

Orthognathic and Reconstructive Surgery

1. A patient with class II div I m a l o c c l u s i o n is B. Segmental osteotomy
operated for genioplasty his anterior teeth after C. Reverse sagittal split osteotomy
the operation would be: D. Sagittal split osteotomy
A. In edge to edge bite 7. T h e basic advantage of sagittal split osteotomy
B. Without any change is/are:
C. Having normal overjet of 2 mm A. It is carried out intraorally as well as extra-
D. Having no overbite orally
2. Jumping genioplasty is a term which connotes: B. No bone grafting is required when defect is
A. Movement of chin posteriorly less than 8 mm
B. Double step genioplasty C. There are no chances of paraesthesia
C. Single step advancement D. All of the above
D. Advancement after set back of mandibular 8. Apertognathia is a condition in which there is:
body A. Retrogenia
3. In a p a t i e n t with class III facial p r o f i l e one B. Maxillary hypoplasia
would think of which type of genioplasty (G)? C. Open bite deformity
D. Maxillary and mandibular prognathism only
A. Reduction G
B. Advancement G 9. D u r i n g g e n i o p l a s t y there are chances of inju-
C. Straightening G ring:
D. Rotational G A. Inferior alveolar nerve
4. Sagittal split osteotomy is a procedure carried B. Marginal mandibular nerve
C. Mental nerve
out for:
D. Lingual nerve
A. Mandibular deformities
B. Maxillary deformities 10. Wassmund and Wunderer procedures are:
C. Deformities in which occlusion is not invol- A. Mandibular segmental osteotomies
ved B. Maxillary segmental osteotomies
D. Condylar repositioning C. Maxillary subapical osteotomies
D. Multiple subapical osteotomy procedures ot
5. Sagittal split osteotomy was first advocated by:
maxilla and mandible respectively
A. Obwegesser
u
B. Dal pont 1 1 . In a patient in whom S N A is 8 2 and S N B is 96"
C. Wundrer indicates he would require:
D. Moose A. Maxillary surgery with setback
6. A patient reported with class III skeletal defor- B. Mandibular surgery
mity the ideal choice would be: C. Mandibular advancement
D. Maxillary advancement
A. Inverted L osteotomy
28 Dentogist: MCQs in Dentistry—Clinical Sciences

12. Allografts are grafts taken from: 19. Alveoplasty should be carried out:
A. Same species and individuals are genetically A. When multiple extractions are done in one
quadrant
related
B. Different species B. When entire arch extraction is there
C. To remove undercuts
C. Same species but individuals are genetically
D. all of the above
not related
D. Same species and between genetically iden- 20. Intercortical alveoloplasty is done by:
A. Removing margins of cortical plates
tical individuals
B. R e m o v i n g i n t e r s e p t a l bone entirely and
13. White grafts are: collapsing labial and palatal cortical plates
A. Never rejected C. Removing septa till upper third of socket and
B. Are immunologically biocompatible
compressing the cortical plates
C. Are rejected without evidence of vasculari- D. None of the above
zation
21. T h e principle problem with tuberosity reduction
D. Behave in same manner as autogenous grafts
is:
14. The best bone graft which can be utilised for
A. Poor access
reconstruction of large mandibular defect is:
B. Formation of O A F
A. Chostochondral graft
C. Infection
B. Calvarial graft
D. Damage to posterior superior alveolar nerve
C. Iliac crest graft
D. Metatarsal bone graft 22. T h e K a z a n j i a n ' s t e c h n i q u e o f v e s t i b u l o p l a s t y
leaves:
15. Iliac crest graft should ideally be taken from: A. Lip surface to reepithelialise
A. Lateral aspect B. Alveolar surface to reepithelialise
B. Medial aspect C. Depth of sulcus periosteum to reepithelialise
C. Posterosuperior aspect D. None of the above
D. Anteroinferior aspect
23. T h e Lipwitch procedure is used for:
16. A patient in w h o m iliac crest graft has been A. Ridge augmentation
taken for mandibular reconstruction, should be B. Sulcoplasty
kept nil orally postoperatively: C. Tuberoplasty
A. For 6 hrs D. Chiroplasty
B. Till bowel sounds appear
24. When there is high crestal attachment of muscle
C. For 12 hours
and tissues the indicated method of vestibulo-
D. Till patient is ambulatory
plasty is:
17. The graft of choice in a 30-year old patient of A. Kazanjian's
ameloblastic resection would be: B. Clark's
A. Free iliac crest graft C. Obwegeser's
B. Free vascularised iliac crest graft D. Howe's lipwitch
C. Medullary bone graft
25. Incision for operation of tongue-tie should be
D. 6th rib
placed:
18. Composite grafts consist of: A. Transversely on lingual frenum
A. Bone only B. Longitudinally along lingual frenum on both
B. Medullary bone only sides
C. Bone and soft tissue C. On crest of frenum longitudinally
D. Particulate bone mixed with resins D. None of the above

Answers
1 B. Genioplasty is an orthognathic procedure in
which surgery is performed only on chin or the
genial segment of mandible without altering the
denture bearing part.
2 B. Two-step genioplasty or jumping genioplasty is
a procedure in which chin is divided or cut into
two segments and moved separately to achieve
more advancement, or lengthening of chin.
3 A. So as to achieve straight facial profile.
4 A. In this body of mandible is moved forward or
backward or rotated after placing cuts at body
angle-ramus region in a sagittal plane. The
procedure is done exclusively intraorally. The
body of mandible is moved with the denture
bearing part and condyles are not moved from
their original position.
5 A. Advocated by Obwegesser and modified by Dal-
pont. VVundrer is a s s o c i a t e d with maxillary
segmental osteotomy.
6 D. In inverted L osteotomy incisions are placed
extraorally therefore not aesthetic.
Segmental osteotomy can correct slight dental
prognathism but not skeletal prognathism.
Reverse sagittal split osteotomy is advocated in
cases of bird face deformity in which ramus
is too thin to allow regular sagittal split osteo-
tomy.
7 B . Since ramus body is cut in sagittal plane there-
fore buccal and lingual cortical plates always
overlap even in 8-10 mm of advancement and no
gap is created at the surgical site. Therefore
grafts are not required. It is exclusively done
intraorally. There is high risk of inferior alveolar
nerve paraesthesia due to stretching, trauma,
swelling.
8 C.
Open-bite deformity is known as apertognathia.
9 C.
The cut of genioplasty extends from lst-2nd
premolar area to the other side below the mental
nerves.
10 B. Maxillary anterior segmental osteotomy.
11 B Mandibular prognathism is present and maxilla
appears normal. Therefore mandibular setback
rather than advancement would be required.
12 C A. Isografts
B. Xenografts
C. Isografts.
13 C When a bone graft has been rejected once and
a new graft of same type is placed again it is
Oral and Maxillofacial Surgery 29
rejected much faster and show no evidence of
acceptance or vascularisation. Such a graft is
termed as 'White graft'.
14 C. It has abundant medullary bone with sufficient
cortical components for support. Also its contour
is compatible to that of mandible. Second choice
would be a costochondral graft. Calvarial graft
are good for small defects of maxilla and middle
third of face. Metatarsal has been used to form
condylar component only because of similarity
of shape.
15 B. If taken from lateral aspect, the muscles of lower
limb are d e t a c h e d t h e r e b y interfering with
walking and limping occurs.
16 B. Usually iliac crest graft is taken from medial
aspect therefore abdominal viscera is contacted
during surgery. If bowel sounds donot appear
and patient is given orally paralytic ilius can
ensue.
17 B, On such a graft, d e n t u r e s , implants can be
constructed without causing resorption of bone
graft much required for such a young patient.
18 C. Such grafts are known as composite free grafts.
19 D
20 B, Intercortical denotes space between two cortex
and in this septal b o n e is removed entirely
before compression.
21 B. Though all can be complications but close proxi-
mity of antrum poses problem of O A F formation.
22 A. In this method a labial flap is pedicled off the
alveolar process from the lip, the alveolar bone
is exposed and this flap is sutured on to the
e x p o s e d b o n e . T h e lip surface is left to
reepithelialize.
(B) Clark's method. The flap is pedicled off the
lip and bone is left exposed.
23 B. H o w e ' s lipwitch p r o c e d u r e is a complex
method. In this alveolar periosteal flap is raised
a n d lip s u b m u c o s a l flap is also raised and
sutured inversely. That is periosteum is sutured
to exposed surface of lip and submucosal flap is
sutured to the bony bed.
24 C. A tunnel is c r e a t e d and crestal attachments
are severed. The redundant mucosa is stretched
over the alveolus with help of overextended
dentures.
25 B. Longitudinally along lingual frenum on both
sides.
30 Dentogist: MCQs in Dentistry—Clinical Sciences

Local and Genera! Anaesthesia

1. A nerve is absolutely refractory during: 9. Local anaesthetic agents with higher pka would
A. Depolarisation have:
B. After depolarisation A. Shorter onset of action
C. Hyperpolarisation B. Longer onset of action
D. Firing level only C. No affect on onset of action
D. None of the above
2. A nerve can be stimulated during relative refrac-
tory period by: 10. Which characteristic of a LA agent is responsible
A. Stronger than normal stimuli for its penetration into the nerve?
B. Sustained normal stimuli A. Lipid solubility
C. Subthreshold stimuli B. Water solubility
D. None of the above C. Its iontsation
D. None of the above
3. Local anaesthetic agents act by:
A. Increasing the rate of depolarisation 11. Addition of a vasoconstrictor to LA agents:
B. Shortening the rate of repolarisation A. Increases alkalinity of the solution
C. Decreasing the threshold potential B. Increases acidity of the solution
D. Increasing the threshold potential C. Has no effect on the pH
D. None of the above
4. The local anaesthetic agent acts on:
A. Nerve membrane 12. Sodium bisulfite has the following affect on the
B. Axoplasm action of LA solution:
C. Epineurium A. Slows down its onset of action
D. Perineurium B. Decreases its duration of action
C. Increases its pH
5. T h e most acceptable theory which explains the
D. Has no affect
actions of LA:
A. Surface charge theory 13. Increasing the concentration of LA from 2% to
B. Calcium displacement theory 5% would have:
C. Membrane expansion theory A. Rapid onset and prolonged action
D. Receptor binding theory B. Onset would not be affected but action would
be prolonged
6. The ultimate action of b i n d i n g the receptor by
C. No change on action
LA agent is brought about by its:
D. Rapid onset and duration not affected
A. Hydrophilic component
B. Lipophilic component 14. T h e e f f i c a c y of b e n z o c a i n e in inflamed area
C. Intermediary chain would be:
D. RN of amide agents A. Decreased B. Increased
C. Not altered D. Prolonged
7. A m i d e group of local a n a e s t h e t i c a g e n t s are
dispensed as salts of strong acids because: 15. T h e main barrier for diffusion of LA into the
A. They are not lipid soluble but stable in air nerve is:
B. They are not water soluble but stable in air A. Epineurium
C. They are not water soluble and unstable in air B. Perineurium
D. They are lipid soluble but stable in air C. Endoneurium
D. Neural membrane
8. In acidic medium (during pyogenic infections)
local anaesthetics are less effective because: 16. Which fibres of the nerve are anaesthetised first:
A. More uncharged particles are released A. Mantle fibres
B. Less uncharged particles are released B. Core fibres
C. Less charged particles are released C. Both are anaesthesised at the same time
D. None of the above D. None of the above
 Oral and Maxillofacial Surgery 31

C. Vasoconstrictors
17. The inadequate pulpal anaesthesia in presence
D. Sodium bisulfite
of adequate soft tissue anaesthesia can be due
to: 27. A patient complains of history of hepatitis one
A. Faulty technique m o n t h ago s h o u l d be preferably given which
B. Insufficient penetration of core fibres local anaesthetic agent?
C. Insufficient penetration of fasciculi A. Lignocaine B. Bupivacaine
D. Insufficient penetration of mantle fibres C. Procaine D. Procainamide

18. Prolonged duration of action of drugs like etido- 28. O n e of the complications of prilocaine LA is:
caine and bupivacaine can be attributed to their: A. Agranulocytosis
A. Increased lipid solubility B. Hepatic dysfunction
B. Increased water solubility C. Methemoglobinemia
C. Increased protein binding D. None of the above
D. Vasoconstrictor action 29. Local anaesthetics are excreted mainly by:
19. Tachyphylaxis occurs due to: A. Lungs B. Fecal route
A. Increased dose of LA C. Kidneys D. Uterus
B. Increased dose of vasoconstrictor 30. Blood level of >7 pg/ml of LA produces:
C. Repeated use of LA A. Anticonvulsive activity
D. Allergy to sodium metabisulfite B. Tonic clonic seizure
20. Which of the following belongs to ester group of C. CVS stimulation
D. None of the above
local anaesthetics?
A. Bupivacaine B. Benzocuine 3 1 . T h e anticonvulsant activity of local anaesthetic
C. Etidocaine D. Mepivacaine agents occurs at:
21. The only local anaesthetic with vasoconstrictor A. < 4 p g / m l B. 4-7 p g / m l
C. 7-10 p g / m l D. 10-12 p g / m l
properties is:
A. Cocaine B. Procaine 32. T h e differentiating factor between LA toxicity
C. Benzocaine D. Lidocaine and developing syncope would be:
A. CNS stimulation
22. Which of the following is not a ester local anaes-
B. CNS depression
thetic? C. Pallor of skin
A. Propoxycaine B. Procaine D. Light reflex
C. Prilocaine D. Piperacaine
33. T h e level of 2% lidocaine which reaches blood
23. W h i c h o f the f o l l o w i n g l o c a l a n a e s t h e t i c s
after use of one or two cartridges is:
crosses the blood brain barrier:
A. 0.5-2 p g / m l
A. Lignocaine B. Etidocaine
B. 1.5-5 p g / m l
C. Bupivacaine D. All of the above C. 5-10 p g / m l
24. All of the local anaesthetics cross the placenta: D. No LA reaches blood if given safely after
A. Except mepivacaine aspiration
B. Statement is true 34. A patient with k n o w n history of hyperthermia
C. Statement is false
should be given:
D. Except lignocaine
A. Lignocaine
25. Ester type local anaesthetics are metabolised in B . Procaine
the: C. Bupivacaine
A. Liver only B. Kidney D. Mepivacaine
C. Plasma D. Lungs 35. W i t h o v e r d o s e of local anaesthetic agent one
26. A patient who had a history of prolonged apnoea would observe:
during a d m i n i s t r a t i o n of m u s c l e relaxant (suc- A. Hypertension
cinvlacholine) should not be given? B . Hypotension
A. Ester local anaesthetics C. No change in BP
B. Amide local anaesthetics D. Cardiac arrhythmias
32 Dentogist: MCQs in Dentistry—Clinical Sciences

36. Epinephrine (Adrenalin) which is used in dental 44. M a x i m u m dose of adrenalin which can be given
cartridge of LA acts on: to a p a t i e n t w i t h h i s t o r y of c a r d i o v a s c u l a r
A. a receptors only disease is:
F3. p receptors only A. 0.2 m g / m l
C. a and P receptors but P predominantly B. 0.2 mg'
D. a and P receptors but a predominantly C. 0.04 mg
D. 0.005 m g / m l
37. When local anaesthetic agent with adrenalin is
i n j e c t e d , the t e r m i n a t i o n o f a c t i v i t y o f the 45. To a patient of 50 kg wt how many cartridges of
vasoconstrictor is brought by: LA w i t h 1: 2 0 0 , 0 0 0 a d r e n a l i n can be g i v e n
A. Adrenergic nerve endings ( c o n s i d e r i n g p a t i e n t i s n o r m a l , h e a l t h y and
B. Blood enzymes C O M T and M A O lignocaine toxicity is not considered):
C. Excretion in urine (80%) A. 10.5 B. 22
D. A and B C. 32 D. 40.
38. Use of norepinephrine in dental practice is not 46. Lidocaine was first prepared by:
recommended because it causes: A. Nils Lofgren B. A. Ekenstam
A. Bradycardia C. A. Einhorn D. None of the above
B. Intense peripheral vasoconstriction
47. T h e duration and depth of pulpal anaesthesia
C. Hypertension
with lignocaine (2%) added to 1:50,000 epinep-
D. Sensitisation of myocardium
h r i n e a s c o m p a r e d t o 1:100,000 e p i n e p h r i n e
39. When one has to use the weakest vasoconstrictor would be:
(e.g. in p a t i e n t w i t h h i s t o r y of a n g i n a ) one A. Longer and profound
should consider: B. Duration would be two times longer but
A. Epinephrine depth would be same
B. Norepinephrine C. No much difference
C. Phenylephrine D. Duration would be 4 times
D. Levonordefrin
48. 3% lignocaine indicates that there is:
40. Rebound phenomenon is most c o m m o n l y seen A. 25 m g / m l of lignocaine
with use of: B. 30 m g / m l of lignocaine
A. Epinephrine C. 54 m g / m l of lignocaine
B. Norepinephrine D. 27 m g / m l of lignocaine
C. Phenylephrine
49. H o w m a n y cartridges o f 2 % lignocaine can b e
D. Levonordefrin
given to a 50 kg man (with adrenalin)?
41. T h e a b s o l u t e c o n t r a i n d i c a t i o n for use of A. 6 B. 12
adrenalin in LA is: C. 17 D. 25
A. Myocardial infarction, 3-6 months ago
50. W h e n v a s o c o n s t r i c t o r i s c o n t r a i n d i c a t e d , the
B. Angina pectoris
ideal local anaesthetic would be:
C. Hyperthyroidism
D. Pregnancy A. Lignocaine B. Mepivacaine
C. Cocaine D. Bupivacaine
42. Adrenalin should not be used w h e n halothane is
used during GA because halothane: 5 1 . A patient with respiratory disease presents for
A. Sensitises the myocardium to adrenalin treatment, w h i c h drug should not be used:
B. Inr eases the heart rate A. Lignocaine
C. Increases the blood pressure B. Adrenaline
D. Interferes with AV conduction. C. Prilocaine
D. Mepivacaine
43. A cartridge of LA contains 1:200,000 adrenalin, it
indicates that there is: 52. W h i c h of the following is least toxic LA?
A. 0.005 m g / m l of adrenalin A. Lignocaine
B. 0.065 m g / m l of adrenalin B. Mepivacaine
C. 0.0125 m g / m l of adrenalin C. Propoxycaine
D. 0.02 m g / m l of adrenalin D. Bupivacaine
 Oral and Maxillofacial^urgery^ 33

B. Antioxidant for lignocaine

>3. W h e n injecting into relatively highly vascular C. Antibacterial for lignocaine
area a s i n p o s t e r i o r s u p e r i o r a l v e o l a r n e r v e D. Not used any more
block, one should use needle with:
62. T h e allergic reactions commonly seen following
A. Smaller gauge use of cartridge of LA is due to:
B. Larger gauge
A. Lignocaine
C. Gauge does not matter
B. Vasoconstrictor
D. None of the above
C. Methyl paraben
54. One should use a needle which has: D. Sodium metabisulphite
A. Greatest angle of bevel 63. Glass LA cartridge should be sterilised by:
B. Minimum angle of bevel with tip lying in the
A. Autoclaving
centre of the lumen
B. Dry heat
C. No bevel at all C. Cold sterilisation
D. None of the above D. None of the above
W h i c h of the f o l l o w i n g is a l o n g a c t i n g LA
55 64. If the diaphragm of cartridge is soaked in iso-
agent? propyl alcohol for purpose of antisepsis, it may
A. Mepivacaine B. Bupivacaine result in:
C. Prilocaine D. Propoxycaine A. Reduced anaesthesia
56 T h e safest local anaesthetic agent: B. No anaesthesia
C. Long-term paraesthesia
A. Cocaine
D. None of the above
B. Procaine
C. Chloroprocaine 65. Local infiltration s h o u l d b e :
D. Propoxycaine A. Paraperiosteal B. Subperiosteal
57. W h i c h l o c a l a n a e s t h e t i c a g e n t w h e n u s e d C. Transeptal D. None of the above
topically interferes with sulphonamide actions: 66. Infiltration is not successful for anaesthetising
A. Lidocaine base
buccal roots of:
B. Lidocaine
A. -Maxillary 1st permanent molar
C. Benzocaine
B. Maxillary 1st deciduous molar
D. Propoxycaine
C. Mandibular 1st permanent molar
58. Self-aspirating syringes, provide aspiration by: D. Decidous maxillary 1st molar
A. Pulling the thumb ring
67. For posterior superior alveolar nerve one should
B. Negative pressure created due to elasticity of
rubber diaphragm use:
A. Long needle (40 m m )
C. Pressure release on thumb disc
B. Short needle (25 m m )
D. All of the above
C. Length not a criterion
59. T h e jet injectors are used to obtain: D. Only bevel should be considered
A. Pulpal anaesthesia 68. Greater palatine foramen is present:
B. Topical anaesthesia A. Between 1st and 2nd maxillary molars
C. Regional block B. Between 2nd and 3rd maxillary molars
D. Nerve block also C. Distal to 3rd maxillary molar
60. T h e gauge of n e e d l e u s e d in dental s y r i n g e s D. Mesial to 1st maxillary molar
refers to: 69. In 80% of p a t i e n t s infraorbital nerve b l o c k is
A. Internal diameter of the lumen effective for buccal aspect of:
B. External diameter of needle A. Central incisors and canines
C. Diameter of bevel only B. Central incisors to 1st premolars
D. Diameter of hub C. Central incisors to mesiobuccal root at 1st
6 1 . Sodium bisulphite used in dental LA cartridge maxillary molar
D. Central incisors only
acts as:
A. Antioxidant for adrenalin
34 Dentogist: MCQs in Dentistry—Clinical Sciences

70. In greater p a l a t i n e n e r v e b l o c k the n e e d l e 78. T h e target of G o w Gates technique is:

should be: A. Coronoid notch
A. Parallel to mucosa B. Sigmoid notch
B. Perpendicular to mucosa C. Foramen ovale
C. 45° inclined to mucosa D. Neck of condyle
D. Parallel to roots of molars 79. In patients with reduced mouth opening which
71. The two techniques used for maxillary block are: technique of mandibular anaesthesia should be
A. Greater and lesser palatine approach used:
B. Greater palatine and high tuberosity appro- A. Gow gates B. Akinosis
ach C. Labyrinths D. Williams
C. Greater tuberosity and retromolar approach 80. For extraoral maxillary nerve block the target
D. Gow gates and Akinosi technique area is:
72. Inferior alveolar nerve b l o c k anaesthetises all A. Posterior to lateral pterygoid plate
(except): B. Anterior to lateral pterygoid plate
A. Body of mandible lower part C. Pterygomandibular fissure
B. Mandibular teeth D. Pterygomandibular fossa
C. Mucous membrane anterior of first mandi- 8 1 . For extraoral mandibular nerve block the needle
bular molar should be inserted from:
D. Mucous membrane distal to 1st mandibular
A. Above the zygomatic arch
molar
B. Below the zygomatic arch
73. The needle while giving inferior alveolar nerve C. Coronoid notch
block passes through: D. None of the above
A. Buccinator muscle 82. If needle breaks during injecting LA and radio-
B. Pterygomandibular raphe graphically it appears to be deep in tissues, the
C. Buccal fat advised management would be:
D. Stylomandibular raphe A. Removal of needle under LA
74. While giving inferior alveolar nerve b l o c k the B. Removal of needle under GA
needle is lateral to: C. Leaving the needle in the tissue
A. Lingual nerve D. None of the above
B. Sphenomandibular ligament 83. Use of which of the solutions relatively can have
C. Medial pterygoid muscle more burning sensation?
D. All of the above A. Plain lignocaine
75. If b o n e is not contacted before injecting local B. Isotonic solution
a n a e s t h e t i c i n i n f e r i o r a l v e o l a r nerve b l o c k , C. Lignocaine and adrenalin
there are chances of: D. Hypotonic solution
A. Lingual nerve anaesthesia 84. Persistent anaesthesia can result most often in
B. Transient facial palsy which of the nerves, after LA injection?
C. Transient maxillary anaesthesia A. Inferior alveolar
D. None of the above B. Lingual nerve
76. Inferior alveolar nerve block at times is not very C. Infraorbital nerve
effective b e c a u s e w h i c h of the nerves is not D. Mental nerve
anaesthetised:
85. Aspiration should be carried out at least in:
A. Mental nerve B. Lingual nerve
A. One plane B. Two planes
C. Mylohyoid nerve D. Incisal nerve
C. Three planes D. Four planes
"7. G o w gates technique is for:
A. Mandibular nerve block 86. E C G changes can first be observed when level of
B. Inferior alveolar nerve block lignocaine is more than:
C. Trigeminal ganglion block A. 5-6 p g / m l B. 10-12 p g / m l
D. V , V, block
2
C. 2-4 p g / m l D. 1-2 p g / m l
 Oral and Maxillofacial Surgery 35

95. N o w a d a y s i n d u c t i o n p h a s e o f G A has b e e n
87. To control tonic clonic seizures following ligno-
reduced b e c a u s e of use of:
caine toxicity the drug of choice would be:
A. Halothane
A. Pentobarbital
B. Ether, halothane combination
B. Diazepam C. Thiopentone sodium
C. Succinylcholine
D. Ether, N 0 , halothane combination
2
D. Antihistamines
96. If long acting muscle relaxants are used during
88. Succinylcholine can be used for control of tonic
GA their action is terminated by use of:
clonic seizures but along with this:
A. Neostigmine
A. Pentobarbitone should be used
B. Atropine
B. Artificial respiration is must
C. Ketamine
C. Atropine should be given
D. Succinylcholine
D. Neostigmine should be given to terminate its
97. T h e N , 0 gas cylinder used in GA is:
action
A. White and black coloured
89. Post ictal phase, w h i c h f o l l o w s C N S toxicity
B. Blue coloured
with lignocaine should be managed by:
C. Red and yellow coloured
A. CNS stimulants D. White and blue coloured
B. Analeptics
98. For maxillofacial injuries one should always use
C. Supportive therapy only
which endotracheal tube for G A ?
D. Diazepam
A. Non inflatable
90. During C V S depression in lignocaine toxicity,
B. Inflatable cuffed
one should administer:
C. Catheterized
A. Vasoconstrictors D. None of the above
B. Atropine
99. T h e endotracheal tube should be placed for GA:
C. Crystalloids
D. All of the above A. In right bronchus
B. In left bronchus
91. Gingival retraction cords contain adrenalin in
C. Above cirina
concentration of: D. In laryngopharynx
A. l:200,000/inch
100. Rotameter on Boyle's trolley for GA is used to
B. 0.3 pg/inch-1.0 p g / i n c h
C. 300 pg/inch-1000 p g / i n c h measure:
D. 1000 pg/inch-2000 p g / i n c h A. Pressure of gas in the cylinders
B. Pressure of halothane
92. Extraction of deciduous teeth in dental clinic can
C. Flow of gases in the tubes
be carried out in which stage of general anaes- D. None of the above
thesia:
101. G o l d m a n ' s vapourizer is used for:
A. Stage I
A. N 0
B. Stage II 2

B. Halothane
C. Stage III plane II
D. Stage III plane III C. Ether
D. Cyclopropane
93. Surgical plane for major surgery during general
102. Entonox is:
anesthesia is during:
A. N , 0 + halothane mixture
A. Stage III plane 1
B. 5 0 % N,Q + 2 0 % O, mixture
B. Stage III plane II
C. 5 0 % N,"0 + 5 0 % C\ mixture
C. Stage III plane III
D., 5 0 % ether + 2 0 % 6 , mixture
D. Stage III plane IV
103. In T M J ankylosis patient, GA can be adminis-
94. Succinylcholine is administered during GA for:
tered by:
A. Better control
A. Oral intubation
B. Intubation
B. Blind nasal intubation
C. Prevention of apnoea
C. Fiberoptic assisted intubation
D. Decreasing respiratory rate and thus decrea- D. B and C
sing GA toxicity
36 Dentogist: MCQs in Dentistry—Clinical Sciences
104. A patient w h o is b e i n g operated u n d e r halo-
thane should not be given:
A. Lignocaine B. Lignocaine + adrenalin
C. Propoxycaine D. Mepivacaine
105. Glycopyrolate is usually used during GA to:
A. Reduce heart rate
B. Increase BP
C. Reduce secretions
D. Control bleeding
106. In most surgical p r o c e d u r e s , GA with N 0 is 2
given as:
A. 70% N 0 + 3 0 % 0
2 2
B. 70% N 0 + 20-30% 0 + other GA agent
2 2
Answers
1 A. The nerve is absolutely refractory i.e., no stimuli
of whatsoever duration or intensity can illicit an
action potential during the phase of depolari-
sation.
2 A. Whereas during stage of after polarisation and
h y p e r p o l a r i s a t i o n the n e r v e is relatively
refractory b e c a u s e it can be s t i m u l a t e d by a
stimuli w h i c h is s t r o n g e r than n o r m a l . But a
normal or subnormal stimuli fails to initiate an
action potential.
3 D. Local anaesthetics act by:
i. Decreasing the rate of depolarisation
ii. Prolonging the rate of repolarisation
iii. Increasing the threshold potential.
4 A. Local anaesthetic after being injected crosses via
epineurium —> perineurium —» endoneurium —>
nerve membrane and actually acts on (A).
5 D. All the theories h a v e been increminated for
explaining action of LA. But most acceptable
today is (D).
A. Surface charge theory: The cations R N H + of
LA align themselves on the nerve membrane
and make outside potential more positive
thus the threshold potential is also increased.
B. Calcium displacement theory: LA displaces
c a l c i u m i n s i d e the n e r v e w h i c h in turn
controls sodium channels
C. Membrane expansion theory: LA molecules
p e n e t r a t e the m e m b r a n e , e x p a n d it and
narrow the sodium channels.
D. Specific receptor theory: It says that there are
specific receptors around sodium channels
which are b o u n d by LA and thus control
sodium channels.
C. 5 0 % N 0 + 5 0 % 0 + other GA agent
2 2
D. 70% 0 + 2 0 % N 0
2 2
107. Which of the following is used as an dissociative
anaesthetic agent:
A. Fentanyl
B . Thiopentone
C. Ketamine
D. Flalothane + ether mixture
108. D u r i n g G A o x y g e n c o n c e n t r a t i o n o f blood
should not fall below:
A. 9 0 % B. 60%
C. 4 0 % D. 2 0 %
6 A. To enter the nerve the drug should be lipophilic.
But binding of LA to receptors inside the nerve
m e m b r a n e is the function of hydrophilic or
+
c h a r g e d ions ( R N H ) RN makes the LA
lipophilic and thus makes penetration easy.
7 C. A m i d e group of LA agents are weak bases,
lipophilic and unstable in air. Therefore, strong
acid is added to obtain acidic salt which is water
soluble. Therefore can disperse in the tissues
where injected, to reach the nerve and is stable
in air, therefore can be dispensed as solutions.
8 B. In an acidic medium
RNFT = RN + FT
The reaction shifts to left. RNFP is responsible
for dispersion and binding to receptors. RN is
responsible for penetration into the nerve. Since
in an acidic medium RNFP > RN therefore the
agent fails to penetrate the nerve and thus is less
effective.
'9 B. Pka indicates the pH at which uncharged and
charged particles are in equilibrium. According
to Anderson-Hasselbalch equation
log Base = pH-pka.
Acid
So if pka is increased as compared to tissue pH
of 7.4, more ions (RNFP) would be there than
basic ions ( R N ) . Therefore (A) agent slowly
penetrates the nerve and (B) results.
10 A. Most important character for any drug to cross
plasma membrane: it should be lipophilic and
unionised. Ionised, hydrophilic drugs cannot
penetrate membranes.
11 B. Local anaesthetics that contain vasoconstrictor
are acidified by the manufacturer to inhibit

oxidation of epinephrine, etc. The pH of solution
without epinephrine is 5.5, whereas epinephrine
containing solutions have a pH of 3.3.
12 A. Since adrenalin is highly unstable therefore to
prevent its rapid oxidation in a LA solution 0.05¬
0.1% sodium bisulphite is added and this lowers
the pH from 5.5 to 4.2. Since pH is low ionized
RNPT is more, which fails to penetrate the nerve
+ +
than the unionised RN ( R N H = RN + H )
required for penetration therefore there results
slower onset of action.
13 D. At higher concentrations more RN is available
to enter the nerve therefore early onset of action.
+
T h o u g h m o r e R N H is also available but
duration of binding to receptor is not dependent
on concentration in all LA agents. Therefore
duration is not affected.
14 C. Benzocaine is not water soluble therefore pH has
no effect on its functioning. In inflammation pH
decrease but benzocaine is not affected. Since it
is only lipid soluble therefore it is used only as
topical anaesthetic agent.
15 B. The nerve is bound from outside to inside by
Epineurium: LA readily diffuses through this
because of its loose consistency
Perineurium: Main barrier for diffusion of LA
Endoneurium/neural membrane: Actual site of
action and depend on lipid solubility of drug.
16 A. The nerve fibre bundles present near the peri-
phery of the nerve are called mantle fibres, and,
are first to be anaesthetised. Then the central
fibres get anaesthetised are called core bundles.
17 B. Sometimes the mantle bundles are anaesthetised
but core bundles have not been affected the
mantle fibres supply to proximal areas and core
fibres supply the distal areas. Therefore the
adjacent mucosa may be anaesthetised but distal
pulpal end may yet not be blocked.
18 C. The specific receptors w h i c h are controlling
sodium channels have p r o t e i n s sites. These
drugs bind to the protein sites firmly and are
released back very slowly, thus prolonging the
duration of action (see answer 13).
19 C. T a c h y p h y l a x i s is defined as an increasing
tolerance to a drug that is given repeatedly. If
nerve function returns and drug is given again
the duration, intensity and spread of anaesthesia
are markedly reduced.
20 B. Ester group Amide group
1. Cocaine 1. Lignocaine
2. Benzocaine 2. Bupivacaine
3. Procaine 3. Prilocaine
Oral and Maxillofacial Surgery 37
4. Chloroprocaine 4. Etidocaine
5. Propoxycaine 5. Mepivacaine
21 A. Local anaesthetics are basically vasodilating in
nature, except only cocaine which produces
vasoconstriction. Cocaine prevents reuptake of
circulating epinephrine and thus local intense
vasoconstriction.
Procaine is the most dilating of the all.
22 C. See (answer 20).
23 D. All local anaesthetics cross blood- brain barrier
therefore result in toxicity if > 4 p g / m l concen-
tration of drug is present in blood —> brain
CNS stimulation —> CNS depression.
24 B. All local anaesthetics cross the placenta and
enter circulatory system of fetus.
25 C. Ester type LA are metabolised in plasma by
enzyme pseudocholinesterase.
26 A. Succinyl choline is structuraly related to ester
type LA. In patients who have atypical form of
pseudocholinesterase in blood fail to metabolise
these drugs and result in increased blood levels
or toxicity. Since succinylcholine is a muscle
relaxant, its increased levels cause prolonged
apnoea during GA, as respiratory muscles are
paralysed or relaxed due to its action. In patients
with such history, ester LA should not be used.
27 C. A m i d e g r o u p of LA agents (A, B, D) are
metabolised in liver. History of hepatitis may
interfere with normal metabolism and result in
LA toxicity. Therefore ester group of LA (C)
should be used.
28 C. Prilocaine and n e w e r LA articaine can cause
methemoglobinemia. This is due to increase in
level of Hb with ferric form rather than ferrous
form. M e t h e m o g l o b i n (ferric form) fails to
release oxygen resulting in cynosis and respi-
ratory distress and 0 tension is reduced.
2
29 C.
Normal blood level
30 B. < 2 p g / m l
2-4 p g / m l Anticonvulsive
4-7 p g / m l C N S stimulation
>7 pg/ml Tonic clonic seizures
CVS Only depression never
stimulation.
31 A. Ideally between 2-4 p g / m l
32 A. In syncope, patient become apathic and there is
decreased muscular activity due to progressive
decreased blood supply to brain. Whereas in LA
toxicity the stages of C N S changes are manifes-
ted as CNS stimulation—>tonic clonic s e i z u r e s
post ictal d e p r e s s i o n . A s t o x i c i t y d e v e l o p s
p a t i e n t b e c o m e s t a l k a t i v e , with slurring of
speech is there and other signs of stimulation are
present.
38 Dentogist: MCOs in Dentistry—Clinical Sciences
42 A. Otherwise causes hypotension and bradycardia.
33 A. > 2 p g / m l would be considered as overdose 43 A. 1:200,000 = 1 gm adrenalin in 200,000 ml of water
indicating LA has been given intravascularly.
A m i d e group o f L A a g e n t s can p r o d u c e
U B.
malignant hyperthermia. T h e y are absolutely
contraindicated in susceptible patients. MH is a
pharmacogenetic disorder characterised by
tachycardia, hyperpyrexia, unstable BP, cynosis,
respiratory and metabolic acidosis —> muscle
rigidity—»with high mortality rate.
35 B. Almost all of LA agents are vasodilating agents
except for cocaine.
36 C. A. Phenylephrine
B. Isoproterenol
C. Norepinephrine.
37 D. All the injected adrenalin is taken up either by
adrenergic endings, or enters blood where it is
metabolised by M A O / C O M T enzymes. Only 1%
is excreted in urine.
38 B. Norepinephrine acts on a receptors predominan-
tly and therefore causes intense vasoconstriction.
When injected in palatal area or in oral cavity as
such, because of a activity, vascular constriction
is so intense that blood supply to that area is
compromised and necrosis ensues.
39 C.
Phenylepherine > levonordefrin > epinephrine >
norepinephrine (weakest to strongest vasocons-
trictors).
40 A. Vasoconstrictors act on a, P receptors
a receptors: are present in smooth muscles of
blood vessels. Their stimulation
p r o d u c e s intense vasoconstric-
P receptors: tion.
Bj in heart-stimulation
increase ± ^ produces
increase
B in vessels
2
HR,of
increase
skeletalBP.
muscles +
bronchioles. Stimulation causes
vasobronchial dilation.
Epinephrine acts on a and P receptors. In small
dose it causes a-vasoconstriction and in higher
doses causes P-vasodilation. When epinephrine
is injected with LA for h e m o s t a s i s it causes
vasoconstriction initially but w h e n wound is
closed and patient goes h o m e , b e c a u s e of P
stimulation vasodilation occurs (see answer 40)
and bleeding starts. This is known as rebound
phenomenon. N o t seen with norepinephrine
because a effect predominent weak effect.
41 C. In A, B, D low dose in range of less than total
of 0.04 mg can be given but in (C) this low dose
can also precipitate cardiac crisis. Already in
such patients HR increases, BP increases, BMR
increases, further rise can lead to cardiac arrest.
= 1000 mg/200,000 ml = 0.005 m g / m l .
44 C. Normal patient = 0.2 mg total
Cardiac patient = 0.04 mg total
45 B. M a x i m u m adrenalin which can be given to a
normal dental patient = 0.2 mg. One cartridge
consists of 1.8 x 0.0005 (see answer 44) = 0.009
mg/therefore 22 cartridges can be injected (only
if LA toxicity is not considered) (0.009 x 22 = 0.2
mg approx).
46 A. B. Bupivacaine and mepivacaine
C. Procaine.
47 C. Both provide equal duration and depth but
1:100,000 epinephrine solution contain half as
m u c h e p i n e p h r i n e as the 1:50,000 solution.
Therefore less cardiovascular effects only when
it has to be used for hemostasis 1:50,000 would
be a better choice.
48 B. W h e n e v e r p e r c e n t a g e is used for drugs it
indicates 3% = 3 g m / 1 0 0 ml = 3000 m g / 1 0 0 ml
= 30 m g / m l .
49 A. Dose of plain lignocaine is 4.4 m g / k g wt. To a
50 kg man = 50 x 4.4 = 220 mg. Lignocaine can
be given.
36 mg in 1 cartridge 2 2 0 mg would be in 6
cartridge (approx).
50 B. M e p i v a c a i n e has a v e r y slight vasodilating
property as c o m p a r e d to other (A) and (D).
Therefore 3% mepivacaine without vasoconst-
rictor is ideal when vasoconstrictor is contrain-
dicated as in hyperthyroidism.
Though cocaine is the only anaesthetic agent
which is a vasoconstrictor but because of its
many side-effects and abuse potential its use in
dentistry is not recommended.
51 C. (C) Is known to cause methemoglobinemia. In
patients with respiratory disease oxygen supply
is already c o m p r o m i s e d and toxicity due to
prilocaine can be life-threatening.
52 D. Toxicity of bupivacaine is less than four times
that of lidocaine and mepivacaine.
Propoxycaine is most toxic of all known LA's.
53 B. In highly vascular areas needles with smaller
gauge m a y show negative aspiration of blood
because of clogging of lumen and LA may be
injected in vascular areas with concomitant toxi-
city with LA.
54 B. N e e d l e s with g r e a t e s t angle of bevel have
tendency to bend and break (B) does not bend.
Without a bevel, needle cannot penetrate into
tissues.

55 13. The duration of pulpal/sofl tissue anaesthesia
for these drugs is
Mepivacaine 20 m i n / 2 h r s
Bupivacaine 90 m i n / 9 h r s
Prilocaine 10 m i n / 2 h r s
Propoxycaine 30 m i n / 2 h r s .
56 C. Procaine is considered safe drug and its toxicity
is marked as 1. But cholroprocaine is half as toxic
as procaine. This is because of its rapid rate of
hydrolysis by plasma cholinesterase. Because of
this its use is restricted to only short duration
paediatric procedures. Propoxycaine: most toxic.
Toxic rating-7.
57 D. Any anaesthetic agent which is ester of paraami-
nobenzoic acid interferes with sulphonomides,
eg. procaine, propoxycaine and chloroprocaine.
58 D. The basic advantage of self aspirating syringes
is that, whenever positive pressure is released
while injecting or prior to injection, because of
elasticity of rubber diaphragm a negative pres-
sure is created—^aspiration occurs on its own.
Though aspiration can be done by (A) and (C)
also.
59 B. jet injectors do not have the capacity to penetrate
the mucosa. Therefore their role is restricted as
topical anaesthesia only.
60 A. Larger the gauge smaller the diameter.
61 A. Adrenalin is very unstable and is easily oxidised.
Therefore sodium bisulphite is added which is
oxidised to bisulphate competitively as compa-
red to adrenalin.
62 C. Most of allergic reactions are due to antibacterial
antifungal agent methyl paraben. Therefore in
some countries its use in dental cartridge has
been banned.
63 D. There is no need to sterilise a dental LA cartridge.
It should be stored at room temperature and in
dark place. All these methods (in ABC) can cause
damage to the glass, metallic cap or irritation due
to chemical sterilisation when injected.
64 C. Alcohol is a neurolytic agent, when diaphragm
is immersed in alcohol for purpose of sterilisa-
tion or asepsis there are chances that it may leech
into the cartridge. When injected causes neuro-
lysis and prolonged paraesthesia.
65 A. Local infiltration should always be paraperio-
steal. Such injections are recommended for area
where bone is thin and LA can diffuse from
periosteum through bone to the pulpal tissue.
66 C.
67 B. Llaematoma formation is quite common while
giving posterior superior alveolar nerve block.
Oral and Maxillofacial Surgery 39
Therefore it is recommended that short needle
(25 m m ) s h o u l d be used, so that pterygoid
plexus of veins which lie posteromedial to the
site of injection is not injured.
68 B .
69 C. In remaining 2 0 % of patients middle superior
alveolar nerve is also present therefore infil-
tration in premolar and 1st molar region is also
to be given.
70 B
71 B Lesser palatine for anaesthetising the soft palate
Retromolar, Gow Gates and Akinosis technique
are for mandibular anaesthesia.
72 D. This is supplied by long buccal nerve which is
not a branch of inferior alveolar nerve. Therefore
buccal block has to be added. (C) is supplied by
mental—a branch of inferior alveolar nerve.
73 A. Lateral to pterygoid raphe inferior to buccal pad
of fat anteroinferior to stylomandibular raphe.
74 D.
75 B. The most important step of inferior alveolar
nerve block is not to inject till bone of mandible
around lingula is contacted. Otherwise there are
chances that needle penetrates too far poste-
riorly into parotid capsule or parotid gland itself
resulting in transient facial nerve paralysis.
76 C. It is postulated that the mylohyoid nerve sup-
plies the floor of mouth and the mylohyoid
muscle. If it is not anaesthetised with inferior
alveolar nerve incomplete anaesthesia occurs in
area supplied by inferior alveolar nerve.
77 A. Gow gates technique is intraoral approach to
give mandibular block. The target area is neck
of m a n d i b u l a r c o n d y l e . M a n d i b u l a r nerve
divides into its 3 main branches just medial to
this area.
78 D. Medial to this mandibular nerve is devided into
auriculotemporal, lingual and inferior alveolar
nerve.
79 B. In trismus or when patient is unable to open the
mouth completely. Needle is placed parallel to
occlusal plane, in line with mucogingival junc-
tion of upper teeth and LA is injected medial to
ramus of mandible, well above the lingula to
a n a e s t h e t i s e the m a n d i b u l a r nerve. This is
known as the Akinosis technique.
80 B. For extraoral have maxillary nerve block: target
area is anterior to pterygoid plate in pterygo-
palatine fossa.
Mandibular nerve block: the target area is poste-
rior to pterygoid plate below the foramen ovale
40 Dentogist: MCQs in Dentistry—Clinical Sciences
s i B. From central point below the zygomatic arch to
pierce the skin subcutaneous tissue—maasseter
muscle —> mandibular notch —> external ptery-
goid plate—> retract the needle—»to reach poste-
rior area of pterygoid plate below foramen ovale.
S2 C. A radiograph must be taken in 2 or 3 planes and
if needle is deep in tissue it should be left as such.
Fibrosis would ensue and needle Would remain
localised in that area only. Regular check up is
mandatory.
83 C. Any acidic or h y p e r t o n i c s o l u t i o n can have
burning sensation. Addition of adrenalin lowers
the pH of LA from 5.5 to 3.3.
84 B. (B) > (A) > (C) > (D).
This occurs due to injury to nerve sheath, pres-
sure due to oedema hematoma which ensues
after injection.
85 B . When needle is injected it may enter a vessel and
on aspiration a negative pressure is created. This
might pull the vessel wall and prevent blood
from entering the lumen of needle. Therefore
needle should be turned at 45° and aspiration
should be done again.
86 A. 1-2 pg/ml—normal dose
2-4 pg/ml—antiarrhythmic
5 p g / m l onwards CVS depression evident
10 p g / m l — C V S collapse.
87 B . With p e n t o b a r b i t o n e - p o s t i c t a l depression is
intense and prolonged. With succinylcholine
artificial respiration has to be carried out during
time of muscle paralysis. Diazepam is effective
if instituted i v . before onset of tonic clonic
seizures and postictal depression is not marked.
88 B. Succinylcholine is a short-acting muscle relaxant.
Its a d m i n i s t r a t i o n p a r a l y s e s all m u s c l e s
including those for respiration. Though it con-
trols outward manifestation of the seizures but
artificial respiration should be carried along with
this to maintain o x y g e n / C 0 tension in the body.
2
89 C. The state of depression which ensues after tonic
clonic seizure or the postictal stage should be
managed by supportive therapy only
0 , p o s i t i o n , suction all o t h e r s w o u l d h a v e
2 102 C.Entonox is a special gas mixture of 5 0 % 0 + 50
adverse effects.
90 D A. To increase HR, BP
B. Atropine to decrease action of vagus
C. to maintain venous return of blood.
91 C. This high c o n c e n t r a t i o n p r e l u d e s its use in
cardiac patients.
92 A Stage I is stage of analgesia. Though patient is
unconscious but reflexes and respiration are
normal.
93 C. Stage
Stage HI
HI Characteristic
Plane I Roving eye ball
Plane II Loss of laryngeal and corneal reflex-
light anaesthesia-patient can
reverse easily.
Plane III Pupils dilated-deep anaesthesiad
ideal for major surgeries
Plane IV Intercostal paralysis ensues.
94 B . Succinylcholine is short acting muscle relaxant
it is g i v e n before intubation for paralysing
laryngeal and pharyngeal muscles to allow easv
intubation. Apnoea results with this.
95 C. T h i o p e n t o n e sodium is an ultra short acting
a n a e s t h e t i c agent with rapid induction and
recovery. After rapid induction other anaesthetic
agents are added to maintain patient under
anaesthesia.
96 A. D u r i n g GA long acting muscle relaxants or
neuromuscular blocking agents e.g. pancuro-
nium, etc are used. Their action is peripheral.
Anti-cholinesterases as neostigmine are used to
reverse the action of pancuronium.
D. is a short acting muscle relaxant
C. is a dissociative anaesthetic agent
B. is a anticholinergic drug used for decreasing
oronasopharyngeal secretions during GA.
97 B. Oxygen cylinder is white and black.
98 B. Because of intraoral bleeding, other secretions
and possibility of displacement of foreign objects
from oral cavity to oropharynx, a cuffed infla-
table tube should be used to prevent aspiration
of these.
99 C. China is the bifurcation of trachea into (Right)
and (Left) bronchus. Endotracheal tube is placed
just a b o v e cirina to allow equal gaseous
exchange in both lungs during GA.
100 C.Pressure gauges are attached to cylinders. But
rotameter of Boyle's trolley measures the flow of
gases e.g. 4 lit/min.
101 B. Halothane is mixed to N 0 + 0 gas mixture in
2 2
vapour form. The vapours are added from the
G o l d m a n ' s v a p o u r i s e r or from Row Botham
vapouriser.
2
N 0 . Routinely 7 0 % N , 0 ;720-30% 0 i s used.
2 2
1 0 3 D . In cases of T M J ankylosis nowadays, Nasoendo-
tracheal i n t u b a t i o n is d o n e with fibre optic
bronchoscope. But if this is not available blind
intubation is to be done since patients mouth
cannot be opened to guide the tube in the larynx.
104 B. Halothane sensitises the myocardium to adre-
nalin. If adrenalin is administered exogenously
untoward C V S problems can occur.
 Oral and Maxillofacial Surgery 41

which gives analgesia with a feeling of disso-

105 C.Atropine and glycopyrolate are anticholinergic
ciation without complete loss of consciousness.
drugs which reduce naso-oropharyngeal and
Fenatyl is a neurolept analgesic agent.
other secretions. T h i o p e n t o n e is ultrashort acting anaesthetic
106 B. Cannot be given alone for long durationsd agent excellent for induction of GA.
drying of mucosa, alveoli, etc occur. Therefore 108 A.Though it should be maintained at 100%, below
to 7 0 % N 0 + 20 O, another anaesthetic agent is
2 this—acidosis, cynosis, etc. develop with con-
added, e.g. halothane. comitant CVS, respiratory changes.
107 C.VVith ketamine, dissociative anaesthesia results

AIDS
8. Body fluids can be responsible for transmission
1. Viral infection/s which can be seen in oral cavity
of A I D S (except):
of patients with H I V is/are:
A. Blood B. CSF
A. Hairy leukoplakia
C. Cervical secretions D. Saliva
B. Herpetic stomatitis
C. Papilloma warts 9. T h e most common pathogen isolated from pul-
D. All of the above monary system of H I V patient is:
A. Mycobacterium tuberculosis
2. The dental infection/s commonly seen in A I D S
B. Mycobacterium avium intracellulare
patient: C. Pneumocystis carinii
A. Necrotising ulcerative gingivitis D. None of the above
B. Rapidly progressive periodontitis
C. Horizontal bone loss 10. T h e facial d e v e l o p m e n t seen in H I V positive
D. All of the above children is characterised by:
A. Normal facial profile
3. T h e major criterion of W H O guidline for diag-
B . Macrocephaly
nosing A I D S consists of (except): C. Ocular hypotelorism
A. Weight loss more than 1 0 % D. Blue sclera
B. Chronic diarrhoea for more than one month
11. Diagnosis of paediatric A I D S can be done by:
C. Prolonged fever for more than one month
A. ELISA test
D. Generalised lymphadenopathy
B. Western blot test
4. HIV virus is a: C. Virus culture
A. DNA virus B. Retrovirus D. None of the above
C. DNA, RNA virus D. None of the above
12. T h e first a n t i b o d y to H I V antigen appears in
5. The main target cells of H I V are: blood after:
A. Plasma cells B. T8 cells A. 1-2 weeks of infection
C. T4 cells D. B cells B. 2-4 weeks of infection
6. Body fluid in which H I V is highly concentrated: C. 4-6 weeks of infection
D. 4-6 months of infection
A. Semen, cervical fluids
B. Blood 13. Detection of H I V antigen is:
C. Saliva A. Positive after 4-6 weeks till clinical disease
D. Tears sets in
7. The cells from which H I V can be isolated: B. Positive after 2-4 weeks of infection and then
A. Langerhans' cells becomes negative till the clinical disease sets
B. Alveolar macrophages in
C. Dendritic follicles C. Only positive when clinical disease sets in
D. All of the above D. Positive only after 10 days of infection
42 Dentogist: MCQs in Dentistry—Clinical Sciences

23. World's A I D S day is observed on:

14. ELISA test demonstrates:
A. 22nd November B. 26th February
A. HIV antigen B. HIV antibodies
C. 1st December D. 29th November
C. HIV D. None of the above
15. The confirmatory test used for H I V infection is: 24. H I V crosses:
A. Blood brain barrier
A. ELISA
B. Placenta and vitreous humor
B. Immunodot test
C. A and B
C. RIPA test
D. Placenta only
D. Western blot test
25. T h e first A I D S patient reported in India was in:
16. W h e n b l o o d o f H I V p a t i e n t s i s a n a l y s e d i t
A. 1972 B. 1987
would show:
C. 1986 D. 1991
A. Leucocytosis
B. Decreased ratio of T 4 / T 8 cells 26. T h e i m p r e s s i o n m a t e r i a l r e c o m m e n d e d for
C. Decreased levels of IgG taking impression for maxillofacial prosthesis
D. Decreased levels of IgA is:
17. T h e i m m u n o d e f i c i e n c y c h a r a c t e r i s t i c o f H I V A. Alginate B. ZnOE
C. Silicone D. Plaster of Paris
infection is due to:
A. Diminished humoral immunity 27. T h e r e c o m m e n d e d m e t h o d for s t e r i l i s i n g
B. Diminished cellular immunity impressions for maxillofacial prosthesis is:
C. Both A and B A. Impression in silicone and autoclaving
D. None of the above B. Impression in alginate and soaking in 2%
18. W h e n T - c e l l s u b s e t a s s a y is d o n e in H I V glutaraldehyde for 10 minutes
C. Impression in silicone and soaking in 2%
positive patients there i s : .
A. Increased ratio of T-helper/T-suppressor cells glutaraldehyde for 20 minutes
B. Decreased ratio of T-helper/T-suppressor cells D. Impression in silicone and soaking in 2%
C. Increased ratio of T 4 / T 8 glutaraldehyde for three hours
D. Decreased production of T8 28. T h e aspirator used for suction/aspiration should
be disinfected after using for HIV patient by:
19. H I V can be inactivated by (except):
A. F l u s h i n g with 2% glutaraldehyde and
A. Autoclaving
washing with fresh water after 10 minutes
B. 2% glutaraldehyde
B. Flushing with 2% glutaraldehyde and leaving
C. Boiling for 20 minutes
overnight
D. Gamma radiation
C. Flushing with savlon and washing with water
20. Besides autoclaving, s i m p l e method of inacti-
after 2 hours
vating H I V is (except): D. None of the above
A. Boiling for 20 minutes
29. T h e w o r k i n g s u r f a c e s in o p e r a t i o n theatre
B. Dry heating at 100°C
s h o u l d be d i s i n f e c t e d e s p e c i a l l y for H I V , by
C. 1% sodium hypochlorite
using:
D. 6% hydrogen peroxide
A. Savlon
21. F o l l o w i n g c h e m i c a l s are used for inactivating B. Gamma radiation
H I V (except): C. Hypochlorite solution
A. 2% Glutaraldehyde D. UV light
B . 5 0 % ethanol 30. I m p r e s s i o n s for m a x i l l o f a c i a l trauma cases
C. 1% sodium hypochlorite should be disinfected by:
D. 2.5% cetamide A. Thorough rinsing with water
22. W H O g u i d e l i n e s for s u s p e c t e d H I V patients B. Immersing in 2% glutaraldehyde for 3 hours
suggest that they should: after rinsing in water
A. Be excluded from main stream C. Immersing in 2% glutaraldehyde for 24 hours
B. Remain integrated within the society D. Immersing in 2% glutaraldehyde for mini-
C. Be excluded to isolation mum of 10 minutes after rinsing in water
D. None of the above

Answers
1 D. Viral infections seen intraorally in HIV positive
patients are:
(i) Hairy leukoplakia caused by Epstein-Barr
virus. It is exclusively found in these patients.
Presents as white patch on lateral surface of
tongue.
(ii) Herpes simplex
(iii) Herpes zoster
(iv) Papilloma warts
(v) Cytomegalo virus infections
2 D. Rapidly progressing periodontitis is characteris-
tically found in HIV positive patients. There is
horizontal bone loss p r e s e n t and there is
necrotising ulcerative gingivitis
3 D. VVPIO diagnostic criteria for adult AIDS
Major criteria
1. Weight loss > 10%
2. Chronic diarrhoea > one month
3. Prolonged fever > one month
Minor criteria
1. Persistent cough > one month
2. Generalised pruritis
3. Recurrent Herpes-zoster, simplex
4. Oropharyngeal candidiasis
5. Generalised lymphadenopathy
4 B. HIV is a retrovirus with typical R N A and
enzyme reverse transcriptase.
5 C. The main target cell of HIV is helper T-Lympho-
cytes (T4 lymphocytes). The other cells of body
which show HIV uptake include monocytes,
macrophages, microglial cells in brain, activated
B cells, follicular cells of lymph nodes.
6 B. B l o o d > s e m e n > cervical fluids. In saliva and
tears very insignificant concentrations are pre-
sent.
7 D. HIV is widespread in cells of various organs.
Organs Cells
Skin Langerhans' cells
Lungs Alveolar macrophages
CNS Glial cells
Lymph nodes Dendritic follicles
8 D. HIV has been isolated from b l o o d , semen,
cervical secretions, lymphocytes, C S F , saliva,
tears, urine. But transmission does not occur by
last three since the concentration of virus in them
is not sufficient to cause infection.
9 C. In HIV positive patients, the most c o m m o n
pathogens isolated from pulmonary system are:
(i) Pneumocystis carinii
(ii) Mycobacterium avium intracellular
Oral and Maxillofacial Surgery 43
10 D. HIV infection in infants leads to the embryo-
pathy or dysmorphic syndrome characterised
by: (i) Microcephaly (ii) Ocular hypertelorism
(iii) P r o m i n e n t b o x - l i k e forehead (iv) Wide
palpebral fissure (v) Blue sclera (vi) Pendulous
lips
11 C. HIV antibodies which are IgG in nature can be
passively transferred transplacentally and hence
can be p r e s e n t in an infant without HIV
infection. Thus one often has to wait till the age
of 15 months to be definite about pediatric HIV
infection. ITence ELISA and Western blot test
give false positive results in first 15 months.
Therefore virus should be cultured from blood
for early definite results in infants.
12 C. The HIV core antigen appears in blood after
about 2-4 weeks and first antibody appears in
blood 4-6 weeks after infection.
13 B. Following infection with HIV the principal core
antigen is detected in blood after 2-4 weeks and
then d i s a p p e a r s from the circulation and
remains undetected throughout the asympto-
matic phase. W h e n clinical phase of disease
begins the antigen reappears.
14 B. The diagnostic investigations for HIV infection
are by:
(i) Demonstration of HIV antigen, e.g. Polyme-
rase chain reaction only, used during early 2¬
4 weeks of infection and when clinical phase
sets in (see Q 13).
(ii) Demonstration of antibodies to HIV by:
(a) ELISA
(b) Rapid immunodot test
(c) Karpas test
(d) R1PA test
(e) Western blot test
(iii) Isolation of virus
15 D. Except for Western blot test all other tests are not
carried for specific antibodies against specific-
core, coat and other antigens. They are not ver\
specific but easiest, c o m m o n l y used tests for
detection of HIV infection.
16 B .
17 B. Main target cells of HIV are the T-lymphocytes
e s p e c i a l l y T4 (helper c e l l s ) . T h e s e cells are
responsible for cellular immunity. Since T cells
decrease due to infection with HIV it leads to
diminished cellular i m m u n i t y . Though with
time antibodies also decrease. But primarily
cellular immunity decreases.
44 Dentogist: MCQs in Dentistry—Clinical Sciences

18 B. See answers 16 and 17. remain integrated within the society. Their medi-
19 D. HIV is a fragile virus which can be inactivated cal reports should be kept confidential.
by simple method of boiling for 20 minutes. 23 C. Since 1988 1st December is observed as AIDS
Other methods recommended are: day every year.
(i) Autoclaving 24 C.
(ii) Chemical sterilization by 25 B .
(a) 1% hypochlorite 26 C. So that it can be disinfected or sterilised.
(b) 2% glutaraldehyde 27 D. The recommended method of disinfection for
(c) 6 % H 0 2 2
impression: impression to be taken in silicone
(d) 5 0 % ethanol and soaking in 2% glutaraldehyde for minimum
(e) 2.5% povidone iodine of 10 minutes.
(iii) Boiling for 20 minutes For sterilisation: impression should be taken in
But it is resistant to g a m m a radiation, dry silicone and soaking in 2% glutaraldehyde for
heating and UV radiation. not less than 3 hours.
20 B. See answer (19). 28 B .
21 D. Cet'amide (Savalon) is ineffective. , 29 C. See answer (27).
22 B. It is r e c o m m e n d e d that such patients should 30 D. See answer (27).
 Oral and Maxillofacial Surgery 45

High Yield Facts (Oral and Maxillofacial Surgery)

22. The Winter war line which gives an indication
is defined as any change in the
of the depth at which the tooth is lying in the
body or its functions which is perceptible to the
mandible is
patient and may indicate diseases
23. T h e W i n t e r ' s l i n e w h i c h is d r a w n from the
is defined as any change in the body
surface of the b o n e lying distally to the third
or its functions which is perceptible to a trained
molar to the interdental septum between the first
observes and may indicate disease
and second molars is
3. test is used to test capillary fragility
24. The Winter's line which encloses the margin of
4. The hematological disorder in which general
the alveolar bone enclosing the tooth is
anesthesia is contraindicated is
25. The Winter line which is used to measure the
5. The vasoconstrictor of choice in patients suffe-
depth at which the impacted tooth lies within the
ring from hypertension is
mandible is
6. Dental treatment undertaken for patients recei-
26. The lingual split bone technique for removing
ving treatment for tuberculosis is complicated impacted mandibular third molars was given by
by
7. An a n t i t u b e r c u l a r d r u g w h i c h is p r o n e to 27. T h e M o o r e / G i l l b e c o l l a r technique for the
developing dry socket after tooth extraction is removal of on impacted mandibular third molar
uses
The ideal time gap between the completion of 28. When taking a vertex occlusal view the X-ray
dental extractions and the start of radiotherapy tube is arranged so that the central ray passes
is along the long axis of tooth
9. Any diabetic patient taking units of
29. occlusal film is taken with the X-
insulin daily or w h o s e condition is unstable
ray tube positioned so that the central ray is at
should be admitted to the dental hospital for
right angles to the film packet
dental treatment 30. % of the middle third fractures of
10. The 'ace test' tablet detects in the skull belong to the zygomatic complex group
urine 31. With respect to fractures the mid facial fractures
11. When diazepam in administered drooping of the is analogous to
eyelid half w a y drooping across the pupil is an 32. The frontal bone and the body of the sphenoid
indicative of sign form an inclined plane which slopes downwards
12. The drug of choice in a really nervous child a day to form an angle of to the occlusal
before surgery is plane of the upper teeth
13. The forceps of choice for transferring sterilized 33. The cranial nerve most commonly involved in
instruments to the trays is fractures of zygomatic, Le Fort II and III is
14. High vacuum type and downward displacement 34. Traumatic telecanthus is due to detachment of
types are two near types of attachment of the eye
15. Handle n u m b e r and blade no 35. Retrobulbar hemorrhage is due to hemorrhage
is the m o s t widely used in oral in of eye
surgey 36. LeFort I is also known as _
16. Instruments most commonly used in surgical 37. LeFort II is also known as
curettage are and 38. LeFort III is also known as
17. An osteotome differs from a chisel by having 39. Scale used to measure the level of consciousness
cutting edge is
40. Amnesia which is seen following accident is
18. Cryers, Lindo Levien and War Wick James are
all different types of A n t e r o g r a d e amnesia is
41. R e t r o g r a d e and
19, A sutures enclosing a mass of tissue and rende-
indicative of
ring it ischemic is known as 42. T r a m line pattern on face and halo effect on
20, pillows is associated with leakage of
Lateral trephenation technique was first descri-
43. Orbital floor fracture is best demonstrated by
bed by
21,
is a line on molar
erupted mandibular the occlusal surface of the
46 Dentogist: MCQs in Dentistry—Clinical Sciences
44. The degree of diplopia is measured using
45. CSF leak has _ _ _ _ _ taste
46. For Gillies temporal approach a 2 cm incision is
made between the bifurcation of .
47. Elevator used to elevate depressed zygomatic
arch fracture is
48. Intraoral approach to zygomatic fracture is also
known as
49. Composition of is Iodoform 10 g,
Benzoin lOg, Storax 7.5g, Balsam of Tolu 5g,
Solvent ether 100 ml
50. Presence of enophthalmosis with retraction of
eye on attempted upward gaze is diagnostic of
51. Blockade of nasolacrimal duct is also known as
52. Theories of pain
(a) Specific theory by
(b) Pattern theory by
(c) Gate Control theory by
53. Nerve fibres and impulse conduction
A fiber group —»
C fiber group —»
B fiber group ~» . responsible for new turn over cells and healing
54. Closed m o u t h a p p r o a c h to inferior alveolar
nerve block was given by
55. Gow gates technique is used as
56. Potency of LA depends solely on
57. Duration of LA is influenced by
58. 1st toxic symptom of all synthetic L A is _ _ _ _ _
59. LA produces loss of function in the following
order
60. Concentration of L A necessary to block conduc-
tion in a peripheral nerve is about
times greater that required to affect the CNS
61. The preservative used to stabilize the vasocons-
trictor in a LA sol. is
62. Least toxic of all the LA's is
63. Prilocaine in contrast to other amide agents
undergoes biotransformation in
64. Local anesthetic used as a standard of compari-
son is
65. Lidocaine was synthesized by procaine
by
66. Maximum acceptable dose of lidocaine is .
67. L A which is resistant to acid and alkali hydro-
lysis is
68. Similarity between mepivacaine, lidocaine and
prilocaine is that they do not contain
in their cartridges
69. Hurricane is a brand name for LA containing
70. The gas which is stored in a blue cylinder as a
liquid under 38 atmosphere is
71. Nitrous o x i d e -
10-15% concentration produces -»
3 5 - 4 0 % concentration produces ->
5 0 % concentration produces —>
72. Adult dose and child age +3 is
73. Dead space in a wound usually gets filled up by
74. Best surgical exposure to expose the TMJ is
75. is also known as Risdon incision and
it is best approach for the ramus and the neck
of the condyle
76. is the most common cause of TMJ
pain
Note: The main cause in MPDS is due to muscle spasm
77. .is the direction of luxation in extracting
a deciduous molar
78. Partsch operation refers to
79. The periosteum of bone is made up of outer
fibrous layer and an inner layer which is
80. is the m o s t important sign of
implant failure
81. When using a bur to cut bone the temperature
if exceeded by can cause bone necrosis
82. is the m o s t important sign in
dehydration
83. The relative and hypnotic which is widely used
in pediatric dentistry is
84. is the most common suture
pattern used in oral surgery
85. Maximum allowable dose for 2% lidocaine with
1. 100,000 epinephrine is (3.5 mg
lidocaine per lb) (Avg adult 70 kg 70 X 3.5 mg
= 245 mg).
86. O r g a n i s m responsible to cause dry socket is
87. Most accepted hypothesis for the cause of dry
socket is
88. When removing maxillary teeth the upper jaw
of the patient in relation to the dentists shoulder
should be at level
Note: For mandibular extractions the occlusal plane
should be parallel to the floor of the mouth and
the chair is positioned low.
89. Most accurate measurement of body tempera-
ture is by route
90. The lever type which is used in oral surgery is
 Oral and Maxillofacial Surgery 47

94. Suture material size used in oral surgery is

Note: In Class II Fulcrum line is in between force and
_ _ _ _ _ _ _ and _ _ _ _ _ _ for ophthalmic use
load
91. During extraction if a small communication is
Sutre Materia!
made with the sinus it depends on the size of the Non Resorbable
Resorbable
communication
(a) Size 1-2 mm Plain cat gut Silk
Chromic catgut Braided polyester
(b) Size 2-6 mm
(c) Size >7 mm Polyeslylene
Polypropylene
92. part of the articular disc is vascular
Poly glactin 910 Stainless steel
Note: The only direction in w h i c h T M J dislocation
occurs is anteriorly Poly glycolic acid
93. Normal prothrombin time is
Note: Catgut is obtained from sheep intestine
Note: Partial t h r o m b o p l a s t i n time P T T m e a s u r e s
clotting mechanism of the intrinsic system.

Answers
33. 6th abducent
1. Symptom
34. Medial canthal
2. Signs
35. Muscle cone
3. Hess's
36. Low level fracture Horizontal
4. Sickle cell anemia
37. P y r a m i d a l fracture, s u b z y g o m a t i c fracture,
5. Felypressin
infrazygomatic fracture
6. Bleeding
7. INH 38. H i g h transverse fracture, suprazygomatic
8. 6 weeks fracture
9. 60 39. Glasgow Coma Scale
10. Ketone bodies 40. Anterograde amnesia
11. Verril's 4 1 . Cerebral damage
12. Diazepam 42. C S F
13. Cheatle forceps 43. Hypocycloid
14. Autoclaves 44. Hess chart
15. 3, 15 45. Salty
16. Mitchell trimmer and cumine scales 46. Superficial temporal vessels
17. Bi-bevelled 47. Bristow's
18. Elevators 48. Kaenes approach
49. White heads varnish
19. Stay suture
50. Orbital blow out fracture
20. Henry Bowdler
5 1 . Epiphora
21. Bowdler
22. Red 52. (a) Descartes, (b) Gold Scheider, (c) Melzack and
23. Amber Wall
24. Amber 53. A- Large myelinated 3-20 m f a s t / I st p a i n -
25. Red C - lOOm/sec
26. Sir William Kelsey fry Small myelinated 0 . 5 - l m s l o w / 2 n d p a i n -
27. Bur B- 0.5-2 m / s e c
28. Central incisors
3 microdiameter 3 - 1 4 m / s e c and confined to
29. True
30. 60-70 preganglionic ant. fibres
54. Akinosi
31. Match box
32. 45 = 55. Open mouth technique for mandibular nerve
block
 DentogistMCQlhDen^
IS
76. M P D S
56. Chemical structure 77. Palatal
57. Mole configuration 78. Marsupialization followed by enucleation
58. CNS stimulation followed by depression 79. Cambium
59. Pain, temp, touch, proprioception and skeletal 80. Mobility
muscle tone 81. 56°C
60. 6 82. Polydipsia
61. Sodium bisulphate 83. Chloral hydrate
62. 2-chloroprocaine 84. Interrupted
63. Kidney 85. 245 mg is the max. allowable dosegs
64. Procaine 86. Treponema denticola
65. Lofgren, einhorn 87. Burnes hypothesis
66. 44 m g / k g = 2 m g / l b 88. Same level
67. Mepivacaine 89. Rectal
68. Germicide 90. Class II
69. Benzocaine 91. (a) Size of 1-2 mm should be left alone and
70. Nitrous oxide allow for blood clot formation
71.
(a) Numbers of extremities, tingling sensation (b) Size of 2-6 mm closure should be performed
(b) Enhanced sedative effect by suture
(c) Unconsciousness (c) Size greater than 7 mm best closed by flap
72. Bastedochild dose 92. Central
73. Blood 93. 12-14 sec
74. Preauricular 94. 3.0 or 4.0, 9.0
75. Submandibular incision