231. With a negative history of allergy, which of the following antibiotics should be initiated immediately for enteric therapy with post-op purulence?
A. penicillin G B. penicillin V C. amoxicillin and penicillin V D. Clindamycin E. clindamycin, erythromycin, and tetracycline F. amoxicillin
232. Which of the following is oral bactericidal? A. amoxicillin, penicillin G and penicillin V B. amoxicillin, erythromycin C. amoxicillin, penicillin and amoxicillin D. clindamycin and erythromycin
233. Which of the following types of antibiotics should be selected for patients who are having procedures involving the sinus?
A. Penicillin V B. Penicillin G C. Amoxicillin D. Gentamycin E. Clindamycin F. Erythromycin
Q233 Answer - ?? • Which of the following types of antibiotics should be selected for patients who are having procedures involving the sinus? A) penicillin V B) penicillin G C) amoxicillin? D) gentamycin E) clindamycin? F) erythromycin
234. Antibiotic prophylaxis is indicated for all the following conditions except:
A. atrial-septal defect B. heart valve C. mitral valve prolapse D. angina pectoris E. rheumatic fever
Q234 Answer - ?? • Antibiotic prophylaxis is indicated for all the following conditions except: ??? A) atrial-septal defect B) heart valve C) mitral valve prolapse? D) angina pectoris? E) rheumatic fever?
235. Which of the following statements is correct when considering the use of prophylactic antibiotics? A. An antibiotic should be coordinated with the antibiotic used in the osseous graft material therefore tetracycline is indicated because of its useful pH. B. A cephlosporin for penicillin allergic patients to be coordinated with antibiotic used in osseous graft. C. Amoxicillin should be used because of its excellent bioavailability and activity against strep and enterococci. D. Sine doxycycline, ampicillin, and amoxicillin are all types of beta-lactams and are ultimately as effective as penicillin.
Q235 Answer • Which of the following statements is correct when considering the use of prophylactic antibiotics? A) An antibiotic should be coordinated with the antibiotic used in the osseous graft material therefore tetracycline is indicated because of its useful pH. NO- TETRA INHIBITS OSTEOBLAST ACTIVITY
B) A cephlosporin for penicillin allergic patients to be coordinated with antibiotic used in osseous graft. Lincomycin –best/diluted C) Amoxicillin should be used because of its excellent bioavailability and activity against strep and enterococci – true D) Sine doxycycline, ampicillin, and amoxicillin are all types of beta-lactams and are ultimately as effective aspenicillin -- NO
236. A patient with a history of daily aspirin is scheduled in your office for implant surgery. How many days should you require the patient to avoid aspirin prior to the surgery day to prevent hemostasis problems?
A. 1-3 days B. 3-6 days C. 7-10 days D. 10-14 days E. Does not matter
Q236 Answer - ?? • A patient with a history of daily aspirin is scheduled in your office for implant surgery. How many days should you require the patient to avoid aspirin prior to the surgery day to prevent hemostasis problems? A) 1-3 days B) 3-6 days C) 7-10 days ?? D) 10-14 days E) Does not matter ?? ** It is contraindicated to discontinue ASA or Plavix for dental work.
237. Provodone-Iodine is not effective against: A. Hep A B. gram positive C. gram negative D. TB
Q237 Answer - ?? • Provodone-Iodine is not effective against: A) Hep A ?? B) gram positive C) gram negative D) TB ??
Question 238 • Matching: A) Augmentin B) Tetracylcine C) Amoxicillin D) Erythromycin E) Metronidazole F) Clindamycin G) Penicillin G H) Azithromycin
1. ___ Produces a high incidence of nausea and is bacteriostatic 2. ___ Used in treating periodontal disease and treating infections around implant posts. Skin sensitivity to sunlight is common 3. ___ Mainly used for treatment of anaerobic organisms and usually combine with another antibiotic 4. ___ Active against most aerobic and anaerobic cocci and has a high incidence of pseudomembranous colitis. 5. ___ Very active against gram (+) cocci; however, is highly degradable in gastric acid. Is usually administered by parenterals routes. 6. ___ Is made up of a combination of Clavulanic Acid and Amoxicillin 7. ___ Broad spectrum antibiotic which is usually the first-line agent in the treatment of oral-facial infections. Is active against H. influenzae and E. coli.
Q238 Answer • Matching: A) Augmentin
B) Tetracylcine
C) Amoxicillin
D) Erythromycin E) Metronidazole F) Clindamycin G) Penicillin G
H) Azithromycin
1. _D_ Produces a high incidence of nausea and is bacteriostatic 2. _B_ Used in treating periodontal disease and treating infections around implant posts. Skin sensitivity to sunlight is common 3. _E_ Mainly used for treatment of anaerobic organisms and usually combine with another antibiotic 4. _F_ Active against most aerobic and anaerobic cocci and has a high incidence of pseudomembranous colitis. 5. _G_ Very active against gram (+) cocci; however, is highly degradable in gastric acid. Is usually administered by parenterals routes. 6. _A_ Is made up of a combination of Clavulanic Acid and Amoxicillin 7. _C_ Broad spectrum antibiotic which is usually the first-line agent in the treatment of oral-facial infections. Is active against H. influenzae and E. coli.
239. Which of the following drugs should not be given to an insulincontrolled diabetic, as it will alter the blood glucose levels?
A. Ibuprofen B. Clindamycin C. Dexamethasone D. Halcion E. Metronidazole
Q239 Answer • Which of the following drugs should not be given to an insulincontrolled diabetic, as it will alter the blood glucose levels? EPI AND GLUCOCORTICOSTEROIDS A) Ibuprofen B) Clindamycin C) Dexamethasone
- GLUCOCORTECOSTEROID/INCREASES BLOOD GLUCOSE
E) Halcion F) Metronidazole – OR FLAGYL/ANTIBIOTIC GRAM –
IN HOSPITAL- TX/CHRON’S DISEASE TX
VE/DIARRHEA,NAUSEA/H.PYLORI TX/C.DIFFICILE
240. 95. Povidine-Iodine antiseptic is not effective against:
A. Hep A Virus B. Gram (+) Bacteria C. Gram (-) Bacteria D. D. M. Tuberculosis
Internal Medicine
• Practice AAID Exam Questions
241. A patient is to undergo radiation treatment and one of is recently placed implants is failing. You removed the failing implant and make the patient wait how long to start radiation treatment: A. 7 days B. 10 days C. 21 days D. 45 days
Q241 Answer • A patient is to undergo radiation treatment and one of is recently placed implants is failing. You removed the failing implant and make the patient wait how long to start radiation treatment:
A) 7 days – 7-10 days for chemotherapy pts-de Rossi B) 10 days C) 21 days D) 45 days
Q241 Explanation Before Head and Neck Radiation Therapy Conduct a pretreatment oral health examination and prophylaxis. • Schedule dental treatment in consultation with the radiation oncologist. • Extract teeth in the proposed radiation field that may be a problem in the future.• Prevent tooth demineralization and radiation caries: • Fabricate custom gelapplicator trays for the patient. • Prescribe a 1.1% neutral pH sodium fluoride gel or a 0.4% stannous, unflavored fluoride gel (not fluoride rinses). • Have patients with porcelain crowns or resin or glass ionomer restorations use a neutral fluoride. • Be sure that the trays cover all tooth structures without After Radiation Therapy • irritating the gingival or mucosal tissues. • Instruct the patient in home application of fluoride gel. For the first 6 months after cancer treatment, recall the patient for prophylaxis and home care evaluation Several every 4 to 8 weeks or as needed. • Reinforce the importance of optimal oral hygiene. • After mucositis subsides, days consult with radiation the oncology team about the usepatient of dentures and other appliances. with friable before therapy begins, should start a daily 5-minutePatients application. • Have tissues and xerostomia may never be able to wear them again. • Watch for trismus, demineralization, and caries. Lifelong, daily applications of fluoride gel aretrays needed for patients xerostomia. Advise against all patients brush with a fluoride gel if using is difficult.• Allowwith at least 14 days• of healing for any oral surgery on irradiated bone, because of the risk of osteonecrosis. Tooth extraction, if unavoidable, should be conservative, using procedures. antibiotic coverage andall possibly hyperbaric oral surgical • Conduct prosthetic surgeryoxygen before therapy. treatment, since surgical procedures Before Chemotherapy are contraindicated on examination. irradiated bone. Conduct a pretreatment oral health • Schedule dental treatment in consultation with the oncologist. • Schedule oral surgery 7 to 10 days before myelosuppressive therapy begins. • In patients with hematologic Scott S. De Rossi, Oral any Health Diagnostic Sciences MCG procedures in patients cancers, consult the oncologist beforeDMD conducting oral&procedures; do not conduct who are immunosuppressed or have thrombocytopenia
242. A 55 year old female with uncontrolled diabetes has broken #8 subgingivally that requires extraction and placement of an implant. What would you expect with regards to her treatment?
A. excessive bone loss around the implant B. increased soft tissue recession around the implant C. abnormal wound healing D. increased bone porosity
Q242 Answer • A 55 year old female with uncontrolled diabetes has broken #8 subgingivally that requires extraction and placement of an implant. What would you expect with regards to her treatment? A) excessive bone loss around the implant B) increased soft tissue recession around the implant C) abnormal wound healing – Dr. Rossi pg.17 D) increased bone porosity
(diabetes)
Q242 Explanation • Medical Complexity Scale and Protocol • Major Categories– MCS 0: No medical problems– MCS 1: Stable or controlled medical problems– MCS 2: Unstable or uncontrolled medical problems– MCS 3: Medical conditions associated with acute exacerbation resulting in high risk of mortality • MCS-2B – Patient with DM with glycosylated hemoglobin of 11%. Due to poor long-term glycemic control, patient may be at risk for poor wound healing or infection. – Perioperative ANBT may be indicated. DeRossi
• Better to defer elective treatment due to increased susceptibility to infection and periodontal disease. • Prescribing antibiotics for poorly controlled DM following surgery - p.p. 18 Dr Rossi
Additional Info •
Patients with burning tongue syndrome - usually exhibit no clinically detectable lesions, although symptoms of pain and burning can be intense, and may be accompanied by altered taste and xerostomia. Occasionally, a patient may attribute the initiation of the malady to recent dental work, such a placement of a new bridge or extraction of a tooth. Any and all mucosal regions of the mouth may be affected, although the tongue is the most commonly involved site. Tissue is intact and has the same color as the surrounding tissue , with normal distribution of tongue papillae. 56Caused by xerostomia, candidiasis, referred pain from muscles, other chronic infections, dental diseases, reflux of gastric acid, medications, mechanical trauma, diabetes mellitus, blood dyscrasias, nutritional deficiencies, allergic and inflammatory disorders, psychogenic factors, or may be idiopathic. On the basis of history, physical evaluation, and specific laboratory studies minimal blood studies should include a complete blood count ( CBC ) with differential, glucose, iron, ferritin, folic acid, and vitamin B 12 levels. For symptomatic relief elixir of diphenydramine is a useful antihistaminic that also has mild topical anesthetic properties.
•
CBC.
An accurate test for anemia is the hematocrit, followed by the hemoglobin; the least accurate is the red blood cell count. Normal hemoglobin values for men are 13.5 to 18 g/dl; those for women are 12 to 16 g/dl. The minimum baseline recommended for surgery is 10 mg/dl, especially for elective implant surgery. For the majority of anemic patients, implant procedures are not contraindicated. However, preoperative and postoperative antibiotics should be administered and the risk of bleeding in anemic patients should not be potentiated by no prescription/use of aspirin. Hygiene appointments should be scheduled more frequently for these patients. •
Bone Complications with in the implant patient may affect both short-term and long-term prognoses. Bone maturation and development are often impaired in the long-term anemic patient. A faint, large trabecular pattern of bone may even appear radiographically, which indicatesa 25% to a 40% loss in trabecular pattern. Therefore the character of the bone needed to support the implant can be affected significantly. The decreased bone density affects theinitial placement and may influence the initial amount of mature lamellar bone forming at the interface of an osteointegrated implant. The time needed for a proper interface formation is longer in poor density bone. Abnormal bleeding is also a common complication of anemia; during extensive surgery, a decreased field vision from the hemorrhage or difficulty in bone impressions forsubperiosteal implants may be encountered. Increased edema and subsequent increased discomfort postsurgically are common consequences. In addition the excess edemaincreases the risk of postoperative infection and its consequences. Not only are anemic patients prone to more immediate infection from surgery, they are also more sensitive to chronic infection throughout their lives. This may affect the long-term maintenance of the proposed implant or abutment teeth.
Additional Info Ctnd. •
There is an increased prevalence of vitamin B12 orcobalamin deficiency with age in 15% of the elderly (Pennypacker et al., 1992). B12 deficiency is associated with both hematological (e.g., megaloblastic anemia, bone marrow suppression) and neurological diseases (e.g. peripheral neuropathy; Stabler, 1995). Although vitamin B12absorption mechanisms depend on many factors (stomach pH, intrinsic factor production, bowel bacteria), the recent Framingham Offspring Study showed that plasma vitaminB12 levels are associated with vitamin B12 intake (Tucker etal., 2000).
•
Leukopenia is a reduction in the number of circulating WBCs to less than 5000/mm3. A decreased leukocyte count may accompany certain infections (e.g., infectious hepatitis), bone marrow damage (from radiation therapy), nutritional deficiency (e.g., vitamin B12 and folic acid), and blood diseases (e.g., anemia). In the potential implant candidate with leukocytosis or leukopenia, many complications can compromise the success of the implant prosthesis. The most common is infection, not only during the initial healing phase but also long term. Delayed healing is also a consequence of WBC disorders. For most implant procedures, the first few months are critical for long-term success. Delayed healing may increase the risk of secondary infection. Severe bleeding can also indicate leukocyte disorders. It may be related to a thrombocytopenia (decreased platelet count) or to the associated anemia. In either condition, the surgical procedure is complicated, with increased edema, post-operative discomfort, and increased chance for secondary infection. Misch 3rd pp. 438
243. Most appropriated bleeding time test for implant patients?
A. CBC B. Ivy bleeding time C. PTT D. PT E. INR
Q243 Explanation
Q243 Explanation Ctnd.
Q243 Explanation Ctnd. • Ivy bleeding time is a bleeding time test in which a sphygmomanometer is inflated to 40 mm Hg around the upper arm, a 5-mm deep incision is made on the flexor surface of the forearm, and the time is measured to cessation of bleeding. • “Advantages of Capillary INR Monitoring for Oral Anticoagulation” - Article in French, CampWachsmuth M, Humair JP, Boehlen F Service de médecine de premier recours, Département de Médecine Communautaire, HUG, 1211 Genève 14. maud.camp-wachsmuth@hcuge.ch – More and more patients are treated with long term oral anticoagulation. The time spent in therapeutic range is often limited since many factors affect INR. Too high or too low INRs increase respectively the hemorrhagic or thromboembolic risks. INR monitoring by a capillary device either in autonomy (self-management) by some selected patients or in relation with the treating physician (self-control), allows increasing the time spent in therapeutic range. Capillary INR monitoring can also be made at the medical office: it is less invasive and provides a quicker answer than a venous INR
Q243 Explanation Ctnd. • The coumarin-derived anticoagulants interfere with vitamin K-dependent synthesis of active coagulation Factors 11 (prothrombin), VII, IX, and X. These oral anticoagulants are effective only in vivo. Their therapeutic effect depends on the half-lives of Factors 11, VII, IX, and X; thus, 8-1/2 hours are required for action. • The maintenance dose is determined by one-stage prothrombin activity, which should be about 1 1/2 - 2 1/2 times the control value. • These agents are widely used in the secondary prophylactic treatment of venous thrombosis and pulmonary embolism to prevent the recurrence or extension of venous thrombus formation because oral anticoagulants have no effect on platelets, they are not used in the treatment of thrombotic disease in the arterial system. Reversal of anticoagulant effects following discontinuation of oral anticoagulants, the one-stage prothrombin time (PT) gradually returns to normal. Oral administration of vitamin K (phytonadione) enhances recovery. • Recommendation for patients within the therapeutic range of INR of 3.5 or below, warfarin therapy need not be modified or discontinued for simple single dental extractions. More complicated and invasive oral surgical procedures would represent an exception to this recommendation for patients with an INR on the high end of the scale, and they should be discussed with the physician managing the condition requiring warfarin. Nevertheless, the clinician’s judgment must always be considered for all treatment decisions. Since the benefit of preventing a thromboembolic episode clearly outweighs the risk of a significant bleeding episode, this is a Class I recommendation. This recommendation is supported by multiple RCTs and is based on Level of EvidenceA. This recommendation was also supported by the expert consultants.
Q243 Explanation Ctnd. •
Preoperative management of bleeding problems is important to avoid life-threatening situations. A thorough history prior to implant surgery can help to identify those patients who are at an increased risk of bleeding. Questions such as “do you bleed excessively when you cut yourself from shaving” may uncover problems related to hemostasis. Further testing may be warranted such as prothombin time (PT), partial prothombin time (PTT), bleeding time, platelet count, and liver function tests (LFTs). Preoperative evaluation should determine if the patient has any systemic bleeding disorders (e.g. Von Willebrand’s) or is on medication that may cause excessive bleeding (e.g. Coumadin, aspirin, Vitamin E).
•
The platelet count is obtained in the CBC; normal values range between 200,000 and 300,000/ml. A clinical manifestation usually does not occur until the platelet count is below 80,000/ml. Values around 20,000 indicate a spontaneous bleeding risk. The Ivy bleeding time is an excellent test to determine adequate platelet function and may also test the vascular phase. The bleeding time measures both coagulation pathways as well as platelet function and capillary activity. The PTT is used to determine the ability of the blood to coagulate within the vessels. Therefore it tests the intrinsic and common pathways of coagulation (factors VII through XII). The PT determines the ability of the blood to coagulate outside the vessels and therefore tests the extrinsic and common pathways of coagulation. Both systems are necessary for normal coagulation.
•
INR greater than 3.5 should be referred to their physician for dose adjustment before invasive dental procedures. Expert opinion suggests that INR values should be obtained within 24 hours before the dental procedure. Portable INR monitors are now available that can measure INR from a finger-stick sample of whole blood and provide results within seconds. Such devices may be useful in cases when INR values are known to fluctuate significantly
244. A 27 year old patient presents for implant treatment. He reports recreational IV drug use and alcohol abuse. He also reports bleeding, inflamed gums. A pseudo membrane’ on gingiva and palate. What would you be suspicious of? A. AIDS B. Periodontal disease C. Lichen Planus D. Psychological problem
Q244 Answer & Explanation • A 27 year old patient presents for implant treatment. He reports recreational IV drug use and alcohol abuse. He also reports bleeding, inflamed gums. A pseudo membrane’ on gingiva and palate. What would you be suspicious of? A) AIDS B) Periodontal disease C) Lichen Planus D) Psychological problem • Malabsorption data showed a great presence of HIV-related oral lesions of which oral candidiasis and hairy leucoplakia are the most prevalent
245. Patient has prosthetic heart valve (MPHV) and is on 7.5 mg of coumadin. What is the INR value for maintenance of coagulation of wound and maintenance of value? A. 1.5-2.0 B. 2.5-3.5 C. 4.0-5.0 D. 6.5-8.0
Q245 Explanation •
INR target ranges (Reference PEPID ED.): – Normal untreated range 0.8-1.2. – DVT prophylaxis 1.5-2.0. DVT treatment 2.0-3.0. – Pulmonary Embolism (PE) treatment 3.0-4.0. Chronic A-fib maintenance 2.0-3.0. – Prosthetic Valve maintenance 2.5-3.5 Reference PEPID ED.
•
Warfarin Rx DVT, PE Prevention of DVT or thrombosis in AF, MPHV Prevention of recurrent MI Oral, 57 mg/day for 3-6 months INR: 2.0 to 3.0, Oral, 7-10 mg/day long-term INR: 2.5 to 3.5
•
The maintenance dose is determined by one-stage prothrombin activity, which should be about 1 1/2 - 2 1/2 times the control value. These agents are widely used in the secondary prophylactic treatment of venous thrombosis and pulmonary embolism to prevent the recurrence or extension of venous thrombus formation because oral anticoagulants have no effect on platelets, they are not used in the treatment of thrombotic disease in the arterial system.
246. Which of these values in a blood chemistry exam will most likely be abnormal in a patient with alcoholic-hepatic disease? A. Glucose B. SGOT C. LDH D. Total bilirubin E. Potassium
Q246 Answer • Which of these values in a blood chemistry exam will most likely be abnormal in a patient with alcoholic-hepatic disease?
A) Glucose - diabetes B) SGOT – heart (liver but can be normal) C) LDH - heart enzyme (myocardial infact0) D) Total bilirubin (Bilirubinemia) E) Potassium - Electrolytes, BP, heart
247. Which of these values in a chem exam would most likely by abnormal if the patient has renal disease? A. Albumin, SGOT, BUN B. Chloride, CO2 C. Calcium, phosphorous D. Potassium E. Chloride, CO2, calcium, phosphorous, potassium
Q247 Answer • Which of these values in a chem exam would most likely by abnormal if the patient has renal disease? A) Albumin (both-usu. liver), SGOT (liver), BUN (both-usu. kidney) B) Chloride, CO2 C) Calcium, phosphorous D) Potassium E) Chloride, CO2, calcium, phosphorous,
potassium
Q247 Explanation •
Blood Urea Nitrogen (BUN) – Low BUN levels are not common and are not usually a cause for concern. They may be seen in severe liver disease, malnutrition, and sometimes when a patient is over hydrated (too much fluid volume), but the BUN test is usually used to diagnose or monitor these conditions.
•
SGOT (Also called AST) test is ordered along with several other tests to evaluate a patient who seems to have symptoms of a liver disorder
•
A physician may order an albumin test, along with other tests, when a person has symptoms of a liver disorder such as jaundice, fatigue, or weight loss, or symptoms of nephrotic syndrome such as swelling around the eyes, belly, or legs.
•
Tests to monitor kidney function: – If you have been diagnosed with a kidney disease, your health care provider will order laboratory tests to help monitor kidney function. Blood levels of BUN and creatinine are measured from time to time to see if the kidney disease is getting worse. The amount of calcium and phosphate in the blood and the balance of serum and urine electrolytes can also be measured, as these are often affected by kidney disease. Hemoglobin, measured as part of a complete blood count (CBC) may be measured (the kidneys make a hormone, erythropoietin, that controls red blood cell production). Urine total protein (TP) can be used to test the effects of treatment in diabetes and nephrotic syndrome. Parathyroid hormone (PTH), which controls calcium levels, is often increased in kidney disease and is often checked to see if enough calcium and vitamin D are being taken to prevent bone damage.
Q247 Explanation Ctnd • Electrolyte panels or basic metabolic panels are commonly used to monitor treatment of certain problems, including high blood pressure (hypertension), heart failure, and liver and kidney disease. • Losing or retaining fluid causes an imbalance in your body's electrolytes. • Electrolytes such as chloride, potassium, sodium, and carbon dioxide (CO2) help keep the proper balance of body fluids and maintain the body's acid-base balance. In the body, most of the CO2 is in the form of a substance called bicarbonate (HCO3-). Therefore, the CO2 blood test is really a measure of your blood bicarbonate level. • People with Type 1 diabetes lack enough insulin, a hormone the body uses to process glucose (blood sugar) for energy. When glucose is not available, body fat is broken down instead. As fats are broken down, acids called ketones build up in the blood and urine. In high levels, ketones are poisonous. This condition is known as ketoacidosis. Blood glucose levels rise (usually higher than 300 mg/dL) because the liver produces glucose to try to combat the problem. However the cells cannot pull in that glucose without insulin. Diabetic ketoacidosis may lead to a diagnosis of Type 1 diabetes, because it is often the first symptom that causes a person to see a doctor. It can also be the result of increased insulin needs in someone already diagnosed with type 1 diabetes. Infection, trauma, heart attack, or surgery can lead to diabetic ketoacidosis in such cases. Missing doses of insulin can also lead to ketoacidosis in people with diabetes. • Tests that may be done to diagnose ketoacidosis include: – Arterial blood gas, Blood glucose test, Blood pressure measurement, Amylase blood test, Potassium blood test
• Deficiency problems are not usually a result of poor nutrition. Rapid excretion of potassium in severe diarrhea, diabetes, and prolonged cortisone administration. The kidneys normally remove excess potassium from the body. Therefore, most cases of hyperkalemia are caused by disorders that reduce the kidneys’ ability to excrete potassium.
248. All of the following are causes of anemia except: A. foliate deficiency B. iron deficiency C. menstrual blood loss D. vitamin B deficiency E. vitamin C deficiency
Q248 Explanation •
Iron deficiency anemia is the most common form of anemia. Iron is a key part hemoglobin. Without iron, the blood cannot carry oxygen effectively.
•
Women are at greater risk for anemia. In women, iron and red blood cells are lost when bleeding occurs from very heavy or long periods (menstruation).
•
Folic acid is a B vitamin. It helps the body form red blood cells and produce DNA. Folic Acid Deficiency can cause anemia (low red blood cell count) with abnormally large red blood cells containing large nuclei. In severe cases, lowering of levels of white blood cells and platelets are seen.
•
B-12 deficiency can cause anemia and in some cases Megaloblastic anemia.
•
B-2 (riboflavin) deficiency can cause anemia and may play an adjunct role in the treatment of iron deficiency anemia
Q248 Explanation Ctnd. •
Vitamin C (ascorbic acid) is a water-soluble vitamin, which is necessary in the body to form collagen in bones, cartilage, muscle, and blood vessels. – Even-though it aids in the absorption of iron, deficient Vitamin C leads to Scurvy not anemia. – Scurvy is a disease resulting from a deficiency of Vitamin C, which is required for the synthesis of collagen in humans. The chemical name for vitamin C, ascorbic acid, is derived from the Latin name of scurvy, scorbutus, which also provides the adjective scorbutic ("of, characterized by or having to do with scurvy"). Scurvy leads to the formation of spots on the skin, spongy gums, and bleeding from the mucous membranes. The spots are most abundant on the thighs and legs, and a person with the ailment looks pale, feels depressed, and is partially immobilized. In advanced scurvy there are open, suppurating wounds and loss of teeth.
Scorbutic gums, a symptom of scurvy. Note gingival redness in the triangle shaped interdental papillae between teeth.
249. Which one of the following is not a characteristic related to hypertension?
A. The type of hypertension medication taken by the patient can indicate the source of hypertension. B. Hypertension can result from increased peripheral resistance. C. Hypertension can result in cardiac dysfunction D. Hypertension can result from both increased peripheral resistance and cardiac dysfunction. E. Higher levels of blood pressure differentiate secondary hypertension.
Q249 Answer • Which one of the following is not a characteristic related to hypertension? A) The type of hypertension medication taken by the patient can indicate the source of hypertension. – Yes, diuretics vs. alpha, beta blockers or ace inhibitors B) Hypertension can result from increased peripheral resistance - NO C) Hypertension can result in cardiac dysfunction - YES D) Hypertension can result from both increased peripheral resistance and cardiac dysfunction - YES E) Higher levels of blood pressure differentiate secondary hypertension.
Q249 Explanation • Congestive Heart Failure – the heart is not strong enough to pump against the high Atrial Pressure. • BP is a factor of Total Peripheral Resistance, Cardiac Output, and Blood Volume. – Most Hypertensive Patients have a normal Cardiac Output and a increased Peripheral Resistance. – Cardiac Output depends on Heart Rate and Stroke Volume – (epinephrin increases both HR and SV) • Peripheral Resistance depends somewhat on blood viscosity but mainly on Arteriolar Radius.
Q249 Explanation Ctnd.
Q249 Explanation Ctnd.
250. Which of the following terms or conditions should be applied as a result of medical history information? A. Steroid therapy is indicated for GI ulcers to prevent swelling of the ulcerated tissue. B. A three month waiting period is recommended for patients following MI. C. Diabetic patients respond best to stress when blood sugar levels are balanced. Schedule surgery between meals 2-3 hours after eating. D. Patients with fordyce spots may have tissue lesions incorporated into the healing incision line. E. Patients on steroid medication should have antibiotics prescribed since steroids can mimic signs on inflammation.
Q250 Answer • Which of the following terms or conditions should be applied as a result of medical history information? A) Steroid therapy is indicated for GI ulcers to prevent swelling of the ulcerated tissue. – No steroids can induce ulcers B) A three month waiting period is recommended for patients following MI. – No 6 months with MD approval C) Diabetic patients respond best to stress when blood sugar levels are balanced. Schedule surgery between meals 2-3 hours after eating. – Yes - Best is AM APPT.1.5-3 HRS AFTER BREAKFAST D) Patients with fordyce spots may have tissue lesions incorporated into the healing incision line. NO-(sebasceous gland, rel cheeks, tongue, lips) E) Patients on steroid medication should have antibiotics prescribed since steroids can mimic signs on inflammation. NO
251. Which of the following is t true of Hepatitis A infection?
A. high morbidity B. high mortality C. may be transmitted by fecal material D. may be transmitted by blood products
Q251 Answer • Which of the following is true of Hepatitis A infection?
A) high morbidity – false B) high mortality – false C) may be transmitted by fecal material – true and by contaminated water & food D) may be transmitted by blood products – false only Hep. B
• The virus spreads by the fecal-oral route and infections often occur in conditions of poor sanitation and overcrowding. Hepatitis A can be transmitted by the parenteral route but very rarely by blood and blood products. Food-borne outbreaks are not uncommon, and ingestion of shellfish cultivated in polluted water is associated with a high risk of infection
252. Which one of the following is not an acute feature of severe anaphylaxis?
A. bronchi spasm B. laryngeal edema C. circulatory collapse
Q252 Explanation •
Anaphylaxis Definition: – Anaphylaxis is a severe, potentially life-threatening allergic reaction. It can occur within seconds or minutes of exposure to something you're allergic to, such as the venom from a bee sting or a peanut. – The flood of chemicals released by your immune system during anaphylaxis can cause you to go into shock; your blood pressure drops suddenly and your airways narrow, blocking normal breathing. Signs and symptoms of anaphylaxis include a rapid, weak pulse, a skin rash, and nausea and vomiting. Common triggers of anaphylaxis include certain foods, some medications, insect venom and latex. – Anaphylaxis requires an immediate trip to the emergency department and an injection of epinephrine. If anaphylaxis isn't treated right away, it can lead to unconsciousness or even death.
•
Anaphylactic shock is a sudden circulatory collapse that results from a severe allergic reaction. It occurs when the immune system reacts to a foreign substance (allergen). In anaphylactic shock, the immune system releases many chemical substances, including histamine and serotonin. These chemicals cause narrowing of the breathing passages (bronchospasm) and relaxation (dilation) of blood vessels. During the reaction, fluid may pool in the lungs (pulmonary edema) and upper airway obstruction may result from laryngeal edema. Hives (urticaria) and deep tissue swelling (angioedema) may also be observed. The result of anaphylaxis may be life-threatening respiratory and circulatory failure, otherwise known as anaphylactic shock.
Q252 Explanation Ctnd. • Symptoms of anaphylaxis are related to the action of Immunoglobulin E (IgE) and other anaphylatoxins, which act to release histamine and other mediator substances from mast cells (degranulation). In addition to other effects, histamine induces vasodilation of arterioles and constriction of bronchioles in the lungs, also known as bronchospasm (constriction of the airways). • Tissues in different parts of the body release histamine and other substances. This causes constriction of the airways, resulting in wheezing, difficulty breathing, and gastrointestinal symptoms such as abdominal pain, cramps, vomiting, and diarrhea. Histamine causes the blood vessels to dilate (which lowers blood pressure) and fluid to leak from the bloodstream into the tissues (which lowers the blood volume). These effects result in shock. Fluid can leak into the alveoli (air sacs) of the lungs, causing pulmonary edema.
253. Laboratory values in anemia or bleeding can be best assessed by: A. WBC count B. Hemoglobin level C. Eosinophil count D. Hematocrit level
Q253 Answer • Laboratory values in anemia or bleeding can be best assessed by: A) WBC count B) Hemoglobin level C) Eosinophil count – measures WBC# to diagnose allergy, drug RX, parasitic infection, collagen disease, Hodgkin’s lymphoma D) Hematocrit level – PCV: Packed cell volume/for anemia - RBC and WBC vol- true
Q253 Explanation •
First step is to evaluate hemoglobin levels
•
Also important to calculate hematocrit – Hematocrit (Ht or HCT) or packed cell volume (PVC) or erythrocyte volume fraction (EVF) is the percentage of red blood cells in blood plasma. – Plasma is the liquid portion of the blood – Hematocrit is normally about 48% for men and 38% for women. [1] it is considered an integral part of a person’s complete blood count results, along with hemoglobin concentration, white blood cell count, and platelet count – People with a high volume of plasma may be anemic even if their blood count is normal because the blood cells have become diluted.
•
Neither hemoglobin or hematocrit are reliable for diagnosing acute anemia or blood loss.
•
To differentiate an anemia of mixed causes from an anemia of a single cause: – Vitamin B12 deficiency produces a macrocytic (large cell) anemia with a normal RDW. However, iron deficiency anemia initially presents with a varied size distribution of red blood cells, and as such shows an increased RDW. And in the case of a mixed iron and B12 deficiency we will have a mix of both large cells and small cells hence the RDW will usually be elevated
254. Which of the following conditions result in bone with a normal composition?
A. Osteomalacia B. Osteoporosis C. Rickets D. Vitamin deficiency
Q254 Answer • Which of the following conditions result in bone with a normal composition? A) Osteomalacia - Decreased mineralization weak and soft bone B) Osteoporosis - Loss of Bone Mass and Volume (Osteoclastic) Composition of bone doesn’t change (weakened but not softened bone) C) Rickets - Osteomalacia in children D) Vitamin deficiency - Vit D deficiency can lead to A & C
Q254 Explanation •
Osteoporosis - lack of bone density or poverty of bone tissue. – Considered (ideopathic) to a large degree attributed to nutrition. Extensive corticord steroid therapy can cause secondary form of the disease. – Chronic calcium deficiency may lead to osteoporosis- the stability of alveolar may be compromised in calcium deficiency. The absorption of calcium declines with age. Deficiency of vitamin D will also lead to calcium deficiency and bone resorption. Diabetes may induce osteoporosis. Decreased testosterone may induce osteoporosis. – Diagnostic tests: – bone density measurements – bone resorption assays – bone formation assays – radiographic assessment –
bone biopsy
– The goal of treatment for osteoporosis is to raise the patients bone density above the fracture threshold. Agents that will increase bone density are: – Fluoride, exercise, calcitonin, anabolic steroids
Q254 Explanation Ctnd • Rickets and Osteomalacia: – Osteomalacia is a term for the softening of the bones due to defective bone mineralization. Osteomalacia in children is known as rickets, and because of this, use of the term osteomalacia is often restricted to the milder, adult form of the disease. It may show signs as diffuse body pains, muscle weakness, and fragility of the bones. A common cause of the disease is a deficiency in vitamin D, which is normally obtained from the diet and/or sunlight exposure.[1] Treatment-resistant osteomalacia – Rickets is a rare disease in the industrial countries, seldom found in adults. This mineralization deficit (hypophosphocalcic bone with osteoidosis), which leads to determined osteopathy (soft bone), responds favorably in more than 95% of the cases to vitamin D-25 therapy in conjunction with the intake of calcium supplements. However, when the treatment fails, osteomalacia may lead to non-integration of an implant and increased infection risk.
255. A single mandibular implant is removed 2-3 weeks after placement due to paresthesia. What is the minimum time to wait for replacement of implant? A. 1 year B. 6 months C. 2 months D. 1 month
Q255 Explanation • The success of implants replacing failed ones at the exact site has been reported 1,12,13,32,35,46. Using the commercially pure titanium screwshaped implants, it has been suggested that when an implant is lost, a flap should primarily cover the entrance to the site and after 9-12 months, a new implant can be replaced at that site (1). Evian and Cutler12 report immediately replacing 5 failed screw-type, commercially pure titanium implants with larger-diameter, hydroxy apatite coated implants in the same sockets. They suggest that a 1-year healing period may not be necessary provided the socket can be prepared to eliminate thread grooves and invasive soft tissue; the implant replacement is larger in diameter than the original implant; and sufficient available bone remains for the procedures. Recently, the implant failure rate was compared between a machined surface and a TiUnite surface used to replace failing implants (3).Of the 29 machined surface implants replaced by implants with the same surface, 6 failed (79.4% survival rate) compared to the 19 machined surface implants replaced by TiUnite surface implants where only 1 failed. Of the 10 TiUnite-surface implants replaced by implants with the same surface, none failed. The difference in failure rate between machined-surface and TiUnite replacement implants was statistically significant. • 1- DMD, Department of Oral Rehabilitation, The Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv,and Periodontology Unit, Department of Oral & Dental Sciences, Rambam Medical Center, Haifa, Israel.Corresponding address: Dr. Liran Levin - Department of Oral Rehabilitation - The Maurice and Gabriela Goldschleger School of DentalMedicine - Tel Aviv University, Tel Aviv, Israel - Fax: +972-3-6409250 - e-mail: liranl@post.tau.ac.ilReceived : January 10, 2008 - Modification : February 23, 2008 - Accepted : February 26, 2008
256. If a patient has elevated levels of alkaline phosphatase they most likely have:
A. Metastasis B. Vitamin D deficiency
Q256 Explanation •
Alkaline Phosphatase: – Extremely high levels of alkaline phosphatase are often associated with hepatic disease. In the absence of liver disease, elevations of alkaline phosphatase are often a sign of osteoblastic activity in the skeletal system. Therefore bone metastases, fractures, Paget's disease, and hyperparathyroidism increase the level of this serum enzyme. Serum alkaline phosphataseis is normal in patients with adult osteoporosis. Low levels of alkaline phosphatase are usually not of clinical significance for the dentist.
– Contemporary Implant Dentistry. 3rd Edition. Carl E Misch, Chapter pp. 433
257. Patient has Paget’s disease, the best option to restore this edentulous patient with the typical cotton wool radiographic appearance is by: A. Subperiosteal B. Conventional removable appliance C. 5 root forms
Q257 Explanation •
Osteitis deformans, or Paget's disease, is a common metabolic disease characterized by slow, progressive, uncontrolled resorption and deposition of bone.
•
Paget's disease is marked by high elevations of serumalkaline phosphatase, normal or elevated calcium, and normal phosphate levels. Edentulous patients are often unable to wear their prostheses without discomfort. There is no specific treatment for Paget's disease, and these patients are predisposed to develop osteosarcoma and possibly osteomyelitis.
•
Dental Implant Implications: – Oral implants are contraindicated in the regions affected by this disorder.
258. Patient has Ectodermal Dysplasia. What are the clinical implications?
SHORTANSWER
Q258 Answer • Patient has Ectodermal Dysplasia. What are the clinical implications? Ectodermal Dysplasia is an autosomal disease characterized as patient having thin, dry hair, dry skin, partial anodontia and conical teeth. Patients have underdeveloped alveolar arches and decreased salivary flow.
Q258 Additional Info •
About Ectodermal Dysplasia: – ED is a genetically inherited disorder that occurs in 1 per 100,000 live births. – Clinically, ectodermal dysplasia has been divided into two broad categories: – X-linked hypohidrotic form (Christ-Siemens-Touraine syndrome) characterized by the classical triad of hypodontia, hypohidrosis, and hypotrichosis and by characteristic facial features such as prominent supraorbital ridges and a depressed nasal bridge – Autosomal inherited hydrotic form (Clouston's syndrome) that usually spares the sweat glands but affects teeth, hair, and nails.
•
In patients with hypodontia or anodontia, conventional prosthodontic procedures often are not successful because of anatomical abnormalities that result in poor retention and stability.
•
Dental implant therapy aimed at restoring function, esthetics, and psychological rehabilitation is an integral part in the management of adolescent patients with ED. Numerous studies have been completed on dental implants in patients with ED. A 3-year study showed impressive success rates in preadolescents (ages 7 to 11, 87%), adolescents (ages12 to 17, 90%), and in adults (older than 17, 97%). Other positive case reports have shown dental implants as a successful adjunct to oral rehabilitation.
Misch 3rd Ed. pp 453
259. A woman has been on coumadin. A good test
to determine if she is a good candidate for implants is: A. Partial Thrombin time PTT B. PT
Q259 Answer • A woman has been on coumadin. A good test to determine if she is a good candidate for implants is: A) Partial Thrombin time PTT (Intrinsic Pathway) B) PT (Extrinsic Pathway)
Q259 Explanation •
The coumarin-derived anticoagulants interfere with vitamin K-dependent synthesis of active coagulation Factors 11 (prothrombin), VII, IX, and X. These oral anticoagulants are effective only in vivo. Their therapeutic effect depends on the half-lives of Factors 11, VII, IX, and X; thus, 8 1/2hours are required for action. The maintenance dose is determined by one-stage prothrombin activity, which should be about 1 1/2 - 2 1/2 times the control value. These agents are widely used in the secondary prophylactic treatment of venous thrombosis and pulmonary embolism to prevent the recurrence or extension of venous thrombus formation because oral anticoagulants have no effect on platelets. They are not used in the treatment of thrombotic disease in the arterial system. Reversal of anticoagulant effects following discontinuation of oral anticoagulants, the one-stage prothrombin time (PT) gradually returns to normal. Oral administration of vitamin K (phytonadione) enhances recovery.
•
Recommendation: –
For patients within the therapeutic range of INR of 3.5 or below, warfarin therapy need not be modified or discontinued for simple single dental extractions. More complicated and invasive oral surgical procedures would represent an exception to this recommendation for patients with an INR on the high end of the scale, and they should be discussed with the physician managing the condition requiring warfarin. Nevertheless, the clinician’s judgment must always be considered for all treatment decisions. Since the benefit of preventing a thromboembolic episode clearly outweighs the risk of a significant bleeding episode, this is a Class I recommendation. This recommendation is supported by multiple RCTs and is based on Level of Evidence A. This recommendation was also supported by the expert consultants.
Q259 Explanation Ctnd. •
Warfarin – Warfarin (Coumadin) is an oral anticoagulant that inhibits the biosynthesis of the vitamin K–dependent coagulation proteins (factors VII, IX, and X and prothrombin). This drug is bound to albumin, metabolized by hydroxylation in the liver, and excreted in the urine. The prothrombin time ratio (PTR, defined as the patient’s prothrombin time divided by a laboratory control value) is used to monitor warfarin therapy because it measures three of the vitamin K– dependent coagulation proteins: factors VII and X and prothrombin. The PT is particularly sensitive to factor VII deficiency. Therapeutic anticoagulation with warfarin takes 4 to 5 days.
MS
Antithrombotic agents: Implications in Dentistry by James W. Little, DMD,
Q259 Explanation Ctnd
260. What can you expect a patient with Diabetes to have?
A. slow healing B. post-operative infection C. altered tissue healing
Q260 Explanation • The major symptoms of diabetes are polyuria, polydipsia, polyphagia, and weight loss. Therefore the patient's medical history should include questions concerning increased thirst, urination, appetite, or recent weight loss. Almost every cell membrane needs insulin to enable glucose penetration to occur with the exception of those cells in the brain and spinal cord. With insulin deficiency, the glucose remains in the bloodstream and increases the blood glucose level. Diabetic patients are prone to develop infections and vascular complications. The healing process is affected by impaired vascular function, chemotaxis, impaired neutrophil function, and an anaerobic milieu. Protein metabolism is decreased, and healing of soft and hard tissue is delayed. Nerve regeneration is altered, and angiogenesis is impaired. Many studies both in animals and humans have been conducted with respect to diabetes. Animal studies have shown a significant reduction in bone implant contacts and a reduction of osseo-integration in trabecular bone but not cortical bone. Clinical human data include the recommendation that no contraindications exist for diet and orally controlled diabetes; however, for insulincontrolled patients, implants may be contraindicated. Some studies have shown that insulin-controlled diabetic patients are implant candidates if they have antibiotic coverage, Misch 3rd, pp 442
261. Allergy-mild symptoms when taking Penicillin (hives), what do you give the patient?
A. Benadryl, discontinue Amoxicillin B. Discontinue Amoxicillin and inject Epinephrine IM
262. 90% of all bleeding problems can be prevented by:
A. Complete blood count B. PT C. PTT D. Medical history
Q262 Answer • 90% of all bleeding problems can be prevented by: A) Complete blood count – CBC, RBC, WBC, Hematocrit Blood Smear, Hemoglobin, Platelet Count B) PT – To see if blood thinners are working, or to help detect or diagnose a blood disorder C) PTT – To monitor heparin, anticoagulant D) Medical history
Q 262 Explanation • Three ways to detect potential bleeding problems are: (1) check the medical history (2) review the physical examination (3) screen the clinical laboratory tests. • More than 90% of bleeding disorders can be diagnosed on the basis of the medical history alone • The history should include the following questions covering five topics entered on the medical history form: 1. Familial history of bleeding disorders 2. Spontaneous bleeding from the nose, mouth, or other apertures 3. Bleeding problems/bruising after operations, tooth extractions, or 4. Use of medications that may cause bleeding disorders 5. Past or present illness associated with bleeding disorders Misch 3rd, pp. 430
trauma
263. CPR compression breaths for a single rescuer are: A. 30:2 B. 15:2 C. 5:1
264. Scalloped lateral border of the tongue is indicative of: A. Scurvy B. Clenching C. Diabetes D. Anemia
Q264 Answer & Explanation • Scalloped lateral border of the tongue is indicative of: – In dysfunctional swallowing, keeping teeth on the occlusal surface of the tongue in mouth breathers A) Scurvy – Vit. C deficiency which may cause gingivitis & periodontitis B) Clenching – may be a cause C) Diabetes – delayed wound healing & increased inflammatory response A commonD) clinical finding clenching is a scalloped of Anemia – of Iron deficiency & Vit. border B12 deficiency the tongue (Figure 6-13). The tongue is often braced against the lingual surfaces of the maxillary teeth during clenching, exerting lateral pressures and resulting in the scalloped border. This braced tongue position may also be accompanied by an intraoral vacuum, which permits a clench to extend for a considerable time, often during sleep. - Misch 3rd, pp. 113
265. After implant placement, which patient would you not use post-op steroids?
A. Diabetes B. Hypothyroid C. Hypertension D. Chron’s
Q266 Answer & Explanation • After implant placement, which patient would you not use post-op steroids? A) Diabetes B) Hypothyroid C) Hypertension D) Chron’s
Contraindications to the use of corticosteroids include active infections (viral, bacterial, fungal), tuberculosis, ocular herpes simplex, primary glaucoma, acute psychosis, and diabetes mellitus. Special attention must be given to diabetic patients, as glucocorticoids have an anti-insulin action that results in increased serum glucose and glycosuria. Misch Ed 3, pp. 476
267. What type of resuscitation is MOST effective on an unconscious non-breathing patient?
A. mask to mouth B. endotracheal intubation C. Cricothyrotomy D. ambubag
Q267 Answer & Explanation - ? • What type of resuscitation is MOST effective on an unconscious non-breathing patient? A) mask to mouth B) endotracheal intubation C) cricothyrotomy D) ambubag The most secure airway in an unconscious patient is a properly placed cuffed endotracheal (ET) tube. The ET tube does not resuscitate nor ventilate the patient. It only maintains patient airway & prevents aspiration. Some types of ventilation devices (ambu bag or automated ventilator) must be attached to the ET tube in order to ventilate (resuscitate) the patient. Technically however, the ambu bag is ventilating the patient, not the ET tube.
268. How long is the health history accurate for? A. 1 month B. 3 months C. 6 months D. 1 year
Q268 Answer & Explanation • How long is the health history accurate for? A) 1 month B) 3 months C) 6 months D) 1 year
A patient’s health history is accurate until it changes. This change may take years, or it can happen the same day you obtained the health history from the patient. Therefore, every time you see a patient, you should check for changes in their health history.
269. A patient with cardiac disease can best be revealed by elevated levels of:
A. LDH, SGOT, Potassium B. LDH, SGOT, Sodium
270. Name three medical conditions that would contraindicate a patient to implant surgery. SHORTANSWER
Q270 Answer • Name three medical conditions that would contraindicate a patient to implant surgery. 1. Hypertensive patient over 180/110 mmHg 2. Unstable angina 3. Severe uncontrolled diabetes (ASA type 2, 3, 4) with glucose levels > 240 mg/dl or HbA1c >10
Q270 Explanation •
Hemoglobin, a protein in red blood cells, binds to the HbA1c form of hemoglobin by a process termed glycosylation. The percent HbA1c reflects how much glucose is bound to the blood during the past 120-day life span of the RBCs. Glycosylated hemoglobin helps to minimize complications in patients exhibiting chronically elevated glucose levels. For non-diabetic patients, normal values are approximately 4.0% to 6.0%. Ideally, diabetic patients will have their HbA1c at approximately 6%, which corresponds to an average glucose of 135 mgjdL (7.5 mmoljL). For every 1% change in the HbA1c, a resultant change of about 30 mgfdL (1.67 mmolfL) will be seen.
271. Patient has a white lesion on buccal mucosa with a white lacey pattern to it and it can’t be scraped off. What is the most likely diagnosis?
SHORTANSWER
Q271 Answer • Patient has a white lesion on buccal mucosa with a white lacey pattern to it and it can’t be scraped off. What is the most likely diagnosis? Lichen Planus
Q271 Explanation • Lichen Planus – Common dermatologic disease of skin and mucous membranes – Common in middle-aged adults; 60% women – Prevalence of oral LP = 0.1-2.2% – Chronic, multiple lesions – Various forms: – Reticular/Wickham’s striae - asymptomatic – Plaque-like - asymptomatic – Bullous/erosive - symptomatic • Etiology of Lichen Planus – Immune mediated - T cell mediated degeneration of the basal cell layer of epithelium – Associated with stress, drug hypersensitivity (lichenoid drug reaction), or infection (HCV) – NSAIDs, allopurinol, sulfonamides, tetracyclines, ACE inhibitors, HCTZ, lorazepam, sulfonylureas – dental materials – Amalgam and resins – Idiopathic • All - DeRossie manifestations of meds pp4
272. If you have normal mucosa and the patient is
complaining that her tongue is burning, the problem is: A. Cardiac problem B. Diabetic problem C. Psychological problem
Q272 Explanation • Patients with burning tongue syndrome usually exhibit no clinically detectable lesions, although symptoms of pain and burning can be intense, and may be accompanied by altered taste and xerostomia. Occasionally, a patient may attribute the initiation of the malady to recent dental work, such as placement of a new bridge or extraction of a tooth. Any and all mucosal regions of the mouth may be affected, although the tongue is by far the most commonly involved site. Tissue is intact and has the same color as the surrounding tissue with normal distribution of tongue papillae (56). Caused by xerostomia, candidiasis, referred pain from muscles, other chronic infections, dental diseases, reflex of gastric acid, medications, mechanical trauma, diabetes mellitus, blood dyscrasias, nutritional deficiencies, allergic and inflammatory disorders, psychogenic factors, or may be idiopathic. On the basis of history, physical evaluation, and specific laboratory studies, rule out all possible causes. Minimal blood studies should include a complete blood count ( CBC ) with differential, glucose, iron, ferritin, folic acid, and vitamin B 12 levels. For symptomatic relief elixir of diphenydramine is a useful antihistaminic that also has mild topical anesthetic properties. Study Guide pp 77
273. What is Ectodermal dysplasia? A. Osteomalacia B. Osteoporosis C. Calcification of faloyx D. Anodontia
Q273 Answer • What is Ectodermal dysplasia? – genetic mutation affecting hair, nails, and skin
A) Osteomalacia B) Osteoporosis C) Calcification of faloyx D) Anodontia – or malformed teeth
274. What is the regimen for prophylaxis when dealing with bacterial Endocrinitis?
A. 2.0 grams of Amoxicillin 1 hour pre-op B. 1 gm of Amoxicillin 1 hour pre-op and 500mg 6 hours pre-op
Q274 Answer • What is the regimen for prophylaxis when dealing with bacterial Endocrinitis? A) 2.0 grams of Amoxicillin 1 hour pre-op B) 1 gm of Amoxicillin 1 hour pre-op and 500mg 6 hours pre-op
275. If a patient has a BP of 140/95, would you sedate them, or get their blood pressure under control first? A. Get their blood pressure under control first B. Sedate them and then recheck their blood pressure
276. If a patient has had bypass surgery and you are doing a prosthetic procedure, you would:
A. not prescribe prophylactic antibiotics B. prescribe 2 grams of Amoxicillin
277. Which of the following diseases contraindicates the use of epinephrine?
A. Arthritis B. Diabetes C. Crohn’s
Q277 Answer • Which of the following diseases contraindicates the use of epinephrine? A) Arthritis B) Diabetes – witipekia (diabetes mellitus) C) Crohn’s Any significant cardiovascular disease can have a
relative precaution for the use of epinephrine. But, none are absolute contraindications.
278. Five minutes into procedure patient gasps, loses consciousness, no pulse, no resp. You start CPR.
A. Nitroglycerin sublingual B. IM Cortisol C. IM solu-ceph D. Epinephrine
279. Patient had a sinus graft done a week ago. Returns with foul smell and bad taste in mouth. Patient was on clindamycin 150 q6h. What would you do?
A. Amoxicillin and Augmentin B. Clindamycin with Flagyl C. Culture sensitivity D. Refer to an otolaryngologist
Q279 Answer - ?? • Patient had a sinus graft done a week ago. Returns with foul smell and bad taste in mouth. Patient was on clindamycin 150 q6h. What would you do? – (Clinda; acts on GRAM+/GRAM- aerobes & anaerobes) A) Amoxicillin and Augmentin (CLAVU+AMOXI=AUGMENTIN) CID pg 965
B) Clindamycin with Flagyl? C) Culture sensitivity? – if 2nd trial of antibiotic fails D) Refer to an otolaryngologist – for severe complications, when all
else fails, danger (sinus thrombosis, meningitis..)
280. Hypoxia is a concern with the administration of narcotics and may potentially trigger cardiac disease. Which of the following methods poses the least risk? A. sedative post-op doses B. IV doses C. pre-op sedative doses D. increasing nitrous oxide supplementation E. IM doses F. sublingual doses
Q281 Answer • Hypoxia is a concern with the administration of narcotics and may potentially trigger cardiac disease. Which of the following methods poses the least risk? – respiratory depression-decreased heart rate-decreased BP A) sedative post-op doses B) IV doses C) pre-op sedative doses D) increasing nitrous oxide supplementation E) IM doses F) sublingual doses
Question 281 Explanation • It is quicker, more accurate, & safer to titrate drugs to their desired effects via IV route than IM. And IM is safer than PO. So, the order of preference is IV then IM then PO. Inhaled gases & volatile agents give similar speed of onset of action as IV route. But the inhaled route is more accurate and safer because it is the only method that allows you to remove the drug if too much is given. This is done by turning off the source of the gas or volatile agent & ventilating the patient with 100% O2. The gases in the patient’s body will rapidly move down their concentration gradient & be expired through the patient’s lungs. Even if you give the patient a competitive antagonist to the IV/IM/PO drug, you do not truly remove that drug. You will have to wait for the drug to be redistributed, metabolized, &/or excreted. Also N2O is less of a respiratory depressant vs. opiates.
282. Which one of the following is not an acute feature of severe anaphylaxis?
A. bronchi spasm B. laryngeal edema C. circulatory collapse D. renal shut down E. skin rash or hives
Q282 Answer • Which one of the following is not an acute feature of severe anaphylaxis? A) bronchi spasm – acute yes B) laryngeal edema – yes C) circulatory collapse – rapid vasodilation and consequent shock – D)renal shut down – yes E) skin rash or hives – no
yes
Bone Graft pt. 2, subperiosteal implants
283. Which of the following statements are true regarding incision line dehiscence following placement of autologous bone graft? A. Postoperative smoking has no effect on incision line healing over autologous grafts. B. Incision line dehiscence is more common in the posterior maxilla. C. Incision line dehiscence may be prevented by using a non-resorbing suture material such as polytetrafluoethylene (PTFE) D. An incision made through the periosteum at the base of the flap is helpful in reducing tension on the wound closure. E. The most common cause in incision line dehiscence is over bulking of the graft site.
284. What type of bone would heal in the shortest amount of time?
A. Course trabecular bone B. Bone with dense cortex or cortical bone
285. What percentage of onlay graft would resorb within 5 years on a type D bone if implants are not inserted?
A. 20% B. 50% C. 70% D. 90%
Q285 Answer - ?? • What percentage of onlay graft would resorb within 5 years on a type D bone if implants are not inserted? A) 20% B) 50% C) 70% D) 90% - (Misch CID, p.195)
286. When grafting bone to a severely atrophied D bone mandible, which is not stimulated by an implant:
A. Onlay graft – 90% resorption within 5 years B. Onlay graft – 50% resorption within 5 years
Q286 Answer • When grafting bone to a severly atrophied D bone mandible, which is not stimulated by an implant: A) Onlay graft – 90% resorption within 5 years (Misch CID, p195) B) Onlay graft – 50% resorption within 5 years
287. The primary purpose of the membrane tack in particulate bone grafting is:
A. Contain the graft B. Contain the membrane C. Prevent epthelial downgrowth
Q287 Answer • The primary purpose of the membrane tack in particulate bone grafting is: A) Contain the graft B) Contain the membrane (Misch CID, p846) C) Prevent epthelial downgrowth
288. There is a graft over an implant, the membrane is exposed and there is slight inflammation. What is the course of treatment?
A. Remove membrane B. Antibiotics C. Chlorhexidine
289. Woven bone grows at what rate in the symphysis?
A. 10-15 um/day B. 30-50 um/day C. 60-75 um/day D. 100-115 um/day
Q289 Answer • Woven bone grows at what rate in the symphysis? A) 10-15 um/day B) 30-50 um/day C) 60-75 um/day (Misch CID, p.805 Woven bone forms 60 um/day, Lamellar is 1-5um/day D) 100-115 um/day
290. D1 bone has a module of elasticity most similar to:
A. ceramic B. titanium C. titanium alloy D. surgical steel
Q290 Answer • D1 bone has a module of elasticity most similar to: (Misch p.516 compact bone appx 21 modulus) A) ceramic (195-392) B) titanium (97) C) titanium alloy (117) D) surgical steel (193)
291. Which of the following is not considered one of the two phases of wound healing?
A. Blood coagulation B. Inflammation C. Maturation D. Proliferation
Q291 Answer - ?? • Which of the following is not considered one of the two phases of wound healing? A) blood coagulation B) inflammation C) maturation D) proliferation
Q291 Info • Dr. Kao handout, • Wound Healing • Phase I Inflammation • Phase II Migration/Proliferation • Phase III Maturation/Remodeling
292. What is the first stage of repair? A. Coagulation B. Scar C. Epithelium
293. Osteoinduction is bone formation from: A. osteoprogenitor cells derived from mesenchymal cells B. cells transferred within the new bone C. regional acceleratory phenomenon D. apposition from surrounding bone
Q293 Answer • Osteoinduction is bone formation from: A) osteoprogenitor cells derived from mesenchymal cells (Misch CID, p. 858) B) cells transferred within the new bone C) regional acceleratory phenomenon D) apposition from surrounding bone
294. When clindamyacin has been administered orally as a preoperative antibiotic, which antibiotic should be mixed with the osseous graft?
A. Penicillin and amoxicillin B. Amoxicillin C. Clindamyacin D. Clindamyacin, erythromycin, and tetracycline
295. What is the most widely used clinical allograft material?
A. Freeze dried bone B. DFDB C. HA D. Irradiated cancellous
Q295 Answer - ?? • What is the most widely used CLINICAL allograft material? A) Freeze dried bone (Misch CID p. 859) “The most common used allografts in implant dentistry are DFDB and FDB. B) DFDB C) HA D) Irradiated cancellous
296. Which of the following statements is true regarding the healing of autogenous grafts?
A. The primary mechanism of bone formation is via viable transferred osteoblasts. B. To mature oblique repair, osteoclasts must be transferred with the bone graft transplant. C. The grafted bone is completely resorbed by osteoclasts and replaced with woven bone. D. Cortical bone grafts heal faster than cancellous bone around the implant. E. Cancellous bone grafts heal differently than cortical bone grafts.
Q296 Answer • Which of the following statements is true regarding the healing of autogenous grafts? A) The primary mechanism of bone formation is via viable transferred osteoblasts. (Misch p 858) B) To mature oblique repair, osteoclasts must be transferred with the bone graft transplant. C) The grafted bone is completely resorbed by osteoclasts and replaced with woven bone. D) Cortical bone grafts heal faster than cancellous bone around the implant. E) Cancellous bone grafts heal differently than cortical bone grafts.
297. Onlay bone graft is best utilized in a: A. 1 wall defect B. 3 wall defect C. 4 wall defect D. 5 wall defect
Q297 Answer • Onlay bone graft is best utilized in a A) 1 wall defect (Misch CID p 876) B) 3 wall defect (2-3 wall FDB/DFDB + autograft+BM) C) 4 wall defect (alloplast, FDB with BM) D) 5 wall defect (any material)
298. In designing a subperiosteal implant the most important consideration affecting long term success is to avoid:
A. Placing struts superior to mental foramen B. Placing struts immediately adjacent to genial tubercles C. Placing struts over the mylohyoid ridge
Q298 Answer • In designing a subperiosteal implant the most important consideration affecting long term success is to avoid: A) placing struts superior to mental foramen B) placing struts immediately adjacent to genial tubercles C) placing struts over the mylohyoid ridge (Linkow 1998, JOI no extensions lingually past the internal oblique ridge)
299. In an infection site (eposteal) subperiosteal coated with HA compared to one without HA coating, which of the following is true?
A. HA coatings do not detoxify well B. Non-HA coated integrate faster
Q299 Answer • In an infection site (eposteal) subperiosteal coated with HA compared to one without HA coating, which of the following is true? A) HA coatings do not detoxify well (Misch CID p1081) B) Non-HA coated integrate faster
300. What gives support for the subperiosteal implant?
A. external oblique B. lateral surfaces of the mandible C. crest of ridge D. anterior symphysis E. suspensory ligament
Q300 Answer • What gives support for the subperiosteal implant? A) external oblique B) lateral surfaces of the mandible C) crest of ridge D) anterior symphysis E) suspensory ligament (Mills lecture -wraps around lateral struts for sling effect, discovered by James, 1983)
301. The process of minimal settling of the mandibular subperiosteal implant due to occlusal forces is attributed to which of the following mechanisms?
A. biomaterial reaction B. biomechanical reaction C. pathologic process D. physiological process
302. Load transmission from a surgical vitalium subperiosteal implant to bone is by:
A. Direct bone interface B. Hemidesmosomes C. Periosteum D. Suspensory ligament E. Screw fixation
Q302 Answer • Load transmission from a surgical vitalium subperiosteal implant to bone is by: A) direct bone interface B) hemidesmosomes C) periosteum D) suspensory ligament (James , 1983) E) screw fixation
303. Prior to inserting a chrome alloy subperiosteal casting it should be:
A. cleaned and polished B. defatted, passivated, cleaned and sterilized C. defatted, depassivated, sterilized D. washed, defatted, and soaked in sterile saline E. sterilized, bagged and made talc free
Q303 Answer • Prior to inserting a chrome alloy subperiosteal casting it should be: A) cleaned and polished B) defatted, passivated, cleaned and sterilized - (defatting is process of making porous, passivation is process of forming Oxide layer that is corrosion resistant) C) defatted, depassivated, sterilized D) washed, defatted, and soaked in sterile saline E) sterilized, bagged and made talc free
304. After placement of a complete subperiosteal implant in the maxilla:
A. screws must be placed to assure fixation B. the maxillary sinus must be augmented C. a palatal stent should be placed D. the periphery should be ligated to the anterior nasal spine E. fixation into the vomer
Question 305 • When doing a subperiosteal implant surgery, which of the following are significant bony areas that must be included in the impression? Maxilla Mandible Anterior Nasal Spine Symphysis The nasal cavities or Mental foramen pyraform apertures
External oblique ridge
Canine fossa up to Retromolar pad infraorbital foramen Mylohyoid ridge Zygomatic process Pterygoid-maxillary fissure Hamulus Palate
Root forms, general surgery
306. A life threatening consideration when drilling an osteotomy in the anterior mandible
A. facial artery B. lingual artery C. air embolism D. edema
Q306 Answer • A life threatening consideration when drilling an osteotomy in the anterior mandible A) facial artery B) lingual artery ( Specifically the sublingual branch, Misch CID p.713) C) air embolism D) edema
307. What is the most important factor when immediately placing an implant?
A. the implant must be HA coated B. the implant should be at least 2mm under the crest of bone C. the implant should be at least 2mm under the crest of bone
308. The maximum safe temperature for the preparation of the osteotomy for an endosseous implant is:
A. 41 B. 43 C. 45 D. 47
Q308 Answer • The maximum safe temperature for the preparation of the osteotomy for an endosseous implant is: A) 41 B) 43 C) 45 D) 47 (Study Guide,) (Misch says the threshold for bone death is 40°C which is 3°C above normal. Without irrigation the osteotomy will reach 100° in 3 seconds and consistent temp of 47°C is measured several mm away from bone. 2500 rpm cuts cooler slower speeds.) p. 649) Eriksson reported bone death at 40°C for 7min, or 47°C for 1 minute.
309. While preparing an osteotomy using internal irrigation, you use a pumping motion to:
A. prevent chatter against the bone B. allow for proper cooling of the bone C. maintain alignment D. prevent over enlargement of the osteotomy
Q309 Answer • While preparing an osteotomy using internal irrigation, you use a pumping motion to: A) prevent chatter against the bone B) allow for proper cooling of the bone (Misch CID, p.651) C) maintain alignment D) prevent over enlargement of the osteotomy
310. The implant site most likely to require threading when placing a screw type endosseous implant is:
A. Premaxilla B. Sinus grafted posterior maxilla C. Posterior mandible D. Anterior mandible
Q310 Answer • The implant site most likely to require threading when placing a screw type endosseous implant is: A) premaxilla B) sinus grafted posterior maxilla C) posterior mandible D) anterior mandible (Misch CID, p.653, especially D1 bone)
311. The following implant requires an extraoral approach in the mandible:
A. Endosseous B. Subperiosteal C. Ramus frame D. Staple
Q311 Answer • The following implant requires an extraoral approach in the mandible: A) endosseous B) subperiosteal C) ramus frame D) staple (or transosteal)
312. The most important factor preventing successful osseointegration of an implant is:
A. Micro movement B. Infection C. Inflammation D. Size of implant
313. A 50 year old female patient. Six root form implants placed one year ago for a maxillary overdenture. Patient states that bar has loosened every 4-6 weeks since placement and two screws have broken. What is the possible cause?
A. Inadequate preload B. Cantilever is too long C. Bar doesn’t have passive fit D. Bar flexes
314. If a root form implant becomes exposed during the healing period the dentist should:
A. prescribe antibiotics to prevent infection B. elevate flap margins and resuture C. debride, resuture and prescribe antibiotics D. relieve the overlying prosthesis
Q314 Answer • If a root form implant becomes exposed during the healing period the dentist should: A) prescribe antibiotics to prevent infection B) elevate flap margins and resuture C) debride, resuture and prescribe antibiotics D) relieve the overlying prosthesis (Misch CID, p.715) No attempt should be made to close, if it is partially exposed Clx rinse and complete uncovering and attach healing abutment.
315. The best practical way to increase amount of force distribution on a root form implant?
A. Increase length B. Surface area
Q315 Answer • The best practical way to increase amount of force distribution on a root form implant? A) Increase length (Misch p203. Surface conditions increase total surface area but is not functional to place compressive loads on bone cells‌it increases BIC during healing but during loading of forces relies on macroscopic implant design ie. Length, Width,Threads) B) Surface area (assuming microscopic)
316. Which has the greatest effect on prognosis of root form implants of the same size, shape and cyclic loading?
A. Axial relationship B. Anterior-posterior relationship
Q316 Answer • Which has the greatest effect on prognosis of root form implants of the same size, shape and cyclic loading? A) Axial relationship (Misch, p. 205, a 30 degree axial change increases load by 50%) B) Anterior-posterior relationship
317. Which of the following has the greatest effect on the prognosis of root form implant of the same size and shape with cyclic loading?
A. quality bone B. axial relationships C. surface modifications D. implant material
Q317 Answer • Which of the following has the greatest effect on the prognosis of root form implant of the same size and shape with cyclic loading? A) quality bone (1) B) axial relationships (2) p. 205 C) surface modifications D) implant material
318. In preparing posterior mandibular osteotomies for endosteal implants, the direction of the drill must: A. be vertical B. a slight lingual angulation should be encouraged C. one should attempt to pass buccal to the mandibular canal D. canting laterally is to be encouraged (15 degrees) E. the periosteum should not be reflected
319. For a single tooth implant replacing #8, the osteotomy should be placed:
A. in line with incisal edge of #9 B. in line with the cingulum of #9 C. forward to #9
Q319 Answer • For a single tooth implant replacing #8, the osteotomy should be placed: A) in line with incisal edge of #9 (Misch CID, p.757 put implant right under incisal edge) B) in line with the cingulum of #9 C) forward to #9
320. A tuberosity maxillary implant is in close proximity to which surface of the maxillary sinus. What is the minimum required distance between an implant and the maxillary sinus?
A. base/2mm B. apex/1.5mm C. roof/0.5mm D. posterior wall/1mm E. floor/2.5mm
321. You have a 28 year old patient who lost teeth 8 and 9 in an accident 6 weeks ago. He has accepted the treatment plan. When is the best time to place the implant?
A. Immediately B. 10-12 weeks
322. You have a 25 year old patient. He had an accident 6 weeks ago and lost teeth 8 and 9. The tissue is ok, but the labial plate is compromised. When should you place the implant?
A. Immediately B. 10-12 weeks C. 4-6 weeks
323. When placing an implant in #7 site with limited thickness and osteotome widening, the implant surgeon must:
A. minimize periosteal reflection for blood supply B. reflect tissue for adequate visualization of landmarks
324. If an implant is insufficient in keratinized tissue, the best time to attempt to increase is:
A. during implant placement B. during second stage surgery C. after loading D. before placement
Q324 Answer • If an implant is insufficient in keratinized tissue, the best time to attempt to increase is: A) during implant placement B) during second stage surgery C) after loading D) before placement (textbook answer)
325. Patient presents with 30% bone loss with saucerization around the implant. What should the dentist do?
A. remove implant B. antibiotic and oral hygiene C. degranulate, irrigate and graft D. chlorhexidine
326. The thin ridge implant: A. has no role in rehabilitation B. made use in the same fashion as all root form implants C. requires a full mucoperiosteal flap D. must be placed using bridge prosthesis as surgical templates E. needs to be tapped into a position if osseo-integration is to occur
Q326 Answer • The thin ridge implant A) has no role in rehabilitation B) made use in the same fashion as all root form implants C) requires a full mucoperiosteal flap D) must be placed using bridge prosthesis as surgical templates E) needs to be tapped into a position if osseo-integration is to occur (Blade?)
327. A posterior implant surgery in the mandible reveals a knife-edge crest on the ridge, you should:
A. perform an osteotomy to flatten the ridge B. place implant lingual to ridge C. place implant buccal to the ridge
328. At the uncovering stage, there is a 3mm band of attached gingiva lingual to implant. Your incision should be made:
A. buccal to implant B. crest of ridge over the implant C. half way through the band of attached gingiva
329. In osteotomy preparation: A. serial increments of increasing drill size is less traumatic B. utilization of high speed hand pieces are never indicated
330. The main consideration in 2nd molar implant placement:
A. position of inferior alveolar nerve B. position of lingual nerve
331. The best way to determine if a patient has an intra-oral fistula is:
A. the nose blowing test B. put water in sinus and see if patient feels anything
332. A patient presents to the clinic 2-3 weeks post-op. The x-ray is WNL and the patient is asymptomatic. Bone is exposed around the implant. The implantologist should:
A. freshen the edges of the gingiva with a scalpel and resuture B. let it heal by secondary intention C. prescribe antibiotic and resuture
333. After sinus surgery, patient has inflammation, swelling, and a foul taste in his mouth with discharge. Patient is on clindamycin. You should:
A. put patient on augmentin B. put patient on flagyl, cleocin C. refer to ENT
334. While placing 5 root form implants in the anterior mandible, the dentist encounters dense bone. He may:
A. load in 6 months B. load in 4 months or less C. expect 50% implant bone contact immediately D. expect woven bone in a year
335. The best way to improve the implant bone interface stress distribution is:
A. increase length B. decrease thread pitch C. increase width D. add surface coating
Q335 Answer • The best way to improve the implant bone interface stress distribution is: A) increase length B) decrease thread pitch C) increase width (Misch p181) D) add surface coating
336. A mandibular posterior implant was placed 4 weeks ago, resulting in paresthesia. The most important consideration is:
A. length of the implant B. extent of sensory deficit C. relationship of implant to mandibular canal
337. If an implant penetrates the sinus floor, the most important determinant of success is:
A. maintain the integrity of the membrane B. placing grafting material C. watertight soft tissue closure D. implant stability
338. During implant surgery you should avoid complete elevation of the mentalis muscle because there is a high probability of :
A. discomfort to the patient B. buccal sulcus swelling C. opening of suture line D. ptosis of the chin
339. In the drilling of bone, the most efficient and atraumatic technique requires incremental steps of:
A. 0.5 mm drill sequence B. always countersinking C. sharpening the pilot drill before each use D. irrigating with tetracycline solution E. keeping the hand piece firmly grasped and the wrist flat
Q339 Answer • In the drilling of bone, the most efficient and atraumatic technique requires incremental steps of: A) 0.5 mm drill sequence( Misch p649) B) always countersinking C) sharpening the pilot drill before each use D) irrigating with tetracycline solution E) keeping the handpiece firmly grasped and the wrist flat
340. In placing 5 implants in the anterior symphysis the flap should be big enough to see:
A. all anatomical features B. just enough bone to drill
Q340 Answer • In placing 5 implants in the anterior symphysis the flap should be big enough to see: A) all anatomical features B) just enough bone to drill (D1 bone gets all blood from periosteum, minimal reflection in this area) - Misch p.648
341. When do you load D1 bone? A. as soon as possible B. progressively
Q341 Answer • When do you load D1 bone? A) as soon as possible (Misch p.647 Immediate load is over 94% successful) B) progressively
342. When placing root form implants into immediate extraction sites:
A. bone grafting is mandatory B. the apical end of the implant must extend at least 40% apically beyond the end of the socket C. the apical end of the implant must extend at least to the full extent of the socket D. one mm of the implant must be allowed to protrude above the alveolar ridge E. the pressures of the adjacent teeth are absolute contraindications to such implantations
343. A precise osteotomy technique for placing root form implants is encouraged by:
A. using the ratchet wrench for tapping bone in preparation for placing an endosteal root form implant B. using the motor driven handpiece to tap bone at speed no greater than 2.0 mm per mm C. performing sequential enlargements with drill of minimal gradual increments D. reflecting as much tissue as possible so that visualization of ridge can be a guide.
Q343 Answer • A precise osteotomy technique for placing root form implants is encouraged by: A) using the ratchet wrench for tapping bone in preparation for placing an endosteal root form implant B) using the motor driven handpiece to tap bone at speed no greater than 2.0 mm per mm C) performing sequential enlargements with drill of minimal gradual increments (Misch CID, p.649) D) reflecting as much tissue as possible so that visualization of ridge can be a guide.
344. The most efficient speed for tapping an osteotomy is:
A. 30-45 rpm B. 60-90 C. 10-25 D. 125
Q344 Answer • The most efficient speed for tapping an osteotomy is: A) 30-45 rpm (Misch, p657) B) 60-90 C) 10-25 D) 125
345. The time of healing after placement of maxillary posterior root form implants is:
A. 4 to 8 months B. 3 to 4 months C. 8 to 9 months
Q345 Answer • The time of healing after placement of maxillary posterior root form implants is: A) 4 to 8 months (Misch, p.665 ‌6mo. Or more is recommended for D4 bone of undisturbed healing) B) 3 to 4 months C) 8 to 9 months
346. The time of healing after placement of maxillary posterior root form implant is:
A. six weeks B. six months C. twelve months D. one month E. four months
Q346 Answer • The time of healing after placement of maxillary posterior root form implant is: A) six weeks B) six months (Misch, p.665 for D4 bone, D3 is 5 or more months p.661) C) twelve months D) one month E) four months
347. Root form implant success is dependent upon:
A. the use of sterile technique B. the control of intra-osseous temperature C. the maintenance of a buried infrastructure for at least three months
Q347 Answer • Root form implant success is dependent upon: A) the use of sterile technique B) the control of intra-osseous temperature (Misch Ch. 29) C) the maintenance of a buried infrastructure for at least three months
348. How many mm from surgical site can be affected and/or damaged during osteotomy preparation?
A. 0.01 mm B. 0.1 mm C. 1.0 mm D. 10 mm
Q348 Answer • How many mm from surgical site can be affected and/or damaged during osteotomy preparation? A) 0.01 mm B) 0.1 mm C) 1.0 mm ??(Misch p 649, heat generated was measured several mm away from osteotomy) D) 10 mm
349. In preparing the osteotomy for a blade implant, the most important bone consideration is to:
A. generate as little heat as possible B. make precise straight line osteotomy C. drill a series of pilot holes to a uniform depth of 3mm D. condense the osteotome with a site former
Q349 Answer • In preparing the osteotomy for a blade implant, the most important bone consideration is to: A) generate as little heat as possible (p649 even though they used HS handpiece at 300,000 rpm) B) make precise straight line osteotomy C) drill a series of pilot holes to a uniform depth of 3mm D) condense the osteotome with a site former
Imaging and Surgery, Part 2
350. What is the easiest way to verify implant location during surgery?
A. Interoperative PA B. Intraoral camera C. Panorex
Q350 Answer • What is the easiest way to verify implant location during surgery? A)Interoperative PA (Misch p. 59, single implants PA, best for multiple implants PAN.) B) Intraoral camera C) Panorex
351. If your view of the maxillary sinus is obscured by the radiopacity of the palate, how do you obtain a clear view?
A. increase kV B. increase exposure time C. tilt the chin down
Q351 Answer • If your view of the maxillary sinus is obscured by the radiopacity of the palate, how do you obtain a clear view? A) increase kV B) increase exposure time C) tilt the chin down (Misch p.46 Table 3-2)
352. A scanning appliance with vertical radiopaque indices at the center of each implant site is useful in identifying:
A. mesio-distal position of implants B. vital anatomical structures C. emergence profile D. radiographic magnification
353. All of the following employ ionizing radiation except:
A. dental x-rays B. Tomography C. CT scan D. digital scan E. MRI
Q353 Answer • All of the following employ ionizing radiation except: A) dental x-rays B) tomography C) CT scan D) digital scan E) MRI (Misch, p.54) magnetic field generate images without ionizing radiation
354. Bone density is best determined by: A. houndsfeld units B. Panorex C. Tomograph D. CT scan
Q354 Answer • Bone density is best determined by: A) houndsfeld units (is the value that describes the density of the CT image at that point, the individual element called voxel, contains 12 bits of data (Misch p4748) B) panorex C) tomograph D) CT scan (CBCT)
355. A 35 year old patient is completing ortho and desires implants to replace congenitally missing laterals. The radiograph most useful in determining interradicular distance is:
A. panorex B. Tomogram C. PA x-ray D. occlusal radiograph
Q355 Answer • A 35 year old patient is completing ortho and desires implants to replace congenitally missing laterals. The radiograph most useful in determining interradicular distance is: A) panorex (Misch p59, PAN for multiple teeth) B) tomogram C) PA x-ray D) occlusal radiograph
356. The radiographic image that gives the best representation of a cross sectional area of the jaw is:
A. Panorex B. ceph C. linear tomogram D. CT scan
Q356 Answer • The radiographic image that gives the best representation of a cross sectional area of the jaw is: A) panorex B) ceph (Misch p43, demonstrates only cross section of both jaws through midline) C) linear tomogram D) CT scan (Misch, p49)
357. What is the value of a ceph? A. jaw relations B. evaluating the available bone before placing anterior implants
Q357 Answer • What is the value of a ceph? A) jaw relations (Misch, p44) B) evaluating the available bone before placing anterior implants
358. Imaging technique most useful for determining if any pathology is present when sinus lift is planned:
A. panorex B. CT scan C. Tomogram D. ceph
Q358 Answer • Imaging technique most useful for determining if any pathology is present when sinus lift is planned: A) panorex (initial eval only) B) CT scan (Misch p917, CT is the best option for viewing pathologic and osseous conditions of the maxillary sinuses) C) tomogram D) ceph
359. An image in a serial tomogram section of the mandible in the area of the second bicuspid should resemble a radiolucent shape similar to a figure eight. Which of the following is the most logical choice?
A. You see two separate mandibular canals B. You see a cystic lesion of the canine C. You see a section through the anterior loop of the canal D. You see a shadow distortion of the canal E. This resolution is not possible
360. Which of the following statements is correct relating to the magnification factor with both panoramic and tomographic film.
A. Magnification is consistent with panoramic film. B. Magnification is consistent with tomogram. C. Magnification is a component of distortion D. Magnification directly affects diagnostic value. E. Magnification can be accurately corrected in all areas of the image.
Q360 Answer • Which of the following statements is correct relating to the magnification factor with both panoramic and tomographic film. A) Magnification is consistent with panoramic film. (relatively constant vertical magnification of 10% and horizontal of 20% Misch, p. 44) B) Magnification is consistent with tomogram. C) Magnification is a component of distortion D) Magnification directly affects diagnostic value. E) Magnification can be accurately corrected in all areas of the image.
361. Which of the following most accurately describes intra-oral radiographs?
A. Dimensional accuracy is controlled by the operator’s technique; therefore, the films produced can be diagnostic. B. These films have the largest source object distance and therefore have significant potential for distortion. C. The exposure time for these films is the primary cause for distortion. D. The degree of object magnification on a single film is not uniform.
Q361 Answer • Which of the following most accurately describes intra-oral radiographs? A) Dimensional accuracy is controlled by the operator’s technique; therefore, the films produced can be diagnostic. (Misch, p.40-41) B) These films have the largest source object distance and therefore have significant potential for distortion. C) The exposure time for these films is the primary cause for distortion. D) The degree of object magnification on a single film is not uniform.
362. Tomograms and panorexes are the same with respect to what?
A. Magnification B. Distortion C. Density
363. What is a corrected tomogram? A. one that has been reformatted B. one that is linear
Q363 Answer • What is a corrected tomogram? A) one that has been reformatted (Misch, p.48) B) one that is linear
364. Which statement is incorrect? A. Metallic restorations in the jaw to be scanned must be taken out B. Metallic restorations in the jaw create artifacts in the CT scan C. Motion in CT scan creates inaccuracies
365. The radiograph that shows the most immediate information is:
A. Panorex B. PA C. Digital radiograph D. Cephalometric
Q365 Answer • The radiograph that shows the most immediate information is: A) Panorex B) PA (Misch, p.59) C) Digital radiograph D) Cephalometric
366. Which of the following statements most accurately describes serial tomograms?
A. The dimensional inaccuracy of the produced image is a direct result of the system technology. B. An accurate diagnosis of image dimension can be calculated, correcting both magnification and distortion. C. The technology of the system, a fixed source distance without adjustments, for a disproportional object, generates the dimensional discrepancy. D. The primary advantage of each linear slice is the correct proportion of cortical and medullary bone.
367. Which of the following describes reformatted tomograms? A. Comparative measurements of skeletal bones and images of the skeletal bones validate the accuracy of the technology. B. Technology of the system provides reformatted calculations that adjust size and clarity. C. The diagnostic value is enhanced using the radiographic stent containing metal type location indicators. D. Consider decreasing the interval between slices below 3mm therefore increasing the numbers of slices, the accuracy of the generated model will predictably increase.
Q367 Answer • Which of the following describes reformatted tomograms (which are CT scans)? A) Comparative measurements of skeletal bones and images of the skeletal bones validate the accuracy of the technology. B) Technology of the system provides reformatted calculations that adjust size and clarity. ???? C) The diagnostic value is enhanced using the radiographic stent containing metal type location indicators. D) Consider decreasing the interval between slices below 3mm therefore increasing the numbers of slices, the accuracy of the generated model will predictably increase.
368. Which of the following does not correctly relate to the terminology of radiology?
A. Magnification is the source object image relationship, that is, a linear proportioning can be calculated. B. Horizontal angulation produces distortion and can be calculated. C. Inconsistent variables that occur during the production of an image produce distortion and prevent accurate correction. D. A reformatted radiograph can provide improved clarity and definition of an image.
Q368 Answer • Which of the following does not correctly relate to the terminology of radiology? A) Magnification is the source object image relationship, that is, a linear proportioning can be calculated. B) Horizontal angulation produces distortion and can be calculated. C) Inconsistent variables that occur during the production of an image produce distortion and prevent accurate correction. (?????) D) A reformatted radiograph can provide improved clarity and definition of an image.
369. What produces the tomographic cut? A. movement of the film B. movement of the x-ray source C. movement of the film and x-ray source in the same direction D. movement of the film and x-ray source in the opposite direction
Q369 Answer • What produces the tomographic cut? A) movement of the film B) movement of the x-ray source C) movement of the film and x-ray source in the same direction D) movement of the film and x-ray source in the opposite direction (Misch, p.47, connected by a fulcrum bar)
370. What is the best x-ray to evaluate for a missing lateral?
A. Panorex B. Tomogram C. PA D. CT scan
Q370 Answer • What is the best x-ray to evaluate for a missing lateral? A) panorex B) tomogram C) PA D) CT scan (?, CT is always the best)
371. A 44 year old female presents for evaluation for implants. A CT scan with scanning appliance is performed. Why is the scanning appliance used?
A. emergence profile B. evaluate the bone at the sites planned to be restored C. radiographic magnification
Q371 Answer • A 44 year old female presents for evaluation for implants. A CT scan with scanning appliance is performed. Why is the scanning appliance used? A) emergence profile B) evaluate the bone at the sites planned to be restored (Misch, p.49) C) radiographic magnification
372. Prior to CT scanning it is mandatory that the patient be given:
A. a review of recent radiation exposure B. a prescription for pre-examination sedatives and an antisialogue C. maxillo-mandibular stabilizing device with radio-opaque points embedded in specific places D. the proper insurance form
Q372 Answer - ?? • Prior to CT scanning it is mandatory that the patient be given: A) a review of recent radiation exposure B) a prescription for pre-examination sedatives and an antisialogue D) maxillo-mandibular stabilizing device with radioopaque points embedded in specific places E) the proper insurance form
373. You placed an implant yesterday. The patient has numbness of the lip and chin. You remove the implant and refer the patient for nerve repair. The repair must be completed within:
A. 6 weeks B. 3 months C. 6 months D. 1 year
Q373 Answer • You placed an implant yesterday. The patient has numbness of the lip and chin. You remove the implant and refer the patient for nerve repair. The repair must be completed within: A) 6 weeks B) 3 months (Misch, p.711, Decision should be made to after 3 months)
refer
C) 6 months D) 1 year (Misch, p. 713, 70-90% are irreparable after 1 year)
374. In order to create an esthetic papillae when uncovering an implant replacing a congenitally missing #7, the incision must be made as follows:
A. midcrestal to midcrestal B. palatally from the distal line angle of #6 to the distal line angle of #8 C. buccal split thickness flap created, reflect the lingual full thickness D. lingual split thickness flap created, reflect the buccal full thickness
Q374 Answer - ?? • In order to create an esthetic papillae when uncovering an implant replacing a congenitally missing #7, the incision must be made as follows: A) midcrestal to midcrestal B) palatally from the distal line angle of #6 to the distal line angle of #8 (?) C) buccal split thickness flap created, reflect the lingual full thickness D) lingual split thickness flap created, reflect the buccal full thickness
375. The most successful healing is seen after incisions made:
A. crestal B. lingual C. facial
Q375 Answer • The most successful healing is seen after incisions made: A) crestal (Misch, p. 687, bisecting attached gingiva) B) lingual C) facial
376. Incision on severely resorbed mandibular ridge in the mental foramen area should be:
A. split thickness on the buccal B. split thickness on the lingual C. full thickness on the buccal D. full thickness on the lingual
Q376 Answer • Incision on severely resorbed mandibular ridge in the mental foramen area should be: A) split thickness on the buccal B) split thickness on the lingual C) full thickness on the buccal D) full thickness on the lingual (Misch, p687, crestal full thickness bisecting attached gingiva if 3mm are present, or positioning at least 1.5mm to the facial of the incision line if less is present).
368. Minimum bone height required for press-fit implant is:
A. 10mm B. 6mm C. 15 mm D. 13mm E. 8mm
Q368 Answer - ?? • Minimum bone height required for press-fit implant is: A) 10mm B) 6mm (?) available sizes are 5-56mm C) 15 mm D) 13mm E) 8mm
369. A patient develops paresthesia following the insertion of an implant. A referral to a doctor experienced in nerve injuries should be made within what time period?
A. 3 months B. 1 month C. 6 months D. 1 year
Q369 Answer • A patient develops paresthesia following the insertion of an implant. A referral to a doctor experienced in nerve injuries should be made within what time period? A) 3 months (Misch, p.711, Decision should be made to refer after 3 months) B) 1 month C) 6 months D) 1 year (deadline when treatment should have occurred)
370. What incision do you use when creating a papilla?
A. palatal incision on the natural tooth B. labial incision
371. Intraoral donor site is preferred over the iliac crest site because:
A. more mesenchymal cells and less chondrocytes B. less osteoclasts C. more rapid integration D. denser when integrated
Q371 Answer • Intraoral donor site is preferred over the iliac crest site because: A) more mesenchymal cells and less chondrocytes B) less osteoclasts C) more rapid integration D) denser when integrated (Misch, p.1015) – the quality of bone is often poorer than with other grafting methods.
372. In severely absorbed mandible, the incision should be made:
A. Buccal B. midcrestal to crest of the alveolar ridge C. lingual
Q372 Answer • In severely absorbed mandible, the incision should be made: A) buccal B) midcrestal to crest of the alveolar ridge (Misch, p.687) C) lingual
373. What percent of new bone drilled is necessary in an immediate extraction site?
A. 40% B. 20% C. 60%
Q373 Answer - ?? • What percent of new bone drilled is necessary in an immediate extraction site? A) 40% ? B) 20% C) 60%
374. In pretreatment planning for a maxillary posterior implant with severe buccal ridge resorption, the dentist determines a need for angled abutment. The maximum angle allowable is:
A. 10 B. 25 C. 35 D. 45
Q374 Answer • In pretreatment planning for a maxillary posterior implant with severe buccal ridge resorption, the dentist determines a need for angled abutment. The maximum angle allowable is: A) 10 B) 25 C) 35 D) 45 (Dr. Mills said this at one time I think)
375. Post-operative bleeding may be caused by all of the following except one:
A. acetosalycilic acid B. torn artery C. chronic liver disease D. elevation of PT due to ascorbic acid deficiency E. factor XI deficiency
Q375 Answer - ?? • Post-operative bleeding may be caused by all of the following except one: (? All sounded good to me) A) acetosalycilic acid B) torn artery C) chronic liver disease D) elevation of PT due to ascorbic acid deficiency E) factor XI deficiency
NIH Questions The NIH has met twice on dental implants, 1978 and 1988
1978 NIH Consensus highlights • The National Institute of Health Implant Consensus Conference in 1978 – Was the first meeting of its kind to retrospectively review clinical case studies – Defined success as , “the dental implant should provide functional service for five years in 75% of the cases.” – They evaluated the subperiosteal; staple/transosteal; vitreous carbon; and blade. – Remember at this time these guys were putting implants in with their BARE HANDS! So survival rates may have been lower.-Patrick Williams FYI
1978 NIH Consensus highlights • The National Institute of Health Implant Consensus Conference in 1978
– The Subperiosteal – Provided data for mandibulars only, The benefit:risk ratio may be improved when the implant is used: 1) in the mandible versus the maxilla, 2) on basal bone and 3) against a full upper denture.
– The Staple/Transosteal –
There was not enough info at the time to make any statements
– Carbon & Blades –
Indicated for all clinical situations
1988 NIH Consensus highlights –
There is a question on 1988, but I cannot find it. I did however include a copy of the meeting from the NIH, 1988.
376. Which of the following statements did the National Institute of Health Implant Consensus Conference make in 1978? A. Subperiosteal implants are indicated for the mandibular arch only. B. Ramus Frame implants are indicated for the completely edentulous mandibular arches only [Default] [MC Any] [MC All]
C. Transosteal implants are indicated for completely edentulous mandibular arches only D. Blade form implants are indicated for the maxilla and mandible partially edentulous arches only.
Q376 Answer • Which of the following statements did the National Institute of Health Implant Consensus Conference make in 1978?
A. Subperiosteal implants are indicated for the mandibular arch only. (They said only benefit:risk ratio may be improved with mandibular arch over the maxilla) and insufficient clinical data existed for them to comment on maxillary subs. B. Ramus Frame implants are indicated for the completely edentulous mandibular arches only (not discussed at all) C. Transosteal implants are indicated for completely edentulous mandibular arches only (True but they did not say this) D. Blade form implants are indicated for the maxilla and mandible partially edentulous arches only. (No)