Jaqueline Doe

MCQ

paresthesia may result from

neurotoxicity of local anesthetics,

hemorrhage into neural sheath

edema

** a sensation of tingling, prickling, or numbness of a person’s skin with no apparent long temp physical effect

which of the options below is a condition typified by partial loss of movement, or impaired movement?

paresis

hyperesthesia

abnormal increase in sensitivity to stimuli of the senses

dysthesisa

unpleasant, abnormal sense of touch

all of the following antibiotics are bactericidal except for this one which is bacteriostatic

bacteriostatic: TETRACYLINE

bacteriocidal: penicillin, clindamycin, augmenting, metronidazole

the conversion of one differentiated cell to another usually in response to persistent injury is termed

metaplasia

eg. squamous epithelium due to smoking

dysplasia

abnormality of development: expansion of immature cells, decrease in number of mature cells

anaplasia

reversion of differentiation in cells and is characteristic of malignant neoplasms

hyperplasia

proliferation of cells within an organ or tissue beyond that which is ordinarily seen, may result in the enlargement of an organ

the maximum recommended dose for lidocaine without a vasoconstrictor is

2.0 mg/ lb

what effects does diazepam have on the neuron upon binding to the GABA receptor

opens Cl channels, causes neuron hyperpolarization, decreases neural excitability

**enhances the effect if neurotransmitter GABA by b ending to the benzodiazepine site on the GABA receptor, leading to CNS depression

which of the following nerve fibers has the fastest conduction velocity but the slowest time to block with local anesthetics

A- alpha fibers

• motor fibers

root scaling and planning is performed in order to

remove harmful microbiota from the periodontal pocket

remove calculus from the root surface

resolve inflammation of the periodontal pocket

gain clinical attachment

penicillin G and penicillin V are most active against

gram positive organisms

how are the herpes simples viruses (HSV-1 and HSV-2 transmitted)

HSV-1 involves oropharyngeal infection, HSV-2 involves genital mucosa and skin or maternal genital infection to newborn

what is generally accepted as the maximum probing depth of healthy gingiva

3 mm

which mandibular nerve lock provides sensory anesthesia to virtually the entire distribution of V5

GOW GATES

• IA block repeatedly fails

• accessory innervation from mylohyoid auriculotemporal is suspected

• lower aspiration rate

blocks: V3 before it branches

• inferior alveolar nerve

• mental nerve

• incisive nerve

• lingual nerve

• long buccal nerve (unlike IA block)

• auriculotemporal nerve

which of the following is NOT true of gingival crevicular fluid

GCF is an inflammatory exudate (true)

Smoking decreases GCF flow (FALSE)

GCF contains components of epithelium, connective tissue, inflammatory cells and microbes (true)

the amount of GCF is greater when gingival inflammation if present (TRUE)

female sex hormones increase GCF flow (true)

which organism are resistant to Clindamycin

Gram negative Aerobes

** used to treat infections caused by anearobic bacteria above the diaphragm: respiratory tract, skin, soft tissue infections, periodontitis

how does tetracycline inhibit protein synthesis

binds to 30S subunit of bacterioal ribosome, blocking the binding of tRNA to the A site

---

broad spectrum polyketide antibiotic produced by the streptomycin genus of actinobacteria, indicated for use against many bacterial infections. it is a protein synthesis inhibitor. tetracyclines work by binding the 30 s ribosomal subunit - prevents the docking of aminoacylated tRNA

where do most oral cancers occur in the oral cavity

lateral border of the TONGUE

which of the following could anesthetize the maxillary anterior teeth on the right side only

anterior superior alveolar nerve block

eikinella corrodes “uniformly resists”

clindamycin

---

eikinella corrodes is a fastidious gram-negative facultative anaerobic bacillus. it is innately resistant to macrocodes (erythromycin), clindamycin, and metronidazole

beta-lactam antimicrobials are usually bactericidal, but only to growing bacteria synthesizing new cell walls

both statements are true

the sulcular epithelium is a

nonkeratinized stratified squamous epithelium

which of the following did the Supreme Court rule as things that need to be explained to a patient if consent is considered to be informed

risks of the proposed treatment

alternatives

risk of having no treatment

concerning the patient’s list of medications, all of the following are true except

the patient’s list of medications may reveal undisclosed diagnoses(true)

it is not necessary for the dental practitioner to be concerned about OTC medications (FALSE)

the number of medications taken for a single ailment and the doses suggest the severity of the disease and the degree of risk associated with dental treatment(true)

which of the following antibiotics function as protein synthesis inhibitors

tetracycline

---

penicillin (wall synthesis)

trimethoprim (DNA synthesis)

tetracycline therapy (250 mg q 6 hr) in conjunction with periodontal surgery is begun for a patient. In addition to its antimicrobial activity, tetracycline will:

block the activity of collagenase

which of the following does not happen in gingivitis

apical migration of the junctional epithelium

---

what DOES happen:

disruption of fiber bundles in the gingiva

thinning and ulceration of crevicular epithelium

formation of heavy inflammation infiltrate in the gingival connective tissue

proliferation of epithelial projections in to the gingival connective tissue

which of the following is associated with a higher risk of periodontal disease

oral contraceptives

diabetes

smoking

pregnancy

the conduction of an iatrosedation interview is helpful for

Fearful patients

patients with a coral score above 12

periodontitis can be classified as aggressive or chronic. but whether periodontitis can occur without a precursor of gingivitis is not known at this time

both true

actinobacillus actinomycetemicomitans

is gram negative

is associated with periodontitis

can cause endocarditis

is one of 5 bacteria in the HACEK group

(same as AA)

which of the following is NOT true about squamous cell carcinoma

the long-term survival rate for patients is favorable (NOT true)

---

TRUE:

it is the most common form of oral cancer

it can arise anywhere in the oral cavity

ithe favored sites of local metastasis are the cervical lymph nodes

local anesthetic act by

binding to specific receptors on the sodium channel

which immunoglobulin is found in mucosal areas as well as saliva, tears, and breast milk

secretory IgA

which of the following is NOT true of gingival crevicular fluid

inhibits the growth of bacterial enzymes

---

true:

contains more potassium and less sodium than serum

derived from serum

is a source of serum IgA

gingival fluid is an exudate/ transudate

place the steps in the iatrogenic interview in the correct order

II. recognize and acknowledge the problem

IV. explore and identify the problem

III. interpret and explain the problem

I. offer a solution

which of the following is the principal site where progenitor cells CFU-B are processed into immunologically compromised B lymphocites

bone marrow

during amelogenesis, enamel is laid down each day approximately at a rate of

4.0 micrometers / day

during odontogenesis, which of the following cells determine the type of tooth to be formed

ectomesenchyme

which the following oral mocosae areas is keratinized

attached gingiva

---

nonkeratinized:

sulcular epithelium

alveolar mucosa

junctional epithelium

which of the following is the most abundant cell of a healthy periodontal ligament

Fibroblasts

sulcular brushing is best accomplished by using a

soft 2 or 3 row brush with rounded bristled tips

which of the following most accurately describes the effect of individual plaque control instructions that are conducted in the classroom

a short term decrease in gingivitis

among the following, the most efficient method of brushing is

sulcular brushing

the bacterial flora in periodontal pockets associated with juvenile periodontitis is predominantly

gram negative anaerobic rods

which of the following is not an adverse effect of augmentin

edema

---

augmentin = amoxicillin + clavulanic acid

adverse effects:

diarrhea

loose stooles

nausea

skin rashes

genetic predisposition to periodontitis include genetic plymorphisms in which of the following

IL-1 alpha/beta

IL-6

TNF- alpha

Fcy receptors

vitamin D receptor

MMPs

NAT2

(all of the above)

which of the following is not one of the major periodontal pathogens leading to periodontal disease

streptococcus pyogenes

---

MAJORS:

AA

bactericides forsythus

P gingivalis

prevotella intermedia

which of the following is NOT true for herpes simplex

HSV-1 is USUALLY transmitted by sexual contact

---

true:

two types HSV-1/2

keratitis and encephalitis can be some of the complications

more than 85% of adults have infected HSV-1 before

HSV can be a latent infection

which of the following can be used to aid in smoking cessation

nicotine lozenge/patch/gum

bupropion

varenicline

hypnosis

(all of the above)

which of the following are long-acting benzodiazepines

Diazepam (valium)

---

short actingL

lorazepam

oxazepam

alprazolam

select a true statement about ht progression of gingivitis to periodontitis

the rate at which gingivitis progresses to periodontitis varies depending on the individual

the following treatment of aggressive periodontitis with antibiotics

patients should return 1-3 months for microbiology testing

what should you not do when administering LA

inject the anesthetic quickly to minimize the amount of pain

Patient is an ASA PS IV. what type of local anesthesia

3% mepivacaine

which of these is not commonly found in the normal oral flora

B. bifidum

---

commonly found:

actinomyces

prevotella

pophyromonas

fusobacterium

veillonella

eikenella

AA

P. aeruginosa

oral carcinoma may arise from which of the following mechanisms

I. an error by DNA polymerase to excise the mutated regions

II. an increase in the production of the enzyme telomerase

III. the activation of the MDM2 oncogene

IV. the suppression of the RB tumor suppressing gene

V≥ an inactivation of the pRb protein in the mucosal cell nucleus

well keratinized stratified squamous cells are best exemplified in which oral mucosal structure

DORSUM OF THE TONGUE

which diseases/ malformations are characteristic of long-term nicotine use

I. leukoplakia

II. advanced periodontitis

III. oral cancer

IV. nicotinic stomatitis

V. erythroplakia

the correct stress pathway for the hormone cortisol is

hypothalamus —> Corticotropin releasing hormone —> anterior pituitary —→ ACTH—> adrenal cortex —> cortisol

the inferior alveolar nerve block and the low gates technique are both mandibular nerve blocks, but only the inferior alveolar block is a true mandibular block

first part of the statement is true, second part is FALSE (only the GOW Gates is the TRUE mandibular nerve block)

what are the three main components of a local anesthetic molecule

aromatic ring (lipophilic - allows the molecule to diffuse through lipid-rich nerve membranes)

intermediate chain (ester or amine linkage)

terminal amine group (hydrophilic portion - travels in body fluids)

which dental instrument has a blade with a rounded tip and back

CURETTE - surgical tool

which is not a characteristic of geographic tongue

crenated lateral borders

---

patchy areas of desquamated filiform papillae

white circinate lines

inflammation

erythematous bands w

which of the following muscles are NOT innervated by the trigeminal nerve

Buccinator

---

lateral ptyrygoid

medial pterygoid

temporalis

masseter

mylohyoid

digastric anterior belly

the unaffected, normal alveolar crest on bitewing radiographs is usually

1-2 mm apical to the CEJ

which immunoglobulin is associated with mucosal epithelium secretions

IgA dimer

predominant Bactria in localized aggressive periodontitis include

A. actinomycetomcomitans

P. gingivalis

E. corrodens

P. intermedia

tetracycline inhibits protein synthesis by

reversibly binding to the ribosomal 30s subunit preventing t-RNA binding to A site

reversible binding —> bacteriostatic effect

smoking is thought to negatively affect the periodontium by which of the following mechanisms

inhibits granulocyte function

inhibits collagen synthesis and protein secretion

lowers serum immunoglobulin levels

the periodontal ligament is made of large collagen fibers that course between cementum and alveolar bone. The portion of the principle fiber that is embedded in the cementum is called

Sharpey’s fiber

extrinsic fiber = collagen fibers produced by PDL fibroblasts, inserted into cementum and bone

---

intrinsic fibers = collagen fibers made by cementoblasts, within cementum and oriented parallel to root surface

which is not part of the periodontium

dentin, enamel

the maxillary division of the trigeminal nerve exits the skull through the

foramen rotundum

which nerve supplies taste sensation to the posterior 3rd of the tongue

IX

the nerve that supplies the soft tissue of the lower lip and chin on its side is the

mental nerve

which of the following is true of medically approved cocaine hydrochloride

schedule II controlled substance

cocaine hydrochloride is used as topical anesthetic for selective ENT surgeries

local anesthetics are divided into 2 groups, amides and esters, based on their structure and how they are metabolized in the body. select the correct pairing/ type

esters/ plasma ; Amides / liver

the DNA of herpes simplex virus (HSV) is which of the following

dsDNA

(double stranded DNA is able to be transcribed by host cells in the lytic cycle )

tetracycline antibiotic is “pregnancy Category D” drug that should not be taken during pregnancy except in unique circumstances

TRUE and TRUE

which of the following statements are true regarding supragingival plaque

it typically demonstrates a stratified organization of multiple bacterial types

gram positive cocci predominate at the tooth suface

gram negative rods and filaments predominate in the outer surface of a mature plaque mass

all of the above are true

which of the following sentences is correct in describing the development of calculus

pellicle formation, bacterial adhesion to glycans, plaque, calculus

which of the following synthesizing products may be synthesized by microorganisms associated with gingivitis, resulting in damage to epithelial and connective tissues

hyalurodinase (proteolytic enzyme)

endotoxin (LPS, produced by gram negative bacteria)

chondroitin sulfates

(all of the above)

which of the following statements is FALSE regarding the use of a sickle scaler (curved scaler) during scaling and root planning

is is primarily used to remove subgingival calculus (FALSE)

---

true statements:

• it is used to remove SUPRAgingival calculus

• it is the first instrument used to remove heavy deposits

• it improves access to subgingival areas previously difficult to reach

which of the following are gram-positive bacteria found in the mouth

streptococcus oralis

staphylococcus aureus

lactobacillus acidophilus

(ALL OF THE ABOVE)

Which of the following are characteristic of generalized aggressive periodontitis

usually affects patients under 30 years old

poor serum antibody response to infecting bacteria

episodic nature of destruction

the dentoalveolar ligament of the periodontium is composed of

principle fibers - dense collagen fibers (type i) arranged in bundles that anchor the tooth to the alveolar bone and cementum

• sharpies fibers are the ends of the principle fibers embedded into cementum and bone

---

oxytalan fibers - run parallel to the root surface, support vascular structrure

which are true about AA

the bacterium actively suppresses immune responses through a number of proteins who of which are toxins: leukotoxin and cytolethal distending toxin

the organisms causes bone destruction by interfering with osteoblast/clast control mechanisms

it is gram-negative

methods to control patient anxiety include

iatrosedation (above 12)

hypnosis

relaxation techniques

iatrosedation interviews are needed for patients who

have a HIGH CORAH score

the activity of a local anesthetic is a function of all of the following except

vasoconstriction properties (this does not affect anesthetic function)

---

lipid solubility (more lipid soluble penetrates faster)

diffusibility

affinity for protein binding ( more protein-bound, lower duration of action, slower absorption)

percent ionization at physiologic pH (pKa) ** only non-ionized (lipid soluble ) form crosses nerve membranes . pKa closest to physiological Ph will more rapidly

which of the following is NOT an instrument designed for scaling?

Wedelstaedt chisel - rarely used, replaced by curettes (designed for supragingival calculus removal )

---

Curette (rounded toe and curved cutting edge - removes subgingival calculus)

Hoe - supragingival calculus

Hirdschfed file - crush or smooth heavy calculus deposits , used to prepare surfaces for scaling

sickle scaler - triangular cross section and pointed tip - supragingival calculus

neutrophils comprise what percent of leukocytes in a healthy individual

50-70%

a patient has an acute periodical abscess and a history of hypersensitivity to penicillin. which of the following antimicrobial agents might be the preferred alternative for this patient?

Clindamycin

---

amoxicillin - a penicillin

Cephalosporin - Beta lactam, Cross reactivity with penicillin (similar allergy )

tetracylin

erythromycin

metronidazole

the presence of aggregatibacter actinomycetemcomitans is always present in

localized aggressive periodontitis

evidence indicates that compounds of smoking inhibit healing through the effects of all of the following except

killing fibroblasts

---

anoxia (absence of oxygen) and hypoxia (reduced oxygen availability)

• smoking increases CO in the blood —> less oxygen delivery

impaired epithelialization

vasocontriction

enzymatic systems toxicity

the mandibular branch of the V3 nerve innervates all of the following except

Palate

---

external ears,

lower lip

temporal region of the chin

anterior 2/3 tongue

what is true regarding topical anesthetics

Eutectic (mixtures of two anesthetics that melt at a lower temperature than either drug alone) mixtures permit higher concentrations which are more effective on intact skin

---

the nerves are blocked by inhibition of neurotransmitters (FLASE) - local anesthetics block voltage-gated sodium channels, preventing depolarization so action potentials cannot propagate. neurotransmitters are not inhibited directly

lidocaine and benzocaine are ester class anesthetics (FALSE) : lidocaine is an amide class (metabolized in the liver), benzocaine is an ester class (metabolized by plasma pseudocholinesterase)

two ii’’s : amide

one I : ester