Ace Achievers

ract
Dental Academy

MISCELLANEOUS
SEDATION AND GENERAL ANESTHESIA b. Anesthesia with nasopharyngeal
airway
1. I.V. diazepam causes following in a patient
c. Nasoendotracheal tube with throat
on dental chair: (Past Q)
pack
a. Tinel's sign
d. I.V. anesthesia with nitrous oxide
b. Virrel's sign
and oxygen
c. Battel's sign
d. Bell's sign
6. All of the following statement about
ketorolac are incorrect EXCEPT: (Past Q)
2. In Jorgensen technique on IV sedation for
a. An effective analgesic for mild to
dental procedure drugs used are: (Past Q)
moderate post operative dental pain
a. Pentobarbital
b. Like morphine it interacts with
b. Scopalamine
opioid receptors
c. Mepiridine
c. Administered only by intravenous
d. All the above
route
d. Safe even in chronic use
3. Sedation by which of the following routes
can be reversed most rapidly: (Past Q)
7. Inhaled general anaesthetic with low blood
a. Oral
gas partial coefficient are characterized
b. Intravenous
by: (Past Q)
c. Inhalation
a. Rapid induction and quick recovery
d. Intramuscular
from anaesthesia
b. Rapid induction and slow recovery
4. The colour of a nitrous oxide cylinder is:
(Past Q)
from anaesthesia
a. Red c. Slow induction and slow recovery
b. White from anaesthesia
c. Blue d. Slow induction and quick recovery
d. Black from anaesthesia

5. Which of the following general anesthetic 8. A patient has day care surgery, what we
techniques should be used for anesthesia in will advise for: (Past Q)
oral surgery: (Past Q) a. Drive by himself
a. Open drop method b. Can operate machinery or drive
c. Don't operate any machinery or drive
for that day
 d. Can take alcohol at night c. Morphine
d. Pethidine
9. Which of the following symptoms is seen in
a patient administered with 20-40% 15. The action of adrenaline is potentiated in
nitrous oxide: (Past Q) the presence of all except: (Past Q)
a. Paresthesia a. Ethyl chloride
b. Sweating b. Halothane
c. Floating sensation c. Cyclopropane
d. None of the above d. Ether

10. Which of the following inducing agent has 16. Which combination forms day care
analgesic property? (Past Q) anesthesia: (Past Q)
a. Nitrous oxide a. Fentanyl, propofol, Isoflurane
b. Enflurane b. Pethidine, Propofol, Isoflurane
c. Halothane c. Thiopental pethidime, Halothane
d. Sevoflurane d. Thiopentane, isoflurane fentanyl

11. Nitrous oxide alone is not used as a G.A 17. The action of long acting muscle relaxants
agent because of: (Past Q) used during GA may be terminated by:
a. Difficulty in maintaining an (Past Q)
adequate oxygen concentration a. Neostigmine
b. Expense of the agent and its b. Ketamine
exposure hazards c. Succinylcholine
c. Adverse effect on liver d. Atropine
d. Poor analgesic property
18. Which of the following intravenous
12. Surgery is carried out in which stage of induction agents is the most suitable for
general anesthesia: (Past Q) day care surgery: (Past Q)
a. Plane I a. Morphine
b. Plane II b. Proplofol
c. Plane III c. Ketamine
d. Plane IV d. Diazepam

13. Which of the following is used to prevent 19. For propofol all are true except:(Past Q)
laryngospasm due to GA: (Past Q) a. Has a rapid recovery rate
a. Atropine b. Used for induction & maintenance of
b. Diazepam anesthesia
c. Epinephrine c. Causes vomiting after use
d. Succinylcholine d. Causes sedation

14. In dentistry which sedatives are generally 20. An anesthetist orders a new attendant to
used: (Past Q) bring the oxygen cylinder. He will ask the
a. Benzodiazepines attendant to identify the correct cylinder
b. NSAID by following color code: (Past Q)
 a. Black cyclinder with white shoulder b. Neurovascular bundle near incisive
b. Black cylinder with grey shoulders foramen
c. White cylinders with black shoulders c. Neurovascular bundle near palatine
d. Grey cylinder with white shoulders foramen
d. Neurovascular bundle coursing
21. Regarding oropharyngeal throat pack all through mandibular canal
are true except?
a. It is given in awake patient DISTRACTION OSTEOGENESIS
b. Should be given after general
26. Latency period in distraction
anesthesia
osteosynthesis is defined as: (Past Q)
c. Prevent ingress of oropharyngeal
a. Time period between surgical
secretions to trachea
osteotomy and starting of distraction
d. Prevent soiling of trachea
b. Time period between starting of
distraction to the completion of
22. Excessive pressure at the angle of
distraction
mandible during establishment of patient
c. Time period for completion of
airway may damage?
distraction process
a. 7th cranial nerve
d. Time period between distraction and
b. 4th cranial nerve
functional loading of the area
c. 5th cranial nerve
d. 3rd cranial nerve
27. The latent period in distraction
osteogenesis is: (Past Q)
23. Throat pack is used in: (Past Q)
a. 4-6 weeks
a. Endotracheal tube without cuff
b. 6-8 months
b. After LMA intubation
c. 5-7 days
c. Endotracheal tube with cuff
d. 4 months
d. In all oral surgical intubations
28. Optimum rate of movement during
24. The most common anesthetic complication
distraction osteogenesis is: (Past Q)
occurring within first 24 hours after
a. 1 mm per day
surgery under general anesthetics is:
b. 5 mm per day
(Past Q)
c. 1 cm per week
a. Hypertension
d. 5 cms per week
b. Atelectasis
c. Renal failure
29. Distraction osteogenesis is done in
d. Cardiac arrest
pediatric patient which of the following is
considered: (Past Q)
PERIRADICULAR SURGERY
a. Increase in rate
25. Primary anatomic structure of concern in b. Increase rhythm
posterior mandible peri-radicular c. Consolidation time is increased
surgery: (Past Q) d. Time of fixation is increased
a. Neurovascular bundle coursing
through infraorbital canal 30. Latent period of distraction osteogenesis in
8 months old child is: (Past Q)
 a. 0-2 days
b. 4-6 weeks 36. In case of nodal metastasis, which is not
c. 5-7 days seen on CT scan: (Past Q)
d. 31-40 days a. Size more than 6 mm
b. Spiculated node
31. Distraction osteogenesis works on the c. Necrotic node
principal: (Past Q) d. Rounded node
a. Traction
b. Passive 37. Cryosurgery utilizes which of the
c. Tension following? (Past Q)
d. Compression a. Nitrous oxide
b. Liquid oxygen
32. Distraction osteogenesis true is? (Past Q) c. Carbon dioxide
a. Applied when bone growth is not yet d. Nitric dioxide
completed
b. Synonym is distraction histogenesis 38. During cryosurgery: (Past Q)
c. Rate of distraction osteogensis is a. Cells get evaporated
4mm per day b. Cells will not die, only freeze
d. Soft tissue envelope remains c. Cell death occurs when the
unaffected temperature falls below -20°C
d. Patients need general anesthesia
MANAGEMENT OF CYSTS AND
TUMORS 39. A 40 years old patient has to undergo a
surgery for removal of the tongue.
33. A 30 year old patient underwent resection
Ligation of which part of the lingual artery
of mandible for the treatment of
would be preferred during the surgery?
ameloblastoma. The best graft is: (Past Q)
(Past Q)
a. Free iliac crest graft
a. First part
b. Free vascularized iliac crest graft
b. Third part
c. 6th rib
c. Second part
d. Allograft of the bone
d. Sublingual part
34. Best graft for reconstruction of mandible
40. A surgical obturator has to be inserted:
is? (Past Q)
(Past Q)
a. Free Vascularized fibula
a. One day prior to the surgery
b. Free Vascularized illiac crest
b. On the day of the surgery
c. Free Vascularized scapula
c. 14 days after the surgery
d. Vascularized costo-chondral graft /
d. 30 days after the surgery
reconstruction
41. Abbey-Estlander flap is used in the
35. Treatment of unilocular ameloblastoma is:
reconstruction of: (Past Q)
a. Enucleation
a. Lip
b. Enucleation with cryotherapy
b. Cheek
c. En bloc resection
c. Tongue
d. Resection with 1 cm margins
 d. Hard Palate d. Below SMAS & below
parotidomasseteric fascia
MANAGEMENT OF SALIVARY GLAND
PATHOLOGY 46. Not given in parotid fistula: (Past Q)
a. Atropine
42. Submandibular salivary duct calcification
b. Propanthaline
treatment includes: (Past Q)
c. Aspiration and dressing
a. Longitudinal incision and suturing
d. Pilocarpine
the duct
b. Longitudinal incision and suturing
47. A painless, fluid filled retention cyst
the wound leaving the duct open
appearing in the area of recent dental
c. Transverse incision and suturing the
treatment may be the result of: (Past Q)
duct
a. Failure of absorption of the
d. Transverse incision and suturing the
anaesthetic
wound leaving the duct open
b. Allergic reaction of agents employed
c. Infection occurred during treatment
43. Which statement with respect to
d. Injury to salivary gland
mucoceles is false? (Past Q)
a. Pseudocysts contain viscous saliva
NERVE INJURIES AND NEURALGIAS
but lack a true epithelial lining
b. Patients relate a history of filling, 48. Tinnel's sign is meant for: (Past Q)
rupture and refilling a. Nerve regeneration
c. Preventing recurrence requires b. Problem in the ear
removal of associated major salivary c. Nerve degeneration
gland d. None of the above
d. Preventing recurrence requires
removal of associated minor salivary 49. Janetta surgical procedure: (Past Q)
gland a. Radiofrequency ganglionolysis
b. Percutaneous ganglion glycerolysis
44. Cranial nerves at risk during removal of c. Microvascular decompression
the submandibular salivary gland:(Past Q) d. Radiofrequency neurolysis
a. Mandibular branch of the facial
nerve IMPACTED TEETH
b. Lingual nerve
50. "Kelsey Fry technique" refer to the
c. Hypoglossal nerve
removal in:
d. All of the above
a. Impacted maxillary 3rd molars
b. Impacted mandibular 3rd molars
45. Facial nerve lies: (Past Q)
c. Impacted mandibular canines
a. Below SMAS & above
d. Impacted maxillary canines
parotidomasseteric fascia
b. Above SMAS & below
51. A 45 years old man comes to a dentist with
parotidomasseteric fascia
pain in the lower jaw. The dentist
c. Above SMAS & above
diagnoses it as infected last molar and
parotidomasseteric fascia
decides to extract it under local anesthesia.
After the anesthesia, he extracted the
tooth. After this, the patient also notices 52. When soft palate is paralysed, which is not
numbness in the later part of lower lip, seen? (Past Q)
chin and the tongue. This is due to a. Clefting of the palate
infiltration of the: (Past Q) b. Nasal regurgitation
a. Posterior superior alveolar nerve c. Nasal twang
b. Lingual nerve d. Flat palate
c. Nerve to mylohyoid
d. Buccal nerve
 Answers & Explanations
SEDATION AND GENERAL ANESTHESIA

1. Ans. is C (Virrel's sign)

Exp.: The three features of Verrill's sign are:
Partial ptosis (50%).
Blurring vision
Slurring speech that indicate the correct level after Diazepam sedation

Option 'A' Tinel's sign is seen during the starting of nerve regeneration. It is elicited by percussion over the
divided nerve that results in tingling sensation in the part supplied by the peripheral section.

2. Ans. is D (All the above)

Exp.: Jorgenson technique includes intravenous administration of opioids. The drugs used in Jorgenson
technique are:
a) Pentobarbitol
b) Mepiridine
c) Scopalamine (Hyoscine)
d) Pethidine, etc.

3. Ans. is C (Inhalation)

4. Ans. is C (Blue)
Exp.:
GAS COLOUR
Nitrous oxide Blue
Oxygen Black cylinder with white shoulder
CO2 Brownish grey
Nitrogen Black
Ethylene Purple

5. Ans. is C (Nasoendotracheal tube with throat pack)

6. Ans. is A (An effective analgesic for mild to moderate post operative dental pain)
Exp.:
- Option B: In post operative pain it has equalled the efficacy of morphine but doesnot interact with
opioid receptors.
- Option C: Ketorolac is rapidly absorbed after oral and I.M administration.
- Option D: Contonuous use for more than 5 days is not recommended at present.
7. Ans. is A (Rapid induction and quick recovery from anaesthesia)
Exp.: Solubility of anaesthetic in blood is the most important. property determining induction and recovery.
Large amount of an anaesthetic that is highly soluble in blood like ether must dissolve before its partial
pressure (pp) is raised. The rise as well as fall of pp in blood and consequently induction as well as recovery
is slow. Drugs with low blood solubility E.g N2O, sevoflurane, desflurane induce quickly.

8. Ans. is C (Don't operate any machinery or drive for that day)

Exp.: Day surgery is surgery that is completed in one day, and does not require the person to stay in hospital
overnight. The patients are discharged shortly after surgery. Patients of day care surgery should be
instructed not to do important and skilful work like driving, operating a machine for at least 24 hours.

9. Ans. is C (Floating sensation)

Exp.:
• Moderate sedation.
5-25%
• Diminution of fear and anxiety
N2O causes
• Marked relaxation.
• Dissociation sedation and analgesia.
25-45% • Floating sensation.
N2O causes • Reducing blink rate.
• Euphoric state (laughing gas)
• Total anaesthesia.
45-65%
• Analgesia is complete.
N2O causes
• Marked amnesia.

10. Ans. is A (Nitrous oxide)

Exp.: Nitrous oxide:
• Also called as laughing gas.
• Name given by Humpry Davy.
• It was first prepared by joseph priestly in 1774.

Anaesthetic properties:
• It is not a complete anaesthetic. It is used as a carrier gas to other inhalational agents.
• Maximum alveolar concentration is 104% which is not possible to deliver so it is not a complete
anaesthetic. Maximum conc. Of nitrous oxide which can be given is 66% (or a minimum 33% oxygen
is to be given otherwise severe hypoxia can occur).
• Blood gas coefficient is 0.47 making it agent with faster induction and recovery.
• It is non inflammable, non explosive.
• Good analgesic
• Not a muscle relaxant.
• When given along with other inhalational agents it increases the alveolar concentration of that agent
(second gas effect) and its own (concentration effect).
• At the end of surgery sudden stoppage of its delivery can reverse the gradient making it gush to alveoli
replacing oxygen from there (diffusion hypoxia) which can be prevented by giving 100 % oxygen for
5 to 10 minutes.
Blood to gas partition coefficient of nitrous oxide is:
a. 0.47
b. 0.59
c. 0.32
d. 0.71

11. Ans. is A (Difficulty in maintaining an adequate oxygen concentration)

Exp.:
• Diffusion Hypoxia: When N2O discontinued after prolonged anesthesia, N2O having low blood
solubility, rapidly diffuses into alveoli & dilutes alveolar air -PP (partial pressure) of oxygen reduced.
The resulting hypoxia, called diffusion hypoxia, is not of much consequence if cardiopulmonary reserve
is normal, but may be dangerous if it is low. This can be prevented by continuing 100% oxygen
inhalation for few minutes after discontinuing N2O. Diffusion hypoxia is not significant with other
anesthetics because they are administered at low conc. (0.2-4%) and cannot dilute alveolar air by more
than 1-2%.
• So Nitrous oxide alone is not used as a G.A agent because of difficulty in maintaining an adequate
oxygen concentration.
• It is generally used as a carrier & adjuvant to other anesthetics.
• A mixture of 70% N2O + 25-30% O2 +0.2-2% another potent anesthetic is employed for most surgical
procedures.

12. Ans. is C (Plane III)

Exp.: Minor surgeries like extractions are carried out in Stage-I or stage of analgesia. Major surgeries are
carried on in Stage-III and Plane-III of general anaesthesia or stage of surgical anaesthesia.

13. Ans. is D (Succinylcholine)

14. Ans. is A (Benzodiazepines)

15. Ans. is D (Ether)

16. Ans. is A (Fentanyl, propofol, Isoflurane)

Exp.: Propofol: Oil based preparation. So injection is painful and should be preceded by lignocaine
injection.

Anaesthetic properties:
• Induction is achieved in 10 to 15 seconds. Conciousness is regained after 2-8 minutes due to
redistribution.
• Elimination half life is 2-4 hours recovery is rapid and associated with fewer hangovers.
• It is not a muscle relaxant.
• Eye: reduces intraocular pressure
• GIT: it is antiemetic
• Immunologic: it is antipruritic
Uses:
• Because of its (i) early induction (ii) early and smooth recovery (iii) inactive metabolites and (iv)
antiemetic effects it is the I.V agent of choice for day care surgery.
• Along with opioids (alfentanil or remifentanil) propofol is the agent of choice for total intravenous
anaesthesia (TIVA).
• Propofol infusion is used to produce sedation in ICU.
• Agent of choice for induction in susceptible individuals for malignant hyperthermia.

Fentanyl: It has rapid onset (2 to 5 minutes) and rapid recovery (1 to 2 hours).

Isoflurane: Agent with moderate potency and with moderate induction and moderate recovery time.

17. Ans. is A (Neostigmine)

18. Ans. is B (Proplofol)

19. Ans. is C (Causes vomiting after use)

Exp.: Propofol:
• This phenol derivative was identified as a potentially useful intravenous anaesthetic agent in 1980, and
became available commercially in 1986.
• It is more expensive than thiopental or methohexital, but has achieved great popularity because of its
favourable recovery characteristics and its antiemetic effect.

Indications:
1. Induction of anaesthesia:
• Propofol is indicated particularly when rapid early recovery of consciousness is required.
Two hours after anaesthesia, there is no difference in psychomotor function between patients who
have received propofol and those given thiopental or methohexital, but the former enjoy less
drowsiness.
• The rapid recovery characteristics are lost if induction is followed by maintenance with inhalation
agents for longer than 10-15 min.
• The rapid redistribution and metabolism of propofol may increase the risks of awareness during
tracheal intubation after the administration of non-depolarizing muscle relaxants, or at the start of
surgery, unless the lungs are ventilated with an appropriate mixture of inhaled anaesthetics, or
additional doses or an infusion of propofol administered.

2. Sedation during surgery: Propofol has been used successfully for sedation during regional analgesic
techniques and during endoscopy. Control of the airway may be lost at any time, and patients must be
supervised continuously by an anaesthetist.

3. Total I.V. anaesthesia: Propofol is the most suitable of the agents currently available. Recovery time
is increased after infusion of propofol compared with that after a single bolus dose, but cumulation is
significantly less than with the barbiturates.
4. Sedation in ICU: Propofol has been used successfully by infusion to sedate ADULT patients for
several days in ICU. The level of sedation is controlled easily, and recovery is rapid (usually < 30 min).

Absolute Contraindications:
• Airway obstruction and known hypersensitivity to the drug are probably the only absolute
contraindications.
• Propofol appears to be safe in porphyric patients.
• Propofol should not be used for long-term sedation of CHILDREN in the ICU because of a number of
reports of adverse outcome.

20. Ans. is A (Black cyclinder with white shoulder)

21. Ans. is A (It is given in awake patient)

Exp.:
• After the patient has been anesthetized and intubated either nasoendotracheally or oroendotracheally,
or if the anesthesia is being administered through tracheostomy tube, it is desirable to insert some form
of moistened sterile gauze pack (throat pack) into oropharynx to screen it from oral cavity (Option 2).
• Soiling of trachea or airway is the process by which liquid or solid matter (blood, vomit, teeth, foreign
body etc) that is not usually present within airwway gains access to the conductive airways. It is of
great importance to anaesthetist as it can cause deoxygenation, airway collapse or infection. If the
procedure will involve extensive irrigation or bleeding, then measures should be taken to protect the
airway from soiling.
• A throat pack must be positioned correctly around laryngeal inlet, not left loose in mouth, to provide
protection of airway from soiling (Option 4). Without a pack, any liquid could seep down into trachea
(Option 3).

22. Ans. is A (7th cranial nerve)

Exp.:
• After exit from stylomastoid foramen, the facial nerve enters the parotid gland over the mandibular
ramus and gives off four branches; temporal and zygomatic branch turn upwards, whereas the buccal
and mandibular branch turn downwards to pass over the mandibular ramus. These two branches are
susceptible to injury during mask ventilation either by direct pressure over the nerves behind the ramus
of mandible or due to stretching caused by forward traction on the jaw.
• The mandibular branch often runs high in relation to angle of mandible.
• Sometimes facial nerve lies superficial rather than deep to parotid gland. This renders the buccal branch
liable to pressure injury from a too tightly fitted mask or head strap.

23. Ans. is D (In all oral surgical intubations)

Exp.: Throat packing is done in all oral surgical procedures to prevent the entry of salivary secretions and
blood in to the trachea. It is done to create a barrier to obstruct either lingual sulcus or as much of the
oropharyngeal inlet as possible. Also, shape of throat pack avoids stimulation of gag reflex in the throat (in
case of conscious sedation).

Throat packs can be of:

• Polyurethane foam
• Gel foam
• Cotton rolls
• Placing throat pack

24. Ans. is B (Atelectasis)

PERIRADICULAR SURGERY

25. Ans. is D (Neurovascular bundle coursing through mandibular canal)

Exp.: It is the answer of exclusion as rest all landmarks is present in maxilla.

DISTRACTION OSTEOGENESIS

26. Ans. is A (Time period between surgical osteotomy and starting of distraction)
Exp.: Latency period/ Delay- This period which generally ranges from 4 to 7 days, allows for the initial
fracture healing to occur, by callus formation in order to bridge the cut bone segments. Premature
consolidation is said to occur specially in children if latency period is too prolonged. On the contrary, some
reporters claim that reliable bone production occurs even after a zero day latency, indicating that a latency
period actually may not be necessary.

27. Ans. is C (5-7 days)

Exp.: Latency period/Delay: Fracture healing is allowed to occur This period generally ranges from 4-7
days allows for the initial fracture healing to occur, by callus formation in order to bridge the cut bone
segments.

28. Ans. is A (1 mm per day)

Exp.: Rate of distraction - it may be defined as the number of milimeters per day at which the bone
surfaces are stretched. The rate of 1 mm/day is considered normal.

29. Ans. is A (Increase in rate)

Exp.: Distraction phase:
• The process of distraction is activated with the bone segments gradually pulled apart using either an
internal or external device.
• Three variables must be set: the rate of distraction, the rhythm and/or frequency of distraction, and the
total time of distraction.
• The rate of distraction is typically 1.0 mm/d. Some advocate up to 2.0 mm/d in younger children to
avoid early consolidation and a slower rate of 0.5 mm/d or 0.25 mm qid in older patients to avoid
fibrous unions.

30. Ans. is A (0-2 days)

Exp.: Latency Phase:
• Fracture healing is allowed to occur before distracting forces are applied.
• This period typically lasts 5-7 days.
• In younger patients (typically, younger than 4-5 years), due to increased bone metabolism, the latency
period may be significantly shortened or omitted (to 0-2 days) altogether to prevent early consolidation.

Latency period for distraction osteogenesis in a 8 month old child is?

a. 0-2 days
b. 1 week
c. 5-7 days
d. 2 weeks

31. Ans. is C>A (Tension > Traction)

Exp.: Illizarov, a Russian scientist with whom the technique has been most associated was the first to design
a scientific protocol on human bone lengthening and gave the principle of law of tension -stress, meaning
thereby that gradual traction on the living tissues created stresses that stimulated and maintained the
regeneration and active growth of certain tissue structures.

32. Ans. is A (Applied when bone growth is not yet completed)

Exp.: DO (Distraction Osteogenesis) involve performing an osteotomy to separate segments of bone and
the application of an appliance that will facilitate the gradual and incremental separation of bone segments.
The gradual tension placed on the distracting bone interface produces continuous bone formation.
Additionally, surrounding tissue appears to adapt to this gradual tension, producing adaptive changes in all
surrounding tissues, including muscles and tendons, nerves, cartilage, blood vessels, and skin. Because the
adaptation involves a variety of tissue types in addition to bone, this concept should also include the term
distraction histogenesis.

DO involves several phases:

• In osteotomy or surgical phase, an osteotomy is completed, and the distraction appliance is secured.
• In the latency period- very early stages of bone healing begin to take place at the osteotomy-bone
interface. The latency phase lasts generally 7 days, during which time the appliance is not activated.
• The distraction phase begins at a rate of 1 mm per day. This distraction rate is usually applied by
opening or activating the appliance 0.5 mm twice each day. The amount of activation per day is termed
rate of distraction; the timing of appliance activation each day is termed rhythm. During the distraction
phase, the new immature bone that forms is called regenerate bone.
• The consolidation phase- Once the appropriate amount of distraction has been achieved, the appliance
remains in place during the consolidation phase, allowing for mineralization of the regenerate bone.
• Appliance removal
• Remodelling- The appliance is then removed, and the period from the application of normal functional
loads to the complete maturation of the bone is termed the remodelling period.

Which of the below is a phase in distraction osteogenesis:

a. Remodeling phase
b. Osteotomy phase
c. Latency phase
d. All of the above
 MANAGEMENT OF CYSTS AND TUMORS

33. Ans. is B (Free vascularized iliac crest graft)

Exp.: Mandibular reconstruction after resection of mandible for treatment of ameloblastoma:
Mandibular reconstruction can also be accomplished by a variety of means. They include
a. Autogenous vascularised bone by pedicled flaps
b. Autogenous vascularised bone by free flaps
- iliac crest based on deep circumflex iliac artery
- fibula based on peroneal artery
- scapula based on circumflex scapular artery
- radial forearm based on radial artery
- rib based on intercostal artery second metatarsal
- calvarium based on superficial temporal artery
c. Autogenous non-vascularised bone
- Calvarium
- iliac crest
- rib
- fibula
d. Allografts
e. Xenografts
f. Alloplastic materials
- stainless steel reconstruction plate
- hydroxyapatite

Allografts and xenografts have fallen out of favour of most authorities. When they are used, it is as banked
bone after lyophilisation to prevent antigenicity-related problems.
• Autogenous vascularised bone gives the best result because of its reliable blood supply. Free flaps
including iliac crest are considered the best choice because of their width which facilitated dental
rehabilitation by implants or dentures.
• Disadvantages of free tissue transfer include longer duration of surgery and the need for sophisticated
and expensive equipment and trained personnel.
• In the absence of these, autogenous non-vascularised bone is a good compromise option, especially for
reconstructing small defects.

34. Ans. is A (Free Vascularized fibula)

Exp.: Vascularised grafts are the best option for reconstruction of mandible. The vascular supply of the
graft is anastomosed with the vascular supply of recipient tissue. Out of vascularised grafts fibula provides
larger size of the bone with a large pedicle of vessels with abundant soft tissue.

35. Ans. is A (Enucleation)

Exp.: Unilocular ameloblastomas are usually small in size than multilocular ameloblastomas and thus
require enucleation only. The solid/multicystic ameloblastoma (SMA) requires radical surgical
intervention. Unicystic ameloblastomas. require only conservative surgical enucleation, unless. infiltration
from the epithelial cyst lining into the cyst wall has been demonstrated, in which case the treatment should
follow that outlined for SMAs.
Note: The standard treatment of ameloblastoma is segmental resection with 1 cm of normal bone.
36. Ans. is B (Spiculated node)
Exp.: The characteristics of metastatic lymph nodes that can be depicted are:
a) Increased size
b) A rounder shape,
c) Presence of noncontrast enhancing parts inside metastatic lymph nodes, caused by tumor necrosis,
tumor keratinization, or cystic areas inside the tumor.
- In general round shape is considered more suspicious than an oval or flat shape. In reactive nodes
the ratio of the longest diameter over the shortest diameter is 2 or higher in 86% of cases. In round
nodes the minimal diameter is same as the maximal diameter.
- Whereas necrosis is a very reliable criterion for lymph node metastases, it is unfortunately quite
rare in small lymph nodes.

37. Ans. is A (Nitrous oxide)

38. Ans. is C (Cell death occurs when the temperature falls below -20°C)
Exp.: In cryosurgery extreme cooling temperature ranging from -20°C to -180°C is used. At this
temperature range, the tissues, capillaries, small arterioles and veinules undergo cryogenic necrosis. This is
caused by dehydration and denaturation of lipid molecules. Cryosurgery is specially used to treat superficial
hemangiomas.

39. Ans. is A (First part)

Exp.:
• The lingual artery arises from the external carotid artery opposite the tip of the greater cornua of hyoid
bone. Its course is divided into three parts by the hyoglossus muscle.
• The first part lies in the carotid triangle. It forms a characteristic upward loop which is crossed by the
hypoglossal nerve. The lingual loop permits free movement of the hyoid bone.
• The second part lies deep to hyoglossus along the upper border of the hyoid bone. It is superficial to
the middle constrictor of the pharynx.
• The third part is called the arteria profunda linguae, or the deep lingual artery. It runs upward along
the anterior border of hyoglossus, and then forwards on the under-surface of the tongue.
• During surgical removal of the tongue, the first part of the artery is ligated before it gives any
branch to the tongue or to the tonsil.

40. Ans. is B (On the day of the surgery)

Exp.: The surgical obturator, placed at the time of tumor resection in the operating room, provides the
surgeon with an anatomically accurate stable, clean scaffold upon which to support the surgical dressing
that, in turn, supports the facial flap and keeps pressure on the skin graft placed over the denuded intraoral
surface of the facial flap.

It provides a barrier between the surgical dressing and oral cavity so the patient does not feel the extent of
the defect or dressing with his or her tongue during the initial healing period.

Surgical obturator also allows patients to take nourishment without a nasogastric tube, enable the patients
to speak normally, and minimize the initial feelings of loss that occur when patient realize the extent of
their surgical defects.
41. Ans. is A (Lip)

MANAGEMENT OF SALIVARY GLAND PATHOLOGY

42. Ans. is B (Longitudinal incision and suturing the wound leaving the duct open)
Exp.: While removing the calculus, the duct is located and a longitudinal slit is made directly over the
stone. The duct must not be cut transversely because retraction may complete the division and a fistula may
result. After removing the stone no effort is made to close the duct proper. The wound edges are sutured at
the level of mucosa only and recanalization occurs without further intervention.

43. Ans. is C (Preventing recurrence requires removal of associated major salivary gland)
Exp.:
• Treatment of the mucocele is excision.
• If the lesion is simply incised, its contents will be evacuated, but it will be rapidly filled again as soon
as the incision heals.
• There is occasional recurrence after excision, but this possibility is less likely if the associated gland
acini are removed also.

44. Ans. is D (All of the above)

Exp.: Anatomical structures at risk during excision of submandibular gland are:
• Lingual nerve (most common)
• Hypoglossal nerve
• Marginal mandibular branch of facial nerve

45. Ans. is D (Below SMAS & below parotidomasseteric fascia)

Exp.:
• The superficial musculoaponeurotic system (SMAS) is the support mechanism for the facial soft tissue
envelope and has become an important structure used in many lifting techniques.
• Face -lifts can improve the ptosis of the malar fat pad, nasolabial fold and jowls.
• Three potential planes of dissection exist: Subcutaneous, sub-superficial musculoaponeurotic system
(SMAS), and subperiosteal.
• Between the facial nerve and SMAS exists a thin fascial layer, the parotid massetric fascia.
• When performing a sub-SMAS dissection in the cheek, the buccal and zygomatic branches of the facial
nerve can be seen emerging from the anterior border of parotid gland below the parotid-massetric
fascia.

46. Ans. is D (Pilocarpine)

Exp.: Parotid fistula can be treated by many ways:
• Pressure dressing
• Antisialogouges
• Total parotidectomy
• Tympanic neurectomy
• Parotid duct transpostioning
47. Ans. is D (Injury to salivary gland)
Exp.: Mucocele results from traumatic severance of salivary duct produced by pinching the lip by
extraction forceps or by biting the lip or cheek leading to spillage of mucin in to the surrounding tissues.

NERVE INJURIES AND NEURALGIAS

48. Ans. is A (Nerve regeneration)

Exp.: Tinel's sign was used earlier as indication of the start of nerve regeneration. It is elicited by percussion
over the divided nerve, which results in a tingling sensation in the part supplied by the peripheral section.

49. Ans. is C (Microvascular decompression)

Exp.: Microvascular decompression (MVD), also known as the Jannetta procedure, is a neurosurgical
procedure used to treat trigeminal neuralgia. It consists of separating/removing and decompressing the
offending artery or vein from the trigeminal nerve root. The majority of patients have immediate relief after
microvascular decompression.

Procedure: A straight incision is behind the ear about the length of the ear. Using a microscope and micro-
instruments, the arachnoid membrane is dissected allowing visualization of the 8th, 7th and finally the
trigeminal nerve. The offending loop of blood vessel is then mobilized. Frequently a groove or indentation
is seen in the nerve where the offending vessel was in contact with the nerve. Once the vessel is mobilized
a sponge like material is placed between the nerve and the offending blood vessel to prevent the vessel from
returning to its native position.

IMPACTED TEETH

50. Ans. is B (Impacted mandibular 3rd molars)

Exp.: Lingual split bone technique of removal of impcated lower third molars was introduced by Kelsey
Fry. This method is useful to remove any impacted III molar placed lingually. The operator must be careful
to avoid damage of the lingual nerve.

Tooth division technique was also described by Kelsy Fry. This technique is indicated when a tooth
occupies a large area as in horizontal impaction. Tooth division permits bone removal and consequent
smaller dead space. "Bone belongs to patient and the tooth belongs to the surgeon". This implies the tooth
division technique.

Lateral trephination technique is indicated for removing the unerupted III molar in the age group of 9 to
16 years. This technique uses modified S-shaped incision, which is made from retromolar fossa across the
external oblique ridge.
51. Ans. is B (Lingual nerve)
Exp.: Injury to the Lingual Nerve: The lingual nerve passes forward into the submandibular region from
the infratemporal fossa by running beneath the origin of the superior constrictor muscle, which is attached
to the posterior border of the mylohyoid line on the mandible. Here, it is closely related to the last molar
tooth and is liable to be damaged in cases of clumsy extraction of an impacted third molar.

52. Ans. is A (Clefting of the palate)

Exp.: Clefting of palate is a developmental defect. All other options are due to paralytic involvement of
vagus nerve.