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1
Q

What condition is a consequence of liver Cirrhosis?

A

Oesophageal Varices

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2
Q

Alpha cells in the pancreas secrete what substance?

A

Glucagon

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3
Q

How many layers are in the cortex of the adrenal gland?

A

3 layers

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4
Q

Visual acuity tests the function of which cranial nerve?

A

optic nerve

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5
Q

What is a typical feature of hypothyroidism?

A

Depression

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6
Q

What best describes Cushing’s response in raised intracranial pressure?

A

Hypertension and bradycardia

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7
Q

In Barret’s oesophagus which metaplasia is taking place?

A

Squamous epithelium is replaced by columnar epithelium.

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8
Q

A male smoker has chest tightness after walking up a hill. The pain disappears shortly after, what is the diagnosis?

A

Stable Angina.

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9
Q

An elderly patient has a shuffling gait and a pill rolling tremor at rest, which part of the brain is abnormal?

A

The substantia Nigra.

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10
Q

A 25 year old homeless patient presents with a chronic cough and haemoptysis, which is the most likely diagnosis?

A

Tuberculosis.

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11
Q

Which feature of dementia would indicate a vascular aetiology?

A

Step-wise progression.

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12
Q

A one ‘pack-year history’ is equivalent to what?

A

Smoking 20 cigarettes a day for a year.

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13
Q

Which test, tests the motor function of the trigeminal nerve?

A

Jaw jerk reflex.

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14
Q

Antidiuretic hormone has what effects?

A

Increases blood volume.

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15
Q

Failure of what results in left ventricle dysfunctoin?

A

Frank-starling Law

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16
Q

For an average male, what is the volume of distribution of a drug confined to the plasma?

A

3 litres

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17
Q

What condition is treated with a muscarinic receptor antagonist?

A

COPD

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18
Q

What is the treatment for gastric acid related disease that can cause blackening of the tongue?

A

Bismuth Chelate

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19
Q

How does warfarin act as an anticoagulant?

A

It inhibits VKORC1 which reduces the activity of clotting factors 2, 7, 9 and 10.

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20
Q

How is benzydamine administered?

A

Oral spray/Mouthwash

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21
Q

ACE inhibitors are used for which clinical condition?

A

Hypertension

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22
Q

What is a side effect of short acting beta antagonist thereapy?

A

Trembling

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23
Q

How does aciclovir work?

A

It inhibits the herpes virus DNA polymerase.

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24
Q

What is a none selective agonist of a dopamine receptor?

A

Apomorphine

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25
Q

What glutamate antagonist can be used to treat Alzheimer’s disease?

A

Memantine

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26
Q

Gingival hyperplasia and excess hair growth are side effects of what?

A

Phenytoin

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27
Q

What is a side effect of gliptin?

A

Gastro-intestinal disturbances.

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28
Q

Excessive exposure o glucocorticoids can lead to what?

A

Cushings syndrome

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29
Q

What drug is a tricyclic antidepressant?

A

Vomipromine

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30
Q

What is an intravenous anaesthetic agent?

A

Propofol

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31
Q

What drug is used to treat a morphine overdose?

A

Naloxone.

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32
Q

What can the hormone antagonist tamoxifen cause?

A

Thrombosis

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33
Q

What is the purpose of a vasoconstrictor in La?

A

To increase the duration of action of the anaesthetic.

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34
Q

How is mumps spread?

A

Through infected droplets of saliva.

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35
Q

Koplick’s spots are associated with which disease?

A

Measels.

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36
Q

What causes a burning sensation and is result of secondary activation of the herpes varicella zoster virus?

A

Post herpetic neuralgia

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37
Q

What is a benign jaw overgrowth of normal mature cells that can be compound or complex?

A

Odontmes

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38
Q

What is not a symptom of colorectal cancer?

A

Dysphagia.

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39
Q

What are the two causes of chronic kidney disease?

A

Diabetes and hypertension

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40
Q

What term is used to describe a drug that enters the blood plasma following administration?

A

Absorption

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41
Q

If a patient is FAST positive what condition do they have?

A

A stroke

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42
Q

What is likely to be associated with a previous XLA site of a lower molar?

A

A residual cyst

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43
Q

What is the most common cause of dementia?

A

Alzheimer’s Disease

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44
Q

What is the concentration of a drug that produces half the maximal response denoted as?

A

ED50

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45
Q

Which histamine receptor antagonist is most likely to cause sedation?

A

Promethazine.

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46
Q

What lesion is a whitish plaque or patch with no clinical cause other than the use of tobacco?

A

Leucoplakia

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47
Q

What bacterial infection is associated with Mulberry molars?

A

Congenital syphilis

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48
Q

What is the most common cause of a mucous retention cyst?

A

Sialoth

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49
Q

If a patient is experiencing chest pain on minimal exertion, the angina is…

A

Unstable

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50
Q

What is the most common type of HPV associated oral cancers?

A

HPV16

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51
Q

How can HPV positive head and neck cancer be described?

A

At the tonsils.
Involves Basaloid SCC
Affects the younger generation
Males more
Socioeconomic status is higher
Associated with sexual behaviour
Survival rates are increasing

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52
Q

How can HPV negative head and neck cancer be described?

A

It is at all sites
Keratinised SCC
Older generation
affects males more
Risk factors are alcohol/tobacco/diet/hygiene
survival rates are decreasing

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53
Q

what are the risk factors for potentially malignant lesions?

A

HPV
Alcohol
Tobacco
OH
Diet
Family history
Age
Gender
Race

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54
Q

What was the first material that was used for air polishing?

A

Sodium Bicarbonate

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55
Q

What is biological width?

A

The distance from the Junctional Epithelium to the root of the tooth.

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56
Q

What is the liver supplied by?

A

The portal Vein

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57
Q

What is the function of the liver?

A

To synthesise plasma proteins.
Make clotting factors.
Store glycogen, vitamins and minerals.
Make bile.
Provide immunity through hepatic macrophages.

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58
Q

What is a liver function test (LFT)?

A

Looks for ALT and if it is elevated it indicates damage.

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59
Q

What can excessive alcohol intake do to a person’s oral health?

A

More susceptible to erosion.
Oral cancer
Dental trauma
Poor OH
Halitosis
Reduced bone density

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60
Q

What are the causes of chronic liver disease?

A

Alcohol
Obesity
Viral hepatitis

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61
Q

How is alcohol metabolised?

A

Alcohol dehydrogenase.
cytochrome P450 system.

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62
Q

How does liver disease present?

A

Abdominal pain
weight loss/gain
Malnutrition
Anorexia
fatigue
Perineal fluid build up

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63
Q

How would you manage a stroke?

A

999 an O2, protect airway.

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64
Q

What are some dental considerations to be made for those who have had a previous stroke?

A

They may be on anticoagulants
Poor OH - may need modifications
Paralysis of the facial muscles
Reduced sensation
Communication
Carers

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65
Q

If a patient having a stroke has ataxia and is ‘past pointing’, where is the stroke?

A

Ischaemic stroke in the middle cerebral artery.

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66
Q

What is a xenobiotic?

A

A chemical or substance that is found in an organism but it is not produced naturally.

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67
Q

How does a pulmonary embolism present?

A

Pleuritic chest pain
Dyspnoea
Collapse
Hypotension
Tachycardia
Fever

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68
Q

What are the dental considerations to be made for a patient with a previous pulmonary embolism?

A

Anticoagulants (INR)
Delay none urgent procedures.

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69
Q

What are the role of lipids?

A

They help to control what goes in and out of the cell.

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70
Q

What is vitamin E?

A

A fat soluble nutrient that protects cells from damage by free radicals.

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71
Q

What are the kidneys supplied by?

A

The renal artery

72
Q

What part of the loop of henle is impermeable to water?

A

The ascending

73
Q

What is tubular resoption?

A

Where water and solutes pass between the tubule and surrounding vasa react to determine what should be excreted.

74
Q

The surrounding tissue of the loop of henle has a high osmolarity but why is there a high interval content?

A

Due to high sodium chloride.

75
Q

What is the collecting duct regulated by?

A

Anti diuretic hormones.

76
Q

How does acute renal disease present?

A

Reduced urine output
Dizziness
Vomiting
Orthopnoea
Peripheral oedema
Tachycardia

77
Q

What are the dental considerations for renal disease?

A

To treat the day after dialysis
They are predisposed to blood borne viruses
La is safe unless a bleeding tendency.

78
Q

What is a class III malocclusion?

A

Where the mandible is protruded relative to he maxilla.

79
Q

What is the class III incosor relationship?

A

The lower incisor edges lie anterior to the cingulum of the upper incisor and the overjet is reduced.

80
Q

What are the general factors that affect the occlusion?

A

Skeletal pattern
CROWDING
Early loss of deciduous teeth
Gernalised spacing

80
Q

What are the general factors that affect the occlusion?

A

Skeletal pattern
CROWDING
Early loss of deciduous teeth
Gernalised spacing

81
Q

What are the local causes of malocclusion?

A

Abnormalities in the number of teeth
Abnormalities in the shape of the teeth
Abnormalities in the position of the teeth.
hibits
Pathology

82
Q

If a patient had an asthma attack, how would you manage the symptoms?

A

Salbutamol inhaler
O2
Assess pulse and BP
Pupil size
Blood glucose
Temperature
Remove allergens
999 if unstable

83
Q

What are the main complications of diabetes?

A

Microangiopathy
Nephropathy
Neuropathy
Macro vascular disease
Delayed wound healing
Periodontitis

84
Q

What are the differences in the immune response with patients that have diabetes?

A

There is altered function of neutrophils (adherence/chemotaxis)
Immune inflammatory responses are upregulated which increases host tissue destruction

85
Q

AGEs alter functions of the extracellular matrix, how do they affect collagen formation?

A

Increase cross linkage between collagen molecules.
reduce solubility
Decrease turnover rate.

86
Q

How can periodontitis have a negative impact on glycaemic control?

A

Diabetes exacerbates the elevated production of pro-inflammatory cytokines.
Increases insulin resistance
Poor wound healing leads to attachment and bone loss.

87
Q

What is azole antifungal used to treat?

A

Oral thrush and cadidiasis

88
Q

How do you manage a patient on warfarin?

A

INR checked 72 hours before in a stable patient.
INR below 4
NO NSAIDs
Delay any non-urgent procedures
See at the beginning of the day
Multiple surgery visits
Antibiotics can increase INR
Refer to primary care if liver impairment
LA with vasoconstrictor
Haemostatic agent

89
Q

What are the factors affecting nerve damage in and extraction?

A

Clinicians expertise
tooth sectioning
Time
Surgical technique
Formed roots
Roots close to the nerve bundle
Age
Distal bone removal
Visualisation of mandibular canal.

90
Q

What is the role of vitamin D?

A

To help the body absorb and retain calcium and phosphorus.

91
Q

Who signs the patient group direction?

A

Dentist/doctor/pharmacist

92
Q

What antibiotics should be avoided in a patient on warfarin?

A

Metro/ammox

93
Q

Antibiotics with the worst resistance are…

A

Penicillin

94
Q

What are the responsibilities when prescribing drugs?

A

To avoid creating dependence
Ensure that the patient can’t increase the dose
Avoid being an unwitting source for addicts.

95
Q

What are the most common side effects with antibiotics?

A

Allergic reaction
Anti-biotic associated colitis
Diarrhoea
Nausea

96
Q

What advice would you give to a diabetic patient with periodontitis?

A

OHI
Eat before appointment
Short recall
Morning appointments
Topical
Prophylactic antibiotics
Diet advice
Good glycaemic control
PMPR
Fluoride

97
Q

What is a radicular cyst?

A

Associated with non-vital teeth. Treat with enucleation during RCT or XLA.

98
Q

What is a residual cyst?

A

Inflammatory odontogenic cysts that are asymptomatic and present on post XLA sites.

99
Q

With what conditions will a patient be put of warfarin?

A

Stroke
Heart attack
Deep vein thrombosis
Pulmonary embolism
Atrial fibrillation
Clotting disorders

100
Q

What type of analgesic is paracetamol?

A

Antipyretic analgesic

101
Q

What does cocodamol contain.

A

codeine and paracetamol

102
Q

What are the 6 keys to an ideal occlusion?

A

Correct molar relationship
Correct crown angulation
correct crown inclination
Teeth in contact
No rotations
Flat occlusal plane

103
Q

What is a class I incisor relationship?

A

The lower incisor edges occlude with or lie immediately below the cingulum plateau of the upper centrals.

104
Q

Describe a class II incisor relationship?

A

The lower incisor edges lie posterior to the cingulum plateau of the upper incisors with an increased overjet and proclined uppers.

105
Q

What is a class III incisor relationship?

A

The lower edges lie anterior to the cingulum plateau of the upper incisors. The over jet is reduced or reversed.

106
Q

What are the risk factors of root caries in the elderly?

A

Diet
OH habits
fluoride exposure
Past dental history
Overall health
Dentures
Dexterity
Xerostomia
Gingival recession

107
Q

What advice and treatment would you give for root caries?

A

GIC restoration
Fluoride
OHI
Diet advice
Check medications for dry mouth
Atraumatic restorative technique
establish risk
consider risk factors

108
Q

What are the treatment targets for a referral?

A

a 2 week rule that the patient must have a diagnosis in 31 days and treatment to start within 62.

109
Q

What are the short term complications of head and neck cancer?

A

Mucositis
Infection
Xerostomia
Pain
dysgeusia

110
Q

When may a patient need an urgent referral?

A

when there are red and white patches present that are painful, swollen or bleeding.

111
Q

Where would you make an urgent referral to?

A

Maxillo-facial/oral med unit

112
Q

How is peri-implantitis diagnosed?

A

Plaque and calculus accumulations
Inflammation of the peri-implant tissue
Increase in peri-implant probing depth
BoP
Suppuration
Mobility
Radiographic changes

113
Q

What is peri-implantitis?

A

An inflammatory process around osseo-integrated implants involving the loss of bone. Peri-implant disease and periodontal diseases have similar signs and symptoms.

114
Q

What are the microbes that are commonly involved in peri-implantitis?

A

Spirochetes
Gram negative anaerobes

115
Q

What are three illnesses that are associated with the elderly?

A

Dementia
Stroke
Parkinson’s

116
Q

What is the warfarin action in relation to vitamin K?

A

Warfarin is a vit K antagonist.
It inhibits VKORC1 which reduces clotting factors 2,7, 9, 10.

117
Q

What is a full mouth disinfection?

A

Used to treat periodontal disease where half the mouth is treated at each visit under LA to remove plaque and calculus where bacteria are killed with chlorohexidine mouthwash.

118
Q

What type of tooth whitening causes root resorption?

A

Intracoronal bleaching

119
Q

What is the definition of institutional abuse?

A

The mistreatment of people through inadequate care to ensure the smooth running of an organisation.

120
Q

What is the definition of descrimination?

A

Prejudicial treatment of people based on their race, ethnicity, gender, sex, disability or age.

121
Q

What are the protected characteristics in the equality act?

A

Age
Sex
Gender Reassignment
Disability
Marriage
Pregnancy
Race
Religion
Sexual orientation

122
Q

How does heart failure present?

A

Tachycardia
Can’t lie down
Fatigue
Palpitations
Confusion
Chest pain

123
Q

What are the risk factors of heart failure?

A

Diabetes
Hypertension
Age
Male
MI
Dyslidaemia

124
Q

What does the failure of the Frank-Starling law mean?

A

That there is increased CO2 and fluid retention.

125
Q

How is heart failure managed by the patient?

A

Beta blockers
Aldosterone antagonists
Lifestyle changes
Implantable cardiac defibrilator
Heart transplant
Pacemaker

125
Q

What are some dental considerations to be made for a patient with heart failure?

A

Polypharmacy
Dry mouth
Poor healing
Increased infection risk
O2 requirement
Don’t lie flat

126
Q

What is the pathophysiology of asthma?

A

A trigger leads to the inflammatory response.
CD4 leukocytes, Chemokines and mast cells release histamine.
The white cells are inflamed and pour into the airway.
This leads to vasoconstriction and a high level of mucous.

127
Q

How does asthma present?

A

Expiratory wheeze
Cough
dyspnoea

128
Q

What are the triggers of asthma?

A

Viral infections
Bacterial infections
Allergens
Occupational exposures
Food additives
Aspirin
Strong emotion

129
Q

A patient begins to have an asthma attack whilst in the midst of treatment, What do you do?

A

Remove all instruments and stop treatment.
Airway - Is the patient breathing? Are they awake, can they talk to you?

130
Q

In the peripheral airways of patients with COPD, why is there airflow limitation?

A

Loss of alveolar attachments
Inflammatory obstruction of the airway
Luminal obstruction with mucus

131
Q

How do inhaled corticosteroids help those with COPD?

A

LCS’s decrease the rate of exacerbation and improve the response to bronchodilators and decrease dyspnea in stable COPD

132
Q

How is COPD diagnosed?

A

A diagnosis is made from one or more of the symptoms: -
- Exertional breathlessness
Chronic cough
Irregular sputum production
Winter bronchitis
Wheeze

133
Q

Describe the pathophysiology of COPD.

A

Noxious particles cause microdamage which leads to inflammation.
CD8+, cytokines and macrophages are released to combat inflammation.
Production of proteases which causes destruction of the alveolar wall and mucous hypersecretion.

134
Q

What are the pharmacological properties of Atropines?

A

Non-selective muscarinic antagonists.
Long duration of action.
Lipid soluble and well absorbed.

135
Q

What are the pharmacological properties of Atropines?

A

Non-selective muscarinic antagonists.
Long duration of action.
Lipid soluble and well absorbed.

136
Q

What are the adverse effects of Atropine?

A

urinary retention
Blurred vision
Dry mouth

137
Q

What is glaucoma characterised by?

A

Elevation of intraocular pressure.
Atrophy of the optic nerve.
Gradual loss of vision

138
Q

What is Ipratropium?

A

A non-selective muscarinic antagonist that acts as a broncho-dilator.

139
Q

What are the adverse effects of Ipratropium?

A

Dry mouth
Altered taste
Throat irritation

140
Q

In the body, where is histamine mainly found?

A

Mast cells
Leukocytes
Neurons

141
Q

What is histamine?

A

An amine that modulates the local immune responses and regulates physiological function.

142
Q

What are H1 receptor antagonists used for?

A

To treat inflammatory and allergic conditions.

143
Q

What do H2 receptor antagonists do?

A

To treat peptic ulcers and inhibit gastric acid secretion.

144
Q

What are the adverse effects of H1 receptor antagonists?

A

Dry mouth
Blurred vision
Urinary retention
If they cross the blood-brain barrier than it can cause sedation.

145
Q

What histamine receptor antagonist is structually reltaed totricyclic antidepressants?

A

Loratadine

146
Q

What are the adverse effects of muscarinic histamine antagonists that are related to dentistry?

A

Burning sensation in the mouth
Poor OH
Increase in dental caries
Increase risk of perio
Intolerance to dentures
Oral infections

147
Q

What protects the mucous cells from acidic lumen in the stomach?

A

Mucous layer with HCO3

148
Q

Which prostaglandin has cytoprotective effects?

A

PGE2

149
Q

How do peptic ulcers develop?

A

failure of luminal defences.
Failure to inhibit gastric acid secretion.
Increased pepsin secretion
Increased gastric acid emptying into the duodenum.

150
Q

What condition is charactrised by discomfort, bloating and a feeling of fullness.

A

Dyspepsia

151
Q

What are complication of peptic ulcer disease?

A

bleeding
Perforation
Peritonitis
Septicaemia
Scarring

152
Q

What molecules stimulate gastric acid secretion?

A

Acetylcholine
Histamine
Gastrin

153
Q

What inhibits gastric acid secretion?

A

Somastatin

154
Q

What is an example of a proton pump inhibitor that inhibits gastric acid secretion?

A

Omeprazole

155
Q

Wat is an example of a histamine receptor antagonist that inhibits gastric acid secretion?

A

Cimetidine

156
Q

What is sucrulfate?

A

A cytoprotective drug.

157
Q

Why should misoprostol beavoided in pregnancy?

A

Causes uterine contractions.

158
Q

What is the triple therapy to eradicate a H pylori infection?

A

Proton pump inhibitor
Anti-bacterial
Bismuth subsalicylate

159
Q

What are the four movements of a fixed orthodontic appliance?

A

Tipping
Intrusion
Extrusion
Bodily tipping

160
Q

How do you know if a removable appliance has not been worn?

A

No movement
No pt lisp
No wear and tear
Trouble inserting appliance
No imprints on the soft tissue
Springs are active

161
Q

What are the active components in a removable prosthesis?

A

Springs
Screws
Balls
Elastics

162
Q

What is the mechanism of action of Azole anti fungal?

A

There is cell membrane synthesis
It inhibits Ergesterol synthesis
It is bacteria static against S.Aureus

163
Q

What do azole anti fungals interact with?

A

Warfarin
Simvastatin

164
Q

What are some antibiotics to avoid in warfarin?

A

Metronidazole
Erythromycin
Clindamycin

165
Q

What information would you put on a referral letter for an oral lesion?

A

Patient details
Consultant
Relevant department
Address appropriately
Mark the letter as urgent under two week rule
Clinical description of the lesion
Attach images
Any related lesions
X-rays
Differential diagnosis
Sign with name and qualification

166
Q

How would you appropriately probe around an implant?

A

A calibrated probe
0.25N
BPE at every visit
6PPC once a year
Fixed reference point

167
Q

What is the role of carbohydrates?

A

To support the body with energy and maintain blood glucose levels.

168
Q

What is the role of fats?

A

To insulate the body from cold
To cushion the organs

169
Q

Which drug legislation includes:-
Authorisation of medicinal products for human use.
Manufacture, import, distribute, sale and supply.
Levelling and advertising.

A

Human medicines regulations 2019

170
Q

What is in the misuse of drugs act 1971?

A

Controls the use of drugs linked to addiction and other social problems.

171
Q

What is contained in the misuse of drugs act 2001?

A

Defines who is allowed to supply, prescribe and possess controlled substances.
Lays down the conditions for their use.

172
Q

What is a dentigenerous cyst?

A

Associated with an unerupted tooth.

173
Q

A neoplasm with more than one germ layer is known as what?

A

Teratoma

174
Q

What are common musculoskeletal disease related to the elderly?

A

Osteoporosis
Osteoarthritis
Rheumatoid arthritis

175
Q

What is excessive bleeding from warfarin treated with?

A

Vitamin K

HHD 2 (5 decks)

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