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Past Questions > Oral Med and Oral Surg > Flashcards

Oral Med and Oral Surg Flashcards

1
Q

What is an OAC?

A

Oro-antral communication. It is an unnatural communication between the oral cavity and the maxillary sinus that is not yet epithelial lined. IMMEDIATE

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2
Q

Management of an OAC

A

Buccal advancement flap - with vertical mattress suture
Buccal fat pad
Palatal rotation flap

Give antibiotics (tetracyclines), analgesics and decongestants (ephedrine, xylometazoline)

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3
Q

What is ANUG?

A

acute necrotising ulcerative ginigivitis. Loss of interdental papillae and halitosis, painful and bleeding gums

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4
Q

Causes of ANUG

A

Mixed bacterial infection that includes anaerobes. Spirochetes, Fusobacterium nucleatum, Prevotella intermia, Treponema, Borellia vincentii

Predisposing factors - Smoking, stress, poor OH, immunodeficiency, viral respiratory conditions

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5
Q

Treatment for ANUG

A

OHI, debridement,Short course of systemic antiobiotics - Metronidazole

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6
Q

How does Metronidazole work?

A

Bacteriacidal against protozoa and anaerobic bacteria. Inhibits DNA synthesis by causing strand breakage of bacterial DNA.

200mg TDS

Disulphuriam like reaction with alcohol

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7
Q

Principles of flap design

A 
Broad base
incision on sound bone
avoid vital structures
full thickness flap
include the interdental papillae
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8
Q

What is desquamative gingivitis?

A

erythematous, shedding, ulcerated appearance of gums. Associated with pemphigus, pemphigoid, lichen planus, dermatitis hepetiformis

NOT PLAQUE INDUCED

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9
Q

What is muscous membrance pemphigoid?

A

autoimmune Primary vesiculo-bullous disorder. Sub-epithelial. Auto antibodies against the epithelial basement membrane. (IgG and c3 along the basement membrane) Conjunctiva involvement

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10
Q

What is pemphigus

A

Most common vulgaris. Autoimmune primary vesiculo bullous disorder. Intra-epithelial. IgG mediated against desmoglein 1 + 3

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11
Q

What is an OAF

A

Or-antral fistula - epithelium lined tract which forms within 48 hours of extraction

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12
Q

What is dysplasia?

A

Abnormaltiy of development. expansion of immature cells and reduction in mature cells. Moderate and severe dysplastic changes should be excised due to the risk of malignant change

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13
Q

Pathological, microscopic changes in dysplasia?

A
  1. Anisocytosis - cells of unequal size
  2. Poikilocytosis - cells of abnormal shape
  3. Hyperchromatism
  4. Increase in mitotic figures
  5. Drop shaped rete ridges
  6. lack of cell polarity
  7. increase in nucleus to cytoplasmic ratio
  8. loss of intercellular adhesion
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14
Q

When do you extract 8’s?

A

Evidence of pathology (caries, periapical pathology, abcess, internal/external resporption of adjacent teeth.

Impeding jaw surgery
greater than 2 episodes of pericoronitis

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15
Q

Types of lichen planus

A

Reticular, erosive, atrophic, plaque-like, papular, bullous

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16
Q

Which types of lichen planus have the worst prognosis

A

erosive and plaque-like (atrophic)

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17
Q

Points of note when looking at a radiograph showing wisdom teeth

A

1/ Angluation of tooth

  1. proximity to the ID neve
  2. shape of the root
  3. position of the second molar
  4. texture of surrounding bone
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18
Q

Differentials of a non-healing socket

A

SCC, BRONJ, osteoradionecrosis, dry socket

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19
Q

What is chronic erythematous candidosis

A

Chronic form of candidosis, most commonly seen in denture wearers. Mucosa is erythematous and the mucosa may become nodular –> papillary hyperpalasia

Diagnois - seperate smear/swab of denture and mucosa,

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20
Q

Where do you give an ID block

A

in the pterygomandibular space. You palpate for the external oblique ridge and advance the needle into the raphe. Usually approach from the opposite premolar area

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21
Q

What is the nerve pathway for the trigeminal nerve

A

Opthalmic - Superior orbital fissure (sensory)
Maxillary - Foramen Rotundum (sensory)
Mandibular - foramen ovale (Sensory and motor)

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22
Q

Differentials for a unilocular radiolucency in the angle of the mandible

A
  1. Radicular cyst - unilocular, well defined at the apex of a non-vital tooth. can displace teeth
  2. Residual cyst - a remaining radicular cyst after tooth removal
  3. Dentigerous cyst - remenants of the reduced enamel epithelium after tooth formation, the crown is unerrupted.
  4. Odontogenic keratocyst - usually associated with an unerupted tooth. Tooth displacement and extensive expansion with cancellous bone
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23
Q

are lesions above the ID canal odontogenic or non-odontogenic

A

odontogenic

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24
Q

What is a mucocele

A

an accumulation of mucous either in the connective tissues (extravastation) or in the salivary duct (retention)

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25
Q

What is a ranula

A

a mucocele inthe floor of the mouth

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26
Q

Herpes labilais

A

Herpes infection caused by HHV 1 AND 2. Very infectious - symptoms usually begin as a burning/tingling sensation in a localized region

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27
Q

Factors which predispose you to herpes labialis

A 
immunosuppression
sunlight
hormonal changes
stress
trauma 
fever
menstruation
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28
Q

What is median rhomboid glossitis

A

It is an erythematous rhomboid area of depapillation on the dorsum of the tongue in the midline, anterior to the circumvallate papilla, Treatment is by the use of antifunglas

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29
Q

Predispositions to candida

A 
immunosupression 
systemic steriods
diabetes
anaemia
poor intra-oral appliance hygiene
extremes of age
malnutrition
smoking
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30
Q

What is angular chelitis?

A

erythema +/- yellow crusting at one or both corners of the mouth, Associated with candidal or staph aureaus infection.

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31
Q

Side effects of systemic steriods

A 
Cushingoid features
buffalo hump
moon face
diabetes
hypertension
thin skin
central obestity
fragile hair 
immunosuppression
glaucoma
huirsutism 
gastric ulceration -- DONT GIVE NSAIDS
osteoperosis
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32
Q

Geographic tongue

A

mucosal condition resembles psoriasis histpathologically

irregular depapillated erythematous areas surrounded by pale well-demarcated margins on the dorsal surface and lateral borders of the tongue

unknown aetiology

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33
Q

Herpes zoster

A

childhood- chicken pox
adulthood - shingles

VZV progresses along the sensory nerves to the nerve ganglia where tit resides in the latent form.

Reactivation characteristically follows suppression due to malignancy, drug administration or HIV infection

ZOSTER DOES NOT CROSS THE MIDLINE

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34
Q

Sialadentis

A

Viral - Mumps (paramyxovirus)
Bacterial - usually caused by reduced salivary flow - staph aureas, strep viridans and strep pneumoniae. Strictly anaerobes

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35
Q

Dermatitis herpetiformis

A

primary vesiculo-bullous disease. RELATIONSHIP WITH COELIACS disease. Development of blisters on the skin and oral mucosa, Granular deposition of IgA along the basement membrane
Treatment - dapsone

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36
Q

What is HIV

A

human immunodeficiency virus that causes AIDS. Transmission through blood semen and breast milk.

Lentivirus/ retrovirus
Attaches to gp120 on cells
Lowers CD4 t-cell numbers

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37
Q

Haemophilia A

A

Factor viii deficiency

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38
Q

Haemophilia B

A

Factor IX deficiency

39
Q

What is Sjogrens

A

chronic autoimmune disease in which the bodies white cells destroy the exocrine glands

Primary - dry eyes and dry mouth
Secondary - CT disorder in addition to suffering from dry eyes/dry mouth (rhematoid arthritis, SLE, systemic sclerosis, primary biliary cirrhosis)

40
Q

Histology of lichen planus

A

Linear deposition of fibrinogen along the basement membrane but no deposition of Igs or complement (with direct immunofluoresence)

Hyperkeratinized epithelium, basal cell destruction and band-like infiltration of t lymphocytes

41
Q

What is eccymosis

A

subcutaneous purpura greater than 1cm. ie a bruise not caused by trauma

42
Q

What is azathioprine

A

Purine analogue and is an immunosupressive drug. Inhibits DNA synthesis of rapidly diving cells and so strongly affects cells such as B and T cells.

Main adverse effect is bone marrow supression.

43
Q

What blood test do you do before giving dapsone

A

Glucose 6 phosphate dehydrogenase

44
Q

What blood test do you do before giving azothioprine

A

TPMT - Thiopurine methyl transferase

45
Q

What is the relevance of TPMT

A

Patients are tested for it prior to the use of thioprine drugs. Low TPMT increases the risk of drug-induced bone marrow toxicity due to the accumulation of unmetabolised drug

46
Q

What can you do to test for Candida

A
  1. Swab to culture
  2. take a smear and histologically stain with a PAS stain - stain the carbohydrate in the fungal cell wall magenta
  3. You can also do a rinse of phosphate-buffered saline
  4. Mucosal biopsy for chronic hyperplastic candidiosis
47
Q

What are the indications for prescribing antibiotics

A

Systemic involvement such as fever, lymphadenopathy, pyrexia.

Pus and trismus

48
Q

Where can the spread of infection go?

A

Direct spread – through facial planes/ muscles. ie the path of least resistance
Lymphatics
Veins – cavernous sinus thrombosis

49
Q

What is a cavernous sinus thrombosis

A

Formation of a blood clot in the cavernous sinus, which is a cavity that drains deoxygenated blood from the brain back into the heart

Staph aureas and streptococcus are usually the causative agents

50
Q

Signs and symptoms of a cavernous sinus thrombosis

A

Decrease loss of vision, drooping or bulging eyes, headaches, paralysis of the cranial nerves (II,IV, V1, V2, VI)

51
Q

Why do you get a chin point/sub metal swelling when there is pathology associated with the mandibular incisors

A

There is a thin labial cortical plate and the mentalis attaches above the apices

52
Q

What is Ludwigs angina

A

Spreading of infection of the sublingual and submental spaces bilaterally. Occurs bilaterally due to the lack of posterior border of the mylohyoid. The swelling forces the tongue up against the palate which causes airway obstruction

53
Q

Spread of infection of pericoronitis

A
  1. Buccal space
  2. Cheek space
  3. Pterygomandibular space
  4. Tonsilla space
  5. Retropharyngeal
  6. lateral pharyngeal
  7. Sub masseteric
54
Q

What is pericoronitis

A

Infection of the operculum or the soft tissues overlying a partially erupted tooth

55
Q

What is in LA

A 
LA base
HCL Salt
vasoconstrictor
buffering agent
preservatives
56
Q

in which direction should you suture

A

from free to fixed

57
Q

Indications for surgical endodontics in the presence of periradicular disease

A

(with or without symptoms)
1, non-surgical root treatment has failed
2. trauma
3. perforations
4. re-root treatment cannot be undertaken due to obliterated canals, very curved canals, fractured instrument.
5. where a biopsy of the periradicular tissue is needed

58
Q

What do bisohosphonates do?

A

They have an affinity for hydroxyapetite crystals and are absorbed by the bone. They inhibit osteoclast mediated bone resorption

59
Q

What radiographic features show an intimate relationship of the IDN with a wisdom tooth?

A
  1. Loss of tramlines
  2. Narrowing of tramlines
  3. sudden change in the direction of tramlines
  4. Radiolucent band across the root
60
Q

Why does LA work less well in patients with acute infection

A
  1. inflammed tissues are acidic and therefore LA is ionised in tissues before it can cross the neural cell.
  2. Increased vascualrity of tissues - solution is removed more quickly
  3. Prostaglandins increase the threshold of nerves thus a higher concentration of LA is needed to anaesthetise
61
Q

Frey’s syndrome

A

occurs due to surgeries in the parotid gland or due to injury of the auriculotemporal nerve (V3) which passes through the parotid gland

Severence of the nerve can cause inappropriate regeneration of parasympathetic nerve fibres –gustatory sweating

62
Q

Bacteriocidal antibiotics

A

Penicillins, metronidazole, cephalosporins

63
Q

Bacteriostatic drugs

A

erythromycin, tetracyclines, clindmycin

64
Q

Allodonyia

A

Pain caused by a stimulus that doesn’t normally cause pain

65
Q

Paraethesia

A

Spontaneous and subjective altered sensation that a patient doesn’t find painful

66
Q

Dysaethesia

A

Spontaneous and subjective altered sensation that a patient finds painful

67
Q

Where are you most likely to come across FNAC

A

Ultrasound guided in a neck lump clinic enables you to examine cell structure and morphology. NOT TISSUE

68
Q

Stages of tooth development

A

bud, cap bell

69
Q

Potentially malignant lesions in the oral cavity

A

Oral lichen planus, erythroplakia, leukoplakia, dyskeratosis congentia, submucous fibrosis, acitinic chelitis

70
Q

What would increase the risk profile of leukoplakia?

A 
Location - FOM, retromolar pad, tongue
Colour - mixed red and white
Texture - raised and non-homogenous
Induration
Presence of ulceration
71
Q

What is leukoplakia

A

A white patch that cannot be identified clinically or pathologically. It cannot be rubbed off

72
Q

What is erthyroplakia

A

A red patch that cannot be identified clinically or pathologically. It has a high risk of malignant transformation.

73
Q

Causes of SCC

A

Smoking, genetic, alcohol, betel quid, HPV

74
Q

Histological features of SCC

A

Dysplasia, invasion through the basement membrane, perineural and vascular invasion

75
Q

What is an odontogenic tumour?

A

A group of heretogenous diseases (benign or malignant) derived form elements of the tooth forming apparatus that contain odontogenic epithelium and/ or odontogenic connective tissue

76
Q

Odontogenic cysts

A

Radicular cyst, residual cyst, dentigerous cyst and lateral periodontal cyst

77
Q

Non-odontogenic cysts

A

Nasopalatine
Nasolabial
Bone cysts - aneurysmal or solitary bone cyst

78
Q

Where is the most common place to have a radicular cysts?

A

Upper laterals. A radicular cyst is in continuity with the lateral periodontal ligament of the affected tooth

79
Q

What is a residual cyst

A

A radicular cyst that remains once the causative tooth has been removed

80
Q

What is a dentigerous cyst?

A

Remnants of the reduced enamel epithelium after tooth formation. From the crown of and unerupted and displaced tooth

81
Q

Where does the nasolabial cyst originate

A

remnants from the embryonic nasolacrimal duct

82
Q

Multilocular radiolucencies

A

Odontogenic tumours and giant cell lesions

83
Q

Giant cell radiolucencies

A

Aneurysmal bone cyst
Browns tumour of hyperparathyroidism
Cherubism
Central giant cell granuloma

84
Q

Multilocular odontogenic tumours

A 
Odontogenic keratocyst
Ameloblastoma
odontogenic myxoma
ameloblastic fibroma
odontogenic fibroma
sialo-odontogenic tumour
85
Q

Where do odontogenic keratacysts usually occur

A

Posterior/body of the mandible
anterior maxilla in the canine region
Smooth, scalloped, well defined and corticated

Present commonly in patients with Gorlin-goltz syndrome.

86
Q

Ameloblastoma

A

Multilocular. Soap bubble effect. Benign but very aggressive. disfiguring

87
Q

cysts vs tumour

A

cysts displace teeth and tumours resorb teeth/roots project into the tumour

88
Q

Central giant cell granuloma

A

Occur in the mandible and the main feature is that it crosses the midline. It is multilocular and has a honeycomb appearance

89
Q

Cherubism

A

multilocular, bilateral giant cell lesion

90
Q

Odontomes

A

odontogenic tumour

91
Q

Compound odomtome

A

organised mass of dental tissue. More common in the anterior maxilla. Superficial resemblance to teeth

92
Q

Complex odontome

A

unrecongizable as dental tissues, Usually appears in the posterior mandible

93
Q

Osteomyelitis

A

Bone infection and inflammation usually caused by bacteria, It can be chronic or acute and the bone has a moth eaten appearance.

94
Q

What conditions can cause opactities of the antrum

A 
Thalassemia
Sickle cell anaemia
Fibrous dysplasia
Pagets disease of the bone
osteopetrosis

Past Questions (1 decks)

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