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oral surgery Flashcards

1
Q

Which of the following is not a complication of removal of mandibular wisdom teeth?

a. dry socket
b. anaesthesia of the inferior dental nerve
c. parasthesia of the facial nerve
d. paraesthesia of the lingual nerve
e. trismus

A

C - paraesthesia of the facial nerve.

Facial nerve is not involved.

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2
Q

An incisional biopsy is indicated in which of the following lesions?

a. SCC
b. fibroepithelial of the lip
c. buccal haemangioma
d. palpable submandibular gland lump
e. amalgam tattoo

A

A - SCC

An excisional biopsy would be contraindicated.

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3
Q

Which of the following is not a common sign of a fractured zygoma?

a. subconjunctival haemorrhage with no visible boundary
b. diplopia
c. paraesthesia of the infraorbital nerve
d. epistaxis
e. anosima

A

E - anosimia

This is the partial or full loss of smell, not associated with a fractured zygoma (cheek bone).

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4
Q

Which of the following regarding the TMJ is correct?

a. disc attaches to the capsule anteriorly
b. articular surface of the disc is made of hyaline cartilage
c. articular surfaces are covered with hyaline cartilage
d. articular surfaces are covered with fibrocartilage
e. the middle region of the disc is the most vascular region

A

D - the articular surfaces are covered with fibrocartilage.

(the articular surfaces of the disc and joint are made of fibrocartilage and the middle region is avascular)

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5
Q

Which of the following regarding the TMJ is incorrect?

a. TMJ is related to to the lateral aspect of the joint
b. the sphenomandibular ligament extends from the spine of the sphenoid to the lingula.
c. the sphenomandibular ligament is an embryological remnant of Meckel’s cartilage.
d. stylohyoid ligament extends from the tip of the styloid process to the angle of the mandible.
e. the stylomandibular ligament is a remnant of the deep cervical fascia as it passes lateral to the parotid gland.

A

E

this is because the stylomandibular ligament is a remnant of the deep cervical fascia as it passes medial to the parotid gland.

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6
Q

Which of the following are not risk factors for oral cancer?

a. smoking
b. alcohol
c. previous trauma to the site
d. social deprivation
e. betel nut chewing

A

C - trauma is not a risk factor.

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7
Q

Which of the following is an indication for the extraction of a lower wisdom tooth?

a. anterior crowding
b. tooth is distoangular in position
c. pt has had 2 episodes of pericoronitis
d. to balance the XLA of one tooth on one side by extracting the 8 on the other side.
e. to appease a patietn who has atypical facial pain

A

C - 2 episodes of pericoronitis

Even 1 episode of pericoronitis can be an indication for XLA of a wisdom tooth but it has to be severe.

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8
Q

Which statement regarding the submandibular gland is incorrect?

a. it is the second largest salivary gland
b. empties via wharton’s duct
c. has a duct closely related to the lingual nerve
d. produces entirely serous saliva
e. most commonly affected by salivary calculi

A

D - produces entirely serous saliva.

The submandibular gland produces MIXED saliva.

(the rest are correct as the lingual nerve is very easily damaged during the removal of salivary stones as it loops around Wharton’s duct).

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9
Q

Xerostomia does not:

a. occur after radiotherapy
b. occur in pts with sjogren’s
c. occur during panic attacks
d. cause an increase in root caries
e. occur when taking prilocarpine

A

E - xerostomia doesn’t occur when taking prilocarpine.

Prilocarpine is a treatment for xerostomia

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10
Q

Which statement regarding the maxillary sinus is incorrect?

a. it develops by pneumatisation
b. it is the largest of the paranasal sinuses
c. when fully grown, it is pyramidal in shape
d. it is lined by psudostratified ciliated columnar epithelium
e. drains via the osteum into the inferior meatus of the nose

A

E - the maxillary sinus drains via the osteum into the inferior meatus of the nose.

This is incorrect as it drains via the osteum into the middle meatus of the nose.

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11
Q

What is the most common cause of a fractured mandible?

a. road traffic accidents
b. interpersonal violence
c. sporting injury
d. industrial accidents
e. iatrogenic following wisdom tooth extraction

A

B - interpersonal violence.

(was previously road traffic accidents until seatbelts were enforced)

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12
Q

What is the correct treatment for an asymptomatic torus palatinus?

a. antibiotics
b. excision
c. incisional biopsy
d. excisional biopsy
e. none of the above

A

E - none of the above.

(tori do not need treatment).

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13
Q

Osteoradionecrosis:

a. is treated with 100% oxygen
b. commonly affects the maxilla
c. commonly occurs following chemotherapy
d. occurs due to a reduction in vascularity secondary to endarteritis obliterans
e. is the same as focal sclerosing osteomyelitis

A

D - osteoradionecrosis occurs due to a reduction in vascularity secondary to endarteritis obliterans.

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14
Q

After an extraction of a lower right first molar, how long should you keep the records for?

a. 1 year
b. 4 years
c. 11 years
d. 25 years
e. 50 years

A

C - notes for adult patients should be kept for 11 years.

(note: children’s notes should be kept for 11 years or until the pt is 25, whichever is longer)

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15
Q

After extraction of the LR6, under which of the following conditions would sterilisation be achieved?

a. 112º for 15 mins
b. 112º for 5 mins
c. 121º for 15 mins
d. 121º for 5 mins
e. 134º for 1 minute

A

C - 121º for 15 mins

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16
Q

Which of the following statements regarding the muscles of mastication is correct?

a. the temporalis can be divided into the anterior, middle and posterior fibres, allowing of which carry out the same movements.
b. the posterior fibres contribute to the protrusion of the mandible
c. anterior and middle fibres contribute to the retrusion of the mandible
d. anterior and middle fibres contribute to the elevation of the mandible
e. anterior and middle fibres contribute to the protrusion of the mandible

A

D - anterior and middle fibres contribute to the ELEVATION of the mandible.

  • temporalis has 3 parts which produce different movements
  • posterior fibres RETRACT
  • other fibres (anterior and middle) ELEVATE
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17
Q

Which antibiotic should be prescribed post-operatively after a surgical extraction?

a. clindamycin
b. metronidazole
c. amoxicillin
d. erythromycin
e. cefuroxime

A

B - metronidazole

Prescribed as it is effective against anaerobes (most common organisms in the mouth).

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18
Q

Which nerve is the motor supply to the tongue?

a. lingual
b. glossopharyngeal
c. hypoglossal
d. vagus
e. facial

A

C - hypoglossal

Motor to the intrinsic muscles of the tongue, hyoglossis, genioglossus, styloglossis, thyrohyoid and geniohyoid.

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19
Q

Which of the following statements is true?

a. glossopharyngeal serves the posterior 1/3 of the tongue for taste only
b. glossopharyngeal serves the posterior 2/3 of the tongue for taste only
c. glossopharyngeal serves the anterior 1/3 of the tongue for taste only
d. glossopharyngeal serves the anterior 1/3 of the tongue for taste AND sensation.
e. glossopharyngeal serves the posterior 1/3 of tongue for both taste AND sensation

A

E - glossopharyngeal serves the posterior 1/3 of the tongue for both TASTE AND SENSATION

  • anterior 2/3 is chorda tympani via the lingual nerve to the facial nerve
  • general sensation to the anterior 1/3 of the tongue is the lingual nerve
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20
Q

Who may be given access to a patient’s notes without the patient’s permission?

a. employer
b. wife or husband
c. children
d. parents
e. defence organisation making allegations of negligence

A

E - defence organisation

There should be no other reasons to disclose a patient’s records.

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21
Q

The buccal artery is a direct branch of which artery?

a. mandibular
b. maxillary
c. facial
d. external carotid
e. internal carotid

A

B - maxillary

Buccal artery is a direct branch of the maxillary artery.

(others include the greater and lesser palatine, sphenopalatine and middle meningeal artery)

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22
Q

A patient presents with inability to smile and close their eye on the left side.

Which cranial nerve is responsible?

A

VII - facial nerve

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23
Q

Which other cranial nerve supplies the facial region?

A

V - trigeminal

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24
Q

Which cranial nerve supplies the muscles of the tongue?

A

XII - hypoglossal

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25
Q

Which cranial nerve palsy is responsible for ptosis of the eyelid?

A

III - oculomotor

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26
Q

A patient complains of loss of sensation of the skin over the parotid region.

Which nerve is responsible?

A

C2 and 3 - cervical nerves

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27
Q

Which muscle is being described?

Inserts onto the lateral surface of the angle and lower ramus of the mandible.

a. lateral pterygoid
b. masseter
c. medial pterygoid
d. temporalis

A

B - masseter

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28
Q

Which muscle is being described?

Inserts on the pterygoid fovea below the condylar process of the mandible and intra-articular cartilage of the TMJ.

a. lateral pterygoid
b. masseter
c. medial pterygoid
d. temporalis

A

A - lateral pterygoid

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29
Q

Which muscle is being described?

Inserts on the medial and anterior aspect of the coronoid process of the mandible.

a. lateral pterygoid
b. masseter
c. medial pterygoid
d. temporalis

A

D - temporalis

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30
Q

Which muscle is being described?

Action: elevates the mandible and posterior fibres retract.

a. lateral pterygoid
b. masseter
c. medial pterygoid
d. temporalis

A

D - temporalis

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31
Q

Which muscle is being described?

Action: elevates, protracts and laterally displaces mandible to opposite side for chewing.

a. lateral pterygoid
b. masseter
c. medial pterygoid
d. temporalis

A

C - medial pterygoid

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32
Q

A pt complains of pain in the same site where a tooth was extracted 2 days ago, much worse than the original toothache.
On examination, the patient is apyrexic and there is food debris in the socket.

What would be the most appropriate diagnosis?

a. alveolar osteitis
b. infection
c. ludwig’s angina
d. oral cancer
e. pneumonia
f. retained root

A

A - alveolar osteitis (dry socket)

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33
Q

A pt presents a month after XLA complaining of a bad taste coming from the site but no pain. OE, the socket has not healed entirely and there is mild swelling in the region.

What would be the most appropriate diagnosis?

a. alveolar osteitis
b. infection
c. ludwig’s angina
d. oral cancer
e. pneumonia
f. retained root

A

F - retained root

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34
Q

A pt presents a week afternoon XLA of 4 wisdom teeth looking very unwell and pyrexia. The pt has difficulty talking, trismus and bilateral drooling. OE, the tongue is raised towards the roof of the mouth.

What would be the most appropriate diagnosis?

a. alveolar osteitis
b. infection
c. ludwig’s angina
d. oral cancer
e. pneumonia
f. retained root

A

C - ludwig’s angina

(bacterial infection occurring in the floor of the mouth, under the tongue. usually develops after infections such as abscesses)

35
Q

An elderly pt has had open reduction and internal fixation of the mandible following a fall. One week later she has shortness of breath and associated pyrexia. She is confused.

What would be the most appropriate diagnosis?

a. alveolar osteitis
b. infection
c. ludwig’s angina
d. oral cancer
e. pneumonia
f. retained root

A

E - pneumonia

36
Q

A 65 year old pt presents 2 months after XLA of 2 mobile teeth. He complains of non-healing sockets which breakdown and bleed. OE, the pt has bilateral lymphadenopathy, radiographs show no retained roots and an unusual appearance of the bone.

What would be the most appropriate diagnosis?

a. alveolar osteitis
b. infection
c. ludwig’s angina
d. oral cancer
e. pneumonia
f. retained root

A

D - oral cancer

37
Q

What is pericoronitis?

A

Infection of the tissue surrounding the crown of a tooth.

Lower 8s most commonly affected.

38
Q

What are the signs and symptoms of pericoronitis?

A

Depends on the severity of infection:

  1. mild - swelling of soft tissue around the crown, bad taste, pain.
  2. moderate - lymphadenopathy, trismus, extraoral swelling.
  3. severe - fever, malaise, spreading infection and abscess formation.
39
Q

How would you treat acute pericoronitis?

A
  1. OHI (cleaning around the tooth and operculum with chlorhexidine and hot salty water)
  2. analgesics
  3. antibiotics (metronidazole)

(severe infection may need hospitalisation, IV antibiotics, XLA of the 8 and/or incision of drainage)

40
Q

According to NICE guidelines, which of the following are indications for the extraction of a lower third molar?

a. crowding of lower anterior teeth
b. a single episode of pericoronitis
c. a contralateral tooth requiring removal under GA
d. treatment of facial pain
e. mesioangular impaction

A

ALL STATEMENTS ARE FALSE

NICE guidelines state that impacted wisdom teeth that are free from disease should not be operated on due to no reliable research showing it benefits pts and them being exposed to the risks of surgery by doing so.

None of the above are indications UNLESS the single episode of pericoronitis is severe.

41
Q

Which of the following statements about the cranial nerves is true?

a. abducens nerve supplies the superior oblique muscle
b. motor supply to the muscles of mastication comes from the facial nerve
c. sensation and taste to the posterior 1/3 of the tongue is supplied to the hypoglossal nerve
d. trigeminal is motor to the muscles of mastication
e. lower face has bilateral nerve innervation

A

D - trigeminal is motor to the muscles of mastication.

  • abducens supplies the lateral rectus because the superior oblique is supplied by the trochlear nerve.
  • motor supply to the muscles of mastication is the trigeminal nerve because the facial nerve is motor to muscles of facial expression.
  • hypoglossal is motor to all muscles of the tongue (except palatoglossus).
  • glossopharyngeal is the sensory supply to posterior 1/3 of the tongue.
  • lower face = unilateral innervation, upper face = bilateral
42
Q

Temporal Arteritis:

a. may cause blindness
b. is more common in women
c. treated with NSAIDs
d. results in a lowered erythrocyte sedimentation rate
e. causes pain in the face

A

A, B and E - may cause blindness, is more common in women and causes pain.

  • results in a raised ESR
  • treated with steroids
43
Q

Which of the following muscles OPENS the mouth?

a. masseter
b. temporalis
c. lateral pterygoid
d. digastric muscle
e. medial pterygoid

A

C and D - lateral pterygoid and digastric.
(masseter, medial pterygoid and anterior fibres of temporalis OPEN the mouth)

44
Q

Deviation of the mandible on opening can be due to:

a. a unilateral anteriorly displaced disc
b. ankylosis of 1 condyle
c. occlusal interference between the retruded contact position (RCP) and intercuspal position (ICP)
d. internal derangement of the TMJ
e. a fractured condyle

A

A, B, D and E

(any interference with normal condylar movement can cause deviation on opening , occlusal interferences only impact closing)

45
Q

Glossopharyngeal Neuralgia:

a. more common than trigeminal neuralgia
b. described as a dull ache
c. may be felt in the ear of the affected side
d. impacts the postero-lateral side of the tongue

A

C and D - felt in the ear and postero-lateral side of the tongue

46
Q

Regarding the maxillary sinus:

a. it is not present at birth
b. pyramidal shape in adults with the base lying medially
c. drains via the osteum into the inferior meatus of the nose
d. lined by pseudostratified ciliated columnar epithelium
e. largest of the paranasal sinuses

A

B, D and E - pyramidal shape, lined by pseudostratified epithelium and is the largest of the paranasal sinuses.

47
Q

Osteoradionecrosis:

a. is a suppurative type of osteomyelitis
b. affects the maxilla more commonly than the mandible
c. occurs due to a reduction in vascularity secondary to endarteritis obliterans
d. can occur following hyperbaric oxygen treatment for SCC
e. is the same as focal sclerosing osteomyelitis

A

C - occurs due to a reduction in vascularity secondary to endarteritis obliterans

  • occurs following radiotherapy to the jaws
  • due to the bone becoming less vascular and hypocellular following radiation treatment
  • impacts the mandible more than the maxilla
  • not caused by hyperbaric oxygen treatment - this is used to treat it
48
Q

In the TNM classification system:

a. a 1.5cm tumour on the lateral border of the tongue with no palpable neck nodes would be stage 1
b. stages are based solely on histopathalogical grades
c. the N classification relates only to lymph nodes on the ipsilateral side to the tumour
d. No means the patient has undergone a previous neck dissection
e. M1 means distant metastasis

A

A and E - a 1.5cm tumour on the lateral border of the tongue with no palpable neck nodes is stage 1 and M1 means distant metastases.

49
Q

The submandibular gland:

a. is the largest of the salivary glands
b. empties via Stensen’s duct
c. has a duct that is closely related to the lingual nerve
d. is the gland most commonly affected by salivary gland calculi
e. is a mixed salivary gland

A

C, D and E - has a duct closely related to the lingual nerve, most commonly impacted by salivary stones and is MIXED.

  • Submandibular empties via WHARTON’S DUCT and the lingual nerve loops underneath so can be easily damaged when removing salivary stones.

(parotid is the largest salivary gland which empties via Stensen’s duct)

50
Q

Dry Mouth:

a. can be caused by radiation therapy
b. can occur in diabetes mellitus
c. occurs with anxiety
d. occurs when the salivary flow rate falls below the normal of 1ml/min
e. can result in an increase in root caries

A

A, B, C, E - caused by radiation therapy, diabetes, anxiety and results in root caries.

51
Q

Burning Mouth Syndrome:

a. is more common in females than males
b. usually affects patients over 50
c. may occur in patients who are stressed or depressed
d. is always associated with vitamin B1 deficiency
e. may respond to treatment with an antidepressant drug

A

A, B, C and E - F>M over 50, pts may be stressed or depressed and may respond to antidepressants.

  • haematinic deficiencies may also cause burning sensations
52
Q

If a patient returns 3 hours post XLA complaining of bleeding from the site, what would be the appropriate management?

a. lie the pt in the chair to calm them down
b. get the pt to bite on a gauze pack
c. pack socket with Alvogyl
d. pack socket with an oxidised cellulose dressing
e. suture the socket with prolene sutures

A

B and D - ask the pt to bite on a gauze pack and pack socket with oxidised cellulose dressing.

  • sitting upright reduces bleeding.
  • alvogyl is only used for DRY SOCKET
53
Q

When extracting an upper 6 in a patient with a large maxillary sinus, what should you warn the pt of prior to the XLA?

a. possible oronasal communication
b. possibility of an oronasal communication
c. possible infection following the XLA
d. possible pain following XLA
e. possibility of a nose bleed following the XLA

A

C and D - possible infection and pain following the XLA.

(may resultin an oroANTRAL communication which may become epithelialised to form an oro-antral fistula)

54
Q

To which of the following spaces can infection directly spread from a lower wisdom tooth?

a. submasseteric space
b. pterygomaxillary space
c. submandibular space
d. cavernous sinus
e. maxillary sinus

A

A, B and C - spreads to the submasseteric, ptergomaxillary and submandibular space.

(spread to the cavernous sinus is usually from infections in the MIDDLE 1/3 of the face)

55
Q

Which of the following are well-recognised complications of removal of lower wisdom teeth?

a. paraesthesia of the lingual nerve
b. dry socket
c. anaesthesia of the inferior dental nerve
d. paraesthesia of the inferior dental nerve
e. paralysis of the lingual nerve

A

A, B, C and D - paraesthesia of the lingual nerve, dry socket and anaesthesia/paraesthesia of the inferior dental nerve.

56
Q

Which 2 of the following lesions would require an incisional biopsy?

a. SCC on the lateral border of the tongue
b. fibroepithelial polyp on the buccal musoca
c. capillary haemangioma on the lower lip
d. sublingual keratosis
e. a palpable lump in the submandibular gland

A

A and D - SCC and sublingual keratosis

57
Q

Which of the following could occur in a fractured zygoma?

a. anosima (loss of smell)
b. bruising on the ipsilateral (same side) upper buccal sulcus
c. anaesthesia of the ipsilateral cheek
d. epistaxis (bleeding from the nose)
e. diplopia (double vision)

A

B, C, D, E - bruising on the ipsilateral upper buccal sulcus, anaesthesia of the ipsilateral cheek, epistaxis and diplopia.

58
Q

Common signs and symptoms of a fractured zygomatic arch:

a. limitation of mouth opening
b. deviation of the mandible on opening to the ipsilateral side
c. deviation of the mandible on opening to the contralateral side
d. diplopia
e. epistaxis

A

A and B - limitation of mouth opening and deviation to the ipsilateral side.

(difficulty in mandibular movements due to the fracture impinging on the temporalis muscle and coronoid process)

59
Q

Regarding structures surrounding the submandibular gland:

a. damage to the lingual nerve will cause loss of sensation to the posterior 1/3 of the tongue
b. submandibular gland wraps around the posterior border of mylohyoid
c. buccal branch of the facial nerve is at risk of surgical trauma
d. the hypoglossal nerve is seen to loop under the submandibular duct
e. safest site for an incision is on the lower border of the mandible to prevent damage to the facial nerve

A

B - submandibular gland wraps around the posterior border of mylohyoid.

a - the lingual nerve supplies the anterior 2/3 of the tongue and glossopharyngeal nerve supplies the posterior 1/3 of the tongue
d - the hypoglossal nerve loops under the submandibular duct.

60
Q

Regarding the muscles of mastication:

a. temporalis can be divided into the anterior, middle and posterior fibres which all carry out the same movements
b. anterior and middle fibres contribute to the elevation of the mandible
c. middle and posterior fibres contribute to elevation of the mandible
d. anterior and middle fibres contribute to retrusion of the mandible
e. posterior fibres contribute to retrusion of the mandible

A

B and E:

ANTERIOR and MIDDLE fibres contribute to elevation.
POSTERIOR fibres contribute to retrusion.

61
Q

Regarding TMJ ligaments:

a. the temporomandibular ligament is related to the lateral aspect of the joint
b. the stylomandibular ligament is a remnant of the deep cervical fascia as it passes lateral to the parotid gland
c. the stylohyoid ligament extends from the tip of the styloid process to the lingula
d. the spenomandibular ligament extends from the spine of the sphenoid to the lingula
e. the sphenomandibular ligament is a remnant of Meckel’s cartilage

A

A, D and E

a. the temporomandibular ligament is related to the lateral aspect of the joint
d. sphenomandibular ligament extends from the spine of sphenoid to the lingula
e. sphenomandibular ligament is a remnant of Meckel’s cartilage

62
Q

What are the signs of a solitary ulcer present due to infection (e.g: syphilis or TB)?

A
  • pt feels unwell and feverish
  • skin rash
  • lymphadenopathy
  • chronic cough / chest infection
63
Q

What are the potential signs of an ulcer due to malignancy?

A
  • weight loss
  • pt feels unwell
  • smoking/drinking history
  • CONTACT BLEEDING
  • induration (hardening of soft tissue)
  • lymphadenopathy
64
Q

How would you manage a malignant lesion?

A

Make an urgent 2 week referral to local max fax department

65
Q

Following the differential diagnosis of an SCC of the left posterior lateral tongue, what is the next step in dental management?

A

Determine if any XLAs or other dental treatment will need to be carried out prior to starting radiotherapy/surgery.

66
Q

What is the mechanism of formation for RAS?

A

Cytotoxic T cells damage keratinocytes and destroy the epithelium.

67
Q

What is the lowest platelet count to be able to perform an extraction?

A

50 x 10^9

68
Q

Which type of biopsy should be used for leukoplakia?

A

excisional

69
Q

After how long should you be referred to max fax for a white patch which does not rub off?

A

3 weeks

70
Q

Reasons for Extraction

A
  • caries
  • periodontitis
  • pulpal / PA pathology
  • fracture
  • supernumerary teeth
  • impacted teeth
  • orthodontic treatment
71
Q

3 benefits of LA use in extractions:

A
  1. pain management
  2. anxiety management
  3. haemorrhage control
72
Q

How would you minimise pain when giving LA?

A
  • pull the tissues tight
  • sharp needle
  • slow injection
  • topical anaesthetic
  • not scraping bone
73
Q

What is the working time for lidocaine?

A

2-3 hours

74
Q

3 most common complications post extraction:

A
  1. dry socket
  2. infection
  3. post op pain
75
Q

Why is chlorhexidine no longer recommended in oral surgery?

A

Due to recent deaths from anaphylaxis.

76
Q

Should antibiotics be prescribed for dry socket?

A

Not unless the pt is compromised (e.g: risk of infective endocarditis)

77
Q

What is primary haemorrhage?

A

Bleeding at the time of XLA

78
Q

What is reactionary haemorrhage?

A

Bleeding 2-3 hours post XLA when the vasoconstrictor wears off.

79
Q

What is secondary haemorrhage?

A

Up to 14 days post XLA

(likely due to infection - think secondary occurs due to underlying cause)

80
Q

What should be expected when conducting an XLA on a pt on antiplatelets?

A

prolonged bleeding

(manage with pack and suture)

81
Q

What is pericoronitis?

A

Inflammation of the operculum / soft tissues surrounding an erupting tooth (usually 8s).

(usual cause is food trapping under)

82
Q

How would pericoronitis be managed?

A

Irrigate the area with saline, recommend analgesics.
Consider XLA after 2 episodes.

(antibiotics only indicated for signs of spreading infection)

83
Q

What is Trismus?

A

limited mouth opening

general revision (11 decks)

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