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MSA Questions > Past Papers > Flashcards

Past Papers Flashcards

1
Q

Describe 3 difference between stroke and a facial palsy?

A

LA same side, stroke opposite side
Stroke- can still wrinkle forehead
In stroke all muscles of the face/mastication/pharynx are still working except muscles of lower face and tongue from the opposite side
Facial palsy is often iatrogenic where stroke is caused by infarction

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2
Q

Definition of Xerostomia?

A

Dry mouth, subjective complaint of dryness of the mouth, can be a sign and a symptom
Half the amount of normal unstimulated flow rate. Clinically <0.15ml/min in unstimulated salivary flow

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3
Q

What are some medications that cause dry mouth (xerostomia)?

A

Tricyclic antidepressants, antihistamines, antichlorinergics, diuretcs, benzodiazepines, beta-blockers, antipsychotics (polypharmacy)

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4
Q

What are some other reasons for dry mouth?

A

Sjogrens syndrome
Radiotherapy to head and neck
diabetes
rheumatoid arthritis
parkinsons
alzheimers
stroke
nerve damage

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5
Q

What is platelet dysfunction?

A

Thrombocytopoenia (low circulating platelet)

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6
Q

What are the 3 blood tests to confirm thrombocytopoenia?

A

Bleeding time
INR (prothrombin time)
FBC
APTT (activated partial thromboplastin time)

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7
Q

What is the mechanism for apixaban?

A

Selective inhibitor of factor Xa
Apixaban has no direct effect on thrombin but indirectly inhibits platelet aggregation induced by thrombin

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8
Q

What alterations regarding apixaban do you make when extracting?

A

Do not take the first dose and just take the second dose as normal

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9
Q

What are the cardinal signs of patient’s with Parkinson’s disease?

A

Bradykinesia, postural instability, muscle rigidity, resting tremour

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10
Q

How does Parkinson’s cause dry mouth?

A

Anticholinergic effect of drugs

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11
Q

What is the difference between a patient with Parkinson’s and with cerebral disease?

A

Patients with Parkinson’s disease have a resting tremor whereas patients with a cerebral disease have an intension tremour

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12
Q

What are some symptoms of early stage dementia?

A

Difficulty concentrating, decreased memory of recent events, socialising becomes difficult, confusion, poor judgement, anxiety

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13
Q

What are some symptoms of middle stage dementia?

A

Major memory discrepancies and may need help with everyday activities like bathing and preparing meals
Forget names of friends and family
Personality changes
Risk of wandering

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14
Q

What are some symptoms of late stage dementia?

A

Essentially no ability to communicate, assistance required for most activities
Difficulty swallowing
Incontinence
Little/no motor skills

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15
Q

How can you adapt a practice to make it more disability friendly?

A

Ramps, hand rails, low desk at reception, wide clutter free corridors, hoists, disabled access toilets, visible signs for visually impaired

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16
Q

What are the 2 models of disability?

A

Social view: society must respond to medical problems, society is an issue, needs to be adapted
Medical view: People with disability are the issue, need treatment and care, should adapt to environment and society

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17
Q

Name 2 cognitive tests for dementia?

A

Mini-mental state examination (MMSE)
The Montreal Cognitive Assessment (MoCA)
Combined single tests

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18
Q

Describe the basic principle of tooth movement in orthodontics?

A

If prolonged pressure is applied to a tooth it will move as the bone around it remodels
Periodontal ligament mediates the bony response

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19
Q

What is spina bifida?

A

Neural folds fuse to form neural tube
Failure to fuse will lead to spina bifida

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20
Q

Describe the process of when light orthodontic forces are applied to a tooth.

A

Hyperaemia within PDL
Appearance of osteoclasts and osteoblasts
Resorption of lamina dura from pressure sides
Aposition of osteoid on tension side
Remodelling of socket- frontal resorption
Periodontal fibres reorganise but gingival fibres remain distorted

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21
Q

What does an EPT do?

A

Electric current used to stimulate sensory nerves
Primarily A-delta fast conducting fibres are stimulated
Unmyelinated C-fibres may or may not respond

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22
Q

On which teeth is the EPT unreliable?

A

Teeth with open apices

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23
Q

Why would you take pre-operative radiographs?

A

To show
-Any periradicular pathology and how far it extends
-The anatomy of the root canal
-Canal calcifications
-Check angulation of root in relation to adjacent teeth
-Number, length and morphology of roots
-Proximity of vital structures

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24
Q

What is the ideal shape of a root canal system?

A

Create a continuously funnelling tapered canal
Maintain apical foramen in original position
Keep apical foramen as small as possible

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25
Q

What does sodium hypochlorite do?

A

Strong antimicrobial agent
Dissolves pulp remants and collagen (organic part of dentine) debris. Thus helps disrupt the smear layer
Dissolves both necrotic and vital tissue

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26
Q

What is EDTA used for?

A

Cheleating agent capable of removing smear layer when used with NaOCl
Lubricant for files

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27
Q

What is the smear layer and what is its relevance to endodontic treatment?

A

Organic pulpal material and inorganic debris formed during prep
Superficial 1-5micrometres with packing into tubules
Bacterial contamination, substrate and interferes with disinfection
Prevents sealer penetration

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28
Q

Describe the double flare canal preparation.

A

2 stages
Apical enlargement
-Diameter of apical portion gauged by inserting ISO hand files passively to working length until a file binds at the working length
-Largest file used to working length is the master apical file (MAF). This file size is dependent on original size and curvature of root canal
Apical Taper
-Files of increasing size are used in an apical to coronal manner while stepping back which creates an apical taper and binds apical prep to coronal flare

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29
Q

What is the function of the intracanal medication?

A

Placed inside root canal between treatment appointments in an attempt to destroy microorganisms and prevent re-infection
Reduce inflammation and exudate
Control of root resorption

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30
Q

What is the purpose of obturation?

A

Prevent microorganisms from re-entering the root canal system
Isolate any microorganisms that may remain within the tooth from nutrients in tissue fluids

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31
Q

What are the problems with incompetent lips?

A

Face may not develop properly, longer face, impeded speech, mouth-breathing leading to dry mouth

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32
Q

What are 4 signs of a child who has a digit sucking habit?

A

Proclination of upper anteriors
Anterior open bite
Reclination of lower anterior incisors
Unilateral posterior cross bite
Narrowing of the upper arch
Reduced over bite

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33
Q

What are the causes of congestive heart failure? Name at least 4.

A

Coronary artery disease
Cardiomyopathy
Heart attack
Alcohol abuse
Hypertension
Valve disease
MI
Diabetes

34
Q

What are the symptoms of congestive heart failure?

A

Rapid irregular heart beat
Fatigue and weakness
Swelling of abdomen
Swelling of leg/ankle/feet
Nausea
Shortness of breath
Cough, wheezing
Chest pain when breathing

35
Q

What are the treatments and prophylaxis for congestive heart failure

A

Lifestyle changes (balanced diet, exercising, stop smoking)
Medication
-ACE inhibitors (ramipril)
-Angiotensin-2 receptor blockers
-Beta blockers (bisoprolol)
-Diuretics (furosemide)
Devices implanted in your chest to control your heart rhythm such as pacemaker, CRT, ICD
-Heart valve surgery
-Coronary angioplasty or bypass
-Left ventricular assist devices
-Heart transplant

36
Q

What are the virulence factors involved in carious bacteria?

A

Adhesions - makes up fibrillar layer of cell wall
Binding proteins - glucosyltransferase, glucan binding protein
Sugar modifying enzymes - fructanase, dextranase polysaccharides
Acid tolerance and adaptation

37
Q

What are the virulence factors involved in periodontal disease?

A

Host cell adherence and invasion - fimbiae
Elaboration with proteases
Endotoxins (LPS)
Capsular polysaccharide and outer membrane vesicles
Tissue toxic metabolic by products- hydrogen sulphide, ammonia and fatty acids

38
Q

Why do biofilms not allow antibiotics to penetrate them?

A

Biofilms can produce a penetration barrier of LPS which prevents antimicrobials and antibiotics from penetrating
Biofilms also require mechanical disruption so alone medications will not work to remove them fully
The biofilm impairs diffusion
-Causes binding of the antibiotics
-Extracellular DNA persists

39
Q

What are some reasons for liver cirrhosis. Name at least 4

A

Alcohol abuse
Viral hepatitis (B, C and D)
Fat accumulating in the liver (non alcoholic fatty liver disease)
Cystic fibrosis
Iron build up in the body (haemochromatosis)
Medications

40
Q

How do you deal with a blood spillage?

A

Wear PPE (gloves, apron, visor, goggles)
Contain with paper towel
Assemble all equipment needed (spillage kit)
Sprinkle chlorine releasing granules
Clear affected area with paper towels and dispose of as clinical waste
Wash area with water and detergent and then dry
Make sure sharps are disposed of
Perform hand hygiene

41
Q

What do you use to clean a blood spillage?
What concentration? How long do you leave it for?

A

Sodium dichloroisocyanurate
Sodium hypochlorite
10,000ppm for 3-5 mins

42
Q

Give 2 reasons why an overhang can occur when placing an amalgam restoration.

A

Poor adaptation of matrix band
Excessive force applied when condensing amalgam

43
Q

How can you improve an overhang?

A

Replace the restoration and retreat it
By using finishing strips or soft flex discs

44
Q

What are the short and long term consequences of an overhang?

A

Food trap
Difficulty cleaning
Trauma to soft tissues
Plaque trap
Secondary caries
Gingivitis and periodontitis

45
Q

What is the horizontal line for OPT parallel to the floor?

A

Frankfort plane

46
Q

Why do anterior teeth appear horizontally wider in an OPT?

A

Canine behind the guideline
Patient too far back in the machine

47
Q

Why do posterior teeth appear horizontally wider?

A

Patient is rotated in the machine

48
Q

Name 3 features of a ghost image.

A

Always higher
Always horizontally magnified
On the opposite side

49
Q

What radiograph do you take for a pre extraction of 48 when the 38 is fine?

A

Right side OPT

50
Q

How are ghost images produced?

A

Can occur when there is horizontal distortion if the patient is in the incorrect position relative to the focal plane

51
Q

What else can you call a secondary impression?

A

Definitive impression
Master impression

52
Q

What anatomical features should be captured for the position of posterior border of the upper?

A

Palatine fovea at vibrating line
Hamular notches
Border of hard palate

53
Q

What anatomical features should be captured on the mandibular?

A

Residual ridge
Buccal shelf
Retromolar pad

54
Q

Name 2 materials that can be used for masters on lowers.

A

Alginate
Light bodied silicone
Impregnum

55
Q

Name 3 reasons to do non-surgical before surgical treatment in perio.

A

Deep pockets may heal following non-surgical therapy
Improve soft tissue consistency for easier surgical movement
Allows evaluation of patients motivation and plaque control

56
Q

Give 2 indications for surgical at re-evaluation of therapy.

A

Pockets of 5mm or greater persist
Furcation
Presence of excellent oral hygiene

57
Q

What is the aim of surgical therapy?

A

To arrest the disease by gaining access to complete root surface debridement
To regenerate lost periodontal tissue

58
Q

When would you carry out surgical therapy and when would you re-evaluate non surgical therapy?

A

6-8 weeks after non-surgical therapy

59
Q

Why do you keep a denture moist?

A

For retention and to stop infection and more comfortable in the patients mouth

60
Q

Give 2 thermal properties of denture bases.

A

High softening temperature
Low thermal conductivity

61
Q

What are some gaseous properties of denture bases.

A

Monomer boiling
Occurs in bulkier parts
Occurs due to exothermic reaction of polymerisation (should be carried out slowly to prevent this)
Porosity affects
-Strength
-Appearance
-Rough sensation to tongue
-Absorbs saliva- poor hygiene

62
Q

Give 2 aims for raising a flap.

A

Better access
Protection of soft tissues

63
Q

Give 4 things that can influence flap design

A

Procedure being carried out
Surrounding nerves
Visualisation issues
How much access is required
Personal preference of the operator

64
Q

What type of handpiece is used for bone removal?

A

Electrical straight handpiece with saline cooled bur
Round or fissure tungsten carbide burs

65
Q

Give 3 methods of debridement

A

Physical
–using bone files or handpiece to remove sharp bony edges
Irrigation
–Sterile saline into socket
Suction
–Aspirate under flap to remove debris

66
Q

What is apixaban used for?

A

Treatment or secondary prevention of DVT
Prevention of stroke
Prevention of pulmonary embolism

67
Q

Give 2 reasons why there is an increased risk of periodontitis for those with Down Syndrome.

A

Immunocompromised
Poor oral hygiene

68
Q

Give 4 physical features of down syndrome.

A

Hypodontia
Short neck
Short nose
Small arched palate
Macroglossia - big tongue and protruding tongue
Class III malocclusion
Small arched palate

69
Q

How do you prevent dentures being lost in a care home?

A

Initials during process - mark using sandpaper or a sealant
Store them in a labelled container

70
Q

When do you not extract teeth in individuals with Parkinson’s?

A

Tremor could make the extraction difficult
Poor mouth opening due to rigidity
Will require new prostheses to replace missing teeth. Won’t be able to tolerate it

71
Q

When would you use a dual cure?

A

Thick porcelain
Metal restorations

72
Q

What do you use to bond porcelain to composite luting resin?

A

Silane coupling agent

73
Q

What is the part of the mandible that interferes during maxillary working impression?

A

Coronoid Process

74
Q

How do you reduce bias in a study?

A

Randomising
Double blinding

75
Q

What features of an ECM make them resistent?

A

The biofilm impairs diffusion
It causes binding of antibiotics
Extracellular DNA persists

76
Q

What is a special investigation you can carry out on an uncooperative child?

A

OPT

77
Q

When is the ideal time to remove 6’s?

A

5’s present
Bifurcation of 7’s
Class I incisor relationship
Mild buccal segment crowding

78
Q

Give 2 ways to treat an anxious child.

A

Work quickly, calm manner
Empathy
Distraction techniques
Densensisitisation

79
Q

Give 4 reasons for a child to be anxious.

A

Past negative dental experience
Attitude of parents towards the dentist
Expectation of pain
Past negative family experiences
Poor knowledge of treatment

80
Q

Name 4 behaviour management methods for children.

A

Positive reinforcement
Acclimitisation
Desensitisation
Distraction
Relaxion techniques
Voice control

81
Q

What is an endodontic lesion with periodontal involvement?

A

Primary endodontic disease remains untreated, it may become secondarily involved with periodontal breakdown
Plaque forms at the gingival margin of the sinus tract and leads to plaque induced periodontitis in that area

82
Q

What is generalised chronic periodontitis?

A

Characterised by the destruction of the junctional epithelium and connective tissue attachment of the tooth, together with bone destruction and formation of periodontal pockets
Disease progresses slowly and the amount of bone loss tends to reflect the age of the patient

MSA Questions (3 decks)

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