Surgery1 Flashcards
The gold standard test for primary adrenal failure is the: • blood glucose test • ACTH stimulation test • serum creatinine level • BUN test
ACTH stimulation test
About 20 mg of hydrocortisone is secreted by the adrenal cortex daily. During stress, the cortex can increase the output to ?
200 mg daily
A person who has been on suppressive doses of steroids will? Select all that apply.
• take as long as a year to regain full adrenal cortical function
• take as long as a month to regain full adrenal cortical function
• may show signs of hyperpigmentation
• does not require consultation with a physician prior to surgery
- take as long as a year to regain full adrenal cortical function
- may show signs of hyperpigmentation
Some guidelines of adrenal function suppression before performing surgery:
- People on small doses (5 mg prednisone/day) will have suppression when they have been on the regimen for a month.
- People taking the equivalence of 100 mg cortisol/day (20-30 mg prednisone/day) will have abnormal cortical function in a week.
- Short-term therapy (1-3 days) of even high-dose steroids will not alter adrenal cortical function.
- A person who has been on suppressive doses of steroids will take as long as a year to regain full adrenal cortical function
an adrenally insufficient patient have adequate steroid replacement since the stress of oral surgery can precipitate ?
adrenal crisis
Patients with glucocorticoid hypersecretion have: • ectopic ACTH Syndrome • MEN • cushing syndrome • addison disease
cushing syndrome
what is important in cushing syndrome?
The patient’s cardiovascular status must be evaluated and treated if necessary prior to surgery
A 52-year-old woman requests removal of a painful mandibular second molar. She tells you that she has not rested for 2 days and nights because of the pain. Her medical history is unremarkable, except that she takes 20 mg of prednisone daily for erythema multiforme. How do you treat this patient?
• have patient discontinue the prednisone for 2 days prior to the extraction
• give steroid supplementation and remove the tooth with local anesthesia and sedation
• instruct the patient to take 3 grams of amoxicillin 1 hour prior to extraction
• no special treatment is necessary prior to extraction
give steroid supplementation and remove the tooth with local anesthesia and sedation
Which of the following foramen/location pairings are correct? Select all that apply.
• greater palatine foramen/distal to the apex of maxillary 1st molar
• incisive foramen/posterior to the interproximal space of the central incisors
• lesser palatine foramen/lateral to the greater palatine foramen
incisive foramen/posterior to the interproximal space of the central incisors
Motor Innervation of palate?
the tensor veli palatini is innervated by a muscular branch from the mandibular division of the trigeminal nerve (CN V). All other muscles are innervated by the pharyngeal plexus (motor portion from the vagus nerve and cranial part of the accessory nerve)
The facial nerve carries which of the following? Select all that apply. • efferent components • afferent components • sympathetic components • parasympathetic components
- efferent components
- afferent components
- parasympathetic components
the facial nerve exits the skull by way of the ? of the temporal bone, innervating ?.
- stylomastoid foramen
* the muscles of facial expression
The afferent component of facial nerve serves ?
a tiny patch of skin behind the ear, taste sensation, and the body of the tongue
Bell palsy cause?
One theory of its cause is that the facial nerve becomes inflamed within the temporal bone, possibly with a viral etiology
- Trigeminal neuralgia (tic douloureux) involves the ? nerves of the trigeminal nerve
- Trigeminal neuralgia cause?
- its treatment?
- afferent (the maxillary or mandibular nerve branches but not the ophthalmic branch)
- pressure on the sensory root of the trigeminal ganglion by area blood vessels
- Carbamazepine (Tegretol) is still the mainstay of treatment
Which component of the TMJ has the most vasculature and innervation? • articular fossa • anterior band of the articular disc • posterior band of the articular disc • articular eminence • retrodiscal tissue
retrodiscal tissue
The maxillary sinus opens into the middle meatus of the nose through the: • frontonasal duct • bulla ethmoidalis • hiatus semilunaris • nasolacrimal duct
hiatus semilunaris
- Chronic bacterial sinusitis is treated with ?
* Chronic noninfectious sinusitis often is treated with ?
- antibiotics (ampicillin or augmentin)
* steroids (topical or oral) and nasal washes
The arises from the anterior surface of the external carotid artery and then passes near the greater cornu of the hyoid bone. • submental artery • inferior alveolar artery • lingual artery • ascending pharyngeal artery
lingual artery
The loop of the lingual artery is crossed superficially by ? nerve
the hypoglossal nerve (does not accompany the lingual nerve throughout its course)
If the lingual nerve is cut after the chorda tympani joins, there will be loss of ?
both taste and tactile sensation
? muscle forms the roof of the pterygomandibular space
The lateral pterygoid
The buccinator and superior pharyngeal constrictor muscles of the pharynx are attached to each other at the:
• pterygomandibular raphe
• mastoid process
• epicranial aponeurosis
• genial tubercles on the internal surface of the mandible
pterygomandibular raphe (fold) (extends from the hamulus and attach to the posterior end of the mandible’s mylohyoid line)
When draining purulent exudate from an abscess of the pterygomandibular space using an intraoral approach, ? muscle is most likely to be incised
the buccinator
Which of the following are involved in the path for parasympathetic innervation of the parotid gland? Select all that apply. • trigeminal nerve • glossopharyneal nerve • vagus nerve • otic ganglion • pterygopalatine ganglion
- glossopharyneal nerve
* otic ganglion
The pterygopalatine ganglion is responsible for innervation of ?
- the lacrimal gland
* other glands of the nasal cavity
- Postganglionic parasympathetic fibers reach the parotid gland via ? nerve, which lies in contact with the deep surface of the gland.
- Postganglionic sympathetic fibers reach the gland as ?
• the auriculotemporal
• a plexus of nerves around the external carotid artery
(Although it passes through the parotid gland, the facial nerve does not provide any innervation to it)
A dentist is performing a routine restoration on the left mandibular first molar. He is giving an inferior alveolar nerve block injection, where he deposits anesthetic solution right next to the lingula and mandibular foramen.
Which ligament is most likely to get damaged?
• sphenomandibular ligament
• temporomandibular ligament
• stylomandibular ligament
sphenomandibular ligament
The temporomandibular ligament (also called ?) runs from the articular eminence to ?. It provides ?. This ligament prevents ? displacement of the condyle (it is the main stabilizing ligament of the TMJ).
- the lateral ligament
- the mandibular condyle
- lateral reinforcement for the capsule
- posterior and inferior
Collateral ligaments (medial and lateral) also referred to as ? are ligaments that arise from ?, are attached to, the medial and lateral poles of the condyle, respectively, and ? the disc on the top of the condyle. They are composed of ? connective tissue; thus they do not stretch.
- discal ligaments
- the periphery of the disc
- stabilize
- collagenous
Which of the following injuries would cause a patient to deviate toward the side of injury when protruding? Select all that apply. • damage to the lateral pterygoid muscle • ankylosis of the condyle • condylar hyperplasia • unilateral condylar fracture
• damage to the lateral pterygoid muscle
• ankylosis of the condyle
• unilateral condylar fracture
(The mandible will deviate away from the affected side with condylar hyperplasia)
Which lymph nodes directly receive lymph from the anterior two-thirds of the tongue (except the tip)?
• submental lymph nodes
• submandibular lymph nodes
• parotid lymph nodes
submandibular lymph nodes
Which artery descends on the posterior surface of the maxilla and supplies the maxillary sinus and the maxillary molar and premolar teeth? • sphenopalatine artery • greater palatine artery • posterior superior alveolar artery • infraorbital artery
posterior superior alveolar artery
The venous return of both dental arches is the ?
pterygoid plexus of veins
Which oral landmark marks the opening of the submandibular duct? • lingual frenum • nasolacrirnal duct • parotid raphe • sublingual caruncle
sublingual caruncle (Wharton duct)
The blood supply of submandibular gland comes from branches of ?
the facial and lingual arteries
? is the most common cause of swelling of the tissues in the submandibular triangle.
Lymphadenopathy
The TMJ is a/an:
• arthrodial joint
• ginglymus joint
• ginglymoarthrodial joint
ginglymoarthrodial joint (Because the TMJ has characteristics of both a hinge joint and a gliding joint)
Components of the TMJ:
- Mandibular condyle
- Articular fossa (the anterior three-fourths of the larger mandibular fossa)
- Articular eminence (functional portion of the joint, lined with a thick dense layer of fibrous connective tissue)
- Articular disc (fibrocartilaginous disk)
When a maxillary third molar is displaced into the infratemporal fossa, it is usually displaced through the periosteum and located ? to the lateral pterygoid plate and ? to the lateral pterygoid muscle with displacement • medial, inferior • medial, superior • lateral, inferior • lateral, superior
lateral, inferior
If no functional problems exist after displacement of a maxillary third molar into the infratemporal fossa, the patient may elect not to have the tooth removed but ?
proper documentation of this is critical
