TQs Flashcards by Lindsay Shear

Once a patient with oral cancer has metastasis to cervical lymph nodes, he automatically enters what stage of disease?

a. Stage 1
b. Stage 2
c. Stage 3
d. Stage 4

Stage 3

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Before a patient is to begin radiation therapy for an oral malignancy, teeth with questionable or poor prognosis should

a. Be saved at all costs
b. Undergo RCT and amputation
c. Be extracted
d. Be left alone, as all these patients need radiation right away

Be extracted

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Which of the following are side effects of radiation?

a. mucositis
b. xerostomia
c. dermatitis
d. radiation caries
e. all of the above (also osteoradionecrosis)

All of the above

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Xerostomia is a result of effects of radiation on salivary glands including

a. Fibrosis
b. Atrophy
c. Degeneration
d. All of the above

All of the above

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Decreased salivary flow can often lead to

a. Periodontal disease
b. Root caries
c. Dysphagia
d. A and b only
e. All of the above

All of the above

(in ppt said Dysphonia and Dysguesia, just in case they add this two

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Patients undergoing radiation therapy to the head and neck should have a home regimen including

a. Topical fluoride application
b. Sensodyne tooth paste
c. Hydrogen peroxide rinses
d. Only pureed diet

Topical fluoride application

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When performing extractions on a patient who will soon undergo radiation therapy to the head and neck, the dentist should

a. Perform coronectomies whenever possible
b. Be as atraumatic as possible
c. Perform the extractions as close of possible to the initiation of radiation treatments.
d. Never attempt primary closure of extraction site

Be as atraumatic as possible

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Healing time after extractions and initiation of radiation therapy should be approximately

a. 1-2 days
b. 2-3 months
c. 2-3 weeks
d. None of the above

2-3 weeks

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Marx protocol for extractions in a patient at the risk for osteoradionecrosis is (referring to hyperbaric oxygen):

a. 10 dives preop followed by 10 dives postop
b. 20 dives preop followed by 20 dives postop
c. 20 dives preop followed by 10 dives postop
d. 10 dives preop followed by 20 dives postop

20 dives preop followed by 10 dives postop

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Management of osteoradionecrosis includes all of the following except:

a. Saline irrigation
b. Local debridement
c. Antibiotics
d. Topical Fluoride

Topical fluoride

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Radial forearm free flaps

a. This is the best flap for reconstructing the oral cavity
i. the “work horse” of head and neck reconstruction
b. constant anatomy, easy surgical access
c. thin, pliable skin ; large size
d. great versatility in design due to septocutaneous blood supply
e. all of the above

All of the above

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What is/are characteristics of anterolateral thigh flap:

i. provides BULK & VOLUME
ii. limitation: variations in anatomy
iii. multiple skin paddles
iv. All of the above

All of the above

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Anterolateral thigh flap…what is the blood supply to this?

a. descending branch of lateral circumflex femoral artery
b. ascending branch of lateral circumflex femoral artery
c. Superior iliac artery
d. Fibular artery

Descending branch of lateral circumflex femoral artery

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What is the most popular flap for mandibular reconstruction?

Microvascular free fibula flap

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Head and neck cancer associated in young patients associated with which virus?

a. HPV 16
b. HPV 7
c. HPV 6
d. HPV 4

HPV 16

Also 18, 31, and 33

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What percentage of intraoral cancers are oral tongue carcinomas?

20-30%

Of those, 75% is in the anterior 2/3 and 25% is in the posterior 1/3.

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What is the Vignette classification of a patient that has a tumor greater than 4 cm (TNM classification)?

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What is the Vignette classification of a patient that has a tumor between 2 and 4 cm (TNM classification)?

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What is the Vignette classification of a patient that has a tumor that invades near-by structures (TNM classification)?

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What is the Vignette classification of a patient that has a tumor 2 cm or less (TNM classification)?

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What is the Vignette classification of a patient that has a lymph node involved

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What is the Vignette classification of a patient that has a lymph node involved > 3 cm in diameter but

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What is the Vignette classification of a patient that has no distant metastasis (TNM classification)?

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What is the Vignette classification of a patient that has distant metastasis (TNM classification)?

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Oral cancer makes up which percentage of NEW cancer cases in USA every year?

2-3%

Prognosis in oral cancer - know greatest single indicator of prognosis aka what will you look at in a patient to give you the idea they will do well? a. Staging determines tx…. b. The status of the prognosis depends on the cervical lymph nodes….. c. Diet and exercise

STAGING

What percent of patients receive radiation therapy?

60-70%

When getting radiation therapy for SCC for head and neck, what is the dosage for: - Subclinical disease - Skin and lips - Gross Disease - Naso/oropharynx

- Subclinical Disease: 50 to 55 Gy in 5 to 6 weeks - Skin & Lip: 60 Gy in 4 week - Gross Disease: 1.8-2.0 Gy/fraction x 5 days/week for 6-7 weeks = 65-66Gy - Naso Oro/Hypopharynx & BOT: 70 to 72 Gy

Know about dentist role as part of multidisciplinary team of managing cancer a. Restorations/ Extractions b. OH program c. Diet advice d. Use/make FL trays e. Smoking cessation f. dental oncology/maxillofacial prostho g. All of the above

All of the above

What are the effects of ACUTE toxicity due to radiation?

acute skin reactions, hyperemia, reduced salivary gland function, mucositis, hypogeusia

What are the effects of LATE toxicity due to radiation?

Seems not to occur when tissues are exposed to less than 45 gy; chronic damage to skin, muscle, nerves/bone

Hypoxia reperfusion theory accepts all of the following Except: a. Trauma posteriorly results in obstructed vascular supply b. Increase in joint pressure in decrease flow posteriorly c. Hypoxic condition increases free radical breakdown of healthy joint d. Increased pressure physically pushes the disc anteriorly allowing more space for free radical degeneration

d. Increased pressure physically pushes the disc anteriorly allowing more space for free radical degeneration

What year was Orthognatic surgery to US?

1965

What is the most common surgical procedure in mandible?

Bilateral sagittal split osteotomy

What is NOT removed in radical neck dissection? a. Jugular vein b. SCM muscle c. Spinal Accessory Nerve d. All lymph nodes on the affected side e. None of the above

None of the above - all are removed during radical neck dissection

What IS removed in modified radical neck dissection?

All lymph nodes are removed but you have preservation of one or more of the non-lymphatic structures (jugular, dcm, or spinal accessory n.)

Your patient is a 65 year old white male, who has smoked two packs a day for 45 years. He has a 2.3cm ulceration, which he noticed in the mirror. Patient reports no symptoms. Upon your examination, you determined the presence of two involved lymph nodes, bilaterally. What is his TNM classification? a. T2N2bM0 b. T2N2cM0 c. T1N2cM0 d. T1N2bM0

T2N2cM0 N2c = bilaterally involved lymph nodes

The microvascular free fibula flap has been shown to be thin, faciolingually and in relationship to the surrounding bone, to support dental implants. a. True b. False

False

What are the disadvantages to microvascular flaps such as anterolateral thigh and latissimus dorsi flap? a. Both flaps are relatively large and are usually not required for most microvascular reconstructions b. Ablative concerns need to be addressed before others.

Both flaps are relatively large and are usually not required for most microvascular reconstructions

What are the benefits of radial forearm free flaps? a. Best for reconstructing oral cavity b. Thin, pliable skin c. Great versatility in design due to septocutaneous blood supply d. All of the above

All of the above

What important factors will the surgeon will take into account when evaluating a patient for reconstruction? a. Patient medical history and physical b. The type of ablative surgery to be performed c. Patient habits d. All of the above

All of the above

Head and neck cancer associated in young patients who don’t smoke and drink is associated with which virus a. HPV b. HIV c. Mononucleosis d. Herpes

HPV

According to statistics, 20-30% of all oral cancers develop where? a. Lateral border of the tongue b. Parotid c. Oropharynx d. Floor of mouth

Lateral border of the tongue

What is the greatest single indicator of prognosis in oral cancer?

Metastasis to cervical lymph nodes

When getting radiation therapy for SCC for head and neck, what is the dosage? a. 5000-7200 cGy b. 5000-7000 Gy c. 80-90 Gy

5000-7200 cGy

What percent of patients that have head and neck malignancies receive radiation therapy? a. 70% b. 100% c. 30% d. 10%

70%

Which orthognathic surgery is the most stable skeletal movement? a. Maxilla up b. Maxilla down c. Mandible back d. Maxilla expansion

Maxilla up

Which of the following arteries is not one of those associated with vertical ramus ostectomies: a. Maxillary a. b. Masseteric a. c. Descending inferior alveolar a. d. Superior thyroid artery

Superior thyroid artery

Bleeding in Le Fort Osteotomy I is supplied by which vessels?

Ascending pharyngeal and ascending palatine arteries

Healing by all of the following can occur except: a. Primary b. Secondary c. Tertiary d. Quaternary

Quaternary

The solution to pollution is dilution. a. True b. False

True

What is the Microbe found most in dog bites?

P. multocida

One of the goals of soft tissue reconstructive surgery is to: a. Line and maintain the original anatomic borders b. Restore function and esthetics c. Restore blood supply to the area

Restore function and esthetics

The fibula is a weight bearing bone. a. True b. False

False

When doing reconstructive surgery, what should you NOT remove/alter? a. Skin b. Eyebrow c. Nose d. Tissue

Eyebrow

T/F - It is important to line the vermillion border in anatomic position when approximating wound edges.

True

Ellis II fracture is a fracture through: a. enamel b. enamel-dentin c. exposed pulp d. crown/root

enamel-dentin

Most common pediatric fracture in which bone: a. Maxilla b. Mandible c. Zygoma d. Nasal

Nasal | slide 21 of the Trauma: Pediatric Fractures lecture

Most common pediatric fracture that requires hospitalization: a. Maxilla b. Mandible c. Zygoma d. Nasal

Mandible | slide 21 of the Trauma: Pediatric Fractures lecture

T/F - As a child grows, there is more forward and vertical growth resulting in a more prominent facial skeleton.

True

When tooth is loosened but not displaced: a. Concussion b. Subluxation c. Avulsion

Subluxation

T/F - A period of 7-10 days is necessary to splint a mobile tooth.

True

You must wait how many days after replanting a mature tooth? a. 7-10 days b. 2-3 weeks c. 3-4 weeks d. 4-6 weeks

7-10 days

Wait how many weeks for dentoalveolar fracture? a. 2 weeks b. 3 weeks c. 4 weeks d. 8 weeks

4 weeks

All of the following are done in pre-hospital care except: a. Airway protection b. Long bone fracture stabilization c. Cervical spine stabilization d. Blood volume replacement e. Hemorrhage control

Blood volume replacement

Motorcyclist scenario. Complete displacement of midface. Zygomatic fractures on both sides. Nasal-frontal suture fracture. What is the LeFort classification for this guy? a. LeFort I b. LeFort II c. LeFort III d. LeFort IV

LeFort III

Motorcyclist has leakage from the patient’s nose and suspect it is cerebrospinal fluid. What bone fracture could result in this? a. Cribriform plate b. Maxilla c. Orbit d. Zygoma

Cribriform plate

T/F - Hank’s Balanced Salt Solution is the best solution to preserve an avulsed tooth.

True Hanks > milk > saliva > water

The severity of horizontal root fractures is dependent on: a. Where it is relative to the gingival crevice b. Where it is relative to the root c. Where it is relative to the opposing tooth

Where it is relative to the gingival crevice

Anosmia is what?

Loss of smell

What CN is damaged if patient has anosmia?

CN I

What does HBO stand for?

hyperbaric oxygen treatment

What is used to treat candidiasis systemically?

200 mg Ketoconazole 100 mg Fluconazole

What is used to treat candidiasis topically?

Nystatin 5 ml PO QID Clotrimazole - table Amphotercin B - 1ml swish and swallow QID

What is the survival rate for a Stage I SSC patient?

85 % Stage 1 = T1N0M0

What is the survival rate for a Stage III SSC patient?

41% T3N0M0, or T1, T2, or T3, N1M0

What is the survival rate for a Stage II SSC patient?

66% T2N0M0

What is the survival rate for a Stage IV SSC patient?

9% Classified as any T4 lesion, or any N2 or N3 lesion, or any M1 lesion

How should the sutures be placed on face for better healing? a. Inverted b. Everted

Everted

T/F - IT is important to line the vermillion border in anatomic position when approximating wound edges.

True

T/F - In pre-surgical ortho treatment you should align teeth over basal bone.

True

T/F - Regional blocks contraindicated for closure of facial lacerations

False

T/F - Animal bites more serious than human bites.

False Human bites are more serious than animal bites.

Gunshot wounds can creat a cavity 30-40 times the diameter of the bullet. The tissue destruction is proportional to the mass of the bullet, and exponentially proportional to the velocity. a. First statement true, second false. b. Both true c. Both false d. First statement false, second true

Both true

A break of the zygomatic bone on both sides and connects at nasal ridge is what type of Le fort break?

Le fort 2

What type of Le fort break is it when there is a disarticularion of mid face and both orbitals are completely broken in the fracture.

Le fort 3

What is the proper Hyperbaric oxygen therapy time and dosage?

Administration of 100% oxygen in a special chamber at 2.4 atmosphere absolute pressure for 90 minutes each session Delivered once a day, 5 times a week. - If done properly O2 gradient increased 7-10 fold

When HBO is used the incidence of Osteoradionecrosis reduces from 30% to what percentage?

Which of the choices below does occur with HBO? a. Increases macrophage migration into wound b. Induces vascular endothelial growth factor to stimulate capillary angiogenesis and fibroplasias c. Improves tissue healing by – angiogenesis, inducing fibroplasias & neocellularity, promoting survival of osteoprogenitor cells, promoting the formation of functional periosteum d. All of the above occur

All of the above occur

A patient undergoing radiation should use fluoride. How often and what type?

0.4% stannous fluoride or 1.1% sodium fluoride applied using custom trays, Applied 10 minutes daily

When does mucositis occur in radiation therapy patients?

5-7 days

What are the WHO toxicity gradings for XRT patients with mucositis?

1 – soreness/ erythema 2 – erythema, ulcers but able to eat solids 3 – ulcers, but requires liquid diet 4 – oral alimentation not possible

How long does healing of mucositis take after XRT?

~3 weeks

What are some treatments for mucositis?

minimizing doses of radiation using mucosa-sparing blocks using amifostine before therapy betamethasone mouthwashes

Patients with XRT may get xerostomia. How much might salivary flow decrease in a week?

50%

What are some ways to prevent xerostomia?

* IMRT * Amifostine (Ethyol) – cyptoprotective agent * RTOG 0244 * RTOG 97-09

What is used to treat xerostomia?

salagen 5mg po TID – 6 weeks to work

What are the 3 Hs to Marx theory of osteoradionecrosis?

Hypovascular Hypocellular Hypoxic

What are some radiographic features of osteoradionecrosis?

diffuse radiolucency without sclerotic demarcation

Which is least sensitive to radiation? a. germinal cells b. lymphoreticular cells c. endothelial cells d. nerve cells

nerve cells | also muscle cells

Radiation affects which part of the cell cycle the most a. mitosis b. g1 phase c. s phase d. g2 phase

Mitosis

T/F - Xerostomia is a quantitative change in salivation, resulting in an increase in pH.

FALSE (causes decrease in pH, to acidic/cariogenic levels)

Patient on the 25th radiation therapy. 10 more left. He has periapical lesion. What do you do? a. stop radiation therapy, extraction b. stop radiation therapy, endo and antibiotics c. do not stop radiation therapy, extraction d. do not stop radiation therapy, endo, and antibiotics

do not stop radiation therapy, endo, and antibiotics

Golden window where you can perform extraction without HBO and not result in Marx 3Hs is how many months?

4 months

What is the least acceptable medium for an avulsed tooth?

Water

Where on the mandible is it most likely to fracture?

1st: Condyle - 29% 2nd: Ramus 24.5% 3rd: Symphysis 22%

In order to see a root fracture, how should the central beam of the X-ray be placed?

Parallel to the line of fracture

A kids tooth has avulsed. What are the steps used to preserve the tooth?

Rinse: crown down, no scrub. More than 20min out: BSS 30 min then doxycycline 1mg/30cc NS 5 min.) Preserve (BSS, sliva, milk, or save a tooth) Hanks pH7.2

What are the stages of wound healing?

- Initial stage (0-5 days) = wound strength is dependent on sutures - Fibroblastic Phase (5-15 days) = rapid increase in wound strength - Maturation Phase (>14 days) = CT remodeling

What is the incidence % of hypoxic patients in patients who "talked and died"?

54%

What % of patients that have had trauma have injuries associated with the spinal cord?

10-15%

1 Gy = how many RAD?

100 RAD

What is dysphagia?

Can't swallow Seen in patients with xerostomia due to XRT

Maxilla is best described as a: a. Pentagon b. Triangle c. Hexahedrum d. Septahedrum

Hexahedrum

Where are dental caries seen clinically in patients undergoing XRT?

Cervical and incisal caries

T/F - A patient that has undergone XRT, may not recover from xerostomia even years after treatment.

True

What preventative measure for xerostomia has cytoprotective properties?

Amifostine (Ethyol)

What is the triad described by Meyer for pathophysiology of osteoradionecrosis?

radiation therapy, local trauma, infection

What needs to be done prior to radiation in your dental practice? a. Extract all carious teeth in the field of X-ray, except in patients with excellent oral hygiene b. extract all questionable teeth c. extract fully impacted teeth d. a and b e. all of the above

a and b a. Extract all carious teeth in the field of X-ray, except in patients with excellent oral hygiene b. extract all questionable teeth DO NOT remove full bony impacted teeth

How often should the dentist see a XRT patient?

Weekly follow up during therapy and after therapy every 3-4 weeks