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Head Innervations: Dr. Justin D / CEU
Head Innervations: Dr. Justin D / CEU
Justin D / CEU
HEAD INNERVATIONS
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Dr. Justin D / CEU
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280. Sensation on the face and teeth involved what nucleus? Principal Sensory Nucleus of V
281. What are the primary sensory neurons of termination involved in pain from the maxillary
282. Which subnucleus of the spinal nucleus of V is responsible for pain sensation? pars
interpolaris
283. Pain from face goes to? VPM
− Facial pain = VPM (Ventral posteromedial nucleus) | body pain = VPL (Ventral posterolateral
nucleus)
284. Branchiomeric nerves come from where? CN 5, 7, 9, 10
− Branchiomeric nerves are nerves to striated muscles of the head & neck that develop from
branchial arches.
Nerves includes CN 5 (1st arch), CN 7 (2nd arch), CN 9 (3rd arch), and CN 10 (4th/6th
arch).
pg. 3
Dr. Justin D / CEU
285. What nerve involved in blinking 7 CN V1 & CN 7
286. What nerve innervates the skin above the upper lip? Infraorbital N
287. Patient complains about burning sensation in the mandibular anterior? Mental nerve
288. What innervates the posterior hard palate? Greater palatine N (anterior hard palate =
nasopalatine N)
289. Which nerve innervate soft plate? Lesser palatine nerve (CN V2)
290. Which is not part pf the Cavernous Sinus 7 Optic Nerve (CNII)
− nerves that ARE assoc with the cavernous sinus are : CN 3,4,6, V1,V2 (mnemonic: O TOM
CAT)
pg. 4
Dr. Justin D / CEU
291. What parasympathetic nerve runs through the foramen lacerum? Greater Petrosal
292. What foramen transmits pre‐ganglionic parasympathetic fibers? Foramen Ovale (for
lesser petrosal N)
293. Before synapsing in the submandibular ganglion, pre‐parasympathetic travel to
which nerve? Chorda tympani
294. What action of the lingual nerve stays with the nerve through its course? Sensory to
anterior 2/3 of tongue
295. Which nerve does not transmit taste fibers from the tongue? Answer choices: V, VII, IX
pg. 5
Dr. Justin D / CEU
296. What is the position of the lingual nerve in respect to the inferior alveolar nerve? anterior &
medial
297. What ganglion does the postsympathetic for the submandibular ganglion? Superior
cervical ganglion
298. Intraoral approach to get to the submandibular ganglion - cut through the mucous
membrane only.
299. If someone has motor loss underneath their right zygoma, what nerve is damaged? CN
7 when exiting the stylomastoid foramen
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Dr. Justin D / CEU
300. If you cut the nerve for the stylomastoid foramen, what do you lose innervation to?
Orbicularis muscle (oculi & oris) ‐ transmits the facial nerve and stylomastoid artery
301. CN VII & VIII goes through? Internal Acoustic Meatus
302. What nerve brings preganglionic para nerve fibers to the otic ganglion, then eventually to
the parotid gland?
Lesser petrosal nerve via glossopharyngeal N (CN 9) through foramen ovale
pg. 7
Dr. Justin D / CEU
303. What NERVE goes between the superior pharyngeal constrictor & middle pharyngeal
constrictor? CN 9
304. What nerves goes between Palatoglossus & Palatopharyngeus? Tonsillar branch of CN9
305. Circumvallate papilla are innervated by what nerve? CN 9
306. What cranial nerve innervates levator veli palatini? CN X
pg. 8
Dr. Justin D / CEU
307. What nerve does not come out of the jugular foramen? CN 12
− Jugular foramen = CN 9, 10, 11 | hypoglossal canal = CN 12
308. Gag reflex 7 sensory limb (afferent) mediated by CN 9, motor by CN 10
309. What is not innervated by the hypoglossal nerve? Palatoglossal (CN 10)
310. Muscles innervated by Ansa Cervicalis (Cl‐C3) include? Infrahyoid muscle (Branches
from the ansa cervicalis innervate most of the infrahyoid muscles, including the sternothyroid
muscle, sternohyoid muscle, and the omohyoid muscle. Note that the thyrohyoid muscle,
which is also an infrahyoid muscle, is innervated by cervical spinal nerve 1 via the
hypoglossal nerve.)
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Dr. Justin D / CEU
BRAIN
311. What is the primary sensory relay station of the brain (conduit)? Thalamus
pg. 10
Dr. Justin D / CEU
314. Sectioning of the infundibular stalk of hypothalamus w/ normal hypophyseal tract leads
to a decrease in what hormones? ADH
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Dr. Justin D / CEU
− Pituitary stalk (also known as the infundibular stalk or simply the infundibulum) is the
connection between the hypothalamus and the posterior pituitary.)
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Dr. Justin D / CEU
319. Where does the maxillary sinus drain into? Semilunar hiatus of the middle meatus
− Nasolacrimal drains into the inferior concha
pg. 13
Dr. Justin D / CEU
320.
321. Right maxillary sinus is infected, where does it spread to next? Right Ethmoid sinus
322. What is the outer edge of the lateral wall of the ethmoid sinus? Orbit
323. Anterior cerebral artery supplies what lobes? Frontal & Parietal Lobes (Medial Surfaces of
both)
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Dr. Justin D / CEU
324. Arachnoid villa & granulation transport CSF from subarachnoid space to venous system
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Dr. Justin D / CEU
330. Each of the following structures lie between the hyoglossus & mylohyoid muscle expect
one? Lingual artery
(passes deep to hyoglossus m)
331. What muscle goes between the superior & middle pharyngeal constrictor muscles?
Stylopharyngeus muscle (note: Glossopharyngeal Nerve)
332. Know the structure that make up the sphenoid bone: body (containing the sella turcica,
which houses the pituitary), 2 greater wings, 2 lesser wings, pterygoid process
pg. 16
Dr. Justin D / CEU
333. What forms the Superior Orbital Fissure 7 Greater and Lesser Wing of the Sphenoid
pg. 17
Dr. Justin D / CEU
334. Foramen ovale is located in the greater wing of the sphenoid
335. Medial border of the Infratemporal fossa? Pterygomaxillary Fissure
336. Guy shot in back of the head, bullet exits above eyebrows. Which bone is least likely to get
damaged? Maxillary
337. All of the following pass through the medial & lateral pterygoid except? Buccal Nerve
− Passes through lateral pterygoid heads
338.
339. What is anterior to the pharyngeal tonsils? Palatoglossal fold
340. Where is synovial fluid produced? Internal synovial layer of the Fibrous Capsule (joint
capsule)
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341. What cells are responsible for its (synovial fluid) production? Type B Synoviocytes
KIDNEY
a) PARTS (Our Careers In Medicine) ‐ outer cortex, inner medulla
− Proximal Tubules
− Loop Henle
− Distal and Convoluted Tubules
343. All of the following are in the kidney medulla EXCEPT? Glomerulus (cortex)
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Dr. Justin D / CEU
344. In a healthy kidney, what does not get passes through? Albumin & glucose (clearance = 0
mg/mL)
345. What cells line the visceral layer of Bowman’s capsules? Podocytes (Podocytes (or
visceral epithelial cells) are cells in the Bowman's capsule in the kidneys that wrap around
capillaries of the glomerulus.)
346. Most kidney reabsorption & ATP used in the nephron of kidney? Proximal
Convoluted Tubule (Contain truncated pyramidal cells)
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Dr. Justin D / CEU
347. Where is the highest osmolarity? Loop of Henle in the medulla
348. Macula Densa is party of the? 7 DCT –Distal Convoluted Tubule (sense NaCl concentration
in thick ascending limb, can signal afferent arterioles to vasodilate & increase renin
released from JG complex)
349. What would increase GFR? Dilation of afferent arterioles in kidney
350. Which one is the best for GFR? Inulin
351. Kidney substance filtered and secreted. The clearance rate is
a. = inulin
b. > inulin
c. < inulin
Decks : If the clearance of a substance that is freely filtrated is *less than* that of *inulin*, then there
is a net reabsorption of the substance.
If the clearance of a substance that is freely filtered is *greater* than that of inulin, then there is a net
secretion of the substance.
If the clearance of a freely filtered substance is equal to that of inulin, then it is neither secreted nor
absorbed or it is both secreted and absorbed in equal amounts
− Inulin (plant starch) is filtered but not reabsorbed or secreted by any parts of the kidney =
GFR
−
352. What is the para‐aminohippurate (PAH) test used for? Measure renal plasma flow
− PAH 7 freely filtered and secreted by the kidney = Renal Plasma Flow
353. Aldosterone is produced in the zona glomerulosa & affects DCT & Collecting Duct
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Dr. Justin D / CEU
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Dr. Justin D / CEU
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Dr. Justin D / CEU
Note: Antidiuretic hormone (ADH) – is produced in the Posterior pituitary (Deficiency would lead
to Diabetes Insipidus)
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Dr. Justin D / CEU
357. Deficiency of ADH, would cause what type of URINE 7 diluted urine
358. What are the primary stones in gout? Urate (Uric Acid) crystals (uric acid deposits in
the joints) GOUT: A form of arthritis characterized by severe pain, redness, and
tenderness in joints.
359. What do you want to inhibit in a person with gout? Xanthine Oxidase
− Uric Acid is an end product of purine metabolism, specifically via xanthine metabolism.
360. You could decrease plasma osmolarity by injecting serum? ADH (?)
361. What type of enzyme is Fumerase? Isoenzyme (Fumarase (or fumarate hydratase) is an
enzyme that catalyzes the reversible hydration/dehydration of fumarate to malate. Fumarase
comes in two forms: mitochondrial and cytosolic.)
362. ORINTHINE is an intermediate of the UREA CYCLE in
mitochondria
363. 548. Fumerase/fumarate connects urea cycle to
the ? TCA Cycle
− Hydration reaction
−
549. In the urea cycle, where does the Nitrogen come from? ammonia & aspartate
550. What is an intermediate in the urea & precursor for ornithine? Arginine
pg. 26
Dr. Justin D / CEU
CHOLESTEROL/LIPIDS
551. De novo cholesterol involves everything except? Oxygen (Need ATP, NADPH, acetyl
CoA, malonyl CoA)
− acetyl‐CoA carboxylase enzyme of fatty acid synthesis 7 function is to provide
malonyl CoA substrate for biosynthesis of fatty acids
− NOTE: De novo Cholesterol is produced in the LIVER
552. Rate limiting step of cholesterol biosynthesis 7 HMG CoA Reductase
Statin drugs are HMG‐CoA reductase inhibitors.
pg. 27
Dr. Justin D / CEU
553. How do animal cells primarily use cholesterol? Cell Membrane component
− Aside from phospholipid, cholesterol is the most common cell membrane component
−
554. LDL Receptor 7 APOB‐100 (Apolipoprotein B)
555. Triglyceride is carried from the liver to organs by chylomicrons
556. Hyperlipidemia: fat in blood; chylomicrons 7 liver 7 VLDL 7 blood 7 tissue 7 LDL 7
HDL
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Dr. Justin D / CEU
557. Which one is correct about cholesterol synthesis pathway? The pathway has squalene
intermediate
Mevalonate 7 Squalene 7Cholesterol
(Statins drugs(Lipitor) inhibit mevalonate
synthesis)
https://www.youtube.com/watch?v=seRkO
CEfWpo
GI TRACT
pg. 29
Dr. Justin D / CEU
released by G cells of gastric motility
stomach & duodenum
pg. 30
Dr. Justin D / CEU
− 557. What cells secretes Gastrin 7 G cells of the stomach & duodenum
− stimulate HCl from parietal gland, histamine, pepsinogen secretion, and increased gastric
blood flow
558. Where are chief cells produced? Stomach
559. Where is pepsinogen secreted from? Stomach (by chief cells to degrade proteins)
560. What does not secrete bicarbonates? Chief cells of the stomach
A gastric chief cell (also known as a zymogenic cell or peptic cell) is a cell in the
stomach that releases pepsinogen and chymosin) (Pesinogen digests proteins)
561. Where is intrinsic factor secreted from? Fundic portion of Stomach (by parietal cells for Vit
B12)
Intrinsic factor (IF), also known as gastric intrinsic factor (GIF), is a glycoprotein produced
by the parietal cells of the stomach. It is necessary for the absorption of vitamin B12
(cobalamin) later on in the small intestine. (Pernicious anemia attacks IF)
562. Stimulate Histamine H2 receptor to make? parietal cell (release HCl) in the stomach
563. Where is secretin made? S cells of the Duodenum for HCO3 bicarb
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Dr. Justin D / CEU
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Dr. Justin D / CEU
566. Crypts of Lieberkühn (intestinal glands) are in lamina propria of small intestine
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Dr. Justin D / CEU
b. Maltose
c. Galactose
d. Fructose
e. Glucose
Note: Only Monosaccharides can be absorbed in the small intestine. Disaccharides are hydrolyzed
first by brush border enzymes. (pg. 258)
568. Main movement in the small intestine is through segmentation
569. What is NOT absorbed in the jejunum? What IS NOT absorb: iron, vitamin B12, water,
sodium bicarbonate, lipids.
Is absorbed in jejenum: Na, K, and Cl
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Dr. Justin D / CEU
570. Mesentery is a tissue that attaches the posterior wall of the peritoneal cavity to the
jejunum.
571. Difference between colon and all other parts of the digestive system 7 Colon does not
have villi
572. Which is innervated by Vagus nerve? Transverse colon & Lung
− It supplies motor parasympathetic fibers to all the organs from the neck down to the
second segment of the transverse colon (includes ascending & transverse colon) except
the adrenal glands
573. What cells secrete bicarbonate? Epithelial cells lining the pancreas
574. Centroacinar cell are found in what organ 7 Pancreas
− intercalated duct cells, secrete bicarbonate when stimulated by secretion to provide
alkaline pH for enzyme activity in the stomach.
−
575. Trypsinogen (pancreatic enzyme, digest proteins) becomes trypsin by altering N terminal
peptide
576.
577. What acts adjunctively with lipase? Bile
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Dr. Justin D / CEU
MUSCLES
pg. 36
Dr. Justin D / CEU
578. Which one is around a myofibril? Endomysium
579. When do cardiac muscles start to contract? Influx of the Ca2+ from the outside
580. Parasympathetic nerves from vagus nerve (CN 10) acts on the heart by lowering heart
rate
581. Regulation of the contraction in smooth muscle? Calmodulin
− Smooth muscle has calmodulin instead of troponin. All muscles have tropomyosin
CaM mediates many crucial processes such as inflammation, metabolism,
apoptosis, smooth muscle contraction, intracellular movement, short‐term and long‐
term memory, and the immune response.
pg. 37
Dr. Justin D / CEU
− .
pg. 38
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582. Ca+ binds to calmodulin, which activates myosin light chain kinase
585. What does Ach cause the arrector pili to do? 7 increase Ca+ entering the cell to erects
the muscle
− Increase in intracellular Ca 7 greater activation of contractile proteins
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Dr. Justin D / CEU
−
586. Skeletal has multinucleated cells while smooth/cardiac = 1 nuclei
587. Direct source of energy for skeletal muscle? ATP = ADP + phosphate
588. How does ATP get transported out of the mitrochondrial memebrane? ATP–ADP
translocase (ATP–ADP translocase is a transporter protein that enables ATP and ADP to
traverse the inner mitochondrial membrane.)
589. Sarcolemma/sarcomere is only in striated muscle (skeletal & cardiac)
590. Isotonic muscle contraction? H & I band get shorter
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Dr. Justin D / CEU
591. Increasing the load of muscles does what to velocity? Slow it down
592. Gamma efferent motor fibers is for stretch receptors (spindles), regulate stretch/muscle
length & tone. NOTE: the Y-Motor is also know as the Gamma Motor Neuron.
593. Inorganic phosphate is released from ADP in myosin when? For a powerstroke
594. What is responsible for dissociation of phosphate group during muscle contraction?
Cocking Action
595. Myosin has ATPase action that turns ATP - ADP + Phosphate, release of the
phosphate group causes the myosin powerstroke
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596. Which one is not a glycoprotein hormone?
a. GH (somatrophin, peptide hormone) 7 inhibits insulin
b. LH
c. FSH
d. TSH
e. HCG
597. Somatomedins 7 Promote cell growth
598. Growth Hormone stimulated chondrogenesis indirectly by using what? somatomedins
Somatomedians are a group of hormones that promote cell growth & division in response
to stimulation by growth hormone (GH, somatotropin)
599. Vit K 7 is needed for: blood clotting (and Calcium is needed for clotting)
600. What is biotin used for 7 Pyruvate Carboxylase, acetyl CoA (cofactor)
− any carboxylase needs biotin cofactor
−
601. What reaction requires thiamine (B1) 7 Pyruvate decarboxylase
602. B1 (Thiamine) 7 coenzyme for
decarboxylation rxns
pg. 44
Dr. Justin D / CEU
605. B6 (pyridoxine, PLP) 7 Transamination Rxn (amino acid and nucleic acid
metabolism)
pg. 45
Dr. Justin D / CEU
607. Lumbar puncture occurs at the Level of the: 7
L3/L4
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Dr. Justin D / CEU
611. What hormone is responsible for milk secretion postpartum? oxytocin
− Oxytocin EJECTS breast milk, produced in the paraventricular nucleus of the
RANDOM
612. Advantage of using dry heat sterilization over autoclaving 7 No dulling, it keeps
instruments sharp
613. Best method to sterilize instruments without corrosion? Dry heat
614. Ethylene oxide for sterilization is good for? Heat Labile Tools
615. If unable to use heat, what method should be used to sterilize instruments? Ethylene
oxide
616. What’s a way to measure human basal energy? Temperature
617. What enzymes are not involved in making cDNA? Telomerase
− Reverse Transcriptase & RNA‐dependent DNA‐
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Dr. Justin D / CEU
620. Know the steps of PCR: amplify & make more copies of DNA ( I Do
An Exercise Forever) P.299 (FA)
1‐ Initialization: DNA polymerase that need heat activation
2‐ Denature: heat reaction for 20‐30 sec so DNA melts/disrupt H‐
bonds to yield ssDNA
3‐ Annealing: reaction T is lowered for hybridization of primer to strain
4‐ Extension: DNA polymerase added to synthesize new DNA
complement, x2 DNA
5‐ Final Elongation: ensure all DNA strands have elongated
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Dr. Justin D / CEU
621. When does pH = pKa? Isoelectric point (isoelectric point is the pH such that no
migration occurs during electrophoresis)
622. Mechanism of Fluoride 7 Enolase Inhibitor (which inhibits glycolysis)
625. Which lymph nodes are along the external vein 7 Deep
Cervical Lymph nodes
626. Which structure has both afferent and efferent vessels 7 Lymph
Nodes
627. Tetrodotoxin (pufferfish) is a channel blocker for voltage‐gated Na+ channels = no
action potential
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Dr. Justin D / CEU
DENTAL ANATOMY
HEIGHTS OF COUNTOURS ‐9/8/15
Facial/Buccal = Generally in the cervical 3rd, except with mand posterior where it is at the junction
btw cervical and middle
Lingual = Cervical 3rd on anterior teeth and in the middle third of the posterior teeth.
Mesial and Distal = Anteriors are in the incisal third. As you move posteriorly from the midline,
they reach middle third of posterior teeth
Rashkow Plexus=A plexus of myelinated nerve fibers located between the core of the pulp of the
tooth and the cell‐rich zone; axons of Raschkow plexus lose their myeline sheath (but not their
Schwann cells) as they penetrate the cell‐rich and cell‐free zones to make synaptic contact with the
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Dr. Justin D / CEU
odontoblast cell body in the pulp or odontoblastic process within the dentinal tubule; Raschkow
plexus is responsible for transmitting pain sensation from the pulp of the tooth.
6. When does man 2nd molar complete root/apex formation? 15 yrs old
PRIMARY TEETH
pulp horns, bigger cervical bulge (especially 1st M), enamel rods that go from
DEJ occlusally, more flared roots
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pg. 52
Dr. Justin D / CEU
Tooth Fusion is when two tooth buds fuse together to make one large wide crown. The fused
tooth will have two
independent pulp chambers and root canals. The fusion will start at the top of the crown and
travel possibly to the apex of the root.
Tooth Gemination is when one tooth bud tries to divide into two teeth. The tooth count is
normal with gemination. On the radiograph, the geminated tooth will have one pulp canal but
two pulp chambers.
7. What color are primary teeth compared to adult teeth? Whiter, lighter than adults
8. Primary teeth are more bulbous & constricted (smaller occlusal table).
9. Where is the primate space on the mandible for primary teeth? Between the canine & 1st
molar
10. Order of eruption in primary maxillary arch? Centrals > laterals > 1st molar > canine > 2nd
molar
11. Primary maxillary central is wider M/D than inciso‐cervically
12. What permanent tooth is like the primary 2nd molar 7 permanent 1st molar
13. Which primary tooth has a crown similar to a premolar and roots similar to a molar? Primary
17. Most prominent cusps on a primary man 1st molar is between which cusps? MB & ML
18. Primary man 2nd M has 5 cusps, 2 roots & a prominent cervical ridge on the facial (MB).
19. Which cusp is the tallest cusp of the primary mandibular 1st molar? Mesial Lingual
pg. 53
Dr. Justin D / CEU
− 4 cusps 7 MB (Biggest), ML (tallest, sharpest), DB, DL (smallest), most difficult to restore
20. 12 year old patient still has which primary teeth? K, T (primary man 2nd M)
MAXILLARY
21. Most scalloped tooth? mesial of max central incisor
22. If you looked at the midline of the incisal edge of the max central incisors, where would it
be in relation to the root of the tooth? Centered
− Rule: maxillary incisal edges are centered while mandibular incisal edges are lingual
to root axis except maxillary canine, which is facial to root.
23. Maxillary central is least likely to have a divided canal.
24. When extracting a tooth, due to its root shape, what is the easiest tooth to rotate? Maxillary
central
25. Maxillary central incisor is cut @ the CEJ. What shape is the tooth outline? Triangular
26. How do permanent max centrals difference from primary centrals?
a. Longer Root
b. No Mamelons
c.No Cingulum
d. No Marginal Ridge
27. Teeth with Mamelons on incisal edge intact on a adult over 30 years old indicates what?
anterior open bite
28. Compared to the maxillary central incisor, the maxillary canine is wider faciolingually & longer
root
29. Dens in dente has highest frequency in which tooth? Tooth # 7 & 10 (max lateral incisors)
30. Which tooth is most likely to have a peg lateral? Maxillary lateral incisor
31. Girl has no caries except on max lateral. This is due to lingual groove that goes into the gingiva
32. Maxillary lateral has a lingual groove that extends from enamel to cementum = palato‐
radicular groove
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Dr. Justin D / CEU
36. Maxillary 1st PM is the only permeant tooth with a longer mesial slope than distal slope on the
facial.
− Primary maxillary canine = only primary tooth with longer mesial slope than distal slope
37. Lingual cusp of the max 1st PM compared to the facial cusp? Shorter (1mm)
38. Max 1st PM is most similar to what man 2nd PM? H type, Y type, U type
39. In which tooth is the lingual dimension greater than buccal dimension? Maxillary 1st Molar
− because of the Cusp of Carabelli
40. On the maxillary 1st molar, the oblique ridge is formed between which 2 cusps? ML & DB
41. What are the 2 obtuse angles of the max 1st molar? ML & DB
− 2 acute angles are MB & DL.
42. Which tooth is more likely to have 3 cusps? Maxillary 2nd molar & Mandibular 2nd PM
MANDIBULAR
43. Mandibular central is wider F/L than M/D. (smallest, most symmetrical tooth)
− Only opposes 1 tooth (max central), incisal edge is lingual tilted, roots have M & D concavity
− Incisal edge is twisted disto‐lingually
44. Mandibular lateral incisor has a lingual curve on the distal incisal edge & a cingulum offset to
the distal
45. Mandibular canine erupts before premolars (opposite for maxillary)
46. Which anterior teeth is most likely to be bifurcated? Mandibular canine
47. You have to do RCT on a mandibular canine, what is the most likely complication you may
encounter? Bifurcated root
48. Mandibular canine has mesial outline form that’s straight.
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49. Premolar most likely to exhibit pits & has a square occlusal surface? Mandibular 2nd PM
50. Highest cusp in a mandibular Y‐type 2nd premolar 7 Lingual (Buccal cusp is shorter and
blunter than the lingual cusp)
− Y shaped = 3 cusp, H or U shaped = 2 cusp
− U shaped man 2nd PM = crescent shaped central groove
51. Y‐shaped mandibular 2nd premolar is made by a combination of what grooves? Central &
lingual groove
52. Roots of the mandibular 1st M are spread wider than roots of mandibular 2nd M
55. What is the 1st tooth to erupt after the last succedaneous tooth has come in? Man 2nd molar
56. Which of the following cusps is not a primary developmental cusp of the maxillary 1st Molar?
distolingual (?)
MEDICATION
57. Fluorosis causes mottling of teeth
58. A child has brown pits on their enamel, what is the cause of this? Fluorosis (stains yellow‐
brown in pits)
59. Patient had brown & grey tooth discoloration on premolar, canine, and 2nd molars but the
anterior were spared. When was the patient given tetracycline? Tetracycline before the age
of 2
60. Tetracycline MOA 7 inhibits protein synthesis/translation by blocks 30s ribosome subunit
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Dr. Justin D / CEU
Rule: The steeper the articular eminence, the LONGER the posterior cusps MAY be to
prevent occlusal interference in lateral movement
PERIODONTAL DISEASE
69. Main cause of periodontal pocket? Bacteriodes gingivalis (P gingivalis)
70. Immunoglobin associated with periodontal disease? IgG
71. Periodontal disease pathogens are usually anaerobic or capnophilic
72. Most common bacteria in periodontitis: prevotella intermedia (also in ANUG)
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73. What bacteria is likely to cause periodontitis & bleeding gums in a 19 yr old
boy? Actinomyces actinomycetemcomitans (Aa bacteria)
74. Which pathogen is most likely involved in dental abscess of angle of mandible? Actinomyces
israelli (Lumpy Jaw)
− Actinomysosis causes lumpy jaw = growing large abscess that grows on the head/neck.
75. Purulent discharge after extraction & has sulfur granules – Actinomyces
TMJ
76. TMJ is a loading joint & a synovial joint. Both statements are true.
77. Inferior compartment of TMJ = rotation, superior compartment of TMJ = translation (> 25 mm
opening?)
78. What part of the condyle is involved in translation? anterior superior
79. What ligament restricts protrusive movement? Stylomandibular ligament
− ligament gets taut (under tension) in full mouth opening causing the condyles to move
forward
80. When yawning, which ligament tightens up so that the condyle stays in fossa & prevents
retrusion?
Temporomandibular Ligament
− TM ligament attaches to zygoma & prevent excessive retrusion
81. What ligament is connected the lingula of the mandible? Sphenomandibular ligament
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− Origin & insertion of sphenomandibular ligament: Spine of the sphenoid & lingula of the
mandible
− Prevents excessive opening
82. Origin & insertion of the pterygomandibular raphe? Hamulus of the pterygoid plate &
mylohyoid line
83.
84. Origin & insertion of temporomandibular ligament? Articular eminence/posterior
zygomatic arch & neck of condyle
85. Collateral (Discal) ligaments used during lateral movements & keep articulator cartilage on the
condyle head.
86. Disc of TMJ is what to the condyle 7 attached laterally
87. What type of tissue covers the condylar surface of a 10yr old? Dense fibrous connective
tissue
88. What covers the articulating surface of the TMJ? Fibrocartilage
89. Articulating surface of TMJ in older person is covered in? fibrous connective tissue
containing chondrocytes
90. Where is the phagocyte located in the TMJ? Synovial membrane
91. What is the direct source of nutrients to the articulating surfaces? Diffusion from synovial
fluid
92. What type of connective tissue is in the middle portion of the retrodiscal pad? Loose CT with
blood supply
93. Patient is anesthetized & pain at the TMJ is gone, what nerve is was anesthetized?
Auriculotemporal N (CN V3)
94. TMJ innervation is from? Auriculotemporal N
95. Which criteria determines the progressive shift of nonworking condyle? Medial wall
anatomy of the glenoid fossa
96. Cusp tip of tooth #6 & 27 touch on laterotrusive movement, where is the condyle on the non‐
working side?
medial wall of glenoid fossa
− Laterotrusive rotates while mediotrusive side translates forward and opens a bit
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97. When restoring a lingual cusp of man 2nd Molar, which movement is most likely to cause
interference?
Mediotrusive
98. On your articulator, altering horizontal condylar guidance will affect all of the follow except?
Laterotrusive (?)
99. Patient with a Class III crossbite does retrusion. What mandibular teeth will the maxillary
lateral incisor contact?
Canine & lateral incisor
100. In Class II occlusion during protrusive movement, which teeth does the mandibular canine
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− Most anterior point = protrusion, most inferior = maximum opening
MUSCLES
KNOW THIS! 9/8/15
Muscle Origin/Insertion Action Innervation
Massester O: maxillary process of Elevates the mandible CN V3
zygomatic bone
I: lateral ramus of mandible
Temporalis O: temporal fossa of parietal Elevates the mandible CN V3
bone (posterior fibers) retrude
I: coronoid process
Medial Pterygoid O: lateral pterygoid plate of Elevate the mandible CN V3
sphenoid bone
I: medial ramus of the mandible
Lateral Pterygoid O: lateral pterygoid plate of Protrude, depressing/opening CN V3
sphenoid bone mandible,
I: neck of mandible Lateral movements
Geniohyoid O: hyoid bone Raises hyoid bone, assist in C1 via hypoglossal N
I: mandible depressing mandible
Digastric O: mandible Assists in depressing/opening Anterior (CN V3)
I: hyoid bone the mouth Posterior (CN VII)
Raises hyoid bone
108. What muscle inserts into the pterygoid hamulus? Tensor veli palatini
109. What inserts into coronoid process? Temporalis muscle
− Elevate mandible (anterior, superior fibers), Retrude mandible (posterior fibers)
110. Which of these muscle retracts the mandible? Temporalis muscle
111. Right mandibular excursion is done by the left lateral pterygoid muscle
112. Failure of the left lateral pterygoid muscle causes the mandible to deviate to the left. (Ipsilateral
damage)
113. What makes the sling of the mandible? Medial pterygoid & masseter muscle
114. What mandibular movement are the digastric muscles primarily involved with? depression/retraction
115. What movement is being done when both the lateral pterygoid & both the digastric muscles are
involved?
Depressing (open) & protruding the mandible
− lateral pterygoid muscle is responsible for protruding & depressing/opening the mandible
116. Which group of muscles is used in opening the mouth? Suprahyoid muscles (includes digastric)
− muscles involved in depressing the mandible: Geniohyoid, mylohyoid, digastric, lateral pterygoid,
infrahyoid
One of the earliest signs in the formation of a tooth that can be seen microscopically is the
distinction between the vestibular lamina and the dental lamina. The dental lamina connects the
developing tooth bud to the epithelial layer of the mouth for a significant time.This is regarded as
the initiation stage.
Bud stage
The bud stage is characterized by the appearance of a tooth bud without a clear arrangement of
cells. The stage technically begins once epithelial cells proliferate into the ectomesenchyme of the
jaw. Typically, this occurs when the fetus is around 8 weeks old. The tooth bud itself is the group of
cells at the periphery of the dental lamina.
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Along with the formation of the dental lamina, 10 round epithelial structures, each referred to as a
bud, develop at the distal aspect of the dental lamina of each arch. These correspond to the 10
primary teeth of each dental arch, and they signify the bud stage of tooth development. Each bud is
separated from the ectomesenchyme by a basement membrane. Ectomesenchymal cells
congregate deep to the bud, forming a cluster of cells, which is the initiation of the condensation of
the ectomesenchyme. The remaining ectomesenchymal cells are arranged in a more or less
haphazardly uniform fashion.
Cap stage
The first signs of an arrangement of cells in the tooth bud occur in the cap stage. A small group of
ectomesenchymal cells stops producing extracellular substances, which results in an aggregation of
these cells called the dental papilla. At this point, the tooth bud grows around the ectomesenchymal
aggregation, taking on the appearance of a cap, and becomes the enamel (or dental) organ covering
the dental papilla. A condensation of ectomesenchymal cells called the dental sac or follicle
surrounds the enamel organ and limits the dental papilla. Eventually, the enamel organ will produce
enamel, the dental papilla will produce dentin and pulp, and the dental sac will produce all the
supporting structures of a tooth, the Periodontium.
Bell stage
The bell stage is known for the histodifferentiation and morphodifferentiation that takes place. The
dental organ is bellshaped during this stage, and the majority of its cells are called stellate
reticulum because of their star shaped appearance. The bell stage is divided into the early bell
stage and the late bell stage. Cells on the periphery of the enamel organ separate into four important
layers. Cuboidal cells on the periphery of the dental organ are known as outer enamel epithelium
(OEE). The columnar cells of the enamel organ adjacent to the enamel papilla are known as inner
enamel epithelium (IEE). The cells between the IEE and the stellate reticulum form a layer known as
the stratum intermedium. The rim of the enamel organ where the outer and inner enamel epithelium
join is called the cervical loop. In summary, the layers in order of innermost to outermost consist of
dentin, enamel (formed by IEE, or 'ameloblasts', as they move outwards/upwards), inner enamel
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epithelium and stratum intermedium (stratified cells that support the synthetic activity of the inner
enamel epithelium) What follows is part of the initial 'enamel organ', the center of which is made up
of stellate reticulum cells that serve to protect the enamel organ. This is all encased by the OEE
layer.
117. First stage of tooth development? Differentiation of odontoblast (odontoblast is a cell of neural
crest origin that is part of the outer surface of the dental pulp, and whose biological function is
dentinogenesis, which is the formation of dentin)
118. DEJ is developed at what stage? Bell stage
− DEJ = 1st site of enamel formation
119. Dental lamina is formed around 6 weeks
− proliferates into bud @ week 8
120. Dentin & pulp is formed from what? Dental Papilla (DP)
121. What comes from the dental follicle? cementoblast, osteoblast (AV bone), fibroblast (PDL)
122. All of the following come from dental sac except epithelial attachment (comes from
reduced enamel epithelium/enamel organ)
123. Stratum intermedium is needed for enamel formation
124. Which cells are not found in the pulp? Cementoblasts (found in PDL)
125. Lines of Owen resemble 7 Striae of Retzius (enamel)
− Contour Lines of Owen = incremental lines in dentin | Striae of Retzius = incremental lines in enamel
126. What are affected in Lines of Owen? odontoblasts
127. Secretion of ameloblasts is dependent on? Laying down of predentin
128. Crack that goes from the enamel to the DEJ? Enamel Lamellae
− Enamel Lamellae are defects in the enamel resembling cracks or fractures which transverse the
entire length of the crown from the surface to the DEJ. Hyocalcified, can contain oral debris.
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129. What is dentin called when a patient has chronic disruption by bacteria? Reparative dentin
130. Secondary dentin contains no cells
131. Rashkov's plexus are next to odontoblastic process
− Fibers concentrated in plexus underneath odontoblast, monitors painful sensations
132. Know granular layer of tomes: Thin dentin layer adj to cementum, granules are transverse
section of coiled dentinal tubules
133. Peritubular dentin is more calcified than intertubular dentin
134. Primary cementum = acellular, secondary cementum = cellular
135. Which of the PDL fibers is most abundant & most load bearing? Oblique
136. What type of collagen is predominates in PDL fibers & not in bone or dentin? Type III
137. Bit hard on a popcorn kernel, what stops the biting 7 Periodontal Mechanoreceptors
RANDOM
138. What nerve innervates #3‐5? Middle superior alveolar N & posterior superior alveolar N
− PSA: M3, M2, M1 (DB root)
− MSA: MB root of M1, PM2, PM1
− ASA: canine to central
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139. What is the prominence on the surface of the maxillary bone caused by the canine tooth? Canine
eminence
140. Mesiodens = supernumerary tooth located between maxillary central incisors.
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141. Swollen lip or puffy face after amalgam filling? angioedema
142. Patient’s condyle can be obstructed by tuberosity
143. Patient had a heart stent placed 6 years ago & hip replaced 10 years ago, which of the following do
you NOT do?
Antibiotic prophylaxis
144. What allows the radicular pulp to communicate with the periapical tissue‐radicular? apical foramen
145. Cervical ridge is the only ridge that can’t be seen from the incisal view.
146. Know contact points
− Max lingual cusp will contact central fossa + distal MR of man
− Man buccal cusp will contact central fossa + mesial MR of max
147. Height of Contour on teeth
− All facial HOC & anterior lingual side = cervical 1/3
− All remaining lingual HOC = middle 1/3 (except man 2nd PM HOC is in occlusal 1/3)
148. Lingual height of contour of maxillary 1st molar? Middle 3rd
149. Contact point of mesial of man canine 7 incisal 1/3
150. Contact point on distal of max lateral incisor 7 junction of middle & incisal 1/3
151. 17 yr old patient has 2 molars, permanent PM, & primary molars on in the right mandibular
quadrant, what tooth is likely missing? Permanent man 2nd PM
− Most likely reason for still having primary teeth = successor is missing
152. What is the 1st succedaneous premolar to erupt? Man 1st PM
153. How many posterior teeth are succedaneous? 8 (all premolars)
154. What is formed by the marginal ridge & cusps of the teeth? Developmental grooves or occlusal table
(?)
155. Patient has infected man 1st premolar, which lymph node will be infected first? Submandibular
156. Lymph of anterior mandibular teeth (#24) drain to where? Submental
157. What is the most common cause of infection in dental clinics? Air borne inhalation
158. Child has central incisor, lateral incisor, and canine erupt with brown pits in the incisal third of
enamel, what happen? Hypoplastic (pitting)
159. All of the follow should be considered before an extraction except? Density of the mylohyoid line
160. What would be the radiolucency above the first maxillary molar? Maxillary sinus
161. What would be the radiolucency between the maxillary central? Intermaxilllary suture
162. The part of the hard palate that is directly posterior to the maxillary centrals formed from?
Intermaxillary Segment
163. What is the cause of half facial paralysis after Inferior Alveolar Nerve Block? Injection into parotid
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gland
164. Pt comes in 1 day after extraction of max 3rd molar with a hematoma. What is the cause of the
hematoma?
Needle has violated in pterygoid plexus
165. Mandibular Tori is made of? Dense lamellar bone
166. After a dental prophy, bacteremia is when bacteria gets into the blood from scaling of teeth. (Not
septicemia)
167. What happens as a tooth ages 7 Decrease in Cellularity (?)
168. Where is fat found in the palate? Anterolateral
169. Which root shape is most likely to have one canal? Round
170. Taurodontism ‐ body & pulp chamber of a molar is enlarged vertically at the expense of the
roots/moved apically down the root. MOA is the failure or late invagination of Hertwig's epithelial
root sheath, which is responsible for root formation and shaping, causing an apical shift of the
root furcation.
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****Dilaceration is a developmental disturbance in shape of teeth. It refers to an angulation, or a
ETHICS
Veractiy (Truthfulness) The dentist has the duty to communicate truthfully
Justice (Fairness) Dentists (1) shall not refuse to accept pts into their practice or deny dental service to pts bc of
the pt’s race, creed, color, sex, or national origin
(2) have the general obligation to provide care to those in need (ex. refusing to treat HIV+ pt is
unethical)
(3) shall be obligated to make reasonable arrangements for the emergency care of their pts of
record.
Autonomy (Self-Governance) Dentist has a duty to respect the pt’s rights to self-determination & confidentiality
Beneficence (Do Good) Dentist is obliged to (1) give the highest quality of service of which he or she is capable
(2) preserve a healthy dentition unless it compromises the well-being of other teeth
(3) participate in legal and public health-related matters.
Non-maleficence (Do No The dentist has a duty to refrain from harming the pt.
Harm)
171. You extract a primary tooth and you injure the permanent tooth bud, what is the ethical word listed
above that describes the fact that you have to inform the patient what happened? Veracity
172. A case of a child with evidence of child abuse and they asked you what you should do? Report your
suspicions.
173. If the doctor doesn’t feel comfortable practicing on someone? Non‐maleficence
174. During extraction, you break the adjacent marginal ridge of an amalgam treated tooth?
a. Continue with extraction.
b. Stop everything and notify patient.
c. Smooth out edges of broken amalgam so you don't lacerate tissue.
d. Call patients emergency contact.
175. Besides maintaining a patient’s oral health, what would a dentist prioritize?
Autonomy http://teachmeanatomy.info/
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2. (Case Study) Dead girl has swollen right cheek with hematoma on the lateral rim of the right orbit. Erupted
lower canines but not upper canines. Rattlesnake bites her lateral of the right forearm.
a. What’s the age of this girl? 9-10 yrs (max canine = 11-12 yrs)
b. Which bone of the orbit is probably broken? Zygomatic
c. On the x-ray, there is a line of radiolucency on the left orbital lateral margin? Normal suture
d. What would the coup contrecoup injury be (opposite side of impact) Right sphenoid (a coup injury
occurs under the site of impact with an object, and a contrecoup injury occurs on the side opposite
the area that was hit)
e. What nerve is most prone to injury in the forearm? Radial nerve (elbow)
3. (Case study) Patient with pain in the shoulder that extends down to the arms & hands.
a. What nerve is damaged? T1-T2
b. What innervates the middle finger? C7
c. What innervates the Ring Finger? C8
d. What nerve is involved when she has pain turning her head? Accessory N (XI)
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4. (Case Study) Diabetes case: Patient has an HbA1C = 11%
a. How to tell her status for the past few weeks (HbA1C test for what condition)? Diabetes (Type II)
b. All are likely to be associated with this person’s existing condition except? Angioedema
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− HgA1c (glycated hemoglobin assay) is proportional to blood glucose concentration.
− Angioedema is the rapid swelling (edema) of the dermis, subcutaneous tissue, mucosa and submucosal
tissues.
5. (Case study) Female with hypothyroidism that suffers from dry mouth & is taking thyroid medication.
a. What happens if she overdoses on medication? Tachycardia
b. What is the cause of her dry mouth? Sjogren's Syndrome
− Sjogren’s syndrome is the 2nd most common autoimmune rheumatic disorder after RA. Characterized by
diminished lacrimal & salivary gland secretion (sicca complex)
− Can cause distortion of taste (dysgeusia)
− Hypothyroidism: Positive nitrogen balance (intake >loss), cold intolerance (Decreased blood flow to skin),
weight gain, fatigue
6. (Case Study) Man has fair skin and has a mole rapidly growing lateral to nose (or on alar part of nose). The lesion
is growing fast.
a. What is it? (melanoma?) Lentigo maligna?
7. (Case Study) Exam of cadaver: Female. LEFT backstab at L1-L2, adjacent to vertebrae, 12 cm deep. Has Malory-
Weiss tear on her esophagus and multiple mass on her uterus.
a. What is the cause of the Malory-Weiss tear? Alcoholism (Mallory-Weiss tear = bleeding from tears
at esophagus/stomach jxn)
b. What is the multiple mass on her uterus? Leiomyoma (benign neoplasm of uterus)
c. Which organ is most likely damaged/hit 7 Kidney
8. (Case Study) Patient has gestational diabetes & is 10 weeks pregnant.
a. What has not formed? TMJ formation (12 weeks)
− Palate closes @ 10 weeks, tooth bud forms @ 8 weeks
b. What happens to her hormones? ↑ in HcG, ↓ in FSH & LH
(Human chorionic gonadotropin (hCG) is a hormone produced by the syncytiotrophoblast, a portion
of the placenta following implantation)
Gestational diabetes (or gestational diabetes mellitus, GDM) is a condition in which women without
previously diagnosed diabetes exhibit high blood glucose (blood sugar) levels during pregnancy (especially
during their third trimester). Gestational diabetes is caused when insulin receptors do not function properly.
This is likely due to pregnancy-related factors such as the presence of human placental lactogen that
interferes with susceptible insulin receptors. This in turn causes inappropriately elevated blood sugar levels.
9. (Case Study) 6 weeks pregnant lady.
a. How long do you wait to treat her? 6 weeks
b. Tell her to take care of oral health, why? Gingival bleeding
10. (Case Study) Patient has asthma & is on Albuterol and high blood pressure meds.
a. What is a dental complication? Orthostatic Hypotension
b. Asthma treatment = Beta-2 agonist causes bronchiolar relaxation
11. (Case Study) Woman comes into your office complaining that every time she eats, she gets a swelling that is
painful and large. X-Ray shows radioopacity, 1 cm x 1 cm. Inflammation of the submandibular duct/gland,
tenderness.
a. What is the reason for swelling? Bacterial infection
b. What's the diagnosis? Sialolith (calcified mass in salivary gland, usually submandibular. Symptoms:
pain/swelling when salivary gland is stimulated)
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c. What kind of cells would you find when biopsy the salivary duct/gland? neutrophils
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12. (Case Study) Dentist is asked to help w/ an autopsy. There were 2 bullet wounds, evidence of TB. One bullet hit
above the ear & the other was a bullet through the ribs that injured the lower lobe of the lung.
a. The bullet that hit above the ear came out of where? Temporal bone
b. Man is shot & a bullet entering between the right 7th & 8th intercostal ribs & exits to the right of T7.
What lobe of the lung did it puncture 7 Inferior Right lobe
c. T/F 7 hemothorax (blood in pleural cavity)
13. (Case Study) Patient has Myasthenia Gravis
− Mechanism: autoimmune disease, antibodies against post-synaptic NMJ Ach receptor
a. Causes decreased acetylcholine receptors
b. How to medicates treat/help overcome symptoms: acetylcholinesterase inhibitor helps increase
amount of available acetylcholine receptors
c. Patient refuse treatment & can only afford to do a prophy, what do you do? Present him with all
options & refer him to specialty as needed.
14. (Case Study) Girl with from another country has TB; know about the drug & dental problems.
a. What antibiotic is most frequently used in treatment of TB? rifampin = inhibits RNA synthesis
(transcription), used for 6-9 months
− Elective dental Tx should be deferred until the patient has been declared non-infectious by a physician.
− Urgent dental care should be provided in a facility that has the capacity for airborne infection isolation
(OSHA).
− Main cause: Mycobacterium tuberculosis(a small, aerobic, nonmotile bacillus). Tuberculosis typically attacks
the lungs, but can also affect other parts of the body. It is spread through the air when people who have an
active TB infection cough, sneeze, or otherwise transmit respiratory fluids through the air. Most infections
do not have symptoms, known as latent tuberculosis. About one in ten latent infections eventually
progresses to active disease which, if left untreated, kills more than 50% of those so infected.
− The classic symptoms of active TB infection are a chronic cough with blood-tinged sputum, fever, night
sweats, and weight loss.
15. Testlet: 50yr old man comes in for ortho treatment. He has an FPD on #12-14. Need to remove the anterior
abutment.
a. What of the following is not likely to be a complication in the extraction of this tooth? One root
• #12 is max 1st PM, 2 roots
b. What’s a complication of Coxsackievirus Virus that can be manifested in oropharynx? Herpangina
• Herpangina affect soft palate & oropharyngeal mucosa
-Coxsackievirus is a virus that belongs to a family of nonenveloped, linear, positive-sense ssRNA viruses, Picornaviridae
and the genus Enterovirus, which also includes poliovirus and echovirus
-Herpangina, also called mouth blisters, is the name of a painful mouth infection caused by coxsackieviruses. Usually,
herpangina is produced by one particular strain of coxsackie virus A (and the term "herpangina virus" refers to
coxsackievirus A) but it can also be caused by coxsackievirus B or echoviruses. Most cases of herpangina occur in the
summer, affecting mostly children
16. (Case Study) Obese man with Type II diabetes mellitus & drinks alcohol comes in for extraction of #3.
a. Why does he have bad breath (halitosis)? Oral hygiene
b. What is it most related to? Overweight/diet
c. All of following are related to diabetes Type II except? Autoimmune, no destruction of Beta cells
d. After extraction of the tooth, you notice histological pseudostratified ciliated epithelium at the root
tip, what is it from? Maxillary sinus
17. (Case Study) 6 weeks pregnant women taking tetracycline for rosacea.
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a. What does not occur during 6 weeks of fetus? Palatal shelves fusion (7 weeks)
b. Which one is seen in the fetus but not the mother? Ductus venosous
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c. What is the problem with using tetracycline for the fetus? Changes the color of the
teeth/discoloration
d. At what time is best for elective dental tx as it would after organogenesis of the fetus? After 10
weeks (Better 2nd trimester = 12weeks)
• organogenesis occur embryonic weeks 3-8 & is completed by 10 weeks
18. (Case Study) Diabetic firefighter with a bad upper left bridge looking for an implant.
a. When placing an implant in bone, what epithelium is encountered? Pseudostratified columnar
ciliated epithelial cells (that line the maxillary sinus, similar to respiratory epi)
b. If patient wants an implant but it is too close to the sinus, what ethics are involved? Non-
maleficence & autonomy
c. Implant patient: Which cells will be most actively dividing 7Osteoprogenitor
19. Testlet: Left maxillary canine experiences sharp shooting pain.
a. What kind of fibers are responsible for the pain? A-delta
b. No sign of decay. What is the most likely cause of the pain?
a. Maxillary Sinus Infection
b. Broken root
20. (Case Study) Patient with Grave’s disease
− Mechanism against Graves’ Disease: binding Ig antibodies to TSH receptor in the thyroid (mimic TSH) 7
stimulate production of thryroxin
a. Graves’s disease causes/lab test show? High T3/T4, low TSH (on a graph)
b. What are the symptoms of Graves’ disease? Exophthalmos (bulging eyes)
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c.
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* It’s an autoimmune disease that affects the thyroid. It frequently results in hyperthyroidism and an enlarged thyroid.
Signs and symptoms of hyperthyroidism may include irritability, muscle weakness, sleeping problems, a fast heartbeat,
poor tolerance of heat, diarrhea, and weight loss. Other symptoms may include thickening of the skin on the shins,
known as pretibial myxedema, and eye problems such as bulging, a condition known as Graves' ophthalmopathy.
The onset of disease may be triggered by stress, infection, or giving birth. Those with other autoimmune diseases such
as type 1 diabetes and rheumatoid arthritis are more likely to be affected. Smoking increases the risk of disease and may
make the eye problems worse. The disorder results from an antibody, called thyroid stimulating immunoglobulin (TSI),
that has a similar effect to thyroid stimulating hormone (TSH). These antibodies cause the thyroid gland to produce
excess thyroid hormone.
21. (Case Study) Dental assistant whose hand’s shakes due to Parkinson’s disease
a. Which part of brain affected? Substantia nigra
b. Neurotransmitter affected? Lack of dopamine
c. This dental assistant is still performing work so what moral value? Maleficence
− Common symptoms: Loss of automatic movements, such as smiling and blinking (dry eye) & loss of facial
expression
22. (Case Study) HIV patient had an ulcer near tooth #15 that is very sore.
a. Biopsy was done on ulcer & it was undifferentiated something, what is it most likely? Kaposi
Sarcoma (?)
b. Which injection would u give? 7 PSA
c. Opportunistic infections associated & not associated with AIDS
d. How to treat patient ideally? Limit/control infection (?)
Infections common to HIV/AIDS
• Tuberculosis (TB). In resource-poor nations, TB is the most common opportunistic infection associated with HIV
and a leading cause of death among people with AIDS.
• Cytomegalovirus. This common herpes virus is transmitted in body fluids such as saliva, blood, urine, semen and
breast milk. A healthy immune system inactivates the virus, and it remains dormant in your body. If your
immune system weakens, the virus resurfaces — causing damage to your eyes, digestive tract, lungs or other
organs.
• Candidiasis. Candidiasis is a common HIV-related infection. It causes inflammation and a thick, white coating on
the mucous membranes of your mouth, tongue, esophagus or vagina.
• Cryptococcal meningitis. Meningitis is an inflammation of the membranes and fluid surrounding your brain and
spinal cord (meninges). Cryptococcal meningitis is a common central nervous system infection associated with
HIV, caused by a fungus found in soil.
• Toxoplasmosis. This potentially deadly infection is caused by Toxoplasma gondii, a parasite spread primarily by
cats. Infected cats pass the parasites in their stools, and the parasites may then spread to other animals and
humans.
• Cryptosporidiosis. This infection is caused by an intestinal parasite that's commonly found in animals. You
contract cryptosporidiosis when you ingest contaminated food or water. The parasite grows in your intestines
and bile ducts, leading to severe, chronic diarrhea in people with AIDS.
Cancers common to HIV/AIDS
• Kaposi's sarcoma. A tumor of the blood vessel walls, this cancer is rare in people not infected with
HIV, but common in HIV-positive people.
Kaposi's sarcoma usually appears as pink, red or purple lesions on the skin and mouth. In people with
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darker skin, the lesions may look dark brown or black. Kaposi's sarcoma can also affect the internal
organs, including the digestive tract and lungs.
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• Lymphomas. This type of cancer originates in your white blood cells and usually first appears in your lymph
nodes. The most common early sign is painless swelling of the lymph nodes in your neck, armpit or groin.
Other complications
• Wasting syndrome. Aggressive treatment regimens have reduced the number of cases of wasting syndrome, but
it still affects many people with AIDS. It's defined as a loss of at least 10 percent of body weight, often
accompanied by diarrhea, chronic weakness and fever.
• Neurological complications. Although AIDS doesn't appear to infect the nerve cells, it can cause neurological
symptoms such as confusion, forgetfulness, depression, anxiety and difficulty walking. One of the most common
neurological complications is AIDS dementia complex, which leads to behavioral changes and diminished mental
functioning.
• Kidney disease. HIV-associated nephropathy (HIVAN) is an inflammation of the tiny filters in your
kidneys that remove excess fluid and wastes from your bloodstream and pass them to your urine.
Because of a genetic predisposition, the risk of developing HIVAN is much higher in blacks.
Regardless of CD4 count, antiretroviral therapy should be started in those diagnosed with HIVAN.
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d. Patient with polymyalgia rheumatic, what problem might she not have now? Splenomegaly
− You perform a dental procedure on person who is taking NSAIDs and is Anemic and she starts to hemorrhage,
why? Because platelets aren’t sticking due to NSAIDs – NSAIDS inhibit platelet aggregation (Tbx2), Due to
her Anemia (if APLASTIC ANEMIA, body doesn’t make enough RBC, WBC, & platelets)
− PREDNISONE: Treats inflammation (swelling), severe allergies, complications of chronic illnesses, and other
medical problems. Also used to decrease some symptoms of cancer. This medicine is a steroid.
− POLYMYALGIA RHEUMATIC is a syndrome with pain or stiffness, usually in the neck, shoulders, upper arms
and hips, but which may occur all over the body. The pain can be very sudden, or can occur gradually over a
period. It may be caused by an inflammatory condition of blood vessels such as temporal arteritis.
29. (Case Study) 65 yr old patient is hypertensive, has high cholesterol, and is on diuretics. Dad died of a heart
attack at 55 yrs old. He needs 3 extractions of the maxillary.
a. Which of the following is the most immediate necessary referral? Hypertension (increased risk of
bleeding during extraction)
30. Testlet - lady had rheumatoid arthritis, osteoarthritis on hip and knees and couldn’t open her mouth affected
her talking and eating. She took lots of meds for arthritis and antidepressant. 20 pack- year smoker.
a. What is cause of her xerostomia? Medication
b. What is dysguesia associated with? Xerostomia from anti-depressant meds
(Dysquesia is a distortion of the sense of taste. Dysgeusia is also often associated with ageusia,
which is the complete lack of taste, and hypogeusia, which is the decrease in taste sensitivity)
c. All of these are correct about osteoarthritis, EXCEPT? Fever
d. What is cause of her chief complaint? – her TMJ prob from osteoarthritis?
e. She has pain on the posterior part of her 2nd molar, what might this mean? Trismus
f. Pt complains of waking up stiff every morning, what is cause of this? Rheumatoid arthritis
31. Testlet - 75 yr old lady has type 1 diabetes mellitus & takes insulin. She also has medications for high BP and
hypercholesterolemia.
a. She comes in with her breath smelling “fruity” what is the cause for this? Hyperglycemia
(ketoacidosis)
In people with diabetes, diabetic ketoacidosis happens when your body doesn't have enough insulin and
starts burning fat for energy. This causes a toxic buildup of acids called ketones in the blood – a sign that
your diabetes is out of control. If untreated, it can lead to diabetic coma and death. Ketoacidosis happens
most often in people with type 1 diabetes
32. (Case Study) Ethics: Man comes in with herpes virus.
a. Which of the following two principles would demonstrate non-ethical complication with referring
the patient? Justice & Beneficence
b. What principle is violated if you refer a patient because he has hepatitis? Justice
c. Patient wants to put in composite even though not needed, what do you do? Put composite
(autonomy)
33. (Case Study) Male patient comes in with pain on his maxilla tuberosity by #3. It get worst at night, sharp pain
and comes suddenly and leaves suddenly. He comes to your office for a clinical exam. Everything is NORMAL
except palpation of the buccal gingiva hurts.
a. What is the diagnosis for the case? Trigeminal neuralgia.
b. Patient comes back and can’t take the pain anymore, so he asks you to take all his teeth out and
make him a removable. Which two principles conflict? Autonomy & non-maleficence.
− Trigeminal neuralgia (Tic Douloureux) - axon demyelination in gasserian ganglion, dorsal root or both
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Dr. Justin D / CEU
− Bronchi (psuedostatified epi), bronchiole (simple columnar epi), alveolus (squamous epi)
− Adenosine nucleoside crosses mitochondria how? Cotransport? (ATP–ADP translocase is a transporter
protein that enables ATP and ADP to traverse the inner mitochondrial membrane. ATP produced from
oxidative phosphorylation is transported from the mitochondrial matrix to the cytoplasm, whereas ADP is
transported from the cytoplasm to the mitochondrial matrix)
− Which one as the right relationship between cycle, enzyme & positive Allosteric regulator of glycolysis?
Glucose: PFK: AMP?
− Glut-1 transporter is what kind of transporter? active or co? (Also known as solute carrier family 2, facilitated
glucose transporter member 1 (SLC2A1), is a uniporter protein that in humans is encoded by the SLC2A1
gene. GLUT1 facilitates the transport of glucose across the plasma membranes of mammalian cells.)
− Arginine – can be converted back into glucose how & where?
− Chronic granuloma is ccaused by what type of organism? (Chronic Granuloma is a diverse group of hereditary
diseases in which certain cells of the immune system have difficulty forming the reactive oxygen compounds
(most importantly, the superoxide radical) used to kill certain ingested pathogens. This leads to the
formation of granulomata in many organs)
− Most square PM? Max 2nd
− Know everything about maxillary lateral, maxillary canine, & mandibular lateral.
− Scoliosis = lateral deviation of spine
− what’s in birth control (estrogen + progesterone)
EDEMA
Osteomalacia: softening of the bones due to deficiency of Vit D
Osteosarcoma: malignant bone cancer
Osteomyelitis: bone infection (common w/ stap aureus) 7 what bacteria/virus is is involved in this? (Staphylococcus
aureus is a gram-positive coccal bacterium that is a member of the Firmicutes, and is frequently found in the respiratory
tract and on the skin.)
Osteopenia: low bone density, before osteoporosis
1. Different Types of necrosis: (9/8/15)
Coagulative
Liquefactive
• See this in infections and, for some unknown reason, in brain infarcts
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• Due to lots of neutrophils around releasing their toxic contents, “liquefying” the tissue
• Gross: tissue is liquidy and creamy yellow (pus)
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Dr. Justin D / CEU
• Micro: lots of neutrophils and cell debris
Caseous
Fat necrosis
Fibrinoid necrosis
Gangrenous necrosis
• See this when an entire limb loses blood supply and dies (usually the lower leg)
• This isn’t really a different kind of necrosis, but people use the term clinically so it’s worth knowing about
• Gross: skin looks black and dead; underlying tissue is in varying stages of decomposition
• Micro: initially there is coagulative necrosis from the loss of blood supply (this stage is called “dry gangrene”); if
bacterial infection is superimposed, there is liquefactive necrosis (this stage is called “wet gangrene”)
Gummatous Necrosis: A gumma is a soft, non-cancerous growth resulting from the tertiary stage of syphilis. It is a form
of granuloma. Gummas are most commonly found in the liver (gumma hepatis), but can also be found in brain, heart,
skin, bone, testis, and other tissues, leading to a variety of potential problems including neurological disorders or heart
valve disease.
BONE MARROW
The two types of bone marrow are "red marrow" (Latin: medulla ossium rubra), which consists mainly of hematopoietic
tissue, and "yellow marrow" (Latin: medulla ossium flava), which is mainly made up of fat cells. Red blood cells,
platelets, and most white blood cells arise in red marrow. Both types of bone marrow contain numerous blood vessels
and capillaries. At birth, all bone marrow is red. With age, more and more of it is converted to the yellow type; only
around half of adult bone marrow is red. Red marrow is found mainly in the flat bones, such as the pelvis, sternum,
cranium, ribs, vertebrae and scapulae, and in the cancellous ("spongy") material at the epiphyseal ends of long bones
such as the femur and humerus. Yellow marrow is found in the medullary cavity, the hollow interior of the middle
portion of long bones. In cases of severe blood loss, the body can convert yellow marrow back to red marrow to increase
blood cell production.
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