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PDF Pastest Mcqs With Answerspdf Compress
PDF Pastest Mcqs With Answerspdf Compress
PDF Pastest Mcqs With Answerspdf Compress
[2014]
Yassin Al Safadi Safadi92 hotmail.com
[Ethics and
Law]
[With Answers]
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a) It assesses whether a patient can take in, retain and weigh information in coming to a
decision
b) It is regarding establishing the competency of children to make decisions regarding their
own health without parental involvement
c) It regards breaking confidentiality when deemed in the
t he public best interests
d) It is one component of four in assessing whether there has been a breech in duty of care
« CORRECT ANSWER
e) It regards end-of-life decisions
2-The Bolam principle, based on English Tort law (Bolam vs Friern Hospital Management
Committee [1957]) has been used in determining whether acts by a doctor/nurse or other
health professional are in accordance with the accepted practice in these largely self-
regulating fields. It is based on the case of R vs Bodkin Adams (1957) in which Dr Adams was
on trial for murdering a patient who had made him a beneficiary of her will. Dr Adams had
prescribed this 80-year-old patient heroin and morphine following a stroke. Despite that this
was not the first patient to whom he had been a beneficiary of their estate, the judge found
him not guilty. From the following options choose the reason for this?
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4-You have been approached by a pharmaceutical company to attend a focus group for a
currently available analgesic that is potentially having its license extended into treating
atypical facial pain. Which one of the following phase of clinical trial is this?
a) Phase 0
b) Phase I
c) Phase II
d) Phase III
e) Phase IV « CORRECT ANSWER
The lifecycle of a drug starts long before it reaches the market and often development also
continues after this time.
• Phase 0 – microdosing in human studies. Gives no information about final effective dose,
but intended to expedite development by showing if the drug has desired in vivo behaviour
before proceeding to more expensive phases of trials
tr ials with larger numbers of participants.
• Phase II – Aimed to demonstrate efficacy of new agent. Use real patients with the
disease. Compared against existing drug in hundreds of participants
• Phase III – Double blinded and multi-centre trials conducted in thousands of participants.
Demonstrates new drug is superior to current alternatives.
5-A patient tells you in confidence that they have HIV and they do not want anyone informed.
Which one of the following would allow you to break confidentiality?
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This situation is permissible by the GDC. They advise that you should try to get patient consent
wherever possible and inform them before the breach. You should be prepared to defend your
decision. The third option would also be correct only if the patient was at risk of serious
seri ous harm
from himself or herself.
a) Your duty of confidentiality is still binding to your deceased patient « CORRECT ANSWER
b) Your duty of confidentiality no longer applies as the patient is deceased
dece ased
c) You are allowed to discuss confidential matters with relatives
d) You should get permission from the GDC to discuss these issues
e) You should contact your indemnifier and obtain permission
The same caveats apply to that of living patients, ie breach in the public interest or if somebody
is at risk of serious harm.
http://www.gdc-uk.org/NR/rdonlyres/FFD61DA5-A09E-4B38-
8FFBBA342E9F0AF4/16689/147164_Patient_Conf.pdf
Local resolution is the first and best step in complaint resolution. Most complaints, if possible,
should be dealt with at this level. This involves, meetings between the complainant and the
health professional involved, facilitated by designated complaints manager (ie practice
manager).
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8-If complainant is not satisfied with resolution attempted at local/primary care trust level
then which one of the following might be the next step in the complaints procedure?
The ombudsman is a civil servant who works independently of the NHS. They report to
Parliament about how the NHS functions and it is their decision to further investigate any
complaints they deem suitable for escalation.
9-Which one of the following personal health conditions might you be required to notify the
GDC about?
a) Angina
b) Asthma
c) Diabetes
d) HIV « CORRECT ANSWER
e) Psoriasis
If you have or believe a colleague has a serious communicable disease that places patients at
risk, it is recommended that you inform the appropriate occupational health department/GDC.
While maintaining your own confidentiality is important, the overriding concern is patient safety
- as Hippocrates said ‘First, do no harm’.
10-An elderly confused lady with known Alzheimer’s disease is unable to understand the
details of a root canal procedure. You deem her to be incompetent to consent for this
procedure. Which one of the following could consent on her behalf?
a) Her son
b) Her husband
c) Her solicitor
d) Nobody unless they have enduring power of attorney « CORRECT ANSWER
e) You, as her dentist
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Nobody can consent for an incompetent patient, although doctors/dentists may act in patients’
best interests. The new Mental Capacity Act (2007) has established that a competent patient
may nominate an ‘enduring power of attorney’ to make medical decisions on their behalf should
they become
incompetent.http://www.direct.gov.uk/en/Di
incompetent.http://www.direct.gov.uk/en/DisabledPeople/HealthAn
sabledPeople/HealthAndSupport/YourRightsInH
dSupport/YourRightsInHeal
eal
th/DG_10016888
a) Being informed
b) Being competent
c) Lack of coercion
d) Autonomy in making a decision
e) Decision is irreversible once the consent
co nsent form is signed « CORRECT ANSWER
This statement is not true. The other four components are essential parts of valid consent for any
medical procedure/investigation.
procedure/investigation. A patient may
m ay withdraw consent without penalty at any time
before the procedure.
12-You are the SHO covering the routine oral surgery list, the patient has been anaesthetised
and is on the operating table. During the time-out check, it is noticed that the patient, who
does not speak any English, has not signed the consent form. Which one of the following is the
appropriate course of action?
There are few defences for carrying out surgery without prior consent, which, except in the
context of an emergency and a patient unable to consent, is considered battery (see Mill’s harm
principle). Nobody is able to consent on behalf of a competent patient. The law is different in
the case of non-competent patients, but capacity
c apacity to consent must be considered in all
circumstances. In this case, consider that a non-English speaking patient will not necessarily
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understand what they are being consented for – therefore, a consent form is not valid – signed
or not.
13-A colleague has a bout of gastroenteritis on the same day that he is due to present an oral
presentation at a national conference. You agree to give the talk on his behalf, but you notice
that there are multiple facial photographs of a patient with ‘blanked out eyes’, which are
fundamentall to the talk. You enquire whether your colleague has obtained the patient’s
fundamenta
consent to use these photographs, and he admits that he forgot to ask them for this.
a) As the eyes are blanked out and it is therefore more difficult to recognise the patient,
you give the presentation, as you are worried that cancelling the talk at this late stage
will appear unprofessional.
b) You apologise to the organisers, explain that you cannot
c annot give the talk, and ask whether
you can have a slot on a different day, to give you time to obtain consent from
fr om the
patient in the photographs.« CORRECT ANSWER
c) You ask the conference IT technician what you should do, and he tells you that it is too
late to find another speaker and that you should make your way to the lecture ttheatre.
heatre.
d) You give the lecture and afterwards phone the General Dental Council to obtain their
advice on how to handle such a situation in future presentations.
e) You speak to your colleague again. He says that the patient in the photograph was very
compliant with all her treatment, and he is sure that she will not mind the picture being
used for educational purposes.
The General Dental Council (GDC) has clear guidelines on the use of sensitive patient data. It is
not acceptable to presume that consent would be given, and blanking out the patient’s eyes in
the photographs will not prevent her from being identified. There is an ethical responsibility
responsibility to
ensure that informed patient consent has been obtained and documented. In this scenario,
breaching this and then later asking the GDC for advice would be indefensible. Although it is your
colleague’s presentation, it is your responsibility to ensure that
t hat you are acting appropriately.
a) A child under 18 years of age who attends the GP surgery/family planning clinic because
they wish to access a termination of pregnancy will need to be accompanied by an
adult.
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b) A child under the age of 16 years can give valid consent without parental knowledge
provided that certain defined criteria are met, which include the child having capacity to
give consent.« CORRECT ANSWER
c) A dentist can accept consent from a child under 16 years of age to remove five of her
teeth, even if the dentist does not feel that this is in the child’s best interest.
d) All children under 16 years of age are able to acce
access
ss contraception without informing
The accepted age of consent is 16 years. However, Gillick competence specifies that valid consent
may be taken from a child under 16 years of age, without parental agreement, if the treatment is
in the best interest of the child and the child has capacity to give consent. It is of paramount
importance that the child is encouraged to inform their parents or guardian about the decision,
as this will result in safer care of the child.
16-You have been asked to attend the maxillofacial hospital ward round to learn more about
hospital-based dentistry. The registrar is bleeped to an emergency, and asks you to consent
Mrs Davis for her imminent surgery in his absence. She is due for an operation to have part of
her tongue removed secondary to a squamous-cell carcinoma. You have never seen this
operation performed, but understand some of the general complications of surgical
procedures. The registrar has left and the nurse is asking you to complete the consent form as
soon as possible so that Mr s Davis’ surgery is not delayed.
a) You apologise to the nurse for any disruption and explain that you are not able to take
consent from a patient for a procedure
proce dure that you have never seen performed and do not
fully understand.« CORRECT ANSWER
b) You bleep the registrar while he is dealing with the emergency and te
tell
ll him that you are
unhappy about doing as he has requested.
c) You ensure that the surgery goes
g oes ahead as planned, as requested by your se
senior
nior
colleague.
d) You inform the patient of the general complications that might arise from surgery, and
tell her that the surgeon who will be operating will reiterate them when she gets to
theatre. You then obtain her signature.
e) You tell the patient that you need to wait for a more senior doctor to go through the
consent form with her, but obtain her signature anyway as she says that she does not
want to know any of the risks of the procedure, as this information will make her too
anxious.
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It is irresponsible and indefensible to take consent from a patient when you do not fully
understand the procedure. It is ultimately the
t he responsibility of the person who will be performing
the procedure, who is often the best person to take informed consent. Even though some
patients would rather not know about
about the risks, it is good practice to explain the
these
se briefly to
them, as you will regret not doing so if the patient later decides to make
m ake a complaint. The
consent process may not be further completed when the patient gets to theatre, and a signature
on the form may result in other healthcare professionals failing to discuss the issue again.
17-You explain to your patient that a root canal and crown are needed to stabilise her
decayed tooth. She says that the tooth is not painful and that she would prefer to wait for a
year or two before this
t his procedure is performed. Your patient is 15 years old and asks you not
to tell her mother, who is in the waiting room, as it might ‘upset her’.
a) You ask the patient to wait while you discuss the situation with an experienced
colleague. « CORRECT ANSWER
b) You explain that ideally the tooth needs work now, and you ask the patient why she is
reluctant to give her consent. If she still declines to give it, you accept this and arrange
an appointment for her in 6 months’ time.
c) You explain to the patient that she is not able to give or re
refuse
fuse consent for treatment as
she is only 15 years old.
d) You invite the patient’s mother in to discuss the topic immediately.
e) You reassure the patient that you will not discuss the matter with her mother, but
emphasise to her that you are not happy about leaving the work for a year or two.
18-You overhear the secretaries discussing the fact that the dentist at a nearby small practice
has recently been subject to investigation for negligence. One of your patients also hears this
and asks your opinion about it, as her husband is thinking of joining that practice.
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d) Politely inform your patient that it would be wrong for you to comment on this, given
the limited information that is available, but tell her that she is entitled to speak to the
practice concerned if she wishes to obtain further information.« CORRECT ANSWER
e) Try not to become involved, and dismiss the patient’s worries swiftly and curtly.
This is a difficult situation, and ultimately it concerns the professionalism of the reception staff,
who should refrain from making such allegations. In view of the very limited information
available, it is important for you to remain non-judgemental and at all times polite towards the
patient. She is asking for your professional
professional advice, so sug
suggesting
gesting another way for her to access
information is helpful to her. Investigations into alleged negligence do occur, but such claims
may turn out to be false accusations, so you should remain impartial until the appropriate bodies
have concluded their investigations.
a) A part of clinical governance that is research based and not relevant to daily clinical
practice.
b) Knowledge that has been passed down from one generation to the next and which has
become the professional ‘norm.’
c) Strict guidelines that must be followed in order to avoid litigation.
d) The judicious use of current best evidence
ev idence when making decisions about the care of
individual patients. « CORRECT ANSWER
e) The random application of small-trial research in order to make the best decisions
possible for a patient.
Evidence-based practice is a key part of clinical governance and is certainly relevant to daily
clinical practice. Increasingly, guidelines for ‘best practice’ ar e being issued and these often
highlight the evidence underlying the recommendations. Although guidelines should be followed
where possible, they will not cover every specific situation that you will encounter, so
professional judgement and
and previous clinical experience
experience should always be used.
20-You work one session a week for the student dental practice at a campus university. A
student has seen a notice that invites healthy volunteers to undergo a revolutionary dental
treatment for tooth whitening. He asks whether you think
t hink he should take part, and tells you
that if he does not make some money soon he may have to drop out of university.
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a) Advise him to ask his own GP whether he is healthy enough to take part in the research.
b) Explain that he must weigh up the pros and cons of taking part in the re
research
search and
discuss the safety of the procedure in detail with those involved. Emphasise that there
are services available at the university to help students who have financial problems.«
CORRECT ANSWER
c) Offer him a part-time job at the student practice and offer to give him a discounted
tooth-whitening procedure.
d) Tell him that there are other ways to make money, and that participating in research
can be very dangerous.
e) Tell him that you have never heard of anyone having problems with tooth-whitening
procedures, and that it should be fine for him to take part.
The rights of individuals involved in medical research must be protected, and fully informed
consent must be obtained. The individual should not be coerced into taking part, and the
financial reimbursement that
that is offered should not prevent them from acting rationally and
responsibly. Offering your own advice is inappropriate, as you do not know enough about the
intended procedure. Equally, although the student’s GP may ascertain that he is in good health,
he is not in a position to give advice on whether the student should take part in the research.
21-You are a newly qualified dentist and have been asked to sign forms to claim for work that
has been carried out in your practice not only by yourself but also by several of your
colleagues, as they are too busy to undertake this administrative task themselves. Your
practice manager says that it is fine for you to sign the forms, but you are unsure about this.
b) Carry on signing the forms and make a note to check with your supervisor as soon as
possible whether this is acceptable.
c) Consult your defence organisation, but carry on signing the forms until you get a chance
to speak to them.
d) Consult your defence organisation immediately. « CORRECT ANSWER
e) Phone your friend, who is also a newly qualified dentist, and ask for their advice.
If you are in any doubt about correct practice, ask for advice. Your signature provides
provides proof of
understanding and acknowledgement of these procedures, and you may be held accountable in
the future. It is appropriate to refuse to sign for the work of other practitioners until you have
sought advice. Although your peers are a good starting point for advice in some circumstances,
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22-In adult practice, for how long are clinical records generally kept?
a) Indefinitely.
b) 2 years.
c) 100 years.
d) Until 11 years after a treatment episode. « CORRECT ANSWER
e) Until 25 years after a treatment episode.
Some patient categories require different minimum retention periods. Generally speaking,
however, records should be kept for 11 years after the treatment episode, as keeping them
indefinitely would cause problems with regard to safe storage, ease of access, etc.
23-You are the on-call maxillofacial surgery registrar and are called to tthe
he Emergency
Department to see a patient who has been assaulted. He is a 41-year-old Somalian man who
speaks little English and who has a clearly fractured mandible and several deep lacerations to
his face. You think that he needs to have his mandible plated and the lacerations
irrigated/debrided and closed in theatre. Unfortunately, it is difficult to explain to him what
you intend to do, due to his lack of English. You think that he is able to understand you if you
use a combination of diagrams and hand gestures.
a) Discuss the situation with a senior colleague and ask them to make the decision.
b) Discuss the situation with the patient’s GP.
c) c heck the patient’s comprehension of the situation. «
Find an interpreter who can check
CORRECT ANSWER
d) Proceed with the surgery, as it is in the patient’s best interests and he has probably
understood enough of what you have told him.
e) Wait for a family member to explain
ex plain your intended treatment to the patient, when tthey
hey
arrive after the weekend.
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It is often better to have an independent interpreter translate for you, rather than a family
member, to avoid the
t he possibility of other agendas being represented and the patient being
coerced into undergoing treatment, rather than being allowed to express their own wishes.
24-You are the senior house officer on call, and you are about to scrub in and assist your
registrar, who is preparing to perform a surgical tracheostomy on an ITU patient. Your
colleague has been behaving strangely during the evening, and you think that you can smell
alcohol on his breath. It is the middle of the night and there are no other registrars or
immediate senior colleagues in the hospital.
You have a duty of care to your patient and a duty of responsibility to your colleague. If you
suspect that a senior colleague is not fit to work, you must act quickly to protect your patient
from potential harm, as it would be indefensible
indefensible to do otherwise. Askin
Asking
g your consultant to come
in because your colleague is not fit to work is the best choice here. These matters need to be
handled with the utmost sensitivity.
wrong procedure, due to a mix-up over paperwork. By the time you get to theatre the patient
is already anaesthetised and the surgeons are scrubbed.
a) Alert the surgeons and theatre staff to the paperwork mix-up. « CORRECT ANSWER
b) Change the details on the consent form to make them correspond to tthe
he procedure that
is to be performed.
c) Discuss the case with your defence organisation.
d) Fill in an incident report form and contact the risk management team.
e) Say nothing and leave, as the surgeons
surgeo ns and theatre staff will certainly have deduced by
now that the wrong procedure was stated on the form.
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By alerting them you will protect the patient from potential harm. It is also possible that the mix-
up has been spotted and the consent form corrected or rewritten before the patient was
anaesthetised.
In any event, the best course of action is to inform your senior colleagues so that they have the
information necessary ahead of time to prevent potential wrong-site surgery.
26-A patient with poor dentition that has caused infective endocarditis is to have his upper
incisors removed. He is unhappy with your explanation and wishes to make a complaint to
your senior colleagues. You feel that you have explained the proposed treatment politely and
that he is being unreasonable.
27-You are a partner at a dental practice. You notice that your fellow partner smells of alcohol
first thing in the morning before a morning clinic. You confront your partner and they admit
that they are under a lot of stress. Which one of the following is the next appropriate step?
This is the best and most appropriate option at this stage. He should not be allowed to undertake
any clinical work while intoxicated as it poses patient safety risks, and patient safety is the
paramount concern. Obviously
Obviously it is important to support your colleague th
through
rough a difficult time,
however it must be made clear that this behaviour cannot be tolerated
t olerated in the workplace. If you
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While a consumerist model of dental care may suit adults who seek care when in pain, children
rely on their parents to make these decisions for them. Poor dental health and extensive caries in
children may cause social problems at school, pain and disturbed sleep. Whether neglect is wilful
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If the power of a study is low, the results are likely to be inconclusive. Factors that affect power
are:
31-The daughter of an 85-year-old patient of yours comes and asks for a summary of her
mother’s dental history as she is moving to Australia and would like to take the information
i nformation
with her to give to
t o a new dentist. You have been her mother’s dentist for many years and
know both the daughter and her mother well. Which one of the following is the next best
course of action?
a) Print out the records for the daughter so as not to cause offence
b) Explain this is only possible with a fee and that you will find out how much it might cost
c) Kindly explain that you will need consent from her mother before proceeding further «
CORRECT ANSWER
d) Explain that under no circumstances may you give out confidential information for
another health professional to use
e) Tell the daughter that, legally, you must have the General Dental Council’s approval
before providing a summary of her notes
It is not unreasonable for patients to give consent for their own notes to be copied for use by
another health professional, as this will ensure good patient care. It is not acceptable, however,
to request this on behalf of another patient, even if they are a family member. No one can
consent on behalf of another patient and the GDC advise that the patient’s consent must be
sought if patient information is to be released. There may be a fee involved to cover
administration costs but this is not the point of this question. Furthermore, for advice regarding
confidentiality matters, the GDC are a source of help but there is no law stating each case must
be discussed individually. It is the responsibility of the health professional to be up-to-date with
w ith
the latest guidance on legal and ethical matters.
32-A colleague asks if you have some interesting radiographs that he may use in a teaching
session. You have recently had three complex cases with
wit h informative imaging and wonder
what your duties to confidentiality are in this setting. Which one of the following is the best
course of action?
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a) Ask the three patients for informed consent to allow their X-rays to be used in teaching
to dental professionals« CORRECT ANSWER
b) Cross off the names/identifying information that appears on each X-ray
X-r ay
c) Refuse to help him with the teaching
t eaching as it breaches confidentiality
d) Photocopy X-rays out of a text-book and give them to your colleague to avoid offending
him
Colleagues may ask you to help with teaching or research and this may involve using patient
information. As per GDC advice, the best course of action to enable this is to get informed
consent from the patient and release only the minimum information needed. Removing patient
identifiers eg names/date of birth from the material is good practice, but is not the ‘best’ answer
as consent should always be sought where possible. Photocopying X-rays from a textbook could
be construed as plagiarism and should be avoided.
av oided.
33-You are a dental trainee and have been recently shown, just once, how to inject local
anaesthetic for a root canal procedure. You have never done the procedure alone, but the
dentist with whom you are working tells you he needs to make an important phone-call and
implies you should do the procedure alone. You do not feel competent to do this. Which one
of the following is correct of the GDC guidance?
There is GDC guidance on this and it states that ‘you have a duty to work within your knowledge,
professional competence and
and physical abilities’. It goes on to explain
explain that carrying out a
procedure that you are not fully trained for
for and not competent at, is not acceptable. It is you
yourr
responsibility, not your seniors, to recognise that you are not able to carry out this procedure
safely after being shown only once before. If you feel unable to broach the subject with the
dentist with whom you are working, it may be necessary to speak to a senior member in the
practice and if the situation is not
not easily resolved, you could seek advice from
from the GDC.
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You should always put the patient’s interests first, even in difficult situations. While he may be
functioning reasonably
reasonably well at work and be a popular dentist, taking al
alcohol
cohol before a surgery is
dangerous and is not acceptable under any circumstances. Waiting a further month could put
numerous patients at risk and if it is known that you did not raise concerns earlier, your own
registration could be at risk. Approaching the GDC
GD C without discussing it first or seeking more
information from your colleague would seem a little hasty but it should be addressed as soon as
possible with the colleague,
colleague, ie. same day, and then you can decide how next to proceed.
proceed. If local
action fails or is not possible, it may be sensible to approach the GDC earlier. A senior dentist in
your surgery should be involved.
a) Acknowledge that dental procedures can cause anxiety but try and carry on with the
filling anyway
b) Convince him to have the procedure any way
w ay you can as you have already given the
anaesthetic
c) Recognise that he has withdrawn consent and stop as continuing would constitute
assault « CORRECT ANSWER
d) Go and speak to his mother in the
t he waiting room and gain consent from her to proceed
e) Tell him he cannot return for the procedure if he withdraws consent at this late stage
One of the most important principles of ethics is autonomy: the right of the individual to decide
what happens to his or herself. If the patient is competent and withdraws consent, at any stage
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of the procedure and for any reason, then you must not proceed as this is assault. Trying to talk
to the patient to address his concerns is reasonable and he may then, with new information, give
valid consent once more. A patient’s further care should never be compromised if they do not
consent for a particular procedure, even if the health professional does not understand or agree
with, the reasons for withdrawing consent. You cannot ask his mother for consent as no one can
consent for a competent adult over the age of 16 years old.
36-A 35-year-old woman asks for a copy of her dental records and clinical reports to take to a
new dentist as she struggles to get an appointment at your surgery. Which one of the
following is the best course of action?
acti on?
a) Apologise but explain that you cannot release her records to another dentist
b) Give her the original records and delete
dele te her from your patient list
c) Tell her it might take a few weeks but it should be possible
d) Try and persuade her to stay at your practice and offer to always find an appointment
for her when she asks
e) Photocopy her records and give her a copy. Keep the originals in a safe place in case you
need to refer back to them at a later date« CORRECT ANSWER
Reports and records must be released to a patient if they request this. You must respect their
autonomy in wanting to move to a new practice and not providing records/delaying advice
about this is irresponsible. Always keep a copy of the records for yourself in case there are any
legal matters that arise as you should be able to reproduce appropriate documentation. Never
make impossible promises to patients in an effort to keep them at your practice. It may not
always be possible to find appointments on demand but you could explain that you and your
staff will try and be as accommodating as possible.
37-Which one of the following is responsible for ensuring that you maintain professional
development and keep up-to-date with current standards?
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Health professionals should always strive to better themselves professionally and improve and
maintain their competency wherever possible. Establishments such as universities and the
Faculty of Dental Surgery may complement this ongoing development but should not be relied
upon solely. It is the responsibility of the health professional to keep up-to-date
up -to-date with current
research, guidance and advice.
38-It is Sunday evening and you have been feeling flu-like symptoms with high fever, muscle
aches and a sore throat all weekend. You are concerned you might have Influenza A (H1N1,
swine flu) as your 6-year-old
6 -year-old son was diagnosed recently. You are giving a lunchtime
presentation tomorrow at work and do not want to let your team down. Which one of the
following is the next best course of action?
a) Go to work despite feeling so unwell and hope you can make it through the
t he day
b) Call the receptionist at your surgery and tell her you won’t be coming in today but you
would prefer not to say why
c) Call your clinical supervisor, explain your symptoms and worries. Speak to your local
virologists/GP to arrange swab taking« CORRECT ANSWER
d) Self-prescribe penicillin for your throat and go to work at lunchtime
e) Self-prescribe Tamiflu and discuss this with your local pharmacist
The advice regarding symptoms and management of H1N1 influenza are continually changing as
the pandemic progresses. As a health professional, ‘you should not let your own state of health
put other patients at risk’ according
according to the GDC. Influenza is easily spread an
and
d if you have
convincing symptoms, it would be recommended to stay off work until either you have a
negative swab, or your symptoms have ceased. The virus is spread by droplet/aerosol
transmission and increased by close contact, which makes transmission in the dental settings
very likely. It is worth letting your colleagues at the practice know about your symptoms as they
t hey
may be experiencing similar symptoms and further action may need to be taken. Self-prescribing
is not appropriate as it may be dangerous for you to be improperly treated and also a risk to
t o your
patients as pencillin nor tamiflu
tamiflu will ensure you are not infectiou
infectious.
s.
http://www.gdc.uk.org/Our+work/Standards/Infl
http://www.gdc.uk.org/Our+work/Standards/Influenza+Pandemic+State
uenza+Pandemic+Statement.htm
ment.htm
a) Maintain satisfactory standards to maintain their registration with the GDC « CORRECT
ANSWER
b) Are qualified to practice
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The General Dentist Council register already ensures that dentists are qualified to practice so this
th is
is not the aim of revalidation. Similarly, it has not been designed to supervise income/tax
declaration or ensure co-operation with legal proceedings. Revalidation is a new process that
attempts to ensure that dental professionals have up-to-date knowledge and are fit to practise
to stay on the general dental register. It is currently being investigated to ascertain the most
effective way of implementing this.
40-A patient asks you for advice about travelling to Fiji for a once in a lifetime trip. She is often
in need of emergency dental treatment and seeks your advice about how regulated overseas
dental surgeries may be. Which one of the
t he following would be your best advice?
In the UK, all dental practitioners must be registered with the General Dental Council to work
and they must adhere to the set standards.
st andards. It is difficult to say that other countries adhere to
these high standards or have similar regulations. It is the responsibility of the patient to
to
investigate the relevant country and the standards to which they adhere. You could advise if you
had useful knowledge in this area or perhaps direct them to the GDC website which has advice.
41-A 21-year-old woman comes to your practice for a routine check-up. She ttells
ells you that she
has recently been diagnosed with depression and is looking for work as a model. She feels
that tooth-whitening treatment is the answer to her problems, but she cannot afford to pay
for it. She insists that you perform the procedure as part of her routine NHS care, and hints
that she might harm herself if this cannot be done.
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a) As the patient has expressed her intention to self-harm, you ask her permission to speak
to her GP to arrange an urgent appointment for the same day to fully assess her mood
t his.« CORRECT ANSWER
disorder. She agrees to this.«
b) You discuss her concerns about her teeth
teet h but also explain that she cannot demand
treatment.
c) You discuss her concerns, explain that she cannot
c annot demand treatment, and advise her to
see her GP in the next few weeks for advice about her depression.
d) You tell her that she cannot
c annot have the tooth-whitening treatment on the NHS and that
you will see her at her next routine appointment.
e) You tell her that you will perform the treatment without charge on this oc
occasion,
casion, but
that she cannot demand free treatments in the future.
You have a duty of care to the patient and she has expressed worrying self-harm ideation.
Patients may not always present with purely dental issues and, as a dentist, you have a
responsibility to direct them to other healthcare professionals if necessary. It would be unsafe to
address only the tooth-whitening issue and then send this patient away. She is clearly distressed,
and liaising with her GP will help to ensure safe and appropriate follow-up.
42-You have been asked to submit a review paper for publication by your consultant. In the
process of editing it, you find major similarities to a published article that you have recently
read, with some sentences reproduced word for word. You check the references and find that
they do not include the published article, despite the fact that the content is remarkably
similar. You discuss this with your consultant and he dismisses your concerns and the
similarity to the article that you have shown him.
a) Assume that this is just a coincidence and submit the paper as it is without any
modifications.
b) Include the similar-sounding article in the references without telling your consultant,
and then submit the paper.
c) Remove the similar-sounding parts of the submission even though this will weaken the
arguments that have been made.
d) Reword the paper so that it is subtly different from the published article that you had
read.
e) Tell your consultant that the paper requires re-working
r e-working and cannot be submitted as it
stands. « CORRECT ANSWER
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This is the best solution to a difficult dilemma. You must maintain intellectual integrity in
publishing, as the work will be attributed
attributed to you. However, it is a difficult ba
balance
lance to achieve, as
you must also preserve the
t he relationships within the team.
43-You are concerned that one of your colleagues is posting information about their working
day on a social networking website. This includes some statements about patient conditions,
as well as critical comments about management by another team within the hospital. These
statements and comments could be construed as controversial, and are potentially viewable
by the public.
a) Contact your colleague’s consultant or immediate senior and discuss the best course of
action.
b) Contact your defence union for an opinion.
c) Contact the hospital’s risk management team.
d) Discuss the matter with your colleague and suggest that they refrain from posting
critical statements in the public domain.« CORRECT ANSWER
e) Report your colleague to the General Dental Council in the first instance.
c) Explain that your colleague should have noticed that part of the
t he dental tool was missing.
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d) Provide the patient with the information necessary to make a complaint to the dental
practice manager.
e) Tell the patient that this happens all the time,
t ime, so it is not often mentioned.
When speaking to a patient it is never appropriate to 23riticize a colleague, especially if they are
the patient’s longstanding practitioner, as this will damage the practitioner–patient relationship.
relationship.
It is unfortunate that the patient was not warned that such an incident could occur as a result of
endodontic therapy, and an apology can be offered on behalf of your absent colleague. If the
patient still wishes to make a compliant,
compliant, obviously the local procedures can be followed, but it is
advisable to defuse the complaint at this stage if possible.
45-You are the maxillofacial registrar working with a disabled wheelchair-bound junior trainee
who has recently joined the rotation. He is very keen to prove that he can perform all of the
necessary procedures without any of the support that has been offered to him. He often
refuses the help of nurses, who have subsequently expressed
expressed concerns about his practice in
terms of not maintaining sterility during procedures.
There are two problems here, namely patient safety, and the obligation to train a junior
colleague so that they become competent. These issues are closely interrelated, as potential
problems could arise if the trainee
trainee is not adequately supported in diffi
difficult
cult situations. You must
must
encourage him to use the help that is available, perhaps by demonstrating that you would do
this even if he did not have a disability.
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It is important to encourage and support the trainee, but at the same time to swiftly address any
patient safety issues that arise or that could
could potentially occur.
46-You are the senior partner at a practice. You have noticed that your new partner is arriving
at work increasingly late, is abrupt with patients and staff, and is receiving phone calls from
credit card companies during working hours. She appears very tired and anxious.
a nxious.
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Your SHO is very diligent but over-cautious. A fine balance needs to be achieved in practice.
However, he is probably over-investigating patients, which in the long term will
w ill have
implications for resource allocation. His working patterns are also having an impact on his life
outside work. He may not even perceive them as being a problem, but they are certainly not
sustainable in the long term. Booking a smaller clinic is not a long-term solution, but as a
learning exercise it might be a useful way to broach these issues sensitively.
48-A patient discloses that she has been abused as a child but asks you to keep it to yourself.
What management, if any, is best?
a) Ask the patient’s permission to write in the patient’s notes. Ask if they have sought
advice/guidance about it.« CORRECT ANSWER
b) Do nothing. It was a long time ago.
ago .
c) Report it in the patient notes. Do nothing further. The patient notes are co
confidential.
nfidential.
d) Report the incidence to social services.
ser vices.
e) Write nothing in the notes but discuss with
w ith colleagues in the coffee room.
If a patient reveals sensitive issues about their past or present it is best to try and discuss
it with the patient further. They may then disclose that they have sought treatment and
management of the issues arising and are now happy as a result. If they have not, you may need
to guide them to sources of assistance. If they have asked for discretion it is important you
maintain this, and therefore do not break their confidentiality without asking by discussing with
colleagues in an open area. If you discuss the matter further it may or may not be appropriate to
refer to social services, but this is not necessary as an immediate course of action.
49-An untrained dental nurse is just starting on reception while she obtains her hepatitis B
immunisation. However
However one of the trained nurses telephones in sick and this leaves one male
dentist a nurse down. They are happy to see patients alone as they have examinations all day.
What is the best way to proceed?
It is inappropriate to work alone without a chaperone even if the dentist and patient are happy.
This ensures that if there are any issues or allegations in the future there is a third person to
corroborate what happened. A dental nurse cannot nurse or have any exposure to any risk of
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needlestick injuries (which includes decontamination and nursing work) until they have their
t heir
hepatitis B immunisation. However, they can act as a chaperone, particularly for male dentists.
a) A framework to ensure all the paperwork for the Care Quality Commission (CQC) is
completed by running audits and maintaining continuing professional development.
b) A framework to provide a systematic approach to maintain high standards. This includes
keeping up-to-date regular team briefings, clinical audit and quality assurance.
c) A framework to provide a systematic approach to maintaining and improving the quality
of care and safeguarding high standards of care in which clinical excellence can flourish.
This includes evidenced-based dentistry, clinical audit, quality assurance and continuing
professional development.« CORRECT ANSWER
d) A systematic approach to maintaining and improving the quality of care by using
evidenced based dentistry, patient feedback and complaints handling.
e) Continually assessing standards through clinical audit and implementing changes to
raise and maintain clinical standards.
Clinical governance is a way of continually increasing standards. It has six pillars that include
clinical audit, quality assurance programmes, evidence-based dentistry and continuing
professional development.
development. It is not just about CQC paperwork but abou
aboutt continually improving
standards and quality of care. It is important to have good complaints handling and patient
feedback, but it is not a key part of clinical governance.
governance.
a) 50 hours verifiable and 100 hours non-verifiable. This includes 5 hours of medical
emergencies, 5 hours of infection control and 5 hours of radiography.
b) 50 hours verifiable and 100 hours non-verifiable. This includes 10 hours of medical
emergencies, 5 hours of infection control and 5 hours of radiography.« CORRECT
ANSWER
c) 50 hours verifiable and 150 hours non-verifiable. This includes 10 hours of medical
emergencies, 5 hours of infection control and 5 hours of radiography.
d) 75 hours verifiable and 120 hours non-verifiable. This includes 5 hours of medical
emergencies, 5 hours of infection control and 5 hours of radiography.
e) 75 hours verifiable and 125 hours non-verifiable. This includes 10 hours of medical
emergencies, 5 hours of infection control and 5 hours of radiography.
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verifiable including 10 hours of medical emergencies, 5 hours of infection control and 5 hours of
radiography.
53-A 7-year-old child attends the practice. He was referred for a full dental clearance under
general anaesthetic at 4 years old. The family had diet and oral hygiene advice at the time but
he has not been seen since and now attends in pain. On examination there is extensive caries
in his LL12 and LR12, and early caries in all 6’s. How would you manage the situation?
a) Complete the restorative work necessary and reinforce good oral hygiene and diet
advice.
b) Discuss management with the family. Advise that the rest of
o f the family may need
treatment.
c) Highlight the patient as a possible neglect case and raise concerns with the family, in
particular about siblings. Refer immediately to community dental service for complex
management. If there are any further issues or concerns refer to social services.«
CORRECT ANSWER
d) Refer for a general anaesthetic for further extractions. Assess the rest of the family for
possible treatment as well.
e) Refer immediately to social services. Do not inform the family and complete the
restorative work necessary.
Due to the extensive nature of the work it would be advisable to have assessment and possible
treatment with a paediatric consultant, particularly if extensive caries reaching to the pulp is
suspected. The patient has had previous advice that they have not taken on board; this needs to
be noted. If they fail to attend appointments in the future, a referral to social services needs to
be considered. Any siblings or family members may also have complex problems that are not
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currently being treated and these need to be highlighted. The family may not be aware of the
situation, and therefore it is important that all options and treatment and the seriousness of the
case be discussed with them.
54-A 10-year-old patient attends with their mother who does not speak very good English.
During the appointment the child translates to allow the mother to understand. You need to
If you do not believe that the patient has Gillick competence to understand all the treatment
then they cannot act as a translator for their parent. It is best to use a third party as a translator
who is not involved with the family as they will not add any bias to the translation. A stepdad
who speaks fluent English is OK but they are unable to consent to a child that is not their own
unless they are a lawful guardian. It is not appropriate to continue with the treatment if they are
not in pain and to book another appointment with a translator is straightforward.
55-A patient comes in and asks about tooth whitening. You clarify the new regulations. Which
of the following best fits the new guidelines.
a) Whitening products equal to <6% hydrogen peroxide are available to use by all
professionals provided the person has have had suitable training.
b) Whitening products equal to <6% hydrogen peroxide are available to use through a
dental professional provided that the patient has had a suitable clinical examination and
guidance.« CORRECT ANSWER
c) Whitening products equal to <10% hydrogen peroxide are available to use through a
dental professional provided that the patient has had a suitable clinical examination and
guidance.
d) Whitening products up to 0.1% hydrogen peroxide are available over the counter; all
bleaching products with a higher concentration are available through a dental
professional.
e) Whitening products up to 1% hydrogen peroxide are available over the counter, but
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New EU guidelines have been published recently stating that products <0.1% hydrogen peroxide
are available over the counter. Anything between 0.1% and 6% hydrogen peroxide is available
only through a dental professional registered with the GDC. All bleaching products over 6%
hydrogen peroxide are still prohibited.
57-Which principle of ethics is best described when considering a patient's ability to think
about and reason their own choices?
a) Justice
58- Which one of the following ethical principles demands the fair allocation of resources in
society and so people to be treated as equals?
59- Which one of the following declarations dealing with biomedical research states that 'the
interests ofthe subject must always prevail over the interests of science and society'?
a) Declaration of Independence
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[Dental
Materials
MCQs]
[With Answers]
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a) Gypsum type I
b) Gypsum type II
c) Gypsum type III
d) Gypsum type IV “ CORRECT ANSWER
e) Gypsum type V
Type IV Gypsum products are high strength, low expansion dental stones. Type I
gypsum products are the least hard and type V products are the most.
Addition polymerisation
polymerisation involves the
the establishment
establishment of
of inter-chain crosslinking.
crosslinking.
3-The diagram below shows the rheological properties of fluids and pastes when
extruded from a syringe.
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4-With regards to the structure and properties of polymers, which one of the
following is true?
a) The temperature at which they were mixed has an effect on the properties of the
set material
b) The presence of of fillers has no effect on the properties of the set material
c) Fillers only affect the setting time of the material
d) The greater the density of the crosslinking, the faster the material is likely to have
set
e) The molecular structure of the pre-polymerisation
pre-polymer isation monomer units has an effect
on the resulting polymer’s properties”
properties” CORRECT ANSWER
The molecular structure of the pre-polymerisation monomer units has an effect on the
resulting polymer’s properties.
a)
b) Ethyl methacrylate
Denture is a commonly
base polymers used
tend to offer
offer denture
poor colour base material
stability
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Denture base polymers can suffer from porosity defects if not cured appropriately.
6-With regards to gold alloys used in dentistry, which one of the following is true?
a) Using a liner
b) Incremental filling and curing of the cavity “ CORRECT ANSWER
c) Using of a matrix band
d) Curing the composite in bulk
e) Using a rubber dam
a) Improved carving
b) Better adhesion to tooth
c) Reduced setting time “ CORRECT ANSWER
d) Improved resistance to caries
e) Greater ease of use in moist conditions
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a) Improved carving
b) Better adhesion to tooth
c) Reduced setting time “ CORRECT ANSWER
d) Improved resistance to caries
e) Greater ease of use in moist conditions
a) 0.1 µm
b) 0.25 µm
c) 0.30 µm
d) 0.50 µm
e) 0.75 µm “ CORRECT ANSWER
Light-bodied silicones can reproduce detail of 0.25 µm, medium bodied silicones can
reproduce detail of 0.5 µm and heavy bodied silicone can reproduce detail of 0.75 µm.
a) 95%
b) 85% “ CORRECT ANSWER
c) 75%
d) 65%
e) 55%
Type 4 gold alloys are harder than type I alloys and contain 65% gold.
a) Beryllium
b) Chromium
c) Cobalt “ CORRECT ANSWER
d) Molybdenum
e) Nickel
13-The property that makes cobalt chromium alloys favourable for removable
partial dentures is:
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a) Density
b) Ductility
c) Hardness
d) Rigidity “ CORRECT ANSWER
e) Thermal diffusivity
Cobalt chromium removable partial denture frameworks need to be rigid and so not be
susceptible to permanent deformation. This aids in ensuring their accurate and
reproducible seating and longevity.
14-Cobalt chromium clasps are able to engage tooth undercuts of which depth:
•
Comment on this Question
Cobalt chromium alloys are rigid and brittle in thin section. If the undercut is 0.25 mm in
depth cobalt chromium is the material of choice. For undercut depths of 0.5 mm
stainless steel is the material of choice for clasps and for undercuts of 0.75 mm wrought
gold is the material of choice.
a) Calcium sulphate
b) Hydroxyl terminal groups on pre-polymer chains
c) Lead dioxide and terminal and pendant thiol groups on pre-polym
pre-polymer
er chains
d) Platinum a salt “ CORRECT ANSWER
e) Ester derivative of aromatic sulphonic acid salt
a) A chemical reaction
b) A physical reaction “ CORRECT ANSWER
c) Involves a reaction where crosslinking
crosslinki ng occurs between polymer chains
d) Is a reversible reaction
e) Is notable
notable for being an exothermic reaction
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Upon mixing the powder and the liquid, the resultant reaction is a purely physical one
and no chemical reaction per se occurs.
a) 20o
b) 40o
c) 60o
d) 90o “ CORRECT ANSWER
e) 110o
270 nm
370 nm
570 nm
670 nm
The light required to cure composite is usually in the blue range of the electro-magnetic
spectrum, which is typically in the range of 470 –
–475
475 nm.
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c) That optical property where two colours appear to be matching under the same
light source, but have different spectral reflectance
d) The relative lightness or darkness of a colour “ CORRECT ANSWER
e) The temperature of the light under which a shade is recorded
Nayyar cores are constructed to provide retention for crowns in endodontically treated
teeth with insufficient supra-gingival tooth tissue. They are constructed by removing 3 –
–4
4
mm of radicular gutta percha, then packing these with amalgam and then building the
tooth up.
a) 0–
–5
5 MPa
b) 10–
–15
15 MPa
c) 20–
–30
30 MPa “ CORRECT ANSWER
d) 45–
–55
55 MPa
e) 60–
–65
65 MPa
23-Definitive posts for post and cores restorations are NOT commonly made of:
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25-Which one of the following does not form a component of cobalt chromium
removable partial dentures?
The term abutment refers to the tooth that is used to retain a bridge. B, C, D and E
options are all components of a cobalt chromium removable partial denture.
a) Acrylic
b) Cobalt chromium
c) Gold alloy
d) Stainless steel
e) Titanium “ CORRECT ANSWER
Titanium is not commonly used in the construction for clasps for dentures. While cobalt
chromium, stainless steel and gold alloy are commonly used for clasp construction,
acrylic clasps are also available as a non-metallic alternative and can be used to provide
a component that is tooth coloured. These are however somewhat brittle and prone to
fracture.
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a) As liners in surgical stents and under dentures in sites where surgery has been
carried out
b) As a long-term denture liner in cases of painful dentures “ CORRECT ANSWER
c) For recording functional impressions, such as for piezography
d) On baseplates in sites where a surgical defect may need to be obturated,
particularly if traumatised
tr aumatised
e) To allow irritated
irritate d soft tissue, such as sites with denture induced hyperplasia, to
resolve before recording impressions
Tissue conditioners are a soft and compliant material, composed of polymer, monomer
and plasticizer. Over a period of the time, following mixing, the plasticizer leaches out of
the body of the gel and the material becomes harder and less gel-like. In light of this
progressive hardening,
hardening, its use is not indicated
indicated in procedures where the gel is likely
likely to be
present in the mouth for prolonged
prolonged periods
periods of time. Tissue conditioners
conditioners are
are used most
most
often in scenarios that are preparatory for procedures such as impressions or to allow
The minimum thickness of gold alloy for a cuspal coverage restoration is 0.5 mm.
a) A bevel
b) A chamfer “ CORRECT ANSWER
c) A feather edge
d) A shoulder
e) A shoulder with bevel
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The glass ionomer cements (GIC) represent a reaction between a polyalkenoic acid and
an aluminosilicate powder. They are classified by function as follows:
a) Type I
b) Type II
c) Type III
d) Type IV “ CORRECT ANSWER
e) Type V
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The glass ionomer cements (GIC) represent a reaction between a polyalkenoic acid and
an aluminosilicate powder. They are classified by function as follows:
a) Type I
b) Type II “ CORRECT ANSWER
c) Type III
d) Type IV
e) Type V
The glass ionomer cements (GIC) represent a reaction between a polyalkenoic acid and
an aluminosilicate powder. They are classified by function as follows:
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Glass ionomer cements (GIC) are extremely useful materials. Their disadvantages are
that they are water sensitive and soluble, and they are brittle and prone to wear.
However, their adhesion to dentine is good, and they have a similar coefficient of
thermal expansion to that of dentine, so form an excellent seal, although their physical
properties make them unsuitable
unsuitable for occlusal
occlusal loading.
loading. GIC are easy to use
use and have a
setting time of 6–
–8
8 minutes, which makes them easier to manipulate into a cavity.
a) Alumina
b) Aluminium fluoride
c) Calcium fluoride
d) Silica “ CORRECT ANSWER
e) Sodium fluoride
• silica 41.9%
• alumina 28.6%
a) 30 nm
b) 250 nm
c) 350 nm
d) 470 nm “ CORRECT ANSWER
e) 500 nm
a) Addition of HEMA
b) Addition of silver powder “ CORRECT ANSWER
c) Change of the alumina-silicate
alumina-s ilicate glass
d) Mixing with a composite cement 50:50 mix
e) Use of polyvinyl acid
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These composites with added silver were designed to have an ideal combination of the
properties of ceramic and
and metal
metal parts, hence
hence the name ‘cermet.’
‘cermet.’
38-Which of the following, if added to zinc oxide eugenol (ZOE), changes it into
Kalzinol?
a) 300 °C
b) 550 °C
c) 1000 °C
d) 1500 °C
e) 2000 °C “ CORRECT ANSWER
Sintering is the process by which powdered porcelain is heated to just below its melting
point, so that the particles fuse to form a solid, which then cools and shrinks
shrinks firmly on to
a metal substructure.
a) 300 °C
b) 550 °C
c) 1000 °C
d) 1500 °C “ CORRECT ANSWER
e) 2000 °C
This alloy of cobalt and chromium is extensively used in dentures. Its melting point is
1500 °C.
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a) Aesthetic factors
b) Depth of light cure is limited to 6 mm
c) Hydrophilic properties
d) Polymerisation
Polymerisat ion shrinkage of 0.5%
e) Temperature rise during light curing “ CORRECT ANSWER
a) Aesthetic factors
b) Depth of light cure is limited to 6 mm
c) Hydrophilic properties
d) Polymerisation
Polymerisat ion shrinkage of 0.5%
e) Temperature rise during light curing “ CORRECT ANSWER
a) 10 μm
b) 20 μm
c) 50 μm “ CORRECT ANSWER
d) 75 μm
e) 100 μm
With acid etch techniques and dentine bonding agent, composite can produce good
adhesion to dentine through ‘tags’, which fill the dentinal tubules to a depth of
approximately 50 μm.
a) 5 nm
b) 20 nm “ CORRECT ANSWER
c) 40 nm
d) 75 nm
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e) 100 nm
Titanium will osseointegrate with bone. However, the bone is not fully covered on
electron microscopy, as there is a small gap of 20 nm. It is the lack of soft tissue
between bone and implant that defines osseointegration.
a) 4 carat
b) 10 carat
c) 14 carat
d) 18 carat
e) 24 carat “ CORRECT ANSWER
For direct dental restorations, gold foil (24-carat gold) is used, whereas cast gold (14- or
18-carat gold) is used for indirect restorations.
The addition of zinc acetate to ZOE decreases the setting time to about 5 minutes.
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a) 300 °C
b) 550 °C
c) 1000 °C “ CORRECT ANSWER
d) 1500 °C
e) 2000 °C
The ‘lost wax’ technique, which dates back to ancient times, is used for dental casting.
Wax is invested and melted, leaving a dead space into which liquid gold (14- to 18-carat)
is poured. This is then spun, cooled, and the investment material cleaned off.
a) Carbon
b) Chromium
c) Molybdenum
d) Nickel
e) Titanium “ CORRECT ANSWER
Stainless steel is an alloy that consists mainly of iron and carbon. It also contains
chromium (which makes it resistant to scratching and tarnishing), nickel (which provides
a smooth polished surface) and molybdenum (which helps to maintain a sharp cutting
edge, as for example is required in a scalpel).
a) 0.25%
b) 2% “ CORRECT ANSWER
c) 8%
d) 10%
e) 12%
a) 0.01 μm
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2.5–5.0 μm is
is the particle
particle size of macrofilled composites.
composites.
52-The surface of a ceramic restoration must be prepared with what before repair
with a composite resin restoration material? Select one option only.
•
Comment on this Question
Hydrofluoric acid is required to etch the surface of ceramic restorations before repair.
53-When required, which one of the following is the preferred lining material
below a composite resin restoration?
a) Calcium hydroxide
b) Copal ether
c) Resin-modif
Resin-modified
ied glass ionomer cement “ CORRECT ANSWER
d) Zinc oxide eugenol
e) Zinc polycarboxylate
Resin-modified glass ionomer cement (RMGIC) is the preferred lining material from the
above. Composite resin can bond to RMGIC. Zinc oxide eugenol plasticises composite
and must not be used.
49
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•
Comment on this Question
a) Increased corrosion
b) Increased creep
c) Increased marginal breakdown
d) Increased tarnishing “ CORRECT ANSWER
e) Decreased speed to full compressive strength
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MTA is very biocompatible. MTA has a similar composition to Portland cement but it
does not contain arsenic or lead. Bismuth oxide is added for radio-opacity. It is not an
ideal temporary restorative material, as small quantities are very expensive.
a) Polybutester
b) Polyglactin “ CORRECT ANSWER
c) Polypropylene
d) Silk
e) Staples
•
Comment on this Question
Novafil™ is a non-absorbable
non-absorbable monofilament formed of polybutester.
Prolene™ is a non-absorbable
non-absorbable monofilament formed of polypropylene.
Vicryl™ and Vicryl Rapide™ are absorbable, synthetic, braided sutures composed of
polyglactin..
polyglactin
51
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Flexible impression trays lead to impression distortion and hence decreased accuracy.
52
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[History and
Examination
MCQs]
[With answers]
53
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1-Which one of the following signs is not associated with infective endocarditis?
e) Splinter haemorrhages
• Comment on this Question
Pulsus paradoxus describes the phenomenon of the heart rate and blood pressure falling during
inspiration. This usually occurs when there is a restriction of the ventricles, eg. Cardiac
tamponade or constrictive pericarditis. Roth spots are boat-shaped retinal haemorrhages with
pale centers seen on fundoscopy.
fundoscopy. Janeway lesions are pain
painless
less palmar/plantar macu
maculas.
las.
Remember that diabetes is a multi-system disease and that patients require regular multi-
disciplinary team review - dieticians for dietary advice, ophthalmology for diabetic retinopathy
monitoring, endocrine/renal input for BM/HbA1c control, nephropathy review, peripheral pulse
checks and autonomic/peripheral neuropathy screening. Peripheral neuropathy will place these
patients at increased risk of
of ulcers/infections and the difficult to treat ‘diabetic foot’. Good BM
control will also reduce the risk of cardiovascular disease. A balanced diet and oral
hypoglycaemics such as metformin/gliclazide are the treatment of choice. Necrobiosis lipoidica is
associated with diabetes and are yellow waxy plaques commonly found on the shins that are
surrounded by rusty margins.
a) Palpitations
b) Weight loss
c) Tremor
d) Cold intolerance « CORRECT ANSWER
e) Anxiety
54
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Typically patients with hyperthyroidism complain of palpitations (atrial fibrillation), weight loss,
tremor, heat intolerance, diarrhoea and anxiety.
Sternocleidomastoid divides the neck into an anterior and posterior triangular compartment.
Thyroglossal cysts are embryonic remnants and are commonly found in the midline around the
hyoid bone. A thyroglossal cyst will move upwards from its resting position when the patient
protrudes their tongue. The cranial nerve (CN) VII may be damaged along its course if great care
is not taken during excision of a parotid gland tumour. Goitres can be present in both hyper- and
hypothyroidism and further biochemical tests are required to confirm the diagnosis.
5-Which one of the following is not a 2ecognized cause of salivary gland enlargement?
a) Bacterial infection
b) Sarcoid
c) Sjögren’s syndrome
d) Diabetes mellitis
e) Sodium valproate « CORRECT ANSWER
a) Assess for danger, check airway, breathing, circulation, call for help, call for ambulance
b) Assess for danger, check responsiveness,
r esponsiveness, call for help, assess airway, breathing,
circulation, call 999, start cardiopulmonary resuscitation (CPR)« CORRECT ANSWER
c) Assess for danger, check responsiveness, call 999, assess airway, breathing, circulation,
start CPR
d) Assess for danger, check responsiveness,
r esponsiveness, call 999, assess airway, breathing, circulation,
and check patient notes
e) Assess for danger, check responsiveness,
r esponsiveness, call 999, assess airway, breathing, circulation,
and give adrenaline
55
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a) Penicillamine
b) Nifedipine « CORRECT ANSWER
c) Levothyroxine
d) Cardivelol
e) Digoxin
a) Vitamin A deficiency
b) Vitamin D deficiency
c) Iron deficiency « CORRECT ANSWER
d) Phenytoin
e) Polyarteritis nodosa
This disease predominantly affects elderly women (three times their male counterparts).
co unterparts). The
patient may complain of fever, jaw pain, scalp pain on combing their hair, headache or visual
disturbance, if left untreated the patient may suffer permanent blindness. It is common to find
an erythrocyte sedimentation rate (ESR) > 60 mm/h
mm/ h but rarely may it be within the normal
range. Biopsy of the temporal artery is the
t he investigation of choice but non-uniform infiltration of
giant cells may give a false negative biopsy on a small sample. Prednisolone 60 mg once daily
(OD) should be commenced immediately.
10-A patient presents with swan necking of their thumbs and ulnar deviation of their fourth
and fifth fingers. They have just been prescribed methotrexate. Which of the following
conditions do they have?
a) Dupuytren’s contracture
b) Osteoarthritis
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c) Osteoporosis
d) Psoriatic arthritis
e) Rheumatoid arthritis « CORRECT ANSWER
11-A patient has a fixed flexion contracture of the palm, where the fingers bend towards the
palm and cannot be fully extended. What is the cause of this condition?
Dupuytren’s contracture is caused by underlying contractures of the palmar fascia. The ring
finger and little finger are the
the most commonly affected digits. The midd
middle
le finger may be affected
in advanced cases, but the index finger and thumb are nearly always spared. Dupuytren’s
contracture progresses slowly and is usually painless. In patients with
w ith this condition, the tissues
under the skin on the palm of the hand thicken and shorten so that the tendons connected to the
fingers cannot move freely.
a) Osteomyelitis
b) Osteopetrosis
c) Osteoporosis
d) Osteosarcoma
e) Paget’s disease « CORRECT ANSWER
Paget’s disease of bone is a condition in which the normal cycle of bone growth is disrupted. This
can cause bones to become weakened and deformed. Common symptoms of Paget’s disease
include bone pain and deformity.
This condition is caused by inflammation of the air passages in the lungs, and it affects the
sensitivity of the nerve endings in the airways, which become easily irritated. During an asthma
attack the linings of the passages swell, causing the airways to narrow and reducing the flow of
air into and out of the lungs.
a) Heart
b) Kidney
c) Liver « CORRECT ANSWER
d) Lungs
e) Spleen
Rapidly developing (acute) ascites can occur as a complication of trauma, perforated ulcer,
appendicitis, or inflammation of the colon or another tube-shaped organ (diverticulitis). This
condition can also develop when intestinal fluids, bile, pancreatic juices or bacteria invade or
inflame the smooth transparent membrane (peritoneum) that lines the inside of the abdomen.
However, ascites is more often associated with liver disease and other long-lasting (chronic)
conditions.
a) Gardner syndrome
b) Gaucher syndrome
c) Gorlin–Goltz syndrome
d) Plummer–Vinson syndrome « CORRECT ANSWER
e) Sturge–Weber syndrome
• dysphagia
• pain
• weakness
58
• odynophagia
• atrophic glossitis
• angular stomatitis.
16-In which condition are Roth spots, Osler’s nodes and Janeway’s lesions seen?
Infective endocarditis.
• Splinter haemorrhages are dark red linear lesions in the nail beds.
• Roth spots are retinal haemorrhages with small, clear centres. They are rare, being
observed in only 5% of patients.
17-You are examining a patient in the dental chair, and when they protrude their tongue it
deviates to the right. Which nerve is failing to function?
a) Accessory nerve
b) Facial nerve
c) Glossopharyngeal nerve
d) Hypoglossal nerve « CORRECT ANSWER
e) Trigeminal nerve
Disorders of the 12th cranial nerve (hypoglossal nerve), which is responsible for moving the
tongue, cause weakness and/or atrophy (wasting) of the tongue
t ongue on the affected side. Causes of
loss of function of the hypoglossal nerve include a tumour or bone abnormality at the base of the
skull, a stroke, infection of the brainstem, or an injury to the neck. As a result of the weakness
and/or atrophy of the tongue, individuals with this disorder have difficulty speaking, chewing
and swallowing.
59
18-A patient with active tuberculosis who has been admitted under your care is concerned
about the fact that they are passing red-orange urine. Which of the following drugs is likely to
be the cause of this?
a) Ethambutol
b) Isoniazid
c) Pyrazinamide
d) Rifampicin « CORRECT ANSWER
e) The cause is unlikely to be drug related
re lated
Rifampicin is a solid with an intense red colour, and the small fraction of this antibiotic that
reaches the body fluids is known to impart a harmless red-orange color to the urine (and to a
lesser extent to the sweat and tears) for a few hours after a dose has been taken. Maximal
concentrations in the blood are decreased by about a third when the antibiotic is taken with
food.
Digastric.
• The submandibular triangle is bounded above by the lower border of the body of the
mandible, and a line drawn from its angle to the mastoid process.
• It is bounded below by the posterior belly of the digastric muscle, and in front by the
anterior belly of the digastric muscle.
20-A patient with chronic facial pain has been referred to you because they have developed
anaemia and their liver function tests are deranged. Which of the following drugs is the likely
cause?
a) Amitriptyline
b) Amoxicillin
c) Carbamazepine « CORRECT ANSWER
d) Dothiepin
e) Gabapentin
60
It is important that
t hat carbamazepine is used carefully, and close clinical and frequent laboratory
supervision should be maintained throughout treatment.
21-Which of the following muscles does not have a motor supply from the mandibular branch
of the trigeminal nerve?
The posterior belly is supplied by the digastric branch of the facial nerve.
The digastric muscle extends from the mastoid process of the cranium to the mandible at the
chin, and part of the way between these it becomes a tendon, which passes through a tendon
pulley attached to the hyoid bone.
22-A young child who has chickenpox (varicella) has a red rash and blisters/vesicles within
their ear and eardrum. What is the name of this syndrome?
a) Albright syndrome
b) Cushing syndrome
c) Frey syndrome
d) Patterson–Brown-Kelly syndrome
e) Ramsay Hunt syndrome « CORRECT ANSWER
Ramsay Hunt syndrome is a herpes zoster virus infection of the geniculate ganglion of the facial
nerve. It is caused by reactivation of herpes zoster virus that has previously caused chickenpox in
the patient. Ramsay Hunt syndrome results in paralysis of the facial muscles on the same side of
the face as the infection, as the virus infects the facial nerve that normally controls the muscles
61
of the face. Ramsay Hunt syndrome is typically associated with a red rash and blisters in or
around the ear and eardrum, and sometimes on the roof of the mouth or the
t he tongue.
23-A patient has had a neck dissection as part of their treatment for an oral malignancy. They
now have weakness of their trapezius and sternocleidomastoid muscles on that side, and are
unable to shrug their shoulders equally. Which nerve has been damaged?
The trapezius muscle is tested by asking the patient to shrug their shoulders with and without
resistance. A one-sided weakness is indicative of an injury to the spinal accessory nerve on the
same side of the body as that being assessed.
The sternocleidomastoid muscle is tested by asking the patient to turn their head to the left or
right against resistance. A weak leftward turn of the head is indicative of a weak right
sternocleidomastoid muscle (and thus right spinal accessory nerve injury), whereas a weak
rightward turn of the head is indicative of a weak left sternocleidomastoid muscle (and thus left
spinal accessory nerve injury).
24-A patient had a superficial parotidectomy 6 weeks ago. They report that an area of their
cheek on the same side becomes red and sweats at mealtimes. Which nerve has been
damaged?
Frey syndrome often occurs as a side-effect of parotid gland surgery. The auriculotemporal
branch of the trigeminal nerve carries sympathetic fibres to the sweat glands of the scalp and
parasympathetic fibres to the parotid
parotid gland. As a result of severance and ina
inappropriate
ppropriate
regeneration, the fibres may switch courses, resulting in ‘gustatory sweating’ (sweating in
response to a food stimulus) instead of the normal salivatory response.
25-How many branches does the internal carotid artery give off as it travels
travel s from its
bifurcation to the carotid canal?
62
a) 0 « CORRECT ANSWER
b) 2
c) 3
d) 4
e) 7
a) The anterior belly of the digastric is innervated by the hypoglossal nerve. « CORRECT
ANSWER
b) The digastric depresses the mandible and raises the hyoid bone.
c) The posterior belly of the digastric is innervated by the
t he facial nerve.
d) The superior attachment of the anterior belly of the digastric is the digastric fossa of the
mandible.
e) The superior attachment of the posterior belly of the digastric is the mastoid notch of
the temporal bone.
The digastric muscle consists of two fleshy bellies united by an intermediate rounded tendon. The
two bellies are supplied by different cranial nerves.
• The posterior belly is supplied by the digastric branch of the facial nerve.
• The anterior belly is supplied by the trigeminal nerve via the mylohyoid nerve, a branch
of the inferior alveolar nerve, which
w hich is itself a branch of the mandibular division of the trigeminal
nerve.
27-A patient has oral lichen planus, and some small, shiny, flat-topped, firm papules are
present on their wrists. The papules are purple in colour and are crossed by fine white lines.
What are these lesions called?
a) Candidiasis
b) Drug reaction
c) Psoriasis
d) Waldenström
Waldenström’s
’s macroglobulinaemia
macroglobulinaemia
e) Wickham’s striae « CORRECT ANSWER
These are characteristic fine white or grey lines or dots seen on the top of the pruritic papular
rash of lichen planus, and they also affect the oral mucosa in the same disease.
63
28-A patient presents to your clinic with oral ulceration. They have started five new drugs
recently. Which drug is most likely to have caused the oral ulceration?
a) Aspirin
b) Bendroflumethiazide
c) Diltiazem « CORRECT ANSWER
d) Fluoxetine
e) Propranolol
29-A patient presents to your practice. They tell you that they have recently had an operation
for oral cancer, which involved taking a free flap from their arm for reconstruction. They are
now experiencing some numbness of the skin over their thumb. Which nerve has been
affected?
a) Digital nerve
b) Median nerve
c) Nerve to C4
d) Radial nerve « CORRECT ANSWER
e) Ulnar nerve
The radial nerve and its branches supply the dorsal muscles, such as the triceps, the extrinsic
extensors of the wrist and hand, and the cutaneous nerve supply to most of the back of the hand.
30-On examination you feel a click on opening of the left jaw joint. There is no associated pain
and the patient thinks it may have been present to for a long time. What is the likely
diagnosis?
a) Anterior displaced disc « CORRECT ANSWER
b) Atypical facial pain
c) Rheumatoid arthritis
d) Temporomandibular joint dysfunction
e) Trigeminal neuralgia
Temporomandibular joint dysfunction is associated with pain in the muscles of mastication and
can be associated with bruxism or occlusal problems. Rheumatoid arthritis can cause breakdown
of the joint which can have a click but is usually associated with pain. Again, atypical facia
faciall pain
is associated with pain that has no known cause. Trigeminal neuralgia usually has a trigger
t rigger point
64
causing extensive pain. Anterior displaced disc is common and the click occurs when the disc slips
past the joint on opening and translating
translating forwards.
31-After receiving an inferior dental block, the patient finds her eye starts watering and
complains of difficulty blinking. Which branch of which nerve is most likely to have been
affected?
The facial nerve enters the parotid duct and splits into five main branches. These include the
marginal mandibular, cervical, temporal, zygomatic and buccal. The zygomatic
zy gomatic branch
innervates the muscles of facial expression around the eye. In giving an inferior dental block, if it
is given too high or there is diffusion to the facial nerve it can affect the facial nerve.
32-A patient complains of a beefy tongue, recurrent ulcers and soreness at the ccorners
orners of her
mouth. What is the likely diagnosis?
a) Angular chelitis
b) Lack of intrinsic factor
c) Macrocytic anaemia
d) Microcytic hypochromic anaemia « CORRECT ANSWER
e) Minor recurrant aphthous stomatitis
33-A 55-year-old woman is taking alendronic acid. What is the most likely reason to be taking
it?
a) Breast cancer
b) Leukaemia
c) Multiple myeloma
d) Osteogenesis imperfecta
34-During a new patient dental examination you find a large bony lump in the palate. The
mucosa is pale pink, non-ulcerated and keratinised. It is firm to touch a
and
nd fixed. The patient is
unaware of how long it has been present and it is not causing any pain. What is the likely
diagnosis?
a) Kaposi’s sarcoma
b) Pleomorphic adenoma
c) Repair of a cleft palate
d) Squamous cell carcinoma
e) Torus palatini « CORRECT ANSWER
Kaposi’s sarcoma is a tumour caused by human herpes virus 8. It often presents in the palate but
is not a bony lump and often appears as a purplish bruises. A torus palatini is a bony growth in
the palate for which no treatment is necessary. A cleft palate repair is unlikely to show the
appearance of a growth in the palate but more as a defect. A squamous cell carcinoma is rare to
present in the palate and usually has the appearance
appearance of a rolled unheal
unhealing
ing ulcerated growth. A
pleomorphic adenoma is a benign
benign salivary gland tumour that is most co
commonly
mmonly found in the
parotid, although it can present
present in the palate. It has the appearance of a fi
firm
rm singular nodular
mass but is not normally bony.
The parasympathetic innervation originates from the facial nerve but branches through the
36-A patient attends who is taking warfarin. She has a consistently high INR and multiple
carious lesions. On taking a diet sheet you discuss issues affecting the caries rate. Which one
of the following foodstuffs is most likely to be causing a high INR?
Cranberry juice has been known to increase the potency of warfarin. Ginger is also known to
affect warfarin. There have been some investigations into grapefruit juice but has not been
proven to increase the INR. Strawberry jam has a high titrated pH but does not affect warfarin.
Chocolate and coffee do not interfere with
w ith warfarin.
37-What spaces are most commonly affected with an infected maxillary molar tooth?
38-You are looking after a patient on the ward who has been admitted for extraction of teeth
later today following an abscess. They have been given a course of penicillin for management
of the abscess. They get up to go and get changed and they collapse. On examination they
have a rash spreading across their chest and are finding it difficult to breathe. What drugs, and
in what correct order, are you going to administer within the hospital setting?
Diagnosis of anaphylactic attack. It is important to ensure help is on its way, as it can be fatal.
The adrenaline is important to administer first as it will reopen the airway and reduce the
oedema. High flow oxygen is then
t hen important to maintain the airway. Chlorphenamine will help
counteract the histamine that is being produced causing the oedema but takes longer to take
effect. The hydrocortisone will act as an anti-inflammatory and immunosuppressant to prevent
the swelling developing further but takes time to act. During this time another dose of
adrenaline may be necessary.
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[ Human
Diseases
MCQs]
[With Answers]
69
a) Down’s syndrome
b) Patau’s syndrome
c) Cri-du-chat syndrome
d) Edward’s syndrome « CORRECT ANSWER
e) CREST (calcinosis cutis, Raynaud’s phenomenon, oesophophageal dysfunction,
sclerodactyly and telangiectasia syndrome) syndrome
3-A young man presents with bloody diarrhoea, weight loss and a swollen lower lip. Which
one of the following is the diagnosis?
a) Coeliac disease
b) Ulcerative colitis
c) Crohn’s disease « CORRECT ANSWER
d) Gastroenteritis
e) IBS
Crohn’s is a disease with skip lesions throughout out the gastrointestinal (GI) tract that has a
known history of lip swelling.
a) Staphylococcus aureus
b) Legionella « CORRECT ANSWER
c) Mycoplasma
d) Pneumocystis jiroveci
e) Chlamydia psittaci
70
This bacterium is common in water tanks, which are kept at 60o C and is seen in travellers,
especially to Spain. It presents with a dry cough, bibasal consolidation and myalgia.
a) Staphylococcus aureus
b) Legionella
c) Mycoplasma
d) Pneumocystis jiroveci « CORRECT ANSWER
e) Chlamydia psittaci
The organism was previously called Pneumocystis carinii and is now Pneumocystis jiroveci.
a) Pulmonary embolus
b) Aspiration pneumonia
c) Heart failure
d) Hospital-acquired pneumonia « CORRECT ANSWER
e) Pulmonary oedema
a) Pulmonary embolus
b) Pregnancy
c) Alcoholism
d) Cushing’s disease « CORRECT ANSWER
e) Hyperthyroidism
8-A 65-year-old lady presents with a ‘burning sensation’ in her left hand in the thumb, index
and middle finger, that wakes her at night. Which one of the following nerves is affected?
a) Ulnar
b) Median « CORRECT ANSWER
c) Radial
d) Digital
e) Brachial plexus
71
9-A student presents with a headache that is the worst he has ever had on waking in the
morning after the night out. His neck feels stiff and he feels nauseous. He has a history of
polycystic kidney disease. Which one of the following is the likely diagnosis?
a) Hangover
b) Subarachnoid haemorrhage « CORRECT ANSWER
c) Meningitis
d) Migraine
e) Extra-dural haemorrhage
Presents with worse headache ever and sudden onset with neck stiffness.
10-You suspect a patient has a subarachnoid haemorrhage. You will make a diagnosis based
on which of the following urgent tests?
11-A 21-year-old man presents to the Emergency Department. He has been punched in the
side of the head over the left temple. He was knocked out, but rregained
egained consciousness.
consciousness. After
some time in the Emergency Department he starts to become confused and irritable. Which
one of the following is the most likely diagnosis?
a) Subarachnoid haemorrhage
b) Extradural haemorrhage « CORRECT ANSWER
c) Concussion
d) Subdural bleed
e) Hypoglycaemia
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12-A patient with recurrent oral cancer presents with brain metastasis, which one of the
following is part of the Cushing’s response to raised intra-cranial pressure?
a) Chocolate
b) Alcohol
c) Early mornings « CORRECT ANSWER
d) Fear
e) Exercise
a) Asprin
b) Clopidogrel
c) Ibuprofen
d) Alcohol
e) Prednisolone « CORRECT ANSWER
Steroids lead to tissue fragility, so patients are more likely to bleed, but not bleed
spontaneously.
15-A known alcoholic is seen with confusion and hallucinations. On examination he is sweaty,
flushed, tachycardic and agitated. From the following options choose one that explains what
is occurring?
a) Alcohol intoxication
b) Subdural haemorrhage secondary to a fall
c) Wernicke’s encephalopathy
d) Delirium tremens « CORRECT ANSWER
e) Korsakoff’s psychosis
16-Which one of the following options is not associated with alcohol abuse?
a) Folate deficiency
b) Arrhythmias
c) Cortical atrophy
d) Microcytic anaemia « CORRECT ANSWER
e) Falls
a) Syphilis
b) Fibrous dysplasia « CORRECT ANSWER
c) Ectodermal dysplasia
d) Delayed puberty
e) Oral cancer
It is a syndrome associated with fibrous dysplasia, precocious puberty, skin pigmentation and
endocrine diseases.
19-A man presents with persistent refractory hypertension, hypokalaemia and a unilateral
adrenal mass. Which one of the following diseases does he suffer?
a) Cushing’s disease
b) Conn’s disease « CORRECT ANSWER
c) Phaeochromocytoma
d) Addison’s
e) Congenital hyperaldosteronism
20-A 19-year-old man present to your practice. He has a history of recurrent chest infections,
wheeze and a positive sweat test. Which one of the following is the likely diagnosis?
a) Asthma
b) Bronchiectasis
c) AIDS
d) Cystic fibrosis « CORRECT ANSWER
e) Sarcoidosis
75
21-A 45-year-old female patient collapses in your surgery while waiting to have a tooth
extracted. She was extremely anxious for this procedure. She has a medical history of asthma
for which she frequently uses her brown inhaler (lately she has been using the inhaler more
frequently). On examination
examination she is very hypotensive. Which one of the following best
describes what has occurred?
Patients who suffer from anxiety are often prone to suffering from vasovagal attacks. During
such an attack, they are likely to be hypotensive until emergency intervention is carried out.
22-A 16-year-old male patient presents with a dental abscess. He has a history of recent
weight loss, abdominal pain, thirst and frequency of micturation. Which one of the following
is of concern?
a) Diabetes insipidus
b) HIV
c) Diabetes mellitus « CORRECT ANSWER
d) Urinary tract infection
23-An unwell 16-year-old with diabetes has a blood glucose monitoring (BM) of 16. He needs
an important test. Which one of the following is the suitable firstline investigation?
This child could have diabetic ketoacidosis. A blood gas will show the pH, but urine will show
presence of ketones. The blood gas test is more important in the sick patient.
24-Which one of the following is a syndrome of dysphagia and pain on mastication with
elongated styloid processes?
a) Eagle’s syndrome
b) Frey’s syndrome
c) Gardner’s syndrome
d) Gorlin–Goltz syndrome
e) Crouzon’s syndrome « CORRECT ANSWER
a) Eagle’s syndrome
b) Frey’s syndrome
c) Gardner’s syndrome « CORRECT ANSWER
d) Gorlin–Goltz syndrome
e) Crouzon’s syndrome
27-Which one of the following syndromes is not associated with lowered IQ?
a) Sturge–Weber syndrome
b) Treacher Collin’s syndrome « CORRECT ANSWER
c) Cri-du-chat syndrome
d) Crouzon’s syndrome
e) Edward’s syndrome
Treacher Collin’s syndrome is a facial deformity secondary to a first brachial arch defect. It does
not affect intelligence!
a) Eagle’s syndrome
b) Frey’s syndrome « CORRECT ANSWER
c) Gardner’s syndrome
d) Gorlin–Goltz syndrome
e) Crouzon’s syndrome
Symptoms include gustatory sweating, erythaema and pain as parasympathetic fibres from the
parotid ‘rewire’ to innervate the skin.
29-Which one of the following is a syndrome associated with odontogenic keratocysts and
basal cell carcinoma?
a) Eagle’s syndrome
b) Frey’s syndrome
c) Gardner’s syndrome
d) Gorlin–Goltz syndrome « CORRECT ANSWER
e) Crouzon’s syndrome
Symptoms include basal cell carcinoma (BCC), multiple odontogenic keratocysts, calcified falx
cerebri and bifid ribs and cervical ribs.
78
a) Acarbose
b) Glibenclamide
c) Insulin « CORRECT ANSWER
d) Metformin
e) Rosiglitazone
Insulin is injected, whereas all the other drugs are oral medications.
32-An elderly woman presents with pain, numbness and tingling over the lateral digits of the
hand. She has hypothyroidism and has previously had surgery to her left wrist. What is the
diagnosis?
Carpal tunnel syndrome is a clinical diagnosis. The signs and symptoms are caused by
compression of the median nerve travelling through the carpal tunnel.
The symptoms of this condition include pain, paraesthesias and occasionally weakness in the
median nerve distribution. Patients with carpal tunnel syndrome often experience pain,
numbness and tingling sensations in the arm, and sometimes extending to the
t he shoulder and
neck area.
79
33-A patient has a severe head injury and suffers damage to the foramen ovale. Which of the
following nerves may be damaged?
a) Facial nerve
b) Hypoglossal nerve
c) Mandibular division of the trigeminal nerve « CORRECT ANSWER
d) Maxillary division of the trigeminal nerve
e) Ophthalmic division of the trigeminal nerve
34-A patient has a severe head injury and suffers damage to the foramen rotundum. Which of
the following nerves may be damaged?
a) Facial nerve
b) Hypoglossal nerve
c) Mandibular division of the trigeminal nerve
d) Maxillary division of the trigeminal nerve « CORRECT ANSWER
e) Ophthalmic division of the trigeminal nerve
35-Which of the following hormones is released by the posterior part of the pituitary gland?
a) ACTH
b) FSH
c) GH
d) Oxytocin « CORRECT ANSWER
e) TSH
• The hormones released by the posterior pituitary are vasopressin and oxytocin.
• The hormones released by the anterior pituitary are follicle-stimulating hormone (FSH),
luteinising hormone (LH), adrenocorticotropic hormone (ACTH), thyroid-stimulating hormone
(TSH), melanocyte-stimulating hormone (MSH) and prolactin.
80
36-With deficiency of which vitamin are rickets (in children) and osteomalacia (in adults)
associated?
a) Vitamin A
b) Vitamin B12
c) Vitamin C
d) Vitamin D « CORRECT ANSWER
e) Vitamin E
Rickets is a lack of mineralisation of bones in children, which potentially leads to fractures and
deformity. It is among the most frequent childhood
c hildhood diseases in many developing countries. The
most common cause is vitamin D deficiency. Although it can occur in adults, the majority of
cases occur in children from areas of the world where famine is prevalent.
37-When you examine a 6-year-old child, you observe Koplik spots on their buccal mucosa.
What childhood infection do they have?
a) Diphtheria
b) Herpes simplex 1
c) Measles « CORRECT ANSWER
d) Mumps
e) Varicella
The classical symptoms of measles are a four-day fever with cough, conjunctivitis and coryza.
Koplik’s spots on the inside of the mouth are pathognomonic of measles.
38-A 60-year-old woman cut her arm while gardening 10 days ago. She presents to the
Emergency Department with neck stiffness, trismus, facial spasms, dysphagia and pyrexia.
What is the diagnosis?
a) Dental abscess
b) Meningitis
c) Rubella
d) Tetanus « CORRECT ANSWER
e) Tonsillitis
rigidity of the pectoral and calf muscles. Other symptoms may include elevated temperature,
sweating, elevated blood pressure and rapid heart rate.
39-An elderly man who drinks 50 units of alcohol a week has a red, painful, stiff big toe. He is
afebrile. He has previously taken colchicine for this condition. What is the likely cause?
a) Cellulitis
b) Gout « CORRECT ANSWER
c) Osteoarthritis
d) Septic arthritis
e) Vascular insufficiency
Gout is a medical condition that is usually characterised by a red, tender, hot, swollen joint. The
big toe is most commonly affected, accounting for around
ar ound 50% of all cases. Gout is caused by
elevated blood levels of uric acid, which crystallises and is deposited in joints, tendons and the
surrounding tissues.
40-A 74-year-old man who used to work with asbestos has a lung mass. What is the likely
cause?
a) Adenocarcinoma
b) Basal-cell carcinoma
c) Mesothelioma « CORRECT ANSWER
d) Squamous-cell carcinoma
e) Transitional-cell carcinoma
The main risk factor for mesothelioma is exposure to asbestos dust. In contrast to lung cancer,
mesothelioma is not associated with smoking.
a) Clonidine
b) Chlorpromazine
c) Dopamine
d) L-DOPA « CORRECT ANSWER
e) Vasopressin
42-A 19-year-old man has breakfast consisting of scrambled eggs and toast. He later develops
headache, fever, abdominal pain and diarrhoea that last for 4 days. What is the likely cause?
a) Campylobacter
b) Clostridium difficile
c) E. coli 0157:H7
d) Salmonella « CORRECT ANSWER
e) Shigella
intestines, causing diarrhoea, fever, abdominal cramps and nausea and/or vomiting that usually
resolve without medical treatment.
43-A patient has immunity to hepatitis B. What is the serological marker that proves this?
44-A 30-year-old man has a sudden-onset headache, neck stiffness and nausea, and collapses
with a fluctuating level of consciousness
consciousness.. What is the likely cause?
c) Meningitis
d) Subarachnoid haemorrhage « CORRECT ANSWER
e) Subdural haematoma
A subarachnoid haemorrhage is bleeding that occurs in the subarachnoid space, which is the
area between the arachnoid
arac hnoid membrane and the pia mater surrounding the brain. Such bleeding
may occur spontaneously, usually from a ruptured cerebral aneurysm.
45-Which is the best chemical marker for determining whether a patient has had a myocardial
infarction?
a) Alkaline phosphatase
b) Creatinine kinase
c) C-reactive protein
d) D-dimer
e) Troponin « CORRECT ANSWER
a) Trisomy 13
b) Trisomy 18
c) XO
d) XXY « CORRECT ANSWER
e) XYY
a) Trisomy 13
84
b) Trisomy 18
c) XO « CORRECT ANSWER
d) XXY
e) XYY
This condition occurs only in females, and is the most common cause of primary amenorrhoea.
The main features of the syndrome are ovarian
ovar ian dysgenesis, webbing of the neck and coarctation
of the aorta.
If palpation of the left lower quadrant of a person’s abdomen results in more pain in the right
lower quadrant, the patient is considered to have a positive Rovsing’s sign, and may have
appendicitis.
49-When you tap repeatedly along the course of the facial nerve of a patient, the nerve goes
into spasm. Then, to further your investigation, you inflate the cuff of a sphygmomanometer
and the patient has a spasm at the wrist. Which of the following electrolyte disturbances does
the patient have?
a) Hypercalcaemia
b) Hyperkalaemia
c) Hypernatraemia
d) Hypocalcaemia « CORRECT ANSWER
e) Hypokalaemia
The facial spasms are known as Chvostek’s sign, and the carpal spasms, which occur as a result
of arterial occlusion, are known as Trousseau’s sign. Both are classic signs of hypocalcaemia.
50-A 24-year-old woman has a raised beta-hCG level. She has not had a period for 6 weeks.
What is the most likely diagnosis?
a) Ovarian cancer
b) Vaginal cancer
85
c) Normal physiology
d) Pregnancy « CORRECT ANSWER
e) Early menopause
A raised beta-human chorionic gonadotropin (beta-hCG) level is the blood test used to confirm
pregnancy.
51-A 28-year-old man who has recently immigrated to the UK from Somalia presents with a
cough of 3 months duration, fever, haemoptysis and nights sweats. Which one of the
following is the most likely diagnosis?
a) Cholera
b) Community-acquired pneumonia
c) Malaria
d) Pulmonary malignancy
e) Tuberculosis « CORRECT ANSWER
This patient has presented with the classical signs and symptoms of tuberculosis. This has a high
prevalence in Africa and Asia. The incidence is increasing in the UK, especially among
immigrants.
52-A patient has been diagnosed with trigeminal neuralgia. What is the most common vessel
implicated in trigeminal nerve compression
c ompression and demyelination in trigeminal neuralgia? Select
one option only.
a) Basilar artery
b) Internal carotid artery
The most common vessel implicated in trigeminal nerve compression and demyelination in
trigeminal neuralgia is the superior cerebellar artery.
arter y.
a) Betamethasone
b) Salbutamol
c) Salmeterol « CORRECT ANSWER
86
d) Theophylline
e) Tiotropium bromide
Betamethasone is a glucocorticoid.
Theophylline is a methylxanthine.
54-Which one of the following is the anticoagulant medication of choice when a patient is
identified pre-operatively as being high risk for venous thromboembolism?
thromboembolism?
a) Aspirin
b) Clopidogrel
c) Compression stocking
d) Enoxaparin « CORRECT ANSWER
e) Warfarin
Prophylactic enoxaparin, a low molecular weight heparin, is the anticoagulant of choice when a
patient is identified as being high risk for venous thromboembolism, as dictated by NICE
guidelines. Venous thromboembolism prophylaxis guidelines
guidelines are essential reading for all of the
oral and maxillofacial surgery team. Compression stockings can be used in combination.
55-A patient presents with sudden onset, severe epigastric abdominal pain. There is bilateral
free air under the diaphragm on erect chest X-ray. Which of the following is the most likely
diagnosis?
a) Flatus
b) Gastric bubble
c) Perforated peptic ulcer « CORRECT ANSWER
d) Pneumothorax
e) Small bowel obstruction
ulcer. The gastric bubble can be differentiated from free air under the diaphragm as this is on
the left side and a fluid level in the stomach is normally visible.
56-Which of the following is the most accurate method of confirming correct nasogastric tube
position?
57-Which one of the following is a common cause for right upper quadrant abdominal pain?
a) Acute appendicitis
b) Acute cholecystitis « CORRECT ANSWER
c) Gastrointestinal malignancy
d) Pelvic inflammatory disease
e) Rupture aortic aneurysm
Acute cholecystitis is commonly caused by choleliths (gallstones). This initially presents as biliary
colic, an intermittent pain, but develops into a constant severe pain.
Melaena is the name given to black, tar-like stool. It obtains its colour from altered blood. This is
a sign of upper GI haemorrhage.
88
[ Oral
Oral and
Maxillofacial
MCQs ]
[With Answers]
89
1. Which one of the following drugs in hospital cannot be used in a patient with
anaphylactic shock?
a) Oxygen
b) Hartman’s solution
c) Adrenaline
d) Prednisolone « CORRECT ANSWER
e) Chlorphenamine malate
Anaphylaxis is an emergency and as such in the hospital and intravenous drug such a
hydrocortisone would be used.
This is the histological-defining feature of a pleomorphic adenoma, that if true, biopsy would
also show to have a pseudocapsule.
4. A fine needle aspiration biopsy (FNAB) reported for a parotid tumour shows
perineural spread and Swiss-cheese appearance. Which one of the following is the
most likely diagnosis?
a) Mucoepidermoid carcinoma
b) Pleomorphic adenoma
c) MALToma
d) Adenoid cystic carcinoma « CORRECT ANSWER
e) Warthin tumour
This is the classical histological appearance of a tumour which has a predilection for perineural
spread and often presents with pain or cranial nerve dysfunction.
5. A 78-year-old lady, who smokes presents with a left parotid gland swelling. On
examination she has a scar in the right parotid region, which she says was from an
operation to remove a gland and the result was a benign tumour.
a) Mucoepidermoid carcinoma
b) Pleomorphic adenoma
c) MALToma
d) Adenoid cystic carcinoma
e) Warthin’s tumour « CORRECT ANSWER
6. A 21-year-old man presents with a 3-month history of a bluish sessile soft swelling in
the hard palate near the upper left 1st molar, which is pain free. Which one of the
following is the most correct lesion to differential first?
91
a) Dentigerous cyst
b) Melanoma
c) Kaposi’s sarcoma
d) Mucous retention cyst
e) Mucoepidermoid carcinoma « CORRECT ANSWER
You must always assume that a pigmented swelling in the palate is a malignant minor salivary
gland tumour until proven otherwise.
9. A 23-year-old woman is seen in the one stop head and neck clinic with thyroid
swelling, which one of the following is the most likely diagnosis?
a) Lymphoma
b) Papillary cell carcinoma « CORRECT ANSWER
c) Follicular cell carcinoma
d) Secondary deposits
e) Anaplastic malignancy
11. Which one of the following does not cause a unilateral lower motor neurone palsy of
the facial nerve?
a) Guillain–Barré syndrome « CORRECT ANSWER
b) Diabetes
c) Ramsey Hunt Syndrome
d) Bell’s palsy
e) Acoustic neuroma
12. Which one of the following is the correct incidence of cleft lip in the UK?
a) 1 in 200
b) 1 in 500
c) 1 in 900 « CORRECT ANSWER
d) 1 in 1800
e) 1 in 2500
This is a guardsman’s fracture, so named after household guards fainting and falling flat on their
chin, which produces this fracture pattern.
14. Which one of the following anatomical structures is not contained in the cavernous
sinus?
a) Optic nerve « CORRECT ANSWER
b) Abducent nerve
c) Ophthalmic nerve
d) Maxillary nerve
e) Internal carotid
94
15. Which one of the following muscles does the facial nerve supply?
a) Masseter
b) Sternocleidomastoid
c) Stapedius « CORRECT ANSWER
d) Intrinsic muscles of the tongue
e) Lateral rectus
16. Which one the following features of basal cell carcinoma (BCC) makes for a good
prognosis?
a) Early detection
b) Rarity
c) Ease of removal
d) Sensitivity to chemotherapy
e) Rarity of metastasis « CORRECT ANSWER
BCC, also called rodent ulcers, are common but only locally aggressive and very rarely
metastasise.
Ectodermal dysplasia is a group of syndromes all deriving from abnormalities of the ectodermal
structures. Patients present with missing or peg-shaped or pointed teeth.
The enamel is lost early in DI, but only because the dentine is too weak to support it.
a) Temporalis
b) Lateral pterygoid
c) Masseter
d) Buccinator « CORRECT ANSWER
e) Medial pterygoid
All muscles of mastication are supplied by the trigeminal nerve. The buccinator muscle is very
important in mastication, but it is not supplied by the trigeminal nerve. The buccinator muscle
96
pulls back the angle of the mouth and flattens the cheek area, which aids in holding the cheek to
the teeth during mastication. It is also used for facial expression.
22. Which one of the following tumours does not metastasis to bone?
a) Prostate
b) Breast
c) Parathyroid « CORRECT ANSWER
d) Thyroid
e) Bronchus
Archibald McIndoe (1900–1960) is the cousin of Sir Harold Gillies and treated
t reated the patients who
went on to form the ‘Guinea Pig Club’ during World War 2 in East Grinstead.
24. Which one of the following has the highest change of malignant change?
change?
a) Lichen planus
b) Paget’s disease of the bone
c) Syphylitic leucoplakia « CORRECT ANSWER
d) Solar keratosis
e) Hairy leukoplakia
25. Which one of the following spreading odontogenic infections can present with
minimal swelling and absolute trismus?
a) Sublingual
b) Parapharyngeal
c) Submandibular
d) Submasseteric « CORRECT ANSWER
e) Buccal
The masseter is an extremely powerful muscle and irritation due to underlying abscess leads to
irritation, spasm and therefore trismus.
Submasseteric abscess is the best answer, but parapharyngeal can also give minimal external
swelling and trismus.
26. Which one of the following is not a long-term complication of spreading odontogenic
infections?
a) Death « CORRECT ANSWER
b) Scarring
c) Halitosis
d) Chronic abscess formation
e) Oro-cutaneous fistula
98
27. Which one of the following is the correct incidence of oral cancer in the UK (2006)?
a) 5 per 100,000
b) 7 per 100,000
c) 9 per 100,000 « CORRECT ANSWER
d) 11 per 100,000
e) 13 per 100,000
28. A patient presents with a 3-cm lesion that is shown to be squamous cell carcinoma
(SCC), clinically he has a unilateral ipsilateral
ipsilateral lymph node of 2 cm diameter. Which one
of the following is the correct TNM classification?
a) T1 N2 M0
b) T2 N1 Mx « CORRECT ANSWER
c) T3 N1 Mx
d) T3 N2 Mx
e) Tis N1 M1
Please refer to the World Health Organization TNM classification of head and neck tumours.
Most but not all submandibular stone are radio-opaque; however the reverse is true with
parotid stones.
31. How many origins and insertions does each muscle of mastication have?
a) It varies with each muscle
b) One insertion and one origin
c) One insertion and two origins
d) Two insertions and one origin
e) Two insertions and two origins « CORRECT ANSWER
For each muscle of mastication there are two insertions and two origins.
The lateral rectus muscle is supplied by the abducent nerve. This can be remembered using the
t he
mnemonic ‘LR6 SO4’ (Lateral Rectus supplied by VI and Superior Oblique supplied by IV).
33. Which one of the following would you request if you suspected a mandibular fracture?
a) OM facial bones
b) Orthopantomogram
c) PA mandible
d) Towne’s view
e) None of the above « CORRECT ANSWER
If there is a suspected fracture, two views should always be requested, namely OPG and PA
mandible in this case.
34. Double vision following trauma is a common sign when which of the following injuries
is sustained?
a) Frontal bone fracture
b) High condyle fracture
c) Isolated zygomatic arch fracture
d) Nasal bone fracture
Orbital floor fractures will disrupt the anatomy of the floor, causing entrapment of the inferior
rectus muscle, which results in diplopia.
35. According to 'ATLS' principles, which one of the following is a priority when first
assessing a trauma patient?
a) Airway and cervical spine immobilisation « CORRECT ANSWER
b) Airway control
c) Arrest of haemorrhage
101
Airway and cervical spine immobilisation is the first-line management when assessing a trauma
patient.
It is ecchymosis posterior to the ear lying over the mastoid. It generally indicates a base of skull
fracture involving the middle cranial fossa. Although mentioned regularly, it is a relatively late
sign.
37. Which fascial space lies inferior to the mylohyoid muscle, and has as its inferior
boundary anteriorly the anterior and posterior bellies of the digastric muscle, and as
its medial boundary the mylohyoid, hyoglossus and styloglossus muscles?
a) Buccal space
b) Masseteric space
c) Pterygomandibular space
d) Submandibular space « CORRECT ANSWER
e) Submental space
These are the boundaries of the submandibular space, which is also bounded laterally by the
skin, the superficial fascia, the platysma muscle, the superficial layer of deep cervical fascia and
the lateral border of the mandible.
102
38. Which anatomical structures are derived from the fourth pharyngeal arch?
a) All of the muscles of mastication
b) The laryngeal muscles and the recurrent laryngeal branch of the vagus nerve
c) The muscles of facial expression, the posterior digastric,
diga stric, stylohyoid and stapedius
muscles, and the facial nerve.
d) The pharyngeal constrictors, levator veli palatini, cricothyroid, larynx and vagus nerve «
CORRECT ANSWER
e) None of the above
stylopharyngeus muscle and the glossopharyngeal nerves. The fourth arch gives rise to the t he
pharyngeal constrictors, levator veli palatini, cricothyroid, larynx and vagus nerve, and the fifth
arch gives rise to the laryngeal muscles and the recurrent laryngeal branch of the vagus nerve.
39. Which one of the following would suggest a malignant neoplasm in a salivary gland?
a) Bilateral salivary gland swelling
b) Pyrexia with acute onset of swelling
c) Rapidly growing lesion with involvement of the facial nerve « CORRECT ANSWER
d) Slow-growing lesion
e) None of the above
40. Following a biopsy of an intra-oral lesion, the pathology report states the following:
‘Large irregularly shaped nuclei which are darkly stained with abnormal mitoses and
loss of architecture, with local invasion into the lymphatic and blood vessels, with
poor differentiation.’ Which one of the following conditions is this likely to be?
a) Carcinoma in situ
b) Lichen planus
c) Squamous-cell carcinoma « CORRECT ANSWER
103
d) Squamous papilloma
e) Traumatic ulceration
This is a classical histological picture of squamous-cell carcinoma, and it is not in situ as it has
invaded. Carcinoma in situ is the most severe stage
st age of epithelial dysplasia, involving the entire
thickness of the epithelium, with the epithelial
e pithelial basement membrane remaining intact.
41. What is the most frequent sequela of an inadequately treated orbital floor fracture?
a) Blindness
b) Diplopia and enopthalmos « CORRECT ANSWER
c) Paraesthesia of the distribution of the infra-orbital nerve
d) Ptosis
e) Superior orbital fissure syndrome
Diplopia (as the entrapment may not be fully released) and enopthalamos (due to the incorrect
volume of the orbit).
42. Which of the following is the most appropriate treatment for a patient in ventricular
fibrillation?
a) 1 mg IV adrenaline 1:10 000
b) 3 mg atropine IV
c) CPR
d) DC shock « CORRECT ANSWER
e) Intubation via an endotracheal tube
Ramsay Hunt syndrome (cephalic herpes zoster) is a peripheral facial nerve palsy, usually
accompanied by pain and an erythematous vesicular rash on the ear (zoster oticus) or in the
mouth. Ramsay Hunt syndrome can occur with an absence of rash (zoster sine herpete) and is
thought to be the cause of about a fifth of clinically diagnosed cases of Bell palsy.
44. Which one of the following is the treatment of choice for a bilaterally displaced
mandibular fracture?
a) Conservative management (ie soft diet and analgesics)
b) Extra-oral reduction and fixation
c) Inter-maxillary fixation (IMF) with screws and elastic
d) Inter-maxillary fixation (IMF) with wires and arch-bar reduction
e) Open reduction and internal fixation (ORIF) « CORRECT ANSWER
45. What is one of the most common causes of xerostomia in the general population
today?
a) Alcoholism
b) Drug induced « CORRECT ANSWER
c) Malignancy
d) Radiotherapy
e) Sjögren syndrome
105
A high proportion of the population today are on a variety of medications, many of which cause
xerostomia as a side-effect. Other causes must
m ust also be excluded.
gland?
a) Mandibular branch of the facial nerve and the hypoglossal nerve
b) Mandibular branch of the facial nerve and the inferior alveolar nerve
c) Mandibular branch of the facial nerve and the lingual nerve
d) Mandibular branch of the facial nerve, the hypoglossal nerve and the mental nerve
e) Mandibular branch of the facial nerve, the lingual nerve and the hypoglossal nerve «
CORRECT ANSWER
A neck incision at least 3 cm below the lower border of the mandible and careful surgical
technique will avoid damage to the facial nerve, and meticulous dissection with haemostasis is
required throughout the procedure.
47. Which one of the following solutions can be used to treat a keratocyst?
a) Betadine solution
b) Carnegie solution
c) Carnoy’s solution « CORRECT ANSWER
d) Chlorhexidine solution
e) None of the above
Carnoy’s solution is a fixative consisting of 60% ethanol, 30% chloroform and 10% glacial acetic
acid.
48. Which one of the following is a primary branch of the external carotid artery
artery?
?
a) Ascending pharyngeal branch « CORRECT ANSWER
b) Buccal branch
c) Labial branch
d) Mandibular branch
e) Supratrochlear branch
106
The ascending pharyngeal branch is the first branch of the external carotid artery.
49. When placing a nasogastric tube following severe midface trauma, which of the
following should one be cautious about?
a) Causing further haemorrhage
b) Infection
c) Intubation of the trachea
d) Perforation into the anterior cranial fossa « CORRECT ANSWER
e) None of the above
In cases of midface trauma there is a potential risk of a facial dysjunction of the midface from
the cranium. Therefore when passing a nasogastric tube through
thr ough the nostril there is a small risk
that it will not pass easily through the floor of the nose and inferiorly, but instead will travel
superiorly or posteriorly into the anterior cranial fossa.
50. Which one of the following can cause lichen planus as an extra-hepatic sign?
a) Hepatitis B virus (HBV)
b) Hepatitis C virus (HCV) « CORRECT ANSWER
c) Herpes simplex virus
51. Which of the following images would you request for a patient with a suspected
52. Which one of the following is an indication, according to NICE, for third molar
removal?
a) Anterior crowding in the mandible
b) Distoangular impaction
c) Mesioangular impaction
d) Unerupted third molar
e) Unrestorable caries in the third molar
mo lar « CORRECT ANSWER
Unrestorable caries is an indication according to the NICE guidelines. None of the other options
is an indication due to the risk of inferior alveolar nerve or lingual nerve damage.
53. A patient who is 6 hours post-operative from the reconstruction of his orbital floor is
complaining of pain behind his eye with a decrease in vision. What is the most
appropriate first-line management
management for this case?
a) Administer high dose analgesia
b) Administer steroid eye drops
c) Call the ophthalmologist on call
d) Remove the sutures from the operative site to allow drainage of blood « CORRECT
ANSWER
e) Review the patient on the next morning ward round
54. As the maxillofacial junior on call you are called to the Emergency Department to see
a patient with an acute facial swelling that is causing him to drool his saliva. His
tongue is elevated and he has suddenly become short of breath. What is your
immediate management?
a) Admit for intravenous antibiotics and book on the urgent theatre list
b) Admit for intravenous antibiotics and review with the team on the ward round
c) Call non-resident senior
d) Get senior help in the form of anaesthetic and surgical team « CORRECT ANSWER
e) Admit and prescribe oral antibiotics
This patient has an ensuing airway obstruction. They will potentially need a surgical airway and
incision, and drainage of the swelling. Once you have sought help on site then it is pertinent to
call your senior colleague who is most likely non-resident, or
o r ask someone to do that while you
seek an airway specialist. Do not delay in managing this patient.
55. Which one of the following is likely to alter early in response to systemic infection?
a) Blood glucose
b) Blood pressure
c) C-reactive protein « CORRECT ANSWER
d) Haemoglobin
C-reactive protein is elevated early in response to infection. Blood pressure may alter later.
Other early responses are increase in respiratory rate and heart rate.
56. With regard to dentigerous cysts, which one of the following is correct?
a) Are likely to recur
58. A patient who presents following an alleged assault to the face and complains of
double vision is likely to have sustained which of the following injuries?
a) Fractured condyle
b) Fractured parasymphysis
c) Nasal bone fracture
d) Palatal fracture
e) Zygomatic complex fracture « CORRECT ANSWER
Fractured zygomatic complex can lead to a depression in the orbital floor causing a ‘trap door’
effect and this can lead to restriction of the inferior rectus muscle.
110
[Oral
Medicine
MCQs]
[With Answers]
111
1. 5-year-old school boy presents with a golden crusting sore at the angle of his mouth.
Which one of the following is the diagnosis?
a) Angular cheilitis
b) Scarlet fever
c) Herpes labialis
d) Chickenpox
e) Impetigo « CORRECT ANSWER
Impetigo is a very common local Staphlococcus aureus infection in children with a classic golden
crust.
2. A 13-year-old presents with a sore throat with Koplik’s spots. Which one of the
following is the correct diagnosis?
a) Glandular fever
b) Scarlet fever
c) Gonorrhoea
d) Chickenpox
e) Measles « CORRECT ANSWER
The prodromal phase is of small white spots with surrounding erythaema. This is before the
maculopapular rash occurs on the trunk.
3. Which one of the following diseases is associated with a high infant mortality rate that
used to kill children and also associated with a strawberry tongue.
a) Glandular fever
b) Scarlet fever « CORRECT ANSWER
c) Gonorrhoea
d) Chickenpox
e) Measles
112
Scarlet fever is an infection with β-haemolytic streptococci. It is associated with malaise, fever
and skin rash.
4. A 25-year-old woman presents with multiple superficial ulcers and pharyngitis. Her
swab is reported as Gram –ve intracellular diplococci. Which one of the following is
the most likely diagnosis?
a) Glandular fever
b) Scarlet fever
c) Gonorrhoea « CORRECT ANSWER
d) Chickenpox
e) Measles
Gonorrhoea is spread by oro-genital contact and can present with a milder stomatitis.
Treatment is with high-dose penicillin.
6. A 25-year-old man present with fever, fatigue and a sore throat. On examination he is
noted to have cervical lymphadenopathy, hepatosplenomegaly
hepatosplenomegaly and macular –papular
rash. Intra-orally there is a petechial rash on the palate and multiple small ulcers.
Which one of the following is the correct diagnosis?
a) HIV
b) Herpes simplex
c) Coxsackie virus infection
d) Glandular fever « CORRECT ANSWER
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e) Toxoplasmosis
7. Which one of the following fungal infections has a potential for malignant cchange?
hange?
a) Histoplasmosis
b) Chronic atrophic candidosis
c) Atrophic erythaematous candidosis
d) Chronic mucocutaneous candidosis
e) Chronic hyperplastic candidosis « CORRECT ANSWER
9. Which one of the following is associated with an elongation of the filiform papillae?
a) Ankyloglossia
b) Fissured tongue
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In itself this is not pathological with about 3% of the population have a deeply fissure tongue.
Melkerson-Rosenthal syndrome is a deeply fissured tongue, recurrent facial nerve palsy and
swelling.
12. Which one of the following gives atrophic areas of filiform papillae appearing red next
to the normal white areas, which give strickling patterns?
115
a) Ankyloglossia
b) Fissured tongue
c) Hairy tongue
d) Erythaema migrans « CORRECT ANSWER
e) Odontoglossum
13. A 7-year-old deaf child has Hutchinson’s incisors and Moon’s molars. Which one of the
following is his likely diagnosis?
a) Osteogenesis imperfect
b) Syphilis « CORRECT ANSWER
c) Romberg syndrome
d) Papillion-Lefevre syndrome
e) Amelogenesis imperfect
These are signs of congential syphilis along with fontal bossing and saddle nose.
14. Which one of the following statements about malignant melanomas intra-orally is
false?
a) Rare and accounts for about 1% of intra-oral malignancy
b) Maybe amelanotic
c) Spread haematologically only « CORRECT ANSWER
d) Tend to be maxillary
e) May be preceded by melanosis
15. A 65-year-old man has severe throbbing pain in his head. You eliminate the possibe
cause as toothache. It transpires
t ranspires that the pain is made worse when putting on his
glasses and mastication increases the temporal pain. What investigation is diagnostic?
a) Full blood count (FBC)
b) Computerised tomography (CT) brain
c) Orthopantomogram (OPG)
d) Erythrocyte sedimentation rate (ESR) « CORRECT ANSWER
e) X-ray om
16. Which one of the following best describes congenital endocrine disease, which
presents with macroglossia, puffy lips and checks with a peaches and cream
complexion?
a) Cushing’s disease
b) Addisons’ disease
c) Hypothyroidism « CORRECT ANSWER
d) Hyperparathyroidism
e) Acromegaly
Congenital hypothyroidism is rare and produces the listed effects. In adults there are no real
intra-oral signs.
17. Which one of the following presents with melanotic lesion on the buccal mucosa,
palmar creases and an old scar
sc ar from parotid surgery?
a) Cushing’s disease
b) Addison’s disease « CORRECT ANSWER
c) Hypothyroidism
d) Hyperparathyroidism
e) Acromegaly
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18. A round faced lady with friable gingival mucosa sees her dentist with thrush under
denture. Which one of the following is indicated?
a) Cushing’s syndrome « CORRECT ANSWER
b) Addisons’ disease
c) Hypothyroidism
d) Hyperparathyroidism
e) Acromegaly
This lady has Cushing’s syndrome, which is excess blood cortisol (steroid) leading to increased
infection risk due to immunosuppression, ‘moon’ face and weaker tissues.
19. A 21-year-old man sees you for a routine check-up. He tells you he has been
investigated in the hospital for kidney stones, which has depressed him and still gives
abdominal pain. The orthopantomogram (OPG) you take shows a multi-locular
radiolucency at the angle of the mandible. Which one of the following is a possible
aetiology/diagnosis?
a) Cushing’s disease
b) Addisons’ disease
c) Hypothyroidism
d) Hyperparathyroidism « CORRECT ANSWER
e) Acromegaly
Hyperparathyroidism with a Brown’s tumour. This endocrine disease gives the classic symptoms
of ‘stones, groans and psychic moans’.
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20. Of the following conditions which one does not have altered facial sensations as a
possible neurological sequelae?
a) Multiple sclerosis (M)
b) Cerebrovascular accident (CVA)
c) Diabetes mellitus (DM)
d) Paget’s disease
e) Bell's palsy « CORRECT ANSWER
21. Which one of the following is not associated with minor recurrent aphthous ulcers
(RAU)?
Minor RAU start at 10–19 years. Herpetiform RAU starts at 20–29 years.
22. Which one of the following is not asociated with major recurrent aphthous ulcers
(RAU)?
a) Affects palate, lips, cheeks tongue and pharynx
b) Usually last 14 to 21 days « CORRECT ANSWER
c) Scarring
d) Number of ulcers 1 to 10
e) Age of onset 10–19
Major RAU last more than 30 days and are very slow to heal, which
w hich is unusual in the mouth
where defects normally heal rapidly.
23. Which one of the following is not true of herpetiform recurrent aphthous ulcers
(RAU)?
a) Age of onset 20–29 years
b) Number 10 to 100
c) Size 1 to 2 mm
d) Duration 10 to 30 days
e) Affects a more select region of the oral cavity than minor aphthous ulcer « CORRECT
ANSWER
25. Hailey-Hailey disease is associated with which one of the following vesicular bullous
diseases?
a) Linear IgA
b) Pemphigus « CORRECT ANSWER
c) Dermatitis herpetiformis
d) Angina bullosa haemorrhagica
e) Erythaema multiforme
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26. Which one of the following vesicular bullous diseases would produ
produce
ce a positive
Nikolsky’s sign?
a) Linear IgA
b) Pemphigus « CORRECT ANSWER
c) Dermatitis herpetiformis
d) Angina bullosa haemorrhagica
e) Erythaema multiforme
This is the intraepithelial vesiculobullous lesion, which lead to a positive Nikolsky’s sign, in which
the epithelium can be slid over the superficial layer.
27. Which one of the following vesiculobullous diseases would produce a basement
membrane zone of immunofluoresence
immunofluoresence (indirect)?
a) Bullous pemphigoid « CORRECT ANSWER
b) Pemphigus
c) Dermatitis herpetiformis
d) Linear IgA
e) Erythaema multiforme
29. Which one of the following oncogenes has been shown to be important in squamous
cell carcinoma (SCC)?
a) p41
b) p53 « CORRECT ANSWER
c) RAS
d) BRAC
e) p-ANCA
Mutations of the tumour suppressor such as p53 are associated with SCC.
Syphilis is a disease that is caused by Treponema pallidum . It has been a disease studied
throught the ages and is now on the increase again!
31. Which one of the following is the most common cause of recurrent oral ulceration?
a) Aphthae « CORRECT ANSWER
b) Carcinoma/malignancy
c) Infection
d) Radiotherapy
e) Trauma
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32. Behçet syndrome is a rare condition originally described by a triad of oral ulceration,
genital ulceration and which other symptom?
a) Anaemia
b) Anterior uveitis « CORRECT ANSWER
c) Hypertension
d) Neutropenia
e) Xerostomia
Anterior uveitis is inflammation of the anterior chamber of the eye. Anaemia and neutropenia
can be associated with oral ulceration, and xerostomia has many causes, but is associated with
Sjögren syndrome.
33. What condition is a patient who presents with hyperplastic gingiva, pallor,
lymphadenopathy
lymphadenopathy and gingival haemorrhage most likely to have?
a) Anaemia
b) Epstein–Barr virus
c) Leukaemia « CORRECT ANSWER
d) Pemphigus
e) Sjögren syndrome
Leukaemia is an uncommon but important cause of oral signs. Ulceration is common, but usually
presents with the above signs. It is an important diagnosis to exclude.
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34. In which condition are antibodies directed against various proteins in the basement
membrane zone, causing damage that results in the full thickness of the epithelium
lifting off the submucosa?
a) Angina bullosa haemorrhagica
b) Dermatitis herpetiformis
35. Which one of the following is associated with gluten-sensitive enteropathy (coeliac
disease)?
a) Chronic hyperplastic candidiasis
b) Dermatitis herpetiformis « CORRECT ANSWER
c) Gonorrhoea
d) Lichen planus
e) Pemphigus
This is characterised by an itchy vesicular rash which affects the skin, and most patients also
have oral lesions. All patients with this disease have gluten-sensitive enteropathy, which may or
may not be symptomatic. An integral part of treatment is therefore a gluten-free diet, as there is
an allergy to α-gliadin.
36. A patient presents with a palate that has a diffuse grey/white multi-nodular
appearance, with red dots in the centre of the lesions. Which one of the following
diagnoses is most likely?
a) Candida
b) Leukoplakia
c) Lichen planus
d) Lupus erythematosus
e) Nicotinic stomatitis « CORRECT ANSWER
This is a specific lesion that affects the palate, and which occurs mostly among pipe smokers.
The small red dots represent dilated minor salivary gland duct orifices.
or ifices. In extreme examples the
palate may become fissured or cracked. It is a benign lesion which usually resolves once the
patient has stopped smoking.
37. Which one of the following conditions is defined by the World Health Organization as
‘a bright red velvety plaque that cannot be characterised clinically or pathologically as
being due to any other condition’?
c ondition’?
a) Erythroplakia « CORRECT ANSWER
b) Leukoderma
c) Leukoplakia
d) Lichen planus
e) Malignant melanoma
38. Which one of the following viruses can lie dormant in the trigeminal ganglion or basal
ganglia of the brain before becoming reactivated following a secondary infection?
a) Coxsackie virus
b) Cytomegalovirus (CMV)
c) Herpes simplex virus (HSV) « CORRECT ANSWER
d) Human immunodeficiency virus (HIV)
e) Human papilloma virus (HPV)
Coxsackie viruses are RNA viruses. There are a number of different types of human papilloma
virus, the commonest of which is the wart
war t or verruca virus.
39. Which one of the following diagnoses is most likely in a patient who presents with
‘snail-track’ ulcers?
a) Acute ulcerative gingivitis
b) Behçet syndrome
c) Primary syphilis
d) Recurrent aphthous ulceration
e) Secondary syphilis « CORRECT ANSWER
Primary syphilis presents in the mouth as a primary chancre, whereas mucous patches and
‘snail-track’ ulcers are secondary lesions.
40. Which one of the following oral conditions is a patient with HIV infection most likely
to develop?
a) Acute dental abscess/bacterial infection
b) Human papilloma virus/oral wart-like lesions
c) Kaposi’s sarcoma
d) Oral candidiasis « CORRECT ANSWER
e) Periodontal disease
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All of the other conditions can develop with HIV infection, but oral candidiasis is most commonly
reported.
41. A 47-year-old woman has been referred to you with a lump in her parotid gland. She
does not think that its size has changed much, although it has slowly increased.
Clinical examination reveals that it is firm and painless, but rubbery in texture. She has
no other medical conditions and is otherwise asymptomatic. Which tumour is this
most likely to be?
a) Adenoid cystic carcinoma
b) Mucoepidermoid carcinoma
c) Oncocytoma
d) Pleomorphic adenoma « CORRECT ANSWER
e) Warthin’s tumour
Pleomorphic adenoma is the commonest salivary gland neoplasm, most often arising in the
parotid gland. The symptoms and clinical findings described above are classical. Warthin’s
tumours are also common, but tend to be soft or cystic in nature, w
with
ith some fluctuation in size.
These tumours are derived from B lymphyoctes and produce immunoglobulin, which can be
detected in the urine and serum. Gingival bleeding is the commonest sign, but this can occur
following an extraction.
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This is usually elevated significantly in this condition, although very rarely it may be normal.
Initially symptomatic treatment and rehydration are the priority. Antibiotics may be indicated if
there are signs of systemic infection. The diagnosis is made on clinical grounds, although it can
be confirmed via antibody titres between acute and convalescent serum. Vaccination is now
available for children, but there are several viruses which can cause this condition.
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e) Histoplasmosis
Infectious mononucleosis (caused by the Epstein–Barr virus), also known as glandular fever, is
characterised by a sore throat, lymphadenopathy and malaise. The Paul-Bunnell test is
performed on a venous blood sample and is a heterophil antibody test (Monospot®).
47. For the management of which condition are systemic corticosteroids often indicated?
a) Geographic tongue
b) Lingual tori
c) Mucocoele
d) Pemphigus « CORRECT ANSWER
e) Recurrent aphthous ulceration
Systemic corticosteroids are often indicated for the management of pemphigus, and should be
A sharp or electric shock-like pain is a classic symptom of neuralgia. It is frequently treated with
carbemazepine, however monitoring of liver function is also required.
Vitamin B12 deficiency causes megaloblastic anaemia, which is the most common cause of
macrocytic anaemia.
This is a lifestyle risk factor for osteoporosis along with lack of exercise, diet low in calcium or
vitamin D, and excess alcohol intake.
52. Which of the following is a recognised sign of oral squamous cell carcinoma?
a) Angular cheilitis
b) Apthous ulcers
c) Persistent ulcer lasting over 2 weeks « CORRECT ANSWER
d) Smooth erythematous tongue
e) Wickman’s striae
53. A patient of yours has a coarse tremor. You recognise this as one of the symptoms of
Parkinsonism. What other symptom would increase your suspicions?
a) Labile mood
b) Lid lag
c) Panic attacks
d) Rigidity of the limbs « CORRECT ANSWER
e) Uncontrolled fasiculations of muscles of facial muscles
Parkinsonism is a common serious brain disorder causing trembling, muscle rigidity, difficult in
walking and problems with balance and coordination. Prevalence increases with age. It affects
the basal ganglia with degeneration of the substantia nigra pigmented cells that release
dopamine.
e) Weight gain
55. Which one of the following results would lead to a diagnosis of concerning
hyperglycaemia?
a) Glycosuria
b) Haematuria
c) Ketonuria « CORRECT ANSWER
d) Proteinuria
e) Urobilinogen
Ketones in the urine reflect a sign of ketoacidosis or starvation. This should be treated urgently
before diabetic ketoacidosis ensues.
56. With regard to left-sided heart failure, which of the following is a classic clinical
symptom?
a) Chest pain
b) Finger clubbing
c) Palpitations
d) Shortness of breath when climbing a flight of stairs
e) Shortness of breath when lying flat/in the night « CORRECT ANSWER
Paraoxysmal nocturnal dyspnea is due to pulmonary oedema, and patients often wake at night
with a feeling of choking or suffocation. An additional pillow or two may help relieve this
symptom.
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d) Normal haemoglobin
e) Normal MCV
The mean cell volume will increase with a normochromic macrocytic anaemia as the ce
cell
ll size
increase, but the degree of haemoglobinisation will remain the same.
58. A patient presenting with ‘snail track’ ulcers in their oral mucosa is likely to have
This rarely presents intra-orally nowadays, but this is a classic appearance. A biopsy should be
taken, and the patient referred to the genito-urinary medicine clinic for consultation, or to their
physician.
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[Oral
Pathology
MCQs]
[With Answers]
134
2. With regard to acute inflammation, integrins are involved in which one of the
following phases?
a) Transmigration
b) Rolling
c) Adhesion « CORRECT ANSWER
d) Margination
e) Chemotaxis
Adhesion is the process whereby there is firm adhesion to the endothelium and the integrins are
the molecules involved in this. Selectins are involved in rolling and platelet endothelial cell
adhesion molecules are involved in transmigration.
tr ansmigration.
135
d) Osteogenesis imperfecta
e) Paget’s disease
There are many rare syndromes in which hypodontia is a feature, but Down’s is the most
common. Palatal clefts are also common and anodontia is rare.
5. Which one of the following is not a factor in the aetiology of dental caries?
a) Diet
b) Oral flora
c) Age « CORRECT ANSWER
d) Time
e) Susceptible surface
The buffering power of saliva depends mainly on its bicarbonate content and is increased at high
rates of flow. IgA is not a component of the buffering power of saliva.
Remember that hydrogen ions permeate the organic matric on enamel in the initial attack.
Liquefaction foci are involved in the destruction and collection of bacteria in dentinal tubules.
9. Which one of the following is the most common cause of dental pain and loss
l oss of teeth,
especially in the younger population:
a) Fracture of a crown/cusp
b) Thermal or chemical irritation
c) Dental caries « CORRECT ANSWER
d) Traumatic pulpal exposure
e) ‘Cracked tooth syndrome’
Dental caries penetrating the dentine is the most common cause of dental pain and loss o off teeth
in the younger population. This is usually obvious unless it is underneath a restoration.
10. he histology of chronic closed pulpitis is most likely to resemble which one of the
following?
a) Initial hyperaemia and infiltration by inflammatory cells
b) Predominantly mononuclear cell infiltrate with a vigorous connective tissue reaction «
CORRECT ANSWER
c) Predominantly mononuclear cell infiltrate without a connective tissue reaction
d) Presence of granulation tissue with a few odontoblasts present
e) Formation of a calcific barrier beneath the lesion
Initial hyperaemia and inflammatory cell infiltrate is found in acute pulpitis, granulation tissue
and a few odontoblasts resembles a pulp polyp following open pulpitis and a calcific barrier
formation is rarely seen, but when it is present is related to acute pulpitis.
138
a) Hypophosphatasia
b) Down’s syndrome
c) Actinomycosis « CORRECT ANSWER
d) Ehlers–Danlos syndrome
e) Eosinophilic granuloma
Phenytoin (EpanutinÔ) is used in the treatment of epilepsy and long-term use can cause gingival
hyperplasia. Other drugs eg calcium-channel blockers (diltiazem and nifedipine) also have similar
side-effects. Nicorandil
Nicorandil (potassium channel activator) is known for its oral ulceration.
13. Which one of the following is the correct definition of a cyst?
a) A pathological fluid-filled cavity lined by epithelium « CORRECT ANSWER
b) A cavity filled with exudate
c) A pathological pus filled cavity lined by epithelium
d) A cavity filled with oedema due to inflammation
e) A cavity with islands and trabeculae of epithelial cells in a connective tissue stroma
A cavity with islands and trabeculae of epithelial cells in a connective tissue stroma is classic of a
follicular ameloblastoma.
14. Which one of the following conditions is uncommon with acute osteomyelitis?
a) Paget’s disease
b) Osteopetrosis
c) HIV infection « CORRECT ANSWER
d) Acute leukaemia
e) Poorly controlled diabetes mellitus
Acute osteomyelitis of the jaws is uncommon in HIV infection. The effect of immunodeficiencies
is variable. All of the other conditions are important predisposing factors for acute
osteomyelitis.
15. Which one of the following is a common cause of swelling of the edentulous jaw in
older patients?
a) Lateral radicular cyst
b) Residual cyst « CORRECT ANSWER
c) Odontogenic keratocyst
d) Lateral periodontal cyst
e) Eruption cyst
Residual cysts may persist after extraction of the causative tooth but are also a common cause
of swelling of edentulous jaw in older
o lder patients. They may interfere with the fitting of dentures
and sometimes regress spontaneously.
16. Which one of the conditions below is associated with the calcification of the falx
cerebri?
a) Gorlin–Goltz syndrome « CORRECT ANSWER
b) Crouzon’s syndrome
c) Apert’s syndrome
d) Paget’s disease
e) Gardner’s syndrome
140
Gorlin–Goltz syndrome has intra-cranial anomalies that include calcification of the falx cerebri
and an abnormally shaped sella turcia
Dermoid cysts are due to the abnormality of the branchial arches or pharyngeal pouches.
18. Which one of the following condition is hyperplastic and not neoplastic?
a) Giant cell granuloma « CORRECT ANSWER
b) Giant cell tumour (osteoclastoma)
c) Ameloblastoma
d) Osteochondroma
e) Cemento-ossifying fibroma
Giant cell granulomas are hyperplastic rather than neoplastic. However, the giant cell tumour
(osteoclastoma) is an aggressive neoplasm – commonly affecting the limbs but rarely the jaws.
141
20. Which one of the following conditions stains wth Congo red?
a) Plasmacytoma
b) Candida spp.
c) Amyloidosis « CORRECT ANSWER
d) Burkitt’s lymphoma
e) Warthin’s tumour
Amyloidosis is deposition of protein within the tissues that is typically perivascular and stains
with Congo red, which also shows a characteristic apple-green birefringence under polarised
light.
21. A classic mulberry appearance is seen with which one of the following conditions on
smear?
a) Herpetic vesicle « CORRECT ANSWER
b) Cytomegalovirus
c) Syphilis
d) Candida spp.
e) Tuberculosis
Herpetic vesicles on a smear have a typical mulberry appearance. Candida shows fungal hyphae
on gram stain. Syphilis is diagnosed typically via dark-ground illumination of a smear from the
chancre. Cytomegalovirus microscopically the ulcers are non-specific, although is commonly
confirmed by immunocytochemistry.
immunocytochemistry.
142
22. Parakerat
Parakeratosis
osis or hyperkeratosis,
hyperkeratosis, saw-tooth-like profile of the rete ridges and
liquefaction degeneration
degeneration of the basal cell layer are histological
histological appearances of which
one of the following conditions?
a) Behçet’s disease
b) HIV-associated oral ulceration
c) Lichen planus « CORRECT ANSWER
d) Pemphigus
e) Pemphigoid
Lichen planus is a common chronic inflammatory disease of skin and mucous membrane. Other
classical histological features are a pre-dominantly T-cell infiltrate and CD8 lymphocytes.
23. A male patient in his mid-30s presents with a firm rubbery neck lump in the cervical
c ervical
chain and the presence of Reed– –Sternberg
Sternberg cells on biopsy. Which one of the following
conditions is he likely to have?
a) Non-Hodgkin’s lymphoma
b) Hodgkin’s lymphoma « CORRECT ANSWER
c) Leukaemia
d) Infectious mononucleosis
e) Agranulocytosis
24. Palatal petechiae are common in which one of the following conditions?
a) Scurvy (vitamin C deficiency)
143
Scurvy is associated with purpura and is due to vascular vessel wall fragility. Hereditary
haemorrhagic telangiectasia is associated with multiple small raised reddish papules on the
dorsum of the tongue as opposed to the palate. Haemophilia is more likely to present with
‘bruises’ or ecchymosis either on the skin or in the oral mucosa.
b) Hyperchromatic nuclei
c) Decreased mitotic activity « CORRECT ANSWER
d) Prominent nucleoli
e) Nuclear pleomorphism
27. Which one of the following is not a member of the herpesvirus family?
a) Varicella zoster virus
b) Cytomegalovirus
c) Epstein–Barr virus
d) Herpangina « CORRECT ANSWER
e) Human herpesvirus 6
28. Which one of the following can be mistaken for a poorly differentiated carcinoma
microscopically?
a) Calcifying odontogenic cyst
145
Bladder tumours rarely metastasise to the jaws, all of the other primary sites are important ones
to consider.
30. A concerned mother brings her 2-year-old child to your practice. The child has
inflamed gingivae, and ulcerative lesions on the oral mucosa, tongue and gingivae.
Initial infection with primary herpetic gingivostomatitis most commonly affects children under
10 years of age, with a peak incidence at 2 –4 years of age. The incubation period for herpes
simplex virus infection is approximately 2–10 days. Patients usually present with an acute
gingivostomatitis characterised by the following:
• high fever
146
tissue, consisting of mucin that has accumulated as a result of rupture of a salivary gland duct,
usually caused by local trauma. Mucus retention cysts are caused by a collection of mucin
resulting from an obstructed salivary duct. The mucocoele is bluish in colour and translucent,
and is more commonly found in children and young adults.
32. At which of the following sites does squamous-cell carcinoma most commonly
present?
a) Floor of mouth
b) Hard palate
c) Lip
d) Retromolar pad
e) Tongue « CORRECT ANSWER
The tongue is the most common site for oral squamous-cell carcinoma. It presents on the
tongue in 30% of cases. The next most common sites are the lower lip (17%) and the floor of the
mouth (17%).
33. Which of the following sites of presentation of oral squamous-cell carcinoma has the
best prognosis?
a) Floor of mouth
b) Hard palate
c) Lip « CORRECT ANSWER
d) Retromolar pad
e) Tongue
Squamous-cell carcinoma
carcinoma of the lip has the best prognosis. One of the main reasons is that, as it
is visible on the lip, patients notice the lesion earlier and therefore present to hospital at an
early stage.
34. Which one of the following viruses is implicated in the development of squamous-cell
carcinoma?
a) Cytomegalovirus
147
b) Epstein–Barr virus
c) Herpes simplex virus 1
d) Herpes simplex virus 2
e) Human papilloma virus « CORRECT ANSWER
Human papilloma virus is implicated in the production of squamous-cell carcinoma, and has
been implicated in the rise in squamous-cell carcinomas especially in the young. It is also a risk
factor for cervical cancer and rectal cancer.
35. The pathology report for a lesion that has been found in a right superficial
parotidectomy
parotidectomy states the following: ‘Mixed
‘ Mixed tumour (epithelial and mesenchymal).
mesenchymal).
Circumscribed, partially encapsulated,
encapsulated, firm, yellow-white
yell ow-white tumour composed of cords
36. In which oral disease are Wickham’s striae the cutaneous component?
a) Bullous pemphigoid
b) Bullous pemphigus
c) Lichen planus « CORRECT ANSWER
d) Lichenoid reaction
e) Lupus erythematosus
• Comment on this Question
148
Classical lichen planus is characterised by the presence of firm, shiny, flat-topped papules that
range from pinpoint size to more than 1 cm in diameter. They may be close together or
widespread, or grouped in lines (linear lichen planus) or rings (annular lichen planus). Although
sometimes there are no symptoms, the condition is often very itchy.
Gas gangrene is a life-threatening bacterial infection that results in the production of gas
bubbles in gangrenous tissues. It is usually caused by infection with the bacterium Clostridium
perfringens.
39. An elderly woman presents with a headache and jaw pain during mastication. Her
blood tests show a raised erythrocyte sedimentation rate (ESR). Which of the
following is the most likely cause?
a) Dental abscess
b) Migraine headache
c) Temporal arteritis « CORRECT ANSWER
d) Temporomandibular joint dysfunction
149
e) Trigeminal neuralgia
Temporal arteritis affects patients over 50 years of age. Although it typically affects the
superficial temporal arteries, it can involve medium-sized and large vessels, including the aorta
and the carotid, subclavian, vertebral and iliac arteries.
Headache is the most common symptom, and is present in over two-thirds of patients with
temporal arteritis. It tends to be new or different in character to previous headaches, and is
typically sudden in onset, localising to the temporal region. Therefore the possibility of temporal
arteritis should be considered when patients over 50 years of age present with any new
headache.
The involvement of the superficial temporal artery can lead to severe scalp tenderness when,
for example, resting the head on a pillow, combing the hair, or wearing a hat or spectacles.
Patients may also present with visible areas of scalp necrosis. Similarly, jaw claudication when
speaking or chewing is observed when the maxillary artery is involved (around 50% of patients
with temporal arteritis).
Visual loss may also be a presenting symptom, and can be sudden and painless.
Most girls are born with two X chromosomes, but those with Turner syndrome have only one of
these chromosomes. The effects of the condition vary widely.
Girls with Turner syndrome are usually of short stature. Those who are not treated for this reach
an average height of about 1.4 metres (4 feet 7 inches). Treatment with growth hormones helps
girls with this condition to reach a height that is closer to normal.
150
Turner syndrome also prevents the ovaries from developing normally, which affects girls’ sexual
development and their ability to have children.
Additional physical features that are commonly seen in girls with Turner syndrome include the
following:
• a ‘webbed’ neck (extra folds of skin extending from the tops of the shoulders to the
sides of the neck)
• differently shaped ears that are set lower than normal on the sides of the head.
41. A patient has a factor IX deficiency. What is the common name of this condition?
a) Christmas disease « CORRECT ANSWER
b) Disseminated intravascular coagulopathy
c) Easter disease
d) Haemophilia
e) Von Willebrand’s disease
Haemophilia B is a blood clotting disorder caused by a mutation of the factor IX gene, which
leads to a deficiency of factor IX. It is rarer than haemophilia A (the more common form of
haemophilia). Haemophilia B is often called Christmas disease, after Stephen Christmas, the first
151
43. Which of the following substances is the major causative agent for mesothelioma?
a) Aflatoxins
b) Arsenic
c) Asbestos « CORRECT ANSWER
d) Naphthalene
e) Nitrosamines
Most mesotheliomas are caused by exposure to asbestos. They are usually diagnosed 30 years
or more after the first exposure to asbestos. Mesothelioma occurs more often in men than in
women, and the risk of developing the disease increases with age.
44. Which one of the following statements about salivary
salivary calculi is true?
a) They cause marked xerostomia
b) They are always seen radiographically
c) They are never asymptomatic
d) They most commonly occur in the parotid gland
e) They most commonly occur in the submandibular gland « CORRECT ANSWER
Calculi are most commonly found in the submandibular gland, where Wharton’s duct can
become obstructed by stones. They are frequently associated with chronic infection of the
glands, dehydration and/or increased calcium levels locally, but in many cases they can arise
idiopathically. If pain occurs, it usually originates from the floor of the mouth, although in many
cases the stones cause only intermittent swelling. Since chewing promotes the release of saliva,
symptoms tend to increase when the patient is eating. A palpable lump o orr visible swelling in the
area of the gland is often observed.
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a) Erythema multiforme
b) Herpes zoster
c) Pemphigoid « CORRECT ANSWER
d) Pemphigus
e) Stevens–Johnson syndrome
Pemphigoid is a group of uncommon autoimmune diseases that cause blistering of the skin. It is
similar to pemphigus, but in contrast to the latter it does not feature acantholysis.
Pemphigoid is more common than pemphigus. It is slightly more common in women than in
men, and in people over 60 years of age than in younger individuals.
153
This type of cyst, also known as a nasopalatine duct cyst, occurs in the median of the palate. It is
usually anterior to the first molars. It is the commonest type of oral non-odontogenic cyst, and is
usually asymptomatic, but sometimes produces an elevation in the anterior portion of o f the
palate. Radiographically, it appears as a heart-shaped radiolucency.
This type of cyst, also known as a periapical cyst, is the most common type of odontogenic cyst.
It is caused by inflammation or death of the pulp as a result of trauma or dental caries. These
cysts are usually asymptomatic, but pain can be caused by secondary inflammation.
Radiographically, a radicular cyst appears as radiolucency around the apex of the root of a
tooth.
49. Which of the following cysts is derived from the epithelial cell rests of Malassez?
a) Dentigerous cyst
b) Eruption cyst
c) Gingival cyst
d) Odontogenic keratocyst
e) Radicular cyst « CORRECT ANSWER
This type of cyst, also known as a periapical cyst, is the most common type of odontogenic cyst.
The lining of the cyst is derived from the epithelial cell rests of Malassez.
50. A lady attends an oral medicine clinic after an urgent referral from her GDP. She
presented with an asymptomatic,
asymptomatic, bilateral white lesion with poorly defined margins.
The lesion was soft on palpation but irregularly thick. Incisional biopsy revealed
hyperplastic epithelium and rete ridges with a smooth border. What is this lesion most
likely to be?
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a) Frictional keratosis
b) Leukoplakia
c) Lichen planus
d) White hairy leukoplakia
e) White sponge naevus « CORRECT ANSWER
Pemphigus predominantly affects women more than men. It consists of intraepithelial bullae,
and while Nikolsky’s sign would prove the diagnosis it should be avoided as it will produce more
bullae. Pemphigus also generally spreads widely on the skin.
52. Which one of the following diseases has a diagnostic autoantibody associat
associated
ed with
secondary Sjögren syndrome?
a) Diabetes mellitus
b) Osteoarthritis
c) Psoriasis
d) Rheumatoid arthritis « CORRECT ANSWER
e) Sarcoidosis
155
53. Which one of the following syndromes has been known to predispose to oral
squamous cell carcinoma?
a) Crouzon syndrome
b) Gorlin–Goltz syndrome
c) Paterson–Kelly syndrome « CORRECT ANSWER
d) Ramsay Hunt syndrome
e) Sjögren syndrome
Paterson–Kelly syndrome has been linked to oral and oesophageal carcinoma, but is reducing as
a risk factor. Ramsay Hunt syndrome is related to varicella zoster infection around the ear.
Gorlin–Goltz is related to multiple basal cell carcinomas and odontogenic
od ontogenic keratocysts.
54. A patient attends the oral medicine clinic following a referral from their GDP. She has
been experiencing recurrent aphthae for several months. The GDP has prescribed
benzydamine (Difflam®)
(Difflam®) mouthwash, which does manage to control her symptom
symptoms,
s,
but the aphthae are still recurring. What is your first stage of treatment?
a) Blood tests and diet analysis « CORRECT ANSWER
b) B12 supplements
c) No treatment
d) Systemic corticosteroids
e) Topical corticosteroids
Minor recurrent aphthous stomatitis (MiRAS) has been linked to benzoates in the diet, and iron
or B12 deficiency, and these must be ruled out prior to adopting any further treatment.
55. Orthopantomogram (OPG) radiograph shows a unilocular swelling associated with the
enamocemental junction. What is this lesion most likely to be?
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Dentigerous cysts are developmental and are associated with the crowns of unerupted (or
partially erupted) teeth, most commonly third molars. The cyst cavity is lined with epithelial cells
derived from the reduced enamel epithelium.
56. A swelling related to a dentigerous cyst is biopsied. The histological report states
islands of epithelium with a peripheral layer
l ayer of cells that have nuclei at the opposite
to the basement membrane (reversed polarity). What is the lesion most likely to be?
a) Dentigerous cyst
b) Eruption cyst
c) Keratocystic odontogenic tumour
d) Radicular cyst
e) Unicysytic ameloblastoma « CORRECT ANSWER
This pathology suggests an ameloblastoma. Unicystic ameloblastoma can envelop the crowns of
third molars, and radiographicall
r adiographicallyy could be mistaken for a dentigerous cyst.
57. A young lady attends your surgery embarrassed as she has developed marked
halitosis. Which one of these organisms could you attribute to the sulphur production
underlying this problem?
a) Aggregatibacter actinomycetemcomitans
actinomycetemcomitans
b) Candida albicans
c) Centipedia periodontii « CORRECT ANSWER
d) Streptococcus mutans
e) Treponema denticola
• Comment on this Question
157
[Or
[Oral
al
MCQs] S
Surgery
urgery
[With Answers]
159
2. Which one of the following scalpel blades is commonly used in intra-oral surgery?
a) No. 10
b) No. 11
c) No. 12
d) No. 15 « CORRECT ANSWER
e) No. 22
No. 15
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This is a root elevator, and should be used to remove upper wisdom teeth.
4. Upper wisdom teeth are especially associated with an infection leading to trismus.
Extract with a rotation and pull:
a) Upper 1, 2, 3 « CORRECT ANSWER
b) Upper 4, 5
c) Upper 6, 7
d) Lower 4, 5
e) Lower 6, 7
Upper 1, 2, 3
5. Extract with a bucco-palatal movement until they give, then pulled down and buccally:
a) Upper 1, 2, 3
b) Upper 4, 5 « CORRECT ANSWER
c) Upper 6, 7
d) Lower 4, 5
e) Lower 6, 7
Upper 4, 5
6. Moved buccally while pushing coronally, but frequently need a varied rocking
movement to extract:
a) Upper 1, 2, 3
b) Upper 4, 5
c) Upper 6, 7 « CORRECT ANSWER
d) Lower 4, 5
e) Lower 6, 7
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Upper 6, 7
162
11. Which one of the following odontogenic pathologies is associated with an unerupted
tooth?
a) Ameloblastoma
b) Odontomes
c) Solitary bone cyst
d) Dentigerous cyst « CORRECT ANSWER
e) Keratocyst
Dentigerous cysts form around the crown of impacted permanent teeth and arise from the
reduced enamel epithelium.
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Odontogenic keratocyst.
Solitary bone cyst, which is often an incidental finding devoid of lining and containing straw-
coloured fluid.
16. What does a black gas cylinder with a white valve contain?
c ontain?
a) Air
b) Oxygen « CORRECT ANSWER
c) Nitrogen
d) Nitrous oxide
e) Entonox
Oxygen
17. What is Vicryl made from?
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a) Polyglycolic acid
b) Polydioxanone
c) Polyglactin « CORRECT ANSWER
d) Polyglecaprone
e) Polyglyconate
Polyglactin
Hard lasers produce a cutting affect, as in the James Bond film Goldfinger. Soft lasers work by
stabilising cell membranes by a non-thermal photochemical process, increasing cellular
metabolism. Helium-neon lasers are used for laser pointers!
19. Which one of these is not an NHS justification for implant placement?
a) Prosthetics tolerance issues
b) Trauma
c) Hypodontia
d) Teaching « CORRECT ANSWER
e) Oncology
Teaching need is not a justification for the NHS to pay for implants.
20. Which one of the following syndromes is associated with multiple tori?
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a) Eagle’s syndrome
b) Frey’s syndrome
c) Gardner’s syndrome « CORRECT ANSWER
d) Golin–Goltz syndrome
e) Crouzon’s syndrome
Gardner’s syndrome is associated with multiple osteomas, epithelial cysts and intestinal polyps.
Paget’s affects 3% of over 55-year-olds and is associated with the above feature and cranial
nerve defects.
22. Which one of these biochemical changes is associated with Paget’s disease?
a) Anaemia
b) Vitamin increase
c) Raised alkaline phosphate « CORRECT ANSWER
d) Low serum calcium
e) High serum phosphate
Paget’s disease is a disease of increased turnover and chaotic bone remodelling, which leads to
enlarged but weak bone morphology. It has normal calcium and phosphate, but increased
alkaline phosphate.
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Paget’s produce HIGH output heart failure, as the heart is asked to perform an abnormally high
function and not that it cannot cope with normal base-like function.
24. A bone biopsy shows irregular Chinese characters. Which one of the following is the
diagnosis?
a) Paget’s disease
b) Giant cell granuloma
c) Cherubism
d) Fibrous dysplasia « CORRECT ANSWER
e) Osteogenesis imperfect
Areas of bone are replaced by fibrous tissue with a ‘ground -glass’ appearance on radiographs
and a histologically characteristic appearance due to fibrous replacement of bone with osseous
trabeculae.
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MTA, which is a derivative of Portland cement, is recommended as the material of choice, but
remains very expensive and technique sensitive.
Glass ionomer could also be used, but that would be a less effective choice than MTA.
26. Which one of these sutures could be used to close a face skin biopsy?
a) Silk
b) Polypropylene « CORRECT ANSWER
c) Steel
d) Polytetrafluoroethylene
e) Vicryl
Polypropylene is prolene.
27. How close is the implant to bone in osseointegration?
osseointegration?
a) 5 nm
b) 10 nm
c) 20 nm « CORRECT ANSWER
d) 30 nm
e) 50 nm
20 nm is the distance from the bone edge to the implant surface in osseointegration.
28. Tracheostomy:
a) has to be formally closed after use
b) helps the cough reflex
c) is a recognised cause of hypothyroidism
d) is best placed at the first tracheal cartilage
e) may be complicated by tracheal stenosis « CORRECT ANSWER
• Comment on this Question
168
Tracheal stenosis following tracheostomy may occur at three possible sites – the level of the
stoma, the level of the cuff and at the tip of the tube. The incidence is approximately 10%. The
standard approach is a 2 cm transverse
tr ansverse incision 2 cm above the sternal notch. The thyroid
isthmus may need to be tied as it lies over the second and third tr
tracheal
acheal rings. This has no effect
on the thyroid status of the patient. In adults the tracheostomy is placed between the second
and fourth tracheal rings, and in children at the second and third tracheal rings. The cough reflex
is lost in someone with a tracheostomy and thet he patient is unable to clear se
secretions
cretions from the
tracheobronchial tree – frequent suction is therefore necessary.
nece ssary.
Local anaesthetics work better at higher pH, when they are less ionised. Infected tissue has an
increased blood supply, which could lead to rapid absorption and hazardous effects – hence a
general anaesthetic may be a better choice. Bupivacaine lasts longer than prilocaine, which in
turn lasts longer than lidocaine; the safe dosages of lidocaine are 3 mg/kg, or 7 mg/kg with
adrenaline.
30. Which one of the following is correct regarding radical neck dissection?
a) it has frozen shoulder as a late complication « CORRECT ANSWER
b) it may preserve the sternocleidomastoid muscle
c) it results in a 30-fold increase in intracranial pressure
d) it results in a 50-fold increase in intracranial pressure
e) it should not be undertaken bilaterally
• Comment on this Question
169
A radical neck dissection refers to the removal of lymph nodes in the anterior and posterior
triangles, along with the submandibular gland, the spinal accessory nerve, and internal jugular
vein and the sternocleidomastoid muscle. To omit at least one of these removals makes it a
modified radical neck dissection. Intracranial pressure rises threefold in a unilateral dissection,
and rises tenfold in a bilateral one – so bilateral dissections are not undertaken unless they are
completely necessary. Frozen shoulder is a late complication, although removal of the spinal
accessory nerve results in an immediate loss of shoulder shrugging.
Eighty per cent of all salivary gland tumours originate in the parotid and, of these, 80% are
benign. The peak incidence of pleomorphic adenoma is in the fifth decade.
dec ade. In the minor salivary
glands only 50% are benign; 10% are bilateral in the case of Warthin’s tumours.
Mucoepidermoid carcinoma is the most common malignant parotid tumour, followed by
adenoid cystic carcinoma.
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Long cone CT may be indicated following an initial assessment of the third molars on the OPG,
but OPG should be the image of choice
c hoice initially.
36. Which of the following is supplied by the mandibular branch of the trigeminal nerve?
a) Motor component to the muscles of the face, cheek and scalp
b) Motor component to the muscles of mastication, the mylohyoid, the anterior belly of
the digastric muscle and the tensor
te nsor veli palatini
c) Motor component to the muscles of mastication, the mylohyoid, the anterior belly of
the digastric muscle, the tensor veli
ve li palatini and the tensor typmani« CORRECT ANSWER
d) Sensory innervation to the mandibular dentition
e) Sensory innervation to the skin of the cheek, over the mandible, the lower lip, the side
of the head, the mandibular teeth and the posterior third of the tongue
The mandibular branch of the trigeminal nerve supplies sensory innervation to the skin of the
cheek, over the mandible, the lower lip, the side of the head, the mandibular teeth and the
anterior two-thirds of the tongue, not the posterior third.
A distal relieving incision is commonly made to provide access for the removal of an impacted
third molar. All of the other options involve anatomical considerations and risks.
38. Which muscle is passed through when performing an inferior alveolar nerve block?
a) Buccinator « CORRECT ANSWER
b) Lateral pterygoid
c) Masseter
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d) Medial pterygoid
e) Temporalis
In performing an inferior alveolar nerve block, the buccinator muscle is pierced when aiming for
the inferior alveolar nerve.
The most likely complication is a fracture. Following this there is also a risk of oro-antral
communication, but this is dependent upon the anatomy of the sinus floor and the amount of
bone present.
40. Which of the following is a cardinal sign of alveolar osteitis (dry socket)?
a) Acute swelling
b) Bleeding
c) Pyrexia
d) Throbbing pain « CORRECT ANSWER
e) None of the above
Throbbing pain is usually diagnostic of dry socket. All of the other signs listed are
ar e rarely, if ever,
associated with a dry socket.
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a) Elderly patient
b) Forceps extraction
c) Medically compromised patient
d) Oral contraceptives « CORRECT ANSWER
e) Previous treatment with bisphosphonates
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44. Which of the following nerves is at risk during the extra-oral drainage of a
submandibular abscess?
a) Cervical branch of the facial nerve
b) Lingual nerve
c) Mandibular branch of the trigeminal nerve
d) Marginal mandibular branch of the facial nerve « CORRECT ANSWER
e) Mental nerve
The incision should lie two finger-breadths below the inferior border of the mandible.
Penicillin is an inhibitor of cell wall synthesis. Penicillin has an interesting mode of action: it
prevents the cross-linking of small peptide chains in peptidoglycans, the main wall polymer of
bacteria. Pre-existing cells are unaffected, but all newly-produced cells grow abnormally, unable
to maintain their wall rigidity, and they are susceptible to osmotic lysis.
Fluconazole is a crystalline solid which is slightly soluble, and as such, can be administered
intravenously, as an oral tablet or as an oral suspension.
Erythromycin increases the plasma concentration of simvastatin, leading to an increased risk r isk of
myalgias, rhabdomyolysis and renal failure. Avoid prescribing it if possible. Alternatively, request
the physician to stop the simvastatin temporarily if necessary.
48. In which group of patients should inferior alveolar nerve blocks be avoided if possible?
a) Anticoagulated patients « CORRECT ANSWER
b) Anxious patients
c) Immunocompromised patients
d) Patients on long-term treatment with non-steroidal anti-inflammatory drugs (NSAIDs)
e) Patients undergoing treatment under intravenous sedation
There is a higher risk of haematoma formation in patients who are anticoagulated. When
performing an inferior alveolar nerve block, local infiltration should be used wherever possible.
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None of the above investigations are required. An INR (international normalised ratio) is
required for patients who are warfarinised
war farinised but not anticoagulated with clopidogrel, as
clopidogrel specifically and irreversibly inhibits the P2Y12 subtype of ADP receptor, which has an
important role in aggregation of platelets and cross-linking by the
t he protein fibrin.
50. Which of the following drugs is an absolute contraindication for a patient who gives a
history of allergy to penicillin?
a) Cefalexin
b) Clindamycin
c) Co-amoxiclav « CORRECT ANSWER
d) Erythromycin
e) Metronidazole
51. Which of the following cases requires antibiotic prophylaxis when undergoing a
surgical dental procedure?
a) Patient on long-term steroid treatment
b) Previous history of infective endocarditis
c) Prosthetic cardiac valve replacement
d) Total knee replacement
e) None of the above « CORRECT ANSWER
None of the above cases require antibiotic prophylaxis according to guidelines published by the
National Institute for Health and Clinical Excellence (NICE) in March 2008, Prophylaxis
P rophylaxis against
infective endocarditis: Antimicrobial prophylaxis against infective endocarditis in adults and
children undergoing interventional procedures.
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52. For which of the following are excisional biopsies usually indicated?
a) All lesions
b) Lesions greater than 1 cm in diameter, where the clinical appearance suggests that the
lesion is benign
c) Lesions less than 1 cm in diameter, where the clinical appearance suggests that the
lesion is benign« CORRECT ANSWER
d) Lesions where the clinical appearance suggests that it is malignant
e) None of the above
Lesions less than 1 cm in diameter, whose clinical appearance is considered (by an experienced
clinician) to suggest that the lesion is benign, can be excised. If there is any doubt about the
clinical diagnosis, an incisional biopsy should be performed.
53. Which one of the following local anaesthetics, when given as a local nerve block, is
likely to cause
c ause permanent paraesthesia
paraesthesia?
?
a) Articaine « CORRECT ANSWER
b) Bupivacaine
c) Lidocaine
d) Mepicavine
e) Prilocaine
Articaine is unique in that its initial metabolism occurs in plasma and therefore has a shorter
half-life that is safer systemically than other amides. It can therefore be used in higher
concentrations, but the risk of this is that in high concentrations and delivered as a block it
might increase the chance of permanent paraesthesia.
54. Loss of sensation in the lower lip is most likely caused by:
a) Bell’s palsy
b) Fracture of the mandible in the parasymphysis area « CORRECT ANSWER
c) Ludwig’s angina
d) Traumatic bone cyst
e) Trigeminal neuralgia
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55. An oro-antral fistula (OAF) that persists for several weeks is best treated by which one
of the following?
a) Broad spectrum antibiotic therapy
b) Broad spectrum antibiotic therapy with combination ephedrine nasal drops
c) Debridement and closure with a buccal advancement flap « CORRECT ANSWER
d) Debridement and washout of the antrum via a caldwell luc
e) Ephedrine nasal drops
Persistent OAFs should be debrided and closed surgically. Initial management of a suspected
OAF may include medical management such as antibiotics combined with nasal decongestants,
but a persistent one should be treated surgically and medically.
56. Which of the following is a principle of flap surgery during surgical exodo
exodontia?
ntia?
a) Broad base « CORRECT ANSWER
b) Ensure closure is over the defect
c) Ensure the papillae are not in the flap
d) Limit the size of flap
e) Vertical incision
An essential element of flap design is to ensure that there is a broad base, otherwise the blood
supply to the flap is compromised. Papillae should always be included in the flap design to
ensure good apposition; flaps should never, where possible, be closed over a defect – only over
sound bone - and they should be the size required
r equired to carry out the surgery required. Vertical
incisions can compromise the blood supply and also compromise the base size.
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Perforation of the root or pulp chamber floor that cannot be treated through the pulp would
also be an indication, but if accessible through the pulp then an orthograde approach should be
taken.
It is thought that implants are achievable in many patients with co-morbidities providing there is
a thorough assessment and consent is obtained from the patient; some co-morbidities lead to a
higher likelihood of failure; whereas patients who are currently being treated with intravenous
bisphonates are at the highest risk of failure of osseointegration and osteonecrosis.
59. Which one of the following retractors is especially useful in the removal of maxillary
third molars?
a) Kilner retractor
b) Lasters retractor « CORRECT ANSWER
c) Minnesota retractor
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d) Rake retractor
e) McKesson
60. A 33-year-old woman currently taking the oral contraceptive pill, who recently had a
difficult mandibular surgical extraction
extraction carried out, presents with pain that is
excruciating and not relieved with analgesics is most likely to be ssuffering
uffering from:
a) Actinomycosis
b) Alveolar osteitis « CORRECT ANSWER
c) Bisphosphonate-induced necrosis
d) Osteoradionecrosis
e) Post-operative infection
Alveolar osteitis or ‘dry socket’ is more common in patients who: are female, are on the oral
contraceptive pill, have had lower extractions, have had difficult extractions, or are smokers. It is
commonly not relieved with analgesics.
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[Orthodontics
and
Pedodontics
MCQS]
[With Answers]
182
1. Which one of the following is the classical extraction pattern for the
t he serial extraction
technique?
a) Deciduous canines, first premolars then first deciduous molars
b) Deciduous canines, first permanent molars then first premolars
c) Deciduous canines, second deciduous molars then second premolars
d) Deciduous canines, second molars then second deciduous molars
e) Deciduous canines, first deciduous molars then first premolars « CORRECT ANSWER
• All deciduous canines are extracted just as the upper lateral incisors are erupting at the age of
8.5 to 9.5 years. This process allows spontaneous incisor alignment.
• All first deciduous molars are extracted 1 year later, ideally when the roots of the first
premolar are half formed. This is to encourage eruption of the first premolars before the
canines.
• All four first premolars are extracted as the permanent canines are erupting to provide space
for them to erupt.
2. In facial growth, at the age of 5 years, what percentage of growth has been
completed?
a) Cranium 96%, maxilla 45%, mandible 45%
b) Cranium 85%, maxilla 4%, mandible 65%
c) Cranium 85%, maxilla 45%, mandible 45% « CORRECT ANSWER
d) Cranium 4%, maxilla 85%, mandible 45%
e) Cranium 85%, maxilla 65%, mandible 4%
Neural development is completed fairly early and therefore by the age of 5, the majority of
cranial development has been completed. Between the ages
age s of 8–10 years 96% of cranial
development is completed and only 4% of further cranial development occurs between the ages
of 10–20 years. In contrast, the majority
m ajority of maxillary and mandibular development occurs later
so that at the age of 5 years on 45% of maxillary
m axillary and mandibular growth has occurred. At age 10
years 65% of maxillary and mandibular growth has been completed with a further 35% of
growth occurring between the ages of 10–20 years.
3. What is the ideal age for extraction of a lower first permanent molar to get favourable
spontaneous space closure and development of the dentition?
a) 6–8 years
b) 8–10 years « CORRECT ANSWER
c) 10–12 years
d) 12–14 years
183
e) 14–16 years
4. Which appliance would you use to treat an 8-year-old child with an anterior crossbite
associated with an upper central incisor?
a) URA with anterior bite plane and a midline screw
b) URA with a midline screw and a T spring
c) URA with posterior bite planes and a midline screw
d) URA with an anterior bite plane and a T spring
e) URA with posterior bite planes and a T spring « CORRECT ANSWER
The posterior bites planes disclude the occlusion anteriorly and allow the T spring to push the in-
standing upper central incisor labially to correct the
t he cross bite. An anterior bite plane would
disclude the buccal segments whereas a midline
m idline screw is used to correct buccal cross bites.
5. In the slide below, when a force is applied to a tooth as shown, what happens on the
side labelled ‘A’?
184
6. For extraction of permanent first molars, which one of the following statements is
incorrect:
a) Compensating extraction of an upper first molar is often recommended when extraction
of the lower is required
re quired to prevent over-eruption of an unopposed upper first molar
b) In crowded cases with bilateral buccal segment crowding, consider a balancing
extraction to provide space and maintain the centreline
c) Balancing the extraction of healthy first molars is generally recommended in either arch
as a unilateral extraction will adversely affect the dental centreline« CORRECT ANSWER
d) Compensating extraction of an upper first molar is often recommended when extraction
of the lower is required
re quired to allow mesial movement of the lower second molar
e) In uncrowded cases, if the upper first molar is to be lost, do not compensate with
extraction of the lower first molar if it is healthy.
There is no evidence to suggest that unilateral extraction of a first permanent molar has a
detrimental affect on the dental centreline.
ce ntreline.
7. In the slide below, when a force is applied to a tooth as shown, what happens on the
side labelled ‘B’?
185
a) Class II division 1 incisor relationship with a class I molar relationship with the lower
second premolar in lingual crossbite
b) Class II division 2 incisor relationship with half a unit class II molar relationship with the
lower second premolar in buccal crossbite« CORRECT ANSWER
c) Class I incisor relationship with a full unit class II
I I molar relationship with the lower
second premolar in buccal crossbite
d) Class II division 1 incisor relationship with half a unit class II molar relationship with the
lower second premolar in lingual crossbite
e) Class II division 2 incisor relationship with a full unit class II molar relationship with the
lower second premolar in buccal crossbite
This patient has a class II division 2 incisor relationship: the lower incisor edge lies posterior to
the cingulum plateau of the upper incisors and the upper incisors are retroclined. In a class I
molar relationship, the mesiobuccal cusp of the upper first permanent molar
mo lar occludes with the
mesiobuccal groove of the lower first permanent molar. In this case as the upper molar is half a
unit anterior to the lower molar the
t he molar relationship is half a unit II. The lower second
premolar is in buccal crossbite as it lies buccal to the opposing upper teeth.
9. Which of the following cephalometrical points are required for measuring the
maxillary-mandibular
maxillary-mandibu lar plane angle?
a) Sella, menton, gonion, anterior nasal spine
b) Gonion, menton, anterior nasal spine, posterior nasal spine « CORRECT ANSWER
c) Pogonion, menton, anterior nasal spine, posterior nasal spine
d) A point, pogonion, menton, posterior nasal spine
e) Posterior nasal spine, pogonion, menton, anterior nasal spine
The maxillary plane is represented by a line from the anterior nasal spine to the poste
posterior
rior nasal
spine. The mandibular plane is represented by a line from gonion
go nion to menton. The maxillary-
mandibular plane angle is measured at the intersection of these two lines.
10. What is the definition of the cephalometrical landmark gonion?
a) The most inferior point on the mandibular symphysis in the midline
b) The most anterior point on the mandibular symphysis
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Gonion is the most posterior inferior point on the angle of the mandible. Gnathion is the most
inferior point on the mandibular symphysis in the midline. Pogonion is the most anterior point
on the mandibular symphysis. Menton is the lowermost point of the mandibular symphysis in
the midline. The B point is the most posterior
poster ior point on the profile of the mandible between the
chin and alveolar crest.
a) Tuberculate supernumerary
b) Denticle
c) Supplemental tooth
d) Odontome
e) Conical supernumerary « CORRECT ANSWER
This small conical tooth is the supernumerary most commonly found in the permanent dentition
de ntition
and usually presents as a mesiodens. Although it may be found high and inverted into the palate
in a horizontal position, in most cases, the long axis of the tooth is normally inclined. The conical
supernumerary can result in rotation or displacement of the permanent incisor, but rarely
delays eruption.
a) 1
b) 2
c) 3
d) 4
e) 5 « CORRECT ANSWER
13. Which statement best describes how twin block appliances work?
a) A majority of skeletal effects with
w ith a minority of dental effects
b) A majority of dental effects with no skeletal effects
c) A majority of dental effects with a minority of skeletal effects « CORRECT ANSWER
d) A majority of skeletal effects with no dental effects
e) A majority of skeletal and dental effects
Twin block appliances are functional appliances used in treating class II malocclusions. The
majority of treatment effects seen are due to dental changes such as upper incisor
retroclination, lower incisor proclination, distal tipping of the upper molars and mesial
movement of the lower molars. They also have minor
m inor skeletal effects such as restraint of
maxillary growth and acceleration of mandibular growth.
14. Which active component is commonly used to move a tooth mesio-distally within the
arch?
a) Palatal finger spring « CORRECT ANSWER
b) T spring
c) Robert’s retractor
d) Z spring
188
e) Labial bow
This spring is fabricated from 0.5 mm stainless steel and is used to move teeth mesiodistally
within the arch. T and Z springs are used to push teeth buccally whereas a Robert’s retractor and
a labial bow are used to retract
re tract the upper incisors palatally.
15. Which of the following cases is an ideal case for functional appliance therapy?
a) A 16-year-old girl with a moderate class II malocclusion and uncrowded arches
b) A 12-year-old girl with a moderate class III malocclusion and uncrowded arches
c) A 16-year-old girl with a moderate class III malocclusion and crowded arches
d) A 12-year-old girl with a moderate class II malocclusion and uncrowded arches «
CORRECT ANSWER
e) A 12-year-old girl with a class
c lass I malocclusion and crowded arches
Functional appliances are most useful in treating class II malocclusions especially when used
during the pubertal growth spurt. Older patients who have a moderate skeletal II or III
discrepancy would require orthognathic intervention to correct the discrepancy.
17. Fixed appliances can achieve tooth movement in all three spatial planes. What type of
tooth movement is achieved with a second order bend?
a) Bucco-lingual movement of the root apex to correct the inclination of teeth
b) Vertical movement of the crown to correct discrepancies in crown height
c) Bucco-lingual movement of the crown to correct
corr ect the inclination of teeth
d) Movement in the horizontal plane to account for differences in bucco-lingual thickness
of teeth
e) Movement in the vertical plane to correct
cor rect the mesio-distal angulation of teeth «
CORRECT ANSWER
A second order bend achieves movement in the vertical plane to correct the mesio-distal
angulation (or tip) of teeth. A first order bend achieves movement in the horizontal plane to
account for differences in bucco-lingual thickness of teeth (in-out discrepancies) where as a
third order bend achieves bucco-lingual movement of the root apex to correct the inclination (or
torque) of teeth.
189
In a class I molar relationship, the mesiobuccal cusp of the upper first permanent molar occludes
with the mesiobuccal groove of the lower first permanent molar. Therefore in a full unit II
I I molar
relationship, the upper molar is a full unit anterior to the lower molar and therefore the
t he
distobuccal cusp of the upper first permanent molar occludes with the mesiobuccal groove of
20. Using the Veau classification of clefts, what type of cleft is this patient most likely to
have?
190
a) Class I
b) Class II
c) Class III « CORRECT ANSWER
d) Class IV
e) Class V
This patient had a unilateral cleft lip and palate and therefore would be Veau class III. Veau class
I is an isolated cleft of the soft palate Veau class II is a cleft of the
t he hard and soft palate Veau class
IV is a bilateral cleft of the lip and palate Veau class V does not exist.
21. Which of the following features are most commonly associated with a digit sucking
habit?
a) An increased overjet with a deep overbite and no crossbites
b) A unilateral crossbite with a decreased overjet and an deep overbite
c) An increased overjet with a deep overbite and a unilateral crossbite
d) A unilateral crossbite with a reduced overjet
overj et and an incomplete bite
e) A unilateral crossbite with an increased overjet and an incomplete overbites « CORRECT
ANSWER
Digit sucking habits are commonly associated with a unilateral cross bite with
w ith an increased
overjet and an incomplete overbite. The finger acts
ac ts like a brace and proclines the upper labial
segment increasing the overjet. At the same time the finger limits eruption of the lower incisors
and may even retrocline them. The resultant effect is an incomplete overbite, or in more severe
cases an anterior open bite. During sucking the tongue adopts a lower position and the cheeks
exert pressure on the buccal teeth resulting in upper arch narrowing and a cross bite.
Cleft lip has an increasing incidence with 1/750 affected live births. The condition is more
common in males. The subsequent risk of future affected children
c hildren is 5%, rising to 9% w
with
ith two
affected siblings. Cleft lip has an association with palate defects in up to 50% of cases.
23. Which of the following eruption sequences is chronologically correct in the permanent
dentition?
a) Lower canine, upper central incisor, upper canine, lower first premolar
b) Lower central incisor, lower lateral
later al incisor, lower canine, lower first molar
c) Lower first molar, upper central incisor, lower lateral incisor, upper second molar «
CORRECT ANSWER
d) Upper first premolar, lower central incisor, lower second premolar, upper first molar
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e) Upper lateral incisor, lower canine, lower central incisor, lower second premolar
• lower canine
• upper canine
24. When extracting a lower 1st permanent molar for orthodontic purposes in a child
under local anaesthetic, which is the
t he most reliable form of anaesthesia?
a) Buccal and lingual infiltration
b) Buccal infiltration
c) Inferior alveolar nerve block
d) Inferior alveolar nerve block & long buccal block « CORRECT ANSWER
e) Maxillary buccal and palatal infiltration
Infiltration anaesthesia is rarely effective in the adolescent in the posterior mandible. Inferior
alveolar nerve block alone will not anaesthetise the buccal mucosa hence cause discomfort
during extraction. The most reliable form of anaesthesia for extraction of this tooth would be
inferior alveolar nerve block & long buccal block.
25. A 6-year-old patient presents with a large unilateral ulcerated area on the buccal
mucosa in the lower right quadrant of the mouth. Two days previously they had the
192
lower right deciduous molars extracted under local anaesthetic. What is the most
likely diagnosis?
a) Allergy
b) Chemical burn
c) Major recurrent apthous stomatitis
d) Self-inflicted trauma « CORRECT ANSWER
e) Vesiculo bullous disease
With younger children, the feeling of numbness that comes with a local anaesthetic can be
disorientating and a sensation that they may have never felt before. Often they can bite the
anaesthetised area, either accidentally while eating or out of inquisitiveness, without feeling
pain or discomfort until the anaesthetic has worn off.
Over 50% of primary incisors were found to have some form of erosion, according to the 1993
National Child Dental Health Survey. Abfracture are rare in children, while trauma and abrasion
are seen but not as commonly
co mmonly as erosion.
27. A 14-year-old patient presents complaining of teeth which are constantly breaking
down. Clinically, they appear to have a brownish/blueish hue. Radiographica
Radiographically,
lly, pulp
chambers have been obliterated. What is the most likely diagnosis?
a) Amelogenesis imperfecta
b) Caries
c) Chronological hypoplasia
d) Dentinogenesis imperfecta « CORRECT ANSWER
e) Molar incisor hypomineralisation
The abnormal dentine and weaker enamel:dentine junction results in frequent chipping of the
teeth. The teeth exhibit a brownish/blueish dicolouration and pulp chambers become
obliterated over time as abnomal dentine is deposited.
28. An 8-year-old patient presents with an unerupted upper left central incisor tooth and
a history of severely intruded upper left deciduous incisors at 4 years of age. What is
the most likely diagnosis?
a) Absent upper left permanent central incisor
b) Dilacerated upper left permanent central incisor « CORRECT ANSWER
c) Eruption cyst associated with the upper left permanent
perm anent central incisor
193
Intrusion of a primary incisor can cause the root of the tooth to come into contact with the
permanent successor. The outcome of such trauma depends on the force. In severe intrusions
the crown of the permanent
pe rmanent successor may be displaced or its orientation
or ientation altered which can
result in dilaceration.
29. What type of dental traumatic injury requires a splinting regimen of 4 weeks of rigid
splinting?
a) Dentoalveolar fracture « CORRECT ANSWER
b) Enamel dentine fractured incisor
c) Incisor root fracture
d) Intrusion
e) Luxation injury
Rigid fixation requires any splint to extend to two teeth either side of the fractured
tooth/root/bone. Functional splinting requires any splint to extend to one tooth either side of
the fractured tooth/root. All dental trauma
tr auma requiring splinting should be functionally splinted
only whereas dentoalveolar fractures should be rigidly splinted.
30. When investigating an ectopic unerupted maxillary canine tooth, which is the most
likely finding?
a) It is buccally placed
b) It is hypoplastic
c) It is in the line of the arch
d) It is microdont
e) It is palatally placed « CORRECT ANSWER
Approximately 80% of ectopic maxillary canine teeth are found to be palatally placed.
31. A 7-year-old patient attends with a buccal sinus associated with an upper 1st
deciduous molar. Which of the following is the most appropriate definitive treatment?
a) Prescribe antibiotics
b) Incise and drain the sinus
c) Extraction of the tooth « CORRECT ANSWER
d) A ferric sulphate pulpotomy
e) Remove the caries and place an amalgam
The tooth in this case is non vital and the only definitive treatment for this tooth is to extract it.
Antibiotics are not effective treatment for localised infection such as this. Incising and draining
the sinus would put the patient through an unnecessary procedure.
proce dure. Removing the caries and
194
placing an amalgam would not address the issue of the non vital pulp. A ferric sulphate
pulpotomy is only effective in vital teeth.
32. A 4-year-old child with a history of trauma to the lower lip, presents with a soft
fluctuant fluid-filled swelling of the lower lip. Which one of the following is the most
likely cause?
a) Bohn’s Nodules
b) Minor salivary gland tumour
c) Mucocele « CORRECT ANSWER
d) Pyogenic granuloma
e) Rannula
33. What is the best restorative solution for an upper 2nd deciduous molar which has a
mesio-occlusal cavity where breakdown of the marginal ridge has occurred in a 6-year-
old co-operative patient?
a) Amalgam
b) Compomer
c) Composite
d) Glass Ionomer cement
e) Preformed metal crown « CORRECT ANSWER
Preformed metal crowns have the best longevity of restorations in class II cavities of deciduous
teeth. As the patient is co-operative,
co -operative, dressing the tooth with a glass ionomer cement
ceme nt would be
an inappropriate treatment.
34. Which of the following behaviour management techniques are not widely used in the
United Kingdom?
a) Hand over mouth « CORRECT ANSWER
b) Modelling
c) Positive reinforcement
d) Systematic desensitisation
e) Tell-show-do
In the United Kingdom, the use of physical restraint for dental treatment is unacceptable. Tell-
show-do, modelling and positive reinforcement are simple techniques which can be used
effectively in anxious children. Systematic desensitisation involves working through fears from
the mildest to the most anxiety-provoking
anxiety -provoking and may be useful in cases where simple behaviour
management techniques are ineffective.
195
35. An 11-year-old attends your surgery having intruded their upper central incisor
i ncisor 7mm.
Which one of the following is the recommended treatment for this tooth?
a) Leave the tooth to re-erupt spontaneously
b) Luxate the tooth with forceps and leave to erupt
c) Reposition the tooth using a fixed orthodontic appliance
d) Reposition the tooth using a removable orthodontic appliance
e) Surgically reposition and splint the tooth « CORRECT ANSWER
Despite the pulp not being initially involved in the trauma, ingress of bacteria can cause the
tooth to become non vital. External inflammatory root resorption occurs in non vital teeth with
infected canals, but is initiated by damage to the
t he periodontal ligament. Internal inflammatory
root resorption is also associated with non vital teeth, but occurs rarely. Replacement resorption
is associated with severe luxation or avulsion injuries especially where the
t he tooth has been stored
dry. Pulp canal obliteration is also associated with luxation injuries.
37. Which of the following medicaments are used in the promotion of apexification of an
immature non vital incisor?
a) Antibiotic/steroid paste
b) Formocresol
c) Non-setting calcium hydroxide « CORRECT ANSWER
d) Setting calcium hydroxide
e) Zinc oxide eugenol cement
Non-setting calcium hydroxide has a long history of use in apexification. Antibiotic/steroid paste
can be used in cases where there is infection, but do not promote apexification. Formocresol
and zinc oxide eugenol cements have been
bee n used in non vital pulp therapy of deciduous teeth.
38. Which of the following medical conditions is not associated with delayed eruption of
teeth?
a) Cleidocranial Dysplasia
196
b) Down syndrome
c) Hereditary gingival fibromatosis
d) Hyperthyroidism « CORRECT ANSWER
e) Turner’s syndrome
39. An 8-year-old patient attends with a painless lower right 1st permanent molar which
requires extraction. The patient has a Class I occlusion with no crowding. What feature
will determine the ideal time to extract the tooth to maximise space closure?
a) Clinically, the lower 2nd molar is fully erupted
b) Clinically, the lower right 2nd premolar is fully erupted
c) Radiographically, none of the root of the lower right 2nd molar has formed
d) Radiographically, the bifurcation of the lower right 2nd molar has formed « CORRECT
ANSWER
e) Radiographically, the roots of lower right 2nd molar are fully formed
When extracting a lower 1st permanent molar in a Class I case where there is no crowding, the
aim is to ensure that as much space closure occurs as possible. From a clinical point of view,
once the 2nd premolar and 2nd permanent
pe rmanent molar have erupted, it is too late for space closure
to occur. Optimum extraction time is judged radiographically and this is when furcation of the
2nd permanent molar has just formed. If none of the root has formed, the
40. A 2-year-old attends your practice. His parents report a one week history of fever and
oral pain, and then 2 days ago they noticed that he had red and ulcerated gums. He
has no other lesions on his body. What is the most likely causative agent?
a) Herpes Simplex virus I « CORRECT ANSWER
41. Histologically, what percentage of primary molars where the loss of the marginal ridge
has occurred have been found to have irreversible pulpitis?
a) Less than 20%
b) Between 20% and 30%
c) Between 30% and 40%
197
Various studies have demonstrated this, the latest being Duggal et al. 2002. It underlines the
importance of pulp therapy when restoring primary molars.
42. With regard to young people of 16- and 17-years-old, which one of the following is
true?
a) They are able to consent or refuse treatment and this cannot be overridden even if it is
considered in their best interests
b) They are able to refuse
re fuse dental treatment, but their parents/guardians must consent to
dental treatment on their behalf
c) They are entitled to consent to their own dental treatment, but should they re
refuse
fuse
treatment, this can be overridden in some cases where it is felt to be in their best
interests« CORRECT ANSWER
d) They are not entitled to consent to their own treatment under any circumstances
e) They are subject to Gillick competence
Young people are considered to be adults at the age of 16 years and therefore consent to their
own treatment. However 16- and 17-year-olds
17 -year-olds are not able to refuse tre
treatment
atment and their wishes
in this respect can be overridden by the Courts if it is felt to be in their best interests. In reality,
there are few cases in dentistry where this is likely to occ
occur.
ur. Gillick competence only applies to
children under the age of 16 years.
43. Which one of the following medications has been associated with gingival
enlargement in children?
a) Carbamazepine
b) Clonazepam
c) Lamotrigine
d) Phenytoin « CORRECT ANSWER
e) Sodium valproate
Gingival enlargement is seen in approximately 50% of patients. Fortunately, other newer anti-
epileptic medication such as carbamazepine or sodium valproate do not cause gingival
enlargement.
44. A mother attends the dental practice with her 4-year-old son. She wants some advice
on how much and what type of toothpaste to use. They live in an area with no water
fluoridation and you assess that her son is a low caries risk. Which one of the
following do you advise?
a) Brush his teeth twice daily with a pea sized amount of 600ppm fluoride toothpaste
b) Brush his teeth twice daily with a pea sized amount of 1000ppm fluoride
198
c) Brush his teeth twice daily with a pea sized amount of 1350-1500ppm fluoride
toothpaste « CORRECT ANSWER
d) Brush his teeth twice daily with a smear of 1000ppm fluoride toothpaste
e) Brush his teeth twice daily with a smear of 1350-1500ppm fluoride toothpaste
Low fluoride toothpastes (600ppm fluoride) are no longer recommended. For children under 3
years of age, twice daily brushing with a smear of 1000ppm is advised. For those betwee
betweenn 3 and
6 years old, twice daily brushing with a pea sized amount of 1350-1500ppm paste is
recommended. The patient should spit, but not rinse with water after brushing as the effect of
the fluoride is reduced.
(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/Pu
(http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidanc
blicationsPolicyAndGuidanc
e/DH_102331)
Crossbite is an occlusal irregularity where a tooth (or teeth) has a more buccal or lingual position
than its corresponding tooth in the upper or lower arch.
a) The lower incisor edges lie anterior to the cingulum plateau of the upper incisors and
the upper central incisors are proclined or of average inclination
b) The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and
the upper central incisors are proclined or of average inclination« CORRECT ANSWER
c) The lower incisor edges lie posterior to the cingulum plateau of the upper incisors and
the upper central incisors are retroclined
d) The upper incisor edges lie posterior to the cingulum plateau of the upper incisors and
the upper central incisors are retroclined
e) The upper incisors are retroclined and there is an increase in overjet
By definition, in a Class II division 1 malocclusion the lower incisor edges must lie posterior to
the cingulum plateau. The upper incisors may be proclined or of average inclination.
47. What are the circumstances in which a Class I canine relationship occurs?
199
a) The upper permanent canine occludes anterior to the embrasure between the lower
permanent canine and first premolar
b) The upper permanent canine occludes in the embrasure
em brasure between the lower first and
second premolars
c) The upper permanent canine occludes in the embrasure
em brasure between the lower permanent
canine and first premolar« CORRECT ANSWER
d) The upper permanent canine occludes in the embrasure
em brasure between the lower permanent
canine and lateral incisor
e) The upper permanent canine occludes posterior to the
t he embrasure between the lower
permanent canine and first premolar
48. Which of the following statements about the Leeway space is correct?
a) It is always greater in the upper arch than in the lower one
b) It is usually equal in the upper and lower arches
c) It relates to the total space taken up by the combined mesiodistal widths of the
deciduous canine, first and second premolar teeth
d) It relates to the difference between the combined mesiodistal widths of the permanent
canine, first and second premolar teeth that is greater than that of their deciduous
precursors
e) It relates to the difference between the combined mesiodistal widths of the permanent
canine, first and second premolar teeth that
t hat is less than that of their deciduous
precursors« CORRECT ANSWER
The Leeway space relates to the difference between the combined mesiodistal widths of the
permanent canine, first and second premolar teeth that is less than that of the deciduous
precursors. The Leeway space is also greater in the lower arch, which enables the lower first
permanent molar to drift further mesially than the upper first permanent molar. This allows the
molar relationship in the developing dentition to change from a cusp-to-cusp
cusp-to -cusp to a Class I
relationship.
50. Which of the following ANB values would represent a Class III malocclusion?
200
a) 0° « CORRECT ANSWER
b) 2°
c) 3°
d) 4°
e) 6°
51. Which of the following types of tooth movement can be achieved with a removable
appliance?
a) Bodily movement
b) Correction of rotation
c) Rapid maxillary expansion
d) Tipping « CORRECT ANSWER
e) Torque
Tipping is the only type of tooth movement that can be achieved with a removable appliance. All
of the others require a fixed appliance or, in the case of rapid maxillary expansion, a fixed
expansion device.
52. Which of the following statements about rapid maxillary expansion is true?
a) It can be used in the mandible
b) It can only be carried out in adults
c) It can only be carried
carr ied out in the deciduous dentition
d) It involves expansion of the mandibular symphysis
e) It is a form of distraction osteogenesis « CORRECT ANSWER
Rapid maxillary expansion involves distracting the two halves of the maxilla apart using a
maxillary expander to allow new bone to form within the midpalatal suture.
201
55. Which one of the following conditions is associated with premature loss of teeth?
a) Down syndrome
b) Hereditary gingival fibromatosis
c) Hypophosphatasia « CORRECT ANSWER
d) Hypothyroidism
e) Williams syndrome
57. Which of the following medicaments is recommended for primary vital pulp therapy?
a) Beechwood creosote
b) Cresophene
c) Ferric sulphate « CORRECT ANSWER
d) Setting calcium hydroxide
e) Sodium hypochlorite
Ferric sulphate is a haemostatic agent that has gained popularity as a vital pulpotomy agent. It is
thought to work by causing agglutination of blood proteins due to the reaction of blood with
both ferric and sulphate ions. These agglutinated proteins form plugs that occlude
occ lude the
capillaries. The use of beechwood creosote is no longer advocated. The International Agency for
Research on Cancer (IARC) has classified formaldehyde as a carcinogen. Therefore although it
has not been banned, it is not recommended as the first choice of treatment. Sodium
hypochlorite is used as an irrigant in non-vital teeth during root canal therapy. Calcium
hydroxide is not used in vital pulp therapy in primary teeth, nor is Cresophene used. The other
material that has been shown to have a high success rate in vital pulpotomy of primary teeth is
mineral trioxide aggregate (MTA).
202
Hand, foot and mouth disease is caused by the Coxsackie A virus. It usually affects infants and
children. It is spread through direct contact
co ntact with the mucus, saliva or faeces o
off an infected
person. It typically occurs in small epidemics in schools, usually during the summer and autumn
months. The normal incubation period is 3–7 days.
• Intrusion is the displacement of the tooth into the socket with associated fracture of the
socket wall.
• Lateral luxation is displacement of the tooth away from its socket in a direction other
than axial.
• Subluxation is abnormal loosening of the tooth, but without any displacement of the
tooth.
203
• An incomplete crack in the enamel surface without loss of tooth tissue is known as an
infraction.
• Root fractures are defined as affecting the cementum, dentine and pulp.
61. What is the prevalence of non-syndromic cleft lip and palate in the UK?
a) 1 in 20
b) 1 in 300
c) 1 in 400
d) 1 in 700 « CORRECT ANSWER
e) 1 in 1000
In the UK the prevalence of cleft lip and palate is 1 in 700 live births. The incidence is between
betwee n 1
in 300 and 1 in 1000. The prevalence varies according to family history, ethnicity, gender and
geographical origin. Cleft lip and cleft palate are among the most common congenital
abnormalities.
62. In embryology, when does fusion of the secondary palate occur?
a) At 2–3 weeks in utero
b) At 3–4 weeks in utero
c) At 4–5 weeks in utero
d) At 5–6 weeks in utero
e) At 7–8 weeks in utero « CORRECT ANSWER
the maxillary processes. Failure of these processes will result in clefts of the lip, alveolus and
palate.
204
• Fluoride supplements are recommended for children who are deemed to be at high risk
and who live in an area where the concentration of fluoride in the water is less than 0.3 ppm.
64. Which of the following materials has been shown to be the clinically most successful
restoration for a class II cavity in a primary molar tooth?
a) Compomer
b) Composite
c) Glass ionomer
d) Stainless steel crown
e) None of the above « CORRECT ANSWER
66. Which one of the following statements is correct concerning molar incisor
hypomineralisation (MIH)?
a) MIH affects incisors only
b) MIH affects more males than females
c) MIH is a genetic condition
d) MIH typically affects the first permanent molars and incisors « CORRECT ANSWER
e) Teeth have an opalescent appearance
Molar incisor hypomineralisation can be defined as hypomineralisation of systemic origin of one
to four first permanent molars, associated frequently with affected
affecte d incisors. The expression of
205
this can vary from patient to patient, and also in the mouth, with a molar in o
one
ne quadrant being
mildly affected while in another quadrant a molar is severely affected,
affecte d, resulting in post-eruptive
breakdown.
67. Which of the following is the ‘active component’ in an upper removal appliance to
correct a localised anterior crossbite between UR1 and LR1? Please select one option.
a) Adams clasps
b) Baseplate
c) Posterior bite plane
d) Southend clasp
e) Z-spring « CORRECT ANSWER
A is the active component. Springs are most commonly used. Z springs or T springs are used. The
smallest diameter of the wire used is 0.5 mm.
R is retention of the appliance. Typically Adams clasps are used and these engage into the
undercut on fully erupted molars or premolars. They are fabricated from 0.7 mm stainless steel
wire.
A is anchorage. This is defined as the source of resistance to the forces generated in reaction to
the active components of the appliance. It is required to prevent unwanted movements.
68. Which one of the following is the most likely cause of an asymmetrical anterior open
bite (AOB):
a) Bilateral condylar fracture
b) Digit sucking habit « CORRECT ANSWER
c) Endogenous tongue thrust
d) Incompetent lips
e) Skeletal development
Digit sucking habits may result in AOBs. The other options are likely to result in a more
symmetrical distribution of the AOB, apart from incompetent lips which will not directly
direc tly cause
an AOB. The incidence of digit sucking as a cause of AOB decreases with age (12% at 9 years of
age, and 5% at 12 years of age). A habit of 6 hours or more per day can develop a malocclusion.
69. The British Standards (1983) incisor classification for a Class II Division 2 incisor
relationship is:
206
a) The lower incisor edge lies anterior to the cingulum plateau of the upper incisors. The
overjet is reduced or reversed.
b) The lower incisor edges lie anterior to the cingulum plateau of the upper incisors. The
overjet may be reduced, normal or increased, and the upper incisors are retroclined.
c) The lower incisor edges lie posterior to the cingulum plateau of the upper incisors. The
upper central incisors are proclined or of average inclination and there is an increase in
overjet.
d) The lower incisor edges lie posterior to the cingulum plateau of the upper incisors. The
upper central incisors are retroclined.
ret roclined. The overjet is usually minimal or may be
increased.« CORRECT ANSWER
e) The lower incisor edges occlude with or lie immediately below the cingulum plateau of
the upper incisors.
In Class II Division 2 incisor relationships, the upper central incisors are usually retroclined, and it
is common for the upper lateral incisors to be proclined. The Class II element comes from the
lower incisor edges being posterior to the
t he cingulum plateau of the upper central incisors. The
correction of the overjet with your functional appliance. The Frankel II, Herbst and Clark twin
blocks are all functional appliances. The transpalatal arch is a fixed anchorage reinforcement
device.
71. Which one of the following options shows the correct frequency of developmentally
absent teeth (from most to least):
a) Mandibular central incisors > maxillary lateral incisors > mandibular second premolars >
maxillary second premolars
b) Maxillary lateral incisors > mandibular second premolars > maxillary second premolars >
mandibular central incisors
c) Maxillary second premolars > mandibular second premolars > maxillary lateral incisors >
mandibular central incisors
d) Mandibular second premolars > maxillary lateral incisors > maxillary second premolars >
mandibular central incisors« CORRECT ANSWER
207
e) Mandibular second premolars > maxillary second premolars > maxillary lateral incisors >
mandibular central incisors
Although the frequency of congenitally absent teeth varies between ethnic groups, the
mandibular second premolars (1–6%) are affected more than the maxillary lateral incisors (1–
4%). Agenesis of the mandibular incisors is rare (0.08–0.23%), as are missing maxillary and
mandibular canines along with first molars, which are usually associated with severe
hypodontia.
[Periodontics
MCQs]
[With Answers]
209
a) 3
b) 1
c) 2
d) 4
e) * « CORRECT ANSWER
210
The BPE uses the CPITN probe with its first black band between 3.5 and 5.5 mm. The probing
depth between this band would give a BPE of 3, providing no other probing depth of that
sextant is greater than 5.5.
3. Which one of the following would not be considered a plaque retentive factor?
a) Subgingival calculus
b) Well fitting crown « CORRECT ANSWER
c) Severe imbrication of the teeth
d) Supragingival calculus
e) Fixed orthodontic retention
4. Which one of the following is the greatest risk factor for periodontal disease?
a) Plaque retentive factors
b) Down’s syndrome
c) Shortened dental arch
d) Smoking « CORRECT ANSWER
e) Intravenous drug abuse
5. Which one of the following is the correct name for the instrument in the picture
below.
211
a) Periodontal hoe
b) Periodontal curette
c) Gracey curette
d) Reverse action hoe
e) Sickle scaler « CORRECT ANSWER
6. Which one of the following predictable treatments of this recession defect is correct?
c orrect?
212
a) Rotational flaps
b) Palatal soft tissue graft
c) Extraction of the tooth and replacement with
w ith a conventional bridge
d) Emdogain with advancement flap « CORRECT ANSWER
e) Membrane placement over the defect
The initial adhesion of micro-organisms is via Van der Waals force. Some species are not able to
attach to the tooth surface but can anchor themselves either to the matrix or the colonists. The
internal bacteria become anaerobic and start to produce acids. The biofilm will be dependant
upon the position within the mouth.
10. Which one of the following statements about the periochip is correct?
a) The periochip is used in the treatment of periodontitis « CORRECT ANSWER
b) The periochip is completely synthetic
c) Use is confined to pockets less than
t han 5 mm
d) Is associated with an increase in pocket probing depths
e) Is an atopical antibiotic
214
11. The most predictable use of guided bone regeneration occurs in which one of the
following?
a) One-walled defects
b) Two-walled defects
c) Three-walled defects « CORRECT ANSWER
d) Grade 2 furcation defects
e) Grade 3 furcation defects
12. Which one of the following statements regarding the platform switching concept in
implant dentistry is FALSE?
a) The platform switching concept uses an increased diameter of abutment compared to
the implant size« CORRECT ANSWER
b) The platform switching concept uses a reduced diameter of abutment compared to the
implant size
c) The platform switching concept is associated with a reduction in crestal bone resorption
d) The platform switching concept can be used in both submerged and unsubmerged
surgical techniques
e) The platform switching concept provides a horizontal platform to offset the biological
width surrounding a dental implant
• Comment on this Question
The platform switching concept involves using a reduced diameter of abutment compared to
the implant size, e.g. placing a 3.8 mm-wide abutment on a 4.8 mm-wide implant. It may be
215
15. Which one of the following is associated with the greatest increase in risk of
periodontal disease?
a) Malocclusion
b) Pregnancy
c) Poor diet
d) Type 1 diabetes mellitus « CORRECT ANSWER
216
Both type 1 and type 2 diabetes mellitus are associated with periodontal disease. In particular,
poorly controlled diabetes. Type 1 does have an increase in attachment
attac hment loss compared to type 2.
16. Which one of the following is the correct definition for a xenograph?
a) Tissue transplanted from the same individual, same site
b) Tissue transplanted from the same individual, different site
c) Tissue transplanted from a different individual, same species
d) Tissue transplanted from a different species « CORRECT ANSWER
e) Synthetically constructed tissue
17. Buccal recession associated with implants is most commonly associated with which
one of the following?
a) Greater than 2mm of buccal plate
b) Immediately placed implants « CORRECT ANSWER
c) Thick gingival biotype
d) Platform switched implants
e) All ceramic restorations
18. Which one of the following is the most reliable indicator of active periodontal
disease?
a) Bleeding on probing « CORRECT ANSWER
b) Presence of subgingival calculus
c) Probing depths of over 7 mm
d) DNA presence of periodontal pathogens
e) Plaque
217
Presence of periodontal pathogens does not indicate any active disease. The probing depths
although associated with periodontal disease are not an indicator of current
curre nt or future disease.
20. Which one of the following treatments would not be considered to be in the initial
phase of perimplantitis
perimplantitis treatment?
a) Occlusal evaluation and equilibration
b) Anti-smoking advice
c) Subgingival irrigation with 0.12% chlorhexidine
d) Non-surgical debridement
e) Surgical debridement « CORRECT ANSWER
As in the treatment of periodontal disease, the initial treatment will involve non-surgical anti-
infective therapy. This may be sufficient to re-establish gingival health or may be followed by
surgical therapy.
21. Which one of the following statements about the Florida probe is incorrect?
a) Reduces inter- and intra-operator error by using a constant force
b) Records the pocket depth and not attachment loss
218
The Florida probe uses a constant force of 15N and is a computerised probe. The ttip
ip is placed at
the bottom of the sulcus and the blue sleeve positioned at the gingival margin. The difference
between is measured by the computer and activated with a foot control.
22. Which one of the following examinations may be used as a screen to iidentify
dentify patients
for further investigations?
a) Community Periodontal Index of Treatment Need (CPITN) « CORRECT ANSWER
b) 6-point pocket chart
c) Gingival index
d) Plaque index
e) Bleeding index
investigation.
23. A 25-year-old man attends your clinic who has not been seen by a dentist for the last
10 years. He is complaining of mobile upper central incisors. These have probing
depths of 9 mm and are bleeding on probing. There is bleeding on probing in all other
sextants but no probing depths above 3mm. Which one of the following is the most
likely diagnosis?
a) Juvenile periodontitis
b) Refractory periodontitis
c) Localized aggressive periodontitis « CORRECT ANSWER
d) Generalized periodontitis
e) Necrotising ulcerative periodontitis
219
24. Which one of the following is the correct pressure applied when using the BPE?
a) 5g
b) 10-15g
c) 20-25g « CORRECT ANSWER
d) 30g
e) 35g
25. Which one of the following statements is incorrect regarding surgical regenerative
treatment of peri-implantitis lesions?
a) A three-walled defect is more successfully treated than a single walled defect
b) The use of bone regenerative
regener ative materials without barrier membranes show good clinical
improvements« CORRECT ANSWER
c) Impeccable oral hygiene is a prerequisite
prer equisite for successful treatment
d) Should follow a course of non-surgical treatment
e) The use of bone regenerative
regener ative materials with barrier membranes show good clinical
improvements
Initial treatment of a peri-implantitis lesion should involve oral hygiene instruction and non
surgical techniques. This can then be supplemented by surgical regenerative
regener ative treatment. A three
walled defect will be the most predictable to treat and a barrier membrane is essential in
excluding soft tissue invasion to allow for bone regeneration.
26. Regarding the links between periodontitis and risk for artherosclerosis, which of the
following is untrue?
a) Periodontitis has been associated with an increase in cardiovascular events
b) Periodontitis causes only localized inflammation « CORRECT ANSWER
220
Evidence to date is consistent with the notion that severe generalized periodontitis causes
systemic inflammation and endothelial dysfunction. Periodontitis has effects that reach beyond
the oral cavity and its treatment and prevention may contribute to the prevention of
atherosclerosis.
A recent systematic review by Clot et al. 2008 reported that inter-dental brushes are able to
remove more dental plaque than dental floss or wood-sticks.
29. Which one of the following associated with dentifrices does not offer advantages in
controlling gingivitis?
a) Amine fluoride/stannous fluoride
b) Chlorhexidine
c) Fluoride « CORRECT ANSWER
d) Stannous fluoride
e) Triclosan
221
30. Which one of the following is not associated with an increased risk of periodontitis?
a) Cohen’s syndrome
b) Down’s syndrome
c) Epilepsy « CORRECT ANSWER
d) Glycogen-storage disease
e) Hypophosphatasia
All the other conditions are named as systemic diseases associated with periodontitis in the
1999 classification. Certain epileptic drugs can lead to gingival hyperplasia but not associated
with periodontitis in patients with good oral hygiene.
31. Which of the following does not have an increased risk of severe periodontal disease?
a) A 21-year-old patient with evidence of erosion
e rosion on the palatal surfaces of her upper
incisor teeth « CORRECT ANSWER
b) A patient who smokes 10 or more cigarettes a day
There is no association between tooth surface loss (tooth wear) and periodontal disease, so a
21-year-old patient with evidence of erosion on the palatal surfaces of her upper incisor teeth is
not at higher risk of developing severe periodontal disease. All of the other options are
associated with a high risk of periodontal disease.
222
• Patients who smoke show greater attachment loss than non-smokers. Smokers also
respond less well to periodontal therapy than non-smokers.
• Diabetic patients show greater periodontal attachment loss than non-diabetic patients,
and the attachment loss is related to the severity of their condition and their deg
degree
ree of
glycaemic control.
• The persistence of high bleeding scores in patients with small amounts of plaque also
suggests a high risk of disease progression.
Attachment loss of more than 6 mm corresponds to a BPE Code 4, while overhanging crown
margins and subgingival calculus correspond to a BPE Code 2.
The BPE system does not include any assessment of tooth mobility.
m obility.
33. With which of the following periodontal risk factors is fremitus associated?
a) Bleeding on probing
b) Furcation involvement
c) Occlusal trauma « CORRECT ANSWER
d) Pocketing
e) Pus formation
• Comment on this Question
223
Destructive disease is a feature of periodontitis. All of the other features could be found in
association with chronic gingivitis either alone or coexisting with chronic periodontitis.
36. Furcation involvement is a local risk factor for periodontal disease. Which teeth are
most likely to be affected by furcation involvement?
a) Lower first premolars
b) Upper canines
c) Upper central incisors
d) Upper first molars « CORRECT ANSWER
224
Furcation involvement can only occur in teeth with two or more roots. Of the teeth
te eth listed above,
only upper first molars are multi-rooted (they have three roots). All of the other teeth have one
root, and thus no furcation area.
37. Histologically
Histologically,, periodontal lesions have been classified as initial, early, established or
advanced. Which cell type is most common in the early lesion?
a) Eosinophils
b) Macrophages
c) Neutrophils « CORRECT ANSWER
d) Plasma cells (B cells)
e) T cells
38. Which of the following bacteria is most commonly associated with aggressive
periodontitis?
a) Aggregatibacter actinomycetemcomitans « CORRECT ANSWER
b) Lactobacillus acidophilus
c) Porphyromonas gingivalis
d) Streptococcus anginosus
e) Treponema vincentii
• Lactobacillus acidophilus and Streptococcus anginosus are associated with dental caries.
225
d) Periodontal pocketing
e) ‘Punched out’ interdental papillae « CORRECT ANSWER
Furcation involvement, grade I mobility and periodontal pocketing are features of chronic
periodontitis, while bleeding on probing can be a feature of chronic gingivitis and chronic
periodontitis.
Interestingly, studies in the early 1990s demonstrated that only 30% of sites with bleeding on
probing go on to develop periodontal destruction (pocket deepening). In other words, the
absence of bleeding on probing is considered to be a sign of stability, and treatment should be
aimed at achieving this result.
41. In a healthy individual, which of the following structures is attached to enamel at the
base of a healthy gingival crevice?
a) Attached mucosa
b) Dentogingival fibres
c) Junctional epithelium « CORRECT ANSWER
d) Rete pegs
e) Sulcular epithelium
226
42. Which of the following measures is not suitable for monitoring a patient’s response to
periodontal treatment?
a) Bleeding score
b) BPE score « CORRECT ANSWER
c) Mobility
d) Plaque score
e) Probing pocket depth
Probing pocket depth, bleeding score and mobility can be used to monitor the response of an
individual site or tooth to periodontal treatment. The plaque score can be used to monitor a
patient’s compliance with plaque control (which will have an effect on the underlying
periodontal condition). The Basic Periodontal Examination (BPE) is a screening tool rather than a
monitoring tool. As it records the condition of the worst
w orst site in a sextant (of four to six teeth), it
does not monitor the responsiveness of individual sites to periodontal treatment.
When performing a Basic Periodontal Examination (BPE) for a new patient, you record the
following scores:
3/1/3
3/1/3
43. As this is a new patient, you then decide that radiographs are indicated. Which are the
most appropriate radiographs to prescribe for this patient?
a) Bitewings (horizontal or vertical) « CORRECT ANSWER
b) Intraoral periapical radiographs (IOPAs) of upper and lower posterior teeth
tee th
c) Lateral cephalogram
d) OPG (with no condyles)
e) Upper anterior occlusal
227
• due to the angulation of the film relative to the X-ray beam, a more accurate
assessment can be made of the periodontal bone levels relative to the crown of the tooth.
As this patient has calculus and is a smoker, he is more likely to have chronic periodontitis than
aggressive periodontitis. As there is 70% bone loss affecting the lower molars, this is localised
advanced disease (more than 30% of sites are affected).
Necrotising ulcerative gingivitis is an acute painful condition that causes destruction of the
gingival soft tissues.
45. Which of the following is a systemic risk factor for periodontal disease?
228
a) Anaemia
b) Diabetes mellitus « CORRECT ANSWER
c) Furcation involvement
d) Overhanging crown margins
e) Subgingival calculus
Overhanging crown margins, subgingival calculus and furcation involvement are all local risk
factors for periodontal disease. There is no demonstrated link between anaemia and
periodontal disease. Diabetes mellitus is a systemic risk factor for periodontal disease and is
thought to affect the host response by altering neutrophil function and causing abnormal
collagen formation.
46. A patient presents with gingival recession on the labial surface of a lower central
incisor tooth. Which of the following is not a possible cause?
a) Excessive tooth brushing
b) Frequent intake of acidic fruits (eg oranges)
or anges) « CORRECT ANSWER
c) Localised periodontitis
d) Pronounced frenal attachment (‘high frenum’)
e) Recent orthodontic treatment leading to proclination of the affected tooth
There is no association between the frequent intake of acidic fruits and gingival recession,
although such habits will cause erosion and dentine sensitivity in patients who have already
experienced recession. A pronounced frenal attachment is thought
t hought to ‘pull’ on the gingival
tissues during function, causing local ischaemia. Although the evidence for the involvement of a
frenum in gingival recession has been questioned, removal of the frenum is indicated during a
gingival grafting procedure to restore the recessed area. It is also thought that a ‘high’ frenal
attachment makes it difficult for the patient to maintain adequate oral hygiene, and can
therefore predispose them to localised periodontitis, which in turn will
w ill cause gingival recession.
Proclination of teeth, particularly lower incisors, which have a thin labial plate, will result in
localised recession. Excessive tooth brushing can also traumatise the area and cause recession.
47. Which of the following statements about the association between diabetes mellitus
and periodontal status is correct?
229
a) Diabetic patients who control their condition by diet alone are still likely to develop
advanced periodontal destruction
b) Poorly controlled diabetic patients experience a similar degree of periodontal
destruction to non-diabetic patients
Periodontal destruction is correlated with glycaemic control, and as a result poorly controlled
diabetic patients show increased periodontal destruction compared with non-diabetic patients.
Responsiveness to periodontal treatment is correlated with overall diabetic control, with poorly
controlled diabetic patients not responding as well to periodontal treatment as well-controlled
or non-diabetic patients. The damage caused by diabetes mellitus appears to be related to
altered neutrophil function and altered collagen formation in diabetic patients. The evidence
suggests that there is a bidirectional association between diabetes mellitus and periodontal
disease. Thus poorly controlled diabetes can cause increased susceptibility to periodontal
disease, and poorly controlled periodontal disease can cause deterioration in glycaemic/diabetic
control. Diabetic patients who control their condition by diet alone show better
bette r glycaemic
control, and consequently do not experience advanced periodontal destruction due to their
condition.
230
The threshold for changing a diagnosis of periodontal disease from localised to generalised
occurs when more than 30% of sites exhibit pocketing of more than 4 mm.
Periodontal surgery is indicated for teeth with short clinical crowns (eg due to tooth we
wear),
ar), to
Direct application of tetracycline is indicated for the treatment of sites affected by localised
aggressive periodontitis. Amoxicillin and metronidazole may be used to treat generalised
aggressive periodontitis or chronic advanced periodontitis. Antibiotics should only be used
following, or in association with, non-surgical management.
51. What is a secondary local factor of periodonta
periodontall disease? Select one option only.
a) An Every denture
b) Fractured central incisor
231
An Every denture is one that is designed to provide minimal periodontal interference, and while
all removable partial dentures can cause plaque to accumulate
ac cumulate this minimises plaque
accumulation by having free gingival margins. A fractured central incisor would not in itself
cause a plaque trap around the gingival margin. A Hawley retainer and all orthodontic
appliances often cause plaque traps as they sit around the gingival tissues and can make it
difficult to clean them. HIV is a factor in periodontal disease, but it is a systemic factor not a
local factor. An open contact between teeth that enables cleaning without food packing should
not increase the risk of periodontal
pe riodontal disease.
52. Which one of the following is classed as a code 2 on the Silness and Loe plaque index?
a) Film of plaque visible only by removal on probe or by disclosing
b) Heavy accumulation of soft material filling the niche between the gingival margin and
the tooth surface; the interdental region is filled with debris
c) Moderate accumulation of plaque that can be seen with
w ith the naked eye « CORRECT
ANSWER
d) Soft debris covering more than one-third but not more than two-thirds of the tooth
surface
e) Soft debris covering not more than one-third of the tooth surface
0: No plaque
The others are taken from the Greene and Vermillion Oral Hygiene Index.
232
53. What treatment is indicated from the following basic periodontal examination (BPE)?
3 1 3
2 2 3
A code 3 on a BPE indicates the presence of a pocket between 3.5 and 5.5 mm. To assess the
extent of the problem, a 6 point pocket chart is indicated to assess the bone loss, whether a
vertical or horizontal defect. Oral hygiene instruction is indicated to improve the home care of
the patient. A code 2 on
o n a BPE indicates the presence of calculus that needs to be removed; if
the patient has pockets (indicated by a code 3), this would indicate a subgingival scale. Vertical
bitewings can also be indicated depending on what radiographs are currently available.
av ailable.
54. Which one of the following is the main collagen fibre in the periodontal ligament?
ligament?
a) Collagen I « CORRECT ANSWER
b) Collagen II
c) Collagen III
d) Collagen IV
e) Collagen V
The periodontal ligament has mostly collagen I, which consists of two α1 chains and one α2
chain. Collagen III is also present and this consists of is three α1 III chains.
55. Which one of the following micro-organisms is most associated with acute necrotising
ulcerative gingivitis?
a) Actinobacillus actinomycetemcomitans
b) Fusobacterium sp. obligate anaerobe « CORRECT ANSWER
233
c) Porphyromonas gingivalis
d) Prevotella intermedia
e) Streptococcus mutans
56. Which one of the following patients is likely to have true pocketing?
57. Which one of the following would be the most appropriate treatment of a grade 1
furcation lesion?
a) Extraction
b) Hemisection
c) Non-surgical management « CORRECT ANSWER
d) Root resection
e) Tunnel preparation
234
A grade I furcation lesion would be horizontal loss of support that is not more than one-third of
the tooth width. Conservative management would be the first approach and this would be non-
surgical scaling and oral hygiene instruction. Tunnel preparation is where the whole
w hole furcation
area is investigated and widened to allow home care;
c are; this is not indicated in a grade I lesion as
there is minimal bone loss around the furcation. Root resection
resect ion and hemisection involve elective
root treatment and then removal of one or more of the rroots
oots to allow good cleaning. Root
resection, hemisection and extraction are all aggressive
aggr essive treatments of an early furcation lesion.
58. Which one of the following is associated with periodontal disease in the permanen
permanentt
dentition?
a) Apert syndrome
b) Chediak–Higashi syndrome
c) Gorlin–Goltz syndrome
d) Papillon–Levefre syndrome « CORRECT ANSWER
e) Ramsay Hunt syndrome
Apert syndrome is a developmental deformity with early fusion of the cranial sutures. Chediak–
Higashi syndrome is associated with neutropenia; periodontal disease is associated with it but
mainly in the deciduous dentition. Gorlin–Goltz syndrome is associated with odontogenic
keratocysts, bifid ribs and calcification of the falz cerebri. Ramsay Hunt syndrome is caused by
herpes zoster causing vesicles on the face and external auditory meatus associated with lower
facial palsy. Papillon–Levefre syndrome is an autosomal recessive disorder. It is characterised by
hyperkeratosis of the palms and soles. Initially there is normal dental development, then onset
of periodontal disease affecting both the deciduous and the permanent dentition.
235
[Pharmacology
MCQs]
[With Answers]
236
Pharmacology MCQs
1. A 62-year-old diabetic man who was started on diclofenac for post-operative pain
develops abdominal pain and dark stools. On examination, he has melaena. By what
2. A 56-year-old woman attends for a routine appointment. She tells you she is
undergoing chemotherapy for metastatic breast carcinoma and has noticed white
patches on her tongue and inside of her mouth for the last 4 days. She does not
complain of a sore throat
t hroat and is otherwise well in herself. Which would be the best
therapeutic agent?
a) Co-amoxiclav
b) Flucloxacillin
c) Fluconazole « CORRECT ANSWER
d) Caspofungin
e) Aciclovir
Mucosal candidiasis infections are commonly seen in immunosuppressed patients such as those
undergoing chemotherapy. Other diagnoses to consider would include herpes simplex infection,
but this usually presents with very painful vesicles rather than white
w hite patches and so aciclovir
would not be indicated. The best antifungal agent would be fluconazole orally, as caspofungin
can only be given intravenously and is reserved for severe
seve re invasive fungal infections.
Flucloxacillin is an antistaphylococcal antibiotic and co-amoxiclav is a broader spectrum
antibiotic, neither of which would be suitable for an uncomplicated fungal infection.
237
3. The exact pathogenesis of dental caries is complex but which bacteria are commonly
implicated in the disease process?
a) Viridans streptococci « CORRECT ANSWER
b) Staphylococcus aureus
c) Streptococcus pneumoniae
d) Enterococci
e) Group A beta–
–haemolytic
haemolytic streptococci
Streptococci, staphylococci and enterococci are all Gram-positive cocci. Streptococci are divided
into α-
α- or β-
β-haemolysis. Common α-haemolytic
α-haemolytic streptococci include Streptococcus viridans and
Streptococcus pneumoniae, although the latter is unlikely to cause dental caries and is more
often associated with community acquired pneumonias. Viridans streptococci are groups of
organisms commonly associated with dental caries, in particularStreptococcus mutans has been
implicated in the disease process. Enterococci are similar to streptococci and are principally
found in the gastrointestinal tract. Beta-haemolytic streptococci can cause a variety of infections
including tonsillitis (Group A streptococci) and neonatal meningitis (Group B streptococci).
238
his 75 mg aspirin this morning but missed his cholesterol lowering tablet last night.
You suspect this gentleman is having a myocardial infarction (MI) and call an
ambulance. Which of the following medications are known to decrease mortality
during an acute MI?
239
e) Dipyridamole 200 mg
7. Oral steroids are often used in the treatment of chronic illnesses such as chronic
obstructive airways disease and rheumatological conditions. Which of the following
concurrent illnesses can be exacerbated by steroids?
a) Asthma
b) Diabetes « CORRECT ANSWER
c) Psoriasis
d) Inflammatory bowel disease
e) Systemic lupus erythaematous
Steroids are commonly used for conditions including systemic lupus erythaematous (SLE),
inflammatory bowel disease, asthma and psoriasis, so these are unlikely to be exacerbated
exace rbated by
their administration. Steroids are known to antagonise the action of
o f insulin and so can cause
hyperglycaemia in patients not known to have diabetes but also worsen
wor sen glycaemic control in
patients with known diabetes. Therefore, close monitoring of blood sugars should be
encouraged during steroid administration.
8. You are using lidocaine 2% w/v to provide a nerve block in a dental patient before
giving them a filling. Which of the
t he following best describes the mechanism of
lidocaine’s action?
a) Agonism of the transmembrane sodium receptor
240
Lidocaine diffuses as an uncharged base through the axonal membranes. After combining with
hydrogen ions to form a cationic species, they blockade the sodium receptor.
9. You are suturing a laceration on an 81 kg man under local anaesthesia. You have
lidocaine available without adrenaline. What is the maximum safe dose you can use in
10. Which of the following is the most accurate definition of the pKa?
a) The concentration required of a weak acid to produce a change in pH of a solution
b) The pH at which 50% of molecules in solution are ionised « CORRECT ANSWER
c) The pH at which 100% of molecules
molec ules in solution are ionised
d) The concentration required of a weak base to produce a change in pH of a solution
e) A constant that determines how much drug is absorbed across a membrane
241
The pKa therefore provides useful information concerning into which compartment (stomach,
plasma or urine) the drug will be maximally absorbed. < /P>
11. Which of the following systems is affected by local anaesthetic toxicity earliest?
a) Cardiovascular
b) Respiratory
c) Neurological « CORRECT ANSWER
d) Endocrine
e) Gastrointestinal
Neurological signs are often the earliest sign of local anaesthetic toxicity, followed by cardiac
signs at higher dosages. It is crucial to aspirate to avoid accidental intravenous administration.
12. After prescribing a dose of post-operative antibiotics, you are called to the ward to
to
review the patient who is dyspnoeic with audible wheeze, has facial swelling and is
covered in a red rash. Her pulse is 120/min regular and blood pressure is 86/40 mmHg.
Oxygen saturations on 15 l of oxygen are 100%. You quickly diagnose anaphylactic
shock. Which is the most important immediate treatment?
a) 0.5 mg 1:1000 adrenaline given intravenously
b) 0.5 mg 1:1000 adrenaline given intramuscularly « CORRECT ANSWER
c) 10 ml 1:10,000 adrenaline given intravenously
d) 0.5 mg 1:1000 adrenaline given subcutaneously
e) 0.5 mg 1:1000 adrenaline given by sublingual route
• Comment on this Question
242
The correct dose and route is 0.5 mg of 1:1000 adrenaline given by intramuscular route. IV is
only recommended by specialist use (critical care/anaesthetics). All the other
ot her routes are
incorrect. This is essential knowledge, you must know the immediate management
m anagement of
anaphylaxis:
• Assessment of airway, breathing and circulation – potentially you might face problems
with all three of these, but airway will be most immediate to require intervention.
• Intravenous access and iv fluids (to compensate for hypotension and tachycardia and
fluid is shifted to physiologically non-useful spaces).
• Adrenaline 0.5 mg 1:1000 im (may be most important drug to give quickly depending on
the level of compromise from your ABC assessment).
The RESUS council have provided excellent guidelines and information on frequent causes of
anaphylaxis, outcomes and treatment.
http://www.resus.org.uk/pages/reaction.pdf
13. A diabetic patient on your operating list for dental extraction under local anaesthesia
complains of feeling sweaty and unwell. He has been mistakenly instructed to fast
overnight and took his evening insulin as usual. You ask the nurse to check the blood
sugar, it reads as 1.8 mmol. If the patient was to become unconscious, what is the
most appropriate immediate pharmacological option?
a) Hypostop
b) Administer a sugary drink
c) 10 ml of 50% dextrose solution
d) 1 mg glucagon iv
e) 1 mg glucagon im « CORRECT ANSWER
• Comment on this Question
After assessing airway, breathing, circulation, disability and exposure, correcting the blood sugar
is the most immediate treatment in the
t he treatment of hypoglycaemia. Administering a sugary
243
drink to an unconscious problem would potentially cause aspiration and create an A and B
problem. The correct IV treatment is 50 ml of 50% dextrose. Glucagon acts by breaking down
glycogen resulting in an increase in the free glucose concentration in plasma. It is administered
by intramuscular route.
14. In the assessment of a patient with severe anaphylactic shock, which part of
assessment is most crucially affected by the administration of intramuscular
adrenaline?
a) Airway « CORRECT ANSWER
b) Breathing
c) Circulation
d) Disability
e) Exposure
Adrenaline acts on α-
α- and β-adrenergic
β-adrenergic receptors, the main action here
her e is to provide
bronchodilatation and reduce airway compromise. The a agonism and β-1
β-1 agonism will affect
the circulation by increasing blood pressure and cardiac output. While the affect on B and C are
important, it is the affect on A that is lifesaving.
15. During a cardiac arrest, you are asked to administer adrenaline intravenously between
the second and third cycle of CPR. What is the correct IV dose?
a) 0.5 mg 1:1000 adrenaline
b) 1 mg 1:10 000 adrenaline « CORRECT ANSWER
c) 0.5 mg 1:10 000 adrenaline
d) 5 mg 1:10 000 adrenaline
e) 50 mg 1:10 000 adrenaline
This is the correct iv dose for adrenaline in cardiac arrest. The other options are incorrect in
terms of either concentration or dosage.
16. You are taking a medical history from a 55-year-old woman who tells you she is on
ramipril. What class of drug is ramipril?
a) B-blocker
244
b) Thiazide diuretic
c) Loop diuretic
d) Angiotensin II blocker
e) Angiotensin-converting enzyme (ACE) inhibitor « CORRECT ANSWER
17. Which topically applied antibiotic can be applied to facial wounds to prevent infection
and reduce scarring?
a) Pencillin
b) Erythromycin
c) Chloramphenicol « CORRECT ANSWER
d) Metronidazole
e) Fluconazole
Chloramphenicol is frequently applied to facial wounds to reduce infection and prevent scarring.
sc arring.
245
a) Adrenaline
b) Atropine « CORRECT ANSWER
c) Amoxicillin
d) Anti-malarials
20. Which one of the following drugs should not be given to asthmatic patients?
a) Metronidazole
b) Amoxicillin
c) Ibuprofen « CORRECT ANSWER
d) Captopril
e) Paracetamol
Metronidazole has the classic disulfiram-like reaction with alcohol. Patients should always be
advised to avoid alcohol when taking this drug.
246
22. Which one of the following interacts with warfarin to decrease the patient’s INR?
a) Fluconazole
b) Vitamin K « CORRECT ANSWER
c) Metronidazole
d) Erythromycin
e) Aspirin
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Tetracyclines should not be given in pregnancy nor in patients who are under 12 years of age. A
250mg tetracycline capsule can be used as a mouthwash to prevent or treat infected oral
ulceration.
25. Which one of the following drugs does not induce gingival hyperplasia?
a) Nifedipine
b) Carbamazepine « CORRECT ANSWER
c) Phenytoin
d) Diltiazem
e) Ciclosporin
Nifedipine and diltiazem are calcium channel blockers, phenytoin is an anti-epileptic and
ciclosporin is an immunosuppressant. These all induce gingival hyperplasia.
26. Which one of the following drugs can be prescribed safely in pregnancy?
a) Metronidazole
b) Paracetamol « CORRECT ANSWER
c) Prilocaine
d) Miconazole
e) Methotrexate
248
The 2.2ml cartridge contains 44mg of lidocaine. Both lidocaine and prilocaine are amides and
therefore are less likely to cause an allergic reaction. Lidocaine is a much more toxic drug than
prilocaine.
The warning card is a yellow card, and they do not need to wear a Medic Alert bracelet. Their
doctor decides the appropriate level of INR, which may be as much as 4.5 for patients who have
had a valve replacement. They may not need to
t o stop their anticoagulants for simple extractions
if their INR is below 3.5 as we should be able to cope with this level of haemorrhage.
30. Against which of the following diseases does a live attenuated vaccine not provide
protection?
a) Hepatitis B « CORRECT ANSWER
b) Measles
c) Mumps
d) Polio
e) Rubella
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Live attenuated vaccines are usually produced from the naturally occurring bacterium or virus,
which can still be infective, but rarely causes serious disease. Viruses are attenuated (weakened)
by growing them repeatedly.
250
d) Calcium-channel blocker
e) Proton pump inhibitor
• prevention of heart attack and stroke in people who are at high risk
Ramipril works by causing blood vessels to dilate, lowering the blood pressure and increasing
incre asing
the flow of blood, and therefore oxygen, to the heart.
d) Nausea
e) Osteoporosis « CORRECT ANSWER
Common side-effects of ACE inhibitors, which affect less than 1 in 10 people who take this
medicine, include the following:
• dry, tickly cough
• nausea or vomiting
• dizziness
251
• headache
• dry mouth
• constipation
• diarrhoea.
34. What is the correct dose of aspirin for prophylaxis of cardiovascular events?
a) 7.5 mg
b) 75 mg « CORRECT ANSWER
c) 150 mg
d) 300 mg
e) 750 mg
Salbutamol works by acting on receptors in the lungs called beta-2 receptors. When it stimulates
these receptors, it causes the muscles in the airways to relax, which in turn allows the airways to
open.
In conditions that are associated with narrowing of the airways, such as asthma and chronic
obstructive pulmonary disease (eg emphysema and chronic bronchitis), it is difficult for air to
252
enter and leave the lungs. As a result of its action in opening the airways, salbutamol makes it
easier to breathe.
Salbutamol is the drug most commonly taken via an inhaler device. Inhalation of the drug allows
it to act directly in the lungs, at the location where it is needed most. Administering salbutamol
via this route also reduces the risk of side-effects occurring in other part
partss of the body, as the
amount of drug that is absorbed into the bloodstream through
t hrough the lungs is lower than if the
drug is given orally.
36. Which additional drug is added to amoxicillin to produce the drug known as co
co--
amoxiclav?
a) Alendronic acid
b) Clavenulol
c) Clavulanic acid « CORRECT ANSWER
d) Furosemide
e) Salicylic acid
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Alendronic acid is used to treat and prevent osteoporosis (a bone disease that causes bones to
become brittle and fragile, and thus susceptible to breakage and fractures). It does this by
preventing loss of bone mass and helping to rebuild lost bone, thereby reducing the risk of
fractures of the spine and hip.
Alendronic acid can be combined with cholecalciferol (also known as vitamin D3 ), which aids
the absorption of calcium by the bones. The body’s main source of cholecalciferol is exposure
ex posure to
sunlight, although this vitamin is also present in small amounts in some foods (eg oily fish).
38. Which of the following has broad-spectrum activity against both Gram-positive and
Gram-negative bacteria?
a) Amoxicillin « CORRECT ANSWER
b) Gentamicin
c) Indomethacin
d) Metronidazole
e) Vancomycin
Simple penicillins are only active against Gram-positive organisms, as they cannot cross the
Gram-negative lipopolysaccharide outer membrane. The addition of an amino group makes the
penicillin molecule more hydrophilic, allowing it to cross the lipopolysaccharide layer of Gram-
negative bacteria. Amoxicillin, which has a free amino group, is therefore active against both
Gram-positive and Gram-negative bacteria.
39. Which of the following drugs is not required in the treatment of anaphylaxis?
a) Adrenaline
b) Chlorpheniramine
c) Intravenous fluids
d) Oxygen
e) Prednisolone « CORRECT ANSWER
• Comment on this Question
Prednisolone is an orally administered drug. The steroid that should be given is hydrocortisone,
which is administered intravenously.
40. Against which of the following bacteria is the drug metronidazole active?
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e) Streptococcus pyogenes
41. Which of the following drugs does not interact with warfarin to alter the INR of a
patient?
Fluconazole, metronidazole and erythromycin all potentiate the action of warfarin. Vitamin K is
the reversal agent for warfarin.
war farin. Aspirin does not interfere with warfarin metabolism.
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Warfarin inhibits the vitamin K-dependent synthesis of biologically active forms of the calcium-
dependent clotting factors II, VII, IX and X, as well as protein C, protein S and protein Z, which
have a regulatory role.
Drug Maximum dose for infiltration Maximum dose for plexus anaesthesia
Lignocaine 4 mg/kg 5 mg/kg
Lignocaine blocks the fast voltage-gated sodium channels and thus alters signal conduction in
nerves. If enough channels are blocked, the membrane of the postsynaptic neuron will not
depolarise, and so cannot transmit an action potential. This is what causes the anaesthetic
256
effect. Careful titration of the drug means that a high degree of selectivity can be achieved with
regard to the blockage of sensory neurons. At higher concentrations, other modalities of neuron
signalling will also be affected.
45. Which of the following drugs is the reversal agent for midazolam?
a) Flamazine
b) Fludrocortisone
c) Flumazenil « CORRECT ANSWER
d) Fluoroethane
e) Fluphenazine
47. For which of the following medical conditions is the combined oral contraceptive pill a
risk factor?
a) Bowel cancer
b) Deep vein thrombosis « CORRECT ANSWER
c) Hypotension
d) Leukaemia
e) Non-
Non-Hodgkin’s
Hodgkin’s lymphoma
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The combined oral contraceptive pill is a risk factor for deep vein thrombosis (DVT), and when a
patient is suspected of having a DVT, it is very important to establish this link as quickly as
possible.
48. Which of the following drugs causes onset of wheezing in a patient who is asthmatic?
a) Codeine
b) Diamorphine
c) Ibuprofen « CORRECT ANSWER
d) Morphine
e) Paracetamol
c) Increased sweating
d) Muscle hypertrophy
e) Weight loss
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51. A patient collapses in the dental practice surgery waiting room. They have been fitting
for 5 minutes, what is your next course of action?
a) Buccal midazolam « CORRECT ANSWER
b) Chest compressions
c) Intramuscular midazolam
d) Rectal diazepam
e) Two rescue breaths
The UK Resuscitation Council guidelines for dental practice state the buccal midazolam is the
drug and delivery of choice for persistent fitting, after a rapid ABC assessment is carrie
carriedd out.
52. You are considering your choice of local anaesthesia for a surgical procedure that you
anticipate to be difficult. Which one of the following agents provides the most
prolonged anaesthesia?
a) Articaine
b) Bupivicaine « CORRECT ANSWER
c) Lignocaine
d) Mepivicaine
e) Prilocaine
53. Which one of the following conditions or drug treatments can make a patient more
prone to post-extraction bleeding?
a) Controlled hypertension
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A bleeding tendency results from depressed synthesis of blood clotting factors and excess
ex cess
fibrinolysins. PT, INR and APTT are all increased.
54. Which of the following is the most appropriate to check before administering
intravenous sedation?
a) The patient’s blood pressure « CORRECT ANSWER
55. Which of the following is most commonly used for intravenous sedation during dental
treatment?
a) Diazepam
b) Flumazenil
c) Lorazepam
d) Midazolam « CORRECT ANSWER
e) Tempazepam
• Comment on this Question
260
Midazolam is the most commonly used benzodiazepine in dentistry for sedation. It is a very
v ery safe
and effective drug and is given incrementally and titrated to the desired response. Flumazenil is
the reversal, to be used only in an emergency.
56. Which of the following is the most common unwanted effect of non-steroidal anti-
inflammatories (NSAIDs)?
a) Adverse renal effects
b) Analgesic-associated nephropathy
c) Bronchospasm
d) Gastric disturbances « CORRECT ANSWER
e) Skin reactions
Class V does not exist. Class I drugs block voltage-sensitive sodium channels. Class III drugs
substantially prolong the cardiac action potential, and class IV drugs are calcium antagonists.
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[Radilogy
MCQs]
[With Answers]
262
1. Carious lesions are difficult to diagnose and can be influenced by local factors. Which
one of the following statements is false?
a) Clinically carious lesions are larger than they appear radiographically
b) The image of the carious
car ious lesion can be affected dramatically depending on which technique
is used
c) The exposure and factors relating to can
c an have a significant affect on the overall contrast and
therefore affecting the appearance of the carious lesion
d) The bucco-lingual extent of the lesion can always be determined with the parallelling
technique « CORRECT ANSWER
e) The presence of existing restorations maye completely
c ompletely overlie the undiagnosed carious
lesion
The buccal-lingual extent of the lesion cannot always be assessed due to the superimposition
and two-dimensional image of plain film radiography.
r adiography.
Dental caries diagnosis on radiographs is not always straighforward due to two additional
radiographic shadows: firstly the radiolucent cervical burnout/translucency and the radiopaque
zone beneath amalgam restorations. Cervical burnout is a radiolucent shadow often evident at
the neck of teeth. It is an artifactual phenomenon created by the anatomy of the teeth and the
variable penetration of the X-ray beam.
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The soft tissue relationships are not assessed using the lateral cephalogram. The lateral
cephalogram is used to assess the saggital relationships of the jaws to the skull base, max
maxilla
illa to
mandible, teeth in to each jaw and teeth in the maxilla to teet
teethh in the mandible.
5. Having seen the orthopantomogram (OPG), select which one of the following image
types would you request from the list below:
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Upper standard occlusal will not allow the parallax technique to be employed for the bucco-
palatal position of the canine. A vertex occlusal has several
sever al drawbacks and disadvantages
including the radiation beam being directly in the lens of the eye; the primary X-ray beam may
be in line with the reproductive
re productive organs; and there is lack of detail and contrast. An upper
standard occlusal slightly off the centre line will allow the parallax technique to be used.
6. A patient presents to the Emergency Department; the patient has already had the
image below taken. What second image would you request?
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a) Lateral cephalogram
b) Posterior–anterior mandible/jaws « CORRECT ANSWER
c) Bilateral lateral oblique mandible
d) Occipito-mental (OM)
e) Computerised tomography (CT) facial bones
A second image is always necessary when suspicious of facial fractures in order to create a
second dimension.
7. A patient presents with a swelling over the anterior mandible/lower central incisors.
Which one of the following methods of imaging would be your primary choice?
a) Orthopantomogram (OPG)
b) Posterior–anterior (PA) mandible image
c) Periapical radiograph of lower incisors « CORRECT ANSWER
d) Computerised tomography (CT) scan of mandible
e) Lower occlusal radiograph
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OPG has the disadvantage of the focal trough; the PA mandible image will not show a clear
enough picture of the area needed,
nee ded, as would a lower occlusal; and a CT scan is too much of a
radiation dose before a primary diagnosis has been made.
8. Which one of the following imaging modalities would be of choice for an unerupted
maxillary canine?
a) Vertex occlusal
b) Orthopantomogram (OPG) « CORRECT ANSWER
c) Computerised tomography (CT) scan of the maxilla
d) Upper oblique occlusal
e) Lower oblique occlusal
An OPG will give a more specific area of the location of the impacted canine – if it is impacted,
there is always the chance that it is absent. From there, further imageing can be requested to
give a precise location of the tooth and any associated pathology.
The nasal septum is the vertical wall that divides the nose into two nasal cavities and is made up
of cartilage in the front and thin bone in the back.
10. Which one of the following statements is not a disadvantage of dental tomography?
a) Soft tissue and air shadows can overlie the required hard tissue structures
b) Ghost or artifactual shadows can overlie the structures
str uctures in the focal trough
c) Patient movement in the vertical plane distorts that part of the image being produced at
that instant
d) The use of indirect-action film and intensifying screens results in some loss of image quality
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e) Some patients do not conform to the shape of the focal trough and therefore gives a better
image « CORRECT ANSWER
The focal trough in all patients gives a distorted image and therefore is a major disadvantage of
dental tomography.
11. A patient presents to the Emergency Department having being assaulted. As yet he
has not been seen by a doctor in the Emergency Department. His main complaint
complaint iiss of
double vision, altered sensation over his cheek, nausea and a headache. Which one of
the following is the next most appropriate step in his management?
a) Fine cut coronal computerised tomography (CT) orbits
b) Ophthalmological consultation
c) Occipito-mental 30° plain film
d) Primary and secondary advanced trauma life support (ATLS) survey « CORRECT ANSWER
e) Computerised tomography (CT) head to exclude intra-cranial injury
All patients should have a primary survey according to the ATLS approach ie Airway, Breathing,
and Circulation. Following from that assessment, a secondary survey will pick up non-life-
threatening injuries. This ABC approach applies to all patients irrespective of
o f their
complaint/mechanism of injury. Of direct relevance here is nausea and a headache, which are
cardinal signs of a head injury.
12. A 56-year-old man has been diagnosed with a T2 N0 squamous cell carcinoma of the
right lateral tongue. As the maxillofacial SHO you are asked to complete the patients
imaging work up. He has already had computerised tomography
tomography (CT) and MRI of his
head and neck to stage his disease. Which one of the following would you request
next?
a) Angiogram of the head and neck
b) Chest X-ray « CORRECT ANSWER
c) Fully body positron emission tomography (PET) scan
d) Angiogram of the legs
e) Ultrasound scan of the carotid arteries
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Once the primary imageing of the lesion has been carried out, patients commonly undergo
imageing of the chest for metastatic tumours. CT scan of head, neck and cchest,
hest, and sometimes
abdomen, are commonly carried out thereby eliminating
e liminating the need for a chest X
X-ray.
-ray. A full body
PET scan is sometimes carried out to detect
dete ct other lesions, Angiograms are requested of the legs
when composite flaps eg fibula are to be harvested. Carotid artery ultrasound would be
requested with other complaints regarding the head and neck, it is unusual in oral cancer to
require this procedure, unless from a medical point of view.
v iew.
13. A patient presents with a submandibular swelling, drooling saliva, elevated tongue,
pyrexia and tachycardia. Which one of the following would be your primary
management?
a) Computerised tomography (CT) scan of neck
b) Orthopantomogram (OPG)
c) Ultrasound scan
d) ABC assessment and contact senior « CORRECT ANSWER
e) Commence broad spectrum iv antibiotics
Dento-facial abscesses are common and can be serious. Patients with systemic symptoms (ie
pyrexia and tachycardia) need hospital admission and intense management. Those with
significant local symptoms that are cause of concern for airway management need urgent
management – which usually is not an imageing modality. Commonly these patients will have
already had an OPG and it can be seen where the offending tooth is. However, basic
resuscitation and discussion with seniors is important. It is not appropriate for these patients to
be sent to the radiology department for imageing, especially not one such as a CT scan for which
they need to lie down – thereby potentially causing an airway obstruction.
14. Which one of the following is the hallmark radiographically of an initial low grade
chronic inflammation?
a) Area of bone loss at the apex of the tooth
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There is usually no apparent bone loss, but there is dense sclerotic bone around the tooth apex,
ape x,
otherwise known as sclerosing osteitis.
The infra-orbital nerve exits the skull through the infra-orbital foramen and is more commonly
associated with a fractured zygoma, Le Fort or orbital fractures. All of the other answers are
commonly associated with a fractured mandible.
16. Which one of the following is the correct diagnosis likely to be for the patient who
presents with the following radiograph?
a) Dentigerous cysts
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Keratocysts are commonly oval, extending along the body of the mandible with little
mediolateral expansion. The outline is usually smooth and well defined, sometimes corticated.
17. Which one of the following lesions below is not a multi-locular lesion?
a) Ameloblastoma
b) Central giant cell granuloma
c) Odontogenic keratocyst
d) Stafne’s bone cavity « CORRECT ANSWER
e) Aneurysmal bone cyst
18. Acute maxillary antral sinusitis is not caused by which one of the following?
Most commonly patients present with epistaxis or blockage of one or both of the nares, or even
dental pain in the maxilla. It is rare for patients with a malignant tumour to pre
present
sent with acute
sinusitis. Patients who do present with recurrent epistaxis should be treated
tre ated with suspicion,
especially if they have high risk factors.
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19. Which one of the following is the most likely complication following an isolated
fractured zygoma?
a) Oro-antral communication
b) Infra-orbital paraesthesia « CORRECT ANSWER
c) Diplopia
d) Subconjunctival haemorrhage
e) Mental nerve paraesthesia
Infra-orbital paraesthesia is the most likely complication following the initial injury, diplopia is
usually present if the orbit is involved as well. Subconjunctival haemorrhage is a possible
complication, but again usually if the orbit is involved. Mental nerve paraesthesia is not
associated with an isolated zygoma, more likely to be a mandibular fracture.
20. A patient is involved in an RTC (road traffic collision) and admitted to critical care. He
is intubated, ventilated, sedated and has his C-spine
C -spine fully immobilised.
immobilised. Clinically, he
has gross facial swelling, bilateral racoon eyes, epistaxis and what looks like clear fluid
from his nose, bilateral perforated tympanic membranes. He has an obviously mobile
mandible, although difficult to assess the extent of the injury due to the endotracheal
tube. Which one of the following is the most appropriate imaging request for this
patient at this stage?
a) Occipito-mental views (OM)
b) Dental tomogram (OPG)
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21. Which one of the following statements is false with regard to cervical burnout?
a) When exposure factors are increased
incre ased cervical burnout is more obvious
b) Cervical burnout is more difficult to diagnose if there is a restoration present
c) Cervical burnout is more difficult to diagnose if the parallelling technique is used « CORRECT
ANSWER
d) Cervical burnout is usually triangular in shape, which becomes less apparent towards the
t he
centre of the tooth
e) Cervical burnout is difficult to diagnose when using the bitewing radiograph
Cervical burnout is easier to diagnose using the parallelling technique due to the nature of the
angle of the cone.
e) SNA relates the anteroposterior position of the maxilla, as represented by the A point to the
cranial base
23. A patient presents to the Emergency Department following a road traffic collision
(RTC) and you are called as the maxillofacial senior house officer on call to assess their
facial injuries. They complain of tenderness over the cheek
c heek bones, neck pain and
difficult biting their teeth together. As yet they have not been seen by the Emergency
Department SHO. Which radiograph is not indicated in this scenario?
a) Posterior–anterior (P) mandible
b) Orthopantomogram (OPG)
c) Submento-vertex (SMV) « CORRECT ANSWER
d) Occipito-mental view 10°
e) Occipito-mental view 30°
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The head positioning for this image means that it is contraindicated in patients with suspected
neck injuries, especially with an odontoid peg.
24. A 32-year-old man was treated for a fractured mandible and had post-operative
radiographs taken, which one of the following treatments has he received?
d) Open reduction and internal fixation with temporary inter-maxillary fixation in the form of
eyelet wires « CORRECT ANSWER
e) No surgical treatment
25. Which one of the following is not an indication for taking bitewing radiographs?
a) Assessment of existing restorations
b) Assessment of the periodontal status
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Bitewings radiographs do not give an adequate image of the apex to the inferior alveolar canal.
26. Which one of the following conditions is sometimes associated with hypercementosis?
hypercementosis?
a) Cimento-osseous dysplasia
b) Giant cell granulomas
c) Hyperparathyroidism
d) Paget’s disease « CORRECT ANSWER
e) Stone’s bone cavity
27. Which one of the following lesions is regarded by many as a cyst is actually in the
WHO classification as an odontogenic tumour?
a) Adenomatoid odontogenic tumour
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b) Osteoarthritis
c) Osteomyelitis « CORRECT ANSWER
d) Osteoradionecrosis
e) Paget’s disease
Classically, the area of bone affect is ragged, patchy or moth eaten with areas of radiolucency.
The outline of the area of destruction
de struction is irregular and poorly defined.
29. Which one of the following classical descriptions relates to congenital syphilis?
a) Brown staining of the teeth in incremental
increme ntal lines
b) Discoloured teeth
c) Hyperdontia
d) Hypoplastic enamel and altered tooth shape « CORRECT ANSWER
e) Multiple pulp stones
Brown staining is associated with fluorosis or tetracycline use, pulp stones are associated with
Ehlers–Danlos syndrome and hyperdontia can have various causes. Altered tooth shape is
commonly described as ‘Hutchinson’s incisors’ where the crowns are small, screwdriver or
carre-shaped and often notched. It can also be described as ‘Moon’s or mulberry
m ulberry molars’, which
are dome shaped or nodular.
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Radicular or ‘dental cysts’ are the most common form of jaw cyst. Those found in adults over 3
300
and are rare are usually lateral periodontal cysts (B), those which are less than 5% of all dental
cysts and of various ages are usually a keratocyst.
ke ratocyst. Those found in adolescents and sometimes
the elderly (~20%) are commonly dentigerous cysts.
Old developer fluids lighten the film after processing. Processing errors that lead to lightening of
the film include:
• underexposure
32. Which metal is commonly used to produce electrons in simple X-ray machines?
a) Iron
b) Gold
c) Lead
d) Silver
e) Tungsten « CORRECT ANSWER
The cathode of the X-ray machine releases electrons into a vacuum, and the electrons hit the
anode target, where their interaction produces X-rays. The X-ray spectrum depends on the
t he
voltage and the anode metal. Medical machines most commonly use tungsten, but copper and
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b) Deposition of energy
c) Increase in the wavelength of X-rays with modulation of field
d) Reduction in the intensity of the main X-ray
X -ray due to scatter and absorption « CORRECT
ANSWER
e) Removal of an electron from a neutral atom
Attenuation is the gradual loss of intensity of any kind of flow through a medium.
34. What is the estimated risk per million of developing fatal radiation-induced cancer
from an OPG?
a) 0.2 per million
b) 0.47 per million
c) 1.0 per million « CORRECT ANSWER
d) 1.7 per million
e) 2.5 per million
Somatic stochastic effects are a possible outcome of radiation exposure. However, their
development is random and is a chance effect.
35. What is the estimated risk per million of developing fatal radiation-induced cancer
from an intra-oral film?
a) 0.2 per million « CORRECT ANSWER
b) 0.47 per million
c) 1.0 per million
d) 1.7 per million
e) 2.5 per million
• Comment on this Question
Somatic stochastic effects are a possible outcome of radiation exposure. However, their
development is random and is a chance effect.
278
36. Which metal is found inside a film packet to absorb secondary scatter?
a) Copper
b) Lead « CORRECT ANSWER
c) Silver
d) Titanium
e) Zinc
Lead is the most commonly used shield against X-rays, due to its high density, stopping power,
ease of installation and low cost.
38. Which of the following film faults would not result in a llight//pale
ight//pale adult film?
a) Developer solution that is too hot « CORRECT ANSWER
b) Developer that is contaminated by fixer
c) Film pack that is back to front
d) On paediatric setting
e) Thick patient tissues
• Comment on this Question
279
If the developer fluid is too hot, it accelerates the chemical reaction involved in development of
the film, so the film becomes over-developed
over -developed and dark. The other options would lead to a pale
film, due to either underexposure or underdevelopment.
Ultrasound imaging is used in all of the above medical applications. It has been
bee n widely used
throughout medicine since it was first pioneered in the
t he 1940s by George Ludwig. Its major
m ajor
benefits are that it is non-invasive and it has no associated radiation dose. Ultrasound scanning
machines are also relatively cheap, small, and easy to use.
40. Which radiological lesion is associated with squamous-cell carcinoma of the lung?
l ung?
a) Brown’s tumour « CORRECT ANSWER
b) Cherubism
c) Eosinophilic granuloma
d) Odontogenic keratocyst
e) Stafne’s bone cavity
41. Who developed a system of lines for assessing the midface on occipito-mental X-rays?
a) Avery
b) Campbell « CORRECT ANSWER
c) Hutchinson
d) Morello
e) Morgani
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In the 1950s, McGrigor and Campbell developed a system based on four axial levels.
43. Which metal is commonly used as the heat sink for the anode in simple X-ray
machines?
a) Copper « CORRECT ANSWER
b) Gold
c) Iron
d) Lead
e) Tungsten
• Comment on this Question
When an X-ray is produced in an X-ray tube, the electrons are converted into energy, and 99% of
that energy is in the form of heat. The copper acts as a heat sink by absorbing and conducting
away the heat energy, thus
t hus preventing the machine from overheating.
281
The removal of an electron from a neutral atom in the process of ionisation results in the
production of a negative ion (ie the electron)
e lectron) and a positive ion (ie the remaining atom).
• Scatter is the change in direction of a photon with or without the loss of energy.
• Attenuation is the main decrease in intensity of an X-ray beam due to scatter and
absorption.
46. What is the average value of natural background radiation per annum in the UK?
a) 320 μSv
b) 550 μSv
c) 2000 μSv « CORRECT ANSWER
d) 4000 μSv
e) 10 000 μSv
282
This represents the sum of all naturally occurring sources of radiation, but not man-made
radiation (eg dental X-rays, or radiation produced as a result
r esult of nuclear explosions).
47. What is the average value of cosmic background radiation per annum in the UK?
This is the small component of natural background radiation that originates from sources
outside the earth’s atmosphere (mostly from the sun).
49. Which of the following is a true radiological sign of orbital floor fracture?
a) Opacity in the antrum
b) Soft tissue swelling in the periorbital region
c) Surgical emphysema
d) ‘Tear-drop’ sign « CORRECT ANSWER
e) Zygomatico-Frontal distraction
283
50. Which of the following represents one of the four main types of scatter that are seen
at the nucleus of an atom with X-ray radiation?
a) Brownian motion
b) Pair production
c) Piezoelectric effect
d) Photodynamic effect
e) Rayleigh scattering « CORRECT ANSWER
1. Compton effect
2. Pair production
3. Rayleigh scattering
4. Photoelectric effect.
Brownian motion represents the random movement of particles, especially gas particles that are
suspended in a fluid.
Piezoelectric effect is the mechanism by which ultrasonic scalers work. The piezoelectric effect is
understood as the linear electromechanical interaction between the mechanical and the
electrical state in crystalline materials.
Please note that while answers B (Pair production) & D (Photodynamic effect) are close, they are
not actually correct terms of scatter.
51. Which of the following is an indication for a cone beam computed tomography
(CBCT)?
a) Assessment of an undisplaced fracture of the mandible
b) Assessment of temporomandibular joint dysfunction
c) Mandibular open-reduction and rigid internal fixation post-operative review
d) Occlusal caries in lower molars
e) Relationship of the inferior alveolar nerve with the roots of an impacted third molar «
CORRECT ANSWER
284
52. A patient attends the Emergency Department following an alleged assault and it is
thought that they have sustained hard tissue injuries
i njuries to the facial skeleton. Which of
the following imaging methods would be most appropriate to screen the mandible?
a) Head computed tomography (CT)
b) Lateral cephalometric radiograph
c) Orthopantomogram (OPG)
d) Posteroanterior (PA) mandible and lateral cephalometric radiograph
e) PA mandible and OPG « CORRECT ANSWER
These two radiographs show locations of fractures along the mandible, including the condyles,
displaying size of fracture, amount of displacement and loss in height if fractured
fracture d condyle is
involved.
53. A patient attends the Emergency Department following an alleged assault. It is
thought that they have sustained hard tissues injuries to the facial skeleton. Which of
the following imaging methods would be most appropriate to screen the zygoma?
a) Computed tomography (CT) orbit
b) OM 10 and 30 « CORRECT ANSWER
c) Orthopantomogram (OPG) and lateral cephalometric radiograph
d) Posteroanterior mandible and OPG
e) Reverse Towne s
285
Facial views are normally adequate to assess a suspected fracture of the zygoma, including
maxillary sinus, zygoma, arches and ZMC. If the orbital
o rbital floor is involved then a CT may be
indicated but not as a first-line investigation.
54. Who was the individual responsible for relating the use of X-rays to medicine in 1895?
a) Chappelle
b) Grant
c) Roentgen « CORRECT ANSWER
d) Shaw
e) Williams
Wilhelm Roentgen was a physicist attributed with the discovery of X-rays and their uses in the
medical field.
55. Which of the following is encompassed by Campbell’s line 1 when assessing middle
third facial fractures?
a) Left lateral wall antrum
b) Right angle mandible
c) Right coronoid process
d) Right supraorbital ridge « CORRECT ANSWER
e) Right zygomatic arch
Campbell’s lines are used as a systematic approach to assessing middle third fractures. There are
four in total. Line 1 follows the contour encompassing the zygomaticofrontal sutures,
supraorbital ridges and frontal sinus.
286
d) Orthopantomogram (OPG)
e) Orthopantomogram (OPG), head and chest CT « CORRECT ANSWER
58. When radiographically assessing the extent of caries in a tooth, which of the following
is correct?
a) D1: only one side of the tooth is affected by caries
b) D2: carious lesions extending into the pulp
c) D2: clinically detected caries extending to the
t he cemento-enamel junction (CEJ) «
CORRECT ANSWER
d) D4: all surfaces of the tooth are affected by caries
e) D4: lesions only extending into the dentine
287
D1: lesions extending within enamel only; D2: to the CEJ; D3: within cementum but not
incorporating >50%; D4: lesions extend into the pulp.
288
[Restorative
MCQs]
[With Answers]
289
1. Which one of the following is the correct definition for CAD CAM?
a) Computer-aided design, computer-aided manufacturing « CORRECT ANSWER
b) Computer-aided design, ceramic added machined
c) Computer-aided design, computer-aided modifications
d) Ceramic advantage design, ceramic advantage milled
e) Ceramic assessed design, computer assessed milled
CAD CAM is short for Computer aided design, computer aided manufacturing. It involves the
milling of a fixed prosthesis.
2. Which one of the following is the definition for a restoration that encompasses the
mesial and occlusal aspects of an upper right first permanent molar?
a) Class 1 cavity
b) Class 2 cavity « CORRECT ANSWER
c) Class 3 cavity
d) Class 4 cavity
e) Class 5 cavity
290
d) Class 4
e) Class 5
• Class 3: a unilateral edentulous area with natural teeth anterior and posterior.
• Class 4: a single but bilateral (crossing the midline) edentulous area anterior to the
remaining natural teeth.
5. The Golden proportion is a ratio that has a long history in mathematics, plus Greek
and Egyptian architecture and is now used ini n planning dental aesthetics. Which one of
the following is the correct description?
a) AB:BC = AC:BC
b) AB:CD = AC:BC
c) AB:BC = AC:BC
d) AB:BC = AC:BC = 1.618:1 = 1:0.618
e) AB:BC = AC:AB = 1.618:1 = 1:0.618
1 :0.618 « CORRECT ANSWER
The conventional preparation of a veneer will be 0.3 mm cervically, 0.5 mm centrally with the
incisal edge either being retained or reduced by 1 mm. The preparation should stay within the
enamel for increased bonding, as well as keeping
kee ping the preparation as minimal as possible.
291
The retruded contact position is the occlusal position when the first tooth contact occurs on the
mandibular path of closure with the condyles in the retruded axis position.
8. Which one of the following preparations would be considered to be best practice for a
full gold crown?
a) Chamfer finishing line, 30° taper
b) Chamfer finishing line, 10° taper « CORRECT ANSWER
c) Shoulder finishing line, 0° taper
d) Shoulder finishing line, 10° taper
e) Shoulder finishing line, 30° taper
292
e) The angle formed by the sagittal plane and the path of advancing condyle during lateral
mandibular movement, as viewed in the transverse plane
11. Which one of the following has the best 10-year survival rate, when replacing a single
upper central incisor?
a) Cantilever adhesive bridge from the lateral incisor
b) Double-winged adhesive bridge with wings on the lateral incisor and corresponding
co rresponding
central incisor
c) Cantilever conventional bridge, central incisor abutment
d) Fixed/ movable bridge
e) Osseointegrated dental implant « CORRECT ANSWER
Current published data gives a dental implant the greatest success rate, with up to 9
99%
9% surviving
the ten-year period. A cantilever adhesive bridge from a lateral incisor has a very poor success
rate and double winged adhesive bridges have a tendency
t endency to debond on the wing allowing
recurrent caries under the debonded wing. Any conventional bridge will reduce the life
expectancy of the abutment.
12. Overdentures are a useful treatment option. Which one of the following options is not
correct?
a) Overdentures benefit from ridge preservation
b) Overdentures benefit from increase proprioception
c) Overdentures may have increased retention, from the use of precision attachment
d) Requires reduced maintenance of the remaining tooth structure
st ructure « CORRECT ANSWER
293
e) Implant retained lower complete overdentures have a very high success rate
14. Which one of the following is classifications is used for an occlusal restoration?
a) Class 1 « CORRECT ANSWER
b) Class 2
c) Class 3
d) Class 4
e) Class 5
15. Which one of the following is the current guidelines for the time interval between
bitewing radiographs in a patient with a high risk of caries?
a) 1 month
b) 2–3 months
c) 6–12 months « CORRECT ANSWER
d) 2 years
e) 3 years
294
16. A patient attends your clinic with a root-filled premolar that has fractured at gum
level. Which one of the following treatment options represents the poorest
restorative prognosis?
a) Post and core, crown « CORRECT ANSWER
b) Crown lengthening, post and core, crown
c) Orthodontic extrusion, post and core, crown
d) Extraction and implant placement
e) Extraction and provision of a denture
In a case of a tooth that has fractured at gingival level, a ferrule effect is required to ensure that
the forces of mastication are transmitted
t ransmitted to both the tooth and the post. A tooth without a
ferrule of 1.5 mm will offer no form of resistance to transverse forces and the entire load is
taken by the post, with failure inevitable. Orthodontic extrusion or crown
c rown lengthening will be
required for a ferrule effect to occur before restoration.
17. This patient attends your clinic complaining of the appearance of his root filled upper
right lateral incisor. Which one of the following treatment options is the most
appropriate?
a) Scale and polish
b) All ceramic crown
c) Veneer preparation within dentine
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The intrinsic staining will not be removed by a scale and polish, and the other options are more
destructive of tooth tissue.
18. Which one of the following areas of a crown preparation for a porcelain bonded crown
should have the most reduction? (Full porcelain occlusal coverage.)
a) Buccal, apical third
b) Buccal, coronal third
c) Distal finishing line
d) Non working cusp
e) Working cusp « CORRECT ANSWER
The working cusp should be reduced by the greatest amount, typically 2–2.5 mm, in order for
adequate strength of metal and porcelain.
19. Which one of the following is the correct definition of Bennett shift?
a) Bennett shift is the movement of
o f the non-working condyle towards the working side «
CORRECT ANSWER
b) Bennett shift is the movement of
o f the working condyle towards the working side
c) Bennett shift is the movement of
o f the working condyle towards the non-working side
d) Bennett shift is the movement of
o f the non-working condyle towards the non-working
side
e) Bennett shift is the movement of
o f both condyles in anterior movement
20. Which one of the following is a disadvantage
disadvantage to immediate dentures?
a) Gives the patient an aesthetic advantage as can
c an replace a tooth immediately
b) Reduced number of clinical stages, as CJR is normally registered
c) Is designed to fit the ridge immediately after extraction « CORRECT ANSWER
296
Following any tooth extraction, the underlying socket will initially be filled with a blood clot
which will then start to remodel. The socket can be initially protected by the immediate
denture, but during the next 6 months of remodelling, the fit of the denture will become poorer.
It may then need to be remade.
21. Which one of the following maybe associated with an unretentive denture?
a) A fully extended denture
b) Soft lining « CORRECT ANSWER
c) Implant retained bars
d) Implant retained magnets
e) Precision attachments
22. Which one of the following combinations produces the lowest stress within a root
when used as a post and core?
a) Cast metal post and core
b) Composite resin post and core
c) Composite resin core in combination with a glass fibre post « CORRECT ANSWER
d) Parallel prefabricated metal post
e) Tapered prefabricated metal post
• Comment on this Question
Stress analysis of the different post and core restoration methods has suggested that abutment
build-up using composite resin core in combination with a glass fibre post produced the lowest
stress concentration.
297
Both A and B are examples of abrasion, as a third party is involved. Options D and E are both
examples of erosion as it is the acids that are causing the tooth surface loss. Attrition will be
tooth surface loss due to tooth-to-tooth contact.
24. Which one of the following has the most minimum preparation?
a) Conventional veneer preparation
b) Full gold crown
c) Porcelain jacket crown
d) Adhesive bridge « CORRECT ANSWER
e) Conventional bridge
Current design of adhesive bridge is for minimal or even no preparation of the tooth. The bridge
is better designed as a single cantilever with a wrap around design. If the w
wing
ing is in occlusal
contact, it will be left to Dahl the opposing tooth.
25. Which of the following is the most commonly missing congenitally absent tooth?
a) Lower lateral incisor
b) Lower first premolar
c) Upper central incisor
d) Upper lateral incisor « CORRECT ANSWER
e) Upper first premolar
298
26. When designing a partial denture, which one of the following steps comes first?
a) Direct retention
b) Minor connectors
c) Support « CORRECT ANSWER
d) Indirect retention
e) Major connectors
• saddles
• support
• pathway of insertion
• direct retention
• major connectors
• minor connectors
• indirect retention
• simplification.
299
28. Which one of the following conditions is most likely for you to choose an inlay rather
than an onlay
a) Group function
b) Height:width > 1:1
c) Restoration size less than 1/3 buccal-lingual width « CORRECT ANSWER
d) Parafuctional habits
e) Severely undermined cusps
The other answers would contraindicate the use of an inlay. It is more prudent to provide some
cuspal support that an onlay provides.
29. Which one of the following will be first in the design of a partial denture?
a) Direct retention
b) Indirect retention
c) Major connectors
d) Pathway of insertion « CORRECT ANSWER
e) Support
The patient shown in the photograph below requires a lower removable partial denture.
Assuming that the distance between the gingival margin on the lingual surface of the
lower anterior teeth and the base of the lingual sulcus is 7 mm, which of the following
is the most appropriate
appropriate major connector to prescribe in this case?
a) Continuous plate
b) Dental bar
c) Lingual bar « CORRECT ANSWER
d) Lingual plate
e) Sublingual bar
A lingual bar is the most appropriate major connector because it meets the criteria of being rigid
and hygienic in nature. This requires a distance of 7 mm between the gingival margins of the
adjacent teeth and the functional depth of the sulcus (3.5 mm height of lingual bar for rrigidity,
igidity,
and 3 mm of clearance for hygienic reasons).
A lingual plate is the next best option, and can be used where the distance between the gingival
margins of the adjacent teeth and the functional depth of the sulcus is less than 7 mm.
However, as this connector covers the
t he gingival margins and lingual surfaces of the adjacent
teeth, it can be plaque retentive, and is therefore associated with a risk of periodontal disease.
The other options (ie sublingual bar, dental bar and continuous plate) are no longer used in
contemporary practice, as they are associated with tolerance problems.< /P>
31. Composite resin and amalgam are often used for restoring posterior teeth. Which of
the following scenarios is better suited for amalgam than for composite resin?
a) Aesthetically visible region
b) Deep cavity
c) Replacement restoration
301
Amalgam materials are more appropriate when a cavity margin extends subgingivally, as they
are less moisture sensitive than composite resin. Composite resins are more suitable for small
occlusal cavities (as they are more minimally invasive) and are indicated for aesthetic
ae sthetic regions. A
deep cavity and a replacement restoration
re storation can be provided in either composite resin or
amalgam.
32. Which of the following reactions describes the setting mechanism of resin-composite
materials?
a) Acid–base reaction
b) Free radical polymerisation « CORRECT ANSWER
c) Ionic bond formation
d) Sol–gel transition
e) None of the above
Resin-composite materials set as a result of a polymerisation reaction (ie the linking of smaller
monomer units to form a growing polymer chain). This reaction is initiated by free radicals,
which are formed when camphorquinone (the activator molecule within most resin-composite
materials) is exposed to incident light of wavelength 470 nm. A sol–gel transition is the setting
reaction within hydrocolloid impression materials, with the reaction being irreversible in
alginate, but reversible in agar. Acid–base reactions occur in the setting reaction of certain
cements (eg glass ionomer cements). Ionic bond formation occurs during the formation of
certain alloys.
33. What is the predominant metal in a typical dental amalgam?
a) Copper
b) Mercury
302
34. How many root canals are typically present in an upper first molar tooth?
a) 1
b) 2
c) 3
d) 4 « CORRECT ANSWER
e) 5
Around 69% of upper first molars have four canals. These consist of a large palatal canal, a
distobuccal canal and two mesiobuccal canals. In those upper first molars that have three
canals, the second mesiobuccal canal is absent.
35. You have fitted a set of complete dentures (upper and lower) for a 70-year-old man.
After 2 weeks he returns to your surgery complaining of difficulty making ‘f’ and ‘v’
sounds. What is the most likely reason
r eason for this problem?
a) Inadequate freeway space
b) Inappropriate position of incisal edges of upper teeth « CORRECT ANSWER
c) Occlusal error
d) Palate on upper complete denture is too thick
e) Upper molar teeth are set too far buccally
• Comment on this Question
303
The tissues in the anterior 2 mm of the soft palate are non-mobile, and it is useful to compress
them (in the so-called ‘post-dam area’) to enhance retention. Extending the denture beyond the
vibrating line means that it will be displaced by the mobile soft palate tissue, and the patient will
then complain that the denture is loose. Leaving the denture margin on the hard palate will
reduce the retention of the complete denture, and if the denture is designed to compress
tissues in this region, the area will
w ill probably ulcerate.
37. When recording a master impression for an upper complete denture, which of the
following impression materials
materials is used with a ‘close-
‘close -fitting’ (ie non-spaced)
non-spaced) non-
perforated special tray?
a) Alginate
b) Condensation-cured silicone
c) Impression plaster
d) Polyether
e) Zinc oxide and eugenol-based cements « CORRECT ANSWER
304
Condensation-cured silicones require spacing, but these materials are rarely used nowadays as
significant contraction occurs during setting.
38. Removable partial dentures are retained using clasps. Which of the following factors
does not determine the flexibility of a clasp?
a) Clasp length
b) Clasp thickness
c) Cross-sectional design
d) Degree of horizontal undercut in which the
t he clasp sits « CORRECT ANSWER
e) Material used in the clasp construction
• Cross-sectional design: round clasps can flex in all directions, whereas a half-round clasp
will have reduced flexibility in the plane parallel to its shorter
shorte r axis.
• Clasp length: longer clasps are more flexible than shorter ones.
• Clasp thickness: thicker clasps are less flexible than thinner ones.
• Material used: cobalt chromium clasps are stiffer than gold clasps.
305
• Abrasion is tooth wear caused by the action of external agents on the surface of teeth,
such as over-vigorous tooth brushing.
• Untreated tooth wear can lead to pulpal involvement and the need for root canal
treatment or extraction.
• Erosion causes loss of tooth tissue, such as dentine, whereas restorative materials such
as amalgam are more resistant to dissolution.
• Attrition (tooth-to-tooth wear) causes flattened lesions on the incisal edges of affected
teeth. Cup-shaped lesions are associated with erosion.
A root filling should ideally be extended to the apical constriction. The latter is a narrowing
within the root canal system approximately 0.5–1 mm away from the apical foramen. This is
regarded as the junction between the intracanal and extracanal tissues.
The radiographic apex is the radiographic representation of the anatomical apex of the tooth.
The apical foramen itself is usually 1 mm coronal to this
t his on the lateral surface of the root. In
general, filling a root canal as far as the radiographic apex will mean that the canal is ‘overfilled’
(ie the root filling material is beyond the apical constriction).
41. When performing a re-root canal treatment of a tooth with a failed root ccanal
anal
treatment, which of the following is the most appropriate irrigating solution to use?
a) Chlorhexidine « CORRECT ANSWER
b) EDTA
c) Local anaesthetic without adrenaline
d) Saline
e) Sodium hypochlorite
306
Neither local anaesthetic nor saline are particularly useful as root canal irrigants, even when
performing primary root canal treatments. Although these materials are useful lubricants, they
have little antibacterial action. Sodium hypochlorite is commonly used during primary root canal
treatments where, in addition to being a lubricant, it has tissue-dissolving and antibacterial
actions. However, its antibacterial action only lasts for about 15 minutes, so regular irrigation is
indicated. EDTA is not a root canal irrigant but a chelating agent, which is used for ‘‘softening’
softening’
dentine and thus enabling its removal during canal shaping.
42. Which of the following intra-oral regions has the highest success rate for implant
placement?
a) Anterior mandible « CORRECT ANSWER
b) Anterior maxilla
c) Posterior mandible
d) Posterior maxilla
e) Upper premolar region
The highest success rates for implant placement are seen in the anterior mandible. This is
thought to be due to the
t he fact that it contains a higher proportion of dense cortical bone relative
to softer cancellous bone. It is also relatively free from limiting anatomical structures, which are
found in other areas such as the floor of the nose, the maxillary sinus and the inferior dental
canal, and which limit the length of implants that can be placed, which in turn affects implant
success. The success rates for implant surgery can be arranged in descending order as follows:
• anterior mandible
• anterior maxilla
• posterior maxilla
307
• posterior mandible.
43. Which of the following impression materials has the greatest dimensional accuracy
when measured 3 days after being recorded
rec orded in the dental surgery?
a) Addition-cured silicone « CORRECT ANSWER
b) Agar
c) Alginate
d) Condensation-cured silicone
e) Polysulphide
Addition-cured silicone is the most dimensionally stable impression material in the above list.
Both condensation-cured silicone and polysulphide impression materials contract on setting,
due to the loss of setting reaction
r eaction by-products. Alginates and agar need to be poured quickly
after being removed from the mouth. As they are water based tthey
hey can dry out rapidly and
contract (a process called syneresis) or take
t ake water up water and swell (a process called
imbibition) if left to stand or handled incorrectly.
Due to the incorporation of resin polymers and the presence of fillers, resin composites offer
the greatest wear resistance. As the resin and filler content is highest in resin composites, lower
in compomers, lower still in resin-modified glass ionomer cements and lowest in conventional
c onventional
glass ionomer cements, the wear resistance of these materials decreases in the same order,
being highest in resin composites and lowest in conventional glass ionomer cements.
308
45. A patient presents with a throbbing pain that can be localised to the lower right
quadrant. However, the patient cannot identify the tooth that is affected. What is the
most likely diagnosis?
a) Apical periodontitis
b) Atypical odontalgia
c) Cracked tooth syndrome
d) Irreversible pulpitis « CORRECT ANSWER
e) Reversible pulpitis
• In irreversible pulpitis, the pulp has been damaged by invading bacteria. Typically a
throbbing pain is felt. However, the patient cannot identify the tooth affected, as there are no
proprioceptive fibres within the dental pulp. Proprioceptive fibres are found in the periapical
tissues, and when the infection/pulpal damage spreads to this region, the patient will complain
of a throbbing pain and can identify the tooth involved.
• Reversible pulpitis is associated with a sharp pain which is relieved once the irritant has
been withdrawn. It is not possible to identify the affected tooth.
• Cracked tooth syndrome is usually characterised by a sharp pain when biting on the
affected tooth, or when the biting pressure is released. It is often difficult to localise the affected
tooth.
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47. Which of the following is a characteristic of microfilled composites but not hybrid and
macrofilled composites?
composites?
a) Increased dimensional stability
b) Increased fracture resistance
c) Increased opacity
d) Increased surface smoothness « CORRECT ANSWER
e) Increased wear resistance
310
49. What is the most appropriate wavelength of the incident curing light for a resin
Some useful mathematical points with regard to the options listed above:
• 1 nm = 1 nanometre = 10-9 m
• 470 mm = 470 × 10-3 m, so this value is 1 000 000 times too large
• 470 µm = 470 micrometres = 470 × 10-6 m, so this value is 1000 times too large
311
a) Epidemiological studies show that more than 50% of the population have one or more
sites with recession of at least 3 mm
b) In the UK, this is more common in woman
c) The aetiology never involves inflammation
d) The gingival biotype is an important determinant of gingival recession « CORRECT
ANSWER
e) The width of the attached gingiva is considered to be an important determinant of
gingival recession
The gingival biotype is an important determinant of gingival recession. A thick gingival biotype
51. Complete the following statement, selecting one option from the list below:
52. Which one of the following statements regarding patient satisfaction with dentures is
correct?
a) Cost of dentures does not influence patient satisfaction with dentures
b) Denture quality positively influences patient satisfaction with dentures « CORRECT
ANSWER
312
Many studies have shown that dentures made to high quality result in increased
incre ased patient
satisfaction with dentures.
53. Which of the following statements regarding the use of a dental bar as a major
connector is most likely to apply?
a) It facilitates indirect retention « CORRECT ANSWER
b) It facilitates patient adaptation to the appliance
c) It is the most aesthetic option of major connectors
d) It is the most hygienic option
o ption of major connectors
e) It is useful when teeth are markedly inclined lingually
The dental bar facilitates indirect retention, as it runs along the lingual surfaces of the teeth.
54. Which of the following statements regarding periodontitis and systemic conditions is
most likely to be correct?
a) Atherosclerosis is a major risk factor for periodontitis
b) Diabetes is not a risk factor for periodontitis
c) There is no evidence of an association between oral health and respiratory disease
d) There is no increased risk of stroke
st roke in patients with periodontitis
e) There is potential for pathogens to gain access
ac cess to the systemic circulation through an
ulcerated pocket wall.« CORRECT ANSWER
• Comment on this Question
Potential pathogens can gain access to the systemic circulation through an ulcerated
periodontal pocket wall. When they have entered the circulation they have the potential to
affect systemic conditions.
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55. Which one of the following statements regarding subgingival debridement is most
applicable?
a) It should be confined to patients who are non-smokers
b) It should be confined to sites that are easy for the patient to access
c) It should be confined to sites that exhibit persistent bleeding on probing
d) It should be confined to sites that show pocket depth equal to or gr
greater
eater than 4 mm «
CORRECT ANSWER
e) It should be confined to sites with re-infection
r e-infection and suppuration
of the presence of the other factors mentioned in the first, second, third and fifth options. The
statement of subgingival debridement to be confined to sites that are easy for the patient to
access is clearly false as the procedure should be carried out at sites that are not easily
assessable by the patient, thus requiring professional intervention.
Rotation-oscillating powered toothbrushes tend to remove more plaque than manual brushes.
This statement is supported by ample research findings.
57. A particulate graft material derived from bovine bone is an example of:
a) Allograft
b) Alloplast
c) Autograft
d) Osseograft
e) Xenograft « CORRECT ANSWER
314
58. Which one of the following statements regarding direct composite restorations for
treatment of toothwear is most appropriate?
a) Patients always complain of functional problems in relation to their occlusion
b) These are more wear resistant than ceramics
c) These increase costs because of long treatment times
The statement of intrusion of anterior teeth eruption of posterior teeth does not apply to the
Dahl concept, which is based on the concept
co ncept of intrusion of anterior teeth and e
eruption
ruption of
posterior teeth.
315