TOTAL PROMETRIC EXAM ( Oral & Maxillofacial Surgery ) (2) (1)

+QUESTIONS ACCORDING TO TOPIC

(Better to read full topic of each question)

PATIENT ASSESEMENT AND MANAGEMENT 1. A hypertensive patient is scheduled for surgery. What antihypertensive drugs should not be taken the morning of surgery a)

Thiazide diuretics

b) ACE Inhibitors c)

Calcium channel blockers

2.

Anisocoria refers to

a.

Uneven pupils

b.

Corneal Lacerations

c.

Corneal injury with penetration wound

d.

Pupils which do not constrict

3.

An unconscious patient undergoing CPR, the respiration changes that needs to be made

a.

Continue with the same rate of 30 compressions with 2 breaths

b.

12 cycle per minute

4.

Pt is on warfarin therapy. What is way to continue treatment

a.

Vit K (FFP best antidote)

b.

Stop 24 hrs before

c.

Consult with his haematologist

d.

No need to stop carry on with Xn

5.

Which of the following drugs is contraindicated in pt with bronchial asthma

a.

NSAIDS

b.

Acetaminafen

c.

Beta Blockers

d.

Pencillin

1

6.

The skin over the parotid is supplied by which nerve

a.

Facial

b.

Auriculotemporal

c.

Greater Auricular

d.

Branches of the cervical trunk

7. A 34 year old female patient is rushed to the ER following MVA. Her limbs are cold and clammy. The following vitals were recorded. 1.

BP- 100/60 mm of Hg

2.

HR- 100 /min

3.

Temperature – 35.3 deg centigrade

4.

Urine – negligible

8.

She is in which stage of shock

a.

1

b.

2

c.

3

d.

4

9.

Which of the following is not a secondary immunocompromised state

a.

Malnutrition

b.

Anemia

c.

Luekemia

d.

Lymphocytopenia

10. The lymphatic drainage of the Submandibular gland is

2

a.

Submental

b.

Submandibular

c.

Deep cervical

d.

Superficial cervical

11. Which of the following values would you term to be hyper tensive a.

135/85

b.

140/90

c.

145/95

d.

150/90

12. 18 year old girl is predisposed to fainting attacks and gives a positive history of syncope and shortness of breath. Her examination reveals a mid systolic click and a late systolic murmur. She is on GTN and anti hypertensives. The dental treatment for such a patient includes a. SABE prophylaxis 13. A 54 year old man with a ho of type 2 DM is diagnose and taking treatment with Glipizide and diet control and exercise. His blood reports are as follows RBS, FBS, PPBS, glycosylated Hb. (All within normal values)(THEY HAVE GIVEN THE RANGE) What is the mode of tretament for him a.

Infective prophylaxis

b.

No change in treatment

c.

2 other choices I cant remember

14. What feature is seen in renal failure is:

a. Hypocalcemia++ (Hyperkalemia + Hypocalcemia + Hyper Magnesemia) b. Hypokalemia c. Hypernatremia d. alkalosis 15. - Buccal branch of facial nerve supplies:

A. Buccinator B. Buccinator and inferior orbicularis C. Buccinator and superior orbicularis D. Buccinator and orbicularis oris++ 16. - In an upright position, blood from medial cantus, lateral nose and upper lip drains into:

A. Inferiorly to the facial vein B. Superiorly to facial vein C. Cavernous sinus D. Pterygoid plexus 3

17. After doing CPR to an adult patient the pulse returns but without breath. Management is: A. Provide rescue breathing at rate of 10-12/mint ++ B. Provide rescue breathing at rate of 5-6/mint C. Put the patient in recovery position 18. All is true about facial nerve except: A. The facial nerve leaves the skull with accessory nerve through the jugular foramen ++ B. ?‫لتأتذكرهذاالخيارلكنهكانكانصحيحا‬ C. ?‫لتأتذكرهذاالخيارلكنهكانكانصحيحا‬ D. ?‫لتأتذكرهذاالخيارلكنهكانكانصحيحا‬ 19. Skin below the ear covering the parotid gland is supplied by: A. Superficial temporal B. Greater auricular++ C. Temporal nerve D. ? 20. Chemotherapy results in A. Reduced count of WBC B. Reduced count and function of WBC C. Reduced function but normal count D. Reduced count but normal function 21. What is the size of Maxillary Sinus: A. 14 ML ++ B. 20ML C. 9M? 22. Cell life cycle phases A. 2 B. 3 C. 4 D. 5 23. The five soft plate muscles arise from (controversial question with no answer) A. Hard palate B. Palatal bone C. Base of skull D. Palatopharyngeal arch 24. Best plain film to show maxillary sinus and orbital rim A. Caldwell view B. Water view ++ C. Lateral oblique 25. Antibiotic for empiric treatment in end stage renal deficiency is: A. Flagyl B. Doxycillin C. Clindamycin D. Penicillin 26. Ibuprofen: A. Peak effect (concentration) after 6-8 hours of administration B. Initial secretion is via liver biliary rout C. Mostly found bound to plasma protein ++ 27. Secondary immunodeficiency is associated with all except A. Malnutrition B. Anemia ++ (Refer Abubaker pg 208) C. Immunodeficiency drugs

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D. Steroid 28. Patient has been treated for rheumatoid arthritis was taking steroids for the last year and he needs multiple tooth extraction. The surgeon should A. Give supplement 50-100mg before surgery ++? B. Give 100-150mg steroid supplment C. Proceed extraction without steroid supplement

29. Cyclosporin effect is A. Increase T-Lymphocytes and decrease B-Lymphocytes B. Increase T-Lymphocytes and B-Lymphocytes C. Decrease T-Lymphocyte and increase B-Lymphocytes D. Affect T-Lymphocytes only++ 30. Following statement is true about ibuprofen a.

It cannot cross placenta

b.

It mainly excreted by hepatobiliary route

c.

Its peak plasma level after 6 to 8 hr

d.

Its largely bound to plasma protein

31. 24 year women with history of fatigue and lethary and history of syncope. Clinically mid systolic click with late systolic murmur. Probably she is suffering from a.

Hypertrohic Cardiomyopathy

b.

Mitral valve prolapse

c.

Aortic regurgitation

d.

Mitral stenosis

32. 24 year woman with history of fall with fracture central incisor comes to the clinic for extraction and immediate implant placement. She gives history of fatigue and lethargy and history of syncope. Clinically mid systolic click with late systolic murmur. What is your line of management in this pt a.

Avoid local anaesthesia with vasoconstriction

b.

SABE prophylaxsis

c.

Lab investigation for bleeding problem

d.

Do nothing

33. Fluid of choice in surgical shock a.

NS

b.

DNS

c.

RL

5

d.

Plasma

34. Hepatitis B can be transmitted by all except (controversial) a.

Dialysis

b.

Blood products

c.

Transfusion

d.

Child birth

35. Increase serum sodium level a.

Dehydration

b.

Renal problem

c.

Liver problem

d.

GIT

36. DM period of control evaluation a.

HbA1c

b.

FBS

c.

GTT

d.

24 hr serum creatinine

37. COPD pt for extraction of multiple teeth you will give a.

2.5 L oxygen

b.

4L oxygen

c.

6L oxygen

d.

No need if its only COPD

38. Nerve through internal acoustic meatus a.

CN 9

b.

CN 10

6

c.

CN 7

d.

CN 6

39. True about penicillin is a.

Narrow spectrum

b.

Broad spectrum

c.

Bacteriostatic

d.

Highly toxic

40. Management of hypoglycemic shock in 41. Largest compartment where fluid is present

7

DENTOALVEOLAR AND IMPLANT SURGERY 1. A 45 year old man has an asymptomatic impacted mandibular third molar detected on radiograph. What are the treatment options that you would choose from a.

Surgical extraction mandatory

b.

Just observe and follow up on a 6 monthly basis

c.

Wait and watch for several years

d.

No treatment required

2.

As part of preoperative assessment for elective facial cosmetic surgery, photographs need to be done

a.

With ring flash

b.

Flash at the side of the lens

c.

With overhead flood lights

d.

In natural light

3. During implant placement surgery, the head of the implant fractured but the surgeon was able to seat the healing abutment. What are the surgeons options a.

As the internal apparatus is fine nothing further need be done

b.

Removal of the implant

c.

Place another bigger implant?

4. The surgeon has a patient for whom he has placed an implant last week in relation to 15 region. The patient returns with the implant in his hand. What should be done a.

Place another bigger implant in its place

b.

Do nothing now but wait and watch for 4 weeks

8

c.

Fix the same implant with addition of bone

d.

?

5. The radiograph is shown of a tooth #10. (The crown is destroyed completely up to the level of bone with some bone loss at the apical third)The plan is for immediate placement of implant following surgery. What is the plan for extraction a.

Intralveolor extraction with straight forceps

b.

Transalveolar extraction

c.

Transalveolar extraction with elevtors

d.

Intraalveolar extraction using root tip forceps

6.

Surgeon wants to place an immediate implant after extraction. The role of resorbable membrane in this case

a.

Should be used to prevent tissue in growth in the socket space (abubaker)

b.

Should be used only in case of bone grafting when primary closure is not possible

c.

Should not be used if primary closure is achieved

d.

Is used only to prevent crestal bone loss

7.

The area lateral to the ptyerogopalatine fossa

a.

Orbital space

b.

Pterygomandibular space

c.

Infratemporal space

d.

Temporal space

8.

How much of minimal cortical thickness is required around an implant

a.

1

b.

2

c.

3

d.

4

9.

What is the reason for percussion of primary teeth before extraction

a.

Root resorption

9

b.

Periapical abcess

c.

Ankylosis

d.

To check for succadeneous tooth

10. Most commonly impacted primary tooth is a.

Incisor

b.

Canine

c.

Molar mandible

d.

Molar maxilla

11. Most commonly occurring odontogenic infection is a.

Vestibular abcess

b.

Submandibular space infection

c.

Ludwig's Angina

d.

Canine space infection

12. How would you drain a parotid abcess a.

Horizontal in skin ,horizontal in fascia

b.

Vertical in skin, vertical in fascia

c.

Horizontal in skin, vertical in fascia

d.

Vertical in skin, horizontal in fascia

13. A short maxillary central incisor with short roots is due for endodontic surgery. How much of root tip should be cut a.

1mm

b.

2mm

c.

3mm

d.

4 mm

14. A patient has ceramic crowns and requires endodontic surgery. Which is the best approach a.

Semilunar

b.

Para semilunar

c.

Sub marginal

10

d.

Sulcular

15. A 24 year old has an impacted full bony 38 distoangular third molar. During extraction, the mandibular angle fractured. The proximal fragment is displaced upwards. What is the next step a.

IMF 4 weeks

b.

Trans cervical fixation of the # with plates

c.

Transoral fixation of the #with 1 plate

d.

Transoseous wiring

16. A surgeon is placing a dental implant irt #12. Implant displaced into sinus. What is next step? a.

Leave in the sinus, prescribe antibiotics and observe

b.

Just leave it as it is

c.

Explore and removal it surgically trans crestally

d.

Wait for a week and remove it trans nasally after that

17. What is the speed of handpiece used in OMFS a.

2000-12000 rpm

b.

12000-20000 rpm

c.

20000- 40000 rpm

d.

40000 rpm and more

18. The antibacterial best suited to treat odontogenic infections in end stage renal failure patients who is allergic to pencillin a.

Trimethoprim/Sulbactum

b.

Flagyl

c.

Clindamycin

11

d.

Doxycycline

e.

Cefaclor

19. The best antibacterial of choice to treat ethmoidal and maxillary sinusitisi is a.

Pencillin

b.

Ceftazidime

c.

Ampicillin

d.

Trimethoprim\sulfamethaxozole

e.

Metronidazole

20. a. b. c. d.

The most complaint of patient with acute infection is: Calor (Heat) Dolor (Pain) Tumor (Swelling) Rubor (Redness)

21. a. b. c. d.

While doing implant in #22 severe bleeding is encountered. The surgeon should: continue implanting Pack the socket and reevaluate ++ Fill the socket with bone and continue implant Place surgical stent and follow up patient the following day

22. The forceps used for extraction of of 2nd mandibular molar with decayed crown is: A. No 23 ++ B. No 151 C. No 286 D. 88 23. The following day of inserting and implant in #22, the patient returns complaining of numbness. Management is: . Remove the implant B. Surgical exploration of the area C. Keep the implant in site since the numbness will resolve spontaneously in few days D. Follow up for few days to and remove implant if numbness persists ++ 24. In 12 year old patient, after doing extraction of maxillary first molar for orthodontic treatment, what implant is required: A. Use correct size implant B. Use smaller size implant C. Use larger size implant D. Do not implant but wait until full growth is reached. ++ 25. In thrombocytopenic patient, extraction of upper molar is contraindicated when platelets count is: A. Less than 40000 mm³ B. Less than 80000 mm³ C. Less than 150 mm³ D. Less than 250mm³

26. Antibiotic of choice for treatment of osteomyleties is: A. Clindamycine

12

B. Penicillin (1st choice is Penicillin and then Clindamycin) C. Ceftazine 27. The test for determining if a patient is affected with cat-scratch disease is: A. Handberg ? B.(It should be Warthin–Starry stain but this test was not included -PCR, IMMUNOFLUROSCENT ANTIBODY TEST) C. Skin protein test? d. hanger – rose ( fonseca ) 28. The optimum speed of rotation when preparing a tap for inserting an implant is: A. 30-40 ( contemporary tells only 15rpm) B. 40-60 C. 60-80 D. 80-100 29. 30. 31. Patient with Osteomyelitis treated with sequestrectomy and prolonged antibiotic but without improvement. Management is: A. Review culture results ++++ B. Give longer antibiotic regime C. ?(May be repeat procedure is the right answer) 32. Difficulty of tooth extraction is determined by: A. Limited mouth opening and root pattern. ( contemporary ) B. depth and age ( Peterson ) Both answers are correct 33. Patient returned the following day after extraction with gross bleeding from socket. Management is: A. Irrigate and apply packing to stop bleeding and local anesthesia. B. Gentle exploration of socket and local anesthesia. ++ 34. Sublingual Space is bounded posteriorly: A. Communicated with submandibular space B. Mylohyiod muscle 35. Lymph from Submandibular gland drains into A. Submandibular lymph nodes B. Superfacial cervical lympf nodes C. Deep cervical lymph node ++

36. Acute sinusitis is caused by: A. Mixed aerobic and anaerobic bacteria (chronic sinusitis) B. Streptococcus pneumonia (answer not typed but copied from Abubaker) 37. Narrow spectrum antibiotic causes A. Host flora minimised B. Host flora maximized C. Causing organisms minimized D. Causing organisms not affected 38. Opening ostectomy to gain access when doing microsurgical apicectomy and using ultrasound tip is A. 3mm B. 5mm C. 7mm D. 12mm

13

39. Patient with shallow vault and severely resorbed alveolar ridge require full denture. What augmentation is needed for this patient A. Onlay bone graft ++ B. Interpositional bone graft C. Transpositional bone graft D. Vestibuloplasty 40. The most common odontogenic infection A. Vestibular abscess ++ B. Cellulitis C. Ludwig angina D. Submandibular abscess 41. The most common route of spread of infection from lower third molar A. Lingucoritcal plate ++ B. Buccocortical palate C. Lingo-Bucco cortical D. Through associated muscle

42. 58 years patient with deficient alveolar ridges required construction of full denture and was determined by the surgeon to undertake Dean’s method of alveoloplasty (augmentation). Disadvantage of this method is A. ? B. ? Main disadvantage 1. Reduced ridge thickness 2. Inability to place implants (Contemporary Peterson) 43. 8 year old patient required extraction of decayed tooth and had history of easy bleeding. Hematological picture includes increases BT, elevated APTT and normal PT. His condition is a. Deficiency Factor VIII-C b. ? c. Von Willebrand disease++ d. Thrombocytopenic purpura 44. Odontogenic infection caused by A. Normal flora++ B. Exogenous flora C. Bacteria different from bacteria causing caries

45. Lab findings which is not seen in Von-Willbrand disease is: A. Increases APTT B. Norma PT C. Deficiency of Factor VIII-C and Von-Willbrand factor D. Normal platelet aggregate studies ++

46. Prophylactic antibiotic for endocardititis is indicated in A. Prosthetic valve replacement ++ B. Heart bypass surgery 47. 46- 625 mg Augmentin consists of A. 500mg Ampicillin and 125mg Clavunic acid B. 500mg Amoxicillin and 125mg Clavunic acid ++ C. ?

14

48. In type 4 (D4 density) of bone when doing implant the surgeon should A. – wider implant B. ? C. ? D. ? 49. Pt after lower third molar surgery suffer severe bleeding, how will you control bleeding a.

Local anesthesia with adrenaline , remove clot, pack and suture.

b.

Remove clot, place gelfoam, apply pressure, LA with adrenaline, suture

c.

Give vitamin K……..?

d.

Use 1:1000 adrenaline in to socket and soft tissue

50. 8 year girl require lower molar extraction due to severe caries. Gives history of bleeding. On lab investigation, increased bleeding, increased APTT, normal PT. she is suffering from a.

Factor eight deficiency

b.

Von Willebrand factor deficiency

c.

DIC

d.

Thrombocytopenia

51. Orbital cellulitis is caused by a.

Paranasal sinus infection

b.

Soft tissue infection of orbit

c.

–

d.

–

52. 18 year old with impacted third molar bilateral with soft tissue and bone chance of eruption is a.

10 – 30%

b.

30 – 50%

c.

50 – 80%

d.

100%

53. Prosthodontist desire angulation of implant 30 degree. a.

Place implant straight

b.

15 degree angulation

c.

30 degree angulation

15

d.

Revaluate

54. Prediction of operation time in third molar surgery a.

Depth of impaction

b.

Approximation of teeth to vital structures

c.

Root pattern angulation ?

55.

Absolute indication of root tip fractures removal

a.

Above apical third

b.

Close to vital structures

c.

Fracture while luxation

d.

Infected root can cause a major concern

56. Cyclosporine a.

Increase T, decrease B lymphocyte

b.

Decrease T, Increase B lymphocyte

c.

Decrease T and B lymphocyte

d.

Decrease T lymphocyte only

57.

Lateral pharyngeal space infection posterior compartment can lead to

a.

External jugular thrombosis

b.

Carotid artery rupture

c.

Recurrent laryngeal nerve damage

d.

–

58. Odontogenic infection following not true a.

Mucormycosis most common in DM

b.

25% animal bite staph. 25% human bite P. Multicida?

c.

Chronic maxillary sinusitis both aerobic and anaerobic

59.

Flap design following is not true

16

a.

Apex smaller than base

b.

Length not greater than base

c.

Axial vessel in the base

d.

No manipulation at base

60.

Oroantral communication 4mm managed by marzix Buccal sliding flap

a.

Decrease vestibular depth

b.

Bone exposure on either side

c.

–

d.

–

61.

Retropharyngeal abscess driange

a.

Intraoral

b.

Pharyngeal

c.

Anterior to SCM

d.

Angle of mandible

62. Abscess not involving airway true is a.

Cellulitis more dangerous than abscess

b.

Abscess more dangerous than cellulitis

63. Suture in Hermitically sealed wound a.

Interrupted suture

b.

running suture

c.

Subcuticular suture

d.

Suture 1-0

64. Dsyesthesia is a.

Unpleasant sensation due to normal stimuli

b.

Increased pain sensation to normal stimuli

c.

Increased sensation to painful stimuli

d.

Anaesthesia for a prolonged period of time

17

65. Maxillary molar teeth extraction infection spreading in to cranium through all except a.

Superior ophthalmic vein

b.

Inferior ophthalmic vein

c.

Pharyngeal plexus

66. Commonest aerobic organism in odontogenic infection a.

Staph

b.

Streptococcus

c.

Bacteriods

67. Calvarial bone formed by a.

Intramembraneous ossification

b.

Endochondral ossification

c.

–

d.

–

68. Extraction forceps number for lower anterior tooth (Only theory written) 151 – lower ant., 151A – mand bicuspids, 17 – molars lower, 23- cowhorn mandibular, mand wisdom – 222 150 – upper anterior and single rooted (universal ) 150A – Upper bicuspids 53 – up molars

18

210s – upper 3rd molar 88 – cowhorn 286 – bayonet 150s maxilla deciduous, 151s – mandible deciduous 69. upper molar extraction IOPA – RS 26 Diabetic patients – open or closed extraction 70. cyst in the maxilla –enucleation or endodontic surgery or extraction – order of treatment 71. commonly used flap in oral surgery ---- envelope flap, 72. bleeding from the anterior maxilla while placing implant…. what will u do … just place

implant

73. PPS Maxilla – 1mm bone from sinus.. narrow palatal vault – which surgery will u do… --- superior border augmentation 74. Preprosthetic procedure for 12 mm ridge in between foramina 75. Chances of Tumor development with 3rd molar – increases decreases, no change, 76.

Organism not seen in acute suppurative osteomyelitis - s.aureus……?????????.

77.

Sublingual space communicates posteriorly with -----

SM, LATERAL PHARYNGEAL ???????? 78. Incision for drainage of retropharngeal space - anterior border of SCM 79. Cavernous Sinus thrombosis – doesn’t occur ---- via Sup ophthalmic vein , inferior opthalmic, angular, pterygoid plexus ????????? 80. Complication of draining retropharyngeal space – injury to carotid sheath 81. Management of impacted tooth in 45 year old patient without any problem 82. 83. 84. 85. 86. 87. 88. 89. 90.

Implant in sinus Chances of eruption of impacted tooth after the age of 18 Most common cause for impaction Extraction of 10 root stump Most common flap in oral surgery Cyst w.r.t to 9 and 10 in the maxilla Implant causing numbness in 21 what u do next Implant coming out after placement after 1 week what to do Ibuprofen metabolism

91. Absolute indication for extraction of tooth 92. Study after methylene t99 in osteomyelitis 93. Protocol for HBO therapy

19

94. Following statement is true about ibuprofen e. It cannot cross placenta f.

It mainly excreted by hepatobiliary route

g. Its peak plasma level after 6 to 8 hr h. Its largely bound to plasma protein 95. 24 year women with history of fatigue and lethargy and history of syncope. Clinically mid systolic click with late systolic murmur. Probably she is suffering from a. Hypertrophic Cardiomyopathy b. Mitral valve prolapse c. Aortic regurgitation d. Mitral stenosis

20

LOCAL ANESTHESIA 1. A patient with history of uncontrolled hyperthyroidism requires surgery. Which is the surgeon’s is choice of LA a.

Lidocaine

b.

Mepivacaine -

c.

Propoxycaine

d.

Bupivacaine? – least toxic

2. A patient presents with submandibular space infection requiring I and D. The surgeon wishes to makes use of EMLA for the site of Venipuncture. Which of the statements are correct a.

EMLA is a mixture of Bupivacaine and Prilocaine

b.

EMLA is 2.5 % of lidocaine and Procaine

c.

EMLA is a combination of 2.5 % of lidocaine and Prilocaine

d.

It should be applied at least 60 mins prior to venipuncture

3.

What is considered as the maximum dose for adrenaline in a hypertensive patient

a.

0.2 mg

b.

0.02mg

c.

0.04mg

d.

0.0018 mg

4. A surgeon wants to use X tip system for intraosseous anesthesia of the mandibular premolar. What is the size of the needle used(study from malamed) a.

25 gauge short needle

b.

27 gauge long needle

c.

27 gauge ultra short needle

21

d.

30 gauge short needle

NOTE: IAN – 25 Gauge long needle Buccal – 27 gauge short needle Mental – 27 short Supraperiosteal – 27 short PDL – 27 Short Intraosseus – 27 short PSA – 27 Short , Infraorbital – 25 long, Maxillary – 25 long , Infiltration – 27 short

5.

Local anesthetic of choice in uncontrolled hyperthyroidism

a) prilocaine b) mepivacaine c) bupivacaine d) lidocaine 6. A person on tricyclic antidepressants if injected with Lidocaine containing 1:100000 of epinephrine will have the following effects a.

An increase in blood pressure due to VC

b.

A decrease in heart rate due to LA

c.

An increase in heart rate due to VC

d.

A decrease in blood pressure due to LA

7.

The heart has the following number of receptors sensitive to adrenaline in the body

a.

1

b.

2

c.

3

d.

4

8. An 8 year old child who weighs 16 kg is in need of extraction. How many carpules of 2% lidocaine with 1:100000 epi be safely given a.

1

b.

3

c.

5

d.

10

22

9.

Pain conduction is through which nerve fibres

a.

Unmyelinated c fibres

b.

Myelinated c fibres

c.

A fibres

d.

Delta fubres (If A DELTA FIBRES THIS IS THE CORRECT ANSWER)

10. After reversal of the IANB, in which of the structures will the effects first be felt a.

Central incisor

b.

Canine

c.

Premolar

d.

Molar

11. An inexperienced dentist soaks his dental anesthetic cartridges in isopropyl alcohol. When he delivers a nerve block what will be the effect ? a.

Gingival sloughing

b.

Palatal ulcerations

c.

Prolonged anesthesia

d.

No change

12. Subclasses adrenergic receptors which vasoconstrictor act upon in myocardium A. 1 B. 2 C. 3 ++ (α1 + β1 + β2) D. 5 13. The least effective vasoconstrictor A. Norepinephnne B. Epinephnne C. Levonordefrin++ D. Octapressin (Felypressin) 14. Pt on TCA, Local anesthesia with norepinephrine a.

Lidocaine induces hypotension

b.

Norepinephrine induced hypertension

c.

Norepinephrine induced relapse of depression

d.

Lidocaine induced relapse of depression

15. Local anaesthetic which can be only injected

23

a.

Tetracaine

b.

Benzocaine

c.

Prilocaine

d.

Etidocaine

GENERAL ANESTHESIA 1. A patient who cannot maintain the airway has a tendency for vomiting. Best method to prevent aspiration is by employing

24

a.

A cuffed ET tube

b.

Laryngeal mask

c.

??

2. In a conscious patient with intact pharyngeal reflexes, which is the best method of airway patent? a.

Nasopharyngeal airway

b.

Venturi mask

c.

Bifid nasal canula

d.

Oropharyngeal airway

maintaining

3. The anesthetist is at work in a pt with limited mouth opening and manages to secure his airway after repeated attempts. Which of the following laryngeal cartilages are most likely traumatized a.

Cuneiform

b.

Cricoid

c.

Thyroid

d.

Arytemoid medial surface

4.

Which of the following drugs need to be stopped on the day of the surgery

a.

ACE inhibitors

b.

Beta blockers

c.

Thiazide Diuretics

d.

Ca Channel blockers

5. During anesthesia, the patient starts coughing and body becomes rigid. The pt is apneic. Which of the following drugs is not helpful in this condition a.Lidocaine b. Suxamethonium c. Propofol d. fentanyl

6.

Which of the following devices can hold the maximum gastric content in case the patient accidently vomits.

a.

Cuffed ET tube

b.

Laryngeal mask airway

25

c.

Cobra LMA(PLA - Perilaryngeal airway)

7.

The drug of choice in Fentanyl associated chest wall rigidity is one of the following

a.

Lido caine

b.

Flumezenil

c.

Nalaxone

d.

Propranol

8. A 26 year old male patient has a skeletal class 2 with retrogenia. His BMI is 32. What is the best way to secure his airway before surgery a.

Blind awake nasotracheal without sedation

b.

Awake Orotracheal under sedation

c.

Fiberoptic guided nasotracheal intubation

d.

Treacheostomy

9. In a post trauma patient who is obtunded, in whom pharyngeal reflexes are intact, which of the folowing is advised to secure airway b.

Orotracheal airway

c.

Nasopharyngeal airway

d.

Nasal cannula

e.

Venturi mask

10. General anesthetist uses topical anesthesia – which area– supraglottic , infraglottic (transtracheal) or glottic (Question not clear)

11. Rotameter - used for what --- GAS flow

ANESHTHESIA MEASURMENT.

12. Malampatti classification

13. Adrenaline dose in intubated patient is: A. 1 mg in 1 ML B. 1 mg in 10 ML C. 2.5 mg 2.5 ML D. 2.5 mg in 10 ML 14. The fastest nondepolarisingneuromascular drug is:

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A. Succinylcholine B. Artacurium C. vecuronium D. Rocuronium 75 Sec) 15. Patient with difficult airway posted for surgery, premedication all except A. Diazepam++ B. Ranitidine 16. Endotracheal drugs are all except A. Glycopyrrolate++ B. Atropine C. Vasopressin D. Naloxone 17. The most common cause of hypotention after general anesthesia A. Hypoxia ++ (Assumingly this one) B. ? IF INHALATION ANESTHETIC DRUGS ARE THERE IN THE ANSWER – CHOSE IT FIRST 18. TMJ ankylosis to pt. induced by inhalation anesthetic after 60 minutes pt produces crowing sound and severe chestwall movement. Drug which will be not be useful is a.

IV Propofol

b.

IV lidocaine

c.

Sch

d.

Fentanyl

19. Surgeon plans for surgery. Desires decreased secretion with slight depression of CNS, drug of choice

a.

Atropine

b.

Scopolamine +++

c.

Glycopyrolate

20. First skeletal muscles to contract after using succinyl choline used during general anesthesia is A. Eyelids B. Shoulder C. Hands D. Abdomen

21. Pt on TCA, Local anesthesia with norepinephrine a. Lidocaine induces hypotension b.

Norepinephrine induced hypertension

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c.

Norepinephrine induced relapse of depression

d.

Lidocaine induced relapse of depression

DENTOFACIAL DEFORMITIES 1. A pt with Class 1 molar relation has severe retrogenia and a severe disparity in the anteroposterior relation of her mand to maxilla relation. What Treatment plan

28

a.

Genioplasty

b.

Mandibular advancement with genioplasty

c.

Lefort 1 with mandibular advancement

2. A patient walks into your clinic with subconjunctival ecchymosis without visualization of posterior limit. (She also has black eye.? No nerve paresthesia. She gives h/o an Orthognathic surgery done to correct mid face deformity. What would be the most likely procedure a.

High Lefort 1

b.

Quadrangular lefort 2

c.

Lefort 3

d.

Pyramidal Lefort 2

3. A patient has midface deformity with deficiency in the malar and zygomatic regions. How would you correct her condition. a.

High level lefort 1

b.

Quadrangular lefort 2

c.

Lefort 2

d.

Lefort 3

4. While doing an IVRO osteotomy of the mandible for advancement, there is an unfavourable fracture high in the proximal segment. What is the most apt way the surgeon should proceed. a.

Change the osteotomy to the inverted L

b.

Do a C osteotomy

c.

Treat the pt for a condylar neck fracture

d.

Abandon the procedure and do MMF

5.

Following BSSO, the TMDs commonly seen are

a.

Retro positioned chin

b.

Deviation of the mandible

c.

Posterior displacement of the condyle in high mandibular plane angle cases

d.

Derangement of the disc

6.

Post operative numbness associated with the lower lip after BSSO is seen commonly after

a.

Use of drill to osteotomize

b.

Use of Bone osteotomy

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c.

Use of plate and screw for fixation

d.

Mandibular manipulation

7.

Class 1 with AP deficiency(Class2) and good chin

8.

Surgery for midface and infraorbital and malar deficiency

9. After doing bimaxillary osteotomy and fixation the surgeon realises that the occlusion is unstable. Management is: A. Remove maxillary fixation and stabilise the occlusion and fix again B. Remove mandibular fixation and stabilise the occlusion and fix again C. Remove both maxillary and mandibular fixation and stabilise occlusion and fix again D. Do nothing 10. Genioplasty is done A. Inferior to mental foramen ++ B. Superior to mental foramen C. Anterior to mental foramen D. According cephalometric analysis 11. In true asymmetry of mandible A. Incisor midline doesn’t coincide to symphysis middline in centric occlusion B. No functional shift C. Midsymphysis doesn’t coincide with midsagittal plane ++ D. Bilateral end to end crossbite 12. Maximum range of interincisal opening A. 25mm B. 45mm C. 45-55 in men ++ 35-45 in women ++ 13. Maximum range of lateral movement of mandible A. 10mm ++ Average Lateral excursion movement is 10-15mm ( 8-14 mm Protrusion) B. 25mm 14. The effect of Le fort I on nasal tip is: A. Protrusion when doing advancement++ B. Not affected when doing downward positioning C. Retrusion when doing stepback 15. Pt with class 2 with good chin a.

Advancement genioplasty

b.

Increase orthodontically class 2 condition and maxillary setback?

c.

Orthodontically increase and protrude incisors to class 3?

d.

Mandibular advancement and reduction Genioplasty

16. True Mandibular asymmetry can be detected by

30

a.

Dental midline and midsymphseal mismatch

b.

Lateral shift in Centric occlusion

c.

Bilateral Edge to Edge cross bite in CO

d.

Mid saggital and Midsymphseal mismatch

17. Prevention or management of alar base widening in maxillary osteotomy by a.

Single layer closure of mucosal incision

b.

Alar Cinch suture with non resorbable suture

c.

Nasal septum suture to nasal spine

d.

By avoiding superior placement of maxilla

18. Lip length in normal adult will be a.

Equal to commissural height

b.

Less than commissural height

c.

More than commissural height

d.

–

PATHOLOGY 1.

Ca alveolus and buucal mucosa. Mandibulectomy with SND2. Reconstruction of choice

a.

Fibula oseocutaneous free flap

b.

Temporalis

c.

SCM

d.

Skin graft

2.

Most commonest odontogenic tumor

a) ameloblastoma (2nd most common)

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b) odontoma c) CEOT d) Fibroma (non-odontogenic tumor commonest)

3. Ulcer in the FOM in a 65 yr old. SOHND ( 1 to 3) is chosen to treat him. What are the reconstructive options that are best suited? a.

PMMC

b.

Temperomyofascial flap

c.

Massetric ?

d.

Radial forearm free flap

4.

A ca of lower lip entails sacrificing 80% of the lower lip. Which is the best reconstructive option available?

a.

Advancement of the lip flap based on sup labial artery

b.

Rotation flap

c.

Bernard ... flap / technique

d.

5. A 54 year old man has undergone an anterior en-bloc resection of the mandible for treating as part of cancer therapy. The surgeon wishes to use the clavicle based on the SCM to reconstruct the mandibular defect. Select the statement which is true. a.

The graft cannot be segmented to fit the morphology

b.

The graft is good to place dental implants

c.

Gives good morphological substitution for defect

d.

It is the best of reconstructive options available

6. A 56 year old lady has a small giant cell granuloma in her mandible. She is diagnosed to be having secondary hyperparathyroidism. What is the next step a.

Treat her tumour by enucleation and curettage

b.

Excision of the parathyroid gland to conrol excess secretion of PTH

c.

Treat her renal condition and supplement with Vit D and Calcium

d.

Treat the lesion by steroid injections

7.

Most common affliction of the Sublingual salivary gland

a.

Sialolith

b.

Mucocele

32

c.

Ranula

d.

Pleomorphic adenoma

8.

In a patient who is 30 years old, which of the following is the most common tumour

a.

Ameloblastoma

b.

CEOT

c.

Cementoblastoma

d.

AOT

e.

9.

IgG antibodies is demonstrated in the basement layer of which of the following

a.

Lichen Planus

b.

Erythema Multiforme

c.

Discoid lupus erythematosus

d.

Pemphigus Vulgaris

10. A 45 year old man who is a chronic smoker for the past 25 years has been diagnosed with a well differentiated carcinoma of the lower lip measuring 2 cm. On examination there are no palpable lymph nodes. Which is the best method of treatment for him? a.

Wedge excision

b.

Chemotherapy

c.

Just observe

d.

Radiotherapy

11. A 58 year old male presents with an ulcer that is 3x2 cm in size with no palpable lymph nodes. Contrast enhanced CT is done and reveals no cortical perforation in the lesion and no lymphatic involvement. A SND(iiii) is planned for his treatment. The surgeon wishes to reconstruct the defect. His best option is a.

PMMC

b.

Temporalis myofascial flap

c.

Full thickness skin graft

d.

Split thickness skin graft

12. cysts of jaws usually cause CORTICAL EXPANSION, ROOT RESORPTION, TOOTH DISPLACEMNT 13. Hairy leukoplakia in AIDS 14. Most common tumor in pediatric age group – haemangioma. Lipoma, fibroma

33

15. Recent modality of treatment of pagets disease 16. Reconstruction after snd 1-3 17. Treatment of choice for salivary cancers 18. Clavicle based graft 19. 0.4 cm lesion found below ear lobe. The lesion is: A. Attached to skin but movable and not attached to underlying connective tissue sebaceous cyst. B. Attached to skin but movable and not attached to underlying connective tissue epidermoid cyst. C. Attached to skin not movable and attached to underlying connective tissue sebaceous cyst. D. Attached to skin not movable and attached to underlying connective tissue epidermoid cyst. 20. Definitive treatment of ranula is A. Marsipulization B. Marsipulization and packing C. Sublingual gland excision ++ D. ? 21. Posterior iliac graft nerve injured is a.

Lateral cutaneous

b.

Lateral femoral

c.

Superior cuneal

d.

–

22. The most common odontogenic tumor A. Ameloblastoma++ (Note = The most common = Odontoma) B. Cementoblastoma C. Adenotamoid tumor D. Calcifying epithelial odontogenic cyst 23. 24. 25.

Post CA upper lip 80% loss. Reconstruction a.

Wester – bernald flap

b.

Perialar advancement flap

c.

Abbe flap

d.

Radial ?

e.

26. Curettage and enucleation true (Question incomplete??? a.

Indicated in OKC

b.

Removal of bone 5mm or 1cm

34

c.

Treatment of Dentigerous cyst

d.

–

35

CLEFTS AND SYNDROMES 1.

The skin of the prolabium is used for

a.

Collumela lengthening

b.

Creation of vermillion

c.

Lining the labial mucosa

2. A 7 year old boy has come to your maxillofacial clinic with a history of congenital facial deformity. His OMENS score is 8. What systemic examination will you send the boy to next. a.

CNS, Skeletal, CVS

b.

CVS, Pulmonary , skeletal

c.

CVS, CNS, Skeletal

d.

CNS, CVS, Pulmonary

3. Syndrome question = Facial paralysis + fissural tongue + swollen lip A. Melkersson-Rosental Syndrome ++ 4. Syndrome question(Question incomplete) A. Crhon syndrome B. Carpenter Syndrom C. Crouson D. Angioneurmatic Edema 5. Best site for harvesting clavarial bone graft A. Parietal bone B. Occipatal bone C. Temporal bone D. Frontal bone 6. With age the cranium becomes A. Thick and dense B. Thin and light++ C. Thick and heavy 7. Patient with Treacher Collins syndrome needed correction of mandibular deficiency which included 12cm advancement. Best approach is A. BSSO B. Inverted L osteotomy ++ extra oral C. Intraoral vertical ramus osteotomy D. Extraoral vertical ramus osteotomy Peter ward Booth 2 page 947 8. Millard C flap in correction of cleft lip is A. Rotation flap of lateral lip B. Rotation flap of medial lip C. A divided rotation to increase columella length and nasal floor ++ D. ? 9. Cleft palate patient prepared for modified lefort I osteotomy. How much advancement the surgeon plans to counteract relapse during osteotomy and bone graft healing period and to adjust posterior placed condyle intraoperatively.

a. 1mm 36

b. 2mm c. 4mm d. 6mm 10. New born the mandible is separated in the midline by

a. b. c. d.

Synovial joint Fibrous joint Catrilagenous tissue Fibrous tissue

11. Pt with wide cleft lip and palate lip adhesion or nasoalveolar molding planned a.

Few week after birth

b.

First – third month

c.

Third to sixth

d.

6–9

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TRAUMA 1. A 25 year old man is admitted for surgery after RTA with diagnosis of Bilateral Condylar # with communition of Midface. This condition is a case for a.

Absolute indication for fixing the condyles

b.

Relative indication ...

c.

Case for MMF

d.

Absolute contraindication for fixing Condyle

2.

In which condition there is no need for ORIF for ZMC fractures

a.

Medial displacement

b.

Lateral displacement

c.

Inferior displacement

d.

No displacement

3.

Which is a most relevant finding for a patient in shock

a.

Pulse pressure

b.

Heart rate

c.

Systoic blood pressure

d.

Diastolic blood pressure

4.

An 8 year old child has sustained a fracture of the condyle. What is the indication for ORIF

a.

Dentoalveolar injury

b.

Intarcapsular fracture with middle cranial fracture

c.

Inability to open mouth after 1 week of closed reduction

d.

The degree of displacement of condyle

38

5. A 34 year old man has sustained a MVA with fractures of the skull base with orbital fractures. On examination for consensual light reflex in the right eye, there is a negative response. The same reflex for the left eye is normal. There is associated ptosis of the left eye. The pt has damage to a.

CN1 on the L; CN 2 R

b.

CN2 R and CN3 L

c.

CN2 L and CN1 L

d.

CN3 R and CN2 L

6. A patient has sustained head injury after MVA. He has cerebral concussion and is in coma. If the patient stays in coma for how many hours, will there be residual nuerological deficit. a.

1

b.

2

c.

4

d.

8 0r 6

7. predominant medial wall of orbit – ethmoid(lateral wall – zygomatic & gr wing of sphenoid, floor – orbital surface of maxilla, palatine bone and zygoma)

8.

Placement of

9.

Airway maintenance in a conscious patient

10. Nerve injured commonly in ZMC fracture 11. Cause for sublingual ecchymosis 12. In surgical shock the patient should be given: A. Normal Saline B. Lactated Ringers ++ 13. What is the CT scan interval for zygomaticfracture: (OBLIQUE PARASAGITTAL VIEW FOR ORBITAL FRACTURES) A. 0.5mm B. 1-1.5mm C. 15.2.5mm D. 2.5-3.5 14. In maxillofacial trauma patient with suspected injury to cervical thoracic vertebra, the diagnostic radiograph is: A. ? B. ? C. ? D. swimmers view or cross table views 15. Maximum MMF in fracture mandible of 12 year old boy is: A. One week B. 2-3 weeks

39

C. 5-6 weeks 16. Trauma patient with pulse rate =130, BP 100/60, breathing =30/mint, how much blood loss is expected in this patient A. Less than 15% B. 15-30% C. 40% D. 30-40 % ++ 17. In trauma patient the initial pulmonary reaction A. Tachypnea and decreased CO2 serum++ B. Tachypnea and increased CO2 serum C. Bradypnea and increased CO2 serum D. Bradypnea and decreased CO2 serum 18. Glasgow comma scale score in trauma patient who is non responsive to verbal communication + can open the eye + responds to pain stimuli A. 8 B. 10 C. 12 D. 15 19. Best plain film for showing zygomatic arches A. Submentovertix++ B. Occipatal C. PA D. ? 20. Towne’s view is similar to A. Anteroposterior++ B. Posteroanterior C. Water D. ? 21. Trauma patent to the skull showed vertical diplopia and torsional diplopia. The most likely injured nerve A. II B. III C. IV++ D. V 22. Trauma patient developed asymmetrical pupil (Not round). The most likely cause A. Blow out fracture B. Blow in fracture C. Perforation of the eye ball D. ? 23. Reason of airway obstruction in obtunded patient A. Bleeding B. Vomitus C. Tongue fall ++ D. ? 24. Axial CT for zygomatic fracture is done to show A. Orbit floor involvement B. lateral wall and zygomatic arches C. ? D. ?

40

25. Orbital floor trauma which gaze cause diplopia a.

Upward and lateral

b.

Upward and medial

c.

Downward and lateral

d.

Downward and medial

26. 24 year female with angle fracture. Surgeon decides to fix with compression plating technique. Following is true a.

Less chance of motor and sensory nerve injuries

b.

Will need two week IMF postop

c.

Should be approached extraorally

d.

Will heal by secondary intension

27. Greenstick fracture a.

Fracture of onside of the bone with out fracture of other side

b.

Incomplete fracture

c.

Will cause severe displacement of while fixation

d.

–

28. Compound fracture a.

Multiple fracture at on site

b.

Severe loss of tissue around the fracture

c.

External communication through oral cavity

d.

–

29. Ptosis A. –drop upper eyelid B. – C. – D. –

41

TMJ 1.

Which of the following statements are true of Pulsed MRI

a.

T1 images are useful to visualize discal perforations and position

b.

T2 images signify the presence of Inflammation

c.

T2 images signify inflammatory changes.

d.

??

2.

Pulsed MRI scanning of the TMJ shows

a.

T1 weighted images shows disc position and disc perforation

b.

T2 weighted images shows disc position and disc perforation

c.

T1 weighted Images show inflammatory changes

d.

T2 weighted Images show inflammatory changes

3. What is the position of disc irt to condyle in case of early internal derangement when mandible is in closed position a.

Anterior and straight

b.

Anterior and medial

c.

Anterior and lateral

d.

No change

4.

Hypermobility of tmj botulinum toxin

5. a. b. c.

stylomandibular ligament Formed from the parotid fascia Runs from styloid process to the angle mandible Lateral check ligament

42

d.

Prevents the movement of the condyle

6.

Disc position

7. In Internal disk derangement the disk is displaced A. Anteriorly ++ ( antromedially ) B. Medially C. Posteriorly D. Laterally 8. The most degenerative changes of bony parts of TMJ is done when A. Diskectomy B. Eminectomy C. Disk treatment

9. Most likely cause of myofacial pain dysfunction is A. Bruxism following stress++ B. Internal derangement with reduction C. Internal derangement without reduction D. ? 10. Commonest cause of myofacial pain a.

Degenerative joint disease

b.

Internal derangement without reduction

c.

Internal derangement with reduction

. Bruxism following stress++

11. Hydrostatic pressure causing TMJ degeneration based on theory a.

Hypoxic – reperfusion theory

b.

–

c.

–

d.

–

‫مع تمنياتي للجميع بالتوفيق والنجاح‬

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