Canadian NDEB 2012 Clinical Judgment Practice

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N. Incisional biopsy
- lesion >1cm in diameter
- hazardous location
- suspicion of malignancy

O. Excisional biopsy
- lesion <1cm in diameter
- benign

Any white & or red lesion persistent for more than 2 week.
Any lesion can not diagnosed clinically
Any lesion excised for any reason for confirmation of Dx.
(Oxford Handbook 2nd Edi)

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..Please give your Ref. if you can.
Thanks
:thumbup:
 
.Question: 2 (Select ONE OR MORE correct answers.) .
.Which of the following should be included in the treatment plan for the management of this patient? .
.A. No special consideration needed. .
.B. Prophylactic antibiotics. .
.C. Short appointment. .
.D. Anxiolytic/sedative drug administration. .
.E. Prophylactic nitroglycerin. .
.F. Avoid NSAIDs. .
.G. Avoid opioids. .
.H. Avoid epinephrine. .
.I. Minimize the use of epinephrine. .
.J. Avoid local anesthetic. .
.K. Adjust current medication. .
.L. Stop current medication prior to appointment. .
.M. Delay routine treatments. .
.N. Treat at the end of the day. .
.O. Must treat in a hospital facility. .
 
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question #2 which should be included in tx plan:

A. no special consideration

B. prophylactic antibiotic
- http://www.nsdental.org/media_uploads/pdf/37.pdf (page 4-6 has tables)

C. short appointment
-anxious patients
-with systemmic condition: DM, history of angina, MI, stroke, HF, COPD, epilepsy.. etc.

D. anxiolytic admin
-very anxious patients
-optional: to reduce anxiety that may trigger attack: patient with history of MI, angina, stroke, heart failure, asthma (stress induced), epilepsy.. etc

E. prophylactic nitroglycerin
-unstable angina
-MI: only if directed by physician

F. Avoid NSAID
-allergies
-on anticoagulant
-has defect in blood clotting
-peptic ulcer
-impaired kidney or liver
-asthmatic patients

G. Avoid opioid
-allergies
-significant respiratory disease
-current substance abuse
-pregnancy(unless benefits>risks)

H. avoid epi
-allergic to epi
-narrow angle glaucoma
-thyrotoxicosis
-hypertensives (max of 0.04mg)
-hyperthyroid
-shock

I. minimize epi
-hypertensives (max of 0.04mg)
-hyperthyroid

J. avoid local anes
-pateints needing gen anes.. patients with disabilities??
-NOT FAMILIAR.. KINDLY ADD..

K. adust current meds

L. stop current meds prior to appointment

M. delay routine tx
-unstable angina
-MI < 6 months
-pregnant esp 1st and 3rd semester

N. treat at end of day
-COPD patients

O. must tx in hospital

please feel free to correct or add on the answers.. thanks!!
Where did you get your answers from?
 
A) This was last year Q for "Exclusive cases of prophylaxis Endocarditis"
"A well controlled diabetics Pt." and case similar to these.
 
I dont really understand what you mean by your post. Please can you explain what you mean?
 
A) This was last year Q for "Exclusive cases of prophylaxis Endocarditis"
"A well controlled diabetics Pt." and case similar to these.
I dont really understand what you mean by your post. Please can you explain what you mean?
 
I dont really understand what you mean by your post. Please can you explain what you mean?
If the Pt. is Normal healthy person or one of above (well controlled Condition) then we have to chose this answer to get score.
Is it OK?
 
Where did you get your answers from?
got my answers from orala nd maxillofacial surgery (peterson) chapter 1: preoperative health status evaluation.. i can send you the pdf file of that chapter. what is your email add?
 
If the Pt. is Normal healthy person or one of above (well controlled Condition) then we have to chose this answer to get score.
Is it OK?
Ok, I get what you mean now. How many questions were there per book last year?
 
In last year's exam Q about patient taking atenolol you had to reduce epinephrine dosage
 
Also the picture with white buccal mucosa lesion I was confused between fictional keratosis and linea alba.how do we differentiate??
 
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Short appointments and anxiolytic administration for uncooperative pediatric pts
 
I realized you have to read the cases very carefully to score well on the exam
 
Hi
Is any one applying to the universities this year?
 
In last year's exam Q about patient taking atenolol you had to reduce epinephrine dosage

It should be reduce for Cardiac-risk Pt.
0.04mg epinephrine (1:100,000 >> 2 cartridges or 1:200,000 >> 4 cartridges)
0.20mg Levonordefrin
(DD 2007-8)
 
Any other Ans for J to O?
I am sure there are.
 
Also the picture with white buccal mucosa lesion I was confused between fictional keratosis and linea alba.how do we differentiate??
i think that the answer would most likely be linea alba since it is more common, especially if the lesion is along the occlusal plane.. however, it it was stated that patient wears dentures, frictional keratosis would be the choice.

Frictional (traumatic keratosis):
-White plaque
-Rough and frayed surface
-Due to mechanical irritation
-Resolves on elimination of irritant (after 2 weeks of removal)
-Similar to calluses on skin
-Frequently associated with:
------rough or maladjusted dentures
------sharp cusps
------edges of broken teeth


Linea Alba:
-horizontal streak at BM
-level of occlusal plane from commisure to post tth
-very common
-associated with:
-----pressure
-----frictional irritation
-----sucking trauma from facial surfaces of tth
-usually bilateral
-prominent in individuals with reduced overjet of post teeth
-usually scalloped
-restricted to dentulous areas
-no treatment
-may disappear spontaneously

.Burket's Oral Medicine: Diagnosis & Treatment.
. By Lester William Burket, Martin S. Greenberg, Michaël Glick.
 
Hey does anyone have an idea what are the proportions of the questions of the exam ie. How many questions are oral path/pharm/ perio/ Ortho/ surgery etc
 
I could not see absolute contraindication of LA. but some in cases should consider to avoid LA.
1) Hepatic disease. All Amides type LA metabolized by liver & excreted by Kidney (Ester type >> metabolized by plasma)
2) Renal failure?!! (NS)
3) Hypersensitive to LA (usually sodium bisulfite ) more common in Ester type.

4) Uncooperative Pt. kids( NS)

(DD 2007-8)
 
Adjusting Pt. Medication ONLY with consultation of his/her physician.
1) Pt. on systemic Corticosteroid
2) Pt on anticoagulant medicine, Aspirin & clopidogrel (plavix)
 
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After consulting with Pt. physician, Anticoagulant may need to stop prior to surgery. e.g Aspirin & clopidogrel (plavix)
In some cases they switch Oral anticoagulant to short acting Heparin on the day of surgery & then back to normal medication
(I do not recall the reference)
 
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stop delayed acting insulin for diabetic patient getting oral surgery that will affect his food intake post-operatively.
 
Nothing much to add. These are from my past experience & personal perception.

M. Delay routine Tx.
Any Unstable condition that was stable before, need to control first.

N. Treating at end of the day
HIV, Hepatitis & other highly contiguous cases.

O. Must treat at hospital facility
Those Pts. need strict control of existing condition for surgery & /or Pts. need special care after Dental, surgical Tx.

Any thing more to add ?
 
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.Question: 3
.

.Which of the following is the most likely diagnosis for the entity shown in the above photograph? .
. A. Linea alba. .
.B. Fordyce's granules. .
.C. Leukoedema. .
.D. Leukoplakia/hyperkeratosis with or without dysplasia. .
.E. Frictional/traumatic keratosis. .
.F. Mucosal burn. .
.G. Lichen planus. .
.H. Candidiasis. .
.I. Hairy leukoplakia. .
.J. Lupus erythematosus. .
.K. White sponge nevus. .
.L. Erythema migrans/geographic tongue. .
.M. Mucous patches of secondary syphilis. .
.N. Hairy tongue. .
.O. Verrucous carcinoma. .
 
A normal variation in the buccal mucosa that appears as a white line beginning at the corners of the oral cavity and extending posteriorly at the level of the occlusal plane. It is composed of keratinized oral mucosa.
 
- Sebaceous glands
- Soft, symmetrically discoloured creamy spots slightly elevated a few mm in diameter (esp elderly)
- Common site – buccal mucosa
- Also – lips
- Rarely tongue

Linea alba and Fordyce granules refs: Cawson's Essentials of Oral Pathology and Oral Medicine, 8e
 
A normal variation in the buccal mucosa that appears as a white line beginning at the corners of the oral cavity and extending posteriorly at the level of the occlusal plane. It is composed of keratinized oral mucosa.
Etiology: Pressure, sucking from the buccal surface of the teeth.
Clinical features: Asymptomatic, bilateral, linear elevation with a slightly whitish color at the level of the occlusal line, normal consistency on palpation. The diagnosis is based on clinical grounds alone.
No treatment is needed.
(Pocket atlas of Oral Dise. 2nd Edi. G. Laskaris)
 
• Varied appearance - filmy opalescence of the mucosa in early stages to a more definate grayish-white cast with a coarsely wrinkled surface in the later stages
• Bilateral - more noticable along the occlusal line in the premolar-molar region
• Diagnostic - stretch the tissue and white disappears (Leukoplakia - does not dissapear)
• No treatment needed (varient of normal mucosa)

Cawsons Essentials of Oral Pathology and Oral Medicine 8ed
 
I know this is a later question, but does anyone know what Epinephrine Reaction is and the symptoms/signs for it? Q24L (Medical Emergencies)
 
- Sebaceous glands
- Soft, symmetrically discoloured creamy spots slightly elevated a few mm in diameter (esp elderly)
- Common site – buccal mucosa
- Also – lips
- Rarely tongue

Linea alba and Fordyce granules refs: Cawson's Essentials of Oral Pathology and Oral Medicine, 8e
No Tx. required
 
Leukoplakia is defined as a white patch or plaque, firmly attached to the oral mucosa, that cannot be classified as any other White lesion.
Etiology: unknown exactly. But tobacco, alcohol, chronic local friction, and Candida albicans Human papilloma virus (HPV) may consider factors.
Clinical features: Three clinical varieties are recognized:
homogeneous (common), speckled (less common), and verrucous (rare).
Speckled and verrucous leukoplakia have a higher risk for malignant
transformation. The average percentage is between 4% and 6%. The
buccal mucosa, tongue, floor of the mouth, gingiva, and lower lip are the
most commonly affected sites.
Dx. confirm by Biopsy
Treatment Elimination of predisposing factors, systemic
retinoid compounds. Surgical excision is the treatment of choice.
(Laskaris, Pocket)
 
Nothing much to add. These are from my past experience & personal perception.

M. Delay routine Tx.
Any Unstable condition that was stable before, need to control first.

N. Treating at end of the day
HIV, Hepatitis & other highly contiguous cases.

O. Must treat at hospital facility
Those Pts. need strict control of existing condition for surgery & /or Pts. need special care after Dental, surgical Tx.

Any thing more to add ?


do you have any reference for letter N?
i always come across with treating them like any other patient for as long as you take precautionary measures.. i read in one article from canadian journal that it's unethical to treat them at end of day.. i'm confused..
 
Frictional (traumatic keratosis):
-White plaque
-Rough and frayed surface
-Due to mechanical irritation
-Resolves on elimination of irritant (after 2 weeks of removal)
-Similar to calluses on skin
-Frequently associated with:
------rough or maladjusted dentures
------sharp cusps
------edges of broken teeth


Linea Alba:
-horizontal streak at BM
-level of occlusal plane from commisure to post tth
-very common
-associated with:
-----pressure
-----frictional irritation
-----sucking trauma from facial surfaces of tth
-usually bilateral
-prominent in individuals with reduced overjet of post teeth
-usually scalloped
-restricted to dentulous areas
-no treatment
-may disappear spontaneously

.Burket's Oral Medicine: Diagnosis & Treatment.
. By Lester William Burket, Martin S. Greenberg, Michaël Glick.
 
do you have any reference for letter N?
i always come across with treating them like any other patient for as long as you take precautionary measures.. i read in one article from canadian journal that it's unethical to treat them at end of day.. i'm confused..

No. As I said these are from my past experience & personal perception.
Treating any pt. at end of day is not unethical as always some one is at the end of the list. HIV virus is very weak at out side environment. If by chance they left for long time they can not survive. You may agree this, at the end of practice or at beginning of next day your staff can clean all surfaces of the room more efficient without time limit. This is what I was told & practice.
 
It is a normal anatomical variation,
Etiology: Increased thickness of the epithelium and intracellular edema of the prickle-cell layer.
Clinically, it is characterized by a grayish-white, opalescent pattern of the mucosa and a slightly wrinkled, it disappears when the mucosa is everted and stretched. It usually occurs bilaterally on the buccal mucosa, and rarely on the tongue and lips.

Treatment No treatment is required.
Laskaris, Pocket
 
white lesion of mucous membrane that cannot be identified as any other “white” disease Using this definition, biopsy is required for accurate diagnosis.
Biopsy show hyperkeratosis, a purely reactive and harmless lesion. However 20% will show dysplasia, a premalignant lesion.
Leukoplakia is more common in males in older age groups.
There are usually no symptoms.
Etiology is unknown although physical trauma, smoking, excessive alcohol intake and Vit.A deficiency are suspected.
20% of leukoplakia are dysplastic or malignant on biopsy.
Leukoplakia in the floor of the mouth and lateral/ventral
tongue mucosa are more likely to be precancerous.
Tx. for simple hyperkeratosis, removal of cause.
Those showing dysplasia, or carcinoma, >> methods used in treatment of
cancers.
(A GUIDE TO COMMON ORAL LESIONS DR. CHARLES L. DUNLAP AND DR. BRUCE F. BARKER)
 
E. Frictional/traumatic keratosis

Common white lesion caused by chronic friction on mucosa
• The lips, the lateral margins of the tongue, the buccal mucosa (mainly along the occlusal line), and the edentulous alveolar ridges are the most common sites to find frictional keratosis and its variants.
• Typically, the lesions appear as distinct, focal, and translucent-to-opaque white asymptomatic patches with sharply delineated borders. The surface of a lesion may appear irregular and feel rough to the tongue.
• Slight variations in the clinical presentation are directly related to the nature and the source of the physical trauma.
• Management:
• Removal of irritant
• Biopsy only if patch persists
• Completely benign – no malignant potential

Cawsons Essentials of oral pathology and oral medicine 8th ed
 
ORTHO QUESTIONS:
i think the bulk of the questions are ortho...
i only anserwd some items, only those that i am familiar with and have read about..
i have yet to search on the other items..
feel free to comment, add, or correct the answers..
kindly use another color so it will be easier to see.. thanks :)

.Question:.. 26.. (Select ONE OR MORE correct answers.)...
.Which.. of the following facial characteristics does this patient have?...
. .
.A... Convex profile type..
.-seen in class II skeletal patients.
.-lower 3rd way behind rest of face.
.B. Straight profile type..
.-self explanatory.
.C. Concave profile type..
.-seen in class III skeletal patients.
.-..lower 3rd way ahead of rest of face...
.D... Retrognathic facial type..
.-refers to the mandible (retrognathic mandible).
.-seen in class II skeletal patients.
.-lower 3rd way behind rest of face.
.E... Orthognathic facial type..
.-straight profile...
.F... Prognathic facial type..
.-refers to the mandible (prognathic mandible).
.-seen in class III skeletal patients.
.-lower 3rd way ahead of rest of face..
.

.G... Long lower face height..
.-usually seen in anterior open bite...
.H... Normal lower face height.
.-upper, middle and lower 3rd equal in height (ideal)...
.I. Short lower face height..
.-usually seen in deep bite cases (like class II div 2).
.-also seen in class III patients.
.. .J. Acute nasolabial angle..

-.usually seen in class III patients. .K... Obtuse nasolabial angle..

.-usually seen in class II patients.. . .L... Short upper lip..
.-associated with excessive display of maxillary gingiva...
.M... Incompetent lips..
.-lips are separated >3-4mm at rest.
.-seen in bimaxillary protrusion.
.-patient must strain to bring lips together...
.N... Everted (redundant) lips....
.-seen in cases when teeth are protruded excessively.
.-sometimes seen in short lower face coz lips are overclosed so upper lip presses against lower lip.
.-draw a vertical line passing soft tissue pt. A and pt. B, if lips are too far forward from the lines = everted lips.
. .
.Question:.. 27.. (Select ONE correct answer.)...
.Which.. of the following dental occlusions does the patient have?...
. .
.A... Angle Class I..
.-.. mesiobuccal cusp of the maxillary first molar is aligned with the buccal groove of the.. mandibular first molar.
.B. Angle Class II division 1..
.-.. class II molar relationship.
.- maxillary anterior teeth are proclined and a large overjet is present.
.C. Angle Class II division 2..
.-.. class II molar relationship.
.-.. maxillary anterior teeth are retroclined and a deep overbite exists.
.D... Angle Class II division 1 subdivision right....
.E... Angle Class II division 1 subdivision left....
.F... Angle Class II division 2 subdivision right....
.G... Angle Class II division 2 subdivision left..
.-subdivisions refer to the side where the malocclusion is found.
.H... Angle Class III..
.-..buccal groove of the mandibular first molar mesially positioned to the mesiobuccal cusp of the maxillary first molar.
.I. Angle Class III subdivision right....
.J. Angle Class III subdivision left...

.
. . .
.Question:.. 28.. (Select ONE OR MORE correct answers.)...
.Which.. of the following reflect the overjet, overbite and midline relationships for this...
.patient?...
. .
.A... Negative overjet....
.B. Normal overjet....
.C. Excessive overjet....
.D... Negative overbite....
.E... Normal overbite....
.F... Excessive overbite....
.G... Maxillary midline coincident with the mandibular midline....
.H... Maxillary midline to the left of the mandibular midline....
.I. Maxillary midline to the right of the mandibular midline..
.- I think these are self explanatory.. feel free to comment or add though
.

.-normal overjet and overbite: 1-3mm...
. .
. .
.Question:.. 29.. (Select ONE OR MORE correct answers.)...
.This.. patient presents with...
. .
.A... no space discrepancy in the maxilla....
.B. no space discrepancy in the mandible..
.C. crowding in the maxilla....
.D... crowding in the mandible....
.E... spacing in the maxilla....
.F... spacing in the mandible..
.- I think these are self explanatory.... feel free to comment or add though.

.
.
.Question:.. 30.. (Select ONE OR MORE correct answers.)...
.Based on the cephalometric values provided, the patient presents with...
. .
.A... a prognathic maxilla..
.-SNA greater than normal range...
.B. a normally positioned maxilla....
.C. a retrognathic maxilla..
.-SNA less than normal range...
.D... a prognathic mandible..
.-SNB greater than normal range...
.E... a normally positioned mandible....
.F... a retrognathic mandible..
.-SNB less than normal range...
.G... a flat (low) mandibular plane..
.-S-N-mandibular plane angle less than normal (more acute than normal).
.-seen in short lower face cases...
.H... a normal mandibular plane....
.I. a steep (high) mandibular plane..
.-S-N-mandibular plane angle greater than normal (more obtuse than normal).
.-seen in long lower face cases...
.J. labially inclined maxillary incisors..
.-max incisor to palatal plane greater than normal...
.K... normally inclined maxillary incisors....
.L... lingually inclined maxillary incisors..
.-max incisor to palatal plane less than normal...
.M... labially inclined mandibular incisors....
.-IMPA greater than normal...
.N... normally inclined mandibular incisors....
.O... lingually inclined mandibular incisors....
.-IMPA less than normal...
. .
. .
.Question:.. 31.. (Select ONE OR MORE correct answers.)...
.What type of crossbite does this patient have?...
. .
.A... Bilateral posterior crossbite with a functional shift....
.B. Bilateral posterior crossbite without a functional shift....
.C. Unilateral posterior crossbite with a functional shift....
.D... Unilateral posterior crossbite without a functional shift....
.E... Anterior crossbite with a functional shift....
.F... Anterior crossbite without a functional shift..
.-with functional shift: ..results from an occlusal interference that requires the mandible to shift either anteriorly and/or laterally in order to achieve maximum occlusion.
.-without functional shift: mandible closes smoothly to maximum occlusion.

.
.
.Question:.. 32.. (Select ONE OR MORE correct answers.)...
.The patient presents with...
. .
.A... a maxillary Bolton discrepancy....
.B. a mandibular Bolton discrepancy..
.C. late eruption..
.-just memorize age of eruption...
.D... early eruption..
.-just memorize age of eruption...
.E... an abnormal midline diastema..
.-if diastema is present after eruption of permanent maxillary canines.
.-if diastema is extremely large...
.F... a normal midline diastema..
.-normal sized diastema from primary dentition until before eruption of permanent maxillary canines...
.G... over-retained primary teeth..
.-just memorize age of eruption (primary teeth may exfoliate 6 months before until end of age range)...
.H... supernumerary teeth..
.- self explanatory...
. .
. .. .

.Question:.. 33.. (Select ONE OR MORE correct answers.)...
.Which.. of the following is/are appropriate interceptive orthodontic treatment(s) for this...
.patient?...
. .
.A... No treatment at this time....
.B. Interproximal discing of one or more primary canines....
.C. Interproximal discing of one or more primary molars....
.D... Extraction of one or two primary maxillary canines....
.E... Extraction of one or two primary mandibular canines....
.F... Extraction of one or more primary maxillary molars....
.G... Extraction of one or more primary mandibular molars....
.H... Space maintenance in the maxillary arch..
.-early loss of primary teeth, no evidence of erupting permanent...
.I. Space maintenance in the mandibular arch..
.-early loss of primary teeth, no evidence of erupting permanent...
.J. Space regaining in the maxillary arch..
.-teeth drifted due to early loss or primary teeth (space defieciency is 3mm or less)...
.K... Space regaining in the mandibular arch..
.-teeth drifted due to early loss or primary teeth (space defieciency is 3mm or less)...
.L... Habit breaking appliance..
.-especially for tongue thrusting/sucking...
.M... Posterior bilateral maxillary arch expansion incorporating habit control..
.-constricted maxilla due to thumbsucking...
.N... Posterior bilateral maxillary arch expansion..
.-constricted maxilla resulting to posterior crossbite...
.O... Anterior crossbite correction..
.- self explanatory.
.- must be treated immediately.

.
.
. .
.Question:.. 34.. (Select ONE OR MORE correct answers.)...
.The appliance(s) shown in the photograph will result in the following movements of...
.tooth.. ____?...
. .
.A... Mesial root tipping....
.B. Distal root tipping....
.C. Mesial crown tipping....
.D... Distal crown tipping....
.E... Buccal (labial) crown rotation....
.F... Lingual crown rotation....
.G... Extrusion....
.H... Intrusion....
.I. Distal translation....
.J. Mesial translation....
. .
 
ORTHO QUESTIONS:
i think the bulk of the questions are ortho...
i only anserwd some items, only those that i am familiar with and have read about..
i have yet to search on the other items..
feel free to comment, add, or correct the answers..
kindly use another color so it will be easier to see.. thanks :)
.
.

.Question:.. 35.. (Select ONE OR MORE correct answers.)...
.The removable orthodontic appliance shown in the photograph is designed to...
. .
.A... incline incisors labially....
.B. incline incisors lingually....
.C. move posterior teeth mesially....
.D... move posterior teeth distally....
.E... advance the mandible....
.F... prevent space loss..
.G... advance the maxilla....
.H... expand the maxillary arch....
.I. gain arch space....
.J. eliminate a habit....
. . . .
.Question:.. 36.. (Select ONE correct answer.)...
.What is the most appropriate orthodontic appliance that is the most appropriate to treat...
.the patient's malocclusion?...
. .
.A... Maxillary Hawley with springs....
.B. Palatal expander..
.-maxillary constriction associated with post crossbite...
.C. Functional appliance....
.D... Space maintainer..
.-early loss of primary teeth.. if lost 6 months before age of eruption of succedaneous tooth, no need for space maintainer (verify also in radiograph if succedaneous tooth is developing normally..)...
.E... Anterior biteplate....
.F... Posterior biteblock....
.G... Habit breaking appliance..
.-patients with oral habits.....
.H... Retainer..
.-after orthodontic correction...
.
.
. .
.Question:.. 37.. (Select ONE correct answer.)...
.What is the most appropriate type of occlusal appliance for this patient?...
. .
.A... Anterior biteplate..
.-for patients with reverse anterior overjet...
.B. Posterior biteblock..
.-patients with deep bite...
.C. Full coverage biteplane....
. .
. .
.Question:.. 38.. (Select ONE OR MORE correct answers.)...
.Which.. of the following etiological factors may explain the interdental spacing seen in the...
.patient?...
. .
.A... Normal development..
.-physiologic spacing seen during primary dentition.
.-midline diastema present until before eruption of permanent maxillary canines...
.B. Thumbsucking..
.-history of thumsucking.
.-palate may be constricted...
.C. Large frenum..
.-abnormally large space.
.-as seen clinically.. inserts in between the incisors.
.-frenum blanches when upper lip is lifter up...
.D... Mesiodens..
.-abnormally large space/ diastema after eruption of permanent maxillary canines.
.-as seen on radiograph or clinically...
.E... Incisive canal cyst..
.-abnormally large space/ diastema after eruption of permanent maxillary canines.
.-as seen on radiograph...
.F... Missing permanent lateral incisor(s)..
.-confirm on radiograph...
.G... Peg lateral incisor(s)..
.-as clinically seen...
.H... Ectopic eruption of permanent teeth....

. .
.Question:.. 39.. (Select ONE correct answer.)...
.When should orthodontic treatment be initiated for the patient?...
. .
.A... Immediately....
.B. During the primary dentition....
.C. During the mixed dentision (after eruption of the first permanent molars and incisors)....
.D... During the late mixed dentition prior to pubertal growth spurt....
.E... Immediately following the eruption of the permanent second molars....
. .
. .
.Question:.. 40.. (Select ONE OR MORE correct answers.)...
.Treatment of the mandibular arch of this patient with fixed orthodontic brackets will...
.result in...
. .
.A... incisors inclined lingually....
.B. incisors inclined labially....
.C. decreased arch length....
.D... increased arch length....
.E... no change in arch length....
.F... intrusion of premolars....
.G... extrusion of premolars....

.
. .Question:.. 41.. (Select ONE correct answer.)...
.At.. this time, the most appropriate management for this patient is...
. .
.A... reassess in 9 to 12 months....
.B. a habit breaking appliance..
.-confirm if patient has habit...
.C. space maintenance..
.-early loss of primary teeth...
.D... a frenectomy..
.-fibrotic frenum causing abnormal diastema.
.-frenum blanches when upper lip is lifted...
.E... to close the space by orthodontic treatment..
.-minimal abnormal spacing/diastema.
.F... to close the space by prosthodontic treatment..
.-extremely large abnormal spacing...
.G... to extract primary canine(s)....
. .
. .
.Question:.. 42.. (Select ONE OR MORE correct answers.)...
.What record(s) would be necessary to establish an orthodontic diagnosis for this patient?...
. .
.A... Facial and intra-oral photographs..
.-needed for all cases except for minor or adjunctive tooth movements only...
.B. Models..
.-needed for all cases...
.C. Panoramic radiograph..
.-needed for all cases...
.D... Periapical radiograph(s)..
.-supplemental to pano when certain teeth needs to be further inspected.
.-for patients with perio concerns before having ortho treatment...
.E... Lateral cephalometric radiograph(s)..
.-needed for all cases except for minor tooth movements...
.F... Antero-posterior cephalometric radiograph..
.-facial assymetry (but must be postero-anterior ceph, not antero-posterior ceph)...
.G... Hand-wrist film(s)..
.-to assess growth potential.
.H... Cone-beam CT(s)..
.-TMJ disorder related...
. .
 
.Question: 3
.

.Which of the following is the most likely diagnosis for the entity shown in the above photograph? .
. A. Linea alba. .
.B. Fordyce’s granules. .
.C. Leukoedema. .
.D. Leukoplakia/hyperkeratosis with or without dysplasia. .
.E. Frictional/traumatic keratosis. .
.F. Mucosal burn. .
.G. Lichen planus. .
.H. Candidiasis. .
.I. Hairy leukoplakia. .
.J. Lupus erythematosus. .
.K. White sponge nevus. .
.L. Erythema migrans/geographic tongue. .
.M. Mucous patches of secondary syphilis. .
.N. Hairy tongue. .
.O. Verrucous carcinoma. .


.Question:. .3. .(Select. .ONE. .correct. .answer.).
.Which. .of. .the. .following. .is. .the. .most. .likely. .diagnosis. .for. .the. .entity. .shown. .in. .the. .above.
.photograph?.

.A.. .Linea. .alba..
-horizontal streak at BM
-level of occlusal plane from commisure to post tth
-very common
-associated with: pressure, frictional irritation, sucking trauma from facial surfaces of tth
-usually bilateral
-prominent in individuals with reduced overjet of post teeth
-usually scalloped
-restricted to dentulous areas
-no treatment
-may disappear spontaneously

.B.. .Fordyce’s. .granules..
-ectopic sebaceous glands
-developmental
-yellowish
-symmetrically distributed
-asymptomatic
-loc: BM, vermilion
-no tx
.C.. .Leukoedema..
.-general opacification of BM.
.-asymptomatic.
.-symmetrically distributed.
.-disappears when stretched.
.-no tx.
.D.. .Leukoplakia/hyperkeratosis. .with. .or. .without. .dysplasia..
.-clinical term for white patch that cannot be rubbed off.
.-needs biopsy.
.-high risk site for malignant transformation: floor or mouth>tongue> lip> palate> BM> vestibule.
.E.. .Frictional/traumatic. .keratosis..
.-cause: chronic rubbing friction.
.-like callus on skin.
.-loc: lips, lateral margin of tongue, edentulous ridge due to dentures, BM along occlusal line.
.-tx: remove cause, no malignant potential.
.F.. .Mucosal. .burn..
.-confirm with history of placing aspirin on mucosa.
.-most common: aspirin burn.
.-increase concentration and contact time = coagulative necrosis.
.G.. .Lichen. .planus..
.-unknown cause.
.-chronic mucocutaneous disease.
.-white keratotic striae = wickham’s striae.
.-loc: BM, tongue, gingiva.
.-tx: corticosteroids, antifungal, retinoids.
.H.. .Candidiasis..
.-acute pseudomambranous = thrush, most common form.
. =white, soft plaques can be rubbed off .
. = leaves raw surface (painful).
.-chronic erythematous = denture sore mouth (bright red, pebbly surface) and angular cheilitis (decrease VDO).
.-chronic hyperplastic = median rhomboid glossitis, loc: dorsum of tongue.
.I.. .Hairy. .leukoplakia..
.-associated with AIDS.
.-causes: EBV, HIV, immunosuppression.
.-asymptomatic.
.-well demarcated white lesion.
.-plaque like or papillary or corrugated.
.-loc: lateral border of tongue.
.J.. .Lupus. .erythematosus..
.-autoimmune disease.
.-(+) ANA to circulating antibodies.
.-skin: butterfly rash.
.-oral: erythematous/ ulcerative with delicate white keratotic striae radiating from periphery.
.-SLE: fever, malaise, weight loss.
.-tx: SLE-systemic steroids, DLE-topical corticosteroids.
.K.. .White. .sponge. .nevus..
.-hereditary.
.-asymptomatic.
.-folded, thickkened, spongy.
.-bilateral, symmetric.
.-before puberty.
.-loc: BM, tongue, vestibule.
.-no tx.
.L.. .Erythema. .migrans/geographic. .tongue..
.-unknown cause.
.-loc: dorsum of tongue.
.-atrophic patches surrounded by elevated keratotic margins.
.-desquamated areas: red, may be tender.
.-pattern moves and changes.
.-tx: keep mouth clean.
.M.. .Mucous. .patches. .of. .secondary. .syphilis..
.-reddish-brown.
.-covered by mucoid exudate.
.-most contagious stage.
.-may have fever, flu-like symptoms, lymphadenopathy.
.N.. .Hairy. .tongue..
.-overgrowth of filiform papillae.
.-alteration of microbial flora.
.-white to tan to deep brown to black.
.-causes: drugs, mouth rinses, intense smokers, radiotherapy.
.-tx: eliminate initiating factor, brush tongue with baking soda.
 
ORTHO QUESTIONS:
i think the bulk of the questions are ortho...
i only anserwd some items, only those that i am familiar with and have read about..
Well last year there was only one case on Ortho with 5-6 Qs I guess so.
Thanks for your Ans on Ortho
 
I have all the important information and links from all the different courses to prepare for both the clinical skills and clinical judgement exams with all the experience from the applicants who passed last year exams.
If any body needs it, u can contact me at [email protected]
 
From what we. Know. Epinephr new emergency means too much epinephrine causing reacting I read in an Article that it's treatment is nitroglycerin.
 
From what we. Know. Epinephr new emergency means too much epinephrine causing reacting I read in an Article that it's treatment is nitroglycerin.
Do you have a link to this article?
 
Well last year there was only one case on Ortho with 5-6 Qs I guess so.
Thanks for your Ans on Ortho
Do you know how the rest of the questions were allocated ie how much perio, oral path, surgery etc?
 
Do you know how the rest of the questions were allocated ie how much perio, oral path, surgery etc?
Sorry I was late I am practicing Clinical skill.
As far as I remember there were 6 case, one ortho and others cases mostly were pt. with systemic condition ( not very complicated ) need routine Tx.
The afternoon secession was totally X-ray reading & interpretation.
 
..
.Question: 4 (Select ONE correct answer.) ..
.
.Patient ____ Photograph ____ .
.Which of the following is the most likely diagnosis for the entity shown in the above photograph? .
. A. Aphthous ulcer(s). .
.B. Herpes zoster. .
.C. Traumatic ulcer(s). .
.D. Recurrent herpes simplex. .
.E. Primary herpetic gingivostomatitis. .
.F. Necrotizing ulcerative gingivitis. .
.G. Erythema migrans/geographic tongue. .
.H. Herpangina. .
.I. Mucosal burn. .
.J. Lichen planus. .
.K. Squamous cell carcinoma. .
.L. Cicatricial pemphigoid/benign mucous membrane pemphigoid. .
.M. Pemphigus vulgaris. .
.N. Erythema multiforme. .
.O. Lupus erythematosus. .
. .
 
Dandani can you remember any of the lesions in last year's exam...I remember one was for linea alba,one was for some ulcer. Do you remember any other pictures.
 
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