AIIMS JUNE 2013

GENERAL ANATOMY

1. Temporomandibular joint develops at ?

a. 10 weeks

b. 2 weeks

c. 20 weeks

d. 22 weeks

2. All the following cranial nerves transmit taste sensation to the brain EXCEPT?

a. 9

b. 10

c. 5

d. 7

3. Which of the following nerve carries taste sensations from circumvallate papillae?a. Lingual nerve

b. Glossopharyngeal nerve

c. Chorda tympani nerve

d. Hypoglossal nerve

4. Muscle responsible for opening of mandible ?

a. Lateral pterygoid

b. Medial pterygoid

c. Temporal

d. Buccinator

5. All of the following are true about facial nerve, except ?

a. It is secretomotor to submandibular gland

b. It supplies anterior belly of digastric

c. It has a large motor & small sensory root

d. Parasympathetic innervation to palatal & nasal glands

6. Damage to facial nerve just above branching of chorda tympani causes all except ?

a. Hyperacusis

b. Decrease salivation

c. Loss of taste from tongue

d. Paralysis of muscles of facial expression

7. Danger layer of scalp is?

a. Periostiumb. Connective tissuec. Loose areolar tissued. Aponeurosis

8. Infection from dangerous area of face goes to cavernous sinus through?

a. Pterygoid plexus

b. Ethmoid

c. Maxillary sinus

d. Submental lymph nodes

9. Deepest layer of deep cervical fascia is

a. Carotid sheath

b. Vertebral fascia

c. Temporal fascia

d. Prevertebral fascia

GENERAL PHYSIOLOGY

10. In an experiment a scientist injected myeloid stem cells in ablated animal. At end of incubation period he found colonies of ?

a. Erythrocytes

b. T lymphocytes

c. Fibroblasts

d. Hematopoietic stem cells

11. A patient with prolonged PT & APTT , normal fibrinogen, platelets & Thrombin Time , The most probable cause is?a. DIC

b. Factor VII deficiency

c. Liver disease

d. Vitamin K deficiency

12. In the jugular venous pulse the c wave indicates?a. Rapid ventricular fillingb. Atrial filingc. Tricuspid bulgingd. Arterial contraction

13. CO transfusion in lung is diffusion limited as (AIPG 2012)a. The CO has high affinity to hemoglobin

b. The base of lung poorly ventilated

c. PCO increase in blood immediately on exposure

d. Diffusion of CO across blood barrier very slow

14. The 20 to 30 % of increase in cardiac output is seen in which of the following period of pregnancy ?

a. 20 week

b. 22 week

c. 24 week

d. 28 week

BIOCHEMISTRY

15. Number of base pairs found in human genome DNA is

a. 1.5 billion

b. 3 billion

c. 4.5 billion

d. 6.2 billion

16. The process of studying chromosome shape ,size and fine structure under microscope is known as ?

a. Chromosome mapping

b. Karyotyping

c. Gene Mapping

d. Genotype

17. Which of the following amino acid is both ketogenic and glucogenic is

a. Isoleucine

b. Leucine

c. Arginine

d. Glycine

GENERAL PHARMACOLOGY

18. All of the following drugs causes gingival hyperplasia except ?

a. Bleomycin

b. Sodium valproate

c. Carbamez

d. Verapamil

19. Drug given by nasal drops for conscious sedation is ?

a. Halothane

b. Ketamine

c. Midazolam

d. Diazepam

20. Lithium interferes with non-depolarizing muscle relaxant should be stopped how many days before surgery

a. 1

b. 2

c. 3

d. 4

21. All are true of paracetamol toxicity except ?

a. acetyl cysteine is an antidote

b. 10mg is safe dose

c. Patient remain asymptomatic for 24-48 hrs

d. Combine with gluthathione residue to reduce the toxicity

22. Suxamethonium is available as clear liquid has a shelf lifea. 6 months

b. 1 year

c. 2 year

d. 3 year

23. Articaneall are true except?(AIPG 2012)

a. Plasma half-life90 min

b. Is amide which is metabolized in liver

c. Infiltration more effective than nerve block in mandible

d. More break down causes more toxicity

24. Malignant hyperthermia is caused by?

a. Suxamethonium

b. Thiopentone

c. Propofol

d. Cis-Atracurium

25. Cis-atracurium is one of purest form of the 10 isomers of Atrcurium. The recommended dose is ?

a. 0.01 mg/kg

b. 0.15 mg/kg

c. 0.2 mg/kg

d. 0.5 mg/kg

26. True about use of midazolam over diazepam in sedation is all except (AIPG 2012)

a. Less thrombophlebitis due to low solubility in blood

b. More plasma binding and less toxicity

c. More potent than diazepam

d. Binds to benzodiazepine receptors with 34 times more avidity

27. Anticholinergic drug which did not cross blood brain barrier ?

a. Atropine

b. Hyoscine butyl bromide

c. Hyoscine methonitrate

d. Glycopyrrolate

GENERAL PATHOLOGY

28. chromosomes is found in which of the following conditions?

a. Turner syndrome

b. Downs syndrome

c. Klinefelterd. All of the above

29. A 32 year lady having painless palpable left supraclavicular lymph node revealed acidophilic double nuclei owl eye appearance of lymph node on histopathological examination with CD15 & CD30 positivity on immunochemistry. The probable diagnosis is ?

a. Reactive nodular hyperplasia

b. Anaplastic large cell lymphoma

c. Nodular lymphocytic Hodgkin Lymphoma

d. Lymphocytic predominant Hodgkin Lymphoma

ORAL HISTOLOGY

30. Nerve supply in pulp is

a. Sympathetic and afferent postganglionic

b. Parasympathetic postganglionic

c. Motor sympathetic and autonomic

d. Motor only

GENERAL SURGERY

31. The best source for factor 8 concentration (KCET 98)

a. Whole blood

b. Desmopressin

c. Fresh frozen plasma

d. Cryoprecipitate

ORTHODONTICS

32. Preferred retainer for midline diastema is ?a. Hawley retainerb. Hawley retainer with finger spring c. Tooth positioner d. Bonded retainer

33. Decreased collum angle seen in ?

a. Class II Div I

b. Class II Div II

c. Bimaxillary protrusion

d. Class III

34. Collum angle is seen in which of the following conditions (PGI 2012)a. Class II div IIb. Class II div Ic. Class III casesd. Bimaxillary protrusion

35. Maximum Lip thickness achieved in adult male by is achieved at the age of ?

a. 12 year

b. 21 year

c. 16 year

d. 25 year

36. Increased interincisal angle is seen in which of the following conditions?

a. Bimaxillary protrusion

b. Class II div 2

c. Class I type 2

d. Class I cases

37. Maxillary bone grown by

a. Displacement and drift

b. Drift alone

c. Apposition

d. Resorption

38. A 14yrs boy with class 2 div 1 malocclusion. which model ananlysis method is used to decide ,whether to do extraction or not? (AIIMS NOV 2011)

a. Ashley Howe

b. Pecks n pecks

c. Bolton

d. Ponts

39. 90 degree activation of pendulum appliance created how much distal force on molars? (AIIMS NOV 2011)

a. 125

b. 75

c. 350

d. 250

40. All of the following assumptions are considered true when doing space analysis for calculating space discrepancy except ?

a. All permanent teeth will develop normally

b. Correlation between the size of mandibular incisor and succedaneous teeth

c. Prediction table most valid for all population

d. Arch dimension remain stable throughout the growth

41. Which of the following malocclusions likely to result due to early surgical repair of cleft lip and palate?a. Anterior open bite

b. Rotated maxillary central incisor

c. Anterior deep bite

d. Unilateral or Bilateral Posterior cross bite

42. Surgery of cleft lip is done at age of ?

a. 3 month

b. 3 week

c. 1 year

d. 3 year

43. Moyers classification Type D class II malocclusion is

a. Retrogntahic maxilla ,retrognathic mandible

b. orthognathic maxilla ,retrognathic mandible

c. retrognathic maxilla ,orthognathic mandible

d. Orthognathic maxilla, orthognathic mandible

44. A parent of 10 month child is worrying as teeth has not yet erupted. The ideal treatment would be to ?

a. Wait and watch

b. Advice OPG to check for tooth buds

c. Advice A-P view to check for tooth buds

d. Not recalled

45. Gjessing canine retraction is made up ofa. 0.016 X 0.022 inch stainless steel wire

b. 0.018 X 0.025 inch stainless steel wire

c. 0.017 X 0.025 inch TMA wire

d. 0.015 X 9.022 inch TMA wire

PEDODONTICS

46. Which of the has a little significance ?

a. Mandibular incisor erupting before mandibular molar

b. Mandibular canine erupting before mandibular premolar

c. Mandibular 2 PM erupting before mandibular 2 molar

d. Maxillary Premolar and canine erupting before maxillary 2nd molar

47. To predict the Occurrence of caries in a 10-year-old child, which of the following gives best result?

a. Sibling caries

b. Mothers caries

c. Previous caries experience

d. Snyders test

48. Growth of children of different age group is evaluated on different parameter at same point of time ?

a. A longitudinal studies

b. Cross sectional

c. Coss longitudinal

d. Interventional

49. CAT defines high risk group as all except ?

a. Visible plaque on anterior tooth

b. Atleast one area of demineralization or white spot lesion

c. Enamel hypoplasia

d. Children with special health care needPROSTHODONTICS

50. Masseteric notch is formed due to action of ?

a. Masseter on buccinator

b. Buccinator on masseter

c. Superior constriction on buccinators

d. Buccinators on superior constriction

51. Bacteria free zone of dentinal caries ?

a. Decalcification zone

b. Decomposed zone

c. Bacterial invasion zone

d. Zone of Dentinal sclerosis

52. Which the following it characteristic of Mandibulofacial dysostosis ?

a. Vertical maxillary excess

b. Normal hearing

c. Normal vision with coloboma

d. Mandibular prognathism

53. Halo effect around root seen in ?

a. Horizontal root fractureb. Widened pdlc. Acute periapical abscessd. Apical periostitis

54. Minimum dose required for tetracycline staining is said to be ?

a. 5 mg/kg body weight

b. 20mg/kg body weight

c. 50 mg/kg bodyweight

d. 80 mg/kg body weight

55. In order to prevent pigmentation via tetracycline, it is not given before the age

a. 3 yrs

b. 8 yrs

c. 12yrs

d. 5 years

56. Impression material used to take impression of a bite mark ?

a. Impression plaster

b. Alginate

c. Silicon putty

d. Polyvinyl siloxane

ORAL RADIOLOGY

57. All of the following are the features of tuberous sclerosis except ?

a. Calcified subependymal nodulesb. Ependymoma

c. White matter lesion

d. Giant cell astrocytoma

58. Occupational exposure of radiation to dentist is ?

a. 100 miliroentgen /week

b. 10 roentgen /week

c. 100 Roentgen /week

d. 300 roentgen /week

59. For viewing root fractures following angulations can be used are ?a. 900b. 900 and 450c. 900 ,450 and 1100d. 450 , 1100ORAL SUREGRY

60. Initial clicking in TMJ while opening is due to ? (AIIMS MAY2012)

a. Disc in anterior position ahead of the condyle

b. Condyle in anterior position ahead of the disk

c. Perforated disc

d. Rough surface of eminence

61. Preservative present in local anesthetic in India is ?

a. Methyl hydroxy benzoate

b. Sodium Paraben

c. Cetirizine

d. 2.5 % lignocaine

62. In bus accident which of the following is the priority to send to the hospital

a. Leg fracture with severe bleeding

b. Head injury

c. Airway problem

d. Circulatory shock

63. The most commonly cause for the of epidural hematoma is said to be?

a. Middle meningeal artery

b. Verteberal artery

c. Anterior cereberal artery

d. Superior cerebellar artery

64. Young individual reported with fluctuant swelling and infection of left lateral incisor. On clinical examination the entire left side of face is swollen and tooth is tender on percussion . The patient is unable to chew and as well as he has a high fever of 102 degree . What should be the treatment plant? ( REPEAT AIIMS MAY 2011 )

a. Incision and drainage

b. Aspiration

c. Antibiotics and Heat application

d. Antibiotics and Heat and Fluid

GENERAL MEDICINE

65. A 45-year-old obese woman presents with increasing fatigue,malaise, and fullness in the right upper quadrant of her abdomen.Pertinent clinical history includes type II diabetes mellitus and hyperlipidemia. The liver biopsy will mostly diagnose it as?a. Autoimmune hepatitis

b. Primary biliary cirrhosis

c. Non alcoholic steatohepatitis

d. Peliosishepatitis

66. A patient comes with complain of headache, nausea, tenderness over temporal region; diagnosis is?

a. Aneurysm

b. Granulomatous giant cell lesion

c. Giant cell arteritis

d. Not recalled

67. A patient with recurrent attack of rheumatic fever and allergic to penicillin. Which of the following drug should be givena. Penicillin G

b. Sulfisoxazole

c. Streptomycin

d. Sulphasalazine

68. 60 year old male patient with uncontrolled hypertension with signs of renal failure reported to the hospital. Biopsy shows medial thickening of arteries with onion skinning was present. The probable diagnosis isa. Thromboangitisobliterans

b. Arteriosclerosis Obliterans

c. Hyperplastic arteriosclerosis

d. Hyaline arteriosclerosis

69. A 4-year-old girl is brought in with severevomitingthat developed suddenly5 daysafter she had aviral infection.She is hospitalized and quickly develops signs ofcerebral edema. The liver biopsy will mostly reveal?

a. Necrosisb. Non alcoholicsteatohepatitis

c. Central haemorrhagicnecrosis

d. microvesicularsteatosis

70. A 29-year-old woman presented with pain in the calf. She had a history of recurrent abortions and arthritis.Which deficiency of following might be the cause for the same?

a. Factor 7

b. Protein c

c. Plasmin

d. Trombin

ENDODONTICS

71. Mandibular incisors have % of 2 canals

a. < 3 %

b. 3 %-12 %

c. 12 % -20 %

d. 20 % -25 %

72. Inferior alveolar nerve block is most successfully done by ?

a. A increasing the concentration of L.A from 1.5 ml to 3.25 ml

b. Increasing concentration of epinephrine

c. By using carbonated local anesthetic agent

d. By reducing speed of injection

73. Pre clinical consideration of endodontic flare up is ?

a. Acute apical periodontitis

b. Acute apical abscess

c. Necrosed pulp having periapical lesion

d. Patient having pain and swelling

74. 8 year old child reports to the dental clinic with avulsed central incisor to trauma which occurred 20 min back. On subsequent on inspection teeth were found to be contaminated with debris. What would be the ideal line of treatment for the same?

a. Clean root surface with saline and reimplant

b. Sterilize and reimplant

c. Scrub the root and reimplant

d. Clean with water and reimplant

75. In the Electric pulp test , the pain sensation is carried by ?

a. delta fibers

b. alphafibers

c. fibers

d. d Beta fibers

76. Pulse oximetry is based on which law ?

a. Pascals Law

b. Doppler law

c. Poiseuille Lawd. Beer law

CONSERVATIVE DENTISTRY

77. Caries associated with pre eruptive enamel hypoplasia?

a. Secondary caries

b. Chronic caries

c. Occult caries

d. Incipient caries

78. Which of the following is not true for artificial sweetener aspertame?a. Is an ester derivative

b. 200 times more sweeter than sugar

c. Can be safely given in type 1 diabetes

d. Calorific value is 4 Kcal

79. Additional period required for enamel calcification after eruption is about

a. 1 yr

b. 2 yr

c. 3 yr

d. 4 yr

80. Diagnodent uses which source of light ?

a. Laser light

b. Visible light

c. Sound waves

d. Nanotechnology

COMMUNITY DENTISTRY

81. A Pregnant lady uses Fluridated drinking water All of the following are true exposure of fluoride except

a. Placenta acts as regulator and increased concentration reaches foetus

b. Placenta acts as regulator and less concentration reaches foetus

c. Placenta acts as a barrier

d. Placenta has no role

82. Metallic taste after application of stannous fluoride varnish is due to?(AIPG 2012 )

a. Stannous tri flourophosphate

b. Stannic tri flourophosphate

c. Calcium trifloro stannate

d. Tin hydroxyl phosphate

PERIODONTICS

83. Supragingival plaque undergoes which of the following changes with time? (AIPG 09, 11)

a. Plaque mass decreases

b. Plaque microflora becomes more gram positive

c. Plaque microflora becomes more gram negative

d. Plaque microflora becomes predominantly spirochetal

84. After enamel has been exposed to bacteria irreversible bacteria colonization takes place in about

a. 24 hours

b. Few min

c. 1-2 hours

d. 2-4 hours

85. Diameter of bristles used in soft tooth brushes?

a. 0.007

b. 0.014

c. 0.012

d. 0.009

86. Who among the following modified Kochs criteria as related to periodontal diseases?

a. Socransky

b. Glickmanc. Russeld. Green and Vermilion

87. In gingivitis , role of immunoglobulins is consistent with increase in number of ? (AP 08)

a. Fibroblast

b. Neutrophils

c. Lymphocytes

d. Plasma cells

88. It is likely that cell mediated immune reactions (delayed hypersensitivity) occur in periodontal disease because subjects with periodontitis have? (AIPG 2001)

a. IgG antibodies reactive with plaque bacterial antigen

b. T-Lymphocytes sensitised to bacterial plaque antigens

c. High levels of collagenase in gingival fluids

d. High levels of histamine in involved gingival tissue

89. Which is characteristic of supragingival plaqueand not of subgingival plaque in humans?

a. Motile bacteria are prominentb. Spirochetes are evident microscopicallyc. Gram negative bacteria are predominantd. Bacterial composition is altered by dietary sugar consumption.

90. Which of the following is not a sign of trauma from occlusion?a. Mobility

b. Thermal sensitivity

c. Sensitivity to percussion

d. Vertical bone loss

AIIMS JUNE 2013- KeyA

B

B

A

B

A

C

A

D

A

D

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B

B

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B

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CA

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AIIMS JUNE 2013

Explanatory answers

1. Ans is A . 10 week

Ref:-OralandMaxillofacial Surgery:Temporomandibulardisorders by Fonseca 1st ed Vol 4 /Pg 3: Text book of orthodontics by Gowri sankar-1st/55

The TMJ begins to develop by the 10th week of gestation from two separate blastemas(mesenchymal condensation) , one for the temporal bone component, and one for the condyle

Meckel's cartlage provides the template for the development of the mandible. It extends from the midline backward and dorsally and terminates as the malleus. It articulates with the incal cartilage. Early minor movements of jaw occur between these two cartilages This primary jaw joint exists for about 4 months until the cartilages ossify and become incorporated in the middle ear

At 3 months of gestation, the secondary jaw joint, the TMJ begins to form. The first evidence of its development is the appearance of two distinct regions of mesen chymal condensation, the temporal and condylar blastemas. The temporal blastema appears before the condylar, and initially both are positioned some distance from each other. The condylar blastema grows rapidly in a dorsolateral direction to close the gap. Ossification begins first in the temporal blastema. While the condylar blastema is still condensed mesenchyme, a cleft appears immediately above it that becomes the inferior joint cavity. The condylar blastema differentiates into cartilage (condylar cartilage), and then a second cleft appears in relation to the temporal ossffication that becomes the upper joint cavity With the appearance of this cleft, the primitive articular disk is formed.

2. Ans is B - 10

Ref:-Gray's Anatomy 39th ed Pg 585NERVE SUPPLY OF TONGUE All the muscles of the tongue, except the palatoglossus are supplied by the hypoglossal nerve. The palatoglossus is supplied by the pharyngeal plexus. ( SO OPTION B - 10 - HYPOGLOSSAL NERVE IS MOTOR IN NATURE) Lingual branch of mandibular nerve is nerve for general sensation for anterior 2/3rd of tongue. Glossopharyngeal nerve is the nerve for general sensation as well as taste sensation for posterior l/3rd of the tongue and the Circumvallate papillae

Posterior most part of tongue is supplied by Vagus nerve, through internal laryngeal nerve. Taste sensation is carried out by chorda tympanibranch of facial nerve for anterior 2/3rd and glossopharyngeal nerve for posterior l/3rd.

3. Ans is B Glossopharyngeal nerve

Ref:-Gray's Anatomy 39th ed/ Pg 585Circumvallate papillae are derived from third pharyngeal arch and are thus supplied by the nerve of the arch. i.e. glossopharyngeal nerve.

4. Ans is A Lateral Pterygoid

Ref:-B.D Chaurasias Human Anatomy 3rd ed page no 125

Friends .This question is asked many times. I am sure you all know this

5. Ans is B - It supplies anterior belly of digastric

Ref:-Gray's Anatomy 38th ed Pg. 1549 Theposterior belly of digastricmuscle develops from the mesoderm of second branchial arch hence it is supplied by thefacial nerve. The anterior belly develops from the mesoderm of first branchial arch and hence is supplied by the nerve mandibular nerve

6. Ans is A Hyperacusis

Ref:-B.D Chaurasias Human Anatomy 4th ed page no 138-140

SYMPTOMS ACCORDING TO LEVEL OF INJURY OF FACIAL NERVE

A lesion higher up in the facial canal, above the origin of the chorda tympani causes facial paralysis, a loss of taste in anterior past of the tongue.[ NO HYPERACUSIS]

A lesion still higher above the origin of the nerve to stapedius results in hyperacusis. These are all lesions of the lower motor neuron (intranuclear).

A typical upper motor neuron lesion (supranuclear) paralyses the lower part of the face but not the upper (forehead and orbicularis oculi). The upper part of the facial nerve nucleus that innervates upper musculature is supplied by the cerebral cortex of both sides whereas the lower part which innervates lower face receives only contralateral cortical fibres.

7. Ans is C Loose areolar tissue

Ref:-B.D chaurasias general anatomy 3rd edition page no 46Danger area of Scalp Loose areolar tissue containing the emissary veins and is termed as "dangerous area of scalp" because it allows spread of infection even, by the way of emissary veins, to cavernous sinus.

Friends.. this is repeated in exams many times.

8. Ans is A- Pterygoid plexus

Ref:-B D Chaurasias Human Anatomy,3rd ed Vol III 46

Dangerous area of Face

Facial vein communicates cavernous sinus through

Communication between the supraorbital vein and superior ophthalmic vein

Through pterygoid plexusof vein via deep facial vein

Infection involves cavernous sinus by spreading through this path which is most likely to occur when the lower part of nose and upper lip is the source of infection

Friends.. this is repeated in exams many times.

9. Ans is D Prevertebral fascia

Ref:-Grays anatomy 39th ed Pg no. 542

Thedeepest layerof thedeep cervical fascia, called the prevertebrallayer, is visible posteriorly on the left side.

10. Ans is A Erythrocyte

Ref:- Human Embryology and Developmental Biology By Bruce M. Carlson 5th ed Pg 410

Hematopoietic stem cells can give raise to any time of cell. Hence they are the first generation cells.

The lymphoid and myeloid stem cell are second generation cells.

The lymphoid stem cell can give raise to B and T lymphocytes only

Myeloid stem cells give rise to granulocytes and red blood cells(OPTION A), and megakaryocytes and Only neutrophils ,eosinophil and basophil.

11. Ans is D - Vitamin K deficiency

Ref:- Harriosons Internal Medicine 17th ed Pg 1926

12. Ans is C Tricuspid bulging

Ganong's Review of Medical Physiology, 24th Edition - Page 544

Ref:-Venous Pulse Waves a- presystolic; produced by right atrial contraction.

c- bulging of the tricuspid valve into the right atrium during ventricular systole (isovolumic phase).

Descents v- occurs in late systole; increased blood in the right atrium from venous return.

x- a combination of atrial relaxation, downward movement of the tricuspid valve and ventricular systole.

y- the tricuspid valve opens and blood flows into the right ventricle.

13. Ans is A - The CO has high affinity to hemoglobin

Ref:-Ganong's Review of MedicalPhysiology, 24th Edition - Page 635Friends..Lets know the facts.

It is difficult to measure pO2 in pulmonary capillary blood (because collection of sample is extremely difficult). Friends.. Please note that the question asks about LUNG.

Therefore, diffusion capacity for O, is measured from the diffusion capacity for carbon monoxide.. But why ????

Carbon monoxide is preferred for measuring the diffusion capacity of lung because of two reasons:

After entering the blood the CO very rapidly reacts with haemoglobin to form carboxyhaemoglobin and so do not allow the partial pressure of CO to build up in plasma. Hence the option A is right.

In this way. pCO in pulmonary capillary blood is almost zero (unless the subject is a smoker or exposed to atmospheric CO levels).

Therefore, problem of collecting of CO in the pulmonary capillary blood is avoided.

Diffusion of CO across respiratory membrane is diffusion limited.

Therefore, the amount of CO transferred to blood is correct estimate of the diffusion capacity. Since diffusion of O, across the respiratory membrane is flow limited, so measuring the amount of O2transferred to blood will underestimate the true diffusion capacity.

14. Ans is D 28th week

Ref:-Textbook of medical physiology by Gyton 11th ed Page 1035

Changes in the Maternal Circulatory System During Pregnancy

About 625 milliliters of blood flows through the maternal circulation of the placenta each minute during the last month of pregnancy

This, plus the general increase in the mothers metabolism, increases the mothers cardiac output to 30 to 40 per cent above normal by the 27th week of pregnancy; then, for reasons unexplained, the cardiac output falls to only a little above normal during the last 8 weeks.

of pregnancy, despite the high uterine blood flow. Hence the closet answer is 28th week.

Friends. There has been reports of different option and question format but this is the format which our students reported and hence was included.

15. Ans is B 3 million

Ref:-Harper's IllustratedBiochemistry, 28th Edition Page 318The human genomecontainsDNAwith approximately 3 billion base pairs that encode 30,000 to 40,000 geneslocatedon 23 pairs of chromosomes

16. Ans is B Karyotyping

Ref:-McDonald and Avery Dentistry for the Child and Adolescent 8th ed Pg no 82

One area of special interest to the clinician is cytogenetics, the study of chromosomes.

This interest has been stimulated by the development of techniques in which cells are grown in culture and the chromosomes are examined under a microscope for changes in size, shape, and fine structure. This is called karyotyping. By applying this technique, Lejeune and colleagues demonstrated that the fundamental cause in Down syndrome is the presence of an extra specific chromosome (number 21) in the affected individuals karyotype.

17. Ans is A isoleucine

Ref:-Textbook ofBiochemistryfor Medical Students by Vasudevan 6th ed Page 21

A review of amino acids-juzz relax-Amino acids are divided based

1. Side chain

2. Ability to produced in body or not

3. Polarity of R group

4. Catabolic pathway of the amino acid

I. Based on the structure of side chain

Aliphatic Amino acids

Acidic amino acids Asparate, Asparagine, Glutamate, Glutamine

i. Neutral aliphatic amino acids Glycine, Alanine, Serine, Theonine, Valine, Leucine and Isoleucine

ii. Basic amino acids Arginine, Lysine, Histidine

iii. Branched chain Valine, Leucine and Isoleuicine

iv. Sulfur containing- Cysteine and Methionine

v. Amide groups-Asparagine and Glutamine

vi. Hydroxy amino acids- serine Threonine and tyrosine

vii. Simple amino acids- Glycine and alanine

Aromatic amino acids- phenyl alanine and tyrosine and tryptophan and histidine Imino acids- proline

HeterocycyclicHistidine and tryptophan, proline Dicarboxylic amino acids-- Aspartic acid and Glutamic acid.

Dibasic amino acidsArginine and Lysine

++++ S0 tryptophan is both aromatic as well as heterocyclic .

**** proline is both hetero cyclic and imino acid. It is the only DNA coded heterocyclic Alpha amino acid.

II. Based on polarity and side group( little bit confusing!)

Non polar

R groups

Polar but uncharged R groups

Polar but charged groups

Alanine, Serine, , Valine, Leucine and Isoleucine, Methionine, phenyl alanine, proline, tryptophan and valine.

Asparagine, cysteine, glutamine, glycine, serine, threonine and tyrosine

Negatively charged( acidic amino acids)

Aspartic acid and Glutamic acid and

Positively charged ( basic amino acids)

histadine ,Arginine and Lysine

Based on catabolism fate-II.Both glucogenic and

ketogenic amino acids

Glucogenic amino acids

Ketogenic amino acids

Amino acid

Product

Amino acid

Product

Amino acid

Product

Alanine

Serine

Pyruvate

Leucine

Acetoacetate

Phenylalanine

Fumarate

Tyrosine

Acetoacetate

Glycine

Pyruvate

Succinate

Isoleucin

Propinyl CoA

Acetyl CoA

Threonine

Valine

Propoinate

Proline

Ketoglutarate

Histidine

Arginine

Lysine (glu-

tamic acid)

Cystine

Pyruvate

Hydroxy proline

Aspartic acid

Oxaloacetate

Based on whether they can be produced in body or not

IV.Essential and non essential

Essential amino acids are not synthesized in the food and are supplied in the diet

Nonessential amino acids are synthesized in the body even if they are not present in the food .Semiessential synthesized in the body in small quantities and not absolutely essential in the food

Essential

Non essential

Semi essential

Threonine valine , leucine, isoleucine, methionine, phenyl alanine, tryptophan,

Remember H.VITTAL LMP

Glycine , serine, cysteine, cystine,proline, hydroxyl praline, ornithine , citrulline, tyrosine

arginine* , histidine *

Conditionally essential (required to some degree in growing children): Glycine, cysteine, cystine, proline, hydroxyl proline, ornithine, citrulline, tyrosine.

Semiessential are synthesized in the body in small quantities and not absolutely essential in the food arginine and histidine.

So, two statements can be made:

1.All acidic amino acids (Asparate, Asparagine, Glutamate, Glutamine) are Nonessential amino acids.

2.All branched chain amino acids (Valine, leucine and isoleuicine) are essential amino acids.

Aromatic Amino acids which contain aromatic ring in the side chain . Aclosed ring structure formed by six carbon atoms, with a single hydrogen atom attached to each one is called as Aromatic ring . Also called a phenyl ringor a benzene ring.Heterocyclic amino acids chemical compounds containing at least oneheterocyclicring, which by definition has atoms of at least two different elements, plus the compound has at least oneamine(nitrogen-containing) group.The prefixhetero- meansother.Thenitrogenatom is anotheratoman atom other than carbonin the ring itself.

Only Benzene containing ( purely aromatic) --- phenyl alanine and tyrosine

Aromatic amino acids Tryptophan, phenyl alanine and tyrosine and histidine.

Heterocyclic- Tryptophan, Histidine and proline.

Tryptophan has indole substituted alanine hence it is aromatic as well as heterocyclic.

Histadine is imidazole substituted alanine.. This hetero cyclic ring is aromatic in nature

All the amino acids have primary amino groups where as Proline secondary amino group incorporated in five ringered structure.( imino group)

18. Ans is C- Carbamazepine

Ref:-Burket's Oral Medicine: Diagnosis and Treatment 10th ed Pg 183 Well friends.. we all know that Sodium valproate and verapamil are the causes for gingival enlargement and many questions did ask those in earlier exams. But I guess many will be confused about the option B and C

Please go through the Burkits reference. There is full info on which drug might cause the enlargement. The bleomycin is also included. I did not find Carbamazepine in it.

I also checked in KATZUNG pharmacology where they have not mentioned adverse effect of hyperplasia under the carbamazepine drug

Surely Option C is the right answer.

19. Ans is C Midazolm

Ref:-Ingles Endodontics 6th ed Pg 746 , Millers Anesthesia 7th ed 2616 and many other references

Friends .. I went through several books most of them consider midazolam for conscious sedation and not many other have been tried as nasal drop

Ingle also explains only Midazolam in the section of anesthetics by Intra nasal route.

20. Ans is C 3 > a-1

Ref:-Bailey & Love's Short Practice of Surgery 26th ed Page 235 and Structured Oral Examination Practice for the Final FRCA 1st ed Pg 259 , Principles and Practice ofSurgery by James Gardan and Textbook of anesthesia by Allan Pg 477 283, Textbook ofOraland MaxillofacialSurgery by Malik 3rd ed Page 178 Lithium potentiates non-depolarising relaxants .It may also delay the onset and prolong relaxation with suxamethonium. Hence should be stopped before surgery.

Friends.. I went through all the books. And found it very controversial. You can find almost all the answers in many books.

I am really not sure what answer Aiims is expecting. If the reference is Baily and Love then answer is 1 day.

I did bit more research and tried to check what exactly is the half life of lithium which is 12 hours. And it takes 1 -2 weeks to excrete from the body. It also says Lithium has a low therapeutic index and plasma levels should therefore be maintained between 0.8 and 1.2 mmol/1. It should be stopped 2 to 3 days before using a muscle relaxant drug.

I also found few books which say ideally it should be stopped 2 3 days. And if not possible then before major surgery 1 day but with monitoring.

Considering all the factors its better to mark it as 3 days than 1 days

21. Ans is C - Patient remain asymptomatic for 24-48 hrs

Ref:-GoodmanandGilman'sThePharmacologicalBasis 12th ed Page 983 and NMS Pediatrics edited by Paul H. Dworkin 5th ed Pg 50

Paracetamol or Acetaminophen is the drug most commonly administered to children.

Toxicity may occur in an acute dose of 150 mg/kg (ten times the therapeutic dose of 1015 mg/kg) but can also occur after repeated ingestions of as little as 20 to 30 mg/kg/dose or a total daily dose of 160 mg/kg (approximately two times the therapeutic dose).

Clinical findings.

Acetaminophen poisoning has three stages:

Stage I (1/2-24 hours postingestion): Often asymptomatic, occasionally nausea, vomiting, diaphoresis, pallor

Stage II (2448 hours postingestion): Nausea, vomiting, right upper quadrant pain, elevation of aspartate aminotransferase (AST), alanine aminotransferase (AIT), bilirubin, and alkaline phosphatase(HENCE OPTION C IS WRONG)

Stage III (72- 96 hours postingestion): Fulminant hepatic failure with thrombocytopenia, prolonged prothrombin time, and hepatic encephalopathy. Renal failure and cardiomyopathy may occur. If the patient survives, complete resolution of liver abnormalities occurs.

22. Ans is C 2 year

Ref:-Fundamentals of Anaesthesia by Pinnock3rd ed Page 619

Suxamethonium is a short acting muscle relaxant Its a clear, colourless, aqueous solution of pH 3.0-5.0 with ashalf lifeof2 years

23. Ans is A Plasma half life is 90 min

Ref:-Malamed, 5th ed., p 71; Management of Pain and Anxiety by Dionne, Becker, and Phero 1st ed., p 94 Articane is the only amide-type local anaesthesia that contains a thiophene group, (Option B).

It is claimed that articane is able to diffuse through soft and hard tissues more reliably than other local anaesthesia. Clinically, it is claimed that maxillary buccal infiltration of articane, on occasion provides palatal soft tissue anesthesia, obviating the need for palatal soft tissue anaesthesia. (option C)

Furthermore, it is claimed that articane can provide pulpal and lingual anaesthesia when administered by infiltration in the adult mandible. Reports of paresthesia usually in the mandible have become more frequent since the introduction of articane, so articane is generally avoided for nerve block.

This high concentration may also explain why articane is more likely than other formulations to cause nerve damage after inferior nerve block.

Half-life 30 min (Option A).Therfore, as can be seen, half life of articane is 30 min and not 90 min and hence the answer of choice.

24. Ans is A Suxamethonium

Ref:-Harrison'sprinciples of internal medicine 11th ed Volume 1 - Page 295

Malignant hyperthermia (MM) is an autosomal- dominant pharmacogenetic disorder

Acute episode ofmalignant hyperthermiaoccur following use of halothane orsuxamethonium In susceptible individuals, these drugs can induce tachycardia, a greatly increased body metabolism, muscle contracture and an elevated body temperature (above 40C) with a rapid rate of increase.

Dantroleneis also used to treat and preventmalignant hyperthermia

25. Ans is B 0.15 mg/kg> -c- 0.2 mg/kg

Ref:-GoodmanandGilman'sThePharmacological Basis 12th ed Page 265 , Churchill-Davidson'sA Practice of Anaesthesia,7th ed Pg 590 , Miller's Anesthesia 7th ed Volume 1 Pg 876 Cisatracurium is a benzylisoquinolinium nondepolarizing neuromuscular-blocking drug It is said to be superior to atracurium as it has greater margin of safety. I went thought many books and most of them give a range. But friends.. Few books (EXCEPT GOODMAN) which I have mentioned did gave the answer specifically as 0.15mg/kg. Many books also say that the actual dose required is lesser but to hasten initiation the higher doses are required. As far as all the books, I would prefer marking Option B 0.15mg/kg than option 0.2mg/kg

26. Ans is B- More plasma binding and less toxicity

Ref:-McDonalds 8th ed., p 303; KDT, 4th ed Pg 344

A significant advantage of midazolam over diazepam is its high water solubility. Consequently, the possibility of thrombophlebitis is reduced to a minimum. (option A). Once the drug enters the blood, which has a pH of 7.4, the chemical structure changes to an active form with high lipid solubility. In fact, its lipid solubility is among the highest of all benzodiazepines.

There is no rebound phenomenon from metabolites. Midazolam can also be given effectively intramuscularly.

Onset of action when given orally is between 20 and 30 min with an elimination half-life of 14 hrs, which provides approximately 30 min of working time (option B).

Midazolam may produce respiratory depression with higher doses. There is also a dose-related risk of apnea.

Compared with diazepam, midazolam produces better anxyolysis and amnesia. In fact, between 75% and 90% of patients will experience retrograde amnesia for up to 4 hrs when given midazolam.

Midazolam is three to four times more potent than diazepam and has twice the affinity for the benzodiazepam receptor. (option C and D). Water soluble, non irritating to veins, faster and shorter acting and 3 timed more potent than diazepam. Therefore, they are less plama protein bound (option B).

27. Ans is D - Glycopyrrolate

Ref:-Essentials of Pharmacology for DentistryBy K. D. Tripathi 1st ed Pg 78Because glycopyrrolate is a quaternary amine, itdoes noteasilycrosstheblood-brainbarrier anddoes notproduce sedation

28. Ans is A - Turner syndrome

Ref:-essential pathology for dental students Harsh mohan 4thed page 69TURNERS SYNDROME It is a monosomy of sex chromosomal disorder characterized by sexual infantilism, webbed neck and cubitus valgus in females. It involves monosomy of sex chromosomes. It is the commonest genetic cause of primary amenorrhoea.

Chromosomal complement: XO

Number of chromosomes in each cell: 45

Phenotype: Female.

Most prominent feature: Amenorrhoea

29. Ans is C - Nodular lymphocytic Hodgkin Lymphoma

Ref:-Robins Pathology 7th ed Pg 688 Table 14.6 Friends.. Remember the questions of OWL EYE appearance right??... Yes.. As soon as you remember that your options should be narrowed down to Hodgkins Lymphoma.

Now regarding the differentiation between the Nodular lymphocytic Hodgkin Lymphoma and Lymphocytic predominant Hodgkin Lymphoma is as follows

Nodular type is the most commonly occurring in the subgroup

Nodular lymphocytic Hodgkin Lymphoma occurs in ages below 40 in contrast to option D which occurs in older individual

Lymphocytic predominant Hodgkin Lymphoma is more common in males but the option C has equal distribution.

CD30 positivity is not seen in Lymphocytic predominant Hodgkin Lymphoma

30. Ans is A - Sympathetic and afferent postganglionic

Ref:-Friends .. its a direct lift from NBDE ENDO PERIO section

31. Ans is D - Cryoprecipitate

Ref:-Nelima Malik Oral surgery 1st ed Pg 689

The most widely used and cheapestsourcesoffactor VIIIcalled 'cryoprecipitate'. Friends.. This is already asked few times in different exams.There are controversies and overthinking on this question going deep and deep. Always remember answer and think in the most common terms

32. Ans is D Bonded retainer

Ref:-Text book of orthodontics By Gowrishanker 1st ed Page 586 The treated midline diastema has a very high chance of repalse hence it is advisable to use permanent bonded retainer for such cases.

This is many times asked in KCET

33. Ans is BClass II Div II

Ref:-Orthodontics by Om Prakash 1st ed Pg 396 The angle formed by the intersection of the long axes of the crown and root angulation or column angle

It is decreased in Class II Div II cases

34. Ans is A- Class II div 2Ref:-Orthodontics by Om Prakash 1st ed Pg 396

35. Ans c 16 years

Ref:-Grabers Orthodontics 3rd ed Pg 33

Repeated fom PGI 2012 NOV

Female attain the maximum lip thickness by age of 14 and the males by age of 16

36. Ans is B Class II div 2

Ref:-Profitt Orthodontics 4th ed Pg 207Increased interincisal angle is present in in Class II div 2 and it decreased in Bimaxillary protrusion and classI with maxillary incisor proclination.

37. Ans is A - Displacement and drift

Ref:-Oral Development and Histology 3rd ed Avery Page 65,66The maxilla changes position in the growing face as a result of both drifting by remodeling, and displacement due to growth at the sutures

38. Ans is A- Ashley Howe

Ref:-Text book of orthodontics By S Gowri Sankar 1st ed Pg 207

One can infer from Ashley Howe 1. Whether expansion possible 2. Whether extraction or border line or non extraction case It is done in maxillary arch only

In careys or archperimeter analysisone can derive to extract a 1st premolar or second premolar or non extraction.

Boltons analysis gives the tooth size matching in Upper and lower arches abd gives an clue in which arch more tooth size has to be reduced.This cannot give clue whether the space gained should be extraction or non extraction means.

Ponts predicts the amount of expansion possible in premolar and molar region for given mesiodistal dimension of upper incisors. Done only in upper arch.

Peck and Peck Index gives an indication how much proximal stripping should be done in lower incisors.

39. Ans is D 250

Ref:-Orthodontics by Profitt 3rd ed Page no 550

Pendulum appliance activated to produce 200 to 250 grams, Byloff et al found that molar movement averaged just over 1 mm/month (1.02 0.68), with a considerable degree of distal tipping of the crown and an elevation of the molar

40. Ans is C - Prediction table most valid for all population

Ref:-Pediatric dentistry by Pinkham4th ed Page 496

The statement in option C is false and hence correct answer. Prediction tables differ for different population groups Friends.. this is the direct lift from the books.

Following are the four assumptions while doing an space analysis

All the permanent teeth are developed normally

There is a correlation between the size of erupted mandibular incisor and remaining succedaneous teeth

The Prediction table most valid for specific population (HENCE OPTION C IS WRONG AS IT SAYS FOR ALL POPULATIONS)

Arch dimension remain stable throughout the growth

41. Ans is D Unilateral or Bilateral Posterior cross bite

Ref:-Textbook of Oral and MaxillofacialSurgery by Balaji 1st ed - Page 511 Early repair of the palate may have a profound effect on the developing maxilla and dentition. The most common malocclusion of patients who have had repair of a cleft lip or palate is a dental crossbite of anterior and/or posterior teeth, due to maxillary hypoplasia as a result of surgical scaring.

42. Ans is A - 3rd month

Ref:-Contemporary oral and maxillofacial surgery by Peterson 4th ed pg 729 and balaji oral surgery 503

CHEILORRHAPHY is the surgical correction of the cleft lip deformity.

Surgeonsapply a rule of ten for determining the time ofoperation, i.e. baby should be10 weeksold (3 MONTHS ), weight10lbs and have haemoglobin above10gm per cent

43. Ans is B>A - Orthognathic maxilla/ retrognathic mandible

Ref:- ( Repeat of aiims nov 2012, and PGI nov 2012 paper)

Differential diagnosis of Class II by Robert Moyer Volume 78, Number 5 November, 1980 malocclusions Handbook of orthodontics by Moyer 4th ed Page 183 and Textbook of Craniofacial Growth By Sridhar Premkumar 1st ed Pg 243

Friends.. I referred the original article of the Moyers and there is a description of all the Class with diagram with heading indicating the special skeletal arrangements. They are as follows.

Type A

ORTHOGNATHIC MAXILLA AND ORTHOGNATHIC MANDIBLE

Type B

PROGNATHIC MAXILLA AND ORTHOGNATHIC MANDIBLE

Type C

RETROGNATHIC MAXILLA AND RETROGNATHIC MANDIBLE WITH DENTAL PROCUBENCY

Type DRETROGNATHIC / ORTHOGNATHIC MAXILLA AND RETROGNATHIC MANDIBLE WITH MAXILLARY DENTAL PROTRACTION

Type E

BIMAXILLARY PROTRUSION WITH DENTAL PROCUBENCY

Type F

MANDIBULAR RETROGNATHISM

In summary

TYPE A

ORTHO

ORTHO

TYPE B

PROG

ORTHO

TYPE C

RETRO

RETRO

TYPE D

ORTHO/ RETRO

RETRO

TYPE E

PROG

PROG

In

44. Ans is A wait and watch

Ref:-Oral Development and Histology Avery 3rd ed Pg 138 The first tooth erupts between 8 12 months

Primary dentition, eruption occurs earlier in boys than in girls.

In the permanent dentition, however, eruption in girls usually precedes that in boys.

In general, the mandibular teeth precede the maxillary teeth in the permanent dentition. Only the mandibular central incisors and. occasionally, the mandibular second molars precede the corresponding maxillary teeth in the primary dentition

Under normal conditions, teeth tend to be delayed rather than early in eruption.

A difference of 1 or 2 months on either side of the noted range should not be considered abnormal.

A tooth generally takes from 1.5 to 2.5 months from the beginning of clinical eruption until it reaches the occlusal plane. Canines usually take the longest time to erupt

45. Ans is A 0.016 X 0.022 inch stainless steel

Ref:-Glossary of orthodontic terms Volume 1 by John Daskalogiannakis Page 201 and Orthodontics by Om Prakash 1st ed Pg 360Gjessingspring is a universal retraction spring made of 0.016 x 0.022-inchstainless steelwire

46. Ans is A A mandibular incisor erupting before mandibular molar

Ref:-McDonald and Avery Dentistry for the Child and Adolescent 9th ed Pg 178 Exactly picked from the book

The mandibular first permanent molars are often the first permanent teeth to erupt. They are quickly followed by the mandibular central

Lo and Moyers found little or no clinical significance to the eruption of the incisors before the molars.

47. Ans is - C- Previous caries experience

Ref:-Fundamentals of operative dentistry A Contemporary approach by Summitt 3rd ed Pg 81 Caries risk may be defined as the probability of an individual developing a certain number of cries lesions reaching a given stage of disease progression during a specified period

It is useful for the dentist to be able: to assess caries risk so that preventive treatments, which are time-consuming and therefore expensive, can be targeted appropriately.

Because caries is a multifactorial disease, it is probably not surprising that it is difficult to predict accurately.

Clinical and radiographic examination and dental history are the most important sources of information.

Thus, a person with no active lesions, few or no restorations, and no history of needing restorations replaced may safely be designated as currently at low risk.

On the other hand, a person with multiple active lesions, a heavily restored mouth, and a history of repeated replacement of restorations may be designated as being at high risk.

So friends.. Its clear that the best indicator caries risk is the past caries experience

48. Ans is B - Cross sectional

Ref:-Textbook of Preventive and Community Dentistry By Hiremath 1st ed Pg 172

All longitudinal studies measure the similar measurement on the same units at different point of time. Cross sectional studies provide snap shot at one point of time

49. Ans is B- Atleast one area of demineralization or white spot lesion

Ref:-Principles and Practice ofPedodontics by Arti Rao 3rd ed Page 192CARIES RISK INDICATOR

LOW RISK

MODERATE RISK

HIGH RISK

Clinical condition

No caries teeth in past 24 hours

No enamel hypoplasia

No visible pluque

No gingivitis

Caries teeth in past 4 months

1 area of enamel demineralization

(OPTION B )

Gingivitis

Carious teeth in past 12 months

More than one area enamel demineralization(enamel caries , White spot lesion)

Visible plaque in front tooth

High titers of mutants

Radiographic enamel caries

Wearing dental or orthodontic appliance

Enamel hypoplasia

Environmental Characteristics

Optimal systemic and topical fluoride exposure

Consumption of simple sugar or foods strongly associated with caries initiation primarily at meal times

High care giver socioeconomic status

Regular use of dental care in established dental home

Suboptimal systemic and with optimal topical fluoride exposure

Occasional ( 1 2 ) between meal exposure to simple sugars of foods strongly associated with caries

Midlevel care giver socioeconomic status

Irregular use of dental services

Suboptimal topical fluoride exposure

Frequent ( 3 or more ) between meal exposure to simple sugars of foods strongly associated with caries

Low level care giver socioeconomic status

No usual use of dental care services

Active caries present in the mother

GENERAL HEALTH CONDITIONS

Children with special health care needs

Conditionsimpairing saliva flow and composition

50. Ans is A Masseter on buccinators

Ref:-Textbook of Prosthodontics by Nallaswami 1st ed - Page 89

The masseter muscle acting on the buccinator, produces a depression in the impression, called the masseteric notch

It is immediately lateral to the retromolar pad and continues anteriorly to buccal vestibular sulcus.

It is an area where the masseter muscle in function (anterior fibers) may push against the distal part of the buccinator muscle

Clinical consideration It is due to the contraction of the masseter that a depression is formed at the distobuccal corner of the retromolar area.

When the mouth is opened widely the borders in this area cut into the tissue, so it should be recorded with the mouth slightly opened.

During impression procedure in the area of masseteric notch, downward pressure is applied and the patient is asked to close the mouth against the pressure. Over extension of the denture causes:

Dislodgement of the denture.

Laceration.

51. Ans is D Zone of Dentinal sclerosis

Ref:-Shafers textbook of oral pathology 5th ed pg no 626 Zone 1: Zone of fatty degeneration of Tomes fibers. Zone 2: Zone of dentinal sclerosis characterized by deposition of calcium salts in dentinal tubules. Zone 3: Zone of decalcification of dentin, anarrow zone, preceding bacterial invasion. Zone 4: Zone of bacterial invasion of decalcified but intact dentin. Zone 5: Zone of decomposed dentin.So friends.. , it is clearly seen that as you go more to the deeper zone there are less chances of presence of micro organisms. So Its better to consider Zone 2 Zone of dentinal sclerosis as the correct answer than option A- Zone of decalcified dentin

52. Ref:-Shafer's Textbook OfOral Pathology 6th ed - Page 35 and Oski's Pediatrics: Principles & Practice 4th ed PG 2675

There Ans is C Normal vision with Cloboma

is variable penetrance in Treacher Collins syndrome or Mandibulofacial dysostosiswith some patients appearing mildly unusual and others severely affected with facial and otologic deformities.

The TREACLE gene has been cloned from this locus.

Features

antimongoloid slant of the eyes, coloboma of the lower eye lid( missing pieces of tissue in structures that form the eye) (HENCE OPTON C IS RIGHT)

Micrognathia(Hence option D is wrong)

Hypoplastic zygomatic arches( Hence option A is also wrong) and external auditory atresia (frequently bilateral).

Hearing loss (Hence option B is wrong) and airway obstruction are the primary functional problems

None of the book mention that vision is impaired in this syndrome BUT YES its important to take proper care of eye as there is chance of corneal damage due to dryness and improper closer of eyelid.

53. Ans is D Apical Periostitis

Text book of Oral Medicine, Oral Diagnosis and Oral Radiology by Ongle 1st ed Pg 510 , 511 and Contemporary Implant dentistry by Carl 3rd ed Pg 920

Friends ..this question was tricky one.. First thing which comes in mind when we think of halo effect is the vertical root fracture which is missing in the options.

Its known that the periapical abscess or cyst of granuloma or a periodontal disease can cause a sinusitis which might result in localised thickening which is seen as the radiopaque band adjacent to the offending tooth and is termed as Apical Periostitis

Sometimes the root may even perforate the sinus producing a radiographic appearance which is termed as Halo effect.

54. Ans is B - 20mg/kg body weight

Ref:-Textbook of Oral Medicine 1st ed by Ghomes Page 632The minimum amount required to produce discoloration is 21/mg/kg/body weight. Option B was the closest to the right answer

55. Ans is C 12 years

Ref:-Cawson's Essentials of Oral Pathology and Oral Medicine 8th ed Pg 32Tetracycline should be avoided from approximately the fourth month to at least the 12th year of childhood, ideally the 16th year.

56. Ans is D- Polyvinyl siloxaneRef:-Manual of Forensic Odontology by David R Senn - Page 421Most odontologists todayuseeitherpolyvinylsiloxane impression materialto record surface characteristics of the area of abite markor patterned injury.

57. Ans is B Ependymoma

Ref:-Text book of Oral Medicine, Oral Diagnosis and Oral Radiology 1st ed By Ongole 297 98

Tuberous sclerosisortuberous sclerosiscomplex (TIC) is rare multi-system genetic disease that causes non-malignant tumors to grow in the brain Diagnosis Tuberous sclerosis complex (TSC) Multiple calcified subependymal nodules. Subependymal giant cell astrocytomas Subcortical tuber White matter lesion Ependymomasare tumors that arise from the ependymal cells lining the venrtricles of the brain and the center of the spinal cord and need to be differentiated from tuberous sclerosis.

58. Ans is A100 miliroentgen /week

Ref:-Oral Radiology: Principles and InterpretationBy Stuart C. White 5th ed 65

The MPD calls for the dose limit of occupational exposure to be at 0.05 Sv (5.0 rems) per year or100 mrem per week

59. Ans is C- 900 ,450 and 1100Ref:-Cohens Pathways of pulp 10th ed Pg 635

Its a direct lift from the book friends.

60. Ans is A - Disc in anterior position ahead of the condyle

Ref:-Burkett Oral Medicine 9th Pg No. 316, Ghom Oral medicine 1st ed Pg 551-552

(repear AIPG 2012)

Clicking of TMJ is most commonly associated with an anteriorly displacement with reduction on mandibular opening.

The condyle is initially functioning on the retrodiscal tissue and as the translation proceeds a click occurs as the condyle moves anteriorly into its normal relation with the disc

This permits completion of condylar translation ..reciprocal clicking ,clicking during closing and opening occurs when a sound is produced as the condyle slips off the disc onto the retrodiscal tissues

61. Ans is A- Methyl hydroxyl benzoate

Ref:-Malamed Localanesthesia 3rd ed Pg 91

Friends.. I was very curious when I read the question. I preferred to look at the bottle of the LA here and not the books.

All have methyl Paraben as preservative

The answer was tricky. As not many of us know that Methyl paraben is also called as ethyl p-hydroxybenzoate and Methyl parahydroxybenzoate hence option A was the answer.

62. Ans is C - Airway problem

Ref:-Emergency Care and Transportation of the Sick and Injured By American Academy of Orthopaedic Surgeons 9th ed Pg 1095Bottom of Form

Well friends.. The question can be answered on the bases of Triage

Triage simply means 'to sort" your patients based on the severity of their injuries.The goal of doing the greatest good for the greatest number means that the triage assessment is brief and the patient condition categories arebasic.

Primary is the initial triage done in the field, whereas secondary is done as patients arebrought to the treatment area.

During primary triage, patients arc briefly assessed and then identified in some way. such as by attaching a triage tag.

Primary triage considers three aspects. Airway circulation , bleeding and consciousness with priorities of ABC, Airway being the priority

The duty of triage officer is just to triage and not to treat

Many books have given almost all the option in the main priority group. Hence was the confusion.

But In all the books the first priority is given to airway breathing.

Its important to check whether patient who has breathing difficulties needs assistance , then the person needs to be marked with the Red Tag which indicates the need of immediate assistance and transport.

The next priority is the cases with severe bleeding

If the immediate assistance at spot treats breathing problem then it falls in yellow category. But friends nothing is mentioned in question here.

I also found that few books which mention severe bleeding in the red category and fracture of long bone in yellow category. The option A mentions about the long bone fracture. Hence I would still go for Option C still preferred over the option A. BUT HIGHLY CONTRAVERSIAL. I LVEAVE THE ANSWER TO YOU.

TRIAGE PRIORITY

Triage CategoryPatient DescriptionTypical InjuriesRed Tag

First Priority

(immediate) Patients who need immediate care andtransport.

Treat these patients first, and transportas soon as possible. Airway and breathing difficulties

Uncontrolled or severe bleeding

Severe medical problems

Decreased mental status

Signs of shock (hypoperfusion)

Severe burns

Open chest or abdominal injuriesYellow Tag

Second Priority

(delayed)Patients whose treatment and transport can be temporarily delayed. Burns without airway problems

Major or multiple bone or joint injuries

Back injuries with or without spinal cord damageGreen Tag

Third Priority

(walking wounded)Patients who require minimal or no treatment and transportation can be delayed until last. Minor fractures

Minor soft-tissue injuriesBlock Tag

Fourth Priority

(expectant: some areas callthis Priority Zero) Patients who are already dead or have little chance (or survival.

Treat salvageable patients before treating these patients. Obvious death

Obviously nonsurvivable injury, such as major open brain trauma

Respiratory arrest (if limited resources)

Cardiac arrest

63. Ans is A Middle meningeal artery

Ref:-Oraland MaxillofacialSurgeryby Anderson Page 794 Hemorrhage may occur beneath the dura (subdural) or between the dura and skull (epidural); each has characteristic clinical and radiographic features.

Epidural hematomas occur in up to 10% of patients with severe head trauma. They typically evolve rapidly. Many of these patients are unconscious when first seen but may have a "lucid" interval of minutes to hours before coma develops.

These hematomas are located between the skull and dura and are lenticular in shape. They are most often seen in the temporal or temporoparietal region and usually result from a tear of the MIDDLE MENINGEAL ARTERY. The high pressure arterial bleeding of an epidural hematoma can lead to irreversible brain injury and death within hours.

Rapid surgical evacuation and ligation of the damaged vessel is indicated.

64. Ans is A- Incision and drainage

Ref:-Friends its a National board question.

Its important to note here is there is swelling which is fluctuant and large and life threatening. Hence the incision and drainage is the best treatment option in the above case

65. Ans is C Non alcoholic steatohepatitis

Ref:-Harrison Internal medicine 16th ed , Pg no 1870 Friends.. This is a direct lift from USMLE Pretest pathology series

Nonalcoholic steatohepatitis is a condition of intermediate severity that resembles alcohol-induced liver disease but occurs in patients who are not heavy drinkers.

The major causes are

Obesity

Dyslipidemia

Hyperinsulinemia

Insulin resistance

Type 2 diabetes mellitus

66. Ans is C Giantcell arteritis

Ref:-Burket's oral medicine 11t ed page no 294 Giant cell arteritis is a necrotizing granulomatous systemic arteritis that affects medium and large arteries, especially those branching from the proximal aorta.

It occurs primarily in middle-aged and elderly persons. Although it is manifest by a wide range of clinical symptoms, headache is both the most common symptom and the reason why patients with GCA are seen by neurologists.

The average age of onset is approximately 70 years, and the disease is rare before the age of 50. More than 90% of cases occur in those over 60 years of age. Women are affected about twice as commonly as men.

Although temporal headaches have become synonymous with this disease, the headache may be diffuse or localized to any head region, including the occiput.

Scalp tenderness is usually localized to the temporal or, less commonly, the occipital arteries.

It is also associated with polymylagia rheumatic,jaw claudicating,fever, nausea weight loss

67. Ans b Sulfisoxazole

Current Medical Diagnosis & Treatmentby Lawrence46th ed Pg 406 For patients allergic to penicillin, sulfadiazine is recommended

But Sulfadiazine and sulfisoxazole appear to be equivalent, therefore, the use of Sulfisoxazole is acceptable on the basis of extrapolation from data demonstrating that Sulfisoxazolehas proven effectiveness in secondary prophylaxis

68. Ans is C- Hyperplastic arteriosclerosis

Ref:-Robbins Pathology 7th ed Pg 529

Friends.. Please note that the question has clearly mentioned about hypertension.

Hypertension is also associated with two forms of small bloodvessel disease

Hyaline arteriolosclerosis

Hyperplastic arteriolosclerosis

HYPERPLASTIC ARTERIOLOSCLEROSIS

See in in severe form of hypertension as mentioned in question(Uncontrolled and Kidney failure )

Characteristic of but not limited to malignant hypertension (diastolic pressures usually over 120 mm Hg).

Onionskin, concentric, laminated thickening of the walls of arterioles with progressive narrowing of the lumina

In malignant hypertension, these hyperplastic changes are accompanied by deposits of fibrinoid and acute necrosis of the vessel walls, referred to as necrotizing arteriolitis. particularly in the kidneyHYALINE ARTERIOLOSCLEROSIS.

This vascular lesion consists of a homogeneous, pink, hyaline thickening of the walls of arterioles with loss of underlying structural detail, and with narrowing of the lumen Encountered frequently in elderly patients, whether normotensive or hypertensive

69. Ans is D - Microvesicularsteatosis

Ref:-Rubin's Pathology 6th ed Pg 720

Friends ..This question is also made from USMLE Pathology Pretest series.

This case clearly falls in to the diagnosis of Reyes syndrome for sure

Reye Syndrome

Definition: rare disease that causes swelling in the liver and brain that can result in encephalopathy and acute liver dysfunction.

Though no age group is immune, this disease generally occurs in individuals under 12 years old

Subjective symptoms

Recent viral illness followed by abrupt onset of vomiting within 12 hours to 3 weeks (average is 5 days)

Fiveto sevendayslater,vomiting(due to increased intracranial pressure), delirium, stupor, seizures, and coma Laboratory studies show

Threefold elevation of scrum transaminases and ammonia.

The hepatic pathology consists of Microvesicular hepatocellularsteatosis and striking mitochondrial changes

The brain is markedly swollen due to cytotoxic astrocytic edema

70. Ans is B Protein c

Ref:-Robbins illustrated 7th ed Pg131 132 and Harrison internal medicine 16th ed Pg 685 666

The deficiency of Protein c leads to the hyper coagulabilty state and deep when thrombosis and hence the pain in the calf which is also associated with recurrent abortions.

71. Ans is D 20 % to 25 %

Ref:-Ingles endodontics 6th ed Pg 183

Friends.. The questions specifically does not ask which incisor --right. But however the Ingle gives the ratio where both central and lateral together.

One canal - 77.4 %

Two canal - 22.5 %

Three or more 0.1 %

72. Ans is D By reducing speed injection

Ref:-Ingle's Endodontics 6th ed - Page 716 Guys .. this is a straight pick from ingle. Line to line

Several procedures have been evaluated for increasing the rate of successful anesthesia of the IAN block

But note that increasing the volume of 2% lidocaine with epinephrine (from 1.8 to 3.6 mL) ,increasing epinephrine concentration (from 1:100,000 to 1:50,000) ,use hyaluronidase an enzyme that reduces tissue viscosity with favorable anesthetic enhancement properties or use of carbonated solutions was no more effective for anesthetic success.

But the book clearly mentions that a slow IAN block injection (60 seconds) significantly increases anesthesia success rates compared to a rapid injection (15 seconds).

73. Ans is C- Patient having pain and swelling

Ref:-Ingles Endodontics 6th ed - Page 702 and Endodontics: Principles and Practice 4th ed TorabinejadPg 40

The development of moderate to severe inter-appointment pain, with or without swelling is termed as Flareup. Most studies have found a highly significant relationship between the presence of preoprative pain and/ or swelling and the incidence of inter-appointment emergencies and the 2nd reference also concludes the same . But I am sure many will be still confused with option C Necrosed pulp but the next line of ingle says that there is no universal agreement in association between flare up and different type of the pulpal status . But yes.. the necrotic pulp has higher incidence.

But both reference clearly says that preoperatively if the patient has swelling and pain then there will be more chances of inter appointment flareups.

Friends..Few students reported that the question did not had the option PAIN AND SWELLING in that case the second best option would be Necrosed pulp having periapical lesion

74. Ans is A - Clean root surface with saline and reimplant

Ref:-Cohens Pathways Of Pulp 10th ed Page no 647 Extra-oral time is the most critical factor affecting prognosis and less than 20 min is found to be the best according to 11th ed of Grossman.

Prolonged extraoral time causes dehydration and death of root surface cells and impairment of viability of periodontal ligament.

International Association of Dental Traumatology guidelines for management of Avulsed tooth (ONLY IMPORTANT POINTS GIVEN HERE )

Radiographic examination recommended

90 - horizontal angle, with central beam through the tooth in question;

Occlusal view;

Lateral view from the mesial or distal aspect of the tooth in question.

Treatment guidelines for avulsed permanent teeth with CLOSED APEX and extraoral dry time is less than60 min

If tooth has been replanted prior to the patient arriving at the dental office or clinic

Administer systemic antibiotics. Doxcycline 1st coice

Apply a flexible splint for up to 2 weeks.

Initiate root canal treatment 710 days after replantation and before splint removal

If tooth has been kept in special storage media

Clean with saline remove coagulum from socket , administer doxycycline,

Rest same as above after reimplantation

Treatment guidelines for avulsed permanent teeth with CLOSED APEX and extraoral dry time is longer than 60 min

Remove attached necrotic soft tissue with gauze.

Root canal treatment can be done on the tooth prior to replantation, or it can be done 710 days

Immerse the tooth in a 2% sodium fluoride solution for 20 min

Stabilize the tooth a using a flexible splint.

Treatment guidelines for avulsed permanent teeth with OPEN APEX and extraoral time less than 60 min

If tooth has already been replanted prior to the patient arriving in the dental office or clinic.

Clean the area with water spray, saline or chlorhexidine. Do not extract the tooth

Administer systemic antibiotics- Penicillin V

Apply a flexible splint for up to 2 weeks.

The goal for replanting still-developing (immature) teeth in children is to allow for possible revascularization of the tooth pulp.

The tooth has been kept in special storage media

Clean with saline remove coagulum from socket

If available, cover the root surface with minocycline hydrochloride microspheres (Arestin) before replanting the tooth.

Rest same as above

Treatment guidelines for avulsed permanent teeth with OPEN APEX and extraoral time dry time longer than 60 min

Root canal treatment can be done on the tooth prior to replantation through the open apex.

Immerse the tooth in a 2% sodium fluoride solution for 20 min

Reimplant it and monitor

75. Ans is A A delta Fibres

Ref:-Endodontictherapy by Weine 6th ed Page 58

The Book clearly mentions that theelectriccharges disseminated by the tester are responded to by theA-delta fibersof the nerve tissues in thepulp

76. Ans is _D Beer Law

Ref:-Textbook ofOperative Dentistry 2nd ed Page 177 The oximeter applies a principle known as the Beer-Lambert law, which states that an unknown concentration of solute (hemoglobin) dissolved in a known solvent (blood) can be assessed by the light absorption of the solute.

HagenPoiseuille Lawwhich regulates the flow of the complex polymers such as guttapercha.The flow is directly proportional to the condensation forces and to the radius of the canal, while it is inversely proportional to the viscosity. The flow of Thermafil gutta-percha and the accompanying sealer obeys the law of Hagen-Poiseuille.

77. Ans is B Chronic caries

Ref:-Shafer's Oral Pathology 5th Pg 71 and Nutrition in Pediatrics by Christopher Duggan Pg 714 Friends.. the question here basically asks whether there is any relation between the developmental enamel hypoplasia and the caries incidence.

Now when I read the Shafers , its mentioned that the progress of caries in such lesion is faster when compared to normal caries initiation.

Now I was unable to correlate the description to the options given in the above question. But with considering many diseases , the disease caries is considered to be chronic in origin. But yes.. if you consider the actual classification of caries then this does not correlate to it.

But I tried to answer it rule of exclusion

It can not be the secondary caries as there is no restoration or earlier residual caries

Occult caries will not be the answer as there is demineralization by caries and not hypoplasia

Incipient caries is clear cut differential diagnosis from developmental hypoplasia

SO FRIENDS.. ALTHOUGH I AM NOT REALLY SURE ABOUT THE RIGHT REFERENCES BUT WE CAN CONSIDER OPTION B CHRONIC AS THE CLOSEST RIGHT ANSWER. BUT I LEAVE THE FINAL DECISION TO YOU.

78. Ans is C - Can be safely given in type 1 diabetes

Ref:-Paediatric Dentistry: Principles and Practice By Muthu 1st and Nutrition in ClinicalDentistr by Abraham 3rd ed Page 24 and journals

Well friends..

Aspartame(Equal) is a dipeptide methylester

Approximately200 timessweeter than sucrose.

Aspartamecontains4 kcal/g but because of its intense sweetening ability provides negligible calories Friends, I went through the journal and found that many articles say that aspartame is found to increase the insulin resistance and also increases the weight gain in the human body. Hence its role is still controversial in the diabetes treatment.

Hence I am sure that by exclusion and by the journal information we can surely consider Option C as the right answer.

79. Ans is B 2 years

Ref:-A Textbook of Public Health Dentistry by marya 1st ed Page 348Enamel calcification is incomplete at the time of eruption of the teeth and an additional period of about 2 years is required for the calcification process to be completed by exposure to saliva.

80. Ans is A Laser light

Ref:-Textbook of Operative Dentistry by Vimal Sikri 1st ed page no 77 DIAGNODENT A variant of Quantitative Laser or Light Induced Fluorescence system

Light source diode laser red light 655 nm.

Red light is transported via an angulated tip with central fiber. Reflected light is eliminated by and taken up by the photo-diode and processed and presented on display as 0-99.

5-25 initial lesions in Enamel

25-35 initial dentinal caries

> 35 advanced dentinal lesion.

81. Ans is B - Placenta acts as regulator and less concentration reaches foetus

Ref:-Fundamentals of Pediatric Dentistry by Rrichard J. Mathewson 2ndPage 103 Well friends.. I went through Soben peter and found that it has almost all the options in the discretion except the option D. So I checked the other reference. Then I came across Mathewson which is quite standard and found that the book has exact same line as like question. I am sure you can mark option B as the right answer.

The placenta does act as a regulator, and the fluoride concentration that reaches the fetus is considerably lower than thatfound in the maternal circulation as clearly mentioned in the book.

82. Ans is D- Tin hydroxyl phosphateRef:-Textbook of Preventive and Community Dentistry 2ND ed by Hitermath Page 386Thetin hydroxy phosphategets dissolved in oral fluids and is responsible for metallic taste

83. Ans is C - Plaque microflora becomes more gram negative

Ref:-Carranzas Clinical Periodontology 8thed Pg No. 87

Early plaque is composed mainly of Gram-positive cocci, which gradually give way to a more filamentous Gram-positive microflora and finally to a complex mixture of many different species containing a larger proportion of Gram-negative species

Several reports have shown that the microbial composition of the dental plaque will change with a shift toward a more anaerobic and a more gram-negative flora, including an influx of fusobacteria, filaments, spiral forms, and spirochetes (Figure 23-21).

In this ecologic shift within the biofilm, there is a transition from the early aerobic environment characterized by gram-positive facultative species to a highly oxygen- deprived environment in which gram-negative anaerobic microorganisms predominate. Bacterial growth in older plaque is much slower than in

84. Ans is D 2 4 hours

Ref:-Clinical Periodontology for the Dental Hygienist by Fermn A. Carranza 1st ed Pg 81

Its a direct pick from the book which says Irreversible bacterial colonization of the pellicle does not appear to take place until 2 to 4 hours after enamelhas been exposed to the bacteria

85. Ans is A - 0.007Carranzas

Ref:-Clinical Periodontology 10th ed Pg No. 731

Diametersof commonbristles

0.007 inch (0.2 mm) forsoft brushes0.012 inch (0.3 mm) for medium

0.014 inch (0.4 mm) for medium

86. Ans is A- Socransky

Ref:-Carranzas Clinical Periodontology 10th ed Pg No 155 SIGMOND SOCRANSKY proposed criteria by which periodontal microorganisms may be judged to be potential pathogens.

They are:

Be associated with disease with increase in number of organisms at diseased sites

Be Eliminated or decreased with treatment

Demonstrate host response

Demonstrate virulence factors capable of causing disease in experimental animals

The pathogenic potential of bacteria within the plaque varies from individual to individual and from one gingival site to another gingival site.

87. Ans is D Plasma cellsRef:-Clinical periodontology by Carranza 10th ed Pg 359

88. Ans is B- T-Lymphocytes sensitised to bacterial plaque antigens

Ref:-Clinical periodontology by Carranza 8th ed Page 128

89. Ans is D - Bacterial composition is altered by dietary sugar consumption.Ref:-Glickman's clinical Periodontology7th ed Page 349 Changes in dietary carbohydrates alter the microbial composition of Supragingival plaque

Carbohydrate fermentation produces a low pH and an acidic environment.

Thus, only those bacteria able to survive in such an environment will colonize and predominate in supragingiva plaque

90. Ans is B - Thermal sensitivity

Ref:-Clinical periodontology by Carranza 10th ed Page 468The Carranza clearly mentions all the three signs except the thermal sensitivity which is not seen in the trauma from occlusion

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