NADA for sample

ORTHODONTICS
1. A removable orthodontic appliance, producing a light force
on the labial of a proclined maxillary central incisor will cause
A. lingual movement of the crown and lingual movement of the root
apex.
B. intrusion of the central incisor and lingual movement of the
crown.
C. lingual movement of the crown and labial movement of the root
apex.
D. intrusion of the central incisor.
Ans C (Ref : page no. 374 proffit 4/e)
Consider a proclined maxillary central incisor. If a single force of
50gm is applied against the crown of this tooth, as might happen
with a spring on a maxillary removable appliance, a force system
will be created that includes a 750gm-mm moment . The result will
be that the crown will be retracted more than the root apex, which
might actually move slightly in the opposite direction. (Remember
that a force will tend to displace the entire object, despite the fact
that its orientation will change via simultaneous rotation around the
center of resistance).
2. Maxillary incisor protrusion can be treated by
1. premolar extraction with orthodontic retraction of the incisors.
2. premolar extraction with surgical repositioning of the anterior
dentoalveolar segment.
3. extraction of the incisors, alveoloplasty and prosthodontic
replacement.
4. reduction and genioplasty.
A. (1)(2) (3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans A (Ref : page no. 204 and 701 proffit 4/e)
Orthodontic treatment of maxillary incisor protrusion:
Excessive protrusion of incisors( bimaxillary protrusion,(not
excessive overjet) usually is an indication for premolar extraction
and retraction of the protruding incisors.

Surgical treatment of maxillary incisor protrusion:

Segments of the dentoalveolar process can be repositioned
surgically in all three planes of space. Genioplasty is the surgical
repositioning of the chin. It can not be used for maxillary incisor
protrusion.
3. The mandible grows primarily at the
A. symphysis and condyles.
B. posterior border of the ramus and the alveolar crest.
C. condyles and lateral border of the body.
D. condyles and posterior border of the ramus.
E. symphysis and posterior border of the ramus.
Ans D (Ref : page no. 46 proffit 4/e)
If data from vital staining experiments are examined, it becomes
apparent that the principal sites of growth of the mandible are the
posterior surface of the ramus and the condylar and coronoid
processes.There is little change along the anterior part of the
mandible.
As a growth site, the chin is almost inactive. It is transIated
downward and forward, as the actual growth occurs at the
mandibular condyle and along the posterior surface of the ramus.
The body of the mandible grows longer by periosteal appositiono f
bone on its posteriors urface,while the ramus grows longer by
endochondralr eplacemenat the condyle accompanied by surface
remodeling.
4. Which of the following are mechanisms of growth of the
naso-maxillary complex?
A. Sutural.
B. Cartilaginous.
C. Appositional.
D. All of the above.
Ans D (Ref : page no. 51 proffit 4/e & Graber pg 43 3/ed)
Proponents of the cartilage theory hypothesize that the
cartilaginous nasal septum serves as a pacemaker for other
aspects of maxillary growth. growth. Note in Figure that the
cartilage is located so that its growth could easily lead to a
downward and forward translation of the maxilla. If the sutures of
the maxilla served as reactive areas,as they seem to do, then they
would respond to this translation by forming new bone when the

sutures were pulled apart by forces from the growing cartilage.

Although the amount of nasal septal cartilage reduces as growth
continues, cartilage persists in this area throughout life, and the
pacemaker role is certainly possible.
Fig. Diagrammatic representation of the chondrocranium at an
early stage of development showing the large amount of cartilage
in the anterior region that eventually becomes the cartilaginous
nasal septum.
5. Wolffs Law states that bone elements
A. rearrange themselves in the direction of functional pressures.
B. increase their mass to reflect functional stress.
C. decrease their mass to reflect functional stress.
D. All of the above.
Ans A (Ref : page no.276 proffit 4/e & Graber pg 631 3/ed &
Julius Wolffs original book, das Gesetz der Transformation
der Knochen )
In the early 1900s,t he German physiologist Wolff demonstrated
that bone trabeculae were arranged in response to the stress lines
on the bone.
A, Bone trabeculae in the head of the femur follow the calculated
stress lines.This observation by the German physiologist Wolff at
the end of the 19th century lead to "Wolff's law of bone" that the
internal architecture of bones represents the stress pattern on
them.
B, Frontal section through the head of the mandibular condyle.
C, Sagittal section through the head of the condyle.Note the
arrangement of bony trabeculae in dicating a similar arrangement
for resistance to stress as seen in the head of the femur.
6. In clinical dentistry, stiffness of wire is a function of
A. length of the wire segment.
B. diameter of the wire segment.
C. alloy composition.
D. All of the above.
E. None of the above.
Ans D (Ref : page no 361, 366 Proffit 4/e)
In orthodontics, there are three major elastic properties: Strength,
Stiffness and Range and these three major properties have an
important relationship:

Strength = Stiffness x Range

Each of the major elastic properties-strength, stiffness, and rangeis substantially affected by a change in the geometry of a beam.
Both the cross-section(whether the beam is circular, rectangular, or
square) and the length of a beam are of great significance in
determining its properties
NOTE : Keep in mind that the performance of a beam, whether
beneath a highway bridge or between two teeth in an orthodontic
appliance,is determined by the combination of material properties
and geometric factors.
7. There is a differential between girls and boys with respect
to the age at which the growth velocity reaches its peak. That
difference is
A. boys six months ahead of girls.
B. girls six months ahead of boys.
C. girls one year ahead of boys.
D. girls two years ahead of boys.
Ans D (Ref : page no 578 Proffit 4/e)
Girls mature considerably earlier than boys and are often beyond
the peak of the adolescent growth spurt before the full permanent
dentition is available and comprehensive orthodontic treatment can
begin. Boys, who mature more slowly and have a more prolonged
period of adolescent growth, are much more likely to have a
clinically useful amount of anteroposterior growth.
8. Excessive orthodontic force used to move a tooth may
1. cause hyalinization.
2. cause root resorption.
3. crush the periodontal ligament.
4. impair tooth movement.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans E (Ref : page no 331, 348 Proffit 4/e)
Deleterious effects of Orthodontic Force :
Effects on the pdl
Causes hyalinization.
Effects on the Height of Alveolar
Height of Alveolar Bone decreases

Bone
Effects on the Pulp
Effects on Root Structure

There are occasional reports of loss of too

Heavy continuous orthodontic force can le
severe root resorption.
9. Which of the following is/are correct?
A. There is no histological difference between basal and alveolar
bone.
B. There is no difference in the response of basal and alveolar
bone to pressure.
C. Osteoid is a highly mineralized bundle bone.
D. All of the above.
Ans C (Ref : page no 331, 348 Graber Vanarsdall 3/e)
Lamellar bone
Lamellar bone, a strong, highly organized, well-mineralized tissue,
makes up more than 99% of the adult human skeleton. When new
lamellar bone is formed, a portion of the mineral component
(hydroxylapatite) is deposited by osteoblasts during primary
mineralization.
Secondary mineralization, which completes the mineral
component, is a physical process (crystal growth) that requires
many months. Within physiologic limits the strength of bone is
directly related to its mineral content. 17,43 The relative strengths
of different histologic types of osseous tissue can be stated thus:
woven bone is weaker than new lamellar bone, which is weaker
than mature lamellar bone.Adult human bone is almost entirely of
the remodeled variety: secondary osteons and spongiosa. The full
strength of lamellar bone that supports an orthodontically moved
tooth is not achieved until approximately 1 year after completion of
active treatment. This is an important consideration in planning
orthodontic retention, as well as in the postoperative maturation
period that follows orthognathic surgery.
Composite bone
Composite bone is an osseous tissue formed by the deposition of
lamellar bone within a woven bone lattice, a process called
cancellous compaction.This process is the quickest means of
producing relatively strong bone." Composite bone is an important
intermediary type of bone in the physiologic response to
orthodontic loading , and it usually is the predominant osseous

tissue for stabilization during the early process of retention or

postoperative healing. When the bone is formed in the fine
compaction configuration, the resulting composite of woven and
lamellar bone forms structures known as primary osteons.
Although composite bone may be high-quality, load-bearing
osseous tissue, it eventually is remodeled into secondary osteons.
Bundle bone
Bundle bone is a functional adaptation of lamellar structure to allow
attachment of tendons and ligaments. Perpendicular striations,
called Sharpey's fibers, are the major distinguishing characteristics
of bundle bone. Distinct layers of bundle bone usually are seen
adjacent to the PDL along physiologic bone-forming surfaces.
Bundle bone is the mechanism of ligament and tendon attachment
throughout the body.
10. The predominant type of movement produced by a finger
spring on a removable appliance is
A. torque.
B. tipping.
C. rotation.
D. translation.
Ans B (Ref : page no 339 Proffit 4/e)
The simplest form of orthodontic movement is tipping. Tipping
movements are produced when a single force (e.g. a spring
extending from a removable appliance) is applied against the
crown of a tooth. In tipping, only one-half the PDL area that could
be loaded actually is. As shown in Figure, the "loading diagram"
consists of two triangles, covering half the total PDL area.
ORAL MEDICINE & RADIOLOGY
11. A Vitamin B2 (Riboflavin) deficiency usually arises in
patients
1. who are elderly.
2. with acute infection.
3. consuming a high protein or fat diet.
4. taking systemic antibiotics.
A. (1)(2)(3)
B. (l)and(3)

C. (2) and (4)

D. (4) only
E. All of the above.
Answer:- C
Assessment of riboflavin status
Biochemical tests are essential for confirming clinical cases of
riboflavin deficiency and for establishing subclinical deficiencies.
Among these tests:
Erythrocyte glutathione reductase activity:
Glutathione reductase is a nicotinamide adenine dinucleotide
phosphate (NADPH), a FAD-dependent enzyme, and the major
flavoproteins in erythrocyte. The measurement of the activity
coefficient of erythrocyte glutathione reductase (EGR) is the
preferred method for assessing riboflavin status. It provides a
measure of tissue saturation and long-term riboflavin status. In vitro
enzyme activity in terms of activity coefficients (AC) is determined
both with and without the addition of FAD to the medium. ACs
represent a ratio of the enzymes activity with FAD to the enzymes
activity without FAD. An AC of 1.2 to 1.4, riboflavin status is
considered low when FAD is added to stimulate enzyme activity. An
AC > 1.4 suggests riboflavin deficiency. On the other hand, if FAD
is added and AC is < 1.2, then riboflavin status is considered
acceptable.[8] Tillotson and Bashor reported that a decrease in the
intakes of riboflavin was associated with increase in EGR AC. In
the U.K. study of Norwich elderly, initial EGR AC values for both
males and females were significantly correlated with those
measured 2 years later, suggesting that EGR AC may be a reliable
measure of long-term biochemical riboflavin status of individuals.
These findings are consistent with earlier studies.
Urinary riboflavin excretion:
Experimental balance studies indicate that urinary riboflavin
excretion rates increase slowly with increasing intakes, until intake
level approach 1.0 mg/d, when tissue saturation occurs. At higher
intakes, the rate of excretion increases dramatically. Once intakes
of 2.5 mg/d are reached, excretion becomes approximately equal
to the rate of absorption (Horwitt et al., 1950)(18). At such high
intake a significant proportion of the riboflavin intake is not
absorbed.If urinary riboflavin excretion is <19 g/g creatinine

(without recent riboflavin intake) or < 40 g per day are indicative

of deficiency.
Ref:- Oral Pathology. Regezi . 4th edition.page no- 122.
12. All of the following are well documented initiating factors
of hairy tongue EXCEPT
A. candidiasis.
B. mouth rinses.
C. antibiotics.
D. systemic corticosteroids (Prednisone).
E. radiotherapy to the head and neck.
Answer:- A
Hairy tongue is a clinical term referring to a condition of filiform
papillae overgrowth on the dorsal surface
of the tongue.
Etiology. There are numerous initiating or predisposing factors for
hairy tongue. Broad-spectrum antibiotics, such as penicillin, and
systemic corticosteroids are often identified in the clinical history of
patients with this condition. In addition, oxygenating mouthrinses
containing hydrogen peroxide, sodium perborate, and carbamide
peroxide have been cited as possible etiologic agents in this
condition. Hairy tongue may also be seen in individuals who are
intense smokers and in individuals who have undergone
radiotherapy to the head and neck region for malignant disease.
The basic problem is believed to be related to an alteration in
microbial flora, with attendant proliferation of fungi and
chromogenic bacteria, and papillae overgrowth.
Clinical Features. The clinical alteration translates to hyperplasia
of the filiform papillae, with concomitant retardation of the normal
rate of desquamation. The result is a thick, matted surface that
serves to trap bacteria, fungi, cellular debris, and foreign material.
Hairy tongue is predominantly a cosmetic problem, since
symptoms are generally minimal. However, when extensive
elongation of the papillae occurs, a gagging or a tickling sensation
may be felt. The color may range from white to tan to deep brown
or black, depending on diet, oral hygiene, and the composition of
the bacteria inhabiting the papillary surface.
Histopathology. Microscopic examination of a biopsy specimen
confirms the presence of elongated filiform papillae, with surface

contamination by clusters of microorganisms and fungi. The

underlying lamina propria is generally mildly inflamed.
Diagnosis. Because the clinical features of this lesion is usually
quite characteristic, confirmation by biopsy
is not necessary. Cytologic or culture studies are of little value.
Treatment and Prognosis. Identification of a possible etiologic
factor, such as antibiotics or oxygenating mouthrinses, is helpful.
Discontinuing one of these agents should result in improvement
within a few weeks. In others there may be benefit to brushing the
dorsum of the tongue with a slurry of sodium bicarbonate in water.
In cases of individuals who have undergone radiotherapy, with
resultant xerostomia and altered bacterial flora, management is
more difficult. Brushing the tongue and maintaining fastidious oral
hygiene should be of some benefit (application of a 1 % solution of
podophyllum resin with thorough rinsing has also been described
as a useful treatment). It is important to emphasize to patients that
this process is entirely benign and self-limiting and that the tongue
should return to normal after institution of physical debridement
and proper oral hygiene.
Ref:- Oral Pathology. Regezi . 4th edition.page no- 84-85.
12. A patient has a history of shortness of breath and ankle
edema. You would suspect
A. asthma.
B. emphysema.
C. rhinophyma.
D. cardiac insufficiency.
Answer:- D
Chronic heart failure (CHF) is a progressive syndrome that results
in a poor quality of life for the patient and places an economic
burden on the health care system. Despite advances in the control
of cardiovascular diseases such as myocardial infarction (MI), the
incidence and prevalence of CHF continue to increase. An
accurate estimate of disease burden is difficult to gather because
of the vast number of patients with asymptomatic left ventricular
(LV) dysfunction. As the population ages, there is an
epidemiological shift toward a greater prevalence of clinical heart
failure with preserved LV function, the so-called stiff-heart
syndrome. In fact, heart failure with preserved systolic function may

account for up to two-thirds of cases in patients older than 70

years.2 Regardless of age, the lifetime risk of developing heart
failure is approximately 20% for all patients older than 40 years.
Despite the growing prevalence, novel screening techniques and
therapeutic directions have improved the outlook for patients with
heart failure by focusing not only on symptom control but also on
ameliorating the pathophysiology toward a corrective phenotype.
This review discusses accepted and emerging therapeutic
directions, with an emphasis on practical implications. In light of the
available literature and clinical trials, the primary emphasis will be
on systolic dysfunction, with a separate brief discussion of heart
failure with preserved systolic function.
DIAGNOSIS
No single test can be used to establish the clinical diagnosis of
heart failure. Instead, history and physical examination findings
showing signs and symptoms of congestion and/or end-organ
hypoperfusion are used to make the diagnosis. Imaging studies
documenting systolic or diastolic dysfunction and biomarkers are
helpful adjuncts. Physical examination is not helpful in
discriminating between systolic and diastolic heart failure because
similar findings, including cardiomegaly and an S3 gallop, can be
seen in both conditions. Pulmonary rales, often considered a sign
of pulmonary venous congestion, are often absent in CHF despite
elevated left-sided filling pressures. This absence is due to chronic
lymphatic hypertrophy, which prevents alveolar edema despite
elevated interstitial pressures. Framingham criteria, widely used in
clinical research, comprise a series of major and minor criteria that
aid in the diagnosis of heart failure and emphasize the importance
of jugular venous pressure elevation, an S3 gallop, and a positive
hepatojugular reflex in establishing a diagnosis, while minimizing
the importance of lower extremity edema. The use of brain-type
natriuretic peptides, in their active or inactive circulating forms, has
evolved during the past decade, but the most well-established use
remains in discriminating between causes of dyspnea when the
diagnosis is in doubt. Comorbid conditions must be taken into
account because renal insufficiency increases these levels and
obesity lowers them.
The etiology of systolic heart failure dramatically affects prognosis

and treatment. Coronary artery disease (CAD) accounts for the

vast majority of cases of systolic heart failure in the United States,
followed by hypertensive and dilated cardiomyopathies. In the
acute setting of newly diagnosed cardiomyopathy, the exclusion of
underlying CAD and potential at-risk myocardium that might
benefit from revascularization is critical. Patients with CAD and
concomitant heart failure have a worse prognosis than those with
nonischemic cardiomyopathy, but myocardial function may
substantially improve after revascularization in selected cases,
highlighting the importance of making the appropriate diagnosis
early and accurately.
Ref:- 16th Edition of Harrisons Principles of Internal Medicine
by Harrison. Page no- 2581.
14. A 34 year old male patient complains of night sweats,
weight loss, malaise, anorexia and low-grade fever. Clinical
examination shows a nodular, ulcerated lesion on the palate.
The most likely diagnosis is
A. viral hepatitis.
B. infectious mononucleosis.
C. tuberculosis.
D. actinomycosis.
Answer:- C
Tuberculosis (TB) is an infection, primarily in the lungs (a
pneumonia), caused by bacteria called Mycobacterium
tuberculosis. It is spread usually from person to person by
breathing infected air during close contact. TB can remain in an
inactive (dormant) state for years without causing symptoms or
spreading to other people.When the immune system of a patient
with dormant TB is weakened, the TB can become active
(reactivate) and cause infection in the lungs or other parts of the
body.
The risk factors for acquiring TB include close-contact situations,
alcohol and IV drug abuse, and certain diseases (for example,
diabetes, cancer, and HIV) and occupations (for example, healthcare workers). The most common symptoms and signs of TB are
fatigue, fever, weight loss, coughing, and night sweats. The
diagnosis of TB involves skin tests, chest X-rays, sputum analysis
(smear and culture), and PCR tests to detect the genetic material

of the causative bacteria. Inactive tuberculosis may be treated with

an antibiotic, isoniazid (INH), to prevent the TB infection from
becoming active. Active TB is treated, usually successfully, with
INH in combination with one or more of several drugs, including
rifampin (Rifadin), ethambutol (Myambutol), pyrazinamide, and
streptomycin.
Drug-resistant TB is a serious, as yet unsolved, public-health
problem, especially in Southeast Asia, the countries of the former
Soviet Union, Africa, and in prison populations. Poor patient
compliance, lack of detection of resistant strains, and unavailable
therapy are key reasons for the development of drug-resistant TB.
The occurrence of HIV has been responsible for an increased
frequency of tuberculosis. Control of HIV in the future, however,
should substantially decrease the frequency of TB
Ref:- 16th Edition of Harrisons Principles of Internal Medicine
by Harrison. Page no- 2087.
15. Myxedema is associated with
A. insufficient parathyroid hormone.
B. excessive parathyroid hormone.
C. insufficient thyroid hormone.
D. excessive thyroid hormone.
Answer:- C
Myxedema is also used to describe the clinical syndrome
secondary to hypothyroidism. Symptoms can include depression,
mental slowness, weakness, bradycardia, fatigue, hypothermia,
alopecia, and many others (see symptoms of severe
hypothyroidism). Used in this way, myxedema can be considered
the adult counterpart of cretinism.
Myxedema coma is rare and establishing the diagnosis requires a
high index of suspicion. Myxedema coma represents the severest
form of hypothyroidism and has an associated mortality rate of 30
percent to 40 percent. It can occur due to long-standing, untreated
hypothyroidism, but is often linked to a precipitant, such as acute
infection, myocardial infarction, congestive heart failure, cerebral
vascular accident, trauma, or drug toxicity. Several medications
can cause hypothyroidism, and patients taking them must be
carefully monitored. These medications include amiodarone,
lithium, and sedatives. No consensus exists on specific thyroid

hormone replacement regimens for myxedema coma. Most experts

agree that a large intravenous bolus of levothyroxine should be
administered (200 to 400 mcg), followed by daily doses of 50 to
100 mcg, based on the patient's weight and comorbidities. Other
experts advocate the use of triiodothyronine (T3) or a combination
of both T3 and T4. In addition to thyroid replacement therapy, it is
important to detect coexisting adrenal insufficiency and treat
patients with stress-dose steroids to avoid precipitating adrenal
crisis.
Cause- The increased deposition of glycosaminoglycan is not fully
understood, however two mechanisms predominate.
Exophthalmos in particular results from TSH receptor stimulation
on fibroblasts behind the eyes which leads to increased
glycosaminoglycan deposition. It is thought that many cells
responsible for forming connective tissue react to increases in TSH
levels.
Secondarily, in autoimmune thyroid diseases lymphocytes react to
the TSH receptor. Thus, in addition to the inflammation within the
thyroid, any cell that expresses the TSH receptor will likely
experience lymphocytic infiltrates as well. The inflammation can
cause tissue damage and scar tissue formation, explaining the
deposition of glycosaminoglycans.
The increased deposition of glycosaminoglycans causes an
osmotic edema and fluid collection. Hashimoto's thyroiditis is the
most common cause of myxedema in the United States
Ref:- 16th Edition of Harrisons Principles of Internal Medicine
by Harrison. Page no- 1041.
16. Radiographically, the opening of the incisive canal may be
misdiagnosed as a
1. branchial cyst.
2. nasopalatine cyst.
3. nasolabial cyst.
4. periradicular cyst.
A. (1)(2) (3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.

Answer:- C
The incisive foramen (also called the nasopalatine or Anterior
palatine foramen in the maxilla is the oral terminus of the
nasopalatine canal. It transmits the nasopalatine vessels and
nerves (which may participate in the innervation of the maxillary
central incisors) and lies in the midline of the palate behind the
central incisors at approximately the junction of the median
palatine and incisive sutures. Its radiographic image is usually
projected between the roots and in the region of the middle and
apical thirds of the central incisors. The foramen varies markedly in
its radiographic shape, size, and sharpness. It may appear
smoothly symmetric, with numerous forms, or very irregular, with a
well demarcated or ill-defined border. The position of the foramen
is also variable and may be recognized at the apices of the central
incisor roots, near the alveolarcrest, anywhere in between, or
extending over the entire distance. The great variability of its
radiographic image is primarily the result of (1) the differing angles
at which the x-ray beam is directed for the maxillary central incisors
and (2) some variability in its anatomic size. Familiarity with the
incisive foramen is important because it is a potential site of cyst
formation. An incisive canal cyst is radiographically discernible: it
frequently causes a readily perceived enlargement of the foramen
and canal. The presence of a cyst is presumed if the width of the
foramen exceeds 1 cm or if enlargement can be demonstrated on
successive radiographs. Also, if the radiolucency of the normal
foramen is projected over the apex of one central incisor, it may
suggest a pathologic periapical condition. The absence of pathosis
is indicated by a lack of clinical symptoms and an intact lamina
dura around the central incisor in question. The lateral walls of the
nasopalatine canal are not usually seen but on occasion can be
visualized on a projection of the central incisors as a pair of
radiopaque lines running vertically from the superior foramina of
the nasopalatine canal to the incisive foramen
Ref:- Oral Radiology- Principles And Interpretation. 5th Edition .
White & Ferro. Page No- 174.
17. Which of the following bone lesions of the mandible is/are
malignant?
1. Osteosarcoma.

2. Osteochondroma.
3. Ewing's tumor.
4. Fibrous dysplasia.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- B
Conventional osteosarcomas involving the mandible and maxilla
display a slight predilection for males (60%). Although the peak
incidence of osteosarcomas of the skeleton occurs in the second
decade, those arising in the jaws present 1 to 2 decades later, with
a mean age of 35 years (range 8 to 85 years). The mandible is
more commonly affected than the maxilla by a ratio of 1.7 to 1.
Ewing's sarcoma has been a highly lethal round cell sarcoma that
was first described by James Ewing in 1921. The cause is
unknown, the cell of origin uncertain, and even the multipotentiality
of antigenic expression controversial. Ninety percent of Ewing's
sarcomas occur between the ages of 5 and 30 years, and more
than 60% affect males (Figure 14-14). The mean age of
occurrence for primary tumors involving the bones of the head and
neck is 11 years. Pain and swelling are the most common
presenting symptoms. Involvement of the mandible or maxilla may
result in facial deformity, destruction of alveolar bone with
loosening of teeth, and mucosal ulcers. Radiographic findings in
the jaws are nonspecific and may simulate an infectious process,
as well as a malignant process. The most characteristic
appearance is that of a moth-eaten destructive radiolucency of the
medullary bone and erosion of the cortex with expansion. A
variable periosteal onionskin reaction may also be seen. A
significant number of patients also have a soft tissue mass.
Ref:- Oral Pathology. Regezi . 4th edition.page no-321 & 330.
18. Radiolucent lesions of the jaws can be seen in
1. hyperparathyroidism.
2. multiple myeloma.
3. fibrous dysplasia.
4. hyperthyroidism.

A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Answer:- A
Fibrous dysplasia has available radiographic appearance that
ranges from a radiolucent lesion to a uniformly radiopaque mass.
The classic lesion has been described as having a radiopaque
change that imparts a "ground glass" or "peau d'orange" effect.
This characteristic image, which is most identifiable on intraoral
radiographs, is not, however, pathognomonic. Lesions of fibrous
dysplasia may also present as unilocular or multilocular
radiolucencies, especially in long bones. A third pattern, most
commonly seen in patients with long-standing disease, is a mottled
radiolucent and radiopaque appearance. Additional radiographic
features that have been described include a fingerprint bone
pattern and superior displacement of the mandibular canal in
mandibular lesions.
An important distinguishing feature of fibrous dysplasia is the
poorly defined radiographic and clinical margins of the lesion. The
process appears to blend into the surrounding normal bone without
evidence of a circumscribed border. In addition, these lesions are
often elliptic as opposed to spheric.
Ref:- Oral Pathology. Regezi . 4th edition.page no-292-293.
19. Which of the following sites for squamous cell carcinoma
has the best prognosis?
A. Lower lip.
B. Retromolar area.
C. Gingiva.
D. Buccal mucosa.
E. Hard palate.
Answer:- A
Carcinoma of the Lips- From a biologic viewpoint, carcinomas of
the lower lip are separated from carcinomas of the upper lip.
Carcinomas of the lower lip are far more common than upper lip
lesions. UV light and pipe smoking are much more important in the
cause of lower lip cancer than in the cause of upper lip cancer. The

growth rate is slower for lower lip cancers than for upper lip
cancers. The prognosis for lower lip lesions is generally very
favorable, with over 90% of patients alive after 5 years. By
contrast, the prognosis for upper lip lesions is considerably worse.
Lip carcinomas account for 25% to 30% of all oral cancers. They
appear most commonly in patients between 50 and 70 years of
age and affect men much more often than women. Some
components of lipstick may have sunscreen properties and
account, in part, for this finding. Lesions arise on the vermilion and
typically appear as a chronic nonhealing ulcer or as an exophytic
lesion that is occasionally verrucous in nature. Deep invasion
generally appears later in the course of the disease. Metastasis to
local submental or submandibular lymph nodes is uncommon but
is more likely with larger, more poorly differentiated lesions.
Ref:- Oral Pathology. Regezi . 4th edition.page no- 57.
20. In hyperparathyroidism, typical features of bone
involvement are
1. subperiosteal erosion of the phalanges.
2. osteopetrosis.
3. pathological fractures.
4. renal stones.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. All of the above.
Answer:- D
The disease spectrum of primary hyperparathyroidism ranges from
asymptomatic cases (diagnosed by routine serum calcium
determinations) to severe cases manifesting as lethargy and
occasionally coma. The incidence increases with age and is
greater in postmenopausal women. Early symptoms include
fatigue, weakness, nausea, anorexia, arrhythmias, polyuria, thirst,
depression, and constipation. Bone pain and headaches are often
reported.
Several clinical features are associated with the primary form of
this disease, classically described as "stones, bones, groans, and
moans." Lesions of the kidneys, skeletal system, gastrointestinal
tract, and nervous system are responsible for this syndrome

complex. The renal component includes the presence of renal

calculi or, more rarely, nephrocalcinosis associated with
hypercalcemia.
Gastrointestinal manifestations include peptic ulcer secondary to
the increase in gastric acid, pepsin, and serum gastrin levels.
Rarely, pancreatitis may develop secondary to obstruction of the
smaller pancreatic ducts by calcium deposits.
Neurologic manifestations may become evident when serum
calcium levels are very high, exceeding 16 to 17 mg/dl. In such
instances coma or parathyroid crisis may occur. Loss of memory
and depression are common, and rarely, true psychosis may
appear. Some of the neurologic findings may be attributed to
calcium deposits in the brain. Severe osseous changes (called, in
the past, osteitis fibrosa cystica) are the result of significant bone
demineralization, with fibrous replacement producing radiographic
changes that appear cyst like. In the jaws these lesions resemble
central giant cell granuloma microscopically. Less obvious
radiographic changes may include an osteoporotic appearance of
the mandible and maxilla, reflecting a more generalized resorption.
Loosening of the teeth may also occur, as well as corresponding
obfuscation of trabecular detail and overall cortical thinning. Partial
loss of lamina dura is seen in a minority of patients with
hyperparathyroidism. Pulpal obliteration, with complete calcification
of the pulp chamber and canals, has been reported in association
with secondary hyperparathyroidism.
The bone lesions of hyperparathyroidism, although not specific, are
important in establishing the diagnosis. The bony trabeculae exhibit
osteoclastic resorption, as well as the formation of osteoid
trabeculae by large numbers of osteoblasts. In these areas a
delicate fibrocellular stroma contains numerous multinucleated
giant cells. Accumulations of hemosiderin and extravasated red
blood cells also are noted. As a result, the tissues may appear
reddish brown, accounting for the term brown tumor. The lesions
are microscopically identical to central giant cell granulomas.
Ref:- Oral Pathology. Regezi . 4th edition.page no- 342-343.
CONSERVATIVE DENTISTRY & ENDODONTICS
21. The primary retention of a Class II gold inlay is achieved
by

1. adding an occlusal dovetail.

2. increasing the parallelism of walls.
3. lengthening the axial walls.
4. placing a gingival bevel.
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only
E. All of the above.
Ans. A [Ref. Sturdevants Art & Science of Operative Dentistry
5th Edition, Pg 307]
Cast metal intracoronal restorations rely primarily on almost
parallel vertical walls to provide retention of the casting. The
preparation walls must be designed maintaining parallelism with
small angle of divergence (2-5 degrees per wall) that would
enhance retention form. The degree of divergence needed
primarily depends on the length of the prepared walls: greater
the vertical height of the walls, the more divergence is permitted &
recommended, but within the range described. Having sufficient
length of these almost parallel walls allows enough frictional
resistance & mechanical locking of the luting agent into minute
irregularities of the casting & the preparation walls to counteract
the pull of sticky foods.
In class II preparations involving only one of the two proximal
surfaces, an occlusal dovetail may aid in preventing the tipping of
the restoration by occlusal forces. When an unusually large
amount of retention form is required, occlusal dovetail may be
placed whether or not caries is on the occlusal surface.
Fig A shows primary retention form in class II tooth preparation for
amalgam with vertical external walls of proximal & occlusal portios
converging occlusally while fig B shows primary retention form for
an inlay with similar walls slightly diverging occlusally.
22. A vertical cross-section of a smooth surface carious lesion
in enamel appears as a triangle with the
A. base at the dentino-enamel junction.
B. base facing toward the pulp.
C. apex pointing to the enamel surface
D. apex pointing to the dentino-enamel junction.

Ans. D [Ref.Sturdevants Art & Science of Operative Dentistry

5th Edition, Pg 165,166]
Smooth-surface caries does not begin in an enamel defect, but
rather in a smooth area of the enamel surface that is habitually
unclean & is continually or usually covered by plaque. The
disintegration in the enamel in smooth-surface caries may be
pictured as a cone with its base on enamel surface & the apex
directed towards DEJ.
In contrast, caries cone in pit & fissure caries may be pictured with
its apex on enamel surface & base towards DEJ. Thus, caries in
this case forms a small area of penetration in the enamel & does
not spread laterally to a great extent until DEJ is reached.
23. For an acid-etched Class III composite resin, the
cavosurface margin of the cavity can be bevelled to
A. eliminate the need for internal retention.
B. improve convenience form.
C. aid in finishing.
D. increase the surface area for etching.
Ans. D [Ref. Sturdevants Art & Science of Operative Dentistry
5th Edition, Pg 313, 530]
Bevelling the cavosurface margin of composite restorations
increasese the surface area of etchable enamel by increasing the
number of exposed enamel rods thus maximising the effectiveness
of bond. Most class III composite restorations are retained only by
the micromechanical bond from acid etching & resin bonding, so
no additional retention form is required. Also, bevel brings the
margins into more accessible areas thus improving the
convenience form & allowing better blending and finishing of the
margins.
24. The tooth preparation for a porcelain veneer must have a
1. rough surface.
2. space for the veneer material.
3. definite finish line.
4. margin at least 1mm supragingivally
A. (1)(2)(3)
B. (l)and(3)
C. (2) and (4)
D. (4) only

E. All of the above

Ans. E [Ref.Sturdevants Art & Science of Operative Dentistry
5th Edition, Pg 650]
Intraenamel preparation before placing a veneer is strongly
recommended for following reasons:
1. to provide space for opaque, bonding or veneering materials for
maximal esthetics without overcontouring
2. to remove the outer, fluoride-rich layer of enamel that may be
more resistant to acid-etching
3. to create a rough surface for improved bonding
4. to establish a definite finish line.
Whenever possible, margins should be placed supragingivally.
25.