Oral Surgery (Shimi)

Front 1

Trilafron: Class and mode of action

Back 1

Anti-Nauseants. Antidopaminergic blocks dopamine pathways in vomiting centre chemoreceptor trigger zone .

Front 2

Gravol : Class and mode of action

Back 2

Anticholinergic, sedative, and H1 blocking contribute to antiemetic effect

Front 3

Odansetron: Class and Mode of action

Back 3

antiserotonergic. blocks 5ht receptors on neurons located peripheral or central nervous system.

Front 4

Dexamethasone: Class and mode of action

Back 4

Anti-nauseant. MOA unknown

Front 5

Mechanism that causes renal toxicity

Back 5

Normal: decrease Hb Volume=decrease renal Hb flow = decrease GFR= Increase vascular resistance+Na retention. PGE1 and PGE2 counters this.

NSAIDS: No Cyclooxygenase = No PGE1 and PGE2=No counter= Uncontrolled increase of renal vascular resistance = renal failure!

Front 6

Typical Dosage for Ibuprofen (Adult and Child):

Back 6

Adult: 600mg po q6h

Child: 10mg/kg po 6h

Front 7

Typical Dosage for Naproxen (Adult and Child):

Back 7

Adult: 500mg po q12h

Child: 5mg/kg po 12h

Front 8

Typical Dosage for Acetominophen (Adult and Child):

Back 8

Adult: 650-1000mg q4h max 4000mg/24h

Child: 10-15mg/kg q4h max65 mg/kg/24h

Front 9

Typical Dosage for Ketoprofen SR (Adult and Child):

Back 9

Adult: 200 mg po q24h

Child: not indicated under 12

Front 10

What are the components in Tylenol 1

Back 10

15mg Caffeine

300mg Acetominophen

8mg Codeine

Front 11

What are the components in Tylenol 2

Back 11

15mg Caffeine

300mg acetominophen

15mg Codeine

Front 12

What are the components in Tylenol 3

Back 12

15mg Caffeine

300mg acetominophen

30mg Codeine

Front 13

What are the components in Tylenol with Codeine elixir

Back 13

160mg Acetominophen/5ml

8mg Codeine

Front 14

What are the components in 292

Back 14

375mg ASA

15mg Caffeine

30mg Codeine

Front 15

What are the components in Percocet-demi

Back 15

325mg Acetominophen

2.5mg Oxycodone

Front 16

Amoxicillin Dosage for Prophylaxis?

Back 16

Adults: 2gram 1 hour prior

Children: 50mg/kg 1 hour prior

Front 17

Clindamycin dosage for prophylaxis?

Back 17

Adults: 600mg 1 hour prior

Children: 20mg/kg 1 hour prior

(As per AHA guidelines)

Front 18

Contraindications for NSAIDs

Back 18

1)PUD

2) Hypersensitivity

3) RIsk of renal failure

Front 19

Contrindications for Acetominophen

Back 19

1) Hypersensitivity

2) Alcoholics

Front 20

Contraindications for Opioids

Back 20

1) Hypersensitivty

2)Diarrhea caused by poisoning

3) Acute respiratory depression, acute asthma attack, upper airway obstruction

4) MAO Inhibitors

5)Morphine

Front 21

What is one mechanism in which NSAIDs can cause PUD

Back 21

PGE normally inhibits Acid (H+) release in parietal cells. Since NSAIDs prevent production of PGE (normally downstream product of COX but it's knocked out by NSAIDS), you get uncontrolled acid release which causes destruction of GI lining and Ulcers

Front 22

Pathophysiological effects of NSAIDs

Back 22

1) GI=ulcer, pain, nausea

2) Allergic reactions

3) CVS: CHF, elevated BP

4) Renal: Acute renal failure

5) Hemostasis: reversible decrease in TXA2, decrease platelet function

Front 23

9 risk factors for NSAID induced Renal failure

Back 23

Age >60

Arteriosclerotic Cardiovascular disease

Use of Diuretics

Acute Gouty Arthritits (caused by over production of uric acid)

CHF

Renal Disease

SLE

Severe liver disease and cirrhosis

Intravascular volume depletion

Front 24

What percentage of IANB fail?

Back 24

15-20%

Front 25

% of infection that are: Aerobe? Anaerobe? both?

Back 25

5% Aerobe

35% Anaerobe

65% both

Front 26

List the instruments on a standard oral surgery tray

Back 26

Bishops/Austin/Minnesota/Retractor

Fraser Suction

#15 Blade

#3 Bard parker handle

#9 Molt Periosteal Elevator

#34 straight elevator

Reverse Cutting Needle

Plain Gut suture Needle

Front 27

If Warfarin is stopped as part of the pre-op preparation, when should the patient stop taking warfarin?

Back 27

72 hours pre-op. Day before=useless

Front 28

If a Diabetic patient is about to undergo surgery but does not require NPO, how should they be managed?

Back 28

normal diet & oral hypoglycemics; if anticipate difficulty with eating post-op, hold am hypoglycemic til able to eat post-op

Front 29

If a Diabetic patient is about to undergo surgery and requires NPO, how should they be managed?

Back 29

Oral hypoglycemics should be withheld 24 hrs pre-op if the patient is made NPO

Front 30

How long does Plain Gut last and when should it be used?

Back 30

4-7 days, quick healing mucosa

Front 31

How long does Chromic Gut last and when should it be used?

Back 31

9-14 days, quick healing mucosa

Front 32

How long does Vicryl (Polyglactic acid) last and when should it be used?

Back 32

20-30 days, subcutaneous sutures, mucosa, muscle

Front 33

How long does Dexon last and when should it be used?

Back 33

14-21 days, subcutaneous sutures, mucosa

Front 34

What are major risks of tooth extraction?

Back 34

a) Altered sensation: 1% permanent

b) Vital organ infection

c) Fracture of the mandible (>0.01%) and maxillary tuberosity

d) injury and litigation

Front 35

Risks of not extracting 3rd molar?

Back 35

a) Infection (20-40%)

b) Trismus

c) Caries which may lead to loss of second molars d) Development of pathological condition such as cyst (3%) or tumor (0.2%)

e) Vital Organ infection

f) Resorption of adjacent tooth

g)Increase risk of permanent nerve injury if have to remove when root fully developed

Front 36

Components of Alvogyl

Back 36

Iodoform, Butyl paraminobenzoate, Eugenol, Penghawar, Excipient

Front 37

MOA of Alvogyl

Back 37

Antiseptic, Analgesic

Front 38

Contraindications to Alvogyl

Back 38

Allergy to Procaine type anesthetics, hypersensitivity to iodone

Front 39

What forceps are used to take out A?

Back 39

222

Front 40

What forceps are used to take out B?

Back 40

17, 23

Front 41

What forceps are used to take out C?

Back 41

203, 74

Front 42

What forceps are used to take out D?

Back 42

151,151A

Front 43

What forceps are used to take out A?

Back 43

121S

Front 44

What forceps are used to take out B?

Back 44

53R/L

88 R/L

89/90

Front 45

C and E?

Back 45

150 and 150A

Front 46

D?

Back 46

1, 99C

Front 47

Minor transient risks of intervention (surgery)?

Back 47

1. Sensory Nerve alteration

2. Alveolitits

3. Trismus

4. Infection

5. Hemorrhage

6. Dentoalveolar fracture

7. Displacement of Tooth

8. Oral-Antral fistula

Front 48

What some minor PERMANENT risks of injury?

Back 48

Periodontal Injury

Adjacent tooth injury

TMJ injury

Front 49

Likely pathogens. What Bacterias belongs in Box A

Back 49

Strep (Viridans)

Front 50

Likely pathogens. What bacteria goes in Box B

Back 50

Peptostreptococcus

Front 51

Likely pathogens. What bacteria goes in Box C

Back 51

Lactobacillus

Front 52

Likely pathogens. What bacteria goes in Box D

Back 52

Nothing.

Front 53

Likely pathogens. What bacteria goes in Box E, F and G?

Back 53

Nothing!

Front 54

Likely pathogens. What bacteria goes in Box H?

Back 54

Bacteroides

Porphyromonas

Prevotella

Fusobacterium

Front 55

Less Common Pathogens What bacteria goes in Box A?

Back 55

Staph

Front 56

Less Common Pathogens What bacteria goes in Box B?

Back 56

Nothing

Front 57

Less Common Pathogens What bacteria goes in Box C?

Back 57

Cornybacterium

Front 58

Less Common Pathogens What bacteria goes in Box D?

Back 58

Actinomycetes

Front 59

Less Common Pathogens What bacteria goes in Box E?

Back 59

Moraxella

Front 60

Less Common Pathogens What bacteria goes in Box F?

Back 60

Veillonella

Front 61

Less Common Pathogens What bacteria goes in Box G?

Back 61

Enterobacteriaceae

Eikenella

Front 62

What percent of cleft patients have other anomalies?

Back 62

7-13% CL

20-50% CP

2-11% CL/CP

Front 63

What percent of cleft palates have other anomalies associated with a syndrome?

Back 63

2-4%

Front 64

What is involved in an assessment to determine whether an alveolar bone graft is required for a cleft patient?

Back 64

1. Oronasal fistula (do you get ice cream going through your nose?, clinical exam)

2. Lack of alveolar bone stock (by xray, clinical exam)

Front 65

What are the goals of alveolar bone grafting in the cleft patient?

Back 65

1) Closure of vestibular and palatal oral nasal fistulae

2) Provision of bone of sufficient quality and quantity to allow eruption of permanent LI and Canine

3) Provisional of support of lateral ala of nose and skeletal nasal base

4) Provision of suitable bone architecture of premaxilla and anterior face of maxilla on cleft side to support accurate nasolabial muscle reconstruction.

5) Establishment of functional nasal airway on cleft side

Front 66

Reasons for removing root tips

Back 66

1) Superficial

2) Tooth was infected

3) Tooth is far from Vital structures

4) future implant

Front 67

Reasons for not removing the root tip

Back 67

1) Small (less than 5mm)

2) Deep

3) Near vital structures

Front 68

What type of needle is 1?

Back 68

Tapered

Front 69

What type of needle is 2?

Back 69

Cutting

Front 70

What type of needle is 3?

Back 70

Reverse Cutting

Front 71

What is the most likely emergency associated with asthma?

Back 71

Bronchospasm

Front 72

What medication should be administered to the patient in the event of a bronchospasm?

Back 72

Salbutamol

Front 73

What is mechanism of action of a Beta 2 agonist?

Back 73

Stimulates Beta 2 receptors in bronchial smooth muscles leading to increased cAMP and bronchodilation

Front 74

What are contraindications to the drug of choice (Ventolin)?

Back 74

Hypersensitivty, tachyarrhythmia, hypokalemia

Front 75

What are the side effects of Salbutamol?

Back 75

Nervousness, tremor, headache, tachycardia, palpitations, nausea, weakness, hypokalemia

Front 76

In the event of a bronchospasm, how much salbutamol should you administer to the patient?

Back 76

1-2 puffs (100-200ug) PRN

Front 77

What are 3 indications for biopsy a lesion?

Back 77

1) Persists for more than two weeks with no apparent cause

2) Persistant tumor-like structure either visible/palpable

3) Interferes with local function

Front 78

Does 81mg have a antiplatelet effect?

Back 78

Yes

Front 79

List 6 risk factors for NSAID associated GI toxicity in the general population

Back 79

Age >60 years

Concommitant use of corticosteroids

Previous upper GI bleed

Use of excessively high NSAID doses

History of peptic ulcer disease

History of CVD

Front 80

What spectrum of activity does Penicillin V target?

Back 80

Strep, peptostrep, +/- actinomyces

Front 81

What spectrum of activity does Amoxicillin target?

Back 81

Strep, peptostrep, actinomyces, prevotella, +/- H.influenza

Front 82

What spectrum of activity does Amoxicillin w/Clavulanic acid target?

Back 82

Strep, S. Aureus, H. Influenza, M. Catarrhalis, actinomyces, prevotella, peptrostrep

Front 83

What spectrum of activity does metronidazole target?

Back 83

Anaerobes (Bacteroides, prevotella, peptostrep)

Front 84

What spectrum of activity does Clindamycin target?

Back 84

Strep, S. Aureus, Actinomyces, bacteroides, prevotella

Front 85

Patient is having a MI. List 4 first line agents including dose and administration you will use

Back 85

1. Nitroglycerin sublingually 0.3-0.6mg every 5 minute up to 3 times (if systolic >90)

2. ASA 325mg chewed. 1 more taken orally

3. Morphine 5-10mg IM/SC

4. Oxygen 4L/min nasal canula

Front 86

6 year 44lb (20kg). 2% lidocaine 1:100,000 epi. You injected 3 carpules. How much lido in mg did you inject?

Back 86

36mg lidocaine/carpule x 3 carp=108mg

Front 87

6 year 44lb (20kg). 2% lidocaine 1:100,000 epi. You injected 3 carpules. How much epi did you inject?

Back 87

0.018mg epi/carp x 3carp=0.054mg

Front 88

6 year 44lb (20kg). 2% lidocaine 1:100,000 epi. You injected 3 carpules. How much epi did you inject?

What is the max dose of lido you can give her?

What is the Max epi you can give her?

Back 88

Max =7mg/kg x 20=140mg lido

0.2mg Epi MAX

Front 89

Write a prescription for pain medication

Back 89

Name, Date

Age

Address

Rx: Tylenol 3 (three)

Dispense 24 (twenty four) tabs

Directions: take 2 tabs PO q4h PRN pain

Do NOT Refill

Signature and name

Front 90

Please write prescription for amoxicillin

Back 90

Name, Date

Age

Address

Rx: Amoxicillin 500mg

Dispense 22 (twenty two) tabs

Directions: take 2 tabs (1g) STAT, and then T 1 tab (500mg) po q8h until finished

Signature and name

Front 91

Indications for antibiotic prophylaxis

Back 91

1)Artificial Heart valves

2) History of infective endocarditits

3) Certain specific, serious congenital heart conditions such as:

-Unrepaired or incompletely repaired cyanotic congenic congenital heart disease including those with palliative shunts and conduits

-Completely repaired congenital heart defect with prosthetic material or device by surgery or catheter intervention during the first 6 months after the procedure

-repaired congenital heart defect with a residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device

4) Cardiac transplant recipients who develop cardiac valulopathy

Front 92

Technical goals of overcoming complex extractions?

Back 92

Improve Mechanical advantage

Reduce resistance

Correct an inadequate path

Front 93

What are some methods of achieving the technical goals in complex extractions?

Back 93

Improved Access: Flap, bone removal

Improved MA: bone removal

Reduced resistance: bone removal, section teeth

Correct path of removal: Remove bone, section teeth

Front 94

4 general contraindications for vertical releasing incisions

Back 94

1. Canine prominence

2. Palate

3. Over mental foramen

4. Lingual of the mandible

5. Bony Defects

6. Over incisive papilla

Front 95

List signs and symptoms of Acute MI

Back 95

Visceral or precordial chest pain, crushing, heavy, squeezing, burning, or dull ache, +/- radiation to neck jaws, back, shoulders or arms, dyspnea, diaphoresis, restlessness, presyncope, n/v, diarrhea

Front 96

Draw surgical flap incision for tooth 46 below.

Back 96

Front 97

Draw surgical flap incision for tooth 37

Back 97

Front 98

Draw where you would make the biospy

Back 98

Front 99

Draw where the knife would cut for a biopsy in the longitudinal view

Back 99

Front 100

Draw where the knife would cut for a biopsy in the cross-section view

Back 100

Front 101

Definition of Local infiltration

Back 101

Anesthesia that targets terminal branches of the nerves to block transmission

Front 102

Definition of Conscious sedation

Back 102

A depressed level of consciousness via the use of oral, inhaled or IV drugs

Front 103

Regional block definition

Back 103

Blocks transmission in a entire dermatome

Front 104

GA definition

Back 104

State of reversible loss of sensation and consciousness causing reversible drug induced coma

Front 105

What are the three ways to use a elevator?

Back 105

Displacement: putting it into PDL space

Lever Action: Engaging tooth through purchase point and using bone as fulcrum to life tooth up

Wheel and axle: When elevator engages purchase point and handle is roated and tooth is displaced laterally to line of shaft.

Front 106

Definition of Osteogenesis

Back 106

new bone formation by surviving pre-osteoblasts and obsteoblasts within the graft

Front 107

Definition of Osteoconduction

Back 107

Vascular tissue invades the graft, bringing with it the osteoblasts that deposit new bone = creeping substitution

Front 108

Definition of Osteoinduction

Back 108

Components in bone graft (e.g. BMP) stimulate recipient cells to form new bone

Front 109

Name the function of axon:

Back 109

Long projection of neuron that conducst electrical impulses away from cell body

Front 110

Name the function of Cell body

Back 110

contains nucleus and other organelles

Front 111

Name the function of Dendrites

Back 111

branched projections of neuron that receives signals from body

Front 112

Three components of LA and their functions

Back 112

Lipophilic- allows it to cross cell membrane

Intermediate- determines if it’s amide/ester (ester metabolized in tissue by plasma

esterase and amide in the liver by CYPs)

Hydrophilic- allows it to dissolve in interstitial fluid

Front 113

Biochemically why is it difficult to anaesthetize an infected area?

Back 113

Infectious environment is an acidic one thus it is difficult to achieve anesthesia as there will not be enough free base from RN

RNH+ <-- --> RN + H+

Front 114

Vasovagal syncope – what is it, cause, and tx for it?

Back 114

Loss of consciousness resulting from inadequate blood flow to brain.
Cause: pain, fear. Simultaneous loss of sympathetic tone and increased parasympathetic Vagal activation.
Management:

1. Stop

Supine position

ABC and CPR

4. Oxygen

Front 115

What do you do when anesthetic fails?

Back 115

Find out if it’s psychological/ physiological.
If physio: demonstrate patient difference between pressure and pain by perio Probe in area (they should just feel it when it moves not when you place it)-->try Different technique, allow more time, make sure anatomical landmarks correct. If psyc: reduce stress level by TLC, consider sedation/ nitrous oxide/ GA.

Front 116

What is akinosi?

Back 116

Closed mouth IANB.
Anesthetize all teeth on that side, body of mandible, inferior portion of ramus, buccal mucosa in front of mental foramen, ant 2/3 of tongue, FOM, lingual soft tissues. Aim for MGJ of maxillary teeth.

Front 117

Where to take bone from for a graft? How to prevent p/o complications

Back 117

Ramus, zygoma, chin, iliac crest (ant/post), rib, tibia, calvarium
Give antibiotics, antiseptic agent, analgesics post-op.

Front 118

Radiograph with 2 fractures – describe fractures, list 10 clinical features of trauma and where to place plates

Back 118

localized pain

localized swelling

intraoral hematoma

intraoral laceration/bleeding

trismus

malocclusion

crepitations

mobility of teeth

loss of teeth

fetid oral malodor

- If anterior to mental foramen, need to place 2 plates because you need to resist movement in two plates.

Front 119

Sequence of treatment for cysts/tumors:

Back 119

1) Ablative procedures =take tumor/cyst out

2) Soft tissue reconstruction

-Mycocutaneous flaps

-Immediate nerve repair(remove nerve from tumor then reanastamose to NV bundle)

3) osseous reconstruction

4) Denture ready surgery

Front 120

Steps and age at which they are performed for Cleft and palate surgery

Back 120

1) Lip repair and Soft palate repair at 5-6 months

2) Primary hard palate repair with primary gingivoperiosteoplasty at 12 months

3) Alveolar bone graft at 5-6 years

4) Orthognathic surgery at 13-17 years

Front 121

What is the definition of Obstructive sleep apnea syndrome?

Back 121

-Characterized by repetitive episodes of apnea and/or hypopnea

-Due to obstruction of upper airway during sleep

-Assoc w excessive daytime sleepiness

-Relatively common, known to be assoc w significant health + social consequences

Obstructive apnea = no airflow for 10 sec while there is still effort for respiration

Front 122

What is the Apnea hyponea index? What is the threshold of the AHI before a patient is dxed as Obstructive sleep apnea?

Back 122

# of apneas + hypopneas per hour of sleep

.

AHI of at least 5 is associated with excessive daytime sleepiness

Front 123

List symptoms of Obstructive sleep apnea syndrome

Back 123

Prominent snoring

-Excessive daytime sleepiness

-Early morning headaches

-Impaired memory

-Dry throat on awakening

-Enuresis (uncontrolled urination)

-Nocturnal choking/gasping

-Depression

-Recurrent awakenings from sleep

Front 124

Medical complications with OSAS

Back 124

Hypertension

CV and Cerebrovascular disease

Neurocognitive functions

Front 125

Range of success rate for maxillomandibular advancement for tx of OSAS?

Back 125

Overall 70%

With uvulopalatopharyngealoplasty-85%

With Genioplastiy-100%

Front 126

What are the advantages of performing a bone graft in a cleft patient just after eruption of the central incisor rather than canines erupt?

Back 126

+:

1)If bone graft is done at beginning of maxillary permanent central incisor, then the 2 centrals will be the same length on both the normal and cleft side. If wait till permanent canines, then the teeth on the cleft side will be 25% shorter than normal side. Therefore, good aesthetics

2) Second reason: much better perio support of the permanent teeth on the cleft side if graft done earlier

Front 127

Analgesic ladder(dosages)

Back 127

Ketoprofen SR (200mg q24h)

T3: 2 tab q4h prn pain

Percocet: 1 tab q4h prn pain

OxyContin: 10-20mg q12h pain

Dilaudid(hydromorphone): 2-4mg q4h pain