SPEED DENTAL AIIMS

NOVEMBER 2010
ANSWER DISCUSSION
1. Z score indicates
a. normal
b. binomial
c. chi score
Answer: a. normal
Z-score
Explanation:
Thus z is a measure of how far away a measurement
is from the mean,
measured in standard deviations.
Calculation:
z = (X - X-bar)/S
Where X is a measured value, X-bar is the mean of
all
measured values and S is the standard deviation of
all measured
values.
Example
John gets a mark of 64 in a physics
test, where the mean is 50 and the standard
deviation is 8.
Jane gets a mark of 74 in a chemistry test, where the
mean is 58
and the
standard deviation is 10.
John's z = (64 - 50) / 8 = 1.75
Jane's z = (74 - 58) / 10 = 1.6
Although Jane's score is higher, John's score is
further above
the mean, and it might be concluded that John has
achieved
greater success.
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Comments:
The z-score provides a simple measure by which
different measures
can be compared in terms of their deviation from
the mean. This is
often called standardization.
The z-score in use generally assumes parametric
data.
2. Standard error of mean. All the following is
true except
a. Increases as the sample size increases
b. decreases as the sample size increases
c. Is independent of sample size
Answer: b
Explanation:
Standard error of mean decreases as the sample size
increases as the
level of significance decreases along with the
increase in sample size
(i. e) more the difference, lesser the sample size and
lesser the
difference more is the sample size required.
3. Which of the following is the impact indicator
for evaluation of
ASHAs performance?
a. Number of ASHAs trained
b. Infant mortality rate
c. Number of ASHA s attending meeting
d. Percentage of institutional deliveries
Answer: b
Explanation and Comments:
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MONITORING AND EVALUATION
Government of India has set up following indicators
for monitoring

ASHA.
Process Indicators:
Number of ASHAs selected by due process;
Number of ASHAs trained,
% of ASHAs attending review meetings after one
year;
Outcome Indicators:
% of newborn who were weighed and families
counseled;
% of children with diarrhoea who received ORS,
% of deliveries with skilled assistance;
% of institutional deliveries,
% of JSY claims made to ASHA,
% completely immunized in 12-23 months age
group.
% of unmet need for spacing contraception among
BPL;
% of fever cases who received chloroquine within
first week in
an malaria endemic area;
Impact indicators:
IMR;
Child malnutrition rates;
Number of cases of TB/leprosy cases detected as
compared to previous
year.
While MIS to be setup for NRHM will ensure
timely information on
key inputs and process indicators, information on
impact indicators
will come through DRHS being planned for RCHII.
During bi-monthly meetings, ANM should get
information from
ASHAs regarding the progress made and
consolidate the report at PHC
by Medical officer.
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2010 _ Answer Discussion
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CONSERVATIVE DENTISTRY AND
ENDODONTICS
4. A dentin primer
a. Etches the dentin
b. Increase the surface energy and wets the dentin
surface
c. Removes the smear layer
d. Bonds with composite
If less than 3mm, the dressing will probably break
and fall out.
Reference:
http://faculty.ksu.edu.sa/alobaida/Pages/mcqinfectio
n.aspx
http://www.dentistry.bham.ac.uk/ecourse/pages/pag
e.asp?pid=80
5. Magnification allowed in working length
determination by
paralleling technique
a. none
b. 1mm
c. 2mm
d. 3mm
Answer: b. 1mm
Explanation:
Initial working length The tooth is measured on a
good preoperative
radiograph taken using the
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Paralleling technique.
Tentative working length As a safety factor,
allowing for image
distortion or magnification at least 1mm is
subtracted from the initial
measurement for determining tentative working
length.
Reference: Ingle 5th edition, pg: 515

6. What is the depth of etching in enamel?

a. 0.5 5 m
b. 5- 50 m
c. 50 500 m
d. 500 1000 m
Answer: b. 5- 50 m
Explanation:
Acid etching removes about 10 m of the enamel
surface & creates a
micro porous layer from 5- 50m deep.
Ref: James Summit 3rd edition, pg:210
8. The protaper F2 series Gutta percha when cut
1 mm in apical
position of canal of the diameter of the tip of GP
point is
a. 0.29 mm
b. 0.30 mm
c. 0.31mm
d. 0.33 mm
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Answer: d. 0.33 mm
Explanation:
Finishing files F1, F2, F3 are marked with a yellow,
red & blue
identification rings, respectively. The finishing files
have a fixed taper
in the first 3mm from D0 to D3 .
F1 7% taper
F2 8% taper
F3 9% taper
Over the remaining length, reverse taper can be
found. These finishing
files have matching GP points for obturation.
As the tip diameter of F2 is 0.25mm & its taper in
apical 3mm is 8%,
when 1mm is cut in the apical portion, resulting tip
diameter will be
0.33 mm (i.e. 0.25 + 0.08) as the raise in taper in
this will be
0.08mm/mm of GP.
Ref: DCNA Jan 2004. Vol 48.No 1,pg: 98.
9. Why etchant is preferred in gel form than
solution?
a. better control over placement
b. easily rinsable
c. increased concentration of acid in that area
d.
Answer: a. better control over placement
Explanation:
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An acid gel is generally preferred over a liquid
because its application
is easier to control.
Ref: James Summit 3rd edition, pg: 210.
10. Pulp tissue closely resembles
a. neural tissue
b. loose connective tissue
c. granulation tissuevascular tissue
Answer: b. loose connective tissue
Explanation:
Pulp tissue closely resembles loose connective
tissue. Pulp polyp
closely resembles granulation tissue.
11. An apical third fracture of the root will most
commonly?
a. remain vital and functional
b. ankylosed
c. will require extraction
d. iscoloration of the teeth
Answer: a. remain vital and functional
Explanation:
Mid root & Apical root fractures:
Pulp necrosis occurs in 25% of root fractures. In the
vast majority of

cases, the necrosis occurs in the coronal segment

only, with the apical
segment remaining vital.
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Ref: Ingle 6th edition, pg: 1341.
12. In a deep carious lesions, the method to
protect pulp while
etching
a. calcium hydroxide liner
b. light cure resin modified GIC
c. cavity varnish
d. chemfill
Answer: b. light cure resin modified GIC.
Explanation:
RMGIC is used to seal the deep dentin. After light
curing, it can be
etched along with the rest of the dentin.
13. Salivary microorganism content
a. 750million /ml
b. 800 million /ml
c. 87million/ml
d. 43million/ml
Answer: a. 750million /ml
Explanation:
Saliva of a normal individual contains
approximately 750 million
microorganisms / ml.
Ref: Text book of Oral Microbiology & infectious
disease, pg:231.
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14. A patient is with necrotizing pulp due to
trauma with
periapical rarefaction & with closed pulp. The
percentage of
viable micro organisms obtained in culture is
a. 10%
b. 40%
c. 70%
d. 80 %
Answer: a.10%?
Explanation:
When the root canals of intact teeth with necrotic
pulp were cultured in
one study, strict anaerobes accounted for more than
90% of the
bacteria.
So, if anaerobic culture is performed, percentage of
viable micro
organisms obtained will be around 90%.If aerobic
culture is
performed, it will be around 10%.But the question
is vague here & so
the ans is uncertain.
Ref: Cohen 9th edition, pg 582.
15. All the following about dentin conditioner are
true except?
a. Increase free surface energy of dentin
b. Bonds composite to dentin
c. Removes smear layer.
Answer: a. Increase free surface energy of dentin
Explanation:
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Complete or partial removal of the smear layer can
be achieved by
applying acidic or chelating solutions, called
conditioners. The more
acidic and aggressive the conditioner, the more
completely the smear
layer and smear plugs are removed. Strong acids not
only remove the
smear layer, but they also demineralize intact
dentin, remove smear

plugs to a depth of 1 to 5m and widen the dentinal

tubule orifices.
Contemporary etch and rinse adhesives usually use
a 30% to 40%
phosphoric acid gel for the conditioning step.
Alternatively, maleic,
nitric, citric and tannic acids may be used in varying
concentrations. A
polyalkenoic acid conditioner used in GIC
restorative techniques also
provides clean dentin surfaces, although without
substantial dentin
demineralization and without rendering dentinal
tubules patent.
The high protein content exposed after conditioning
with acidic agents
is responsible for the low surface free energy of
etched dentin (44.8
dynes/cm), which differentiates it from etched
enamel.
Reference:
Operative dentistry James Summit 3rd edition,
pg: 191,212.
Also refer the explanation for Q.1.
PERIODONTITIS
16. After prophylaxis and pumice polishing, the
time taken for
plaque to develop
a. within few minutes
b. after 1 hr
c. 2-4 hr
d. 0.5 1 hr.
Answer: a
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Explanation:
Within nano seconds after tooth polishing, acquired
pellicle covers the
tooth surface. Bacteria adheres to this pellicle
within seconds after
prophylaxis. Among the options, the appropriate
answer is - within
few minutes
Within 2-8 hrs streptococci saturate the pellicle
After 1 day- organization of plaque is completed to
form BIOFILM
First 24 hours- plaque growth is negligible
clinically. After 3 daysplaque
growth increases at a rapid rate. Microbial
generation time:1
hour for initial plaque, 12 hours for 3 day old
plaque
Reference: Carranza 10th ed pg no 140,141,145
17. The following condition do not create
gingival defects
necessitating gingivoplasty except
a. ANUG
b. Desquamative gingivitis
c. Erosive lichen planus
d. Acute herpetic Gingivostomatitis
Answer: a
Explanation:
ANUG- clinically,Punched out crater like
depressions at the crest of
the interdental papilla, covered by a
pseudomembrane, seperated from
the adjacent gingiva by linear erythema is seen.
Healing of ANUG
usually leads to restoration of the normal gingival
contour. But, if there
is severe loss of interdental bone, or if entire papilla
is lost, healing
results in the formation of shelf like gingival
margin, which favours
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plaque accumulation and is of esthetic concern.

This defect is
corrected by gingivoplasty
Desquamative gingivitis- first reported in 1894.
Term was coined in 1932 by Prinz
Diseases clinically presenting as desquamative
gingivitis are Lichen
Planus, Cicatricial Pemphigoid, Bullous
Pemphigoid, Pemphigus
Vulgaris, Linear Iga Diseadse, Dermatitis
Herpetiformis, Lupus
Erythematosus, Chronic Ulcerative Stomatitis
Lichen planus, Cicatricial pemphigoid- account for
95% of cases
All these desquamative lesions do not cause any
gingival deformity,
hence does not require any surgical reshaping
procedure like
gingivoplasty
Acute herpetic gingivostomatitis- in the
occurinitial stage- discrete
spherical grey vesicles . After 24 hours, vesicle
rupture to form painful
small ulcers with a red elevated halo like margin
and a depressed
yellowish or grayish white central portion-. Course
of the disease is
usually 7-10 days. It heals without scarring.
Hence does not require
gingivoplasty.Treatment- Acyclovir 15mg/kg 5
times daily for 7days
Reference: Carranza 10th ed pg no 391-392,398399, 707-711
18. A periodontal pocket of 8 mm deep having
the junctional
epithelium coronal to the CE junction
a. an infrabony pocket
b. a pseudopocket
c. a true periodontal pocket
d. a furcation involvement
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Answer: b
Explanation:
Normally in health, the junctional epithelium is at
the level of CEJ.
When there is a pocket of 8mm, with the JE at or
coronal to CEJ, it
implies it is a false pocket or gingival pocket or
pseudopocket.
Pocket is a pathologically deepened gingival sulcus
In a pseudopocket, the deepening occurs as a result
of coronal
migration of gingival margin
In a true pocket, deepening is due to an apical shift
in the JE, ie, the
JE is apical to the CEJ
Infrabony pocket is also a type of true pocket,
wherein base of pocket
is apical to the crest of alveolar bone. It is usually
associated with
vertical or angular bone loss. Transseptal and
periodontal ligament
fibres are arranged obliquely. In a suprabony
pocket, the base of the
pocket is coronal to the crest of the alveolar bone.
Patern of bone
destruction is usually horizontal with the transseptal
and PDL fibres
arranged horizontally
Furcation involvement also results in a true pocket
Reference: Carranza 10th ed ,pg no 434, 446-448
19. According to Glickman, maximum plaque
formation occurs
by
a. 7 days
b. 15 days

c. 30 days
d. 60 days
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Answer: b
Explanation:
Clinically early undisturbed plaque formation on
teeth follows an
exponential growth curve. During the first 24 hours,
plaque growth is
negligible from a clinical viewpoint. During the
next 3 days, plaque
growth increases at a rapid rate. After 4 days, 30%
of the tooth is
covered with plaque. As per the experimental
gingivitis model curve, it
is seen that gram positive cocci begin to saturate
and reach a peak at
about 8-10 days and then reach a plateau. Gram
negative rods reach a
peak by the 10 th day and then attain a plateau.
Spirilles and
spirochetes begin appearing from 7 th day, reach a
peak by 12-13 th
day and then reach a plateau.
Summing these findings, it would be apt to choose
15 days as the
answer
Normally in experimental subjects, to induce
gingivitis, subjects are
made to refrain from oral hygiene for 7-21 days.
This protocol further
substantiates the above answer
Referenc: Carranza 10th ed; pg no 144-146
20. Modification of Koch postulate, to identify
the key micro
organism was done by
a. Russell
b. socransky
c. Glickmann
d. vermillon
Answer.b
Explanation:
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In 1879, Robert Koch, developed the postulates, by
which a
microorganism is identified as a causative organism
which stipulates
the following
Must be routinely isolated from diseased individuals
Must be grown in pure culture in the lab
Must produce a similar disease when inoculated in
susceptible
laboratory animals
Must be recovered from lesions in diseased
laboratory animal
For periodontitis, these postulates could not be
applied due to
1. Inabilitiy in culturing the periodontal pathogens
2. difficulty in defining sites of active disease
3. lack of good animal model for the study of
periodontitis
Hence Kochs postulates were modified BY
SIGMUND
SOCRANSKY, which specifies the following
criteria
1. Must be associated with the diisease as seen as an
increase in the no
of organisms at the diseased sites
2. Must be decreased in sites that show clinical
resolution after
treatment
3. Must demonstrate a host response in the form of
cellular or humoral
response

4. Must be capable of causing disease in

experimental animals
5. Must demonstrate virulence factors responsible
for destruction of
periodontium
RUSSELL gave the PERIODONTAL INDEX in
1956. This index
considers both clinical and radiographic
findings.Disadvantage is it
underestimates the prevalence of disease
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VERMILLON and GREENE gave the ORAL
HYGIENE INDEX
SIMPLIFIED IN 1964
Reference: Carranza 10th ed; pg no 155, 120
21. Soft tissue attachment after a flap surgery on
a denuded root
surface occurs by
a. long junctional epithelium
b. Connective tissue attachment
c. scar formation
d.
Answer: a
Explanation:
Normally, after conventional periodontal surgical
procedures, the most
common type of healing observed is a long
junctional epithelium.
After flap surgery, within the first 24 hours, a blood
clot is established
between the flap and tooth/ bone. 1-3 days after
surgery, epithelial
cells migrate over the border of the flap. 1 week
after , an epithelial
attachment is established by means of
hemidesmosomes and a basal
lamina. Blood clot is replaced by granulation tissue.
2 weeks after
surgery, collagen fibres appear parallel to tooth
surface. One month
after surgery, fully epithelialised gingival sulcus
with a well defined
epithelial attachment is seen. Though collagen
fibres appear they are
only parellely arranged and hence do not contribute
to any functional
attachment
New attachment is the embedding of new
periodontal ligament fibres
into new cementum and the attachment of gingival
epithelium to a
tooth surface previously denuded by disease. This
kind of healing does
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not normally occur unless specific procedures like
GTR, root
biomodification is carried on which ensures that
new collagen fibres
are formed that get attached perpendicularly to the
tooth
After scaling and curettage, healing occurs by long
junctional
epithelium
When healing occurs by long JE, pocket is not
completely obliterated,
but it does not permit passage of probe. This long
JE is resistant to
disease similar to connective tissue attachment
Healing by scar refers to healing by Repair
wherein a normal
gingival sulcus is reestablished at the same level as
the base of the
preexisting periodontal pocket. There is no gain in
attachment.

Reference: Carranza 10th ed pg no 935-936, 912,

632-634
22. Radiographic appearance of Chronic
gingivitis
a. Normal bony contour
b. Horizontal bone loss
c.. Vertical bone loss
d. increased bone density
Answer: a
Explanation:
Chronic gingivitis is a pathology involving only the
soft tissues.
Hence it is not associated with any radiographic
change. A normal
bony contour is seen
When the inflammation extends to the bone as in
periodontitis, it can
be visualized on a radiograph. Bone destruction is
seen on a radiograph
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only when atleast 30% of the bone is lost. Hence
radiographs are
highly specific but are not sensitive.
Reference: Carranza 10th ed , pg no 563-566
23. All are true about Kochs Postulates except?
a. The organism can be isolated from disease
b. pure culture obtained
c. organism can be isolated from diseased organism
d. the isolated organism may or may not produce
disease.
Answer: d
According to Koch postulates, the isolated organism
should necessarily
produce disease when inoculated in laboratory
animals
In 1879, Robert Koch, developed the postulates, by
which a
microorganism is identified as a causative organism
which stipulates
the following
Must be routinely isolated from diseased individuals
Must be grown in pure culture in the lab
Must produce a similar disease when inoculated in
susceptible
laboratory animals
Must be recovered from lesions in diseased
laboratory animal
Reference: Carranza 10th ed; pg no 155, 120
24. Depth of clinical gingival sulcus?
a. gingival margin to apical of J.E
b. gingival margin to apical penetration of probe
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c. crest of alveolar bone
d. gingival margin to CEJ
Answer: b
Explanation:
The clinical probing depth is the distance to which a
probe penetrates
into the pocket, i.e the distance from the gingival
margin to the apical
end of the probe. The depth of penetration of the
probe depends on size
of probe, force of introduction, direction of
penetration, resistance of
tissues, convexity of crown.
In animals, in health, probe penetrated to 2/3 rd of
the epithelium. In
gingivitis, the probe stopped 0.1 mm short of the
apical end in
periodontitis, the probe tip consistently went past
the apical cells of
junctional epithelium
In humans, the probe penetrates the most coronal
fibres of the

connective tissue attachment. In a periodontal

pocket, the depth of
penetration of the probe apical to the JE is 0.3 mm
Thus penetration of the probe is highly variable.
Hence the depth of
clinical gingival sulcus is the distance between the
gingival margin
and apical penetration of probe. The probing depth
of a clinically
normal gingival sulcus is 2-3mm
The biologic depth is the distance between the
gingival margin and
base of the pocket (coronal end of junctional
epithelium)
Under absolute conditions, depth is 0 mm.
Histologic depth is 1.8mm
with variations between 0-6mm
Reference: Carranza 10th ed; pg no 46-47, 551552
25. The defect in Localised Juvenille
periodontitis is?
altered neutrophil chemotaxis
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Ans: Patients with aggressive periodontitis
display functional
defects of polymorphonuclear leukocytes and
monocytes.
Explanation:
These defects include
impaired chemotactic attraction of PMN to the site
of infection
inability to phagocytose and kill microorganisms
hyperresponsive monocyte phenotype, leading to
increased
prostaglandin production and hence increased
connective tissue
destruction or bone loss
PEADODONTICS
26. The root resorption in primary central
incisor tooth starts at
a. 2 y
b. 4 y
c. 3 y
Answer: a
Explanation:
Resorption is believed to start immediately after
root completion.
The following chart shows when primary teeth
(also called baby
teeth or deciduous teeth) erupt and shed. It's
important to note that
eruption times can vary from child to child.
Primary Teeth Development Chart
Upper Teeth When tooth
emerges
When tooth falls
out
Central incisor 8 to 12 months 6 to 7 years
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Lateral incisor 9 to 13 months 7 to 8 years
Canine
(cuspid) 16 to 22 months 10 to 12 years
First molar 13 to 19 months 9 to 11 years
Second molar 25 to 33 months 10 to 12 years
Lower Teeth
Second molar 23 to 31 months 10 to 12 years
First molar 14 to 18 months 9 to 11 years
Canine
(cuspid) 17 to 23 months 9 to 12 years
Lateral incisor 10 to 16 months 7 to 8 years
Central incisor 6 to 10 months 6 to 7 years
Ref: Chronology table (Logan and Kronfeld
1933)-Pediatric
Dentistry by MS Muthu and N Sivakumar

27. In a 6 yr old boy, the best way to diagnose

caries is
a. past caries experience
b. snyder s test
c. mother s past caries experience
d. sibling s caries experience
Answer: a.
Explanation:
Each individuals past caries experience best
helps to predict or
diagnose caries.
Synders test only measures acid production. The
Snyder Test is
used to determine a persons susceptibility to dental
caries (cavities). The susceptibility is correlated
with acid production
that is assumed to result from fermentation by
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cariogenic Lactobacillus species on the teeth or in
other areas of the
mouth.
The Snyder Test agar contains 2% glucose and the
pH
indicator bromcresol green. The pH of the agar is ~
4.8, which
inhibits the growth of most organisms, but it is ideal
for acidophiles
such as Lactobacillus species. Saliva samples are
inoculated into the
tubes and allowed to incubate. If Lactobacillus is
present in the saliva,
it will ferment the glucose and produce lactic acid,
causing the pH to
drop to ~ 4.4. This causes the bromcresol green to
change from green
to yellow. A culture demonstrating ayellow color
indicates a person is
susceptible to the formation of dental caries
Reference: Pediatric Dentistry by MS Muthu and
N Sivakumar
28. Deciduous teeth appear light because of
a. dentin is thinner
b. difference in crystalline structure leading to
difference in
refractive index
c. difference in reflection from adjacent surfaces
Answer: b.
Explanation:
Primary teeth are less mineralized and more
porous, hence
altering the refractive index. The refractive
index is the same as
milk and thats why primary teeth are called
milk teeth.
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ORAL AND MAXILLOFACIAL SURGERY
29. Antanalgesia is caused by
a. ketamine
b. Thiopentone
c. Etodimate
d. Propofol
Answer: b
Explanation:
It is applied to the action of a drug which appears to
lower the pain
threshold even when an analgesic has been
previously given
This phemenon has been given by J.Clutton Bruck
The Antanalgesic effect may be related to the ability
of those drugs to
interfere with the descending inhibitory mechanism
through a Gamma
aminobutyric acid.

The antanalgesic effect may be related to the ability

of those drugs to
interfere with the descending inhibitory mechanism
through a gamma
aminobutyric acid receptor mechanism.
The antanalgesic effect only occurs at low blood
levels of barbiturates
such as with small induction doses of thiopental or
after emergence
from Thiopental .
when the blood levels are low Antanalgesia is also
noted with the use
of Pentobarbital.
Reference: B.J.Med 1963 July 2(129-130)
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30. Which of the following inhalational
anaesthetic have analgesic
effect?
a. NO 2
b. Sevoflurane
c. Isoflurane
d. Halothane
Answer: a
Nitrous oxide:
Nitrous oxide is a good analgesic even 20%
produces analgesia
equivalent to that produced by conventional doses
of Morphine.
It is a poor muscle relaxant .
second gas effect and diffusion hypoxia occours
with Nitrous oxide
N20 has little effect on respiration, heart and BP.
Sevoflurane:
It is a polyfluorinated inhalational anaesthetic.
Induction and emergence from anaesthesia are fast
and rapid.
Acceptably good for paediatric patients.
Smooth recovery.
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Isoflurane:
Inhalation anaesthetic that produces rapid induction
and recovery.
Heart rate is increased as a result of stimulation of
BAdrenergic
receptors.
Safer in patients with MI.
Respiratory depression is prominent.
Secretions are slightly increased.
It is a preferred agent in Neurosurgery.
Halothane:
It is a potent anaesthetic but not a good analgesic or
muscle relaxant,
however it potentiates N.M blockers.
It produces direct depression of myocardial
contractility by reducing
intracellular Ca conc.
HR is reduced because of depression.
It sensitizes the heart to arrythmogenic action of
adrenalin.
It produces greated depression of respiration.
Pharyngeal and laryngeal reflex are abolished early
and coughing is
suppressed while bronchi dilate ,so it is preferred in
asthmatics.
Its use during labor can prolong delivery and
increase post partal blood
loss.
Hepatitis occurs in susceptible individuals.
Malignant hyperthermia can rarely be induced.
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31. Needle does not pierce one of the following
during an Epidural

block when approached from midline?

a. Supraspinous
b. Interspinous
c. Posterior longitudinal ligament
d. ligamentum flavum
Answer: C
Anatomy for epidural block:
1. The superior boundry of the cervical epidural
space is the fusion of
periosteal and spinal layers of dura at the foramen
magnum.
2. The cervical epidural space is bounded anteriorly
by the posterior
longitudinal ligament and posteriorly by the
vertebral laminaeand
ligamenteum flavum.
3. The vertebral pedicles and inter vertebral
foramina form the lateral
limits of epidural space.
4. The epidural space contains fat veins arteries
,lymphatics and
connective tissue
5. when performing cervical epidural block in the
midline after
traversing the skin and subcutaneous tissue the
needle will impinge on
the ligamentum nuchae , which runs between the
apices of the cervical
spinous process.
6. The inter spinous process that runs between the
spinous process is
next encountered
A significant increase in resistance to needle
advancement signals that
the needle is impinging on the dense ligamentum
flavum
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SPEED 27
A sudden loss of resistance occurs as the needle
pierces into the
epidural space
Surgical technique:
A 25 Gauge inch needle is advanced in a slow and
deliberate manner
passing through the ligamentum flavum to enter the
epidural space.
32. TMJ capsule is supplied by
a. Maxillary n.
b. Auriculo temporal n.
c. N. to mylohyoid
d. Facial n.
Answer: B
Branches of the auriclulotemporal nerve supply the
sensory
innervations of TMJ. This nerve arises from the
mandibular division
on the infratemporal fossa and sends branches to the
capsule of the
joint.
The deep temporal and massetric nerve supply the
anterior position of
the joint.
The auriculotemporal nerve a branch of the
mandibular portion of the
trigeminal nerve provides innervations of the TMJ.
About 75% of the time the massetric nerve, a
branch of the
maxillarydivision of trigeminal nerve innervates the
anteromedial
aspect of the capsule of TMJ.
In about 33% a separate branch from V2 comes
trough the mandibular
notch and innervates the anteromedial capsule
.These nerves are
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SPEED 28

primarily motor nerves, but they contain sensory

fibres distributed to
the anterior part of TMJ capsule.
33. Following a bilateral fracture of mandible in
the canine
region, the anterior segment of the mandible is
displaced
posteriorly by the action of
a. Anterior belly of digastrics, geniohyoid and
genioglossus
b. Thyrohyoid, geniohyoid and genioglossus
c. Mylohyoid, geniohyoid and genioglossus
d. Mylohyoid, geniohyoid and thyrohyoid
Answer: a
Explanation:
Bilateral body fractures are also infrequent. The
anterior fragment is
driven backwards and downwards and the position
is maintained by
unopposed action of the Genial muscles Geniohyoid
and Genioglossus
and the inframandibular muscles.The two posterior
fragment and
prevented from medial displacement by the anterior
fragment and from
upward displacement by occlusal contactand thus
retain a relatively
normal position .In a edentulous case the lack of
occlusal contact
results in severe displacement of the fragments.
Reference: Rowe and Williams Maxillofacial
injuries Vol 1
34. A patient presents with swelling in relation to
the left
maxillary incisor with deep carious lesion, nonrestorable
having temperature 102F, swelling on left half of
the face unable to
open the left eye, unable to chew for 48hrs,
swelling is soft and
rebounds on palpation the treatment is?
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a. Aspiration
b. Incision and Drainage
c. sclerosing agent
d. Antibiotics heat and fluids
Answer: b
Explanation:
The presentation in the question indicates it as a
patient suffering from
space infection. The clinical features suggestive of
canine space
infection.
Canine space infection:
Infection of the canine is mostly on the labial side
than on the
palatal side.
If canine infection perforates lateral cortex of
maxillary bone
superior to the origin of muscle this space is
affected.
infection Involving this space is less common
Involvement is even less in case of nasal
infections.
Patient exhibits swelling lateral to the nose
obliteration of the nasolabial fold,
swelling of the upper lip,
edema occurs in the upper and lower lid that
may close the
eye
Differential diagnosis of upper face infections
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a. Dacrocystitis with minimal involvement of
nasolabial fold

b. Odontogenic cellulitis where the nasolabial fold

is effaced.
The treatment of choice for space infection is
Incision and
drainage:
Incise in healthy skin and mucosa when possible.
Incision placed at the site of maximum
fluctuance results in a
puckered, unesthetic scar.
Place the incision in an esthetically acceptable
area.
When possible place the incision in a dependent
position to
encourage drainage by gravity.
Dissect bluntly with closed surgical clamp or
finger, through
deeper tissues.
Place a drain and stabilize it with sutures.
Consider use of through and through drains in
bilateral
submandibular space infections.
Do not leave drains in place for an overly
extended period.
Remove them when drainage becomes minimal.
Clean wound margins daily under sterile
conditions to remove
clots and debris.
Another approach to drainage is the use of
computed
tomographic (CT) guided catheter
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35. Patient on steroid therapy in order to extract
a chronically
infected teeth- premedication is
a. Antibiotics
b. Antihistamines
c. Atropine for vagal block
d. Antihypertensives
Answer: a
Explanation:
Dental management of pt with adrenal disease or
steroid
therapy for non adrenal disease:
Assess potential for adrenal suppression
Administer supplemental steroid, proportional to
the presumed
adrenal suppression and the anticipated stress.
Taper supplemental steroid doses rapidly over 2-3
days to
maintenance levels, unless there is infection, severe
pain, or
compromised oral intake
Use appropriate sedation tech. to minimize stress
Use antibiotic prophylaxis to minimize the risk
of infection
Reference: Principle and practice of oral
medicine, S. T. Sonis, R. C.
Fazio, 2nd edition
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SPEED 32
ORAL MEDICINE DIAGNOSIS AND
RADIOLOGY
36. A 9 yrs. old child mother comes to dental
clinic with the
complaint of oral ulceration , fever , and
shedding of skin of
palms and soles she is giving history of
premature shedding of
teeth , teething and increased sweating , she is
also giving 1 month
history of using any new teething gel available in
market. The
child is suffering from
a. acrodynia
b. pemphigus vulgaris

c. epidermolysis bullosa
d. erosive lichen planus
Answer: a
Explanation:
Chronic mercury exposure in infants and children is
termed
ACRODYNIA (pink disease, swift disease). The
children have cold
clammy skin especially on the hands, feet, nose,
ears, and cheeks. An
erythematous and pruritic rash is present. Severe
sweating, increased
lacrimation, irritability, insomnia and photophobia,
hypertension,
weakness, tachycardia, and gastrointestinal upset
also may be present.
On occasion, these highly irritable children have
torn out patches of
their hair. Oral signs include excessive salivation,
ulcerative gingivitis,
bruxism, and premature loss of teeth. Because
mercury salts were
formerly used in the processing of felt, hat makers
in past centuries
were exposed to the metal and experienced similar
symptoms, giving
rise to the phrase mad as a hatter.
Comments: Even though oral ulcerations and
shedding of skin of
palms and soles are seen in pemphigus,
epidermolysis bullosa, and
SPEED DENTAL AIIMS NOVEMBER
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SPEED 33
erosive lichen planus, fever, premature loss of teeth
and bruxism is not
found in these diseases and the association of these
features could be
purely coincidental.
Reference: Neville, Damm, Allen, Bouqout, Oral
and Maxillofacial
Pathology, II edition page no. 273, Elsevier
publication 2007
(Reprinted version)
37. Moth eaten appearance is seen in all of the
following except
a. Osteomyelitis
b. Osteosarcoma
c. Hemorrhagic cyst
d. Odontogenic Keratocyst
Answer: d. Odontogenic keratocyst
Explanation:
Radiologic differential diagnosis is usually obtained
from clues by:
Appearance of lesion
Location of lesion
Type of periosteal reaction
Matrix of lesion
Density of lesion
Number of lesion
By appearance of lesion, they could be classified as:
Geographic: Destructive lesion with sharply
defined border. It implies
a less aggressive, more slow growing benign
process with a narrow
transition zone
Moth eaten: Areas of destruction with ragged
borders. It implies
more rapid growth with high probability of
malignancy
Permeative: Ill-defined lesion with multiple worm
holes spreading
through marrow space with a wide transition zone.
It implies an
aggressive malignancy.
Both Osteomyelitis and Osteosarcoma show moth
eaten appearance

at various stages. An SBC may have an appearance

similar to that of a
true cyst, especially a KOT. This is because KOTs
tend to grow along
bone with very little expansion and often have
scalloped borders
similar to those of an SBC. However, KOTs
usually have a more
definite cortical boundary, resorb and displace teeth,
and occur in an
older age group. Because the SBC may remove
bone around teeth
without affecting the teeth, there may be a tendency
to include a
malignant lesion in the differential diagnosis.
However, maintenance
of some lamina dura and the lack of an invasive
periphery and bone
destruction should be enough to remove this
category of diseases from
consideration.
Note: Radiographic appearances of a disease should
always be
correlated with the clinical stages of the disease
Reference: White and Pharaoh, Oral Radiology,
Principles and
interpretation, Sixth edition, 2009: Elsevier
publications.
Other sources: Internet- Bone tumor radiology
38. A periapical radiograph of upper anterior
teeth with loss of
cementum, increased horizontal anterior bone
loss?
a. Hypophosphatasia
b. Vit D resistant rickets
c. Juvenile periodontitis
d. Osteomalacia
Answer: a. Hypophosphatasia
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Explanation:
Hypophosphatasia is a rare metabolic bone disease
that is
characterized by a deficiency of tissue nonspecific
alkaline
phosphatase. One of the first presenting signs of
Hypophosphatasia
may be the premature loss of the primary teeth,
presumably caused by
a lack of cementum on the root surfaces. Generally,
the younger the
age of onset, the more severe the expression of the
disease. The
common factors in all types include the following:
Reduced levels of the bone, liver, and kidney
isozyme of alkaline
phosphatase
Increased levels of blood and urinary
phosphoethanolamine
Bone abnormalities that resemble rickets
Four types of Hypophosphatasia are generally
recognized, depending
on the severity and the age of onset of symptoms:
Perinatal
Infantile
Childhood
Adult
The childhood form is usually detected at a later
stage and has a wide
range of clinical expression. One of the more
consistent is the
premature loss of primary teeth without evidence of
a significant
inflammatory response the deciduous incisor teeth
are usually affected
first and may be the only teeth involved. In some
patients, this may be

the only expression of the disease. The teeth may

show enlarged pulp
chambers in some instances, and a significant
degree of alveolar bone
loss may be seen. More severely affected patients
may have open
fontanelles with premature fusion of cranial sutures.
Affected patients
typically have a short stature, bowed legs, and a
waddling gait. The
development of motor skills is often delayed.
SPEED DENTAL AIIMS NOVEMBER
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SPEED 36
The perinatal and infantile types are associated with
a rather poor
outcome. The childhood and the adult forms are
compatible with a
normal life span
Reference:
1. Neville, Damm, Allen, Bouqout, Oral and
Maxillofacial
Pathology, II edition, Elsevier publication 2007
(Reprinted version)
2. White and Pharaoh, Oral Radiology, Principles
and interpretation,
Sixth edition, 2009: Elsevier publications
39. Geniculate neuralgia is the uncommon
neuralgia associated
with
a. Trigeminal n.
b. Facial n.
c. Optic n.
d. Vagus n.
Answer: b. Facial nerve
Explanation:
Geniculate neuralgia is a condition where a small
nerve (the nervus
intermedius) is compressed by a blood vessel. This
results in severe,
deep ear pain which is usually sharpoften
described as an "ice pick
in the ear"but may also be dull and burning, and
can be accompanied
by facial pain. This pain can be triggered by
stimulation of the ear
canal, or can follow swallowing or talking.
Doctors will typically prescribe treatment with
medication before
recommending surgery. If surgery is required,
UPMCs neurosurgeons may recommend
Microvascular Decompression. Microvascular
decompression is a surgical procedure that relieves
abnormal compression of a cranial nerve.
The intermediate nerve of Wrisberg (the nervus
intermedius) is a small sensory branch of the facial
nerve (cranial nerve VII) carrying general visceral
efferent, special visceral afferent (taste), and general
somatic afferent fibers. The cell bodies of the
sensory afferents dwell in the geniculate ganglion,
and their peripheral axons innervate the inner ear,
the middle ear, the mastoid cells, the eustachian
tube, and part of the pinna of the ear.
40. Infectious Mononucleosis is caused by
a. Epstein barr virus
b. Cyto megalo virus
c. Human papilloma virus
d. herpes simples virus
Answer: a. Epstein barr virus
Explanation:
Infectious mononucleosis is a clinical syndrome
caused by Epstein- Barr virus (EBV, Human Herpes
Virus-4). EBV replicates primarily in betalymphocytes but also may replicate in the epithelial
cells of the pharynx and parotid duct. The typical
features of IM include fever, pharyngitis,
lymphadenopathy, malaise, and an atypical
lymphocytosis.

The rarer complications include splenomegaly,

hepatomegaly,
jaundice, and splenic rupture. Children and young
adults are usually
affected. The virus is transmitted via intimate
contact. Children may
acquire the virus through sharing of saliva
contaminated fingers, toys
or serving spoons. Direct transfer of contaminated
saliva may occur in
adults following kissing (hence the name kissing
disease) or sharing of
straws. The incubation period is 4 to 8 weeks
SPEED DENTAL AIIMS NOVEMBER
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SPEED 38
The Paul-Bunnel test is a serological test that
detects heterophile
antibodies by agglutination of sheep or horse red
blood cells. However
in the first week of infection, the false negative rate
is as high as 25%.
VCA-IgG and VCA-IgM tests are useful in
diagnosing patients who
have highly suggestive clinical features but negative
heterophile
antibody test results.
Antibody to Epstein-Barr nuclear antigen (EBNA),
while typically not
detectable until 6 to 8 weeks after the onset of
symptoms, can help
distinguish between acute and previous infections.
Elevated hepatic
transaminase levels may be seen in about 50% of
the patients.
Reference: RavikiranOngole, Praveen BN,
Textbook of Oral
Medicine, Oral Diagnosis and Oral Radiology,
First edition; Elsevier
publications2010.
41. Hyponatremia with increased total body
sodium
a. Nephrotic syndrome
b. Vomitting
c. Diuresis therapy
d. Renal tubular acidosis
Answer: d. Renal tubular acidosis,
Explanation:
There are four types of Renal tubular acidosis
Type 4: Hyperkalemic RTA
Type 4 is also called hyperkalemic RTA and is
caused by a generalized
transport abnormality of the distal tubule. The
transport of electrolytes
such as sodium, chloride, and potassium that
normally occurs in the
distal tubule is impaired. This form is distinguished
from classical
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SPEED 39
distal RTA and proximal RTA because it results in
high levels of
potassium in the blood instead of low levels. Either
low potassium
hypokalemiaor high potassiumhyperkalemia
can be a problem
because potassium is important in regulating heart
rate.
Type 4 RTA occurs when blood levels of the
hormone aldosterone are
low or when the kidneys do not respond to it.
Aldosterone directs the
kidneys to regulate the levels of sodium, potassium,
and chloride in the
blood. Type 4 RTA also occurs when the tubule
transport of

electrolytes such as sodium, chloride, and potassium

is impaired due to
an inherited disorder or the use of certain drugs.
Drugs that may cause type 4 RTA include
diuretics used to treat congestive heart failure such
as spironolactone or
eplerenone
angiotensin-converting enzyme (ACE) inhibitors
and angiotensin
receptor blockers (ARBs)
the antibiotic trimethoprim
the antibiotic pentamidine, which is used to treat
pneumonia
heparin
NSAIDs
some immunosuppressive drugs used to prevent
rejection
Type 4 RTA may also result from diseases that alter
kidney structure
and function such as diabetic nephropathy,
HIV/AIDS, Addisons
disease, sickle cell disease, urinary tract obstruction,
lupus,
amyloidosis, removal or destruction of both adrenal
glands, and kidney
transplant rejection.
For people who produce aldosterone but cannot use
it, researchers have
identified the genetic basis for their bodys
resistance to the hormone.
SPEED DENTAL AIIMS NOVEMBER
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SPEED 40
To treat type 4 RTA successfully, patients may
require alkaline agents
to correct acidosis and medication to lower the
potassium in their
blood.
If treated early, most people with any type of RTA
will not develop
permanent kidney failure. Therefore, the goal is
early recognition and
adequate therapy, which will need to be maintained
and monitored
throughout the persons lifetime.
Source (internet):
kidney.niddk.nih.gov/kudiseases/pubs/tubularacido
sis/
Reference: e-Medicine article on Hyponatremia
Harrisons Internal
Medicine 17th edition2010Vol
42. A wide eyed patient with increased systolic
BP(widened pulse
pressure) thin skin and hair,loss of weight,
extremely nervous
could have
a. hypothyroidism
b. hyperthyroidism
c. hyperparathyroidism
d. hyperpituitirism
Answer: b. hyperthyroidism
Explanation:
Graves disease or hyperthyroidism
(Thyrotoxicosis) is 5 to 10 times
more common in women than in men and is seen
with some frequency.
It affects almost 2% of the adult female population.
Graves disease is
most commonly diagnosed in patients during the
third and fourth
decades of life. Many of the signs and symptoms of
hyperthyroidism
can be attributed to an increased metabolic rate
caused by excess
thyroid harmone. Patients usually complain about
nervousness, heart palpitations, heat intolerance,
emotional liability, and muscle weakness. The
following are noted during clinical evaluation:

Weight loss despite increased appetite

Tachycardia
Excessive perspiration
Widened pulse pressure (increased systolic and
decreased diastolic
pressures)
Warm and smooth skin
Tremor
Exophthalmos or proptosis.
Reference:
1. Ravikiran Ongole, Praveen BN, Textbook of
Oral Medicine, Oral
Diagnosis and Oral Radiology, First edition;
Elsevier
publications2010.
2. Neville, Damm, Allen, Bouqout, Oral and
Maxillofacial
Pathology, II edition, Elsevier publication 2007
(Reprinted version)
43. A 40 yr old patient withmultiple radiolucency
in mandibular
anterior region. The teeth are vital the probable
diagnosis could
be?
a. Cementoblastoma
b. chronic periapical abscess
c. periapical osteofibrosis
d. multiple granulomas
Answer: c. Periapical osteofibrosis
Explanation: Synonym for periapical cemental
dysplasia - A benign, painless, nonneoplastic
condition of the jaws which occurs almost
exclusively in middle-aged black females. The
lesions are usually multiple, most frequently
involve vital mandibular anterior teeth, surround the
root
apices, and are initially radiolucent (becoming more
radio opaque at
later stages)
Reference:
White and Pharaoh, Oral Radiology, Principles
and
interpretation, Sixth edition, 2009: Elsevier
publications.
44. An anxious mother of a 8 yr old boy
complains of greenish
discoloration on the labial margin of the central
incisor which
cant be removed by brush it could be?
a. Neonatal line
b. Chromogenic bacteria
c. Calculus
d. none of the above
Answer: b. Chromogenic bacteria
Explanation:
The green discoloration associated with
chromogenic bacteria or the frequent consumption
of chlorophyll containing foods can resemble the
pattern of green staining secondary to gingival
hemorrhage. As would be expected, this pattern of
discoloration occurs most frequently in patients
with poor oral hygiene and erythematous
hemorrhagic and enlarged gingiva. The color results
from the breakdown of hemoglobin
into green biliverdin
Reference: Ravikiran Ongole, Praveen BN,
Textbook of Oral Medicine, Oral Diagnosis and
Oral Radiology, First edition; Elsevier
publications2010.
Neville, Damm, Allen, Bouqout, Oral and
Maxillofacial Pathology, II edition, Elsevier
publication 2007 (Reprinted version)
45. Which of the following is true about
calcification of teeth?
a. calcification of primary teeth is almost complete
at the time of
birth

b. calcification of all primary teeth and few

permanent teeth
complete at birth
c. calcification of all permanent teeth complete at
birth
d. calcification of all primary teeth starts around
birth
Answer: a. Calcification of primary teeth is
almost complete at the
time of birth
46. Ehler Danlos syndrome is inherited by
a. Autosomal dominant
b. Autosomal recessive
c. X-linked dominant
d. Xlinked recessive
Answer: a. Autosomal dominant,
Explanation:
The pattern of inheritance and the clinical
manifestations vary with the
type of Ehlers-Danlos syndrome being examined.
About 80% of
patients have the classical type in either the mild or
severe form.
SPEED DENTAL AIIMS NOVEMBER
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SPEED 44
Classical Ehler Danlos syndrome is inherited as
autosomal dominant
trait. Typical clinical findings include hypermobility
of the joints, easy
bruisability, and marked elasticity of the skin. Some
patients have
worked in circus sideshows as the rubber man and
the
contortionist as a result of their pronounced joint
mobility and ability
to stretch the skin.
The oral manifestations of Ehlers-Danlos syndrome
include the ability
of 50% of these patients to touch the tip of their
nose with their tongue
(Gorlin sign). A variety of dental abnormalities
have been described,
however, including malformed, stunted tooth roots,
large pulp stones,
and hypo plastic enamel
Reference: 1.Ravikiran Ongole, Praveen BN,
Textbook of Oral
Medicine, Oral Diagnosis and Oral Radiology,
First edition; Elsevier
publications2010 2.Neville, Damm, Allen,
Bouqout, Oral and
Maxillofacial Pathology, II edition, Elsevier
publication 2007
(Reprinted version)
47. Radicular cyst is always associated with?
a. Vital teeth
b. Non vital teeth
c. Deep caries
d. Pericoronitis.
Answer: b. Nonvital teeth
Explanation:
Radicular cyst is defined as an odontogenic cyst of
Inflammatory origin that is preceeded by a chronic
periapical
granuloma & stimulation of cell rests of malaseez
present in the
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SPEED 45
periodontal membrane.
Classification:It is classified as follows--Periapical Cyst:- These are the radicular cysts
which are present
at root apex.
Lateral Radicular Cyst:- These are the radicular
cysts which are

present at the opening of lateral accessory root

canals of offending
tooth.
Residual Cyst:- These are the radicular cysts which
remains even
after extraction of offending tooth.
SPEED DENTAL AIIMS NOVEMBER
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SPEED 46
Clinical Features:Frequency:- It is most common cystic lesion of jaw
comprising about approximately 52.3% of jaw
cystic lesions
Age:- Large no. of cases are found in 4th & 5th
decades of life after
which there is gradual decline.
Sex:- It is more common in males comprising about
58% & in
females comprising about 42%.
Race:-White patients are involved with a frequency
of about twice
that of Black patients.
Site:- It occurs with frequency of 60% in Maxilla.
Though it may
occur in all tooth bearing areas of both the jaws but
preferably it occurs
in maxillary anterior region. Upper lateral Incisors
and Dense in Dente
are usually the offending teeth. It occurs most
commonly at apices of
involved teeth. They may however be found at
lateral accessory root
canals.
Gross Features:Gross Specimen may be spheroidal or ovoid intact
cystic masses,
but often they are irregular & collapsed. The walls
vary from
extremely thin to a thickness of about 5mm. The
inner surface may be
smooth or corrugated yellow mural nodules of
cholesterol may project
into the cavity. The fluid contents are usually brown
from breakdown
of blood and when cholesterol crystals are present
they impart a
shimmering gold or straw colour.
Clinical Presentation:SPEED DENTAL AIIMS NOVEMBER
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Smaller radicular cysts are usually symptomless and
are discovered
when IOPAs are taken with non-vital teeth.
Larger lesions show slowlyenlarging swelling. At
first the enlargement
is bony hard but as cyst increases in size, the
covering bone becomes
very thin, despite subperiosteal deposition &
swelling exhibits
springiness, only when cyst has become completely
eroded, the bone
will show fluctuation.
In Maxilla, there may be buccal and palatal
enlargement Whereas in
mandible it is usually labial or buccal & only rarely
lingual.
Pain & infection are other clinical features of some
radicular cysts.
These cysts are painless unless infected. However,
complain of pain is
also observed in patient without any evidence of
infection.
Occasionally, a sinus may lead from cyst cavity to
the oral mucosa
Quite often there may be more than one radicular
cyst. Scientists

believe that there are cyst prone individuals who

show particular
susceptibility to develop radicular cysts.
Radicular cysts arising from deciduous tooth are
very rare.Deciduous
tooth which had been treated endodontically with
materials containing
Formecresol which in combination with tissue
protein is antigenic &
may elicit a humoral or cell-mediated response like
rapid buccal
expansion of cyst.
On rare occasion, there may be occurrence of
parasthesia or there may
be pathologic fracture of jaw bone take place.
Radiographic Features:Intra Oral Peri Apical Radiographs i.e. IOPAs are
common
radiographs which are used as diagnostic aid from
radiological point of
view.
Radiographically , Radicular Cysts are round or
ovoid radiolucent
areas surrounded by a narrow radio-opaque margin,
which
extends from Lamina Dura of involved tooth. In
infected or rapidly
enlarging cysts, radio-opaque margins may not be
seen. Root
resorption is rare but may occur.
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SPEED 48
It is often difficult to differentiate radiologically
between radicular
cysts & apical granulomas.
Radiologic presentation of Radicular Cyst is given
in detail as follows
--Periphery & Shape--- Periphery usually have a
well defined cortical
border. If Cyst is secondarily infected, the
inflammatory reaction of
surrounding bone may result in loss of this cortex or
alteration of
cortex into more sclerotic border. The outline of
radicular cyst usually
is curved or circular unless it is influenced by
surrounding structures
such as cortical boundaries.
Internal structure--- in most cases, internal
structure of radicular cyst
is radiolucent. Occasionally, dystrophic calcification
may develop in
long standing cysts appearing as sparsely
distributed, small particulate
radio-opacities.
Effects on surrounding structures--- If a radicular
cyst is large,
displacement and resorption of roots of adjacent
teeth may occur. The
resorption pattern may have a curved outline. In
rare cases, the cyst
may resorb the roots of related non-vital teeth. The
cyst may invaginate
the antrum, but there should be evidence of a
cortical boundary
between contents of cyst and internal structure of
antrum. The outer
cortical plates of maxilla and mandible may expand
in a curved or
circular shape. Cyst may displace the mandibular
alveolar nerve canal
in an inferior direction.
48. The radiograph of a boy with radiopacity in
the apical region
in relation to his young permanent incisor having
chronic

pulpitis
a. apical condensing osteitis
b. radicular cyst
c. peri apical granuloma
d. chronic periodontitis
SPEED DENTAL AIIMS NOVEMBER
2010 _ Answer Discussion
SPEED 49
Answer: a. Apical condensing osteitis
Explanation:
Early periapical inflammatory lesions may show no
radiographic
change in the normal bone pattern. The earliest
detectable change is
loss of density, which usually results in widening of
the periodontal
ligament space at the apex of the tooth and later
involves a large
diameter of surrounding bone. At this early stage no
evidence may be
seen of a sclerotic bone reaction. Later in the
evolution of the disease,
a mixture of sclerosis and rarefaction (loss of bone
giving a radiolucent
appearance) of normal bone occurs. The percentage
of these two bone
reaction varies. When most of the lesion consists of
increased bone
formation, the term periapical sclerosing osteitis is
used, and when
most of the lesion is undergoing bone resorption,
the term periapical
rarefying osteitis is used. The area of greatest bone
destruction usually
is centered on the apex of the tooth, with the
sclerotic pattern located at
the periphery. The radiolucent regions may be bereft
of any bone
structure or may have a faint outline of trabeculae.
Close inspection of
sclerotic regions reveals thicker than normal
trabeculae per unit area.
In chronic cases the new bone formation may result
in a very dense
sclerotic region of bone, obscuring individual
trabeculae. Occasionally
the lesion may appear to be composed entirely of
sclerotic bone
(sclerosing osteitis), but usually some evidence
exists of widening of
the apical portion of the periodontal membrane
space.
Reference:White and Pharaoh, Oral Radiology,
Principles and
interpretation, Sixth edition, 2009: Elsevier
publications.
Note: Out of these four choices, only Condensing
osteitis will have a
radio opaque appearance
49. Maximum Magnification allowed in working
length
determination by paralleling technique is:
a. none
SPEED DENTAL AIIMS NOVEMBER
2010 _ Answer Discussion
SPEED 50
b. 1
c. 2
d. 3
Answer: a. 1, (0.5 to 1mm)
Explanation:
The rules of Projection geometry are:
Use as small an effective focal spot as practical
Increase the distance between the focal spot and the
object by using a
long, open-ended cylinder
Minimize the distance between the object and the
film

The third consideration of projection geometry is

clearly violated in
paralleling technique and this is the reason why
long cones have been
used in this technique so that to allow the more
central and parallel
rays of the beam to the film and teeth and to reduce
image
magnification while increasing image sharpness and
resolution
Reference: White and Pharaoh, Oral Radiology,
Principles and
interpretation, Sixth edition, 2009: Elsevier
publications.
50. Modern radiologic technique employed to
detect posterior
proximal caries in children is
a. Bitewing with bisecting angle technique
b. Bitewing with paralleling technique
c. Bitewing with RVG
d. Digital OPG
Answer: c. Bitewing with RVG
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2010 _ Answer Discussion
SPEED 51
Explanation:
Note:
Using tabs are not compatible with solid state
detectors
It is sometimes not possible to use an image
receptor holder (with
beam aiming device) and achieve these ideal
technical requirements
particularly with children. Clinicians therefore still
need to be aware of
the original technique of using a tab attached to the
film packet or
phosphor plate and aligning the X-ray tubehead by
eye
The Bitewing technique (using tabs) can be
summarized as follows:
The appropriate sized barrier-wrapped film packet
or phosphor plate is
selected and the tab attached, oriented appropriately
for horizontal or
vertical projections.
Large film packets/ phosphor plates (31x41 mm) for
adults
Small film packets/ phosphor plates (22x35mm) for
children under12
years. Once the second molar is erupted the adult
size is required
Occasionally a long film packet/ phosphor plate
(53x26 mm) is used
for adults
The patient is positioned with the head supported
and with the occlusal
plane horizontal
The shape of the dental arch and the number of
films required are
assessed.
The operator holds the tab between thumb and
forefinger and inserts
the image receptor into the lingual sulcus opposite
the posterior teeth
The anterior edge of the image receptor should
again be positioned
opposite the distal aspect of lower canine in this
position, the
posterior edge of the film packet extends usually
just beyond the
mesial aspect of the lower third molar
The tab is placed on to the occlusal surfaces of the
lower teeth
The patient is asked to close the teeth firmly
together on the tab
As the patient closes the teeth, the operator pulls the
tab firmly

between the teeth to ensure that the image receptor

and the teeth are in
contact
The operator releases the tab
The operator assesses the horizontal and vertical
angulations and positions the X-ray tubehead so that
the X-ray beam is aimed directly through the
contact areas, at right angles to the image receptor,
with an approximately 50- 80 downward vertical
angulation
The exposure is made If required, the procedure is
repeated for the premolar teeth with a new
image receptor and X-ray tubehead position
Reference: Eric Whaites: Essentials of Dental
Radiography and
Radiology, Fourth edition, Elsevier Publications
2007.
51. Radiolucency between the root apex of vital
lateral incisors
and canine could be:
a. Globulomaxillary cyst
b. Nasolabial cyst
c. Radicular cyst
d. Nasopalatine cyst
Answer: a. Globulomaxillary cyst,
Explanation:
As originally described, the Globulomaxillary
cyst was purported to
be a fissural cyst that arose from epithelium
entrapped during fusion of
the globular portion of the medial nasal process.
This concept has been
questioned, however, because the globular portion
of the medial nasal
process is primarily united with the maxillary
process and a fusion
does not occur. Therefore, epithelial entrapment
should not occur
during embryologic development of this area.
Current theory holds that
most (if not all) cysts that develop in the
Globulomaxillary area are
actually of Odontogenic origin
SPEED DENTAL AIIMS NOVEMBER
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SPEED 53
The Globulomaxillary cyst classically develops
between the
maxillary lateral incisor and cuspid teeth, although
occasional
Globulomaxillary lesions have been reported
between the central and
the lateral incisors. Radiographs typically
demonstrate a wellcircumscribed
unilocular radiolucency between and apical to the
teeth.
Because this radiolucency often is constricted as it
extends down
between the teeth, it may resemble an inverted pear.
As the lesion
expands tipping of the tooth toots may occur.
Virtually all cysts in the Globulomaxillary region
can be explained on
an Odontogenic basis. Many are lined by inflamed
stratified squamous
epithelium and are consistent with periapical cysts.
Some exhibit
specific histopathologic features of an Odontogenic
keratocystore
developmental lateral periodontal cyst or
rarelycan be lined by
respiratory epithelium because of the close
proximity of sinus lining. It
also has been theorized that some of these lesions
may arise from
inflammation of the reduced enamel epithelium.
Reference: 2.White and Pharaoh, Oral Radiology,
Principles and

interpretation, Sixth edition, 2009: Elsevier

Neville, Damm, Allen,
Bouqout, Oral and Maxillofacial Pathology, II
edition, Elsevier
publication 2007 (Reprinted version) publications.
52. Which of the following is the principle of
bisecting angle
technique?
a. Rule of isometry
b. ALARA
c. SLOB rule
d. none of the above
Answer: a. Rule of isometry,
SPEED DENTAL AIIMS NOVEMBER
2010 _ Answer Discussion
SPEED 54
The bisecting- angle technique was used often in the
first half of the
1900s but has been largely replaced by the
paralleling technique. This
method may be useful when the operator is unable
to apply the
paralleling technique because of large rigid sensors
or the anatomy of
the patient. The bisecting-angle technique is based
on simple geometric
theorem, Cieszynskis rule of isometry, which
states that two
triangles are equal when they share one complete
side and have two
equal angles. Dental radiography applies then
theorem as follows as
follows. The receptor is positioned as close as
possible to the lingual

surface of the teeth, resting in the palate or in the

floor of the mouth.
The plane of the receptor and the long axis of the
teeth form an angle
with its apex at the point where the receptor is in
contact with the teeth
along an imaginary line that bisects this angle and
directs the central
ray of the beam at right angles to this bisector. This
forms two triangles
with two equal angles and a common side ( the
imaginary
bisector).consequently, when these conditions are
satisfied, the images
cast on the receptor theoretically are the same
length as the projected
object. To reproduce the length of each root of a
multirooted tooth
accurately, the central beam must be angulated
differently for each
root. Another limitation of this technique is that the
alveolar ridge
often projects more coronally than its true position,
thus distorting the
apparent height of the alveolar bone around the
teeth.
Reference:White and Pharaoh, Oral Radiology,
Principles and
interpretation, Sixth edition, 2009: Elsevier
publications.
53. Longitudinal radiolucency between central
and lateral incisor
can be identified as:
a.Nutrient canal
b.artefact

c.fracture
d. None of the above
SPEED DENTAL AIIMS NOVEMBER
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SPEED 55
Answer: a. Nutrient canal,
Explanation:
Nutrient canals carry a neurovascular bundle and
appear as radiolucent
lines of fairly uniform width. They are most often
seen on mandibular
periapical radiographs running vertically from the
inferior dental canal
directly to the apex of a tooth or into the interdental
space between the
mandibular incisors. They are visible in about 5%
of all patients and
are more frequent in blacks, males, older persons,
and individuals with
high blood pressure or advanced periodontal
disease. They also
indicate a thin ridge, useful in implant assessment.
Because they are
anatomic spaces with walls of cortical bone, their
images occasionally
have hyperostotic borders. At times a nutrient canal
will be oriented
perpendicular to the cortex and appear as a small
round radiolucency
simulating a pathologic radiolucency.
Reference:White and Pharaoh, Oral Radiology,
Principles and
interpretation, Sixth edition, 2009: Elsevier
publications.