INDBE Spring 2021

Q8: Which of the following is NOT an example of using universal health literacy precautions?

Requiring all patients to complete a literacy test before their initial exam Feedback: (Image)

Q5: Immediately after the accident, your patient's blood needed to clot at the side of injured blood vessels. The sequence of chemicals that are involved in the process of clot formation is:

1. Tissue factor 2. Prothrombin 3. Thrombin 4. Fibrinogen 5. Fibrin Feedback: The extrinsic and intrinsic pathways serve to activate Factor X to Xa, which converts prothrombin to thrombin. Thrombin catalyzes the conversion of fibrinogen to fibrin.

Q12: In the contractile cycle, the dissociation of the actomyosin complex results MOST immediately from

ATP replacing ADP on the myosin heads.

Q9: Where does epinephrine bind?

Beta adrenergic receptor Feedback: Epinephrine binds to the beta adrenergic receptor, a G-protein coupled receptor (but does not bind to the G-protein itself).

Q4: Proteins for extracellular use can be synthesized in which of the following structures? A. Heterochromatin B. Nuclear envelope C. Smooth endoplasmic reticulum D. Mitochondria E. Rough endoplasmic reticulum

E Feedback: Proteins are synthesized on ribosomes. Endoplasmic reticulum with attached ribosomes is called rough endoplasmic reticulum.

Q8: Which type of tissue is most likely to be affected by the disease?

Epithelium Feedback: Desmosomes are strong cell-to-cell adhesion junctions that use cadherin-mediated binding. Pemphigus vulgaris attacks cadherins, damaging desmosomes. Epithelial cells are tightly bound to one another with desmosomes (desmosomes are also found within intercalated discs of cardiac muscle). The patient had symptoms affecting her oral mucosa, which (like all mucosa) has epithelium as its apical-most layer.

Q5: From which branchial arch is the fractured bone derived?

First Feedback: (Image)

Q9: What is the likely effect of the lidocaine?

Keeps the sodium channel closed Feedback: The local anesthetic will bind to the S6 loop of the sodium channel, stabilizing the channel in a closed state. The voltage sensor is the S4 loop, not the S6 loop.

Q13: What nerve innervates the enlarged muscle?

Mandibular branch of trigeminal nerve (CN V3) Feedback: The mandibular nerve innervates the muscles of mastication.

Q9: The blood supply to the tooth in question is derived from which artery?

Maxillary Feedback: The maxillary artery supplies the upper and lower dentition.

Q7: The patient's pattern of sensitivity suggests that which of the following nerves is involved?

Maxillary (CNV2)

Q3: Which of the following steps is most likely to happen FIRST? A. Formation of loose (primary) hemostatic plug B. Release of von Willebrand factor (vWF) C. Fibrinolysis D. Degranulation of platelets E. Conversion of fibrinogen to fibrin

Release of von willibrand factor Feedback: After a blood vessel is injured, the first step of hemostasis is the release of endothelin (a vasoconstrictor) and vWF (which binds to collagen fibers exposed by the injury).

Q15: Which of the following represents the consequence of the fact that DNA strands are complementary?

Separated strands are able to reassociate. Feedback: By the end of transcription, complementary DNA strands can reassociate (with hydrogen bonding between complementary base pairs)

Q10: The observed symptoms stem from dysfunction in which of the following?

Skeletal Muscle Feedback: Myasthenia gravis affects the function of skeletal muscle via an autoimmune response against acetylcholine receptors at the neuromuscular junction

Q8: Patient: 23-year-old male Chief complaint: "I've been very tired lately and cannot sleep." Background/or patient history: Diagnosed with a rare genetic disorder, a point mutation that leads to a Glu to Arg substitution in the pore of a sodium channel. Current Findings: None at this time. What is the likely effect on sodium transport?

Sodium influx into the cell will be slower. Feedback: The mutation resulted in a negatively charged amino acid being replaced by a positively charged amino acid. The selectively filter for a sodium channel is made of negatively charged amino acid residues, which will attract positively charged sodium ions. Decreasing the negative residues and increasing the positive ones, will slow sodium influx through the channel.

Q7: Patient: 62-year-old African-American female Chief Complaint: "Excruciating pain in my right face and mouth. Can't even brush my teeth without getting this horrible pain. This is the worst pain I have ever experienced. It feels like an electric shock and then I don't have any pain for a while. It doesn't happen every time I touch my face or brush my teeth - so I'm always anxious not knowing when to expect it. These pain "attacks" happen a dozen or more times on some days, and on other days no attacks at all" Background/or Patient History: The patient sought help from another dentist who could not find an obvious cause but thought maybe a molar with a big filling was the problem so he performed a root canal on the right 2nd maxillary molar. This procedure did not change the pain. Medications: Extra strength Tylenol (doesn't really relieve the pain; also tried ibuprofen and that didn't help much either) Current findings: Light touch to patient's upper right lip elicits a strong pain attack, but not every time. Tapping on the root canal tooth had the same effect: sometimes a sharp pain, sometimes not. Light touch on her forehead, tip of her nose, chin and lower lip do not elicit a pain response. The lack of consistent evoked pain response and the pain free intervals are atypical and you suspect the pain is neuropathic in nature. You send her to get an MRI of the brain. Which of the following is the most likely diagnosis?

Trigeminal Neuralgia Feedback: Sharp, strong pain responses to light touch or movement is typical or trigeminal neuralgia. The pain is episodic, lasting several seconds and is followed by pain-free intervals.

Q7: The cell bodies of the nerve you suspect is transmitting the pain are in the:

Trigeminal ganglion Feedback: The trigeminal ganglion consist of first-order sensory cell bodies.

Q15: The roots of the tooth you will extract could extend into the maxillary sinus (true/false).

True

Q10: The patient's difficulty swallowing is caused by weakness in a muscle (or muscles) innervated by which cranial nerve?

X Feedback: The vagus nerve (CN X) is motor to the soft palate and pharynx. Difficulty swallowing could be caused by weakness of the palate and/or pharynx.

Q14: The treatment administered to the patient inhibits a key enzyme in the degradation of purines. What is the enzyme inhibited and what metabolite(s) are produced instead?

Xanthine oxidase, xanthine and hypoxanthine Feedback: Correct! Allopurinol reacts within the active site of xanthine oxidase to produce alloxanthine, a strong competitive inhibitor of the enzyme. Thus, xanthine and hypoxanthine are produced via normal degradation pathways, which are highly soluble compared to uric acid.

Q8: As per current recommendations by FDA and CDC, public water is optimally fluoridated at...

0.7ppm Feedback: An optimal level of fluoride in drinking water provides enough fluoride to prevent tooth decay in children and adults while limiting the risk of dental fluorosis, which is the only unwanted health effect of community water fluoridation. Dental fluorosis is a change in the appearance of the dental enamel that occurs in children whose teeth are forming under the gums. The risk of dental fluorosis increases as children ingest higher levels of fluoride. The most common impact of fluorosis is faint white spots on teeth that usually only a dental professional would notice. National survey data show that prevention of tooth decay can be maintained at the recommended level of 0.7 milligrams of fluoride per liter of drinking water. This recommended level updates and replaces the previously recommended range of 0.7 to 1.2 milligrams per liter. (CDC) In 2019, the FDA proposed a rule to lower the allowable level of fluoride in bottled water to which fluoride is added by the manufacturer to 0.7 mg/L to be consistent with the 2015 recommendation by the U.S. Public Health Service. The FDA stated that it would align the limits for fluoride with the updated recommendation by the U.S. Public Health Service for community water systems that add fluoride, a recommendation that provides an optimal balance between the prevention of dental caries and the risk of dental fluorosis.

Q5: Patient: 23-year-old Caucasian woman Chief complaint: "My jaw feels a lot better than it did the last time I was here - I hope it's healing ok." Background/or patient history: The patient was in a motor vehicle accident 2 months ago, in which she fractured the body of her mandible. Current Findings: Radiographs show that the healing of the fracture is progressing well, with no signs of infection. However, the patient still complains of pain in the area of the fracture. Which choice shows the stages of bone healing in the correct order?

1. Inflammation & Hematoma 2. Soft callus 3. Hard callus 4. Remodeling Feedback: After an initial injury (with the accompanying bleeding and inflammation), a cartilaginous (or soft) callus is formed. This is replaced by a bony (hard) callus. Overtime, the bony callus is remodeled and is histologically identical to the original bone.

Q1: Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. What is the location of the lesion? (Based on the attached image)

2 Feedback: Correct! The lesion is distal to the geniculate ganglion, so the patient has moist eyes, but is proximal to the nerve to stapedius (which dampens sound), the chorda tympani(which consists of taste fibers from the anterior 2/3 of the tongue and parasympathetics to the submandibular ganglion) and branches to the muscles of facial expression.

Q15: Patient: 22-year-old male is accompanied by their caregiver and presents to the dental office for a routine dental recall. Chief complaint: The caregiver reports that the patient has a large cavity but has not observed any discomfort or symptoms by the patient. Background/or patient history: Patient is an individual with profound intellectual disability and uses a wheelchair. Patient is non-verbal and requires assistance for transportation and everyday self-care activities including oral home care. Patient lives at home with parents and has a part-time home health aide. Current Findings: A large cavitated carious lesion is noted on the upper left maxillary teeth (the occlusal surface of tooth #14). Patient is negative to percussion and palpation.Clinical review of radiographs taken that day reveal radiographic evidence of extensive caries into the pulp and below the gumline. It is determined that the tooth is non-restorable and requires extraction. Radiographs also reveal a long mesial root. According to the Center for Disease Control and Prevention, what percentage of US adults have some type of disability?

26% Feedback: According to the CDC, 26 percent of US adults have some type of disability.

Q3: If the anticodon on transfer-RNA is 5'ACG3', then which of the following is its corresponding codon on messenger-RNA? A. 5' CGT 3' B. 5' UGC 3' C. 5' CGU 3' D. 5' TGC 3' E. 5' UAG 3'

5' CGU 3' Feedback: (Image)

Q14: Which of the following molecules plays a critical role in both de novo synthesis and salvage pathways?

5-phosphoribosyl-pyrophosphate (PRPP) Feedback: Correct! This activated pentose phosphate is part of the initial steps of both the de novo synthesis and salvage pathways.

Q6: Patient: 60-year-old female Chief complaint: "I have severe pain in my chest and arm, and I'm feeling dizzy." Background/or patient history: The patient has been on a regiment of statins and aspirin to control her cholesterol and high blood pressure. She has healthy levels of A1C (glycated hemoglobin) and has been exercising regularly and dieting after her brother had a heart attack last year. Current Findings: The patient is diagnosed as having a heart attack due to plaque rupture in her coronary artery. She is given thrombolytic drugs to help dissolve the clot while being prepped for surgical intervention. Her condition is attributed to arteriosclerotic cardiovascular disease (ASCVD), also known as atherosclerosis. Heart attacks are related to the deposition of lipoproteins in lesion prone areas of coronary arteries. In the following diagram of a lipoprotein particle, which answer correctly pairs the letter shown with the biomolecule that contributes to lipoprotein structure? (Refer to attached image)

A -- Cholesterol, B -- Phospholipid, C -- Triglyceride, D -- Cholesteryl Ester, E -- Apoprotein. Feedback: Cholesterol, phospholipids, and the apoprotein will be located at the surface of the lipoprotein particle, while the triglycerides and cholesteryl esters are stored in the hydrophobic interior.

Q6: In the metabolism of fats and lipoproteins, which of the following is responsible for taking up fats and repackaging them for fuel distribution? (check all that apply) A. Adipocytes B. Liver C. Kidney D. Intestinal epithelial cells E. Muscle

A, B Feedback: Correct! Adipose tissue is the site where fatty acids are stored as triglycerides, and where they are broken down into glycerol and fatty acids for distribution to the liver and periphery. Correct! The liver is the site of beta-oxidation and fatty acid synthesis, and also is where VLDL particles are assembled and where the majority of LDL particles are absorbed.

Q11: Patient Box Updated1.0 Points Patient: George Smith is a 50-year-old male hospital security guard Chief complaint: Routine dental examination Background/or patient history: Patient reports no significant medical history Current Findings: Mobile tooth #30. Vital signs are normal. Your radiographic and clinical findings are consistent with the patient needing tooth #30 extracted immediately. The patient states: "I just want a cleaning." You decide to: (Select all correct choices) A. explain the risks, alternatives, and benefits of NOT doing the extraction. B. allow the patient to express his concerns. C. dismiss the patient's wishes, have him sign the consent form, and do the extraction anyway. After all, you're the doctor. You know what's best.

A, B Feedback: Practitioners need to always have a patient's informed verbal and written consent in order to proceed with any procedure regardless of their clinical judgement. Key to this is providing patients with a full explanation of benefits of doing or not doing a particular procedure. Allowing patients to express their concerns allows for good and effective communication as well as a better doctor-patient relationship. Practitioners need to always have a patient's informed verbal and written consent in order to proceed with any procedure regardless of their clinical judgement. Key to this is providing patients with a full explanation of benefits of doing or not doing a particular procedure. Allowing patients to express their concerns allows for good and effective communication as well as a better doctor-patient relationship

Q9: Patient: 19-year-old female Chief complaint: The back of my mouth hurts. Background/or patient history: No significant history. Current Findings: Tooth number 32 (right mandibular 3rd molar) is impacted. The tooth needs to be extracted; you administer lidocaine with epinephrine to prepare for surgical extraction. Which of the following nerves will need to be anesthetized? (check all that apply) A. Long buccal (CN V3) B. Lingual (CN V3) C. Inferior alveolar (CN V3) D. Greater palatine (CN V2)

A, B, C Feedback: The long buccal nerve (buccal branch of the mandibular division of the trigeminal nerve) supplies the buccal gingiva of the mandibular molars. Feedback: The lingual nerves supplies the lingual mandibular gingiva. Feedback: The inferior alveolar branch of the mandibular division of the trigeminal nerve supplies the roots of all the mandibular teeth.

Q7: The etiology of her condition could be: (check all that apply) A. Intracranial vascular compression of the trigeminal nerve B. Autoimmune demyelinating disease C. Traumatic injury nerve or vascular injury D. Intracranial mass E. Unknown

A, B, C, D, E

Q2: Which arteries could be involved in the epistaxis? (Select all correct answers) A. Sphenopalatine B. Greater Palatine C. Superior Labial D. Lesser Palatine E. Anterior Ethmoidal

A, B, C, E Feedback: The sphenopalatine artery is a branch of the maxillary artery. After entering the nasal cavity via the sphenopalatine foramen, it has an extensive distribution on both septal and lateral surfaces, and contributes to the arterial plexus of Kiesselbach's area at the anterior septum. The greater palatine artery is a branch of the maxillary artery. After supplying the hard palate, its nasal branch passes through the incisive canal to join Kiesselbach's area. The superior labial artery is a branch of the facial artery. Its septal branch runs superiorly to enter the nostril and join Kiesselbach's area. The anterior ethmoidal artery is a branch of the ophthalmic artery. After passing through the anterior ethmoidal foramen of the ethmoid bone, it supplies the anterior and superior regions of the nasal cavity, on both septal and lateral surfaces, and contributes to the arterial plexus of Kiesselbach's area at the anterior septum.

Q10: Patient: 42-year-old Caucasian female Chief complaint: "I've been having difficultly swallowing." Background/or patient history: No relevant patient history. Current Findings: You notice ptosis of both eyelids and some slurring of words. The patient says that her arms feel week and her vision is sometimes blurry. She says her symptoms tend to get worse at bedtime.You tell the patient she might have myasthenia gravis. If your diagnosis is correct, what is the cause of your patient's disease?

Antibodies that block acetylcholine receptors. Feedback: Myasthenia gravis is an autoimmune disorder in which antibodies form against acetylcholine (ACh) postsynaptic receptors at the neuromuscular junction.

Q9: Injury to the lingual nerve would result in which of the following symptoms? (check all that apply) A. Loss of taste to the anterior 2/3 of the tongue on the right side. B. Reduced salivation C. Deviation of the tongue to the right side on protrusion. D. Loss of general sensation to the anterior 2/3 of the tongue on the right side.

A, B, D Feedback: The chorda tympani nerve (CN VII) travels with the lingual nerve and a component of chorda tympani is taste fibers to the anterior 2/3 of the tongue. The chorda tympani nerve (CN VII) travels with the lingual nerve and a component of chorda tympani is preganglionic parasympathetic fibers to the submandibular and sublingual gland. The lingual nerve provides the anterior 2/3 of the tongue with general sensory innervation.

Q14: Patient: 60-year-old male Chief complaint: "I have extreme pain in my big toe, and my joints ache." Background/or patient history: The patient presents as overweight and has a diet rich in meat and alcohol. He suffers from sudden bouts of joint pain and recently passed a kidney stone. Current Findings: The patient is diagnosed with gout and given allopurinol to treat his condition. Allopurinol decreases the build-up of uric acid in the patient, a metabolite that crystallizes in the synovial fluid and forms sharp crystals. Also, the patient is advised to consider changes in his diet which can decrease urate levels by 10-20%. The patient is suffering from the metabolism of which of the following molecules? (Refer to choices in attached image)

A, B, E Feedback: Correct! This is the structure of guanine, a common purine base. Gout is related to the metabolism of purines. Correct! This is the structure of hypoxanthine, the nitrogenous base associated with the nucleoside inosine which is a precursor to guanine and adenosine. Correct! This is the structure of adenosine, a common purine base. Gout is related to the metabolism of purines.

Q13: Which of the following structures are most likely involved in the painful movement? (check all that apply) A. Articular disc B. Medial pterygoid C. Lateral pterygoid D. Temporalis E. Buccinator

A, C Feedback: Opening the mouth involves the lateral pterygoid muscle pulling the disc anteriorly inferior onto the articular eminence. The lateral pterygoid attaches to the articular disc and neck of the mandible and protrudes the mandible.

Q7: Your patient has a pulse of 110. The patient said that his/her normal pulse in 70. Which factors are most likely to have raised the pulse this day? (Select all that apply) A. The patient had 3 cups of coffee before appointment B. The patient lost a job a month ago C. The patient ran to make the appointment D. Dental anxiety

A, C, D

Q6: Following successful surgery, the patient and her doctor reflect further on the possible complications that lead to her condition. Which of the following may have contributed to the formation and eventual rupture of her atherosclerotic plaque? (check all that apply) A. A high ratio of LDL-to-HDL B. Impaired renal function C. Age D. A family history of cardiovascular disease (CVD) E. Diabetes

A, C, D Feedback: Correct! This is a key clinical markers for someone at risk for developing ASCVD, and would be the reason for the patient being prescribed statins. Healthy levels of HDL to LDL greatly decreases the risk of developing ASCVD. Correct! Women have a higher risk for ASCVD after menopause but have a lower risk of heart attack than men before menopause. Correct! A family history of CVD does increase the risk about 2-fold of developing ASCVD.

Q4: Patient: 40-year-old male Chief complaint: The patient is in a hospital emergency room. He says, "My upper teeth on the right side really hurt. I have pain in my face and a fever. Also, my eye feels really weird." Background/or patient history: None at this time. Current Findings: The patient has a temperature of 102 F. The patient's right eyelid is drooping, and the right eye is drifting medially. A CT scan reveals thrombosis of the cavernous sinus, as well as an abscess of the third right maxillary molar. Which nerve/s are being affected by patient's condition? (check all that apply) A. CN V2 (Maxillary) B. CN V1 (Ophthalmic) C. CN VI (Abducent) D. CN III (Oculomotor) E. CN V3 (Mandibular)

A, C, D Feedback: CN V2 travels though the cavernous sinus, on its way to the maxillary region of the face. It is not involved in muscular innervation in the orbit, but it is the sensory nerve for the maxillary teeth, and therefore would be responsible for pain in those teeth. CN VI travels through the cavernous sinus on its way to the orbit. It innervates the lateral rectus muscle, which abducts the eye. If there is a CN VI disorder due to cavernous sinus thrombosis, the eye may drift medially (adduct). CN III travels through the cavernous sinus on its way to the orbit. Compression and inflammation of this nerve can occur in the presence of cavernous sinus thrombosis. CN III supplies motor innervation to the levator palpebrae superioris muscle, and disruption of its function will result in drooping of the eyelid (ptosis).

Q11: You've finished the extraction and sent Mr. Smith home with the appropriate post-operative instructions. The following is the BEST way to proceed is to: (Select all correct answers) A. Call the patient that evening to see how he's doing. B. Have the room cleaned with an OSHA level disinfectant. C. wash your hands before seeing your next patient. D. Have the room cleaned with an EPA level disinfectant. E. Between changing your gloves use hand sanitizer.

A, C, D Feedback: The Environmental Protection Agency or EPA is responsible for regulating disinfectants for hospitals and other outpatient settings. OSHA is responsible for worker safety but not the effectiveness of disinfecting agents. Hand sanitizers although very good in community settings, are not the first choice when soap and water are available. Calling patients especially after major procedures establishes a good doctor-patient relationship. The Environmental Protection Agency or EPA is responsible for regulating disinfectants for hospitals and other outpatient settings. OSHA is responsible for worker safety but not the effectiveness of disinfecting agents. Hand sanitizers although very good in community settings, are not the first choice when soap and water are available. Calling patients especially after major procedures establishes a good doctor-patient relationship The Environmental Protection Agency or EPA is responsible for regulating disinfectants for hospitals and other outpatient settings. OSHA is responsible for worker safety but not the effectiveness of disinfecting agents. Hand sanitizers although very good in community settings, are not the first choice when soap and water are available. Calling patients especially after major procedures establishes a good doctor-patient relationship.

Q11: As part of the initial examination, you also decide to perform an intraoral examination. Which of the following is consistent with the intraoral examination? (Select all correct choices) A. Examining the lateral borders of the tongue B. Examination of the sternocleidomastoid muscle C. Examination of the buccal mucosa D. Examination of the floor of the mouth E. Examination of the hard and soft palates

A, C, D, E Feedback: Intraoral has to do with anything related inside the oral cavity. The sternocleidomastoid muscle can be palpated EXTRAORALLY (outside the mouth) on the lateral side of the neck. Intraoral has to do with anything related inside the oral cavity. The sternocleidomastoid muscle can be palpated EXTRAORALLY (outside the mouth) on the lateral side of the neck. Intraoral has to do with anything related inside the oral cavity. The sternocleidomastoid muscle can be palpated EXTRAORALLY (outside the mouth) on the lateral side of the neck. Intraoral has to do with anything related inside the oral cavity. The sternocleidomastoid muscle can be palpated EXTRAORALLY (outside the mouth) on the lateral side of the neck.

Q3: Which of the following base pairs promotes helix stabilization in DNA but does NOT do so in RNA? A. G-C B. G-U C. A-T D. C-T

A-T Feedback: Correct answer A-T pair exist in DNA but not in RNA, because in RNA, the correct pair is A-U

Q14: Effective communication has all of the following benefits for dentists except: A. Reduced risk of malpractice claims B. Reduced stress C. Reduced overhead expenses D. Reduced burnout

C Feedback: Reducing overhead has to do with clinical expenses and has nothing to do with patient communication.

Q5: There is a distinct change in the type of surface epithelium at the junction of the A. oropharynx and esophagus. B. fundus of the stomach and pyloric region of stomach. C. stomach and esophagus. D. ileum and colon. E. duodenum and jejunum.

C Feedback: The esophagus is lined with nonkeratinized stratified squamous epithelium, while the stomach is lined with simple columnar epithelium.

Q12: The following image shows healthy oral mucosa. Where would you find damage in the oral mucosa of this patient? (Refer to attached image)

C Feedback: This is where the basal layer of epithelial cells sits on the basement membrane.

Q13: All the following structures are derived from the neural crest EXCEPT: A. Connective tissue of the face B. Anterior pituitary C. Spinal ganglia D. Middle ear ossicles E. Adrenal medulla

B

Q11: Patient: George Smith is a 50-year-old male hospital security guard Chief complaint: Routine dental examination Background/or patient history: Patient reports no significant medical history Current Findings: Mobile tooth #30 As part of your initial examination, you decide to measure Mr. Smith's vital signs. As such you are measuring the following except: A. his temperature B. his waist line and height C. his pulse D. his respiration rate E. his blood pressure

B Feedback: DEFINITION: Vital signs are basic components of assessment of physiological and psychological health of a patient. Body temperature, pulse, respiration, blood pressure are the signs of life. Vital signs are also known as 'cardinal signs'. Although weight may be within a normal or abnormal range, it is not part of vital signs.

Q6: Which of the following are the major structural components of a mature atherosclerotic plaque? (check all that apply) A. Vascular endothelial cells B. Lipid pool in plaque center C. Fibrous, collagenous cap D. Macrophage-rich plaque shoulder E. Erythrocytes

B, C Feedback: Correct! The plaque center, which is cell-rich and collagen poor, can become unstable and may rupture. It contains a mixture of crystalized cholesterol, necrotic cells, foams cells (fatty macrophages), cholesterol esters, and activated macrophages. Correct! The cap, which is collagen-rich and cell-poor, is relatively stable and grows slowly over years.

Q12: Which of the following are aspects of providing culturally competent care? (Select all correct choices) A. Ensure that patients only receive treatment from providers with the same cultural background B. Accommodate the office location and hours of operation to increase effective interaction within the culture of the patient population. C. Provide printed materials in different languages to meet the language needs of their patient population

B, C Feedback: (Image)

Q4: In addition to those symptoms exhibited by the patient, which of the following symptoms may be associated with the patient's condition? (check all that apply) A. Paralysis of the muscles of mastication B. Facial sensory loss C. Vision loss D. Non-reactive pupil E. Disruption of the sense of smell

B, C, D Feedback: Because CN V1 and CN V2 pass through the cavernous sinus, compression and inflammation of these nerves can occur in the presence of cavernous sinus thrombosis. This can result in sensory loss in their regions of distribution on the upper and middle face. The internal carotid artery passes through the cavernous sinus, and occlusion in the artery due to thrombosis in the cavernous sinus may impair the blood-flow to the ophthalmic artery, in turn affecting blood-flow to the retina via the central retinal artery. Because both sympathetic and parasympathetic fibers pass through the cavernous sinus (the former as part of the internal carotid plexus, the latter as part of CN III), compression and inflammation due to cavernous sinus thrombosis can affect both dilation and constriction of the pupil.

Q4: Which of the following veins could have been involved in the transmission of infection? (check all that apply) A. The inferior alveolar vein B. The inferior ophthalmic vein C. Superior Ophthalmic Vein D. The deep facial vein E. The facial vein

B, C, D, E ophthalmic vein Feedback: Infection from an abscess in a maxillary tooth could spread to the facial vein. The facial vein leads to the superior and inferior ophthalmic veins, which connect to the cavernous sinus. Infection from an abscess in a maxillary tooth could spread to the facial vein. The facial vein leads to the superior and inferior ophthalmic veins, which connect to the cavernous sinus. Infection from an abscess in a maxillary tooth could spread to the deep facial vein, which leads to the pterygoid plexus of veins. From the pterygoid plexus, emissary veins connect through the base of the skull to the cavernous sinus. Infection from an abscess in a maxillary tooth could spread to the facial vein. The facial vein leads to the superior and inferior ophthalmic veins, which connect to the cavernous sinus. Additionally, the facial vein connects to the deep facial vein which leads to the pterygoid plexus of veins. From the pterygoid plexus, emissary veins connect through the base of the skull to the cavernous sinus.

Q2: Which nerve elements are involved? (Select all correct choices) A. Ciliary Ganglion B. CN V1 (Ophthalmic) C. Lesser Petrosal Nerve D. Greater Petrosal Nerve E. Pterygopalatine Ganglion

B, D, E Feedback: Preganglionic parasympathetics that are secretomotor to the lacrimal gland originate with the superior salivatory nucleus and CN VII. The preganglionic fibers fibers travel with the greater petrosal nerve to reach the pterygopalatine ganglion, where they synapse. Postganglionic parasympathetics travel with the zygomatic nerve of CN V2 and then the lacrimal nerve of CN V1 to reach the lacrimal gland. Preganglionic parasympathetics that are secretomotor to the lacrimal gland originate with the superior salivatory nucleus and CN VII. The preganglionic fibers fibers travel with the greater petrosal nerve to reach the pterygopalatine ganglion, where they synapse. Postganglionic parasympathetics travel with the zygomatic nerve of CN V2 and then the lacrimal nerve of CN V1 to reach the lacrimal gland. Parasympathetics that are secretomotor to the lacrimal gland originate with the superior salivatory nucleus and CN VII. The preganglionic fibers fibers travel with the greater petrosal nerve to reach the pterygopalatine ganglion, where they synapse. Postganglionic parasympathetics travel with the zygomatic nerve of CN V2 and then the lacrimal nerve of CN V1 to reach the lacrimal gland.

Q2: Which of the following is likely involved in the patient's symptoms? (Select all correct choices) A. Maxillary Sinus B. Bleeding in Kisselbach's Area C. The Incisive Canal D. Perforation of the cornea E. The nasolacrimal duct

B, E Feedback: Kiesselbach's area is a plexus of arterial supply located anteriorly on the nasal septum, and is the most common source of epistaxis. The nasolacrimal duct connects between the inferior meatus of the nasal cavity and the orbit (specifically the lacrimal sac in the medial corner of the eye). In the presence of pressure in the nasal cavity (e.g., due to squeezing of the nose during a nosebleed), blood can pass up through the nasolacrimal canal into the medial corner of the eye and mix with tears.

Q1: The movement in the upper compartment of the temporomandibular joint is rotation and translation. The movement in the lower compartment is translation.

Both statements are false. Feedback: The movement in the upper compartment of the temporomandibular joint is translation. The movement in the lower compartment is rotation.

Q13: Patient: 30-year-old male Chief complaint: "It hurts to chew and I have headaches." Background/or patient history: None at this time. Current Findings: Hypertrophy of masseter. Painful to open mouth > 20 degrees. The likely diagnosis is bruxism because the masseter is a powerful elevator of the mandible.

Both the statement and the reason are correct and related. Feedback: Bruxism (grinding teeth apart from chewing) would lead to hypertrophy of the masseter, the most powerful elevator of the mandible.

Q5: Calcium stimulates muscle contraction. Its effect is mediated through binding to which of the following? A. Troponin I B. Sarcoplasmic reticulum C. Troponin C D. Actin E. Tropomyosin

C Feedback: (Image)

Q12: A 10-year-old female with a history of acute lymphoblastic leukemia is undergoing orthodontic treatment that is complicated by poor oral hygiene. Oral examination reveals generalized cervical plaque and enlargement of the gingiva. There is generalized bleeding on probing. If this patient's leukemia contributed to increased intraoral bleeding, then the increase is MOST likely due to which of the following conditions? A. Anemia B. Factor VIII deficiency C. Thrombocytopenia D. Leukopenia E. Ca++ deficiency

C Feedback: Thrombocyopenia - a decrease in the number of platelets - would cause increased bleeding and could be a consequence of the patient's leukemia (increased number of abnormal cells in the bone marrow could prevent the normal development of platelets) or could be a consequence of her treatment.

Q12: Which type of microscopy would allow you to localize the autoantibodies binding to type XVII collagen? A. Light microscopy with Giemsa stain B. Light microscopy with H&E C. Scanning electron microscope D. Immunocytochemistry (immunofluorescence)

D Feedback: This technique uses labeled antibodies to provide precise localization of molecules. You could use labeled antibodies that bind to type XVII collagen or that bind to the autoantibodies causing the disease.

Q4: The cavernous sinus has a direct connection to which of the following dural venous sinuses? (check all that apply) A. Transverse sinuses B. Sigmoid sinuses C. Superior petrosal sinuses D. Inferior petrosal sinuses E. Superior sagittal sinus

C, D Feedback: The superior petrosal sinuses connect between the transverse sinuses and the cavernous sinuses. The inferior petrosal sinuses connect between the superior bulbs of the internal jugular veins and the cavernous sinuses.

Q10: Which of the following is true about the cellular component affected by your patient's disease? (Select all correct answers) A. It is a component of the nucleus. B. It is located in the mitochondrial membrane. C. When acetylcholine binds to it, the cell membrane will become depolarized. D. It is a nicotinic receptor. E. It is a ligand-gated ion channel. F. When epinephrine binds to it, a second messenger is activated.

C, D, E Feedback: Myasthenia gravis is an autoimmune disorder in which antibodies form against nicotinic acetylcholine (ACh) postsynaptic receptors at the neuromuscular junction, in the sarcolemma of skeletal muscle. It is a ligand-gated ion channel. When the ligand (Ach) binds, the ion channel opens, causing depolarization of the muscle sarcolemma.

Q14: Cells have the ability to produce nucleotide bases through de novo synthesis and recycle them through salvage pathways. Which of the following types of cells would likely require the greatest amount of de novo nucleotide synthesis? (check all that apply) A. Hepatocytes B. Muscle Cells C. Cancer Cells D. Nerve Cells E. Embryonic Cells

C, E Feedback: Correct! Cancer cells are actively proliferating. Thus the demand for nucleotides for DNA synthesis is high. Correct! Embryonic cells are actively growing. Thus the demand for nucleotides for DNA synthesis is high.

Q2: Between which of the following teeth in the primary dentition is the mandibular "primate" space usually found?

Canine and first molar Feedback: The mesiodistal arch space occupied by primary canines and molars is greater than that occupied by permanent canines and premolars. This difference is called the leeway space. Primate spaces are naturally occurring spaces which contribute to leeway space and provide room for erupting permanent teeth. In the mandible, the primate space most commonly occurs between the canine and first molar. In the maxilla, the primate space most commonly occurs between the canine and the lateral incisor.

Q1: Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. Which nerve is responsible for the patient's loss of taste?

Chorda Tympani Feedback: Chorda tympani consists of taste fibers to the anterior 2/3 of the tongue and preganglionic parasympathetic fibers to the submandibular and sublingual glands.

Q11: Patient: George Smith is a 50-year-old male hospital security guard Chief complaint: Routine dental examination Background/or patient history: Patient reports no significant medical history Current Findings: Mobile tooth #30. Vital signs are normal. Your radiographic and clinical findings are consistent with the patient needing tooth #30 extracted immediately. The patient decides to undergo extraction of tooth #30. You have his verbal and written consent. The BEST way to proceed is to: A. Inject the patient, wash your hands, don your personal protective equipment (PPE), and extract the tooth. B. PPE is not necessary. The tooth is so loose, by the time you don PPE, you could've taken the tooth out. C. Apply topical anesthetic, inject the patient, and extract the tooth. D. Wash your hands, don your personal protective equipment (PPE), apply topical anesthetic, inject the patient, and extract the tooth.

D Feedback: Infection control via proper hand hygiene, personal protective equipment, and effective anesthesia all need to be followed in the proper order. While effectively extracting a fully anesthetized tooth is important, just as important, if not more so is to not potentially expose yourself, your staff, or your patients to any transmissible disease due to hastiness or negligence.

Q5: What types of tissue were damaged by the fracture? (select all correct answers) A. Hyaline cartilage B. Fibrocartilage C. Elastic cartilage D. Cortical compact bone E. Spongy/trabecular/cancellous bone

D, E Feedback: The mandible (like all bones) is made of spongy bone surrounded by compact bone.

Q3: Patient: 23-year-old Asian American male Chief complaint: "About three hours ago a crazy guy came up to me on the street and hit me in the head with a bottle. I felt okay at first, but now I feel dizzy and nauseous." Background/or patient history: Not applicable. Current Findings: Swelling on the right side of the patient's head, superior and anterior to his ear. He is slurring his speech. The results of an MRI indicate an epidural bleed. The hemorrhage is located between which two types of tissue?

Dense CT and compact bone Feedback: This an epidural bleed, which is located between the dura mater (dense irregular connective tissue) and the skull (two layers of compact bone with spongy bone between them).

Q8: Patient: 45-year-old Caucasian female Chief complaint: "I have some sores in my mouth that hurt a lot." Background/or patient history: The patient reports painful blisters that appeared over the past several months. Current Findings: Multiple raised blisters and open lesions on bilateral buccal mucosa. You suspect pemphigus vulgaris, which is confirmed via biopsy. This is an autoimmune disease characterized by antibodies against certain cadherins. Which type of cell junction is most likely to be affected by the disease?

Desmosomes Feedback: Desmosomes (also called maculae adherentes) and belt desmosomes (also called zonulae adherentes or intermediate junctions) are both cadherin-mediated; they would, therefore, be affected by an autoimmune disease attacking cadherins. In reality, pemphigus vulgaris affects desmoglein 1 and 3, two calcium-dependent cadherins found in desmosomes.

Q4: In which of the following structures are glycoproteins assembled for extracellular use? A. Nucleolemma B. Polyribosomes C. Lysosomes D. Smooth endoplasmic reticulum E. Golgi apparatus

E Feedback: Proteins made in the rough endoplasmic reticulum can be modified and glycosylated in the Golgi.

Q5: Which of the following nerves may have been damaged? A. Buccal branch of mandibular nerve (long buccal nerve) B. Glossopharyngeal nerve C. Maxillary nerve D. Facial nerve E. Inferior alveolar nerve

E Feedback: This nerve innervates the roots of the mandibular teeth and travels in the mandibular canal. Since it is located inside the body of the mandible, it could be damaged by the fracture.

Q1: Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. Which nerve do you suspect has a lesion?

Facial Nerve (CN VII) Feedback: The facial nerve innervates the muscles of facial expression and the nerve to stapedius (which dampens sound).

Q2: Patient: 3-year-old female Chief complaint: The patient has come for a routine checkup and cleaning. Background/or patient history: This is the patient's first dental visit. Current Findings: While the patient was in the waiting room, epistaxis began in the left side of her nose. Blood continues to drip from the left nostril after she sits in your dental chair. She is crying, and you notice that the tears coming from her left eye are bloody. Please answer the following statement as true or false: "According to the current clinical guidelines by the American Academy of Pediatric Dentistry, the patient is compliant with the recommended age for a child's first dental visit."

False Feedback: The first examination is recommended at the time of the eruption of the first tooth and no later than 12 months of age.

Q15: Which of the following substances is the predominant source of ATP at MODERATE levels (for greater than 60 minutes) of activity?

Fatty Acids Feedback: Fatty acids are designed to be a helper fuel during aerobic exercise and are the dominant energy source at low power outputs and provides large amounts of energy during moderate intensity exercise

Q7: Hand sanitizer would not be effective if:

Hands were bloody, and/or covered with foreign substance. Feedback: According to data from the CDC hand sanitizers are not as effective in community settings when hands are bloody or soiled.

Q14: Which characteristics of lymph nodes are more likely cancerous?

Hard & fixed Feedback: Please note all other answers refer to moveable lymph nodes. Fixed is associated with a more cancerous outcome.

Q12: Patient: 78-year-old Caucasian male Chief complaint: "I've been getting blisters in my mouth for a few months. They hurt, especially if I eat hot or spicy foods." Background/or patient history: UV light treatment on face, upper limbs, and lower limbs to treat eczema. Current Findings: Generalized gingival and palatal erythema (redness). Multiple blisters and erosions. Epithelium peeled off of labial mucosa when pressure was applied. Biopsy confirms diagnosis of mucous membrane pemphigoid. This is an autoimmune disorder in which antibodies attack type XVII collagen, a molecule that attaches epithelial cells to the basement membrane. Which type of cell junction is most likely to be affected by the disease?

Hemidesmosome Feedback: Hemidesmosomes anchor basal epithelial cells to the basement membrane.

Q11: Which of the following disorders is X-linked recessive?

Hemophilia A Feedback: Hemophilia A - This is X-linked recessive.

Q6: Which of the following represents the structure on the crown of a maxillary canine which is located immediately to the mesial of the mesiolingual fossa?

Mesial marginal ridge Feedback: The mesiolingual fossa is the oval "1" Immediately mesial to this fossa is the mesial marginal ridge "2"

Q10: The patient's ptosis is caused by weakness in a muscle (or muscles) innervated by which cranial nerve?

III Feedback: Ptosis is drooping of the eyelids. It would be caused by weakness of the levator palpebrae superioris muscle, which elevates the upper eyelid. This muscle is innervated by cranial nerve III, the oculomotor nerve.

Q8: Patient: 28-year-old female Chief complaint: "I no longer can drink coffee, because it keeps me alert all the time" Background/or patient history: History of high blood pressure; treated with calcium channel blockers. Otherwise no significant medical background. Current Findings: Blood pressure 145/90, pulse 90. Knowing that coffee contains a phosphodiesterase inhibitor, the culprit in this case, why do you think this patient is alert all the time?

Increased levels of cAMP Feedback: cAMP, a second messenger, is degraded to AMP by a phosphodiesterase. If phosphodiesterase is inhibited, there will be higher than normal levels of cAMP, and the effects of any molecule that uses the cAMP pathway (such as epinephrine) would be amplified.

Q9: Which nerve is most at risk during the extraction?

Lingual Feedback: The Lingual nerve runs on the lingual surface of the mandible. The lingual plate of the mandible is thin in this area and can be injured during extraction of the third molar. The Lingual nerve runs on the lingual surface of the mandible. The lingual plate of the mandible is thin in this area and can be injured during extraction of the third molar.

Q15: Patient: 22-year-old male is accompanied by their caregiver and presents to the dental office for a routine dental recall. Chief complaint: The caregiver reports that the patient has a large cavity but has not observed any discomfort or symptoms by the patient. Background/or patient history: Patient is an individual with profound intellectual disability and uses a wheelchair. Patient is non-verbal and requires assistance for transportation and everyday self-care activities including oral home care. Patient lives at home with parents and has a part-time home health aide. Current Findings: A large cavitated carious lesion is noted on the upper left maxillary teeth (the occlusal surface of tooth #14). Patient is negative to percussion and palpation. Clinical review of radiographs taken that day reveal radiographic evidence of extensive caries into the pulp and below the gum-line. It is determined that the tooth is non-restorable and requires extraction. Radiographs also reveal a long mesial root. Which artery is the principal blood supply to this region?

Maxillary Feedback: The maxillary artery supplies the maxillary and mandibular dentition

Q1: The dentist is called in to assist in the postmortem identification of an unknown person. Parts of a cadaver are presented, including portions of the skull with bones, teeth, and intact soft tissue. Examination of a portion of the left mandible shows a torn piece of muscle attached on the medial side near the angle of the mandible. This is which of the following muscles?

Medial Pterygoid Feedback: The medial pterygoid originates on the medial side of the lateral pterygoid plate and the maxillary tuberosity and inserts on the medial side of the angle of the mandible.

Q10: The inferior alveolar nerve block (IANB) works to anesthetize the:

Mental Nerve Feedback: (Image)

Q13: In what nucleus or ganglion are the cell bodies of proprioceptors of the masseter, temporalis and medial pterygoid?

Mesencephalic nucleus Feedback: The proprioceptive fibers of these muscles are the only primary sensory nerves with cell bodies in the central nervous system.

Q2: In an ideal intercuspal relation, which of the following maxillary cusps will oppose the mesiofacial groove of the mandibular first molar?

Mesiofacial Cusp of the first molar Feedback: In Angle's classification, the Class-1 relation is considered to provide ideal occlusion for anterior and posterior teeth. Angle's Class-1 relation describes the mesiofacial cusp of the maxillary first molar aligning with the mesiofacial groove of the mandibular 1st molar.

Q3: Patient: 23-year-old Asian American male Chief complaint: "About three hours ago a crazy guy came up to me on the street and hit me in the head with a bottle. I felt okay at first, but now I feel dizzy and nauseous." Background/or patient history: Not applicable. Current Findings: Swelling on the right side of the patient's head, superior and anterior to his ear. He is slurring his speech. The results of an MRI indicate an epidural bleed. There is most likely a tear in the wall of which blood vessel?

Middle Meningeal Artery Feedback: This artery crosses the internal surface of pterion where four bones articulate and is vulnerable to a tear.

Q3: Patient: 23-year-old Asian American male Chief complaint: "About three hours ago a crazy guy came up to me on the street and hit me in the head with a bottle. I felt okay at first, but now I feel dizzy and nauseous." Background/or patient history: Not applicable. Current Findings: Swelling on the right side of the patient's head, superior and anterior to his ear. He is slurring his speech. The results of an MRI indicate an epidural bleed. Which bones might be fractured?

Parietal, Temporal, Frontal, Sphenoid Feedback: Pterion is the most likely area to be injured. The parietal bone articulates at pterion with the sphenoid, temporal and frontal bones. Pterion is the most likely area to be injured. The temporal bone articulates at pterion with the sphenoid, parietal and frontal bones. Pterion is the most likely area to be injured. The frontal bone articulates at pterion with the sphenoid, temporal and parietal bones. Pterion is the most likely area to be injured. The sphenoid bone articulates at pterion with the parietal, temporal and frontal bones.

Q6: The occlusal outline of a mandibular first molar is usually similar to a...

Pentagon Feedback: Viewed from the occlusal, mandibular molars are wider mesiodistally than buccolingually. A mandibular first molar's greatest buccolingual dimension is in the middle-third, due to the prominence of the distobuccal cusp. This moves its outline away from being rectangular (like the mandibular second molar), and more pentagonal.

Q15: Patient: 22-year-old male is accompanied by their caregiver and presents to the dental office for a routine dental recall. Chief complaint: The caregiver reports that the patient has a large cavity but has not observed any discomfort or symptoms by the patient. Background/or patient history: Patient is an individual with profound intellectual disability and uses a wheelchair. Patient is non-verbal and requires assistance for transportation and everyday self-care activities including oral home care. Patient lives at home with parents and has a part-time home health aide. Current Findings: A large cavitated carious lesion is noted on the upper left maxillary teeth (the occlusal surface of tooth #14). Patient is negative to percussion and palpation.Clinical review of radiographs taken that day reveal radiographic evidence of extensive caries into the pulp and below the gumline. It is determined that the tooth is non-restorable and requires extraction. Radiographs also reveal a long mesial root. Which nerves will you need to anesthetize?

Posterior Superior Alveolar Nerve & Greater Palatine Nerve Feedback: The posterior superior alveolar nerve innervates the roots of the maxillary molars and the gingiva on the buccal side of the posterior maxillary dentition. The greater palatine nerve innervates the gingiva on the lingual side of the posterior maxillary dentition.

Q1: Patient: 52-year-old white male. Chief complaint: "Suddenly I can't move half my face or close my eye and my ear is ringing! Everything has less taste. My mouth is a little dry." Background/or patient history: Not applicable. Current Findings: Symptoms appeared suddenly. Facial paralysis on the left half of the face, including the forehead. The patient has tenderness posterior to his left ear. Eyes are moist. The nerve in question exits the skull through:

The stylomastoid foramen and passes through the parotid gland. Feedback: (Image)

Q13: During gastrulation the definitive endoderm of the embryo comes from..

the first wave of cells passing through the primitive streak.