Cheez IT file

So I took my exam Sept 14th & 15th. 1st day was either exactly the same as Mamba files or

similar to it. (below are the questions on my exam) Keep in mind, some of the answers were

wrong on the Mamba files which I edited below. Keep in mind my Day 2 had the same case as it

sounded like what Mamba files had but the questions were different. If you’ve already gone

through the Mamba file, then you can skip the first 16 pages and I added the questions that she

didn’t put on the mamba file.

1. Which syndrome has Cafe au laits spots, axillary freckles and lisch nodules?

Neurofibromatosis, careful they also had “Multiple Endocrine Neoplasia Syndrome as option

2. What is the primary indication for splinting?

Mobile teeth and pt’s discomfort

Trauma from occlusion

2. A paralyzing dose of succinylcholine initially elicits a. CNS stimulation

b. CNS depressionc. decreased salivationd. muscle fasiculatione. extrapyramidal reactions

(d) because succinylcholine (SUX) is an agonist at nicotinic receptors, so the initial response is

muscle stimulation. **THIS one is from tuft’s pharm!! I guessed it by cross elimination but

I had not seen it!! DO TUFT’S PHARM NOWWW.

3. Effects of opioids are all of the following except?

A. Peripheral

B. Constipation

4. Side effect of nitroglycerin?

A. Severe Hypotension, flushing and headache

B. Respiratory depression, Hypotension, and something else that tries to get you but it’s A.

5. Which one binds to a specific receptor?

A. Antacids

B. Atrophine Sulfate

6. You have a patient that takes tranquilizers, what is your concern about the treatment?

A. Local Anesthesia IV causes hypertension crisis

7. Endodontic pain is characterized by all except:

A. Dull, aching pain

B. Sharp, shooting pain

C. Throbbing Pain

D. Electrical Pain

8. Which will provide longer duration of anesthesia:

A. 2% Lidocaine with epi 1:100,000

B. 0.5% Bupivicaine with epi 1:100,000

9. Histoplasmosis oral lesions resemble:

A. Candidiasis

B. Carcinoma

C. Pseudomembranous colitis

10. Pseudomembranous colitis is caused by:

A. Overgrowth of crostidium difficile

B. Taking narrow spectrum antibiotics for short period of time (1 week I think)

11. Glabella (soft tissue landmark in ceph) is Frontal bone!!, Ans: frontal

12. 22 year old female patient has fever, malaise erythematous gingiva with multiple ulcerations

in tongue, lips everywhere, had vesicles in the tongue/oral mucosa and maybe in lips too, and

had marginal gingivitis. This showed up 3 days ago, like 3 days ago she didn’t have it, now she

does. What is it?

A. Aphtous Stomatitis

B. ANUG

C. Primary Herpetic Gingivostomatitis

Dentist is doing an EVALUATION in a anxious 2 year old child?

A. Ask parents to help hold him down

B. Papoose board

Which muscle is most likely to get pierced if IANB is placed MEDIAL to the pterygomandibular raphe?

a. Buccinator and Lateral Pterygoid

b. Buccinator and Medial Pterygoid

c. Buccinator with Superior Constrictor Muscle

How many pins should you place in amalgam?

A. 1 pin for each cusp

B. 2 pins for each cusp

C. 1 pin in proximal side

D. 2 pin in proximal side

Cracked tooth with no pulpal involvement, treatment? A. RCT B. Extra-coronal (crown) C. Reduce occlusion

Cleft lip and palate is:

A. Autosomal recessive B. Autosomal Dominant C. X-linked recessive D. Genetically multifactorial –chose this

At which weeks does cleft lip forms?

A. 2-3 weeks B. 6-9 weeks C. 12-15 weeks D. 18-20 weeks

Gingivectomy incision?

A: 90 degree incision facial or lingual toward the tooth

B. Apical to pocket depth

C. Coronal to Mucogingival junction, just above

Best toothbrushing technique?

A. Stillman

B. Charter

C. Sulcular

Dens in Dente most common in?

A. Primary Maxillary Lateral Incisor

B. Permanent Maxillary Lateral Incisor

C. Permanent Maxillary Central Incisor

D. Primary Maxillary Central Incisor

Most common congenitally missing tooth?

A. Mandibular 1st premolar

B. Maxillary Laterals

Maxillary 3rd molars > Mand 3rd molars> mand 2nd premolars > max lateral > max 2nd premolars

Conditions least likely to have alveolar bone loss in primary dentition

A. Hypophosphatasia

B. Leukemia

C. Poor Oral Hygiene

Varices under tongue most associated with:

A. Hypertension

B. Elderly

Purpose of Pulpotomy in permanent 1st molar of 6-year old:

A. Remove caries

B. Continue Physiologic Root Formation (AKA: Apexogenesis). Chose this.

A big factor of Implant failure is:

A. Osteopenia

B. Osteopetrosis

C. Poor Oral Hygiene

Indication for inlay, options were:

A. If the opposing tooth is full coverage crown?

B. If the isthmus is over 1/3rd of the intercuspal width (this one is for onlay, so not correct)

C. REALLY weird options. I don’t know if it’s worth it. But know the basic indications for

inlay vs amalgam, there’s a table in first aid or in Mosby

What resembles epiphyseal plate? Synchondrosis

White spot lesions are:

A. Only Seen when dried with air-dried with air syringe

B. Subenamel porosities

C. Restored with Composite <- no, we don’t restore them.

Contraindications for Endo:

A. Recent MI

B. Leukemia

Pt who is pyrexic (fever), has tachycardia, is flushing/sweating (Diaphoresis), has nausea,

vomiting, is very nervous?

A. Thyroid Storm

B. Pheochromocytoma

Epulis fissuratum is histologically similar to what: A. Irritation fibroma <- picked this. My reason below. B. Neurofibroma

C. Granular cell tumor (not this one)

Bc it was not “congenital epulis in newborn”, ughh but just remembered that congenital epulis in

newborn does NOT have PEH, so histologically congenital epulis is NOT similar to Granular

cell tumor. Maybe epulis fissuratum IS ☺

What is NOT radiopaque?

A. AOT

B. Ameloblastic fibroma

C. Ameloblastic fibro-Odontoma

D. COC

Primary tooth intrudes 5mm on a 3 year old? Observe

What protection for root caries? A. Stannous fluoride B. neutral sodium fluoride

Most common seizure type in children? febrile Ttt of grand mal seizure? phenytoin Ttt of status epileptics? valium diazepam

What is the meaning of conjugation of drugs🡪 adding molecule to drug

most common Complication of mandibular 3rd molar bony impaction: A paresthesia, fracture, infection B. Paresthesia, alveolar osteitis, trismus 1997 law that made all children of low income family get health insurance. A. Medicaid (chose this, because CHIP is more recent and applies to kids who dont apply to low income, but cant afford health insurance). B. CHIP

Facial nerve is most likely to be affected by cut or damage in all except which? A. Internal acoustic meatus B. Jugular foramen C. Stylomastoid foramen D. Parotid gland surgery

All are innervated by the Hypoglossal nerve (CN12), except? A. Hyoglossus B. Palatoglossus- CN10 (Vagus) C. Styloglossus D. Genioglossus

The artery that supplies the tongue, is a branch of: External Carotid Artery If you cut or damage near the mylohyoid ridge, what will be affected? A. Facial Nerve (& you know Chorda Tymoani gives Taste of Anterior 2/3 of the tongue) B. Trigeminal nerve (think lingual nerve..Sensation of anterior 2/3 of tongue) C. Hypoglossal nerve (motor nerves for tongue)

D. Glossopharyngeal nerve You take Arbitrary facebow, then take CR, and you raise the upper molars 1mm? Why.. or why can you do this.. Weird worded questions and difficult about pros. These MUST be in the ASDA Questions, so collect questions from ASDA that mention “surveying, centric relation, and inter-occlusal records.” Had 10 of these difficult questions, which I chose educated guesses but was very confused with. Lower 3 rd of pt is too low and loss of vermillion border. How to correct? Inc VDO, Thicken labial flange, put max incisors facial Pt says his max denture hurts under the nostrils. Why? Labial flange too thick, max incisors too proclined. If you do/or have extrusion of posterior molars what happens? Anterior incisors intrude, anterior open bite, anterior incisors extrude You take arbitrary facebow of patient, and you decide to raise the upper molars by 1mm. Why? Why is it okay to have an interocclusal record of 1mm A. Because arbitrary fb allows you to Centric Relation interocclusal records should have: A. All cusp tips with no perforations B. All cusp tips, with central fossas and ridges and can have perforations C. Is more accurate if it’s very thin and has near perforations (like thin thin, but not perforated) on All cusp tips, with central fossas and ridges and can have perforations -Where to put direct retainers

A. 2 and 15

B. 12 and 5

The pt had Kennedy class III, mod 1, like this picture

DAY 2

Day 2: August 1, 2020 Ok guys, I had many many smokers, so I’m sorry if I switch around between some of them, but they ask different questions for each, so I hope it helps. I studied for 4 hours only for day 2, even though I had a complete day in between, whatever! I did unicorn, smurf cases first pages, SJ file pg 150-154. Master day 2 is also good if you have the time. Pharm was very easy. I’ll include a summary at the end of what I THINK are the most important contraindications to know, but might not be complete. Know NSAIDS contraindications, which meds cause Xerostomia (B-blockers, especially propranolol, thiazides diuretics for HTN, etc see pic at the end), and contraindications of EPI (in your LA), for ex: TCAs anti-depressants and propranolol. Not related to pt’s, had 3 radiographs, asked to identify:

1. Hyoid bone on a PAN 2. Zygomatic process on a PA, it was on top of upper molar roots, and

question asked “what is the U shaped radiolucency in this x-ray? 3. Zygomatic process again. 4. Which sinus is not visible in a cephalometric? Ethmoid, frontal, maxillary, and

sphenoid. This one I don’t know…Chose ethmoid, I think I could identify sphenoid

in a ceph. But check this one. The question included a picture of a ceph.

Not a pt’s case, a short question said “Pt has failed RCT, re-current endodontic infection, which antibiotic is not good for endodontic infection. (or just basically which antibiotic is NOT good for infection of endo origin.

A. Metronidazole B. Minocycline C. Amoxicillin

Got stuck between A and B. check Pt 1: 1st Smoker patient of the day, has a mandibular partial RPD, replacing most posterior teeth, and replacing lower incisors. Maxilla: FPD

Dental Hx: hasn't been to dentist in years!

Med Hx: Previous Hx of Infective Endocarditis, and I think he had an organ removed

(gallbladder, etc, not important for dx)

Meds: takes penicillin 200mg per day.

Clinical: Patient has left only 20, 21, and 27, & maybe 28 in the mandible, maybe a back

molar too. Opposing, in the maxilla he had an FPD which was probably full arch, or 6-11

and crowns in the back. This case, the guy had the last molars on both quadrants of the

maxilla FULL of plaque, they looked green covered in plaque. The mandibular

prosthesis had clasps which were NOT retentive at all, but clasps were like bracing, and

he had no occlusal rests anywhere** remember this for a question below.

Q1: what phase is he in. The guy said he didn’t have time to quit smoking.

Precontemplation

Q2: Asked what I should have him do about quitting??? They were like multiple

things like acupuncture, counseling, smoking cessation drug (I don’t think it

specified, but just in case, should be Buspirone or Chantix. He didn’t have depression

(indication for busp) or bulimia/seizures (Contraindication for chantix) so doesn’t

matter.

Q3: It asked how would you ask the patient I said "would you like to start the steps

to quit"

Q4: Patient was a war vet single doesn't go to doctor lives alone I wrote he had signs

of Post traumatic stress disorder Q5: You plan to extract “x” tooth, does the patient need pre-medication/ (or prob asked what will be his premedication)?

A. No, B. Amoxicillin 2g , 30-60 minutes pre-op

Pt has history of infective endocarditis, even if he’s taking penicillin everyday, he needs to have 2g of amoxicillin 60 minutes prior to operation!!

Similar question to this, in another pt, but this one, it was only 1 question for that patient, and it said that the pt was allergic to penicillin. All of the following Antibiotic drugs he can take EXCEPT: A. Clindamycin 600mg B. Azithromycin C. Ampicillin

Pt 2: 7-7 1/2 year old boy, came with mother. CC: Mother is worried that he is missing an anterior tooth(didnt mention which yet) Q1: most common reason why the anterior tooth/ incisor has not erupted yet? A. Mesiodens When I read this, I imagined it was 1 of the central incisors that had not erupted yet, and forgot to see the clinical picture. I was not feeling good at first bc of the sun glare, but actually, I think this one only provided history. No clinical or x-rays. I had another kid who was 9 years old, that one had everything. Q3: For the next visit, you’re doing restorative, what is the way you’ll use to manage the kid’s mild anxiety? A. Tell show do – chose this B. Nitrous oxide C. Premedicate with Mitrazolam D. Deep sedation or GA

Since it didn’t say the child was so anxious, I chose A. I think that should always be the 1st approach, especially if kid is not 2-4 years old. Kid #2. 9yr old, comes in, general check-up. Med Hx: when he was 4 months to 4 years, he had many viral and bacterial infections. (Prob was 18 months- 4 years). Healthy now, no meds. Q1. What is the possible cause of the discoloration of his LOWER incisors? A. Fluorosis ? check if tetracycline during that time 4 or 18 months-4 yrs can cause B. Trauma C. Genetic D. Bad oral hygiene Discoloration was bit yellow, not too much. Check if the x-rays have calcified pulps, then it’s trauma. If not’ I’d go with fluorosis. BAD oral hygiene in mandibular incisors is unlikely to make them yellow due to the HIGH salivary flow. That would be the case of maxillary incisors (bad OH -> yellow-orange-green stain in max incisors) Clinical exam: kid is missing his primary lateral incisors, and instead has primary canines right next to the centrals. I think he was Class I molar relationship. He had mild overbite (upper molars covered up to the middle of the height of mandibular incisors), and he had overjet. Radiographs: PAN: On the maxilla, has a lot of crowding, no open bite or cross bite but does have malocclusion. This one is the weird one that has a different skeletal bite than his dental bite. I’m looking for a picture, the cephalometric had permanent molars erupted “flush” but like cusp to cusp”. Q2: What is the cause of the midline shift of his lower incisors, and the inclination? A. Erupted mandibular canines (pt only had primary mandibular canines erupted, permanent lower canines were resorbing and trying to erupt. B. Bilateral crossbite that causes a func Q3: What possible ortho problems with this pt in the future? A. Maxillary arch length deficiency B. Retained mandibular premolars C. Mandibular arch lenght Q3: What is the cause of the appearance of the incisal edges of his mandibular incisors?

A. Genetics B. Normal Anatomy

*teeth just had mammelons!! It is normal in kids, it wears down in adulthood, but normal in kids. Smoker #2 or 3 lol: CC: I have very dry mouth. Meds: hydrochlorothiazide, 40-60 year old man, MedHx: Arthritis, hypertension, and Diabetes mellitus type 2 Meds: Meloxicam (Mobic), metformin, Lisinopril, and something else (prob in conjunction to RA) ** check Social history: Hx of smoking pack a day for 10’years Q1. Which is an Effect of lisinopril: A. Depletes levels of Potassium B. Postural hypotension Q2. What’s the cause of his xerostomia?

A. His medications (because thiazides cause xerostomia)

YEP, Another Smoker pt: Med hx: Think he had history of Infective endocarditis, and takes 200mg Penicillin daily. Dental Hx: hasn’t been to the dentist in years Social Hx: has smoked for 20 years or more. doesn’t have time to try to quit smoking. Q1: What is not a differential diagnosis of this lesion ? (On posterior lateral of tongue) A. Benign Migratory glossitis B. Scc C. Leukoplakia D. Focal keratosis Lesion was very edematous, erythematous (RED), indurated (hard and raised), and was surrounded by a white raised keratosis line. Could be erythroplakia, leukoplakia, SCC.. I chose this, because it looked something to be malignant, and the location is very characteristic for SCC. Q2: What is the APPEARANCE of this on his palate?

A. SCC

B. Nicotinic Stomatitis

Many people pick SCC because pt smokes, and so they assume that SCC is the best diagnosis for the differential. BUT, the question asks what is the CLINICAL appearance, clinically what does it look like? If you knew nothing about the patient, you would choose Nicotinic stomatitis. Picture was EXACTLY like the picture.

Young female pt, 20’s, is missing teeth 3 and 4, and had #14 extracted recently. Her maxilla is class 3, modification 1. Med hx: estradiol Social hx: cant remember, but she wasnt a smoker. Dental hx: sporadically visits the dentist when she has an emergency. Oral hygiene is regular, brushes 2x a day but doesn’t floss. Xray: FMS shows that there are root tips of #2 and 3 left, and clinically you can see it’s very decayed. Q1: What makes you decide to do Surgical extraction instead of normal extraction? For her other planned extraction? A. The condition of her crown ( very carious) Q2: order of treatment:

A. Scaling and root planning – extractions, restorative B. Extractions, - prophylaxis – etc C. S/RP – Perio surgery , etc

IMPORTANT NOTE: If patient does NOT have pockets of 5 or DEEPER, there is NO INDICATION TO DO S/RP!!! 3-4mm pocket depths only need prophylaxis, so before answering, open up the clinical chart/perio chart to see his pocket depths. Use this chart also to assess quick how many caries the patient has. Having lots of caries, especially on mandibular incisors cervical areas means the patients has HIGH CARIES RISK, rampant caries, either from poor oral hygiene, bad diet habits, etc..and use this to decide what’s the best restoration for his cervical caries. Had 2 of these questions, both patients had many caries in cervical of mandibular incisors, on facial. AND options were: amalgam, composite, compomer, or RMGI (Resin Modified Glass Ionomer). For those questions also consider that moisture contamination is difficult, so you’re left with RMGI or Amalgam. Since they’re in esthetic zone (amalgam is not good), and since pt has rampant caries (many many), better to give RMGI for it’s benefit of Fluoride release. Q3: For her design of her maxillary RPD, what would you change? Showed a clinical picture of her maxilla, with an RPD design drawn into it. She’s missing teeth 2 and 3, but has tooth #1, and on the other side she’s missing teeth 14. So she’s Kennedy class III modification 1. THE question asked you, what would you change about her design?

A. Change the clasp on tooth #15 to a circumferential clasp B. Cover the whole palate C. Add a linguoplate near the anterior central incisors D. Remove the indirect retainer. Chose this! Because this patient is NOT a

distal extension case (not Class 1 or Class 2 distal extensions), so there’s no need for indirect retainer. The black line in the design represents the indirect retainer, and it’s on a lateral incisor, NOT GOOD!

Pt:, older than 50, male Pt, CC My tooth hurts, I have lots of cavities and want to get them checked. BP: 128/70 (stable)

Med Hx: had 4 cardiac shunts placed, probably history of an MI, but for sure you know he’s at risk of ischemic infarct (in brain or in heart) and that he has atherosclerosis (fat build-up in arteries) bc he takes aspirin & plavix (both anti-platelet drugs, taken to prevent thrombus that can cause MI) Meds: takes Clopidogrel (Plavix) and 81 mg aspirin, daily. Q1: For routine dental extractions, what is your approach: A. Proceed with treatment, refer with physician for follow up. B. Stop medications days before (can’t remember how many days, may be 1-3 days, or may be 10. Q2. After infiltrating local anesthesia, the patient gets chest pain. What do you NOT do? A. Give oxygen B. Take blood pressure before putting nitroglycerin sublingual -chose this, you took his BP before, why take it again? His history clearly tells you he’s prone to an angina attack (angina pectoris) or Myocardial infarction, because he takes aspirin and plavix to prevent thrombosis and thus MI. So this is an emergency, must act immediately. Nitroglycerin will do vasodilation. C. Have assistant call ambulance to transport him asap. Pt African american woman, (doesn’t say that, but I noticed from her skin color) CC: Esthetics, she wants to get a crown or implant to replace area of #12. Med Hx: Social hx: smokes a pack/day. Dental Hx: regular or poor oral hygiene. Radiographs: FMS, pt has missing space of #12. Q1. What is the biggest contraindication of placing an implant in the area of #12? A. Smoking B. Something ambiguous like proper surgery plan C. Primary stability D. Unavailable bone loss If you answer this question without looking at the radiograph, you’ll be tempted to pick smoking! The edentulous space has bone loss that is deeper than the Indian Ocean, lol. It’s lower than the apical 3rd of the roots of adjacent teeth. Q2: All are probable causes for the bone loss in area of #12 except? A. Ankylosis of #12 B. Ankylosis of Primary tooth I (decidious tooth of 12) C. Broke buccal plate during extraction D. Broke Lingual plate during extraction

Radiographs: FMS, pt has missing space of #12. And a LOT OF bone loss, Ridge atrophy.. the bone loss is as deep as the apical 3rd of the roots of adjacent teeth. Another patient: Pt presented with symptoms, she has lingering pain to cold, what is the treatment? Gave a PA radiograph: tooth was a canine. There was no apical lesion, no widening of the PDL nothing!! I don’t think they gave percussion or palpation tests. If they did, it was negative for both (so no apical symptoms) Clinical picture: the tooth was sound, no root exposed, no recession. Q1: what is the best treatment? A. Do RCT B. Apply tooth desensitizer – chose this, bc the endo diagnosis was not complete, maybe the patient had another condition (trigeminal neuralgia, myofascial syndrome, TMD, etc), and doing RCT without a complete endo diagnosis that coincides with the pt’s presenting symptoms, the pulpal diagnosis is in line with the radiograph, etc. It seemed something else, non-endodontic origin was wrong! Another pt: Woman, in 45 years old Can’t remember her history (probably non-contributory), but q was: Q1. What is the most likely reason for the discoloration of tooth #8? A. Trauma. Pick this for sure. The tooth was all yellow, like from calcific metamorphosis. B. Enamel hypoplasia or something C. Dentinogenesis imperfecta E. Genetic Can’t be either B, C or E because it was only 1 tooth that was stained.

New questions:

1) You need to understand the pathway of Ibuprofen. They asked about what were the

factors that get inhibited due to inhibition of COX inhibitors.

2) how the difference between Dentin Dysplasia vs Amelogenesis imperfecta

3) know everything about nitrous oxide, they gave me 5 questions on its MOA and all its

side effects. It sounds simple but they made it somehow tricky. Make sure you KNOW

ALL its side effects. They were all very similar answers so it was tricky.

4) Know about tuberculosis and what are the oral and body implications that it cause

5) The pharamacology questions I got were pretty tough. Not like what mamba files had,

mamba files said she got easy questions but mine were definitely not easy and all tricky.

All my pharm questions asked about the side effects of its drug. And it wasn’t the simple

side effects and common side effects but like, the more uncommon side effects. It was

pretty dirty.

6) Know the differences between Hep. ABCDE.

7) Know the ages of eruption and calcification for primary and permanent. I had 5 questions

on those.

8) Understand the side effects of Von Rcklinghausens and osteopetrosis. (signs)

9) Side effect of Sturge weber Syndrome

10) Side effect of Gardener syndrome.

11) They asked a lot about the side effects of morphine

12) Know all properties of GIC

13) Know I got about HUE, Value, and Chroma really well. I got 5 questions on them.

14) Know your antibiotics real well.

15) Understand periodontal surgery so its ingrained in the back of your mind. It literally felt

like half my 400 questions were all perio surgery questions. A lot of understanding what

gingivectomy does. How to do an incision for gingivectomy, indications, healing process.

16) I had 5 questions on pontics and bridges. Modified ridge lap, hygiene and etc.

17) I got atleast 10 questions on the physics of Xrays. They weren’t easy questions either. So

study up on the physics of xrays (like collumination, focal spots, tugsin filaments, etc)

18) What type of xray is used for MRI & CT

19) Keep updated on facebook cause I have recognized some of the questions people post on

facebook on the exam.

I kid you not, if you know these advice from page 16 alone, it was easily over 30 questions on

these subjects alone. Great if you know them by heart. If you don’t….sucks to suck.

All honesty, good luck guys. And hopefully you all pass and achieve your dreams. If you work

hard for it, you’ll get it.