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Saturday, May 16, 2020

Contraindications of Extraction of Teeth I Dental Guide I

Absolute contraindications of extraction of teeth are:

1. Central Hemangioma

2. Arteriovenous or sinusoidal aneurysms 


Relative contraindications of extraction of teeth are:

1. Six months after MI

2. Extraction of teeth in previously irradiated area

3. Suspicion of hemangioma

4. Diabetes Mellitus

5. Adrenal insufficiency

6. Thyrotoxicosis

7. Necrotizing ulcerative gingivitis (NUG)

8. Untreated coagulopathies

9. Acute blood dyscrasias

 


Thursday, March 26, 2020

Diabetes Mellitus (DM) and Extraction: Case 1


A 62 year old female patient came to department of Oral and Maxillofacial Surgery with chief complaint of decayed teeth in upper right back and lower left back region of jaw since 2 years. She had a medical history of Diabetes Mellitus and was under medication for it since two years.

On examination:
Root stump w.r.t. 18, 15, 14, 38

For this, we send her for medical consultation and told her to come with medical report for
1. Fasting Glucose Level,
2. Postprandial  Glucose level and
3. HbA1c

Her Fasting glucose level was 107 and Postprandial glucose level was 198.

As we know, extractions can be performed with
Fasting glucose level < 125
Postprandial glucose level < 200.
If we go for extraction above this level, there is high chance of post operative complications, especially post operative infection and delayed wound healing. So, we called the patient after one day with antibiotic prophylaxis of 1 g Amoxicillin one hour before extraction as it was of borderline case.

 Note: 
Extraction is contraindicated in case of uncontrolled diabetes Mellitus or poorly controlled Diabetes Mellitus i.e. Fasting glucose level > 125 and Postprandial glucose level > 200.

Extraction was successfully done and proper post operative instructions given with prescription:
1. Cap. Amoxicillin 500 mg p/o x tds x 5 days
2. Tab. Metronidazole 400 mg p/o x tds x 5days
3. Tab. Ibuprofen 400 mg p/o x tds x 1 day then sos
4. Tab. Pantoprazole 40 mg p/o x od x 5 days.

Thursday, November 23, 2017

Periodontium



Download
Definition:

Periodontiumrefers to the specialized
tissues that both surround and support the
teeth, maintaining them in the maxillaryand
mandibularbones.

The word comes from the Greek
terms peri-, meaning "around" and -odons,
meaning "tooth”.Itprovides the support
necessary to maintain the teeth in function.


Components of Periodontium

It consists of four
principal
components namely:

.Gingiva
.Periodontal ligament(PDL)
.Cementum
.Alveolar bone


Gingiva

The gingiva covers the
alveolar bone and the
tooth root to a level
just coronal to the CEJ

TYPES :

.Marginal gingiva
.Interdental gingiva
.Attached gingiva


Mucogingival junction:

A clearly defined mucogingivalline that
demarcates the attached gingiva from the
adjacent alveolar mucosa.

Clinically the alveolar mucosa is
red,smoothand shiny unlike the gingiva
which is pink and stippled in appearance.

Histologically, the epithelium is
thinner,nonkeratinized and contains no
rete pegs.


Gingival Epithelium :

1. Oral (outer) epithelium

2. Junctionalepithelium

3. Sulcular epithelium


1) ORAL EPITHELIUM:

Covers the crest & outer surface of marginal
gingiva & the surface of attached gingiva.Averagethickness is ‘0.2-0.3mm’

2) SULCULAR EPITHELIUM:

Lines the gingival sulcus & is thin,non-
keratinized stratified.sqepi. extends from coronal limit of
JE to crest of gingival margin.

3) JUNCTIONAL EPITHELIUM:

Consists of a collarlikeband of stratified.sqepi.Lengthof JE ranges from `0.25-1.35mm’


Biological Width

The dimension of space that the healthy gingival
tissues occupy above the alveolar bone is
identified as the biological width.


clinically biologic width violation is done when the restoration margin
is placed 2mm or less from the alveolar bone ,esp.whenthe gingival
tissues are inflamed.



Periodontal ligament
Definition:
The periodontal ligament is the soft
specialized connective tissue situated
between the cementumcovering the root
of the tooth and the bone forming the socket wall.


Functions of Periodontal ligament :

.It provides a soft tissue casing to protect
the vessels and nerves from injury by
mechanical forces
.Attachment of teeth to the bone
.Maintenance of gingival tissues in their
proper relationship to the tooth
.Resistance to impact of occlusalforces


Components of the Periodontal
ligament

.The PDL consists
- CELLS

osteoblasts,osteoclasts,fibroblasts,restcells of
malassez,macrophages,undifferentiatedmesenchymalcells and cementoblasts

- AN EXTRACELLULAR COMPARTMENT

Consists of well defined collagenous fibres embedded in a non collagenous extra cellular
matrix of glycoproteins and glycolipids.

- PERIODONTAL FIBRES:

.The predominant collagens of PDL are types
1.
.They are arranged in distinct and definite fiber
bundles and are able to adapt to the continual
stresses placed on them
.The principal fibresconsists of

-alveolar crest group

-the horizontal group

-the oblique group

-the apical group

-the interradiculargroup

.All these principal fibresare embedded as
sharpeysfibresin the cementumor bone.

Principal Fibres

.The Alveolar crest fibres extend obliquely from the cementum to the alveolar crest

.The Horizontal fibres extend at right angles to the long axis of the tooth from the cementum to the alveolar bone

.The Oblique fibres extend from the cementum in a coronal direction obliquely to the bone

.The Apical fibres radiate at the apical region of the socket from the cementum to the bone

.The Interradicular Fibers Fan out from the cementum to the tooth in the furcation areas of multi
rooted teeth

Cementum:

Definition:

Cementumis a calcified
avascular tissue that
forms the outer
covering of the
anatomic tooth.

Types of cementum

-Primary (acellular)
cementum

-Secondary (cellular)
cementum


Composition of cementum:

INORGANIC:

-45 to 50% hydroxyapatite crystals

ORGANIC:

-50% organic(collagens and non collagenous
proteins)

90% is type 1& 5% type 3 collagen.


Classification of cementum

.Acellularafribrillarcementum(AAC):


-Mineralized ground substance

-No cells nor intrinsic or extrinsic collagen

-Present as coronal cementum

.Acellularextrinsic fiber cementum(AEFC):


-densely packed sharpeysfibres

-lacks cells

-found in cervical 3rdof the roots

.Cellular mixed stratified cementum(CMSC):


-contains cells,extrinsicand intrinsic fibers.

-found in the furcation area and in apical 3rdof roots

.Cellular intrinsic fiber cementum(CIFC):


-contains cells but no extrinsic fibres

-fills the resorptionlacunae

.Intermediate cementum:


-a poorly defined zone near the CEJ of teeth.

Cementoenameljunction:

Three types of joints may
exist:

-60-65%Cementum
overlaps enamel

-30% edge-edge butt
joint exists.

-5-10% where
enamel and dentin fail to
meet, leaving dentin
exposed.


Alveolar Process

Alveolar process is the portion of
maxilla and mandible that forms
and supports the tooth sockets.

It consists of,

-External buccaland lingual
cortical plate.

-Inner socket wall of compact
bone called Alveolar bone
proper,seenas lamina durain
radiographs.

-Cancelloustrabeculaebetween these two layers,whichact as a supporting alveolar
bone.

Wednesday, August 30, 2017

Why I don't like our education system?

I personally disagree with the curriculum. 8am to 5pm classes and postings. How can a student tolerate same type of knowledge a whole day, a whole year? After 5pm we get tired and just wait for the next morning for the same race. If we really want to grow and want to create an effective manpower, organization, education system or anything else, I think we should give time in all sectors not only in classes and postings. We are here like the goats and khachhars like we are bringing heavy weights on our shoulders with no particular destination. From my view, the classes and the postings should be maximum 5/6 hours a day so that the students can give time in other productive things for getting personnel excellence in their respective lives. We have new ideas which we want to implement but we have no time. We want to spend some valuable time with our family, friends or effective people but we have no time. We want to do this and that but no time. If this goes on then we are surely going to be the narrow vision people who only know how to wait for the salary after working a whole day for a whole month. I don't like the education system personally.

I am much more optimistic and serious about my profession and I have been doing well academically since long time. Also I am very happy that I've chosen this profession. It's not about being immature to share something we feel about. I am not blaming the whole education system. I am not disrespecting the people who made the curriculum. I just want to say that some modifications are needed in our curriculum and I am focusing on the 10 hours of each day, every day, out of which half the time there is nothing to do like in postings we sit in the department and nobody care what we are doing but we have to sit there for attendance (based on my 3rd year experience). So total wastage of time. Another thing, I know dedication is very important for our profession but dedication doesn't mean hanging on something for a long period of time. It means how much we can do the work efficiently within a maximum range of time within the limitation of our mind and the body... And nobody can do same thing, 10 hours a day, every day efficiently, rather it ceases the capacity of a person that he actually be able to do. What will happen if a bodybuilder lifts weights for 10 hours per day, each day without resting? Obviously, his body system will collapse sooner than we think. So, I just don't like this 10 hour system. And if we ask all students one by one about this, I think they have the same perspective as mine. And I think we are not here for being Doctors only, we are here to be the better human beings too so we need time for other things too. And if there is any fault in our education system then we should raise our voice for the greater good instead of accepting it as it is, shouldn't we?

And there are thousands other examples. They take money to run the show. We don't expect from them to feed us with spoon. God gave us our own hands to do that. At least show us what to eat. And it's not only about their lack of care about our study... It's about. We don't need to study 10 hours a day, every day, a whole year to become good doctors. There must be phases of rest in between the classes, postings, session so that we can live other parts of the life. 10 hours. More than enough...more than we need. Even the one hour class should be Max of 30 minute per class.

 I want to share an example... In a day we take meal (breakfast, lunch, dinner). We don't have to eat for 10 hours (all the Time) to be healthy. I know content of the food is good and it's delicious too but we are not eating the food whole day (food is wasted) and the people are unable to feed us because there is something faulty with the time and content system...we can't eat 10 kg a day. So we are not eating the whole day but still we are healthy, I say more than healthy. But if we keep eating 10 hours each day, every day, we surely are going to be sick. Balanced died is needed to be taken in proper time at proper amount. If not then we will have to suffer from diseases (which I can see here).


We try to make the time (most of) useful in class/ postings. I think the moto is same for eating or education. 10 hours classes/ postings (for 3rd year) + 1 hours for getting ready and having breakfast + 7 hours Vanda kam sutne less than 10 % + half an hour for dinner + bachne time vaneko raati 6 to 8 pm and 8:30 to 11/12 pm. What are we supposed to do at night in hostel room (lab work or homework gardai thikka) after having 10 hours of work whole day every day? And I am not here for debate di. I just put my point of view... If I am wrong then 100 % of them students here are wrong (except some exceptions) and only the people who are running this not realizing what's really going on are very right. If you get what I meant, that's what I want the authorities should get and make the modifications what is needed.

Friday, August 18, 2017

Forensic Medicine MCQs: Question Set 2

1. Cephalic index is important to determine the:
a. Stature from long bones
b. Cranial capacity
c. Race from skull
d. Sex from skull Key: c


2. Putrefaction is rapid in:
a. Air as compared to water and earth
b. Water as compared to earth and air
c. Earth as compared to water and air
d. Water and earth as compared to air Key: a

3. Moral principles which should guide members of the medical profession in their dealings with each other is known as:
a. Medical etiquette
b. Medical law
c. Medical jurisprudence
d. Medical ethics Key: d

4. All of the following are examples of Res ipsa loquitur EXCEPT:
a. Prescribing an overdose of medicine producing ill effects
b. Grossly incompetent administration of general anaesthesia by an anaesthetist
c. Mismatched blood transfusion
d. Amputation of wrong limb Key: b

5. The most reliable method of identification of a living person is:
a. Photography
b. Dactylography
c. Hand writing
d. Anthropometry Key: b

6. A woman can give valid consent for sexual intercourse if she is above the age of:
a. 17 years
b. 15 years
c. 16 years
d. 18 years Key: c

7. Suspended animation means:
a. Irreversible cessation of heart functions
b. Irreversible cessation of respiration
c. Temporary cessation of vital functions
d. Permanent cessation of vital functions Key: c

8. Greenish-blue froth at the mouth and nose is seen in poisoning from:
a. Arsenic
b. Lead
c. Copper
d. Mercury Key: c

9. Xanthoproteic reaction is seen in poisoning by:
a. Sulphuric acid
b. Nitric acid
c. Hydrochloric acid
d. Carbolic acid Key: b

10. Chalky white teeth occurs in poisoning due to:
a. Nitric acid
b. Hydrochloric acid
c. Sulphuric acid
d. Oxalic acid Key: c

11. Shock, hypocalcaemia and renal damage are characteristic features of poisoning due to:
a. Acetyl salicylic acid
b. Oxalic acid
c. Hydrochloric acid
d. Nitric acid Key: b

12. Blue line in gums is seen in chronic poisoning by:
a. Arsenic
b. Lead
c. Copper
d. Mercury Key: b

13. Hydroquinone and pyrocatechol are the metabolic products of :
a. Carbolic acid
b. Oxalic acid
c. Nitric acid
d. Sulphuric acid Key: a

14. “Professional death sentence” is the term to denote:
a. Capital punishment
b. Penal erasure of the name of a medical practitioner
c. Rigorous imprisonment for life
d. Severe warning notice key b

15. In case of assault, if the doctor is negligent in the treatment of the patient, he may be held responsible for subsequent disability or death under the principle of:
a. “calculated risk cases”
b. Medical maloccurence
c. Novus Actus Interveniens
d. Res Ipsa Loquitur key c

16. Surest or the most reliable method of identification is:
a. DNA Profiling
b. Galton Method
c. Gustafson’s method
d. Anthropometry key b

17. Which of the organ is usually first to show autolytic changes:
a. prostate
b. liver
c. spleen
d. pancreas key d

18. Blue line in gums is seen in chronic poisoning by:
a. Arsenic
b. Lead
c. Barbiturate
d. Opium Key: b

19. Arsenic interferes with cell metabolism by combining with:
a. Cytochrome oxidase
b. Sulphydryl enzyme
c. Acctylcholinc esterase lecithines
d. Lecithines Key: b

20. Greenish urine is seen in poisoning with:
a. Carbolic acid
b. Nitric acid
c. Copper sulphate
d. Hydrochloric acid Key: a

21.. Xanthoproteic reaction is seen in poisoning by:
a. Sulphuric acid
b. Nitrict acid
c. Hydrochloric acid
a. Carbolic acid Key:b

22. Which of the following is used in forgeries as an ink remover solution:
a. Sulphuric acid
b. Nitric acid
c. Carbolic acid
d. Oxalic acid Key: d

23. Hypocalcaemia is a feature of poisoning due to:
a. Phosphorus
b. Oxalic acid
c. Arsenic
d. Copper Key: b

24. In Nepal Medico-legal autopsy requires the permission of:
a. Police
b. Chief District Officer
c. Relatives
d. Hospital authority Key: a

25. Amenorrhoea and infertility are the possible complications of chronic poisoning with:
a. Mercury
b. Lead
c. Zinc
d. Chromium Key: b

25. Slight degree of violence may produce a large bruise on:
a. Face
b. Scalp
c. Palms
d. Front of abdomen Key: a

26. The commonest cause of sudden death is due to:
a. Acute myocarditis
b. Pulmonary oedema
c. Myocardial infarction
d. Congestive cardiac failure Key: c

27. Corrosive acids should be diluted and neutralized in the stomach by
a. Sodium carbonate
b. Aluminium hydroxide gel
c. Potassium hydroxide
d. Sodium bicarbonate key b

28. Substances which act on the tissues of the body and counteract the effects of poisons are known as
a. Physiological antidotes
b. Chemical antidotes
c. Universal antidotes
d. Mechanical antidotes key a

29. In arsenic poisoning breath and stools have
a. Garlic-like odour
b. Offensive smell
c. Smell of acetone
d. Odourless key a

30. Which of the following compound of lead is absorbed through intact skin
a. Lead acetate
b. Lead carbonate
c. Tetraethyl lead
d. Lead chromate key c

31. Best method to prove paternity is:
a. Blood grouping
b. Finger prints
c. Phenotypic resemblance
d. DNA fingerprinting key d

32. Teeth bite mark is an example of:
a. Scratch abrasion
b. Graze abrasion
c. Pressure abrasion
d. Impact abrasion key c

33. In female skeleton the long bones are:
a. 5% smaller than the male
b. 8% smaller than the male
c. 10% smaller than the male
d. 12% smaller than the male key b

34. Masculine or feminine characteristics most directly depend on:
a. genotype of gonadal tissue
b. genotype of somatic tissue
c. gonadotropin output
d. level of circulating sex hormones key d

35. Alveolar cavities in the jaw are formed around:
a. seventh month of intrauterine life
b. sixth month of intrauterine life
c. tenth month of intrauterine life
d. third or fourth month of intrauterine life key d

36. The maximum numbers of deciduous teeth a child can have are:
a. Sixteen
b. Twenty
c. Twenty four
d. Twenty eight key b

37. Autopsies in medico-legal cases began to be generally practiced around:
a.Eighteenth century
b.Fourteenth century
c.Sixteenth century
d.Thirteenth century key c

38. Hippocrates was:
a. Egyptian physician
b. Greek physician
c. Italian physician
d. Roman physician key b

39. Warning notice may be issued to a medical practitioner for:
a. Contributory negligence
b. Professional negligence
c. Violation of code of medical ethics
d. Wrong diagnosis and treatment key c

40. Deptheretic colitis (resembling the enteritis of acute bacillary dysentery) involving the ascending and transverse colon is seen in poisoning by:
a. Arsenic
b. Lead
c. Mercury
d. Potassium permanganate key

41. Peritoneal dialysis effectively removes:
a. amphetamine
b. bromides
c. opium
d. salicylates key d

42. Haemorrhage in the skin and subcutaneous tissue are seen in poisoning from:
a. Carbolic acid
b. Lead
c. Mercury
d. Phosphorus key d

43. Which of the following is an antidote for oxalic acid poisoning:
a. Activated charcoal
b. Aluminium oxide gel
c. Calcium lactate
d. Magnesium oxide key c


44. Fragmentation of medulla of scalp hair is a feature of:
a. Negroes
b. Mongolians
c. Caucasians
d. Aryans key a

45. Putrefaction is retarded in poisoning due to:
a. Carbolic acid
b. Organophosphorus
c. Dhatura
d. Opium key a

Saturday, August 12, 2017

Forensic Medicine MCQs: Question Set 1











DEPT. OF FORENSIC MEDICINE
MULTIPLE CHOICE QUESTIONS
Time: 1 hour Maximum Mark: 75

SECTION A
1. Cephalic index is important to determine the:
a. Stature
b. Cranial capacity
c. Race from skull
d. Sex from skull
Key : C

2. The degree of accuracy in determining sex from skeletal remains is best with:
a. Skull
b. Pelvis
c. Long bones
d. Sternum
Key : B

3. Age of marriage in years for a girl in Nepal without the consent of the parents is:
a. 16
b. 18
c. 20
d. 21
Key : D

4. Putrefaction is quicker in a dead body:
a. Left in open air in Dharan in summer
b. Left inside a house in Kathmandu in winter
c. Left in the swimming pool in BPKIHS in summer
d. Buried in a hill of Bhedetar
 Key : A

5. Teeth bite mark is an example of:
a. Scratch abrasion
b. Graze abrasion
c. Pressure abrasion
d. Impact abrasion
Key : C

6. The colour of a bruise on the 4th day will be:
a. Blue
b. Bluish black
c. Green
d. Yellow
Key : B

7. Rifled weapons cause marks in the :
a. Cartridge
b. Wad
c. Bullet
d. Pellet
Key : C

8. "Bakpatra" is:
a. Autopsy report
b. Witness examination
c. Account of events given to the police
d. Doctor's deposition in the court
Key : D

9. Touts services taken by a Doctor is likely to be punished under:
a. Code of medical ethics NMC
b. Medical Association rules
c. HMGN Muluki ain
d. HMGN evidence act
Key : A

10. All of the following are examples of Res Ipsa Loquitur EXCEPT:
a. Prescribing an overdose of medicine producing ill effects
b. Grossly incompetent administration of general anaesthesia by an anaesthetist
c. Mismatched blood transfusion
d. Amputation of wrong limb
Key : B

11. In any crime, as per Muluki ain, punishment is half below the age of :
a. Above 12 years
b. Above 16 years
c. Above 18 years
d. Above 21 years
Key : B

12. The chance of formation of abrasion collar is more with:
a. Bullet wound on naked part
b. Pellet wound on clothed part
c. Crush injury on clothed part
d. Crush injury on naked part
Key : A

13. The type of skull fracture which is seen in burns:
a. Fissured fracture
b. Communited fracture
c. Pond fracture
d. None of the above 
Key : D
14. The type of intracranial haemorrhage which is exclusively caused by trauma is:
a. Extradural haemorrhage
b. Subdural haemorrhage
c. Subarachnoid haemorrhage
d. Intracerebral haemorrhage
Key : A

15. Minimum quantity of the blood if lost rapidly can cause death of an adult healthy man is:
a. 1/2 of the total blood of the body
b. 1/3 of the total blood of the body
c. 1/4 of the total blood of the body
d. 3/4 of the total blood of the body
Key : B

16. The most important postmortem finding in death as a result of septicaemia is;
a. Soft and enlarged spleen
b. Dark coloured fluid blood
c. Pale adrenal cortex
d. Contracted heart
Key : A

17. The most reliable method of identification of a living person is:
a. Photography
b. Dactylography
c. Hand writing
d. Anthropometry
 Key : B

18. Type of anoxia produced by drowning is:
a. Anaemic anoxia
b. Anoxic anoxia
c. Stagnant anoxia
d. Histotoxic anoxia
Key : B

19. During asphyxia, reduction in oxygen tension causes capillary dilatation followed by stasis of blood in the dilated capillaries resulting in:
a. Cyanosis
b. Petechial haemorrhage
c. Visceral congestion
d. Postmortem fluidity of the blood
Key : C

20. Whitish crater like changes in skin is seen in :
a. Joule burn
b. Scalds
c. Anaphylactic shock
d. Snake bite
Key : A

21. Bruises under skin in the neck, bruises in neck muscles with petechial haemorrhages on face is found in :
a. Hanging
b. Strangulation
c. Drowning
d. Electric Burns
Key : B

22. Asphyxia caused by closing the external respiratory orifices by hand is known as:
a. Garrotting
b. Smothering
c. Mugging
d. Throttling
Key : B

23. All of the following are example of homicidal strangulation EXCEPT:
a. Bansdola
b. Garrotting
c. Mugging
d. Gagging 
Key : D

24. Which of the following is NOT a feature of pseudocyesis:
a. Amenorrhoea
b. Quickening
c. Labour pains
d. Enlarged uterus
Key : B

25. Least constricting force is required to cause death in hanging by:
a. Asphyxia
b. Cerebral venous congestion
c. Cerebral hypoxia
d. Dislocation of cervical vertebrae
Key : B

26. The cause of death in dry drowning is:
a. Asphyxia
b. Ventricular fibrillation
c. Laryngeal spasm
d. Vagal inhibition
Key : C

27. The shape of obturator foramen in female is:
a. Oval
b. Triangular
c. Round
d. Square
Key : A

28. Rigor mortis first appears in:
a. Heart
b. Neck
c. Face
d. Lowerlimbs
Key : A

29. Suspended animation means:
a. Irreversible cessation of heart functions
b. Irreversible cessation of respiration
c. Temporary cessation of vital functions
d. Permanent cessation of vital functions
Key : C

30. Punch drunk is a term denoting injury to:
a. Heart
b. Brain
c. Kidney
d. Pancreas
Key : B

31. The following conditions can be produced artificially in a dead body EXCEPT:
a. Cold stiffening
b. Rigor mortis
c. Cadaveric spasm
d. Heat stiffening
Key : C

32. The first external sign of putrefaction is:
a. Greenish discolouration of the right iliac fossa
b. Distension of the lower abdomen
c. Peeling of cuticle
d. Fixation of postmortem staining
Key : A

33. Part prone to bruising is:
a. Sole
b. Scrotum
c. Palms
d. Arms
Key : B

34. Leading questions are permitted during :
a. Cross examination
b. Examination in chief
c. Questions by judge
d. Re-examination
Key : A

35. In case of head injury, if on postmortem examination oozing of watery fluid from nose is noted; you should suspect a skull fracture involving:
a. Nasal bones
b. Ethmoid bone
c. Frontal bone
d. Lesser wing of sphenoid bone
Key : B

36. The incision for hanging is :
a. Same as in other cases
b. Different in chest
c. Different in neck
d. Different in abdomen
Key : C

37. Arborescent markings are seen in:
a. Electrocution
b. Fire burns
c. Chemical burns
d. Lightening
Key : D

38. The best way to detect bruises on autopsy is by:
a. Touch
b. Taking temperature
c. Cutting
d. Using torch light
Key : C

39. The normal weight of heart is:
a. 200gms
b. 300gms
c. 500gms
d. 700gms
Key : B

40. Chop wounds are injuries caused by:
a. Pointed weapon
b. Light sharp edged weapon
c. Heavy sharp edged weapon
d. Broken pieces of glass
Key : C

41. The empty cartridge case is ejected from the weapon after firing in:
a. Shot gun
b. Revolver
c. Pistol
d. Air Pistol
Key : C

42. Tyre mark on the body of a victim is an example of:
a. Scratch
b. Graze abrasion
c. Pressure abrasion
d. Imprint abrasion
Key : D

43. Burking is combination of smothering and:
a. Strangulation by ligature
b. Throttling
c. Gagging
d. Traumatic asphyxia
Key : D

44. The cause of death in immersion syndrome is:
a. Laryngeal spasm
b. Ventricular fibrillation
c. Vagal inhibition
d. Asphyxia
Key : C

45. In typical hanging knot is situated at:
a. Right mastoid
b. Under the chin
c. Occiput
d. Left mastoid
Key : A

46-49. Match the following methods with their corresponding use in:
46. Galton B
47. Bertillon D
48. Cephalic index A
49. Gustafson C

a. Race
b. Finger print
c. Age
d. Arthropometry

50-53. Match the following types of teeth with their corresponding age of eruption:
50. Second premolar D
51. Third molar A
52. Permanent canine B
53. First premolar C

a. 17 to 25 years
b. 11 to 12 years
c. 9 to 11 years
d. 10 to 12 years

54. Moral Principles which should guide members of the medical profession in their dealings with each other is known as :
a. Medical etiquette
b. Medical law
c. Medical jurisprudence
d. Medical ethics 
Key : D

55. Most frequently occluded coronary artery producing myocardial infarction is:
a. Right coronary artery
b. Left main coronary artery
c. Left anterior descending artery
d. Left circumflex artery
Key : C

SECTION B

56. The term “Corpus Delicti” includes:
1. Establishment of the positive identity of the dead body
2. The sentence passed in murder trial
3. Manner of committing crime by the accused
4. Imprisonment of the accused
Key : B

57. The characteristics of male pelvis is/are:
1. Greater sciatic notch is large, wide & shallow
2. Obturator foraman is large, often oval with base upwards
3. Ischial tuberocity is everted
4. Subpubic angle is v shaped
Key : C

58. In turner’s syndrome:
1. Anatomical structure is male
2. Anatomical structure is female
3. Nuclear sexing is female
4. Nuclear sexing is male
Key : C

59. Finger print patterns are:
1. Genetically inherited
2. Permanent lifelong
3. Identical in twins
4. Imparied in leprosy
Key : C

60. Rigor mortis is:
1. Delayed by heat but lasts longer
2. Delayed by cold but lasts longer
3. Hastened by cold but the duration is short
4. Hastened by heat but the duration is short
Key : C

61. Organs that resist putrefaction for a longer time is/are:
1. Prostate
2. Brain
3. Uterus
4. Liver
Key : B

62. Following injuries may indicate the direction in which the force was applied:
1. Bruise
2. Incised wound
3. Lacerated wound
4. Stab wound
Key : C

63. X-ray examination of a rifled firearm wound victim may:
1. Locate the bullet
2. Indicate the distance from which the weapon was discharged
3. Indicate the track of the bullet inside the body
4. Indicate the direction of fire
Key : B

64. Reliable sign/s of antemortem hanging is/are:
1. Dribbling of saliva from the month
2. Oblique and incomplete ligature mark above adams apple
3. Postmortem staining in lower limbs
4. A thin line of congestion or haemorrhage along the edges of ligature mark
Key : E

65. In a case of hanging, ligature mark may be absent on the neck because:
1. Hanging occurred in kneeling position
2. Ligature is made of soft material
3. Narrow ligature is used
4. Clothing is caught between the ligature and the skin
Key : C

66. Fresh water drowing causes:
1. Hyperkalamia
2. Hypernatraemia
3. Ventricular fibrillation
4. Haemoconcentration
Key : B

67. Following injuries can occur only at the site of impact:
1. Contusion
2. Abrasion
3. Laceration
4. Depressed fracture of skull
Key : C

68. Bruises are of less medicolegal value than abrasions because:
1. It do not reveal the direction in which force was applied
2. It may appear away from the actual site of injury
3. It may become visible several hours after the injury
4. It's size may correspond to the size of the weapon
Key : A

69. In a case of pseudocyesis:
1. Foetal movements can be felt on examination
2. Woman is pregnant but she is unaware of it
3. X-ray examination shows foetus parts
4. Subjective symptoms of pregnancy are present in absence of pregnancy
Key : D

70. Lucid interval is/are seen in:
1. Pontine haemorrhage
2. Subdural haemorrhage
3. Intra cerebral haemorrhage
4. Extradural haemorrhage
Key : D

SHORT ANSWER QUESTIONS
TIME: 2 Hours Maximum Marks: 125 (SAQ 100 & MEQ 25)
All Questions carry equal marks.

1. Write short notes on:
a) Professional Secrecy
b) Informed Consent
c) Role of police in crime investigation
d) “AngaBhanga”
e) Unidentified dead body

2. Differentiate between the following:
a) Postmortem lividity and Bruise
b) Antemortem and Postmortem burns
c) Entrance wound and exit wound in case of fire arms
d) Hanging and strangulation
e) Antemortem and Postmortem clot

3. Write in brief:
a) Microscopic changes in heat rigor
b) Registration formalities for a Doctor in Nepal
c) Process of Viscera preservation
d) Importance of constricted pupil after death
e) Spermatozoa and vasectomy

4. Write the Medicolegal importance of:
a) Ligature material
b) 12 years of age
c) Burns
d) Cut throat Injuries
e) Narrowing of left coronary artery found in autopsy

MODIFIED ESSAY QUESTION
Maximum Marks: 25

1. On 10.12.99 at 3.00pm you as medical officer get a call for postmortem examination.
Q. What would you like to check in the inquest papers before acknowledging it ? 5

2. Before starting the postmortem examination you read the inquest papers, the summary of which is as follows. Deceased Name: Ram Bahadur, Age: 40 years, Sex: Male R/O: Itahari ward No. 3.
Early signs of decomposition of the body are mentioned and as per inquest paper cause of death is sudden death.
Q. List the information you would like to include in your post mortem report from the inquest papers ? 5

3. On enquiring from relatives they gave history of torture of the deceased in the police station.
Q. Write in brief about custodial death. 5

4. On postmortem examination you note the following findings External examination Rigor mortis passed off, postmortem hypostasis on back, body showing signs of early stage of decomposition Face blotted, abdomen distended, foul smell coming out of the body, skin can easily pilled out , degloving of skin of hands, veins of chest engorged. Internal examination deep bruise on face and front of chest, Extravasation of blood in left temporal region of scalp, mildcerebral edema, 3cm long fracture of anterior cranial fossa.
a. Write the cause of death. 5
b. Give your opinion about time of death, with reasons ? 5

Thursday, June 8, 2017

Xerostomia: Causes, Clinical Features and Syndromes Associated


Definition:
It is a dryness of mouth due to salivary gland hypofunction or other causes.



Causes: I Love PHD
I = Illness (Sjogren's syndrome, DM)
L = Iatrogenic (medications, Radiation)
P = Psychogenic
H = Habits (Mouth breathing and smoking)
D = Developmental (Aplasia of salivary glands)

Clinical Features
Inside mouth:
Dry mouth with
1.  Infections
2. Dental Caries
3. Dysgeusia (Altered taste sensation)
4. Oral dysesthesia (Burning mouth syndrome)
5. Dysphagia (Difficulty in breathing and chewing)
6. Fissured tongue
7. Thirst

Outside mouth:
1. Xerophthalmia
2. Photophobia
3. Dysphonia

Syndromes associated: