Board Prep

Articaine is unique among injectable local anesthetics because it:
A. is a ketone
B. possesses poor tissue penetrability
C. contains both an amide and ester linkage
D. is never associated with paresthesia
E. is also marketed as a transmucosal patch

Tramadol posseses pharmacological properties that resemble
A. narcotic analgesics
B. non-selective beta blockers
C. narcotic analgesics and TCAs
D. tricyclic antidepressants
E. cardioselective beta blockers

Which bacteria are facultative and associated with root canals requiring retreatment?
A. Fusobacterium nucleatum
B. Porphymonas endodontalis
C. Bacteroides melaninogenicus
D. Enterococcus faecalis

Which type of microorganisms has not been detected in root canal infections?
A. spirochetes
B. bacteria
C. fungi
D. none of the above

Which of the following fascial spaces lies between the levator labii superioris and elevator anguli oris muscles?
A. submasseteric
B. pterygomandibular
C. canine
D. periorbital

Which of the following factors influences the spread of odontogenic infections?
A. bacterial species
B. vascular supply
C. anatomic position of the tooth
D. muscle thickness

Which of the following fascial space infections is also known as a subperiosteal abscess?
A. mental space
B. buccal space
C. deep temporal space
D. body of the mandible

In a patient who presents with an acute apical abscess tooth #19 which has spread into the sublingual fascial space, the apices of tooth #19 lie ___ the attachment of the mylohyoid muscle?
A. above
B. below
C. on the same level

Which of the following is not a clinical symptom of cavernous sinus thrombosis?
A. diarrhea
B. edema of the eyelids
C. exophthalmos
D. vomiting

Which of the following fascial spaces contains the pterygoid plexus of veins?
A. pterygomandibular
B. superficial temporal
C. infratemporal
D. submasseteric

The mandibular incisors drain into which of the following lymph nodes?
A. deep cervical
B. submandibular
C. superficial cervical
D. submental

The following intra-canal species or genera of microorganisms have been associated with clinical symptoms of pulp necrosis and apical periodontitis:
A.  Candidia albicans and various treponemes
B. Porphymonas gingivitis, Tremonema denticola, and Bacteroides forsythus
C. Gram negative anaerobic rods, also known as black pigmented rods, Eubacterium spp. and Streptococcus anginosus
d. Actinomyces spp. and Streptococcus mutans, S. sanguis, and S. gordonii

The most commonly identified microbial species in root canals with primary endodontic infections is:
A. Porphymonas endodontalis
B.  Enterococcus facecalis
C. Prevotella intermedia
D. Fusobacterium nucleatum
E.  Peptostreptococcus micros

Placement of LPS in root canals of experimental animals leads to the development of periapical lesions. LPS is the only bacterial virulence factor capable of producing a periapical lesion.
A. Both statements are correct
B. Both statements are correct and the second statement explains the first statement
C. Both statements are incorrect
D. First statement is correct and the second statement is incorrect
E. First statement is incorrect and the second statement is correct

The most sensitive technique of detecting microorganisms in endodontic infections is:
A. The use of DNA / DNA hybridization techniques to detect microbial DNA
B. Dark field or transmission electron microscopy
C. histologic staining with Brown and Brenn stain or using immonohistochemistry
D. The use of PCR amplification of conserved gene fragments from microbial DNA
E. Culturing aerobically and anaerobically

It is estimated that the following percentage of oral microorganisms is uncultivable:
A. 30%
B. 50%
C. 10%
D. 70%
E. 90%

One of the most important virulence factors of black pigmented endodontic flora of the Porphymonas and Prevotella genera are their:
A. ability to survive mono infections for extended periods of time
B. ability to degrade serum proteins, including immunoglobulins, making amino acids for fermentation
C. high motility
D. adhesion to root canal walls
E. ability to develop antibiotic resistance through plasmid transfer

The question of whether chronic asymptomatic lesions not associated with sinus tracts have bacterial contamination has been controversial in the endodontic literature. The following statements generally describe the current knowledge in this area except:
a. Histologic techniques have localize bacteria in only a small group of these lesions
b. Obtaining a microbial sample of the periapical tissues by surgical curettage bears the risk of contaminating the lesion with sulcular and other oral bacteria unless very careful controls are used
c. Molecular identification techniques have identified DNA from a large number of bacterial species in these areas
d. Actinomyces spp. are capable of surviving in periapical tissues
e. The most accurate periapical specimens are taken through the root canal

Which of the following microorganisms obtained from primary endodontic infections has a high likelihood of co-existing in the same root canal sample?
A. Actinomyces israelii and Eubacterium alactolyticum
B. Fusobacterium nucleatum and Peptostreptococcus micros
C. Candida albicans and Treponema denticola
D. Prevotella intermedia and Porphymonas endodontalis
E.  Streptococcus anginosus and Enterococcus faecalis

Bacteria from root canals with necrotic pulps could potentially gain access to the blood circulation during endodontic treatment and cause infective endocarditis (IE) in a susceptible patient. Which of the following groups/genera of bacteria common in endodontic infections have been most frequently implicated in IE?
A. Streptococcus viridans
B. Enterococci
C. Fusobacterium spp.
D. Candida spp.
E. Black-pigmented bacteria

Which of the following lesions typically occurs as a well circumscribed, unilocular radiolucency below the mandibular canal in the posterior mandible?
A. developmental lingual mandibular salivary gland depression
B. central ossifying fibroma
C. odontogenic keratocyst
D. ameloblastoma
E. central giant cell granuloma

Stafne bone defects occur exclusively in the posterior mandible.
a. True
b. False

Which of the following lesions is a true cyst?
A. Hemorrhagic bone cyst
B. Traumatic bone cyst
C. Stafne bone cyst
D. Eruption cyst
E. Idiopathic bone cyst

A residual radicular cyst is:
A. lined by parakeratinized squamous epithelium with a strong tendency to recur following simple enucleation
B. not a real entity
C. the diagnosis given to a persistent periapical lesion following root canal treatment
D. most likely the result of failure to curette the periapical lesion at the time of tooth extraction
E. easily diagnosed with certainty on periapical radiographs

A well-defined, multilocular radiolucency located between root canal treated tooth #21 and vital tooth #22 is least likely to be:
A. central giant cell granuloma
B. odontogenic myxoma
C. botryoid type of lateral periodontal cyst
D. radicular cyst
E. ameloblastoma

A well defined radiolucency with central irregular radiopacities is located at the apex of tooth #19, which exhibits questionable vitality. The lesion is least likely to be a
A. Pindborg tumor
B. central ossifying fibroma
C. benign cementoblastoma
D. periapical granuloma
E. focal cemento-osseous dysplasia

A 50 year old man presents with a history of trauma to the anterior face and chin. Radiographic examination reveals a 2cm x 3cm unilocular radiolucency associated with the apices of the lower anterior incisors, which test vital. The most likely diagnosis is:
A. odontogenic keratocyst
B. radicular cyst
C. Paget's disease
D. median mandibular cyst
E. periapical granuloma

A well-defined, unilocular radiolucency is located between the roots of the left maxillary lateral and cuspid teeth in a 35 year old woman. The canine has had root canal therapy. Which of the following lesions could be present?
A. central giant cell granuloma
B. periapical granuloma
C. ameloblastoma
D. All Options are correct
E. odontogenic keratocyst

In addition to the ameloblastoma, which of the following lesions occurs most commonly in the posterior mandible, has an average age of occurrence in the 4th decade, does not show a strong gender predilection, can be uni- or multilocular, may be expansile and has a high level of recurrence if not completely removed?
A. traumatic bone cyst
B. odontoma
C. odontogenic keratocyst
D. radicular cyst
E. dentigerous cyst

A well circumscribed unilocular radiolucency is located between the roots of root canal treated tooth #8 and vital tooth #9. The lesion is surgically excised 6 months after root canal treatment because it did not resolve. Microscopically the specimen consists of uninformed connective tissue containing large nerves and blood vessels. A cyst lining is present: it is fairly a flat cuboidal epithelium with areas of thin, non-keratinizing squamous epithelium blending with a small area of respiratory-type epithelium. Based on the clinical and microscopic evidence, the most likely pathogenic diagnosis is:
A. radicular cyst
B. traumatic bone cyst
C. nasopalatine duct cyst
D. unicystic ameloblastoma
E. odontogenic keratocyst

There are at least ___ types of sensory neurons that innervate teeth.
A. 2
B. 6
C. 4
D. 5
E. 3

Sensory innervation of teeth terminates primarily in the:
A. coronal odontoblast layer
B. predentin
C. inner dentin
D. a and b
E. all of the above

Each A delta fiber innervates only one dentinal tubule.
a. True
b. False

The first nerve that enters dentin during development targets:
A. blood vessels
B. odontoblasts
C. the side of the cusp closest to the occlusal plane
D. innervation is randomly distributed
E. none of the above

The response of sensory neurons to pulpal injury:
A. is proportional to the magnitude of the injury
B. resolves after healing
C. occurs in humans as well as rats
D. appears to regulate the rate of pulpal necrosis
E. all of the above

Which of the following stimuli are effective for stimulating pulpal nociceptors?
A. hydrodynamic
B. chemical
C. thermal
D. electrical
E. all of the above

Reduction in the number of primary odontoblasts during tooth development is thought to be due to:
A. apoptosis
B. atrophy
C. metaplasia
D. coagulation necrosis
E. hypertrophy

The two types of tertiary dentin are:
A. reparative / mantle
B. reactionary / intertubular
C. circumpulpal / primary
D. reactionary / reparative
E. peritubular / irritation

Each of the following is an important bacterial virulence factor EXCEPT:
A. production of toxins that are harmful to neutrophils
B. A factor that neutralizes chemotaxins
C. antiphagocytic factors
D. released enzymes that form a fibrin barrier against neutrophils
E. Protein A binding to Fe region of IgG, thereby competing with neutrophil receptors

Release of which of the following produces vasodilation?
A. CGRP
B. epinephrine
C. substance P
D. actin
E. Collagen

Which of the following best describes the initial inflammatory response to caries?
A. tissue breakdown mediated by proteases
B. development of ischemic necrosis
C. suppuration
D. cell mediated immune response
E. release of histamine by mast cell degranulation

The key cells in initiating a chronic inflammatory reaction are:
A. mast cells / macrophages
B. eosinophils / basophils
C. macrophages / epithelial cells
D. CD8+ cells / erythrocytes
E. macrophages / CD4+ cells

Which one of the following statements is FALSE?
A. Suppuration is produced by pyogenic bacteria
B. Gangrenous necrosis is associated with a loss of blood supply
C. Coagulation necrosis is the result of T cell activation
D. Putrefaction is associated with foul smelling nitrogenous products
E. Wet gangrene is a combination of ischemic necrosis and bacterial infection

Antigens entering the pulp are captured and processed by:
A. endothelial cells
B. fibroblasts
C. mast cells
D. odontoblasts
E. dendritic cells

Pus is formed chiefly by:
A. cell lysis resulting from the activation of complement
B. autolysis of neutrophils by their own lysosomal enzymes
C. lack of blood supply to the tissue resulting in coagulation necrosis
D. release of proteolytic enzymes by activated macrophages
E. degranulation of mast cells with the release of platelet activating factor

Leukocyte adhesion molecules include the following EXCEPT:
A. CD44
B. endothelial adhesion molecules
C. selectins
D. integrins
E. NFΚ

The following cells function as antigen presenting cells EXCEPT:
A.  γ-δ cells
B. B cell
C. Macrophages
D. Langerhans cell
E. Dendritic cell

Macrophages are considered the primary mediators of the inflammatory process for the following reasons EXCEPT:
A. They process phagocytosed antigenic molecules and present them to T cells in the context of the MHC-II molecules and T cell receptor
B. They are the primary phagocytic cells in an inflammatory reaction
C. They possess Toll-like receptor 4 that allows them to respond to a variety of bacterial cell wall products
D. They are activated by T cells to produce a number of potent pro-inflammatory cytokines
E. They are capable of producing a specific reaction to proteins or large polysaccharide antigens

NK cells exert their actions against infected cells primarily through the following mechanisms:
a. Production of IL-2, which stimulates the activation of macrophages
b. Stimulates the activation of B cells to produce antibodies
c. Binding to Fe receptor of opsonized infected cells, then killing the cell, a process known as antibody-dependent cell-mediated cytotoxicity
d. Phagocytosis
e. Apoptosis

The following molecules are chemokines EXCEPT:
A. IL-5
B. RANTES
C. MCP-1
D. Eotaxin
E. IL-8

Which of the following is true regarding the structure of an antibody molecule?
a. There are two small light chains and two large heavy chains
b. The constant region is the antigen-binding site whereas the variable region has the effector function
c. Each chain has both a variable and a constant region
d. a and c
e. a, b, and c

The following cytokines are members of the TH1 response EXCEPT:
A. TNF-β
B. IL-10
C. IFN-γ
D. IL-12

Which one of the following cytokines is not a member of the TH2 response?
A. IL-6
B. IL-12
C. IL-13
D. IL-10
E. IL-4

Which statement does not describe one of the functions of the complement system?
A. Activates T helper cells to produce IL-2.
B. The terminal components of the complement generate a lipid soluble macromolecular protein complex called the membrane attack complex (MAC) that causes osmotic lysis of target cells.
C. C3a and C5a (anaphylatoxins) release histamine from mast cells, causing vasodilation and increased vascular permeability.
D. Peptides produced by proteolysis of C3 and other complement proteins stimulate inflammation.
E. C5a activates the lipoxygenase pathway for arachidonic acid in neutrophils and monocytes and is itself a potent chemotactic agent for these cells.

Which of the following statements is true about the molecules of the Major Histocompatibility Complex (MHC)?
a. MHC class I is expressed on all nucleated cells.
b. MHC class I-restricted cells are recognized as self by CD8+ or cytotoxic T cells.
c. MHC class II is expressed on a small group of cells collectively called Antigen Presenting Cells (APCs).
d. Bacterial antigens are presented to MHC class II-restricted CD4+ T helper cells in the context of the MHC class II molecule on the APC and the T cell receptor (TCR) on the T cell.
e. All of the Above

Phagocytes of the innate immune system include:
A. fibroblasts / neutrophils
B. macrophages / neutrophils
C. dendritic cells / mast cells
D. lymphocytes / endothelial cells
E. neutrophils / basophils

Which of the following is a chemotaxin of the complement system?
A. C6b
B. C4a
C. C7a
D. C3b
E. C5a

Myeloperoxidase is involved in the conversion of:
A. Lactoferrin to lysozyme
B. H2O2 to HOCl
C. Superoxide to H2O2
D. H2O2 to H20
E. NADPH to superoxide

Activation of macrophages involves which of the following cytokines?
A. IL-8
B. IL-4
C. IL-1
D. LTB4
E. INF-γ

Using the HMP shunt, glucose consumed by activated neutrophils is converted to:
A. lactic acid
B. glycogen
C. methionine
D. ascorbic acid
E. sulfuric acid

When bacteria begin to enter the pulp from a carious lesion, which of the following inflammatory cells are present in greatest number?
A. macrophages
B. eosinophils
C. lymphocytes
D. plasma cells
E. neutrophils

The four components of the trigeminal nucleus involved in pain processing include all of the following EXCEPT:
A. interneurons
B. projection neurons
C. terminals from descending neurons
D. post ganglionic sympathetic neurons
E. central terminals of sensory neurons

Sigurdsson and Maxine found that referred pain experienced by patients suffering from irreversible pulpitis can be:
A. reduced by activation of nociceptors at a distant site
B. increased by swallowing hot water
C. increased by the valsava maneuver
D. resistant to treatment with diazepam

The findings of Klausen et al. indicate that:
a. irreversible pulpitis is associated with thermal allodynia
b. acute apical periodontitis is associated with mechanical allodynia
c. odontogenic pain can induce specific types of allodynia in patients
d. a and b
e. a, b, and c

Studies by Kwan et al. (Sessle's lab) and Narhi's group indicate that pulpal inflammation can induce:
a. expansion of receptive field size in the trigeminal nucleus
b. increased spontaneous activity in the trigeminal nucleus
c. central sensitization
d. expansion of peripheral receptive fields (by sprouting)
e. all of the above

One of the best predictors of post-operative pain is pre-operative endodontic pain.
a. True
b. False

In Mumford and Newton's studies on electrical pulp testers, the pulse duration is ___ correlated with the threshold current needed for a positive test.
A. directly
B. inversely
C. not

In Mumford and Newton's studies on electrical pulp testers, probes with a smaller surface area required ___ current for a positive response as compared to probes with a larger surface area.
A. greater
B. smaller
C. alternating
D. direct
E. none of the above

Studies by Absi et al. indicate that hypersensitive dentin is characterized by having ___ as compared to control dentin.
a. greater density of tubules
b. larger tubule diameter
c. less organic material
d. a and b
e. a, b, and c

Studies by Tagami et al. indicate that the hydraulic conductance of dentin is ___ in dentin from younger patients as compared to dentin from older patients.
A. the same as
B. smaller
C. greater

Which of the following agents has been shown to have clinical efficacy for reducing dentinal hypersensitivity?
a. application of unfilled resins
b. burnishing the dentin
c. application of KNO3
d. guanethidine
e. all of the above