Oral Surgery

Question 1

Which of the following nerves is most likely to be affected in a patient presenting with deviation of the tongue, on protrusion, to the side of a recent submandibular gland excision?
a. Accessory
b. Facial
c. Hypoglossal
d. Trigeminal
e. Vagus

Answer 1

C. Hypoglossal
Several important nerves travel close to the submandibular gland.
Hypoglossal is the nerve for tongue movement and the lingual nerve is the nerve for tongue sensation. The risk of damage to the hypoglossal or the lingual nerves is very small and almost always temporary (>99%).

Question 2

Which of the following tumours is the most commonly malignant tumour of the parotid gland?
a. Adenocarcinoma
b. Adenoid cystic carcinoma
c. Mucoepidermoid carcinoma
d. Pleomorphic adenoma
e. Squamous cell carcinoma

Answer 2

C. Mucoepidermoid carcinoma
A pleomorphic adenoma is the most common benign tumour of the parotid gland, however, mucoepidermoid carcinoma is the most common malignant tumour of the parotid gland.

Question 3

What is the most common benign tumour of the parotid gland?
a. Pleomorphic adenoma
b. Mucoepidermoid carcinoma
c. Warthin’s tumour
d. Monomorphic adenoma
e. Keratocystoma

Answer 3

A. Pleomorphic adenoma
Pleomorphic adenomas are the most common benign tumour of the parotid gland and mucoepidermoid carcinomas are the most common malignant tumours of the parotid gland.

Question 4

Which of the following medications is most likely to complicate extractions of retained incisor roots?
a. Azathioprine
b. Allopurinol
c. Metformin
d. Propranolol
e. Zoledronate

Answer 4

E. Zoledronate
Zoledronate is a bisphosphonate, and is likely to cause MRONJ (medication-related osteonecrosis of the jaw).

Question 5

How many times more likely is the mandible to get MRONJ than the maxilla?
a. Equally likely
b. Twice as likely
c. Three times more likely
d. Four times more likely
e. Five times more likely

Answer 5

B. Twice as likely
The mandible is twice as frequently affected by medication-related osteonecrosis of the jaw, with most cases occurring after a high dose of intravenous administration used for some cancer patients.

Question 6

How long after an extraction or oral surgery should you review a patient who is at any risk of MRONJ?
a. 2 weeks
b. 4 weeks
c. 6 weeks
d. 8 weeks
e. 10 weeks

Answer 6

D. 8 weeks
According to SDCEP guidelines. If an extraction socket is not healed at 8 weeks and you suspect that a patient has MRONJ, refer to an oral surgery specialist as per local protocols.
A consultation with specialists is also advised prior to treatment for any patients on bisphosphonates or at risk of MRONJ.

Question 7

Which one of the following best describes the risk of permanent nerve damage after removal of a lower 8?
a. 1%
b. 2%
c. 4%
d. 6%
e. 8%

Answer 7

A. 1%
Permanent IAN injury related to third molars is around 1 in 100 patients and temporary in about 8 in 100 patients (8%)

Question 8

Which one of the following is not a complication of removal of lower 8s?
a. Dry socket
b. Anaesthesia of IAN
c. Paraesthesia of the facial nerve
d. Paraesthesia of the lingual nerve
e. Trismus

Answer 8

C. Paraesthesia of the facial nerve
Consent for lower 8 removal should include dental/lingual paraesthesia/anaesthesia, pain, swelling, bruising, bleeding, need for antibiotics and analgesia.
The facial nerve is not involved.

Question 9

Which is the correct acronym for a common treatment of a fractured mandible?
a. OTIF
b. ORIF
c. RIMA
d. LIMA
e. OSIM

Answer 9

B. ORIF
Open-reduction internal fixation is one of the most common ways of treating a fractured mandible in place, most commonly with titanium plates and screws.

Question 10

Which is the resorbable suture of choice when suturing intra-orally after a surgical extraction?
a. Black silk suture 3/0
b. Polypropylene 3/0
c. Vicryl 3/0
d. Prolene 3/0
e. Catgut 3/0

Answer 10

C. Vicryl 3/0
Catgut is a resorbable suture but has not been used for years (it is now illegal). All the others (other than vicryl) are not resorbable and require removal.

Question 11

An incisional biopsy is indicated for which one of the following lesions?
a. Squamous cell carcinoma
b. Fibroepithelial polyp of the lip
c. Buccal haemangioma
d. Palpable submandibular gland lump
e. Amalgam tattoo

Answer 11

A. Squamous cell carcinoma
An excisional biopsy is contraindicated for SCC but is indicated for a fibroepithelial polyp. An amalgam tattoo requires no treatment. Submandibular gland lumps are investigated via fine-needle aspiration. A haemangioma should not be biopsied, as it my well bleed dangerously and be life-threatening.

Question 12

A fine needle aspiration investigation is indicated for which one of the following lesions?
a. Squamous cell carcinoma
b. Fibroepithelial polyp of the lip
c. Buccal haemangioma
d. Palpable submandibular gland lump
e. Amalgam tattoo

Answer 12

D. Palpable submandibular gland lumps
Squamous cell carcinoma is investigated with incisional biopsy. Fibroepithelial polyp can be removed with an excisional biopsy. Buccal haemangiomas should not be biopsied as it can cause dangerous bleeding and be life threatening. Amalgam tattoos require no treatment.

Question 13

After repair of an OAF (oroantral fistula), which one of the following is unnecessary?
a. Analgesia
b. Antibiotics
c. Ephedrine nasal spray/drops
d. Steam inhalations
e. Referral to the ENT team

Answer 13

E. Referral to the ENT team
An ENT referral is unnecessary as the treatment is often successful. All the other choices are prescribed post-operatively.

Question 14

Which one of the following is not a common sign of a fractured zygoma?
a. Subconjunctival haemorrhage with no visible boundary
b. Diplopia (double vision)
c. Paraesthesia of the infra-orbital nerve
d. Epistaxis (nose bleed)
e. Anosmia (loss of smell)

Answer 14

E. Anosmia
Anosmia is the loss of smell and often occurs when the olfactory bulb is damages.

Question 15

Which one of the following statements regarding the temporomandibular joint is correct?
a. The disc attaches to the capsule anteriorly
b. The articular surface of the disc is made of hyaline cartilage
c. The articular surfaces are covered with hyaline cartilage
d. The articular surfaces are covered with fibrocartilage
e. The middle region of the disc is the most vascular region

Answer 15

D. The articular surfaces are covered with fibrocartilage
The articular surfaces of both the disc and joint are made of fibrocartilage. The most central part of the disc is avascular.

Question 16

Which one of the following statements regarding the temporomandibular joint is incorrect?
a. The temporomandibular joint is related to the lateral aspect of the joint
b. The spheno-mandibular ligament is an embryological remnant of Meckel’s cartilage
c. The spheno-mandibular ligament extends from the spine of the sphenoid to the lingula
d. The stylohyoid ligament extends from the tip of the styloid process to the angle of the mandible
e. The stylo-mandibular ligament is a remnant of the deep cervical fascia as it passes lateral to the parotid gland

Answer 16

E. The stylo-mandibular ligament is a remnant of the deep cervical fascia as it passes lateral to the parotid gland
The stylo-mandibular ligament is actually a remnant of the deep cervical fascia as it passes medial to the parotid gland.

Question 17

Which one of the following is not a risk factor of oral cancer?
a. Smoking
b. Alcohol
c. Previous trauma to the site
d. Social deprivation
e. Betel nut chewing

Answer 17

C. Previous trauma to the site
The risk factors for oral cancer include smoking, tobacco chewing, snuff, betel nut, alcohol, immunocompromised patients (HIV). Trauma is not a risk factor.

Question 18

Which of the following is an indication for the extraction of a lower 8?
a. Anterior crowding
b. The tooth is distoangular in position
c. The patient has had two episodes of pericoronitis
d. To ‘balance’ the extraction of one tooth on one side of the mandible by extracting the 8 on the other side of the mandible
e. To appease a patient who has atypical facial pain

Answer 18

C. The patient has had two episodes of pericoronitis.
A single episode of pericoronitis can be an indication for 8 extraction, however, it has to be severe - the recommendation is two episodes. None of the other options are indications for 8 extractions according to NICE guidelines.

Question 19

Which one of the following statements regarding the submandibular gland is incorrect?
a. It is the second largest salivary gland
b. It empties via Wharton’s duct
c. It has a duct closely related to the lingual nerve
d. It produces entirely serous saliva
e. It is the most commonly affected by salivary calculi

Answer 19

D. It produces entirely serous saliva.
The submandibular gland produces mixed saliva. The lingual nerve is very easily damaged during removal of salivary calculi as it loops around Wharton’s duct.

Question 20

Xerostomia does not:
a. Occur after radiotherapy
b. Occur in patients with Sjogren’s disease
c. Occur during panic attacks
d. Cause an increase in root caries
e. Occur when taking pilocarpine

Answer 20

E. Occur when taking pilocarpine.
Pilocarpine is actually the treatment for xerostomia. Patients with Sjogren’s syndrome are prone to dry mouth, eyes, and mucous membranes. Panic attacks leads to dryness of the mouth.

Question 21

Which one of the following statements regarding the maxillary sinus is incorrect?
a. It develops by pneumatisation
b. It is the largest of the paranasal sinuses
c. When fully grown it is pyramidal in shape
d. It is lined by pseudostratified ciliated columnar epithelium
e. It drains via the ostium into the inferior meatus of the nose

Answer 21

E. It drains via the ostium into the inferior meatus of the nose.
The maxillary sinus actually drains via the ostium into the middle meatus of the nose.
The maxillary sinus is small at birth and grows via pneumatisation to become the largest of the paranasal sinuses.

Question 22

Which one of the following methods of treatment is inappropriate for the reduction of a fractured mandibular angle in a dentate patient?
a. IMF with a gunning splint
b. IMF using arch bars
c. IMF using eyelet wires
d. IMF using mini plates and mono-cortical non-compression screws
e. IMF using Leonard’s buttons

Answer 22

A. Intermaxillary fixation with a gunning splint.
Gunning splints are perfectly reasonable for IMF treatment for a fractured mandible, however, it can only be used in edentulous patients. They are splints that are wired to both the mandible and the maxilla.

Question 23

What is the most common cause of a fractured mandible?
a. Road traffic accidents
b. Inter-personal violence
c. Sporting injury
d. Industrial accidents
e. Iatrogenic following extraction of 8s

Answer 23

B. Interpersonal violence
Previously it was road traffic accidents - and then the seatbelt law was enforced:)

Question 24

What is the correct treatment for asymptomatic torus planus?
a. Antibiotics
b. Excision
c. Incisional therapy
d. Excisional therapy
e. None of the above

Answer 24

E. None of the above.
There is no treatment required for torus planus if it is asymptomatic.

Question 25

Osteoradionecrosis: a. Is treated with 100% oxygen b. Commonly affects the maxilla c. Commonly occurs following chemotherapy d. Occurs due to a reduction in vascularity secondary to endarteritis obliterans e. Is the same as focal sclerosing osteomyelitis

Answer 25

D. Occurs due to a reduction in vascularity secondary to endarteritis obliterans. Osteoradionecrosis is frequently treated with hyperbaric oxygen, occurs in the mandible, and commonly occurs after radiotherapy.

Question 26

After extraction of a lower right first molar, how long should you keep the records for? a. 1 year b. 4 years c. 11 years d. 25 years e. 50 years

Answer 26

C. 11 years. Notes for adult patients should be kept for 11 years. Children's notes should be kept for 11 years or until the patient is 25 years of age, whichever is longer.

Question 27

After the extraction of the lower right first permanent molar, which one of the following conditions would sterilisation of the instruments be achieved? a. 112C for 15 mins b. 112C for 5 mins c. 121C for 15 mins d. 121C for 5 mins e. 134C for 1 min

Answer 27

C. 121C for 15 mins. For sterilisation to occur at 134C, it requires the temperature to be maintained for 3 mins at least. At 121C, it requires a maintenance of the temperate for 15 mins.

Question 28

Which one of the following drugs is safe to prescribe to a patient with a penicillin allergy? a. Augmentin b. Ampicillin c. Flucloxacillin d. Clarithromycin e. Cefuroxime

Answer 28

D. Clarithromycin All the other drugs are related to penicillin and can cause lethal anaphylaxis if given to those who are allergic to penicillin.

Question 29

Which antibiotic should be prescribed post-operatively, after a surgical extraction? a. Clindamycin b. Metronidazole c. Amoxicillin d. Erythromycin e. Phenoxymethylpenicillin

Answer 29

B. Metronidazole Metronidazole is the correct antibiotic to be prescribed after surgical extraction. It is effective against anaerobes which are the most common organisms in the mouth.

Question 30

What is the motor nerve supply to the tongue? a. Lingual nerve b. Glossopharyngeal nerve c. Hypoglossal nerve d. Vagus nerve e. Facial nerve

Answer 30

C. Hypoglossal nerve The hypoglossal nerve is the motor to the intrinsic muscles of the tongue, hyoglossus, genioglossus, styloglossus, thyrohyoid and geniohyoid.

Question 31

Which of the following statements is true? a. The glossopharyngeal nerve serves the posterior third of the tongue for taste only b. The glossopharyngeal nerve serves the posterior two thirds of the tongue for taste only c. The glossopharyngeal nerve serves the anterior third of the tongue for taste only d. The glossopharyngeal nerve serves the anterior third of the tongue for both taste and sensation e. The glossopharyngeal nerve serves the posterior third of the tongue for both taste and sensation

Answer 31

E. The glossopharyngeal nerves serves the posterior third of the tongue for both taste and sensation. Taste sensation for the anterior two thirds of the tongue is supplied by the chorda tympani via the lingual nerve to the facial nerve. General sensation to the anterior two thirds of the tongue is supplied by the lingual nerve.

Question 32

The buccal artery is a direct branch of which artery? a. Mandibular b. Maxillary c. Facial d. External carotid e. Internal carotid

Answer 32

B. Maxillary artery. The buccal artery is a direct branch of the maxillary artery and there are many others. Including: greater and lesser palatine, sphenopalatine and middle meningeal arteries.

Question 33

Which clotting factors does warfarin interfere with? a. II, VII, XI, XII b. III, V, VII, IX c. II, VII, X, XII d. II, VII, IX, X e. II, III, IX, XI

Answer 33

D. II, VII, IX, X Decreased formation of these coagulation factors is responsible for warfarin's anti-coagulant effect.

Question 34

The muscle of mastication that helps retract the mandible is: a. Temporalis b. Masseter c. Lateral pterygoid d. Medial pterygoid e. Buccinator

Answer 34

A. Temporalis The temporalis is the muscle of mastication that helps in the elevation of the mandible. It is large and fan-shaped in appearance and covers the temporal area of the skull.

Question 35

A patient has cellulitis involving the tissues of the floor of the mouth and of the sublingual region. The associated swelling happened rapidly and may block the airway. Which eponymous angina does this describe? a. Johann's b. Ludwig's c. Karl's d. Jones' e. Barnett's

Answer 35

B. Ludwig's Ludwig's angina is a serious, potentially life-threatening cellulitis infection of the tissues of the floor of the mouth, usually occurring in adults with concomitant dental infections (often pericoronitis).