AFK weekly newsletter 2

Jul 19 / Mohamed Moussa
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AFK Weekly newsletter 2

In just 30 minutes, you will get some really important concepts for AFK. 
  • Explain the answers in details. 
  • Quick recap for the whole concept.
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#Pathology
 1-During a cytological smear, fungal hypha was observed. You prescribe Nystatin for 2 weeks; during the follow up appointment, the patient returns with edematous red mucosa. Further management is to:
◯ a. Give nystatin for another 15 days.
 ◯ b. Biopsy
◯ c. Observe
◯ d. run laboratory tests

  b. Biopsy
Biopsy is a valuable aid in oral clinical diagnosis; it consists of obtaining a specimen of living tissue in order to study its structure, both macro and microscopically.
This procedure makes it possible to confirm or deny a diagnosis, as well as to determine the nature and characteristics of the lesion and to establish a final diagnosis. Oral biopsy is a simple procedure, which in most cases can easily be performed by the odontologist. Indications and contraindications are relative.
In general terms, the following criteria are candidates for biopsy: suspicious lesions present in the area, any tissue removed for any reason, and positive exfoliative cytology. As to contraindications, it is usually advisable to avoid biopsies on necrotic areas, as well as incisional biopsy of pigmented lesions.
Methods most often used for obtaining a biopsy include: excisional, incisional and transoperatory, always following certain principles for obtaining a representative specimen.

#Anatomy
2-during the embryological development process, failure of the maxillary process to fuse with the mandibular process will result in:
◯ a. Commissural lip pits
◯ b. nasolacrimal groove
◯ c. cleft palate
◯ d. palatal shelves

 a. Commissural lip pits
- Median cleft lip: results from failure of the medial nasal prominences to merge and form the intermaxillary segments .
- Unilateral cleft lip: result from failure of the maxillary prominence to merge with the medial nasal prominence on the affected side.
- Bilateral cleft lip: results due to failure of maxillary prominences to meet and unite with the medial nasal prominences on both sides.

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#Periodontology 
3-What is the clinical attachment loss for a patient with a pocket depth of 8mm and a gingival margin lying 3 mm coronal to the CEJ:
◯ A. 5mm
◯ B. 11mm
 ◯ C. 7 cm
◯ D. 8 mm

A. 5mm
We have 3 possibilities for the relation between CEJ and gingival margin.
First:
Gingival margins apical to the CEJ so, Pocket depth +Gingival Recession (Positive Value) = CAL
Second :
Gingival margins at the CEJ so, Pocket depth = CAL
Third:
Gingival margins on the anatomical crown so, Pocket depth - Gingival Recession = CAL
When you read the question, pay attention to the small details. It makes all the differtance,

#Pathology
4-An 18-month-old child presented with vesicles on the buccal mucosa, fever and lymphadenopathy. Which of the following is the primary management?
◯ A. Antiviral
 ◯ B. Antibiotic
◯ C. Antifungal
◯ D.Antipyretic and analgesics

 D.Antipyretic and analgesics
- Primary herpetic gingivostomatitis- PHS is a viral infection caused by herpes simplex virus type-1.
 - It’s a self limiting disease. Characterized by the presence of systemic prodrome; fever, malaise, headache.
- Clinical picture:
 is multiple small painful ulcers all over the mouth with gingival inflammation and increased salivation.
- Extraoral lesions (preoral mainly) could be found.
- Ulcers heal without scars.
- PHS ulcers are considered secondary infective ulcers.
- Secondary as it preceded by vesicles that erupt forming ulceration.
- After healing, the virus remain latent.
- Reactivation of the virus manifest as recurrent herpes labials and recurrent intraoral herpes.

#Pharma
5-Asthmatic patients using corticosteroid inhalers may develop candidiasis on the dorsal surface of the tongue because of:
◯A systemic antibacterial action
◯ B.Local destruction of normal oral flora
 ◯ C. Prolonged local vasoconstriction
◯ D. Cross-reacting antigens in the tongue
 ◯ E. Local Immunosuppression

E. Local Immunosuppression
- Local immunosuppressive as when this patient is using his steroid inhaler some of the solution goes to his throat, and some stays over the tongue. - Working to suppress the immune systems, giving chance to candida albican to have more change to grow leading to fungal infection. - Management is to ask patient to drink some water after using the inhaler, and give him short term topical anti-fungal.