Mid

year Exam 2011 .1

Endo MID YEAR EXAM 2011 The sympathetic nerve fiber originates from which of the following structures: a) Ragh magnus. b) Stallet ganglion. c) Subcaudalis nucleus. d) Trigeminal ganglion. The normal interstial pulpal pressure is approximately: a) 1-5 mm Hg. b) 6-10 mm Hg. c) 13-15 mm Hg. d) 15-35 mm Hg. Which of the following mediators released by central end of nociceptors: a) Glutamate. b) Serotonin. c) Interleukin 1. d) Norepinephrin. In wihch of the following structure, the Modulation of dental pain occurs: a) Thalamus. b) Ragh magnus. c) Trigeminal ganglion. d) Dental pulp and periapical tissue. Which of the following nerve fibers are responsible for pulpal pain transmission: a) A beta and C nerve fibers. b) A delta and C nerve fibers. c) A beta and A delta nerve fibers. d) A alpha and A delta nerve fibers. Which of the following is the percentage of beta nerve fibers present in the dental pulp: a) 1/2 %. b) 5 %. c) 10 %. d) 13 %. Which of the following is the percentage of sympathetic nerve fibers present in the dental pulp: a) 5-6 %. b) 9-10 %. c) 20-30 %. d) 35-40 %. Which of the following structure is rich with propreoceptors: a) Dentin layer. b) Periapical area. c) Dental pulp stroma. d) Odontoblastic layer.

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9- Which of the following structure is rich with C nerve fibers: a) Dentin layer. b) Cell free zone. c) Dental pulp stroma. d) Odontoblstic layer. 10- Which of the following terms is defined, as "Pain is perceived due to a non-noxious stimulus which does not normally provoke pain": a) Allodynia. b) Perception. c) Modulation. d) Hyperalgesia. 11- Which of the following nerve fibers has the low threshold nociceptors: a) A alpha nerve fiber. b) A beta nerve fiber. c) A delta nerve fiber. d) C nerve fiber. 12- Which of the following nerve fibers transmit the dental pain without modulation: a) A beta nerve fiber. b) A delta nerve fiber. c) A beta and A delta nerve fibers. d) C nerve fibers. 13- Which of the following nerve fibers is/are not activated with external dental stimuli: a. A beta nerve fiber. b. A delta nerve fiber. c. A beta and A delta nerve fibers. d. C nerve fibers. 14- The stressed pulp is defined as the pulp that is subjected over the years to: a) Several dental treatments. b) Caries and/or dental trauma. c) Diseases and dental procedures. d) Endodontic & re-endodontic treatment. 15- Sensory fibers of the inferior alveolar nerve synapse with secondary order neuron in which of the following structure: a) Hypothalamus. b) Stellate ganglia. c) Gasserian ganglion. d) Subnucleucs caudalis. 16- Which of the following nerve fibers has a rule in pain modulation: a) A delta nerve fiber. b) C nerve fiber. c) Sympathetic nerve fibers. d) Parasympathetic nerve fibers.

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17- Which of the following terms is referred to mechanisms by which the transmission of noxious information to the brain is reduced: a) Allodynia. b) Modulation. c) Hyperalgesia. d) Sensitization. 18- Which of the following ions is essential for exocytosis process: a) Calcium ions. b) Sodium ions. c) Chloride ions. d) Potassium ions. 19- Exocytosis is defined as: a) Formation of synaptic vesicles. b) Exaggerated response of nerve fibers. c) Reduction in the threshold level of nerve fibers. d) Action potential generated of nerve membrane. 20- Which of the following structures is responsible for pain modulation before it is Transmitted to the cortex? a) Interneuron, Galia and descending neuron. b) Galia, interneuron and projecting neuron. c) Central terminal of primary neuron, interneuron and Galia. d) Central terminal primary neuron, interneuron and projecting neuron. 21. The hot tooth is referred to that tooth: a) Which is difficult to anesthetize. b) With pink spot coronal discoloration. c) With large reddish mass occupying the carious cavity. d) Which is undergoes excessive blood flow during inflammatory reactions. 22. Which of the following is responsible for symptoms of irreversible: a) Recruitment of immune cells. b) Increase neutrophils emigration. c) Vasodilatation and plasma extravasations. d) Stimulation of sympathetic nerve fibers. 23. Which of the following is the main goal of emergency treatment: a) Canal disinfection. b) Management of flare-up. c) Proper obturation of root canal. d) Through biomechanical preparation.

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24. A patient returns 2 days following routine operative procedure and composite restoration with history of deep caries complaining of severe sharp pain to thermal changes particularly cold drink. Thermal testing procedures showed sharp momentary response. Percussion and palpation tests are within normal range. The proper emergency treatment to relief the patient's complain is: a) Check the marginal seal of the restoration and tooth desensitization. B) Endodontic access and pulp extirpation and schedule for next visit. c) Antibiotic and anti-inflammatory prescription and schedule for next appointment d) Removal of restoration and temporization of tooth to the next appointment. 25.Which of the following cases may undergo flare up after single visit endodontic treatment: a) Chronic apical abscess. b) Symptomatic irreversible c) Asymptomatic irreversible pulpitis. d) Asymptomatic apical periodontitis. 26. The pain exerted from exposed dentine is due to: a) Thermal changes that damage the C-fibers. b) Movement of fluid inside the dentinal tubules. c) Exposing nerve fiber at dentine-enamel junction. d) Stimulation of the inflammatory mediator that stimulate nerve fibers. 27. Spontaneous pain in irreversible pulpitis attributed to: a) Primary Hyperalgesia. b) Periodical sensitization of nociceptors. c) Inflammatory mediators and neuropiptidis. d. All of the above. 28. Which of the following patients are susceptible to sub acute bacterial endocarditis during endodontic procedure: a) Patients with uncontrolled hypertension. b) Patients with a history of rheumatic fever. c) Patients with myocardial infarction within the past 6 month. d) Patents with myocardial infarction within the past 3 months. 29. Regarding HIV/ AIDS patients a vital aspect of treatment plan is to determine: a) Platelet count. b) Neutrophils count. c) White blood cell count. d) CD4 lymphocytic count.

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30. In patients with a history of malignancy endodontic treatment could be performed when: a) Granulocyte count is less than 2000/mm3 and platelet count is less than 50,000/mm3. b) Granulocyte count is less than 2000/mm3 and platelet count is greater than 50,000/mm3. c) Granulocyte count is greater than 2000/mm3 and platelet count is greater than 50,000mm3. d) Granulocyte count is greater than 2000/mm3 and platelet count is less than 50,000mm3. 31. Endodontic treatment is contraindicated when: a) The canal appears to be calcified. b) A large periapical lesion is present. c) The patient has no motivation to maintain the tooth. d) The tooth needs periodontal crown lengthening before restoration. 32. Vasoconstrictors are contraindicated in: a) Asthmatic patient. b) HIV/AIDS patients. c) Uncontrolled diabetic patients. d) Patients with recent coronary bypass graft (less than 3 m.). 33.Electronic apex locators may be useful in which of the following condition: a) Patients with prosthetic implants. b) Patients with psycastric disorder. c) Patients in the first trimester of pregnancy. d) Patients with implanted cardiac pacemaker. 34. Prophylactic antibiotic are recommended in which of the following patients: a) Patient with uncontrolled hypertension. b) Patient with uncontrolled hyperthyroidism. c) Patient with refractory cardiac arrhythmias. d) Patient with a history of multiple cardiac abnormalities. 35.Single-visit root canal treatment is indicated in case of: a) Necrotic pulps with apical abscess. b) Symptomatic irreversible pulpitis with apical periodontitis. c) Asymptomatic irreversible pulpitis with apical periodontitis. d) Symptomatic irreversible pulpitis without any apical changes.

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36.When treating vital cases multi-visits, scheduling between visit should... a. 2-3 days. b. 5-7 days. c. 10-12 days. d. 2 weeks. 37. In concomitant pulpal and periodontal lesions: a. Endodontic lesion had a sinus tract draining pus. b. Periodontal disease has a progressive nature with formation of osseous defects. c. There are two independent endodontic and periodontal lesions around.... tooth. d. There are two separate endodontic and periodontal disease affecting the ... Communicated to each other. 38. In which of the following endodontic periodontal lesions, pulp testing is positive: a. Primary periodontal lesion. b. Primary endodontic lesion with secondary periodontal involvement. c. Primary periodontal lesion with secondary endodontic involvement. d. True combined lesion. 39. In primary endodontic with secondary periodontal lesions, the treatment plan is: a. Periodontal treatment only. b. Proper root canal treatment. c. Endodontic treatment first followed by periodontal treatment. d. Periodontal treatment followed by proper root canal treatment. 40.The prognosis of endodontic periodontal lesion depends on: a. Type of affected tooth. b. Type of pulpal inflammation. c. Amount of periapical bone loss. d. Severity of periodontal involvement. 41. Pulpal inflammation reaches the periodontal areas through: a. Pulp horns. b. Large carious lesion. c. Deep periodontal pocket. d. The apical foramen and accessory canals.

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42-Concurrent endodontic and periodontal treatment: a. May complicate the tooth condition. b. Fails to replace defective bony lesions. c. May save an apparently hopeless tooth. d. Requires no checking of the apical seal of root canal filling. 43- A 33 year old female patient is suffering from repeated swelling related to her right central and lateral incisors. Clinically, deep palatal pocket with extensive attachment loss was detected related to the lingual aspect of the lateral incisor. The pulp test was +ve and radio graphically massive bone loss was evident along the whole root of that lateral incisor. The diagnosis of such condition could be: a) b) c) d) Marginal periodontitis related to upper anterior teeth. Chronic apical periodontitis related to necrosed lateral incisor. Primary periodontal lesion with secondary endodontic involvement. Localized periodontal disease related to a developmental groove defect. 44- A 22 year old male patient came to the clinic complaining of a localized swelling with a sinus draining pus related to badly decayed 36. The patient has good oral hygiene. Probing yields narrow isolated pocket and radiografically periapical bone loss is evident. The most possible diagnosis of that case is:

a) Periodontal bifurcation involvement. b) Chronic periapical abscess with secondary periodontal involvement. c) Asymptomatic irreversible pulpitis with chronic periapical abscess. d) Asymptomatic irreversible pulpitis with asymptomatic apical periodontitis. 45- Which of the following is the most important in determining if the lesion of periodontal origin or pulpal origin? a) b) c) d) Percussion. Pulp testing. Periodontal probing. A periapical radiograph. 46- Proper application of shifting technique allows the dentist to: Determine the mesiodistal fractures. Determine the intra-coronal pulp stones. Distinguish between objects that are resembled. Distinguish between various types of resorption.

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47- The Cone-Beam Computes Tomography scans (CBCT) shows a: a) Dimensions showed with regular radiographs. b) Higher accuracy for detecting pulp calcification. c) Dimensions not showed with regular radiographs. d) Higher accuracy for detecting horizontal root fracture. 48- Digital Subtraction Radiography used in Endodontic for: a) Endodontic obturation follow-up. b) Hard tissue gaining or loosing minerals. c) Evaluating soft tissue healing after treatment. d) Histopathological diagnosis of pulpal disease. 49- Loupe magnifications in endodontics varied from: 2 x to 8 x. 10 x to 16 x. 25 x to 30 x. 40 x & more. 50- The precision & triad of microsurgery includes: a) Magnification, resolution & field width. b) Types of, microscope, lenses & micro instruments. c) Field depth, illumination, & angle of declination. d) Micro instruments, illumination & magnification. 51- The split-dam technique is indicated when attempting to isolate a: a) b) c) d) Fully erupted tooth. Single isolated tooth. Prepared tooth for retrograde surgical restoration. Tooth insufficient coronal structure or badly broken-down tooth. a) b) c) d)

52- Canal Projection means technique that facilitates: a) Access cavity preparation by splitting off the coronal part of the tooth. b) Access cavity preparation by gaining access prior to rubber dam application. c) Pre-endodontic build up broken down coronal & radicular structure while neglecting individualized access to the canal. d) Pre-endodontic build up broken down coronal & radicular structure while preserving individualized access to the canal by using Bonded injectable polymerizing composites.

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53- In taking a periapical radiograph of a two-rooted mandibular premolar from distal to mesial horizontal angle, which of the following is TRUE? a) b) c) d) The lingual root will move distally with respect to the buccal root. The buccal root will move lingually with respect to the lingual root. The lingual root will move mesially with respect to the buccal root. Both roots will move away from the film.

54- One of the benefits of using magnifications in Endodontics is to:(B,C&D are all correct answers but if we should only choose one, Ill choose B which will lead to C &D) Eliminate pain. Reduce scar formation. Decrease traumatization of tissue. Increase the postoperative healing process. 55- The quality of the magnified field is significantly influenced by the: a) b) c) d) Lenses material. Image sharpness of lenses. Manufacture trade of the lenses. Manufacture trade and the image sharpness. a) b) c) d)

56- Regarding field width: a) It is limited to the working tooth with best resolution. b) The larger the field width; the less teeth you can see when looking through the loupes. c) A smaller field makes the new user feel more secure when working with dangerous instruments. d) A wider field makes it easier to establish hand-and-eye coordination when shifting from the naked eye to the loupes and promotes less eye fatigue. 57- Rubber Dam Clamps or Retainers: a) Are made of nickel titanium. b) Consists of a jaw and two bones. c) Aid in adjacent teeth retraction. d) Are designed for all types of teeth. 58- For isolation of a fractures tooth with a subgingival margin: a) b) c) d) Use partial isolation without rubber dam placement. Use a customized acrylic retainer in conjunction with a dam. Use modified anterior clamps and apply them toward each others. Place spots of temporary filling on the cervical surface of the tooth to act as a scaffold for retaining during treatment.

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59- Regarding types of radiographs used in Endodontics: a) Periapical (PA) radiograph shows tooth and related structures b) Panoramic radiograph is used to assess the individualized teeth and related structures c) Occlusal radiograph provides critical information on the cross section of the pulp space d) Bite-wing radiograph provides critical information about the anatomic apex of the tooth and related structures 60- When performing procedures by Surgical Microscope which of the following is the best magnification? a) X 2.5 and X 6 b) X 6 and X 8 c) X 10 and X 16 d) X 30 and X 40 61- Systemic Radiographic interpretation starts with: Pulp space and ends with bone proper Bone proper and ends with pulp space Root surface and ends with pulp space PDL space and ends with bone proper. 62- The advantages of Digital Radiographic Technique includes: a) Significant reduction in the number of films used b) Radiographic images are obtained within minutes c) Radiation exposures is reduced 50% compared with conventional film-based radiography d) Significant reduction in the processing time which is about 80-90% compared with D-speed film. 63- A 45-year-old male comes to your office complaining of severe continuous pain. He mentioned that he cannot chew or drink cold liquids and had little if any sleep in the past 48 hours. The first question you should ask to determine the specificity of the patient's problem is: a) b) c) d) Can you localize the pain? Do you have any swelling? Does the pain is spontaneous? Does the pain is intermittent? a) b) c) d)

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64- A 22-yaer-old female presents with intermittent severe pain in tooth # 36 that began 2 days ago. The pain comes and goes and lasts more than 7 minutes. The tooth hurts on biting. During clinical examination, tooth # 36 responded to cold test using Endo ice with severe pain that subside after 10 seconds. A radiograph shows a large deep amalgam restoration and normal PDL space. Percussion test reveals tenderness of tooth # 36. Your complete endodontic diagnosis is: a) b) c) d) Irreversible pulpitis and normal periapical tissue. Reversible pulpitis and symptomatic apical periodontitis. Irreversible pulpitis and symptomatic apical periodontitis. Irreversible pulpitis and asymptomatic apical periodontitis.

65- According to the American Board of Endodontics meeting 2007, condensing Osteitis is considered to be a variation of: a) b) c) d) Symptomatic pulpitis. Asymptomatic pulpitis. Symptomatic apical periodontitis. Asymptomatic apical periodontitis.

66- Asymptomatic apical periodontitis can be probably diagnosed by: a) b) c) d) 67- One of the following diagnostic tests is considered to be a true vitality test: a) b) c) d) 68- During pulp sensitivity testing, one of the following can cause false-negative response (i.e. vital teeth respond negative): a) b) c) d) Anxious patient. Liquefaction necrosis. Recent traumatized tooth. Contact with metal restoration. CO2 snow. Cavity test. Pulse oximetry. A refrigerant spry (Endo-ice). Cold test. Radiograph. Electric pulp test (EPT). Laser Doppler flowmetry.

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69- A 15-year-old male presents with severe diffuse pain in the maxillary left premolar region. Upon visual examination, the tissue in the mucobuccal vestibule appears inflamed. Palpation reveals tenderness over the apex of the teeth #24 and #25. Both teeth are slightly tender to percussion. Radiographically no changes are notes. Further evaluation and/or treatment should consist of: a) b) c) d) Selective anesthesia test. Dismissing the patient until the pain localizes. Cold testing on teeth #24 and #25 using Endoice. Initiating root canal treatment on teeth #24 and #25 because irreversible pulpitis is diagnosed.

70- A 10-year-old child presents with mild discomfort in teeth #21 and #22. The teeth were traumatized the day before in a fall from a motorcycle. Clinical examination reveals both teeth are tender to percussion and the crowns are intact. Cold test using Endoice indicated that the teeth #21 and #22 are not responsive. Treatment plan for such case is: a) b) c) d) 71- Regardless of stimulus, all afferent impulses from the human dental pulp result in sensation of: a) b) c) d) 72- According to a new diagnostic terminology, Asymptomatic irreversible pulpitis is defined as a clinical diagnostic category: a) Indicating that the pulp is partially necrotic and non-responsive to vitality testing. b) In which the pulp is free from inflammation and abnormally responsive to vitality testing. c) Indicating that the vital inflamed pulp is incapable of healing and no clinical symptoms. d) Based on subjective and objective findings indicating that the inflammation should resolve and pulp return to normal. Pain. Cold. Heat. Touch. Heat testing for teeth #21 and #22. Partial pulpotomy for teeth #21 and #22. Root canal treatment for teeth #21 and #22. No treatment and follow-up of the patient over the next few weeks.

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73- A 35-year-old patient was presented to your clinic complaining of dull pain related to tooth #36. Clinically, the tooth had proximal caries with pulp exposure. The tooth didnt respond to sensitivity tests. The radiograph revealed periapical radiolucency related to distal root. The root canal was initiated & temporization was performed in the first visit. After24 hours the patient came to the clinic complaining from diffuse swelling and severe pain related to the treated tooth. What is your diagnosis? Acute apical abscess. Chronic apical periodontitis. Secondary apical periodontitis. Symptomatic apical periodontitis. 74- Symptomatic apical periodontitis can be probably diagnosed by: Heat test. Cold test. Percussion test. Electric pulp test (EPT). 75- Which of the following is a feature of irreversible pulpitis during taking the history of the present illness? a) b) c) d) Heat act as relieving factor in the later stage. Positive response to percussion and palpation. Pain may develop spontaneously without stimulus. Pain immediately disappeared after stimulus removal. a) b) c) d) a) b) c) d)

76- After application of Endoice for evaluation of pulp sensitivity of normal tooth with completely formed apex, the patient will report on of the following as normal response: a) b) c) d) 77- Recent innovation in rotary Ni-Ti instruments manufacturing process allowed the manufacturing of files that is: a) b) c) d) Casted. Twisted. Swaged. Machined. Lack of response to the stimulus. Lingering of a painful sensation upon stimulus removal. A sensation is felt but disappear upon stimulus removal. Immediate, excruciating painful sensation as soon as the stimulus is placed.

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78- Helical angle as a component of rotary file is defined as the angle: Of the tip of the file. Between the first and second cutting edge of the file. Between the first cutting edge and the long axis of the file. Between the leading edge of the cutting blade and a perpendicular line to the surface being cut. 79- Regarding radial land of rotary file, it: May be full or recessed. May be positive or negative. Helps to keep the file centered in the canal. Is the surface that projects axially from the central axis between flutes as far as the cutting edges. 80- Revo-S rotary nickel titanium system has: a) Symmetrical cross section, which initiates a Snake-like movement of the instrument in the root canal. b) Symmetrical cross section, which initiates a direct straight movement of the instrument in the root canal. c) Asymmetrical cross section, which initiates a Snake-like movement of the instrument in the root canal. d) Asymmetrical cross section which initiates a direct straight movement of the instrument in the root canal. 81- Twisted File (TF) rotary Ni-Ti files system is manufactured by: Twisting of heated and cooled wire which leaves Ni-Ti file temporarily in R-phase. Twisting of continuously heated wire which leaves Ni-Ti file temporarily in R-phase. Grinding of heated and cooled wire which leaves Ni-Ti file temporarily in R-phase. Grinding of continuously heated wire which leaves Ni-Ti file temporarily in R-phase. 82- The ProTaper cross section is: a) b) c) d) 83- In Revo-S Ni-Ti system the shaper and cleaner 1 (SC1) file preparation: a) b) c) d) Whole RC. Apical 1/3 of the RC. Cervical 1/3 of the RC. Cervical and middle 1/3 of the RC. Triple helix with u shape cross section. Triple helix with convex triangle cross section. Convex triangle cross section with wide radial land. Convex triangle cross section with small radial land. a) b) c) d) a) b) c) d) a) b) c) d)

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84- Electric pulp tester (EPT) can be used reliably for differential diagnosis of one of the following pulp diseases: a) b) c) d) 85-Test cavity is used to assess pulp sensitivity in case of: a) b) c) d) 86-Which of the following local anesthetic injection types is a supplemental injection? a) b) c) d) Buccal nerve injection. Intra-ligmental injection. Mental nerve block injection. Inferior alveolar nerve injection. Recent erupted teeth. Recent traumatized teeth. Results of the other tests are inconclusive. Previously initiated therapy in case of molar. Reversible pulp inflammation. Irreversible pulp inflammation. Calcific degeneration of the pulp. None of the above.

87- Advanced stage of irreversible pulpitis, a dull pain sensation is attributed to the: a) b) c) d) 88- It is easy for the patient to localize periodontal pain than pulpal pain because: a) The periodontal tissue contains proprioceptors but pulp stoma does not. b) The pulp has low compliance environment while periodontal tissue c) The pulp has A beta nerve fibers but periodontal tissues contain more A delta nerve fibers. d) The pulp has A delta nerve fibers but periodontal tissues contain more sympathetic nerve fibers. Hydrodynamic theory. Inflammatory mediators which stimulate C-nerves fibers. Increase in the intrapulpal pressure stimulating A nerve fibers. Presence of mechanoreceptor that is stimulated by injured dentinal.

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89- Elective endodontic treatment is contraindicated in patients having myocardial infarction within the past 6 months, this is because: a) b) c) d) 90- retrograde periodontitis is: a) Localized apical periodontal tissue destruction. b) Generalized massive periodontal tissue destruction. c) Migration of periodontal tissue destruction from gingival margin towards root. d) Migration of periodontal tissue destruction from root apex towards gingival margin. Done By: Local anesthetic is absolutely contraindicated. There is an increased susceptibility to infection. There is an increased susceptibility of repeated infarctions. Such patients should be treated in hospital under care of his physician.

Mutasem Khairo, Alaa Basudan , Shayma Mudhaffer and Arwa khawaji.

Answered By: Mutasem Khairo, Hassan Abed, Mustafa Tashkandi , Elham Sahafi , Arwa al-Ghamdi , Ayah alfarsi, Eman al-Sharafi, Sumeyah Halabi

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