Using the information provided for Patient Silvia Ahuja, answer questions 1 to 10 on the answer score sheet.

Patient Information:           Age: 25 , Gender: Female
Height: 140cm (ft/in)
Weight: 52kg (lbs)

Blood Pressure:124 /83mmHg
Pulse Rate: 72bpm
Respiration Rate: 16/min

Chief Complaint: My gums start swelling after my surgery few months back.

History of Chief Complaint: I never had any severe gum problems in past but after my kidney operation my gums got bulbous. No history of bleeding.

Dental History: I took last dental check up and prophylaxis just before kidney operation 10 months back.

Medical History:
Significant Findings: Patient went through renal transplantation 10 months back due to acute renal failure, Hypertension.

Current Medication: Nifedipine 20 mg and Cyclosporin 125-150 mg (It was 150-175 mg 1st three months)

Allergies : Morphine

Social/Family History:
Married for four years. 2nd among 3 siblings, all are in good health. Father was Immuno-suppressive, passed away 3 years back.

Clinical Examination: Generalized gum swelling, firm pink color gingiva, no bleeding
Significant Findings:

Extraoral: WNL

Intraoral: Generalized Swelling of gums. Oral hygiene poor.

Question: 1 (Select ONE OR MORE correct answers.)
Which of the following should be included in the treatment plan for the management of
this patient?

A. No special consideration needed.
B. Prophylactic antibiotics.
C. Short appointment.
D. Anxiolytic/sedative drug administration.
E. Prophylactic nitroglycerin.
F. Avoid NSAIDs.
G. Avoid opioids.
H. Avoid epinephrine.
I. Minimize the use of epinephrine.
J. Avoid Procaine local anesthetic.
K. Adjust current medication.
L. Stop current medication prior to appointment.
M. Delay routine treatments.
N. Treat at the end of the day.
O. Must treat in a hospital facility.

Dentist performed a Periodontal Exam
The recordings for a Sextant were representative of her complete dentition

Vestibular
Tooth #                        3.3          3.2          3.1          4.1            4.2           4.3
Probing Depth           455          554        545         445           545          555
Recession                  0mm       0mm      0mm      0mm         0mm       0mm
Bleeding on Probing  +++         +++        +++        +++            +++          +++

Lingual
Tooth #                      3.3             3.2          3.1          4.1             4.2              4.3
Probing Depth          433            534        545         545            534            444
Recession                 0mm        0mm     0mm       0mm          0mm         0mm
Bleeding on Probing +++           +++      +++           +++             +++          +++

Tooth #                      3.3            3.2           3.1           4.1             4.2           4.3
Mobility            1st degree   1st degree1st degree 0 degree 0 degree 1 degree
Furcation 0 0 0 0 0 0

Patient Silvia Ahuja Photograph:

Question: 2 Select ONE OR MORE correct answers.)
Which of the following conditions is/are consistent with this patient’s periodontal
findings?

A. Healthy periodontal status.
B. Drug-influenced gingival enlargement.
C. Generalized aggressive periodontitis.
D. Generalized chronic periodontitis.
E. Localized aggressive periodontitis.
F. Localized chronic periodontitis.
G. Periodontal abscess.
H. Gingivitis modified by systemic factors.
I. Gingivitis associated with plaque only.
J. Necrotizing ulcerative gingivitis.
K. Necrotizing ulcerative periodontitis.
L. Gingival manifestations of systemic disease.
M. Endodontic – periodontic lesion.
N. Vertical root fracture.
O. Horizontal root fracture.

Question: 3 (Select ONE OR MORE correct answers.)
Which of the following is/are appropriate for the management of this periodontal
condition?

A. Nonsurgical debridement.
B. Systemic antimicrobial therapy.
C. Extraction.
D. Open flap debridement alone.
E. Open flap debridement with apically positioned flap.
F. Coronally positioned flap.
G. Laterally positioned flap.
H. Free (autogenous) gingival graft.
I. Sub-epithelial connective tissue graft.
J. Guided tissue regeneration.
K. Bone graft.
L. Gingivectomy/gingivoplasty.
M. Distal wedge.
N. Gingival curettage.

The dentist has to perform a periodontal procedure in the lower anterior sextant for gingival hyperplasia, severely affected gum area in the next appointment.

Question: 4 (Select ONE OR MORE correct answers.)
Which of the following would be/would have been appropriate to achieve anesthesia for
Deep Scaling of lower anterior sextant?

A. Supraperiosteal/Paraperiosteal/Infiltration injection.
B. Inferior alveolar nerve block.
C. Incisive nerve block.
D. Mental nerve block.
E. Gow-Gates mandibular nerve block.
F. Buccal nerve block.
G. Periodontal ligament injection (intraligamentary).
H. Intraosseous injection.
I. Intrapulpal injection.
J. Varizani/Akinosi technique.

Question: 5 (Select ONE correct answer.)
Which of the following would be the maximum number of cartridges of 2% Lignocaine with 1:200,000 that could safely be given to this patient at one time?

A. 0.
B. 1.
C. 2.
D. 3.
E. 4.
F. 5.
G. 6.
H. 7.
I. 8.
J. 9.
K. 10.
L. 11.
M. 12.
N. 13.
O. 14

Question: 6 (Select ONE OR MORE correct answers.)
More than one antibiotic may be acceptable in any given clinical situation. Which of the
following antibiotics would be acceptable for the management of periodontal condition of this patient?

A. No antibiotic is indicated.
B. Amoxicillin.
C. Cephalexin.
D. Clarithromycin.
E. Clindamycin.
F. Doxycycline.
G. Erythromycin.
H. Metronidazole.
I. Penicillin V.
J. Tetracycline.

On the second visit while in the dental chair and after having local anesthesia, the patient became restless and her respiration rate increased to 27 from 16.

Question: 7 (Select ONE correct answer.)
This patient’s signs and symptoms are most consistent with which one of the following?

A. Acute asthmatic attack (bronchospasm).
B. Upper airway obstruction.
C. Mild allergic reaction.
D. Anaphylaxis.
E. Angina pectoris/myocardial infarction.
F. Cardiac arrest.
G. Cerebrovascular accident.
H. Hyperglycemia (diabetic coma).
I. Hypoglycemia (insulin shock).
J. Hyperventilation.
K. Local anesthetic toxicity.
L. Epinephrine reaction.
M. Vasodepressor (vasovagal) syncope.
N. Seizure disorder.

Question: 8 (Select ONE OR MORE correct answers.)
Which of the following is/are appropriate for the immediate management of this patient?

A. No intervention necessary.
B. Administer acetylsalicylic acid.
C. Administer diphenhydramine.
D. Administer epinephrine.
E. Administer glucagon and/or oral glucose.
F. Administer nitroglycerin.
G. Administer oxygen.
H. Administer salbutamol.
I. Breathe into cupped hands.
J. Head-tilt/chin-lift.
K. Ventilate the patient and begin cardiac compressions.
L. Abdominal thrusts.
M. Finger sweeps.
N. Use automated external defibrillator.
O. Call emergency medical services.

Question: 9 (Select ONE OR MORE correct answers.)
In the event that this patient needs an analgesic for post operative pain, which of the
following would be appropriate?

A. Acetaminophen.
B. Acetylsalicylic acid.
C. Codeine.
D. Ibuprofen.
E. Ketorolac.
F. Meperidine.
G. Naproxen.
H. Oxycodone.

If this patient didn’t have Hypertension and Renal Transplant

Question: 10 (Select ONE correct answer.)
Which of the following would be the maximum number of cartridges of 2%lignocaine with 1:100,000 epinephrine that could safely be given to this patient at one time?

A. 0.
B. 1.
C. 2.
D. 3.
E. 4.
F. 5.
G. 6.
H. 7.
I. 8.
J. 9.
K. 10.
L. 11.
M. 12.
N. 13.
O. 14.