Radiology Question And Answers

Question 1. Enumerate the causes of halitosis.
Answer:

• Halitosis is the abnormal breath odors caused by a variety of underlying factors.
• The result of the metabolic activity of oral gram-negative bacteria on degenerated epithelial cells, inflammatory cells, and food particles is the release of volatile sulfur compounds and causing an unpleasant breath odor.
• Bad breath is common on awakening due to the absence of self-cleansing mechanisms like a movement of the tongue and salivary flow. But if it persists during the daytime, then the following factors should be considered:

Read And Learn More: Oral Medicine and Radiology Question And Answers

• • Oral and nasal—Oral infection like severe gingivitis, periodontitis or abscessed teeth, tonsillitis, nasal and nasopharyngeal discharge.
  • Respiratory diseases—Lung abscess and bronchitis.
  • Fever and dehydration
  • Diseases of the salivary gland—Suppurative parotitis.
  • GIT disorders—Gastritis, gastric or peptic ulcer, digestive disorders.
  • Metabolic diseases—Diabetic mellitus (acetone odor), high-fat diet, uremia (fishy or ammonia smell), liver failure (mousy odor).
  • Drugs—Organophosphorus, anticholi¬nergics, sublingual isosorbide, disulfiram
  • Psychoneurosis

Question 2. Describe mycosis fungoides.
Answer:

• It is otherwise known as cutaneous lymphoma. It is a rare form of chronic skin disease and starts as pruritus. The next is the “premycotic” stage is associated with skin eruptions (urticarial or psoriatic-like).
• This stage is followed by red or purple-colored skin tumors (tomato-like) which finally ulcerate and fungates (mycotic stage).
• The aggressive form produces Sezary syndrome characterized by generalized nodular lesions, papules, hair loss, drooping of the lower eyelid, lymphadenopathy, anxiety, and depression. The prognosis is poor.

Question 3. Angioneurotic edema
(or)
Angioedema.
Answer: Angioedema is a deep cutaneous swelling due to the release of inflammatory mediators.

Angioedema Pathogenesis:

• The basic reason is the mast cell response with increased release of histamines, serotonin, bradykinin, and other inflammatory media¬tors.
• These substances cause increased vascular leakage and edema of the deep layers of connective tissue.

Angioedema Types:

1. Based on etiology:

• The hereditary type (hereditary angioedema) is due to the deficiency of the CI esterase inhibitors which inhibit the action of plasma kallikrein and functions to break the kininogen and for the production of bradykinin. In the absence of CI esterase, there will be excess kininogen and circulating kinins.
• IgE-mediated angioedema occurs due to an immediate hypersensitivity reaction following the exposure to an antigen like food substances (milk products, eggs, chocolates, peanuts), antibiotics, and analgesics.
• It occurs secondary to infection, connective tissue disorders, and insect bites.

2. Based on duration:

• Acute—Presence of symptoms for less than 6 weeks
• Chronic—Presence of symptoms for more than 6 weeks

Angioedema Clinical Findings:

• Females are affected more than males and affect individuals above 30 years.
• The affected organs include lips, eyelids, tongue, oral mucosa, and extremities. In severe conditions, the mucosa of the respiratory tract and larynx are also affected.
• The boundaries are ill-defined, and there will be no associated pain, burning sensation, and pruritus.
• Urticaria is common in many patients.

Angioedema Diagnosis: Lab investigations have a limited role. The diagnosis is primarily based on history, symp-toms, and examination findings.

The basic tests include:

• ESR, CBC
• Allergic testing in suspected cases
• C4 level for C1 esterase activity.

Angioedema Management: In acute conditions, symptomatic relief is achieved with:

• H1 antihistamines like:
  • Cetrizine 5-10 mg once daily
  • Loratadine 10 mg once daily
  • Chlorpheniramine 4 mg 6th hourly
  • Diphenhydramine 25-50 mg once daily
• In resistant cases, H2 antihistamines are added with H1 antihistamines.
  • Ranitidine 150 mg two times/day
  • Cimetidine 400 mg two times/day
• IgE-mediated angioedema with laryngeal involvement is treated with:
  • Epinephrine 0.3 mg in a solution of 1:1000, subcutaneous route
  • Diphenhydramine 25-50 mg IM or 4
  • Ranitidine 50 mg 4
  • Antihistamine combined with the corticosteroid (prednisone) reduces the severity of attacks in life-threatening episodes.
• For hereditary angioedema, C1-INH concentrate or fresh frozen plasma 4 may be used.

Question 4. Explain the dental findings in patients with anorexia nervosa and the treatment plan.
Answer: Anorexia nervosa is a disordered eating problem characterized by a hesitation to obesity and the refusal for maintaining normal body weight especially exhibited by young females (age less than 25 years).

Anorexia nervosa Clinical Findings:

• Underweight, a history of weight reduction primarily due to caloric restriction or self-induced vomiting after eating.
• Perception of weight loss as an achievement.

Anorexia nervosa Dental Findings:

• Dental effects are due to gastric acid regurgitation
• Wear facets lead to loss of vertical dimension and development of premature occlu¬sal contact and traumatic occlusion
• Dental erosion particularly on palatal aspect of maxillary incisors
• Notched incisal edges of anterior teeth
• Loss of tooth contour
• Bilateral parotid gland hypertrophy
• Traumatized oral mucosa is seen in patients using objects for inducing vomiting.

Anorexia nervosa Dental Management:

• Patient education about diet and oral health
• Advice regular dental examination, oral prophylaxis, and topical fluoride application
• Defer definitive dental treatment like restorations and endodontic therapy until control of eating disorder is established
• Definitive dental treatment depends on the severity of structural loss of the tooth and may include composite and glass ionomer restorations, porcelain laminate veneers or full mouth rehabilitation.

Question 5. Describe the features of non-Hodgkin lymphoma. Add a note on the dental management for non-Hodgkin patients.
Answer:

Non-Hodgkin lymphoma (NHL) is a group of lymphoproliferative tumors with a range of behavioral patterns and treatment responses.

There are two types:

1. B-cell (most common, 85-90% of cases) and T-cell (10-15%). It originates from lymphoid tissues and spreads to other organs. Extranodal dissemination is also common.
2. NHL affects all age groups but is common in patients above 40 years of age, males are affected more.

Non-Hodgkin Lymphoma Classification:

• The pattern of distribution: Diffuse and nodular.
• Cell type: Lymphocytic, histiocytic and mixed.
• Degree of cellular differentiation: Well- differentiated, moderately, and poorly differentiated

There are more than 30 types of NHLs. The most common forms are:

• Diffuse large B-cell lymphoma (DLBCL)— Active and destructive form
• Follicular lymphoma—Indolent lymphoma but may transform into DLBCL
• Mucosa-associated lymphoid tissue (MALT ) tumor usually develops in the abdomen but may transform into DLBCL.
• Burkitt’s lymphoma—Less common type. Clinically aggressive form and seen in immunocompromised individuals like patients undergone for organ or bone marrow transplants. Epstein-Barr virus infec¬tion is also a causative factor.

Non-Hodgkin Lymphoma Clinical Features:

• Usually, patients present with painless, persistent lymphadenopathy
• Common symptoms are fever, weight loss, night sweats, widespread itching
• If the bone marrow is affected, lymphoma cells predominate and cause anemia
• If the brain is affected, the patient may present with headaches, visual disturbance, and seizures.

Non-Hodgkin lymphoma Diagnosis:

• Lymph node and bone marrow needle biopsy
• Blood smear test, complete blood count, and differential count
• MRI, lymphangiogram.

Non-Hodgkin lymphoma Complications: Infection is secondary to immunosuppression from chemotherapy, radiotherapy or due to the disease itself.

Non-Hodgkin Lymphoma Dental Consideration:

• Patients may present with painless cervical lymphadenopathy.
• Waldeyer’s ring is most commonly affected
• Intraoral tumors occur on the cheek and palatal mucosa, gingiva, and floor of the mouth, and present as swelling.
• If jaw bones are affected, the mobility of teeth, neurologic disturbance, and jaw fracture may occur.
• Asymptomatic ulcerations are present on oral soft tissues.

Non-Hodgkin Lymphoma Dental Management:

• Treatment should be provided for the elimination of the potential source of bacteremia like periodontitis, carious teeth, etc. before chemotherapy.
• Nonfunctional, nonrestorable, partially erupted teeth should be extracted before chemotherapy.
• Extraction should be carried out 5 days before initiation of chemotherapy for maxillary teeth and 7 days before for mandibular teeth. For radiotherapy, extraction should be carried out 3 weeks before initiation.
• For patients receiving chemotherapy, before initiating dental procedures, CBC and platelet counts should be evaluated. Routine dental procedures can be performed if the total WBC count is above 2,000/mm³ and the platelet count is above 50,000/mm³.
• For emergency procedures, platelet replacement therapy with oncologists’ consent is essential when platelets are below 50,000/mm³.
• However, if the WBC count is below 2,000/mm³ and the neutrophil count is less the 500-1,000/ mm³, consultation with the oncologist is recommended.
• Management for mucositis following chemo-and radiotherapy.

Treatment Modalities for NHLs:

• Radiation and chemotherapy are the two possible modalities
• Bone marrow transplant and monoclonal antibodies against B cell surface antigens.

Question 6. Briefly describe Hodgkin’s lymphoma.
Answer:

• It is a curable form of malignancy affecting the lymph nodes, spleen, liver, and bone marrow. It occurs in children and young adults.
• It has bimodal age distribution—early adulthood (15-40 years, commonly around 25-30 years), late adulthood (after 55 years of age).

Hodgkin’s Lymphoma Etiology:

• A combination of factors like infection, environmental exposure, and genetic alterations play a role. The Epstein-Barr virus (EBV) is a cofactor.
• In many cases, the tumor cells are EBV-positive. Patients with HIV infections have a higher prevalence of HL.

Hodgkin’s lymphoma Clinical Features:

• Painless enlargement of lymph nodes
• Asymptomatic lymphadenopathy above the diaphragm in 80-90% of cases
• Cervical node enlargement
• Unexplained weight loss, fever, and night sweats
• Pruritus is a symptom seen in young women with HL
• Pel-Ebstein fever in some patients (a cyclic pattern of high fever).

Hodgkin’s lymphoma Diagnosis: Lymph node biopsy—Reed-Sternberg cells (large-sized, lobular nucleus) confirm the diagnosis.

Hodgkin’s Lymphoma Dental Significance:

• Primary jaw lesions are uncommon
• Increased susceptibility to bacterial, viral, and fungal infections.

Question 7. Postexposure prophylaxis for a dental professional following occupational exposure to HIV.
Answer: Following an accidental exposure to HIV through a needle prick or other sharp instrument piercing which are used to treat a patient with a medical history of HIV infection.

• Through washing of injured site with plain water.
• Place a gauze soaked with a disinfectant solution (for example, povidone iodine or 75% alcohol) for 15 minutes at the injured site.
• Chemoprophylaxis should be started immediately following the exposure.
• A serological examination should be carried out to detect the HIV antigen. HIV can be detected after 72 hours of acquiring infection and viremia develops in 5 days.

Postexposure Prophylaxis:

• Depending on the viral load of the patient two or three antiretroviral drugs are used for prophylaxis.
• The drugs should be two nucleo¬sides with/without a protease inhibitor. The effect of these retroviral drugs will last for 4 weeks and prevent seroconversion with 80% success rate.

Question 8. What is biofeedback? How it is helpful in dentistry.
Answer:

• Biofeedback is a therapeutic learning mechanism that helps to improve body function by observing electrical signals generated (feedback) from the body (bio).
• It is a method of alternative therapy to improve physical performance by learning and practicing voluntary control of the autonomous nervous system. It improves life quality by allowing the subject individual to “see” or “hear” body activities.

Biofeedback in Dentistry:

• The commonly used biofeedback method in dentistry is related to muscles.
• The electrodes attached to your skeletal muscles will display a range of readings on the computer monitor.

Biofeedback Devise and Function:

• Biofeedback equipment consists of a computer, electrodes, and signaling devices. The electro¬des should be attached to the masseter muscle for assessing the temporomandibular joint function or the intensity of the myofascial pain.
• The electrodes capture the signals when muscles contract and relax. During the contractile phase (like clenching or grinding), an upward arrow or a beep sound will be displayed. In a relaxed state, the arrow goes down, or the sound stops.

Hodgkin’s Lymphoma Application:

• In the management of:
  • Chronic orofacial pain
  • Myofascial pain dysfunction syndrome
  • Temporomandibular disorders.

Hodgkin’s Lymphoma Advantages:

• Noninvasive
• It improves the quality of life through behavioral modification
• It reduces the need for pharmacological medications
• No adverse effects.

Question 9. Enumerate the types of transcutaneous electric nerve stimulation. State the mode of action and uses of TENS in dental practice.
Answer:

Transcutaneous electric nerve stimulation (TENS) is an alternative method for pain management. Two theories explain the basic mechanism of TENS in pain control which are as follows:

1. Gate control theory of pain: Pain is transmitted by small unmyelinated ‘C’ fibers and the active state of C fibers keeps the gate in the relatively open position. The myelinated “A” fibers release an inhibitory effect on C fibers and this action closes the gate. TENS act by closing the gate by increasing the input from large fibers and diminishing the input from small fibers.

2. Endogenous opioid theory: TENS activate local circuits within the spinal cord and release the endogenous opioid to control the pain.

Transcutaneous electric nerve stimulation Types: Two types are available:

1. High-frequency TENS—Operate by gate control mechanism and pain relief is effective only for a short duration.
2. Low-frequency TENS—Operate by releasing endogenous opioids and pain relief will persist for a longer duration.

The components of the TENS device include the TENS unit, lead wires, and electrodes.

Application in Dentistry:

• To manage acute and chronic pain:
  • TMJ disorders
  • Trigeminal neuralgia
  • Postherpetic neuralgia.
• To increase salivary secretion in patients with xerostomia.

Transcutaneous electric nerve stimulation Advantages:

• Noninvasive
• The patient can use on their own to manage the pain after learning the adjustment mechanism.

Transcutaneous electric nerve stimulation Contraindications:

• Patients with cardiac pacemakers
• Patients with cerebrovascular problems
• Epileptic patients
• Cannot be used in apprehensive patients as it needs patients’ cooperation.

Question 10. Describe the Rumple-Leede test.
Answer: The rumple-Leede test is applied in patients with bleeding diathesis. The test measures the capillary wall integrity and quantitative plus qualitative defects of platelets.

Rumple-Leede test Method:

• Place the blood pressure cuff on the patient’s arm. Record the patient’s blood pressure.
• Inflate the cuff to a middle point between systolic and diastolic blood pressure and maintain for 5 minutes.
• Reduce and wait 2 minutes.
• Count petechiae below antecubital fossa.
• The test is positive if 10 or more petechiae appear per 1 square inch.
• The petechiae formation is distal to a tourniquet or sphygmomanometer on releasing the pressure is known as the Rumpel-Leede sign.

Basic Principle of the Test:

• An inflated blood pressure cuff at a specific pressure, for a specific time, will produce an increased pressure and hypoxia in the capillaries distal to the cuff.
• Decreased capillary resistance ruptures the capillaries, resulting in bleeding and petechiae formation. The result is nonspecific. A positive test in women aged above 40 years may not be pathogenic.

Rumple-Leede test Contraindications:

• Platelet count <50,000/mm³
• Bleeding disorders
• Anticoagulant therapy
• Skin changes due to aging
• Aspirin ingestion within a week before performing the procedure.

Question 11. Write the salient features of Angina bullosa hemorrhagica.
Answer:

• Angina bullosa hemorrhagica (ABH) is an acute condition of a blood-filled bulla on the oral cavity. They are not attributed to any blood disorders, vesiculobullous conditions, systemic diseases or other known causes.
• It is a benign condition. It occurs on the soft palate and is characterized by the sudden appearance in middle-aged individuals. Minor trauma, iatrogenic causes and use of steroid inhalers are the few reported causes of onset.
• The widely accepted pathological reason is the low-grade trauma or irritation rupturing the epithelial-connective-tissue junction, causing superficial capillary bleeding, and formation of hemorrhagic bullae.
• Spontaneous rupture of the bulla will lead to an ulcer of 1-3 cm in diameter which heals without scar formation is characteristic.
• The bulla frequently develops on the soft palate; however, the buccal mucosa and tongue may also develop such lesions.
• Symptoms of sudden onset, painless nature, and spontaneous rupture of the bulla help in establishing the diagnosis.
• Histopatho- logical findings are non-specific. Treatment is not required. Topical application of benzydamine hydrochloride will relieve the symptoms.

Image Receptors X-Ray Film Intensifying Screens And Grids And Image Characteristics Essay Questions

Question 1. Describe the major imaging characteristics of an X-ray film.
(or)
Enumerate the factors that determine image quality.
Answer: Radiographic image characteristics include both visual and geometric characteristics. An ideal radiograph is a diagnostic one that provides more significant information.

• X-ray film Visual characteristics: Density and contrast influence the diagnostic quality.
• X-ray film Density: The overall degree of darkness or blackness of an exposed film is known as radiographic density. Processing of unexposed film shows some density known as, the inherent density of the base. This minimal density is called gross fog or base plus fog.

Factors Influencing the Radiographic Density:

• Exposure: Increasing the milliamperage (mA), peak kilovoltage (kVp), or exposure time increases the number of photons reaching the film and increases the image density. Reducing the focal spot-film distance increases the image density.
• Subject thickness and density: When the subject is thicker, more beams will be attenuated, and the resultant image will appear lighter. Exposure factors (kVp or time) should be adjusted to suit for subject density.
  • Dense objects (well absorbs the radiation) appear as a light image in the radiograph— radiopaque. Less dense objects absorb less radiation while allowing most of the X-rays to pass through it and appear as a dark image on a radiograph—radiolucent.
• Contrast: Contrast is the difference in densities between adjacent light and dark areas in a radiograph. An image showing both dark and light regions has high contrast or a short grayscale of contrast. An image composed of only light gray and dark gray areas has low contrast or long grayscale of contrast.

Factors Influencing the Radiographic Contrast:

• Subject contrast: Refer to the characteristics like thickness, density, and composition of the subject that influence the image contrast. It can be altered by altering kVp. When high kVp is used, (above 90 kVp) low contrast image results with many shades of gray. When low kVp (65-70 kVp) is used, high contrast image results with areas of black and white.
• Film contrast: High contrast film reveals areas of small difference in subject contrast more clearly than low contrast film. Inherent qualities of the film, processing time and temperature of the developer will influences film contrast.
• Geometric characteristics: The formation of an accurate radiographic image is dependent on minimizing specific geo¬metric characteristics that are present to a certain degree in every radiograph.
• Image or geometric unsharpness (penum¬bra): Penumbra refers to the diffusion of detail and appears as a fuzzy, unsharp margin surrounding the teeth and osseous structures. In dental radiographs, the penumbra can be minimized by:
  • Reducing the focal spot size
  • Increasing the source—object distance
  • Reducing the film object distance.
• Image magnification: Magnification is the equal enlargement of the actual size of the object on the radiograph. It is possible to minimize magnification by:
  • Increasing source film distance
  • Reducing object film distance.
• Image shape distortion: Refer to the uneven development of the same object in different parts.
  • It can be minimized by using a paralleling technique where the central beam is perpendicular to the tooth and film which are parallel to each other.

 

Radiology Miscellaneous Viva Voce

Question 1. Name a few conditions associated with a prominent forehead.
Answer:

• Acromegaly
• Leontiasis ostium
• Chronic hydrocephalus
• Frontal bossing.

Question 2. In which conditions, is macroglossia seen?
Answer:

• Congenital macroglossia
• Acromegaly
• Hypothyroidism
• Cretinism
• Hurler’s syndrome
• Amyloidosis
• Down’s syndrome
• Hemangioma and lymphangioma
• Mucopolysaccharidosis
• Congenital hemihypertrophy.

Question 3. Name the conditions with microglossia.
Answer:

• Starvation and malnutrition
• Uni-or bilateral hypoglossal nerve palsy
• Facial hemiatrophy
• Myasthenia gravis.