৪৮তম বিশেষ বিসিএস [স্বাস্থ্য] ⎯ ডেন্টাল অংশ [Archived]

Radiologists are more exposed to leukemia.(Ref Balaji)

Lymph nodes are matted in tuberculosis.
(Ref Balaji)

Raised and rolled out edge is present in squamous cell carcinoma.(Ref Balaji)

Claustrophobia is a  disadvantage of MRI.
(Ref Neelima)

Anemia is examined in lower palpebral conjunctiva.(Ref Makhan Lal Clinical surgery)

Virchow's gland is left supraclavicular lymph node. (Ref-Makhon Lal Clinical surgery)

Cardiac output is high in distributive shock.
(Ref-Bailey and Love’s)

One of the Universal precautions for hepatitis is to avoid the unnecessary movement in theatre.(Ref bailey and love’s)

 Bleeding time is increased in von willebrand disease.(Ref-Balaji)

CT scan gives the best three-dimensional information on fractures.
(Ref- Bailey and love’s)

121°C for 15mins, 126°C for 10mins, 134°C for 3mins are appropriate for autoclaving.
(Ref-Neelima)

Cidex requires immersion of 20-30 minutes for disinfection.(Ref Neelima)

Dry heat has less penetration than moist heat.
(Ref-Neelima)

Explanation :
Local causes of gum bleeding include:
ANUG
Gingivitis
Periodontitis
Epulis
Aggressive toothbrushing or injury to the gingiva etc

Systemic causes of gum bleeding :
Leukemia
Scurvy ( vitamin C deficiency)
Von willebrand disease
Hemophilia
Dengue
Tombrocytopenia
Vitamin k deficiency etc
Ref: Oral Medicine by odell+ Davidson (24th Edition)

Recently, the transmission of new sub-variants of the coronavirus, especially Omicron
*LF.7,
*XFG & XFC
*JN.1 and
*NB.1.8.1  ; has been increasing in various neighboring countries.In this regard, The Ministry of Health and Family Welfare has issued a warning.
Ref: DGHS

Cyanosis

Cyanosis is a blue discoloration of the skin and mucous membranes that occurs when the absolute concentration of deoxygenated haemoglobin is increased.

Central cyanosis

Central cyanosis can be seen in the lips, tongue and buccal or sublingual mucosa.

Peripheral cyanosis

Peripheral cyanosis is seen in the distal extremities and may simply be a result of cold exposure, when prolonged peripheral capillary flow allows greater oxygen extraction and hence increased levels of deoxyhaemoglobin.

Ref: Macleod's Clinical Examination

Clinical features of MI:

Symptoms:

a)Prolonged cardiac pain that radiates to Chest, throat, arms, epigastrium or back

b)Anxiety and fear of impending death

c)Associated symptoms like Nausea and vomiting

d)Breathlessness

e)Collapse/synocope

Signs:

a) Signs of sympathetic activation: Pallor, sweating, tachycardia

b) Signs of vagal activation: Vomiting, bradycardia

c) Signs of impaird myocardial function:

➤ Hypotension, oliguria, cold peripheries

➤ Narrow pulse pressure

➤ Raised jugular venous pressure

➤ Third heart sound may heard


Investigations:

1) ECG: ST elevation, followed by T-wave inversion, then pathological Q-wave development.

2) Plasma biochemical markers:

1.Troponin-I: Released within 3-6 hours, peak at about 36 hours and remain elevated up to 2 weeks.

2.CK-MB: Starts to rise at 4-6 hours, peaks at about 12 hours, and falls to normal within 48-72 hours.

3. Other blood tests: Leucocytosis, raised ESR and C-reactive protein.

4. Chest X-ray: Features of pulmonary oedema of LVF develops.

5. Echocardiography: Detects infarct associated regional wall motion abnormalities.

Ref: Davidson+ Harrison

Features of ALL:

1.ALL is more common in children and AML in adults 
2.Fever, bleeding manifestation, weakness, sore throat may be seen
3.Lymph node enlargement is more common in ALL 
4.Spleen is usually slightly or moderately enlarged
5.severe anaemia may be seen, Hb-reduced (3-9 gm/dl)
6.Total WBC count 20,000-500,000/mm3 total count may be less than 10,000/mm3.

7.WBC: Predominant cells are blast cells (more than 20%  blast cell have high nuclear. myeloblast, lymphoblast, monoblast are difficult to differentiate. In Lymphoblastic leukemia there are smear cells, indicate damaged cells during blood film preparation.

8.RBC: Normocytic or microcytic, Aniso poikilocytosis with mild polychromas red cells may appear.

9.Platelet: Thrombocytopenia

Ref: Khaleque Pathology + Davidson

Classical features of type I DM:
1.Typical age at onset-<40 years
2.Duration of symptoms- Weeks
3.Body weight- Normal or low
4.Ketonuria- Present
5.Rapid death without treatment with insulin- Yes
6.Autoantibodies- Positive 80-90% cases
7.Diabetic complications at diagnosis- Yes
8.Family history diabetes of - uncommon 
9.Other autoimmune disease- common

Classical features of type II DM:
1.Typical age at onset->50 years
2.Duration of symptoms- Months to years
3.Body weight- Obese
4.Ketonuria- Not present 
5.Rapid death without treatment with insulin- No
6.Autoantibodies- Negative
7.Diabetic complications at diagnosis- slightly (25%)
8.Family history diabetes of - common
9.Other autoimmune disease- uncommon 

Ref: Davidson 24th Edition + Harrison 

Anaphylaxis is treated immediately with intramuscular epinephrine (0.5 mg in adults, 0.01 mg/kg in children) into the thigh. Supportive care includes high-flow oxygen, IV fluids, and adjuncts like antihistamines and corticosteroids. The patient should be monitored for 4–6 hours for recurrence. Epinephrine is life-saving and must not be delayed.

Ref- Cawaon + Davidson

Explanation : Characteristics of pain (SOCRATES)

Site

Somatic pain, often well localised, e.g. sprained ankle

Visceral pain, more diffuse, e.g. angina pectoris

Onset

Speed of onset and any associated circumstances

Character

Described by adjectives, e.g. sharp/dull, burning/tingling, boring/stabbing, crushing/tugging, preferably using the patient's own description rather than offering suggestions

Radiation

Through local extension

Referred by a shared neuronal pathway to a distant unaffected site, e.g. diaphragmatic pain at the shoulder tip via the phrenic nerve (C3, C4)

Associated symptoms

Visual aura accompanying migraine with aura

Numbness in the leg with back pain suggesting nerve root irritation

Timing (duration, course, pattern)

Since onset

Episodic or continuous:

If episodic, duration and frequency of attacks

If continuous, any changes in severity

Exacerbating and relieving factors

Circumstances in which pain is provoked or exacerbated, e.g. eating

Specific activities or postures, and any avoidance measures that have been taken to prevent onset

Effects of specific activities or postures, including effects of medication and alternative medical approaches

Severity

Difficult to assess, as so subjective

Sometimes helpful to compare with other common pains, e.g. toothache

Variation by day or night, during the week or month, e.g. relating to the menstrual cycle.

Ref: Macleod Clinical Examination

                                                                                                                                                                          

Scurvy:

Cause:  Due to vitamin C (ascorbic acid) deficiency which leads to defective collagen synthesis

General Clinical Features:

1.General Symptoms:

* Weakness, fatigue, malaise
* Loss of appetite
* Irritability
* Weight loss

2.Skin & Mucous Membrane Changes:

* Perifollicular hemorrhages: pinpoint bleeding around hair follicles
* Corkscrew hairs: coiled, fragile hairs due to abnormal keratin
* Ecchymoses & purpura:easy bruising
* Petechiae: tiny red spots due to capillary bleeding
* Poor wound healing

3.Gum Changes: (Classic)

* Swollen, spongy, bleeding gums
* Gum recession & tooth loss 

4.Musculoskeletal Manifestations:

* Bone pain & tenderness
* Subperiosteal hemorrhage → causes severe pain, pseudoparalysis in children
* Joint swelling

5.Anemia: Due to chronic bleeding + poor iron absorption

6.Other Classic Signs:

*Scorbutic rosary:
prominent costochondral junctions (like rickets, but due to bleeding)

*Frog leg’ position in infants: to reduce limb pain

Ref: Cawson+ Davidson+Website

An infected dental pulp (like in untreated pulpitis or dental abscess) can lead to bacteria entering the bloodstream (bacteremia) during chewing, tooth extraction, or even spontaneously. This bacteremia can seed heart valves or endocardium, especially in patients with predisposing heart conditions (like damaged or prosthetic valves), causing infective endocarditis, a serious, potentially life-threatening heart infection.

Ref: Cawson 

Clinical feature of dengue fever ( break bone fever):
1.High grade fever 
2. Pain on eye movement 
3.Maculopapular rash may be seen
4.Generalised weakness etc

Warning signs:
1.Abdominal pain
2.Persistent vomiting 
3.Plural effusion 
4.Mucosal bleeding including gum bleeding 
5.Plasma leakage etc

Diagnosis :
1. Dengue NS1 Antigen- positive in high titre upto 3 days
2.PCR
3.IgM - positive in high titre after 3-5 days etc

Ref: Guideline by DGHS 

Status Asthmaticus: Acute severe asthma is called status asthmaticus.
 
Feature of Acute severe asthma
*PEF 33-50% predicted (<200 L/min)
*Heart rate >110 beats/min
*Respiratory rate ≥ 25 breaths/min
*Inability to complete sentences in 1 breath

Life-threatening features
*PEF 33% predicted (<100 L/min)
*SpO2 <92% or PaO2 < 8 kPa (60 mmHg) (especially if being treated with oxygen)
*Normal or raised PaCO2
*Silent chest
*Cyanosis
*Feeble respiratory effort
*Hypotension Exhaustion
*Bradycardia or arrhythmias
*Delirium
*Coma

Ref: Davison+ Harrison+Macleod clinical examination

Infections transmitted due to contaminated dental instruments during invasive procedure :

Hepatitis Virus: HAV, HBV, HCV, HDV, HGV
Retro virus: HIV-1, 2 and HTLV
Herpes virus: CMV, EBV, HHV-8
Parvo virus: Parvo virus B19
Others: West Nile virus, transfusion transmitted virus

Ref: Cawson+ Davison + Macleod 

Disease due to Vitamins  Deficiency :
Vitamin A- Night blindness 
Vitamin D - Rickets, osteomalacia
Vitamin C- Impaired wound healing
Vitamin B1- Peripheral nerve damage
Vitamin B2- Angular Cheileitis, stomatitis 
Vitamin K- Impaired blood clotting etc

Ref- Davidson

Types of fever with example :
1.Continued fever: 
Typhoid fever
Typhus 
Drug fever
Malignant hyperthermia

2. Intermittent Fever:
Malaria fever

3.Remittent fever:
Infective endocarditis

Ref: Macleod + Davidson

Bite marks are caused by teeth pressing into a surface — so humans, animals, and even saw blade can show bite marks due to actual biting.

Ref: SS Hiremath

Explanation:
When a doctor attends a patient while being drunk, it goes beyond a simple mistake — it shows a gross disregard for the patient’s safety and standard medical care.

 Civil negligence means failure to take reasonable care, which may cause harm and usually results in a civil lawsuit for compensation.
 Criminal negligence involves such a high degree of carelessness or recklessness that it is considered an offense against society, punishable under criminal law.
 Contributory negligence means the patient’s own negligence contributed to the harm — which is not the case here.

Being intoxicated while treating a patient is so dangerous and reckless that it is classified as criminal negligence. It may lead to criminal charges like causing harm or even manslaughter if the patient dies due to the doctor’s condition.

Explanation:

Intentional tort means a deliberate act that violates another person’s legal rights. Examples include defamation, invasion of privacy, battery, false imprisonment, etc.
Posting a patient’s photo without permission is a clear violation of their right to privacy and confidentiality — done intentionally, not by accident. So it is an intentional tort (specifically, invasion of privacy).
Professional negligence means failing to follow standard care, but unintentionally — here, it’s not just a careless act; it’s an intentional breach of privacy.
Assault means creating a fear of harmful or offensive contact — not applicable here.
Malpractice is a general term for professional negligence causing harm — but this act is intentional, so it’s categorized more specifically as an intentional tort.

Same as previous explanation 

Explanation:
 Forensic odontology deals with the use of dental knowledge in legal investigations. Main areas covered include:

Sex determination → By analyzing teeth size, morphology, DNA from pulp.
Race determination → By studying morphological dental traits (shovel-shaped incisors, cusp patterns).
Skeletal analysis → Teeth help estimate age, identify remains, and analyze trauma to jaw and facial bones.
 Hypothesis testing, however, is not a core area of forensic odontology. It is a general scientific method used in all research fields, not a specific forensic dental application.

Ref: SS Hiremath

Assult, battery, defamation are intetional tort

 A patient record is a legal and medical document that should include only relevant clinical and administrative information about the patient’s health, diagnosis, treatment and related communication.

 Included in patient record:

Chief complaint — the main reason the patient seeks care; fundamental part of the history.
Referring party — records who referred the patient; important for communication and accountability.
Treatment recommendation — clinical advice given by the doctor; part of treatment planning.
Financial condition — the patient’s income level or ability to pay is not a medical or clinical detail; it is an administrative or billing matter, kept separately. Including it in the clinical patient record is unnecessary and can be unethical.

Therefore, the correct answer is: গ) Financial condition

Explanation:
 Patient medical records are confidential documents protected under medical ethics and privacy laws. They cannot be disclosed to police or anyone else without valid consent or legal authority.


ক) if the doctor dies — Irrelevant; the doctor’s death does not remove the patient’s right to confidentiality.
খ) if the patient dies — Confidentiality survives even after the patient’s death; disclosure requires legal authority or next-of-kin permission.
গ) if the patient complains — If the patient files a complaint, they may allow disclosure, but the police still usually need proper legal requisition or patient consent.
ঘ) if there is a requisition from the court —  This is the correct legal situation. If a court issues an order or summons, the doctor is legally bound to produce the records.
 So, medical records can rightfully be given to police only with:

Patient consent, OR
Court order/requisition (subpoena) — then it is mandatory.
 Correct option: ঘ) if there is a requisition from the court

AS A MEMBER OF THE MEDICAL PROFESSION:

I SOLEMNLY PLEDGE to consecrate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTICE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely and upon my honour.

Owner of dental record 
practitioner concerned
in case of employee is employer
Hospital 
clinic

Explanation:
 Res ipsa loquitur means “the thing speaks for itself” — it applies to cases where the negligence is so obvious that it needs no further proof.
 Extracting the wrong tooth is a classic example:
It’s an error that should not happen if proper care is taken.

The fact that the wrong tooth was removed proves negligence by itself.
Other options:

Failing to acquire accurate medical history — needs proof of harm; not obviously self-explanatory.
Slander by gesture/words — these are defamation, not negligence.
So, extracting the wrong tooth is a case of res ipsa loquitur.

Ref: SS Hiremath