AAPD QE Board Exam Questions and Answers

AAPD QE Board Exam Questions and Answers What layer do neural crest cells develop from? Ectoderm At what embryonic age does the dental lamina begin to develop? 6 weeks What are the three components of the tooth bud? Enamel Organ Dental papilla Dental sac What are the three morphologic stages of a developing tooth bud? Bud stage Cap stage Bell stage During the bell stage invagination of the epithelium occurs, which layer is essential for enamel production? Stratum intermedium Which cells does the stellate reticulum support and protect? Ameloblasts What do remnants of Hertwig's epithelial root sheath persist as? Rests of Malassez What is the origin of the dental papilla? Neural crest cells What does the dental papilla differentiate in to? Dentin and primordium of pulp What are enamel pearls? Cells of epithelial root sheath that remain attached to dentin. Differentiate into ameloblasts and produce enamel What are the 7 steps (in order) of histophyisological differentiation of a tooth bud? Initiation Proliferation Histodifferentiation Morphodifferentiation Apposition Mineralization Maturation During which stage of tooth development may problems that lead to anomalies of tooth number occur? Initiation Which three stages of tooth development encompasses the bud, cap, early bell and late bell? Proliferation Histodifferentiation Morphodifferentiation Disruptions of proliferation may result in what type of tooth anomalies? (4) Size Proportion Numbers Twinning Which stage of tooth development may lead to anomalies of the enamel, dentin, and cementum? Morphodifferentiation What is the incidence of hyperdontia? Males vs females? 0.3 - 3% Males 2:1 females Is hyperdontia more common in maxilla or mandible? More common in primary teeth or permanent teeth? Maxilla 90% Permanent dentition 5x more common that primary Which permanent teeth are most frequently missing? List in order from most to least common Third molars Mandibular second pre molars Maxillary lateral incisors Maxillary second pre molars Name 9 syndromes that may be associated with supernumerary teeth Apert Cleidocranial dysplasia Gardner syndrome Crouzon syndrome Sturge Weber syndrome Orofacialdigital Syndrome I Hallermann-Strieff Syndrome - A Cleft lip and palate Down syndrome Which syndrome is associated with shovel shaped incisors? A. Sturge Weber Syndrome B. Cleidocranial dysplasia C. Apert syndrome D. Hallermann Strieff Syndrome-A C. Apert Syndrome Narrow high palate Cleft of soft palate Delayed or ectopic eruption Shovel shaped incisors Hypoplastic midface Which syndrome is associated with osteomas of the jaw? A. Orofiaciodigital Syndrome I B. Apert Syndrome C. Crouzon Syndrome D. Gardner Syndrome D. Gardner Syndrome Delayed eruption Supernum teeth Osteomas of the jaw Agensis of third molars is associated with agenesis of which permanent tooth? Maxillary lateral - either one or both What is the inheritance pattern for non syndromic hypodontia? Autosomal dominant Which teeth (from most to least) commonly present as microdontia? Lateral incisors Second pre molars Third molars Which tooth anomaly is characterized by: abortive attempt by single tooth to divide; bifid crown with single root and pulp chamber? Gemination Which tooth anomaly is characterized by: complete cleavage of single bud results in supernum mirror image tooth? Twinning Which race is fusion of teeth most commonly seen? Japenese (5%) Which tooth anomaly is characterized by: dental union of 2 embryologically developing teeth two separate pulp chambers; separate or fused canals appear as large bifid crown with one chamber; dentin is always confluent? Fusion Which tooth anomaly is characterized by fusion after root formation is completed? What is a common cause? Concresence Etiology: trauma What class drug is chloral hydrate? Non-barbituate Sedative hypnotic What is the dosing range for Chloral Hydrate? What is the max dose? 25 - 50 mg/kg (typically with CCHMC triple, dose at 15 - 25 mg/kg) Max 100 mg What is the other name for Meperidine? What dug class is Meperidine? Demerol Opiod, narcotic What are the most common side effects of meperidine? Hypotension Respiratory depression Emesis Dizziness Neurotoxic metabolite What is the dosage (mg/kg) for meperidine? What is the max dose? 0.5 - 2 mg/kg Max: 50 mg What is the reversal agent for meperidine? At what dose? Naloxone (Narcan) 0.1 mg/kg, max dos of 2 mg What are 4 contraindications for the use of meperidine? - History of seizures: Lowers seizure threshold - Asthma: due to histamine release, can result in bronchospasms - Hepatic disease - Renal disease What are two other names for hydroxyzine? Vistaril Atarax What class drug is hydroxyzine? Antihistamine Anti-emetic What is the dosage of Hydroxyzine? What is the max dose? 0.5 - 1 mg/kg Max dose: 50 mg What is another name for Diazapam? What drug class is it in? Valium Benzodiazapine What are some common side effects of Diazapam? Anxiolytic Amnesic Muscle relaxant CNS depression Minimal CV or respiratory effects What is the dosage of Diazapam (mg/kg)? What is the max dose? 0.25 - 0.3 mg/kg Max: 10 mg What is the reversal agent of Midazolam/Diazapam? What is the dosage? Flumazanil 0.01 mg/kg (with a max dose of 0.2 mg - may repeat up to 4 times) What are the contraindications for Diazapam? Narrow angle glaucoma Potentiated by erythromycin, TCAs, valproic acid Increases digoxin levels What drug class is Midazolam? Benzodiazapiene What is the dosage of Midazolam? Oral: 0.25 - 0.75 mg/kg (max 15mg) Nasal: 0.2 - 0.3 mg/kg (max 10 mg) What are the contraindications for Midazolam? 2% have a paradoxical negative reaction Potentiated by erythromycin, antifungals, antacids, and grapefruit ( interferes with liver cytochromes, results in reduced first pass metabolism of medazolam and causes increased sedation) Inhibited by rifampin With Midazolam, how is the intranasal onset and effect different from the oral effect? Intranasal - mucosa links to CNS, provides plasma levels similar to IV (use lower dose because no first-pass metabolism) Oral - first-pass hepatic metabolism leads to low bioavailability. Relatively safe if using only one drug - combination increases risk of adverse outcome What are the monitoring requirements for deep sedation? 1. One person available for monitoring 2. EKG monitor used, pediatric defibrillator readily available 3. IV line placed at start of procedure (or person capable of placing IV immediately available) What does pulse-oximetry measure? Peripheral oxyhemoglobin saturation (peripheral lags behind central) What is the heart rate of a healthy 4 year old? 10 year old? 4 year old: 100 bpm 10 year old: 90 bpm How big should a blood pressure cuff be? 2/3 upper arm length (Small gives high reading, large gives low reading) What 4 ways is the airway anatomy different in children than adults? 1. Narrow trachea, glottis, nasal passages 2. Larger tongue, epiglottis 3. Small mandible 4. Increased airway resistance What are the specific requirements for moderate sedation rescue? Bag-valve-mask ventilation Advanced pediatric airway skills training