Loading...
Question 1
Examples of Joint Disorders
Nonsteroidal anti-inflammatory drugs (NSAIDs)
Statins
• Gout • Osteoarthritis
Calcium channel blockers
Question 2
What is the primary cause of gout?
deposition of monosodium urate (MSU) crystals → acute inflammation (due to excessive nucleotide turnover or decreased excretion)
deposition of calcium crystals
deposition of potassium chloride crystals
deposition of sodium chloride crystals
Question 3
Risk factor for gout?
genetic predisposition
female sex
male sex, genetic predisposition, diet, hypertension, diabetes, kidney disease and medications like thiazide diuretics and aspirin
diabetes
Question 4
What process is initiated by MSU crystals in the synovial fluid?
fibrosis
inflammatory process
inflammatory process
coagulation process
Question 5
What are the primary symptoms of the condition described?
Inflammation, pain and joint swelling
Shortness of breath, cough, and chest pain
Nausea, vomiting, and diarrhea
Fatigue, fever, and rash
Question 6
What is the diagnostic method for gout
MRI scans
X-ray imaging
Blood tests for antibodies
Identification of MSU crystals
Question 7
Treatment for acute flare of gout
NSAIDs and steroids to control inflammation
Question 8
What is the long-term treatment approach for this condition?
Antibiotics
urate lowering therapy like allopurinol
Pain relievers
Antidepressants
Question 9
What is the most common form of age-related joint disease?
Gout
Osteoarthritis
Rheumatoid Arthritis
Fibromyalgia
Question 10
Which joints are commonly affected by osteoarthritis?
Elbow and wrist joints
Foot and toe joints
Synovial joints Knee, hip, hand, and spine joints
Ear and jaw joints
Question 11
Cause of osteoarthritis
destruction of the articular cartilage → joint damage
Question 12
What are the primary risk factors for osteoarthritis?
Male, older age (>70), underweight, no joint trauma
Female, older age (>60), obesity, and joint trauma
Female, younger age (<40), normal weight, no family history
Male, younger age (<30), thinness, no joint trauma
Question 13
What are the primary symptoms of osteoarthritis?
• Pain and burning, worse with activity • morning stiffness • Motor restriction • Joint noises or grinding sounds
Severe morning stiffness lasting hours, joint swelling, fever
No joint noises, no morning stiffness, severe motor restriction
Pain and burning sensation in non-weigh-bearing joints, constant stiffness
Question 14
Treatment options for osteoarthritis?
Antibiotics, physical therapy, bed rest
Diuretics, blood thinners, painkillers
NSAIDs, intra-articular glucocorticoids, lifestyle and surgery
Antidepressants, muscle relaxants, hot compresses
Question 15
What is the most common type of inherited dwarfism?
Hypochondroplasia
Gigantism
Achondroplasia
Pituitary dwarfism
Question 16
Etiology of achondroplasia
Loss of function mutation
Silent mutation
Gain of function mutation
Frameshift mutation
Question 17
What does the gain of function mutation in FGFR3 inhibit?
Chondrocyte proliferation
Collagen synthesis
Bone formation
Cartilage synthesis at the epiphyseal growth plate
Question 18
Characteristics of achondroplasia
• Disproportionate dwarfism • Bowed lower legs, and trident hand • Flat bones (skull, trunk) are usually normal leading to relatively large head and trunk. • Crowded/misaligned teeth, and maxillary hypoplasia
Question 19
What is the medical term for short and thick extremities?
Disproportionate dwarfism
Short stature
Thin extremities
Long bone syndrome
Question 20
What condition is characterized by extra space between the middle and ring fingers?
Trident hand
Short fingers
Webbed fingers
Curved fingers
Question 21
What is the medical condition known as 'Marble bone disease'?
Osteopetrosis
Osteoporosis
Fibrodysplasia
Osteosarcoma
Question 22
Types of osteopetrosis
1. Autosomal recessive “Infantile malignant type” 2. Autosomal dominant “Adult benign type” (osteopetrosis tarda)
Question 23
Cause of osteopetrosis
• Hereditary • decreased osteoclast function and decreased bone resorption • dense, thickened but defective bones (stone bones) that can fracture easily
Question 24
What is the genetic cause of the autosomal recessive 'infantile' condition?
mutations in carbonic anhydrase 2 (CA2) gene impairs the ability of osteoclasts to generate acidic environment
Question 25
Symptoms of autosomal recessive osteopetrosis?
skeletal dysplasia
skeletal fibrosis
• Impaired growth • skeletal sclerosis (abnormal hardening), • bones fracture easily • bone marrow failure (pancytopenia) • vision and hearing impairment • delay in tooth eruption • enamel hypoplasia • caries
skeletal myopathy
Question 26
What is the genetic cause of the autosomal dominant 'Adult benign type' condition?
mutations in calcium channel 7 gene
mutations in chloride channel 7 (CLCN7) gene
mutations in potassium channel 7 gene
mutations in sodium channel 7 gene
Question 27
What are the symptoms of the autosomal dominant 'Adult benign type' condition?
ranging from fatigue to muscle weakness
ranging from mild headaches to severe vision loss
ranging from asymptomatic to pathological fractures, vision/hearing loss
ranging from joint pain to skin rashes
Question 28
Management options for the congenital form of osteopetrosis?
Bone marrow transplant and Supportive: calcium, vit. D supplementation, erythropoietin
Kidney transplant
Heart transplant
Liver transplant
Question 29
Management of Osteopetrosis Tarda
supportive to repair fractures, physical therapy
Question 30
What causes Osteogenesis Imperfecta?
viral infections
environmental factors
hormonal imbalances
autosomal dominant mutations • genes encoding α1 and α2 chains of type I collagen • (example: COL1A1 and COL1A2) • leading to
defective collagen type I synthesis
Question 31
What are the types of Osteogenesis Imperfecta?
Ten main types
Five main types
Three main types
Seven main types
Question 32
What are common symptoms of Osteogenesis Imperfecta?
fatigue and muscle weakness
Brittle bone, blue discoloration for the sclera, hearing loss
skin rashes and joint pain
fever, rash, and cough
Question 33
Dentinogenesis imperfecta results in...
small, fragile, and discolored teeth due to dentin deficiency
Question 34
Treatment of osteogenesis imperfecta
bisphosphonates, surgical, physical therapy
Question 35
What is Paget's Disease?
A type of arthritis
Increased bone remodeling of undetermined cause affects adults over 50 years old
A genetic disorder affecting children
A bacterial infection of the bones
Question 36
What happens in the lytic phase of Paget's disease
Mixed phase
Increased osteoclast activity, causing lytic lesions
Remodeling phase
Osteosclerotic phase
Question 37
What happens in the mixed phase of Paget's disease
• OC activity with highly increased OB activity • produces a disorganized bone → deformed bone
Question 38
What happens in the Osteosclerotic phase of Paget's disease
OB activity is predominant → disorganized, thicker and weaker bone
Question 39
What is the predominant activity in the osteosclerotic phase of Paget's Disease?
Fibroblast activity
Chondroblast activity
Osteoclast activity
Osteoblast activity
Question 40
Symptoms of Paget's disease
immediate bone pain
severe headaches
constant fever
depend on severity and stage • initially asymptomatic • bone pain • increase risk of fractures • bone deformation • enlarged skull • enlarged jaw bones.
Question 41
Management approach for Paget's Disease
antibiotics
surgery
bisphosphonates and calcitonin
physical therapy
Question 42
What is Osteomalacia
Rickets Bone softening disease
Question 43
What is the primary cause of osteomalacia in adults?
Vitamin C deficiency
Defective collagen synthesis
Increased calcium intake
defective mineralization of bone matrix or cartilaginous growth plates
• secondary to vit D deficiency • Decreased vit D = ↓ serum calcium, ↑ PTH, ↓ phosphate level
Question 44
Symptoms of osteomalacia - Children
Softening of the bones
• softening of the bones • impaired bone growth • altered gait/bowlegs
Impaired bone growth
No changes in gait
Question 45
Symptoms of osteomalacia - Adults
bone fragility, increase risk of fracture or falls, bone/joint pain
Question 46
What is the main treatment for osteomalacia?
Surgery
Vit D and correction of calcium intake
Phosphorus supplements alone
Calcium supplements alone
Question 47
What is the most common bone disorder?
Fibromyalgia
Osteoarthritis
Rheumatoid Arthritis
Osteoporosis
Question 48
What is osteoporosis?
muscle weakness
joint inflammation
high bone density
low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility
Question 49
Osteoporosis characteristics
Fibromyalgia
Rheumatoid arthritis
Osteoarthritis
– Loss of bone matrix – Thinning of cortical bone – Increased bone fractures – Localized or generalized
Question 50
Statistics on osteoporosis
15%
25%
30%
• Women (50+) = 19.5% • 1.5 million fractures annually • vertebral > hip + pelvic fractures
Question 51
Which type of fracture is most commonly caused by osteoporosis?
pelvic fractures
wrist fractures
vertebral fractures
hip fractures
Question 52
What is the term for the peak bone mass that occurs during early adulthood?
Peak Bone Mass
Bone Formation Peak
Early Bone Mass
Maximum Bone Density
Question 53
Which hormone is associated with increased bone resorption during menopause?
Testosterone
Estrogen
Cortisol
Insulin
Question 54
What is the primary factor leading to increased bone resorption in menopausal osteoporosis?
Increased calcium intake
Increased testosterone levels
Increased vitamin D levels
Decreased estrogen levels
Question 55
Pathophysiology of menopausal osteoporosis
Decreased estrogen → increase inflammatory cytokines (IL-6, TNF-α, and IL-1) Increase RANKL + decrease OPG → increased OCs → higher bone resorption
Question 56
Pathophysiology of senile osteoporosis
Bone marrow cells differentiate into more adipocytes rather than OBs → diminished capacity to make bone
Question 57
What is the approximate annual bone loss rate in senile osteoporosis?
0.3 %/year
1.0 %/year
1.5 %/year
0.7 %/year
Question 58
What medications can increase the risk of osteoporosis?
• Glucocorticoids: decrease serum calcium, increase osteoclast survival • Prednisone: increase risk for osteoporosis. • Thyroxin: decrease bone mineralization density, increase risk of fractures • Heparin: enhance OC activity, inhibits OPG • PPIs: Ca+2 absorption • anticonvulsants: increase CYP450 → metabolize vit. D
Antihistamines
Antidepressants
Antibiotics
Question 59
What conditions can lead to osteoporosis
• Hyperparathyroidism • diabetes • malabsorption diseases • alcoholism • reduced physical activity
Hypertension
Hyperthyroidism
Hyperlipidemia
Question 60
What does a DEXA scan primarily test?
Blood pressure
Bone density
(Dual Energy X-Ray Absorptiometry)
Heart rate
Muscle mass
Question 61
What is the T-score threshold for diagnosing osteoporosis?
≤ -1.5
≥ -2.5
≤ -3.0
≤ -2.0
Question 62
According to WHO criteria, what is considered a normal T-score range?
≥ -1.5
≥ -2.0
>-1.0
>-2.5
Question 63
Symptoms of osteoporosis
Loss of height
Fractures
• asymptomatic until fracture • Back pain • Spontaneous fracture • fracture with minor falls • Spinal kyphosis • Loss of height (common)
Spontaneous fracture
Question 64
Where are spontaneous fractures commonly found?
Vertebra (thoracic & lumbar) weight bearing: femur, neck or pelvis
Ribs
Femur
Pelvis
Question 65
What type of exercise is recommended for bone remodeling?
Cycling
Swimming
Weight training
Yoga
Question 66
Which lifestyle change is recommended to prevent osteoporosis?
Increased caffeine intake
Reduced sleep
No dietary changes
nutrition, exercise, smoking cessation, limit alcohol
Question 67
What is one of the key pharmacological treatments for osteoporosis?
Surgery alone
Bisphospohonates & Denosumab
Physical therapy alone
Dietary supplements alone
Question 68
Hormonal treatment options for osteoporosis?
• Calcitonin: reduces bone resorption • Roloxifene: estrogen receptor modulator • Teriparatide: form of PTH
Question 69
What is the primary function of calcitonin in osteoporosis treatment?
Reduces the bone resorption and increase bone building
Reduces muscle pain
Increases bone density
Stimulates bone growth
Question 70
Indications of calcitonin
• postmenopausal osteoporosis • corticosteroid induced osteoporosis • hypercalcemia • Paget's disease
Question 71
What is the role of teriparatide in osteoporosis treatment?
recombinant form of human parathyroid hormone • stimulates OB → reduces apoptosis → builds bone
Selective estrogen receptor modulator
Reduces bone resorption
Antibiotic for bone infections
Question 72
How often is Teriparatide typically given?
Intravenously once a month
Intramuscularly every other day
Subcutaneously once a day
Oraly once a week
Question 73
What is the primary function of Raloxifene?
A recombinant form of estrogen
A synthetic analog of progesterone
Selective estrogen receptor modulator (SERM)
A non-steroidal anti-inflammatory drug
Question 74
Raloxifene MOA
Partial agonist: estrogen receptors in bones Antagonist: estrogen receptors in breast tissue
Question 75
What is the mechanism of action (MOA) of Denosumab?
binds to calcium receptors
monoclonal antibody
against
RANKL Reduces OC differentiation and function
stimulates bone marrow cells
inhibits osteoblast activity
Question 76
What is the primary indication for Denosumab?
treatment of childhood obesity
management of prostate cancer
treatment of rheumatoid arthritis
postmenopausal osteoporosis in women at high risk of fracture
Question 77
Adverse effects of denosumab
hypocalcemia, MRONJ and increased risk of infections
Question 78
What are simple, non-nitrogenous bisphosphonates?
Risedronate
Clodronate
Ibandronate
Etidronate, Tiludronate
Question 79
What is the mechanism of action (MOA) of Etidronate and Tiludronate?
Cause osteoclast apoptosis and decrease bone resorption.
Stimulate bone formation
Increase bone density by promoting mineralization
Prevent bone loss through calcium absorption
Question 80
What are the side effects of Etidronate and Tiludronate?
MRONJ, Abnormal taste sensation.
Diarrhea and abdominal pain
Dizziness and headache
Skin rash and itching
Question 81
What is the primary indication for the use of Etidronate and Tiludronate?
Prevention of cardiovascular diseases
Management of rheumatoid arthritis
Treatment of Paget disease of the bone.
Treatment of gout
Question 82
Nitrogenous biphosphonate examples
alendronate risedronate zoledronate
Question 83
Nitrogenous bisphosphonates MOA
bind to hydroxyapatite crystals in the teeth
decrease bone formation in the body
increase bone density in plants
bind to hydroxyapatite crystals → decrease osteoclastic bone resorption → increase bone mass + decrease fractures
Question 84
Which bisphosphonates have an antiresorptive activity of 10,000?
Ibandronate
Alendronate
Risedronate
Ibandronate + Zoledronic acid
Question 85
What is the primary reason for taking oral bisphosphonates with water?
To decrease GI side effect • take on empty stomach and sit upright for 30 minutes
To prevent stomach upset
To increase absorption rate
To enhance taste
Question 86
What is the bioavailability of intravenous bisphosphonates?
40%
80%
60%
20%
Question 87
What organ system should avoid bisphosphonates?
Kidney
Heart
Liver
Severe renal impairment bc biphos are renally eliminated
Question 88
Characteristics of biphosphonate absorption
• rapidly up taken by the bones • bind to the hydroxyapatite • cleared at a very slow rate Ex. alendronate half life = 10 yrs
Question 89
Indications for bisphosphonate therapy?
Common cold
Gastroesophageal reflux disease
Rheumatoid arthritis
• Osteoporosis • Paget’s disease • Metastatic bone diseases • Osteogenesis imperfecta
Question 90
Adverse effects of Bisphosphonates?
Diarrhea
Headache
Nausea and vomiting
Skin rash
Question 91
Which of the following factors increases the risk of MRONJ?
No previous medical history
Oral route
Low potency medication
High drug dosage
Question 92
What is MRONJ?
Medication-induced necrosis of the jaw
Medication-induced jaw necrosis
Medication-related jaw necrosis
Medication-related osteonecrosis of the jaw
Question 93
Which drugs are commonly associated with MRONJ?
Anticoagulants
Antidepressants
Antibiotics
Bisphosphonates, denosumab, and other drug classes
Question 94
What are the symptoms of MRONJ?
Intraoral exposed bone, delayed healing, inflammation, or pain, and swelling especially following tooth extraction
Nausea, vomiting, and diarrhea
Fatigue, muscle pain, and joint pain
Fever, chills, and night sweats
Question 95
What is the primary treatment associated with more than 90% of MRONJ cases?
Low doses of IV bisphosphonates
Oral bisphosphonates
high doses of IV bisphosphonates or SC denosumab (120 mg every 4 weeks) therapy
Hormone replacement therapy
Question 96
How long must exposed or necrotic bone in the mandible or maxilla persist for a patient to be considered to have MRONJ?
more than 8 weeks
more than 12 weeks
more than 4 weeks
more than 6 weeks
Question 97
What type of patient is categorized as an osteoradionecrosis (ORN) patient?
a patient with a prior immunotherapy
a patient with a prior radiation therapy
a patient with a prior surgery
a patient with a prior chemotherapy
Question 98
What is the primary location for MRONJ to appear?
floor of the mouth
tongue
mandible
palate
Question 99
Which type of dental procedure is reported as a causative factor for MRONJ?
orthodontic adjustment
tooth extraction
trauma, pre-existing inflammatory dental diseases, poor oral hygiene, dentures
root canal
teeth cleaning
Question 100
What type of tumors are associated with a higher risk of MRONJ?
skin cancer
lung cancer
stomach cancer
myeloma
Question 101
What genetic factor is associated with a sixfold increase in MRONJ risk?
variations in the BMPR2 gene
polymorphisms in the RBMS3 gene
mutations in the COL1A1 gene
changes in the VDR gene
Question 102
Comorbidities associated with a higher risk of MRONJ?
diabetes mellitus
anemia
renal failure
anemia, diabetes mellitus, and renal failure
Question 103
Why is the jawbone turnover significantly higher than many other bones?
Because of increased muscle activity
Due to higher calcium absorption
Higher exposure to oral bacteria
• Alveolar bone turnover significantly higher - incorporate more bisphos • least-protected from infection - proximity to oral microflora • mechanical stress • Embryonic origin
Question 104
Factors of MRONJ
• inhibition of OC activity • inhibition of angiogenesis • inflammation/infection • soft tissue toxicty
Question 105
What is the primary factor leading to the inhibition of angiogenesis?
Increased bone density
Enhanced osteoclastic activity
Decreased soft tissue toxicity
Reduced inflammation
Question 106
What is the primary cause of soft tissue toxicity?
Systemic and local oral risk factors
Inhibition of angiogenesis
Decreased bone resorption and remodeling
Increased apoptosis of multiple cell types (bisphosphonates)
Question 107
What is the first step in the prevention process?
Surgical screening
Pretherapy: Dental exam and screening
Dental cleaning
Medical exam and screening
Question 108
What should be discussed during antiresorptive therapy?
Exercise routine
Medication dosage
Patient education, OHI, follow up
Dietary restrictions
Question 109
What is a key technique used in emergency dental care?
• coordination of care between providers • surgical/conservative techniques • drug holiday (controversial)
Medication increase
Dental cleaning
Surgical intervention
Question 110
What is the description for patients in the 'At risk category'?
Patients with exposed and necrotic bone
• Asymptomatic patients treated with IV/oral antiresorptive therapy • No apparent necrotic bone
Patients with a history of pathologic fracture
Patients with pain and infection
Question 111
Patients at Stage 1 of MRONJ
Magnetic resonance imaging
Angiogenesis exploration
• Exposed and necrotic bone/fistula probes to the bone • asymptomatic patients • no evidence of infection/inflammation
Biomarkers for bone turnover
Question 112
What is the description for Stage 2 patients?
Patients with exposed bone and no symptoms
Asymptomatic patients with no evidence of infection
Patients with pain but no infection
• Exposed, necrotic bone/fistula that probes to the bone • patients are symptomatic • clear signs of infection or inflammation
Question 113
Stage 3 of MRONJ
• Exposed and necrotic bone or fistulae that probes to the bone • pain, infection, 1+ of: • fracture, extra-oral fistula, osteolysis in inferior border of mandible or sinus floor
Question 114
What is the MRONJ staging for patients with no clinical evidence of necrotic bone but non-specific clinical findings?
Stage 1
Stage 3
Stage 0
Stage 2
Question 115
Which stage involves exposed and necrotic bone or fistula that probes to bone, associated with infection as evidenced by pain and/or drainage?
Stage 0
Stage 2
Stage 1
Stage 3
Question 116
What is the recommended treatment for Stage 3 MRONJ?
Antibiotics and pain control
Surgical debridement/resection for longer term palliation of infection and pain
Symptomatic treatment with oral antibiotics
Systemic management including pain medication and antibiotics