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The presentation of burning mouth, depapillation of the tongue (atrophic glossitis), and angular cheilitis strongly suggests a Vitamin B12 deficiency. Vitamin B12 is essential for maintaining the integrity of the oral mucosa and nerve function. Deficiency leads to mucosal atrophy, causing a smooth, sore tongue and burning sensation. Angular cheilitis arises from mucosal breakdown and secondary infection. These findings are classic in Vitamin B12 deficiency anemia and are less prominent in other deficiencies.

Reference: Oral Pathology, Neville et al., 4th Edition.
The cobblestone appearance of the buccal mucosa is a classic oral manifestation of Crohn’s disease, resulting from granulomatous inflammation that causes swelling and fissuring of the mucosa. This pattern reflects the underlying transmural inflammation and edema characteristic of Crohn's, differentiating it from other oral lesions. It is often accompanied by aphthous ulcers and linear ulcerations. Recognizing this feature helps in the early diagnosis of Crohn’s disease, especially when gastrointestinal symptoms are absent or mild.

Reference: Oral Pathology, Neville et al., 4th Edition.
The most important initial step in managing an avulsed permanent tooth is immediate reimplantation or, if not possible, storing the tooth in an appropriate medium like milk or saline to preserve periodontal ligament cell viability. This approach maximizes the chances of successful reattachment and reduces the risk of complications such as ankylosis or root resorption. Prompt dental referral is crucial for proper assessment and stabilization. Avoiding delays or inappropriate handling improves long-term prognosis of the tooth.

Reference: *Andreasen and Andreasen, Traumatic Dental Injuries, 3rd Edition.*
The presentation of multiple missing teeth (hypodontia), conical-shaped teeth, and inability to sweat (anhidrosis) strongly indicates ectodermal dysplasia, a genetic disorder affecting ectodermal structures such as teeth, hair, nails, and sweat glands. The inability to sweat leads to problems with thermoregulation, which is a hallmark of this condition. The characteristic dental abnormalities, especially conical teeth and hypodontia, are key diagnostic features. These clinical findings distinguish ectodermal dysplasia from other syndromes or conditions that affect the dentition but do not impair sweating.

Reference: Nelson Textbook of Pediatrics, Kliegman RM, 21st Edition.
Granulomatosis with polyangiitis (GPA) is a systemic vasculitis characterized by necrotizing granulomatous inflammation affecting small to medium vessels. "Strawberry gingivitis" is a distinctive oral manifestation of GPA, presenting as a hyperplastic, erythematous, and hemorrhagic gingival lesion resembling the surface of a strawberry. This appearance results from underlying granulomatous inflammation and vasculitis. Recognizing strawberry gingivitis is crucial as it can be an early clinical sign of GPA, prompting timely diagnosis and treatment to prevent systemic complications. Other listed conditions do not typically present with this oral finding.

Reference: Oral Pathology, Neville, 4th Edition.
Medication-related osteonecrosis of the jaw (MRONJ) occurs in patients with a history of bisphosphonate therapy due to inhibition of osteoclast-mediated bone resorption, leading to impaired bone remodeling and healing. The hallmark clinical finding is exposed necrotic bone in the mandible or maxilla lasting more than 8 weeks without prior radiation to the area. MRONJ is different from osteomyelitis as it is primarily a drug-induced avascular necrosis rather than an infectious process. Surgical management should prioritize conservative debridement to minimize worsening of necrosis and preserve bone. Early diagnosis and avoidance of invasive dental procedures are essential to prevent progression.

Reference: Oral and Maxillofacial Pathology, Neville, 4th Edition.
The lateral border of the tongue is the most common site for oral squamous cell carcinoma due to its thin, non-keratinized mucosa and high exposure to carcinogens like tobacco and alcohol. This area has a rich lymphatic supply, facilitating early metastasis. Clinically, lesions here often present as ulcerative or exophytic growths, requiring careful surgical excision with clear margins to prevent local recurrence. Early recognition and biopsy of suspicious lesions on the lateral tongue are critical for improving prognosis. Reference: Oral and Maxillofacial Pathology, Neville et al., 4th Edition.
Phenytoin is an antiepileptic drug well-known for causing gingival hyperplasia as a side effect. This occurs due to the drug’s effect on fibroblast proliferation and extracellular matrix production in the gingival tissues. Clinically, this manifests as an overgrowth of the gums, which can lead to discomfort, difficulty in oral hygiene, and increased risk of periodontal disease. Patients on phenytoin require regular dental monitoring to manage this side effect effectively. Unlike warfarin or metformin, phenytoin’s impact on gingival tissues is direct and dose-dependent.

Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.
The patient’s sudden facial swelling, fever, and difficulty swallowing following a dental extraction strongly suggest a deep neck space infection. These infections often arise from odontogenic sources and can rapidly progress, causing airway compromise. Prompt recognition and early surgical drainage combined with intravenous antibiotics are critical to prevent life-threatening complications such as airway obstruction or mediastinitis. Unlike mumps or angioedema, the presence of fever and recent dental procedure point toward a bacterial infection involving deep fascial spaces. Imaging and securing the airway are essential initial steps in management.

Reference: Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, Bennett et al., 9th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
Vitamin C deficiency (scurvy) impairs collagen synthesis, which is essential for maintaining the integrity of connective tissues, including the gums. This leads to fragile capillaries, resulting in swollen, bleeding gums and ultimately loose teeth due to weakened periodontal support. These oral manifestations are hallmark signs of scurvy. The other options (atrophic glossitis, oral leukoplakia, pigmented macules) are not specifically related to vitamin C deficiency but to other nutritional or pathological conditions.

Reference: Oral Pathology, Neville et al., 4th Edition.
The patient’s chronic renal failure leads to secondary hyperparathyroidism, causing increased osteoclastic activity and bone resorption, known as renal osteodystrophy. This manifests as jaw pain and radiolucent "brown tumors" in the mandible, representing areas of fibrous tissue and osteoclastic resorption. These lesions are characteristic of the metabolic bone disease related to renal failure, distinguishing it from infection or neoplastic causes. Recognition of this condition is critical to avoid misdiagnosis and guide appropriate management focused on correcting mineral imbalances.

Reference: Robbins Basic Pathology, Kumar et al., 10th Edition.
The most common cause of trismus in a dental patient is pericoronitis of the mandibular third molar. This condition involves inflammation of the soft tissues surrounding a partially erupted wisdom tooth, leading to pain, swelling, and spasm of the masticatory muscles. The infection and edema in the pericoronal flap restrict mandibular movement, resulting in trismus. Prompt management with local debridement, antibiotics, and possibly surgical extraction helps relieve symptoms and prevent progression. Other causes like TMJ dislocation, tetanus, and mumps are less common in the dental setting.

Reference: Oral and Maxillofacial Pathology, Neville, DD, 4th Edition.
The Abducens nerve (VI) is most commonly affected in cavernous sinus thrombosis because it runs within the lumen of the cavernous sinus, unlike the other cranial nerves that are located in the lateral wall. This anatomical position makes it highly vulnerable to compression or ischemia during thrombosis. Clinically, this results in lateral rectus muscle paralysis, manifesting as horizontal diplopia. Early recognition of abducens nerve palsy is crucial for diagnosis and management of cavernous sinus thrombosis secondary to dental infection.

Reference: Gray’s Anatomy, Standring S, 42nd Edition.
The presentation of recurrent oral ulcers, genital ulcers, and uveitis is characteristic of Behçet’s disease, a chronic, multisystem vasculitis. This triad is highly suggestive and differentiates it from other causes of ulcers. Recurrent mucocutaneous ulcerations combined with ocular inflammation (specifically uveitis) are hallmark features and key to diagnosis. Unlike aphthous ulcers or herpetic stomatitis, Behçet’s involves genital ulcers and significant systemic involvement. Stevens-Johnson syndrome typically presents with acute mucocutaneous blistering, not recurrent ulcers or isolated uveitis.

Reference: Harrison’s Principles of Internal Medicine, Jameson et al., 20th Edition.
Erythroplakia is considered the oral lesion with the highest risk of malignant transformation due to its association with severe epithelial dysplasia, carcinoma in situ, or invasive carcinoma upon biopsy. Clinically, it appears as a well-demarcated red patch that lacks the keratinization seen in leukoplakia, indicating more profound mucosal alteration. The vascularity and epithelial atrophy contribute to its red appearance and correlate with greater cellular atypia. Early surgical excision and close follow-up are critical because erythroplakia often represents a precursor to squamous cell carcinoma. In contrast, other lesions like leukoplakia have a lower and more variable risk of malignant change.

Reference: Oral Pathology, Neville et al., 4th Edition.
Ludwig’s angina is a rapidly progressive, potentially life-threatening cellulitis involving the submandibular space, commonly seen in diabetic patients due to immunocompromise. It causes painful swelling and elevation of the floor of the mouth, which can obstruct the airway. Immediate priority is to secure the airway to prevent respiratory compromise. Intravenous broad-spectrum antibiotics should be started promptly. Surgical drainage is indicated when there is evidence of abscess formation or airway compromise, to prevent further spread of infection. Early recognition and aggressive management significantly reduce morbidity and mortality.

Reference: Harrison's Principles of Internal Medicine, J. Larry Jameson, 20th Edition.
The most common oral manifestation of HIV infection is oral candidiasis, which occurs due to the immunosuppression caused by the virus, leading to an opportunistic fungal infection by Candida species. It presents as white, removable plaques on the oral mucosa and is often one of the earliest signs of HIV-related immunodeficiency. Oral candidiasis is highly prevalent in HIV-positive patients and serves as an important clinical marker of disease progression. Early identification aids in timely diagnosis and management of HIV infection.

Reference: Oral Pathology for the Dental Hygienist, Olga A. C. Ibsen, Joan Andersen Phelan, 7th Edition.
The cotton wool appearance seen on jaw radiographs is a characteristic radiographic feature of Paget’s disease of bone. This appearance results from the irregular, patchy sclerosis interspersed with lytic areas due to the disorderly bone remodeling process. The disease causes excessive osteoclastic resorption followed by chaotic osteoblastic bone formation, leading to the bulky, dense, and sclerotic regions resembling cotton wool. This distinguishes it from other systemic diseases affecting bone density or integrity. Recognizing this pattern is crucial for diagnosis and management.

Reference: Oral Radiology, White and Pharoah, 7th Edition.
Ameloblastoma typically presents as a painless, slow-growing swelling in the jaw, often in the posterior mandible. Radiographically, it characteristically appears as a multilocular radiolucency (soap-bubble or honeycomb appearance). This lesion is locally aggressive but benign, requiring wide surgical excision with clear margins to prevent recurrence. Unlike odontogenic keratocysts, ameloblastomas show more expansion and multilocularity. Dentigerous cysts are usually unilocular and associated with the crown of an unerupted tooth. Osteosarcoma presents with pain and mixed radiographic features, not painless multilocular radiolucency.

Reference: Oral and Maxillofacial Pathology, Neville et al., 4th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
Atrophic glossitis presents as a smooth, shiny tongue due to papillary atrophy, and angular cheilitis involves inflammation and fissuring at the corners of the mouth. Both are classic oral manifestations of iron deficiency anemia caused by impaired epithelial cell renewal and iron’s role in maintaining mucosal integrity. These changes result from iron’s essential function in oxygen transport and epithelial metabolism, leading to mucosal atrophy and susceptibility to secondary infections. Leukoplakia, oral lichen planus, and geographic tongue are not specific to iron deficiency anemia.

Reference: Oral Pathology, Neville et al., 4th Edition.
N-acetylcysteine (NAC) is the definitive antidote for paracetamol overdose because it replenishes hepatic glutathione stores, allowing safe metabolism of the toxic metabolite NAPQI. Without NAC, NAPQI accumulates and causes severe hepatocellular injury. Early administration (ideally within 8 hours) significantly reduces liver damage and improves patient outcomes. NAC also has antioxidant and anti-inflammatory properties that protect liver cells. This makes it the primary treatment, unlike options that only limit absorption or treat unrelated toxicities.

Reference: Harrison's Principles of Internal Medicine, Kasper et al., 20th Edition.
The first priority in a patient coughing up 200 ml of fresh blood (massive hemoptysis) is to protect the airway to prevent aspiration, airway obstruction, and respiratory failure. Securing the airway minimizes the risk of asphyxiation from blood flooding the trachea and bronchi. This may involve positioning, suctioning, or even intubation if necessary. Once the airway is secured, further diagnostic and therapeutic interventions can be safely performed. Immediate stabilization takes precedence over interventions such as antibiotics or vitamin K administration.

Reference: Bailey & Love’s Short Practice of Surgery, Norman S. Williams, 27th Edition.
The patient with malaria exhibiting high fever (41°C), seizures, and confusion likely has hyperpyrexia, a dangerous elevation of body temperature. This condition requires immediate active cooling measures to prevent further neurological damage. Additionally, intravenous antimalarials are essential to rapidly reduce parasitemia and control infection. Oral chloroquine is inadequate in severe malaria, and antibiotics or fluids alone do not address the primary cause. Prompt recognition and treatment of hyperpyrexia in malaria minimize mortality and complications.

Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.
The patient presents with severe asthma exacerbation characterized by wheezing, silent chest, and hypoxia (SpO2 85%), indicating life-threatening bronchospasm and airflow obstruction. The immediate priority is to reverse bronchoconstriction and improve oxygenation. Nebulized salbutamol (a short-acting β2-agonist) rapidly dilates bronchial smooth muscle, while ipratropium (an anticholinergic) provides additional bronchodilation by blocking muscarinic receptors. This combination is the first-line emergency treatment to restore airflow quickly. Oral corticosteroids and IV aminophylline have roles but act slower and are not immediate rescue treatments. Antibiotics are not indicated unless there is evidence of infection.

Reference: Harrison’s Principles of Internal Medicine, Fauci et al., 20th Edition.
The patient presents with massive hematemesis, hypotension, and tachycardia indicating active upper gastrointestinal bleeding with hemodynamic instability. The priority is rapid resuscitation with blood transfusion to restore circulating volume and improve oxygen delivery. Following initial stabilization, urgent endoscopy is essential for diagnosis and therapeutic intervention, such as variceal band ligation or sclerotherapy. Immediate correction of coagulopathy or other measures without addressing volume loss delays life-saving treatment. Nasogastric tube insertion or beta-blockers are secondary considerations.

Reference: Harrison's Principles of Internal Medicine, J. Larry Jameson, 20th Edition.
The presentation of confusion, dehydration, a blood glucose of 600 mg/dL, and positive urine ketones strongly indicates diabetic ketoacidosis (DKA). DKA is characterized by hyperglycemia, ketosis, and metabolic acidosis. Immediate treatment involves IV fluids to correct dehydration and insulin to reduce blood glucose and stop ketone production. This approach counteracts the underlying insulin deficiency causing ketogenesis and hyperglycemia. Electrolytes should also be monitored, especially potassium, but initial management prioritizes fluid resuscitation and insulin administration. This prevents progression to serious complications such as cerebral edema or cardiac arrhythmias.
Reference: Harrison's Principles of Internal Medicine, Jameson et al., 20th Edition.
The combination of absent breath sounds on the left, tracheal deviation to the right, and hypotension in a trauma patient strongly indicates a tension pneumothorax. This occurs due to air accumulating under pressure in the pleural space, causing lung collapse and mediastinal shift, which compresses the heart and major vessels leading to hypotension. The immediate life-saving intervention is needle decompression to relieve the pressure, followed by chest tube insertion. Delay in decompression can quickly result in cardiovascular collapse and death. Therefore, prompt recognition and emergency needle thoracostomy are critical.

Reference: Tintinalli's Emergency Medicine: A Comprehensive Study Guide, Judith E. Tintinalli, 9th Edition.
The patient is exhibiting signs of anaphylaxis, characterized by facial swelling, stridor, and hypotension following a bee sting. The immediate treatment is intramuscular (IM) adrenaline (epinephrine) 0.5 mg because it rapidly reverses airway obstruction, vasodilation, and hypotension by vasoconstriction, bronchodilation, and increasing cardiac output. Adrenaline is the first-line treatment and should be administered without delay to prevent progression to respiratory failure or cardiovascular collapse. Other therapies like hydrocortisone or antihistamines are adjuncts but have a delayed onset and are not substitutes for adrenaline. Nebulized salbutamol may help bronchospasm but does not address systemic vasodilation or shock.

Reference: Harrison’s Principles of Internal Medicine, Jameson et al., 20th Edition.
The patient’s presentation of sudden dyspnea, pink frothy sputum, and bilateral crackles in the context of heart failure is classic for acute pulmonary edema. This condition results from elevated hydrostatic pressure in the pulmonary capillaries causing fluid leakage into alveoli. Immediate treatment includes IV furosemide to reduce preload by promoting diuresis and nitrates to decrease both preload and afterload, thus rapidly improving pulmonary congestion and oxygenation. Quick intervention is critical to prevent respiratory failure and hemodynamic compromise.

Reference: Harrison’s Principles of Internal Medicine, J. Larry Jameson et al., 20th Edition.

ফ্রিতে ২ লাখ প্রশ্নের টপিক, সাব-টপিক ভিত্তিক ও ১০০০+ জব শুলুশন্স বিস্তারিতে ব্যাখ্যাসহ পড়তে ও আপনার পড়ার ট্র্যাকিং রাখতে সাইটে লগইন করুন।

লগইন করুন
This patient presents with an acute STEMI, evidenced by severe chest pain and ST elevation in leads V1-V4, indicating an anterior myocardial infarction. The most urgent management is to administer aspirin 300 mg immediately to inhibit platelet aggregation and reduce clot propagation. Simultaneously, arranging emergency primary percutaneous coronary intervention (PCI) is critical to restore coronary blood flow and limit myocardial damage. Early reperfusion therapy significantly improves survival and reduces complications. Other options like IV beta-blockers, nitroglycerin, or morphine are secondary and not priorities before revascularization.

Reference: Braunwald’s Heart Disease, Douglas L. Mann, Edition 12.
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