By H. Nasib. Northern Michigan University.
Table 2 Dimensions of the Bone Bridges Transverse Outside Inside Dovetail hole width Implant Inside Outside tenon tenon slot (mm) Dovetail Dog length diameter diameter width width width slot depth number (mm) (mm) (mm) (mm) (mm) (mm) (d1 d 2) (mm) 1 27 arcoxia 120 mg for sale. Some implants were broken during stabilization and discarded order 120 mg arcoxia amex. Some implants broke up after implanting, probably the result of undetected cracking during stabilization. The thin-walled implants were more fragile, and fewer survived the preparation process. The dimensions of the implants actually implanted are those shown in Table 2. Histology The spinel component of the implants cannot be demineralized so the histology was based on optical microscopy, macroradiography, and microradiography of sections impregnated with a low-viscosity resin. Specimens were dehydrated with a series of ethanol solutions starting with 70% ethanol and continuing with replacements of higher concentrations until two 24-h periods of 100% ethanol were completed. The ethanol was replaced with acetone for two 24-h periods. Fifty percent of acetone and a low-viscosity resin was agitated for 48 hours, followed by 100% of the resin with agitation and a vacuum for 48 h to boil off any residual acetone. A low-speed diamond saw was used to cut axial and transverse sections. The microradiographs were made from selected 300- m sections. Results One or two wires encircling the implant were less effective in inhibiting axial motion of the implant than a single wire threaded through the holes at the root of the grooves. The thinner wire conformed well to the implant and plate, and was less likely to cause implant fracture during stabilization. In every procedure the contact plane of the implant and the contact plane of the bone plate were in alignment laterally. The medial alignment depended on the diameter of the bone and the diameter of the implant.
She was in her usual state of health until 7 days ago arcoxia 60 mg with visa, when she developed fever and severe right facial pain discount arcoxia 120mg without prescription. Her pain and fever have continued, and she has developed purulent nasal drainage and foul breath odor. She admits that she has suffered from similar symptoms in the past but never this severe. She denies having had any contact with sick persons. Her general state of health has been good, although she has a 30 pack-year smoking histo- ry. On physical examination, the patient’s temperature is 100. Her pain is exacerbated when she leans forward, and there is tenderness to palpation over the right maxillary and right frontal sinuses. Each of these sinuses is opaque on transillumination. Which of the following statements regarding acute and chronic sinusitis is true? Ethmoiditis is the most common form of sinusitis in adults B. The most useful criterion for the diagnosis of bacterial sinusitis is the presence of purulent nasal discharge 58 BOARD REVIEW C. Antihistamines are useful in the treatment of acute sinusitis D. Antibiotics should be used in patients who are moderately to seri- ously ill, in patients whose symptoms fail to respond to deconges- tants, and in those who have complications Key Concept/Objective: To understand the diagnosis and treatment of bacterial sinusitis Antibiotics should be used in the following patients: those who are moderately to seri- ously ill; those whose symptoms fail to respond to decongestants; and those who have complications. Frontal sinusitis and maxillary sinusitis are most common in adults; eth- moiditis is most common in children. The diagnosis of acute sinusitis can usually be established on clinical grounds.
None of the above Key Concept/Objective: To be able to recognize the presentation of acute benign viral pericarditis This patient’s presentation is classic for acute viral pericarditis: constant anterior chest pain that is worse with inspiration generic arcoxia 120 mg amex, tachycardia buy cheap arcoxia 120 mg on-line, and a low-grade fever. A pericardial fric- 38 BOARD REVIEW tion rub is often heard when patients are symptomatic but may be missed on examina- tion. The differential diagnosis includes pneumonia, spontaneous pneumothorax, and musculoskeletal pain; an electrocardiogram would be the appropriate first step in the evaluation. A finding of diffuse ST segment elevations without reciprocal changes or PR depressions would confirm the diagnosis of viral pericarditis. The patient in Question 65 is found to have PR depressions on electrocardiography. What should be the next step in this patient’s management? Treatment with codeine Key Concept/Objective: To understand the management of acute pericarditis This patient has acute benign pericarditis. Anti-inflammatory medications, including aspirin, are usually effective for reducing pericardial inflammation and decreasing pain. Codeine or another narcotic may be added for pain relief if needed. Although prednisone is effective as well, steroids are generally reserved for patients who are unresponsive to other treatments, because symptoms may recur after steroid withdrawal. Patients do not require hospitalization unless they have other complications such as arrhythmia or tamponade. A 44-year-old man on long-term dialysis for lupus nephritis presents with progressive dyspnea on exer- tion. He has no chest pain or lower extremity edema, nor does he have any other symptoms. Other results of his physical examination are as follows: blood pressure, 130/70 mm Hg; pulse, 84 beats/min; respiratory rate, 14 breaths/min. His neck veins are elevated, and the elevation increases upon inspiration. His cardiovascular examination is remarkable for an extra sound in early diastole, and he has no paradoxical pulse.
