Infective Soft Tissue Lesions II - Bacterial, Fungal

Question 1

Which of the following bacterial or fungal infections is characterized by the formation of a painless, white patch on the oral mucosa that cannot be scraped off?

A) Herpetic stomatitis
B) Oral thrush
C) Oral lichen planus
D) Syphilis

Answer 1

D

Question 2

Which of the following is true about median rhomboid glossitis?

A) Depapillation on dorsum surface of tongue
B) Papillation on dorsum surface of tongue
C) White anular ring present
D) White patches which can be rubbed off

Answer 2

A

Question 3

The ideal first line of treatment to a simple pseudomembranous candidiasis infection is?

A) Amphotericin B
B) Nystatin
C) Topical corticosteroids
D) Use of enzymatic saliva stimulants

Answer 3

B

Question 4

Patient presents with fever, malaise and lymphadenopathy. Upon examination there is a fetid odour and exquisite pain. Which is NOT a causative organism of this condition?

A) Borrelia vincetti
B) Fusobacterium nucleatum
C) Porphyromonas gingivalis
D) Tannerella forsythia

Answer 4

D

Question 5

Patient presents with white lesions on the buccal mucosa in the oral cavity, cytological smear reveals the following:

(Picture shows branching thread-like hyphae structures and yeast cells)

What is the clinical diagnosis?

A) Acute necrotising ulcerative gingivitis
B) Angular Cheilitis
C) Mucormycosis
D) Pseudomembranous candidiasis

Answer 5

D

Question 6

Which of the following clinical signs are associated with zygomycosis

A) Covered by diffuse white plaques that are able to be wiped off
B) Proptosis, palatal ulcers and facial swelling
C) Papillae are blunt and “punched out” along with a very distinctive fetid odor
D) Tenderness, erythema and fissuring at labial commissures

Answer 6

B

Question 7

56 year old diabetic patient on concurrent corticosteroid therapy presents with extreme facial swelling and bulging eyes. Necrosis of the palatal mucosa is observed clinically. What is the likely diagnosis?

A) Median Rhomboid Glossitis
B) Necrotising Ulcerative Gingivitis
C) Pseudomembranous candidiasis
D) Zygomycosis

Answer 7

D

Question 8

Which of the following statements regarding necrotizing ulcerative gingivitis/periodontitis is most likely FALSE?

A) Can spread to adjacent soft tissues in necrotizing ulcerative stomatitis/mucositis
B) Clinically presents in young and middle-aged adults
C) Increased prevalence in third world countries
D) Papillae appear fuller and have sharp, defined edges

Answer 8

D

Question 9

A 20 year old patient presents with white plaques on the buccal mucosa and the palate resembling cheese curds. When you use a gauze to wipe at the white patch, it can be wiped off. The patient complains of a burning sensation and bitter taste in his mouth. What would be the most appropriate differential diagnosis in this case?

A) Angular Cheilitis
B) Erythematous Candidiasis
C) Median Rhomboid Glossitis
D) Pseudomembranous Candidiasis

Answer 9

D

Question 10

Which of the following is least likely to increase the rate of development of candidiasis infection in a patient wearing complete dentures?

A) Excess production of saliva
B) Immune status of host
C) Medications such as antibiotics and corticosteroids
D) Strain of organism present

Answer 10

A

Question 11

Which of the following statements is false of zygomycosis?

A) Arises from inhalation or implantation of spores by minor trauma or insect bites
B) Clinical signs include: palatal ulcer, facial swelling, multiple clouded sinuses
C) Leukemia is the condition most strongly correlated with zygomycosis
D) Tissue necrosis occurs as it is angioinvasive, leading to arterial occlusion and infarction
E) Ubiquitous fungus becomes pathogenic in immunocompromised host

Answer 11

C

Question 12

What is not a clinical sign of Zygomycosis

A) Proptosis
B) Cranial Nerve Defect
C) Palatal Ulcer
D) Rapid Heart Rate

Answer 12

D

Question 13

Which of these is a causative organism of necrotising ulcerative gingivitis?

A) Bacillus fusiformis
B) Candida albicans
C) Epstein Barr virus
D) Aspergillus

Answer 13

A

Question 14

What is the most appropriate differential diagnosis for the below condition?

(Image shows diamond shape inflammation of the tongue with no white changes surrounding it)

A) Benign migratory glossitis
B) Chronic hyperplastic oral candidiasis
C) Median rhomboid glossitis
D) Pseudomembranous oral candidiasis

Answer 14

C

Question 15

Patient wearing complete dentures presents with redness of mucosa on the denture bearing areas. Upon taking his denture history, the patient reveals that he wears his denture 24 hours a day and does not clean his dentures. What is the most appropriate differential diagnosis?

A) Chronic Erythematous Candidiasis
B) Chronic Hyperplastic Oral Candidiasis
C) Necrotising Ulcerative Periodontitis
D) Pseudomembranous Candidiasis

Answer 15

A

Question 16

Which of this stains are used to detect Oral Candidiasis through cytologic preparations?

A) Periodic acid-Schiff stain
B) Hematoxylin and eosin stain
C) Gomori methanamine silver (GMS) stain
D) Prussian blue stain

Answer 16

A

Question 17

Which of the following does not accurately describes the histopathologic features of necrotising ulcerative gingivitis?

A) Extensive bacterial colonization present
B) Finger-like processes of proliferating stratified squamous epithelium
C) Lamina propria infiltrated by thick band of mixed inflammatory cells
D) Non specific features showing ulcerative changes with thick fibrinopurulent membrane

Answer 17

B

Question 18

Your patient comes in with oral candidiasis. You want to prescribe her with oral fluconazole. She mentions that she is taking a few other medications. Which of the following drugs do you need to ask her to stop taking while she is taking fluconazole?

A) Diclofenac
B) Metformin
C) Paracetamol
D) Simvastatin

Answer 18

D

Question 19

A 30 year old male comes into your clinic complaining of irritation at his cheek area. He has asthma and uses an inhaler. He has no other medical history, and is alert, normally developed and in no distress when he enters the clinic. He brushes his teeth and flosses twice a day. When you examine his mouth, you notice white patches on his left and right buccal mucosa. You use a gauze to wipe it off and notice the mucosa below is erythematous. No other abnormalities noted.
What would be your clinical diagnosis?

A) Erythematous oral candidiasis
B) Hyperplastic oral candidiasis
C) Pseudomembranous oral candidiasis
D) Zygomycosis

Answer 19

C

Question 20

Which of the following is false about oral candidiasis?

A) Development of infection is independent of the strain of organisms present.
B) It is the most common oral fungal infection.
C) Usage of Nasonex nasal spray for sinusitis is a risk factor.
D) White lesions can be wiped off by gauze.

Answer 20

A

Question 21

Your patient is a middle aged male who complains of a foul odour in his mouth and bleeding gums. You observe his papilla have a “punched out” appearance and there are ulcerative lesions covered by greyish pseudomembrane. He shares that he is stressed by his long working hours and has no time to brush his teeth twice a day. Which is not an appropriate treatment for this patient?

A) Frequent rinse with Chlorhexidine
B) Debridement
C) Oral health education to improve oral hygiene
D) Application of Miconazole 2% gel on ulcerated gingiva

Answer 21

D

Question 22

Which of the following is not a predisposing factor for oral fungal infections?

A) Antibiotic therapy
B) Hyperthyroidism
C) Topical steroids
D) Xerostomia

Answer 22

B

Question 23

Which of the following is false when considering the type of antifungal therapy the patient needs?

A) Miconazole should not be prescribed to patients who are on statins for hyperlipidemia due to the possible drug-drug interactions
B) Antifungal tablets are the preferred route of delivery for patients with reduced salivary production
C) Gel or topical forms of antifungals are the preferred route of delivery for patients with reduced salivary production
D) Different antifungals are given depending on the ability of the drug to eliminate or control the causative factor

Answer 23

B

Question 24

Which of the following is NOT a method for diagnosis of oral candiasis?

A) Check Clinically
B) Cytologic Preparations
C) Biopsy
D) Blood Test

Answer 24

D

Question 25

Which of the following types of candidiasis is often related to poorly fitted denture and poor oral hygiene?

A) Chronic erythematous candidiasis
B) Acute atrophic candidiasis
C) Pseudomembranous oral candidiasis
D) Chronic hyperplasticity oral candidiasis

Answer 25

A

Question 26

A 30 year old female enters the clinic complaining of pain at the sides of her mouth on opening, with the feeling of “tearing”. On clinical examination, you observe tenderness, erythema, and fissuring at the labial commisures. What would you advise your patient to do?

A) Use antifungal cream at corners of the lips for 2-3 days.
B) Lick the corners of the lips periodically to lubricate the area with saliva.
C) Prescribe patient antibiotics.
D) Order for a biopsy.

Answer 26

A

Question 27

Infection by which organism calls for intravenous amphotericin B regime to be implemented immediately?
A) Acute necrotizing ulcerative gingivitis (ANUG)
B) Angular cheilitis
C) Candidiasis infection
D Mucormycosis

Answer 27

D

Question 28

Which of the following is NOT a reason why erythematous candidiasis should be treated even if asymptomatic?

A) Asymptomatic erythematous candidiasis can progress to symptomatic atrophic candidiasis if left untreated.
B) Chronic inflammation may increase bone resorption.
C) Edematous soft tissue provides a poor base for the prosthesis.
D) May contribute to inflammatory papillary hyperplasia, which if severe may require surgical management.

Answer 28

A

Question 29

Which of the following is not suitable for treatment of oral candidiasis?

A) Triazole
B) Amphotericin B
C) Amoxicillin
D) Nystatin

Answer 29

C

Question 30

Which of the following options is true with regards to Necrotising Ulcerative Gingivitis (NUG) in a patient with no lymphadenopathy or fever?

A) If it spreads to the underlying bone, it is termed as necrotizing ulcerative osteitis.
B) It is a must to rule out other differential diagnosis, such as gonorrhea, first.
C) Management must include debridement, chlorhexidine rinses and systemic antibiotics
D) Poor kidney function is a predisposing factor in NUG

Answer 30

B

Question 31

A Patient with HIV presents with fungal infection in the para nasal sinuses and is seen with facial swelling. Which of the following treatment is appropriate when managing this case?

A) Debridement of affected area and administer Amphotericin B
B) Debridement of affected area and rinse with chlorhexidine
C) Debridement of affected area and administer ampicillin
D) Debridement of affected area and prescribe Nystatin

Answer 31

A

Question 32

Patient comes with the appearance of his tongue shown in the picture below.

(Image shows diamond shape inflammation of the middle region of the dorsum of the tongue with no white changes surrounding it)

What is the affected area of the tongue lacking of?

A) Circumvallate papillae
B) Filiform papillae
C) Foliate papillae
D) Fungiform papillae

Answer 32

B

Question 33

What is median rhomboid glossitis?

A) Atrophic oral candidiasis
B) Benign migratory glossitis
C) Chronic hyperplastic oral candidiasis
D) Pseudomembranous oral candidiasis

Answer 33

A

Question 34

Which infection features ulcerative changes with thick fibrinopurulent membrane and lamina propria infiltrated by a thick band of mixed inflammatory cells with extensive hyperemia?

A) Aspergillosis
B) Oral candidiasis
C) Necrotizing ulcerative gingivitis/periodontitis
D) Zygomycosis

Answer 34

C

Question 35

Which of the following about chronic erythematous oral candidiasis is false?

A) It is the most common form of candidiasis
B) It can be found on denture bearing mucosa
C) It needs to be treated as chronic inflammation may increase bone resorption
D) It is clinically presented as tenderness and fissuring

Answer 35

D

Question 36

Patient presents with a superficial candida infection, which histopathological finding will be observed?

A) Acute inflammatory cell infiltrate
B) Decrease thickness of parakeratin layer
C) Hyphae embedded in superficial spinous layer
D) Small collections of neutrophils

Answer 36

D