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Best of Fives for Dentistry > Oral medicine > Flashcards

Oral medicine Flashcards

1
Q
  1. Pt presents with angular cheilitis and decide to perform some haematological investigations. Which one is not relevant?
    a. Full blood count
    b. Fasting venous glucose
    c. Vitamin B12
    d. Liver junction tests
    e. Ferritin
A

 D. Liver function test.
 Some studies show that 50% of pts with angular cheilitis have haematological abnormalities. Anaemia and diabetes are the most common. Liver function tests are irrelevant.

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2
Q
  1. Which one of the following drugs is inappropriate for the treatment of angular cheilitis?
    a. Aciclovir
    b. Nystatin
    c. Miconazole
    d. Fluconazole
    e. Amphotericin
A

 A. Aciclovir
 Aciclovir is an antiviral agent, and is used mainly for human herpes virus infections. Nystatin, amphotericin and miconazole are used topically. Amphotericin can be used systemically, but it has many side effects, so it should not be used systemically for minor infection such as angular cheilitis. Fluconazole, however, can be used systemically.
 Amphotericin B is an antifungal medication.

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3
Q
  1. Target lesions are associated with which one of these conditions?
    a. Stevens-Johnson syndrome
    b. Major aphthous stomatitis
    c. Pemphigus
    d. Pemphigoid
    e. Syphilis
A

 A. Stevens-Johnson syndrome
 Stevens-Johnson syndrome produces target lesions on the skin which look like ‘bulls eyes’. This reaction is frequently caused by drug reactions, especially to sulphonamides. Patients can be systemically very unwell, and more often then not require admission.

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4
Q
  1. What is the male to female ratio of the prevalence of recurrent aphthous ulceration/stomatitis?
    a. 3:1
    b. 2:1
    c. 1:1
    d. 1:2
    e. 1:3
A

 C 1:1
 Recurrent aphthous ulceration occurs equally among males and females.

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5
Q
  1. Where in the mouth is ‘burning mouth syndrome’ most frequently reported?
    a. Lips
    b. Lower denture-bearing area
    c. Palate
    d. Buccal mucosa
    e. Tongue
A

 E. Tongue
 ‘Burning mouth syndrome’ is most frequently reported in the tongue region (80% of patients with burning mouth syndrome)

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6
Q
  1. What is the male to female ratio of patients with ‘burning mouth syndrome’?
    a. 7:1
    b. 3:1
    c. 1:1
    d. 1:3
    e. 1:7
A

 E. 1:7
 Females are far more likely to report burning mouth syndrome

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7
Q
  1. What is the mean age of presentation of burning mouth syndrome?
    a. 18 years
    b. 25 years
    c. 40 years
    d. 60 years
    e. 80 years
A

 D. 60 years
 Burning mouth syndrome is far more prevalent in women than in men, has a mean age presentation of 60 years, and is rarely seen in people younger than 45 years. There are many causes of burning mouth syndrome. These include vitamin B complex deficiency, haematological disorders, undiagnosed type 2 diabetes, xerostomia, parafunctional habits, poorly constructed dentures, cancerphobia, anxiety, depression, climacteric and allergy. It is important to investigate these patients haematologically and psychologically.

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8
Q
  1. A child of 14 months presents with blood-crusted lips, pyrexia and widespread oral ulceration. What is the most likely diagnosis?
    a. Teething
    b. Traumatic injury
    c. Primary herpetic gingivostomatitis
    d. Hand, foot and mouth
    e. Human papilloma virus
A

 C. Primary herpetic gingivostomatitis
 A traumatic injury would be possible, but it is unlikely the child has pyrexia. Teething would not cause blood-crusted lips. Human papilloma virus does not cause this. The treatment for primary herpetic gingivostomatitis is aciclovir, antiseptic mouthwash, and paracetamol to reduce the pyrexia. The child should be discouraged from touching the lesion, and their fluid intake increased.

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9
Q
  1. Which one of the following does not cause the reactivation of herpes simplex infection?
    a. Stress
    b. Sunlight
    c. Immunosuppression
    d. Local trauma
    e. Dental caries
A

 E. Dental caries
 The common triggers for reactivation of herpes simplex are stress, local trauma, exposure to sunlight or cold, menstruation, systemic upset and immunosuppression.

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10
Q
  1. A 12-year-old child who has had chickenpox previously presents with vesicles in and around his left ear, hearing loss and some facial nerve weakness. What is the diagnosis?
    a. Herpes simplex 1 reactivation
    b. Herpes simplex 2 reactivation
    c. Ramsay-Hunt syndrome
    d. Coxsackie viral infection
    e. Infectious mononucleosis
A

 C. Ramsay-Hunt syndrome
 Ramsay-Hunt syndrome originates in the geniculate ganglion of the seventh cranial nerve and is associated with varicella zoster infection. Treatment is usually with steroids and antivirals, to reduce the chance of permanent hearing loss.

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11
Q
  1. What is the usual prescription of aciclovir given to patients with acute herpes simplex infection?
    a. 200mg twice daily for 5-10 days
    b. 200mg three times daily for 5-10 days
    c. 200mg four times daily for 5-10 days
    d. 200mg five times daily for 5-10 days
    e. 200mg six times daily for 5-10 days
A

 D. 200mg five times daily for 5-10 days
 Aciclovir is one of the unusual medicines required to be taken 5 times daily.

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12
Q
  1. A 70-year-old patient presents with systemic upset, a unilateral headache around the temporal region, and a severe cramp-like pain when the patient begins to chew. They have never had any symptoms like this before. What is your diagnosis?
    a. Paroxysmal facial hemicrania
    b. Giant cell arteritis
    c. Periodic migrainous neuralgia
    d. Salivary calculi
    e. Trigeminal neuralgia
A

 B. Giant cell arteritis
 This is a classic presentation of giant cell arteritis, which can be a medical emergency. It requires prompt administration of prednisolone to prevent onset of blindness.

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13
Q
  1. What would be the best blood test to aid your diagnosis in question 12 (giant cell arteritis)?
    a. Full blood count
    b. Liver function tests
    c. Erythrocyte sedimentation rate (ESR)
    d. Vitamin B12
    e. International normalised ration (INR)
A

 C. Erythrocyte sedimentation rate (ESR)
 ESR is a marker of inflammation, and is markedly raised in patients with giant cell arteritis.

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14
Q
  1. A 15-year-old patient presents with pyrexia, sore throat, and bilateral parotitis. However, on palpation of the parotids the saliva is clear, and there is no xerostomia. What is your most likely diagnosis?
    a. Measles
    b. Mumps
    c. Bacterial parotitis
    d. Sjogren’s syndrome
    e. Cytomegalovirus
A

 B. Mumps
 Sjogren’s disease is possible, however there is no reduced saliva flow. Bacteria parotitis would produce a pus-filled saliva, and therefore it would not be clear. It would also be unusual to have bilateral bacterial parotitis. Mumps is the most common cause of bilateral parotitis. It usually settles down after 2 weeks, but patients must be aware that the complications of mumps include orchitis or oophoritis, leading to infertility. Mumps is on the increase as parents are reluctant to vaccinate their children with the MMR (measles, mumps, rubella) vaccine because of the controversy surrounding it.

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15
Q
  1. Which one of the following viruses is associated with Kaposi’s sarcoma?
    a. Human herpes virus 1
    b. Human herpes virus 2
    c. Varicella zoster virus
    d. Cytomegalovirus
    e. Human herpes virus 8
A

 E. Human herpes virus 8
 Kaposi’s sarcoma is an acquired immune deficiency syndrome (AIDS) – related illness associated with human herpes virus 8. It has three forms: classic, endemic and epidemic.

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16
Q
  1. A patient presents with a unilateral, electric shock-like pain along the course of the mandible. He says it happens when he shaves, and it is the worst pain he has ever had. What is your likely diagnosis?
    a. Temporomandibular joint dysfunction.
    b. Trigeminal neuralgia
    c. Dental abscess
    d. Parotitis
    e. Paroxysmal facial hemicrania
A

 B. Trigeminal neuralgia
 This is the classic description of trigeminal neuralgia.

17
Q
  1. What would be the best medication for the condition in questions 16 (Trigeminal neuralgia)?
    a. Dothiepin
    b. Fluoxetine
    c. Carbamazepine
    d. Prednisolone
    e. Amitriptyline
A

 C. Carbamazepine
 Carbamazepine is the treatment of choice for trigeminal neuralgia. Patients are usually started on 100mg three times daily and then require and increase in the dose after a month or two to 200mg three times daily to a maximum of 800mg three times daily. These patients require regular monitoring. Prednisolone is a steroid, used for many conditions but not for neuralgia. The other drugs are more effective in patients with atypical facial pain.

18
Q
  1. Which one of the following blood tests is important when monitoring patients taking carbamazepine?
    a. Vitamin B12
    b. Ferritin
    c. Erythrocyte sedimentation rate (ESR)
    d. Liver function tests (LFT)
    e. Serum folate
A

 D. Liver function tests
 Carbamazepine is metabolised in the liver and can lead to altered liver function and can cause drug-induced inflammation of the liver (hepatitis). It can also cause aplastic anaemia in a few patients, so a full blood count is also useful.

19
Q
  1. An 18-year-old girl presents with a grossly enlarged lower lip, angular cheilitis, full-width gingivitis, mucosal tags and cobblestone mucosae. What is the most likely diagnosis?
    a. Allergic reaction leading to anaphylaxis
    b. Lichenoid reaction
    c. Erythema multiforme
    d. Orofacial granulomatosis (OFG)
    e. Lichen planus
A

 D. Orofacial granulomatosis (OFG)
 An incisional biopsy down to muscle will show that the patient has non-caseating granulomas and lymphoedema, which are indicative of OFG. It is associated with reactions to cinnamon and benzoates, and patients with OFG frequently have a large intake of these substances. Patients with OFG also show a tendency to have atopic conditions such as eczema and asthma.

20
Q
  1. Which gastrointestinal condition is commonly associated with orofacial granulomatosis?
    a. Ulcerative colitis
    b. Crohn’s disease
    c. Coeliac disease
    d. Irritable bowel disease
    e. Hirschsprung’s disease
A

 B. Crohn’s disease
 Crohn’s disease has the same histological features as OFG and is present in 12% of patients with OFG.

21
Q
  1. In patients who truly have an allergic reaction to local anaesthetic, which one of the following is the most likely cause?
    a. Lidocaine
    b. Adrenaline
    c. Octapressin
    d. Methylparaben
    e. Sodium chloride
A

 D. Methylparaben
 Methylparaben is the preservative in local anaesthetics and is the most common cause of an allergic reaction in patients. Occasionally sodium bisulphite is used as a preservative and this too can cause an allergic reaction. It would be highly unlikely that a patient is allergic to adrenaline as the body produces it.

22
Q
  1. Which one of the following does not predispose a patient to candidosis?
    a. Currently taking a broad-spectrum antibiotic
    b. Taking prednisolone daily
    c. Agranulocytosis
    d. Stress
    e. Folic acid deficiency
A

 D. Stress
 All the others are predisposing factors for candidosis.

23
Q
  1. What condition is Wickham’s striae associated with?
    a. Pseudomembranous candidosis
    b. Chronic hyperplastic candidosis
    c. Lichenoid reactions
    d. Lichen planus
    e. White sponge naevus
A

 D. Lichen planus
 Lichen planus is a systemic as well as an oral disease. It is actually more common found extra-orally. Wickham’s striae are irregular, itchy, white streaks on the flexor surfaces of the forearms, elbows and ankles. We must remember that patients have bodies and not just mouths! Looking at the rest of the body can aid our diagnosis.

24
Q
  1. Which one of the following autoantibodies is not associated with Sjogren’s syndrome?
    a. Anti-Ro
    b. Anti-La
    c. Rheumatoid factor
    d. Anti-nuclear antibodies
    e. Anti-Smith antibodies
A

 E. Anti-Smith antibodies
 Anti-Smith antibotides are associated with Systemic Lupus Erythematosus. It is important to known which antibodies are associated with Sjogren’s syndrome. It is a viva favourite.

25
Q
  1. Sjogren’s syndrome is associate with other autoimmune diseases (acronym CREST). Which one of the following is not involved in CREST syndrome?
    a. Calcinosis
    b. Raynaud’s phenomenon
    c. Rheumatic fever
    d. Oesophageal dysmotility
    e. Telangiectasia
A

 C. Rheumatic fever
 Patients with Sjogren’s syndrome frequently have other autoimmune disorders. Xerostomia is the most common presentation, but they may have other systemic disease which are linked to this. It is important to ask them about cold fingers, difficulty swallowing and arthritis, and to look for telangiectasia.

26
Q
  1. A 75-year-old lady with a history of gastric cancer who has been clear of disease for 25 years presents to you with a red, raw beefy tongue, oral ulceration, tachycardia, numbness in the extremities and an unusual gair. What would be your most likely diagnosis?
    a. Iron-deficiency anaemia
    b. Vitamin B12 deficiency
    c. Recurrence of gastric cancer
    d. Brain tumour
    e. Alzheimer’s disease
A

 B. Vitamin B12 deficiency
 Having had a gastric cancer previously, it is likely that the patient has a reduced amount of intrinsic factor, and therefore reduced absorption of vitamin B12. As she has been clear of cancer for 25 years it is unlikely that she has had a recurrence or has a brain tumour. Vitamin B12 deficiency leads to the classic red, raw beefy tongue, oral ulceration and peripheral neuropathy.

 Intrinsic factor is a protein produced in the stomach that helps the body absorb vitamin B12. Vitamin B12 deficiency can occur when the body is unable to absorb enough vitamin B12 from food, and a common cause is pernicious anaemia. Pernicious anaemia is an autoimmune disease that destroys the stomach cells that produce intrinsic factor.

27
Q
  1. If you suspect Vitamin B12 deficiency in a patient, and you want to known whether lack of intrinsic factor is the cause, which test would you perform?
    a. Full blood count
    b. Red cell folate
    c. Schilling’s test
    d. Ferritin
    e. Bence Jones protein
A

 C. Schilling’s test
 For Schilling’s test, after an overnight fast, the patient is given an injection of non-radiolabelled vitamin B12 to saturate the body’s stores. The patient that takes an oral vitamin B12 dose labelled with cobalt 58, followed by an oral dose of vitamin B12 and intrinsic factor labelled with cobalt 57. Urine is collected over 24 hours to measure the levels of the isotopes present in it. From the urinary levels it can be worked out if the cause is a lack of intrinsic factor. Bence Jones proteins are measured in multiple myeloma.

28
Q
  1. Which one of the following drugs does not cause a lichenoid reaction?
    a. B-blockers
    b. Gold
    c. Allopurinol
    d. Nifedipine
    e. Anti-malarials
A

 D. Nifedipine
 Nifedipine causes gingival hyperplasia and not lichenoid reaction

29
Q
  1. Which one of the following conditions/lesions is not caused by viruses?
    a. Koplik’s spots
    b. Herpetiform ulceration
    c. Herpes gingivalis
    d. Hand, foot and mouth disease
    e. Herpangina
A

 B. Herpetiform ulceration
 Herpetiform ulceration means that the ulcers look like herpes but are not actually caused by herpes virus. Hand, foot and mouth disease and herpangina are caused by coxsackie virus. Koplik’s spots are associated with measles (rubeola virus).

30
Q
  1. Which one of the following is not a type of lichen planus?
    a. Plaque-like
    b. Atrophic
    c. Hyperplastic
    d. Erosive
    e. Reticular
A

 C. Hyperplastic
 All others are types of lichen planus.

31
Q
  1. In which age group does lichen planus usually occur?
    a. 0-18 years
    b. 18-30 years
    c. 30-50 years
    d. 50-70 years
    e. 70+ years
A

 C. 30-50 years.
 About half of people with lichen planus skin rash develop white streaks on the inside of the cheeks, gums or tongue. This is usually painless and not itchy. It may not be noticed unless looked for. Sometimes lichen planus of the mouth occurs without any skin rash. Lichen planus can also cause ulcers in the mouth but this is uncommon. If ulcers do occur they can be very sore and unpleasant, and hot or spicy foods are especially difficult to eat. Mouth ulcers can occur with or without the skin rash. In some cases, the gums become red and sore.

32
Q
  1. If temporal arteritis is left untreated, what is the most serious complication?
    a. Blindness
    b. Deafness
    c. Anosmia
    d. Paralysis of the muscles of mastication
    e. Loss of taste
A

 A. Blindness
 The most serious complication of temporal arteritis is blindness.

33
Q
  1. Which one of the following is not described in a classical history of trigeminal neuralgia?
    a. 10/10 pain
    b. Shooting or electric shock-like pain
    c. There is a trigger factor
    d. It is bilateral
    e. Occurs in the region of the mandibular branch of the trigeminal nerve
A

 D. It is bilateral
 Trigeminal neuralgia is a neuropathic disorder of the trigeminal nerve that causes episodes of intense pain in the eyes, lips, nose, scalp, forehead and jaw. The pain is unilateral. It is estimated that 1 in 15 000 people have pain from trigeminal neuralgia, although the numbers may be considerable higher due to frequent misdiagnosis. Trigeminal neuralgia usually develops after the age of 50, more commonly in women, although there have been cases of patients as young as 3 years of age. The condition can bring about, stabbing, mind-numbing, electric shock-like pain from just a finger’s glance of the cheek.

34
Q
  1. To which virus family does varicella zoster belong?
    a. Coxsackie
    b. Herpes
    c. Hepadnavirus
    d. Parvovirus
    e. Respiratory syncytial virus (RSV)
A

 B. Herpes
 Primary varicella zoster infection leads to chickenpox (varicella), which may rarely result in complications including encephalitis and pneumonia. Even when clinical symptoms of chickenpox have resolved, the varicella zoster virus remains dormant in the nervous system of the infected person (virus latency) – in the trigeminal and dorsal root ganglia. In about 10-20% of cases, varicella zoster reactivates later in life to cause a disease known as herpes zoster or shingles.

35
Q
  1. A 7-year-old boy presents with bilateral parotitis. What is the most likely diagnosis?
    a. Sjogren’s syndrome
    b. CREST
    c. Salivary calculi
    d. Mumps
    e. Hand, food and mouth disease
A

 D. Mumps
 Mumps is a viral disease of the human species, caused by the mumps virus. Prior to the development of vaccination and the introduction of a vaccine, it was a common childhood disease worldwide, and is still a considerable threat to health in the developing world. Painful swelling of the salivary glands (classically the parotid gland) is the most typical presentation. Painful testicular swelling and rash may also occur. The symptoms are generally not severe in children. In adolescent boys and men, complications such as infertility or subfertility are more common, although still rare in absolute terms.

36
Q
  1. What is the best treatment for mumps?
    a. Aciclovir
    b. Prednisolone
    c. Augmentin
    d. Clarithromycin
    e. Nothing
A

 E. Nothing
 Mumps is self-resolving condition, and requires no treatment.

Best of Fives for Dentistry (6 decks)

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