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SBA Dentistry > Oral Pathology > Flashcards

Oral Pathology Flashcards

1
Q

A patient who has had bisphosphonate treatment intravenously for multiple myeloma presents with an asymptomatic, root-filled mandibular first premolar with a periapical radiolucency. How should you proceed?
a. XLA at the GDP
b. XLA in a hospital setting
c. XGA in a hospital setting
d. Re-RCT
e. Observe the tooth for the next 6 months, then take another PA

A

E. Observe the tooth for the next 6 months, then take another PA
IV bisphosphonates increase the risk of MRONJ. The tooth is asymptomatic and therefore the most pragmatic treatment is observations.

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2
Q

Which of the following is an odontogenic cyst of developmental origin?
a. Aneurysmal bone cyst
b. Epidermoid cyst
c. Lateral periodontal cyst
d. Nasopalatine cyst
e. Residual cyst

A

C. Lateral periodontal cyst
A lateral periodontal cyst is an uncommon type of odontogenic cyst of developmental origin that typically occur laterally on the root surface of teeth. They are usually located in the mandibular/premolar area. They are usually asymptomatic and discovered on a routine radiograph. Associated teeth are usually vital.

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3
Q

Which one of the following best represents the time (in days) taken for a Vicryl suture to resorb?
a. 5 days
b. 15 days
c. 25 days
d. 35 days
e. 45 days

A

D. 35 days
Vicryl Rapide looses 50% of its tensile strength within 5 days and is completely resorbed in 30-40 days.

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4
Q

A 7 year old child presents with horizontal linear grooves on the tips of the mandibular and maxillary incisors. What is the most likely cause?
a. Amelogenesis imperfecta
b. Childhood illness
c. Dentinogenesis imperfecta
d. Hyperfluorosis
e. Osteogenesis imperfecta

A

B. Childhood illness
Ridging of teeth are commonly caused by childhood illnesses, such as measles and chickenpox (varicella). Amelogenesis and dentinogenesis imperfecta will cause marked changes to the surface of the enamel and dentine and fluorosis causes staining.

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5
Q

Which one of the following statements regarding carcinoma of the lip is true?
a. It is more common on the lower lip
b. It is often caused by chewing betel nut
c. It has a worse prognosis than intra-oral carcinoma
d. It is caused principally by alcohol consumption
e. It occurs in patients with oral submucous fibrosis

A

A. It is more common on the lower lip
Intra-oral carcinoma is principally caused by tobacco products, betel nut, paan and alcohol. Carcinoma of the lip is mainly caused by UV light and has better prognosis because it is more visible, so patients see it sooner.

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6
Q

Which one of the following is not a microscopic feature of epithelial dysplasia?
a. Atypical mitosis
b. Hyperkeratinisation
c. Loss of cellular polarity
d. Altered nuclear/cytoplasmic ratio
e. Loss or decrease in intercellular adherence

A

B. Hyperkeratinisation
Dysplasia is a term used to describe the histological abnormalities in malignant and pre-malignant lesions. The abnormal features include: unusual mitoses; drop-shaped rete ridges; loss of polarity; and abnormal nuclear cytoplasmic ratio. Hyperkeratinisation is not a feature of dysplasia.

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7
Q

Which one of the following statements regarding oral cancer is false?
a. It accounts for 2% of all cancers in the UK
b. It is more common in men
c. Smoking and alcohol have a synergistic effect
d. Betel nut is safer than smoked tobacco
e. It may arise from white patches

A

D. Traditionally oral cancer has been occurring most commonly in males over 50 years old. However, it is being found to occur more often in younger people and its incidence is on the increase, especially in women. Alcohol and smoking do have a synergistic effect, but betel nut is more carcinogenic than smoked tobacco.

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8
Q

Who proposed in 1889 the acidogenic theory, which is recognised as the correct description of the cause of dental caries?
a. Miller
b. Clarke
c. Jones
d. Brody
e. Smith

A

A. Miller
Miller described the acidogenic theory, which states hat acid formed from the fermentation of dietary carbohydrates by oral bacteria leads to the progressive demineralisation of the tooth with subsequent disintegration of the organic matrix.

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9
Q

Which bacterium is most commonly isolated from root caries?
a. Lactobacillus
b. Actinomyces
c. Streptococcus mutans
d. Streptococcus mitior
e. Clostridium

A

B. Actinomyces
S. Mutans is most frequently isolated from pit and fissure caries, lactobacillus is most commonly isolated from the advancing edge of the carious process in dentine and actinomyces is most commonly isolated from root caries.

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10
Q

Which one of the following epidemiological studies involved the elimination of sucrose and white bread from the diet in an Australian children’s home with the subsequent fall in caries in this population during their stay?
a. Vipeholm study
b. Hopewood House Study
c. Turku Xylitol Study
d. Tristan da Cunha Study
e. Hereditary Fructose Intolerance Study

A

B. Hopewood House Study
In Tristan da Cunha, there was low caries incidence until the Americans arrived during the war bringing refined carbohydrates, when the caries rates soared. In Hopewood House, the children demonstrated a higher caries rate before and after being in the children’s home. The Turku Xylitol Study showed a 90% caries decrease when xylitol was substituted for sucrose.

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11
Q

What is chronic hyperplastic pulpitis more commonly known as?

A

A Pulp Polyp
Clinically a pulp polyp has the appearance of a bright red or pink soft tissue mass within a large carious cavity.

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12
Q

Which one of the following is a non-odontogenic cyst?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Nasopalatine cyst

A

E. Nasopalatine Cyst
All the other cysts are odontogenic in origin and have an epithelial residue which occurs as the glands of Serres, reduced enamel epithelium or rests of Malassez. The nasopalatine cyst is a heart shaped or ovoid cyst which forms from the remnants of the nasopalatine canal, and is lined by stratified squamous epithelium or pseudostratified squamous epithelium.

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13
Q

Which one of the following cysts is an inflammatory odontogenic cyst?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Gingival cyst

A

D. Radicular cyst
All of the other cysts are developmental cysts. There are three types of radicular cysts: apical periodontal (75%); lateral periodontal (5%); and residual cyst (20%). They are the most common type of odontogenic cysts - accounting for 75% of odontogenic cysts.

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14
Q

Which one of the following cysts is derived from the root sheath of Hertwig and has the rests of Malassez as an epithelial residue?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Gingival cyst

A

D. Radicular cyst

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15
Q

Which one of the following cysts is derived from the dental lamina and has the glands of Serres as an epithelial residue?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Gingival cyst

A

A. Odontogenic Keratocysts

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16
Q

Which two of the following cysts is derived from the enamel organ and has the reduced enamel epithelium as an epithelial residue?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Gingival cyst

A

B and C
Dentigerous and Eruption Cysts

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17
Q

Where are you most likely to find a radicular cyst?
a. Maxillary central incisor region
b. Mandibular central incisor region
c. Mandibular premolar region
d. Maxillary premolar region
e. Mandibular third molar region

A

A. Maxillary central incisor region
The maxillary central incisors are responsible for 37% of all radicular cysts. They are frequently traumatised and often occur as asymptomatically non-vital teeth. The radicular cyst is often found as an incidental finding on a radiograph.

18
Q

Which one of the following cysts is most likely to recur?
a. Odontogenic keratocyst
b. Dentigerous cyst
c. Eruption cyst
d. Radicular cyst
e. Gingival cyst

A

A. Odontogenic Keratocyst
Odontogenic Keratocysts frequently recur and require close monitoring.

19
Q

Which one of the following non-odontogenic cysts is typically found as a firm mass 2-4cm in diameter, mostly below the level of the hyoid, occasionally gets infected, and is developmentally related to the foramen caecum?
a. Lymphoepithelial cyst
b. Nasopalatine cyst
c. Nasoalveolar cyst
d. Thyroglossal duct cyst
e. Dermoid cyst

A

D. Thyroglossal duct cyst
The thyroglossal duct cyst is a remnant of the process of descent of the thyroid gland. It is often found in adolescents and requires excision of part of the hyoid bone as well to prevent recurrence.

20
Q

Which one of the following is not a physical cause of non-carious tooth surface loss?
a. Fracture
b. Attrition
c. Abrasion
d. Vomiting
e. Iatrogenic

A

D. Vomiting
Vomiting is a common cause of chemical tooth surface loss. It is the low pH of the vomit that frequently causes the palatal tooth surface loss.

21
Q

Which one of the following is not a cause of tooth surface loss on the palatal surfaces of the maxillary central incisors?
a. Chemotherapy
b. Oesophageal reflux
c. Anorexia
d. Bulimia
e. Pregnancy

A

C. Anorexia
Anorexia involves the reduction in calorific intake to reduce weight gain. All the others involve vomiting.

22
Q

Which one of the following statements regarding acute osteomyelitis is true?
a. It affects the maxilla more than the mandible
b. It always causes paraesthesia of the IDN
c. It will not be apparent on radiographs for a month
d. It will usually cause a sharp shooting pain
e. It may cause the loosening of teeth

A

E. It may cause the loosening of teeth
Osteomyelitis occurs most frequently in the mandible and the pain associated is usually a severe throbbing pain.

22
Q

Regarding Paget’s disease, which one of the following statements is false?
a. Hypercementosis occurs, leading to ankylosis and difficult extractions
b. Patients with Paget’s disease are liable to get post-extraction osteomyelitis
c. Patients with Paget’s disease have problems with post-extraction haemorrhage
d. Patients with Paget’s disease can have facial nerve paralysis
e. The mandible is more frequently affected than the maxilla in Paget’s disease

A

E.
In Paget’s disease, the maxilla is more commonly affected. The disease occurs in males over the age of 40. The patients have bony pain, and the disorder causes compression of nerves leading to paralysis. There is spacing of the teeth and hats and dentures become ill-fitting.

23
Q

What is the most common age of presentation of giant cell granuloma?
a. Under 5 years old
b. 10-25 years
c. 30-40 years
d. 45-65 years
e. 65+ years

A

B. 10-25 years

24
Q

A 20 year old presents with a well-defined radiolucent area in the anterior mandible with thinning and expansion of the cortex. The teeth involved are displaced with root resorption. What is the most likely diagnosis?
a. Dentigerous cyst
b. Giant cell granuloma
c. Radicular cyst
d. Eruption cyst
e. Odontogenic keratocyst

A

B. Giant cell granuloma
This is a textbook presentation of giant cell granulomas

25
Q

Which one of the following statements regarding hairy leukoplakia is true?
a. It only ever occurs in patients with HIV infection
b. It is caused by candida
c. It commonly affects the dorsal surface of the tongue
d. It is a premalignant lesion
e. It has koilocyte-like cells in the prickle cell layer

A

E. It has koilocyte-like cells in the prickle cell layer.
Hairy leukoplakia occur in patients who are immunocompromised, and is often secondarily infected with candida. It is not a premalignant lesion. It is most commonly located on the lateral border of the tongue.

26
Q

Which one of the following statements regarding salivary glad tumours is true?
a. Adenoid cystic carcinomas have a good prognosis
b. Acinic cell carcinomas spread perineurally
c. Mucoepidermoid carcinomas histologically have a ‘Swiss cheese appearance’
d. Pleomorphic adenomas usually undergo malignant change
e. Pleomorphic adenomas contain fibrous, elastic and myxoid tissue

A

E. Pleomorphic adenomas contain fibrous, elastic and myxoid tissue
Adenoid cystic carcinomas have a very poor prognosis, spread perineurally and have a ‘Swiss cheese’ appearance. A small proportion of pleomorphic adenomas (2%) undergo malignant change, but these adenomas contain a variety of tissues including fibrous, elastic and myxoid tissue.

26
Q

Which one of the following statements regarding salivary calculi is true?
a. They may be asymptomatic
b. They are always visible on a lower occlusal radiograph
c. They most frequently occur in the parotid gland
d. They most frequently occur in the sublingual gland
e. They are a common cause of xerostomia

A

A. They may be asymptomatic
Salivary gland calculi are most common in the submandibular gland. They do not lead to xerostomia, as the parotid gland produces the most amount of saliva. These calculi may be seen on plain film radiographs, but sialography may be required to visualise them.

27
Q

Which one of the following statements regarding fibrous dysplasia is true?
a. It is more common in males
b. It affects the maxilla more than the mandible
c. It is very painful
d. Histologically there is resorption and deposition of bone
e. It commonly occurs in patients around 40 years of age

A

B. It affects the maxilla more than the mandible.
Fibrous dysplasia is a disease which occurs in women more than men and presents in people younger than 20 years. It is infrequently painful and involves the replacement of bone by fibrous tissue.

28
Q

Which one of the following statements regarding osteosarcoma is false?
a. It is a complication of Paget’s disease
b. It occurs in men more frequently than women
c. It occurs more commonly in the maxilla than the mandible
d. Patients frequently present between the ages of 30 and 40 years
e. Patients frequently present with paraesthesia

A

C.
Osteosarcoma is an infrequent complication of Paget’s disease, and occurs in men between the age of 30 and 40 years old. It affects the mandible more frequently than the maxilla, and often the presenting complaint is paraesthesia.

29
Q

Which one of the following statements regarding odontomes is true?
a. They are hamartomas
b. They present at the age of 30 years
c. They can undergo malignant transformation
d. They are frequently present in the anterior mandible
e. The lesion is composed of cementum embedded in fibrous tissue and surrounding capsule

A

A. They are hamartomas
Odontomes usually present between the ages of 10 and 20 years, and are benign. They commonly present in the anterior maxilla and posterior mandible. The lesion is composed of pulp, dentine, enamel and cementum.

30
Q

Which one of the following conditions is associated with anti-basement membrane auto-antibodies?
a. Erythema multiforme
b. Stevens-Johnson syndrome
c. Pemphigoid
d. Pemphigus
e. Herpes Zoster

A

C. Pemphigoid
Pemphigoid is a subepithelial vesiculo-bullous disorder, which occurs in women over the age of 60. It is characterised by tough bullae, which last 2-3 days before bursting. It can involve the skin, conjunctiva, nasal and laryngeal regions. It also heals with scarring.

31
Q

Which one of the following prenatal/neonatal problems does not affect the dentition?
a. Syphilis
b. Rubella
c. Hypocalcaemia
d. Haemolytic disease of the new born
e. Zoster

A

E. Zoster
All the other disorders lead to either hypo-mineralisation of the dentition or a developmental anomaly.

32
Q

After wisdom teeth, what teeth are the most commonly congenitally absent?

A

Mandibular second premolar.
Of people who have congenitally absent teeth, 40.9% are missing a mandibular second premolar; 23.5% are missing a maxillary lateral incisor; and 20.9% are missing a maxillary second premolar.

33
Q

How many days after fertilisation does the dental lamina develop?
a. 23 days
b. 37 days
c. 51 days
d. 65 days
e. 79 days

A

B. 37 days
The dental lamina develops 37 days after fertilisation, and from this, the tooth buds develop.

34
Q

What is the typical location of a mesiodens?

A

Between the maxillary central incisors
Mesiodens are the most common supernumerary teeth, occurring in 0.15-1.9% of the population. Mesiodentes can cause delayed or ectopic eruption of the permanent incisors.

35
Q

Which one of the following is not an acquired white spot lesion?
a. Keratosis traumatic
b. Smoker’s keratosis
c. Oral hairy leukoplakia
d. Oral candidiasis
e. White sponge naevus

A

E. White sponge naevus
White sponge naevus, also known as Cannon’s disease or hereditary leukokeratosis of mucosa, appears to follow a hereditary pattern as an autosomal dominant trait.
It presents in the mouth, most frequently, as a thick bilateral white plaque with a spongey texture, usually on the buccal mucosa, but sometimes on the labial mucosa, alveolar ridge and FOM. The gingival margin and dorsum of the tongue are almost never affected.
This condition is benign but is commonly mistaken for leukoplakia. There is no treatment but the prognosis is excellent as there are no serious clinical complications.

36
Q

A pathology report comes back with the following: subepithelial band-like lymphocytic infiltrate with the presence of Civatte bodies and immunoglobulin deposition. This report is describing:
a. Squamous cell carcinoma
b. White sponge naevus
c. Lichen planus
d. Rheumatoid arthritis
e. Sjogren’s disease

A

C. Lichen planus
The cause of lichen planus is not known. It is not contagious and does not involve any known pathogen. Lichen planus affects women more than men (3:2), and occurs most often in middle-aged adults.

37
Q

Which one of the following is a mesenchymal odontogenic tumour?
a. Ameloblastoma
b. Odontogenic fibroma
c. Squamous odontogenic tumour
d. Calcifying epithelial odontogenic tumour
e. Adenomatoid odontogenic tumour

A

B. Odontogenic fibroma
Mesenchymal odontogenic tumours: odontogenic myxoma; odontogenic fibroma; cementoblastoma; cementifying fibroma
Epithelial odontogenic tumours: ameloblastoma; squamous odontogenic tumour; calcifying epithelial odontogenic tumour; adenomatoid odontogenic tumour.

38
Q

Which type of collagen makes up the periodontal ligament?
a. I
b. II
c. III
d. IV
e. V

A

A. Collagen Type I
This is the most abundant collagen in the human body. It is present in scar tissue and found in tendons, skin, artery walls, the endomysium of myofibrils, fibrocartilage, and the organic parts of bones and teeth.

39
Q

Pressure on a tooth root stimulates:
a. Growth
b. Osteoblast activity
c. Osteoclast activity
d. Transforming growth factor release
e. Nothing

A

C. Osteoclast activity
This is the basic principle of root resorption. The pressure stimulates osteoclast activity, which leads to resorption.

40
Q
A

SBA Dentistry (10 decks)

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