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Best of Fives for Dentistry > Oral pathology > Flashcards

Oral pathology Flashcards

1
Q
  1. Which one of the following statements regarding carcinoma of the lip is true?
    a. It is commoner on the lower lip
    b. It is often caused by chewing betel quid
    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 commoner 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 ultraviolet light, and has a better prognosis because it is more visible, and therefore patients present sooner.

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2
Q
  1. 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 premalignant 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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3
Q
  1. 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. Betel nut is safer than smoked tobacco
 Traditionally oral cancer has been occurring most commonly in males older than 50 years. 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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4
Q
  1. 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 that 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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5
Q
  1. 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, Lactobaccilius 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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6
Q
  1. 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 caires 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 a low caries incidence until the Americans arrived during the war bringing refined carbohydrates with them; and afterwards the caries rate soared. In the Hopewood House study, the children demonstrated a higher caries rate before and after being in their children’s home. The Turku xylitol study showed a 90% caries decrease when xylitol was substituted for sucrose.

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7
Q
  1. Which one of the following histopathological zones is the advancing edge of caries in enamel?
    a. Zone of sclerosis
    b. Translucent zone
    c. Surface zone
    d. Dark zone
    e. Zone of destruction
A

 B. Translucent zone
 Translucent zone, Dark zone, Body of lesion, Surface zone

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8
Q
  1. Which one of the following histopathological zones is the advancing edge of the carious lesion in dentine?
    a. Zone of sclerosis
    b. Dark zone
    c. Surface zone
    d. Zone of demineralisation
    e. Zone of destruction
A

 A. Zone of sclerosis
 Zone of sclerosis, Zone of demineralisation, Zone of bacterial invasion, Zone of destruction

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9
Q
  1. What is chronic hyperplastic pulpitis more commonly known as?
    a. Acute pulpitis
    b. Pulp polyp
    c. Chronic pulpitis
    d. Acute periapical periodontitis
    e. Chronic periapical periodontitis
A

 B. 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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10
Q
  1. 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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11
Q
  1. 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 above are developmental cysts. There are three types of radicular cyst: apical periodontal cyst (75%), lateral periodontal cyst (5%) and residual cyst (20%). They are the most common type of odontogenic cyst and are responsible for 75% of odontogenic cysts.

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12
Q
  1. 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
 The dental lamina is responsible for the production of odontogenic keratocysts and its epithelial residue is the gland of Serres. The enamel organ is responsible for the production of both dentigerous cysts and eruption cysts, and their epithelium residue occurs as the reduced enamel epithelium. Radicular cysts are derived from the root sheath of Hertwig and have the rests of Malassez as the epithelial residue.

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13
Q
  1. 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.

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14
Q
  1. 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

Odontogenic keratocyst
 Odontogenic keratocysts frequently recur and require close monitoring.

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15
Q
  1. 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. The function of the thyroid gland is assessed. This can be done by measuring the thyroxine (T4) levels of the patient.

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16
Q
  1. 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. All of the others are physical causes of tooth surface loss.

17
Q
  1. Which one of the following is not a cause of tooth surface loss on the palatal surfaces of maxillary central incisors?
    a. Chemotherapy
    b. Oesophageal reflux
    c. Anorexia
    d. Bulimia
    e. Pregnancy
A

 A. Anorexia
 Anorexia involves the reduction in calorific intake to reduce weight gain. Bulimia is the act of ingesting food and then regurgitating to prevent weight gain. Chemotherapy causes hyperemesis, and this can be quite marked. Oesophageal reflux causes the reflux of acidic stomach contents into the mouth leading to erosion. Pregnancy causes hyperemesis gravidarum in the first trimester which settles normally by the second trimester, but can be present throughout pregnancy.

18
Q
  1. 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 inferior dental nerve in the mandible
    c. It will not be apparent on radiographs for a month
    d. It will usually cause sharp shooting pain
    e. It may cause the loosening of teeth
A

 E. It may cause the loosening of teeth
 Osteomyelitis most frequently occurs in the mandible. The pain most commonly associated with osteomyelitis is a severe throbbing pain. It may cause the loosening of teeth, but does not always cause paraesthesia of the inferior dental nerve when associated with the mandible.

19
Q
  1. 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. The mandible is more frequently affected than the maxilla in Paget’s disease.
 In Paget’s disease the maxilla is more frequently affected than the mandible. This disease was first described by Sir James Paget in 1877, and is a disorder of bone turnover. It occurs in males over the age of 40, and is most common in weight-bearing bones of the axial skeleton such as the sacrum, vertebrae, femur and skull. The patients have bony pain, and the disorder causes compression of nerves leading to paralysis. There is spacing of teeth, and hats and dentures become ill fitting.

20
Q
  1. What is the most common age of presentation of a giant cell granuloma?
    a. Under 5 years
    b. 10-25 years
    c. 30-40 years
    d. 45-65 years
    e. 65+ years
A

 B. 10-25 years
 Giant cell granulomas occur more frequently in the mandible than in the maxilla, often in the most anterior part of the jaws. They present as a well-defined radiolucent area with thinning and often expansion of the cortex. They may be multi-locular, and involved teeth may be displaced and roots may be resorbed. They heal readily after curettage and are histologically identical to lesions of hyperparathyroidism.

21
Q
  1. 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 can occur in patients who are immunocompromised, and is often secondarily infected with Candida. It is not a premalignant lesion.

22
Q
  1. 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 frequently occur in the submandibular gland. They do not lead to xerostomia, as the parotid gland produces the greatest amount of saliva. These calculi may be seen on plain film radiographs, but sialography may be required to visualise them.

23
Q
  1. Which one of the following statements regarding salivary gland 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, cystic and myxoid tissue.

24
Q
  1. Which one of the following statements regarding fibrous dysplasia is true?
    a. It is commoner 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.

25
Q
  1. 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. It occurs more commonly in the maxilla than the mandible.
 Osteosarcoma is an infrequent complication of Paget’s disease, and occurs in men between the age of 30 and 40 years. It affects the mandible more frequently than the maxilla, and often the presenting complaint is a paraesthesia.

26
Q
  1. Which one of the following statements regarding odontomas is true?
    a. They are hamartomas
    b. They present at the age of 30 years.
    c. They can undergo a malignant transformation
    d. They are frequently present in the anterior mandible
    e. The lesion is composed of cementum embedded in fibrous tissue and a surrounding capsule.
A

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

27
Q
  1. Which one of the following conditions is associated with anti-basement membrane auto-antibodies?
    a. Erythema migrans
    b. Stevens-Johnsons 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 lasts for 2-3 days before bursting. It can involve the skin, conjunctiva, nasal and laryngeal regions. It also heals with scarring.

28
Q
  1. Which one of the following prenatal/neonatal problems does not affect the dentition?
    a. Syphilis
    b. Rubella
    c. Hypocalcaemia
    d. Haemolytic disease of the newborn
    e. Zoster
A

 E. Zoster
 All of the other disorders lead to either hypomineralisation of the dentition or a developmental anomaly.

29
Q
  1. Which one of the following teeth is most commonly congenitally absent (barring wisdom teeth)?
    a. Maxillary central incisor
    b. Maxillary lateral incisor
    c. Maxillary first premolar
    d. Maxillary second premolar
    e. Mandibular second premolar
A

 E. Mandibular second premolar
 Of people who have a congenitally absent tooth, 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.
 L5s > U2s> U5s

30
Q
  1. 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.

31
Q
  1. What is a typical location of a mesiodens?
    a. Between the maxillary central incisors
    b. Between the mandibular central incisors
    c. Associated with the maxillary canines
    d. Associated with the mandibular premolars
    e. Associated with the mandibular third molars
A

 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.

32
Q
  1. Which one of the following is not an acquired white spot lesion?
    a. Keratosis traumatica
    b. Smokers keratosis
    c. 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. Although it is congenital in most cases, it can develop in childhood or adolescence. It presents in the mouth, most frequently as a thick bilateral white plaque with a spongy texture, usually on the buccal mucosa, but sometimes on the labial mucosa, alveolar ridge or floor of the mouth. The gingival margin and dorsum of the tongue are almost never affected. Although this condition is perfectly benign, it is often mistaken for leukoplakia. There is no treatment, but because there are no serious clinical complications, the prognosis is excellent.

33
Q
  1. 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. Some lichen planus-type rashes (known as lichenoid reactions) occur as allergic reactions to medications for high blood pressure, heart disease and arthritis. These lichenoid reactions are referred to as lichen mucositis (of the mucosa) or dermatitis (of the skin). Lichen planus has been reported as a complication of chronic hepatitis C virus infection and can be a sign of chronic graft-vs-host-disease of the skin. It has been suggested that true lichen planus may respond to stress, where lesions may present on the mucosa or skin during times of stress in those with the disease. Lichen planus affects women more than men (ratio of 3:2) and occurs most often in middle-aged adults. Lichen planus in children is rare.

34
Q
  1. 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

35
Q
  1. Which type of collagen makes up the periodontal ligament?
    a. I
    b. II
    c. III
    d. IV
    e. V
A

 A. I

36
Q
  1. Pressure on a tooth root stimulates:
    a. Growth
    b. Osteoblast activity
    c. Osteoclast activity
    d. Transforming growth factor release
    e. Nothing
A

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

Best of Fives for Dentistry (6 decks)

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