ORPTH ADONS DSE SLVRY GLNDS

Question 1

1. A mucocele is not a true cyst because
   (a) It is lined by epithelium
   (b) Its lumen is filled with pus
   (c) It occurs as a result of trauma
   (d) It is not lined by an epithelium

Answer 1

(d) Mucocele is a common lesion of the oral mucosa that results
from rupture of a salivary gland duct and spillage of mucin into the surrounding soft tissues and unlike the salivary duct cyst, mucocele is not a true cyst because it lacks an epithelial lining.

Question 2

2. The most common location for occurrence of mucoceles is
   (a) Upper lip
   (b) Floor of mouth
   (c) Lower lip
   (d) Palate

Answer 2

(c) The lower lip is the most common site for a mucocele,
accounting for over 60 percent of all cases. This could be
due to the fact that lower lip region is more prone to trauma.

Question 3

3. Plunging/cervical ranula is a clinical variant of ranula which
   occurs when the spilled mucin dissects between the fibers of
   _______ muscle.
   (a) Anterior belly of digastric
   (b) Mylohyoid
   (c) Omohyoid
   (d) Posterior belly of digastric

Answer 3

(b) When the spilled mucin dissects through the mylohyoid
muscle, it produces a swelling within the neck. In such cases,
a concomitant swelling in the floor of the mouth may or may
not be present

Question 4

4. Which amongst the following cannot be used to describe a
   salivary duct cyst?
   (a) Mucous retention cyst
   (b) Sialocyst
   (c) Mucous duct cyst
   (d) Mucous extravasation phenomenon

Answer 4

(d) Mucous extravasation phenomenon is a term applied to
mucoceles which arise as a result of trauma to salivary
ducts resulting in extravasation of mucin into surrounding
tissues. However, a sialocyst is a true cyst and may arise due
to dilatation of a duct secondary to ductal obstruction

Question 5

5. Submandibular salivary gland is the most common location for
   which one of the following pathologies?
   (a) Mucocele
   (b) Sjögren’s syndrome
   (c) Sialolithiasis
   (d) Necrotizing sialometaplasia

Answer 5

(c) Calculi of salivary ducts are more likely to develop in
submandibular gland duct owing to its tortuous course and
also due to the fact that the saliva flows more slowly in such
ducts, leading to its stasis

Question 6

6. Which one out of the following is the most common bacterial
   agent responsible for causing acute sialadenitis?
   (a) Streptococcus mutans
   (b) Lactobacillus acidophilus
   (c) Staphylococcus aureus
   (d) Actinomyces israelii

Answer 6

(c) Acute sialadenitis most commonly occurs in parotid glands
as a result of retrograde infection in debilitated patients
suffering from dehydration, xerostomia, vomiting, etc. after
a surgical procedure

Question 7

7. Cheilitis glandularis typically occurs on the
   (a) Upper lip
   (b) Lower lip
   (c) Soft palate
   (d) Gingiva

Answer 7

(b) Cheilitis glandularis is a poorly understood disease that
occurs in response to diverse sources of chronic irritationlike sun damage, etc

Question 8

8. Baelz disease is also known as
   (a) Keratosis follicularis
   (b) Cheilitis glandularis
   (c) Cheilitis granulomatosa
   (d) Cheilitis follicularis

Answer 8

(b) It is a superficial type of cheilitis glandularis characterized
by painless, indurated lip swelling with shallow ulceration
and crusting

Question 9

11. Benign lymphoepithelial lesion usually develops as a component
    of which syndrome?
    (a) Sjögren’s
    (b) Grinspan
    (c) Rubinstein-Taybi
    (d) Chédiak-Higashi

Answer 9

(a) Sjögren’s syndrome is an autoimmune disease that may
produce bilateral salivary and lacrimal gland enlargement,
with microscopic features of benign lymphoepithelial
lesion. However, not all benign lymphoepithelial lesions are
necessarily associated with the clinical disease complex of
Sjögren’s syndrome

Question 9

9. Out of the below mentioned causes, which one is not a cause of
   xerostomia?
   (a) Medications
   (b) Diabetes insipidus
   (c) Salivary gland aplasia
   (d) Tobacco chewing

Answer 9

(d) Xerostomia refers to a subjective sensation of a dry mouth.
It is frequently, but not always, associated with salivary
gland hypofunction. Many factors have been linked with
xerostomia-like developmental, water/metabolite loss,
systemic diseases, local factors and even iatrogenic

Question 10

10. Xerostomia is often associated with atrophy of ______ papillae
    (a) Filiform
    (b) Circumvallate
    (c) Fungiform
    (d) Foliate

Answer 10

(a) The dorsal surface of tongue often appears fissured with
atrophy of the filiform papillae.

Question 11

12. The characteristic “cherry blossom” or “branchless fruit laden
    tree” appearance on sialography is seen in which of the following
    conditions?
    (a) Melkersson-Rosenthal syndrome
    (b) Rubinstein-Taybi syndrome
    (c) Necrotizing sialometaplasia
    (d) Sjögren’s syndrome

Answer 11

(d) Though not diagnostic, sialographic examination often
reveals punctate sialectasia and lack of normal branching
of the ductal system, typically demonstrating a “fruit laden,
branchless tree” pattern. Scintigraphy with radioactive technetium—99m pertechnetate characteristically shows
decreased uptake and delayed emptying of the isotope.

Question 12

13. Regarding Sjogren’s syndrome, which one of the following
    ststements is incorrect?
    (a) Primary Sjögren’s is also called as Sicca syndrome
    (b) Elevated rheumatoid factor is found
    (c) Most commonly occurs in males
    (d) Salivary glands show presence of epimyoepithelial islands

Answer 12

(c) Between 80 percent and 90 percent of cases of Sjögren’s
syndrome occur in females. It is seen predominantly in
middle-aged adults.

Question 13

14. Microscopic appearance of necrotizing sialometaplasia can be
    confused with those of which other lesion?
    (a) Pleomorphic adenoma
    (b) Warthin’s tumor
    (c) Squamous cell carcinoma
    (d) Basal cell carcinom

Answer 13

(c) Necrotizing sialometaplasia is an uncommon, locally
destructive inflammatory condition of the salivary glands.
The importance of this lesion rests in the fact that it mimics
a malignant process both clinically and microscopically

Question 14

15. The most frequent site for occurrence of tumors in minor salivary
    glands is
    (a) Palate
    (b) Floor of mouth
    (c) Buccal mucosa
    (d) Lower lip

Answer 14

(a) The palate is the most frequent site for minor salivary gland
tumors with 42% to 54% of all cases found there. Most of
these occur on the posterior lateral hard or soft palate which
has the greatest concentration of salivary glands.

Question 15

16. The mesenchymal appearing elements in pleomorphic adenoma
    are produced by _______ cells.
    (a) Myoepithelial
    (b) Squamous
    (c) Serous
    (d) Ductal

Answer 15

(a) The stromal changes in pleomorphic adenoma are
believed to be produced by myoepithelial cells. Extensive
accumulation of mucoid material may occur between
the tumor cells, resulting in a myxomatous background.
Vacuolar degeneration of cells in these areas can produce a
chondroid appearance. In many tumors, the stroma exhibits
areas of an eosinophilic hyalinized change. At times, fat or
osteoid also is seen

Question 16

17. Myoepithelial cells in pleomorphic adenoma which appear
    rounded, with eosinophilic, hyalinized cytoplasm and having
    an eccentric nucleus are called as ______ myoepithelial cells.
    (a) Myxoid
    (b) Adenomatoid
    (c) Plasmacytoid
    (d) Oncocytic

Answer 16

(c) Some myoepithelial cells in pleomorphic adenoma are
rounded and demonstrate an eccentric nucleus and
eosinophilic hyalinized cytoplasm, thus resembling plasma
cells. These characteristic plasmacytoid myoepithelial cells
are more prominent in tumors arising in the minor glands

Question 17

18. All of the following except _____ are mesenchymal elements
    commonly seen in a pleomorphic adenoma.
    (a) Fat
    (b) Osteoid
    (c) Chondroid
    (d) Nerve fibers

Answer 17

(d) Pleomorphic adenoma demonstrates various mesenchymal
elements like chondroid, myxoid, fat and osteoid. It is this
variability of appearance that provides another name to
pleomorphic adenoma, i.e. mixed tumor.

Question 18

19. Abundant granularity within the oncocytes in oncocytosis is due
    to increased quantity of
    (a) Golgi bodies
    (b) Proteins
    (c) Ribosomes
    (d) Mitochondria

Answer 18

(d) Oncocytosis is the transformation of ductal and acinar cells
to oncocytes. These cells appear polyhedral in shape and
demonstrate abundant granular, eosinophilic cytoplasm
as a result of the proliferation of mitochondria

Question 19

20. Warthin’s tumor is also known as
    (a) Papillary cystadenoma lymphomatosum
    (b) Intraductal papilloma
    (c) Papillary cystadenoma
    (d) Sialadenoma papilliferum

Answer 19

(a) It is a histological term and denotes a primarily cystic tumor
showing papillary projections into the cystic lumen, along
with lymphoid proliferation in the wall.

Question 20

21. Myoepithelioma is considered by many to represent one end of
    spectrum of
    (a) Warthin’s tumor
    (b) Oncocytoma
    (c) Pleomorphic adenoma
    (d) Ductal papillomas

Answer 20

(c) The neoplastic cells in this tumor are almost exclusively
myoepithelial cells appearing either spindle shaped or
plasmacytoid. Many authors consider this neoplasm to represent the other side of the spectrum of pleomorphic
adenoma.

Question 21

22. The most common histological variant of basal cell adenoma is
    (a) Tubular
    (b) Solid
    (c) Trabecular
    (d) Membranous

Answer 21

(b) Basal cell adenoma is a benign salivary gland tumor that
derives its name from the basaloid appearance of the
tumor cells. The most common variant, solid type consists
of multiple islands and cords of epithelial cells that are
supported by a small amount of fibrous stroma.

Question 22

23. Canalicular adenoma most frequently occurs in the intra-oral
    accessory salivary glands of
    (a) Upper lip
    (b) Soft palate
    (c) Lower lip
    (d) Floor of mouth

Answer 22

(a) Canalicular adenoma is an uncommon tumor that occurs
almost exclusively in the minor salivary glands, showing
a striking predilection for the upper lip, with nearly 75%
occurring in this location

Question 23

24. Which one of the following is not a variety of ductal papillomas?
    (a) Inverted ductal papilloma
    (b) Intraductal papilloma
    (c) Sialadenoma papilliferum
    (d) Cystadenoma

Answer 23

(d) Sialadenoma papilliferum, intraductal papilloma, and
inverted ductal papilloma are three rare salivary gland
neoplasms that also show unique papillomatous features
apart from the Warthin’s tumor

Question 24

25. Which one of the following malignant salivary gland neoplasms
    demonstrates serous acinar differentiation?
    (a) Adenoid cystic carcinoma
    (b) Mucoepidermoid carcinoma
    (c) Acinic cell adenocarcinoma
    (d) Malignant pleomorphic adenoma

Answer 24

(c) Acinic cell adenocarcinoma is a salivary gland malignancy
with cells that show serous acinar differentiation. It is
generally agreed today that acinic cell adenocarcinoma
should be considered a low-grade malignancy because
some of these tumors do metastasize or recur and cause
death.

Question 25

26. The most common malignant salivary gland neoplasm is
    (a) Acinic cell carcinoma
    (b) Malignant pleomorphic adenoma
    (c) Adenoid cystic carcinoma
    (d) Mucoepidermoid carcinoma

Answer 25

(d) Most studies show that the mucoepidermoid carcinoma
is the most common malignant salivary gland neoplasm.
In most studies, it made up 10 percent of all major gland
tumors and 15 percent to 20 percent of minor gland tumors

Question 26

27. Intraosseous/central mucoepidermoid carcinoma is believed to
    arise from
    (a) Malignant transformation of rests of Malassez
    (b) Malignant transformation of epithelial lining of odontogenic
    cysts
    (c) Malignant transformation of cell rests of Serres
    (d) Arises de novo from ectopic mucous cells located intraorally

Answer 26

(b) The most likely source for most intraosseous tumors is
odontogenic epithelium. Mucus producing cells are common
in odontogenic cyst linings, especially dentigerous cysts. In
addition, many intraosseous mucoepidermoid carcinomas
develop in association with impacted teeth or odontogenic
cysts.

Question 27

27. Intraosseous/central mucoepidermoid carcinoma is believed to
    arise from
    (a) Malignant transformation of rests of Malassez
    (b) Malignant transformation of epithelial lining of odontogenic
    cysts
    (c) Malignant transformation of cell rests of Serres
    (d) Arises de novo from ectopic mucous cells located intraorally

Answer 27

(a) Adenoid cystic carcinoma is one of the best recognized
salivary malignancies. Approximately, 50 percent develop
within the minor salivary glands with palate being the most
common location. The neoplasm is composed of a mixture
of myoepithelial cells and ductal cells that can have a
varied arrangement, with three major patterns recognized
cribriform, tubular, and solid

Question 28

29. Which amongst the following is the most recently recognized
    salivary gland neoplasm?
    (a) Polymorphous low-grade adenocarcinoma
    (b) Malignant pleomorphic adenoma
    (c) Adenoid cystic carcinoma
    (d) Mucoepidermoid carcinoma

Answer 28

(a) Polymorphous low grade adenocarcinoma is a recently
recognized type of salivary malignancy that was first
described in 1983. Before its identification as a distinct
entity, examples of this tumor were categorized as
pleomorphic adenoma, an unspecified form of adenocarcinoma, or sometimes adenoid cystic carcinoma.

Question 29

30. Which cells in mucoepidermoid carcinoma are believed to be
    progenitors of both mucous as well as epidermoid cells?
    (a) Basaloid cells
    (b) Intermediate cells
    (c) Reserve cells
    (d) Intercalated duct cells

Answer 29

(b) Mucoepidermoid carcinoma is composed of a mixture of
mucus producing cells, squamous cells and in addition, a
third type of cell, the intermediate cell. This cell is basaloid
in appearance and is believed to be a progenitor of the
mucous and epidermoid cells.