Pathology1 Flashcards
The congenital absence of many, but not all, teeth is known as: • hypodontia • oligodontia • diphyodontia • anodontia
oligodontia (usually six or more)
refers to the absence of only a few teeth?
Hypodontia
type II of dentinogenesis imperfecta features?
most common, only the dentin abnormality exists with no bone involvement
Which type of dentinogenesis imperfecta features multiple pulp exposures, periapical radiolucencies, and a variable radiographic appearance?
• type I
• type II
• type III
type III (In Type III, the dentin appears thin, and the pulp chambers and root canal are extremely large)
type I of dentinogenesis imperfecta features?
occurs in patients that have osteogenesis imperfecta
dentinogenesis imperfecta appearance?
The teeth exhibit an unusual translucent or opalescent appearance with color variation from yellow-brown to gray
Hypercementosis is the excessive deposition of secondary cementum on the roots. Any tooth may be involved, however, which teeth are most frequently involved? • molars • incisors • premolars • canines
premolars (Hypercementosis produces no significant clinical signs or symptoms and a continuous and unbroken periodontal membrane space)
Hypercementosis is found in which disease?
Paget disease
An enamel defect resulting from the incomplete formation of the enamel matrix is called: • enamel pearls • enamel hypocalcification • enamel hypoplasia • regional odontodysplasia
enamel hypoplasia
If only one permanent tooth is affected with enamel hypoplasia, it is usually caused by physical damage or periapical infections to the primary tooth that this permanent tooth replaced. This is known as ?
“Turner hypoplasia.”
? involves the hard tissues that are derived from both epithelial (enamel) and mesenchymal (dentin and cementum) components
Regional odontodysplasia
Regional odontodysplasia features?
short roots, open apical foramina, and enlarged pulp chambers. The thinness and poor mineralization quality of the enamel and dentin layers have given rise to the term “ghost teeth.”
the complete division of a single tooth bud. The divided teeth are seen as completely separate with no connection to each other except each tends to be mirror image of the other?
Twinning
Clinically, percussion of the ankylosed tooth produces a ?
dull sound
Which of the following statements concerning amelogenesis imperfecta are true? Select all that apply.
• it is an inherited condition that is transmitted as a dominant trait
• because of the enamel malformation, the teeth of individuals with amelogenesis imperfecta are often discolored, sensitive to temperature changes, and painful to brush
• it only affects the permanent teeth
• it causes the enamel to be soft and thin
• the teeth appear yellow because the dentin is visible through the thin enamel
• the teeth are easily damaged and susceptible to decay
- it is an inherited condition that is transmitted as a dominant trait
- because of the enamel malformation, the teeth of individuals with amelogenesis imperfecta are often discolored, sensitive to temperature changes, and painful to brush
- it causes the enamel to be soft and thin
- the teeth appear yellow because the dentin is visible through the thin enamel
- the teeth are easily damaged and susceptible to decay
which malocclusion is a common clinical finding in amelogenesis imperfecta?
Open bite
The abnormal loss of tooth structure due to nonmasticatory physical friction is referred to as: • erosion • abfraction • attrition • abrasion
abrasion
Abfraction lesions ?
are cervical erosive lesions that cannot be attributed to any particular cause; causing the enamel to “pop” off starting at the base of the tooth and exposing the gumline of the tooth to excessive wear.
Which of the following can cause intrinsic staining of teeth? Select all that apply. • dentinogenesis imperfecta • erythroblastosis fetalis • porphyria • fluorosis • diabetes mellitus • pulpal injury • internal resorption • tetracyclines
- dentinogenesis imperfecta
- erythroblastosis fetalis
- porphyria
- fluorosis
- pulpal injury
- internal resorption
- tetracyclines
the expectation of an endodontic therapy success rate in internal resorption?
relatively high success rate
the expectation of a endodontic therapy success rate in external resorption?
of no assistance, since the source of the lesion is not in the pulp
A patient with which type of amelogenesis imperfecta will have teeth with demonstrate enamel that varies from thin and smooth to normal thickness with grooves, furrows, and/or pits?
• type I (hypoplastic)
• type II (hypomaturation)
• type III (hypocalcified)
type I (hypoplastic)
Dentin dysplasia is a rare condition that has been subdivided into ?
- type I or radicular type
* a more rare type II or coronal type
In Type I dentin dysplasia, roots appear extremely short, and pulps are: • normal • somewhat smaller • extremely large • completely obliterated
completely obliterated
Type I dentin dysplasia clinical features?
- Type I dentin dysplasia
- teeth are generally mobile, frequently abscess, and can be lost prematurely
- teeth show greater resistance to caries
- extremely short roots
- obliterated pulp chambers
- periapical radiolucencies
Type II dentin dysplasia (coronal dysplasia) features?
- Coronal pulps of permanent teeth are usually enlarged
* Absence of periapical radiolucencies
Leukemia is a group of bone marrow diseases involving an uncontrolled increase in: • red blood cells (erythrocytes) • platelets • plasma cells • white blood cells (leukocytes)
white blood cells (leukocytes)
four types of leukemia ?
- Acute lymphocytic leukemia (ALL): most common type in children
- Acute myelogenous leukemia (AML): most malignant type
- Chronic lymphocytic leukemia (CLL): least malignant type
- Chronic myelogenous leukemia (CML): 2 distinct phases, invariably fatal
A 48-year-old female patient walks into your office. She states that she is diagnosed with some disease which she can't remember the name of. Her physician wants her to follow up with you, her dentist, regularly to watch out for cancer of the tongue and throat. She also has a bald tongue, and states that her fingernails "look funny." What disease does she have? • aplastic anemia • plummer-vinson syndrome • pernicious anemia • cushing syndrome
plummer-vinson syndrome (iron-deficiency anemia is common in it)
Aplastic anemia ?
a form of anemia in which the capacity of the bone marrow to generate red blood cells is defective
Aplastic anemia types?
I. Primary: unknown cause, affects young adults. It is usually fatal.
2. Secondary: caused by exposure to toxic agents, such as radiation, chemicals, or drugs (for example, chloramphenicol). It can occur at any age. Prognosis is good
the most serious and life-threatening blood dyscrasia associated with drug toxicity ?
Aplastic anemia
What disorder is a result of a genetic mutation causing the substitution of glutamic acid by a valine and results in dental radiographs with enlarged marrow spaces? • cystic fibrosis • muscular dystrophy • polio • sickle cell anemia
sickle cell anemia (abnormal hemoglobin, the lamina dura and the teeth are unaffected)
in sickle cell anemia the life span of red blood cells is reduced ?
from 120 to 20 days.
The category of pigmented (usually purple) lesions in the skin caused by extravasation of blood from the capillaries is known as: • petechiae • purpura • ecchymosis • varicose veins
purpura (Tooth extractions are contraindicated due to the tendency for excessive bleeding)
Which of the following is true of acute leukemias? Select all that apply.
• slow onset and progession
• characterized by the appearance of immature, abnormal cells in the bone marrow and peripheral blood and frequently in the liver, spleen, lymph nodes, and other parenchymatous organs
• marked by the effects of anemia, which are usually severe (fatigue, malaise), an absence of functioning granulocytes (prone to infection and inflammation), and thrombocytopenia (hemorrhagic diathesis)
• moderate enlargement of the spleen, liver, and lymph nodes. Fever and very high ESR
• leukocyte counts vary greatly from patient to patient
• characterized by the appearance of immature, abnormal cells in the bone marrow and peripheral blood and frequently in the liver, spleen, lymph nodes, and other parenchymatous organs
• marked by the effects of anemia, which are usually severe (fatigue, malaise), an absence of functioning granulocytes (prone to infection and inflammation), and thrombocytopenia (hemorrhagic diathesis)
• moderate enlargement of the spleen, liver, and lymph nodes. Fever and very high ESR
• leukocyte counts vary greatly from patient to patient
(Acute leukemias have a rapid onset and progression)
You have a dental patient who mentions during his health history that he has an "overactive thyroid".You ask him about his medications and he states that he doesn't know what he takes now, but at one time he took methimazole. He had to stop that because it "really tore up my gums and the roof of my mouth." Which condition of the blood is most commonly caused as a reaction to medication that could have caused these symptoms? • thrombocytopenic purpura • agranulocytosis • sickle cell anemia • peutz-jeghers syndrome
agranulocytosis (The most characteristic feature of this condition is the presence of infection, particularly in the oral cavity)
One important aspect agranulocytosis ?. Histologically, this is pathognomonic of agranulocytosis.
there is little or no apparent inflammatory cell infiltration around the lesions
difference between agranulocytosis and cyclic neutropenia?
Cyclic neutropenia is an unusual form of agranulocytosis with severe gingivitis. The severe ulcerations seen in agranulocytosis usually do not occur
The term used to describe a leukemia in which leukemic cells appear in the blood but there is no significant increase in the number of white blood cells is called:
• aleukemic leukemia
• subleukemic leukemia
• stem cell leukemia
subleukemic leukemia
a form of leukemia in which there are leukemic cells present in the bone marrow, but the circulating white blood cells are neither immature nor increased in number.
aleukemic leukemia
abnormal cells that are poorly differentiated but are considered to be precursors of lymphoblasts, myeloblasts, or monoblasts. Note: these cells are too immature to classify.
stem cell leukemia
a marked increase in the number of circulating granulocytes. This condition is seen in a variety of disorders, including chronic infections and neoplasms
leukemoid reaction
A dentiist is often consulted first by a patient with pernicious anemia for relief of: • denuded gingiva • glossitis • edematous buccal mucosa • severe gingivitis
glossitis
pernicious anemia?
- megaloblastic anemia
- intrinsic factor
- vitamin B 12 (necessary for the maturation of erythrocytes)
- A Schilling 24-hour urine test is done to evaluate whether vitamin B 12 is being absorbed
Oral manifestations of thalassemia:
- Oral mucosa may exhibit the characteristic anemic pallor
* Flaring of the maxillary anterior teeth with malocclusion
In your office, you see a 6-month-old child whose first teeth are erupting and whose mother is concerned about the color. The mandibular incisors do show a brownish-blue hue. You are going to ask the mother about which of the following conditions during her pregnancy: • sickle cell anemia • erythroblastosis fetalis • patent ductus arteriosus • low-weight preterm birth
erythroblastosis fetalis (The fetus’ blood is Rh-positive because the father passed along an Rh-positive trait, which is a dominant trait. The mother responds to the incompatible blood by producing antibodies against it)
- The most common form of erythroblastosis fetalis is called ?
- The less common form is called
- ABO incompatibility, which can vary in its severity.
* Rh incompatibility, which more often causes a very severe anemia in the baby.
The most severe form of erythroblastosis fetalis, Rh incompatibility, can be prevented if the mother takes a medicine called ? at certain times during and after pregnancy
Rhogam
Which of the following statements are true regarding chronic leukemias? Select all that apply.
• they have a delayed onset and progression
• the clinical course is less devastating than that of an acute leukemia
• they constitute 75% of all leukemias
• they are characterized by proliferations of lymphoid or hematopoietic cells that are more mature than those of the acute leukemias
• they have a delayed onset and progression
• the clinical course is less devastating than that of an acute leukemia
• they are characterized by proliferations of lymphoid or hematopoietic cells that are more mature than those of the acute leukemias
(they constitute 50% of all leukemias)
Philadelphia chromosome and low levels of leukocyte alkaline phosphatase are common in ?
chronic myeloid leukemia
Leukemias are evenly split between the acute and chronic forms, but among children, one form accounts for about two-thirds of cases. This one form is: • acute lymphocytic leukemia (ALL) • acute myeloid leukemia (AML) • chronic lymphocytic leukemia (CLL) • acute monoblastic leukemia (AMoL)
acute lymphocytic leukemia (ALL)
which leukemia are the most common types in adults?
Acute myeloid leukemia and chronic lymphocytic leukemia
You have a new patient in your dental office who has just moved from Denver. He says his doctor told him that he has some disease caused by living at a high altitude. When conducting an intraoral exam, you find that his tongue is a deep purple and his gingiva bleed easily. What disease is a likely cause of these findings? • polycythemia vera (primary) • secondary polycythemia • hemophilia B • thalassemia major • porphyria
secondary polycythemia (too many red blood cells in the circulation, leads to clot formation and blockage of the small vessels, which can lead to a stroke)
polycythemia vera (primary)
excess erythrocytes are produced as a result of tumorous in the tissues that produce blood cells, Splenomegaly is a feature
The translocation from chromosome 22 to chromosome 9 is a finding of which leukemia? • acute lymphocytic leukemia • chronic myeloid leukemia • acute myeloid leukemia • chronic lymphocytic leukemia
chronic myeloid leukemia (Philadelphia chromosome)
The typical symptoms of chronic myeloid leukemia include:
- spongy bleeding gums
* repeated infections
Which of the following is a troublesome fibroblastic neoplasm that is locally aggressive and infiltrative? • peripheral fibroma • traumatic neuroma • nodular fasciitis • fibromatosis
fibromatosis
A traumatic neuroma is a lesion caused by trauma to the peripheral nerve. In he oral cavity, the injury may be in the form of trauma from ?. It is usually a very small nodule (less than 0.5 cm in diameter). In the oral cavity, it is most commonly seen at ?. It is firm, movable, and well encapsulated. It is ? when palpated. Pressure applied to the neuroma elicits a response often described as an ?
- a surgical procedure such as a tooth extraction, from a local anesthetic injection, or from an accident
- the mental foramen in edentulous mouths
- painful
- “electric shock”
While in the OR on a general surgery rotation, a 3-month-old is brought in with a large (20 cm) fluid-filled mass on her neck. The diagnosis is a cystic hygrom a (hygroma coli). This lesion is under which umbrella of lesions, which also contains enlarged tissue on the posterior and lateral border of the tongue? • angiomas • lymphangiomas • schwannomas • fibrosarcomas
lymphangiomas (develop early in life, do not undergo malignant change, regress spontaneously during childhood, Aspiration is “mandatory” before surgical excision of a lymphangioma to prevent complications associated with the similar-appearing hemangioma)
A 24-year-old female patient comes into your office complaining of 14-mm exophytic, red mass present on the gingiva between teeth 5 and 6. A health history reveals that she is a smoker and is 3 months pregnant. Her oral hygiene is poor. A likely diagnosis of the mass is: • lipoma • pyogenic granuloma • epulis granulomatosum • peripheral fibroma
pyogenic granuloma
The peripheral fibroma is a reactive hyperplastic mass that occurs in ? and may be derived from ?. It is similar in color to ?. The treatment for a peripheral fibroma is ?. Recurrence is ?.
- the gingiva
- connective tissue of the submucosa or the PDL
- the surrounding connective tissue
- local excision
- rare
variant forms of the peripheral fibroma include:
- The peripheral odontogenic fibroma: gingival mass composed of a fibrous connective tissue
- The peripheral ossifying fibroma: gingival mass in which calcified islands, presumed to be bone, are seen
Focal fibrous hyperplasia is hyperplasia of oral mucosa. It is also called ?
traumatic fibroma, irritation fibroma, and hyperplastic scar (caused usually by chronic trauma to oral mucous membranes)
? is a focal fibrous hyperplasia in which connective tissue cells, many of which are multinucleated, assume a stellate shapes
The giant cell fibroma
A patient presents to your clinic with multiple exophytic masses covering the buccal mucosa, tongue, and lips. A biopsy reveals that these are mucosal neuromas. The most important reason this patient should be referred to a physician is because of the risk of related: • squamous cell carcinoma of the tongue • pituitary hyperplasia • medullary carcinoma of the thyroid • sipple syndrome
medullary carcinoma of the thyroid (because of its ability to metastasize and cause death, the detection of the mucosal neuromas may alert the clinician for early diagnosis and treatment)
Which of the following is probably the most common benign peripheral nerve tumor? • traumatic neuroma • neurilemmoma (schwannoma) • neurofibroma • nodular fasciitis • fibromatosis
neurofibroma — this is a tumor of the nerve fibers itself and it commonly appears as a sessile, firm, pink nodule
sessile = بدون پایه و ساقه
A patient presents to the dermatologist with light brown birthmark-like spots on his back. A thorough scan reveals freckles in his armpits and pigmented lesions within the iris. Intraorally, this patient has multiple lesions on the gingiva and alveolus. What is the most likely diagnosis of these oral lesions? • neurilemmoma • neurofibroma • neuroma • fibroma
neurofibroma its signs:
pigmentations of the skin (Cafe-au-Lait spots),
iris freckling (Lisch spots),
axillary freckling (Crowe sign).
The presence of six or more cafe au lait macules greater than 1.5 cm in diameter is generally regarded as being indicative of ? disease until proven otherwise.
neurofibroma
The importance of neurofibroma is ?
the high risk (5% to 15%) of malignant transformation
A 55-year-old patient comes into your office for routine dental work. You see that he has a tooth fracture (due to decay) of tooth #31. A smooth, firm, asymptomatic lesion is noted on the lateral border of the tongue adjacent to the sharp enamel of tooth #31. The patient states that the lesion has been there for years and is annoying because sometimes he will bite it accidentally. Name this most frequently encountered intraoral benign neoplasm of connective tissue origin. • a leiomyosarcoma • a traumatic fibroma • a leiomyoma • a rhabdomyoma
a traumatic fibroma (also called irritation fibroma)
Scleroderma is a systemic disease that affects many organ systems. The symptoms result from inflammation followed by progressive tissue fibrosis and occlusion of the microvasculature by excessive production and deposition of: • types II and IV collagens • types I and III collagens • elastin and reticulin • all of the above
types I and III collagens
Oral radiographs of a patient with scleroderma would show ?
an abnormal widening of the PDL (uniform in width).
The abnormal widening of the periodontal membrane space is a radiographic finding in ?
- scleroderma
* osteosarcomas
A newborn girl was delivered via cesarean section due to airway patency concerns. During ultrasound, there was the discovery of a tumor of the oral cavity. On delivery, the pink, compressible tumor of the anterior maxilla was deemed to be a congenital epulis of the newborn. This lesion is composed of cells that are identical to those of the: • a traumatic neuroma • a schwannoma • a granular cell myoblastoma • a lipoma
a granular cell myoblastoma (also called a granular cell tumor)
The granular cell myoblastoma is a rare neoplasm, researchers believe its origin is from ?
the Schwann cell
The granular cell myoblastoma and congenital epulis of the newborn are identical histologically. They both contain ?, however, the congenital epulis of the newborn does not exhibit ?.
- granular cells
* pseudoepitheliomatous hyperplasia of the overlying epithelium (is frequently seen in the granular cell myoblastoma)
An emergency patient walks into your office with swelling of the left submandibular space. He says his lower left molar recently "broke down" and has been very painful, especially when something cold hits it or when he chews on it. What is the most likely etiology of this swelling? • orthodontics • trauma • infection of the pulp of the tooth • periodontal disease
infection of the pulp of the tooth (follows the caries)
If a periapical abscess is not treated, it can lead to serious complications such as ?
osteomyelitis, cellulitis, and bacteremia
A healthy patient comes into your office for an initial exam. On the full mouth series of radiographs you see a radiopaque lesion periapical to tooth #19. Tooth #19 has a deep amalgam restoration with recurrent decay underneath. You can see the entire outline of the mesial root of tooth #19 - the lesion seems to stem from the tooth. What is the most likely diagnosis of the lesion? • condensing osteitis • cementoblastoma • cementoma • fibrocementoma
condensing osteitis (Synonyms for it include focal sclerosing osteomyelitis, bony scar, and sclerotic bone) usually asymptomatic, well-circumscribed radiopaque mass, entire root outline is almost always visible
condensing osteitis radiographically resemble ?
benign cementoblastoma
Diffuse sclerosing osteomyelitis represents an inflammatory reaction ?
- chronic periodontal disease
- frequently in middle-aged black females
- pain, swelling, and occasional drainage
- the lesion is ill-defined (diffused)
Most cases of acute osteomyelitis are infectious. Almost any organism may be part of the etiologic picture, although ? have been the most frequently cited. • bacteroides and campylobacter • clostridia and corynebacterium • staphylococci and streptococci • enterococci and lactobacilli
staphylococci and streptococci (it is usually an extension of a periapical abscess)
acute osteomyelitis signs?
- Pain
- Paresthesia of the lower lip
- radiographic evidence of acute osteomyelitis is usually not present
chronic osteomyelitis signs?
- Pain
- swelling of the jaw
- loose teeth and sinus tracts are less frequently seen
- anesthesia is very uncommon
- radiolucent pattern is often described as “moth-eaten” because of its mottled radiographic appearance.
- Treatment includes antibiotics and sequestrectomy
Cleft palate occurs in the ? of embryonic life. • first to third week • fourth to sixth week • eighth to tenth week • twelfth to fourteenth week
8-10th week
cleft lip = 6-7th week
A child with achondroplasia has a:
• relatively normal torso and long arms and legs
• short torso and long arms and legs
• long torso and long arms with short legs
• relatively normal torso and short arms and legs
relatively normal torso and short arms and legs (most common type of dwarfism. The upper arms and thighs are more shortened than the forearms and lower legs)
Potential problems in children with achondroplasia include ?
- overcrowding of the teeth,
- speech problems (articulation),
- frequent ear infections (otitis media)
- saddle-like nose
- mandible prognathism
Type I dentinogenesis imperfecta is associated with which genetic disease? • osteogenesis imperfecta • marfari syndrome • ehlers-danlos • cystic fibrosis
osteogenesis imperfecta (bones are prone to fracture due to inadequate collagen)
Hypophosphatasia is a genetic metabolic disorder of bone mineralization caused by a deficiency in: • acid phosphatase • vitamin K • alkaline phosphatase • phosphorus
alkaline phosphatase enzyme (essential to the calcification
of bone)
Hypophosphatasia characteristic?
The premature loss of teeth in children and adults
which patients have high levels of serum alkaline phosphatase?
with Paget disease
Pituitary adenoma in a 9 -year-old will most likely lead to: • gigantism • acromegaly • achondroplasia • dwarfism
gigantism
A new 6-year-old pediatric patient walks into your operatory with his mother. Your initial physical assessment notes a prominent forehead and flattened nose. The patient initially seems to have no eyebrows but you later realize that the hair is just very fine and sparse. When you shake her hand and she smiles, you also notice that she is missing teeth and the ones she has are cone shaped. What is her most likely systemic condition? • pierre robin syndrome • ectodermal dysplasia • cleidocranial dysplasia • peutz-jeghers syndrome • osteopetrosis
ectodermal dysplasia
ectodermal dysplasia clinical findings?
- hypothrichosis (decrease in hair)
- anhidrosis (no sweat glands, leading to heat intolerance)
- anodontia or oligodontia (complete or partial absence of teeth)
- depressed bridge of nose
- lack of salivary glands
- the child appears much older than what he or she is
An old patient presents to your office with ill-fitting dentures. Radiographic and clinical exam lead you to believe the patient has Paget disease. Which of the following would support this diagnosis? Select all that apply. • hypercementosis • enlarged cranium • headaches • hearing loss • bone of increased density
• hypercementosis • enlarged cranium • headaches • hearing loss • bone of increased density also called osteitis deformans (X-rays of the skull and the jaws demonstrate the typical "cotton-wool" appearance)
You are consulting on a pathological case for a fellow dentist. The biopsy of the lesion shows multinucleated giant cells and perivascular collagen cuffing. After asking about the clinical signs, your colleague mentions that the young patient seems always to be "staring off into space" and that she has "puffy cheeks."The most likely diagnosis of this case is: • aneurysmal bone cyst • central giant cell granuloma • tumor of hyperparathyroidism • cherubism
cherubism
• multilocular radiolucencies of the jaw
• occlusal radiograph of the maxilla may give a “soap bubble-like” picture
A deficiency of parathyroid hormone can be treated with: • vitamin A • vitamin C • vitamin D • vitamin K
vitamin D
hypoparathyroidism findings?
- Hypocalcemia
- tetany
- A positive Chvostek sign (twitching of the facial muscles when tapped on the facial nerve near the parotid gland)
The most acute and severe type of hyperthyroidism is: • toxic nodular goiter • graves disease • hashimoto disease • addison disease
graves disease
Severe hypothyroidism in a child is called: • dwarfism • myxederna • cretinism • acromegaly
cretinism
• (common hypothyroidism is called Hashimoto)
• (Extreme hypothyroidism in adults is called myxedema)
The clinical features of the primary form of which disease is classically described as "stones, bones, groans, and moans?" • paget disease • hypophosphatasia • hyperparathyroidism • hyperthyroidism
hyperparathyroidism
