Quartz 4

Oral Pathology - 20 - PRACTICE QUESTIONS

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Oral Pathology Question Bank

Comprehensive Review Questions1

  1. Which of the following is a common benign tumor of the oral cavity derived from squamous epithelium?

    • Papilloma
    • Fibroma
    • Lipoma
    • Neuroma

  2. A 45-year-old patient presents with a white, lace-like pattern on the buccal mucosa. This clinical presentation is most characteristic of:

    • Leukoplakia
    • Lichen Planus
    • Candidiasis
    • Pemphigus Vulgaris

  3. The most common site for an Ameloblastoma to occur is the:

    • Anterior Maxilla
    • Posterior Mandible
    • Hard Palate
    • Floor of the Mouth

  4. Which condition is characterized by the presence of “Tzanck cells” in a Tzanck smear?

    • Herpes Simplex Virus
    • Pemphigus Vulgaris
    • Erythema Multiforme
    • Both A and B

  5. A “sunburst” appearance on a radiograph is a classic diagnostic feature of:

    • Osteosarcoma
    • Osteoma
    • Fibrous Dysplasia
    • Paget’s Disease of Bone

  6. The primary etiologic agent proposed for Aphthous Stomatitis is Human Leukocyte Antigen (HLA), an immunologic condition rather than an infectious one.

  7. Intracellular viral inclusions are characteristic of Hairy Leukoplakia, which is caused by the Epstein-Barr Virus (EBV) and typically seen in AIDS patients.

  8. Patients with Sjogren’s Syndrome have an increased risk of developing Lymphoma due to lymphocyte infiltration of salivary glands.

  9. The mechanism of Pemphigus Vulgaris involves Acantholysis, where autoantibodies weaken desmosomes by targeting the protein desmoglein.

  10. Behçet’s Syndrome is characterized by a clinical triad of lesions in the oral, ocular, and genital regions.

  11. Oral Papillomas are clinically described as having a "warty" or "cauliflower" appearance and can occur on the tongue, lips, gums, or cheeks.

Clinical Diagnostic Indicators

  • Nikolsky Sign: Positive in Pemphigus Vulgaris; negative in Bullous Pemphigoid.
  • Wickham Striae: Characteristic white lines seen in Lichen Planus.
  • Cotton-Wool Appearance: Radiographic feature associated with the late stages of Paget’s Disease.
  • Mulberry Molars: A dental anomaly associated with Congenital Syphilis.
  • ==Numb Lower Lip: A significant clinical indicator (lip paresthesia) that a malignancy== should be seriously considered.
  • ==Koplik Spots: Pathognomonic white spots on the buccal mucosa indicative of Measles (Rubeola)==.
  • ==Odontogenic Keratocyst (OKC) Histology: Key features include thin, parakeratinized epithelium and palisading of basal cells==.

Table of Contents

Clinical Categories and Disease Classifications2

  • Developmental Conditions
    • Geographic tongue
  • Mucosal Lesions—Reactive
  • Mucosal Lesions—Infections
    • Viral (Herpes simplex, EBV), Bacterial (Syphilis, Actinomycosis), Fungal (Candidiasis)
  • Mucosal Lesions—Immunologic Diseases
    • Aphthous stomatitis (canker sores)
  • Mucosal Lesions—Premalignant
  • Mucosal Lesions—Malignant
  • CT Tumors—Benign
  • CT Tumors—Malignant
    • Sarcomas and carcinomas
  • Salivary Gland Diseases—Reactive
  • Salivary Gland Diseases—Benign
  • Salivary Gland Diseases—Malignant
  • Lymphoid Neoplasms
  • Odontogenic Cysts
  • Odontogenic Tumors
  • Bone Lesions—Fibro-Osseous
  • Bone Lesions—Giant Cell
  • Bone Lesions—Inflammatory
  • Bone Lesions—Malignant
  • Hereditary Conditions
    • White sponge nevus

Mucosal Lesions and Immunologic Diseases

One of the primary etiologic agents of aphthous stomatitis is proposed to be:

Aphthous Stomatitis and Viral Inclusions3456

A. Cytomegalovirus B. Staphylococcus C. Herpes simplex D. Human leukocyte antigen E. Candidiasis

One of the primary etiologic agents of aphthous stomatitis is proposed to be:

A. Cytomegalovirus B. Staphylococcus C. Herpes simplex D. Human leukocyte antigen E. Candidiasis

Intracellular viral inclusions are seen in tissue specimens of which of the following?

A. Solar cheilitis B. Minor aphthous ulcers C. Geographic tongue D. Hairy leukoplakia E. White sponge nevus

  • ==Aphthous Stomatitis: Also known as aphthous ulcers or canker sores. It is immunologic in nature.==
  • ==Sutton Disease: This is a synonym for the major form of aphthous ulcers.==

Autoimmune and Systemic Conditions78910

Sjogren’s Syndrome has been linked to which of the following malignancies?

A. Leukemia B. Lymphoma C. Pleomorphic adenoma D. Osteosarcoma

Sjogren’s Syndrome has been linked to which of the following malignancies?

A. Leukemia B. Lymphoma C. Pleomorphic adenoma D. Osteosarcoma

Acantholysis, resulting from desmosome weakening by autoantibodies directed against the protein desmoglein, is the disease mechanism attributed to which of the following?

A. Epidermolysis bullosa B. Mucous membrane pemphigoid C. Pemphigus vulgaris D. Herpes simplex infections E. Herpangina

Pemphigus vs. Pemphigoid

  • ==Pemphigus Vulgaris: “Pemphigus is above”—it attacks desmosomes in the upper layers of the skin and mucosa.==
  • ==Mucous Membrane Pemphigoid: “Pemphigoid is below”—it attacks the basement membrane.==
  • ==Actinic Cheilitis: Also known as Solar Cheilitis, caused by sunlight exposure.==

Infectious Diseases and Syndromes

HPV has been found in all of the following lesions EXCEPT one. Which one is the exception?

Human Papillomavirus and Genetic Syndromes111213141516

A. Oral papillomas B. Verruca vulgaris C. Condyloma acuminatum D. Condyloma latum E. Focal epithelial hyperplasia

HPV has been found in all of the following lesions except one. Which one is the exception?

A. Oral papillomas B. Verruca vulgaris C. Condyloma acuminatum D. Condyloma latum E. Focal epithelial hyperplasia

  • Focal epithelial hyperplasia is also known as Heck’s disease.
  • Condyloma latum is associated with secondary syphilis (bacterial), not HPV.

Which one of the following syndromes commonly presents with light-brown patchy macules (café au lait spots)?

A. Neurofibromatosis type I B. Gardner Syndrome C. Osler-Weber-Rendu Syndrome 0. Van der Woude Syndrome E. Von Recklinghausen’s disease of bone

  • Neurofibromatosis Type 1 is also known as Von Recklinghausen’s disease (distinct from Von Recklinghausen’s disease of bone).
  • McCune-Albright Syndrome also presents with Cafe au lait spots.

Conservative surgical excision would be appropriate treatment and probably curative for which of the following?

A. Nodular fasciitis B. Fibromatosis C. Fibrosarcoma D. Rhabdomyosarcoma E. Adenoid cystic carcinoma

Viral Exanthems and Multi Organ Syndromes17181920

A cutaneous maculopapular rash of the head and neck preceded by Koplik’s spots in the buccal mucosa would suggest which of the following?

A. Primary herpes simplex B. Rubeola C. Varicella D. Primary syphilis E. Actinomycosis

A cutaneous maculopapular rash of the head and neck preceded by Koplik’s spots in the buccal mucosa would suggest which of the following?

A. Primary herpes simplex B. Rubeola C. Varicella D. Primary syphilis E. Actinomycosis

Rubeola

Rubeola is the alternative name for Measles.

Which syndrome classically contains lesions on oral, ocular, and genital regions?

A. Sutton Disease B. Behcet’s Syndrome C. Neurofibromatosis D. Sturge-Weber syndrome E. Stevens-Johnson syndrome

  • Gardner Syndrome is characterized by multiple odontomas and intestinal/colonic polyps.
  • Peutz-Jeghers Syndrome is characterized by freckles (melanotic spots) and intestinal polyps.

Odontogenic Tumors and Cysts

The odontogenic neoplasm, which is composed of loose, primitive-appearing connective tissue that resembles dental pulp, microscopically is known as _____________.

Neoplasms of Dental Origin2122

A. Odontoma B. Ameloblastoma C. Ameloblastic fibroma D. Ameloblastic fibro-odontoma E. Odontogenic myxoma

The odontogenic neoplasm, which is composed of loose, primitive-appearing connective tissue that resembles dental pulp, microscopically is known as ______________.

A. Odontoma B. Ameloblastoma C. Ameloblastic fibroma D. Ameloblastic fibro-odontoma E. Odontogenic myxoma

  • Odontogenic Myxoma: Described as having “slimy stroma.”
  • Ameloblastoma: An aggressive odontogenic neoplasm.

Cystic Lesions of the Jaws232425262728

Which of the following odontogenic cysts occurs as a result of stimulation and proliferation of the reduced enamel epithelium?

A. Dentigerous cyst B. Lateral root cyst C. Radicular cyst D. Odontogenic keratocyst E. Gingival cyst

Dentigerous Cyst

Occurs due to the accumulation of fluid between the crown of a tooth and the reduced enamel epithelium.

Two cystic radiolucencies in the mandible of a 16-year-old boy were lined by thin, parakeratinized epithelium showing palisading of basal cells. All teeth were vital, and the patient had no symptoms. This patient most likely has which of the following?

A. Odontogenic keratocysts B. Periapical granulomas C. Periapical cysts D. Traumatic bone cysts E. Ossifying fibromas

When a diagnosis of odontogenic keratocyst is made, the patient should be advised regarding the __________.

A. Need for full-mouth extractions B. Association with colonic polyps C. Associated recurrence rate D. Likelihood of malignant transformation E. Need for additional laboratory studies

  • Odontogenic Keratocyst (OKC): Also known as Keratocystic Odontogenic Tumor (KCOT).
    • Characterized by high recurrence rates and aggressive behavior.
    • Gorlin Syndrome: Associated with multiple OKCs and multiple basal cell carcinomas.

Clinical Diagnostics and Malignancy2930

A 15-year-old patient has a numb lower lip and pain in her right posterior mandible. A radiograph shows uniform thickening of the periodontal membrane space of tooth #30. The tooth shows abnormally increased mobility. Which one the following diagnoses should be seriously considered?

A. Periapical cyst B. Periapical granuloma C. Traumatic bone cyst D. Ameloblastoma E. Malignancy

  • Treatment Approaches:
    • Conservative Surgical Excision: Appropriate for benign lesions like Nodular Fasciitis.
    • Aggressive Resection: Required for malignancies such as sarcomas (Fibrosarcoma, Rhabdomyosarcoma) and carcinomas (Adenoid Cystic Carcinoma).
  • Fibromatosis vs. Nodular Fasciitis: While similar, nodular fasciitis is easier to treat and can be managed conservatively, whereas fibromatosis is more difficult to treat.

Audio Appendix

Additional Audio Content

The following sections from the lecture audio did not correspond to any heading in the main document.

Case Study: 16-year-old with Mandibular Radiolucencies

  • Presentation: Two cystic radiolucencies in the mandible of a 16-year-old boy.
  • Histology: Lined by thin parakeratinized epithelium with palisading basal cells.
  • Clinical Findings: All teeth are vital; the patient is asymptomatic.
  • Diagnosis: Odontogenic Keratocyst (OKC).

Case Study: 15-year-old with Paresthesia

  • Presentation: A 15-year-old patient presents with a numb lower lip and pain in the right posterior mandible.
  • Radiographic Findings: Uniform thickening of the periodontal membrane space.
  • Clinical Findings: Abnormally increased tooth mobility.
  • Diagnosis: This presentation is a classic indicator for Malignancy.

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