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INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS
 
Oral Pathology For The Dental Hygienist 7th Edition By by Olga A. C. Ibsen – Test Bank

 

Sample  Questions

 

Chapter 01: Introduction to Preliminary Diagnosis of Oral Lesions

Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. Which descriptive term is described as a segment that is part of the whole?
a. Bulla
b. Vesicle
c. Lobule
d. Pustule

 

 

ANS:  C

A lobule is described as a segment or lobe that is part of a whole. A bulla is a large, elevated lesion that contains serous fluid and may look like a blister. A vesicle is a small, elevated lesion that contains serous fluid. Pustules are circumscribed elevations containing pus.

 

REF:   Vocabulary, Clinical of Soft Tissue Lesions, page 1       OBJ:   1

 

  1. A lesion with a sessile base is described as
a. an ulcer.
b. stemlike.
c. pedunculated.
d. flat and broad.

 

 

ANS:  D

Sessile describes the base of a lesion that is flat and broad. An ulcer is a break in the surface epithelium. A stemlike lesion is referred to as pedunculated. A pedunculated lesion is stemlike or stalk-based (similar to a mushroom).

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. Which condition is not diagnosed through clinical appearance?
a. Mandibular tori
b. Fordyce granules
c. Black hairy tongue
d. Compound odontoma

 

 

ANS:  D

The compound odontoma is initially identified radiographically as a radiopaque area in which tooth structure can be identified. No clinical component exists. Mandibular tori are identified clinically as areas of exostosis on the lingual aspects of mandibular premolars. Fordyce granules are yellow clusters of ectopic sebaceous glands diagnosed through clinical appearance. Black hairy tongue is diagnosed clinically. The filiform papillae on the dorsal tongue elongate and become brown or black. Causes include tobacco, alcohol, hydrogen peroxide, chemical rinses, antibiotics, and antacids.

 

REF:   Radiographic Diagnosis, page 9      OBJ:   3

 

  1. Another name for geographic tongue is
a. median rhomboid glossitis.
b. benign migratory glossitis.
c. fissured tongue.
d. black hairy tongue.

 

 

ANS:  B

Benign migratory glossitis is another name for geographic tongue. Research suggests that median rhomboid glossitis is associated with a chronic fungal infection from Candida albicans. Sometimes the condition resolves with antifungal therapy. Fissured tongue is seen in 5% of the population. It is a variant of normal. Genetic factors are typically associated with the condition. Black hairy tongue is caused by a reaction to chemicals, tobacco, hydrogen peroxide, or antacids. The filiform papillae on the dorsal tongue become elongated and are dark brown to black.

 

REF:   Geographic Tongue, page 24          OBJ:   7

 

  1. This bony hard structure in the midline of the hard palate is genetic in origin and inherited in an autosomal dominant manner. The diagnosis is made through clinical appearance. Which condition is suspected?
a. Palatal cyst
b. Torus palatinus
c. Mixed tumor
d. Ranula

 

 

ANS:  B

A torus palatinus is developmental and bony hard and is found on the midline of the palate. Diagnosis is made on the basis of clinical appearance. A palatal cyst appears radiolucent on a radiographic examination and is not diagnosed through clinical appearance. A mixed tumor or pleomorphic adenoma is a benign tumor of salivary gland origin, found unilaterally off the midline of the hard palate. It is composed of tumor tissue that is not bony hard to palpation. Ranula is a term used for a mucocele-like lesion that forms unilaterally on the floor of the mouth.

 

REF:   Torus Palatinus, page 21                 OBJ:   4

 

  1. The gray-white opalescent film seen on the buccal mucosa of 85% of black adults is a variant of normal that requires no treatment and is termed
a. linea alba.
b. leukoedema.
c. leukoplakia.
d. white sponge nevus.

 

 

ANS:  B

Leukoedema is a diffuse opalescence most commonly seen on the buccal mucosa in black individuals. Linea alba is a “white line” that extends anteroposteriorly on the buccal mucosa along the occlusal plane. It is most prominent in patients who have a clenching or grinding habit. Leukoplakia is a clinical term for a white lesion, the cause of which is unknown. White sponge nevus is a genetic (autosomal dominant) trait. Clinically, it is characterized by a soft white, folded (or corrugated) oral mucosa. A thick layer of keratin produces the whitening.

 

REF:   Leukoedema, page 23                               OBJ:               8

 

  1. Which condition most likely responds to therapeutic diagnosis?
a. Angular cheilitis
b. Amelogenesis imperfecta
c. Paget disease
d. Stafne bone cyst

 

 

ANS:  A

Angular cheilitis most commonly responds to antifungal therapy once nutritional deficiencies have been ruled out. Amelogenesis imperfecta is a genetic condition associated with abnormal development of the enamel. Paget disease is a chronic metabolic bone disease. A highly elevated serum alkaline phosphatase level contributes significantly to the diagnosis. A Stafne bone cyst is determined through surgical diagnosis in which entrapped salivary gland tissue is identified.

 

REF:   Therapeutic Diagnosis, page 18      OBJ:   3

 

  1. The gingival enlargement in this patient was caused by a calcium channel blocker. Which medication is the likely cause?
a. Dilantin
b. Nifedipine
c. Quinidine
d. Clozapine

 

 

ANS:  B

Nifedipine is a calcium channel blocker. Dilantin is an anticonvulsant used to prevent or control seizures. Quinidine is an antiarrhythmic agent used to treat cardiac arrhythmias. Clozapine is an antipsychotic used in the management of psychotic symptoms in schizophrenia.

 

REF:   Historical Diagnosis, Fig. 1.38, page 17                          OBJ:   3

 

  1. Radiographic features, including cotton-wool radiopacities and hypercementosis, are especially helpful in the diagnosis of
a. Paget disease.
b. dentinogenesis imperfecta.
c. anemia.
d. diabetes.

 

 

ANS:  A

Paget disease is a chronic metabolic bone disease. Radiographically, cotton-wool radiopacities and hypercementosis are characteristic features. Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin. Anemia, a decrease in red blood cells, requires blood tests to determine the etiologic factors. Diabetes is a chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels.

 

REF:   Laboratory Diagnosis, Fig. 1.40, pages 16, 18                 OBJ:   3

 

  1. In internal resorption, the radiolucency seen on radiographic examination is usually
a. well circumscribed.
b. diffuse.
c. multilocular.
d. unilocular.

 

 

ANS:  B

Diffuse borders are ill defined, making it impossible to detect the exact parameters of the lesion. Therefore treatment is more difficult. Well circumscribed describes borders that are specifically defined. Exact margins of the lesion are identified. Multilocular has also been described as resembling “soap bubbles”; lobes seem to fuse together to make up the lesion. This term has been used to describe the odontogenic keratocyst. Unilocular means having one compartment or unit that is well defined. This term is often used to describe the radicular cyst.

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ:   1

 

  1. Which condition is diagnosed through clinical appearance?
a. Fordyce granules
b. Unerupted mesiodens
c. Periapical cemento-osseous dysplasia
d. Traumatic bone cyst

 

 

ANS:  A

Fordyce granules are diagnosed on the basis of their clinical appearance. They are ectopic sebaceous glands seen on the lips and buccal mucosa. Clinically, they appear as yellow lobules in clusters and are considered a variant of normal. Unerupted mesiodens requires a radiographic image for diagnosis. Periapical cemento-osseous dysplasia requires a radiographic image, specific patient history, and a pulp test to evaluate tooth vitality. Traumatic bone cyst requires a radiographic image and surgical intervention to establish a diagnosis.

 

REF:   Clinical Diagnosis, page 7 | Fordyce Granules, page 20  OBJ:   3

 

  1. Retrocuspid papillae are located on the
a. palate.
b. floor of the mouth.
c. gingival margin of the lingual aspect of mandibular cuspids.
d. canine eminence.

 

 

ANS:  C

Retrocuspid papillae are located on the gingival margin of the lingual aspect of mandibular cuspids. Retrocuspid papillae are not located on the palate. Retrocuspid papillae are not located on the floor of the mouth. Retrocuspid papillae are not located on the canine eminence.

 

REF:   Retrocuspid Papilla, page 22          OBJ:   3

 

  1. Which condition is not considered a variant of normal?
a. Fordyce granules
b. Leukoedema
c. Linea alba
d. Pyogenic granuloma

 

 

ANS:  D

Pyogenic granuloma is a reactive inflammatory response to injury. It is not a variant of normal. Fordyce granules are seen in more than 80% of adults over 20 years of age and are considered a variant of normal. Leukoedema is observed in about 85% of black individuals and is considered a variant of normal. Linea alba is located on the buccal mucosa along the occlusal plane of the teeth. It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is considered a variant of normal.

 

REF:   Box 1-1, Case Study, page 20 | Variants of Normal, pages 21-23

OBJ:   6

 

  1. When antifungal therapy is used to treat angular cheilitis, which diagnostic process is being applied?
a. Microscopic
b. Laboratory
c. Surgical
d. Therapeutic

 

 

ANS:  D

Therapeutic diagnosis is used here in the treatment and management of angular cheilitis, which is most commonly a fungal condition. A careful patient history should be obtained to rule out a contributory nutritional deficiency. Microscopic diagnosis requires a biopsy. Laboratory diagnosis involves the use of clinical laboratory tests, including blood chemistries and urinalysis. Surgical diagnosis requires surgical intervention.

 

REF:   Therapeutic Diagnosis, page 18      OBJ:   3

 

  1. A lesion with a stemlike base is described as
a. sessile.
b. macular.
c. pedunculated.
d. lobulated.

 

 

ANS:  C

Pedunculated means the lesion has a stemlike or stalklike base similar to that of a mushroom. A sessile base is broad and flat. A macular lesion is flat, does not protrude, and is distinguished by its color. A freckle is an example of a macule. Lobulated means the lesion consists of lobules making up the whole.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   8

 

  1. A small, circumscribed lesion, usually less than 1 cm in diameter, that is elevated or protrudes above the surface of normal surrounding tissue is termed a
a. papule.
b. macule.
c. vesicle.
d. bulla.

 

 

ANS:  A

A papule is defined as a small circumscribed lesion, usually less than 1 cm in diameter, that is elevated or protrudes above the surface of normal surrounding tissue. A macule is flat and does not protrude above the surface of normal tissue. A vesicle is elevated and contains serous fluid. A bulla is elevated, contains serous fluid, and looks like a blister.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. Which condition is considered a genetic/inherited disorder?
a. Linea alba
b. Amelogenesis imperfecta
c. Necrotizing ulcerative gingivitis
d. Internal resorption

 

 

ANS:  B

Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth. Linea alba is a variant of normal characterized by the white line that extends anteroposteriorly on the buccal mucosa, along the occlusal plane. Necrotizing ulcerative gingivitis is an ulcerating gingival condition caused by anaerobic bacteria. Internal resorption is usually associated with an inflammatory response in the pulp.

 

REF:   Historical Diagnosis, page 15         OBJ:   3

 

  1. Ectopic geographic tongue can be found in which location?
a. On the lateral border of the tongue
b. Within bone
c. On mucosal surfaces other than the tongue
d. The dorsal surface of the tongue

 

 

ANS:  C

Ectopic geographic tongue is also called stomatitis areata migrans and is found on mucosal surfaces other than the tongue. Geographic tongue may be seen on any surface of the tongue, including the lateral borders. Ectopic geographic tongue is a mucosal condition and is unrelated to the bone. Geographic tongue may be seen on any mucosal surface and is commonly seen on the dorsal surface of the tongue.

 

REF:   Geographic Tongue, page 24          OBJ:   7

 

  1. A Stafne bone cyst contains
a. salivary gland tissue.
b. an empty void.
c. inflammatory cells.
d. an epithelium-lined cyst containing serous fluid.

 

 

ANS:  A

Stafne bone cyst is a developmental invagination in the lingual aspect of the mandible that is filled with salivary gland tissue. An empty void describes the contents of a traumatic bone cyst. A Stafne bone cyst has no inflammatory response. It is developmental and requires no treatment. A Stafne bone cyst is not a true cyst and does not have an epithelial lining. It contains normal salivary gland tissue.

 

REF:   Surgical Diagnosis, page 18            OBJ:   3

 

  1. Which papillae are elongated in the condition black hairy tongue?
a. Circumvallate
b. Foliate
c. Filiform
d. Fungiform

 

 

ANS:  C

The filiform papillae are composed primarily of keratin and are the papillae that elongate in black hairy tongue. Circumvallate papillae on the posterior dorsal tongue do not elongate. Foliate papillae are located on the posterior lateral borders of the tongue. They are vertical, slightly exophytic folds of tissue located in the same area as the lingual lymphoid tissue (lingual tonsils) and do not elongate. Fungiform papillae on the dorsal areas do not elongate.

 

REF:   Hairy Tongue, page 24                   OBJ:   3

 

  1. Diagnosis of anemia is best accomplished through which examination?
a. Laboratory tests
b. Evaluation of the color of the gingiva
c. Bleeding on probing
d. Patient medical history

 

 

ANS:  A

Laboratory blood tests provide the best information with which to diagnose anemia. Although the color of the gingiva may be a clinical sign, a diagnosis of anemia, or more specifically the type of anemia, must be made through laboratory testing. Bleeding on probing is not useful in the diagnosis of anemia. The patient’s medical history may be helpful in the diagnosis of anemia, but it is only contributory. The final diagnosis comes from appropriate laboratory tests.

 

REF:   Laboratory Diagnosis, page 16       OBJ:   3

 

  1. A radiolucency that “scallops around the roots of teeth” is often used to describe which condition?
a. Traumatic bone cyst
b. Stafne bone cyst
c. Lingual mandibular bone concavity
d. Median palatine cyst

 

 

ANS:  A

Scalloping around the roots is a term often used to describe the radiographic appearance of a traumatic bone cyst. A Stafne bone cyst usually presents as an oval radiolucency anterior to the angle of the ramus and inferior to the mandibular canal. A lingual mandibular bone concavity is the same lesion as a Stafne bone cyst. A median palatine cyst is a developmental cyst that presents as a unilocular radiolucency found in the midline of the hard palate.

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ:   3

 

  1. When geographic tongue occurs on the dorsal tongue, the erythematous areas are described as
a. inflamed.
b. depapillated.
c. allergic.
d. fungal.

 

 

ANS:  B

In geographic tongue, the erythematous areas on the dorsal tongue are devoid of filiform papillae and therefore are appropriately described as depapillated. The erythematous areas seen on the dorsal tongue in geographic tongue are not caused primarily by inflammation. Geographic tongue is not an allergic reaction. Geographic tongue is not a fungal infection.

 

REF:   Geographic Tongue, page 24          OBJ:   7

 

  1. It has been suggested that Candida albicans is associated with which condition?
a. Median rhomboid glossitis
b. Linea alba
c. Leukoedema
d. Retrocuspid papillae

 

 

ANS:  A

Research has suggested that median rhomboid glossitis may be associated with Candida albicans. Linea alba is a variant of normal. Leukoedema is a variant of normal. Retrocuspid papillae are developmental and found on the gingiva of the lingual aspect of mandibular canine teeth.

 

REF:   Median Rhomboid Glossitis, page 23                              OBJ:   7

 

  1. Which term is used to describe a radiographic lesion with borders that are specifically defined, revealing the exact margins and extent of the lesion?
a. Unilocular
b. Well circumscribed
c. Diffuse
d. Multilocular

 

 

ANS:  B

Well circumscribed defines a lesion with borders that are specifically defined and in which one can see the exact margins and extent of the lesion. Unilocular means having one compartment or unit that is well defined (as in a radicular cyst). Diffuse describes a lesion with borders that are not well defined. Multilocular lesions are described radiographically as resembling “soap bubbles” (i.e., a lesion with many lobes beyond the confines of one distinct area).

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ:   1

 

  1. Fordyce granules
a. are ectopic sebaceous glands.
b. are seen on the dorsal surface of the tongue.
c. require antibiotic treatment.
d. are lesions that require biopsy for diagnosis.

 

 

ANS:  A

Fordyce granules are ectopic sebaceous glands. Fordyce granules are seen on the buccal and labial mucosa, not the dorsal tongue. Fordyce granules require no treatment. Fordyce granules are diagnosed through clinical appearance. Biopsy is not necessary.

 

REF:   Fordyce Granules, page 20             OBJ:   4

 

  1. The base of this lesion is correctly described as
a. pedunculated.
b. lobule.
c. bulla.
d. sessile.

 

 

ANS:  D

The base of this lesion is sessile, or broad and flat. A pedunculated lesion has a stemlike base similar to that of a mushroom stem. A lobule is a segment or lobe that is part of the whole. A bulla usually contains serous fluid and looks like a blister.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, Fig. 1.5, A, pages 1, 3

OBJ:   1

 

  1. This torus palatinus is correctly described as
a. bullous.
b. papular.
c. lobulated.
d. nodular.

 

 

ANS:  C

This torus palatinus is lobulated (i.e., lobes that are fused together). Bullous lesions contain serous fluid and resemble blisters. A papule is a soft tissue lesion that is elevated above the surface of normal surrounding tissue. A nodule is a palpable solid lesion found in soft tissue.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, Fig. 1.1, pages 1, 2

OBJ:   1

 

  1. Another term for an amalgam tattoo is a
a. melanoma.
b. focal argyrosis.
c. nevus.
d. multiple myeloma.

 

 

ANS:  B

Focal argyrosis is a synonym for amalgam tattoo. A melanoma is a malignant tumor. A nevus is a benign overgrowth of melanocytes. Multiple myeloma is a malignant proliferation of plasma cells.

 

REF:   Clinical Diagnosis, page 7              OBJ:   2

 

  1. Which finding is not apparent in leukoedema?
a. Intracellular edema in the spinous cells
b. Acanthosis of the epithelium
c. Generalized opalescence of the buccal mucosa
d. A white diffuse material on the buccal mucosa that can be wiped off

 

 

ANS:  D

A white diffuse material that can be wiped off is significant in diagnosing pseudomembranous candidiasis. Intracellular edema in the spinous cells is found in leukoedema. Acanthosis of the epithelium is found in leukoedema. Generalized opalescence of the buccal mucosa is seen in leukoedema.

 

REF:   Leukoedema, page 23                               OBJ:               8

 

  1. Which term best describes an elevated, 5-mm soft tissue lesion containing serous fluid?
a. Macule
b. Vesicle
c. Lobule
d. Pustule

 

 

ANS:  B

A vesicle is a small (less than 1 cm in diameter), elevated lesion that contains serous fluid. A macule is a flat area usually distinguished by a color different from the surrounding tissue. A lobule is described as a segment or lobe that is part of a whole. A pustule is a circumscribed elevation containing pus.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. A lesion with a pedunculated base is best described as
a. an ulcer.
b. stemlike.
c. pallor.
d. broad and flat.

 

 

ANS:  B

A stemlike lesion is referred to as pedunculated. An ulcer is a break in the surface epithelium. Pallor is a paleness of the skin or mucosal tissues. Broad and flat describes the base of a sessile lesion.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. The following lesions can be identified radiographically except one. Which one is the exception?
a. Root resorption
b. Fordyce granules
c. Interproximal dental caries
d. Compound odontoma

 

 

ANS:  B

Fordyce granules are yellow clusters of ectopic sebaceous glands that are diagnosed through clinical appearance. Root resorption is identified radiographically when the apex of the tooth appears shortened or blunted. Interproximal dental caries are seen as radiographic radiolucencies. A compound odontoma is initially identified radiographically as a radiopaque area in which tooth structure can be identified.

 

REF:   Clinical Diagnosis, page 7 | Fordyce Granules, page 20  OBJ:   3

 

  1. These reddish-purple clusters observed on the ventral surface of the tongue and diagnosed through clinical observation are referred to as which variants of normal conditions?
a. Palatal cyst
b. Mandibular tori
c. Lingual varicosities
d. Ranula

 

 

ANS:  C

Lingual varicosities are prominent lingual veins usually observed on the ventral and lateral surfaces of the tongue. A palatal cyst is radiolucent and not diagnosed through clinical appearance. Mandibular tori are outgrowths of hard dense bone and found on the lingual aspect of the mandible. Ranula is a term used to describe a mucocele-like lesion that forms unilaterally on the floor of the mouth.

 

REF:   Lingual Varicosities, page 22          OBJ:   4

 

  1. An elevated serum alkaline phosphate level, significant in the diagnosis of Paget disease, is determined from which diagnostic category?
a. Laboratory
b. Therapeutic
c. Clinical
d. Surgical

 

 

ANS:  A

Laboratory tests, including blood chemistries, can provide information that contributes to a diagnosis. Therapeutic testing applies the principle of diagnosis based on clinical and historical information with confirmation by the response of the condition to therapy. Clinical diagnosis suggests that the strength of the diagnosis comes from the clinical appearance of the lesion. Surgical diagnosis is based on information about a lesion gained during surgical intervention.

 

REF:   Laboratory Diagnosis, page 16       OBJ:   2

 

  1. The following conditions most likely respond to therapeutic diagnosis except one. Which one is the exception?
a. Angular cheilitis
b. Necrotizing ulcerative gingivitis
c. Nutritional deficiencies
d. Stafne bone cyst

 

 

ANS:  D

Stafne bone cyst, in which entrapped salivary gland tissue is identified, is diagnosed through surgical examination. Angular cheilitis commonly responds to antifungal therapy once nutritional deficiencies have been ruled out. Necrotizing ulcerative gingivitis responds to hydrogen peroxide rinses. Nutritional deficiencies are common conditions diagnosed by therapeutic means.

 

REF:   Surgical Diagnosis, page 18            OBJ:   3

 

  1. The variant of normal coloration seen on the mandibular gingival surface is termed
a. lingual varicosities.
b. leukoedema.
c. melanin pigmentation.
d. linea alba.

 

 

ANS:  C

Melanin pigmentation is most commonly seen in dark-skinned individuals and gives color to the oral mucosa and gingiva. Lingual varicosities are prominent lingual veins observed on the ventral and lateral surfaces of the tongue. Leukoedema is a generalized opalescence imparted to the buccal mucosa. Linea alba is a white line that extends anteroposteriorly on the buccal mucosa along the occlusal plane of the teeth.

 

REF:   Melanin Pigmentation, Fig. 1.50, pages 21-22                 OBJ:   6

 

  1. A white lesion that cannot be rubbed off and cannot be diagnosed on the basis of clinical characteristics alone is termed
a. leukoplakia.
b. dentinogenesis imperfecta.
c. erythroplakia.
d. squamous cell carcinoma.

 

 

ANS:  A

Leukoplakia is a clinical term for a white lesion that cannot be rubbed off and cannot be diagnosed on the basis of clinical characteristics alone. Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin. Erythroplakia is a clinical term for a red lesion that cannot be diagnosed on the basis of clinical features alone. Squamous cell carcinoma is diagnosed by microscopic evaluation and does not refer to all white lesions that cannot be rubbed off.

 

REF:   Microscopic Diagnosis, page 18     OBJ:   9

 

  1. The radiographic appearance of a simple radicular cyst is best described as
a. coalescence.
b. diffuse.
c. multilocular.
d. unilocular.

 

 

ANS:  D

Unilocular means having one compartment or unit that is well defined. This term is often used to describe a radicular cyst. Coalescence refers to the process by which parts of a whole join together, or fuse, to make one. Diffuse describes a lesion with ill-defined borders, making it impossible to detect the exact parameters of the lesion. A multilocular lesion has also been described as “soap bubble”–like; the lobes appear to fuse together to make up the lesion.

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, Fig. 1.13, pages 5, 6

OBJ:   1

 

  1. A pathologic lesion found frequently in 30-year-old black women that requires a radiographic image and historical data for diagnosis is termed
a. verrucous vulgaris.
b. necrotizing ulcerative gingivitis.
c. periapical cemento-osseous dysplasia.
d. amalgam tattoo.

 

 

ANS:  C

Periapical cemento-osseous dysplasia requires a radiograph, specific patient history, and a pulp test to evaluate tooth vitality. It is frequently found in black women in the third decade of life. Verrucous vulgaris is diagnosed on the basis of its clinical and microscopic appearance and does not require a radiograph. Necrotizing ulcerative gingivitis requires clinical and historical data for diagnosis and does not require a radiograph. An amalgam tattoo relies on clinical and historical data for diagnosis and does not require a radiograph.

 

REF:   Historical Diagnosis, page 16         OBJ:   5

 

  1. Leukoedema is a generalized opalescence appearing on the buccal mucosa; linea alba is a dark pigmented line appearing on the buccal mucosa.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true, and the second statement is false.
d. The first statement is false, and the second statement is true.

 

 

ANS:  C

The first statement is true, and the second statement is false. Leukoedema is a generalized opalescence appearing on the buccal mucosa, as stated, but linea alba is not a dark pigmented line. The statement that leukoedema is a generalized opalescence appearing on the buccal mucosa is true; the statement that linea alba is a dark pigmented line is false. (Linea alba is a white line.) Leukoedema is a generalized opalescence appearing on the buccal mucosa, but linea alba is not a dark pigmented line.

 

REF:   Leukoedema, Fig. 1.54, page 23 | Linea Alba, Fig. 1.53, page 23

OBJ:   8

 

  1. Each condition is considered a variant of normal except one. Which is the exception?
a. Melanin pigmentation
b. Linea alba
c. Geographic tongue
d. Retrocuspid papilla

 

 

ANS:  C

Geographic tongue is characterized by diffuse areas devoid of filiform papillae. It is not a variant of normal. Melanin pigmentation is commonly seen in dark-skinned individuals and is considered a variant of normal. Linea alba is located on the buccal mucosa along the occlusal plane. It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is considered a variant of normal. Retrocuspid papilla is a sessile nodule on the gingival margin of the lingual aspect of the mandibular cuspids and is considered a variant of normal.

 

REF:   Geographic Tongue, page 24 | Variants of Normal, pages 20-23

OBJ:   6

 

  1. The term erythroplakia is best used in which context?
a. Microscopic
b. Laboratory
c. Surgical
d. Clinical

 

 

ANS:  D

Erythroplakia is a descriptive clinical term for a red lesion. Microscopic diagnosis requires a biopsy. Laboratory diagnosis involves the use of clinical laboratory tests, including blood chemistries and urinalysis. Surgical diagnosis requires surgical intervention.

 

REF:   Vocabulary, Color of Lesion, page 2                                         OBJ:    9

 

  1. The pathologic lesion seen on the dorsal surface of the tongue is characteristic of
a. fissured tongue.
b. hairy tongue.
c. median rhomboid glossitis.
d. migratory glossitis.

 

 

ANS:  C

Median rhomboid glossitis appears as a flat or slightly raised oval or rectangular erythematous area in the midline of the dorsal surface of the tongue. Fissured tongue is characterized by deep fissures or grooves. Hairy tongue has the appearance of white, elongated filiform papillae. Migratory glossitis is another name for geographic tongue and appears as patches on the lateral and dorsal surfaces of the tongue.

 

REF:   Median Rhomboid Glossitis, page 23 | Fig. 1.20, page 8 OBJ:   7

 

  1. Each condition is considered benign and of unknown cause except one. Which one is the exception?
a. Hairy tongue
b. Amelogenesis imperfecta
c. Migratory glossitis
d. Fissured tongue

 

 

ANS:  B

Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth. Hairy tongue is a benign condition of unknown cause. Migratory glossitis is a benign condition of unknown cause. Fissured tongue is a benign condition of unknown cause.

 

REF:   Historical Diagnosis, page 15         OBJ:   7

 

  1. A medical history of a patient prescribed a calcium channel blocker may reveal which condition?
a. Gingival enlargement
b. Cementoma
c. Paget disease
d. Ulcerative colitis

 

 

ANS:  A

A patient taking a calcium channel blocker may exhibit gingival enlargement. A cementoma is not a result of a patient taking a calcium channel blocker. An elevated serum alkaline phosphatase level is significant for Paget disease but not for use of a calcium channel blocker. Ulcerative colitis may contribute to oral lesions but not gingival enlargement.

 

REF:   Historical Diagnosis, Fig. 1.38, B, pages 16, 17              OBJ:   3

 

  1. Urticaria is an example of a(n)
a. genetic disorder.
b. developmental disturbance.
c. immediate response to an allergen.
d. immunodeficiency response.

 

 

ANS:  C

Urticaria is an immediate response to an allergen. Urticaria is not the result of a genetic disorder. Urticaria is not the result of a developmental disturbance. Urticaria is not a result of immunodeficiency.

 

REF:   Historical Diagnosis, page 16         OBJ:   3

 

  1. Which term describes a lesion in which parts of a whole are joined together, or fused, to make one?
a. Fissured
b. Coalescence
c. Diffuse
d. Multilocular

 

 

ANS:  B

Coalescence describes the process by which parts of a whole join together, or fuse, to make one. Fissured describes a cleft or groove, normal or otherwise, showing prominent depth. Diffuse describes a lesion with borders that are not well defined. Multilocular lesions are described radiographically as “soap bubbles” (i.e., a lesion with many lobes beyond the confines of one distinct area).

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 3

OBJ:   1

 

  1. While obtaining diagnostic information from a patient, the dental hygienist learns that the appearance of this patient’s teeth is familial. The correct diagnosis is
a. tetracycline staining.
b. pulpal dysplasia.
c. extrinsic staining.
d. dentinogenesis imperfecta.

 

 

ANS:  D

Dentinogenesis imperfecta is a pathologic condition in which the family history plays a significant role in the diagnosis. Tetracycline staining is not a familial condition. Pulpal dysplasia is not a pathologic familial condition. Extrinsic staining is not a familial condition.

 

REF:   Historical Diagnosis, Fig. 1.37, pages 15, 16                   OBJ:   3

 

  1. The eight categories that provide information leading to a definitive diagnosis are as follows: microscopic, clinical, laboratory, surgical, differential findings, radiographic, therapeutic, and
a. etiology.
b. historical.
c. chief complaint.
d. treatment.

 

 

ANS:  B

Historical information reveals past experiences that may be relevant to the diagnosis. Etiology is not a component of the definitive or final diagnosis. The chief complaint may be helpful in understanding the patient’s perspective but is not considered a diagnostic tool. Treatment is decided after the definitive or final diagnosis is made, and it is not part of the information leading to the diagnosis.

 

REF:   Making a Diagnosis, page 6            OBJ:   3

 

  1. What is the radiographic appearance of periapical cemento-osseous dysplasia in its earliest stage?
a. Radiolucent
b. Radiopaque
c. Radiolucent and radiopaque
d. Cotton-wool radiolucencies

 

 

ANS:  A

In stage I of periapical cemento-osseous dysplasia, the appearance is radiolucent. Radiopacities are not seen in the early stage of perioapical cemento-osseous dysplasia. In stage II, the appearance is radiolucent and radiopaque. Cotton-wool radiopacities are seen in patients with Paget disease.

 

REF:   Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 3

OBJ:   5

 

  1. All conditions are associated with lingual varicosities except one. Which is the exception?
a. Red to purple enlarged vessels
b. May be associated with varicosities in the legs
c. Age-related condition
d. May swell during eating

 

 

ANS:  D

Lingual varicosities do not swell during the eating process. Red to purple enlarged vessels are seen with lingual varicosities. Lingual varicosities may be associated with varicosities in the legs. Lingual varicosities are considered an age-related condition, often seen in individuals over the age of 60.

 

REF:   Variants of Normal, pages 22-23    OBJ:   4

 

  1. Various sizes of circumscribed elevations that contain pus are termed
a. vesicles.
b. pustules.
c. papules
d. lobules

 

 

ANS:  B

Pustules are variously sized circumscribed elevations containing pus. Vesicles are elevated lesions that contain serous fluid. Papules are elevated lesions that protrude above the surface of normal surrounding tissue. Lobules are segments or lobes that are part of the whole.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. Studies have linked the presence of a lingual thyroid in association with the following life events except one. Which is the exception?
a. Pregnancy
b. Infancy
c. Menopause
d. Puberty

 

 

ANS:  B

Infancy is not associated with the presence of a lingual thyroid. The emergence of a lingual thyroid is linked to hormonal changes, such as pregnancy. The emergence of a lingual thyroid is linked to hormonal changes, such as menopause. The emergence of a lingual thyroid is linked to hormonal changes, such as puberty.

 

REF:   Benign Conditions of Unknown Cause, page 23             OBJ:   11

 

  1. The lingual thyroid is most often found in which intraoral location?
a. Posterior to the circumvallate papillae in the midline of the tongue
b. Along the occlusal plane on the buccal mucosa
c. At the junction of the hard and soft palate
d. At the labial commissures

 

 

ANS:  A

The lingual thyroid is seen as a mass in the midline of the dorsal surface of the tongue, posterior to the circumvallate papillae. The lingual thyroid is not seen on the buccal mucosa. The lingual thyroid is not found at the junction of the hard and soft palate. The lingual thyroid is not found at the labial commissures.

 

REF:   Benign Conditions of Unknown Cause, page 23             OBJ:   11

 

  1. Your patient is diagnosed with a lingual thyroid. What is the next step on the treatment plan?
a. Biopsy
b. Surgical removal
c. Thyroid scan
d. Radiographic evaluation

 

 

ANS:  C

A thyroid scan should be performed to determine if the thyroid gland is functioning normally. A biopsy is not needed for a lingual thyroid because it is composed of normal thyroid tissue. Surgical removal is not recommended since this may represent the patient’s functioning thyroid. Radiographic evaluation is not helpful in the confirmation of a lingual thyroid.

 

REF:   Benign Conditions of Unknown Cause, page 23             OBJ:   11

 

  1. Because of its size and location, patients with a lingual thyroid may complain of
a. dysphagia.
b. gingival inflammation.
c. intraoral ulcers.
d. tooth erosion.

 

 

ANS:  A

Clinical symptoms of lingual thyroid can include dysphagia, or difficulty swallowing, because of the mass located at the posterior dorsal surface of the tongue. Gingival inflammation is not associated with patients with a lingual thyroid. Intraoral ulcers are not associated with patients with a lingual thyroid. Tooth erosion is not associated with patients with a lingual thyroid.

 

REF:   Benign Conditions of Unknown Cause, page 23             OBJ:   11

 

  1. Where is the common intraoral location for leukoedema?
a. Lateral borders of the tongue
b. Soft palate and uvula
c. Floor of the mouth
d. Buccal mucosa

 

 

ANS:  D

A generalized opalescence is imparted to the buccal mucosa in leukoedema. Leukoedema is not evident on the lateral borders of the tongue. The soft palate and uvula is not a location to find leukoedema. The floor of the mouth is not a location to see leukoedema.

 

REF:   Variants of Normal, page 23          OBJ:   8

 

  1. The human papillomavirus (HPV) is associated with what condition?
a. Thrush
b. Tuberculosis
c. Verruca vulgaris
d. Herpangina

 

 

ANS:  C

Verruca vulgaris (the common wart) is caused by a low-risk type of the human papillomavirus. Thrush, or pseudomembranous candidiasis, is a superficial fungal infection seen in the oral cavity. Tuberculosis is a bacterial infection caused by inhalation of airborne droplets from someone with active disease. Herpangina is caused by a coxsackie virus and is characterized by fever, sore throat and oral lesions.

 

REF:   Microscopic Diagnosis, page 18     OBJ:   10

 

  1. A “white” hairy tongue indicates an increase in the amount of
a. keratin.
b. medications.
c. fluoride use.
d. HPV circulating in the blood.

 

 

ANS:  A

The increased amount of keratin on the filiform papillae gives the tongue a white appearance. Medications may affect the surface of the tongue but generally do not produce a white color. Fluoride use does not cause a “white” hairy tongue. The presence of the HPV does not cause a “white” hairy tongue.

 

REF:   Benign Conditions of Unknown Cause, page 24             OBJ:   7

 

  1. Benign migratory glossitis is a condition that does not remain static. What does this statement mean?
a. A variety of over-the-counter treatments are available for this condition.
b. Surgical intervention may be required.
c. Remission and changes in the surface of the tongue occur.
d. An intraoral habit is responsible for this condition.

 

 

ANS:  C

Benign migratory glossitis (geographic tongue) is a condition that does not stay the same over time; remission and changes in the surface of the tongue occur. A condition that does not remain static does not refer to treatment protocol. A condition that does not remain static does not refer to treatment protocol. Intraoral habits are not related to benign migratory glossitis.

 

REF:   Benign Conditions of Unknown Cause, page 24             OBJ:   7

 

  1. Which statement about a palatal torus is true?
a. A palatal torus is symptomatic.
b. A palatal torus appears as a radiolucent mass on a radiograph.
c. Palatal tori are typically bilateral, seen along the lingual side of the maxilla.
d. Palatal tori are inherited.

 

 

ANS:  D

Palatal tori are inherited. Palatal tori are asymptomatic. A palatal torus appears as a radiopaque mass on a radiograph. Palatal tori can take on various shapes and sizes yet occur in the midline of the palate.

 

REF:   Variants of Normal, page 21          OBJ:   4

 

  1. Serous fluid can typically be found in which lesion?
a. Bulla
b. Lobule
c. Macule
d. Papule

 

 

ANS:  A

Bullae are circumscribed, elevated lesions that usually contain serous fluid and resemble a blister. Lobules are segments or lobes that are part of a whole. Macules are areas distinguished by a different color than the surrounding tissue. Papules are small, circumscribed lesions that protrude above the surface.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. Which term describes a lesion that displays a color different from surrounding tissue?
a. Bulla
b. Lobule
c. Macule
d. Papule

 

 

ANS:  C

Macules are areas distinguished by a different color than the surrounding tissue. Bullae are circumscribed, elevated lesions that usually contain serous fluid and resemble a blister. Lobules are segments or lobes that are part of a whole. Papules are small, circumscribed lesions that protrude above the surface.

 

REF:   Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ:   1

 

  1. Trying to establish the correct number of primary and permanent teeth present in a 7-year-old child may best be accomplished by which diagnostic component?
a. Clinical
b. Historical
c. Radiographic
d. Differential

 

 

ANS:  C

A radiographic examination including intraoral and extraoral images would provide sufficient information to establish the correct number of teeth present. The clinical diagnosis would be adequate to view only the erupted teeth, not the unerupted permanent teeth. Some historical data might be helpful in this case but would not be considered the best diagnostic component. Enough information should be present in the clinical and radiographic examinations that a differential diagnosis is not necessary.

 

REF:   Making a Diagnosis, page 9            OBJ:   3

Chapter 03: Immunity and Immunologic Oral Lesions

Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

 

MULTIPLE CHOICE

 

  1. The breakdown of cellular adhesion between epithelial cells is termed
a. cell-mediated immunity.
b. acantholysis.
c. Nikolsky sign.
d. anaphylaxis.

 

 

ANS:  B

Acantholysis is the dissolution of the intracellular bridges of the prickle cell layer of epithelium. Cell-mediated immunity is immunity in which the predominant role is played by T-lymphocytes. Nikolsky sign occurs when the superficial epithelium separates easily from the basal layer on exertion of firm, sliding, manual pressure. Anaphylaxis is a severe type of systemic hypersensitivity reaction.

 

REF:   Pemphigus, page 101                                OBJ:               1

 

  1. Which protein molecule is produced by plasma cells and is also termed an immunoglobulin?
a. An autoimmune disease
b. A natural killer (NK) cell
c. Rheumatoid factor
d. An antibody

 

 

ANS:  D

An antibody is a protein molecule, also called an immunoglobulin, that is produced by plasma cells and reacts with a specific antigen. An autoimmune disease is a disease characterized by tissue injury caused by a humoral or cell-mediated response against constituents of the body’s own tissues. An NK cell is a lymphocyte that is part of the body’s innate immunity. Rheumatoid factor is a protein, immunoglobulin M (IgM), found in serum and detected in laboratory tests. It is associated with rheumatoid arthritis and other autoimmune diseases.

 

REF:   Vocabulary, page 79 | B-cell Lymphocyte, page 81        OBJ:   1

 

  1. Which lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies?
a. T-lymphocyte
b. B-lymphocyte
c. Macrophage
d. LE cell

 

 

ANS:  B

The B-lymphocyte matures without passing through the thymus and later can develop into a plasma cell that produces antibodies. The T-lymphocyte matures in the thymus before migrating to tissues. A macrophage is a large tissue-bound mononuclear phagocyte derived from monocytes circulating in the blood. The LE cell is an atypical mature neutrophil characteristic of lupus erythematosus and other autoimmune diseases.

 

REF:   Vocabulary, page 79 | B-cell Lymphocyte, page 81        OBJ:   3

 

  1. In which type of immune response do B-lymphocytes and antibodies play the predominant role?
a. Cell-mediated immunity
b. Immune complex
c. Humoral immunity
d. Passive immunity

 

 

ANS:  C

In humoral immunity the B-lymphocytes and antibodies play the predominant role. In cell-mediated immunity, the T-lymphocyte plays the predominant role. The immune complex is a combination of antigen and antibody. Passive immunity occurs when antibodies produced by another person are used to protect an individual from an infectious disease.

 

REF:   Major Divisions of the Immune Response, page 84        OBJ:   2

 

  1. Which is not a specific component of immunity?
a. A humoral response
b. A cell-mediated response
c. Memory
d. Pavementing

 

 

ANS:  D

Pavementing is the adherence of white blood cells to the walls of a blood vessel during an inflammatory response. Humoral immunity involves the production of antibodies. The B-lymphocyte is the predominant cell. Cell-mediated immunity involves the T-lymphocyte. Memory is an important function of the immune system. Certain lymphocytes retain the memory of an antigen after an initial encounter, allowing for faster immune responses.

 

REF:   Major Divisions of the Immune Response; Memory and Immunity, pages 80, 84

OBJ:   6

 

  1. An example of natural passive immunity occurs when
a. antibodies from a mother pass through the placenta to the developing fetus.
b. a microorganism causes a disease.
c. a person receives a vaccination.
d. a person is immunized.

 

 

ANS:  A

Natural passive immunity occurs when antibodies from a mother pass through the placenta to the developing fetus. Active immunity occurs naturally when a microorganism causes a disease. Active acquired immunity occurs as a result of vaccination. After vaccination, the immune system produces a stronger response and prevents the development of the disease. This production of acquired immunity is called immunization.

 

REF:   Types of Immunity, page 85          OBJ:   7

 

  1. Which is an example of type I hypersensitivity?
a. Immune complexes formed between microorganisms and antibody in the circulating blood
b. Asthma
c. Autoimmune hemolytic anemia
d. Serum sickness

 

 

ANS:  B

Asthma is an example of type I hypersensitivity. In type III hypersensitivity, immune complexes are formed between microorganisms and antibody in the circulating blood. Autoimmune hemolytic anemia is a type II hypersensitivity reaction. Serum sickness is a classic example of a type III hypersensitivity reaction.

 

REF:   Type I Hypersensitivity, page 85    OBJ:   8

 

  1. Which route of drug administration causes the most significant hypersensitivity reaction?
a. Topical
b. Patch
c. Parenteral
d. Oral

 

 

ANS:  C

When the reaction occurs after parenteral administration (injection), it may be more severe because the allergen can be carried quickly to many parts of the body through the bloodstream. It takes more time for topically applied drugs to enter the bloodstream compared with parenterally applied (injected) drugs. It takes more time for a drug to enter the bloodstream via a patch compared with parenteral administration. It takes more time for oral medications to enter the bloodstream than parenterally applied drugs.

 

REF:   Hypersensitivity to Drugs, page 86 OBJ:   8

 

  1. Which is a condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products?
a. Autoimmune disease
b. Leukocytosis
c. Immunodeficiency
d. Anaphylaxis

 

 

ANS:  C

Immunodeficiency is a type of immunopathologic condition that involves a deficiency in number, function, or interrelationships of the involved white blood cells and their products. Autoimmune disease is characterized by tissue injury caused by a humoral or cell-mediated immune response against constituents of the body’s own tissues. Leukocytosis is an increase in the circulating white blood cells. It is a systemic sign of an inflammatory response. Anaphylaxis is a severe type of hypersensitivity reaction.

 

REF:   Immunodeficiency, page 87           OBJ:   8

 

  1. What is the most common precipitating factor in the development of aphthous ulcers?
a. Allergy
b. Trauma
c. Systemic disease
d. Citrus foods

 

 

ANS:  B

Trauma is the most common precipitating factor in the development of aphthous ulcers. Allergies do not cause aphthous ulcers. Aphthous ulcers do occur in association with certain systemic diseases, but they are not the most common precipitating factor. Citrus foods can trigger episodes of aphthous ulcers, but they are not the most common precipitating factor.

 

REF:   Aphthous Ulcers, Recurrent Aphthous Ulcers, page 87   OBJ:   11

 

  1. Certain recurrent ulcers appear on movable mucosa. These ulcers are discrete, round-to-oval, 3 to 5 mm in diameter and exhibit a yellowish-white fibrin center surrounded by an erythematous halo. These ulcers are termed
a. major aphthous ulcers.
b. Sutton disease.
c. herpetiform aphthous ulcers.
d. minor aphthous ulcers.

 

 

ANS:  D

Minor aphthous ulcers are recurrent and appear on movable mucosa. They are 3 to 5 mm in diameter and have a yellowish-white fibrin center surrounded by an erythematous halo. Major aphthous ulcers are deeper in the tissue, are larger (5 to 10 mm), take much longer to heal, and often heal with scarring. Sutton disease is the same as major aphthous ulcers. Herpetiform aphthous ulcers are very tiny (1 to 2 mm). The size of this type of aphthous ulcer is similar to the size of ulcers caused by the herpes simplex virus.

 

REF:   Types of Aphthous Ulcers, page 87                                           OBJ:    11

 

  1. Which ulcer may require a biopsy to make the diagnosis?
a. Minor aphthous
b. Major aphthous
c. Herpetiform aphthous
d. Behçet syndrome

 

 

ANS:  B

Major aphthous ulcers sometimes require a biopsy to rule out other causes of ulceration such as squamous cell carcinoma or deep fungal infections. Minor aphthous ulcers are diagnosed through clinical appearance, location, and complete patient history. Herpetiform aphthous ulcers resemble those associated with the herpes simplex virus, but there are no systemic signs or symptoms as in primary herpes simplex infection. Behçet syndrome is a multisystem disorder characterized by numerous clinical manifestations. Although there are oral ulcerations, the diagnosis requires the presence of other features such as genital, ocular, and skin lesions.

 

REF:   Types of Aphthous Ulcers, page 87                                           OBJ:    11

 

  1. Antihistaminic drugs are the principal method of treatment for
a. urticaria.
b. minor aphthous ulcers.
c. herpetiform aphthous ulcers.
d. contact mucositis.

 

 

ANS:  A

Urticaria, also called hives, appears as well-demarcated areas of swelling on the skin accompanied by pruritus. The release of the chemical mediator histamine causes the increased vascular permeability. Antihistaminic drugs are used to treat urticaria. Minor aphthous ulcers heal spontaneously in 7 to 10 days. They may be treated with topical corticosteroid or nonsteroidal antiinflammatory medications. Herpetiform aphthous ulcers do not respond to antihistaminic drugs. They may respond to corticosteroid therapy or topical liquid tetracycline. Contact mucositis results from direct contact of an allergen with the mucosa. Treatment begins with removal of the cause.

 

REF:   Urticaria and Angioedema, Treatment and Prognosis, page 90

OBJ:   13

 

  1. A prodromal period begins
a. 1 week before the onset of ulcers.
b. 1 to 2 days before the onset of ulcers.
c. the day the ulcers erupt.
d. 7 to 10 days before ulcers erupt.

 

 

ANS:  B

The prodromal period occurs 1 to 2 days before ulcers appear. There are a burning sensation and soreness where the ulcers will appear. The prodromal period before ulceration is only 1 to 2 days. Prodromal symptoms should not occur 1 week before ulceration. The prodromal period does not occur on the day of ulceration. The prodromal period precedes ulceration by only 1 to 2 days. Prodromal symptoms should not occur 7 to 10 days before ulceration.

 

REF:   Types of Aphthous Ulcers, page 87                                           OBJ:    11

 

  1. A condition thought to be a hypersensitivity reaction is characterized by skin and mucous membrane lesions. The skin lesions are referred to as target, iris, or bull’s eye lesions. The lip and mucosal lesions are more extensive and painful and often appear bloody and crusted. The intraoral lesions are extensive superficial ulcerations. The onset is explosive. On the basis of these clinical features, what condition is suspected?
a. Erythema multiforme
b. Fixed drug reaction
c. Behçet syndrome
d. Angioedema

 

 

ANS:  A

Erythema multiforme is a hypersensitivity reaction that affects the skin and mucous membranes. Bloody crusted lips are a common presentation. The onset is explosive, and the skin lesions are referred to as target, iris, or bull’s eye lesions. Fixed drug eruptions are lesions that appear in the same site each time a drug is introduced. There may be a single red patch or macule on the skin. Mucous membranes are rarely involved. Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation. Angioedema appears as a diffuse swelling of tissue caused by permeability of deeper blood vessels.

 

REF:   Erythema Multiforme, page 91       OBJ:   14

 

  1. Wickham striae is a term used to describe the oral mucosal lesions of
a. linea alba.
b. frictional keratosis.
c. lichen planus.
d. erythema multiforme.

 

 

ANS:  C

Wickham striae describe the slender white lines seen in lichen planus. Linea alba is the white line on the buccal mucosa that extends anteroposteriorly along the occlusal plane. Frictional keratosis occurs when there is chronic cheek and tongue chewing and chewing on edentulous ridges. Erythema multiforme is an acute self-limited disease that affects the skin and mucous membranes. The skin lesions are described as iris, target, or bull’s eye lesions. The mucosal lesions are superficial ulcerations.

 

REF:   Lichen Planus, page 93                   OBJ:   15

 

  1. The diagnosis of lichen planus is made on the basis of
a. clinical and radiographic appearance.
b. clinical and histologic appearance.
c. history of the condition.
d. therapeutic medication.

 

 

ANS:  B

Diagnosis of lichen planus is made on the basis of clinical appearance and histologic findings of biopsy tissue. Radiographic findings do not contribute to the diagnosis of lichen planus. History of the condition is not definitive enough for the diagnosis of lichen planus. Topical and systemic corticosteroids have been used in the treatment of lichen planus but not to establish the diagnosis.

 

REF:   Types of Lichen Planus, Diagnosis, page 94                              OBJ:    15

 

  1. Which condition is not a component of Reiter syndrome?
a. Arthritis
b. Geographic tongue–like lesions
c. Urethritis
d. Wickham striae

 

 

ANS:  D

Wickham striae are associated with lichen planus. Arthritis is a component of Reiter syndrome. Oral mucosal lesions that resemble geographic tongue have been described in patients with Reiter syndrome. Urethritis is associated with Reiter syndrome.

 

REF:   Reactive Arthritis (Reiter Syndrome), page 95                OBJ:   16

 

  1. An antigenic marker termed HLA-B27 is present in most patients with
a. lichen planus.
b. Reiter syndrome.
c. erythema multiforme.
d. Stevens–Johnson syndrome.

 

 

ANS:  B

An antigenic marker called HLA-B27 is present in most patients with Reiter syndrome. Lichen planus is diagnosed through the clinical and histologic appearance of biopsy tissue. Erythema multiforme is thought to be a hypersensitivity reaction involving the skin and mucous membranes. Stevens–Johnson syndrome is the most severe form of erythema multiforme.

 

REF:   Reactive Arthritis (Reiter Syndrome), page 95                OBJ:   16

 

  1. The acute disseminated form of Langerhans cell disease is termed
a. eosinophilic granuloma.
b. Hand–Schüller–Christian disease.
c. Letterer–Siwe disease.
d. Reiter syndrome.

 

 

ANS:  C

Letterer–Siwe disease is the acute disseminated form of Langerhans cell disease. Eosinophilic granuloma is a solitary or chronic localized form of Langerhans cell disease. Hand–Schüller–Christian disease is the chronic disseminated or multifocal form of Langerhans cell disease. Reiter syndrome is not a form of Langerhans cell disease.

 

REF:   Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96

OBJ:   17

 

  1. Which form of Langerhans cell disease resembles lymphoma, affects children younger than age 3, and has a rapidly fatal course?
a. Letterer–Siwe disease
b. Hand–Schüller–Christian disease
c. Eosinophilic granuloma
d. Chronic localized form

 

 

ANS:  A

Letterer–Siwe resembles lymphoma, affects children under 3 years, and has a rapidly fatal course. It is the most severe form of Langerhans cell disease. Hand–Schüller–Christian disease is the multifocal form of Langerhans cell disease. It occurs in children younger than 5 years. A classic triad is seen in 25% of patients. Eosinophilic granuloma affects older children and young adults. The chronic localized form is the same as eosinophilic granuloma.

 

REF:   Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96

OBJ:   17

 

  1. The classic triad of symptoms seen in 25% of patients with Hand–Schüller–Christian disease includes all conditions except
a. well-defined or punched-out radiolucent areas in the skull.
b. exophthalmos.
c. cyclic neutropenia.
d. diabetes insipidus.

 

 

ANS:  C

Cyclic neutropenia is an inherited disorder characterized by a cyclic decrease in the number of circulating neutrophils. Aphthous ulcers, gingival recession, and alveolar bone loss can be seen in association with this systemic condition. Well-defined or punched-out radiolucent areas in the skull are part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Exophthalmos is a part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease. Diabetes insipidus is part of the triad of symptoms in chronic disseminated Hand–Schüller–Christian disease.

 

REF:   Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96

OBJ:   12

 

  1. Sjögren syndrome is a(n)
a. autoimmune disease that affects the salivary and lacrimal glands.
b. allergic reaction.
c. form of aphthous ulcers.
d. type of Langerhans cell disease.

 

 

ANS:  A

Sjögren syndrome is an autoimmune disease that affects the salivary and lacrimal glands. Sjögren syndrome is not an allergic reaction. Sjögren syndrome is not a form of aphthous ulcers. Sjögren syndrome is not a type of Langerhans cell disease.

 

REF:   Sjögren Syndrome, page 97            OBJ:   18

 

  1. The most common oral manifestation of Sjögren syndrome is
a. xerostomia.
b. xerophthalmia.
c. epimyoepithelial islands.
d. aphthous ulcers.

 

 

ANS:  A

Xerostomia, or dry mouth, is the most common oral manifestation of Sjögren syndrome. Xerophthalmia is dry eyes caused by lack of lacrimal flow. Epimyoepithelial islands are seen histologically in Sjögren syndrome, but are not the most common oral manifestation. Aphthous ulcers are not associated with Sjögren syndrome, but are seen more commonly in Behçet syndrome, another autoimmune disease.

 

REF:   Sjögren Syndrome, page 97            OBJ:   18

 

  1. Primary Sjögren syndrome occurs when
a. another autoimmune disease accompanies salivary and lacrimal gland involvement.
b. only salivary and lacrimal gland involvement occurs without the presence of another autoimmune disease.
c. rheumatoid arthritis is present.
d. Raynaud phenomenon is present.

 

 

ANS:  B

Primary Sjögren syndrome occurs when there is only salivary and lacrimal gland involvement without the presence of another autoimmune disease. Secondary Sjögren syndrome occurs when another autoimmune condition accompanies the salivary and lacrimal gland involvement. Rheumatoid arthritis is an autoimmune disease that can be a component of secondary Sjögren syndrome. Twenty percent of patients with Sjögren syndrome have Raynaud phenomenon. It is characterized by pallor of the skin that results from vasoconstriction and reduced blood flow. The toes and fingers are affected.

 

REF:   Sjögren Syndrome, page 97            OBJ:   18

 

  1. The eye damage that occurs in Sjögren syndrome is termed
a. xerophthalmia.
b. keratoconjunctivitis sicca.
c. conjunctivitis.
d. burning eyes.

 

 

ANS:  B

Keratoconjunctivitis sicca is damage to the eye in Sjögren syndrome. It is confirmed by eye examination. Xerophthalmia, or dry eyes, may be present in Sjögren syndrome. Conjunctivitis is inflammation of the conjunctiva. Burning eyes may also be a component of Sjögren syndrome.

 

REF:   Sjögren Syndrome, page 97            OBJ:   18

 

  1. Diagnosis of systemic lupus erythematosus (SLE) is made on the basis of
a. skin lesions.
b. multiorgan involvement and the presence of antinuclear antibodies in the serum.
c. arthritis and arthralgia.
d. shortness of breath.

 

 

ANS:  B

Diagnosis of systemic SLE is made on the basis of multiorgan involvement and the presence of antinuclear antibodies in the serum. Skin lesions occur in 85% of individuals, but the diagnosis is not made on the basis of skin lesions. Arthritis and arthralgia may be components of SLE, but are not sufficient to make the diagnosis. Shortness of breath may be a component of SLE, but is not significant to the diagnosis.

 

REF:   Systemic Lupus Erythematosus, Diagnosis, page 99       OBJ:   18

 

  1. The most characteristic skin lesion in SLE is described as
a. a blister.
b. urticaria.
c. a butterfly rash.
d. a bulla.

 

 

ANS:  C

The classic skin lesion in SLE is described as a butterfly rash. A blister is not the classic skin lesion in SLE. Urticaria is associated with a hypersensitivity reaction. A bulla may occur in SLE, but it is not the most characteristic skin lesion.

 

REF:   Systemic Lupus Erythematosus, Diagnosis, page 99       OBJ:   18

 

  1. The histologic appearance of lesions in SLE may resemble
a. an ulcer.
b. lichen planus.
c. pemphigus vulgaris.
d. erythema multiforme.

 

 

ANS:  B

The histologic appearance of lesions in SLE may resemble lichen planus. An ulcer appears as a break in the epithelium and is histologically nonspecific for SLE or lichen planus. Pemphigus vulgaris is a severe progressive autoimmune disease characterized by intraepithelial blister formation that results from breakdown of the cellular adhesion between epithelial cells. In erythema multiforme, the microscopic appearance is nonspecific.

 

REF:   Systemic Lupus Erythematosus, Diagnosis, page 99       OBJ:   18

 

  1. Which one is not a characteristic feature of pemphigus vulgaris?
a. Epithelial acantholysis
b. Bullae
c. Tzanck cells
d. Occurrence most commonly in females

 

 

ANS:  D

No sex predilection exists in pemphigus vulgaris. Epithelial acantholysis occurs in pemphigus vulgaris. Bullae do appear in pemphigus vulgaris. Tzanck cells, or acantholytic cells, appear in pemphigus vulgaris as rounded epithelial cells and are present in the area of separation of epithelial cells.

 

REF:   Pemphigus Vulgaris, pages 101-102                                          OBJ:    18

 

  1. Treatment for pemphigus vulgaris involves
a. high doses of systemic corticosteroids.
b. antihistamines.
c. antibiotics.
d. antiviral drugs.

 

 

ANS:  A

High doses of systemic corticosteroids are used in the treatment of pemphigus vulgaris. Antihistamines are not used to treat pemphigus vulgaris. Antibiotics are not used to treat pemphigus vulgaris. Antiviral drugs are not used to treat pemphigus vulgaris.

 

REF:   Pemphigus Vulgaris, Treatment and Prognosis, page 102          OBJ:    18

 

  1. The most common oral site for cicatricial pemphigoid is the
a. floor of the mouth.
b. gingiva.
c. palate.
d. tongue.

 

 

ANS:  B

The gingiva is the most common site for cicatricial pemphigoid. The floor of the mouth is not a common site for cicatricial pemphigoid. The palate is not a common site for cicatricial pemphigoid. The tongue is not a common site for cicatricial pemphigoid.

 

REF:   Mucous Membrane Pemphigoid, page 102                                OBJ:    18

 

  1. The diagnosis of cicatricial pemphigoid is made on the basis of
a. the clinical appearance of the lesions.
b. Nikolsky sign.
c. biopsy and histologic examination.
d. response to corticosteroids.

 

 

ANS:  C

Biopsy and histologic examination are used to diagnose cicatricial pemphigoid. The clinical appearance of lesions is not sufficient for the diagnosis of cicatricial pemphigoid. The Nikolsky sign is not sufficient to determine the diagnosis of cicatricial pemphigoid. Although corticosteroids are the recommended treatment for cicatricial pemphigoid, diagnosis of the condition is not made through therapeutic diagnosis.

 

REF:   Mucous Membrane Pemphigoid, Diagnosis, page 102    OBJ:   18

 

  1. Pemphigus vulgaris differs histologically from cicatricial pemphigoid in that pemphigus vulgaris involves
a. degeneration of the epithelium.
b. connective tissue fragmentation.
c. significant numbers of inflammatory cells.
d. scarring.

 

 

ANS:  A

The lesions of pemphigus vulgaris histologically exhibit acantholysis, which is degeneration of the epithelium. In pemphigus vulgaris, the basal cells of the epithelium and the basement membrane remain attached to the underlying connective tissue. Inflammatory cells are present in both cicatricial pemphigoid and pemphigus vulgaris. Scarring occurs in lesions associated with cicatricial pemphigoid.

 

REF:   Pemphigus Vulgaris, page 101        OBJ:   18

 

  1. The diagnosis of Behçet syndrome requires which considerations?
a. Two of the three principal manifestations
b. The presence of all three manifestations
c. A biopsy
d. A history of pemphigus vulgaris

 

 

ANS:  A

Behçet syndrome is a chronic recurrent autoimmune disease consisting primarily of oral ulcers, genital ulcers, and ocular inflammation. Two of these three principal manifestations must be present for the diagnosis. Only two principal manifestations must be present for the diagnosis of Behçet syndrome. A biopsy is not necessary for the diagnosis of Behçet syndrome. Pemphigus vulgaris is another severe progressive autoimmune disease. Pemphigus vulgaris is not associated with Behçet syndrome.

 

REF:   Behçet Syndrome, Diagnosis, page 103                          OBJ:   18

 

  1. The classic appearance of what condition shown below is a pattern of interconnecting slender lines referred to as Wickham striae?
a. Lichen planus
b. Linea alba
c. Erythema multiforme
d. Reiter syndrome

 

 

ANS:  A

The classic clinical appearance of lichen planus is a pattern of slender white interconnecting lines referred to as Wickham striae. Linea alba is the white line that develops on the buccal mucosa along the occlusal plane; it is more prominent in patients with clenching or bruxism habits. Erythema multiforme is an acute self-limiting disease affecting the skin and mucous membranes; it is thought to be a hypersensitivity reaction. The oral lesions in Reiter syndrome are characterized by aphthous-like ulcerations, erythematous lesions, and geographic tongue–like lesions.

 

REF:   Lichen Planus, page 93                   OBJ:   15

 

  1. In which condition is the Langerhans cell not the proliferating cell?
a. Lichen planus
b. Letterer–Siwe disease
c. Hand–Schüller–Christian disease
d. Eosinophilic granuloma

 

 

ANS:  A

In lichen planus, there is degeneration of the basal cell layer, sawtooth rete ridges, and a broad band of lymphocytes in the connective tissue immediately subjacent to the epithelium. Letterer–Siwe disease is an acute disseminated form of Langerhans cell disease. Hand–Schüller–Christian disease is a chronic disseminated or multifocal form of Langerhans cell disease. Eosinophilic granuloma is the solitary or chronic localized form of Langerhans cell disease.

 

REF:   Langerhans Cell Histiocytosis (Langerhans Cell Disease), page 96

OBJ:   15

 

  1. The onset of this condition is explosive. It is characterized by skin and mucosal lesions. The skin lesions are referred to as target, iris, or bull’s eye lesions. The mucosal lesions affect the buccal mucosa, lips, and tongue and appear as superficial ulcerations. The lip lesions are ulcerated, encrusted, and bloody. On the basis of this description, which condition is suspected?
a. Lichen planus
b. Erythema multiforme
c. Contact dermatitis
d. SLE

 

 

ANS:  B

The skin lesions of erythema multiform are described as target, iris, or bull’s eye lesions. The mucosal lesions are superficial ulcerations. The lip lesions are bloody and encrusted. In lichen planus, skin lesions are 2- to 4-mm papules. In contact dermatitis, skin lesions result from direct contact with the allergen. The lesions may be erythematous with swelling and vesicles. In SLE, the most classic skin lesion appears on the face and is described as a butterfly rash. The erythematous rash involves the cheeks and the bridge of the nose.

 

REF:   Erythema Multiforme, page 91       OBJ:   15

 

  1. This patient has Sjögren syndrome and severe xerostomia. Which clinical feature most appropriately describes the changes on the tongue in this patient?
a. Dryness
b. Candidiasis
c. Loss of filiform and fungiform papillae
d. Fissures

 

 

ANS:  C

Loss of filiform and fungiform papillae is the main clinical feature that is responsible for the appearance of this patient’s tongue. The entire mouth is dry, but this is not the main clinical feature involving changes in the tongue. Candidiasis may be present, but it does not describe the changes seen in this patient’s tongue. Fissures can occur as a result of the dryness, but they are not the main clinical feature involving the tongue.

 

REF:   Sjögren Syndrome, page 97            OBJ:   18

 

  1. A cell product produced by the cells involved in the immune response is a(n)
a. attenuation.
b. cytokine.
c. dendritic cell.
d. Langerhans cell.

 

 

ANS:  B

A cytokine is a cell product produced by cells involved in the immune response. Attenuation describes the reduction in the severity of a disease or the virulence of a pathogenic agent, as is done in the development of certain vaccines. A dendritic cell is a white blood cell that acts as an antigen-processing cell in the skin and mucosa. A Langerhans cell is a specialized dendritic cell, found in skin and mucosa, that is involved in the immune response.

 

REF:   Cellular Involvement in the Immune Response, page 81 OBJ:   1

 

  1. The immune response differs from the inflammatory response because it has the capacity for memory and responds more quickly to a foreign substance if encountered again.
a. Both the statement and reason are correct and related.
b. Both the statement and reason are correct but not related.
c. The statement is correct but the reason is not.
d. Neither the statement nor the reason is correct.

 

 

ANS:  A

The immune response differs from the inflammatory response because it has the capacity for memory and responds more quickly to a foreign substance if encountered again. Both the statement and reason are correct and related.

 

REF:   Acquired Immune Response, pages 80-81                                 OBJ:    2

 

  1. The three main types of lymphocytes active during an immune response include the following except one. Which one is the exception?
a. T-cell
b. NK cell
c. B-cell
d. C-cell

 

 

ANS:  D

The C-cell is not a type of lymphocyte active during an immune response. The T-cell is a type of lymphocyte active during an immune response. The NK cell is a type of lymphocyte active during an immune response. The B-cell is a type of lymphocyte active during an immune response

 

REF:   Cellular Involvement in the Immune Response, page 81 OBJ:   3

 

  1. The various types of T-cell lymphocytes include the T-helper cell, the T-suppressor cell, the cytotoxic cell, and what other type of cell?
a. T-enhancement cell
b. Virulence cell
c. Memory cell
d. Oral cell

 

 

ANS:  C

The memory cell is a type of T-cell lymphocyte. The T-enhancement cell is not a type of T-cell lymphocyte. The virulence cell is a not a type of T-cell lymphocyte. The oral cell is not a type of T-cell lymphocyte.

 

REF:   T-cell Lymphocyte, page 83           OBJ:   4

 

  1. Along with phagocytosis, the macrophage acts to process antigen material and present it on its surface to the T-helper cell. This stimulates both types of lymphocytes to travel from the lymphoid tissue or surrounding blood vessels to the injury site.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second is false.
d. The first statement is false; the second is true.

 

 

ANS:  A

Both statements are true.

 

REF:   Macrophage, page 83                                OBJ:               5

 

  1. The major divisions of the immune response are the cell-mediated and humoral responses. Both of these responses originate from what type of cell?
a. Plasma cell
b. Stem cell
c. T-lymphocyte
d. B-lymphocyte

 

 

ANS:  B

Both the cell-mediated response and the humoral response originate from the stem cell. The plasma cell is part of the humoral response, but not the cell-mediated response. The T-lymphocyte is part of the cell-mediated response, but not the humoral response. The B-lymphocyte is part of the humoral response, but not the cell-mediated response.

 

REF:   Major Divisions of the Immune Response, Fig. 3.6, page 84

OBJ:   6

 

  1. Antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease; this is termed ____________ immunity.
a. natural active
b. acquired passive
c. acquired active
d. natural passive

 

 

ANS:  D

Natural passive immunity is acquired when antibodies pass through the placenta to a developing fetus and protect the newborn infant from disease. Natural active immunity is acquired when a pathogenic microorganism causes the disease. Acquired passive immunity occurs through an injection of antibodies. Acquired active immunity occurs through immunization.

 

REF:   Types of Immunity, page 85          OBJ:   7

 

  1. Anaphylaxis occurs as a result of what type of hypersensitivity?
a. I
b. II
c. III
d. IV

 

 

ANS:  A

Type I, or anaphylactic type, hypersensitivity is a reaction that occurs immediately, within minutes of exposure to a previously encountered antigen or allergen. Type II, or cytotoxic type, hypersensitivity occurs when an antibody combines with an antigen that is bound to the surface of tissue cells. Type III, or immune complex type, hypersensitivity is marked by the formation of immune complexes between microorganisms and antibody in the circulating blood. Type IV, or cell-mediated type, hypersensitivity involves a cell-mediated immune response rather than a humoral response that produces antibodies.

 

REF:   Type I Hypersensitivity, page 86    OBJ:   8

 

  1. An example of an immunopathologic condition in which one’s own body cells are no longer tolerated is
a. contact mucositis.
b. angioedema.
c. autoimmune disease.
d. contact dermatitis.

 

 

ANS:  C

Autoimmune disease occurs when one’s own body cells are no longer tolerated. Contact mucositis results from direct contact of an allergen with the oral mucosa or skin. Angioedema is a skin and oral mucosal hypersensitivity. Contact dermatitis occurs as a result of direct contact of an allergen with the oral mucosa or skin.

 

REF:   Autoimmune Diseases, page 86      OBJ:   9

 

  1. Each condition is an example of an oral immunologic disorder except one. Which one is the exception?
a. Aphthous ulcers
b. Erythema multiforme
c. Fixed drug eruptions
d. Osteomyelitis

 

 

ANS:  D

Osteomyelitis is an example of an infectious disease. Aphthous ulcers are an example of an oral immunologic disorder. Erythema multiforme is an example of an oral immunologic disorder. Fixed drug eruptions are an example of an oral immunologic disorder.

 

REF:   Aphthous Ulcers, page 87 | Erythema Multiforme, page 91 | Drug Eruption, page 91

OBJ:   10

 

  1. The diagnosis of the type of aphthous ulcers is made on the basis of their distinctive clinical appearance, the location of the lesion, and a
a. patient history.
b. therapeutic result.
c. radiographic examination.
d. laboratory test.

 

 

ANS:  A

A complete patient history is part of the final diagnosis of aphthous ulcers. Therapeutic results do not aid in the diagnosis of aphthous ulcers. Radiographic examinations are not diagnostic for aphthous ulcers. Laboratory results are not specific for any form of aphthous ulcer.

 

REF:   Types of Ulcers, Diagnosis, pages 87, 89                        OBJ:   10

 

  1. Which is a systemic disease associated with aphthous ulcers?
a. Stafne bone cyst
b. Necrotizing sialometaplasia
c. Behçet syndrome
d. Erythema multiforme

 

 

ANS:  C

Behçet syndrome is a disease characterized by aphthous ulcers, genital ulcers, ocular inflammation, and arthritis. Stafne bone cyst is a developmental disorder and is not considered a systemic disease. Necrotizing sialometaplasia is an inflammatory condition of the salivary glands. Erythema multiforme is not a systemic disease.

 

REF:   Behçet Syndrome, page 103           OBJ:   12

 

  1. A patient presents with a diffuse swelling of the upper lip caused by permeability of deeper blood vessels. The skin covering the swelling appears normal and not accompanied by itching. This is characteristic of what pathologic condition?
a. Minor aphthous ulcer
b. Lichen planus
c. Angioedema
d. Sjögren syndrome

 

 

ANS:  C

This description is indicative of angioedema. Minor aphthous ulcers are round-to-oval ulcers that exhibit a yellowish-white fibrin surface surrounded by a halo of erythema. Lichen planus appears as interconnecting white lines and circles on the oral mucosa or skin. Sjögren syndrome is characterized by a decrease in salivary gland secretion.

 

REF:   Urticaria and Angioedema, page 89                                           OBJ:    13

 

  1. Each statement about lichen planus is true except one. Which statement is false?
a. The tongue is most commonly affected.
b. It is an idiopathic condition.
c. It is a benign condition.
d. It is a chronic condition.

 

 

ANS:  A

Lichen planus occurs on the skin and oral mucosa; in the latter case, the buccal mucosa is most frequently affected. Many factors have been implicated in lichen planus; however, the cause remains unknown. Lichen planus is considered benign. Lichen planus is a chronic disease.

 

REF:   Lichen Planus, pages 92-93            OBJ:   15

 

  1. Which conditions are not appropriately paired?
a. Reactive arthritis—Reiter syndrome
b. Aphthous ulcer—canker sore
c. Urticaria—hives
d. Lichen planus—Sjögren syndrome

 

 

ANS:  D

No association exists between lichen planus and Sjögren syndrome. Reactive arthritis is another name for Reiter syndrome. An aphthous ulcer is also called a canker sore. Urticaria is also referred to as hives.

 

REF:   Lichen Planus, pages 92-93 | Sjögren Syndrome, page 97         OBJ:    16

 

  1. Which form of Langerhans cell disease occurs in children younger than 5 years, is multifocal, and a classic triad is seen in 25% of patients?
a. Letterer–Siwe disease
b. Hand–Schüller–Christian disease
c. Eosinophilic granuloma
d. Chronic localized form

 

 

ANS:  B

Hand–Schüller–Christian disease is the multifocal form of Langerhans cell disease. It occurs in children younger than 5 years. A classic triad is seen in 25% of patients. Letterer–Siwe disease resembles lymphoma, affects children younger than 3 years, and has a rapidly fatal course. It is the most severe form of Langerhans cell disease. Eosinophilic granuloma affects older children and young adults. The chronic localized form is the same as eosinophilic granuloma.

 

REF:   Langerhans Cell Histiocytosis, page 96                           OBJ:   17

 

  1. In the mildest form of this autoimmune disease, oral lesions appear as erythematous plaques or erosions. White striae radiating from the center of the lesion are also commonly present.

These oral lesions are indicative of what autoimmune disease?

a. Mucous membrane pemphigoid
b. Pemphigus vulgaris
c. Lupus erythematosus
d. Behçet syndrome

 

 

ANS:  C

In the mildest form of lupus erythematosus, oral lesions appear as erythematous plaques or erosions. White striae radiating from the center of the lesion are also commonly present. Oral lesions in mucous membrane pemphigoid are clinically described as desquamative gingivitis. The oral lesions in pemphigus vulgaris range from shallow ulcers to fragile vesicles or bullae. The oral ulcers that occur in Behçet syndrome are very similar in appearance to aphthous ulcers.

 

REF:   Systemic Lupus Erythematosus, page 99                         OBJ:   18

 

  1. This patient presents with an intraepithelial bulla from breakdown of the cellular adhesion between epithelial cells. The bulla rupture, resulting in a painful itching ulcer. The correct diagnosis for this progressive autoimmune disease is
a. pemphigus vulgaris.
b. Reiter syndrome.
c. aphthous ulcers.
d. Langerhans cell disease.

 

 

ANS:  A

Acantholysis (breakdown of the cellular adhesion between epithelial cells) is characteristic of pemphigus vulgaris. Reiter syndrome does not present with a bulla that ruptures, resulting in an ulcer. Aphthous ulcers are not a progressive autoimmune disease. Oral manifestations of Langerhans cell disease include loss of bone support, sore mouth, halitosis, gingivitis, and sore teeth.

 

REF:   Pemphigus Vulgaris, page 101        OBJ:   18

 

  1. Behçet syndrome is an acute, nonrecurring autoimmune disease consisting mainly of oral ulcers, genital ulcers, ocular inflammation, and skin lesions. Systemic and topical corticosteroids, as well as immunosuppressive drugs, are used in the management of Behçet syndrome.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true; the second is false.
d. The first statement is false; the second is true.

 

 

ANS:  D

Behçet syndrome is chronic and recurring; and systemic and topical corticosteroids, as well as immunosuppressive drugs, are used to treat it. The first statement is false: Behçet syndrome is not acute and it does recur. The second statement is true: systemic and topical corticosteroids, as well as immunosuppressive drugs, are used to treat it. The first statement is false; the second is true.

 

REF:   Behçet Syndrome, page 103           OBJ:   20

 

  1. Decreased salivary flow that results in xerostomia is also known as
a. hyposalivation.
b. mucositis.
c. pruritus.
d. anaphylaxis.

 

 

ANS:  A

Hyposalivation is the decreased salivary flow that may result in dry mouth, or xerostomia. Mucositis refers to mucosal inflammation because of a disease process. Pruritus is another term for itching. Anaphylaxis is a severe or immediate type of hypersensitivity in which an exaggerated immunologic reaction occurs.

 

REF:   Vocabulary, page 79                                 OBJ:               1

 

  1. NK cells have the ability to destroy foreign cells. NK cells are active against a variety of cells except one. Which is the exception?
a. Cancer cells
b. HIV and AIDS
c. Viruses
d. NK cells are active against A, B, and C

 

 

ANS:  B

NK cell function is abnormal in HIV-related acquired immunodeficiency syndrome. NK cells are active against cancer cells. NK cells are active against most viruses. NK cells are active against most viruses and cancer cells, but not HIV-related AIDS.

 

REF:   Cellular Involvement in the Immune Response, page 83 OBJ:   3

 

  1. Which statement is false about the T-cell lymphocyte?
a. The T-cell lymphocyte develops from a bone marrow stem cell.
b. The T-cell lymphocyte travels to the liver and is processed into a mature cell.
c. The T-cell lymphocyte has a special receptor on its surface.
d. The T-cell lymphocyte increases the functioning of the B-cell.

 

 

ANS:  B

The T-cell lymphocyte does not travel to the liver to be processed into a mature cell; the cell travels to the thymus. The T-cell lymphocyte develops from a bone marrow stem cell. The T-cell lymphocyte has a special receptor on its surface. The T-cell lymphocyte increases the functioning of the B-cell.

 

REF:   Cellular Involvement in the Immune Response, pages 82-83

OBJ:   3

 

  1. In addition to a clinical diagnosis, which additional category is used in diagnosing aphthous ulcers?
a. Laboratory
b. Differential
c. Historical
d. Therapeutic

 

 

ANS:  C

The diagnosis of aphthous ulcers is made on the basis of their clinical appearance and a complete patient history. Laboratory results are not specific for any form of aphthous ulcer. The thoroughness and data collection of a differential diagnosis is not necessary to diagnose aphthous ulcers. A therapeutic diagnosis is not necessary to diagnose aphthous ulcers.

 

REF:   Oral Immunologic Lesions and Diseases, page 89           OBJ:   12

 

  1. What is the common name for urticaria?
a. Hives
b. Dermatitis
c. Dry socket
d. Jaundice

 

 

ANS:  A

Urticaria is also known as hives. Dermatitis (eczema) is the inflammation of the skin. Dry socket (alveolar osteitis) is a postoperative complication of tooth extraction. Jaundice (icterus) is an abnormal accumulation of bilirubin in the blood and manifested by a yellowish discoloration of the skin.

 

REF:   Oral Immunologic Lesions and Diseases, page 89           OBJ:   14

 

  1. What is the group of medications used to treat patients with urticaria and angioedema?
a. Barbiturates
b. Antihistamines
c. Antidepressants
d. Corticosteroids

 

 

ANS:  B

Antihistamines (e.g., Benadryl) are the standard drugs used to treat urticaria and angioedema. Barbiturates are not useful when treating urticaria and angioedema. Antidepressants are not needed when treating patients with urticaria or angioedema. Corticosteroids are not the drugs of choice when treating urticaria or angioedema.

 

REF:   Oral Immunologic Lesions and Diseases, page 90           OBJ:   14

 

  1. Skin lesions, called target or bull’s eye lesions, are characteristic of persons with erythema multiforme. If the oral cavity is also involved, which conditions are typically seen?
a. Gingival inflammation
b. Periodontal disease
c. Oral ulcers on the tongue and lips
d. Xerostomia

 

 

ANS:  C

Oral lesions are usually ulcers that frequently form on the lateral borders of the tongue. Crusting and bleeding lips are also often seen. Gingival involvement with erythema multiforme is rare. Since gingival involvement is rare, periodontal issues are not common with erythema multiforme. Xerostomia is not an oral manifestation of erythema multiforme.

 

REF:   Oral Immunologic Lesions and Diseases, page 91           OBJ:   15

 

  1. What is a clinical difference between lichen planus and linea alba?
a. Lichen planus may be removed with a gauze square; linea alba cannot be removed.
b. Lichen planus appears more bluish; linea alba appears white.
c. Lichen planus may appear on the buccal mucosa as well as the tongue, lips, and floor of the mouth; linea alba is confined to the buccal mucosa.
d. Lichen planus is asymptomatic; linea alba may cause erosions, bullae, or ulcers.

 

 

ANS:  C

Lichen planus can occur in numerous regions of the oral cavity, whereas linea alba is best seen on the buccal mucosa. Lichen planus is not removed with a gauze square. Lichen planus does not carry a blue appearance. Lichen planus may be associated with erosions, bullae, or ulcers. Linea alba is asymptomatic.

 

REF:   Oral Immunologic Lesions and Diseases, page 92           OBJ:   16

 

  1. Patients with Sjögren syndrome who experience xerostomia are at a high risk of the following conditions except one. Which is the exception?
a. Melanotic macules
b. Dental caries
c. Oral candidiasis
d. Periodontal disease

 

 

ANS:  A

Patients with Sjögren syndrome are not prone to the development of melanotic macules. Patients with xerostomia are at a high risk for the development of dental caries. Patients with xerostomia are at a high risk for the development of oral candidiasis. Patients with xerostomia are at a high risk for the development of periodontal disease.

 

REF:   Autoimmune Disease With Oral Manifestations, page 97          OBJ:    19

 

  1. Some patients with Sjögren syndrome will also demonstrate the Raynaud phenomenon, which is a disorder that affects the
a. joints.
b. fingers and toes.
c. lacrimal glands.
d. eyelids.

 

 

ANS:  B

Raynaud phenomenon is a disorder affecting the fingers and toes, usually triggered by cold and emotional stress. Raynaud phenomenon does not affect the joints of the patient. The lacrimal glands are not affected by Raynaud phenomenon. The eyelids are not affected by Raynaud phenomenon.

 

REF:   Autoimmune Disease With Oral Manifestations, page 98          OBJ:    19

 

  1. A person with SLE may have oral manifestations similar to which other condition?
a. Lichen planus
b. Angioedema
c. Minor aphthous ulcers
d. Mucous membrane pemphigoid

 

 

ANS:  A

Oral lesions appear as erythematous plaques or erosions with white striae radiating from the center, resembling lichen planus. Angioedema appears as a diffuse swelling of tissue caused by permeability of deeper blood vessels. Minor aphthous ulcers are discrete, punched-out, round to oval ulcers surrounded by a halo of erythema. Mucous membrane pemphigoid demonstrates desquamative gingivitis, which is a range of ulceration and erythema involving the marginal and attached gingiva.

 

REF:   Autoimmune Disease With Oral Manifestations, page 99          OBJ:    19

 

  1. Oral lesions accompanying skin lesions may occur in the following diseases except one. Which is the exception?
a. SLE
b. Pemphigus vulgaris
c. Lichen planus
d. Aphthous ulcers

 

 

ANS:  D

Aphthous ulcers are not seen on skin but may develop in the oral cavity. Oral lesions accompany skin lesions in about 25% of patients with SLE. Pemphigus vulgaris is a severe, progressive autoimmune disease that affects both the skin and mucous membranes. Several forms of lichen planus have been described. In addition to oral lesions, skin lesions of itching and pruritus have been noted.

 

REF:   Autoimmune Disease With Oral Manifestations, page 87          OBJ:    19

 

  1. What is the most common precipitating factor seen in the development of aphthous ulcers?
a. Tobacco use
b. Trauma
c. Emotional stress
d. Infection

 

 

ANS:  B

Trauma is the most commonly reported precipitating factor in the development of aphthous ulcers (e.g., toothbrush trauma, x-ray film or sensor placement, injection site of local anesthetics). Tobacco use is not considered a precipitating factor in the development of aphthous ulcers. Nonsmokers report aphthous ulcer development. Emotional stress has been suggested as a contributing factor of the development of aphthous ulcers. Infection is not typically associated with the development of aphthous ulcers.

 

REF:   Oral Immunologic Lesions and Diseases, page 87           OBJ:   12

 

  1. Acantholysis, or the dissolution of the intercellular bridges of the prickle cell layer of the epithelium, is an oral manifestation of which disease?
a. HIV
b. Urticaria
c. Pemphigus vulgaris
d. Behçet syndrome

 

 

ANS:  C

Pemphigus vulgaris is characterized by intraepithelial vesicle formation that results from breakdown of the cellular adhesion between epithelial cells, termed acantholysis. While HIV disease presents with numerous oral manifestations, acantholysis is not typically listed. Urticaria appears as multiple areas of well-demarcated edema and erythema of the skin. Behçet syndrome is an autoimmune disease that presents with oral ulcers that are painful and recurrent.

 

REF:   Autoimmune Disease With Oral Manifestations, page 101

OBJ:   19

 

  1. Persons with Behçet syndrome suffer from the following symptoms except one. Which is the exception?
a. Nikolsky sign
b. Oral ulcers
c. Ocular inflammation
d. Genital lesions

 

 

ANS:  A

The Nikolsky sign is associated with finger pressure causing a cleavage in the intraoral epithelium, resulting in the formation of a bulla. This finding is associated with pemphigus vulgaris. Oral ulcers are seen in persons with Behçet syndrome. Ocular inflammation usually begins with photophobia and develops into conjunctivitis in persons with Behçet syndrome. Genital lesions are usually small yet painful and recurrent in persons with Behçet syndrome.

 

REF:   Autoimmune Disease With Oral Manifestations, page 103

OBJ:   19