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 2. 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 3. 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 4. 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 5. 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 6. 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 7. 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 8. 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 9. 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 10. In internal resorption, the radiolucency seen on radiographic examination is usually a. well circumscribed. b. diffuse