1. Systemic Clues from Oral History
Which systemic condition is most likely if a patient reports dry mouth, dry eyes, and arthralgia during history-taking?
A: Diabetes mellitus
B: Hyperthyroidism
C: Sjögren’s syndrome
D: Rheumatoid arthritis
Answer: C: Sjögren’s syndrome
2. Evaluating Oral Burning Sensation
A patient presents with a persistent oral burning sensation but no visible mucosal lesions. Which is the most appropriate next step in clinical evaluation?
A: Perform a biopsy
B: Take a detailed medication and psychosocial history
C: Start antifungal therapy
D: Refer to ENT
Answer: B: Take a detailed medication and psychosocial history
3. Medical History Relevance in Oral Medicine
Why is it critical to obtain a full medical history when evaluating oral lesions?
A: Many systemic diseases present first in the oral cavity
B: Only infectious diseases affect the oral mucosa
C: Oral lesions are rarely influenced by systemic health
D: Medications do not typically impact oral presentations
Answer: A: Many systemic diseases present first in the oral cavity
4. Importance of Lymph Node Palpation
During an oral cancer screening, which of the following findings during lymph node palpation is most concerning?
A: Soft, tender, mobile lymph node under 1 cm
B: Non-palpable lymph nodes in a healthy patient
C: Slightly enlarged but fluctuant lymph node
D: Firm, fixed, non-tender lymph node over 2 cm
Answer: D: Firm, fixed, non-tender lymph node over 2 cm
5. History Clues for Candidiasis
Which patient-reported history most strongly supports a diagnosis of oral candidiasis?
A: Recent use of broad-spectrum antibiotics
B: History of peptic ulcers
C: Regular alcohol use
D: Occasional spicy food intolerance
Answer: A: Recent use of broad-spectrum antibiotics
6. Significance of Mucosal Pigmentation
Which of the following pigmentation patterns warrants immediate biopsy or further systemic investigation?
A: Uniform brown patch on attached gingiva
B: Physiologic pigmentation in a dark-skinned patient
C: Amalgam tattoo in posterior buccal mucosa
D: Irregular, asymmetrical pigmented lesion on the lateral tongue
Answer: D: Irregular, asymmetrical pigmented lesion on the lateral tongue
7. Clarifying Ulcer Etiology with History
Which historical clue best helps distinguish recurrent aphthous ulcers from herpetic ulcers?
A: Associated fever during lesion onset
B: Occurrence of ulcers on non-keratinized mucosa
C: Lesions beginning as vesicles before ulcerating
D: History of sexual transmission
Answer: B: Occurrence of ulcers on non-keratinized mucosa
8. Oral Symptoms Suggesting Hematologic Disorders
Which constellation of oral findings should raise concern for an underlying hematologic disorder?
A: Halitosis and gingival recession
B: Hyperkeratosis and fissured tongue
C: Spontaneous gingival bleeding, petechiae, and pallor
D: Painful ulcers with pseudomembrane
Answer: C: Spontaneous gingival bleeding, petechiae, and pallor
9. Differentiating Ulcers from Neoplasia
During clinical examination, which of the following characteristics most strongly suggests malignancy rather than benign ulceration?
A: Painful lesion with a yellow pseudomembrane
B: Recurrent ulcers healing within 10 days
C: Ulcers confined to the labial mucosa
D: Indurated ulcer with rolled borders and no pain
Answer: D: Indurated ulcer with rolled borders and no pain
10. Medication History in Oral Medicine
Which of the following classes of medication should be flagged during oral medicine history due to its potential to cause lichenoid mucosal reactions?
A: Antihypertensives (e.g., beta-blockers)
B: Antacids
C: Diuretics
D: Antihistamines
Answer: A: Antihypertensives (e.g., beta-blockers)
11. Histopathology of Oral Lichen Planus
Which histologic feature is most characteristic of reticular oral lichen planus?
A: Koilocytosis and nuclear atypia
B: Dysplastic epithelial changes throughout all layers
C: Saw-tooth rete ridges with a band-like lymphocytic infiltrate
D: Giant cell granulomatous reaction in the lamina propria
Answer: C: Saw-tooth rete ridges with a band-like lymphocytic infiltrate
12. Red Lesions of the Oral Cavity
Which red lesion is most associated with a high risk of malignant transformation?
A: Geographic tongue
B: Erythroplakia
C: Median rhomboid glossitis
D: Denture stomatitis
Answer: B: Erythroplakia
13. Etiology of Hairy Leukoplakia
What is the primary etiological agent of oral hairy leukoplakia?
A: Epstein-Barr Virus (EBV)
B: Human Papillomavirus (HPV)
C: Candida albicans
D: Treponema pallidum
Answer: A: Epstein-Barr Virus (EBV)
14. Pigmented Lesions Differential Diagnosis
Which of the following pigmented lesions of the oral cavity requires a biopsy due to its malignant potential?
A: Racial pigmentation
B: Smoker’s melanosis
C: Amalgam tattoo
D: Melanoma
Answer: D: Melanoma
15. White Sponge Nevus Presentation
What is the most distinguishing clinical feature of white sponge nevus?
A: Bilateral, asymptomatic, thickened white plaques on the buccal mucosa
B: Ulcerative white lesions on the soft palate
C: White patches that scrape off, leaving a red base
D: Unilateral corrugated lesion on the ventral tongue
Answer: A: Bilateral, asymptomatic, thickened white plaques on the buccal mucosa
16. Management of Frictional Keratosis
What is the recommended management approach for confirmed frictional keratosis?
A: Initiate antifungal therapy
B: Immediate biopsy due to malignant potential
C: Apply topical corticosteroids
D: Eliminate the source of trauma and monitor for resolution
Answer: D: Eliminate the source of trauma and monitor for resolution
17. Etiology of Smoker’s Melanosis
Which of the following best explains the pathogenesis of smoker’s melanosis?
A: Fungal stimulation of melanocyte activity
B: Tobacco-associated upregulation of melanin synthesis
C: Viral-induced epithelial transformation
D: Inflammatory cytokine-mediated tissue damage
Answer: B: Tobacco-associated upregulation of melanin synthesis
18. Leukoplakia with Epithelial Dysplasia
Which clinical presentation increases the likelihood of epithelial dysplasia in leukoplakia?
A: Smooth and well-demarcated appearance
B: Exclusively located on the dorsal tongue
C: Non-homogeneous, speckled or verrucous leukoplakia
D: Asymptomatic flat lesion on the attached gingiva
Answer: C: Non-homogeneous, speckled or verrucous leukoplakia
19. Diagnosis of Melanoacanthoma
Which statement is true regarding oral melanoacanthoma?
A: It is often seen in the hard palate and associated with HPV
B: It has high malignant potential and is treated surgically
C: It is a congenital lesion found in young children
D: It rapidly enlarges but is benign and often regresses after biopsy
Answer: D: It rapidly enlarges but is benign and often regresses after biopsy
20. Differential Diagnosis of Red and White Lesions
Which lesion is most likely to be misdiagnosed as both red and white in clinical appearance and requires biopsy for confirmation?
A: Speckled leukoplakia (erythroleukoplakia)
B: Fordyce granules
C: Linea alba
D: Leukoedema
Answer: A: Speckled leukoplakia (erythroleukoplakia)
21. Classification of Recurrent Aphthous Stomatitis (RAS)
Which of the following best describes the distinguishing feature of major aphthous ulcers compared to minor ulcers?
A: Occurs exclusively on keratinized mucosa
B: Resolves within 7 days without scarring
C: Exceeds 1 cm in diameter and may scar upon healing
D: Is typically painless and self-limiting
Answer: C: Exceeds 1 cm in diameter and may scar upon healing
22. Etiology of RAS in Immunocompromised Patients
Which of the following is most commonly associated with RAS-like ulcerations in patients with HIV/AIDS?
A: Vitamin B12 deficiency
B: Immune dysregulation with reduced CD4 counts
C: Iron-deficiency anemia
D: Allergic reactions to dental materials
Answer: B: Immune dysregulation with reduced CD4 counts
23. Behçet’s Syndrome vs. Classic RAS
What clinical feature most clearly distinguishes Behçet’s syndrome from classic RAS?
A: Presence of genital ulcers in addition to oral lesions
B: Lack of systemic symptoms
C: Rapid healing of lesions
D: Association with Epstein-Barr virus
Answer: A: Presence of genital ulcers in addition to oral lesions
24. Histopathologic Findings in RAS
Which of the following histological features is most typical of an aphthous ulcer?
A: Hyperplasia of the epithelium with intact basement membrane
B: Presence of fungal hyphae in the lamina propria
C: Neutrophilic infiltration of minor salivary glands
D: Ulceration with underlying mononuclear inflammatory infiltrate
Answer: D: Ulceration with underlying mononuclear inflammatory infiltrate
25. Nutritional Deficiency and RAS
Which nutritional deficiency is most classically associated with an increased incidence of recurrent aphthous stomatitis?
A: Iron
B: Calcium
C: Vitamin D
D: Zinc
Answer: A: Iron
26. Herpetiform Ulcerations
Which of the following is true regarding herpetiform ulcers?
A: They are caused by herpes simplex virus
B: They are confined to the gingiva and hard palate
C: They are typically solitary and large
D: They appear as multiple, small ulcers that may coalesce
Answer: D: They appear as multiple, small ulcers that may coalesce
27. Systemic Conditions Mimicking RAS
Which condition is most likely to mimic the appearance of recurrent minor aphthous ulcers but also includes systemic gastrointestinal symptoms?
A: Sjögren’s syndrome
B: Celiac disease
C: Lichen planus
D: Pemphigus vulgaris
Answer: B: Celiac disease
28. Treatment Modalities for Major RAS
Which of the following is a second-line treatment for major aphthous ulcers that are unresponsive to topical corticosteroids?
A: Antiviral therapy
B: Vitamin B6 injections
C: Systemic corticosteroids (e.g., prednisone)
D: Topical antifungals
Answer: C: Systemic corticosteroids (e.g., prednisone)
29. Drug-Induced Ulcerations
Which of the following medications is most commonly associated with aphthous-like oral ulcerations?
A: Statins
B: Diuretics
C: Bisphosphonates
D: Nicorandil
Answer: D: Nicorandil
30. Differentiating Viral vs. Aphthous Ulcers
Which feature best distinguishes primary herpetic gingivostomatitis from aphthous ulcers?
A: Presence of systemic symptoms such as fever and malaise in herpetic infections
B: Exclusively affects non-keratinized mucosa
C: Tends to recur in identical locations
D: Associated with iron and folate deficiencies
Answer: A: Presence of systemic symptoms such as fever and malaise in herpetic infections
31. Host Factors in Chronic Hyperplastic Candidiasis
Which host condition is most closely associated with the persistence of chronic hyperplastic candidiasis despite antifungal therapy?
A: Diabetes mellitus
B: Sjögren’s syndrome
C: Smoking and immunosuppression
D: Use of inhaled corticosteroids
Answer: C: Smoking and immunosuppression
32. Pseudomembranous Candidiasis Microscopic Features
Which of the following best describes the histopathological hallmark of pseudomembranous candidiasis?
A: Subepithelial vesicle formation
B: Superficial epithelial desquamation with fungal hyphae invading the parakeratin layer
C: Granulomatous inflammation with multinucleated giant cells
D: Intact epithelium with deep hyphal invasion into connective tissue
Answer: B: Superficial epithelial desquamation with fungal hyphae invading the parakeratin layer
33. First-Line Treatment in Denture-Related Candidiasis
What is the most appropriate initial treatment for denture stomatitis in an otherwise healthy patient?
A: Removal of the denture at night and disinfection combined with topical antifungals
B: High-dose systemic antifungals
C: Immediate replacement of the denture
D: Chlorhexidine rinses and observation
Answer: A: Removal of the denture at night and disinfection combined with topical antifungals
34. Differentiation Between Acute and Chronic Candidiasis
Which feature best distinguishes chronic hyperplastic candidiasis from acute pseudomembranous candidiasis?
A: Erythema of the tongue
B: Painful, diffuse lesions
C: Detachable white plaques
D: Non-scrapable white patches with epithelial dysplasia
Answer: D: Non-scrapable white patches with epithelial dysplasia
35. Predisposing Factor for Angular Cheilitis
Which of the following is a primary predisposing factor for angular cheilitis of fungal origin?
A: Reduced vertical dimension from worn prostheses
B: Vitamin D deficiency
C: Excessive intake of acidic foods
D: Chronic mucosal trauma
Answer: A: Reduced vertical dimension from worn prostheses
36. Role of Biofilms in Refractory Candidiasis
Why are biofilms formed by Candida albicans significant in the context of treatment resistance?
A: They promote transformation into a viral co-infection
B: They reduce host recognition of fungal antigens
C: They increase salivary gland involvement
D: They significantly increase antifungal resistance by shielding fungal cells from agents
Answer: D: They significantly increase antifungal resistance by shielding fungal cells from agents
37. Classification of Erythematous Candidiasis
In the context of Candida infections, erythematous candidiasis is best classified as:
A: A premalignant lesion associated with leukoplakia
B: A type of acute candidiasis often seen post-antibiotic use
C: A congenital presentation in immunocompromised neonates
D: A chronic condition seen exclusively in denture wearers
Answer: B: A type of acute candidiasis often seen post-antibiotic use
38. Common Co-Infection in Chronic Mucocutaneous Candidiasis
Chronic mucocutaneous candidiasis is most frequently associated with which systemic condition?
A: Iron-deficiency anemia
B: Celiac disease
C: Endocrinopathies, such as hypoparathyroidism
D: HIV infection
Answer: C: Endocrinopathies, such as hypoparathyroidism
39. Antifungal Resistance Mechanism in Candida glabrata
Which mechanism contributes most significantly to Candida glabrata’s resistance to azole antifungals?
A: Enzymatic degradation of azoles
B: Enhanced ergosterol synthesis
C: Reduced fungal adhesion to mucosa
D: Overexpression of efflux pumps and altered drug targets
Answer: D: Overexpression of efflux pumps and altered drug targets
40. Topical Agent with Fungicidal Action
Which of the following topical agents has fungicidal rather than fungistatic activity against Candida albicans?
A: Nystatin
B: Ketoconazole
C: Chlorhexidine
D: Amphotericin B
Answer: A: Nystatin
41. Histopathological Features of Reticular Oral Lichen Planus
Which histopathological feature is most characteristic of reticular oral lichen planus?
A: Subepithelial clefting with granulomatous inflammation
B: Epithelial dysplasia with acanthosis
C: Saw-tooth appearance of the rete ridges with a band-like lymphocytic infiltrate
D: Plasma cell-rich infiltrate in the lamina propria
Answer: C: Saw-tooth appearance of the rete ridges with a band-like lymphocytic infiltrate
42. Immunofluorescence Findings in Oral Lichen Planus
Which immunofluorescence pattern is typically seen in oral lichen planus?
A: Linear IgA deposition along the basement membrane
B: Fibrinogen deposition at the basement membrane zone
C: Granular C3 deposition within the basal layer
D: IgG targeting intercellular junctions
Answer: B: Fibrinogen deposition at the basement membrane zone
43. First-Line Therapy for Symptomatic Erosive Lichen Planus
What is considered the first-line treatment for symptomatic erosive oral lichen planus?
A: High-potency topical corticosteroids
B: Systemic antifungal agents
C: Antibiotic mouth rinse
D: Low-dose methotrexate
Answer: A: High-potency topical corticosteroids
44. Differentiation Between Erosive Lichen Planus and Pemphigoid
Which of the following features best differentiates erosive lichen planus from mucous membrane pemphigoid?
A: Presence of desquamative gingivitis
B: Association with systemic lupus erythematosus
C: Erosive ulceration limited to buccal mucosa
D: Positive Nikolsky sign and subepithelial clefting on histology
Answer: D: Positive Nikolsky sign and subepithelial clefting on histology
45. Risk of Malignant Transformation
What is a major concern in the long-term management of oral lichen planus, particularly the erosive type?
A: Risk of malignant transformation into oral squamous cell carcinoma
B: Risk of rapid periodontal destruction
C: High potential for fungal superinfection
D: Association with increased gingival recession
Answer: A: Risk of malignant transformation into oral squamous cell carcinoma
46. Use of Calcineurin Inhibitors in OLP
What is the rationale behind using topical calcineurin inhibitors (e.g., tacrolimus) in oral lichen planus?
A: To induce apoptosis in dysplastic epithelial cells
B: To promote re-epithelialization of ulcers
C: To inhibit microbial colonization
D: To suppress T-cell mediated inflammation when corticosteroids are ineffective or contraindicated
Answer: D: To suppress T-cell mediated inflammation when corticosteroids are ineffective or contraindicated
47. Wickham’s Striae in Reticular Lichen Planus
What is the best explanation for the presence of Wickham’s striae in reticular oral lichen planus?
A: Dilated capillaries beneath the epithelium
B: Areas of hypergranulosis and keratinization on mucosal surfaces
C: Subepithelial bullae filled with lymphocytes
D: Degeneration of basal cells leading to erosion
Answer: B: Areas of hypergranulosis and keratinization on mucosal surfaces
48. Systemic Association of Oral Lichen Planus
Which systemic condition has the strongest evidence of association with oral lichen planus?
A: Rheumatoid arthritis
B: Type II diabetes mellitus
C: Hepatitis C virus infection
D: Systemic sclerosis
Answer: C: Hepatitis C virus infection
49. Indication for Biopsy in OLP Management
In which scenario is biopsy most critical for a patient with suspected oral lichen planus?
A: Reticular pattern in an asymptomatic patient
B: Lesion confined to the gingiva with no systemic symptoms
C: Presence of white plaque with a corrugated surface
D: Chronic erosive lesion unresponsive to standard therapy or showing dysplastic features
Answer: D: Chronic erosive lesion unresponsive to standard therapy or showing dysplastic features
50. Long-Term Monitoring for OLP Patients
Why is long-term follow-up necessary for patients with oral lichen planus?
A: To monitor for malignant transformation and assess response to treatment
B: To prevent spread to the nasal mucosa
C: To reduce the risk of caries
D: To ensure adequate saliva flow is maintained
Answer: A: To monitor for malignant transformation and assess response to treatment
51. Immunopathology of Pemphigus Vulgaris
Which specific autoantibodies are primarily involved in the pathogenesis of pemphigus vulgaris?
A: Anti-collagen IV
B: Anti-laminin-5
C: Anti-desmoglein 1 and 3
D: Anti-keratinocyte growth factor
Answer: C: Anti-desmoglein 1 and 3
52. Target Antigens in Mucous Membrane Pemphigoid
What is the primary basement membrane antigen targeted in mucous membrane pemphigoid?
A: Desmoplakin
B: BP180 (Type XVII collagen)
C: Desmoglein 3
D: Interleukin-1 receptor
Answer: B: BP180 (Type XVII collagen)
53. Histological Feature of Pemphigus Vulgaris
Which histologic feature is characteristic of pemphigus vulgaris?
A: Intraepithelial acantholysis above the basal layer
B: Subepithelial clefting with neutrophil infiltration
C: Pseudoepitheliomatous hyperplasia
D: Granulomatous inflammation
Answer: A: Intraepithelial acantholysis above the basal layer
54. Differentiation Between PV and MMP
Which clinical or diagnostic feature is most helpful in distinguishing mucous membrane pemphigoid from pemphigus vulgaris?
A: Presence of desquamative gingivitis
B: Pain intensity of oral lesions
C: Positive Nikolsky’s sign
D: Location of blister separation on histology
Answer: D: Location of blister separation on histology
55. First-Line Systemic Therapy for Pemphigus Vulgaris
What is typically the first-line systemic treatment for severe pemphigus vulgaris?
A: Systemic corticosteroids (e.g., prednisone)
B: Methotrexate
C: Dapsone
D: Antihistamines
Answer: A: Systemic corticosteroids (e.g., prednisone)
56. Direct Immunofluorescence in MMP
Which finding is expected on direct immunofluorescence (DIF) of perilesional tissue in mucous membrane pemphigoid?
A: Intercellular deposition of IgG in the epithelium
B: Linear deposition of IgM at the dermoepidermal junction
C: Granular deposition of fibrinogen around blood vessels
D: Linear deposition of IgG and C3 at the basement membrane zone
Answer: D: Linear deposition of IgG and C3 at the basement membrane zone
57. Ocular Involvement in MMP
Which statement best describes ocular involvement in mucous membrane pemphigoid?
A: It is self-limiting and rarely requires intervention
B: It can cause progressive scarring and blindness if untreated
C: It only occurs in patients with severe skin involvement
D: It resolves with topical antihistamines alone
Answer: B: It can cause progressive scarring and blindness if untreated
58. Role of Rituximab in Autoimmune Bullous Diseases
Why might rituximab be indicated in treatment-resistant pemphigus vulgaris?
A: It increases neutrophil activity
B: It blocks basement membrane antigen expression
C: It depletes CD20+ B cells, reducing autoantibody production
D: It enhances keratinocyte adhesion
Answer: C: It depletes CD20+ B cells, reducing autoantibody production
59. Differential Diagnosis of Desquamative Gingivitis
Desquamative gingivitis is a common presentation. Which diagnosis should be considered last when others are ruled out?
A: Lichen planus
B: Chronic ulcerative stomatitis
C: Pemphigus vulgaris
D: Linear IgA disease
Answer: D: Linear IgA disease
60. Tzanck Cells in Cytologic Smear
What is the clinical significance of Tzanck cells in a cytologic smear of a suspected pemphigus lesion?
A: They confirm acantholysis and support a diagnosis of pemphigus vulgaris
B: They indicate a viral etiology like herpes simplex
C: They are specific for mucous membrane pemphigoid
D: They signal fungal superinfection of vesiculobullous lesions
Answer: A: They confirm acantholysis and support a diagnosis of pemphigus vulgaris
61. Oral Candidiasis and HIV Disease Progression
Which oral manifestation is considered a strong predictor of HIV disease progression?
A: Linear gingival erythema
B: Oral hairy leukoplakia
C: Pseudomembranous candidiasis
D: Herpes labialis
Answer: C: Pseudomembranous candidiasis
62. Oral Hairy Leukoplakia Etiology
What is the causative agent of oral hairy leukoplakia in immunocompromised patients?
A: Candida albicans
B: Epstein-Barr virus (EBV)
C: Human papillomavirus (HPV)
D: Cytomegalovirus (CMV)
Answer: B: Epstein-Barr virus (EBV)
63. Major Aphthous Ulcers in Immunocompromised Hosts
Which of the following is most characteristic of major aphthous ulcers seen in advanced HIV patients?
A: Deep, irregular ulcers exceeding 1 cm in diameter that heal slowly and may scar
B: Small, round ulcers limited to the non-keratinized mucosa
C: Painful ulcers that resolve within 10 days without scarring
D: Vesiculobullous precursors followed by crusting ulcers
Answer: A: Deep, irregular ulcers exceeding 1 cm in diameter that heal slowly and may scar
64. Kaposi Sarcoma Clinical Presentation
Which of the following best describes the oral presentation of Kaposi sarcoma in patients with HIV/AIDS?
A: Painful white plaques on the buccal mucosa
B: Ulcerated lesions on the tongue that bleed easily
C: Yellow nodules on the gingiva
D: Red, purple, or brown macules or nodules, commonly on the hard palate
Answer: D: Red, purple, or brown macules or nodules, commonly on the hard palate
65. Management of Necrotizing Ulcerative Periodontitis (NUP)
What is the first-line approach in managing necrotizing ulcerative periodontitis in an HIV-positive patient?
A: Mechanical debridement with antimicrobial rinses
B: Immediate extraction of affected teeth
C: High-dose antifungal therapy
D: Local corticosteroid application
Answer: A: Mechanical debridement with antimicrobial rinses
66. Oral Manifestation Associated with Severe Immunosuppression
Which of the following oral conditions is most strongly associated with severe immunosuppression (CD4 <200 cells/mm³)?
A: Recurrent herpes simplex on the lip
B: Linear gingival erythema
C: HPV-induced squamous papilloma
D: Necrotizing ulcerative stomatitis
Answer: D: Necrotizing ulcerative stomatitis
67. Recurrent Herpes Simplex Virus (HSV) in HIV Patients
Which of the following best describes oral HSV infection in immunocompromised individuals?
A: Typically limited to the vermilion border of the lips
B: Can involve keratinized and non-keratinized mucosa with chronic, deep, and painful ulcerations
C: Presents with yellow pseudomembrane on the dorsal tongue
D: Resolves without antiviral therapy in most cases
Answer: B: Can involve keratinized and non-keratinized mucosa with chronic, deep, and painful ulcerations
68. Linear Gingival Erythema in HIV/AIDS
What is a distinguishing feature of linear gingival erythema in HIV-positive individuals?
A: Presence of heavy plaque and calculus
B: Bleeding and deep periodontal pockets
C: A red band along the marginal gingiva unrelated to plaque accumulation
D: Extensive gingival recession across the anterior sextant
Answer: C: A red band along the marginal gingiva unrelated to plaque accumulation
69. Oral Warts and Immunocompromised State
Which of the following oral findings in HIV-positive individuals is typically associated with HPV infection and increased immunosuppression?
A: Candidal hyperplasia
B: Mucosal ulceration
C: Oral hairy leukoplakia
D: Multiple verrucous or papillomatous lesions on the tongue or lips
Answer: D: Multiple verrucous or papillomatous lesions on the tongue or lips
70. Oral Cytomegalovirus (CMV) Lesions
What is the most appropriate first-line management for oral ulcerations caused by CMV in immunocompromised patients?
A: Systemic antiviral therapy such as ganciclovir
B: Antifungal rinses and topical steroids
C: Antibiotics combined with surgical debridement
D: Observation unless lesions persist >2 weeks
Answer: A: Systemic antiviral therapy such as ganciclovir
71. Pernicious Anemia and Tongue Changes
Which of the following is a classic oral manifestation associated with pernicious anemia?
A: Petechiae on the soft palate
B: Gingival hyperplasia
C: Atrophic glossitis with a smooth, red tongue surface
D: Desquamative gingivitis
Answer: C: Atrophic glossitis with a smooth, red tongue surface
72. Oral Signs of Acute Myeloid Leukemia
What is a common early oral manifestation of acute myeloid leukemia (AML)?
A: Necrotizing ulcerative stomatitis
B: Diffuse gingival enlargement due to leukemic infiltration
C: Burning tongue sensation
D: Geographic tongue
Answer: B: Diffuse gingival enlargement due to leukemic infiltration
73. Oral Clues to Iron Deficiency Anemia
Which oral finding is most closely associated with iron deficiency anemia?
A: Angular cheilitis
B: Gingival bleeding
C: Cyanosis of the oral mucosa
D: Odontogenic infection
Answer: A: Angular cheilitis
74. Thrombocytopenia and Hemorrhagic Lesions
Which of the following is most suggestive of thrombocytopenia in the oral cavity?
A: Delayed eruption of teeth
B: White striations on the buccal mucosa
C: Enlarged circumvallate papillae
D: Spontaneous gingival bleeding and petechiae
Answer: D: Spontaneous gingival bleeding and petechiae
75. Oral Clues to Vitamin B12 Deficiency
What is a classic oral feature that may lead to suspicion of vitamin B12 deficiency?
A: Burning sensation of the tongue
B: Vesiculobullous lesions of the gingiva
C: Hemorrhagic ulcers of the palate
D: Rapid onset mucosal pigmentation
Answer: A: Burning sensation of the tongue
76. Gingival Manifestations of Chronic Leukemia
Why might gingival tissues appear hyperplastic in patients with chronic leukemia?
A: Due to excessive iron deposits
B: Due to overgrowth from antifungal therapy
C: Due to bacterial plaque accumulation
D: Due to leukemic cell infiltration into gingival connective tissue
Answer: D: Due to leukemic cell infiltration into gingival connective tissue
77. Plummer-Vinson Syndrome and Oral Health
Which of the following best characterizes Plummer-Vinson syndrome?
A: Associated with folate deficiency and hyperkeratosis
B: Iron deficiency anemia, dysphagia, and atrophic oral mucosa
C: Caused by chronic myeloid leukemia affecting the jaw
D: Characterized by necrotizing gingivitis and lymphadenopathy
Answer: B: Iron deficiency anemia, dysphagia, and atrophic oral mucosa
78. Petechiae as an Oral Diagnostic Clue
Which oral condition should raise suspicion for an underlying hematologic disorder if petechiae are observed?
A: Erythema multiforme
B: Herpetic stomatitis
C: Thrombocytopenia or clotting disorders
D: Recurrent aphthous stomatitis
Answer: C: Thrombocytopenia or clotting disorders
79. Oral Clues of Agranulocytosis
Which of the following oral findings may indicate agranulocytosis?
A: Diffuse pigmentation of the hard palate
B: Persistent mucoceles on the lower lip
C: Angular stomatitis with white pseudomembranes
D: Rapidly progressing necrotizing ulcerations of the gingiva
Answer: D: Rapidly progressing necrotizing ulcerations of the gingiva
80. Gingival Bleeding in the Absence of Plaque
In a patient with excellent oral hygiene but persistent gingival bleeding, which systemic condition should be considered first?
A: Leukemia or another hematologic abnormality
B: Local trauma from brushing
C: Undiagnosed diabetes mellitus
D: Vitamin D deficiency
Answer: A: Leukemia or another hematologic abnormality
81. Genetic Mutations in Oral Cancer
Which genetic mutation is most commonly associated with the development of oral squamous cell carcinoma (OSCC)?
A: BRCA1
B: KRAS
C: TP53
D: APC
Answer: C: TP53
82. Behavioral Risk Factors
Which of the following combinations significantly increases the risk for developing oral cancer due to synergistic effects?
A: Alcohol and HPV
B: Tobacco and alcohol
C: HPV and betel nut
D: Alcohol and poor oral hygiene
Answer: B: Tobacco and alcohol
83. Role of Human Papillomavirus (HPV)
Which strain of HPV is most commonly implicated in oropharyngeal squamous cell carcinoma?
A: HPV-16
B: HPV-6
C: HPV-11
D: HPV-33
Answer: A: HPV-16
84. Field Cancerization Concept
What does the concept of “field cancerization” in oral oncology imply?
A: The cancer originates from bone and spreads to the mucosa
B: Each oral lesion arises independently
C: One lesion suppresses the development of others
D: Large areas of mucosa undergo premalignant changes, predisposing to multiple independent cancers
Answer: D: Large areas of mucosa undergo premalignant changes, predisposing to multiple independent cancers
85. Site-Specific Cancer Prevalence
Which site in the oral cavity is most commonly affected by squamous cell carcinoma?
A: Lateral border of the tongue
B: Floor of the mouth
C: Dorsal tongue
D: Maxillary gingiva
Answer: A: Lateral border of the tongue
86. Role of Toluidine Blue in Screening
What is the role of toluidine blue in oral cancer detection?
A: It eliminates bacterial contamination prior to biopsy
B: It is used as a therapeutic dye to reduce lesion size
C: It acts as a radiographic contrast medium
D: It selectively stains areas of dysplasia or carcinoma for further evaluation
Answer: D: It selectively stains areas of dysplasia or carcinoma for further evaluation
87. Use of VELscope in Clinical Settings
What is the primary diagnostic utility of devices like the VELscope?
A: They identify viral DNA in cancerous tissue
B: They help visualize mucosal abnormalities using tissue autofluorescence
C: They determine the histological grade of a lesion
D: They replace the need for biopsy
Answer: B: They help visualize mucosal abnormalities using tissue autofluorescence
88. Early Clinical Signs of Oral Cancer
Which of the following is the most concerning early clinical sign that warrants biopsy?
A: Generalized gingival inflammation
B: Bilateral cheek biting lesions
C: Persistent indurated ulcer with rolled borders
D: Diffuse tongue erythema
Answer: C: Persistent indurated ulcer with rolled borders
89. High-Risk Demographics
Which patient demographic is at highest risk for developing oral cancer?
A: Young females with poor oral hygiene
B: Elderly patients with dental implants
C: Middle-aged non-smokers with bruxism
D: Males over 50 years old with a history of alcohol and tobacco use
Answer: D: Males over 50 years old with a history of alcohol and tobacco use
90. Indication for Immediate Referral
Which scenario requires the most urgent referral to an oral medicine or oncology specialist?
A: A non-healing ulcer of 3 weeks duration on the floor of the mouth
B: A fibroma with a clear history of trauma
C: A small mucosal tag on the buccal mucosa
D: Geographic tongue in a healthy adult
Answer: A: A non-healing ulcer of 3 weeks duration on the floor of the mouth
91. Risk Stratification in Oral Premalignant Lesions
Which feature is most predictive of malignant transformation in oral leukoplakia?
A: Size of lesion
B: Patient age
C: Presence of epithelial dysplasia on histology
D: Bilateral location
Answer: C: Presence of epithelial dysplasia on histology
92. Histological Features of Erythroplakia
Compared to leukoplakia, why is erythroplakia associated with a higher rate of malignant transformation?
A: It is more likely to appear in immunocompromised patients
B: It almost always shows severe dysplasia or carcinoma in situ upon biopsy
C: It commonly involves larger mucosal surfaces
D: It presents with associated pain, leading to late detection
Answer: B: It almost always shows severe dysplasia or carcinoma in situ upon biopsy
93. Clinical Appearance of Actinic Cheilitis
Which of the following best describes the clinical appearance of actinic cheilitis?
A: Ill-defined, atrophic, scaly white patches on the lower lip with potential crusting and ulceration
B: Firm, exophytic, keratinized growth on the upper lip
C: Erythematous mucosal patch with a velvety texture on the buccal mucosa
D: Vesiculobullous lesions recurring seasonally
Answer: A: Ill-defined, atrophic, scaly white patches on the lower lip with potential crusting and ulceration
94. Management Decision in Nonhomogeneous Leukoplakia
Which of the following is the best next step for a 1.5 cm nonhomogeneous leukoplakic lesion on the lateral tongue with no pain?
A: Apply topical antifungal therapy and re-evaluate in 2 weeks
B: Recommend smoking cessation and observe for changes
C: Schedule excisional biopsy only if lesion increases in size
D: Perform incisional biopsy to assess for dysplasia
Answer: D: Perform incisional biopsy to assess for dysplasia
95. Etiologic Association of Actinic Cheilitis
Which is the most significant etiological factor in the development of actinic cheilitis?
A: Chronic exposure to ultraviolet (UV) radiation
B: Excessive alcohol consumption
C: Poor oral hygiene
D: Iron deficiency anemia
Answer: A: Chronic exposure to ultraviolet (UV) radiation
96. Field Cancerization in Oral Leukoplakia
What concept explains the presence of multiple dysplastic areas in patients with oral leukoplakia?
A: Clonal neoplasia
B: Langerhans cell migration
C: Viral field effect
D: Field cancerization due to widespread epithelial mutation
Answer: D: Field cancerization due to widespread epithelial mutation
97. Gender Disparity in Malignant Transformation
Which group is at a higher risk for malignant transformation of leukoplakia, all else being equal?
A: Female patients under 30 with anterior buccal lesions
B: Female patients over 60 with lateral tongue lesions
C: Male patients under 40 with palatal lesions
D: Male patients with gingival involvement and no dysplasia
Answer: B: Female patients over 60 with lateral tongue lesions
98. Verrucous Leukoplakia vs Homogeneous Leukoplakia
Why is proliferative verrucous leukoplakia (PVL) considered particularly high risk?
A: It occurs only in immunosuppressed individuals
B: It is more responsive to surgical excision than homogeneous leukoplakia
C: It demonstrates multifocality, recurrence, and a high transformation rate
D: It presents as a completely reversible white patch
Answer: C: It demonstrates multifocality, recurrence, and a high transformation rate
99. Histopathological Grading of Dysplasia
Which histological feature is most associated with severe epithelial dysplasia in a leukoplakic lesion?
A: Parakeratosis with underlying inflammation
B: Hyperplasia of the basal cell layer only
C: Elongation of rete pegs
D: Loss of polarity and mitotic figures in upper epithelial layers
Answer: D: Loss of polarity and mitotic figures in upper epithelial layers
100. Surgical Margins in Dysplastic Lesion Management
When surgically excising a dysplastic oral lesion, what is the most important factor to consider?
A: Achieving clear histological margins to minimize recurrence
B: Using electrocautery to reduce healing time
C: Preserving the lesion for natural regression
D: Avoiding biopsy due to risk of tumor spread
Answer: A: Achieving clear histological margins to minimize recurrence
101. Histopathological Classification of Salivary Gland Tumors
Which of the following features is most consistent with the diagnosis of polymorphous adenocarcinoma?
A: High mitotic index and necrosis
B: Cribriform growth pattern with aggressive invasion
C: Infiltrative growth with low-grade cytology and perineural invasion
D: Abundant mucin production with intermediate-grade atypia
Answer: C: Infiltrative growth with low-grade cytology and perineural invasion
102. Etiology of Chronic Sialadenitis
Which of the following is the most likely underlying cause of chronic sialadenitis in the submandibular gland?
A: Autoimmune destruction of acinar cells
B: Obstruction by a calcified sialolith in Wharton’s duct
C: Viral infection of the acini
D: Paraneoplastic syndrome involving the gland
Answer: B: Obstruction by a calcified sialolith in Wharton’s duct
103. First-Line Imaging for Suspected Sialolithiasis
Which imaging modality is typically considered first-line for diagnosing suspected sialolithiasis in a symptomatic patient?
A: Non-contrast occlusal radiograph
B: MRI with sialography sequences
C: Sialendoscopy with contrast enhancement
D: Cone-beam computed tomography
Answer: A: Non-contrast occlusal radiograph
104. Complication of Untreated Acute Bacterial Sialadenitis
If left untreated, acute bacterial sialadenitis is most likely to result in which of the following complications?
A: Salivary hypofunction
B: Fistula formation
C: Malignant transformation
D: Abscess formation requiring surgical drainage
Answer: D: Abscess formation requiring surgical drainage
105. Common Presentation of Pleomorphic Adenoma
Which of the following best describes the clinical presentation of a pleomorphic adenoma of the parotid gland?
A: Painless, slow-growing, firm, mobile mass at the angle of the mandible
B: Rapidly enlarging, painful, fixed lesion with cervical lymphadenopathy
C: Recurrent swelling post-meal with purulent discharge from Stensen's duct
D: Fluctuant lesion with spontaneous hemorrhage and ulceration
Answer: A: Painless, slow-growing, firm, mobile mass at the angle of the mandible
106. Histological Features of Mucoepidermoid Carcinoma
Which feature is considered a poor prognostic indicator in mucoepidermoid carcinoma?
A: Presence of mucous-producing cells
B: Well-circumscribed borders with cystic areas
C: Absence of perineural invasion
D: High-grade histology with necrosis and cellular atypia
Answer: D: High-grade histology with necrosis and cellular atypia
107. Sialolithiasis Predilection
Which salivary gland is most commonly affected by sialolithiasis, and why?
A: Parotid, due to its serous secretion
B: Submandibular, due to alkaline pH and tortuous Wharton's duct
C: Sublingual, due to mucous predominance
D: Minor salivary glands, due to lack of drainage
Answer: B: Submandibular, due to alkaline pH and tortuous Wharton's duct
108. Distinguishing Feature of Warthin Tumor
Which of the following characteristics is most distinctive of Warthin tumor among salivary gland neoplasms?
A: Rapid growth with facial nerve paralysis
B: Bony invasion and pain
C: Papillary cystic spaces lined by oncocytic epithelium with lymphoid stroma
D: Mucin pools with signet ring cells
Answer: C: Papillary cystic spaces lined by oncocytic epithelium with lymphoid stroma
109. Indication for Parotidectomy
Which of the following scenarios would most strongly indicate the need for superficial parotidectomy?
A: Chronic sialadenitis unresponsive to antibiotics
B: Small, mobile parotid nodule with consistent size over 5 years
C: Bilateral submandibular gland hypertrophy
D: Mobile parotid mass with FNAB showing pleomorphic adenoma
Answer: D: Mobile parotid mass with FNAB showing pleomorphic adenoma
110. Role of Sialogogues in Management
What is the primary mechanism by which sialogogues assist in the management of non-infectious sialadenitis?
A: They increase salivary flow to flush out obstructions and reduce stasis
B: They suppress bacterial overgrowth by altering duct pH
C: They directly dissolve sialoliths via enzymatic action
D: They promote fibrosis of the affected gland
Answer: A: They increase salivary flow to flush out obstructions and reduce stasis
111. Salivary Gland Dysfunction in Sjogren’s Syndrome
What is the primary mechanism of salivary gland dysfunction in Sjogren’s syndrome?
A: Viral destruction of salivary acinar cells
B: Fibrosis of glandular ducts
C: Lymphocytic infiltration causing acinar cell apoptosis
D: Hyperplasia of ductal cells
Answer: C: Lymphocytic infiltration causing acinar cell apoptosis
112. Autoantibodies in Sjogren’s Syndrome
Which two autoantibodies are most commonly associated with Sjogren’s syndrome?
A: Anti-dsDNA and RF
B: Anti-Ro (SSA) and Anti-La (SSB)
C: ANA and anti-centromere
D: Anti-Scl-70 and anti-Jo-1
Answer: B: Anti-Ro (SSA) and Anti-La (SSB)
113. Classification of Primary vs. Secondary Sjogren’s Syndrome
How is primary Sjogren’s syndrome best distinguished from secondary Sjogren’s syndrome?
A: Primary occurs without another autoimmune disease; secondary is associated with another autoimmune disorder
B: Secondary occurs only in males
C: Primary only affects the salivary glands; secondary affects only lacrimal glands
D: Secondary is more commonly seen in younger patients
Answer: A: Primary occurs without another autoimmune disease; secondary is associated with another autoimmune disorder
114. Histopathologic Criteria in Minor Salivary Gland Biopsy
What histological finding confirms Sjogren’s syndrome in a labial salivary gland biopsy?
A: Fibrotic ductal tissue
B: Decreased acinar density
C: Presence of germinal centers
D: Focal lymphocytic sialadenitis with a focus score ≥1
Answer: D: Focal lymphocytic sialadenitis with a focus score ≥1
115. Oral Manifestation of Sjogren’s Syndrome
What is the most common oral symptom reported by patients with Sjogren’s syndrome?
A: Xerostomia (dry mouth)
B: Altered taste sensation
C: Burning mouth syndrome
D: Mucosal ulceration
Answer: A: Xerostomia (dry mouth)
116. Extra-Glandular Systemic Complications
Which of the following is a recognized extra-glandular complication of Sjogren’s syndrome?
A: Cataracts
B: Skin hyperpigmentation
C: Cardiomyopathy
D: Interstitial nephritis
Answer: D: Interstitial nephritis
117. Associated Risk of Lymphoma
Patients with Sjogren’s syndrome have an increased risk for which type of malignancy?
A: Oral squamous cell carcinoma
B: Non-Hodgkin’s B-cell lymphoma
C: Leukemia
D: Thyroid carcinoma
Answer: B: Non-Hodgkin’s B-cell lymphoma
118. Salivary Flow Measurement Techniques
Which test is used to quantitatively assess unstimulated salivary flow in patients suspected of having Sjogren’s syndrome?
A: Rose Bengal staining
B: Labial salivary gland biopsy
C: Sialometry (collection of saliva over a timed period)
D: Parotid gland scintigraphy
Answer: C: Sialometry (collection of saliva over a timed period)
119. Ocular Component in Diagnosis
Which test is used to assess ocular dryness in Sjogren’s syndrome diagnosis?
A: Fluorescein angiography
B: Visual field test
C: Tear break-up time
D: Schirmer’s test
Answer: D: Schirmer’s test
120. Pharmacologic Management of Xerostomia
Which medication is commonly used as a salivary stimulant in patients with Sjogren’s syndrome?
A: Pilocarpine
B: Hydroxychloroquine
C: Rituximab
D: Prednisone
Answer: A: Pilocarpine
121. Neurologic Control of Salivary Secretion
Which component of the autonomic nervous system predominantly stimulates watery saliva production from the parotid gland?
A: Sympathetic postganglionic fibers
B: Glossopharyngeal afferents
C: Parasympathetic efferents from the glossopharyngeal nerve via the otic ganglion
D: Sympathetic fibers from the superior cervical ganglion
Answer: C: Parasympathetic efferents from the glossopharyngeal nerve via the otic ganglion
122. Polypharmacy in Geriatric Patients
Which of the following medication classes is most commonly associated with xerostomia in elderly patients?
A: Statins
B: Tricyclic antidepressants
C: Antihistamines (H1 blockers)
D: Beta blockers
Answer: B: Tricyclic antidepressants
123. Autoimmune Etiology of Xerostomia
Which autoimmune disorder is classically associated with both xerostomia and xerophthalmia?
A: Sjögren’s syndrome
B: Systemic lupus erythematosus
C: Rheumatoid arthritis
D: Scleroderma
Answer: A: Sjögren’s syndrome
124. Salivary Flow Diagnostic Methods
Which diagnostic method is considered most accurate for quantifying unstimulated whole salivary flow rate in xerostomia assessment?
A: Salivary gland scintigraphy
B: Sialography
C: Minor salivary gland biopsy
D: Timed spitting method (sialometry)
Answer: D: Timed spitting method (sialometry)
125. First-Line Management for Medication-Induced Xerostomia
What is the most appropriate initial step in managing medication-induced xerostomia in a medically stable patient?
A: Review and modify the patient’s medication regimen in consultation with their physician
B: Prescribe systemic sialogogues immediately
C: Recommend high-fluoride toothpaste without further evaluation
D: Refer to an oral medicine specialist
Answer: A: Review and modify the patient’s medication regimen in consultation with their physician
126. Systemic Sialogogues and Contraindications
Which of the following is a contraindication to the use of systemic sialogogues like pilocarpine?
A: Controlled hypertension
B: Controlled type 2 diabetes mellitus
C: Primary Sjögren’s syndrome
D: Uncontrolled asthma or narrow-angle glaucoma
Answer: D: Uncontrolled asthma or narrow-angle glaucoma
127. Non-Pharmacological Therapy for Xerostomia
Which of the following is an evidence-based non-pharmacological intervention for managing mild xerostomia?
A: Avoiding spicy foods entirely
B: Using sugar-free chewing gum containing xylitol
C: Drinking large amounts of carbonated beverages
D: Applying antifungal rinses routinely
Answer: B: Using sugar-free chewing gum containing xylitol
128. Histopathological Assessment in Xerostomia
What is the purpose of performing a minor salivary gland biopsy in xerostomia patients suspected of having Sjögren’s syndrome?
A: To measure salivary pH
B: To detect mucin content
C: To evaluate lymphocytic infiltration (focus score) for diagnostic confirmation
D: To confirm glandular fibrosis
Answer: C: To evaluate lymphocytic infiltration (focus score) for diagnostic confirmation
129. Complications of Chronic Xerostomia
Which of the following is a long-term complication of unmanaged xerostomia?
A: Loss of gustatory function
B: Chronic gingival hyperplasia
C: Temporomandibular joint dysfunction
D: Rampant cervical and root caries
Answer: D: Rampant cervical and root caries
130. Topical Fluoride Use in Xerostomia
Why is daily use of prescription-strength fluoride toothpaste recommended for patients with xerostomia?
A: It helps remineralize enamel and protect against the high caries risk due to reduced salivary buffering
B: It restores normal salivary gland function
C: It prevents mucosal ulceration
D: It stimulates parotid flow
Answer: A: It helps remineralize enamel and protect against the high caries risk due to reduced salivary buffering
131. Role of the Articular Disc in TMJ Function
What is the primary function of the articular disc within the temporomandibular joint (TMJ)?
A: Acts as a cushion for occlusal forces
B: Maintains the vertical dimension of occlusion
C: Allows smooth movement between the condyle and temporal bone during jaw function
D: Prevents posterior displacement of the condyle
Answer: C: Allows smooth movement between the condyle and temporal bone during jaw function
132. Internal Derangement of the TMJ
Which of the following is most indicative of anterior disc displacement with reduction in TMJ dysfunction?
A: Absence of joint noise and restricted opening
B: Audible clicking on opening and closing with normal range of motion
C: Pain during protrusion without joint noise
D: Lateral deviation during closing only
Answer: B: Audible clicking on opening and closing with normal range of motion
133. Myofascial Pain vs. Arthrogenous Pain
Which clinical sign is more consistent with myofascial pain rather than joint pathology?
A: Diffuse tenderness in the muscles of mastication without joint limitation
B: Crepitus during mandibular movement
C: Limitation of opening due to bony obstruction
D: Joint swelling with deviation on opening
Answer: A: Diffuse tenderness in the muscles of mastication without joint limitation
134. Imaging Modality for TMJ Disc Evaluation
Which imaging technique is most effective for assessing the position and condition of the TMJ articular disc?
A: Cone-beam CT
B: Panoramic radiography
C: Standard MRI T1-weighted
D: MRI with T2-weighted imaging
Answer: D: MRI with T2-weighted imaging
135. Initial Treatment Approach for TMD
What is generally the first-line treatment for patients diagnosed with myofascial-type temporomandibular disorder?
A: Behavioral modification, soft diet, and jaw exercises
B: Corticosteroid injection into the joint
C: Arthrocentesis
D: Occlusal equilibration
Answer: A: Behavioral modification, soft diet, and jaw exercises
136. Joint Effusion in TMJ Disorders
What does joint effusion detected on MRI typically indicate in a TMJ patient?
A: Disc displacement without reduction
B: Adaptive remodeling
C: Muscular etiology of pain
D: Active inflammation or synovitis within the joint
Answer: D: Active inflammation or synovitis within the joint
137. Effectiveness of Occlusal Appliances
What is the main therapeutic benefit of occlusal stabilization splints in managing TMD?
A: Permanent repositioning of the articular disc
B: Reduction in muscle hyperactivity and nocturnal bruxism
C: Realignment of occlusion and vertical dimension
D: Increased joint space to reduce inflammation
Answer: B: Reduction in muscle hyperactivity and nocturnal bruxism
138. TMJ Disc Displacement Without Reduction
Which clinical finding is most consistent with disc displacement without reduction?
A: Clicking with wide opening
B: Hyperextension during mandibular depression
C: Limited mouth opening with deflection toward affected side
D: Bilateral crepitus and deviation away from the affected side
Answer: C: Limited mouth opening with deflection toward affected side
139. Arthritis-Related TMJ Dysfunction
Which feature distinguishes rheumatoid arthritis-related TMJ involvement from internal derangement?
A: Crepitus during movement
B: Myofascial pain symptoms
C: Clicking without pain
D: Progressive condylar resorption visible on radiographs
Answer: D: Progressive condylar resorption visible on radiographs
140. Condylar Translation Limitation
Which of the following is most likely to occur in a patient with limited translation of the mandibular condyle?
A: Restricted opening with deviation
B: Hypersalivation
C: Pain during swallowing
D: Inability to achieve posterior guidance
Answer: A: Restricted opening with deviation
141. Central Mechanisms of BMS
Which of the following central nervous system abnormalities is most closely associated with primary Burning Mouth Syndrome?
A: Hypoactivity in the hippocampus
B: Hyperactivity in the occipital lobe
C: Altered dopaminergic function in the basal ganglia
D: Increased serotonin receptor expression in the cerebellum
Answer: C: Altered dopaminergic function in the basal ganglia
142. BMS vs. Secondary Causes
Which of the following is most likely to suggest secondary burning mouth symptoms rather than primary BMS?
A: Absence of clinical lesions with normal labs
B: Presence of oral candidiasis and iron deficiency anemia
C: Normal salivary flow rates and taste perception
D: Symmetrical pain limited to the anterior tongue
Answer: B: Presence of oral candidiasis and iron deficiency anemia
143. Typical Clinical Presentation
What is a classic feature of primary Burning Mouth Syndrome in terms of pain characteristics?
A: Bilateral, daily burning pain of the anterior two-thirds of the tongue without clinical signs
B: Unilateral pain associated with swelling and erythema
C: Intermittent sharp pain exacerbated by chewing
D: Pain only present during sleep
Answer: A: Bilateral, daily burning pain of the anterior two-thirds of the tongue without clinical signs
144. Distinguishing Neuropathy from Psychogenic BMS
Which of the following would most likely support a diagnosis of neuropathic BMS over psychogenic causes?
A: Concurrent history of depression
B: Pain relief with benzodiazepines
C: History of temporomandibular joint disorder
D: Reduced corneal nerve fiber density on confocal microscopy
Answer: D: Reduced corneal nerve fiber density on confocal microscopy
145. Initial Diagnostic Approach
What should be included in the first-line diagnostic workup for a patient with suspected burning mouth syndrome?
A: Comprehensive history, oral exam, CBC, iron studies, and vitamin B12 levels
B: Full dental panoramic radiograph and sialography
C: Taste test and salivary gland biopsy
D: Biopsy of the dorsal tongue
Answer: A: Comprehensive history, oral exam, CBC, iron studies, and vitamin B12 levels
146. Pharmacologic Treatment Options
Which of the following pharmacological agents has shown benefit in randomized trials for primary BMS?
A: Chlorhexidine rinse
B: Oral corticosteroids
C: Amoxicillin
D: Clonazepam (oral or topical)
Answer: D: Clonazepam (oral or topical)
147. Systemic Conditions Mimicking BMS
Which of the following systemic conditions may mimic BMS and must be ruled out?
A: Temporomandibular disorder
B: Hypothyroidism
C: Post-herpetic neuralgia
D: Osteonecrosis of the jaw
Answer: B: Hypothyroidism
148. Pain Chronobiology in BMS
Which of the following describes the typical diurnal pattern of burning mouth pain?
A: Pain is most severe at night and absent in the morning
B: Pain fluctuates randomly throughout the day
C: Pain is mild in the morning and worsens as the day progresses
D: Pain only occurs during eating and brushing
Answer: C: Pain is mild in the morning and worsens as the day progresses
149. Role of Taste Dysfunction
Which of the following findings is most consistent with primary BMS?
A: Hyperactive salivary glands
B: Positive Nikolsky sign on the tongue
C: Pain relieved by spicy foods
D: Hypogeusia or dysgeusia, often involving metallic or bitter tastes
Answer: D: Hypogeusia or dysgeusia, often involving metallic or bitter tastes
150. Patient Counseling and Expectations
What is the most appropriate initial counseling point for a patient newly diagnosed with primary BMS?
A: The condition is chronic but manageable; treatment focuses on symptom relief and quality of life
B: Immediate resolution is expected once antifungal therapy begins
C: Surgery is usually required to remove affected nerve fibers
D: The disorder is contagious and may require quarantine measures
Answer: A: The condition is chronic but manageable; treatment focuses on symptom relief and quality of life
151. Pathogenesis of MRONJ
Which of the following best explains the proposed mechanism behind MRONJ development?
A: Increased osteoblast activity in the mandible
B: Decreased salivary flow leading to bone exposure
C: Inhibition of bone remodeling and angiogenesis
D: Autoimmune reaction against bisphosphonates
Answer: C: Inhibition of bone remodeling and angiogenesis
152. Drugs Most Commonly Associated with MRONJ
Which of the following medications is most frequently associated with MRONJ?
A: Denosumab used for osteoporosis
B: Zoledronic acid used for metastatic bone disease
C: Selective estrogen receptor modulators (SERMs)
D: Corticosteroids used long-term
Answer: B: Zoledronic acid used for metastatic bone disease
153. Anatomic Site Predilection
What is the most common anatomic site for MRONJ to occur?
A: Posterior mandible
B: Maxillary tuberosity
C: Hard palate
D: Midline of the tongue
Answer: A: Posterior mandible
154. Clinical Definition Criteria
According to the AAOMS (American Association of Oral and Maxillofacial Surgeons), which of the following is not required for a diagnosis of MRONJ?
A: Exposed bone in the maxillofacial region
B: Current or previous treatment with antiresorptive or antiangiogenic agents
C: History of radiation therapy to the jaws
D: Persistence of exposed bone for more than 8 weeks
Answer: D: Persistence of exposed bone for more than 8 weeks
155. Management in Asymptomatic MRONJ
What is the recommended management for a patient with Stage 0 MRONJ and no clinical bone exposure?
A: Observation and regular follow-up with symptomatic treatment
B: Surgical resection of the suspected area
C: Hyperbaric oxygen therapy
D: Full-mouth extraction and antibiotic prophylaxis
Answer: A: Observation and regular follow-up with symptomatic treatment
156. Effect of Denosumab vs. Bisphosphonates on Bone Turnover
Why does denosumab differ from bisphosphonates in its pharmacodynamics related to MRONJ risk?
A: Denosumab binds irreversibly to hydroxyapatite
B: Denosumab increases bone vascularization
C: Denosumab deposits in bone for years
D: Denosumab has a shorter half-life and does not incorporate into bone
Answer: D: Denosumab has a shorter half-life and does not incorporate into bone
157. Surgical Risk Considerations
Which of the following dental procedures carries the highest risk for developing MRONJ in a patient on IV bisphosphonates?
A: Root canal therapy
B: Tooth extraction
C: Scaling and root planing
D: Periodontal probing
Answer: B: Tooth extraction
158. Radiographic Features of MRONJ
Which radiographic finding is most characteristic of advanced MRONJ?
A: Widened periodontal ligament space
B: Periapical radiolucency with sclerotic border
C: Mixed radiolucent-radiopaque areas with sequestrum formation
D: Floating teeth appearance
Answer: C: Mixed radiolucent-radiopaque areas with sequestrum formation
159. Staging MRONJ
A patient presents with exposed necrotic bone and pain, but no signs of infection or fistula. What stage of MRONJ is this?
A: Stage 0
B: Stage 1
C: Stage 3
D: Stage 2
Answer: D: Stage 2
160. Drug Holiday Consideration
What is the rationale for considering a drug holiday in patients on oral bisphosphonates undergoing invasive dental procedures?
A: To allow for partial recovery of bone turnover and reduce MRONJ risk
B: To prevent systemic allergic reactions
C: To improve osseointegration of future implants
D: To reduce the chance of secondary caries
Answer: A: To allow for partial recovery of bone turnover and reduce MRONJ risk
161. Radiation-Induced Fibrosis Mechanism
Which cellular mechanism is most associated with radiation-induced fibrosis in oral tissues?
A: Hyperplasia of basal epithelial cells
B: Inactivation of odontoblasts
C: Fibroblast activation and excess collagen deposition
D: Vascular hypertrophy and lymphatic compression
Answer: C: Fibroblast activation and excess collagen deposition
162. Timing of Oral Mucositis Onset
When does oral mucositis most commonly develop in patients undergoing chemotherapy?
A: Within the first hour of drug infusion
B: Approximately 7–10 days after treatment initiation
C: Several weeks post-treatment, during tissue healing
D: Only after bone marrow suppression reaches a critical threshold
Answer: B: Approximately 7–10 days after treatment initiation
163. Most Affected Tissue in Radiotherapy
Which oral tissue type is most sensitive to ionizing radiation?
A: Rapidly dividing basal epithelial cells
B: Acellular cementum of the teeth
C: Alveolar bone
D: Mature adipose tissue
Answer: A: Rapidly dividing basal epithelial cells
164. Oral Candidiasis During Cancer Therapy
Which factor most contributes to the development of oral candidiasis in patients undergoing cancer therapy?
A: Salivary buffering capacity
B: Enhanced epithelial turnover
C: Bacterial colonization of mucosal tissues
D: Immunosuppression and salivary gland dysfunction
Answer: D: Immunosuppression and salivary gland dysfunction
165. Prevention of Osteoradionecrosis (ORN)
What is a key preventative measure for osteoradionecrosis in head and neck radiation patients?
A: Extraction of non-restorable teeth prior to radiotherapy
B: Increased carbohydrate intake
C: Daily use of alcohol-containing mouth rinses
D: Frequent use of topical corticosteroids
Answer: A: Extraction of non-restorable teeth prior to radiotherapy
166. Radiation Caries Development
What is the primary mechanism behind radiation-induced caries?
A: Increased Streptococcus mutans colonization
B: Acid reflux due to GI complications
C: Demineralization from nutrient loss
D: Salivary gland damage leading to decreased pH and buffering
Answer: D: Salivary gland damage leading to decreased pH and buffering
167. Effect of Chemotherapy on Oral Microbiome
How does chemotherapy most significantly alter the oral microbiome?
A: By increasing fungal resistance to antifungal therapy
B: By reducing microbial diversity and favoring opportunistic pathogens
C: By promoting enamel remineralization
D: By increasing oral pH through metabolic alkalosis
Answer: B: By reducing microbial diversity and favoring opportunistic pathogens
168. Use of Palifermin in Oral Mucositis
What is the role of palifermin in cancer therapy–related oral mucositis?
A: Direct antifungal activity
B: Inhibition of epithelial mitosis
C: Stimulation of epithelial cell growth and mucosal healing
D: Suppression of inflammatory cytokines in salivary glands
Answer: C: Stimulation of epithelial cell growth and mucosal healing
169. Xerostomia and Taste Alteration
Why do patients frequently experience altered taste sensation during and after radiotherapy?
A: Accumulation of chemotherapeutic agents in taste buds
B: Direct toxicity to enamel organ
C: Fluoride deficiency due to saliva loss
D: Damage to salivary glands and taste receptor cells
Answer: D: Damage to salivary glands and taste receptor cells
170. Best Oral Hygiene Practice During Cancer Therapy
What is the most recommended strategy to reduce oral complications during chemotherapy?
A: Use of soft-bristled toothbrush and non-alcoholic fluoride rinse
B: Systemic corticosteroids before each treatment cycle
C: High-dose antiseptic mouthwashes twice daily
D: Avoidance of all brushing during neutropenia
Answer: A: Use of soft-bristled toothbrush and non-alcoholic fluoride rinse
171. Pathophysiology of Neuropathic Pain
Which mechanism most accurately describes the pathophysiology of neuropathic pain in trigeminal neuralgia?
A: Increased release of histamine from mast cells
B: Ischemia in the pons affecting pain fibers
C: Ectopic action potentials generated at damaged afferent neurons
D: Loss of inhibitory GABAergic interneurons in the spinal nucleus
Answer: C: Ectopic action potentials generated at damaged afferent neurons
172. Clinical Features of Trigeminal Neuralgia
Which of the following best describes the pain in classic trigeminal neuralgia?
A: Continuous dull ache with diffuse radiation
B: Sudden, unilateral, electric shock-like pain triggered by light touch
C: Bilateral burning sensation with nocturnal exacerbation
D: Deep pressure-like pain aggravated by chewing
Answer: B: Sudden, unilateral, electric shock-like pain triggered by light touch
173. Diagnosis of Glossopharyngeal Neuralgia
What is the most common initial site of pain in glossopharyngeal neuralgia?
A: Posterior tongue or oropharynx, often radiating to the ear
B: Maxillary alveolus
C: Lateral border of the tongue
D: Buccal mucosa
Answer: A: Posterior tongue or oropharynx, often radiating to the ear
174. Post-Herpetic Neuralgia Management
Which of the following is the most appropriate first-line pharmacologic treatment for post-herpetic neuralgia?
A: NSAIDs and local anesthetics
B: Opioids and corticosteroids
C: Tricyclic antidepressants only
D: Gabapentin or pregabalin for neuropathic modulation
Answer: D: Gabapentin or pregabalin for neuropathic modulation
175. Differentiating Atypical Odontalgia
Atypical odontalgia is best defined as:
A: Persistent tooth pain without identifiable dental pathology
B: Inflammatory pain from pulpal necrosis
C: A dull ache aggravated by percussion
D: Pain limited to the periodontal ligament
Answer: A: Persistent tooth pain without identifiable dental pathology
176. Peripheral Sensitization in Oral Neuropathic Pain
Which best explains the phenomenon of peripheral sensitization in neuropathic pain?
A: Increased synaptic vesicle release in central pathways
B: Inhibition of descending modulatory systems
C: Recruitment of immune cells in the dorsal horn
D: Lowering of nociceptor activation threshold at the peripheral nerve terminals
Answer: D: Lowering of nociceptor activation threshold at the peripheral nerve terminals
177. Central Post-Stroke Pain in the Oral Region
Which feature supports a diagnosis of central post-stroke pain affecting the oral region?
A: Hyperalgesia localized to the contralateral side of the lesion
B: Persistent spontaneous burning pain with allodynia and sensory loss
C: Unilateral electric-shock sensations triggered by chewing
D: Dull, bilateral facial pain relieved by rest
Answer: B: Persistent spontaneous burning pain with allodynia and sensory loss
178. Red Flags in Neuropathic Orofacial Pain
Which of the following would be considered a red flag symptom requiring further investigation in orofacial neuropathic pain?
A: Pain that responds to carbamazepine
B: Localized pain triggered by cold drinks
C: Numbness or hypoesthesia in the same distribution
D: Pain that is aggravated by stress
Answer: C: Numbness or hypoesthesia in the same distribution
179. Cranial Nerve V Lesion Localization
Damage to which of the following specific branches of the trigeminal nerve is most likely to cause isolated neuropathic pain in the anterior hard palate?
A: Inferior alveolar nerve
B: Buccal nerve
C: Zygomaticotemporal nerve
D: Nasopalatine nerve
Answer: D: Nasopalatine nerve
180. Surgical Decompression in Trigeminal Neuralgia
What is the rationale behind microvascular decompression in trigeminal neuralgia management?
A: It relieves neuralgia by eliminating vascular compression of the nerve root
B: It severs pain fibers within the spinal trigeminal nucleus
C: It removes demyelinated regions of the trigeminal ganglion
D: It delivers botulinum toxin into the Gasserian ganglion
Answer: A: It relieves neuralgia by eliminating vascular compression of the nerve root
181. Cross-Reactivity in Oral Allergy Syndrome (OAS)
Which mechanism best explains the symptoms of oral allergy syndrome in individuals allergic to birch pollen?
A: Direct histamine release by fruit enzymes
B: IgG-mediated immune response to food proteins
C: Cross-reactivity between pollen and structurally similar fruit proteins
D: Autoimmune attack on oral epithelial tissues
Answer: C: Cross-reactivity between pollen and structurally similar fruit proteins
182. Type I Hypersensitivity Pathway
Which immune component is primarily involved in Type I hypersensitivity reactions such as oral allergy syndrome?
A: CD8+ T cells
B: IgE antibodies bound to mast cells
C: Complement proteins
D: Neutrophil activation via Fc receptors
Answer: B: IgE antibodies bound to mast cells
183. Oral Allergy Syndrome vs. Anaphylaxis
What is the key difference between oral allergy syndrome (OAS) and anaphylaxis?
A: OAS symptoms are localized and typically confined to the oral mucosa
B: OAS often includes respiratory symptoms like bronchospasm
C: Anaphylaxis rarely involves systemic vasodilation
D: Anaphylaxis symptoms always resolve without intervention
Answer: A: OAS symptoms are localized and typically confined to the oral mucosa
184. Systemic Reaction Risk in OAS
Which of the following most accurately describes the risk of systemic allergic reactions in OAS?
A: All OAS patients are at high risk for anaphylaxis
B: Systemic reactions are common when cooked forms of the food are ingested
C: Cross-reactive proteins are more stable to heat, increasing systemic exposure
D: Systemic reactions are rare because cross-reactive proteins are typically heat-labile and easily degraded
Answer: D: Systemic reactions are rare because cross-reactive proteins are typically heat-labile and easily degraded
185. Diagnostic Method for Type I Hypersensitivity
What is the most definitive method to confirm an IgE-mediated hypersensitivity reaction in OAS?
A: Serum-specific IgE testing (RAST or ImmunoCAP)
B: Biopsy of oral mucosa during reaction
C: Total serum IgE level measurement
D: Skin biopsy with immunofluorescence
Answer: A: Serum-specific IgE testing (RAST or ImmunoCAP)
186. Pathophysiology of Delayed Hypersensitivity Reactions
Which immune mechanism is primarily responsible for Type IV (delayed-type) hypersensitivity reactions in the oral cavity?
A: IgA deposition in the lamina propria
B: Degranulation of mast cells and basophils
C: Activation of eosinophils by TH2 cells
D: T-cell mediated activation of macrophages and cytotoxic T cells
Answer: D: T-cell mediated activation of macrophages and cytotoxic T cells
187. Management of OAS in Patients with Pollen Allergy
What is the initial management strategy for patients with mild OAS symptoms linked to birch pollen?
A: Prescribe systemic corticosteroids for long-term control
B: Recommend avoidance of raw trigger foods and consider antihistamines
C: Desensitize using sublingual fruit extracts
D: Perform an emergency food challenge in a hospital setting
Answer: B: Recommend avoidance of raw trigger foods and consider antihistamines
188. Allergenic Stability in Cooked vs. Raw Foods
Why do most patients with oral allergy syndrome tolerate cooked versions of trigger foods?
A: Cooked foods increase IgE degradation
B: Cooking enhances protein cross-reactivity
C: Heat denatures labile proteins involved in cross-reactivity
D: Heat activates complement proteins that block allergic pathways
Answer: C: Heat denatures labile proteins involved in cross-reactivity
189. Allergen-Specific Immunotherapy in OAS
What is a potential benefit of allergen-specific immunotherapy in managing OAS?
A: It completely eliminates all food-related allergies
B: It is contraindicated due to the risk of systemic anaphylaxis
C: It offers immediate relief from oral symptoms
D: It may reduce pollen-related sensitization and improve OAS symptoms over time
Answer: D: It may reduce pollen-related sensitization and improve OAS symptoms over time
190. Nickel Allergy as a Type IV Hypersensitivity Reaction
What is the immunological classification of allergic contact dermatitis from nickel exposure in the oral cavity?
A: Type IV delayed-type hypersensitivity reaction
B: Type I immediate hypersensitivity reaction
C: Type II antibody-mediated cytotoxicity
D: Type III immune complex-mediated hypersensitivity
Answer: A: Type IV delayed-type hypersensitivity reaction
191. Melanin Deposition and Pigmentation
What is the most common endogenous cause of pigmentation in the oral mucosa?
A: Hemosiderin accumulation
B: Amalgam tattoo
C: Melanin from melanocyte activity
D: Exogenous metal salts
Answer: C: Melanin from melanocyte activity
192. Physiologic Pigmentation Patterns
Which statement best characterizes physiologic (racial) pigmentation in the oral cavity?
A: It occurs symmetrically and is usually painful
B: It is common in darker-skinned individuals and presents as diffuse, asymptomatic brown coloration
C: It is typically unilateral and ulcerated
D: It necessitates immediate biopsy to rule out melanoma
Answer: B: It is common in darker-skinned individuals and presents as diffuse, asymptomatic brown coloration
193. Amalgam Tattoo Identification
Which feature helps distinguish an amalgam tattoo from other pigmented lesions?
A: Presence of radiopaque particles on dental radiographs
B: Association with mucosal bleeding
C: Rapid growth and change in color
D: Symmetry and uniform coloration
Answer: A: Presence of radiopaque particles on dental radiographs
194. Oral Melanoacanthoma Characteristics
What is the appropriate management for an oral melanoacanthoma in a healthy individual?
A: Cryosurgery
B: Antibiotic therapy
C: Electrosurgical excision
D: Biopsy to confirm diagnosis and rule out melanoma
Answer: D: Biopsy to confirm diagnosis and rule out melanoma
195. Peutz-Jeghers Syndrome Oral Findings
Which of the following pigmented lesions is associated with Peutz-Jeghers syndrome?
A: Multiple freckle-like macules on lips and buccal mucosa
B: Blue nodular vascular lesions
C: Brown-black macules on the gingiva only
D: Diffuse pigmentation along the midline palate
Answer: A: Multiple freckle-like macules on lips and buccal mucosa
196. Biopsy Indications in Pigmented Lesions
In which of the following cases is a biopsy most strongly indicated?
A: Symmetric brown gingival pigmentation in a child
B: Diffuse melanosis in a known smoker
C: Stable physiologic pigmentation with no color variation
D: Focal pigmented macule on the hard palate with recent size increase
Answer: D: Focal pigmented macule on the hard palate with recent size increase
197. Kaposi’s Sarcoma in HIV+ Patients
Which statement about oral Kaposi’s sarcoma is most accurate?
A: It typically presents as a white patch on the gingiva
B: It often appears as a red-blue or purple macule or nodule, especially on the hard palate
C: It is usually confined to the tongue dorsum and is ulcerative
D: It can be diagnosed clinically without biopsy
Answer: B: It often appears as a red-blue or purple macule or nodule, especially on the hard palate
198. Differentiating Melanotic Macule from Melanoma
Which clinical feature is most helpful in differentiating a melanotic macule from oral melanoma?
A: Gingival location
B: Association with a dental restoration
C: Uniform color and lack of change over time
D: Deeply ulcerated surface
Answer: C: Uniform color and lack of change over time
199. Oral Melanoma Characteristics
Which of the following is true regarding oral malignant melanoma?
A: It is most commonly found on the buccal mucosa
B: It always presents with pain and bleeding
C: It is usually diagnosed in patients under 30
D: It often presents as a rapidly enlarging, asymmetric, darkly pigmented lesion on the palate or maxillary gingiva
Answer: D: It often presents as a rapidly enlarging, asymmetric, darkly pigmented lesion on the palate or maxillary gingiva
200. Drug-Induced Oral Pigmentation
Which of the following drugs is most likely to cause oral pigmentation as a side effect?
A: Antimalarials such as chloroquine
B: Antihistamines
C: NSAIDs
D: Statins
Answer: A: Antimalarials such as chloroquine
201. Biopsy Margin Consideration
When performing an incisional biopsy of a suspicious oral lesion, where should the sample be ideally taken from?
A: The center of the ulcerated area
B: The area most painful to the patient
C: The advancing margin, including normal and abnormal tissue
D: The thickest region of the lesion only
Answer: C: The advancing margin, including normal and abnormal tissue
202. Preferred Fixative for Oral Biopsy Specimens
Which of the following is the most appropriate fixative for routine oral soft tissue biopsy specimens?
A: Ethanol 95%
B: 10% neutral buffered formalin
C: Glutaraldehyde
D: Saline-moistened gauze
Answer: B: 10% neutral buffered formalin
203. Biopsy of Pigmented Lesions
Which type of biopsy is most appropriate for a small, pigmented lesion of unknown origin in the oral cavity?
A: Excisional biopsy with clear margins
B: Brush biopsy
C: Needle biopsy
D: Observation without intervention
Answer: A: Excisional biopsy with clear margins
204. Laser Biopsy Limitations
Why is laser biopsy not always recommended for initial diagnosis of suspicious oral lesions?
A: It causes excess hemorrhage
B: It lacks precision in deep tissue sampling
C: It is contraindicated in immunocompromised patients
D: It can cause thermal artifact, which may hinder histopathological interpretation
Answer: D: It can cause thermal artifact, which may hinder histopathological interpretation
205. Clinical Decision for Biopsy
Which of the following is the most appropriate reason to perform a biopsy on an oral lesion?
A: The lesion has persisted for more than two weeks without an identifiable cause
B: The patient insists on removal for cosmetic purposes
C: The lesion is mildly painful but changing color
D: The lesion appears to be aphthous in origin
Answer: A: The lesion has persisted for more than two weeks without an identifiable cause
206. Punch Biopsy Considerations
What is a primary limitation of punch biopsy in diagnosing deep or large oral lesions?
A: It cannot be performed without general anesthesia
B: It causes excessive tissue damage
C: It is only useful for pigmented lesions
D: It may not sample the full depth or most diagnostically relevant area of the lesion
Answer: D: It may not sample the full depth or most diagnostically relevant area of the lesion
207. Interpreting Granulomatous Inflammation
If a biopsy report reveals granulomatous inflammation in an oral lesion, which of the following is a likely cause?
A: Traumatic ulcer
B: Deep fungal infection or foreign body reaction
C: Lichen planus
D: Mucous retention cyst
Answer: B: Deep fungal infection or foreign body reaction
208. Frozen Section Utility
What is the main clinical advantage of a frozen section biopsy technique during oral surgery?
A: It allows for deeper margins to be sampled
B: It replaces the need for a permanent biopsy
C: It provides rapid assessment of lesion margins during surgery
D: It increases patient comfort
Answer: C: It provides rapid assessment of lesion margins during surgery
209. Interpreting Dysplasia in Biopsy Reports
Which of the following histological features most strongly indicates high-grade epithelial dysplasia?
A: Mild nuclear hyperchromatism and basal cell crowding
B: Parakeratosis with no atypia
C: Acanthosis with chronic inflammatory cells
D: Loss of epithelial polarity and mitotic figures in upper third of epithelium
Answer: D: Loss of epithelial polarity and mitotic figures in upper third of epithelium
210. Contraindications for Oral Biopsy
Which of the following is generally a contraindication for performing an oral biopsy at the initial visit?
A: Lesion of vascular origin without prior imaging or aspiration
B: White lesion with suspected hyperkeratosis
C: Ulcer persisting beyond 2 weeks with unknown cause
D: Asymptomatic fibroma on the buccal mucosa
Answer: A: Lesion of vascular origin without prior imaging or aspiration
211. Mechanism of Drug-Induced Gingival Overgrowth
Which pathway is primarily implicated in the fibroblast proliferation seen in drug-induced gingival hyperplasia?
A: Nitric oxide-mediated vasodilation
B: Prostaglandin E2 activation
C: Calcium influx affecting collagen synthesis
D: Histamine-induced fibroblast activation
Answer: C: Calcium influx affecting collagen synthesis
212. Medication Class Most Commonly Associated with Xerostomia
Which of the following drug classes is most frequently associated with xerostomia due to its anticholinergic effects?
A: Proton pump inhibitors
B: Tricyclic antidepressants
C: Beta blockers
D: ACE inhibitors
Answer: B: Tricyclic antidepressants
213. Anticonvulsant-Related Gingival Changes
Which anticonvulsant drug is most strongly associated with gingival hyperplasia?
A: Phenytoin
B: Valproic acid
C: Levetiracetam
D: Diazepam
Answer: A: Phenytoin
214. Chemotherapy-Induced Oral Mucositis
Which chemotherapeutic agent is most commonly associated with severe oral mucositis due to its rapid effect on epithelial turnover?
A: Methotrexate
B: Vincristine
C: Bevacizumab
D: 5-Fluorouracil
Answer: D: 5-Fluorouracil
215. Immunosuppressants and Gingival Overgrowth
Which immunosuppressant is particularly known for causing gingival enlargement as an adverse effect?
A: Cyclosporine
B: Prednisone
C: Methotrexate
D: Azathioprine
Answer: A: Cyclosporine
216. Bisphosphonate-Related Jaw Complications
What is the primary pathophysiological mechanism of bisphosphonate-related osteonecrosis of the jaw (BRONJ)?
A: Immune complex deposition in periosteal tissues
B: Inhibition of osteoblast activity and angiogenesis
C: Overstimulation of osteoclast resorption
D: Suppression of bone remodeling and impaired vascular supply
Answer: D: Suppression of bone remodeling and impaired vascular supply
217. Calcium Channel Blockers and Oral Findings
Which calcium channel blocker is most commonly associated with gingival enlargement?
A: Verapamil
B: Nifedipine
C: Amlodipine
D: Diltiazem
Answer: B: Nifedipine
218. Drug-Induced Taste Disturbance
Which medication is most associated with dysgeusia due to altered zinc metabolism and taste receptor interference?
A: Metoprolol
B: Metformin
C: Captopril
D: Furosemide
Answer: C: Captopril
219. Lichenoid Drug Reaction
Which class of drugs is most frequently implicated in causing oral lichenoid reactions?
A: Proton pump inhibitors
B: Antifungals
C: NSAIDs
D: Beta blockers
Answer: D: Beta blockers
220. Tetracyclines and Intrinsic Staining
Why does tetracycline use in children lead to permanent tooth discoloration?
A: It binds to calcium ions in developing teeth
B: It increases melanin synthesis in the oral epithelium
C: It oxidizes enamel proteins post-eruption
D: It inhibits salivary gland development
Answer: A: It binds to calcium ions in developing teeth
221. Oral Candidiasis and Endocrinopathy
Which endocrine disorder is most commonly associated with recurrent oral candidiasis due to immunosuppression and altered salivary function?
A: Hypothyroidism
B: Cushing’s syndrome
C: Type II Diabetes Mellitus
D: Hyperparathyroidism
Answer: C: Type II Diabetes Mellitus
222. Hyperpigmentation of Oral Mucosa
Which endocrine disorder is characterized by diffuse brown pigmentation of the oral mucosa, often presenting before cutaneous signs?
A: Hypoparathyroidism
B: Addison’s Disease
C: Grave’s Disease
D: Hashimoto’s Thyroiditis
Answer: B: Addison’s Disease
223. Delayed Tooth Eruption in Children
Which of the following conditions can cause delayed tooth eruption due to reduced metabolic activity and impaired growth?
A: Congenital Hypothyroidism
B: Type I Diabetes
C: Hyperthyroidism
D: Pheochromocytoma
Answer: A: Congenital Hypothyroidism
224. Bisphosphonate Risk in Endocrine Disorders
In patients being treated for endocrine-related osteoporosis, which complication may arise due to bisphosphonate therapy?
A: Hyperplasia of gingival tissues
B: Oral lichen planus
C: Burning mouth syndrome
D: Medication-related osteonecrosis of the jaw (MRONJ)
Answer: D: Medication-related osteonecrosis of the jaw (MRONJ)
225. Periodontal Disease and Glycemic Control
Which of the following is a direct oral manifestation of poorly controlled diabetes mellitus?
A: Exaggerated inflammatory response and increased severity of periodontitis
B: Gingival bleeding due to platelet deficiency
C: Petechiae and ecchymosis on the hard palate
D: Diffuse white patches that do not scrape off
Answer: A: Exaggerated inflammatory response and increased severity of periodontitis
226. Thyrotoxicosis and Dental Implications
Which of the following is a concern when managing a hyperthyroid patient undergoing dental surgery?
A: Delayed wound healing
B: Hyposalivation
C: Increased risk of oral candidiasis
D: Risk of thyroid storm triggered by epinephrine
Answer: D: Risk of thyroid storm triggered by epinephrine
227. Oral Burning Sensation and Hormonal Imbalance
A postmenopausal woman presents with burning mouth symptoms. Which endocrine-related mechanism is most likely contributing?
A: Excessive salivary calcium
B: Estrogen deficiency affecting mucosal nerve fibers
C: Cortisol overproduction
D: Thyroid-stimulating immunoglobulin activity
Answer: B: Estrogen deficiency affecting mucosal nerve fibers
228. Parotid Gland Enlargement in Endocrinopathies
Which endocrine condition is associated with bilateral, non-tender parotid gland enlargement due to acinar hypertrophy and fatty infiltration?
A: Cushing’s Syndrome
B: Graves' Disease
C: Diabetes Mellitus
D: Acromegaly
Answer: C: Diabetes Mellitus
229. Oral Clues to Undiagnosed Addison’s Disease
In a patient presenting with fatigue and generalized hyperpigmented macules on the buccal mucosa, what systemic condition must be ruled out?
A: Type I Diabetes
B: Hyperthyroidism
C: Multiple Endocrine Neoplasia (MEN) Syndrome
D: Addison’s Disease
Answer: D: Addison’s Disease
230. Bone Density and Endocrine Disorders
How might hyperparathyroidism indirectly present in the oral cavity?
A: Reduced lamina dura and ground-glass appearance of jaw bones
B: Lichen planus involving the buccal mucosa
C: Burning sensation on the tongue
D: Mucosal petechiae and gingival erythema
Answer: A: Reduced lamina dura and ground-glass appearance of jaw bones
231. Glossitis in Nutritional Deficiencies
What best explains the mechanism behind atrophic glossitis seen in vitamin B12 deficiency?
A: Inflammatory infiltration in submucosa
B: Overproduction of keratin
C: Impaired DNA synthesis in rapidly dividing epithelial cells
D: Increased collagen degradation
Answer: C: Impaired DNA synthesis in rapidly dividing epithelial cells
232. Oral Ulcers and Micronutrient Deficiency
Which nutritional deficiency is most consistently associated with painful recurrent oral ulcers?
A: Zinc
B: Iron
C: Calcium
D: Vitamin D
Answer: B: Iron
233. Angular Cheilitis Etiology
Which deficiency is most commonly associated with bilateral angular cheilitis?
A: Riboflavin
B: Magnesium
C: Vitamin A
D: Copper
Answer: A: Riboflavin
234. Histological Feature of B12 Deficiency in Oral Tissues
Which histopathologic change is most characteristic of B12 deficiency in oral mucosa?
A: Hyperplastic epithelium with parakeratosis
B: Abundant mitotic figures in basal layer
C: Increased vascularization with inflammatory cells
D: Nuclear-cytoplasmic asynchrony and megaloblastic changes
Answer: D: Nuclear-cytoplasmic asynchrony and megaloblastic changes
235. Hunter’s Glossitis Identification
Hunter’s glossitis is most commonly a clinical manifestation of which deficiency?
A: Vitamin B12
B: Vitamin C
C: Vitamin K
D: Vitamin D
Answer: A: Vitamin B12
236. Neurological Complication of B12 Deficiency
Which neurological finding may accompany the oral symptoms of vitamin B12 deficiency?
A: Chorea
B: Facial nerve palsy
C: Trigeminal neuralgia
D: Posterior column demyelination leading to paresthesia
Answer: D: Posterior column demyelination leading to paresthesia
237. Role of Iron in Oral Mucosa Health
How does iron deficiency contribute to the development of oral mucosal atrophy?
A: By reducing vitamin D conversion
B: By impairing epithelial regeneration and oxygen transport
C: By increasing tissue permeability
D: By altering calcium metabolism
Answer: B: By impairing epithelial regeneration and oxygen transport
238. Folate Deficiency Oral Indicators
Which of the following is a recognized oral manifestation of folate deficiency?
A: Macroglossia with surface fissuring
B: Hyperkeratotic leukoplakia
C: Pale mucosa with sore, burning tongue
D: Nodular eruptions on buccal mucosa
Answer: C: Pale mucosa with sore, burning tongue
239. Plummer-Vinson Syndrome Components
Plummer-Vinson Syndrome includes iron deficiency anemia, dysphagia, and which additional feature?
A: Mucosal petechiae
B: Palatal torus
C: Gingival hyperplasia
D: Atrophic glossitis
Answer: D: Atrophic glossitis
240. Pernicious Anemia Diagnostic Clue
What is a classic oral feature that may help in diagnosing pernicious anemia before systemic symptoms appear?
A: Beefy red, smooth tongue with burning sensation
B: Hemorrhagic bullae on hard palate
C: Diffuse pigmentation of the gingiva
D: Lichenoid striations on the buccal mucosa
Answer: A: Beefy red, smooth tongue with burning sensation
241. Neurobiological Basis of Psychosomatic Oral Disorders
Which brain region has been most strongly associated with the modulation of pain perception in psychosomatic oral conditions?
A: Hippocampus
B: Cerebellum
C: Anterior cingulate cortex
D: Medulla oblongata
Answer: C: Anterior cingulate cortex
242. Burning Mouth Syndrome and Psychiatric Comorbidity
Which psychiatric condition has the strongest epidemiological association with primary burning mouth syndrome (BMS)?
A: Schizophrenia
B: Generalized anxiety disorder
C: Bipolar disorder
D: Post-traumatic stress disorder
Answer: B: Generalized anxiety disorder
243. Factitious Oral Disorders
What is the most characteristic feature of factitious oral disorders like self-inflicted ulcers?
A: Lesions with bizarre, geometric patterns inconsistent with known pathology
B: Bilateral symmetrical ulcerations involving the tongue
C: Rapid healing following corticosteroid therapy
D: Positive fungal culture on cytology
Answer: A: Lesions with bizarre, geometric patterns inconsistent with known pathology
244. Oral Dysesthesia Differential Diagnosis
Which of the following findings supports a diagnosis of oral dysesthesia as a psychosomatic disorder?
A: Presence of vesiculobullous lesions on mucosa
B: Positive allergy test to dental materials
C: Detection of Candida species
D: Normal clinical and laboratory findings despite intense subjective symptoms
Answer: D: Normal clinical and laboratory findings despite intense subjective symptoms
245. Management of Psychogenic Halitosis
What is the most appropriate initial approach in a patient presenting with psychogenic halitosis?
A: Reassure the patient and consider psychiatric referral
B: Prescribe antiseptic mouth rinse and antibiotics
C: Recommend extraction of all nonvital teeth
D: Perform full-mouth scaling and root planing
Answer: A: Reassure the patient and consider psychiatric referral
246. Somatization and Chronic Orofacial Pain
How does somatization typically present in patients with unexplained orofacial pain?
A: Pain that improves significantly with NSAIDs
B: Consistent trigger points on palpation
C: Radiographically evident osseous pathology
D: Multiple vague symptoms without organic findings across different systems
Answer: D: Multiple vague symptoms without organic findings across different systems
247. Temporomandibular Disorders (TMD) and Psychological Factors
Which psychological factor is most strongly linked to increased pain perception in TMD patients?
A: Euphoria
B: Catastrophizing
C: Altruism
D: Intellectualization
Answer: B: Catastrophizing
248. Body Dysmorphic Disorder in Dentistry
What is the hallmark feature of body dysmorphic disorder in dental patients?
A: Edentulism accompanied by refusal of prosthetic rehabilitation
B: Complete satisfaction after cosmetic dental treatment
C: Preoccupation with minor or nonexistent dental imperfections
D: Multiple carious lesions attributed to systemic disease
Answer: C: Preoccupation with minor or nonexistent dental imperfections
249. Clinical Clue for Psychogenic Oral Paresthesia
Which of the following clinical signs best supports a psychogenic etiology in a patient with oral paresthesia?
A: Numbness in a precise anatomical distribution
B: Corresponding radiographic nerve impingement
C: History of mandibular fracture
D: Inconsistent or shifting areas of numbness not following anatomical nerve pathways
Answer: D: Inconsistent or shifting areas of numbness not following anatomical nerve pathways
250. Cognitive Behavioral Therapy (CBT) in Oral Medicine
What is the primary goal of cognitive behavioral therapy in managing psychosomatic oral conditions?
A: To restructure maladaptive thoughts and improve coping mechanisms
B: To reduce inflammatory markers in gingival tissues
C: To stimulate regeneration of sensory neurons
D: To enhance mucosal healing with improved blood flow
Answer: A: To restructure maladaptive thoughts and improve coping mechanisms
251. Antibiotic Prophylaxis in Cardiac Patients
Which cardiac condition requires antibiotic prophylaxis prior to certain dental procedures according to the latest AHA guidelines?
A: Coronary artery disease
B: Stable angina
C: History of infective endocarditis
D: Hypertension
Answer: C: History of infective endocarditis
252. INR Monitoring Before Dental Surgery
In a patient on warfarin therapy, what INR range is generally considered safe for minor oral surgery?
A: 1.0–1.5
B: 2.0–3.0
C: 3.5–4.0
D: >4.5
Answer: B: 2.0–3.0
253. Adrenal Insufficiency and Stress Management
For a patient with adrenal insufficiency on chronic corticosteroids, what is the best course of action before invasive dental treatment?
A: Administer stress-dose steroids prior to the procedure
B: Refer to endocrinology for IV hydrocortisone
C: Do not modify steroid dose
D: Delay treatment until steroid therapy is stopped
Answer: A: Administer stress-dose steroids prior to the procedure
254. Glucose Control in Diabetic Patients
What is the most appropriate management if a diabetic patient presents with a fasting blood glucose of 310 mg/dL before an extraction?
A: Proceed with the procedure with local anesthesia
B: Delay treatment and advise hydration
C: Perform the extraction after glucose intake
D: Defer elective procedure and refer for glycemic control
Answer: D: Defer elective procedure and refer for glycemic control
255. Management of Hypertensive Patients
What is the recommended maximum epinephrine dose for local anesthesia in a patient with controlled hypertension?
A: 0.04 mg (approximately 2 carpules of 1:100,000 epi)
B: 0.2 mg (approximately 11 carpules)
C: 0.1 mg (approximately 5 carpules)
D: Epinephrine is contraindicated
Answer: A: 0.04 mg (approximately 2 carpules of 1:100,000 epi)
256. Dialysis and Dental Treatment Timing
When is the safest time to perform invasive dental procedures on a patient undergoing hemodialysis?
A: The same day after dialysis
B: Immediately before dialysis
C: On the weekend following dialysis
D: The day after dialysis
Answer: D: The day after dialysis
257. Neutropenic Precautions in Cancer Patients
Which of the following WBC values necessitates antibiotic prophylaxis before invasive dental treatment in a cancer patient?
A: WBC > 5,000/mm³
B: ANC < 500/mm³
C: Platelets > 100,000/mm³
D: Hematocrit > 40%
Answer: B: ANC < 500/mm³
258. Management of Post-Transplant Patients
Why is consultation with a transplant team necessary before invasive dental work in a post-transplant patient?
A: To adjust anesthesia dose
B: To stop immunosuppressive drugs
C: To assess for risk of infection and bleeding based on immunosuppressive therapy
D: To avoid triggering organ rejection
Answer: C: To assess for risk of infection and bleeding based on immunosuppressive therapy
259. Oral Considerations in Liver Disease
Why must patients with advanced liver disease be evaluated carefully prior to oral surgery?
A: They may have uncontrolled diabetes
B: They are resistant to anesthetics
C: They may be immunocompromised
D: They often have coagulopathy due to reduced clotting factor synthesis
Answer: D: They often have coagulopathy due to reduced clotting factor synthesis
260. Osteoradionecrosis Risk in Head and Neck Radiation Patients
What is the best preventive strategy for osteoradionecrosis (ORN) before initiating radiation therapy to the jaw?
A: Complete all necessary extractions and allow healing 2–3 weeks prior to radiation
B: Start radiation before any oral treatment
C: Use chlorhexidine mouth rinse prophylactically
D: Begin IV bisphosphonate therapy
Answer: A: Complete all necessary extractions and allow healing 2–3 weeks prior to radiation
261. Latency and Reactivation of Oral Herpes Simplex Virus
What is the typical site of latency for Herpes Simplex Virus-1 (HSV-1) in oral infections?
A: Submandibular salivary gland
B: Floor of mouth mucosa
C: Trigeminal ganglion
D: Buccal mucosa
Answer: C: Trigeminal ganglion
262. Acute Necrotizing Ulcerative Gingivitis (ANUG) Microbiology
Which bacterial species is primarily associated with acute necrotizing ulcerative gingivitis (ANUG)?
A: Streptococcus mutans
B: Fusobacterium nucleatum
C: Actinomyces israelii
D: Lactobacillus casei
Answer: B: Fusobacterium nucleatum
263. Primary Herpetic Gingivostomatitis
What is the most common age group affected by primary herpetic gingivostomatitis?
A: Children aged 1–5 years
B: Adolescents aged 13–18 years
C: Adults aged 30–50 years
D: Elderly individuals over 70
Answer: A: Children aged 1–5 years
264. Oral Candidiasis in Immunocompetent Individuals
Which of the following best describes pseudomembranous candidiasis in healthy individuals?
A: Usually painless, pigmented macules
B: Always associated with xerostomia
C: Presents with submucosal induration
D: Can be scraped off, leaving erythematous mucosa
Answer: D: Can be scraped off, leaving erythematous mucosa
265. Treatment of Angular Cheilitis
What is the first-line treatment for angular cheilitis of fungal origin?
A: Topical antifungal agents like clotrimazole
B: Systemic corticosteroids
C: Chlorhexidine mouth rinses
D: Antibiotics such as amoxicillin
Answer: A: Topical antifungal agents like clotrimazole
266. Oropharyngeal HPV Infections
Which subtype of HPV is most strongly associated with oropharyngeal squamous cell carcinoma?
A: HPV-1
B: HPV-6
C: HPV-11
D: HPV-16
Answer: D: HPV-16
267. Syphilitic Oral Lesions – Diagnostic Clues
In secondary syphilis, what is the most characteristic oral finding?
A: Chancre on the lip
B: Mucous patches with serpiginous borders
C: Condyloma acuminatum
D: Generalized gingival hyperplasia
Answer: B: Mucous patches with serpiginous borders
268. Differential Diagnosis: Chronic Hyperplastic Candidiasis
Which of the following best distinguishes chronic hyperplastic candidiasis from leukoplakia?
A: Location on the lateral tongue
B: Presence of pain or burning
C: Histological evidence of fungal hyphae invading epithelium
D: Appearance of a red velvety surface
Answer: C: Histological evidence of fungal hyphae invading epithelium
269. Tuberculosis of the Oral Cavity
Which clinical feature most strongly suggests tuberculosis involving the oral mucosa?
A: Bilateral ulcers of the buccal mucosa
B: Vesicular lesions on the soft palate
C: White striations resembling lichen planus
D: Chronic, non-healing, painful ulcer often on the tongue
Answer: D: Chronic, non-healing, painful ulcer often on the tongue
270. Viral Infection Management – Herpes Zoster
What is the most appropriate pharmacologic approach to manage acute oral herpes zoster?
A: Initiate systemic acyclovir within 72 hours of symptom onset
B: Prescribe topical corticosteroids
C: Recommend chlorhexidine rinses only
D: Delay treatment until vesicles rupture
Answer: A: Initiate systemic acyclovir within 72 hours of symptom onset
271. Central Sensitization in Chronic Oral Pain
What is the primary mechanism of central sensitization in chronic orofacial pain?
A: Inhibition of peripheral nociceptors
B: Increased activity of endogenous opioids
C: Amplification of nociceptive signaling in the central nervous system
D: Reduction in synaptic transmission in the spinal cord
Answer: C: Amplification of nociceptive signaling in the central nervous system
272. Pharmacologic Management of Burning Mouth Syndrome
Which pharmacologic agent is often used off-label for symptomatic relief in burning mouth syndrome?
A: Acetaminophen
B: Clonazepam
C: Metronidazole
D: Ibuprofen
Answer: B: Clonazepam
273. First-Line Therapy in Trigeminal Neuralgia
What is considered first-line pharmacologic treatment for trigeminal neuralgia?
A: Carbamazepine
B: Amitriptyline
C: Gabapentin
D: Prednisone
Answer: A: Carbamazepine
274. Topical Agents for Local Neuropathic Pain
Which of the following is a commonly used topical treatment for localized neuropathic pain in the oral mucosa?
A: Topical fluocinonide
B: Lidocaine rinse
C: Magic mouthwash
D: Capsaicin gel
Answer: D: Capsaicin gel
275. Psychosocial Factors in Chronic Pain
Why is addressing psychological factors crucial in managing chronic oral pain?
A: They influence pain perception and treatment outcomes
B: They eliminate the need for pharmacologic therapy
C: They reduce inflammation directly
D: They confirm a diagnosis of psychogenic pain
Answer: A: They influence pain perception and treatment outcomes
276. Neuropathic Pain and Diagnostic Confirmation
What is a common diagnostic feature of neuropathic oral pain?
A: Intense swelling and erythema
B: Presence of ulceration or vesicles
C: Triggered by mastication or speaking
D: Dysesthesia in the absence of obvious clinical findings
Answer: D: Dysesthesia in the absence of obvious clinical findings
277. Tricyclic Antidepressants in Oral Pain
What is the role of tricyclic antidepressants (e.g., amitriptyline) in managing chronic oral pain?
A: They suppress immune-related inflammation
B: They modulate central pain pathways by inhibiting serotonin and norepinephrine reuptake
C: They act directly as anesthetics on mucosal surfaces
D: They serve as anti-infective agents
Answer: B: They modulate central pain pathways by inhibiting serotonin and norepinephrine reuptake
278. Central Acting Analgesics
What is the mechanism of action of duloxetine in chronic oral pain management?
A: Voltage-gated sodium channel blockade
B: Antagonism of NMDA receptors
C: Serotonin and norepinephrine reuptake inhibition
D: Opioid receptor agonism
Answer: C: Serotonin and norepinephrine reuptake inhibition
279. Multimodal Approach to Chronic Oral Pain
Which approach is most effective for managing complex chronic orofacial pain cases?
A: Monotherapy with analgesics
B: Use of systemic corticosteroids
C: Avoidance of pharmacologic agents
D: A combination of pharmacologic, behavioral, and physical therapy modalities
Answer: D: A combination of pharmacologic, behavioral, and physical therapy modalities
280. Pain Descriptors in Burning Mouth Syndrome
Which of the following best characterizes the pain experienced in burning mouth syndrome?
A: Chronic burning sensation without visible clinical changes
B: Intermittent stabbing pain with swelling
C: Throbbing pain with mucosal ulceration
D: Pressure pain triggered by food intake
Answer: A: Chronic burning sensation without visible clinical changes
281. Wavelength and Tissue Penetration
Which of the following best explains why diode lasers are preferred for soft tissue surgery in oral medicine?
A: They emit high thermal energy and are absorbed by hydroxyapatite
B: They coagulate blood vessels by targeting hemoglobin
C: They operate at wavelengths that are selectively absorbed by pigmented tissues, allowing precise cutting and hemostasis
D: They reflect off soft tissues, minimizing tissue damage
Answer: C: They operate at wavelengths that are selectively absorbed by pigmented tissues, allowing precise cutting and hemostasis
282. CO₂ Laser Interaction with Tissues
Why is the CO₂ laser considered ideal for superficial oral epithelial lesions?
A: It penetrates deeply, treating connective tissue disorders
B: Its wavelength is highly absorbed by water, allowing shallow tissue penetration and precise ablation
C: It selectively targets melanin for pigmented lesion treatment
D: It stimulates bone regeneration in deeper structures
Answer: B: Its wavelength is highly absorbed by water, allowing shallow tissue penetration and precise ablation
283. Clinical Application of Laser in Lichen Planus
What is a major advantage of laser therapy over topical corticosteroids in managing symptomatic oral lichen planus?
A: It provides immediate symptomatic relief with minimal recurrence and no systemic side effects
B: It reverses the autoimmune mechanism underlying the condition
C: It enhances mucosal pigmentation to mask erythematous areas
D: It eliminates the need for biopsy in erosive lesions
Answer: A: It provides immediate symptomatic relief with minimal recurrence and no systemic side effects
284. Safety Precautions in Laser Use
Which of the following is a critical safety consideration when using laser devices in oral soft tissue procedures?
A: Ensuring thermal contact with alveolar bone to promote healing
B: Increasing pulse duration for better coagulation
C: Reducing water spray to prevent tissue hydration
D: Use of wavelength-specific protective eyewear for both operator and patient
Answer: D: Use of wavelength-specific protective eyewear for both operator and patient
285. Laser Biostimulation Mechanism
How does low-level laser therapy (LLLT) promote healing in mucosal lesions?
A: By enhancing mitochondrial ATP production and modulating inflammatory cytokines
B: By thermally ablating infected epithelial layers
C: By targeting DNA synthesis and increasing epithelial thickness
D: By increasing leukocyte infiltration and tissue necrosis
Answer: A: By enhancing mitochondrial ATP production and modulating inflammatory cytokines
286. Laser Use in Herpetic Lesions
What is a proven benefit of laser therapy for recurrent intraoral herpetic lesions?
A: It eliminates viral particles permanently
B: It restores keratinized mucosa immediately
C: It prevents virus latency in the trigeminal ganglion
D: It reduces pain and duration of episodes without inducing tissue damage
Answer: D: It reduces pain and duration of episodes without inducing tissue damage
287. Histological Healing After Laser Surgery
Compared to scalpel surgery, laser incisions in oral soft tissues show what histological difference during early healing?
A: Increased hemorrhage and fibrin accumulation
B: Reduced inflammatory cell infiltration and faster epithelial regeneration
C: Delayed collagen remodeling due to thermal injury
D: Higher necrosis due to carbonization
Answer: B: Reduced inflammatory cell infiltration and faster epithelial regeneration
288. Laser Treatment of Pyogenic Granuloma
Why might diode lasers be preferred for excision of oral pyogenic granulomas?
A: Due to deep penetration and selective absorption by water
B: Due to stimulation of calcified matrix deposition
C: Due to superior hemostatic control and reduced intraoperative bleeding
D: Due to minimal pigmentation targeting
Answer: C: Due to superior hemostatic control and reduced intraoperative bleeding
289. Drawback of Laser Use in Oral Biopsy
What is a recognized disadvantage of using lasers for biopsy of suspicious oral lesions?
A: Increased postoperative infection
B: Need for general anesthesia
C: Delayed wound healing
D: Heat artifact at the margins, which may hinder histopathological interpretation
Answer: D: Heat artifact at the margins, which may hinder histopathological interpretation
290. Indication for Laser Gingivoplasty
In which of the following cases is laser gingivoplasty preferred over conventional scalpel technique?
A: When precise contouring is needed with minimal bleeding in a patient with anticoagulant therapy
B: When rapid hard tissue removal is necessary
C: When subgingival calculus removal is the goal
D: When bone recontouring is indicated
Answer: A: When precise contouring is needed with minimal bleeding in a patient with anticoagulant therapy
291. Referral Criteria for Undiagnosed Oral Lesions
Which of the following is a key indication for referring a patient to an oral medicine specialist?
A: Simple dental caries with no mucosal involvement
B: Localized gingivitis with identifiable etiology
C: A persistent non-healing oral ulcer for more than 2 weeks with no obvious cause
D: Mild tooth sensitivity with normal soft tissues
Answer: C: A persistent non-healing oral ulcer for more than 2 weeks with no obvious cause
292. Collaboration in Autoimmune Mucosal Disorders
When should a general dentist initiate interdisciplinary collaboration for a patient with suspected mucous membrane pemphigoid?
A: Only if gingival tissues bleed during probing
B: When there are widespread desquamative gingival lesions unresponsive to conventional therapy
C: When there's a mild burning sensation without visible lesions
D: After the lesion is confirmed to be benign by biopsy
Answer: B: When there are widespread desquamative gingival lesions unresponsive to conventional therapy
293. Referral in Suspected Leukoplakia Cases
A 57-year-old patient presents with a homogeneous white patch on the lateral tongue that does not rub off and has been present for 4 weeks. What is the best course of action?
A: Refer to oral medicine for biopsy and further evaluation
B: Reassure the patient and monitor every 6 months
C: Prescribe antifungal treatment and reassess
D: Perform scaling and root planing
Answer: A: Refer to oral medicine for biopsy and further evaluation
294. Oral Medicine and Oncology Collaboration
In which situation is collaboration with oral medicine and oncology specialists most critical?
A: A patient with asymptomatic geographic tongue
B: A patient with a burning mouth but no visible lesions
C: A patient with controlled HIV presenting with dry mouth
D: A patient undergoing head and neck radiation therapy requiring pre-radiation dental clearance and management
Answer: D: A patient undergoing head and neck radiation therapy requiring pre-radiation dental clearance and management
295. Oral Lichen Planus Management
When should a general dentist refer a patient with oral lichen planus to an oral medicine specialist?
A: When the lesions are erosive or symptomatic, and not resolving with topical corticosteroids
B: When lesions are asymptomatic and reticular
C: Only after a biopsy confirms dysplasia
D: If the patient is over 65
Answer: A: When the lesions are erosive or symptomatic, and not resolving with topical corticosteroids
296. Referral Timing in Chronic Orofacial Pain
Which scenario warrants a referral to oral medicine for evaluation of orofacial pain?
A: TMJ clicking without pain
B: Dental hypersensitivity to cold
C: Mild tension-type headache
D: Chronic idiopathic facial pain persisting for months with no identifiable dental cause
Answer: D: Chronic idiopathic facial pain persisting for months with no identifiable dental cause
297. Systemic Condition Manifesting Orally
A patient presents with angular cheilitis, glossitis, and burning sensation, but no local etiological factors. Labs reveal anemia. How should a general dentist proceed?
A: Prescribe topical antifungals
B: Refer to oral medicine and possibly internal medicine for systemic evaluation
C: Recommend iron-rich foods and reassess
D: Advise salt water rinses
Answer: B: Refer to oral medicine and possibly internal medicine for systemic evaluation
298. Medication-Related Osteonecrosis of the Jaw (MRONJ)
A patient taking bisphosphonates for 6 years presents with exposed bone in the posterior mandible without pain. What should be the immediate action?
A: Refer to oral surgery
B: Begin antibiotics and follow up in 2 weeks
C: Refer to oral medicine for diagnosis and multidisciplinary management planning
D: Smooth the exposed bone and prescribe chlorhexidine
Answer: C: Refer to oral medicine for diagnosis and multidisciplinary management planning
299. Immunocompromised Patient with Oral Lesions
A patient undergoing immunosuppressive therapy develops multiple ulcerative oral lesions unresponsive to antifungals. What is the next best step?
A: Try a different antifungal agent
B: Recommend probiotics
C: Prescribe systemic steroids
D: Refer to oral medicine for comprehensive immunologic and microbiologic workup
Answer: D: Refer to oral medicine for comprehensive immunologic and microbiologic workup
300. Co-management in Burning Mouth Syndrome
In managing a patient with classic signs of idiopathic burning mouth syndrome, what is the general dentist’s best approach?
A: Initiate basic workup and refer to oral medicine for diagnosis and long-term management
B: Prescribe antibiotics empirically
C: Extract any teeth near the painful area
D: Refer to ENT for complete evaluation
Answer: A: Initiate basic workup and refer to oral medicine for diagnosis and long-term management
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