MCQs in Oral Pathology PDF

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MCQs in

Oral PathOlOgy

MCQs in

Oral PathOlOgy (With Explanatory answers)

Sundeep S Bhagwath MDS (Oral Pathology)

Professor (Oral Pathology) and Head Department of Basic Sciences College of Dentistry University of Ha’il Kingdom of Saudi Arabia

Foreword Dr (Col) NK Ahuja

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Jaypee Brothers Medical Publishers (P) Ltd. Bhotahity, Kathmandu, Nepal Phone: +977-9741283608 E-mail: [email protected] Website: www.jaypeebrothers.com Website: www.jaypeedigital.com © 2016, Jaypee Brothers Medical Publishers The views and opinions expressed in this book are solely those of the original contributor(s)/author(s) and do not necessarily represent those of editor(s) of the book. All rights reserved. No part of this publication may be reproduced, stored or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission in writing of the publishers. All brand names and product names used in this book are trade names, service marks, trademarks or registered trademarks of their respective owners. The publisher is not associated with any product or vendor mentioned in this book. Medical knowledge and practice change constantly. This book is designed to provide accurate, authoritative information about the subject matter in question. However, readers are advised to check the most current information available on procedures included and check information from the manufacturer of each product to be administered, to verify the recommended dose, formula, method and duration of administration, adverse effects and contraindications. It is the responsibility of the practitioner to take all appropriate safety precautions. Neither the publisher nor the author(s)/editor(s) assume any liability for any injury and/or damage to persons or property arising from or related to use of material in this book. This book is sold on the understanding that the publisher is not engaged in providing professional medical services. If such advice or services are required, the services of a competent medical professional should be sought. Every effort has been made where necessary to contact holders of copyright to obtain permission to reproduce copyright material. If any has been inadvertently overlooked, the publisher will be pleased to make the necessary arrangements at the first opportunity. Inquiries for bulk sales may be solicited at: [email protected]

MCQs in Oral Pathology (With Explanatory Answers) First Edition: 2016 ISBN: 978-93-85891-50-2 Printed at

Dedicated to My wife, Vani, for being such a wonderful source of strength and my two lovely daughters, Damini and Dhhriti, for their overwhelming love and affections

Foreword

Multiple choice questions (MCQs) tests are the preferred format for accurate and comprehensive assessment of students’ ability to think objectively and critically. Apart from postgraduate entrance examinations, they have also become an integral part of undergraduate examinations with most universities amalgamating them along with other longer forms of assessment. Hence, it is imperative that undergraduate students acquire the skills to solve the MCQs, which will be beneficial to them not only for success in undergraduate examinations but also for the postgraduate entrance examinations later on. It gives me great pleasure to state that Dr Sundeep S Bhagwath has taken great interest and pains to bring out this resource for the benefit of students. I have no hesitation in recommending this book for the students as it covers all the topics in the subject of oral pathology and also has explanatory answers to aid the students in better understanding of the topics. I hope that students find this resource beneficial and wish the author all the success in this and all other such endeavors.

Dr (Col) NK Ahuja Professor Emeritus Swami Vivekanand Subharti University, Meerut Director General Kalka Group of Institutions Meerut, Uttar Pradesh, India

Preface

I felt that there is a need for a book on multiple choice questions (MCQs) for the undergraduate dental students. MCQs have become the format of choice for most of the competitive entrance examinations worldwide. MCQs are also an integral part of undergraduate examinations in medical subjects. The reason they are favored is, due to the fact that, they are easy to evaluate and accurately assess the objective thinking of the candidates. This book is designed to cater to the needs of undergraduate dental students undergoing a study in the subject of oral and maxillofacial pathology. It includes all the pertinent areas covered under this subject and attempts to inculcate in the students an endeavor to explore the horizons of this subject. The questions have been framed keeping in mind particularly the undergraduate dental students as not many such resources are available to them. I hope that the students make full use of this resource. In case of any factual errors, the mistake is entirely from my side and I shall be more than glad to entertain queries and criticisms at [email protected].

Sundeep S Bhagwath

Acknowledgments

No endeavor can be successful without active cooperation, support and encouragement from colleagues, friends, family and the benevolence of the Almighty. This book would not have seen the light of the day without constant encouragement and moral support of my wife, Vani, who has always been there whenever I needed her and my two angels, Damini and Dhhriti, who sorely missed their father’s presence during the preparation of this manuscript. To my guide and mentor, Dr GS Kumar, I owe my professional standing. To him, I render my special thanks. I am deeply indebted to my parents for inculcating sound values and for being such pillars of strength. My sincere thanks to M/s Jaypee Brothers Medical Publishers (P) Ltd, New Delhi, India, for giving me this opportunity and publishing the book.

Contents

1. Developmental Anomalies of Orofacial Structures Including Teeth

1

2. Dental Caries

9

3. Diseases of Pulp and Periapical Tissues

17

4. Diseases of Periodontium

25

5. Infections: Bacterial, Viral and Mycotic

33

6. Spread of Oral Infections

40

7. Benign and Malignant Nonodontogenic Tumors of Oral Cavity

48

8. Odontogenic Cysts and Tumors

66

9. Diseases of Salivary Glands

85

10. Diseases of Osseous Structures

94

11. Diseases of Skin

102

12. Hematological Diseases

110

13. Diseases of Nerves and Muscles

118

14. Disorders of Metabolism

125

15. Healing of Oral Wounds

133

16. Physical and Chemical Injuries of Teeth

141

17. Regressive Changes of Oral Cavity

150

1

Developmental Anomalies of Orofacial Structures Including Teeth

1. Which amongst the following is not a cause of acquired micrognathia? (a) (b) (c) (d)

Infection of mastoid Trauma to TMJ Infection of the middle ear Infection of inner ear

2. Which amongst the following is not a clinical feature of micrognathia? (a) Steep mandibular angle (b) Severe retrusion of chin (c) Prominent chin button (d) Deficient chin button 3. Indicate the incorrect statement regarding macrognathia (a) (b) (c) (d)

It is commonly associated with Paget’s disease Patients tend to have a short ramus Excessive condylar growth predisposes to macrognathia Patients have a prominent chin button

4. Facial hemiatrophy is not associated with which of the following conditions? (a) Bell’s palsy (c) Jacksonian epilepsy

(b) Trigeminal neuralgia (d) Delayed eruption of teeth

5. Cleft of the primary palate occurs (a) (b) (c) (d)

Anterior to incisive foramen Posterior to incisive foramen Between lateral incisor and canine Between canine and 1st premolar

2 MCQs in Oral Pathology

6. Minimal form of clefting of palate is seen in (a) (b) (c) (d)

Soft palate Uvula Hard palate and soft palate Posterior to incisive foramen

7. Increased risk of development of squamous cell carcinoma is associated with which of the following developmental conditions? (a) Cheilitis granulomatosa (b) Heck’s disease (c) Cheilitis glandularis (d) Fibromatosis gingivae 8. If a patient has multiple intestinal polyps, cutaneous melanocytic macules, rectal prolapse and gynecomastia, he/she is probably suffering from (a) (b) (c) (d)

Gardner syndrome Goltz-Gorlin syndrome Peutz-Jeghers syndrome Grinspan syndrome

9. Fordyce’s granules is heterotopic collection of _______ in oral cavity (a) Sweat glands (c) Hair follicles

(b) Salivary glands (d) Sebaceous glands

10. Heck’s disease is caused by ________ virus (a) Herpes simplex (c) Varicella zoster

(b) Human papilloma (d) Epstein-Barr

11. A well-circumscribed, soft, sessile, bilateral, nodular mass which is located lingual to mandibular canines between mucogingival junction and free gingiva could most likely be (a) Peripheral giant cell granuloma (b) Pyogenic granuloma (c) Retrocuspid papilla (d) Peripheral ossifying fibroma

Developmental Anomalies of Orofacial Structures Including Teeth 3

12. Which amongst the following is not a cause of macroglossia? (a) Hemangioma (c) Down’s syndrome

(b) Lymphangioma (d) Leukemia

13. Which one of the following is a synonym of fissured tongue? (a) Lingua nigra (c) Geographic tongue

(b) Scrotal tongue (d) Lingual varix

14. Median rhomboid glossitis occurs (a) (b) (c) (d)

Anterior to circumvallate papillae Posterior to circumvallate papillae Tip of tongue Lateral border of tongue

15. Histopathological features of benign migratory glossitis closely resemble that of (a) (b) (c) (d)

Lichen planus Psoriasis Systemic lupus erythematosus Erythema multiforme

16. Amongst the following causes, the least probable cause of hairy tongue is (a) Smoking (c) Epstein-Barr virus

(b) Poor oral hygiene (d) Radiation therapy

17. A nodular mass near base of tongue with presenting complaints of dyspnea and dysphagia and without a demonstrable main thyroid gland could most probably be (a) (b) (c) (d)

Reactive lymphoid aggregate Lymphoid hamartoma Lingual thyroid nodule Lymphoepithelial cyst

18. Stafne cyst/Stafne defect is an aberrant collection of _____ gland tissue within a deep depression in the mandible (a) Sweat glands (c) Mucous glands

(b) Sebaceous glands (d) Salivary glands

4 MCQs in Oral Pathology

19. Apart from maxillary lateral incisor, which other tooth is commonly affected by microdontia? (a) (b) (c) (d)

Mandibular premolars Maxillary canines Mandibular central incisors Third molars

20. Fusion of teeth involves a confluence of (a) Enamel only (c) Dentin only

(b) Enamel and dentin (d) Cementum only

21. In association with which syndrome does talon cusp usually occur? (a) (b) (c) (d)

Rubinstein-Taybi Down Hereditary ectodermal dysplasia Gardner

22. With which variation in coronal morphology is dens evaginatus associated? (a) Peg-shaped laterals (c) Dilaceration

(b) Shovel-shaped incisors (d) Distomolar

23. Dilated odontome is a synonym of (a) Dens invaginatus (c) Dens evaginatus

(b) Talon cusp (d) Macrodontia

24. The base of invagination of crown/root in dens invaginates contains (a) Dystrophic dentin (c) Necrotic pulp tissue

(b) Dystrophic enamel (d) Dystrophic cementum

25. Which bone disorder should be considered for differential diagnosis in case of a finding of generalized hypercementosis? (a) Paget’s disease (c) Osteopetrosis

(b) Fibrous dysplasia (d) Osteogenesis imperfecta

26. If a patient shows signs of kinky hair, osteosclerosis at base of skull, brittle nails along with hypomaturation—hypoplastic amelogenesis imperfecta, he/she is most probably suffering from

Developmental Anomalies of Orofacial Structures Including Teeth 5

(a) (b) (c) (d)

Rubinstein-Taybi syndrome Klinefelter syndrome Cranioectodermal syndrome Tricho-dento-osseous syndrome

27. The appearance of normal thickness enamel with extremely thin dentin and abnormally large pulp chamber is indicative of (a) (b) (c) (d)

Amelogenesis imperfecta Dentinogenesis imperfecta Type I Dentinogenesis Type III Dentin dysplasia Type II

28. Loss of organization of radicular dentin with subsequent shortening of root length is a feature of (a) (b) (c) (d)

Dentin dysplasia Type I Dentin dysplasia Type II Dentinogenesis imperfecta Type II Dentinogenesis imperfecta Type III

29. Which amongst the following diseases is capable of producing developmental alterations in teeth? (a) Tetanus (c) Diphtheria

(b) Chickenpox (d) Syphilis

30. Lack of development of six or more teeth is denoted by the term (a) Oligodontia (c) Anodontia

(b) Hypodontia (d) Partial anodontia

ANSWERS 1. (d) Acquired micrognathia is of postnatal origin and results usually from disturbance in the area of the temporomandibular joint like infection of mastoid, middle ear or joint itself. 2. (c) Micrognathia is characterized by severe retrusion of chin, steep mandibular angle and a deficient chin button. 3. (b) Macrognathia may be associated with other diseases like Paget’s disease, fibrous dysplasia, acromegaly, etc. and shows features like increased ramus height and length of

6 MCQs in Oral Pathology

4. (a)

5. (a)

6. (b) 7. (c)

8. (c)

9. (d)

10. (b)

11. (c)

12. (d)

mandibular body, decreased maxillary length, prominent chin button increased gonial angle, etc. Progressive hemifa cial atrop hy is an uncommon, degenerative condition characterized by atrophic changes affecting one side of the face. Possible causes include trophic malfunction of the cervical lymphatic nervous system, trauma and viral or Borrelia infection. A complete cleft palate includes cleft of hard palate, soft palate and uvula. Cleft anterior to the incisive foramen is called cleft of primary palate, while cleft posterior to incisive foramen is defined as cleft of secondary palate. Clefting occurs in a wide range of severity. Clefting of uvula is the minimal form of cleft. It is an unusual clinical presentation of cheilitis that develops in response to various sources of chronic irritation. There is progressive enlargement and eversion of lower lip that significantly exposes it to actinic damage which may be a potential predisposing factor to development of squamous cell carcinoma. It is an autosomal dominant, inherited disorder characterized by multiple intestinal polyps and concomitant mucocutaneous melanocytic macules. Occurrence of sebaceous glands in oral cavity may result from inclusion in oral cavity, of ectoderm having some of the potentialities of skin. It is caused by human papillomavirus HPV-13 and probably HPV-32. It is different from other HPV lesions in that it produces extreme acanthosis and hyperplasia of stratum spinosum with minimal surface projection or connective tissue proliferation. Retrocuspid papilla is a developmental lesion micro scopically similar to giant cell fibroma. It occurs on the gingiva lingual to the mandibular cuspid, is frequently bilateral and typically appears as a small, pink papule that measures less than 5 mm in diameter. It is an uncommon condition characterized by enlargement of the tongue. The enlargement may be caused by a wide variety of conditions including both congenital malformations and acquired diseases. The most frequent causes are vascular malformations and muscular hypertrophy.

Developmental Anomalies of Orofacial Structures Including Teeth 7

13. (b) Scrotal/fissured tongue is a common condition characterized by presence of numerous grooves on dorsal surface of tongue. Cause is uncertain but may be heredity. Aging and local environmental factors may also play some role. 14. (a) Clinically median rhomboid glossitis appears as a welldemarcated erythematous zone that a ffects the midline, posterior dorsal tongue and often is asymptomatic. 15. (b) Hyperparakeratosis, spongiosis, acanthosis, elongation of epithelial rete ridges and collections of neutrophils (Munro abscesses) are also seen in psoriasis. 16. (c) Epstein-Barr virus is responsible for causing hairy leukoplakia which occurs on the lateral surfaces of tongue and is associated with HIV or other immunosuppressive conditions. 17. (c) Lingual thyroids may range from small, asymptomatic nodular lesions to large masses that can block the airway. The most common clinical symptoms are dysphagia, dysphonia, and dyspnea. Diagnosis is best established by thyroid scan using technetium 99m. 18. (d) Stafne defect presents as an asymptomatic radiolucency below the mandibular canal in the posterior mandible, between the molar teeth and the angle of the mandible. 19. (d) Isolated microdontia within an otherwise normal dentition is not uncommon. The maxillary lateral incisor is affected most frequently, followed by third molars. 20. (b) Fusion is defined as a single-enlarged tooth or joined (i.e. double) tooth in which the tooth count reveals a missing tooth when the anomalous tooth is counted as one. 21. (a) A talon cusp (dens evaginatus of anterior tooth) is a welldelineated additional cusp that is located on the surface of an anterior tooth and extends at least half the distance from the cementoenamel junction to the incisal edge. 22. (b) Dens evaginatus is a cusp-like elevation of enamel located in the central groove or lingual ridge of the buccal cusp of permanent premolar or molar teeth. Frequently, dens evaginatus is seen in association with another variation of coronal anatomy, shovel-shaped incisors. Affected incisors demonstrate prominent lateral margins, creating a hollowed lingual surface that resembles the scoop of a shovel.

8 MCQs in Oral Pathology

23. (a) Dens invaginatus is a deep surface invagination of the crown or root that is lined by enamel. Two forms—coronal and radicular are recognized. 24. (b) Coronal dens invaginatus has been classified into three major types. Type I exhibits an invagination that is limited to the crown. The invagination in Type II extends below the cementoenamel junction and ends in a blind sac that may or may not communicate with adjacent dental pulp. Large invaginations may become...