Question 1

All of the following are a consequence of snuff dipping except:

Accepted Answer

Increased incidence of herpes simplex labialis is not a consequence of snuff dipping. Snuff dipping primarily affects oral health, leading to issues such as mucosal changes, gingivitis, dependence, and tooth abrasion, but it does not increase the incidence of herpes simplex labialis.

Question 2

A 9-year-old boy has bilateral, white thickening of his buccal mucosa that extends into the vestibules. The lesions have been present since birth. His brother has similar lesions. Which of the following is suggested?

Accepted Answer

White sponge nevus is a condition characterized by a white, spongy appearance of the mucosa, which is often present at birth or develops during childhood. It is typically bilateral and can affect the buccal mucosa and other areas of the oral cavity. The fact that the lesions have been present since birth and that the patient's brother also has similar lesions suggests a genetic component, which is consistent with white sponge nevus.

Question 3

On routine examination of a 52-year-old male pipe smoker, an asymptomatic tissue change was found in his palate. The entire hard palate was white with occasional red dots. He has:

Accepted Answer

Nicotine stomatitis is a condition often seen in heavy smokers, characterized by a whitish mucosal change in the palate, sometimes with red dots representing inflamed minor salivary gland ducts. This description matches the findings in the patient's examination.

Question 4

The most common mucosal site for AIDS-related oral hairy leukoplakia is:

Accepted Answer

Oral hairy leukoplakia most commonly affects the lateral aspects of the tongue. It is characterized by white patches that cannot be scraped off, often seen in immunocompromised patients, especially those with HIV/AIDS.

Question 5

Which of the following microscopic features accounts for the white appearance of leukoedema?

Accepted Answer

Leukoedema is characterized by a white appearance due to the hydropic (intracellular edema) change of keratinocytes, which reflects light differently than normal cells, giving the mucosa a whitish hue.

Question 6

What is the most likely cause of lichen planus?

Accepted Answer

Lichen planus is most commonly associated with an immunologic defect. It is characterized by an inflammatory response that is thought to be mediated by T lymphocytes, indicating an immune system involvement rather than a direct infection by pathogens such as viruses, bacteria, or fungi.

Question 7

A 14-year-old bone marrow transplant patient developed bilateral white lesions of the lateral border of the tongue that measured 1 * 2 cm. Which of the following conditions should receive serious consideration in a clinical differential diagnosis?

Accepted Answer

Hairy leukoplakia is commonly associated with immunocompromised patients, such as those who have undergone bone marrow transplantation. The appearance of white lesions on the lateral borders of the tongue is characteristic of this condition.

Question 8

Biopsy of a lesion of the buccal mucosa shows epithelial cells with hyperchromatic and pleomorphic nuclei. Abnormal mitotic figures are found at all levels in the epithelium. The basement membrane is intact. This is consistent with:

Accepted Answer

The description of epithelial cells with hyperchromatic and pleomorphic nuclei, abnormal mitotic figures at all levels in the epithelium, and an intact basement membrane is consistent with carcinoma in situ. This condition represents a severe dysplasia that has not yet invaded past the basement membrane, distinguishing it from invasive squamous cell carcinoma.

Question 9

Which of the following is an autosomal-dominant disease?

Accepted Answer

White sponge nevus is an autosomal-dominant condition characterized by the appearance of white, spongy lesions on the mucous membranes, most commonly in the oral cavity.

Question 10

Clinical diagnosis of candidiasis is confirmed by:

Accepted Answer

The diagnosis of candidiasis, a fungal infection caused by Candida species, is confirmed by the demonstration of mycelia and spores in scrapings from the infected area. This method directly observes the fungal elements, providing definitive evidence of the infection.

Question 11

Ectopic lymphoid tissue is commonly seen in which of the following sites?

Accepted Answer

Ectopic lymphoid tissue can be found in various sites within the oral cavity, including the posterior lateral tongue, floor of mouth, soft palate, and tonsillar pillar. These are areas where lymphoid tissue may appear outside of the primary lymphoid organs, contributing to local immune responses.

Question 12

Which of the following benign conditions exhibits a clinical mucosal pattern that seems to change or migrate over time?

Accepted Answer

Geographic tongue, also known as benign migratory glossitis, is characterized by areas of depapillation that can change location, size, and pattern over time, giving the appearance of a map-like pattern that seems to migrate across the tongue's surface.

Question 13

Which of the following disorders places the patient at risk for the appearance or development of a malignancy?

Accepted Answer

All of the listed disorders place patients at risk for the appearance or development of a malignancy. Primary Sjögren's syndrome is associated with an increased risk for lymphoma, proliferative verrucous leukoplakia is a precancerous lesion that frequently progresses to oral cancer, neurofibromatosis is associated with an increased risk for various types of cancer, and MEN III (multiple endocrine neoplasia type III) predisposes individuals to medullary thyroid carcinoma, pheochromocytoma, and parathyroid hyperplasia.

Question 14

Three small (2 * 2 mm), nodular, nonulcerated, and asymptomatic lesions were found in the floor of the mouth of a 21-year-old man. Microscopically, the lesions were composed of a collection of normal mature lymphocytes with germinal centers. This patient has:

Accepted Answer

The description of the lesions as being composed of a collection of normal mature lymphocytes with germinal centers suggests that these are ectopic lymphoid tissues. Ectopic lymphoid tissue refers to lymphoid tissue that is found in locations where lymphoid tissue is not normally present. The presence of normal mature lymphocytes and germinal centers indicates that this is not a pathological condition like lymphoma, which would show abnormal lymphocyte proliferation. It is also not consistent with mucous extravasation phenomenon, Fordyce granules, or dermoid cysts, which have different histological features.

Question 15

Appropriate management of geographic tongue is:

Accepted Answer

Geographic tongue is a benign condition that often requires no treatment other than observation. It is characterized by map-like patterns on the tongue's surface due to transient areas of depapillation. Since it is not caused by a fungal infection or a condition that would necessitate a biopsy or antidepressants for diagnosis or management, observation is typically the most appropriate management approach.

Question 16

Examination of an asymptomatic 27-year-old man reveals numerous circular white lesions surrounding red atrophic patches on the dorsum of the tongue. The lesions cannot be rubbed off with a gauze square. The patient most likely has:

Accepted Answer

Benign migratory glossitis, also known as geographic tongue, is characterized by circular white lesions surrounding red atrophic patches on the tongue, which match the description given. These lesions are not removable by rubbing, distinguishing it from conditions with removable plaques.

Question 17

Lupus erythematosus is caused by which of the following?

Accepted Answer

Lupus erythematosus is an autoimmune disease, where the body's immune system attacks its own tissues, causing widespread inflammation and tissue damage in the affected organs.

Question 18

Which of the following represents an opportunistic fungal infection?

Accepted Answer

Candidiasis is an opportunistic fungal infection caused by Candida species, commonly occurring in individuals with weakened immune systems.

Question 19

Which of the following occurs in the midline dorsum of the tongue?

Accepted Answer

Median rhomboid glossitis, which is associated with candidiasis, typically occurs in the midline dorsum of the tongue. This condition presents as a smooth, red, depapillated patch on the tongue, often at the site where the lingual frenulum attaches. It is thought to result from a chronic fungal infection, specifically Candida species.

Question 20

Biopsy of bilateral white buccal mucosa lesions showed hyperkeratotic epithelium with basal cell destruction. The epithelium was supported by connective tissue containing a dense lymphocytic infiltrate. This is descriptive of:

Accepted Answer

The description of hyperkeratotic epithelium with basal cell destruction and a dense lymphocytic infiltrate in the connective tissue is characteristic of Lichen Planus.

Quiz 3: White Lesions