Question 1

A 22-year-old woman complains of mildly painful ulcers in her hard palate. The ulcers are multiple and confluent. A similar condition has been noted in the patient on two previous occasions. This is most likely:

Accepted Answer

Secondary herpes (herpes simplex virus reactivation) can cause painful ulcers in the oral cavity, including the hard palate, and can recur, fitting the patient's history of similar conditions on previous occasions.

Question 2

Bilateral buccal mucosal white lesions would be expected in all the following except:

Accepted Answer

Bilateral buccal mucosal lesions are not typically seen in secondary herpes zoster, as the lesions are usually unilateral and follow a dermatomal distribution. The other conditions listed may cause bilateral buccal mucosal white lesions.

Question 3

The bullous eruption of attached gingiva mediated by autoantibodies directed against basement membrane antigens is known as:

Accepted Answer

The correct answer is "None of the above" because the description given matches the condition known as "Mucous Membrane Pemphigoid" (MMP), not listed among the options. MMP is characterized by autoantibodies against basement membrane antigens, leading to bullous lesions primarily affecting mucous membranes, including the gingiva.

Question 4

A patient seeks help for recurrent palatal pain. She presents with multiple punctate ulcers in the hard palate that were preceded by tiny blisters. Her lesions typically heal in about 2 weeks and reappear during stressful times. She has:

Accepted Answer

The description of multiple punctate ulcers in the hard palate that were preceded by tiny blisters, which heal in about 2 weeks and reappear during stressful times, is characteristic of recurrent secondary herpes (herpes simplex virus reactivation), not primary infection or the other conditions listed.

Question 5

A 55-year-old man presents with a single deep indurated crateriform lesion of the posterior lateral border of the tongue. It is asymptomatic. This could be all of the following except:

Accepted Answer

Secondary herpes typically presents as multiple, painful vesicles or ulcers. A single, asymptomatic lesion is not consistent with herpes. The other options should be considered and ruled out through further diagnostic testing.

Question 6

The palate and maxillary ridge of a 56-year-old woman contain multiple flat ulcers of 8 weeks' duration. She has a positive Nikolsky sign and has no evidence of skin or lip lesions. Which of the following should receive serious consideration in the clinical differential diagnosis?

Accepted Answer

The presence of multiple ulcers with positive Nikolsky sign and absence of skin or lip lesions is highly suggestive of pemphigus vulgaris, a rare autoimmune disease that affects the skin and mucous membranes. Herpangina and herpes simplex infection typically present with vesicular lesions rather than ulcers, while lichen planus and aphthous stomatitis do not typically exhibit a positive Nikolsky sign.

Question 7

Site specificity is a characteristic clinical feature of which of the following conditions when it occurs intraorally?

Accepted Answer

The answer of Site specificity is a characteristic clinical feature...

Question 8

Which of the following vesiculobullous disorders is nonhereditary and occurs almost exclusively on the skin?

Accepted Answer

Bullous pemphigoid is nonhereditary and almost exclusively occurs on the skin. Pemphigus vulgaris and cicatricial pemphigoid can affect mucous membranes and have an autoimmune component. Epidermolysis bullosa is a genetic disorder that affects the skin and mucous membranes. Lupus erythematosus can have vesiculobullous lesions, but it is primarily a systemic autoimmune disorder.

Question 9

A middle-aged man developed multiple flat ulcers in his palate, tongue, and buccal mucosa. The lesions measured approximately 1 cm in diameter and were preceded briefly by bullae. The lesions have been persistent for 6 weeks. He has no skin, eye, or genital lesions. Biopsy shows acantholysis with intraepithelial separation. He most likely has:

Accepted Answer

The description and biopsy findings are indicative of pemphigus vulgaris, which is not listed among the options provided. Pemphigus vulgaris is characterized by acantholysis leading to intraepithelial blisters and ulcers, primarily affecting mucous membranes.

Question 10

Which of the following conditions exhibits subepithelial separation microscopically?

Accepted Answer

Mucous membrane pemphigoid (MMP) is characterized by subepithelial separation on histopathologic examination. Pemphigus vulgaris is characterized by intraepithelial acantholysis, aphthous stomatitis is a non-specific ulcerative condition, and secondary herpes simplex exhibits herpetic viral cytopathic changes.

Question 11

Which of the following is important in the clinical efficacy of a topical corticosteroid?

Accepted Answer

All of the choices are important in the clinical efficacy of a topical corticosteroid. The vehicle plays a role in the penetration and absorption of the medication, the concentration of steroid in the preparation affects the potency of the medication, halogenation of the parent compound can affect its potency and selectivity, and the frequency and amount of application can affect its efficacy and the risk of side effects.

Question 12

The Tzanck cells in pemphigus vulgaris result from:

Accepted Answer

Tzanck cells are formed due to acantholysis or separation of cells in the outer layer of the skin. In pemphigus vulgaris, autoantibodies attack desmosomes, the adhesive structures that hold cells together, causing acantholysis and the formation of Tzanck cells.

Question 13

Herpes simplex infections are most rationally treated with:

Accepted Answer

Acyclovir is an antiviral medication that specifically targets herpes simplex infections. It is the most effective treatment for such infections and is often prescribed for both initial outbreaks and recurrent episodes. Lysine has been suggested as a treatment but research on its effectiveness is inconclusive. Topical clobetasol and topically applied tetracycline are not indicated for herpes simplex infections and may exacerbate the symptoms. Prednisone is a corticosteroid medication that may suppress the immune system and thus worsen the infection.

Question 14

Systemic corticosteroids can affect many metabolic processes. Which of the following effects of prednisone is regarded as therapeutic when prescribed for patients with pemphigus vulgaris and mucous membrane pemphigoid?

Accepted Answer

The immunosuppressive actions of prednisone are therapeutic when treating autoimmune conditions such as pemphigus vulgaris and mucous membrane pemphigoid.

Question 15

Lesions found in the buccal mucosa, known as Koplik's spots, are first signs of which of the following?

Accepted Answer

Koplik's spots are a classic sign of rubeola, also known as measles.

Question 16

Cytologic examination can be diagnostic of which of the following diseases?

Accepted Answer

The answer of Cytologic examination can be diagnostic of which...

Question 17

All but one of the following are contagious and thus are potential occupational hazards to the dentist and dental hygienist. Choose the noncontagious condition.

Accepted Answer

Pemphigus vulgaris is an autoimmune disorder and is not contagious. The other conditions listed can be transmitted through contact with infectious bodily fluids or lesions.

Question 18

Generally, corticosteroids are contraindicated in the treatment of which of the following conditions?

Accepted Answer

Corticosteroids are contraindicated in the treatment of viral infections such as hand-foot-and-mouth disease, as they can worsen the infection. The other conditions listed may be treated with corticosteroids.

Question 19

Biopsy confirmation of mucous membrane pemphigoid can be made by which of the following?

Accepted Answer

Biopsy confirmation of mucous membrane pemphigoid is made by direct immunofluorescence, which shows linear deposition of immunoglobulin G (IgG) and C3 along the basement membrane zone. Fite stain is used to visualize acid-fast bacilli in tissues, determination of serum antinuclear antibodies is used to diagnose autoimmune disorders such as systemic lupus erythematosus, and response to acyclovir is not relevant in the diagnosis of mucous membrane pemphigoid.

Question 20

Intercellular deposits of IgG are consistently found in oral epithelium in which of the following?

Accepted Answer

Pemphigus vulgaris is characterized by the presence of intercellular deposits of IgG within the epithelium, leading to acantholysis (the breakdown of cell-to-cell adhesion) and intraepithelial blistering.

Quiz 1: Vesiculobullous Diseases