Question 1

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 histological findings of hyperkeratosis and basal cell destruction with a dense lymphocytic infiltrate in the connective tissue support a diagnosis of lichen planus. Erythema multiforme would show necrotic epithelial cells with a superficial lymphocytic infiltrate, while pemphigus and pemphigoid would show intraepithelial and subepithelial blister formation respectively. White sponge nevus would show a hyperkeratotic epithelium with a thickened spinous layer and intracellular edema.

Question 2

Lupus erythematosus is caused by which of the following?

Accepted Answer

Lupus erythematosus is an autoimmune disease, meaning that the body's immune system attacks its own tissues and organs, leading to inflammation and damage.

Question 3

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 the patient at risk for the development of a malignancy. Primary Sjögren's syndrome increases the risk of lymphoma, proliferative verrucous leukoplakia increases the risk of oral squamous cell carcinoma, neurofibromatosis increases the risk of malignant nerve sheath tumors, and MEN III increases the risk of medullary thyroid carcinoma.

Question 4

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

Accepted Answer

Snuff dipping does not have a direct correlation with an increased incidence of herpes simplex labialis. However, it can lead to other consequences such as mucosal opacification, gingivitis, dependence, and tooth abrasion.

Question 5

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

The bilateral, white thickening of the buccal mucosa that extends into the vestibules that has been present since birth suggests the diagnosis of white sponge nevus. This condition is rare and genetic, and often presents as bilateral thickening of the mucosa in the oral cavity. The fact that the boy's brother also has similar lesions further supports the diagnosis of white sponge nevus.

Question 6

Clinical diagnosis of candidiasis is confirmed by:

Accepted Answer

The demonstration of mycelia and spores in scrapings is the most definitive way to diagnose candidiasis. Other methods, such as characteristic odor or response to medication, may be suggestive but are not highly specific for candidiasis. Sulfur granules are typically associated with Actinomyces infections.

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 a viral-induced lesion commonly found in immunosuppressed patients, such as those undergoing bone marrow transplantation. The bilateral white lesions on the lateral border of the tongue are consistent with the presentation of hairy leukoplakia. White sponge nevus presents as a diffuse white thickening of the oral mucosa, geographic tongue presents as red patches on the tongue, pemphigus vulgaris presents with blistering of the oral mucosa, and aphthous stomatitis presents with painful ulcers in the oral cavity.

Question 8

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

Accepted Answer

Geographic tongue exhibits a clinical pattern that appears to change or migrate over time, with irregular red patches surrounded by white borders that move around the tongue. The other conditions listed have more stable clinical presentations.

Question 9

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 10

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

Accepted Answer

The midline dorsum of the tongue is the typical location for median rhomboid glossitis, which is a form of candidiasis. Ectopic lymphoid tissue and peripheral giant cell granuloma are not typically found on the midline dorsum of the tongue. Basal cell carcinoma and secondary herpes simplex are also not commonly found in this location.

Question 11

Which of the following represents an opportunistic fungal infection?

Accepted Answer

Candidiasis is an opportunistic fungal infection, which means it typically affects individuals with weakened immune systems or those whose normal microbiota has been disrupted (such as by antibiotic use). Shingles (A) is caused by the reactivation of the herpes zoster virus, and while it may occur in individuals with compromised immune systems, it is not typically considered an opportunistic infection. Aphthous stomatitis (B) is a type of mouth ulcer that is typically caused by trauma or stress, although it can be associated with some systemic diseases. Herpangina (D) is a viral infection that is typically seen in children, and syphilis (E) is a sexually transmitted infection caused by the bacterium Treponema pallidum.

Question 12

What is the most likely cause of lichen planus?

Accepted Answer

Lichen planus is an autoimmune disease where the immune system attacks the skin and mucous membranes. There is no evidence to suggest that the condition is caused by viruses, bacteria, or fungi.

Question 13

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 14

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

The circular white lesions and red atrophic patches on the dorsum of the tongue are characteristic of benign migratory glossitis (also known as geographic tongue). This condition is usually asymptomatic and the lesions cannot be rubbed off. Fissured tongue, squamous cell carcinoma, and lichen planus would present with different clinical findings. Speckled leukoplakia is a possible diagnosis, but typically presents as white and red patches that cannot be rubbed off, as opposed to circular lesions. However, it should still be considered as a potential diagnosis in this case and further evaluation may be necessary.

Question 15

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

Accepted Answer

Ectopic lymphoid tissue can be found in all the above mentioned sites. It can also be seen in other sites such as the salivary glands, thyroid gland, and gastrointestinal tract.

Question 16

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 17

Appropriate management of geographic tongue is:

Accepted Answer

Geographic tongue is a benign condition that typically does not require treatment. Observation is the appropriate management approach. Biopsy and medication are not indicated for this condition.

Question 18

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 19

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 20

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 presence of normal mature lymphocytes with germinal centers in the lesion indicates that it is likely composed of ectopic lymphoid tissue, which is a benign condition. Lymphoma would show abnormal lymphocytes and often have more aggressive clinical features. Mucous extravasation phenomenon, Fordyce granules, and dermoid cysts are all different conditions characterized by distinct histological features and clinical presentations.

Quiz 3: White Lesions