Question 1

The clinical differential diagnosis for chronic red gingival patches would include:

Accepted Answer

All of the listed conditions can cause chronic red gingival patches. Atrophic lichen planus and lupus erythematosus are autoimmune disorders that affect the skin and mucous membranes. Contact hypersensitivity can occur due to an allergic reaction to a substance in contact with the gums. Chronic candidiasis can be caused by a fungal infection. A thorough examination and testing may be necessary to determine the specific cause of the patient's symptoms.

Question 2

Oral white patches that are of unknown cause, cannot be rubbed off, and cannot be clinically diagnosed as any other condition should be:

Accepted Answer

Oral white patches that cannot be clinically diagnosed as any other condition should be biopsied to determine the cause and rule out any potential serious underlying conditions such as oral cancer. Ignoring or observing these patches could delay necessary treatment and potentially lead to more serious complications. If the patches are causing pain, they can be treated symptomatically while awaiting biopsy results.

Question 3

Bilateral buccal mucosa white lesions would least likely be seen in which of the following?

Accepted Answer

Idiopathic leukoplakia typically presents as a unilateral white patch or plaque that cannot be rubbed off and cannot be diagnosed as any other condition. The other options listed (A, B, C, D) are known to frequently present with bilateral buccal mucosa white lesions.

Question 4

Oral epithelial dysplasia may:

Accepted Answer

Oral epithelial dysplasia can appear as white or red patches clinically and can be seen on any mucosal surface. It has the potential to progress to invasive squamous cell carcinoma if left untreated.

Question 5

All the following are effective in the treatment of acute oral candidiasis except:

Accepted Answer

Acyclovir tablets are antiviral medications used to treat viral infections, not fungal infections like oral candidiasis, which is caused by the Candida species. Mycelex troches (clotrimazole), Lotrimin (also clotrimazole but typically not in tablet form for oral candidiasis), Nystatin pastilles, and Mycostatin oral suspension (another form of Nystatin) are all antifungal treatments effective against oral candidiasis.

Question 6

The white appearance associated with acute pseudomembranous candidiasis is due to which of the following?

Accepted Answer

The white appearance associated with acute pseudomembranous candidiasis is due to the fungal colonies growing in and on the superficial keratin.

Question 7

A 55-year-old man presents with a 1 ´ 1 cm white lesion of his edentulous alveolar ridge. The clinical differential diagnosis should include:

Accepted Answer

Frictional hyperkeratosis is a common white lesion that can occur on an edentulous alveolar ridge due to chronic irritation and trauma from dentures or other oral appliances. Lichen planus and hairy leukoplakia are less likely in this scenario, as they typically present with widespread lesions and are not specifically associated with the alveolar ridge. Ectopic lymphoid tissue is also an unlikely diagnosis, as it typically presents as a painless mass rather than a white lesion.

Question 8

Actinic cheilitis:

Accepted Answer

Actinic cheilitis is primarily seen in the lower lip because it is more exposed to sunlight compared to the upper lip. This condition is associated with chronic sun exposure and has a potential for malignant transformation, typically into squamous cell carcinoma, making options A, B, and C incorrect.

Question 9

The hard palate and gingiva are the characteristic sites for the appearance of all the following except:

Accepted Answer

The answer of The hard palate and gingiva are the...

Question 10

A 57-year-old patient presents with bright red mucosa under her 10-year-old maxillary denture. The tissue is painful and has been present for several weeks. The remainder of her examination is negative. This is most likely which of the following?

Accepted Answer

The presence of bright red mucosa, pain, and duration of several weeks suggest the possibility of chronic candidiasis, a fungal infection that commonly affects denture wearers. Allergy to denture material, erythroplasia, and hemangioma are less likely due to the patient's age and clinical presentation.

Question 11

Hairy leukoplakia:

Accepted Answer

Hairy leukoplakia may be seen in non-HIV immunosuppressed patients, may appear as a flat or papillated lesion, occurs most commonly on the tongue, and may be bilateral.

Question 12

A 21-year-old African American man presents for a routine examination. Both sides of his buccal mucosa exhibit a filmy white opacity. There is no pain, and the tissue feels normal to palpation. This could be which of the following?

Accepted Answer

Leukoedema is a benign, diffuse white opacity of the buccal mucosa that is commonly seen in African American individuals. It does not exhibit any pain or abnormal tissue texture upon palpation. Squamous cell carcinoma is a malignancy that would not present as a white opacity but rather as a growth or lesion. Hairy leukoplakia is a white, corrugated lesion usually found on the lateral edges of the tongue, associated with Epstein-Barr virus infection. Nicotine stomatitis is a condition where the hard palate exhibits a white, roughened appearance due to chronic smoking or tobacco use. Geographic stomatitis causes irregular red patches on the oral mucosa, giving a “map-like” appearance.

Question 13

A 32-year-old man presented with a 1 ´ 2 cm macular red-blue lesion in his hard palate. The lesion was asymptomatic and had been present for an unknown duration. He had no dental abnormalities and no significant periodontal disease. This could be all the following except:

Accepted Answer

Nicotine stomatitis is a condition caused by heavy smoking or tobacco use, characterized by a whitish appearance in the palate with red dots, but not a macular red-blue lesion. The other options, including vascular malformation, ecchymosis, Kaposi's sarcoma, and erythroplasia, may present as macular red-blue lesions in the palate.

Question 14

Idiopathic leukoplakia:

Accepted Answer

Idiopathic leukoplakia is a white patch or plaque that cannot be attributed to any specific cause. It can potentially develop into squamous cell carcinoma, and even after excision, it may recur. Therefore, long-term follow-up is necessary. It is not caused by papillomavirus, and a biopsy may be necessary for a definitive diagnosis. It can occur at any age, but it is more commonly seen in older individuals who use tobacco or have a history of alcohol abuse.

Question 15

The microscopic feature that accounts for the white clinical appearance of lichen planus is:

Accepted Answer

The white clinical appearance of lichen planus is due to hyperkeratosis, which is the thickening of the stratum corneum layer of the epidermis.

Question 16

All the following oral diseases have a relatively short (days to weeks) self-limited course except:

Accepted Answer

Lichen planus is a chronic oral disease that can last for months to years. The other options listed are acute oral diseases that have a relatively short self-limited course.

Question 17

Fluconazole is a systemically taken drug that is particularly effective in the treatment of which of the following?

Accepted Answer

Fluconazole is particularly effective in the treatment of candidiasis, which is an infection caused by the yeast Candida. It is not effective in the treatment of syphilis, actinomycosis, tuberculosis or zoster.

Question 18

Which of the following provides a patient with increased risk for the development of oral squamous cell carcinoma?

Accepted Answer

All of the listed conditions are considered precancerous or potentially cancerous oral lesions, with higher risk of developing squamous cell carcinoma. Idiopathic leukoplakia is a white patch on the oral mucosa with unknown cause, erythroplakia is a red patch that often presents as a soft tissue elevation or ulcer and is believed to have a higher rate of malignant transformation than leukoplakia, submucous fibrosis is a progressive scarring condition of the oral mucosa that is associated with betel nut chewing and has a high rate of malignant transformation, and lichen planus is a chronic inflammatory disease that can also have a potentially malignant form.

Question 19

Which of the following typically presents clinically as a yellow submucosal nodule?

Accepted Answer

Ectopic lymphoid tissue, also known as lymphoid hyperplasia or lymphoid aggregates, can present as a yellow submucosal nodule. This is due to the presence of lymphocytes and plasma cells within the tissue. White sponge nevus presents as white, thickened, corrugated mucosal plaques. Squamous cell carcinoma typically presents as a non-healing ulcer or mass. Amalgam tattoo presents as a bluish-grey macule or nodule.

Question 20

The etiology of hairy tongue is associated with:

Accepted Answer

Hairy tongue can be caused by systemic antibiotic therapy, oral hydrogen peroxide abuse, and therapeutic irradiation to the head and neck. Therefore, choice D, "All the above" is the correct answer.

Quiz 3: White Lesions