Deck 3: White Lesions

Question 1

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

A) Increased incidence of herpes simplex labialis
B) Mucosal opacification
C) Gingivitis
D) Dependence
E) Tooth abrasion

Answer 1

Increased 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?

A) Lichen planus
B) Leukoedema
C) Mucous patches
D) White sponge nevus
E) None of the above

Answer 2

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:

A) Candidiasis
B) Nicotine stomatitis
C) Squamous cell carcinoma
D) Frictional hyperkeratosis
E) Major aphthous ulcer

Answer 3

Nicotine stomatitis

Question 4

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

A) Conjunctiva
B) Soft palate
C) Lateral tongue
D) Lingual gingiva
E) Buccal mucosa

Question 5

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

A) Hyperkeratosis
B) Acanthosis
C) Reduced vascular supply
D) Hydropic change of keratinocytes
E) Dyskeratosis

Question 6

What is the most likely cause of lichen planus?

A) Coxsackie virus
B) One of the herpes viruses
C) A mycobacterium
D) Candida albicans
E) Immunologic defect

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?

A) Hairy leukoplakia
B) White sponge nevus
C) Geographic tongue
D) Pemphigus vulgaris
E) Aphthous stomatitis

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:

A) Lichen planus
B) Leukoplakia
C) Squamous cell carcinoma
D) Carcinoma in situ
E) Focal hyperkeratosis

Question 9

Which of the following is an autosomal-dominant disease?

A) White sponge nevus
B) Geographic tongue
C) Hemangioma
D) Pemphigus vulgaris
E) Median rhomboid glossitis

Question 10

Clinical diagnosis of candidiasis is confirmed by:

A) Characteristic odor
B) Response to injection of vitamin B₁₂
C) Response to administration of prednisone
D) Demonstration of mycelia and spores in scrapings
E) Demonstration of sulfur granules in exudates

Question 11

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

A) Posterior lateral tongue
B) Floor of mouth
C) Soft palate
D) Tonsillar pillar
E) All the above

Question 12

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

A) Leukoedema
B) Median rhomboid glossitis
C) Fordyce's granules
D) Geographic tongue
E) None of the above

Question 13

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

A) Primary Sjögren's syndrome
B) Proliferative verrucous leukoplakia
C) Neurofibromatosis
D) MEN III
E) All the above

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:

A) Lymphoma
B) Mucous extravasation phenomenon
C) Fordyce granules
D) Dermoid cysts
E) Ectopic lymphoid tissue

Question 15

Appropriate management of geographic tongue is:

A) Observation
B) Excisional biopsy
C) Incisional biopsy
D) Nystatin therapy
E) Antidepressant medication

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:

A) Fissured tongue
B) Speckled leukoplakia
C) Benign migratory glossitis
D) Squamous cell carcinoma
E) Lichen planus

Question 17

Lupus erythematosus is caused by which of the following?

A) Coxsackie virus
B) Herpes simplex virus
C) Immunodeficiency
D) Vitamin A deficiency
E) Autoimmunity

Question 18

Which of the following represents an opportunistic fungal infection?

A) Shingles
B) Aphthous stomatitis
C) Candidiasis
D) Herpangina
E) Syphilis

Question 19

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

A) Ectopic lymphoid tissue
B) Basal cell carcinoma
C) Secondary herpes simplex
D) Median rhomboid glossitis (candidiasis)
E) Peripheral giant cell granuloma

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:

A) Erythema multiforme
B) Lichen planus
C) Pemphigoid
D) Pemphigus
E) White sponge nevus

Question 21

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

A) Pemphigus vulgaris
B) Lupus erythematosus
C) Erythema multiforme
D) Behçet's syndrome
E) None of the above

Question 22

Epstein-Barr virus is responsible for which of the following?

A) Hereditary benign intraepithelial dyskeratosis
B) Hairy leukoplakia
C) Hairy tongue
D) Oral squamous cell carcinoma
E) None of the above

Question 23

Cutaneous lesions may be seen in all the following except:

A) Erythema multiforme
B) Chronic lupus erythematosus
C) Hairy leukoplakia
D) Secondary herpes simplex infections
E) Primary herpes simplex infections

Question 24

Systemic (acute) lupus erythematosus:

A) Represents an autoimmune disease in which patients develop multiple antibodies against nuclear and cytoplasmic proteins
B) Usually does not develop from preexisting discoid disease
C) May affect kidneys, heart, and joints
D) Has a predilection for middle-aged women
E) All the above

Question 25

A positive ANA test would most likely be seen in which of the following?

A) Primary syphilis
B) Primary herpes simplex
C) Systemic lupus erythematosus
D) Erythema multiforme
E) Pemphigoid

Question 26

Hairy tongue is characterized by hypertrophy of which of the following papillae?

A) Foliate
B) Filiform
C) Fungiform
D) Circumvallate
E) Interdental

Question 27

Chronic exposure to sunlight has been implicated in the pathogenesis of which of the following?

A) Basal carcinoma
B) Squamous cell carcinoma of the skin
C) Actinic cheilitis
D) Carcinoma of the lower lip
E) All the above

Question 28

Ingestion of certain drugs is known to occasionally precipitate which of the following?

A) Herpetiform aphthous ulcers
B) Geographic tongue
C) Cicatricial pemphigoid
D) Mucous patches
E) None of the above

Question 29

Circulating autoantibodies can be demonstrated in which of the following diseases?

A) Minor aphthae
B) Major aphthae
C) Systemic lupus erythematosus
D) Discoid lupus erythematosus
E) Recurrent herpes simplex

Question 30

Lesions of immunologic origin are seen in the heart, kidney, and joints in which of the following diseases?

A) Behçet's syndrome
B) Wegener's granulomatosis
C) Systemic lupus erythematosus
D) Pemphigus
E) Epidermolysis bullosa

Question 31

Median rhomboid glossitis is a chronic white and/or red lesion occurring in the midline dorsum of the tongue anterior to the circumvallate papillae that is believed to be caused by:

A) Epstein-Barr virus
B) Herpes simplex virus
C) Autoantibodies
D) Smokeless tobacco products
E) None of the above

Question 32

The keratinocyte desmosome complex is the pathologic target in which of the following diseases?

A) Discoid lupus erythematosus
B) Systemic lupus erythematosus
C) Tuberculosis
D) Pemphigoid
E) None of the above

Question 33

Degranulation of IgE-coated mast cells is associated with which of the following conditions?

A) Hereditary angioedema
B) Lupus erythematosus
C) Erythema multiforme
D) Contact allergy
E) None of the above

Question 34

Purple to red pruritic patches on lower legs and forearms are the typical cutaneous manifestation of which of the following?

A) Mucocutaneous candidiasis
B) Lupus erythematosus
C) Hereditary benign intraepithelial dyskeratosis
D) Lichen planus
E) Erythema multiforme

Question 35

Hairy tongue:

A) Is a pre-AIDS sign
B) Is an opportunistic Epstein-Barr virus infection
C) Typically occurs bilaterally on the lateral surfaces of the tongue
D) Has malignant potential
E) None of the above

Question 36

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:

A) Erythema multiforme
B) Discoid lupus erythematosus
C) Primary herpes simplex infection
D) Mucous membrane pemphigoid
E) None of the above

Question 37

The white lesion known as idiopathic leukoplakia clinically is most frequently diagnosed microscopically as:

A) Hyperkeratosis
B) Moderate dysplasia
C) In situ carcinoma
D) Invasive carcinoma
E) Leukoedema

Question 38

All of the following conditions affect oral and perioral tissues and are self-limiting (i.e., heal or disappear without therapeutic intervention) except:

A) Varicella
B) Herpangina
C) Erythema multiforme
D) Hand-foot-and-mouth disease
E) Lupus erythematosus

Question 39

The cells that are believed to mediate the destructive basal cell changes seen microscopically in lichen planus are:

A) Plasma cells
B) T lymphocytes
C) B lymphocytes
D) Langerhans cells
E) Keratinocytes

Question 40

Leukoplakia, located in which of the following sites, would be regarded as having the highest risk for malignant transformation?

A) Floor of mouth
B) Upper lip
C) Buccal mucosa
D) Gingiva
E) Palate

Question 41

Candidiasis is also known by which of the following synonyms?

A) Thrush
B) Candidosis
C) Perleche
D) Yeast infection
E) All the above

Question 42

A 42-year-old man presents with a 1 * 1 cm white patch on the lateral surface of his tongue. Based solely on this information, clinical differential diagnosis should include:

A) Frictional hyperkeratosis
B) Hairy leukoplakia
C) Idiopathic leukoplakia
D) All the above
E) None of the above

Question 43

Oral candidiasis is an opportunistic infection that may be associated with one of several predisposing factors. These include all the following except:

A) Prolonged use of oral topical corticosteroids
B) Therapeutic irradiation
C) Antibiotic therapy
D) Smokeless tobacco use
E) AIDS

Question 44

A 31-year-old man presents for a routine dental examination. Soft tissue examination shows that both sides of his tongue have several circular red nonulcerated lesions of approximately 1 cm in diameter. The red patches are surrounded by white hyperkeratotic margins. He is asymptomatic and is otherwise in good health. He most likely has:

A) Bilateral squamous cell carcinomas
B) Hairy leukoplakia
C) Median rhomboid glossitis
D) Leukoedema
E) Geographic tongue

Question 45

Oral mucosal petechiae and/or ecchymoses would be a clinical sign of all the following except:

A) Hemophilia
B) Trauma
C) Idiopathic thrombocytopenia
D) Monocytic leukemias
E) Lupus erythematosus

Question 46

Atrophy of the tongue papillae may be seen in all the following except:

A) Pernicious anemia
B) Hairy tongue
C) Geographic tongue
D) Iron deficiency anemia
E) Vitamin B deficiency

Question 47

Which of the following oral lesions has malignant potential?

A) "Snuff dipper's pouch"
B) Leukoplakia associated with smoking
C) Epithelial dysplasia
D) Actinic cheilitis
E) All the above

Question 48

The use of smokeless tobacco is:

A) Related to the development of opportunistic oral infections
B) More prevalent among young women than young men
C) Associated with the development of oral ulcers
D) A good substitute for smoking cigarettes
E) None of the above

Question 49

A 27-year-old man presents for a routine oral examination. Both sides of his buccal mucosa exhibit a filmy white opacity that disappears when the cheek is stretched. There is no pain, and the tissue feels normal to palpation. This would most likely be:

A) Squamous cell carcinoma
B) Hairy leukoplakia
C) Nicotine stomatitis
D) Leukoedema
E) Benign migratory glossitis

Question 50

Dysplastic changes of oral epithelium can be seen in biopsies of:

A) Idiopathic leukoplakia
B) Leukoedema
C) Melanotic macules
D) Hairy leukoplakia
E) Mucous membrane pemphigoid

Question 51

Ectopic sebaceous glands:

A) Are known as Fordyce's granules
B) Appear as yellow-white nodules intraorally
C) Do not need to be biopsied
D) Have no malignant potential
E) All the above

Question 52

Elevated white plaques are seen in the palate of an HIV-positive patient. Under the microscope, scrapings show hyphae and spores among superficial keratinocytes. This confirms which of the following?

A) Idiopathic leukoplakia
B) Lichen planus
C) Hairy leukoplakia
D) Candidiasis
E) None of the above

Question 53

Although hairy tongue is often idiopathic, some cases are believed to be associated with which one of the following?

A) Systemic antibiotic therapy
B) Infection by HHV8
C) Trauma
D) Vitamin C deficiency
E) Hot, spicy foods

Question 54

Benign migratory glossitis:

A) Is not associated with any risk of malignant transformation
B) Represents a self-limited viral infection
C) Responds to systemic acyclovir
D) Typically affects the ventral surface of the tongue
E) Is commonly seen in children

Question 55

Which of the following clinical abnormalities in a white lesion associated with the use of smokeless tobacco would indicate the need for biopsy?

A) Mass
B) Induration
C) Ulceration
D) Red patch
E) All the above

Question 56

Biopsy of a white lesion from the lower lip of an 82-year-old man showed hyperkeratosis, basophilic change of collagen, numerous telangiectasias, and epithelial atrophy. This is indicative of which of the following:

A) Lip biting
B) Squamous cell carcinoma
C) Idiopathic leukoplakia
D) Lichen planus
E) Actinic cheilitis

Question 57

Opaque white lesions cover right and left buccal mucosae, vestibules, and floor of the mouth of a 15-year-old girl. The lesions do not rub off and are asymptomatic. Biopsy showed intracellular edema and perinuclear condensation of keratin in keratinocytes. There is no inflammatory cell infiltrate of submucosa. This description suggests which of the following?

A) Leukoedema
B) Cheek chewing
C) Idiopathic leukoplakia
D) Lichen planus
E) White sponge nevus

Question 58

A 47-year-old woman presented with painful ulcers and white lesions on her gingiva, tongue, and buccal mucosa of 6 months' duration. Biopsy of one of the white areas showed hyperkeratosis, basal cell destruction, and an intense lymphocytic infiltrate subjacent to the epithelium. This patient most likely has:

A) Lichen planus
B) Mucous membrane pemphigoid
C) Pemphigus vulgaris
D) White sponge nevus
E) Behçet's syndrome

Question 59

Which of the following oral lesions most likely results from chronic friction?

A) Vascular malformation
B) Pigmented nevus
C) Focal hyperkeratosis
D) Secondary herpes
E) Leukoedema

Question 60

Oral candidiasis presents in which of the following ways?

A) White plaques that can be removed, leaving a red bleeding surface
B) Red patch
C) Red or white lesion in the midline of the tongue anterior to the circumvallate papillae
D) Cracking and fissuring of the angles of the mouth
E) All the above

Question 61

Oral epithelial dysplasia may:

A) Appear white clinically
B) Appear red clinically
C) Be seen on any mucosal surface
D) Progress to invasive squamous cell carcinoma
E) All the above

Question 62

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

A) Secondary herpes
B) Erythema multiforme
C) Lichen planus
D) Aphthous ulcers
E) Herpes zoster

Question 63

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

A) Ignored
B) Treated symptomatically if painful
C) Observed
D) Biopsied
E) None of the above

Question 64

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

A) Lichen planus
B) Cheek chewing
C) Hereditary benign intraepithelial dyskeratosis
D) White sponge nevus
E) Idiopathic leukoplakia

Question 65

The etiology of hairy tongue is associated with:

A) Systemic antibiotic therapy
B) Oral hydrogen peroxide abuse
C) Therapeutic irradiation to the head and neck
D) All the above
E) None of the above

Question 66

Idiopathic leukoplakia:

A) May recur after excision
B) Is caused by papillomavirus
C) Is clinically diagnostic and therefore requires no biopsy
D) Is most commonly seen in children and young adults
E) None of the above

Question 67

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

A) Fibrin membrane over a chronic ulcer
B) Intracellular edema of keratinocytes
C) Acanthosis
D) Hyperkeratosis
E) Vasculitis

Question 68

Hairy leukoplakia:

A) May be seen in non-HIV immunosuppressed patients
B) May appear as a flat or papillated lesion
C) Occurs most commonly on the tongue
D) May be bilateral
E) All the above

Question 69

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?

A) Squamous cell carcinoma
B) Hairy leukoplakia
C) Nicotine stomatitis
D) Leukoedema
E) Geographic stomatitis

Question 70

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

A) Atrophic lichen planus
B) Contact hypersensitivity
C) Lupus erythematosus
D) Chronic candidiasis
E) All the above

Question 71

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

A) White sponge nevus
B) Squamous cell carcinoma
C) Ectopic lymphoid tissue
D) Amalgam tattoo
E) None of the above

Question 72

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

A) Idiopathic leukoplakia
B) Erythroplakia
C) Submucous fibrosis
D) Lichen planus
E) All the above

Question 73

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

A) Candidiasis
B) Syphilis
C) Actinomycosis
D) Tuberculosis
E) Zoster

Question 74

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:

A) Vascular malformation
B) Nicotine stomatitis
C) Ecchymosis
D) Kaposi's sarcoma
E) Erythroplasia

Question 75

Actinic cheilitis:

A) Is quite harmless if Vaseline is used to protect the lip
B) Is due to infrared radiation
C) Has no malignant potential
D) Is seen predominantly in the lower lip
E) None of the above

Question 76

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?

A) Allergy to her denture material
B) Chronic candidiasis
C) Erythroplasia
D) Hemangioma
E) None of the above

Question 77

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

A) Mycelex troches
B) Lotrimin tablets
C) Acyclovir tablets
D) Nystatin pastilles
E) Mycostatin oral suspension

Question 78

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

A) Lichen planus
B) Hairy leukoplakia
C) Ectopic lymphoid tissue
D) Frictional hyperkeratosis
E) All the above

Question 79

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

A) Oral pigmented nevus
B) Lichen planus
C) Oral melanoma
D) Kaposi's sarcoma
E) Secondary herpes simplex

Question 80

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

A) Focal decrease in vascularity
B) Edema of keratinocytes
C) Hyperkeratosis
D) Fungal colonies growing in and on the superficial keratin
E) Acanthosis