Question 1

Bisphosphonates have been shown to be effective in the treatment of all the following except:

Accepted Answer

Bisphosphonates have been shown to be effective in the treatment of hypercalcemia of malignancy, osteoporosis, metastatic cancers to bone, and multiple myeloma. However, there is no evidence to support its efficacy in the treatment of salivary gland malignancies.

Question 2

Low-grade intrabony inflammation is a primary factor in the stimulation of which of the following lesions?

Accepted Answer

Low-grade intrabony inflammation is a primary factor in the stimulation of focal sclerosing osteitis.

Question 3

A periosteal reaction consisting of concentric layering of expanding cortical bone known as "onion skin" is most often associated with which of the following?

Accepted Answer

Garré's osteomyelitis is a bacterial infection of the bone that leads to the formation of new bone in layers, which can resemble an onion skin on x-ray. Hyperparathyroidism can also cause a periosteal reaction, but it typically appears as thin, parallel lines along the bone rather than concentric layers. Burkitt's lymphoma, ameloblastoma, and odontogenic keratocyst are not typically associated with periosteal reactions.

Question 4

When an inflammatory process of the jaws results in reduplication of the periosteum, as well as medullary bone inflammation, the condition is known as:

Accepted Answer

The description of reduplication of the periosteum and medullary bone inflammation is characteristic of Garré's osteomyelitis. Acute osteomyelitis is a more general term that refers to any acute inflammation/infection of bone. Diffuse sclerosing osteomyelitis and focal sclerosing osteomyelitis are synonyms for condensing osteitis, which is a different condition characterized by localized radiopacity in the jawbones. Therefore, choice D, Garré's osteomyelitis, is the best answer.

Question 5

A 10-year-old boy was seen because of a bony hard swelling of his left jaw. A panographic radiograph showed a mottled lucency associated with grossly carious tooth no. 19. He also had low-grade, intermittent pain associated with the tooth for the past year. This description best fits which of the following?

Accepted Answer

The description fits Garré's osteomyelitis, which is a chronic osteomyelitis characterized by a bony hard swelling with a periosteal reaction. It is typically associated with dental infections and presents with low-grade pain. The radiographic findings of a mottled lucency and grossly carious tooth support this diagnosis. Acute osteomyelitis would present with more severe symptoms such as fever, painful swelling and erythema. Focal and diffuse sclerosing osteomyelitis present with similar symptoms but without the mottled lucency seen in this case. Malignancy cannot be ruled out entirely but is less likely given the association with the carious tooth.

Question 6

A patient has severe tooth-associated pain. The tooth is sensitive to percussion. A radiograph shows only slight thickening of the apical periodontal membrane space. The tooth shows no response to electric pulp testing. This is most likely which of the following?

Accepted Answer

The severe tooth-associated pain, sensitivity to percussion, and lack of response to electric pulp testing suggest that the tooth has become infected, and the slight thickening of the apical periodontal membrane space indicates a periapical inflammatory response. A periapical abscess is the most likely diagnosis in this case. Chronic pulpitis would likely have less severe pain and less inflammation visible on radiographs. Periapical granuloma and cyst would not cause as much pain, and osteosarcoma is a rare and unlikely diagnosis.

Question 7

Jaw pain is a feature most often associated with:

Accepted Answer

Jaw pain is a common feature of a periapical abscess, which occurs when bacteria enter the tooth through a cavity or crack and infect the pulp, leading to an accumulation of pus at the tip of the tooth's root. The infection and inflammation can cause significant pain and swelling in the affected area. Periapical granuloma, periapical cemento-osseous dysplasia, odontogenic keratocyst, and dentigerous cyst may also cause jaw pain, but periapical abscess is the most common cause.

Question 8

Garré's osteomyelitis is usually associated with which of the following?

Accepted Answer

Garré's osteomyelitis is a form of chronic osteomyelitis that is characterized by the formation of new bone around the infected area. It is typically caused by a chronic dental infection, often associated with a decayed mandibular molar.

Quiz 13: Inflammatory Jaw Lesions