4th year questions

Question 1

A 14-year-old boy presents with a fluctuant, blue, soft tissue swelling affecting his lower labial mucosa following trauma to the lower face while playing football approximately two months ago. What is the most likely diagnosis?

Answer 1

Mucocele

Question 2

A 14-year-old boy been referred to the Oral Surgery Department for removal of the soft tissue mucocele affecting his lower lip. Which of the procedures is likely to be undertaken?

Answer 2

Excisional biopsy

Question 3

A 5-year-old male child is referred for investigation of a swelling affecting the floor of the mouth. Examination reveals a ranula. A ranula principally affects which one of the following glands?

Answer 3

Sublingual gland

Question 4

A 28-year-old woman attends her dental practice complaining of a recent onset of a midline neck swelling. Which of the following is an uncommon cause for this?

Answer 4

Plunging ranula

Question 5

A 27 year old woman attends the oral medicine department complaining of painless progressive bilateral parotid swelling. Examination reveals sialosis. Which one is associated with development of the condition?

Answer 5

Anorexia

Question 6

A 76-year-old man attends the dental practice complaining of ulceration affecting his palate. This was preceded by paraesthesia in the area. He has a history of tobacco use. Which one of the following conditions could account for his symptoms?

Answer 6

Necrotising Sialometaplasia

Question 7

A 56 year old woman complains of dry mouth. To determine if this is objective or subjective, unstimulated salivary flow is measured. Which flow rate indicates dry mouth?

Answer 7

Below 0.1ml/min

Question 8

A 60-year-old woman attends the Oral Medicine clinic complaining of a dry mouth. The Challacombe scale is used to identify and quantify the degree of oral dryness. The patient scores 10 on this scale. What is the most appropriate management?

Answer 8

Refer for further investigations

Question 9

A 67-year-old dentate patient complains of dry mouth and is keen to try salivary replacement. Which of the following preparations is most appropriate?

Answer 9

Orthana

Question 10

A 56-year-old woman attends the Oral Medicine Clinic complaining of dry eyes and a dry mouth. A Schirmer’s test is performed which is positive. Which of the following results is most likely to have been recorded to confirm this?

Answer 10

<5mm in 5mins

Question 11

A 25-year-old patient complains of pain from the floor of his mouth and swelling which coincides with meal times. Which initial investigation would best aid the possible diagnosis?

Answer 11

Occlusal radiographs (sialolith)

Question 12

A 4-year-old child attends with bilateral parotid swelling, fever, and malaise. Mumps is suspected as there has been a recent outbreak at the nursery which the child attends. Which virus is responsible for causing this condition?

Answer 12

Paramyxovirus

Question 13

A 76-year-old man has recently been admitted to hospital following a severe episode of gastroenteritis which has caused dehydration. During examination, a painful left parotid gland was palpated with pus expressed following massage. Which of the following bacteria causes salivary gland infection?

Answer 13

Staphylococcus aureus

Question 14

During the process of consenting a patient from removal of a mucocele affecting the lower lip, which of the following is an uncommon complication?

Answer 14

Paraesthesia

Question 15

A 56-year-old male patient attends with a left parotid swelling. He has recently noted ptosis and a loss of his left nasolabial fold. Which of the following tumours has a tendency for perineural spread?

Answer 15

Adenoid cystic carcinoma

Question 16

In relation to facial pain which of the following are behaviours which may prolong physical dysfunction?

Answer 16

Distorted thought processes

Question 17

In relation to primary/idiopathic trigeminal neuralgia what is a possible cause?

Answer 17

It may be due to pressure on the trigeminal nerve root from an adjacent vessel in the posterior cranial fossa

Question 18

A 25-year-old female patient presents with trigeminal neuralgia-like symptoms. What is the first secondary cause that needs to be excluded in this case?

Answer 18

Multiple sclerosis

Question 19

What is the most common oro-facial pain in the population?

Answer 19

Odontogenic pain

Question 20

What is the gold standard investigation in diagnosis of giant cell arteritis?

Answer 20

Temporal artery biopsy

Question 21

What is the most severe recognised complication of giant cell arteritis?

Answer 21

Blindness

Question 22

What is the usual management for giant cell arteritis?

Answer 22

Systemic corticosteroids

Question 23

Which of the following histories would be most consistent with a diagnosis of glossopharyngeal neuralgia?

Answer 23

Severe stabbing pain affecting the posterior oro-pharynx and triggered by swallowing

Question 24

What other condition other than glossopharyngeal neuralgia can give rise to glossopharyngeal neuralgia-like symptoms

Answer 24

Nasopharyngeal malignancy

Question 25

In relation to periodic migrainous neuralgia what best describes pain experienced by patient?

Answer 25

It is a unilateral excruciating pain in the maxilla or behind the eye

Question 26

Which of the following histories would be most consistent with a paroxysmal hemicrania?

Answer 26

Frequent, short lasting attack of unilateral peri-orbital pain, with associated conjunctival redness and nasal congestion

Question 27

In relation to persistent idiopathic facial pain (PIFP) what best describes the condition?

Answer 27

Constant chronic orofacial discomfort or pain, for which no organic cause can be found

Question 28

Which of the following histories would be most consistent with atypical facial pain?

Answer 28

A deep dull boring pain which can cross the midline

Question 29

What triggers are associated with migraines ?

Answer 29

Attacks may be precipitated by a wide range of triggers e.g chocolate / stress

Question 30

Describe type 1 burning mouth syndrome

Answer 30

It comes on as the day progresses and is unremitting

Question 31

Describe type 2 burning mouth syndrome

Answer 31

It is present on waking and throughout the entire day

Question 32

Describe type 3 burning mouth syndrome

Answer 32

There is no typical pattern, and atypical sites are affected

Question 33

Which of the treatment approach is used initially in the management of BMS?

Answer 33

Topical therapies, systemic treatments and behavioural strategies

Question 34

Describe the factors associated with the development of TMD?

Answer 34

Factors associated with development of the condition are multifactorial

Question 35

Describe the typical presenting symptoms in TMD?

Answer 35

Pain affecting pre-auricular region, with associated loss of hearing

Question 36

A 22-year-old fit, and healthy male patient is referred for diagnosis and management of an asymptomatic click from the left temporomandibular joint. You diagnose disc displacement with complete reduction. What is the most appropriate treatment for this patient?

Answer 36

Education

Question 37

Potential presentation of lichen planus?

Answer 37

It can be an incidental finding

Question 38

Describe the clinical patterns of lichen planus (6)

Answer 38

Reticular, papular, plaque, atrophic, erosive, bullous

Question 39

Where does lichen planus and lichenoid reaction rarely affect? (3)

Answer 39

Floor of mouth Palate Edentulous alveolar mucosa

Question 40

What can predispose a patient to dry socket? (6)

Answer 40

Traumatic extraction Impaired blood supply Smoking Oral contraceptives Osteosclerotic disease

Question 41

How would you manage dry socket?

Answer 41

Irrigate the socket with saline and place alvogel

Question 42

What could be done to reduce the chances of dry socket occurring again in the future?

Answer 42

Use a minimally traumatic extraction technique

Question 43

According to the 2017 ACR-EULAR Classification Criteria for Primary Sjögren's Syndrome, diagnosis is defined as a score of 4 or more. Which of the following permutations would indicate a diagnosis of Primary Sjögren's Syndrome?

Answer 43

Unstimulated salivary flow rate < 0.1ml/min and a focus score ≥ 1 focus/4 mm2

Question 44

A 65 year old woman attends your practice complaining of an ulcer on the side of her tongue that has been there for 2 months, and is around 2cm wide what features would make you suspect OSCC?

Answer 44

A single painless ulcer with red base, raised margins and is firm

Question 45

You refer a patient to your nearest Oral Surgery unit for further investigation of of a longstanding ulcer you feel may be malignant. The consultant there is also concerned about the possibility of malignancy. Which of the following is the best option?

Answer 45

Incisional biopsy

Question 46

A 14 year old girl with no medical problems attends her general dental practice with her parents for a routine dental check-up. It is noted that her upper right canine is still present and non-mobile. Permanent canine has yet to erupt. What would you do to manage this patient?

Answer 46

Take an IOPA to assess for the presence of the permanent canine and refer the patient to an orthodontist

Question 47

What is the most likely cause of a macrocytic anaemia?

Answer 47

B12 deficiency

Question 48

What is the most likely cause of a microcytic anaemia?

Answer 48

Iron deficiency

Question 49

A 72 year old man attends your practice complaining on a lump on his gum. The area is now affecting the fit of his dentures but is otherwise painless. What is the most likely diagnosis?

Answer 49

Denture induced hyperplasia

Question 50

How should denture induced hyperplasia be managed?

Answer 50

Excisional biopsy and alteration of the denture

Question 51

A patient attends your practice complaining of a rapidly enlarging swelling in the left pre-auricular region. The swelling is painless and the overlying skin is of normal colour. The patient had a pleomorphic adenoma excised from the left parotid gland over 10 years ago. What is the most likely diagnosis?

Answer 51

Carcinoma ex Pleomorphic adenoma

Question 52

A female aged 23 presents with a five-day history of pain from the right cheek. She informs you this has happened on numerous other occasions. What is the likely diagnosis?

Answer 52

Minor aphthous ulceration

Question 53

What investigation would be best to aid with your diagnosis of ulceration?

Answer 53

Haematological investigations

Question 54

Which group of drugs does midazolam belong to?

Answer 54

Benzodiazepines

Question 55

What drug can be used to reverse the effects of midazolam?

Answer 55

Flumazenil

Question 56

What of the following diagnoses best fits the definition: “a white patch that cannot be classified as any other disease and may be associated with an increased risk of malignancy”

Answer 56

Leukoplakia

Question 57

Which auto antibodies is likely to be present in a patient with primary Sjogren's syndrome?

Answer 57

Ro 60

Question 58

A 24-year old patient reports recurrent episodes of singular ulcers affecting the hard palate, which are greater than 1cm and heal after approximately 3 weeks. What is the likely diagnosis?

Answer 58

Major aphthous ulceration

Question 59

A 24-year-old patient reports recurrent episodes of ulcers (5 or more) affecting the buccal and labial mucosa, which are less than 1cm and heal within 10 days. What is the most likely diagnosis?

Answer 59

Minor aphthous ulceration

Question 60

An 18-year old patient presenting with cervical lymphadenopathy, lip ulceration and a maculopapular rash who has recently returned after holidaying abroad is likely to be suffering from which of the following infectious conditions?

Answer 60

Syphilis

Question 61

A 74 year old man is referred to you. You notice blueish swelling on lip. The patient is asymptomatic and the area is of soft on notice this area on palpation. What is the most likely diagnosis?

Answer 61

Vascular malformation

Question 62

What is the best way of managing a vascular malformation?

Answer 62

Cryotherapy

Question 63

An otherwise well 45-year-old female patient presents with a large pink, pedunculated lump on the buccal mucosa at the level of the occlusal plane. What is the most likely diagnosis?

Answer 63

Fibro-epithelial polyp

Question 64

An otherwise well 45-year-old female patient presents with a large red swelling affecting the gingiva which bleeds on probing. What is the most likely diagnosis?

Answer 64

Pyogenic granuloma

Question 65

You have diagnosed a patient with a bacterial infection of the right parotid gland. What is a possible presentation?

Answer 65

Pus expressed from the duct

Question 66

Best treatment for bacterial salivary gland infection?

Answer 66

Co-amoxiclav, maintain fluid intake and massage the area

Question 67

A patient notes a recurrent swelling around mealtimes in front of their right ear. Which would be the most appropriate test to aid your diagnosis?

Answer 67

Sialogram

Question 68

A patient presents with symptomatic red patch on the palate. The patient has a history of COPD and uses inhaled steroids daily? What is the most likely diagnosis?

Answer 68

Erythematous candidosis

Question 69

A patient presents with a white and red lesion on their soft palate. The white areas can be rubbed off, which leaves the red patch underneath?

Answer 69

Pseudomembranous candidosis

Question 70

Which species of candida is most associated with oral infection?

Answer 70

C. albicans

Question 71

Bacteria that causes Lyme's disease

Answer 71

Borrelia burgdorferi

Question 72

Bacteria that causes Impetigo

Answer 72

Staphylococcus aureus

Question 73

A 74-year-old man has a new sudden onset of severe throbbing pain in the from the right side of his head. The pain is made worse when he is eating and putting on his glasses. Which one of the following conditions is most likely to account for his symptoms?

Answer 73

Temporal arteritis

Question 74

What intra-oral findings would best support a diagnosis of temporomandibular joint disorder in a patient?

Answer 74

Evidence of parafunction eg. tongue scalloping, linea alba

Question 75

A 22-year-old fit and healthy male patient is referred for diagnosis and management of an asymptomatic click from the left temporomandibular joint. You diagnose disc displacement with complete reduction. What is the most appropriate treatment?

Answer 75

Education

Question 76

A 25-year-old female patient is referred for diagnosis and management of a dull pain from the left temporomandibular joint which is worse at times of stress. The patient has no medical problems and there is no limitation of jaw movements. What is the most appropriate treatment for this patient?

Answer 76

Analgesics

Question 77

Which oral locations have higher risk of transformation to cancer? (3)

Answer 77

Floor of mouth Retromolar pad Tongue

Question 78

Name a factor would cause potentially higher risk of dysplasia transforming into cancer?

Answer 78

Leukoplakia persisting with a lack of risk factors

Question 79

Treatment of recurrent aphthous ulceration

Answer 79

Topical steroid treatment to speed up healing

Question 80

Presentation of Varicella-zoster virus

Answer 80

Unilateral ulceration

Question 81

Patients complain of short bursts of agonising pain in one dermatome of Cranial nerve V. What is the likely diagnosis?

Answer 81

Trigeminal neuralgia

Question 82

Describe 1 feature of pain experienced with Shingles

Answer 82

Pain can mimic toothache

Question 83

Potential side effect of Shingles

Answer 83

Post herpetic neuralgia

Question 84

Pain from the upper jaw which is worse on stooping is most likely related to which non-odontogenic cause?

Answer 84

Maxillary sinusitis

Question 85

Potential trigger for trigeminal neuralgia

Answer 85

It can be triggered by cold air

Question 86

Potential cause of fibro-epithelial polyps

Answer 86

Recurrent trauma

Question 87

Virus causing squamous cell papilloma

Answer 87

Human papillomavirus

Question 88

Which drug is a first line treatment for management of neuralgia?

Answer 88

Carbamazepine

Question 89

What drugs may induce gingival hyperplasia? (3)

Answer 89

Nicorandil Phenytoin Cyclosporin

Question 90

What is the definition of a cyst?

Answer 90

Pathological cavity not formed by the accumulation of pus, which may be lined by epithelium and usually contains fluid or semi-fluid contents

Question 91

A 14 year old presents with a soft, fluctuant swelling on their lower lip. What is the most likely diagnosis?

Answer 91

Mucocele

Question 92

Describe how salivary calculi may be formed

Answer 92

Calcification of mucous plug over time

Question 93

Describe management strategies of salivary calculi (4)

Answer 93

Lemon drops Good hydration Remove with probe Basket retrieval (Sialendoscopy)

Question 94

Patient presents with a socket with pus following extraction. A localised abscess is diagnosed. What is your management?

Answer 94

Localised debridement under LA

Question 95

An 18 year old presents with bilateral salivary swelling around their parotid glands. What is the most likely diagnosis?

Answer 95

Mumps

Question 96

A patient presents to your clinic with a red ulcer on the lateral boarder of the tongue, which hasn’t healed for 3 weeks. What is the most appropriate course of action?

Answer 96

Red flag referral

Question 97

What condition is most likely to cause sub-epithelial blistering?

Answer 97

Mucous Membrane Pemphigoid

Question 98

What result will be raised in blood results from giant cell arteritis?

Answer 98

ESR

Question 99

A patient presents with pain in their pre-auricular region and cannot open past a certain level? What is your diagnosis?

Answer 99

TMD without reduction

Question 100

A patient presents with deformed fingers and is currently suffering from Sjogren’s Syndrome. What condition is likely to be affecting her fingers?

Answer 100

Rheumatoid Arthritis

Question 101

What investigation could be used in diagnosing Sjogren’s Syndrome?

Answer 101

Sialometry

Question 102

Name 2 common complications of Sjogren’s Syndrome

Answer 102

Lymphoma, heart block

Question 103

Common location for sialolith

Answer 103

Submandibular ducts

Question 104

What special investigation is useful in median rhomboid glossitis?

Answer 104

Swab

Question 105

What condition can predispose a patient to median rhomboid glossitis?

Answer 105

Diabetes

Question 106

Lichen planus is most commonly experienced by what gender

Answer 106

Affects more females than males

Question 107

Location that lichen planus/ lichenoid reaction rarely affects

Answer 107

The floor of the mouth

Question 108

Possible features that may predispose patient to dry socket (2)

Answer 108

Failure to follow post-operative instructions Traumatic extraction

Question 109

Onset of recurrent aphthous ulceration

Answer 109

Usually prior to the age of 20

Question 110

First presentation of Varicella-zoster virus infection

Answer 110

Chicken pox

Question 111

A patient arriving with primary Srojgens is likely to complain of

Answer 111

Dry gritty eyes and xerostomia