mosby Gen and ORal PAth mosby Flashcards
(111 cards)
1
Q
- Which intraosseous cyst occurs around the crown of
an unerupted tooth?
A. Eruption
B. Primordial
C. Dentigerous
D. Globulomaxillary
A
ANS: C
A dentigerous cyst (C) occurs around the crown of
an unerupted or developing tooth. An eruption cyst
(A), which is similar to a dentigerous cyst, is found
in the soft tissue around the crown of an erupting
tooth. A primordial cyst (B) develops in the place of
a tooth because of a disturbance in the tooth germ.
A globulomaxillary cyst (D) is a well-defined, pearshaped radiolucency found between the roots of the
maxillary lateral incisor and the canine.
2
Q
- Which condition occurs when the cementum or dentin
of a tooth fuses with the surrounding alveolar bone?
A. Concrescence
B. Ankylosis
C. Impaction
D. Gemination
A
ANS: B
Ankylosis (B) is the condition in which the cementum
or dentin of a tooth fuses with the surrounding
alveolar bone. A primary or permanent tooth
fuses with the surrounding alveolar bone, with no
intervening periodontal ligament. Concrescence (A)
is fusion of the cementum of two adjacent teeth only.
With impaction (C), or when a tooth is said to be
impacted, the tooth cannot erupt because of a physical
obstruction. Gemination (D) is a developmental
anomaly that occurs when a single tooth germ
attempts to divide and results in the incomplete
formation of two teeth
3
Q
- Aphthous ulcers typically occur in all of these sites
EXCEPT one. Which one is the EXCEPTION?
A. Labial commissure
B. Attached gingiva
C. Buccal mucosa
D. Soft palate
A
ANS: B
Aphthous ulcers typically do not occur in the
keratinized attached gingiva (B). Aphthous ulcers
typically occur on nonkeratinized mucosa such as the
labial commissure (A), the buccal mucosa (C), and
the soft palate (D)
4
Q
- Which bluish-gray lesion may appear as a radiopaque
area on a dental image?
A. Hematoma
B. Amalgam tattoo
C. Epulis fissuratum
D. Traumatic neuroma
A
ANS: B
An amalgam tattoo (B) may appear intraorally as
a flat, bluish-gray lesion of the oral mucosa. If
any amalgam particles are dispersed in tissue, the
tattoo may appear radiopaque on a dental image
and appear bluish-gray intraorally. A hematoma (A)
is a collection of blood within tissue as a result of
trauma. An epulis fissuratum (C) is a soft tissue lesion
associated with ill-fitting dentures and is not likely to be seen radiographically. A traumatic neuroma
(D) is a benign neoplasm of nerve cells. Soft tissue
lesions such as a hematoma, an epulis fissuratum, or a
traumatic neuroma are not visible on dental images.
5
Q
- Pericoronitis occurs most commonly in which
location?
A. Maxillary first premolars
B. Maxillary central incisors
C. Mandibular third molars
D. Mandibular second molars
A
ANS: C
Mandibular third molars (C) are the most common
locations for the occurrence of pericoronitis, an
inflammation of the tissue around a partially erupted
tooth. Pericoronitis occasionally occurs during the
eruption of mandibular second molars (D), but much
less frequently than with mandibular third molars.
Pericoronitis does not commonly occur around maxillary
first premolars (A) or maxillary central incisors (B).
6
Q
- There are several types of candidiasis, including
erythematous candidiasis and denture candidiasis.
Regardless of the type, all forms must be treated with
antibiotics.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second
statement is false.
D. The first statement is false, and the second
statement is true.
A
ANS: C
The first statement is true, and the second statement
is false (C). Several different types of candidiasis
exist, including erythematous candidiasis and denture
candidiasis. Candidiasis is a fungal infection, so
antibiotics are ineffective in treating this condition. The
treatment of choice is an antifungal medication. Choices
A, B, and D do not accurately reflect the statement
7
Q
- Enamel hypoplasia is caused by ameloblast formation
of too much enamel. Enamel hypocalcification occurs
when there is too little enamel formation.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second
statement is false.
D. The first statement is false, and the second
statement is true.
A
ANS: B
Both statements are false (B). Enamel hypoplasia
occurs when there is too little enamel formation (not
too much), and enamel hypocalcification is caused by
a defect in mineralization of enamel, not the amount of
enamel formed. Both enamel hypoplasia and enamel
hypocalcification have many causes, including damage
to the ameloblast by infectious agents, excess fluoride
ingestion during enamel formation, and inherited
conditions such as amelogenesis imperfecta. Choices
A, C, and D do not accurately reflect the statements.
7
Q
- Cross-reactive (C-reactive) protein is produced in the
A. liver.
B. thyroid.
C. spleen.
D. stomach.
A
ANS: A
Cross-reactive (C-reactive) protein is produced in the
liver (A) in response to inflammation. High levels
of C-reactive protein are indicative of systemic
inflammation. The thyroid (B) produces thyroid
hormone. The spleen (C) produces blood cells. The
stomach (D) produces intrinsic factor necessary for
absorption of vitamin B12.
8
Q
- Which lesion may be associated with hormonal
changes?
A. Thyroid nodule
B. Pyogenic granuloma
C. Fordyce granules
D. Hemangioma
A
ANS: B
A pyogenic granuloma (B), sometimes called a
pregnancy tumor, may be associated with hormonal changes as occurs during puberty and pregnancy.
These lesions may also occur in males and
nonpregnant women, often as a response to injury or
as an increased response to plaque. A thyroid nodule
(A) is a small mass of thyroid tissue located on the
tongue, distant from the normal anatomic location of
the thyroid gland. Fordyce granules (C) are clusters of
ectopic sebaceous glands, commonly seen on the lips
and buccal mucosa. A hemangioma (D) is a benign
proliferation of newly formed blood vessels.
9
Q
- Which response is NOT a sign or implication of a
local inflammation?
A. Redness
B. Swelling
C. Heat
D. Lymphadenopathy
A
ANS: D
Lymphadenopathy (D), an enlargement of the lymph
nodes, is not a response to a local inflammation but
may be a sign of systemic inflammation. Redness
(A), swelling (B), and heat (C) are all signs of local
inflammation
10
Q
- Bulimia is often associated with which oral
condition?
A. Attrition
B. Abrasion
C. Erosion
D. Abfraction
A
ANS: C
Erosion (C) is tooth loss caused by chemical action.
Bulimia, an eating disorder characterized by food
binges followed by self-induced vomiting, is often
associated with erosion of the lingual surfaces of
teeth. Attrition (A) is wearing of tooth structure
caused by normal wear (i.e., disappearance of
mamelons). Abrasion (B) causes loss of tooth
structure from a repetitive mechanical habit (i.e.,
toothbrush abrasion). Abfraction (D) appears as a
wedge-shaped defect at the cementoenamel junction
(CEJ) and is thought to be a result of biomechanical
forces on teeth.
10
Q
- Aspirin burn will appear
A. as a nonpainful, chronic lesion on the hard palate.
B. as an acute, painful, white lesion on the buccal
mucosa.
C. as an acute, nonpainful, red lesion the floor of the
mouth.
D. as a red-and-white, chronic, painless lesion
requiring biopsy.
A
ANS: B
Aspirin burn is a white lesion usually found on the
buccal mucosa caused by the patient placing aspirin
on the mucosa near a tooth that is painful. Aspirin
placed on mucosa produces a chemical burn that is an
acute, painful reaction (B). Diagnosis would usually be made by questioning the patient on the history of
the toothache and the white lesion. A chronic lesion
(A) is present for a long time. Aspirin burn may be
a red-and-white lesion, but it is rarely painless and
is not usually found on the floor of the mouth (C).
Aspirin burn does not require a biopsy (D). Once the
patient stops placing the irritant (aspirin) in the area,
the mucosal tissue will heal.
11
Q
- The dental hygienist has just done an in-service
presentation to the nurses’ aides at the nursing home,
and one of the nurses’ aides calls and states to the
office that she just noticed a hard lump on the roof of
the mouth of one of the residents, and although it does
not hurt, she is worried that it might be cancer, since
the resident is a smoker. What is the MOST likely
clinical diagnosis?
A. Torus palatinus
B. Paget disease of the bone
C. Compound odontoma
D. Osteosarcoma
A
ANS: A
The tori palatinus or palatal torus is an exophytic
growth of normal compact bone (A). Palatal tori
have a hereditary tendency to occur more frequently
in women. These asymptomatic growths develop
gradually and are found clinically in the midline
of the palate. Tori may be lobulated. Paget disease
of bone (B), also called osteitis deformans, is a
chronic metabolic bone disease, characterized by
resorption, osteoblastic repair, and remineralization
of the involved bone. More common in older men,
the disease usually affects the spinal column and the
pelvis, although it may affect the skull. The maxilla
is more commonly affected compared with the
mandible, and the disease occurs most commonly
in men over the age of 50 years. When found in the
jawbones, the maxilla is more commonly affected
than the mandible; bone enlarges in the maxilla,
causing spaces between teeth, not the midline
of the palate. Paget disease is often painful, and
radiographically appears as a patchy radiolucency
and radiopacity and is referred to as a cottonwool appearance in the later stages of the disease.
Compound odontomas (C), along with complex
odontomas, are the most common odontogenic
tumors and are often associated with unerupted
teeth. Compound odontomas are more common
in the anterior area and are composed of multiple
small toothlike structures. They are usually detected
radiographically, not clinically, and the midline of
the palate is not a likely location. Osteosarcoma or
osteogenic sarcoma (D) is a malignancy of boneforming tissue and is the most common primary
malignant tumor in persons under 40 years of age.
Tumors involving the jaw are twice as common in
the mandible as in the maxilla and occur as a diffuse
swelling or mass that is often painful or causes
paresthesia.
12
Q
- Crack cocaine use may exhibit all clinical findings
EXCEPT one. Which one is the EXCEPTION?
A. Parched lips
B. Xerostomia
C. Irritation of the palate
D. Irritation of the floor of the mouth
E. Increased heart rate and blood pressure
A
ANS: D
The floor of the mouth (D) does not usually exhibit
clinical findings as effects of crack cocaine use.
The lips (A) are frequently parched, and cocaine’s
stimulation of the sympathetic autonomic nervous
system causes xerostomia (B) and increased heart rate
and blood pressure (E). The heat of smoking crack
cocaine irritates the palate (C).
13
Q
- What is the BEST method of diagnosis of linea alba?
A. Clinical appearance
B. Biopsy
C. VELscope™
D. Brush test
A
ANS: A
Linea alba is diagnosed by its unique clinical
appearance (A). Biopsy (B) is not necessary when it
can easily be diagnosed through less invasive means.
VELscope™ (C) and brush test (D) do not make any
contribution to the diagnosis.
14
Q
- Traumatic ulcers are usually diagnosed through which
diagnostic procedure?
A. History of lesion
B. Clinical appearance only
C. Microscopic diagnosis
D. Therapeutic diagnosis
A
ANS: A
Traumatic ulcers are diagnosed on the basis of the
history of the lesion (A). Clinical appearance (B) may
resemble other ulcerative conditions. Microscopic
diagnosis (C) would rule out other, more serious
conditions. Therapeutic diagnosis (D) would not be
helpful at all. Traumatic ulcers heal spontaneously
within a few days.
15
Q
- Actinic cheilitis is only caused by
A. smoking.
B. use of lip gloss.
C. sun.
D. consistent trauma from a pipe stem.
A
ANS: C
Actinic or solar cheilitis is caused by ultraviolet
radiation from the sun (C). Smoking (A) may cause
other traumatic lip or oral lesions but not solar
cheilitis. Lip gloss (B) with a high sun protection
factor (SPF) helps decrease tissue reaction but will not
cause solar cheilitis. Trauma from a pipe stem (D) may
cause other traumatic lesions but not solar cheilitis.
15
Q
- Nicotine stomatitis first appears clinically as a/an
A. overall erythroplakia.
B. white lesion.
C. ulcerated area.
D. brown stain.
A
ANS: A
The initial response in nicotine stomatitis is overall
erythroplakia (A) of the palate. Over time, it becomes
a white lesion (B) (a hyperkeratotic area) with tiny
red spots where the salivary glands are inflamed.
Nicotine stomatitis usually does not manifest as an
ulcerated area (C), and although there may be brown
stain (D) on teeth, the stain would not appear on the
palatal tissues.
16
Q
- Necrotizing sialometaplasia is clinically
characterized by
A. ulceration in the affected area.
B. fever.
C. lymphadenopathy.
D. lack of saliva
A
ANS: A
Necrotizing sialometaplasia is characterized by
ulceration in the affected area (A). The ulceration is
caused by lack of blood supply to the area, usually
associated with trauma, and the most common
site is the palate. Fever (B) and lymphadenopathy
(C) are systemic reactions not characteristic of
necrotizing sialometaplasia. Lack of saliva (D),
or dry mouth, is not a characteristic of necrotizing
sialometaplasia.
17
Q
- Pyogenic granuloma is associated with
A. acute infection.
B. older age.
C. chronic inflammation.
D. a genetic condition.
A
ANS: C
A pyogenic granuloma is a response to chronic
inflammation (C). An acute infection (A) does
not cause a pyogenic granuloma. The patient’s
advanced age (B) and genetics (D) do not
contribute to the development of a pyogenic
granuloma.
18
Q
- Which drug does NOT cause gingival enlargement?
A. Phenytoin (Dilantin)
B. Nifedipine (Procardia)
C. Penicillin
D. Amlodipine (Norvasc)
A
ANS: C
Penicillin (C) is an antibiotic, and antibiotics do not
cause gingival enlargement. Phenytoin (Dilantin) (A)
is an anticonvulsant, and nifedipine (Procardia) (B)
and amlodipine (Norvasc) (D) are calcium channel
blockers frequently prescribed for hypertension and
other cardiovascular conditions, and all cause gingival
enlargement.
19
Q
- Chronic hyperplastic pulpitis is seen clinically
A. within an open carious crown of a tooth.
B. at the apex of the root.
C. between roots.
D. at the gingival margin.
A
ANS: A
Chronic hyperplastic pulpitis, also known as a
pulp polyp, is found within an open carious crown
of a tooth (A). It is an excessive proliferation of
chronically inflamed dental pulp tissue. Therefore, it
is not found at the apex of the root (B), between roots
(C), or at the gingival margin (D).
20
Q
- Which does NOT describe the characteristics of a
radicular cyst?
A. Is a true cyst
B. Is caused by caries
C. Is a pseudocyst
D. Occurs in nonvital tooth
A
ANS: C
A pseudocyst (C) lacks an epithelial lining and does
not fit the characteristics of a true cyst. A true cyst is
a fluid-filled, epithelium-lined sac. A radicular cyst
is a true cyst (A). A radicular cyst is usually caused
by caries (B), and the tooth will test nonvital on a
vitalometer (D).
21
Q
- The radicular cyst will have a similar radiographic
appearance to all of these pathologies EXCEPT one.
Which one is the EXCEPTION?
A. Periapical granuloma
B. Abscess
C. Dentigerous or follicular cyst
D. Periapical cyst
A
ANS: C
Radiographically, a dentigerous or follicular cyst (C)
appears as a radiolucent sac surrounding the crown
of an unerupted tooth. Periapical granulomas (A),
abscesses (B), and periapical cysts (D) all appear
radiographically as a round or oval radiolucency at
the apex of a nonvital tooth.
22
25. Which recurrent aphthous ulcer occurs most
commonly?
A. Major aphthous ulcer
B. Minor aphthous ulcer
C. Herpetiform ulcer
D. Sutton disease ulcer
ANS: B
Of all types of aphthous ulcers, minor aphthous ulcers
(B), which measure 3 to 5 millimeters (mm), occur most
often. Major aphthous ulcers (A) and Sutton disease
ulcers (D) are the same; they are much larger (greater
than 1 centimeter [cm]) than minor or herpetiform ulcers
and may cause scarring upon healing. Herpetiform
aphthous ulcers (C), the smallest of aphthous ulcers,
measure 1 to 2mm and may occur in groups.
23
26. What is another term for hives?
A. Urticaria
B. Sutton disease
C. Pruritus
D. Contact dermatitis
ANS: A
Urticaria (A) is another term for hives, a type 1
hypersensitivity reaction. Sutton disease (B) is
another name for major aphthous ulcers. Pruritus (C)
is itching. Contact dermatitis (D) occurs when an
allergen has direct contact with skin. It is a type IV
hypersensitivity reaction.
24
27. All are characteristics of lichen planus EXCEPT one.
Which one is the EXCEPTION?
A. Benign, chronic condition
B. Wickham striae
C. Desquamative gingivitis
D. Bull’s-eye skin lesions
ANS: D
Bull’s-eye skin lesions (D) are associated with
erythema multiforme, not lichen planus. Lichen planus
is a benign, chronic condition (A) characterized by the
white interconnecting lines that are seen clinically on
the mucosa, known as Wickham striae (B). In addition,
desquamative gingivitis (C) may also accompany the
erosive form of lichen planus.
25
28. A triad of symptoms—joint pain, urethritis, and
conjunctivitis—are associated with which condition?
A. Behçet syndrome
B. Hand-Schüller-Christian disease
C. Reactive arthritis
D. Lichen planus
ANS: C
Arthritis, urethritis, and conjunctivitis are a triad
of symptoms associated with reactive arthritis (C).
Behçet syndrome (A) has a triad of locations: (1) oral,
(2) genital, and (3) ocular. Hand-Schüller-Christian
disease (B) is a form of Langerhans cell disease with
a triad of symptoms that includes: (1) “punched out" radiolucencies in the skull, (2) exophthalmos, and
(3) diabetes insipidus. Lichen planus (D) is a benign,
chronic condition affecting the mucosa and skin and
does not present with these symptoms.
26
29. Patients with systemic lupus erythematosus (SLE)
may require modifications to dental hygiene
treatment EXCEPT one. Which one is the
EXCEPTION?
A. Treatment of erosive oral lesions
B. Delay of treatment because of
immunosuppression
C. Increased use of fluorides
D. Use of adaptive oral hygiene aids
ANS: C
Patients with systemic lupus erythematosus (SLE) may
have complex medical and dental needs because of the
effects of the disease, but increased caries risk is not
directly related to SLE (C). Skin and mucous membrane
lesions are common, especially the “butterfly or malar
rash” that is associated with SLE. The oral lesions (A)
may be quite painful, requiring palliative treatment.
Patients are often on high doses of corticosteroids,
which suppress the immune system and make the
patient more susceptible to infections (B). There is often
significant joint pain and limited mobility as the disease
course progresses, so the patient may require adaptive
oral hygiene aids (D).
27
30. Acantholysis occurs in:
A. lichen planus.
B. normal mucosa.
C. pemphigus vulgaris.
D. mucosal membrane pemphigoid.
ANS: C
Acantholysis, the separation of intracellular bridges in
epithelial cells, occurs in pemphigus vulgaris (C). In
lichen planus (A), there is degeneration of cells at the
basal cell layer. In normal mucosa (B) and mucosal
membrane pemphigoid (D), there is no separation
within the epithelial cells.
28
31. Oral and genital ulcers and ocular
inflammation are characteristics of
which condition?
A. Erythema multiforme
B. Behçet syndrome
C. Hand-Schüller-Christian disease
D. Reactive arthritis
ANS: B
The diagnosis of Behçet syndrome (B) requires that
two of the following three characteristics be met:
(1) oral ulcers, (2) genital ulcers, and (3) ocular
inflammation. In erythema multiforme (A), oral
lesions and “target eye” or “iris eye” skin lesions are
present. Hand-Schüller Christian disease (C) is a form
of Langerhans cell disease, with a triad of symptoms,
including “punched out” radiolucent areas in the
skull, exophthalmos, and diabetes insipidus. Reactive
arthritis (D) has a triad of symptoms that includes:
(1) arthritis, (2) urethritis, and (3) conjunctivitis.
29
32. Which condition is a bacterial skin infection?
A. Impetigo
B. Erythema multiforme
C. Lichen planus
D. Systemic lupus erythematosus (SLE)
ANS: A
Impetigo (A) is a bacterial skin infection seen on the
face and extremities of young children. The lesions, which are vesicles that rupture and form crust or
longer-lasting bullae, are infectious and may itch.
Erythema multiforme (B) is a hypersensitivity
reaction. Lichen planus (C) is a chronic disease
affecting the skin and oral mucosa. Systemic
lupus erythematosus SLE (D) is an inflammatory
autoimmune disease of unknown cause.
30
33. Strawberry tongue is associated with which
condition?
A. Rheumatic fever
B. Scarlet fever
C. Tuberculosis
D. Chickenpox
ANS: B
Strawberry tongue is associated with scarlet fever, a
streptococcal infection (B). Rheumatic fever (A) is
an immunologic response to streptococcal infection
that involves damage to the heart valves, joints, and
the central nervous system. Tuberculosis (C) is an
infection of the lungs. Tubercular oral lesions are
rare, but when they do occur, the tongue and the
palate are the most common locations. Chickenpox
(D) is caused by varicella-zoster virus (VZV), not a
bacterium.
31
34. Which is the MOST characteristic clinical feature of
herpes zoster?
A. Fever
B. Unilateral lesions
C. Patient’s age
D. Ulcers throughout the oral mucosa
ANS: B
The most common clinical feature of herpes zoster is
unilateral vesicles (B) along a sensory nerve. Fever
(A) is a systemic factor and not a key factor in herpes
zoster. Herpes zoster occurs most frequently in adults
as a recurrent infection of the varicella (chickenpox
virus) that manifests as herpes zoster (C). Oral ulcers
in herpes zoster are confined to half the oral cavity
and do not occur throughout the oral mucosa (D).
32
35. Which condition is NOT associated with
tuberculosis?
A. Positive protein derivative (PPD)
B. Granulomatous disease
C. Primary infection in oral tissues
D. Kidney and liver involvement
ANS: C
The primary infection site of tuberculosis (TB) is
the lung, not the oral tissues (C). Purified protein
derivative (A) is the skin test for TB. TB is a
granulomatous disease (B) and a chronic, infectious
disease. In advanced stages, widespread TB involves
the kidneys and the liver (D). Tuberculosis outside
of the lungs is referred to as miliary tuberculosis.
33
36. Actinomycosis is caused by a/an
A. fungus.
B. filamentous bacterium.
C. abscess.
D. spirochete
ANS: B
Actinomycosis is caused by a filamentous bacterium
(B). At one time, the cause was thought to be a
fungus (A), and this gave rise to the term mycosis. An
abscess (C) is present in actinomycosis but is not the
cause. A spirochete (D) causes syphilis.
34
38. An operculum contributes to which condition?
A. Necrotizing ulcerative gingivitis (NUG)
B. Syphilis
C. Tuberculosis (TB)
D. Pericoronitis
ANS: D
An operculum is a flap of tissue around the crown
of a partially erupted tooth. When the operculum
becomes inflamed as a result of bacteria or from
trauma, the condition is called pericoronitis (D).
The mandibular third molar is the most commonly
affected tooth. Necrotizing ulcerative gingivitis
(NUG) (A) involves gingival tissues. Syphilis (B)
may present with lesions on the lips or the tongue.
Tuberculosis (C) rarely manifests oral lesions, but
when it does, the lips and the tongue are affected.
35
37. Syphilis is caused by
A. Actinomyces israelii.
B. Treponema pallidum.
C. Mycobacterium tuberculosis.
D. Borrelia vincentii.
ANS: B
Treponema pallidum (B) is the spirochete that
causes syphilis. Actinomyces israelii (A) causes
actinomycosis. Mycobacterium tuberculosis (C)
causes tuberculosis. Borrelia vincentii (D) and a
fusiform bacillus are associated with necrotizing
ulcerative gingivitis (NUG).
36
39. Which condition is MOST often associated with loss
of vascularity in bone?
A. Paget disease
B. Sickle cell disease
C. Radiation to bone
D. Periapical cemento-osseous dysplasia
ANS: C
Radiation to bone (C) damages small vasculature,
increasing the risk of osteoradionecrosis because of
the resulting decreased blood supply. Paget disease
(A) is primarily associated with bone resorption,
osteoblastic repair, “cottonwool” appearance of bone,
and elevated serum alkaline phosphatase levels in
blood. Sickle cell anemia (B) causes radiographic
changes to bone, including loss of trabeculation with
large marrow spaces. Periapical cemento-osseous
dysplasia (D) causes changes in bone density but is not
usually associated with changes in vascularity in bone.
37
40. Candidiasis is an overgrowth of a
A. yeastlike fungus.
B. spirochete.
C. filamentous bacterium.
D. fusiform bacillus.
ANS: A
Candidiasis is an overgrowth of the yeastlike fungus
(A) Candida albicans. It is usually a result of
immunosuppression. A spirochete (B) is a bacterium
of the order Spirochaetales and may cause syphilis,
relapsing fever, yaws, Lyme disease, necrotizing
ulcerative oral diseases, and others. A filamentous
bacterium (C) is part of a long strand of bacteria
that interlock to each other and are associated with
chronic diseases. A fusiform bacillus (D) is formed by
the fused strands of the narrow filaments of bacteria;
it is tapered at both ends and is commonly associated
with several human diseases, including periodontal
disease. None of these is associated with candidiasis.
38
41. Clinically, pseudomembranous candidiasis is
described as
A. a white, curdlike material that cannot be
rubbed off.
B. denture stomatitis.
C. a white, curdlike material that can be wiped off.
D. red and painful mucosa.
ANS: C
Pseudomembranous candidiasis presents as a white,
curdlike material that can be wiped off (C), leaving a
red and painful area underneath. Chronic hyperplastic
candidiasis (A) manifests as a white material that
cannot be rubbed off. Chronic atrophic candidiasis
(B) is often referred to as denture stomatitis. Candidal
infection presents as red, painful mucosa (D) in
erythematous candidiasis
39
43. Types 16 and 18 of human papillomavirus (HPV)
have been specifically linked to anal, cervical,
vulvar, and oropharyngeal cancers. HPV types 6 and
11, which cause condyloma acuminatum, are also
considered oncogenic viruses.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second
statement is false.
D. The first statement is false, and the second
statement is true.
ANS: C
The first statement is true, and the second statement is
false (C). Viruses with the potential to turn normal cells
into cancerous cells are termed oncogenic viruses. HPV
is part of a group of over 150 related viruses, with over
40 types that are sexually transmitted. HPV types 16
and 18 are termed “high risk” types of HPV because of
their neoplastic potential. These HPV types are linked
to anal cancer, oropharyngeal squamous cell carcinoma,
and cervical cancer. About 90% of condyloma
acuminatum cases are linked to HPV types 6 and 11,
which have the lowest neoplastic potential (“low risk”)
but are one of the HPV types that can cause genital
warts and may be a marker of sexual abuse if found
in the oral cavity of a child. The current HPV vaccine
protects against HPV types 6, 1l, 16, and 18. Choices A,
B, and D do not accurately reflect the statements.
39
42. The MOST common type of candidiasis affecting the
oral mucosa is
A. pseudomembranous candidiasis.
B. hypertrophic candidiasis.
C. candidal leukoplakia.
D. chronic atrophic candidiasis
ANS: D
Chronic atrophic candidiasis (D), also known as
denture stomatitis, is the most common type of
candidiasis. Pseudomembranous candidiasis (A)
occurs when a white, curdlike material appears on
the mucosa and can be rubbed off, leaving a bloody,
red undersurface. Hypertrophic candidiasis (B) and
candidal leukoplakia (C) are different terms for the
same condition, and these lesions cannot be rubbed of
40
45. Varicella-zoster-virus (VZV) causes chickenpox and
what other disease?
A. Measles
B. Mumps
C. Shingles
D. Mononucleosis
ANS: C
Shingles (C), or herpes zoster, is also caused by
varicella-zoster-virus (VZV). Measles (A) and mumps
(B) are caused by a paramyxovirus. Mononucleosis
(D) is caused by Epstein-Barr virus (EBV).
41
44. What is the primary feature that distinguishes herpes
simplex 1 from herpes zoster?
A. Painful, burning gingiva
B. Vesicles in oral cavity
C. Depressed immunologic function
D. Unilateral distribution of vesicle
ANS: D
“Unilateral distribution of vesicles (D) along the
pathway of a sensory nerve” describes the location for herpes zoster. In both diseases, the patient may
experience painful, burning gingiva (A) and vesicles
in the oral cavity (B), and outbreaks occur when the
host’s immune response is depressed (C).
42
46. A negative test for human immunodeficiency virus
(HIV) indicates that a person is free of HIV. This
is because antibodies are produced within days of
exposure to HIV.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second
statement is false.
D. The first statement is false, and the second
statement is true.
ANS: B
Both statements are false (B). A negative HIV
test is not necessarily proof of being free of the
infection. A 4- to 6-week period may exist after viral
exposure before enough antibodies are produced
(seroconversion) to cause a positive antibody assay.
This is termed the window of infectivity and may
allow inadvertent disease transmission. Choices A, C,
and D do not accurately reflect the statements.
43
47. Hairy leukoplakia is caused by which virus?
A. Epstein-Barr virus (EBV)
B. Human-immunodeficiency virus (HIV)
C. Human papilloma virus (HPV)
D. Herpes simplex virus (HSV)
ANS: A
Epstein-Barr virus (EBV) (A) causes hairy
leukoplakia. Human immunodeficiency virus
(HIV) (B), human papilloma virus (HPV) (C), and
herpes simplex virus (HSV) (D) do not cause hairy
leukoplakia.
44
48. Characteristics of ankyloglossia include all EXCEPT
one. Which one is the EXCEPTION?
A. The cause is a short lingual frenum.
B. The patient may experience speech
problems.
C. Corrective treatment is frenectomy.
D. Ankyloglossia is associated with other congenital
syndromes.
ANS: D
Ankyloglossia is an independent finding, not associated
with other syndromes such as cleft lip or cleft palate
(D). Ankyloglossia is caused by a short lingual frenum
(A), may cause speech problems (B), and is treated
with a surgical procedure called a frenectomy (C).
45
49. All are examples of hypersensitivity reactions
involving antibodies EXCEPT one. Which one is the
EXCEPTION?
A. Asthma
B. Hay fever
C. Contact dermatitis
D. Anaphylaxis
E. Angioedema
ANS: C
Contact dermatitis (C) is a type IV hypersensitivity,
or delayed hypersensitivity. T-lymphocytes previously sensitized by an antigen produce
cytokines that cause tissue damage. This is termed
cell-mediated hypersensitivity. Asthma (A), hay
fever (B), anaphylaxis (D), and angioedema
(E) are all examples of type I or immediate
hypersensitivity reactions and occur within
minutes after exposure to an antigen or allergen
such as latex, seafood, or pollen. In this type of
hypersensitivity, B-cells produce plasma cells,
which produce the antibody immunoglobulin
E (IgE) in response to the antigen. IgE stimulates
mast cells to release histamine granules, which
results in vasodilation, vascular permeability,
edema, and constriction of the smooth muscles
of the bronchioles of the lungs, giving rise to
conditions such as asthma, hay fever, anaphylaxis,
and angioedema.
46
50. Which type of cyst develops in place of a tooth?
A. Dentigerous
B. Primordial
C. Botryoid
D. Lateral periodontal
ANS: B
A primordial (B) cyst develops in place of a tooth.
A dentigerous (A) cyst develops around the crown of
an unerupted tooth, usually a third molar. Botryoid
(C) and lateral periodontal (D) cysts have very similar
characteristics, beginning with locations between
the roots of the mandibular cuspid and the premolar.
Radiographically, the botryoid cyst is multilocular,
whereas the lateral periodontal cyst is usually
unilocular
47
51. The type of immunity received after the full
series of immunizations against hepatitis B is
called
A. natural passive immunity.
B. acquired or artificial passive immunity.
C. natural active immunity.
D. acquired or artificial active immunity.
ANS: D
Acquired or artificial active immunity (D) occurs
when the host produces an antibody in response
to an altered pathogenic microorganism or to the
products of the organism that are introduced by
vaccination. Natural passive immunity (A) occurs
when antibodies are passed from an individual who
has immunity to a susceptible individual, usually
in the form of maternal antibodies in utero or
through breast milk. Acquired or artificial passive
immunity (B) may also be achieved through
injection of preformed antibodies such as hepatitis B
immunoglobulin against a microorganism to which
the person has not previously developed antibodies.
Both natural and artificial passive immunities
provide immediate short-term protection against the
pathogen. Natural active immunity (C) occurs when
the host is exposed to a pathogenic microorganism
and the immune system produces protective
antibodies. Artificial and natural active immunities
take several weeks to develop but confer much
longer immunity.
48
52. Which cyst often appears as a heart-shaped radiolucency?
A. Radicular
B. Nasopalatine canal
C. Globulomaxillary
D. Lateral periodontal
ANS: B
The nasopalatine canal (B) cyst often appears as a
heart-shaped radiolucency in the area of the incisive
canal. The radicular (A) cyst is located at the apex
of a carious tooth. The globulomaxillary (C) cyst is
pear shaped and is located between the roots of the
maxillary lateral incisor and the cuspid. The lateral
periodontal (D) cyst is a unilocular lesion located
between the roots of the mandibular cuspid and the
premolar region.
49
53. Which cyst does NOT have alveolar bone
involvement?
A. Nasopalatine canal
B. Nasolabial
C. Residual
D. Radicular
ANS: B
The nasolabial (B) cyst is a soft tissue cyst with
no alveolar bone involvement (also known as a
peripheral cyst). The nasopalatine canal (A) cyst is
located in the anterior maxilla between the apices
of the maxillary central incisors. Residual (C) and
radicular (D) cysts are located in the alveolar process
of the maxilla or the mandible apical to the affected
tooth or the extraction site. Cysts that are located
within alveolar bone are termed central cysts.
50
54. Which cyst is filled with salivary gland tissue?
A. Simple bone
B. Traumatic bone
C. Static bone
D. Dermoid
ANS: C
The static bone (or Stafne bone) (C) cyst is filled with
salivary gland tissue. Simple bone (A) and traumatic
bone (B) cysts are the same and reveal a void
within bone. In the dermoid (D) cyst, hair follicles,
sebaceous glands, and sweat glands may be seen in
the cyst wall.
51
55. The most common supernumerary tooth is the
A. mesiodens.
B. distomolar.
C. maxillary permanent lateral.
D. third molar.
ANS: A
A mesiodens (A), or mesiodent, is the most common
supernumerary tooth and is located between the
maxillary central incisors. The distomolar (B), located
distal to the third molar, is the second most common
supernumerary tooth. The maxillary permanent lateral
(C) varies the most in shape and form but is not a
supernumerary tooth. Third molars (D) are part of the
permanent dentition and not supernumerary teeth.
52
56. The enamel pearl is
A. seen as a radiopaque sphere on the root.
B. an extra cusp seen on the crown of permanent
incisors.
C. the same as a taurodont.
D. the same as a talon cusp.
ANS: A
The enamel pearl is usually located at the root
furcation on maxillary molars and is viewed as a
radiopaque sphere on a radiograph (A). An extra cusp
on the crown of permanent incisors (B), usually on the lingual aspect in the cingulum, is known as an
accessory cusp or talon cusp (D). A taurodont (C)
is a tooth that exhibits elongated, large pulp chambers
and short roots.
53
57. Enamel hypoplasia may result from all
conditions EXCEPT one. Which one is the
EXCEPTION?
A. Trauma
B. Local infection
C. Fluoride
D. Tetracycline
ANS: D
Tetracycline (D), taken during tooth development,
binds to the developing dentin, not to enamel. Trauma
(A), local infection (B), and increased fluoride
ingestion (C) may all cause a defect in enamel
formation or may cause enamel hypoplasia.
54
58. Autosomes are
A. nonsex-linked chromosomes.
B. located at the periphery of the nucleus of cells in
women.
C. codons.
D. centromeres
ANS: A
Autosomes are somatic, or nonsex-linked,
chromosomes (A). Barr bodies are located at the
periphery of the nucleus of cells in women (B).
The codon (C) is the sequence of three bases in
deoxyribonucleic acid (DNA) that encodes an amino
acid. A centromere (D) is the constricted area of the
chromosome that joins the long and short arms.
55
59. The difference between primitive germ cells and
mature germ cells is
A. 23 chromosomes.
B. 46 chromosomes.
C. trisomy.
D. phenotype.
ANS: A
The difference between primitive germ cells and
mature germ cells is 23 chromosomes (A). A
primitive germ cell has 46 chromosomes (B), whereas
a mature germ cell has 23 chromosomes. Trisomy
(C) is a pair of chromosomes with one identical extra
chromosome. Phenotype (D) is a term that describes
the physical traits of an individual.
56
60. Which is NOT associated with trisomy 21?
A. Failure of chromosome pairs to separate or
nondisjunction
B. Down syndrome
C. Three identical chromosomes at the same allele
D. Increased intelligence
ANS: D
Individuals with trisomy 21 are mentally challenged
and have lower intelligence (D). Nondisjunction, or
failure of the chromosome pair to divide properly
(A) is the cause of 95% of individuals with trisomy
21. Trisomy 21 is more commonly known as Down
syndrome (B). Trisomy 21 has three identical
chromosomes at the same allele (C) instead of two,
which is the correct number of identical chromosomes.
57
61. Most cases of Turner syndrome result from
A. nondisjunction of dividing chromosome pair.
B. trisomy.
C. XXY chromosomes.
D. deletion.
ANS: A
Nondisjunction, or failure of chromosome pairs to
separate properly during meiosis (A), is the cause of most cases of Turner syndrome. Patients with
Tuner syndrome have a female phenotype, although
they only have one X chromosome instead of the
normal female pair. Affected women exhibit short
stature, webbing of the neck, edema of hands and
feet, and immature sexual development. Their
cells lack the Barr bodies that are found in females
with two X chromosomes. In trisomy (B), there is
an extra chromosome, resulting in three identical
chromosomes where there should only be a pair. XXY
(C) is a chromosomal abnormality seen in Klinefelter
syndrome, resulting in a male phenotype that fails to
mature during puberty. Deletion (D) is loss of part of
a chromosome.
58
62. Which is the MOST important consideration in the
treatment of a dental hygiene patient with cyclic
neutropenia?
A. High neutrophil count
B. Patient malaise
C. Low neutrophil count
D. Frequency of recall appointments
ANS: C
Patients with cyclic neutropenia experience periodic
drops in circulating neutrophils, which places them at
increased risk for infection. If the absolute neutrophil
count (ANC) drops below 1000 cells per microliter,
treatment may need to be delayed, or the patients may
require premedication with antibiotics (C) before
scaling procedures to prevent secondary infection.
Dental hygiene treatment may take place when the
neutrophil count is high (A), but consultation with the
patient’s physician is always advised in such cases.
The patient may be tired and experience malaise (B),
but this is not a critical factor. More frequent recalls
(D) and improved home care are recommended to
prevent increased inflammation, but this is not as
important as having adequate numbers of circulating
neutrophils to prevent infections.
59
63. All conditions have an autosomal–dominant
trait EXCEPT one. Which one is the
EXCEPTION?
A. Cyclic neutropenia
B. Focal palmoplantar and gingival hyperkeratosis
C. Papillon-Lefèvre syndrome
D. Laband syndrome
ANS: C
Papillon-Lefèvre syndrome (C) has an autosomal–
recessive inheritance pattern. Cyclic neutropenia
(A), focal palmoplantar and gingival hyperkeratosis
(B), and Laband syndrome (D) all have autosomal–
dominant patterns of inheritance.
60
64. Progressive bilateral facial swelling is the first clinical
manifestation in which autosomal–dominant condition?
A. Cherubism
B. Papillon-Lefèvre syndrome
C. Kostmann syndrome
D. Mandibulofacial dysostosis
ANS: A
Bilateral facial swelling is an early clinical
manifestation of cherubism (A). Papillon-Lefèvre
syndrome (B) is an autosomal–recessive condition with marked destruction of periodontal tissue.
Kostmann syndrome (C) is also autosomal–
recessive and is known as chronic neutropenia.
Mandibulofacial dysostosis (D) is an autosomal–
dominant condition with hypoplasia, or absence of the
zygomatic process, and hypoplastic molar bones.
61
65. Which characteristic is NOT a major feature in
osteogenesis imperfecta?
A. Abnormally formed bones that fracture
B. Blue sclerae
C. Dentinogenesis imperfecta
D. Severe deafness
ANS: D
Severe deafness (D) is a major feature of
mandibulofacial dysostosis but NOT of osteogenesis
imperfecta. Osteogenesis imperfecta is a congenital
disorder where the bones are abnormally formed
and fracture easily (A). Other major characteristics
include blue sclerae of the eye (B) and dentinogenesis
imperfecta (C).
62
66. Multiple cysts of the jaws are associated with which
condition?
A. Dentinogenesis imperfecta
B. Cherubism
C. Nevoid basal cell carcinoma syndrome
D. Mandibulofacial dysostosis
ANS: C
Multiple cysts of the jaws are oral manifestations
of nevoid basal cell carcinoma syndrome (C).
Dentinogenesis imperfecta (A) is an inherited
disorder affecting teeth. Cherubism (B) first manifests
clinically as a progressive bilateral facial swelling,
usually involving the mandible. Hypoplastic molar
bones with absence of the zygomatic process;
abnormal ears; deafness; and a high, vaulted palate
are all characteristic features of mandibulofacial
dysostosis (D).
63
67. For which component of Gardner syndrome would a
medical referral be recommended?
A. Odontomas
B. Supernumerary teeth
C. Cottonwool appearance of alveolar bone
D. Intestinal polyps
ANS: D
Intestinal polyps (D) that become malignant
beginning at age 30 years are a serious component of
Gardner syndrome, or familial colorectal polyposis,
making referral to a physician for screening is a wise
choice. Odontomas (A), supernumerary teeth (B), and
a “cottonwool” appearance of alveolar bone (C) are
present in this syndrome but usually do not require a
medical consultation
64
68. Multiple capillary dilations of skin and the mucous
membrane are seen in which genetic condition?
A. Hematoma
B. White sponge nevus
C. Gorlin syndrome
D. Hereditary hemorrhagic telangiectasia
ANS: D
Multiple capillary dilations of skin and the mucosa
are seen in hereditary hemorrhagic telangiectasia
(D). A hematoma (A) is not a genetic condition but
an accumulation of blood within tissue caused by
trauma. White sponge nevus (B) is characterized by a white, corrugated, soft folding of the oral mucosa.
Gorlin syndrome (C) is characterized by multiple
cysts of the jaws.
65
69. In which condition do intestinal polyps most
frequently undergo malignant transformation?
A. Gardner syndrome
B. Peutz-Jeghers syndrome
C. White sponge nevus
D. Ellis-van Creveld syndrome
ANS: A
The intestinal polyps associated with Gardner
syndrome (A) DEFINITELY become malignant. In
Peutz-Jeghers syndrome (B), intestinal polyps rarely
undergo malignant transformation. White sponge
nevus (C) only affects the oral mucosa and is not a
malignant condition. Ellis-van Creveld syndrome (D)
is characterized by major skeletal anomalies.
66
70. The autosomal–dominant, “pitted variety” of
amelogenesis imperfecta is called
A. hypoplastic.
B. enamel agenesis.
C. hypocalcified.
D. hypomaturation.
ANS: A
The “pitted variety” of amelogenesis imperfecta is
referred to as the hypoplastic (A) type. Enamel agenesis
(B) is autosomal recessive and shows a complete lack
of enamel. The hypocalcified (C) type shows yellow to
orange enamel that may be of normal thickness but is
poorly calcified. The hypomaturation (D) variety is the
snow-capped form of amelogenesis imperfecta.
67
71. All are characteristics of hypohidrotic ectodermal
dysplasia EXCEPT one. Which one is the
EXCEPTION?
A. Hypotrichosis
B. Hypodontia
C. Reduced ability to sweat
D. X-linked–recessive only
ANS: D
Hypohidrotic ectodermal dysplasia occurs in both
x-linked–recessive and also autosomal–recessive forms
(D). Hypotrichosis (A), or sparse hair; hypodontia (B),
or missing teeth; partial anodontia; and diminished
ability to sweat (C), or hypohidrosis, are all characteristic
features of hypohidrotic ectodermal dysplasia.
68
72. A lesion that has a stemlike base is described as being
A. pedunculated.
B. lobulated.
C. sessile.
D. bullous.
ANS: A
A pedunculated (A) base is stemlike. Lobulated (B)
describes a lobe that is part of the whole, and these
lobes sometimes fuse together. Sessile (C) is a term
used to describe a lesion with a base that is broad and
flat. Bullous (D) describes an elevated lesion greater
than 5millimeters and filled with fluid (e.g., blister).
69
73. The clinical term used to describe a red lesion with
unknown cause is a(an)
A. hematoma.
B. leukoplakia.
C. erythroplakia.
D. squamous cell carcinoma
ANS: C
Erythroplakia (C) is the clinical term used to describe
a red lesion with unknown cause. Hematoma (A) is an accumulation of blood in tissue caused by trauma.
Leukoplakia (B) is a term used to describe a white,
plaquelike lesion that cannot be wiped off, cannot be
diagnosed as any other disease, and may have malignant
potential. Squamous cell carcinoma (D) is a malignancy
associated with squamous cells. It is the second most
common skin cancer after basal cell carcinoma.
70
74. Which condition is frequently observed
radiographically as a radiolucent scalloping around
the roots of teeth?
A. Traumatic bone cyst
B. Static bone cyst
C. Stage II periapical cemento-osseous dysplasia
D. Radicular cyst
ANS: A
The phrase “scalloping around the roots” is used to
describe the radiolucency often seen in a traumatic
bone cyst (A). A static bone cyst (B) (Stafne bone
cyst) is an oval-shaped radiolucency found in
the posterior mandible anterior to the ramus; it is
filled with salivary gland tissue. Stage II periapical
cemento-osseous dysplasia (C) is viewed as a mix of
radiolucent and radiopaque areas. A radicular cyst (D)
is also called a periapical cyst and is a radiolucency
found at the apex of the involved tooth.
71
75. The dental hygienist typically uses the following
types of diagnostic tools when collecting clinical data
EXCEPT one. Which one is the EXCEPTION?
A. Clinical
B. Radiographic
C. Historical
D. Histologic
ANS: D
Histologic (D) diagnosis requires a biopsy, which is
beyond the typical scope of data collection for the dental
hygienist. Clinical (A), radiographic (B), and historical
(C) diagnostic features all contribute more easily to the
data collection process performed by a dental hygienist.
72
76. Which condition is NOT diagnosed by clinical
diagnosis alone?
A. Tori
B. Black hairy tongue
C. Fistula
D. Lingual varicosities
ANS: C
Following clinical identification of a fistula (C),
a periapical radiograph must be obtained for a
more complete diagnosis. Sometimes microscopic
examination may be necessary. Tori (A), black hairy
tongue (B), and lingual varicosities (D) are all visible
clinically and readily identifiable and can all be
diagnosed by clinical examination alone.
73
77. All conditions are thought to be immunologically
related EXCEPT one. Which one is the
EXCEPTION?
A. Erythema multiforme
B. Pemphigus vulgaris
C. Geographic tongue
D. Aphthous ulcers
ANS: C
The cause of geographic tongue (C), which is also
termed erythema migrans or benign migratory
glossitis, is unknown, but it is linked to genetic
factors. There are no established links to immunologic dysfunction. Erythema multiforme (A) is an acute,
self-limiting disease that presents as “bull’s eye”
or target lesions on skin and mucous membranes.
It is believed to be a hypersensitivity reaction and
may be triggered by infections, tumors, and some
medications. Pemphigus vulgaris (B) is a severe,
progressive autoimmune disease affecting skin and
mucous membranes, characterized by intraepithelial
blisters caused by acantholysis, or breakdown of the
cellular junctions, between epithelial cells. Aphthous
ulcers (D), or canker sores, are common painful oral
ulcers. These ulcers are precipitated by trauma, and
research suggests that cell-mediated immunity is
important to the development of aphthous ulcers, with
different types of T-lymphocytes present at different
stages of the ulcers.
74
78. Pituitary adenoma may cause
A. hyperpituitarism.
B. hypothyroidism.
C. hyperthyroidism.
D. hypodontia.
ANS: A
Pituitary adenoma is the most common cause of
hyperpituitarism (A), which is excessive production
of hormone by the anterior pituitary gland.
Hypothyroidism (B) is a decrease in thyroid hormone.
Hyperthyroidism (C) is excessive production of
thyroid hormone and may have a variety of causes.
Hypodontia (D) refers to missing teeth.
75
80. Which is NOT an etiologic factor in iron deficiency
anemia?
A. Chronic blood loss
B. Nutritional deficiency
C. Pregnancy
D. Genetics
ANS: D
No association exists between genetics (D) and irondeficiency anemia, although other types of anemia
such as thalassemia may be inherited. Iron-deficiency
anemia is caused by chronic blood loss (A) or
nutritional deficiency (B); it may also be a condition
experienced during pregnancy (C), when there is an
increased requirement for iron for the developing fetus.
75
79. A significant clinical finding in Addison disease is
A. exophthalmos.
B. bronzing of skin.
C. gigantism.
D. renal failure.
ANS: B
Bronzing of skin (B) is seen with Addison disease,
or adrenal insufficiency. Exophthalmos (A), or
protruding eyes, is present in hyperthyroidism.
Gigantism (C), or excessive growth, resulting in a size
that is larger than normal for age and ethnicity, may
occur in patients with hyperpituitarism. Renal failure
(D) is directly associated with end-stage diabetes.
76
81. Pernicious anemia is a deficiency in vitamin
A. B12.
B. D.
C. B6
D. C.
ANS: A
Pernicious anemia is a deficiency of vitamin B12 (A).
Autoimmunity is linked to a deficiency of intrinsic factor of the stomach, preventing the absorption of ingested
vitamin B12. Other causes may include gastrectomy,
gastric cancer, and gastritis. Vitamins D (B), B6
(C), and
C (D) are not affected by intrinsic factor.
77
82. Which condition results from a chronic decrease in
neutrophils?
A. Leukemia
B. Polycythemia
C. Plummer-Vinson syndrome
D. Agranulocytosis
ANS: D
Agranulocytosis (D) refers to a significant reduction
in neutrophils and other granulocytes such as
basophils and eosinophils. Patients with leukemia (A)
have a major increase in abnormal white blood cells.
(WBCs). Polycythemia (B) is an increase in red blood
cells (RBCs). Plummer-Vinson syndrome (C) results
from long-term iron-deficiency anemia.
78
83. A decrease in neutrophils is termed
A. leukopenia.
B. sickle cell anemia.
C. thrombocytopenic purpura.
D. leukemia
ANS: A
Leukopenia (A) is a significant reduction in white
blood cells (WBCs), primarily neutrophils. Sickle
cells are red blood cells with a sickle shape and
are seen in individuals with sickle cell anemia
(B). Thrombocytopenic purpura (C) is a severe
bleeding disorder caused by a severe reduction of
platelets. Leukemia (D) is a malignant neoplasm
of hematopoietic stem cells, which results in a
significant increase in immature WBCs.
79
84. Which drug is associated with osteonecrosis of the jaws?
A. Phenytoin (Dilantin)
B. Tetracycline
C. Alendronate (Fosamax)
D. Nifedipine (Procardia)
ANS: C
Alendronate (Fosamax) (C), one of a class of
drugs called bisphosphonates prescribed for the
treatment and prevention of osteoporosis, may cause
osteonecrosis of the jaws. Phenytoin (Dilantin) (A)
is an anticonvulsant, which may cause gingival
enlargement. Tetracycline (B) is an antibiotic, which
may cause intrinsic staining of teeth if it is taken
during tooth development. Nifedipine (Procardia)
(D) is a calcium channel blocker, which may cause
gingival enlargement.
80
85. Which drug is NOT a calcium channel blocker?
A. Diltiazem (Cardizem)
B. Nifedipine (Procardia)
C. Isradipine (DynaCirc)
D. Cyclosporine (Sandimmune)
ANS: D
Cyclosporine (Sandimmune) (D) is an
immunosuppressant prescribed to prevent organ
rejection. Diltiazem (Cardizem) (A), nifedipine
(Procardia) (B), and isradipine (DynaCirc) (C) are
all calcium channel blockers, which are medications
commonly prescribed for hypertension and other
cardiac diseases. The calcium channel blockers may
cause gingival enlargement.
81
86. Sickle cell anemia occurs MOST commonly in which
ethnic group?
A. African Americans
B. Caucasians
C. Native Americans
D. Asians
ANS: A
Sickle cell anemia is an inherited disorder of blood
and occurs most commonly in African American or
black individuals (A) and those of Mediterranean
origin. It is very unusual for Caucasians (B),
Native Americans (C), or Asians (D) to develop
sickle cell anemia, but sickle cell anemia is
occurring much more commonly in Hispanic
Americans.
82
87. Which skin condition may be associated with type 2
diabetes mellitus?
A. Bull’s-eye lesion
B. Acanthosis nigricans
C. Butterfly rash
D. Iris-eye lesion
ANS: B
Acanthosis nigricans (B) is characterized by
hyperpigmented, velvety-textured plaques that
appear in the folds and creases of the body; it is
often seen in individuals who have type 2 diabetes
mellitus. Bull’s-eye (A) and iris-eye (D) lesions
are skin lesions seen in individuals with erythema
multiforme. Butterfly rash (C) skin lesions are
associated with systemic lupus erythematosus and
discoid lupus erythematosus.
83
88. Which severe, progressive autoimmune disease
affecting skin and mucous membranes is
characterized by a positive Nikolsky sign?
A. Erythema multiforme
B. Behçet syndrome
C. Lichen planus
D. Systemic lupus erythematosus (SLE)
E. Pemphigus vulgaris
ANS: E
The Nikolsky sign is seen in some blistering
diseases such as pemphigus vulgaris (E) and
bullous pemphigoid. A positive diagnosis is
obtained if the superficial epithelium separates
from the basal layer with slight manual pressure.
Pemphigus vulgaris is a severe, autoimmune
disease affecting skin and mucous membranes,
with intraepithelial blister formation. Erythema
multiforme (A) is an acute, self-limiting disease
that affects skin and mucous membranes. The
characteristic skin lesion is called a target or
bull’s-eye lesion that has concentric rings of
erythema alternating with normal skin color, with
the darkest color at the center of the lesion. Behçet
syndrome (B) is a chronic autoimmune disease
with recurrent ulcers of the oral mucosa, genitalia,
and eyes, but no blistering. Lichen planus (C)
does not form blisters but is a benign, chronic
disorder with lesions of skin and oral mucosa and
characteristic interconnecting lines called Wickham
striae. Systemic lupus erythematosus (SLE) (D) is
an inflammatory autoimmune disease with a wide
spectrum of signs and symptoms, but a positive
Nikolsky sign is not indicative of this condition.
84
89. Bence-Jones proteins are found in the urine of patients with
A. thalassemia.
B. leukemia.
C. multiple myeloma.
D. carcinoma in situ
ANS: C
Bence-Jones proteins (BJPs) are fragments of
immunoglobulins found in the urine of patients with
multiple myeloma (C), a cancer caused by systemic
proliferation of plasma cells. BJPs are not specific to
thalassemia (A), leukemia (B), or carcinoma in situ (D).
85
92. Which malignant skin tumor has the BEST prognosis?
A. Basal cell carcinoma
B. Squamous cell carcinoma
C. Melanoma
D. Epidermoid carcinoma
ANS: A
Basal cell carcinoma (A) occurs only on skin and has
a very good prognosis if diagnosed in its early stages.
Squamous cell carcinoma (B) is the most common
primary malignancy found in the oral cavity. It is
also found on skin and is more aggressive than basal
cell carcinoma, so early detection and treatment are
important for a good prognosis. Melanoma (C) is a malignant skin tumor that may occur intraorally in
rare cases. It is the most aggressive of skin cancers, so
early detection and treatment are critical. Epidermoid
carcinoma (D) is another name for squamous cell
carcinoma.
85
90. Neoplasia is defined as an abnormal, uncontrolled
proliferation of cells. Neoplasms may be either
benign or malignant.
A. Both statements are true.
B. Both statements are false.
C. The first statement is true, and the second
statement is false.
D. The first statement is false, and the second
statement is true.
ANS: A
Both statements are true (A). Neoplasms, or tumors,
are caused by abnormal, uncontrolled proliferation
of cells. Benign neoplasms remain localized and may
be encapsulated or walled off. Benign neoplasms
resemble normal cells and are described as well
differentiated. Benign tumors are rarely fatal unless
they are adjacent to vital structures but cannot
spread to distant sites. Malignant neoplasms may
invade and destroy surrounding tissue and have the
ability to spread or metastasize. Cancer is another
term for malignancy. Malignant tumors may be
well differentiated to undifferentiated, or anaplastic,
with little resemblance to normal cells. The nuclei
of malignant tumors are darker (hyperchromatic)
compared with normal nuclei, with increased and
abnormal mitotic figures. Choices B, C, and D are not
consistent with the statements
86
91. Raynaud phenomenon is characterized by all
EXCEPT one. Which one is the EXCEPTION?
A. Causes vasospasm of fingers and toes
B. Causes tissue ischemia
C. Is triggered by medications and hot temperatures
D. May occur with rheumatoid arthritis or systemic
lupus erythematosus
ANS: C
Raynaud phenomenon is triggered by stress or cold
temperatures, not medications or hot temperatures
(C). It is a disorder that causes vasospasm of fingers
and toes (A), which can lead to reduced blood flow
and tissue ischemia (B). It often accompanies other
autoimmune diseases such as rheumatoid arthritis,
systemic lupus erythematosus, and Sjögren
syndrome (D).
87
93. Which is NOT a characteristic feature of ameloblastoma?
A. Benign
B. Locally aggressive
C. Unencapsulated
D. Frequently fatal
ANS: D
Ameloblastoma, when diagnosed in the maxilla, is
fatal if it extends into the brain (D); however, this is a
rare occurrence. In general, ameloblastoma is benign
(A), locally aggressive (B), and unencapsulated (C).
Approximately 80% of ameloblastomas occur in the
posterior mandible
88
94. An adenomatoid odontogenic tumor (AOT) often
simulates which cyst?
A. Lateral periodontal
B. Dentigerous
C. Nasopalatine
D. Globulomaxillary
ANS: B
An adenomatoid odontogenic tumor (AOT) simulates
a dentigerous cyst (B) because it is frequently
associated with an impacted tooth. Radiographically,
it appears as a radiolucency that extends beyond the
cementoenamel junction (CEJ), as in a dentigerous
cyst. The AOT may encompass 50% to 60% of
the root. The lateral periodontal cyst (A) is found
between the roots of the mandibular cuspid and the
premolar. The nasopalatine cyst (C) often appears as a
heart-shaped radiolucency in the anterior maxilla. The
globulomaxillary cyst (D) is usually pear shaped and
appears between the maxillary lateral and the cuspid.
89
95. Pain is a frequent symptom of which lesion?
A. Periapical cemento-osseous dysplasia
B. Central ossifying fibroma
C. Benign cementoblastoma
D. Odontoma
ANS: C
Pain is associated with benign cementoblastoma (C),
a cementum-producing tumor that is fused with the
root or roots of vital teeth; this tumor typically occurs
in young adults. Periapical cemento-osseous dysplasia
(A) is a fairly common disease that affects periapical
bone in the anterior mandible. It is asymptomatic,
and the etiology is unknown. Central ossifying
fibroma (B) is an asymptomatic tumor with mixed
globular calcifications resembling cementum and
bone, originating from the periodontal ligament cells’
potential to produce both types of tissue. Odontomas
(D) are odontogenic tumors derived from tooth-forming
tissues and do not have pain as an associated feature.
89
96. All conditions may be found on the tongue EXCEPT
one. Which one is the EXCEPTION?
A. Neurofibroma
B. Schwannoma
C. Granular cell tumor
D. Congenital epulis
ANS: D
Congenital epulis (D) is a benign tumor of female
newborns and occurs on the gingiva, not on the tongue. Neurofibroma (A) is a benign tumor derived
from Schwann cells and perineural fibroblasts, and
the tongue is the most common intraoral location.
Schwannoma (B) is a benign tumor derived from
Schwann cells, the connective tissue component
surrounding nerves, and the tongue is the most
common intraoral location. Granular cell tumors (C)
often occur on the tongue and the buccal mucosa and
are benign tumors composed of large cells with a
granular cytoplasm.
90
97. The MOST common location of intraoral Kaposi
sarcoma is the
A. floor of the mouth.
B. tongue.
C. gingiva.
D. buccal mucosa
ANS: C
The gingiva (C) and palatal tissue are the most
common intraoral sites of Kaposi sarcoma. The floor
of the mouth (A), tongue (B), and buccal mucosa
(D) are not the most common sites for this condition.
Squamous cell carcinoma is commonly found on the
floor of the mouth and tongue. Verrucous carcinoma
is commonly found on the buccal (and vestibule)
mucosa.
91
99. Inability to fully open the mouth is called
A. trismus.
B. crepitus.
C. articulation.
D. apertognathia
ANS: A
Trismus (A) refers to the inability to fully open the
mouth. Crepitus (B) is a dry, crackling sound at the
temporomandibular joint (TMJ). Articulation (C)
is the term for the joining of bones at a location.
Apertognathia (D) is an anterior open bite.
92
98. Which neoplasm is a malignant tumor of bone-forming
tissue?
A. Torus
B. Rhabdomyosarcoma
C. Osteosarcoma
D. Osteoma
ANS: C
Osteosarcoma (C) is a malignant tumor of
bone. Torus (A) is a benign tumor of bone.
Rhabdomyosarcoma (B) is a malignant tumor of
striated muscle. Osteoma (D) is a benign tumor of
normal, compact bone.
93
100. In iron-deficiency anemia, the loss of which type
of papillae of the tongue accounts for the red, beefy
appearance?
A. Fungiform
B. Filiform
C. Foliate
D. Circumvallate
ANS: B
Filiform (B) papillae are the most numerous and
have the highest metabolic requirements and
disappear early in iron-deficiency anemia, causing
the red, beefy appearance of the tongue. Fungiform
(A) papillae are affected in severe cases of irondeficiency anemia. Foliate (C) and circumvallate
(D) papillae are not usually affected by the
condition.
94
101. Which laboratory result provides the BEST
information for diagnosing iron-deficiency anemia?
A. Elevated hemoglobin
B. B12 deficiency
C. Deficiency of intrinsic factor
D. Reduced hematocrit
ANS: D
A reduced hematocrit (D) in laboratory results is the
best information for the diagnosis of iron-deficiency
anemia. Hematocrit is the volume percentage of red
blood in whole blood cells, and hemoglobin is the ironcontaining oxygen-transport protein in red blood cells
(RBCs). A reduction in hematocrit indicates a decrease
in RBCs and the resulting iron levels. A finding of
reduced hemoglobin, not elevated hemoglobin (A),
helps in the diagnosis of iron-deficiency anemia.
Vitamin B12 (B) or pernicious anemia is caused by a
deficiency in intrinsic factor (C), and this finding does
not help diagnose iron-deficiency anemia.
95
102. All are clinical signs of pernicious
anemia EXCEPT one. Which one is the
EXCEPTION?
A. Weakness
B. Fatigue
C. Burning tongue
D. Tooth erosion
ANS: D
Tooth erosion (D) is not a clinical sign of pernicious
anemia, which is a vitamin B12 deficiency caused by
lack of intrinsic factor secreted by the parietal cells
of the stomach required for absorption of vitamin B12.
Weakness (A), fatigue (B), and burning tongue (C)
are all clinical signs of pernicious anemia
96
103. Which test is used to diagnose pernicious anemia?
A. Western blot
B. Pels-Macht
C. Venereal Disease Research Laboratories (VDRL)
D. Schilling
ANS: D
The Schilling (D) test, which determines the body’s
inability to absorb an oral dose of vitamin B12, is used
in the diagnosis of pernicious anemia. The Western blot
(A) test is used in detecting human immunodeficiency
virus. The Pels-Macht (B) test is used to identify
pemphigus. The Venereal Disease Research
Laboratories (C) test is used to diagnose syphilis.
97
104. Which term refers to enamel hypoplasia of a
permanent tooth resulting from infection of a
deciduous tooth?
A. Turner tooth
B. Ghost tooth
C. Hutchison incisor
D. Talon cusp
ANS: A
Turner tooth (A) is a condition in which a permanent
tooth displays enamel hypoplasia from exposure
to infection or trauma in the preceding primary
tooth. Ghost tooth (B) is a developmental problem
in which one or several teeth in the same quadrant
exhibit significant reduction in radiodensity
radiographically. This condition is also termed
regional odontodysplasia, and teeth have a ghostlike
appearance and display very thin enamel and dentin.
A Hutchison incisor (C) is a malformed incisor
formed as a result of exposure to congenital syphilis
during tooth development. The tooth is shaped like a screwdriver with a notched incisal edge. Talon cusp
(D) is an accessory cusp located in the cingulum of a
maxillary or mandibular permanent incisor.
98
107. Which condition is present in polycythemia vera?
A. Excessive number of platelets
B. Insufficient number of white blood cells (WBCs)
C. Excessive number of red blood cells (RBCs)
D. Insufficient number of RBCs
E. Excessive number of WBCs
ANS: C
In polycythemia vera, the number of circulating red
blood cells (RBCs) (C) is elevated. The increased
number of RBCs impairs blood flow and decreases
the number of platelets because of disruption of
bone marrow. An excessive number of platelets (A)
is known as thrombocytosis and may result in blood
clots. An insufficient number of white blood cells
(WBCs) (B) may be present in a number of serious
conditions including cancer, hyperthyroidism, aplastic
anemia, or an infectious disease. An excessive number
of WBCs (E) may also be present in a number of
serious conditions, including infections and leukemia.
99
105. The MOST common odontogenic tumor is
A. central ossifying fibroma.
B. peripheral ossifying fibroma.
C. osteoma.
D. odontoma.
ANS: D
Odontoma (D) is a tumor derived from tooth-forming
tissue. Odontoma is the most common odontogenic
tumor. There are two types of odontomas: (1)
compound and (2) complex. Compound odontoma
is composed of a number of organized toothlike
structures. Complex odontoma is a mass of enamel,
dentin, cementum, and pulp, which is too poorly
organized to resemble a tooth. Central ossifying
fibroma (A) is a benign, well-circumscribed tumor
with calcifications that resemble bone trabeculae; it
does not occur as frequently as odontomas. Peripheral
ossifying fibroma (B) is a well-demarcated sessile or
pedunculated lesion that seems to originate from the
interdental papilla and does not occur as frequently as
odontoma. Osteoma (C) is a benign tumor of normal
compact bone but is not of odontogenic origin.
100
106. Which two nutrients are necessary for DNA synthesis?
A. Folic acid
B. Vitamin B12
C. Vitamin D
D. All of the above
E. A and B only
ANS: E
Choice E is correct. Folic acid (A) and vitamin B12
(B) are both required for deoxyribonucleic acid
(DNA) synthesis. Lack of vitamin D (C) causes
rickets and osteomalacia, but vitamin D is not
necessary for DNA synthesis (D).
101
108. The MOST common malignant soft tissue tumor of
the head and neck in children is
A. squamous cell carcinoma.
B. chondrosarcoma.
C. rhabdomyosarcoma.
D. osteosarcoma.
ANS: C
Rhabdomyosarcoma (C) is an aggressive malignancy
of striated muscle and is the most common
malignant soft tissue tumor of the head and neck in
children. Squamous cell carcinoma (A) is the most
common primary malignancy of the oral cavity.
Chondrosarcoma (B) is a malignancy of cartilage,
which may occur in the maxilla or the mandible but
is not common in children. Osteosarcoma (D), which
is a cancer of bone-forming tissue and is also called
osteogenic sarcoma, is uncommon in children
102
109. The normal prothrombin time (PT) is
A. 1 to 6 minutes.
B. 10 minutes.
C. 11 to 16 seconds.
D. 30 minutes
ANS: C
Normal prothrombin time (PT), which is 11 to 16
seconds (C), indicates the patient’s ability to form
a clot. PT of 1 to 6 minutes (A) has been used to
evaluate bleeding time and assess platelet function.
Time frames of 10 minutes (B) or 30 minutes (D) are
not associated with normal PT
103
110. Thrombocytopenic purpura results from a severe
reduction in
A. red blood cells.
B. platelets.
C. international normalized ratio (INR).
D. white blood cells.
ANS: B
Thrombocytopenic purpura results from a severe
reduction in platelets (B). A decrease in red blood cells
(A) signifies some type of anemia. The international
normalized ratio (C) is a standardized test that determines
the ratio of prothrombin time to thromboplastin activity.
A significant reduction in white blood cells (WBCs)
(D) is leukopenia. Any WBC may be involved, but
leukopenia most often involves the neutrophil
104
111. Which are the MOST common sites for squamous
cell carcinoma?
A. Labial mucosa, buccal mucosa, and hard palate
B. Labial mucosa, maxillary gingiva, and buccal
mucosa
C. Floor of the mouth, ventrolateral tongue, and soft
palate
D. Anterior tongue, gingiva, and retromolar area
ANS: C
Squamous cell carcinomas may occur anywhere in
the oral cavity, but the most common sites are the
floor of the mouth, the ventrolateral tongue, and
the soft palate (C) and tonsillar area. Squamous cell
carcinoma may also occur on the vermillion border
of the lips and the skin of the face, and the prognosis
in those areas is better than that for squamous cell
carcinomas occurring in the oral cavity. Squamous
cell carcinoma may occur at any intraoral location
such as the labial mucosa, buccal mucosa, and hard
palate (A), maxillary gingiva (B), anterior tongue,
gingiva, and retromolar area (D), but occurs much
less commonly in these locations.
