oral med Flashcards
A patient presents with angular chelitis and you decide to perform some haematological investigations.
Which of the following tests is not relevant to angular chelitis?
a. full blood count
b. fasting venous glucose
c. vitamin B12
d. liver function tests
e. ferritin
D
Angular chelitis is associated with haematological abnormalities for which anaemia and diabetes are the most common of these.
Liver function tests are irrelevant.
Which of the following drugs is inappropriate for the treatment of angular chelitis?
a. aciclovir
b. nystatin
c. miconazole
d. fluconazole
e. amphotericin
A
Aciclovir is an antiviral used for herpes simplex and angular chelitis is a bacterial + fungal infection.
Target lesions are associated with which one of the following conditions?
a. stevens-johnson syndrome
b. major apthous stomatitis
c. pemphigus
d. pemphigoid
e. syphilis
A
Steven’s-Johnson produces flat target lesions on the skin which occur as a reaction to sulphonamides.
(erythema multiforme also causes target lesions)
What is the male to female ratio of the prevalence of recurrent apthous ulceration/stomatitis?
a. 3:1
b. 2:1
c. 1:1
d. 1:2
e. 1:3
C
RAS occurs equally in males and females.
Where in the mouth is burning mouth syndrome most frequently reported?
a. lips
b. lower denture-bearing area.
c. palate
d. buccal mucosa
e. tongue
E - tongue
What is the male to female ratio of patients with burning mouth syndrome?
a. 7:1
b. 3:1
c. 1:1
d. 1:3
e. 1:7
E
1:7 as females are a lot more likely to report burning mouth syndrome.
What is the mean age of presentation in burning mouth syndrome?
a. 18 years
b. 25 years
c. 40 years
d. 60 years
e. 80 years
D
More prevalent in women with a mean age of 60, rarely seen younger than 45.
Many causes including vitamin B deficiency, haematological disorders, undiagnosed type 2, xerostomia.
A child of 14 months presents with blood-crushed lips, pyrexia and widespread oral ulceration.
What is the most likely diagnosis?
a. teething
b. traumatic injury
c. primary herpetic gingivostomatitis
d. hand, foot and mouth
e. HPV
C
- Traumatic injury would be possible but unlikely as the child has pyrexia (fever).
- Teething would not cause blood crusted lip.
- HPV does not cause this.
(treatment for PHG is aciclovir, antiseptic mouthwash and paracetamol to reduce pyrexia. child should be discouraged from touching the lesion and fluid intake increased).
Which one of the following does not cause the reactivation of herpes simplex infection?
a. stress
b. sunlight
c. immunosuppression
d. local trauma
e. dental caries
E
A 12 year old child who has had chicken pox previously presents with vesicles in and around his left ear, hearing loss and some facial nerve weakness.
What is the diagnosis?
a. herpes simplex 1 reactivation
b. herpes simplex 2 reactivation
c. ramsay-hunt syndrome
d. coxsackie viral infection
e. infectious mononucleosis
C - Ramsay-Hunt Syndrome
Neurological disorder characterised by facial weakness of the facial nerve (facial palsy) and a rash of the ear/mouth.
Symptoms are usually unilateral.
What is the usual prescription of aciclovir given to patients with acute HSV?
a. 200mg x2 a day for 5-10 days
b. 200mg x3 a day for 5-10 days
c. 200mg x4 a day for 5-10 days
d. 200mg x5 a day for 5-10 days
e. 200mg x6 a day for 5-10 days
D - 200mg x5 a day for 5-10 days
(one of the unusual medications to be taken 5 times a day)
A 70 year old patient presents with systemic upset, a unilateral headache around the temporal region and a severe cramp-like pain when he chews. They have never had any symptoms like this before.
What is your diagnosis?
a. paroxysmal facial hemicrania
b. giant cell arteritis
c. periodic migrainous neuralgia
d. salivary calculi
e. trigeminal neuralgia
B - giant cell arteritis
Arteries at the side of the head become inflamed, can be a medical emergency and required administration of prednisolone to prevent onset of blindness.
Which blood test would be used to aid diagnosis of giant cell arteritis?
a. FBC
b. liver function tests
c. erythrocyte sedimentation rate
d. vitamin B12
e. INR
C - erythrocyte sedimentation rate.
Marker of inflammation which is raised in patients with gain cell arteritis.
A 15 year old patient presents with pyrexia, sore throat and bilateral parotitis. However, on palpation of the parotid the saliva is clear with no xerostomia.
What is your most likely diagnosis?
a. measles
b. mumps
c. bacterial parotitis
d. sjogren’s
e. cytomegalovirus
B - mumps
Most common cause of bacterial parotitis, usually settles after 2 weeks but parents must be aware that consequences may include infertility.
MMR on the rise due to parent reluctance to vaccinate children.
Which one of the following viruses is associated with Kaposi’s sarcoma?
a. Human herpes virus 1
b. Human herpes virus 2
c. Varicella zoster virus
d. cytomegalovirus
e. HHV8
E - HHV8
Kaposi’s is an AIDS related illness associated with HHV8.
A patient presents with a unilateral, electric shock-like pain along the course of the mandible, he says it happens when he shaves and is the worst pain he has ever had.
What is your likely diagnosis?
a. TMJ dysfunction
b. trigeminal neuralgia
c. dental abscess
d. parotitis
e. paroxysmal facial hemicrania
B - classic description of trigeminal neuralgia.
What would the best medication be for trigeminal neuralgia?
a. dotheipin
b. fluoxetine
c. carbamazepine
d. prednisolone
e. amitriptiline
C - carbamazepine
Anti-convulsant to provide pain relief.
Pts usually started on 100mg 2-3 times a day and then dose is increased up to 800.
Which of the following blood tests is important when monitoring patients taking carbamazepine?
a. Vitamin B12
b. Ferritin
c. ESR
d. Liver function tests
e. Serum folate
D - liver function tests
Because carbamazepine is metabolised in the liver and can lead to altered liver function and inflammation (hepatitis).
Full blood count can also be useful as it can cause aplastic anaemia.
An 18 year old girl presents with a grossly enlarged lower lip, angular chelitis, full-width gingivitis, mucosal tags and cobblestone mucosae.
What is the most likely diagnosis?
a. allergic reaction leading to anaphylaxis
b. lichenoid reaction
c. erythema multiformae
d. orofacial granulomatosis
e. lichen planus
D - orofacial granulomatosis
Which GI condition is commonly associated with orofacial granulomatosis?
a. ulceratice colitis
b. chron’s
c. coeliac
d. irritable bowel disease
e. hirschsprung’s disease
B - Chron’s Disease
Orofacial granulomatosis is a manifestation of chronic disease (an inflammatory bowel disease).
In pts who truly have an allergic reaction to local anaesthetic, which of the following is the most likely cause?
a. lidocaine
b. adrenaline
c. octapressin
d. methylparaben
e. sodium chloride
D - methylparaben
The preservative in local anaesthetics and most common cause of allergic reaction in pts.
Sodium bisulphate can also be used as a preservative and this can cause a reaction too.
(highly unlikely that the pt is allergic to adrenaline as the body produces it)
Which of the following does not predispose a pt to candidiasis?
a. taking a broad-spectrum antibiotic
b. taking prednisolone daily
c. agranulocytosis
d. stress
e. folic acid deficiency
D - stress
Broad spectrum antibiotics, prednisolone, agranulocytosis and folic acid deficiency are all contributing factors.
What condition is Wickham’s striae associated with?
a. psudomembranous candidosis
b. chronic hyperplasticity candidosis
c. lichenoid reactions
d. lichen planus
e. white sponge naevus
D - lichen planus
Wickham’s striae are irregular, itchy, white streaks on the flexor surfaces of forearms, elbows and ankles.
(remember lichen planus isn’t just mouth)
Which one of the following autoantibodies is not associated with Sjögren’s syndrome?
a. anti-ro
b. anti-la
c. rheumatoid factor
d. anti-nuclear antibodies
e. anti-smith antibodies
E - anti-smith
These antibodies are associated with systemic lupus erythematous.
Sjögren’s syndrome is associated with other autoimmune diseases (CREST).
Which of the following is not involved in CREST syndrome?
a. calcinosis
b. raynaud’s phenomenon
c. rheumatic fever
d. oesophageal dysmobility
e. telangiectasia (dilation of capillaries)
C - rheumatic fever
If you suspect vitamin B12 deficiency in a patient and you want to know whether lack of intrinsic factor is the cause, which test would you perform?
a. FBC
b. red cell folate
c. schilling’s test
d. ferritin
e. bence jones protein
C - shilling’s test
Pt is given an injection of radio labelled vitamin B12 and urine is collected over 24 hours to measure levels of the isotopes present in it.
A 75 year old lady with a history of gastric cancer presents with a red, raw beefy tongue, oral ulceration, tachycardia, numbness in extremities and an unusual gait. She has been clear for 25 years.
What would be your most likely diagnosis?
a. iron deficiency anaemia
b. vitamin B12 deficiency
c. recurrence of gastric cancer
d. brain tumour
e. alzheimer’s
B - vitamin B12 deficiency
Usually leads to the raw beefy tongue, oral ulceration and peripheral neuropathy.
Which of the following does not cause a lichenoid reaction?
a. beta blockers
b. gold
c. allopurinol
d. nifedipine
e. anti-malarials
D - nifedipine
Causes gingival hyperplasia, not lichenoid reaction.
Which of the following conditions/lesions is not caused by viruses?
a. koplik’s spots
b. herpetiform ulceration
c. herpes labialis
d. hand, foot and mouth disease
e. herpangina
B - herpetiform ulceration (RAS)
The ulcers looks like herpes but are not actually causes by the virus.
Which of the following is not a type of lichen planus?
a. plaque-like
b. atrophic
c. hyperplastic
d. erosive
e. reticular
C - hyperplastic
Which syndrome is associated with odontogenic keratocysts?
a. Gorlin-Goltz
b. Peutz-Jeghers
c. gardner’s syndrome
d. apert’s syndrome
e. horner’s syndrome
A - gorlin-goltz
Syndrome consisting of fronto-temporal bossing, calcified falx cerebri and multiple basal cell naevi.
What is the causative organism for primary syphylis?
a. borrelia burgdorferi
b. staphylococcus aureus
c. treponema pallidum
d. shigella
C - treponema pallidum
Where are primary syphilis lesions usually found?
a. lip
b. floor of mouth
c. tongue
d. palate
C - tongue
What is the name of the primary lesion found in primary syphilis?
a. chancre
b. gumma
c. snail tracks
A - chancre
(firm and painless, oozes fluid containing syphilis bacteria)
How long do primary syphilis lesions last before they heal spontaneously?
a. 1 week
b. 1-3 months
c. 3-6 months
d. 1 year
B - 1-3 months
What is the treatment for primary syphilis?
a. excision
b. no treatment
c. metronidazole
d. penicillin
D - penicillin
Which gland is atrophic in Addinson’s disease?
a. hypothalamus
b. anterior pituitary
c. posterior pituitary
d. adrenal gland
e. thyroid
D - adrenal gland
Which substance is low or absent in Addison’s Disease?
a. thyroxine
b. corticosteroids
c. calcitrol
d. mineralocorticoids
B - corticosteroids
What lesions are present on the gingivae and skin in Addison’s Disease?
a. ulcers
b. raised polypoid lesions
c. lichenoid lesions
d. hyperpigmentation
D - hyperpigmentation
(brown pigmentation of the gingivae and skin)
How would Addison’s be treated?
a. thyroxine
b. carbimazole
c. calcitrol
d. corticosteroids
D - corticosteroids
With regards to Sjögren’s Syndrome, what is the main oral complaint in this condition?
a. swelling
b. xerostomia
c. too much saliva
d. bad taste
B - xerostomia
Which sex is more commonly affected by Sjögren’s Syndrome?
a. male
b. female
B - female
(occurs mainly in middle aged women when oestrogen levels begin to fall)
In which age group does Sjögren’s Syndrome mainly present?
a. 18-30 years
b. 30-50 years
c. 50+ years
B - 30-50 years
Which other systemic condition is Sjögren’s Syndrome associated with?
a. osteoarthritis
b. rheumatoid arthritis
c. seronegative arthritis
B - rheumatoid arthritis
