Ibsen: Oral Pathology for the Dental Hygienist, 5th Edition

Chapter 1: Introduction to Preliminary Diagnosis of Oral Lesions

Test Bank

MULTIPLE CHOICE

	1.	Which of the following would be described as a segment that is part of the whole?
a.	Bullae	c.	Lobule	
b.	Vesicle	d.	Pustule	

ANS:	C

	Feedback	
A	A bullae is an elevated lesion that contains serous fluid and may look like a blister.	
B	A vesicle is a small elevated lesion that contains serous fluid.	
C	Correct! A lobule is described as a segment or lobe that is part of a whole.	
D	Pustules are circumscribed elevations containing pus.	

REF:	1

	2.	A lesion with a sessile base is described as:
a.	an ulcer.	c.	pedunculated.	
b.	stemlike.	d.	flat and broad.	

ANS:	D

	Feedback	
A	An ulcer is a break in the surface epithelium.	
B	A stemlike lesion is referred to as pedunculated.	
C	A pedunculated lesion is stemlike or stalk based (similar to a mushroom).	
D	Correct! Sessile describes the base of a lesion that is broad and flat.	

REF:	2

	3.	Which one of the following is not diagnosed through clinical diagnosis?
a.	Mandibular tori	c.	Black hairy tongue	
b.	Fordyce granules	d.	Compound odontoma	

ANS:	D

	Feedback	
A	Mandibular tori are identified clinically as areas of exostosis on the lingual aspects of mandibular premolars.	
B	Fordyce granules are yellow clusters of ectoptic sebaceous glands that are diagnosed through clinical appearance.	
C	Black hairy tongue is diagnosed clinically. The filiform papillae on the dorsal tongue elongate and become brown or black. Causes include tobacco, alcohol, hydrogen peroxide, chemical rinses, antibiotics, or antacids.	
D	Correct! The compound odontoma is initially identified radiographically as a radiopaque area in which tooth structure can be identified. There is no clinical component.	

REF:	8

	4.	Another name for geographic tongue is:
a.	median rhomboid glossitis.	c.	fissured tongue.	
b.	benign migratory glossitis.	d.	black hairy tongue.	

ANS:	B

	Feedback	
A	Research suggests that median rhomboid glossitis is associated with a chronic fungal infection from Candida albicans. Sometimes the condition resolves with antifungal therapy.	
B	Correct! Benign migratory glossitis is another name for geographic tongue.	
C	Fissured tongue is seen in 5% of the population. It is a variant of normal. Genetic factors are probably associated with the condition.	
D	Black hairy tongue is caused by a reaction to chemicals, tobacco, hydrogen peroxide, or antacids. The filiform papillae on the dorsal tongue become elongated and are dark brown to black in color.	

REF:	25

	5.	
This bony hard radiopaque structure in the midline of the hard palate is genetic and autosomal dominant. The diagnosis is made through clinical diagnosis. You suspect a:
a.	palatal cyst.	c.	mixed tumor.	
b.	torus palatinus.	d.	ranula.	

ANS:	B

	Feedback	
A	Palatal cyst is radiolucent and not diagnosed through clinical appearance.	
B	Correct! Torus palatinus is developmental, bony hard, and found on the midline of the palate. Diagnosis is made on the basis of clinical appearance.	
C	A mixed tumor or pleomorphic adenoma is a benign tumor of salivary gland origin, found unilaterally off the midline of the hard palate. It is composed of tumor tissue that is not bony hard to palpation.	
D	A ranula is a term used for a mucocele-like lesion that forms unilaterally on the floor of the mouth.	

REF:	23

	6.	This gray-white opalescent film seen on the buccal mucosa of 85% of black adults is a variant of normal that requires no treatment. On the basis of this description, you suspect that this is a:
a.	linea alba.	c.	leukoplakia.	
b.	leukoedema.	d.	white sponge nevus.	

ANS:	B

	Feedback	
A	Linea alba is a "white line" that extends anteroposterior on the buccal mucosa along the occlusal plane. It is most prominent in patients who have a clenching or grinding habit. 	
B	Correct! Leukoedema is a diffuse opalescence most commonly seen on the buccal mucosa in black individuals.	
C	Leukoplakia is a clinical term for a white lesion for which the cause is unknown.	
D	White sponge nevus is a genetic autosomal-dominant trait. Clinically it is characterized by a white, corrugated, soft folding oral mucosa. A thick layer of keratin produces the whitening.	

REF:	25

	7.	Which one of the following conditions would most likely respond to therapeutic diagnosis?
a.	Angular cheilitis	c.	Paget disease	
b.	Amelogenesis imperfecta	d.	Stafne bone cyst	

ANS:	A

	Feedback	
A	Correct! Angular cheilitis most commonly responds to antifungal therapy once nutritional deficiencies have been ruled out.	
B	Amelogenesis imperfecta is a genetic condition associated with abnormal development of the enamel.	
C	Paget disease is a chronic metabolic bone disease. A highly elevated serum alkaline phosphatase level contributes significantly to the diagnosis.	
D	Stafne bone cyst is diagnosed through surgical diagnosis in which entrapped salivary gland tissue is identified.	

REF:	20

	8.	
The gingival enlargement in this patient was caused by a calcium channel blocker. Which one of the following would likely be the cause?
a.	Dilantin	c.	Procardia	
b.	Cyclosporine	d.	Clozapine	

ANS:	C

	Feedback	
A	Dilantin is an anticonvulsant used to prevent or control seizures.	
B	Cyclosporine is an immunosuppressant used to prevent organ or tissue rejection.	
C	Correct! Procardia is a calcium channel blocker.	
D	Clozapine is an antipsychotic used in the management of psychotic symptoms in schizophrenia.	

REF:	19 | 307

	9.	Radiographic features, including the cotton wool effect and hypercementosis, are especially helpful to the diagnosis of:
a.	Paget disease.	c.	anemia.	
b.	dentinogenesis imperfecta.	d.	diabetes.	

ANS:	A

	Feedback	
A	Correct! Paget disease is a chronic metabolic bone disease. Radiographically the cotton wool effect and hypercementosis are very characteristic features.	
B	Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin.	
C	Anemia, a decrease in red blood cells, requires blood tests to determine the etiologic factors.	
D	Diabetes is a chronic disorder of carbohydrate metabolism characterized by abnormally high blood glucose levels.	

REF:	18 | 20

	10.	In internal resorption the radiolucency seen radiographically is usually:
a.	well circumscribed.	c.	multilocular.	
b.	diffuse.	d.	unilocular.	

ANS:	B

	Feedback	
A	Well circumscribed describes borders that are specifically defined. Exact margins of the lesion are identified.	
B	Correct! Diffuse borders are ill defined, making it impossible to detect the exact parameters of the lesion. Therefore treatment is more difficult.	
C	Multilocular has also been described as "soap bubble" like. Lobes seem to fuse together to make up the lesion. This term has been used to describe the odontogenic keratocyst.	
D	Unilocular means having one compartment or unit that is well defined. This term often describes the radicular cyst.	

REF:	3 | 11

	11.	Which one of the following is diagnosed through clinical diagnosis?
a.	Fordyce granules	c.	Periapical cemento-osseous dysplasia	
b.	Unerupted mesiodens	d.	Traumatic bone cyst	

ANS:	A

	Feedback	
A	Correct! Fordyce granules are diagnosed on the basis of their clinical appearance. They are ectopic sebaceous glands seen on the lips and buccal mucosa. Clinically they appear as yellow lobules in clusters. They are considered a variant of normal.	
B	Unerupted mesiodens requires a radiograph for diagnosis.	
C	Periapical cemento-osseous dysplasia requires a radiograph, specific patient history, and a pulp test to evaluate tooth vitality.	
D	Traumatic bone cyst requires a radiograph and surgical intervention to establish a diagnosis.	

REF:	8

	12.	Retrocuspid papillae are located on the:
a.	palate.	
b.	floor of the mouth.	
c.	gingiva of the lingual aspect of mandibular canines.	
d.	canine eminence.	

ANS:	C

	Feedback	
A	Retrocuspid papillae are not located on the palate.	
B	Retrocuspid papillae are not located on the floor of the mouth.	
C	Correct! Retrocuspid papillae are located on the gingiva of the lingual aspect of mandibular canines.	
D	Retrocuspid papillae are not located on the canine eminence.	

REF:	23

	13.	Which one of the following is not considered a variant of normal?
a.	Fordyce granules	c.	Linea alba	
b.	Leukoedema	d.	Pyogenic granuloma	

ANS:	D

	Feedback	
A	Fordyce granules are seen in over 80% of adults over 20 years and are considered a variant of normal.	
B	Leukoedema is observed in about 85% of blacks and is considered a variant of normal.	
C	Linea alba is located on the buccal mucosa opposite the occlusal plane of teeth. It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is considered a variant of normal.	
D	Correct! Pyogenic granuloma is a reactive inflammatory response to injury. It is not a variant
of normal.	

REF:	22

	14.	When antifungal therapy is used to treat angular cheilitis, which diagnostic process is being applied?
a.	Microscopic	c.	Surgical	
b.	Laboratory	d.	Therapeutic	

ANS:	D

	Feedback	
A	Microscopic diagnosis requires a biopsy.	
B	Laboratory diagnosis involves the use of clinical laboratory tests, including blood chemistries and urinalysis.	
C	Surgical diagnosis requires surgical intervention.	
D	Correct! Therapeutic diagnosis is used here in the treatment and management of angular cheilitis, which is most commonly a fungal condition. A careful patient history should be obtained to rule out a contributory nutritional deficiency.	

REF:	20

	15.	A lesion with a stemlike base is described as:
a.	a sessile.	c.	pedunculated.	
b.	A macule.	d.	a lobule.	

ANS:	C

	Feedback	
A	A sessile base is broad and flat.	
B	A macule is flat, does not protrude, and is distinguished by its color. A freckle is an example of a macule.	
C	Correct! Pedunculated means the lesion has a stemlike or stalklike base similar to that of a mushroom.	
D	A lobule is a segment or lobe that is part of a whole.	

REF:	2

	16.	A small circumscribed lesion usually less than 1 cm in diameter that is elevated or protrudes above the surface of normal surrounding tissue is a:
a.	papule.	c.	vesicle.	
b.	macule.	d.	bulla.	

ANS:	A

	Feedback	
A	Correct! A papule is defined as a small circumscribed lesion usually less than 1 cm in diameter that is elevated or protrudes above the surface of normal surrounding tissue.	
B	A macule is flat and does not protrude above the surface of normal tissue.	
C	A vesicle is elevated and contains serous fluid.	
D	A bulla is elevated, contains serous fluid, and looks like a blister.	

REF:	2

	17.	Which one of the following is considered a genetic/inherited disorder?
a.	Linea alba	c.	Necrotizing ulcerative gingivitis	
b.	Amelogenesis imperfecta	d.	Internal resorption	

ANS:	B

	Feedback	
A	Linea alba is a variant of normal characterized by the white line anteroposterior on the buccal mucosa along the occlusal plane.	
B	Correct! Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth.	
C	Necrotizing ulcerative gingivitis is an ulcerating gingival condition caused by anaerobic bacteria.	
D	Internal resorption is usually associated with an inflammatory response in the pulp.	

REF:	15

	18.	Ectopic geographic tongue can be found:
a.	on the lateral boarder of the tongue.	
b.	within bone.	
c.	on mucosal surfaces other than the tongue.	
d.	on the dorsal tongue.	

ANS:	C

	Feedback	
A	Geographic tongue may be seen on any surface of the tongue, including the lateral borders.	
B	Ectopic geographic tongue is a mucosal condition and has nothing to do with bone.	
C	Correct! Ectopic geographic tongue is also called stomatitis areata migrans and is found on mucosal surfaces other than the tongue.	
D	Geographic tongue may be seen on any mucosal surface and is commonly seen on the dorsal surface of the tongue.	

REF:	26

	19.	A Stafne bone cyst contains:
a.	salivary gland tissue.	
b.	an empty void.	
c.	inflammatory cells.	
d.	an epithelial-lined cyst containing serous fluid.	

ANS:	A

	Feedback	
A	Correct! Stafne bone cyst is developmental invagination in the lingual aspect of the mandible that is filled with salivary gland tissue.	
B	An empty void describes the contents of the traumatic bone cyst.	
C	Stafne bone cyst has no inflammatory response. It is developmental and requires no treatment.	
D	Stafne bone cyst is not a true cyst and does not have an epithelial lining. It contains normal salivary gland tissue.	

REF:	168

	20.	Which papillae are elongated in the condition called black hairy tongue?
a.	Circumvallate	c.	Filiform	
b.	Foliate	d.	Fungiform	

ANS:	C

	Feedback	
A	Circumvallate papillae on the posterior dorsal tongue do not elongate.	
B	Foliate papillae are located on the posterior lateral borders of the tongue. They are vertical, slightly exophytic folds of tissue located in the same area as the lingual lymphoid tissue (lingual tonsils) and do not elongate.	
C	Correct! The filiform papillae are composed primarily of keratin and are the papillae that elongate in black hairy tongue.	
D	Fungiform papillae on the dorsal areas do not elongate.	

REF:	26

	21.	Diagnosis of anemia is best accomplished through:
a.	laboratory tests.	
b.	evaluation of the color of the gingiva.	
c.	bleeding on probing.	
d.	the patient's medical history.	

ANS:	A

	Feedback	
A	Correct! Laboratory blood tests provide the best information to diagnose anemia.	
B	Although the color of the gingiva may be a clinical sign, a diagnosis of anemia, or more specifically the type of anemia, must be made through laboratory testing.	
C	Bleeding on probing is not used in the diagnosis of anemia.	
D	The patient's medical history may be helpful to the diagnosis of anemia, but it is only contributory. The final diagnosis comes from appropriate laboratory tests.	

REF:	18 | 295

	22.	A radiolucency that "scallops around the roots of teeth" is often used to describe a:
a.	traumatic bone cyst.	c.	lingual mandibular bone concavity.	
b.	Stafne bone cyst.	d.	median palatine cyst.	

ANS:	A

	Feedback	
A	Correct! Scalloping around the roots is a term often used to describe the radiographic appearance of a traumatic bone cyst.	
B	A Stafne bone cyst usually presents as an oval-shaped radiolucency anterior to the angle of the ramus and inferior to the mandibular canal.	
C	A lingual mandibular bone concavity is the same as a Stafne bone cyst.	
D	A median palatine cyst is a developmental cyst that presents as a unilocular radiolucency found in the midline of the hard palate.	

REF:	20

	23.	When geographic tongue occurs on the dorsal tongue, the erythematous areas may be appropriately described as:
a.	inflamed.	c.	allergic.	
b.	depapillated.	d.	fungal.	

ANS:	B

	Feedback	
A	The erythematous areas seen on the dorsal tongue in geographic tongue are not caused primarily by inflammation.	
B	Correct! In geographic tongue the erythematous areas on the dorsal tongue are devoid of filiform papillae and therefore are appropriately described as depapillated.	
C	Geographic tongue is not an allergic reaction.	
D	Geographic tongue is not a fungal infection.	

REF:	26

	24.	It has been suggested that Candida albicans is associated with which one of the following?
a.	Median rhomboid glossitis	c.	Leukoedema	
b.	Linea alba	d.	Retrocuspid papillae	

ANS:	A

	Feedback	
A	Correct! Research has suggested that median rhomboid glossitis may be associated with Candida albicans.	
B	Linea alba is a variant of normal.	
C	Leukoedema is a variant of normal.	
D	Retrocuspid papillae are developmental and found on the gingiva of the lingual aspect of mandibular canine teeth.	

REF:	25

	25.	Which term is used to describe a lesion with borders that are specifically defined and in which one can see the exact margins and extent of the lesion?
a.	Unilocular	c.	Diffuse	
b.	Well circumscribed	d.	Multilocular	

ANS:	B

	Feedback	
A	Unilocular means having one compartment or unit that is well defined (as in a radicular cyst).	
B	Correct! Well circumscribed defines a lesion with borders that are specifically defined and in which one can see the exact margins and extent of the lesion.	
C	Diffuse describes a lesion with borders that are not well defined.	
D	Multilocular lesions are described radiographically as "soap bubbles" (i.e., a lesion with many lobes beyond the confines of one distinct area).	

REF:	5

	26.	Fordyce granules:
a.	are ectopic sebaceous glands.	
b.	are seen on the dorsal tongue.	
c.	require antibiotic treatment.	
d.	are lesions that require biopsy for diagnosis.	

ANS:	A

	Feedback	
A	Correct! Fordyce granules are ectopic sebaceous glands.	
B	Fordyce granules are seen on the buccal and labial mucosa, not the dorsal tongue.	
C	Fordyce granules require no treatment.	
D	Fordyce granules are diagnosed through clinical appearance. Biopsy is not necessary.	

REF:	23

	27.	
The base of this lesion would be described as:
a.	pedunculated.	c.	a bulla.	
b.	a lobule.	d.	sessile.	

ANS:	D

	Feedback	
A	A pedunculated lesion has a stemlike base similar to that of a mushroom stem.	
B	A lobule is a segment or lobe that is part of the whole.	
C	A bulla usually contains serous fluid and looks like a blister.	
D	Correct! The base of this lesion is sessile or broad and flat.	

REF:	4

	28.	
This torus palatinus would be described as:
a.	bullous.	c.	lobulated.	
b.	a papule.	d.	a nodule.	

ANS:	C

	Feedback	
A	Bullous lesions contain serous fluid and appear as a blister.	
B	A papule is a soft tissue lesion that is elevated above the surface of normal surrounding tissue.	
C	Correct! This torus palatinus is lobulated (i.e., lobes that are fused together).	
D	A nodule is a palpable solid lesion found in soft tissue.	

REF:	2

	29.	Another name for amalgam tattoo is:
a.	a melanoma.	c.	a nevus.	
b.	focal argyrosis.	d.	multiple myeloma.	

ANS:	B

	Feedback	
A	A melanoma is a malignant tumor.	
B	Correct! Focal argyrosis is a synonym for amalgam tattoo.	
C	A nevus is a benign overgrowth of melanocytes.	
D	Multiple myeloma is a malignant proliferation of plasma cells.	

REF:	8

	30.	Which one of the following is not apparent in leukoedema?
a.	Intracellular edema in the spinous cells	
b.	Acanthosis of the epithelium	
c.	Generalized opalescence of the buccal mucosa	
d.	A white diffuse material on the buccal mucosa that can be wiped off	

ANS:	D

	Feedback	
A	Intracellular edema in the spinous cells is found in leukoedema.	
B	Acanthosis of the epithelium is found in leukoedema.	
C	Generalized opalescence of the buccal mucosa is seen in leukoedema.	
D	Correct! A white diffuse material that can be wiped off is significant to pseudomembranous candidiasis.	

REF:	25