I85PREP
⌘ K
ABOP Diplomate study materials
ABOP Diplomate study resources

ABOP Diplomate practice questions

One question at a time. Build your ABOP Diplomate understanding.

First 50 of 200 questions. Each one lists the choices, the correct answer, and an explanation. The checker at the top of this page saves progress in this browser when it is available.

Continue in the practice tool above to load more questions, 50 at a time.

Question 1Oral and Maxillofacial Surgical Pathology

Which odontogenic cyst is most strongly associated with an unerupted mandibular third molar and shows a thin, non-keratinized epithelial lining with a low columnar basal layer?

  1. Dentigerous cyst Correct answer.
  2. Lateral periodontal cyst
  3. Radicular cyst
  4. Odontogenic keratocyst

Explanation

A dentigerous cyst encloses the crown of an unerupted tooth, most often a mandibular third molar, and is lined by thin non-keratinized epithelium with a flattened to low columnar basal layer. Keratinization and corrugated parakeratin point instead to keratocyst.

Question 2Oral and Maxillofacial Surgical Pathology

The characteristic histologic finding in an ameloblastoma is which of the following?

  1. Ameloblast-like cells arranged in islands with peripheral palisading and reverse polarity Correct answer.
  2. Sheets of clear cells with amyloid deposition
  3. Reverse polarity of the basal cell layer with subnuclear vacuolization
  4. Spindle cells with wavy nuclei and mast cells

Explanation

Conventional ameloblastoma shows islands of odontogenic epithelium with peripheral palisading of columnar ameloblast-like cells and reverse polarity away from the basement membrane. Central stellate reticulum-like cells complete the pattern.

Question 3Oral and Maxillofacial Surgical Pathology

A 30-year-old presents with a multilocular radiolucency of the posterior mandible with a soap-bubble appearance. Histology shows sheets of odontogenic epithelium with calcifications resembling Liesegang rings. What is the most likely diagnosis?

  1. Central giant cell granuloma
  2. Ameloblastoma
  3. Calcifying epithelial odontogenic tumor Correct answer.
  4. Odontogenic myxoma

Explanation

Calcifying epithelial odontogenic tumor (Pindborg tumor) shows polyhedral epithelial cells with prominent intercellular bridges, amyloid-like material, and concentric calcifications known as Liesegang rings. The soap-bubble radiolucency in the posterior mandible fits this lesion.

Question 4Oral and Maxillofacial Surgical Pathology

Which feature best distinguishes an odontogenic keratocyst from other odontogenic cysts on histology?

  1. Clear cells in the epithelial lining
  2. Corrugated parakeratinized lining with a palisaded hyperchromatic basal layer Correct answer.
  3. Goblet cells and ciliated epithelium
  4. Cholesterol clefts with hemosiderin

Explanation

Odontogenic keratocyst is lined by a uniform parakeratinized epithelium with a corrugated surface and a well-defined palisaded, hyperchromatic basal layer. These features correlate with its high recurrence rate.

Question 5Oral and Maxillofacial Surgical Pathology

A multilocular radiolucency in the mandible of a 12-year-old shows a fibrous stroma with multinucleated giant cells and prominent hemosiderin. Which diagnosis is most consistent?

  1. Adenomatoid odontogenic tumor
  2. Odontogenic myxoma
  3. Central giant cell granuloma Correct answer.
  4. Ameloblastic fibroma

Explanation

Central giant cell granuloma presents as a multilocular radiolucency in young patients and shows multinucleated giant cells in a fibrous, hemosiderin-rich stroma. It is more common in the anterior mandible but can occur posteriorly.

Question 6Oral and Maxillofacial Surgical Pathology

Which tumor is characterized by duct-like structures lined by cuboidal cells and often surrounds the crown of an impacted canine?

  1. Odontoma
  2. Adenomatoid odontogenic tumor Correct answer.
  3. Cementoblastoma
  4. Ameloblastoma

Explanation

Adenomatoid odontogenic tumor typically presents as a well-defined radiolucency associated with an impacted canine and shows duct-like epithelial structures with cuboidal cells. It is a benign, slow-growing lesion.

Question 7Oral and Maxillofacial Surgical Pathology

A painless swelling of the anterior maxilla in a 45-year-old shows a radiolucent lesion with a well-defined border. Biopsy reveals sheets of clear cells with glycogen and a fibrous capsule. Which diagnosis is most likely?

  1. Glandular odontogenic cyst
  2. Clear cell odontogenic carcinoma Correct answer.
  3. Ameloblastoma
  4. Lateral periodontal cyst

Explanation

Clear cell odontogenic carcinoma is a rare malignant tumor composed of nests and cords of clear cells containing glycogen. It occurs in the mandible or maxilla of adults and requires wide excision.

Question 8Oral and Maxillofacial Surgical Pathology

Which of the following is the most common odontogenic tumor?

  1. Odontogenic myxoma
  2. Ameloblastoma
  3. Cementoblastoma
  4. Odontoma Correct answer.

Explanation

Odontoma is the most common odontogenic tumor, often presenting as a radiopaque mass (compound or complex). It is a hamartomatous proliferation of dental hard tissues.

Question 9Oral and Maxillofacial Surgical Pathology

A 60-year-old with a painful, rapidly growing mandibular mass shows islands of atypical squamous cells with keratin pearls and nuclear pleomorphism invading bone. Which diagnosis is most likely?

  1. Primary intraosseous squamous cell carcinoma Correct answer.
  2. Odontogenic keratocyst
  3. Ameloblastoma
  4. Osteosarcoma

Explanation

Primary intraosseous squamous cell carcinoma arises within bone, often from an odontogenic cyst, and shows invasive squamous carcinoma with keratinization and atypia. Rapid growth and pain suggest malignancy.

Question 10Oral and Maxillofacial Surgical Pathology

Which of the following best describes the histologic appearance of an odontogenic myxoma?

  1. Sheets of plasma cells with Russell bodies
  2. Abundant myxoid stroma with stellate cells and sparse collagen Correct answer.
  3. Epithelial islands with calcifications
  4. Dense collagen bundles with spindle cells

Explanation

Odontogenic myxoma consists of a paucicellular myxoid stroma rich in hyaluronic acid with stellate to spindle-shaped cells and little collagen. It appears as a multilocular radiolucency, often with a tennis-racket pattern.

Question 11Oral and Maxillofacial Surgical Pathology

A 25-year-old has a unilocular radiolucency at the apex of a nonvital maxillary incisor. Histology shows non-keratinized stratified squamous epithelium with cholesterol clefts and hemosiderin. What is the most likely diagnosis?

  1. Odontogenic keratocyst
  2. Radicular cyst Correct answer.
  3. Dentigerous cyst
  4. Nasopalatine duct cyst

Explanation

Radicular (periapical) cyst arises from inflammatory stimulation at the apex of a nonvital tooth and is lined by non-keratinized stratified squamous epithelium with cholesterol clefts and hemosiderin. It is the most common odontogenic cyst.

Question 12Oral and Maxillofacial Surgical Pathology

Which lesion is characterized by a cystic space lined by epithelium containing mucous cells and microcysts, often in the anterior mandible?

  1. Nasolabial cyst
  2. Dentigerous cyst
  3. Glandular odontogenic cyst Correct answer.
  4. Radicular cyst

Explanation

Glandular odontogenic cyst is lined by epithelium with mucous cells, microcysts, and sometimes cilia, and it has a tendency to recur. It occurs most often in the anterior mandible.

Question 13Oral and Maxillofacial Surgical Pathology

A patient with a history of a previously excised odontogenic keratocyst presents with a new multilocular radiolucency. Which feature of the original lesion best explains the high recurrence rate?

  1. Thin friable lining that fragments on removal and satellite cysts in the wall Correct answer.
  2. Prominent inflammatory infiltrate with cholesterol clefts
  3. Extensive calcification of the cyst wall
  4. Presence of ciliated respiratory epithelium

Explanation

Odontogenic keratocyst has a thin, friable lining that easily fragments during removal, and satellite cysts or epithelial islands in the wall contribute to recurrence. This explains why recurrence rates are higher than for other odontogenic cysts.

Question 14Oral and Maxillofacial Surgical Pathology

Which of the following is a benign cementum-producing tumor attached to the root of a vital tooth and showing a radiopaque mass with a radiolucent rim?

  1. Odontoma
  2. Osteoma
  3. Ameloblastoma
  4. Cementoblastoma Correct answer.

Explanation

Cementoblastoma is a benign neoplasm of cementum that is fused to the root of a vital tooth and appears as a radiopaque mass with a thin radiolucent halo. Histology shows cementum-like tissue with reversal lines.

Question 15Oral and Maxillofacial Surgical Pathology

A 55-year-old presents with an expansile multilocular radiolucency of the posterior mandible. Biopsy shows islands of basaloid cells with peripheral palisading but no stellate reticulum and prominent reverse polarity. Which diagnosis is most likely?

  1. Basal cell ameloblastoma variant Correct answer.
  2. Calcifying odontogenic cyst
  3. Ameloblastoma
  4. Odontogenic fibroma

Explanation

The basal cell variant of ameloblastoma shows nests of basaloid cells with peripheral palisading and reverse polarity but lacks the central stellate reticulum seen in conventional ameloblastoma. It is a recognized histologic variant.

Question 16Oral and Maxillofacial Surgical Pathology

Which of the following is the most common site for a nasopalatine duct cyst?

  1. Posterior mandible
  2. Midline anterior palate Correct answer.
  3. Angle of the mandible
  4. Lateral maxillary alveolus

Explanation

Nasopalatine duct cyst arises from remnants of the nasopalatine duct and presents in the midline of the anterior palate, often as a heart-shaped radiolucency. It is the most common non-odontogenic cyst of the oral cavity.

Question 17Oral and Maxillofacial Surgical Pathology

A 40-year-old with a long-standing mandibular swelling shows a cystic lesion lined by epithelium with ghost cells and areas of calcification. Which diagnosis is most consistent?

  1. Dentigerous cyst
  2. Calcifying odontogenic cyst Correct answer.
  3. Odontogenic keratocyst
  4. Radicular cyst

Explanation

Calcifying odontogenic cyst (Gorlin cyst) is characterized by a cystic lining with ghost cells and calcifications. It can occur in bone or gingiva and may be associated with an odontoma.

Question 18Oral and Maxillofacial Surgical Pathology

Which feature is most characteristic of an ameloblastic fibroma?

  1. Multinucleated giant cells with hemosiderin
  2. Sheets of atypical clear cells
  3. Ghost cells with calcifications
  4. Odontogenic epithelial cords in a myxoid fibrous stroma resembling the dental papilla Correct answer.

Explanation

Ameloblastic fibroma consists of odontogenic epithelial cords and islands in a cellular myxoid fibrous stroma that resembles the dental papilla. It typically occurs in young patients and may be associated with an unerupted tooth.

Question 19Oral and Maxillofacial Surgical Pathology

A rapidly growing, painful maxillary swelling in a 70-year-old shows islands of malignant squamous cells with prominent atypia and necrosis. Which diagnosis is most likely?

  1. Squamous cell carcinoma arising in an odontogenic cyst Correct answer.
  2. Ameloblastoma
  3. Cementoblastoma
  4. Odontogenic myxoma

Explanation

Squamous cell carcinoma arising in an odontogenic cyst shows malignant squamous transformation of the cyst lining with atypia, invasion, and necrosis. Older age and rapid growth support malignancy.

Question 20Oral and Maxillofacial Surgical Pathology

Which of the following best describes the radiographic and histologic features of an odontoma?

  1. Radiolucent lesion with duct-like epithelium
  2. Radiopaque mass of enamel and dentin with a radiolucent halo Correct answer.
  3. Radiopaque mass attached to a root with cementum-like tissue
  4. Multilocular radiolucency with myxoid stroma

Explanation

Odontoma presents as a radiopaque mass composed of enamel, dentin, and sometimes cementum, often surrounded by a thin radiolucent halo. Compound odontomas contain tooth-like structures, while complex odontomas are disorganized masses.

Question 21Oral and Maxillofacial Surgical Pathology

A 20-year-old with a unilocular radiolucency in the anterior maxilla shows a cyst lined by thin epithelium with focal plaque-like thickenings containing clear cells. Which diagnosis is most likely?

  1. Dentigerous cyst
  2. Odontogenic keratocyst
  3. Radicular cyst
  4. Lateral periodontal cyst Correct answer.

Explanation

Lateral periodontal cyst occurs on the lateral aspect of a vital tooth and is lined by thin epithelium with focal plaque-like thickenings that may contain clear cells. The botryoid variant shows multiple cystic spaces.

Question 22Oral and Maxillofacial Surgical Pathology

Which of the following is the most appropriate initial management for a small, well-defined odontogenic keratocyst of the mandible?

  1. Enucleation with adjunctive peripheral ostectomy or Carnoy solution Correct answer.
  2. Incision and drainage only
  3. Radical resection with free flap reconstruction
  4. Observation without intervention

Explanation

Small, well-defined odontogenic keratocysts are typically treated by enucleation with adjunctive measures such as peripheral ostectomy or chemical cauterization to reduce recurrence. Radical resection is reserved for large or recurrent lesions.

Question 23Oral and Maxillofacial Surgical Pathology

A biopsy of a gingival mass shows a biphasic tumor with islands of odontogenic epithelium and a fibrous stroma, arising in the gingiva without bone involvement. Which diagnosis is most likely?

  1. Peripheral ameloblastoma Correct answer.
  2. Central ameloblastoma
  3. Odontogenic myxoma
  4. Radicular cyst

Explanation

Peripheral ameloblastoma arises in the gingival soft tissue without bone involvement and shows the same histologic features as central ameloblastoma. It is treated by local excision.

Question 24Oral and Maxillofacial Surgical Pathology

Which of the following is a characteristic feature of an ameloblastic carcinoma compared with a conventional ameloblastoma?

  1. Cementum-like material
  2. Abundant myxoid stroma
  3. Presence of ghost cells
  4. Cytologic atypia and malignant behavior in an ameloblastoma-like tumor Correct answer.

Explanation

Ameloblastic carcinoma shows the architecture of ameloblastoma but with cytologic atypia and malignant behavior, including invasion and metastasis. Conventional ameloblastoma is benign despite local aggressiveness.

Question 25Oral and Maxillofacial Surgical Pathology

A 35-year-old presents with a well-defined radiolucency in the anterior mandible. Histology shows a cyst lined by epithelium with mucous cells and cilia. Which diagnosis is most likely?

  1. Surgical ciliated cyst Correct answer.
  2. Radicular cyst
  3. Dentigerous cyst
  4. Odontogenic keratocyst

Explanation

Surgical ciliated cyst arises after surgery or trauma that implants respiratory epithelium into bone and is lined by ciliated columnar epithelium. It is most common in the maxilla but can occur in the mandible.

Question 26Oral and Maxillofacial Surgical Pathology

A 30-year-old presents with a well-circumscribed radiolucency between the roots of the mandibular premolars; the teeth are vital. Histology shows a cyst lined by thin non-keratinized epithelium with focal areas of plaque-like thickening, and the cyst wall contains prominent hyaline rings and multinucleated giant cells. Which diagnosis is most likely?

  1. Lateral periodontal cyst Correct answer.
  2. Glandular odontogenic cyst
  3. Botryoid odontogenic cyst
  4. Radicular cyst

Explanation

A lateral periodontal cyst arises on the lateral root surface of a vital tooth, most often in the mandibular premolar region, and classically shows plaque-like epithelial thickenings in a thin non-keratinized lining. The botryoid variant is multicystic with a lobular (grape-like) architecture rather than a single cyst.

Question 27Oral and Maxillofacial Surgical Pathology

Which lesion is characterized histologically by a fibrous connective tissue wall containing islands of odontogenic epithelium and foci of calcification, and is often found in the anterior maxilla of young patients?

  1. Odontogenic fibroma
  2. Calcifying odontogenic cyst
  3. Adenomatoid odontogenic tumor Correct answer.
  4. Calcifying epithelial odontogenic tumor

Explanation

Adenomatoid odontogenic tumor shows duct-like epithelial structures (rosettes) with interspersed calcifications and is classically a well-defined anterior maxillary lesion in younger patients, often associated with an impacted tooth. The calcifications are dystrophic deposits among epithelial cells, not the amyloid-associated Liesegang rings of a calcifying epithelial odontogenic tumor.

Question 28Oral and Maxillofacial Surgical Pathology

A 45-year-old presents with a slowly enlarging gingival mass on the mandibular alveolar ridge; the underlying bone is intact. Histology shows a proliferation of spindle cells with abundant collagen and scattered calcifications resembling cementum. Which diagnosis is most consistent?

  1. Peripheral odontogenic fibroma Correct answer.
  2. Fibrous epulis
  3. Peripheral giant cell granuloma
  4. Peripheral ossifying fibroma

Explanation

Peripheral odontogenic fibroma is a gingival lesion composed of fibrous connective tissue with strands of odontogenic epithelium and sometimes calcifications, and it arises on the alveolar mucosa. Its distinction from a fibrous epulis rests on the presence of odontogenic epithelial rests and calcified material.

Question 29Oral and Maxillofacial Surgical Pathology

Which of the following best describes the classic radiographic appearance of a glandular odontogenic cyst?

  1. A ground-glass radiopacity with expansion of the jaw
  2. A unilocular radiolucency with a sclerotic border surrounding the crown of an impacted tooth
  3. A sunburst periosteal reaction with cortical destruction
  4. A well-defined multilocular radiolucency with a scalloped margin, often in the anterior mandible Correct answer.

Explanation

Glandular odontogenic cyst typically appears as a well-defined, often multilocular radiolucency with scalloped margins, most frequently in the anterior mandible, and it has a high recurrence rate. It is distinguished from a dentigerous cyst by its multilocularity and its histologic duct-like lining.

Question 30Oral and Maxillofacial Surgical Pathology

A 65-year-old presents with a painful, rapidly growing mandibular mass and paresthesia of the lower lip. Biopsy shows sheets of pleomorphic epithelial cells with frequent mitoses and perineural invasion. Which diagnosis is most likely?

  1. Primary intraosseous carcinoma Correct answer.
  2. Ameloblastic carcinoma
  3. Clear cell odontogenic carcinoma
  4. Squamous cell carcinoma arising in an odontogenic cyst

Explanation

Primary intraosseous carcinoma is a squamous cell carcinoma arising within the jaw bone without an initial connection to the oral mucosa, and it presents with pain, rapid growth, and paresthesia. It must be distinguished from carcinoma arising in an odontogenic cyst by the absence of a preexisting cyst lining.

Question 31Oral and Maxillofacial Surgical Pathology

Which of the following is the most common location for a traumatic bone cyst (simple bone cyst)?

  1. Anterior maxilla
  2. Condylar head
  3. Posterior mandible Correct answer.
  4. Angle of the mandible

Explanation

Traumatic bone cyst most frequently occurs in the posterior mandible of young patients and appears as a well-defined radiolucency that often scallops between the roots. It is an empty or fluid-filled cavity lacking an epithelial lining.

Question 32Oral and Maxillofacial Surgical Pathology

A 50-year-old presents with a firm palatal swelling; imaging shows a well-defined radiolucency of the hard palate. Histology shows a cyst lined by pseudostratified ciliated columnar epithelium with goblet cells. Which diagnosis is most likely?

  1. Dentigerous cyst
  2. Nasopalatine duct cyst
  3. Surgical ciliated cyst Correct answer.
  4. Radicular cyst

Explanation

A surgical ciliated cyst develops after surgery or trauma that implants respiratory epithelium into the jaw, and it is lined by pseudostratified ciliated columnar epithelium. Its location in the maxilla or palate and the history of prior surgery are key diagnostic features.

Question 33Oral and Maxillofacial Surgical Pathology

Which of the following features best distinguishes an ameloblastic fibro-odontoma from a complex odontoma?

  1. Occurrence exclusively in the anterior maxilla
  2. Absence of calcified dental hard tissues
  3. Presence of a well-defined radiolucency with a sclerotic border
  4. Presence of a soft tissue component with odontogenic epithelium and ectomesenchyme resembling an ameloblastic fibroma Correct answer.

Explanation

Ameloblastic fibro-odontoma contains both the soft tissue proliferation of an ameloblastic fibroma and calcified dental hard tissues, whereas a complex odontoma consists only of disorganized hard tissue. The soft tissue component is the distinguishing feature.

Question 34Oral and Maxillofacial Surgical Pathology

A 28-year-old presents with a painless swelling of the posterior mandible. Radiographs show a multilocular radiolucency with a honeycomb pattern. Histology shows a fibrous stroma containing small islands of odontogenic epithelium with a delicate reticular pattern. Which diagnosis is most likely?

  1. Odontogenic keratocyst
  2. Odontogenic myxoma Correct answer.
  3. Central giant cell granuloma
  4. Ameloblastoma

Explanation

Odontogenic myxoma classically produces a multilocular honeycomb or soap-bubble radiolucency in the posterior mandible and is composed of a myxoid stroma with sparse odontogenic epithelial rests. The gelatinous, mucopolysaccharide-rich stroma is characteristic.

Question 35Oral and Maxillofacial Surgical Pathology

Which of the following is the most common clinical presentation of a cementoblastoma?

  1. A painful swelling of the posterior mandible attached to the root of a vital tooth Correct answer.
  2. A painless swelling of the anterior maxilla with tooth mobility
  3. A multilocular radiolucency of the posterior mandible with root resorption
  4. A diffuse radiopacity of the maxilla crossing the midline

Explanation

Cementoblastoma typically presents as a painful swelling in the posterior mandible, attached to the root of a vital tooth, with a radiopaque mass surrounded by a radiolucent halo. The attachment to a vital root distinguishes it from other cemento-osseous lesions.

Question 36Oral and Maxillofacial Surgical Pathology

A 55-year-old presents with a painful, expansile mass of the anterior mandible. Radiographs show a multilocular radiolucency with cortical perforation. Histology shows islands of basaloid cells with peripheral palisading and reverse polarity, and areas of necrosis. Which diagnosis is most likely?

  1. Calcifying epithelial odontogenic tumor
  2. Solid variant of ameloblastoma
  3. Odontogenic keratocyst
  4. Ameloblastic carcinoma Correct answer.

Explanation

Ameloblastic carcinoma combines the histologic features of ameloblastoma with malignant features such as cytologic atypia, necrosis, and perineural or vascular invasion, and it often presents with pain and rapid growth. The presence of necrosis and aggressive behavior distinguishes it from a conventional ameloblastoma.

Question 37Oral and Maxillofacial Medicine and Mucosal Disease

Which mucosal lesion classically presents as a white, adherent plaque that cannot be rubbed off and is defined histologically by hyperkeratosis without dysplasia?

  1. Chemical burn
  2. Leukoplakia Correct answer.
  3. Lichen planus
  4. Pseudomembranous candidiasis

Explanation

Leukoplakia is a clinical descriptive term for a predominantly white patch that cannot be characterized clinically or pathologically as any other disease and cannot be wiped off. Histologically it often shows hyperkeratosis, with or without dysplasia. Pseudomembranous candidiasis and chemical burns wipe away or slough, and lichen planus has a characteristic reticular striae pattern.

Question 38Oral and Maxillofacial Medicine and Mucosal Disease

A patient reports recurrent crops of small vesicles on the keratinized mucosa of the hard palate that rupture to leave shallow ulcers. Which diagnosis best fits this presentation?

  1. Herpangina
  2. Recurrent intraoral herpes simplex Correct answer.
  3. Recurrent herpes labialis
  4. Aphthous major ulceration

Explanation

Recurrent intraoral herpes simplex affects keratinized mucosa such as the hard palate and attached gingiva, producing clustered vesicles that rupture into small ulcers. Herpes labialis occurs on the vermilion border, aphthous ulcers occur on nonkeratinized mucosa, and herpangina affects the posterior pharynx and soft palate.

Question 39Oral and Maxillofacial Medicine and Mucosal Disease

Which feature most reliably distinguishes oral lichen planus from a lichenoid drug reaction?

  1. Bilateral symmetry
  2. Presence of white striae
  3. Female predilection
  4. History of a culprit medication with resolution after withdrawal Correct answer.

Explanation

Lichenoid drug reactions mimic lichen planus clinically and histologically but improve after discontinuation of the offending drug. White striae, bilateral distribution, and female predominance are shared features and do not separate the two. A careful medication history with follow-up is therefore the key discriminator.

Question 40Oral and Maxillofacial Medicine and Mucosal Disease

What is the most common location for oral squamous cell carcinoma arising in the mouth?

  1. Lateral border of the tongue Correct answer.
  2. Hard palate
  3. Buccal mucosa
  4. Ventral tongue

Explanation

The lateral and ventrolateral border of the tongue is the most frequent intraoral site for squamous cell carcinoma, particularly in tobacco and alcohol users. The floor of the mouth is the next most common site. Palatal and buccal lesions occur but are less frequent overall.

Question 41Oral and Maxillofacial Medicine and Mucosal Disease

A 60-year-old with a long-standing white plaque on the floor of the mouth undergoes biopsy showing moderate epithelial dysplasia. What is the most appropriate management?

  1. Reassurance and review in one year
  2. Topical antifungal therapy
  3. Excision or laser ablation with histologic margins Correct answer.
  4. Observation with photographs every three months

Explanation

Moderate epithelial dysplasia carries a significant risk of progression to carcinoma and warrants definitive treatment, usually surgical excision or laser ablation with clear margins. Simple observation or antifungal therapy is inadequate. Long-interval review alone risks missing transformation.

Question 42Oral and Maxillofacial Medicine and Mucosal Disease

Which condition is characterized by chronic, cyclic oral ulceration beginning in childhood, with a family history and no identifiable systemic cause?

  1. Pemphigus vulgaris
  2. Recurrent aphthous stomatitis Correct answer.
  3. Behçet disease
  4. Crohn disease

Explanation

Recurrent aphthous stomatitis is a diagnosis of exclusion characterized by cyclic minor, major, or herpetiform ulcers beginning in youth, often with a family history. Behçet disease and Crohn disease produce similar ulcers but have additional systemic features, and pemphigus vulgaris produces erosions rather than discrete aphthae.

Question 43Oral and Maxillofacial Medicine and Mucosal Disease

A patient has desquamative gingivitis with erosions and a positive Nikolsky sign. Direct immunofluorescence shows intercellular IgG deposition in the epithelium. Which diagnosis is most likely?

  1. Lichen planus
  2. Linear IgA disease
  3. Mucous membrane pemphigoid
  4. Pemphigus vulgaris Correct answer.

Explanation

Intercellular epithelial IgG deposition is the hallmark of pemphigus vulgaris, which often presents with fragile bullae, erosions, and a positive Nikolsky sign. Mucous membrane pemphigoid shows linear basement membrane deposition, and lichen planus shows a linear fibrinogen pattern at the basement membrane.

Question 44Oral and Maxillofacial Medicine and Mucosal Disease

Which of the following is the most common site for mucous membrane pemphigoid involvement?

  1. Esophagus
  2. Gingiva Correct answer.
  3. Larynx
  4. Conjunctiva

Explanation

The gingiva is the most frequently affected oral site in mucous membrane pemphigoid, often producing desquamative gingivitis. Conjunctival involvement is clinically important because of scarring but is not the most common site overall. Esophageal and laryngeal involvement are less frequent.

Question 45Oral and Maxillofacial Medicine and Mucosal Disease

A patient with type 2 diabetes develops a painful, unilateral, sharply demarcated area of erythema and ulceration on the palate following a respiratory infection. What is the most likely diagnosis?

  1. Erythematous candidiasis
  2. Hereditary angioedema
  3. Herpes zoster Correct answer.
  4. Erythema multiforme

Explanation

Herpes zoster produces unilateral, dermatomal vesicular and ulcerative lesions that respect the midline and are often preceded by pain. Palatal involvement can follow trigeminal reactivation. Erythema multiforme is usually bilateral and targetoid, and erythematous candidiasis is diffuse rather than unilateral.

Question 46Oral and Maxillofacial Medicine and Mucosal Disease

Which of the following is a recognized feature of erythema multiforme?

  1. Target lesions on the skin with oral mucosal erosions Correct answer.
  2. Chronic progressive scarring of the conjunctiva
  3. Subepithelial separation with linear IgG
  4. Recurrent crops of vesicles on the hard palate

Explanation

Erythema multiforme is characterized by target or iris skin lesions and mucosal erosions, often triggered by infection such as herpes simplex. It is acute and self-limited rather than chronic. The other options describe pemphigoid, pemphigus, and recurrent herpes simplex.

Question 47Oral and Maxillofacial Medicine and Mucosal Disease

A patient presents with a painless, sessile, firm nodule on the hard palate that has been present for years and is covered by normal-colored mucosa. Which diagnosis is most likely?

  1. Fibroma
  2. Squamous papilloma
  3. Pleomorphic adenoma Correct answer.
  4. Mucoepidermoid carcinoma

Explanation

Pleomorphic adenoma is the most common benign salivary gland tumor and frequently arises in the palatal minor salivary glands, presenting as a firm, painless, slow-growing mass. Fibromas occur at sites of chronic irritation, and squamous papillomas are exophytic and papillary.

Question 48Oral and Maxillofacial Medicine and Mucosal Disease

Which of the following is the most appropriate first-line treatment for oral candidiasis in an otherwise healthy patient?

  1. Topical nystatin or clotrimazole Correct answer.
  2. Topical corticosteroids
  3. Systemic amphotericin B
  4. Oral acyclovir

Explanation

Topical polyene or azole agents such as nystatin or clotrimazole are first-line for uncomplicated oral candidiasis. Systemic amphotericin is reserved for severe or refractory disease, acyclovir treats herpes, and corticosteroids would worsen a fungal infection.

Question 49Oral and Maxillofacial Medicine and Mucosal Disease

Which clinical finding is most characteristic of median rhomboid glossitis?

  1. A fissured, depapillated tongue with burning
  2. A diamond-shaped area of erythema on the midline dorsum of the tongue Correct answer.
  3. Multiple small ulcers on the ventral tongue
  4. A white plaque on the lateral border of the tongue

Explanation

Median rhomboid glossitis appears as a well-demarcated erythematous diamond-shaped patch on the midline dorsum of the tongue, anterior to the circumvallate papillae, and is often associated with candidal infection. Lateral plaques and ventral ulcers suggest other diagnoses.

Question 50Oral and Maxillofacial Medicine and Mucosal Disease

A patient reports intermittent, migrating areas of depapillation on the tongue dorsum with a burning sensation. What is the diagnosis?

  1. Median rhomboid glossitis
  2. Geographic tongue Correct answer.
  3. Fissured tongue
  4. Hairy tongue

Explanation

Geographic tongue (benign migratory glossitis) produces migrating erythematous patches with a white border as filiform papillae are lost and regenerate, often with burning. Fissured tongue shows deep grooves, hairy tongue shows elongated papillae, and median rhomboid glossitis is a fixed midline lesion.