DARA 761 Advanced Oral Radiology and NAME______Exam 1 June 11, 2008

CASE 1 9 y/o white female CC: Mom has noticed a progressive non-tender swelling in the past 3 months. Med Hx: Non-contributory Clinical Exam: Swelling/Expansion noted in the anterior mandible, crossing the midline. The overlying mucosa has a purple color to it. Additional Rad exam: A true occlusal shows expansion in an anterior-posterior direction

1. Is Radicular a likely diagnosis? YES NO 2. Is Central Giant Cell Granuloma a likely diagnosis? YES NO 3. Is Cherubism a likely diagnosis? YES NO

CASE 2 32 y/o white male CC: Noticed swelling on the roof of his mouth, especially in the front Med Hx: Non-contributory Clinical Exam: Slight swelling on the palate around the incisive papilla. All teeth in area test vital.

4. Is Radicular cyst #8 your primary diagnosis? YES NO 5. Is Nasopalatine duct cyst your primary diagnosis? YES NO 6. Would this be a common site for an ? YES NO 7. Is Periapical Cemental Dysplasia a likely diagnosis? YES NO

CASE 3 44 y/o white female CC: Is finally ready to have something done with the space of #22 and the malposed #31. Med Hx: Non-contributory

8. Primary diagnosis area #22 ______

9. Why can the diagnosis of Simple be excluded for the area #22? ______

______

10. Is Dentigerous Cyst #22 a likely diagnosis? YES NO

CASE 4 52 y/o black male CC: Has noticed some mild swelling on the right side for at least 3 years, and it hasn’t been uncomfortable. Med Hx: High blood pressure and cholesterol Clinical Exam: Only slight bony expansion at the cortex. Occlusal shows no buccal-lingual expansion.

11. Is Osteosarcoma a likely diagnosis? YES NO 12. Is OKC a likely diagnosis? YES NO 13. Is Odontogenic Myxoma a likely diagnosis? YES NO 14. What is your primary diagnosis? A OKC B Ameloblastoma C Paget’s Disease D Radicular Cyst

CASE 5 7 y/o white female CC: Mom states she has noticed rapid swelling of the left jaw over the past 3-4 weeks Med Hx: Non-contributory Clinical Exam: Expansive swelling of the Left angle and ramus. Slightly tender on palpation.

15. Is OKC your primary diagnosis? YES NO 16. Is Paget’s Disease a likely diagnosis? YES NO 17. Is Aneurysmal bone cyst a likely diagnosis? YES NO 18. Is Dentigerous Cyst #18 your primary diagnosis? YES NO

19. The group “Giant Cell Lesions” include which of the following? 1. Central Giant Cell Granuloma 2. Osteopetrosis 3. Cemento-osseous dysplasia 4. Cherubism 5. Aneurysmal bone cyst 6. Paget’s disease 7. Brown tumor of hyperparathyroidism

A 1, 2, 3, 7 B 1, 4, 5, 6 C 1, 4, 5, 7 D 1, 3, 4, 7

CASE 6 72 y/o black male CC: Difficulty eating Med Hx: On a myriad of medications

20. Include edentulous maxilla and mandible and ill-fitting dentures in a differential diagnosis? YES NO, if the patient presents on a day with a full moon in June

CASE 7 43-year-old black female presents for routine care. Medical History: Unremarkable. Pt takes only vitamin supplements. Clinical examination: Pt reports no hx of pain or swelling of area. Teeth are vital, with no caries detected. No expansion or irregularity noted.

21. Is Fibrous Dsyplasia a likely diagnosis? YES NO

22. Is Central Giant Cell Granuloma a likely diagnosis? YES NO

23. Is Florid Cemento-Osseous Dysplasia a likely diagnosis? YES NO

24. Is Periapical Abscess a likely diagnosis? YES NO

25. Is a likely diagnosis? YES NO

CASE 8 48 year old white male returns for follow-up care. Medical History: Rx Zocor for elevated cholesterol. Smokes 2 packs of cigarettes/day, and has 3-4 alcoholic drinks/week. Clinical Examination: Re-evaluation of solitary, asymptomatic, erythematous macule/erosion of unknown duration. Not likely caused by . Lesion has not responded to 2-week course of antifungal medication. Remaining mucosa is unremarkable.

26. Is Erosive a likely diagnosis? YES NO

27. Is Cicatricial Pemphigoid a likely diagnosis? YES NO

28. Is mild, moderate, or severe dysplasia a likely diagnosis? YES NO

29. Could this be a Cinnamon allergy? YES NO

30. Is Squamous Cell Carcinoma a likely diagnosis? YES NO

MATCHING Match each of the following lesions (numbered items) to the appropriate organism (lettered items) below. Each lettered item may be used more than once, or not at all.

31. Hairy 32. Kaposi Sarcoma 33. Squamous Papilloma 34. Aphthous 35. Median Rhomboid

a) Human Papilloma Virus b) Epstein Barr Virus c) Candida albicans d) Human Herpes Virus-8 e) Lesion is not thought to be caused by an infectious organism

31 ______32______33______34______35______

MULTIPLE CHOICE QUESTIONS

36. Characteristics of the Odontogenic Keratocyst (soon to be renamed Keratocystic Odontogenic Tumor) include

1. a uniform epithelial lining 7-10 cells thick. 2. a high recurrence rate. 3. tendency to metastasize. 4. radiographic appearance often similar to other 5. aggressive behavior: spread with bone destruction.

a) 1 and 3 b) 3 only c) 2, 4 and 5 d) 1, 2, 4 and 5 e) All of the above

37. In approximately what percentage of cases will show dysplasia or squamous carcinoma? a) 5% b) 15-20% c) 40-50% d) 90%

38. The condition which may occur under a denture, produces nodular enlargement of the palatal mucosa, and frequently shows infection with Candidia albicans, is called

a) inflammatory papillary hyperplasia b) median rhomboid glossitis c) benign migratory glossitis d) stomatitis areata migrans d) acanthosis nigricans . 39. Lesions with a clinical appearance similar to that of Lichen planus can be caused by a) medications b) contact allergens c) Lupus erythematosus d) None of the above e) All of the above

40. Biopsy or surgical provocation of known Florid Cemento-Osseous Dysplasia may cause, or directly lead to the development of, a) osteosarcoma. b) osteochondroma. c) spread of the lesion to previously unaffected areas of bone. d) ameloblastic carcinoma e) osteomyelitis

41. What disorder would you suspect in a patient with elevated serum calcium, low serum phosphate,calcifications in subcutaneous soft tissues and vessels, and a radiolucent bone tumor histologically identical to the central giant cell granuloma?

a) hyperparathyroidism b) hyperthyroidism c) hypoparathyroidism d) hypoadrenalcorticalism e) diabetes mellitus

42. The three common “gum bumps” (benign soft tissue tumors occurring on the gingiva) include , peripheral ossifying fibroma, and

a) peripheral giant cell granuloma b) peripheral odontogenic fibroma c) peripheral ameloblastoma d) parosteal osteosarcoma e) mucocutaneous leishmaniasis

43. Condensing osteitis represents an area of bone sclerosis (increased density) at the periapex of an inflamed or necrotic tooth. a) True b) False

44. Primary and recurrent infections present as vesicles, whereas presents as a shallow ulcer. a) True b) False

45. Tobacco pouch keratosis is associated with , cervical caries, and a) an increased risk of oral squamous cell carcinoma equivalent to that of a smoker. b) a transient mucosal burn with a very minimally increased risk of dysplasia, which will diminish on cessation of the habit. c) an increased risk of laryngeal, lung, bladder, and ovarian cancer. d) a 4-5 fold increase in the risk of epithelial dysplasia or carcinoma.