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Home , Cementoblastoma, Cherubism, Dentigerous cyst, Hypercementosis, Lateral periodontal cyst, Odontogenic cyst

ORAL DIAGNOSIS DEND 329

FINAL EXAMINATION DECEMBER 12,2005

THIS EXAMINATION CONSISTS OF 100 QUESTIONS. PLEASE, FO&OW THE INSTRUCTIONS FOR EACH SECTION.

Questions 1-35 Clzoose the best answer based upon the description and projection presented, and indicate the answer on your scantron sheet.

1. Which of the following statements is true considering a differential diagnosis for the projected radiolucent lesion?

A. Based upon the radiographic appearance, this lesion can only be a dentigerous f%>hile a should head any differential list, one should consider, among other things, a unicystic and a calcifying C. While a dentigerous cyst should head any differential list, one should consider, among other things, a radicular cyst and a Stafne cyst D. While a unicystic ameloblastoma should head any differential list, one should consider, among other things, a dentigerous cyst and a radicular cyst E. A dentigerous cyst should not be included in a differential for this lesion

2. Which of the following is the most likely diagnosis of this ulcerative lesion of the , which has a history of recurrence only to heal uneventfully in a week or so?

A. Minor aphthous ulcer B? Major aphthous ulcer C. Herpetic ulcer D. Traumatic ulcer E. An ulcer associated with

3. Which of the following is the most likely diagnosis of the radiopaque mass observed in this occlusal radiograph of a middle-aged patient, who complained of pain and occasional swelling in the floor of his mouth?

A. Avulsed B. C. Phebolith ,e--. Sialolith E. Shaprel form the Vietnam War 4. The 70 y.0. male patient in this case complains of pain, bleeding around the teeth, and a series of generalized . Which of the following is the most likely diagnosis of his condition? '2

A. Paget disease B. Langerhans disease a~ulti~lemyeloma D. Ewing sarcoma E. Primary hyperparathyroidism

5. Which of the following should not be included in a list of differentials for this gingival mass?

A. Peripheral giant cell B. Peripheral ossifying (2. D. Fibrous hyperplasidirritation fibroma ,-N ' E.)Minor salivary gland tumor

6. Which of the following is the most likely diagnosis of this periapical radiolucency, which was discovered upon routine radiographic examination of this 12 y.0. male patient? All the teeth were vital in this region. P" A. Stafne cyst B. Traumatic

,' C. D. E. Dentigerous cyst

7. Which of the following is the most likely diagnosis of this radiopaque lesion, which presented as a swelling of the lingual alvelolar mucosa?

A. Compound B. Complex odontoma C, Sialolith ~.handibulartorus E. Osteosarcoma 8. Which of the following is the most likely diagnosis of the mixed lesion(s) shown at the apex of the mandibular first molar in this projected radiograph?

A. Idiopathic osteosclerosis B. Mental foramen 9Rarefying and condensing osteitis D. Mandibular torus E. Focal cemento-osseous dysplasia

9. Which of the following is the most likely diagnosis of the mixed radiolucentlradiopaque lesion blocking the eruption of the maxillary central incisor?

A. Rarefying and condensing osteitis B. Adenomatoid C. Chronic D) Compound odontoma E. Complex odontoma

10. Using the projected lateral skull film and a periapical radiograph of a primary molar in this young patient, which of the following is the most likely diagnosis?

A. B. Behqet syndrome C. Multiple myeloma ~J~angerhanscell disease E. Pindborg tumor

1 1. The unique radiographic appearance demonstrated in this periapical radiograph is most commonly associated with which of the following diseases?

\*- A. Proliferative periostitis -1

B. Osteosarcoma A f~>~~~erparathyroidism D. Osteitis deformans E. Osteopetrosis 12. This elderly patient had been on long-term-- antibiotic------therapy-- when she developed these white lesions of her buccal mucosa.-.- The lesions could be removed easily--~--.-- with--- a tongue Ba~iihof the following is the most likely diagnosis?

A. Aspirin bum /B. ~f'~seudomembraneouscandidiasis D. Atrophic candidiasis E.

13. Which of the following is the most likely diagnosis of the radiopac*- - seen at the apex of this normal-appearing, vi-okr? -.- - A'. Periapical granuloma B. Idiopathic osteosclerosis C. Condensing osteitis ,D.' E. Chronic osteomyelitis

14. The uni~e-radiographic appearance observed in this radiograph is most closely associated with which of the following diseases? -- - ,A. Fibrous dysplasia B. Osteosarcoma C. Osteitis deformans ,,El. ,,El. Proliferative periostitis $?Sickle cell anemia

15. Coupling the clinical photograph of this patient with the accompanying , this patient most.-.- likely has which of the following conditions?

A. Nevoid basal cell carcinoma syndrome B. Gardner syndrome (aleidocranial dysplasia D. Mandibulofacial dysostosis E. Osteitis deformans 16. The lesion with a suture through it is about to be removed. This slow-growing, exophytic mass is most likely which of the following? ?

, , A. Fibroma fE'Papilloma C. D. Fibrosarcoma E. Minor salivary gland

17. Which of the following statements is true concerning the ~I~,J~JOS~S of this projected radiograph?

A. A differential list should include: dentigerous cyst, adenomatoid odontogenic tumor and a unicystic ameloblastoma B. A differential list should include: dentigerous cyst, radicular cyst and an odontoma C. The definitive diagnosis can only come with histologic examination of the tissue /;j All of the above A and C only

18. This adult patient had several papules on his face at least two of which had been diagnosed as basal cell carcinomas. The accompanying panoramic radiograph shows some radiolucencies associated with teeth. You remember that this could be part of a syndrome. Which of the following are additional features a patient with this syndrome could manifest?

A. Ocular hypertelorism B. Odontogenic ,.&Palmarlplantar pits " D, 'All of the above _I E. A and C only

19. Which of the following is the most likely diagnosis of this unilateral, slowly-developing, fusiform swelling of the in this 20 y.0. female

A. Hyperparathyroidism

D. Osteosarcoma E. Proliferative periostitis 20. Which of the following disease entities is most likely to present this radiographic appearance knowing that there were no technical errors in the production of this film?

A, Osteosarcoma , 'B. Osteopetrosis C. Osteoporosis D. Metastatic carcinoma F: Fibrous dysplasia

21. This 60 y.0. female's chief complaint was extremely painful gingiva. You observe no other lesions intraorally. Which of the following statements is true concerning the diagnosis?

A.,'Clinically, it could be called a desquamative while a final diagnosis could be cicatricial or lichen planus -6.This is an excellent example of ANUG C. Obviously the patient has a primary herpetic gingivitis D. These gingival lesions are characteristic of herpes zoster E. Because there are both red and white areas of the gingiva, a definitive diagnosis of lichen planus can be made

22. The clinical photograph and lateral oblique radiograph projected is that of a 70 y.0. African American male who's chief dental complaint was bilateral swelling of his "" so his "teeth don't fit". Which of the following is the most likely diagnosis of his condition?

A. Polyostotic fibrous dysplasia B. Osteoporosis ,J). Osteopetrosis - >\ , DlOsteitis deformans / E. Osteosarcoma

23. Which of the following is best clinical diagnosis for this solitary cyst-like radiolucency discovered in a 65 y.0, male from which the surgeon discovered a cavity lined by soft tissue?

A. Radicular cyst B. Dentigerous cyst C. esidual cyst \zinaivalcyst of the adult E. Adenomatoid odontogenic tumor 24. This firm, exophytic mass has been present for over a year. Which of the following is the most likely diagnosis?

A. Osseous choristoma B. Osteoma C. Papilloma D. Mucocele ~hritationfibroma/fibrous

25. Which,of the following is the -.most likely diagnosis of these pecap!ccal.- lesions associated with!'"itafi&*.. . .

KRarefylng and condensing osteitis B. Osteomyelitis (2. Odontoma /'h\~eria~icalcementoosseous dysplasia E: Osteitis deformans

26. This radiograph demonstrates which of the following conditions?

A-~ementoblastoma - B. Idiopathic osteosclerosis - C. Condensing osteitis D. Artifact ., ., E. Hypercementosis

27. Which of the following is the most likely diagnosis of the radiograph?

,A: Mandibular torus " JV'Idiopathic osteosclerosis C. Hypercementosis ,)TProliferative periostitis @ondensing osteitis 28. Which of the following is the most likely diagnosis of the radiopacity observed in this - -- radiograph?

A. Hypercementosis B. Idiopathic osteosclerosis C. Condensing osteitis D. Proliferative periostitis E. Complex odontoma

29. What is the most likely diagnosis of the bluish-h-s observed on the ventrg surface_- of this tongue?

A. Melanoplakia B. Median rhomboid C'j Lingual varices D. Melanoma E. Erythema migrans

30. Using the radiographic image and the projected photomicrograph, which of the following is the correct diagnosis in this case? m A,)Periapical cyst .IB. Periapical granuloma meriapica1 cemento-osseous dysplasia ,RDentigerous cyst JLHypercementosis

3 1. All of the following would be considered in the differential diagnosis of this m~ul~ilocu!~r radiolucent lesiom~r,Which one would not be included in the differential?

\- / ' A. Odontogenic B. Ameloblastoma C. Central giant cell granuloma " D Odontoma 30dontogenic mymma 32. Using the projected radiograph and a history of pain,_swelling and- ---reddness, -" -which . of the following is the most likely diagnosis in this case?

A: Fibrous dysplasia B. ,Osteomyelitis .e.*Florid cementoosseous dysplasia D. Osteopetrosis _EOsteitis deforrnans

33. Using the projected radiograph and the accompanying photomicrograph, which of the following is the diagnosis of this multilocular radiolucent lesion?

, A. Qdontogenic keratocyst B. Ameloblastoma C. Central giant cell granuloma D. E. Osteitis deformans

34. This patient had the projected bony lesions of the , one of which had been diagnosed as central giant cell granuloma and a history of kidney stones, abdominal and bone pain and depression? These findings suggest the patient may really be suffering from which of the following?

A. Osteopetrosis B. Osteoporosis C?Hyperparathyroidism D'. Paget disease E. Multiple myeloma

35. You observed the skin lesions shown in the accompanying photograph and the patient tells you she was diagnosed with skin . In your physical evaluation, you note the projected bony lesions on radiograph. First and foremost, this patient should be evaluated for which of the following disease entities?

A. Cleidocranial dysplasia B. Peutz-Jeghers syndrome C. Nevoid basal cell carcinoma syndrome -- D. Gardner syndrome E. Ascher syndrome Questions 36-100 Multiple choice questions. Choose the best answer and indicate your answer on your scantron sheet.

36. A 14 y. o. boy is seen in consultation because of bilateral swelling of the mandible. Radiographs show bilateral multilocu1,ar lesions in the ascending rami. The mother of this patient has similar findings. which of the following is the most likely diagnosis of this condition?

A. Gardner syndrome B. Ellis-van Creveld syndrome C. $herubism 6,Cleidocranial dysplasia E. Nevoid basal cell carcinoma syndrome

37. A 19 y. o. female is diagnosed with cleidocranial dysplasia. She manifests an absence of her clavicles and a mushroom-shaped skull. Which of the following is an additional feature she is most likely to have?

A, B. Supernumerary teeth C. Hypercementosis D. Pegged lateral incisors E. Large chambers

38. Which of the following is the most serious component of Gardner syndrome?

A. Mandibular osteomas B. Nlultiple C. Sinus obliteration ' D. Intestinal polyposis with a high risk of malignant transformation E. Hypercementosis

39. Odontogenic keratocysts are a clinical component of which of the following?

A. MEN I11 ( 2B) syndrome ,, B. Cherubism C. von Recklinghausen disease B.Gardner syndrome E. Nevoid basal cell carcinoma syndrome 40. Which of the following is considered to be the most serious manifestation of MEN I11 (2B) syndrome?

A. Medullary carcinoma of the thyroid B. of the colon C. ~heochromoc~t&a D. Basal cell carcinomas E. Mucosal neuromas

41. Which of the following is true for von Recklinghausen disease?

A. It is inherited as an autosomal recessive trait B. Patients may manifest cafk au lait spots C. Patients have gingival fibromatosis D. Patients have a generalized whitening of the oral mucosa E. No known risk exists for malignant transformation of the neurofibromas

-7 42. Which of the following statements concerning leukoplakia- - is-true?!

A. Most cases represent examples of epithelial dysplasia B! Sites that are at high risk for epithelial dysplasia include the and gingiva C. A biopsy should be performed to establish a definitive diagnosis D. Leukoplakia is less common than ,E-Leukoplakia is a term that describes a histologic appearance of epithelium

43. Which of the following statements concerning an ameloblastoma is true?

A. It often occurs in young children B. It is a radiopaque lesion .C.P-' It often occurs in the mandibular molar and ramus region D. It should be treated with conservative surgical excision - E. It usually appears as a unilocular radiolucency

44. A benign may be recognized radiographically for which of the following reasons?

4It is usually associated with the root of an unerupted tooth B.;It is a well-circumscribed radiopaque lesion with a radiolucent halo attached to the root of a tooth R.'fi is an ill-defined radiolucent lesion containing scattered opacifications D. It has a multilocular radiolucent appearance E. It has a solitary cyst-like radiolucent appearance 45. A compound odontoma differs from a complex odontoma in that a compound odontoma:

A. Is composed of tooth-like structures B. Has unlimited growth potential C. Is composed primarily of pulp tissue D. Is located in the posterior mandible E. Is composed of a haphazard arrangement of enamel, and pulp that does not resemble a normal tooth

46. Which of the following has a maxillary, ja,w predilection?

Dentigerous cyst B. C. Stafne cyst D. Residual cyst E.

47. A malignant tumor of bone-forming tissue is called which of the following?

A: Osteosarcoma B. Osteoma C. Chondrosarcoma D. Chondroma E. A and C

-\ 48. Which of the following does not arise from squamous epithelium? A. Epidermoid carcinoma B. Squamous cell carcinoma0 -E>ermcous carcinoma D. Papilloma E.

49. Which of the following malignant tumors is most closely associated with a "onionskin"--.-- radiographic appearance?

A. Osteosarcoma B. Fibrous dysplasia ~Chondrosarcoma : D/Ewing sarcoma ---' E. Proliferative osteitis 50. A 50 y. o. Black female has multiple, asymptomatic, radiopaque masses in the and mandible. No expansion of bone take place. Which of the following is the most- likely diagnosis?

A. Multiple odontomas B. Cementifylng fibomas C. Periapical cernento-osseous dysplasia D. Focal cernento-osseous dysplasia E; Florid cernento-osseous dysplasia

\ \ 51. Which of the following is not an example of a benign fhro-osseous. - lesion?

AIbdontoma B. Periapical cemento-osseous dysplasia C. Ossifying fibroma D. Cementifylng fibroma E. Fibrous dysplasia

52. Which of the following is most closely associated with precocious puberty in females?

A. Monostotic fibrous dysplasia K'hilc~une-~lbri~htsyndrome 'C. Paget disease D. von Recklinghausen disease E. Periapical cemento-osseous dysplasia

53. Periapical cemento-osseous dysplasia is characteristically located in which of the following locations?

A. Anterior maxilla ~.)I~nteriormandible C. Posterior maxilla D. Posterior mandible E. Mandibular region

54. In which of the following diseases are cafe au lait spots- ---- seen - on the skin?

polyostotic fibrous dysplasia -

L%. Paget disease GOsteomalacia /' D. Monostotic fibrous dysplasia

JE Osteopetrosis 55. Bone resorption, osteoblastic repair, loss of lamina dura, hypercementosis and "cotton- wool" radiopacities are characteristic of which of the followiiig disease entities? -- A. McCune-Albright syndrome B,.Letter-Siwe disease ,-. ,-. ? C. Osteitis deformans D. Polyostotic fibrous dysplasia E. Florid cemento-osseous dysplasia

56. Which of the following is the only recommended treatm~arnodalityfor patients with --- ? - fibrous dysplasia?

A, Radiation therapy

1B) C. Chemotherapy D: Antibiotic therapy E: Bone marrow transplantation

57. Which of the following is helphl in the diagnosis of Paget disease?

A. Complete blood count B. Serum acid 6-serum alkaline phosphatase D. Serum calcium E. Urinalysis

58. Osteomalacia is usually caused by a deficiency of which of the following?

A. Vitamin A %Vitamin C /- --C.,qitamin D D. Alkaline phosphatase E. PTH

59. Osteomalacia in children is called which of the following?

A. Osteitis deformans B. McCune-Albright syndrome C. Osteopetrosis D. Osteoporosis /?. Rickets 60. Hypercalcemia, hypophosphatemia and abnormal bone metabolism are characteristic of which of the following conditions?

A. Hyperthyroidism B; Hypothyroidism j2. Hypoparathyroidism D.' Hyperparathyroidism E. Cherubism

61. Which of the following oral complications is not associated with diabetes mellitus?

A. Candidiasis B: Excessive periodontal bone loss C. Petechiae D. Mucormycosis E. Xerostomai

62. Which of the following is not characteristic of primary hyperparathyroidism?

A. Osteoclastic bone resorption B. Excessive production of PTH C. Increased serum calcium ,D. Giant cell lesions of bone l?)"~nionskin"radiographic appearance

63. Using a stethoscope to listen to abnormal noises in the is called which of the following?

A. Audiology B. Auscultation C. Palpation D. Arthrography E. Crepitus

64. Which of the following lesions would have a predilection for patients under- _--- the age of30 years?

/a~ulti~lemyeloma ,E?aget disease Primary hyperparathyroidism OAmeloblastic fibroma E. Metastatic carcinoma to the 65. Which cyst is said to develop "in place of' a tooth?

A. Radicular cyst %?primordial cyst C. Odontogenic keratocyst D. Dentigerous cyst E. Eruption cyst

66. Which cyst is characterized by its unique histologic appearance and frequent recurrence?

A. Residual cyst B. Dentigerous cyst C. Odontogenic keratocyst D. E. Stafne cyst

67. The l-al pecodontal cyst is defined, in part, by its location. In which area of the jaws is the lateral periodontal cy~mostcommonly found?

~"r~andibularthird molar region B.Between the mandibular canine and first premolar C. Between the maxillary canine and first premolar D. Between the maxillary central incisors E. In the maxillary tuberosity region 68. With which of the following is the associated tooth -non-vital? A. Lateral periodontal cyst B. Nasopalatine canal cyst Dentigerous cyst

E. Incisal canal cyst

69. Dysphagia is most closely associated with which of the following cysts?

A. Static bone cyst Qhyroglossal tract cyst C. Traumatic bone cyst D. Median palatal cyst E. Nasolabial cyst 70. Which oral lesion has the greatest malignant potential?

A. A white patch on an edentulous ridge ,-B. A white patch in the floor of the mouth ' C.,-, A velvety red patch with no known cause D. A white patch adjacent to a fractured amalgam E. A red patch adjacent to a fractured amalgam

71. Which cyst is considered a ?-A-

~C/odontogenickeratocyst B. Traumatic bone cyst C. Lyrnphoepithelial cyst D. ~enti~erouscyst E. Primordial cyst

72. Which cyst is characteristically pear-shaped?

A. h'~lobulomaxillary"cyst , B. Median palatal cyst i C. Nasopalatine cyst Dentigerous cyst keratocyst

73. Which developmental anomaly is often associated with a non-vital tooth and periapical pathosis?

A. ens in dente <. Taurodontism WTalon cusp 45.' Radicular cyst

J' 74. Which of the following is the most common salivary gland neoplasm?

A. Adenoid cystic carcinoma B. Basal cell adenocarcinoma C. Cylindroma D. E. Pleomorphic adenornas 75. A (benign) mixed tum-or classically contains tissue that resembles . Which of the follow cells gives rise to this tissue?

A. Squamous epithelial cells B. Mucous cells C. Chondroblasts D.'Fibroblasts E. Myoepithelial cells

76. Which of the following statements is true of ? _,_ __ ..--- A. Primary squamous cell carcinoma is the most common oral cancer B. The current five-year survival rate is approximately 75% C. Intraorally, the most common site for oral cancer is the ventral surface of the tongue D. All of the above E. A and C only

77. Which of the following represents the earliest clinical manifestation of an oral squamous cell carcinoma?

. ~;:"kxo~h~ticmass B. Non-healing ulcer C. Erythematous macule or plaque D. Destructive radiolucency E."Fungating mass

78. was separated from the typical squamous cell carcinoma because of which of the following?

A. It does not occur in the oral cavity B. It metastasizes more frequently C. It responds better to chemotherapy D. It grows more rapidly P-fthas a better prognosis

79. involves which site most commonly?

A. Minor salivary glands of the hard palate mubmandibular gland and its duct C. Sublingual gland and its duct D. Parotid gland and its duct E. Minor salivary glands of the floor of the mouth 80. Which of the following is least likely to present as a multilocular radiolucent lesion? A-Ameloblastic fibroma ~Y~entralgiant cell granuloma C. Odontogenic keratocyst D. Multiple myeloma E.

81. Which of the following lesions may present as an ill-defined radiolucency with a- ragged border?

A. Metastatic carcinoma B. Fibrous dysplasia

C. Chronic /chronic osteomyelitis -, D. All of the above A and C only

82. Which of the following lesions may present with more than one radiographic appearance depending upon the stage of the lesion? --.- - -. ..-

A. Periapical cemento-osseous dysplasia B. Paget disease C. Fibrous dysplasia 6. All of the above E. A and C only

83. Which of the following disease entities is associated with a positive Nikolsky sign?

A. vulgaris - B. Lichen planus C. Cicatricial pemphigoid D. All of the above and C only

84. The more severe form of erythema multifome is called which of the following?

A. Ascher syndrome B. Behqet syndrome astevens-~ohnsonsyndrome D. Melkerson-Rosenthal syndrome E. Jaffe-Lichtenstein syndrome 85. Aphthous or aphthous-like ulcers have been associated with which of the following systemic diseases?

A. Behqet syndrome "I B. Ulcerative colitis --C. Crohn disease D.' All of the above E. A and C only

86. Which of the following lesions has the posterior mandible as its site of predilection? _ _ - ..-4. A. Amelob1astoma'- B. Odontogenic keratocyst - C: Calcifying epithelial odontogenic tumor D. kll of the above E. A and C only

87. Which of the following is true of@t&G&f the ds?

A. Most common primary malignant tumor of bone B. May present as symmetric widening of the periodontal ligament space C. While patients are usually less than 40 years of age, osteosarcomas of the jaws , .,typically occur in an older age group than those of the long - D. All of the above E. A and C only

88. Which of the following diseases commonly presents as radiolucencies with poorly defined and/or ragged borders? --.-

A. Osteopetrosis EL Compound odontomas C. 'Osteomyelitis - B: All of the above i' E. A and C only

89. Which of the following statements is true of calcifylngndonto_g_en~ccysts (COCS)? _--- A. Occurs in both a cystic and a solid neoplastic form i B. Occurs more commonly in the anterior maxilla of female patients C. The lining epithelium of COCs often contain ghost cells D. All of the above -T E. A and C only 90. Metastatic carcinomas may appear as mixed radiolucent/radiopaque lesions with poorly demarcated borders. This feature is especially associated with the primary carcinoma arising in which of the following organsT

A. Kidney B? Breast - C. Colon D. Lung E. Pancreas

9 1. Which of the following is often associated with osteopetrosis?,-- . -

A. Secondary osteomyelitis B. of the colon ?$visual and hearing impairment D. All of the above E. A and C only

92. Which of the following statements is true of compound odontomas?

A:hay prevent the eruption of teeth B. Appear as an amorphoushaphazard mass of dental tissues, ie. enamel, dentin.. .. C. Are more common in the posterior segments of the jaws D. All of the above E. A and C only

93. Which of the following disease entities is most often associated with children manifesting teeth "floating. in air"?

A. Ameloblastic fibroma B. Langerhans cell disease C. Cherubism D. E. Ewing sarcoma

94. Which of the following may appear as a soft tissue radiopacity superimposed on bone?

A. Amalgam tattoos B. Phleboliths C. Sialoliths D! All of the above E. A and C only 95. Which of the following may appear as a mixed radiolucen_t_/1:~d~opitque.- .- lesi.on?

A. Periapical cemento-osseous dysplasia -- B. Odontoma - C. Adenomatoid odontogenic tumor - 6~11of the above E. A and C only

96. Which of the following is usually seen at the apex of a non-vital toothl,

A. Periapical abscess B. Condensing osteitis C Periapical granuloma (~?kllof the above E. A and C only

97. In comparing recurrent aphthous ulcers with recurrent ulcers associated with , in which of the following ways are they similar?' *'i_ 2 A. Both may have prodromal symptoms B. Both tend to recur on keratinized tissue C. Both have a viral etiology D. All of the above E. A and C only

- 98. Which of the following is the causative agent for vermca- vulgaris?

HSV

D. VZV E. EBV

99. The etiology of erythema migrans is best described as which of the following?

A. Is caused by Epstein-Barr virus B. Is an immunologically mediated disease 6. Unknown '-D. Is a form of erythema multifonne E. Is caused by a coxsackie virus

ORAL DIAGNOSIS DEND 329

FINAL EXAMINATION NAME V DECEMBER 12,2003 STUDENT NO. 552

THIS EXAMINATION CONSISTS OF 115 QUESTIONS. PLEASE, FOLLOW THE INSTRUCTIONS FOR EACH SECTION.

Questions 1-60 (one pout each) Choose the best answer based upon the descr,iprionand projection presented, and indicate the answer on your' scant?on sheet

1.. Base upon the radiographic appearance and projected photomicrograph, what is the most likely diagnosis of the ~adiolucencyobserved at the root apex of this non-vital toothy L - A.. PeriapicaI abscess B. Periapical granuloma

E.. Periapical cemento-osseous dysplasia

2 Which of the following is the most likety diagnosis of the firm exophytic mass seen in the mandibular incisor region? @genic granuloma < W 4 pwlW- Fi bmma C Mucocele D Exostosis rC E Mucoepidermoid carcinoma )C

3.. The teeth in this case were asymptomatic, vital and of normal color Which of'the .rCC following is the most likeiy~iapicd~adiolucencies?

Adbdeming osteitis b B~fedZ$Ci%lgrmdoma f 'miho vdsJ LON~A-\~- cyst (radicular cyst) x C*'J\~ cemento-osseous dysplasia mental foramen 4. Which of the following is the most likely diagnosis of'the firm exophytic mass observed C in the vestibule region of the dentwe wearer?

A Papilloma )c B Vertucous carcinoma C Benign salivary gland neoplasm- gmangiorna X pulis fissur~atum&

5 What is the most likely diagnosis of this surgical exploration the oral surgeon repo

A. Stafne cyst

&?T~aumatic- bone cyst W/M C Lateral per.iodonta1 cyst D . Periapical cyst E Arneloblastoma

6. Which of'the fol.lowingis the most likely diagnosis of'this slow-growin had been present for "a -few years"? A. Papilloma r; @, Fibrous hyperplasia/f- b C.. Mucocele D,Pyogenic granuloma X E , Squamous cell carcinomatbe

7 The bluish lesion observed in the to_n_lgueof'this patient, who was in exceptionally good health,ernPtied by digital pressure Which of the foUowing is the most likely - . - diagnosis of this lesion?

c,&sawla cell turn01 LKqwsi sarcoma ~elanoticrnacule

8. Which of the following should be in your list of'differential diagnoses of'this pericorond ladiolucency?

A Adenornatoid odontogenic tumor - ah*? stic ameloblastoma u cyst pd? u7\ D Noltnal follicular space . . -7- cyst 9.. The patient in this case indicated that she had had similar lesiw at the same site previously and that they healed in a "couple of'weeks" This solitary lesion was Which of the foliowing lesions should head your list of

A. Recurrent herpes simplex infection 6 ~n~ffi5q current aphthous ulcer PEctopic geog~aphictongue D. Cicatricial pemphigoid E Erythema multiforme, minor

10.. Which of the following should be first in your list of'differential diagnoses- for the iolucency- discovered in this teenage [emale patient? A Arneloblastoma, solid/multicystic~P & B Calcifying odontogenic cyse ameloblastoma odontogenic turnorb &, CmAKJ,, shv*l- mc< cyst or panuloma

1 1.. The appearance of'this solitary s on the anterior toneus of'this 26 y.0. female patient is most consistent with a diagnosis of which of the following lesions?

Fibroma apilloma + mgk C Lymphangioma D Granulat cell tumor E %

12 The patient was unaware of this solitary cyst-like radiolucency Which of the following would most- likely be the diagnosis of this lesion? A A portion of'the B~lasrnacytoma C Stafhe cyst .'I~aumatic bone cyst &esidual c,, e e m~de 18 The asymptomatic, solitary, fUsifonn swelling of'the right mandible in this 18 y.o female patient is most likely which of the following? -s-- A Hyperparathyroidism V B Arneloblastoma p C Acute osteomyelitis Fibrous dysplasia 6 T ~aurnaticbone cyst 7 19 These keratotic white lesions with a led halo were observed bilateraly in the mucosaxa 4- Which of the following is most likely the diagnosis -_. - of these lesions'!

w. -ia

20 This is the cross section through the body-e mandible. Of'the following lesions, this radiographic appearance is most consistent with a diagnosis of' which of'the following?

C..Fibrous dysplasia J

D . Central giant cell granuloma E Ameloblastoma

sh-black rnacule observed on the gingiva and extending into the vestibule of this patient had been plesent for "man months without apparent change.. The macule is most likely which of'the following?Y

C Melanoma C. ::bnztlV£%a -a -a 22 The 64 y.0. male patient complained of bone pain and numerous in'fections over the last several months Laboratory tests indicated WSin his urine These findings are most consistent with a diagno of the following?

A Langer hans cell disease B Paget disease Metastatic carcinoma ultiple myeloma cell anemia

23 The numerous yellowish-white plaques on the buccal mucosa of' this patient me most likely which of the following?

A. Multiple lipomasF mordycegranule& C The result of high se~mcholesterol levels A D The 1.esu1t of cheek chewingx E . Minor salivary

24 This radiogaph demonstmtes multiple "punched out ~adiol&es" in a 12 Y.O. mqle patient In addition to the bony lesions the patient manifested and diabetes , This is most likely a case of which of'the following?

@ Langerhans cell disease B Paget disease )C C Multiple myelom& D Sickle cell anemia E, T halassemia

25. The malignant t-ntiai fo~.the projected palatal lesion is best described by which of the foliowing? N~corh.rut. shmtt&i?3 A. Greater than proliferative verrusous leukoplakia B.,Equal to that of'erythroleukoplakia C. Less than erythmplakia but more than leukoplakia (VJ&uely, if ever, occurs 26 The patient in this case is an elderlv blewho indicates she has had several fractures and bacbin over the past 5 years The history and ~adiographicappearance of the mandible ate most consistent with which of the following disease entities?

D Metastatic carcinoma E Polyostotic fibrous dysptasia

y The elevated warty ?

A nicotina 6 B Papilloma$/ C Necrotizing D Candidiasis ~apillaryhype~plasia

28 This Atican-Amyican patient suffe~shom rmeons, demhand& problems Coupllng this history with the projected radiograph, this patient most likely h-ch h-ch of'the following disease entities?

A Osteosar~oma B. Iron deficiency anemia micklecell anemi& D Fibrous dysplasia E Cherubism

29 This fi~m,smooth swelling was discovered neonaf the hard and soft dates in a 60 y o female patient She indicated the lesion had been slowly enlarging for the past -imars" Which of the following lesions should be placed first in your list of differential diagnoses?

A Maxillary torus B Papillary hyperplasia -& .Mucocele SC inor salivary gland tumoIe stomatitis+ 30. Which of'the following is the most likely diagnosis of'the mixed radiolucent-radiopaque lesions found at the apices ofthe mandibular fir,st molar?

A. Periapical cemento-osseous dysplasia B.. Focal cemento-osseous dysplasia .. C Calcifying odontogenic cyst vwJ' 1

condensing osteitise

3 1 The patient in this case is a 64 V.O.male, who has 11 diabetes Ws,hypertension and smokes and drinks heavily. The r-ened &on observed in the floor of his mouth and over the mandibular alveolar.~idge is wds. Which of' the following is the most likely diagnosis of this lesion?

A. Papilloma P @~~uamous cell carcinomaGa '7 C Melanomap D Basal cell carcinoma f+ E Ver~ucavulgaris X

32. The mixed periapical radiolucent-radiopaque lesion is associated with teeth which are normaland testtal with ~ulutesting What is the most likely diagnosis of this lesion?

aeriapicalcernento-osseous dysplasia B Rarefying and condensing osteitis * C Odontoma r D Calcifying odontogenic cyst ' E Osteitis deforrnans p"F*sF 33 Which of the following is the best diagnosis fosthe white lesion observed in this projection showing the clinical picture and a photomfmgraPh ofthe lesion? -c---.-. A,.Odontogenic keratocyst X' Squamous cell carcinoma < Hypeskeratosis and acanthosis consistent with a clinical diagnosis of' leukopiakia E., White sponge nevus 34 Which ofthe following conditions is observed involving the PO premolar teeth seen in this radiograph?

A Petiapical cemento-osseous dysplasia -.*fa 13. Idiopathic osteosclerosis - utW Condensing osteitis ..-&- 6.D. ypescementosis .,. L.~~rr k E. Hyperostosis )c -- 35.. Which of the following is the most likely diagnosis ofthe red lesion to which the mow is pointing? -

. Squamous celI carcinoma B Median ~homboidglossitis c?Erythema rnigr ans D Erythr~oplakia E.. Lingual varix

36. What is the most likely diagnosis of'the r.adio~aciWto which the head of'the anow is pointing?

@ondensing osteitis ( B Idiopathic osteosclet osisG I C..Hypercementosis D,.Proliferative pe~iostitis 6&eaqw@anulorna%. .

I 37. What is the most likely diagnosis of the bluish-black qeas observed on the linwd surface of' this tongue?

A. Erythema migrans B..Median xhornboid glossitis

C . Hemangiorna Lyrnphangiorna in@ vaiocse

38 Using the radiomaphic- im?pge. .. and the- projected photomicroah, which of'the following is the correct diagnosis in thls case'?

@Pexiapicd cyst eriapical granuloma Pexiapical cemento-osseous dysplasia D Dentigerous cyst D Hypercementosis 39 What is the most likely diagnosis of the bgownish-black macule observed on the of this 22 y o male patient? He says it has t~~herea "long- time" and has not changed in size> sha 01 c lor and it did- not blanch with digital pressure A Amalgam tattoo /bg &TZZan*otic macule D Hematoma E Hemangioma

40 Using the projected radiograph and accompanying pkt~micro-h, which of the following is the diagnosis of this rn-?

C Central giant cell granuloma )C D Cherubism % E Osteitis defotmans

41 Using the projected radiograph and accompanying phgtomic.h, which of'the foliowing is the diagno-s rnultilocular radiolucgnt lesion?

A. Odontogenic keratucyst Ameloblastoma C. entral giant cell gmnuloma 4 0Cherubism hnvcd\oW+ E Osteitis deformans

42 Using the projected hot0 a h and accompanying radiogra~h,which of the following is the most likely diamos~swo t is multilocular radiolucent lesion? A,. Odontogenic keratocyst B.Ameloblastoma giant cell granuloma

E , Osteitis defomans

43. Using the projected I-h and the accompanying photomicramaph, which of'the fo1lowing is the diagnosis of this multilocular radiolucent lesion?

@dontogenic ke~atocyst B . Ameloblastoma C . Central giant cell ganuloma D. Cherubism E . Osteitis deformans 44 Using the projected r hotomicrograph and mmgd with the knowledge that this p ichen;-F o t e ollowing is the most likely diagnosis in this case

Odontogenic ketatocyst yperparathyroidismpsI. -bism DJd+pathyroidism E @statis deformans

45 Use the p~ojectedphotograph (a skin lesion was diagnosed as a basal cell carcinoga) and the accompanying radiograph (one cyst-like radiolucency was diagnosed as anmto answer the following question..Which ofthe following lesions are known to be associated with this syndrome?

A..Calcification of the falx cerebri B.. Rib anomalies such as bifid Iie ncreased head circumference and mild hypertelorism of the above A and C only

46 Using the projected ~a$iograplh and accompanying photomicro-h, which of the following is the diagnosis of this mixed radiolucent-radiopaque lesion?

A Adenomatoid odontogenic tumor alcifying odontogenic cyst @Odontoma D Osteoma E Torus ,K

47 Using the projected radiograph and tw o in photomicrogmphs, which of the

following is the diagno-s mix-diopaque lesion?1

Ameloblastoma alcifying odontogenic cyst @Odontoma D Rarefymg and condensing osteitis E Periapical granuloma 48. Using the projected and accompanying rgdiog~a~hwhich of'the following is the most likely diagnosis of this sol radiopaque lesion? .-% &tplasia 6 C Ameloblastoma )( D maturu stage% E Rarefying and condensing osteitis )C

49 This patient was a $0 y.oae, who had h-and visual problems His alkaline phosphate was markedly elevated. Using this infotmation4band the accompanying two radiograph, which of the following is the most likely diagnosis of his condition?

A Multiple myeloma B F ibsous dysplasia C Langeshans cell disease Metastatic carcinoma, ptobably from the prostate

50 This radiograph demonstrates an area of radiopacity at the apex of the maxillary second premolar. The tooth is of n01ma1 c-and isAtal which or tnaal~owmgisthe best diagnosis- of this lesion?

A..Condensing osteiti* afLing and condensing osteitis osteosc lerosis

E.. Periapical g~andomav

good- health.. pms Condensing osteitis K C.Impacted supernumerary tooth in cleidoc~miald splasia % D.. An osteoma in a patient with Gadner syndrome rx E . Periapical cemento-osseous dysplasia 52 Which ofthe following is the most likely diagnosis of'this radiolucent lesion of the mandible with ~oorlyand i11.egularlyWrders? Also consider the accompanying photornic~mand the fact that the patient complains of'pain and suppuration.

A. F ibrous dysplasia

6 Squarnous cell carcinoma

53 Which of'the fbllowing "unique" radiographic appearances is demonstrated in this x-lay? Please, observe the inferior border of the mandible ZI A. "ground glass" B "Sunburst"

54 Obsexve the projected clinical otogra~hand acc.om~anvinaradioaa~h,~ These features are most consistent with a diagnosis of which of the following?

A Sturge-Weber syndr-ome B Gadner syndrome C Nevoid basal cell carcinoma syndrome D. McCune-Albright syndrome @leidocranial dysplasia

55 Three slides are used to demonstrate this case. Obsezve the demonstrated in the two clinical photographs (epmtsandplg) and in the projected radiograph

(m * ' s).. The features observed in these thsee slides are most eo-'which eo-'which of the following syndromes?

A. McCune-Albright

B . P1urnmer~-Vinson &stl&;yber

E Peutz- Jeghers 56 This lateral skull film is most consistent with a diagnosis of which of the following disease? (There is no technical problem with the film)

Osreoporosis steopetrosis 0Multiple myeloma D Osteogenesis imperfects

E Sickle cell anemia ,- h- adc

57 Which of'rhe following disease entities is most closely associated with the projected I adiographic pattern?

.LRm-bife~atiyg+eriostitis

c e ce anemia Ei,oidism

58. Which of the following disease entities is most closely associated with the projected radiographic pattern?

A,. Osteosarcoma % pe~iostitis%

E . Fibrous dysplasia

59 The radiogr,aphicpattern shown in this occlusal x-ray of the mandible is termed which of' \ the following?

60 The radiographic pattern shown in the previous slide (question # 59) is most often associated with which of'the following diseases?

A Paget disease - Lo tfsh \ B Fibrous dysplasia - 91.m~gw C. PmHemtive periostitis - -on sun s teosar coma / %btMSP -mtm awn Questions 61-1115 (one point each) Multlple choice questions Choose the best answer and indrcate your answer on your scantron sheer

61 Which of the following is the most common type ofor,almucosal ulcer? - 7- A Ulcers associated with cicatricial pemphigoid B Ulcers resulting from odontogenic infections C Recurzent aphthous ulcers Recurrent herpes ulcers raumatic ulcers 6

62 Which of'the following clinical features is more consistent with a diagnosis of recurrent intraor,al_n he es si than with recunent aphthous ulcers, minor tr

A. Lesions occur most frequently on non-kemtinized tissue % ae8 B Lesions usually occur singly @nitid lesion begins as a vesicle " D All of the above E A and C only

63 Which of the following is the site predilection for oral squamous cell carcinoma?

A. Gingiva 0Tongue, latela1 horde C Floor of'mouth, &0 CsMmm D Buccal mucosa E Soft palate

64 Which of the following types of oral Ie-a has the lowat malignant transformation potential2

A Proliferative vemcous leukoplakia hvt B., Thick, fissu1,ed leukoplakia . Cirmdar. leukoplakia moot., thin leukoplakia t= 65, All of'the following lesions could be fluctuant- exceot- one. Which one is the exception? Mucocele - bpdisiissuxatwn % -G (OW D..Abscess H 66 Which of the following conditions is associated with Epstein-Barr virus-)?

A Infectious mononucleosis~ B Oral hairy leukoptakia 4 uskin lymphoma / aD. 11 of the above E A and C only

67 Which of'thefollowing disease entities is most often associated with a "gr,ound-glass" radiographic appearance?

A. Osteosarcoma 8. Proliferative periostitis C . Langerhans cell disease D. Paget's disease of bone &ibrous dysplasia

68 Which of the following disease entities is most often associated with an "o I adiogaphic appearance?

A. Osteosarcoma 0P~oliferative pe~iostitis t G& ~VS C.. Periapical cemento-osseous dysplasia D..Paget's disease of' bone E Fibrous dysplasia

69, Which of the following may appear as a soft tissue radiopacity?

A Sialolith 4 8.. Calcified lymph Amalgam tattoo 6D All of the above E.. A and C only

70.. Which of' the following ay appear. as a mixed radiolucentlradio~~ lesion?

A Periapical cementoosseous dysplasia J B C7?0dontogeniccyst C. Adenornatoid odontogenic tumor r/ -5~&m

A and C only .~~OZUp~g .n?pq!pmu~ ayi s! qool paqohu! bpuanba.g 1soW "3

o a8e ayl .m~od~\rmsn a.m qua!wd ' a A tpool apnpq kmsnuo~drul(s lo SUZ!S ,a ,&a hua:,n~o!p ps!deuad e ~e srsadde bpoumros ISOM a v" a~mw.~orraisod aw q uounuo:, wow an^ €2'v jooydaaxa ayl sr. q3ry/y\. ydaaxa s$srCs sno~aapuapjo an4 are s~uauraiets2upo1loj aw,Jo1~ SL

.- jLj!=a,go pad~~~aq u8a my] uo!sal al!yM E se lsadde Lsw ~U!MO~]OJayl 10 Y3yM ZL 76. All of'rhe following statements are true of'unicystic (mural) except. Which is the exeeptioo? - __I_ ,A Occurs most frequently in the posterio~mandible T-

@he recurrence rate is the same as for the solid/multicyaic ameloblastoma f-4 . zJw&+& /' C Occurs with about equal f~equencyin both sexes - > D May cause delayed tooth e~uption E Most patients are under the age of 30 years '7

7'7 Which cyst occus when a peImanent tooth fails to develop i e which cyst occurs in "place- of'a tooth"?

-- B Residual cyst C Radicular cyst D . Incisive canal cyst E.. Dentigerous cyst

78 Which of the following may occudappeax as solitary cyst-like radiolucency?

A,. Residual cyst -F- B. Traumatic bone cyst C . Marrow space ,I- Sthecyst < All of'the above

79 All of the statements are true of'gian~.celllesions of' primary hype~parathyroidism except. Which is the exception? 6s mole common in males than females X B. Lesions are mote common in rn- u C Patients may manifest kidney stones fl D..Sewn calcium is not^ E Patients are usually over the age of' 3-as d 80 All of'the statements are ttue of'stafne-- cyst except. Which is the exception? A Occurs only in the mandible B. Occurs at all ages @~eeth are always non-via -V C- D Radiolucency usually contains normal salivary gland tissue / 8 1 Which cyst is the one that remains aftet, its associated (usually carious) tooth has been -lost? Dentiger ous C Primordial D Odontogenic keratocyst E Eruption cyst

82 Which feature allows for the diagnosis of an odontogenic keratocyst? I Multilocuiar radiographic appearance B Certain histologic featwe QC Poorly defined scalloped borders D Non-vital tooth E . Association with impacted tooth

83. Basic tissue changes that could pr,oduce abnormal red conditions would include which of the following? I@* A Atrophy or erosion of the rnucosa 7 ,_ q\Yq B Accumulation of heavy metals such as lead C. Vascular dilation becake of. idammation 4~ @~11 of the above E A and C only

84. Differential diagnoses of'er2LL- 'ho lakia would include all of'the following except. Which is the exception? -

. Atrophic candidiasis J Leukoedema X - dk*- Erythema multiforme D Maculax hemangioma E Pupuric macule (early stage)

85 Which of'the following may be a pr,edisposingcondition to ?

A Multiple antibiotic regimes B..Sjogren's syndrome 'b WB&l ~~&~~.ita C. Plolonged denture user -11 of the above E. A and C only 86. All of' the following statements are true of'cicatricial (benign mucous membrane) P hich is the exception?

A While the etiology is unknown, the disease is known to have an autoimmune component Y B. s more common in males under the age of 30 years $L 1-) QPiirnarily found on mucous membranes D The gingiva is the most common oral site of involvement T - 45:,*-+E3 E Immunofluorescence is an important and useful diagnostic technique 87 All of'the following statements are true-of-- to~iexcept. Which is the exception? A. Are the most common oral exophytic lesions B.. Mandibular tori are located on the lingual aspect of'the mandible above 1 the mylohyoid ridge, most often bilaterally in the premolar region T- tori ae located on the soft palate, latela1 to the mine F W@ IUOL'@ In general, tori are slow-@owing bony protube~ancesof' the jaw v' E Growth occurs mainly during the first 30 years of'life 4

88 All of the following statements are true of fissuratum except. Which is the exception? - asmuch more common in males B Can be classified as one of the inflammatory?A C Typically observed at the borders of ill-fitting dentures D Is much more common in adults than children -f+darnft~cm

89. Features common to both recurrent (minor) aphthous ulcers and recurrent intraoral herpes simplex include which of the following? - u,*he! A. Frequent occurrence^ B Both begin as vesicles, which then Iupture to fo~man ulcerative lesion '? C.. Pain Ail of'the above

90 Which of'the following lesions is beni A? P . Osteosarcoma )I

cell carcinoma)( D Chondrosaxcoma )( E Kaposi scornax All ofthe following statements are true of mucoceles- except,- Which is the exception? A. Mucoceles are one of'the most fiequent bluish lesions to occur. on the lo~er.li~ 7 B Are usually soft and fluctuant 7 MucoceIes cannot be emzed by digital p~essure~'--. D &ucoceles are most common on the anterior hard palate - \ bWCl 1I E.. Some mucin-producing salivary gland tumors can mimic a mucoceie clinically 7.

92 McCune-Alb~ightsynd~ome is a developmental defect of'unknown cause that ofien maswhich ot the following?

A Cafe-au-lait macules (spots) B Neurofibromas )( C P~ecociouspuberty in girls / &All of the above E A and C only

93.. Which of the following is most closely associated with ?

@steomas J B Neurofibromas -- V C Odontogenic kexatocysts - D Fibrous dysplasia - h- E "Tram-line calcificationsa 9

94. All of'the following statements are true of'osteoszucqnra(osteogenic sarcoma) Which is the exception?

A. ay appear as a bandlike widening of'the periodontd-e and Qis is p-vP B Radiogaphically may show a 's~bu~st"or 'sunrayn appearance '7- C Pain, swelling, paresthesia 01 -and t- may occur- D is second~tiulemyeloma and lymphoma as the most kuenfly encountered p~im r E-shthe9kd to fourthdecade '~~~-30s 95 All of the following statements are true of fibrous dysplasia ex3Which is the exception? .

A. Is considered a hamartomatous fibro-osseous lesion

B . The etiology is tgkrmwncf

C . Depending upon the stage may appear as a radiolucent, mixed radiolucptf

ue. o * 7- &~s~?eit~b~pyf E Is baiically a disease of children, adolescents and young aduIfs <- 1 - - juopda~xaaql s! q3~gaaxa s!sa~odm~so,jo anq are sauaruapns 8upiolloj aw,jo 11~,001 101 All of the following statements are true of Paget disease -t. Which is the exception? C

A Depending upon the stage it may be tadiolucent, mixed radiolucent/radio-

paque ox sadiopaque ,7 menunalkaline phosphatase low; in fact lower than in any other disease C Teeth may show hypercementosis 7 D Is more common in patients over the age of 40 years E Is more common in the maxilla 7-

102 All of the following statements me true of multiple myeloma~tWhich is the exception?

A..Is the most common efimary malignant turn01 of'boner characterized by the proliferation of abnormal plasma cells? often complain that their dentuxes are too small as well as their hats f yw* -, T~adiogxaphicallymay manifest multiple separate welldefined radiolucencies~

- -- . ~ E Hypacalcemia, amyloidosis and-pancytopeniamay & s&n

I03 Which oral lesion(s) may reflect the presence of a parathyroid adenoma?

A Loss of' lamina dua "Tc B..Lesions microscopically resembling central giant cell granuioma -\ Brown tumor 7

E . None of' the above

104. Which of the following statements is Que of the oral papilloma? 7 Has high potential for malignant hansformatior) F B. cauliflower-like (warty) in appearance 7 0Is known to be caused by the Epstein-Bar1 Virus D. Will invade adjacent tissue F E. All are hue of oral papillomas

105 Which of the following statements is true of the

A Most are considered to be reactiv&shnuathes than true neoplasms 7 B Often undergo malignant trstnsfo~mationto a fibrosarcoma F: C Generally, appea as smooth, firm exophytic masses j D All of'the above @A and C only s* 106. In which way does epithelial dysplasia always diffe~from epidermoid (squamous cell) car'cinoma?

A Degree of ke~atinizationpresent B Degree of' whiteness ize of lesion vasion into under lying tissue E Common intraotd location

107 Which oral lesion has the greatest malignant potential? / A velvety red patch with no known cause QA white patch on an edentulous ridge%. C A white patch adjacent to a fiactu~edamalgam D A fibroma at the occlusal plane)(:

108 Which of the following typs of mm?

Odular3 V&C& B Superficial spteading C Lentigo maligna D Acral ientiginous E Otd

109 Osteosaxcoma of the jaw radiographically may show which of'the following appearances? A.Cortical destruction '" B Altered aabeculatio/ C. Syrnmctlically widened PDL space J Displaced teeth4

1 10. Which of'the following radiogaphic appearances is most commonly associated with multiple myeloma?

A.Ground glass appearance 'f: X Peas-in-a pod tadiolucency bC. unched-out ~adiolucency& D. Cotton wool radiopacity E. All of'the above as it depends upon the stage of the lesion ORAL DIAGNOSIS DEND 329 4. A multilocular radiolucent lesion of the mandibular molar-ramus region was explored and tissue submitted for microswpic examination. A photomicrograph is shown of this FINAL EXAMINATION tissue. The clinical significance of the diagnosis'mhe from @s e$amination would be which of the following? 0 kc, .. . DECEMBER 9,2004 STUDENT NO.- A. The necessity for radical surgical excision and lymph node dissection B. A high risk of malignant transformation of this lesion THIS EXAMINATION CONSISTS OF 100 QUESTIONS. PLEASE, FOLLOW THE @A high recurrence rate for this lesion INSTRUCTIONS FOR EACH SECTION. D. The need for immediate antibiotic therapy to prevent high morbidity and mortality E. Radiation therapy must begin immediately to prevent spread of this lesion Questions 1-50 (one pont each) Choose the best answer based upon the description and projection presented, and indicate the answer on your scaniron sheet. 5. This asymptomatic radiolucency was discovered during routine examination of a "new" patient. You sent the patient to your favorite oral surgeon for diagnosis and treatment. 1. Based upon the radiographic appearance and projected photomicrograph, what is the He reports to you that he found "essentially nothing" in the radiolucent area Which of most likely diagnosis of the radiolucency observed at the root apex of this non-vital the following will be the most likely diagnosis of this lesion? tooth? A. Dentigerous cyst A,, Periapical abscess B. Aneurysmal bone cyst @.)Penapical granuloma C. Periapical cementoosseous dysplasia, early stage C. Periapical cyst .~QITraumatic bone cyst D. Periapical osteitis E. Stafhe cyst E. Periapical cemento-osseous dysplasia 6. Which of the following is the most likely diagnosis of this slow-growing, soft mass that 2. Which of the following wouldle_ast likely be included in a differential diagnosis of this had been present for "a year or so"? gingival swelling which as generalIyT&-in consistency? , d;, Papilloma 4. Pyogenic granuloma '-B.Fibrous hyperplasialfibroma @J~inorsalivary gland tumor C. Mucocele C. Peripheral giant cell granuloma D. Pyogenic granuloma D. Peripheral ossifymg fibroma E. Squarnous cell carcinoma E. Focal inflammatory fibrous hyperplasia 7. Which of the following should be at the top of a list of differential diagnoses of this .-pencGEiiZ-$adiolucency? 3. This solitary cyst-like radiolucency was discovered on routine radiographic examination ---- of the patient's jaws. This radiolucency would most likely be which of the following lesions? A. Adenomatoid odontogenic tumor B. Unicystic arneloblastoma A. Radicular cyst C. ~adiiularcyst B. Multiple myeloma .,O. Nomal follicular space C. Traumatic bone cyst ,.z~enti~erouscyst .. D. Stahe cyst E. Residual cyst 8. The radiolucencies found at the apices of this vital mandibular molar tooth are most 12. In taking a full-mouth set of radiographs in the admitting clinic, you observed areas of likely which of the following? - radiolucency at the apices of the mandibular incisor teeth. The teeth had a normal appearance and tested vital. Which of the following is the most likely diagnosis of these A. Periapical penapical radiolucencies? B. Penapical cysts C. Penapical abscesses A. Penapical abscesses @~entalpapillae B. Penapical granulomas E. Periapical cementoosseous dysplasia C. Penapical cysts 9Penapical scar 9. The patient in this case indicated that she had had similar lesions at the same site @eriapical cementoosseous dysplasia previously and that they healed in a "couple of weeks". These lesions, which began as "blisters", were described as quite painful. Which of the following lesions should head 13. Which of the following is the most likely diagnosis of the vestibular soft tissue mass your list of differential diagnoses? observed in this denture wearer?

18Recurrent herpes simplex infection A. Vermcous carcinoma B. Recurrent aphthous ulcer B. Inflammatory papillary hyperplasia C. Ectopic I,,/&!4 - QEpulis fissuratum D. Cicatricial pemphigoid D. Epulis granulomatosum E. Erythema multiforme, minor E. Hyperplastic candidiasis

10. This teenage patient and her mother were concerned that her permanent canine had not 14. The unique radiographic appearance observed in this radiograph is most closely replaced her "baby" tooth. A radiograph of this area is projected. Which of the following associated with which of the following diseases? should head a list of differential diagnoses of this lesion? Fibrous dysplasia I:I - &'Traumatic bone cyst B. Osteopetrosis ~olid/multicysticarneloblastoma C. Osteitis deformans C. Unicystic ameloblastoma D. Proliferative penost~tis .D.'Adenomatoid odontogenic tumor E. Sickle cell anemia E. Pindborg tumor 15. The patient in this case had purplish skin lesions particularly on her anns and the 11. The unique radiographic appearance demonstrated in this occlusal radiograph is most projected red and white lesions of the buccal mucosa bilaterally. These lesions are most commonly associated with which of the following diseases? Likely which of the following?

A,Proliferative penostitis idlichen planus &Bsteosarcoma B. Leukoedema C. Fibrous dysplasia C. Erythema migrans D. Paget disease D. Cicatricial pemphigoid E. Osteopetrosis E. Leukoplakia 16. The vatient in this case had had a series of infections. felt 'tired and run-down". and was 20. The projected radiograph is that of a 77 y.0. female, who fractured her hip last year. She expe>encing back pain. The projected lateral skull film demomated multiple; well- has complained of back pain for several years and has a "hunch-back". This history and

defined areas of radiolucency. These clinical and radiographic~. features are most radiographic appearance of the mandible are most consistent with which of the following consistent with a diagnosis of which of the following? disease entities?

A. Paget disease A. Osteosarcoma f@Multiple myeloma B. Osteopetrosis C. Primary hyperparathyroidism Osteoporosis D. Osteosarcoma D. Metastatic carcinoma E. Fibrous dysplasia E. Polyostotic fibrous dysplasia

21. This patient wears her complete dentures almost constantly. The elevated warty lesions 17. This bluish swelling of the right side of the floor of the mouth has been present for , approximately three days. This lesion is most likely which of the following? of the palatal vault are most likely which of the following?

A. 4. Papilloma B. Hemangioma Papillarj hyperplasia &~anula C. Necrotizing sialometaplasia D. Lymphangioma D. Candidiasis E. Melanoma E. Epulis fissuraturn

18. The areas of discoloration adjacent to the mandibular second premolar tooth observed in 22. A physician friend sends you this patient with the accompanying radiograph noting the this photograph had not change in the four years they were known to be present. These patient needs new dentures as his old ones no longer fit. You quickly note the patient is areas are most likely which of the following? wearing a hearing aid and has some problems with his sight. Based upon this clinical information and the accompanying radiograph you suspect the patient may be suffering @,4malgam tattoos from which of the following? B. Melanomas C. Oral melanotic macules A. Polyostotic fibrous dysplasia D. Hematomas B. Osteoporosis E. Mucous retention cysts C. Osteopetrosis @0steitis deformans 19. This radiograph demonstrates a tooth "floating in air" in a 10 y.0. male patient. In E. Osteosarcoma addition to the bony lesion, the patient manifested exophthalmos and diabetes insipidus. This is most likely a case of which of the following? 23. Which of the following is most likely blocking the eruption of the maxillary incisor observed in this projected radiograph? A. Sickle cell anemia B. Ewing's sarcoma A. An osteoma C. Multiple myeloma @I An odontoma @;a~angerhanscell disease C. A dentigerous cyst E. Thalassemia D. An osteosarcoma E. A periapical cementoosseous dysplasia

32. Using the projected radiograph and a history of pain, swelling and reddness, which of the 36. The firm swelling of the buccal mucosa projected in this photograph is most consistent following is the most likely diagnosis in this case? with a diagnosis of which of the following?

A. Fibrous dysplasia A. Papilloma @Osteomyelitis @ Mucocele C. Florid cementoosseous dysplasia C. Fibromalfibrous hyperplasia D. Osteopetrosis D. Osteoma E. Osteitis defomans E. Hemangioma

33. Using the projected radiograph and the accompanying photomicrograph, which of the 37. Which of the following "unique" radiographic appearances is demonstrated in this x-ray? following is the diagnosis of this multilocular radiolucent lesion? A. "ground glass" .$Odontogenic keratocyst 8."Sunburst" &JAmeloblastoma C. Central giant cell granuloma omon-skin" AT Cherubism E. "salt and pepper" E. Osteitis deformans 38. After observing the projected radiograph, you further question the patient. During this 34. This patient had the projected bony lesions of the jaw, one of which had been diagnosed conversation, he strikes the pose shown in the accompanying photograph. These features as central giant cell granuloma and a history of kidney stones, abdominal and bone pain are most consistent with a diagnosis of which of the following? and depression? These findings suggest the patient may really be suffering from which of the following? A. Sturge-Weber syndrome B. Gardner syndrome A. Osteopetrosis C. Nevoid basal cell carcinoma syndrome B, Osteoporosis D, McCune-Albright syndrome GIHyperparathyroidism EJCleidocranial dysplasia D. Paget disease E. Multiple myeloma 39. The patient in this case has a history of cancer of the colon at an early age. He relates this "runs in his family". After taking radiographs to evaluate swellings at the angles of the 35. You observed the skin lesions shown in the accompanying photograph and the patient mandible, you suspect the patient has which of the following? tells you she was diagnosed with skin cancer. In your physical evaluation, you note the projected bony lesions on radiograph. First and foremost, this patient should be evaluated @Gardner syndrome for which of the following disease entities? B. Plurnmer-Vinson syndrome -.C. Peutz-Jeghers syndrome A. Cleidocranial dysplasia D. Nevoid basal cell carcinoma syndrome B. Peutz-Jeghers syndrome E. McCune-Albright syndrome (CJNevoid basal cell carcinoma syndrome D. Gardner syndrome E. Ascher syndrome 40. Assuming that this radiogaph has been taken and developed properly, this lateral skull 44. This white condition is observed bilaterally and disappears when stretched. It is most film is most consistent with a diagnosis of which of the following disease? likely which of the following?

A. Osteogenesis imperfects B. Osteoporosis Multiple myeloma C. Leukemia (aOsteopetrosis D. Leukomoid reaction E. Sickle cell anemia E. Lichenoid drug reaction

4 1. The lesions observed on the tongue of this patient have been known to disappear only to 45. Which of the following should be considered in the differential diagnosis of the unilateral reappear in another location. Which of the following is the most likely diagnosis? lesion shown in the projected radiograph? This a 38 y.0. female with no otherI__ medical problems; 4: Median rhomboid glossitis (BJErythema migrans ,A: Odontoma, mature stage C. Hairy tongue X Osteoma D. Hairy leukoplakia a~dontogenickeratocyst E. Lymphangioma ,O: Cherubism E. Primary hyperparathyroidism 42. Which of the following disease entities is most cIosely associated with the projected radiographic pattern? 46. Management of the yellowish-white papules observed on the buccal mucosa of this patient would consist of which of the following? A. Osteosarcoma B. Proliferative periostitis A. Surgical excision C. Paget disease B. Antibiotic therapy :_~.j~icklecell anemia C; Antifungal therapy E. Hyperparathyroidism @~bservation as no treatment is required E. Radiation therapy 43. Which of the following is the most likely diagnosis of this solitary, asymptomatic, cyst- like radiolucency discovered on routine radiographic examination? 47. Which of the following is the correct diagnosis of the mixed radiolucent-radiopaque lesion observed in this radiograph and two accompanying photomicrograph? cyst B. Traumatic bone cyst A. Ameloblastoma ~Desidualcyst B. Dentigerous cyst 11, ~alcifyii~odontogenic cyst - E.Periapical cementoosseous dysplasia D.'Periapical cementoosseous dysplasia -EOdontoma 48. The current standard of care for the lesion observed in the following radiograph and 52. Which of the following is the most common oral mucosal ulcer? photomicrograph is which of the following? 4. Recurrent herpes ulcer @~ar~inalresection with at least 1 cm margin @jTraumatic ulcer B. Radical surgical resection with lymph node dissection C. Recurrent aphthous ulcer C. Radiation therapy D. An ulcer fiom an odontogenic infection D. Curettage E. An ulcer of erosive lichen planus E. Radical surgical resection followed by chemotherapy 53. Which of the following is suggestive of a non-vital pulp? 49. Which of the following lesions should be at the top of your list of differential diagnoses of the pericoronal radiolucency shown in the projected radiograph? A. A dark hue of the crown B. A fixture of the crown or root A. Radicular cyst C. A draining sinus tract from the tooth ;B?l)entigerous cyst 0D All of the above C. Odontogenic keratocyst E. A and C only D. Adenomatoid odontogenic cyst E. Calcifying odontogenic cyst 54. Which of the following has a maxillary jaw predilection?

50. Causes associated with the lesion observed at the comers of the mouth in this photograph A. Odontogenic keratocyst include which of the following? Stafne cyst Caesidual cyst

1- A. Pooling of the saliva because of over-closure of the mouth due to loss of vertical D: Traumatic bone cyst dimension E. Dentigerous cyst ;B. Vitamin D deficiency C. Candida albicans infection 55. Which of the following is not a hue cyst? , DIA~Iof the above 'E. A and C only A. Stafne cyst ,B. Radicular cyst C. Traumatic bone cyst D. All of the above &A and C only Questions 51-100 (one point each) Multiple choice questions. Choose the best answer and indicate your answer on your scantron sheet. 56. Which of the following is most likely to appear as a pericoronal radiolucency?

5 1. Which of the following is tmuof periapical cementoosseous dysplasia? K Radicular cyst ,FC Periapical granuloma .A.Most commonly appears at the apex of a permanent maxillary incisor e>entigerous cyst . &Most often associated with a non-vital tooth D. Condensing osteitis i(s::May appear as a mixed radiolucent-radiopaque lesion E. Stafne cyst D. Is the most common pulpopenapical pathologic radiolucency E.'Is most common in the 5-20 year age bracket 57. Which of the following statements is meof Paget disease? 62. Which of the following is most likely to cause the "hair-on-end" appearance on radiograph? -

58. Which of the following salivary glandsfducts is most frequently involved in cases of 63. Which of the followine- clinical features is more consistent with a diamosis- of sialolithiasis? recurrent aphthous ulcers, miqar4pe than with recurrent inhaoral herpes simplex infection ? '--- A. Minor salivary glands B. Parotid A. Lesions occur most frequently on keratinid tissue @ubmandibular -&Lxsions usually occur singly i!>. -- D. Sublingual C. htial lesion begins as a vesicle - D. All of the above E. A and C only ,, 59. Which of the following can be classified as a mixed radiolucent-radiopaque lesion not necessarily contacting teeth? 64. Which of the following is the site predilection for oral squamous cell carcinoma? A. Focal cementoosseous dysplasia B. Dentigerous cyst A. Gingiva (Dibrous dysplasia B. Buccal mucosa D. All of the above C. Floor of mouth E. A and C only D. Tongue, dorsal surface Uongue, lateral border 60. Which of the following may appear as a periapical mixed radiolucent-radiopaque lesion associated with teeth? 65. Which of the following types of oral leukoplakia has the highest malignant transformation potential? -;A. Periapical cementoosseous dysplasia, intermediate stage -,-B. Ameloblastorna &Proliferative vemcous leukoplakia - - C. Rarefying and condensing osteitis B. Thick, fissured leukoplakia a~ll of the above C. Granular leukoplakia D. Smooth, thin leukoplakia E. A and C only ,:- ,!. Which of the following lesions can be soft and fluctuant? 61. Which of the following statements is true of compound odontomas? 66. A. Hemangioma -:-A.Are more common in the maxilla B. Muwcele B. Are more common in the 5-20 year age bracket r C. Generally, appear as radiolucent-radiopaque lesions containing what appear as small I ' C. Abscess tooth-like structures @,-All of the above of the above E. A and C only E. A and C only 67. Which of the following conditions has been directly associated with Epstein-Barr virus 72. All of the following statements are true of the penapical or apical periodontal cyst except. (EBV)? Which is the exception?

R r7 -1- A. Systemic lupus erythrnatosus I & Is the most common pulpoperiapical lesion -1-B. Oral hairy leukoplakia B. Is the most common of all odontogenic cysts - r C. Kaposi sarcoma C. Can not defmitively be distinguished radiographically &om a periapical granuloma :@AI~ of the above D. Can be treated with non-surgical if the treatment plan calls for E. A and C only the maintenance of the tooth E. An untreated cyst may slowly enlarge and cause expansion the cortical plates 68. Which of the following may appear as a soft tissue radiopacity? 73. Which of the following is the correct management of a lesion suspected to be a Stafne A. Amalgam tattoo cyst? r B. Calcified lymph nodes -iC Phebolith A. Surgical enucleation CD/ All of the above raeriodic observation as no treatment is required E. A and C only C. Block resection D. Radiation therapy 69. Which of the following may appear as a mixed radiolucentiradiopaque E. Injection of a sclerosing agent lesion? 74. Squamous cell carcinoma of the oral cavity is most closely associated with which of the .!.A. Periapical cemento-osseous dysplasia following? B. Adenomatoid odontogenic tumor %. , Odontoma A. Alcohol abuse D.. All of the above B. Avitaminosis A E. AandConly mobacco usage D. Infection with Candida albicans 70. Which of the following is least likely to appear as a multilocular radiolucency? E. Syphilis

@&,I @&,I Radicular cyst 75. All of the following statements are true of dentigerous cysts except. Which is the B. Ameloblastoma exception? C. Cherubism D. Odontogenic myxoma ..iAAre most common in the posterior mandible E. Central giant cell granuloma ~dMost commonly appears as a mixed radiolucency-radiopacity -1-C. Signs or symptoms may include delayed eruption of the tooth 7 1. Which of the following lesions may appear as a unilocular radiolucency? -1-D. Are also known as follicular cysts -r E. Surgical excision is treatment of choice -- A. Periapical cementoosseous dysplasia

I .B. Periapical granuloma .C. Periapical abscess

t, D. ,All of the above

78. Which feature allows for the definitive diagnosis of an odontogenic keratocyst? A. Cafe-au-lait macules (spots) B. Polyostotic fibrous dysplasia A. Multilocular radiographic appearance C. Precocious puberty in girls B. Association with a tooth i@All of the above C. Poorly defined scalloped borders E. A and C only D: Nan-vital tooth rE,i Pathognomonic microscopic features 84. Which of the following is most closely associated with Gardner syndrome?

79. Basic tissue changes that could produce abnormal white conditions would include which A. Fibrous dysplasia of the following? B. Neurofibromas C. Odontogenic keratocysts -A. Marked inhacellular edema @,&upernumerary teeth ;'B. Erosion of the epithelium E. "Tram-line calcifications" ;C. Increased thickness of the layer , D jAll of the above 85. Which of the following statements is true of osteosarcoma of the jaws? *gA and c only , Radiographically may show a "sunburst" or "sunray" appearance 80. Predisposing conditions for oral candidiasis included which of the following? Pain, swelling, paresthesia or anesthesia and tooth mobility may occur Is second to multiple myeloma and lymphoma as the most frequently encountered . A. Prolonged denture use . primary tumor of the jawbones . B. Sjogren's syndrome [',)All of the above : C. Prolonged steroid use E. AandConly D::AII of the above E. A and C only 86. Which of the following is associated with a thickened periodontal ligament or widening of the periodontal ligament space? 91. In which way does epithelial dysplasia differ from epidermoid carcinoma? A. Osteosarcoma B. Periapical cyst A. Site of predilection C. Systemic sclerosis (scleroderma) B. Size of the lesion iJ$ All of the above @Invasion into the underlying tissue E. A and C only D. Degree of whiteness or redness E. Degree of keratinization present 87. Which of the following diseases commonly present as radiolucencies with poorly defined andlor ragged borders? 92. Which of the following statements is meof multiple myeloma?

,jOsteomyelitis -1- A. Some signdsymptoms may result &om an underlying pancytopenia 43: Compound odontomas -./-B. Is characterized by the proliferation of abnormal plasma cells .C:'Osteopetrosis ;- C. Radiographically, may manifest multiple separate well-defined radiolucencies D. All of the above ,-Q. All of the above E. A and C only E. A and C only

88. Which of the following statements is meof osteoporosis? 93. Which oral lesion has the greatest malignant potential? 7 -A. Is more common in females after menopause /%.'A- velvety red patch with no known cause B. May be drug induced B. A white patch on an edentulous ridge C. May cause a generalized rarefaction of the jaws C. A white patch adjacent to a fractured amalgam D. All of the above D. A fibroma at the occlusal plane E. A and C only 94. Osteosarwmas radiographically may show which of the following appearances? 89. Which of the following statements is meof odontogenic keratocysts? --A. Altered trabeculation A. Site of predilection is the anterior maxilla -,-B. Cortical destruction B, A definitive diagnosis can be made by its characteristic radiographic appearance 113. Symmetrically widened PDL space (>)The parakeratinized type recurs more wmrnonly than the orthokeratinized type ('A]] of the above D. Appears most commonly as an ill-defined radiolucency E. A and C only E. Often undergoes malignant change 95. Which of the following is the most common periapical radiolucency? 90. According to your textbook (and reinforced in class), there are seven distinct periapical radiolucent lesions that are sequelae of . These include all of the following ,A. Periapical granuloma except. Which one is the exception? B. Radicular (apical periodontal) cyst C. Periapical cementoosseous dysplasia A. Apical periodontal cyst or periapical cyst D. Periapical abscess

f B:) Dentigerous cyst E. Periapical scar Osteomyelitis D. Periapical abscess E. Periapical scar 96. Odontomas are usually discovered because of which of the following reasons?

A. 'They prevent B. They become infected C. They produce pain D. They produce a marked swelling E. They occur in families

97. Which of the following lesions would have a predilection for patients under the age of 30 years?

&herubism B. Multiple myeloma C. Paget disease D. Primary hyperparathyroidism E. Metastatic carcinoma to the jaws

98. Which of the following statements is true of dentigerous cysts?

A,,Occurs between the roots of two erupted adjacent teeth ,8: bccurs around the crown of an unempted tooth C. Occurs at the apex of an erupted tooth D. Occurs in place of a tooth E. All of the above

99. Which of the following statements is true of the solid~multicysticameloblastoma?

A. Usually appear as a multilocular radiolucency B. Has a predilection for the posterior mandible C. Cells proliferate as nests and islands of epithelium resembling enanlel organ ,m1of the above E. A and C only

100. Periapical cementoosseous dysplasia is most likely to be clinically and radiographically misdiagnosed as which of the following?

A. Ameloblastoma , B. Periapical granuloma -C? Fibrous dysplasia D. Multiple myeloma E. Lateral periodontal cyst