Name: ______Oral Pathology DAPA 741 Examination One September 14, 2001

1. Which of the following is a true statement? A. A cytologic preparation is a good technique to diagnose epithelial dysplasia in the oral cavity B. A cytologic preparation should be fixed in 10% formalin C. A cytologic preparation is a useful technique to diagnose Candida in the oral cavity D. All of the above E. None of the above

2. Routine surgical specimens are most appropriately placed in which fixative? A. 10% Formalin B. 95% Ethanol C. Michel’s solution D. Saline solution

3. Which is the initial stain used for surgical specimens in nearly all pathology laboratories? A. Periodic acid-Schiff B. Cytokeratin C. Hematoxylin and Eosin D. Masson’s Trichrome

4. Incisional biopsy A. Is best performed with a laser or cautery instrument B. Is used to completely remove a lesion with an established diagnosis C. Is used for a large lesion or diffuse process D. Is best kept shallow to prevent patient discomfort

5. Which of the following statements concerning immunofluoresence is true? A. Indirect immunofluoresence demonstrates the presence of autoantibodies in the patient’s serum B. Specimens for immunoflourescence are fixed in 95% ethanol C. Immunoflourescence is most useful in anaplastic tumors or lymphomas. D. Immunoflourescence is most useful for suspected microbial diseases (bacterial, viral, etc.)

6. Which of the following is true concerning orientation? A. Sutures are the preferred method of marking margins. B. Incisional biopsies should be oriented so margins can be evaluated. C. The purpose of orienting a specimen is to determine first if any tumor cells are left behind and second to determine where those tumor cells are located. D. Two of the above are true E. All of the above are true

7. OralCDx (Transepithelial brush biopsy) A. Provides a definitive diagnosis B. Requires local anesthetic C. Needs to be redone is bleeding occurs during the procedure D. Indicates only if “atypical” cells are present

8. Which of the following lesions should be in your differential for a rough white lesion of the floor of the mouth with no identifiable cause? A. Focal keratosis B. Epithelial dysplasia C. Carcinoma-in-situ D. Squamous cell carcinoma E. All of the above

9. Which of the following is true of squamous cell carcinoma? A. Ulceration of carcinomas is usually painless B. Early carcinomas may present as a small red or white area on the mucosa. C. Although the appearance is often innocuous, early carcinomas can be distinguished clinically from benign surface lesions because carcinomas are fixed to the underlying structures and benign surface lesions are not. D. Two of the above E. All of the above

10. Which of the following are risk factors for oral squamous cell carcinoms (including lip)? i. Age ii. Tobacco iii. Spicy food iv. Nutritional deficiencies v. Hot beverages

A. ii, iii, iv B. i, ii, iii C. i, ii, iv D. i, ii, v E. ii, iv, v

11. Which of the following is most important in determining the prognosis of a patient with oral squamous cell carcinoma? A. Grade B. Stage C. Medical status of the patient D. Size

12. What is the essential difference between carcinoma-in-situ and squamous cell carcinoma? A. Microscopically carcinoma demonstrates pleomorphism and atypical mitotic figures while carcinoma-in-situ does not. B. Carcinoma-in-situ presents as a flat macular lesion while carcinoma presents as a tumor mass. C. Carcinoma –in-situ is confined to the epithelium while carcinoma is invasive. D. Carcinoma-in-situ usually resolves spontaneously while carcinoma does not.

13. The most common location of oral squamous cell carcinoma is the A. Tongue B. Floor of the mouth C. Lip D. Buccal mucosa E. Soft palate

14. Which of the following is true of ? A. It is more common in the maxilla than the mandible B. Sequestra must be removed surgically because they harbor bacteria C. A patient receiving a total theraputic dose of radiation of 5000 rads is at high risk for developing osteoradionecrosis D. Two of the above E. All of the above

15. Osteoradionecrosis is best treated by A. Prevention B. Antibiotics C. Hyperbaric oxygen D. Surgical resection

16. Which of the following is true of ? A. Verrucous carcinoma carries a poor 5 year survival B. Microscopically verrucous carcinoma appears as a high grade lesion (extensive pleomorphism, high mitotic rate, limited keratin formation) C. Verrucous carcinoma is usually treated with a combination of radiation and chemotherapy D. Verrucous carcinoma does not metastasize

17. A 47 year-old male patient presents with a diffuse milky white appearance of the buccal mucosa. The lesion appears to diminish when the tissue is stretched. What is the correct diagnosis? A. B. White sponge C. D. Metaplatic keratosis E. Cannot be determined without a biopsy

18. Which of the following is a congenital lesion? A. Linea alba B. Lichen planus C. D.

19. Which of these lesions is the result of chronic irritation? A. Linea alba B. Lichen planus C. Geographic tongue D. White sponge nevus

20. Which of the following is true of tobacco pouch keratosis? A. Tobacco pouch keratosis should be biopsied when initially noted to rule out dysplastic change B. Lesion resolves rapidly with cessation of the habit C. Is most common on the floor of the mouth D. Two of the above E. All of the above

21. The changes noted in nicotinic are the result of A. Particulate matter in the smoke B. Chemicals in the smoke C. Heat D. All of the above

22. Hairy is A. Caused by the Epstien-Barr virus B. Associated with HIV infection C. Caused by chronic irritation D. Two of the above E. All of the above

23. A patient presents with erythematous areas on the tongue surrounded by a white border. You decide to watch the lesions and have the patient back in two weeks. When the patient returns, the lesions, although still present, have changed locations. Your diagnosis is A. Lichen planus B. Candidosis C. Geographic tongue D. Inflammatory papillary hyperplasia E. Cannot make a definitive diagnosis based on the information provided

24. A 45 year-old female presents for the first time to your office for an exam. While performing your thorough oral examination, which you do on all patients, you notice white lacy lines on the buccal mucosa bilaterally. Remembering something about stretching the cheek from dental school you do so. The lacy lines do not diminish or disappear. The lines do not rub off when rubbed by gauze. The patient states that her cheeks are not painful and she is unaware of the white areas. No other oral structures are involved. You do not palpate any lymphadenopathy. The patient denies skin lesions and is unaware of lesions on other mucosal surfaces. Your diagnosis is A. Lichen planus B. Candidosis C. White sponge nevus D. Leukoedema E. Linea alba

25. Which of the following is NOT a predisposing factor for oral candidosis? A. Xerostomia B. Penicillin C. Prednisone D. 24 hour denture wear E. All of the above are predisposing factors

26. Which of the following lesions is associated with a Candida infection? A. Verruca vularis B. Inflammatory papillary hyperplasia C. Keratoacanthoma D. Verruciform Xanthoma E. All of the above

27. Which of the following lesions is associated with the human virus (HPV)? A. Papilloma B. Verruca vulgaris C. Condyloma acuminatum D. Keratoacanthoma E. All of the above

28. Following dental school you decide on a career in oral pathology. (Dr. Stoeckel beams with pride.) When you put your first case under the scope you see a sessile lesion with papillary surface projections surfaced by stratified squamous epithelium. The papillary extensions of the submucosa (the connective tissue in between the rete ridges) are filled with large cells with a foamy cytoplasm. The surgeon’s clinical impression is verruca vulagis. Your diagnosis is A. Verruca vulagaris B. Papilloma C. Verruciform xanthoma D. Condyloma acuminatum

29. Which of the following is a characteristic of a keratoacanthoma? A. Slowly growing B. Smooth surface C. Central pore from which exudates may be extruded D. Resolves spontaneously

30. Which of the following lesion exhibits psuedocarcinomatous hyperplasia? A. Papilloma B. Inflammatory papillary hyperplasia C. Condyloma acuminatum D. Verruciform xanthoma

31. Café au lait spots are seen in A. Peutz Jeghers B. Addison’s disease C. Neurofibromatosis D. Two of the above E. All of the above

32. Which of the following lesions will blanch on pressure? A. Varix B. Ecchymosis C. Purpura D. Hematoma E. None of the above will blanch on pressure

33. Which of the following statements is true? (Normal location being an area where that cell or structure type is normally seen.) A. A hamartoma is a growth of abnormal structures in a normal location B. A hamartoma is invasive but rarely metastasizes C. A hamartoma is a proliferation of normal structures in an abnormal location D. A hamartoma is a proliferation of normal structures in a normal location

34. Which of the following lesions is palpable and does not blanch on pressure? A. Ecchymosis B. Hematoma C. Hemangioma D. Petechiae

35. A patient presents to your office with a blue-gray area on the alveolar mucosa. The patient is edentulous. The lesion is slightly palpable and does not blanch on pressure. A radiograph of the area reveals no abnormalities. Which of the following statements is true regarding this lesion? A. A tattoo can be ruled out because there is no foreign material noted on the radiograph. B. A tattoo can be ruled out because there are no teeth and thus no amalgam restorations in the area. C. A tattoo can be ruled out because this lesion is palpable. D. A tattoo can be ruled out for all of the above reasons. E. A tattoo can not be ruled out.

36. Which of the following lesions is seen exclusively on sun exposed surfaces? A. Melanoma B. Eccymosis C. Melanotic macule D. Ephelis

37. Which of the following lesions is congenital? A. Varix B. Nevus C. Hemangioma D. Kaposi’s sarcoma E. None of these lesions are congenital

38. A nevus in the oral cavity A. Requires a biopsy because it is a premalignant lesion B. Requires a biopsy because it is clinically indistinguishable from an early melanoma C. Does not require a biopsy as long as it appears benign based on the ABCD system D. Does not require a biopsy unless it begins to enlarge

39. The best prognostic indicator of a Kaposi’s sarcoma is A. Stage B. Grade C. Depth of invasion D. Immune status of the patient E. A and B

40. Oral melanoma carries a 5 year survival rate of A. 5% B. 25% C. 40-50% D. 60-75%