Practice questions Oral cavity pathology

Practice questions
Oral cavity pathology
Updated: 02/28/2019
© Jun Wang, MD, PhD
1. A 35-year-old man presents with a firm left gum nodule for 3 months. His past medical history is unremarkable. He has a 15 pack-year history of cigarette smoking. He does not drink alcohol. Physical examination reveals a 0.7 cm firm polypoid mass with focal erosion and exudates. The mass is removed. Microscopically it has a fibrous core with slightly hyperplastic smooth squamous lining. The squamous epithelium has parakeratosis and mild cytological atypia. What is the diagnosis?
A. Erythroplakia
B. Irritation fibroma
C. Pyogenic granuloma
D. Squamous cell carcinoma
E. Squamous papilloma

2. A 15-year-old boy presents with painful lesion of his left lateral tongue. He has a history of infectious mononucleosis a year ago. Physical examination reveals an isolated 0.2 cm shallow ulcer at the left anterolateral tongue. The ulcer has well-defined erythematous edge. No other abnormalities are noted. What is likely the diagnosis?
A. Aphthous ulcer
B. Erythroplakia
C. Hairy leukoplakia
D. Herpes
E. Squamous cell carcinoma

3. A 32-year-old man presents with palate pain for 2 days. He had a cold 1 week ago and recovered spontaneously. His past medical history is unremarkable. Physical examination reveals clusters of small ulcers covered by purulent exudates at the right hard and soft palate. Tzanck smears reveals multinucleated cells with ground glass appearing nuclear matrix and dark stain along nuclear membrane. What is the diagnosis?
A. Aphthous ulcer
B. Erythroplakia
C. Hairy leukoplakia
D. Herpes
E. Squamous cell carcinoma

4. Use the image for this question. A 48-year-old man presents with white painful growth on his palate. He has type 2 diabetes but not compliant with his diet recommendations. He has a 30 pack-year history of cigarette smoking and has been drinking 2 glasses wine per day for 10 years. An image of his oral cavity is shown. After these patches are scraped, there is erythematous base. No ulcer is noted. What is the diagnosis?

A. Candidiasis
B. Erythroplakia
C. Hairy leukoplakia
D. Herpes
E. Squamous cell carcinoma
(Photo Credit: Sol Silverman, Jr., D.D.S)

5. A 21-year-old woman presents with a rapidly growing left gingiva mass for a month. Her past medical history is unremarkable. Physical examination reveals a 0.5 cm fragile purple polypoid growth for focal ulceration. The growth is removed. Microscopically, it has a lobular pattern of capillary growth separated by fibrous septa. No endothelial atypia is noted. What is the diagnosis?
A. Angiosarcoma
B. Irritation fibroma
C. Pyogenic granuloma
D. Squamous cell carcinoma
E. Squamous papilloma

6. Use this case for the next two questions. A 34-year-old homosexual man presents of painful white growth at his left lateral tongue. He is HIV positive and is currently being treated with antiretroviral agents. He has a 10 pack-year history of cigarette smoking, but does not drink alcohol. Physical examination reveals diffuse thick which patch along the left border of his tongue. No ulceration is noted. The patch is non-movable and non-scrapable. No other abnormalities are noted. Biopsy of the lesion reveals hyperkeratotic squamous mucosa containing large squamous cells with abundant pale cytoplasm. No cytoplasmic halo nor nuclear pleomorphism is seen. What is the diagnosis?
A. Candidiasis
B. Erythroplakia
C. Hairy leukoplakia
D. Squamous cell carcinoma
E. Squamous papilloma

7. A 34-year-old homosexual man presents of painful white growth at his left lateral tongue. He is HIV positive and is currently being treated with antiretroviral agents. He has a 10 pack-year history of cigarette smoking, but does not drink alcohol. Physical examination reveals diffuse thick which patch along the left border of his tongue. No ulceration is noted. The patch is non-movable and non-scrapable. No other abnormalities are noted. Biopsy of the lesion reveals hyperkeratotic squamous mucosa containing large squamous cells with abundant pale cytoplasm. No cytoplasmic halo nor nuclear pleomorphism is seen. What is most likely associated with these findings?
A. Cigarette smoking
B. EB virus
C. Human herpes virus
D. Human immunodeficiency virus
E. Human papillomavirus


8. Use this case for the next two questions. A 44-year-old woman presents with painless white growth at her floor of mouth for 2 months. She has type 2 diabetes and hypertension. She has been smoking cigarette 1 pack a day for 20 years. She is a social drinker. Physical examination reveals a thick white patch at the right side of her floor of mouth. This patch is non-movable and non-scrapable, and has a warty appearance. No other abnormalities are noted. What is most likely the diagnosis?
A. Candidiasis
B. Erythroplakia
C. Hairy leukoplakia
D. Leukoplakia
E. Squamous cell carcinoma

9. A 44-year-old woman presents with painless white growth at her floor of mouth for 2 months. She has type 2 diabetes and hypertension. She has been smoking cigarette 1 pack a day for 20 years. She is a social drinker. Physical examination reveals a thick white patch at the right side of her floor of mouth. This patch is non-movable and non-scrapable, and has a warty appearance. No other abnormalities are noted. What is the next step of management?
A. Anti-fungal therapy
B. Anti-viral therapy
C. Biopsy
D. Surgery
E. Topical steroid


10. Use this case for the next two questions. A 51-year-old woman was referred from a local dental office for evaluation of redness at her left buccal mucosa. Her past medical history is unremarkable. She does not smoke cigarette nor drink alcohol, but has been chewing tobacco for 30 years. Physical examination reveals an irregular 2.2 cm reddish patch at her left buccal mucosa. The patch is non-movable and non-scrapable, and has a velvety appearance. The surrounding mucosa appears to be normal. No firm mass is noted. What is most likely the diagnosis?
A. Candidiasis
B. Erythroplakia
C. Hairy leukoplakia
D. Lichen planus
E. Squamous cell carcinoma

11. A 51-year-old woman was referred from a local dental office for evaluation of redness at her left buccal mucosa. Her past medical history is unremarkable. She does not smoke cigarette nor drink alcohol, but has been chewing tobacco for 30 years. Physical examination reveals an irregular 2.2 cm reddish patch at her left buccal mucosa. The patch is non-movable and non-scrapable, and has a velvety appearance. The surrounding mucosa appears to be normal. No firm mass is noted. What is the next step of management?
A. Anti-fungal therapy
B. Anti-viral therapy
C. Biopsy
D. Surgery
E. Topical steroid

12. A 55-year-old man presents with painful ulcer at the left tongue for 6 months. He has a history of type 2 diabetes. He has been chewing betel nuts since age of 18, but does not smoke cigarette nor drink alcohol. Physical examination reveals a 1.3 cm ulceration at the left edge of his tongue. This ulcer has an irregular indurated edge and is covered by white greyish debris. Biopsy of the ulcer reveals irregular nests of markedly atypical cells with recognizable intercellular bridge and irregular concentric layers of atypical cells. What is the diagnosis?
A. Candidiasis
B. Erythroplakia
C. Herpes
D. Lichen planus
E. Squamous cell carcinoma



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