Glossary/Definitions of Terms PDF

**Glossary/Definitions of Terms** **Angular cheilitis:** a common inflammatory condition affecting the corners of the mouth or oral commissures. **Bacteremia:** the presence of bacteria in the blood.[^1^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#1) Bacteremia can result from or...

**Glossary/Definitions of Terms** **Angular cheilitis:** a common inflammatory condition affecting the corners of the mouth or oral commissures. **Bacteremia:** the presence of bacteria in the blood.[^1^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#1) Bacteremia can result from ordinary activities like vigorous toothbrushing, dental/medical procedures, or from infections.[^2^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#2) **Cardiac dose of epinephrine:** limiting the use of vasoconstrictor in local anesthetic to 0.04 mg or 2 cartridges of 1:100,000 epinephrine. **Co-morbidity: **the simultaneous presence of two or more diseases or medical conditions in a patient. **Ecchymosis:** a discoloration of the skin resulting from bleeding underneath, typically caused by bruising. **Evidence-based dentistry (EBD):** the integration of the dentist's clinical expertise, the needs and preferences of the patient, and the most current, clinically relevant evidence. The three components are all considered during the decision-making process for patient care.[^3^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#3) **Fibrinolysis:** the enzymatic breakdown of fibrin.[^4^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#4) **Infective endocarditis:** infection within tissues lining the heart or within valves of the heart, caused by bacteria within the circulating blood that infect these cardiac issues.[^1^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#1) **International Normalizing Ratio (INR):** a system established by the World Health Organization (WHO) and the International Committee on Thrombosis and Hemostasis for reporting the results of blood coagulation (clotting) tests. **Osteonecrosis of the jaw (ONJ):** exposed, necrotic bone in the maxillofacial region for at least 8 weeks in patients receiving an antiresorptive medication. **Osteoradionecrosis (ORNJ):** similar to osteonecrosis of the jaw but caused by radiation to the head and neck. **Petechia:** small, pinpoint collections of blood under the skin or mucous membrane. **Prosthetic joint infection (PJI):** also known as periprosthetic infection, is an infection involving the joint prosthesis and surrounding tissue.[^5^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#5) **Valvulopathy:** a disorder of valve function causing a variety of cardiac disorders, such as arrhythmia, pulmonary hypertension, heart failure, and cardiogenic shock.[^1^](https://www.dentalcare.com/en-us/ce-courses/ce628/references#1) **Thrombocytopenia:** medical term for a low blood platelet count. **Antibiotic Prophylaxis** **[Bacteremia]** This can occur from any manipulation of the gingiva or periapical tissue or perforating the oral mucosa. Examples: Probing; SRP; placing ortho bands subgingivally. If a procedure can cause bacteremia (orally or systemically), and the patient is more at risk for infections, they would require antibiotic prophylaxis. A table with text and words Description automatically generated with medium confidence *Total Joint Replacements* - Immunocompromised/Immunosuppressed - Have Comorbidities (2+ concurrent diseases) *Infective Endocarditis* 1. Prosthetic Heart Valve - Transcatheter-Implanted Prostheses - Homograft 2. Prosthetic Material in Cardiac Valve Repair - Annuloplasty Rings & Chords 3. Previous Hx of IE 4. Cardiac Transplant Pts w/ Valve Regurgitation from Damaged Valves 5. Congenital Heart Disease (CHD) - Unrepaired Cyanotic CHD - Palliative Shunts & Conduits - Repaired CHD Defect - Residual Shunts or Defects - Valvular Regurgitation on, or next to, Prosthetic Patch/Device - Had the repair done in the last 6 months.  A white box with black text Description automatically generated [Amoxicillin is 1^st^ Line Therapy] It effectively kills all 3 micro-organism types which cause IE. - Staphylococcus aureus (on skin) - Streptococci viridans (alpha-hemolytic; in mouth/pharynx) - Enterococci (in GI) If the dental procedure lasts longer than 6 hrs, another dose of Amoxicillin needs to be given. If another antibiotic is being taken by the patient for another reason, or they need more antibiotics \ - This can be done at home by a catheter surgically implanted into the abdomen. - It is performed 4x daily. - It can cause patients to have GERD, so they sit in a semi-supine position. **[Dental Treatment Modification for those with Renal Disease]** A medical consult is recommended to establish disease control & determine the POSSIBLE need for antibiotic prophylaxis due to a hemodialysis shunt. It is best to schedule appointments on the day after their dialysis treatment because they will be rested, and the heparin effects are no longer in the body. Patients can still have nitrous oxide and a local anesthetic w/ a vasoconstrictor. Frequent recalls should be implemented to keep infection under control or to catch them early. **Bleeding Disorders** These people may develop spontaneous gingival bleeding. Therefore, they need good oral hygiene instructions to prevent infections and reduce bleeding. **[Platelet Disorders]** Normal platelet counts are 140,000-400,000. ***Thrombocytopenia*** Low blood platelet count (starting at 50,000). These levels are too low to have treatment from a dental provider. Treatment: **[Anticoagulant Disorders]** ***Hemophilia*** This is a rare, inherited, bleeding disorder where the blood cannot clot normally. Symptoms: Increased/Prolonged Bleeding **[Anemia]** This is a deficiency of hemoglobin where there are too few RBCs. These patients have an increased risk of infection & poor wound healing. Oral Signs of Anemia: Pallor in the oral mucosa. Loss of papilla from the tongue (sore & red). Angular Cheilitis ***Iron Deficiency Anemia*** These people have low iron levels. ***Pernicious Anemia*** These people have low B12 levels due to a lack of intrinsic factor. ***Sickle Cell Anemia*** These people have sickle shaped RBCs. Most common in African Americans. Limit local anesthesia w. epi. **[Drug-Induced Clotting Abnormalities]** ***Anticoagulants*** If the patient is taking blood thinners (anticoagulant), you need to ask them what their PT (Prothrombin Time)/INR is (International Normalizing Ratio). You NEVER take them off their anticoagulant without consulting a doctor. Examples of Anticoagulants Warfarin/Coumadin You can treat patients with an INR of 2-3 (lower \#s are better). INRs 3.5 or more need a medical consult before treatment. Prothrombin Time should be less than 20 sec. Examples of Direct Anticoagulants Apixaban Rivaroxaban It is said that these do not need any alteration before dental procedures. ***Antiplatelets*** If a patient is taking an antiplatelet, you need to ask them what their platelet count and PFA-100 is instead of INR. Examples of Antiplatelet Medications Clopidogrel (Plavix) Aspirin Ibuprofen NSAIDS **Immunocompromised Patients** Certain conditions put people at a greater risk for being immunocompromised. They are discussed below. **[Hepatitis]** This is inflammation of the liver from a viral infection. There are 5 types A-E, but A-C are the most common. A: This is transmitted via fecal-oral route but there is a vaccine to prevent. It does NOT result in chronic infection, but it can result in liver failure. B: This is transmitted via blood, saliva, semen, & vaginal fluid. There is also a vaccine to prevent this type. C: This is the MOST FREQUENTLY TRANSMITTED via IV drug use. \50% develop a chronic infection which can lead to liver failure or cancer. The scary things about this one is there is NO vaccine to prevent. Dental Considerations: Limit local anesthetic w. vasoconstrictor to 2-3 cartridges. **[HIV]** HIV stands for human immunodeficiency virus. It is found in bodily fluids and is transmitted through blood, semen, vaginal secretions, and breastmilk. When CD4+ T-Lymphocyte counts get below 200, HIV patients are considered to have AIDS (Acquired Immunodeficiency Syndrome). The lymphocytes are killed, so their \#'s decrease while their viral load increases. Dental Considerations: Medical consult is needed if current lab reports are not available to determine current CD4+ counts which is correlated to the level of immunosuppression. **[Cancer]** Oral complications are common after patients receive chemotherapy or radiation for cancer treatment. ***Oral Mucositis*** This is inflammation and ulceration of the mouth. Salt & Sodium Bicarbonate Mouth Rinse. ***Fungal Infections*** Candidiasis ***Xerostomia*** This is a result of salivary gland dysfunction. Dental Considerations: Xylimelts or Xylitol Based Gum Suck Ice Chips ***Radiation Caries*** Dental Considerations for Cancer Patients in General: If a patient is taking bisphosphonates, they have an increased risk of developing Osteonecrosis of the Jaw (ONJ). **Endocrine Disorders** **[Thyroid Disorders]** ***Hyperthyroidism*** This is when there are elevated levels of T3 & 4 but low/undetectable TSH levels. *Graves' Disease* This is an autoimmune disease. ***Hypothyroidism*** Decreased levels of T3 & 4 but increased TSH levels. Symptoms = cold intolerance; fatigue; weight gain; diffuse goiter. *Hashimoto's Thyroiditis* This is also an autoimmune disease. This has the same dental considerations as Hyperthyroidism. **[Adrenal Gland Disorders]** ***Primary Adrenalinsuffiency*** *Addison's Disease* ***Secondary Adrenalinsufficiency*** Treatment Synthetic Glucocorticoids These treat: Adrenal Insufficiency Rheumatoid Arthritis Systemic Lupus Asthma Hepatitis Organ Transplantation Immunosuppression Therapy Joint Replacement Immunosuppressive Therapy These include: Cortisone 25mg Hydrocortisone (Cortisol) 20mg Prednisone 5mg Dental Considerations: Nitrous can be used. It can even be helpful for minimizing stress and reducing the demand for cortisol. Local anesthesia with vasoconstrictor is fine and encouraged to achieve adequate anesthesia and reduce the pt's stress levels. A med consult is only needed if they are uncontrolled and have an acute infection. You can also use a med consult to ask about supplemental steroid use for surgical procedures of infections. **Questions to Go Through** 1. **Which of the following statements about antibiotic resistance is correct?** A. Antibiotic resistance occurs most frequently in the elderly population. B. Antibiotic resistance is seen most often in hot, humid climates. C. Antibiotic resistance is causing antibiotics to become more effective at treating infections. D. Antibiotic resistance leads to increased hospital stays and mortality rates. 2. **According to the American Dental Association, the proper antibiotic regimen for a patient who is allergic to penicillin is:** A. Doxycycline (100 mg) B. Amoxicillin (2 g) C. Azithromycin (500 mg) D. A & B E. B & C F. A & C 3. **Which of the following cardiac conditions does NOT require antibiotic prophylaxis according to the American Heart Association?** A. Prosthetic heart valve. B. Repaired congenital heart diseases with residual defects. C. Mitral valve prolapse with regurgitation. D. History of infective endocarditis. E. Transplanted heart with damaged valves. 4. **Each of the patients below has had a total joint replacement and has a corresponding medical condition. All of them may need a medical consult to determine the need for premedication, except one. Which patient does NOT need premedication?** A. John, who is an insulin-dependent diabetic. B. Kirk, who has osteoarthritis. C. Maria, who has systemic lupus. D. Anne, who has HIV. 5. **All of the following treatment modifications are necessary when caring for a patient with chronic renal failure, or ESRD, EXCEPT one. Which one is the exception?** A. Appointments should be scheduled on the same day as dialysis. B. Patients with hemodialysis shunt may need a medical consult. C. Do not use the arm with the hemodialysis shunt when taking vitals. D. Check for excessive bleeding and review lab results from the medical consult. 6. **If a patient presents with thrombocytopenia, which of the following platelet counts would require a medical consultation before treatment?** A. 45,000/mm3 B. 100,000/mm3 C. 150,000/mm3 D. 350,000/mm3 7. **Which of the following treatment modifications are necessary for patients with sickle cell anemia?** A. Nitrous oxide may be used with at least 25% oxygen. B. Premedication is required for minor surgical procedures. C. Patients may receive dental treatment during a sickle cell crisis. D. Local anesthetic with vasoconstrictor should be limited. 8. **Which of the following INR's is an appropriate level for performing routine care on patients who are undergoing Warfarin therapy?** A. 2.7 B. 3.6 C. 4.0 D. 4.3 9. **Which type of hepatitis currently does NOT have a vaccine available?** A. Hepatitis A B. Hepatitis B C. Hepatitis C D. Hepatitis D 10. **Antibiotic premedication is necessary for an HIV patient if:** A. Current labs aren't available to determine level of immunosuppression. B. Local anesthetic will be used for the dental procedure. C. Nitrous oxide will be used during the dental procedure. D. The patient is experiencing severe immune neutropenia. 11. **All of the following conditions are oral manifestations of cancer treatment or radiation to the head and neck EXCEPT one. Which is the exception?** A. Xerostomia B. Oral mucositis C. Salivary stones D. Candidiasis E. Osteonecrosis 12. **It is imperative to monitor blood pressure and vitals for pregnant patients during dental treatment in order to?** A. Detect pre-eclampsia. B. Prevent premature labor. C. Detect signs of a stroke. D. Monitor the effects of epinephrine. 13. **If an analgesic is needed during pregnancy, the best medication to use would be:** A. Advil B. Acetaminophen C. Aspirin D. NSAIDs 14. **Which of the following statements is TRUE regarding dental treatment for patients with hyperthyroidism?** A. The most common medical emergency for hyperthyroid patients is myxedema coma. B. Nitrous oxide must not be given to a patient with controlled disease. C. Patients with controlled hyperthyroidism must not be given epinephrine. D. If the hyperthyroidism is uncontrolled no dental treatment should be performed. 15. **Myxedema coma is a medical emergency associated with?** A. Hepatitis A B. Hypothyroidism C. Cushing's syndrome D. Addison's Disease 16. **What could cause a patient to experience adrenal crisis?** A. A severe lack of cortisol. B. Low or undetectable TSH levels. C. A CD4+ count that falls below 200 mm3. D. A deficiency in factor VIII. 17. **Which of the following is an equivalent dose of Cortisone (25 mg)?** A. Cortisol (10 mg) B. Hydrocortisone (25 mg) C. Prednisone (5 mg) D. Hydrocortisone (15 mg) 18. **All of the following are reasons to send a medical consult for a patient with adrenal gland disorder, EXCEPT one. Which is the exception?** A. The patient is poorly controlled. B. The patient requires local anesthesia for a restorative procedure. C. The patient has an acute infection. D. A surgical procedure is planned and the dental provider needs to inquire about supplemental steroid use. **Chronic Obstructive Pulmonary Disorder (COPD) & Asthma** This is a group of diseases that cause airflow to become blocked which results in breathing related problems... Emphysema Chronic Bronchitis Asthma Signs of COPD: Coughing w/ large amounts of mucous. Nightly coughing or early in the morning. -- Asthma Wheezing Chest Tightness Shortness of Breath Physical activity makes it worse. Frequent Respiratory Infections If Severe: Lower Extremity Edema Weight Loss Decreased Muscle Endurance Blue Lips or Fingernails Tachycardia Decreased Alertness Causes: Long term exposure to lung irritants (air pollution; chemical fumes; dust; secondhand smoke). Genetics: Alpha-1-Antitrypsin Deficiency Respiratory Infections Allergies can be a risk factor for Asthma. Dental Management of Pts with COPD: Asthma medications reduce the amount and quality of saliva, increase the risk of mouth breathing, dental caries, dental erosion, periodontal disease, and oral candidiasis. GERD is common in those with Asthma which can result in enamel erosion. Chronic smokers may have Leukoplakia, Erythroplakia, or Carcinoma. COPD increases the risk of arthritis & depression. Oral conditions could also affect those with COPD. **Diabetes** This is a chronic metabolic disease that affects how the body turns food into energy which causes too much sugar to accumulate in the blood (high blood glucose). ***Type I*** This is an autoimmune disease where the pancreas does not make enough insulin. This type can cause nausea, vomiting, and stomach pain. ***Type 2*** Signs of Diabetes: Peeing a lot...especially at night. Extreme Hunger & Thirst Acetone on Breath Unexplained Weight Loss Blurry Vision Numb/Tingling Hands/Feet Tiredness Dry Skin Sores which don't heal/heal slowly. Increased \# of Infections Long term control of blood glucose is evaluated using HbA1c readings which tells us the amount of glycosylation of hemoglobin A in RBCs. Measurements under 7% indicate the patient's diabetes is well-controlled. 6.5% indicates the patient is a diabetic. Dental Considerations: Uncontrolled diabetes can lead to hypo or hyper-glycemia. Hypoglycemia can lead to the patient becoming unconscious, going into a coma, or dying. Always be mindful of the pt's blood sugar levels because dental procedures can cause stress which increases the likelihood a pt's glucose levels would rise (hyperglycemia). Epinephrine is fine but can sometimes increase glucose levels. Morning appointments are better because the pt's are less likely to have hypoglycemia. **Questions Over These Topics + Heart Diseases & Stroke** 1\. **Which of the following factors does NOT contribute to developing chronic diseases?** A. Exposure to secondhand smoke B. Fluoride in drinking water C. Lack of physical activity D. Excessive alcohol use 2.**When assessing the patient, the medical history should include all of the following EXCEPT for one. Which is the exception?** A. Financial limitations B. Vital signs C. Physical limitations D. Cognitive status 4\. **Informed consent is NOT legally necessary \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. when a spouse is present at the dental appointment B. if a patient is not submitting an insurance claim C. in emergency situations when the dental provider is acting in the best interest of the patient D. when a procedure is reversible 7\. **Asthma medications do not increase the risk of \_\_\_\_\_\_\_\_\_\_\_\_\_.** A. mouth breathing B. dental caries C. oral cancer D. oral candidiasis E. dental erosion 8\. **\_\_\_\_\_\_\_\_\_\_\_\_\_ have been associated with bruxism and TMD.** A. Antihistamines B. Anticholinergics C. Antidepressants D. Antihypertensives 9\. **\_\_\_\_\_\_\_\_\_\_\_\_\_ is an autoimmune disease where the pancreas does not make enough insulin.** A. Type 1 diabetes B. Type 2 diabetes C. Gestational diabetes 10\. **Urinating often at night, smell of acetone on breath, and weight loss without trying are signs and symptoms of \_\_\_\_\_\_\_\_\_\_\_\_\_.** A. Arthritis B. COPD C. Depression D. Diabetes 11\. **HbA1c levels below \_\_\_\_\_ indicate the patient's diabetes in well controlled.** A. 7% B. 8% C. 9% D. 10% 12\. **Shortness of breath, fatigue, and swelling of the lower extremities, stomach, and veins in the neck are signs and symptoms of \_\_\_\_\_\_\_\_\_\_\_\_\_.** A. COPD B. Heart failure C. Multiple sclerosis D. Stroke 13\. **Patients who are taking Warfarin should discontinue or alter their dose for most dental procedures.** A. True B. False 14\. **According to the American Heart Association guidelines, a blood pressure range of 145/100 is considered \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. Normal B. Elevated C. High blood pressure--stage 1 D. High blood pressure--stage 2 E. Hypertensive crisis 15\. **Elective dental treatment should be postponed for patients who have uncontrolled high blood pressure (≥ 180/110 mm Hg).** A. True B. False 21\. **Sudden numbness of the face, arm, or leg on one side of the body is a classic sign and symptom of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. Stroke B. Chronic heart failure C. Multiple sclerosis D. Asthma 22\. **Patients who have experienced a stroke \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. should never be given a vasoconstrictor B. should never be given nitrous oxide with oxygen C. can be safely given local anesthesia with epinephrine 1:100,000 or 1:200,000. **Questions over Intra & Extraoral Exam** 1\. **As you examine the TM joint you notice an altered opening pathway which has its greatest distance from the midline at maximum opening.  This defines which one of the following terms?** A. Crepitus B. Deviation C. Deflection D. Subluxation E. Derangement 2\. **Which one of the following is usually associated with arthritis of the TM joint?** A. Pop B. Click C. Crepitus D. Bruxism E. Missing teeth 3\. **All of the following structures would be noted when examining the oropharynx except one.  Which one is the EXCEPTION?** A. Tonsils B. Adenoids C. Tonsillar crypt D. Anterior/posterior pillars E. Posterior pharyngeal wall 4\. **Which one of the following best describes an acute infection of the tonsils?** A. Post nasal drip B. Enlarged tonsils C. Cratered tonsils D. Purulent exudate E. Non-tender erythema 5\. **Compromised swallowing capabilities are associated with a higher risk of which one of the following?** A. Bifid uvula B. Loss of function C. Aspiration of food D. Candida infections E. Excessively long uvula 6\. **Which one of the following techniques should be used to palpate the hard palate?** A. Digital B. Bidigital C. Bilateral D. Bimanual E. Auscultation 7\. **Which one of the following is a common atypical structural finding in the area of the hard palate?** A. Thermal burn B. Torus palatinus C. Mucosal abrasion D. Nicotine stomatitis E. Papillary hyperplasia 8\. **Stensen's duct is associated with which of the following glands?** A. Buccal B. Parotid C. Sublingual D. Submandibular E. Sublingual caruncle 9\. **Which one of the following conditions would be considered pathologic?** A. Linea alba B. Varicosities C. Leukoedema D. Erythroplakia E. Fordyce\'s granules 10\. **Which one of the techniques listed below would be appropriate for palpating the buccal and labial mucosa?** A. Digital B. Bidigital C. Bilateral D. Bimanual E. Unilateral 11\. **When examining the body of the mandible you would use the mouth mirror to stretch the mucosal tissues away from the inferior border, BECAUSE you might miss a lesion which is obscured by a fold of tissue.** A. Both the statement and the reason are correct and related. B. Both the statement and the reason are correct but NOT related. C. The statement is correct but the reason is not. D. The statement is NOT correct, but the reason is correct. E. NEITHER the statement NOR the reason is correct. 12\. **All of the following are common atypical findings in the body of the mandible and the retromolar area except one.  Which one is the EXCEPTION?** A. Tori B. Scarring C. Pericoronitis D. Hyperkeratosis E. Partially erupted third molars 13\. **Which one of the techniques listed below should be used when palpating the structures of the floor of the mouth?** A. Digital B. Bidigital C. Bilateral D. Bimanual E. Finger and thumb of the same hand 14\. **The \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ is the most common intraoral site for oral cancer development.** A. uvula B. tongue C. hard palate D. buccal mucosa E. floor of the mouth 15\. **Which of the following findings associated with the tongue is caused by an error in development?** A. Fissuring B. Scalloping C. Hairy tongue D. Plica fimbriata E. Lingual thyroid 17\. **The perception of oral dryness may depend upon all of the following except one.  Which one is the EXCEPTION?** A. Amount of saliva actually present B. Amount of serous saliva C. Amount of mucous saliva D. Salt/calcium composition of the saliva E. Consistency of the saliva 18\. **Which of the following examination findings would be considered atypical?** A. Stippled gingiva B. Fordyce granules C. Leukoedema D. Two mms of attached gingiva E. Both B and C 19\. **Nutritional deficiencies, Candida albicans, human herpes virus and lesions associated with loss of dimension are common to which one of the following structures/areas?** A. Tongue B. Hard palate C. Commissures D. Floor of the mouth E. Pharyngeal pillars 20\. **A symblepharon discovered during an extraoral exam would be found in or on which one of the following?** A. Ear B. Nose C. Neck D. Eye E. Lip 21\. **The patient with a symblepharon would be referred to which one of the following specialists?** A. Oral surgeon B. Oral pathologist C. Immunology specialist D. Ophthalmologist E. Dermatologist 22\. **Which one of the following known cancer risk factors cannot be lowered or modified by a change in lifestyle or behavior?** A. Alcohol B. Tobacco C. Diet D. Age E. Sunlight 23\. **Patients with known risk factors for cancer should be screened at \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. normal maintenance visits B. more frequent intervals C. any time that an abnormality is noticed by the patient D. yearly visits E. every visit and encouraged to perform self-exams and report any abnormality 24\. **Which one of the following viruses is associated with a significant increase in oropharyngeal cancers?** A. HIV B. HPV C. HCV D. HBV E. CMV 25\. **What percentage of oropharyngeal cancers are squamous cell carcinomas?** A. 10% B. 30% C. 60% D. 80% E. 90% 26\. **Which of the following most closely describes the appearance of oral cancer?** A. White lesion B. Red and white lesion C. Pigmented lesion D. Ulcer-like lesion E. Any of the above. 27\. **Salivary gland tumors, lymphoma, and sarcoma-related cancers comprise what percentage of oropharyngeal cancers?** A. 10% B. 20% C. 30% D. 40% E. 50% 28\. **Which of the following is a common reason for failing to detect oral cancer in a young person?** A. Oral tissues appear more suspicious in the older person. B. Young people do not seek treatment as readily as older populations. C. Clinicians do not suspect cancerous changes in young individuals. D. Cancer does not progress as rapidly with young individuals. E. Younger individuals usually develop cancer in the tonsil region making it virtually undetectable. 29\. **Debris tends to collect in tonsils affected by which one of the following conditions?** A. Erythema B. Tonsillitis C. Streptococcal infection D. Cratered and cryptic tissue E. Cancer 30\. **Which one of the following is the most common site for cancer to develop on the tongue?** A. Dorsal surface B. Circumvallate papillae C. Lateral border D. Tip of the tongue E. Ventral surface **Oral Mucosal Lesions**  **\ 1. A 19-year-old woman has painful ulcers on the labial mucosa and buccal mucosa of 4 days duration. She has had similar ulcers on previous occasions, and each time the lesions healed in approximately 7 days. The best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. aphthous ulcers B. mucous membrane pemphigoid C. recurrent herpes D. primary herpes E. pemphigus 2\. **A 67-year-old woman has a chronic sore mouth of 2 years duration. The lesions consist of multiple persistent ulcers adjacent to white rough thickened areas which do not rub off and are arranged in a striated pattern. The lesions are bilateral and involve the buccal mucosa, lateral borders of the tongue, and gingiva. Of the following, the best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. epidermolysis bullosa B. pemphigus C. herpangina D. lichen planus E. recurrent herpes 3\. **A patient has multiple, asymptomatic, irregular, flat patches on the dorsum of the tongue. Each patch has a red center and an irregular white periphery. The patient reports that the lesions come and go. The best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. lichen planus B. geographic tongue (erythema migrans) C. epithelial dysplasia D. pemphigus E. superficially invasive squamous cell carcinoma 4\. **A 16-year-old woman has a compressible, nontender, 5x5 mm soft tissue enlargement of the lower labial mucosa. The lesion has a blue mucosal surface which does not blanch upon palpation. The patient states that she has been aware of the lesion for 2 months and that it has increased and decreased in size during this time. Of the following, the best diagnosis is\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. peripheral ossifying fibroma B. pleomorphic adenoma (mixed tumor) C. pyogenic granuloma D. hemangioma E. mucocele 5\. **A 13-year-old female patient has mild fever, lymphadenopathy and vesicles and ulcers of the soft palate and tonsillar pillars bilaterally, of 5 days duration. No other oral lesions are present. The best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. herpangina B. herpes zoster C. recurrent herpes D. primary herpes E. infectious mononucleosis 6\. **A patient has a white, nontender, 5 x 6 mm, soft tissue enlargement on the right soft palate of at least 2 years duration. The surface is rough and resembles a wart. The lesion is pedunculated. The best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. irritation fibroma B. lipoma C. papilloma D. epulis fissuratum E. mucocele 7\. **A 44-year-old man has rough, white, nonpainful lesions which do not rub off located bilaterally on the buccal mucosa, floor of the mouth, and hard and soft palates. He states that he has been aware of the lesions since childhood. Of the following, the best diagnosis is\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. white sponge nevus B. lichen planus C. leukoedema D. squamous cell carcinoma 8\. **A 25-year-old woman has a 5x6 mm, nontender, compressible soft tissue enlargement located on the interdental papilla between teeth \#10 and \#11. The lesion is erythematous and bleeds easily. She states that she has been aware of the lesion for approximately 3 days. The patient is in her second trimester of pregnancy. Of the following, the best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. papilloma B. irritation fibroma C. pleomorphic adenoma D. pyogenic granuloma E. hemangioma 9\. **Which white surface lesion rubs off?** A. Epithelial dysplasia B. Subepithelial fibrosis C. Burn D. Fordyce granules E. Hairy leukoplakia 10\. **Which of the following lesions is asymptomatic and smooth to palpation?** A. Burn B. Familial epithelial hyperplasia C. Nicotinic stomatitis D. Scarring 11\. **Which pigmented surface lesion is consistently flat and not thickened?** A. Oral melanotic macule B. Hemangioma C. Kaposi sarcoma D. Melanoma E. Varix 12\. **Which one of these clinical features would be most helpful in distinguishing hematoma from nevus?** A. Color of the lesion B. Duration of the lesion C. Whether the lesion blanches upon pressure D. Whether the lesion is thickened E. Whether the lesion is painful 13\. **A patient has a thickened, compressible, blue pigmentation of the buccal mucosa that blanches upon pressure. Which of the following should be included in the clinical differential diagnosis?** A. Ecchymosis B. Petechiae C. Lentigo D. Tattoo E. Varix 14\. **Which of the following diseases initially forms oral vesicles?** A. Aphthous ulcers B. Infectious mononucleosis C. Mucous membrane (cicatricial) pemphigoid D. Toxic mucositis 15\. **Which of the following lesions have/has an abrupt or sudden onset?** A. Pemphigus B. Recurrent herpes C. Mucous membrane pemphigoid D. Lichen planus 16\. **Which disease has the worst prognosis?** A. Pemphigus vulgaris B. Mucous membrane pemphigoid C. Bullous pemphigoid D. Discoid lupus erythematosus E. Toxic mucositis 17\. **A 35-year-old man has painful ulcers on the lips and buccal mucosal and asymptomatic macules and vesicles on the face, hands, and trunk. He has a mild fever but no lymphadenopathy. The lesions had an acute onset 3 days ago. The best diagnosis is \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.** A. pemphigus B. lichen planus C. erythema multiforme D. toxic epidermal necrolysis E. primary herpes 18\. **Which disease typically begins with the abrupt onset of pain or altered sensation followed by vesicles and ulcers unilaterally in the distribution of a peripheral nerve?** A. Herpes zoster B. Herpangina C. Primary herpes D. Carcinoma-in-situ E. Varicella 19\. **Which of the following lesions is usually congenital?** A. Hemangioma B. Dermoid cyst C. Irritation fibroma D. Pleomorphic adenoma E. Papilloma 20\. **Which of the following lesions is/are encapsulated?** A. Neurofibroma B. Rhabdomyoma C. Schwannoma D. Neuroma E. Granular cell tumor 21\. **Which of the following lesions is/are compressible to palpation?** A. Keratoacanthoma B. Verruca vulgaris C. Granular cell tumor D. Peripheral fibroma E. Low-grade mucoepidermoid carcinoma