1
Q
A 14-year-old boy presents with a fluctuant, blue, soft tissue swelling affecting his lower labial mucosa following trauma to the lower face while playing football approximately two months ago. What is the most likely diagnosis?
A
Mucocele
2
Q
A 14-year-old boy been referred to the Oral Surgery Department for removal of the soft tissue mucocele affecting his lower lip. Which of the procedures is likely to be undertaken?
A
Excisional biopsy
3
Q
A 5-year-old male child is referred for investigation of a swelling affecting the floor of the mouth. Examination reveals a ranula. A ranula principally affects which one of the following glands?
A
Sublingual gland
4
Q
A 28-year-old woman attends her dental practice complaining of a recent onset of a midline neck swelling. Which of the following is an uncommon cause for this?
A
Plunging ranula
5
Q
A 27 year old woman attends the oral medicine department complaining of painless progressive bilateral parotid swelling. Examination reveals sialosis. What disorder may be associated with development of the condition?
A
Anorexia
6
Q
A 76-year-old man attends the dental practice complaining of ulceration affecting his palate. This was preceded by paraesthesia in the area. He has a history of tobacco use. Which one of the following conditions could account for his symptoms?
A
Necrotising Sialometaplasia
7
Q
A 56 year old woman complains of dry mouth. To determine if this is objective or subjective, unstimulated salivary flow is measured. Which flow rate indicates dry mouth?
A
Below 0.1ml/min
8
Q
A 60-year-old woman attends the Oral Medicine clinic complaining of a dry mouth. The Challacombe scale is used to identify and quantify the degree of oral dryness. The patient scores 10 on this scale. What is the most appropriate management?
A
Refer for further investigations
9
Q
A 67-year-old dentate patient complains of dry mouth and is keen to try salivary replacement. Which of the following preparations is most appropriate?
A
Orthana
10
Q
A 56-year-old woman attends the Oral Medicine Clinic complaining of dry eyes and a dry mouth. A Schirmer’s test is performed which is positive. Which of the following results is most likely to have been recorded to confirm this?
A
<10mm in 5mins
11
Q
A 25-year-old patient complains of pain from the floor of his mouth and swelling which coincides with meal times. Which initial investigation would best aid the possible diagnosis?
A
Sialography with occlusal radiographs
12
Q
A 4-year-old child attends with bilateral parotid swelling, fever, and malaise. Mumps is suspected as there has been a recent outbreak at the nursery which the child attends. Which virus is responsible for causing this condition?
A
Paramyxovirus
13
Q
A 76-year-old man has recently been admitted to hospital following a severe episode of gastroenteritis which has caused dehydration. During examination, a painful left parotid gland was palpated with pus expressed following massage. Which of the following bacteria causes salivary gland infection?
A
Staphylococcus aureus
14
Q
During the process of consenting a patient from removal of a mucocele affecting the lower lip, which of the following is an uncommon complication?
A
Paraesthesia
15
Q
A 56-year-old male patient attends with a left parotid swelling. He has recently noted ptosis and a loss of his left nasolabial fold. Which of the following tumours has a tendency for perineural spread?
A
Adenoid cystic carcinoma
16
Q
In relation to facial pain which of the following are behaviours which may prolong physical dysfunction?
A
Distorted thought processes
17
Q
In relation to primary trigeminal neuralgia what is a possible cause?
A
It may be due to pressure on the trigeminal nerve root from an adjacent vessel in the posterior cranial fossa
18
Q
A 25-year-old female patient presents with trigeminal neuralgia-like symptoms. What is the first secondary cause that needs to be excluded in this case?
A
Multiple sclerosis
19
Q
What is the most common oro-facial pain in the population?
A
Odontogenic pain
20
Q
What is the most common non oro-facial pain in the population?
A
TMD
21
Q
What is the gold standard investigation in diagnosis of giant cell arteritis?
A
Temporal artery biopsy
22
Q
What is the most severe recognised complication of giant cell arteritis?
A
Blindness
23
Q
What is the usual management for giant cell arteritis?
A
Systemic corticosteroids
24
Q
Which of the following histories would be most consistent with a diagnosis of glossopharyngeal neuralgia?
A
Severe stabbing pain affecting the posterior oro-pharynx and triggered by swallowing
25
What other condition other than glossopharyngeal neuralgia can give rise to glossopharyngeal neuralgia-like symptoms
Nasopharyngeal malignancy
26
In relation to periodic migrainous neuralgia what best describes pain experienced by patient?
It is a unilateral excruciating pain in the maxilla or behind the eye
27
Which of the following histories would be most consistent with a paroxysmal hemicrania?
Frequent, short lasting attack of unilateral peri-orbital pain, with associated conjunctival redness and nasal congestion
28
In relation to persistent idiopathic facial pain (PIFP) what best describes the condition?
Constant chronic orofacial discomfort or pain, for which no organic cause can be found
29
Which of the following histories would be most consistent with atypical facial pain?
A deep dull boring pain which can cross the midline
30
What triggers are associated with migraines?
Attacks may be precipitated by a wide range of triggers e.g chocolate / stress
31
Describe type 1 burning mouth syndrome
It comes on as the day progresses and is unremitting
32
Describe type 2 burning mouth syndrome
It is present on waking and throughout the entire day
33
Describe type 3 burning mouth syndrome
There is no typical pattern, and atypical sites are affected
34
Which of the treatment approach is used initially in the management of burning mouth syndrome?
Topical therapies, systemic treatments and behavioural strategies
35
4 causes of burning sensation in the oral mucosa
GORD
Parafunctional habits
Salivary gland hypofunction
Haematinic deficiencies
36
Describe the factors associated with the development of TMD?
Factors associated with development of the condition are multifactorial
37
Describe the typical presenting symptoms in TMD?
Pain on opening widely, which may be bilateral
38
A 22-year-old fit, and healthy male patient is referred for diagnosis and management of an asymptomatic click from the left temporomandibular joint. You diagnose disc displacement with complete reduction. What is the most appropriate treatment for this patient?
Education
39
Potential presentation of lichen planus?
May be an incidental finding
40
Describe the clinical patterns of lichen planus (6)
Reticular, papular, plaque, atrophic, erosive, bullous
41
Where does lichen planus and lichenoid reaction rarely affect? (3)
Floor of mouth
Palate
Edentulous alveolar mucosa
42
What can predispose a patient to dry socket? (5)
Traumatic extraction
Impaired blood supply
Smoking
Oral contraceptives
Osteosclerotic disease
43
How would you manage dry socket?
Irrigate the socket with saline and place alvogel
44
What could be done to reduce the chances of dry socket occurring again in the future?
Use a minimally traumatic extraction technique
45
According to the 2017 ACR-EULAR Classification Criteria for Primary Sjögren's Syndrome, diagnosis is defined as a score of 4 or more. Which of the following permutations would indicate a diagnosis of Primary Sjögren's Syndrome?
Unstimulated salivary flow rate < 0.1ml/min and a focus score ≥ 1 focus/4 mm2
46
A 65 year old woman attends your practice complaining of an ulcer on the side of her tongue that has been there for 2 months, and is around 2cm wide what features would make you suspect OSCC?
A single painless ulcer with red base, raised margins and is firm
47
You refer a patient to your nearest Oral Surgery unit for further investigation of of a longstanding ulcer you feel may be malignant. The consultant there is also concerned about the possibility of malignancy. Which of the following is the best option?
Incisional biopsy
48
A 14 year old girl with no medical problems attends her general dental practice with her parents for a routine dental check-up. It is noted that her upper right canine is still present and non-mobile. Permanent canine has yet to erupt. What would you do to manage this patient?
Take an IOPA to assess for the presence of the permanent canine and refer the patient to an orthodontist
49
What is the most likely cause of a macrocytic anaemia?
B12 or folate deficiency
50
What is the most likely cause of a microcytic anaemia?
Iron deficiency
51
A 72 year old man attends your practice complaining on a lump on his gum. The area is now affecting the fit of his dentures but is otherwise painless. What is the most likely diagnosis?
Denture induced hyperplasia
52
How should denture induced hyperplasia be managed?
Excisional biopsy and alteration of the denture
53
A patient attends your practice complaining of a rapidly enlarging swelling in the left pre-auricular region. The swelling is painless and the overlying skin is of normal colour. The patient had a pleomorphic adenoma excised from the left parotid gland over 10 years ago. What is the most likely diagnosis?
Carcinoma ex Pleomorphic adenoma
54
A female aged 23 presents with a five-day history of pain from the right cheek. She informs you this has happened on numerous other occasions. What is the likely diagnosis?
Recurrent aphthous ulceration
55
What investigation would be best to aid with your diagnosis of ulceration?
Haematological investigations
56
Which group of drugs does midazolam belong to?
Benzodiazepines
57
What drug can be used to reverse the effects of midazolam?
Flumazenil
58
What of the following diagnoses best fits the definition: “a white patch that cannot be classified as any other disease and may be associated with an increased risk of malignancy”
Leukoplakia
59
Which auto antibodies is likely to be present in a patient with primary Sjogren's syndrome?
Ro 60 (SS-A)
60
A 24-year old patient reports recurrent episodes of singular ulcers affecting the hard palate, which are greater than 1cm and heal after approximately 3 weeks. What is the likely diagnosis?
Major aphthous ulceration
61
A 24-year-old patient reports recurrent episodes of ulcers (5 or more) affecting the buccal and labial mucosa, which are less than 1cm and heal within 10 days. What is the most likely diagnosis?
Minor aphthous ulceration
62
An 18-year old patient presenting with cervical lymphadenopathy, lip ulceration and a maculopapular rash who has recently returned after holidaying abroad is likely to be suffering from which of the following infectious conditions?
Syphilis
63
A 74 year old man is referred to you. You notice blueish swelling on lip. The patient is asymptomatic and the area is soft on palpation. What is the most likely diagnosis?
Vascular malformation
64
What is the best way of managing a vascular malformation?
Cryotherapy
65
An otherwise well 45-year-old female patient presents with a large pink, pedunculated lump on the buccal mucosa at the level of the occlusal plane. What is the most likely diagnosis?
Fibro-epithelial polyp
66
An otherwise well 45-year-old female patient presents with a large red swelling affecting the gingiva which bleeds on probing. What is the most likely diagnosis?
Pyogenic granuloma
67
Common symptom assoiated with bacterial salivary gland infections
Pus can be expressed from the duct
68
You have diagnosed a patient with a bacterial infection of the right parotid gland. What is a possible presentation?
Pus expressed from the duct
69
Best treatment for bacterial salivary gland infection?
Co-amoxiclav, maintain fluid intake and massage the area
70
A patient notes a recurrent swelling around mealtimes in front of their right ear. Which would be the most appropriate test to aid your diagnosis?
Sialogram
71
A patient presents with symptomatic red patch on the palate. The patient has a history of COPD and uses inhaled steroids daily? What is the most likely diagnosis?
Erythematous candidosis
72
A patient presents with a white and red lesion on their soft palate. The white areas can be rubbed off, which leaves the red patch underneath?
Pseudomembranous candidosis
73
Which species of candida is most associated with oral infection?
C. albicans
74
Bacteria that causes Lyme's disease
Borrelia burgdorferi
75
Bacteria that causes Impetigo
Staphylococcus aureus
76
A 74-year-old man has a new sudden onset of severe throbbing pain in the from the right side of his head. The pain is made worse when he is eating and putting on his glasses. Which one of the following conditions is most likely to account for his symptoms?
Temporal arteritis
77
What intra-oral findings would best support a diagnosis of temporomandibular joint disorder in a patient?
Evidence of parafunction eg. tongue scalloping, linea alba
78
A 22-year-old fit and healthy male patient is referred for diagnosis and management of an asymptomatic click from the left temporomandibular joint. You diagnose disc displacement with complete reduction. What is the most appropriate treatment?
Education
79
A 25-year-old female patient is referred for diagnosis and management of a dull pain from the left temporomandibular joint which is worse at times of stress. The patient has no medical problems and there is no limitation of jaw movements. What is the most appropriate treatment for this patient?
Education
80
Risk of malignancy of a homogenous white patch in floor of the mouth in a patient who has never smoked
Moderate risk
81
Which oral locations have higher risk of transformation to cancer? (3)
Floor of mouth
Retromolar pad
Tongue
82
Name a reason to suspect a higher risk of dysplasia transforming into cancer?
Lesion persisting with a lack of risk factors
83
Treatment of recurrent aphthous ulceration
Topical steroid treatment to speed up healing
84
Presentation of Varicella-zoster virus
Unilateral ulceration
85
Patients complain of short bursts of agonising pain in one dermatome of Cranial nerve V. What is the likely diagnosis?
Trigeminal neuralgia
86
Describe 1 feature of pain experienced with Shingles
Pain can mimic toothache
87
Potential side effect of Shingles
Post herpetic neuralgia
88
Pain from the upper jaw which is worse on stooping is most likely related to which non-odontogenic cause?
Maxillary sinusitis
89
Potential trigger for trigeminal neuralgia
It can be triggered by cold air
90
Potential cause of fibro-epithelial polyps
Recurrent trauma
91
Virus causing squamous cell papilloma
Human papillomavirus
92
Which drug is a first line treatment for management of neuralgia?
Carbamazepine
93
Likely diagnosis of hard bony swelling midline of palate
Palatine torus
94
What drugs may induce gingival hyperplasia? (3)
Calcium channel blockers
Phenytoin
Cyclosporin
95
What is the definition of a cyst?
Pathological cavity not formed by the accumulation of pus, which may be lined by epithelium and usually contains fluid or semi-fluid contents
96
A 14 year old presents with a soft, fluctuant swelling on their lower lip. What is the most likely diagnosis?
Mucocele
97
NICE guidelines for extractions of 3rd molar teeth (9)
Pericoronitis x2
Unrestorable caries
Non-treatable pulpal disease
Resorption of teeth
Periodontal disease
Fractured root
Cyst
Impeding surgery
Involved in field of tumour resection
98
Describe how salivary calculi may be formed
Calcification of mucous plug over time
99
Describe management strategies of salivary calculi (4)
Lemon drops
Good hydration
Remove with probe
Basket retrieval (Sialendoscopy)
100
Patient presents with a socket with pus following extraction. A localised abscess is diagnosed. What is your management?
Localised debridement under LA
101
An 18 year old presents with bilateral salivary swelling around their parotid glands. What is the most likely diagnosis?
Mumps
102
A patient presents to your clinic with a red ulcer on the lateral border of the tongue, which hasn’t healed for 3 weeks. What is the most appropriate course of action?
Red flag referral
103
What condition is most likely to cause sub-epithelial blistering?
Mucous membrane pemphigoid
104
What result will be raised in blood results from giant cell arteritis?
ESR
105
A patient presents with pain in their pre-auricular region and cannot open past a certain level? What is your diagnosis?
TMD without reduction
106
A patient presents with deformed fingers and is currently suffering from Sjogren’s Syndrome. What condition is likely to be affecting her fingers?
Rheumatoid Arthritis
107
What investigation could be used in diagnosing Sjogren’s Syndrome?
Sialometry
108
Name 2 common complications of Sjogren’s Syndrome
Lymphoma, heart block
109
Common location for sialolith
Submandibular ducts
110
Likely diagnosis of red, depapillated area at midline of dorsal surface of tongue
Median rhomboid glossitis
111
What special investigation is useful in median rhomboid glossitis?
Swab
112
What condition can predispose a patient to median rhomboid glossitis?
Diabetes
113
Lichen planus is most commonly experienced by what gender
Affects more females than males
114
Location that lichen planus/ lichenoid reaction rarely affects
The floor of the mouth
115
Possible features that may predispose patient to dry socket (2)
Failure to follow post-operative instructions
Traumatic extraction
116
Age of onset of recurrent aphthous ulceration
Usually prior to the age of 20
117
First presentation of Varicella-zoster virus infection
Chicken pox
118
A patient arriving with primary Sjogens is likely to complain of
Dry gritty eyes and xerostomia
119
Pathological feature of HIV virus
Primarily disrupts cell mediated immune functions
120
A 36-year-old man with a new diagnosis of HIV presents for examination. White corrugated plaques are noted on the lateral aspects of the tongue and do not scrape off. What is the most likely to cause this condition?
Epstein Barr virus
121
A 40-year-old man with a recent diagnosis of HIV presents for urgent appointment with acute pain and bleeding in his mouth. He has not yet started antiretroviral therapy. Oral examination shows tenderness in gingivae as well as an area of soft tissue loss. Which of the following conditions will most likely cause this man’s oral lesions?
Necrotizing ulcerative periodontitis
122
1 potential presentation of HIV
Bilateral parotid gland cyst formation
123
1 potential presentation of OFG
May present with aphthous like ulceration
124
1 potential allergen causing OFG
May be triggered by benzoic acid acting as an allergen
125
What is the major histological feature of OFG?
Long caseating granuloma
126
Potential management of Erythema Multiforme
Systemic steroids
127
What type of hypersensitivity reaction is Erythema Multiforme
Type IV hypersensitivity reaction
128
Condition characterised by intracellular deposits of IgG in oral epithelium
Pemphigus vulgaris
129
1 cause of buccal mucosal pigmentation
Chloroquine anti-malarial drug
130
A differential diagnosis for amalgam tattoo
Malignant melanoma
131
A 35-year-old woman attends your practice seeking help for recurrent palatal pain. She presents with multiple punctate ulcers in the hard palate that were preceeded by tiny blisters.Her lesions typically heal within 2 weeks but reappear during stressful times. What condition do you suspect she has?
Recurrent intraoral herpes
132
Virus causing intra-epithelial lesions
Herpes virus
133
A 70-year-old woman presents to your clinic with full width gingivitis and associated ulcers of her gingiva. The lesions have been continuously present for 5 months. She describes the appearance of tense blisters before ulcers. She has no eye, skin or genital lesions. She takes no medication. What is the most likely diagnosis?
Mucous membrane pemphigoid
134
Pathogenesis of mucous membrane pemphigoid?
Autoantibodies are directed against epithelial basement membrane zone proteins
135
A 67-year-old woman presents with multiple persistent large ulcers of her gingiva and buccal mucosa. Biopsy of the tissue adjacent to the ulcers shows epithelial separation from the submucosa and through the level of the basement membrane. This is suggestive of which of the following?
Mucous membrane pempigoid
136
What type of hypersensitivity reaction is asthma?
Type I
137
2 cells with a role in the adaptive immune system
T cells
B cells
138
A 5-year-old patient attends his local A+E department with a first episode of sudden onset of extensive oral ulceration of 2 day duration. He feels generally unwell and further examination revels a rash on his hands and soles. What is the likely diagnosis?
Hand foot and mouth disease
139
A 76-year-old woman attends your practice with ulcerations which have been persistent for 33 months. She states they are preceeded by blisters. She recently developed ocular irritation which she describes as gritty sensation when she closes her eyes. Other than her chief complaint and hypertension, she is in good health. What is the likely diagnosis?
Mucous membrane pemphigoid
140
A 60-year-old man was referred to Oral Medicine with painful ulcerative lesions on his buccal mucosa, gingiva and tongue. The lesions were confirmed as pemphigus vulgaris on biopsy. Which of the following treatment regimens would be most effective in controlling this patient’s disease?
Systemic corticosteroids
141
Direct immunofluorescence is performed on which of the following samples?
Perilesional
142
Direct immunofluorescence staining of a biopsy from a patient with mucous membrane pemphigoid would show immunoglobulin deposition in what pattern?
Linear fluorescence of the basement membrane
143
Which 2 viruses can be linked to erythema multiforme?
Herpes simplex
Covid
144
Tomb stoning is a histological finding of which vesiculobullous condition
Pemphigus vulgaris
145
Symblepharon is an ocular finding in which condition?
Mucous membrane pemphigoid
146
A 5-year-old Asian patient attends with multifocal sites of oral pigmentation. What is the likely diagnosis?
Physiological pigmentation
147
Most common cause of foreign body tattoo in the oral cavity
Amalgam
148
Most common cause of post-inflammatory pigmentation in the oral cavity
Lichen planus
149
Pigmentation associated with Addison’s disease affects which part of the oral cavity?
Buccal mucosa
150
A 68-year-old male patient attends with asymptomatic, asymmetrical pigmented lesion on the hard palate. What is the likely diagnosis?
Malignant melanoma
151
Secondary Sjogren’s syndrome is most often seen in conjunction with which 2 conditions
Lupus
Rheumatoid arthritis
152
Characteristic histopathological feature of Sjogren’s Syndrome seen in the labial gland
Infiltration of lymphocytes around intralobular ducts
153
Define Sjogren’s syndrome
Chronic autoimmune disorder of exocrine glands
154
What is the main serum antibody in primary Sjogren’s syndrome
SS-A
155
Corticosteroids are contraindicated in the treatment of which conditions?
Viral, bacterial and fungal conditions
156
Why is Herpes whitlow is now rarely seen in dental practitioners?
Dental personnel wear gloves when practicing
157
What training is required to carry out RA
12 hours CPD within 5 years
158
Name 2 ways to monitor sedated patients
Clinical monitoring
Electromechanical monitoring
159
How is clinical monitoring carried out? (4)
Observe patient
Observe movement of bag
Observe O2 and N2O flow meters
Observe respiratory rate
160
How is electromechanical monitoring carried out?
Pulse oximetry and BP monitoring
161
How is midazolam used for RA?
1mg/ml – 1mg given over 15 seconds – 1 minute between increments
162
A patient presents with hearing loss and blue sclera. What is a potential diagnosis?
Osteogenesis imperfecta
163
What are the clinical signs of angina bullosa haemoraghica?
Blood filled blister on dorsum of tongue accompanied by prodromal syndromes
164
What are clinical signs of impacted canines? (4)
Not palpable 9-10 years
Prolonged retention of C
Distal tipping of laterals
Loss vitality to 1s and 2s
165
Clinical signs of a faint? (5)
Light headed
Slow pulse
Low BP
Pallor
Sweating
166
What drugs are kept in an emergency box (7)
GTN Spray
Salbutamol inhaler
Adrenaline 1:1000
Aspirin 300mg
Glucagon 1mg
Oral glucose solutions
Midazolam
167
Best clinical management of an asthma attack?
Give oxygen at 15 litres per minute
Up to 10 activations of salbutamol in spacer
Ambulance transfer
168
What would you see in anaphylaxis?
Vasodilatation
169
A patient presents to your clinic who sweats on the right side of their body when eating. What syndrome is likely to be causing these symptoms?
Frey’s syndrome
170
Trismus following extraction could be a sign of what?
Spreading infection
171
Give 2 reasons why an alcoholic patient may not be able to clot
Liver disease (lack of clotting factors)
Thrombocytopenia
172
What may be given to an alcoholic patient to aid clotting?
Vitamin K
173
How should a stable warfarin patient be managed?
INR with GP 72 hours prior to appointment
174
How should an unstable warfarin patient be managed?
INR with GP <24 hours prior to appointment
175
What is the mode of action of rivaroxaban?
Factor Xa inhibitor
176
A patient is currently taking apixaban. What condition may they be suffering from?
Deep vein thrombosis
177
What is the mode of action of clopidogrel?
Irreversibly inhibit platelet activation by ADP dependent pathway
178
What is the mechanism of action for aspirin?
Irreversible COX inhibitor
179
What antibiotic should a dentist avoid when a patient is taking warfarin?
Metronidazole
180
When are antibiotics indicated in oral surgery?
Systemic spread of disease
181
Where is a keratocyst most likely to be seen on an OPT?
Angle of the mandible
182
Where is a dental cyst most likely to be seen on an OPT?
Apex of a non-vital tooth
183
Where is a dentigerous most likely to be seen on an OPT?
Around an unerupted tooth
184
3 ways to remove a keratocyst
Resection
Marsupialization
Enucleation (if large need to marsupilaize then enucleate)
185
What is a potential reason an orthodontist may refer canine extraction to oral surgery?
Canine may not align with interceptive orthodontics
186
Can a HIV positive dentist continue practicing?
Yes if they are on effective antiretroviral therapy and viral load is
undetectable
187
What type of biopsy is likely to be taken for Kaposi’s Sarcoma?
Excisional biopsy
188
What virus is commonly associated with Kaposi’s Sarcoma?
HIV
189
Patient presents with pain in preauricular region and can’t open mouth past certain level, what is the likely diagnosis?
TMD without reduction
190
What would informed consent for extraction lower wisdom tooth contain?
All risks, regardless of likelihood
