Diseases of the Oral Cavity and Salivary Glands Practice Questions

Q: A 60-year-old male patient presents with a parotid lump and facial weakness (House Brackmann grade 6). A fine needle aspiration biopsy is arranged under ultrasound guidance. What is the likely cytology report?

Pleomorphic adenoma. ### Explanation The correct answer is **Pleomorphic Adenoma**. **1. Why Pleomorphic Adenoma is correct:** In NEET-PG, this question tests your knowledge of the **"Statistical Probability vs. Clinical Presentation"** rule. * **Pleomorphic Adenoma** is the most common salivary gland tumor (80% of all parotid tumors). * While facial nerve palsy (HB Grade 6) is a classic sign of malignancy (suggesting infiltration), Pleomorphic Adenoma can occasionally cause facial weakness due to its size, pressure effect, or secondary infection. * However, the most critical point for examiners is that even if a tumor presents with malignant features, the **most common tumor overall** remains the most likely finding on cytology unless a specific malignant cell type is described. **2. Why other options are incorrect:** * **Warthin’s Tumor:** The second most common benign tumor. It is typically found in elderly males (smokers) and is often bilateral or multicentric, but it rarely ever causes facial nerve palsy. * **Mucoepidermoid Carcinoma:** This is the most common **malignant** salivary gland tumor. While it is more likely to cause facial nerve palsy than a benign tumor, it is statistically less common than Pleomorphic Adenoma. * **Oncocytic Adenoma:** A rare benign tumor composed of oncocytes; it does not typically present with facial nerve involvement. **3. Clinical Pearls for NEET-PG:** * **Most common parotid tumor:** Pleomorphic Adenoma (Benign Mixed Tumor). * **Most common site for minor salivary gland tumors:** Palate. * **Malignancy Rule:** The smaller the salivary gland, the higher the chance of malignancy (Sublingual > Submandibular > Parotid). * **Facial Nerve Palsy:** In a parotid mass, this is a "Red Flag" sign strongly suggestive of malignancy (usually Adenoid Cystic Carcinoma or Mucoepidermoid Carcinoma), but for MCQ purposes, always prioritize the most frequent pathology unless cytology confirms malignancy.

Q: Death in Ludwig's angina occurs due to which of the following?

Respiratory obstruction. **Explanation:** **Ludwig’s Angina** is a rapidly spreading, life-threatening cellulitis involving the submandibular, sublingual, and submental spaces bilaterally. It is typically odontogenic in origin (usually the 2nd or 3rd mandibular molars). **1. Why Respiratory Obstruction is the Correct Answer:** The primary cause of death in Ludwig’s Angina is **acute airway obstruction**. As the sublingual space becomes involved, the floor of the mouth becomes edematous and firm (woody hard). This pushes the tongue **superiorly and posteriorly**, leading to mechanical blockage of the oropharynx. Rapidly progressing laryngeal edema further exacerbates the risk of asphyxia. **2. Analysis of Incorrect Options:** * **Sepsis (Option A):** While sepsis and septic shock can occur as the infection spreads to the mediastinum or bloodstream, they are secondary complications. Airway compromise occurs much faster and is the most immediate threat to life. * **Cavernous Sinus Thrombosis (Option C):** This is a classic complication of infections in the "danger area of the face" or ethmoid/sphenoid sinusitis, but it is not a typical feature of submandibular space infections. * **Carotid Blow-out (Option D):** This is a rare, terminal complication of deep neck space infections (like parapharyngeal abscess) involving erosion of the carotid artery, but it is not the characteristic cause of death in Ludwig’s Angina. **Clinical Pearls for NEET-PG:** * **Key Clinical Sign:** "Woody" or "Brawny" edema of the neck with a protruding tongue. * **Management Priority:** The first step is always **Airway Maintenance** (Tracheostomy is often preferred over intubation due to distorted anatomy). * **Microbiology:** Usually a polymicrobial infection (Streptococci, Staphylococci, and anaerobes). * **Radiology:** X-ray neck (lateral view) may show the "Steeple sign" or soft tissue swelling, but clinical diagnosis is paramount.

Q: In which of the following conditions is sialography contraindicated?

Acute sialadenitis. **Explanation:** **Sialography** is a radiographic technique where a radio-opaque contrast medium is injected into the salivary ductal system. **Why Acute Sialadenitis is the Correct Answer:** Sialography is strictly **contraindicated** in acute sialadenitis (acute inflammation of the salivary gland) for two primary reasons: 1. **Exacerbation of Infection:** The retrograde injection of contrast under pressure can force bacteria and inflammatory debris deeper into the glandular parenchyma, potentially leading to abscess formation or systemic spread (septicaemia). 2. **Severe Pain:** The procedure involves ductal dilatation and pressure, which is excruciatingly painful for a patient with an already inflamed and tender gland. **Analysis of Incorrect Options:** * **A. Ductal Calculus:** Sialography is often used to identify radiolucent stones or to map the ductal anatomy distal to a stone, though it has largely been replaced by USG or CT. * **B. Chronic Parotitis:** This is a classic indication. Sialography helps visualize characteristic patterns like "sialectasis" (punctate, globular, or cavitary) seen in chronic inflammatory conditions. * **C. Parotid Obstruction:** Sialography is indicated here to identify the site and nature of the obstruction (e.g., strictures or mucous plugs). **High-Yield Clinical Pearls for NEET-PG:** * **Contraindications:** Acute infection and **known allergy to iodine** (contrast medium). * **Sialographic Patterns:** * **Sjögren’s Syndrome:** "Snowstorm" or "Cherry blossom" appearance (punctate sialectasis). * **Chronic Sialadenitis:** "Sausage-string" appearance (due to segments of dilatation and stenosis). * **Benign Tumors:** "Ball-in-hand" appearance (displacement of ducts around a mass). * **Gold Standard:** For visualizing salivary stones, **Non-Contrast CT (NCCT)** is highly sensitive, while **Sialendoscopy** is the modern interventional gold standard.

Q: Preauricular pain, grating sensation, and partial trismus are the symptoms of which condition?

Temporomandibular joint (TMJ) pain dysfunction syndrome. **Explanation:** **1. Why Option C is Correct:** Temporomandibular Joint (TMJ) Pain Dysfunction Syndrome (also known as Costen’s Syndrome or Myofascial Pain Dysfunction Syndrome) is a functional disorder rather than a structural one. The classic triad of symptoms includes **preauricular pain** (often referred to the ear), **clicking or grating sensations** (crepitus) during jaw movement, and **partial trismus** (limited mouth opening). The pain is typically exacerbated by chewing or stress and is caused by spasm of the masticatory muscles and incoordination of the intra-articular disc. **2. Why Other Options are Incorrect:** * **Options A & B (TMJ Ankylosis):** Ankylosis involves the fusion of the joint. **Bony ankylosis** presents with a total inability to open the mouth (severe trismus) and an absence of pain or grating because the joint is immobile. **Fibrous ankylosis** allows minimal movement but is generally characterized by a "painless" restriction of motion. * **Option D (Ear Infection):** While otitis externa or media causes ear pain (otalgia), they do not typically present with a grating sensation in the joint or trismus unless there is secondary spread to the infratemporal fossa (e.g., Malignant Otitis Externa). **3. Clinical Pearls for NEET-PG:** * **Referred Otalgia:** TMJ disorders are the most common cause of secondary (referred) otalgia. The nerve involved is the **auriculotemporal nerve** (a branch of V3). * **Management:** Initial treatment is conservative, including soft diet, analgesics (NSAIDs), and warm compresses. * **Differential Diagnosis:** Always rule out Eagle’s Syndrome (elongated styloid process) if the patient also complains of a foreign body sensation in the throat.

Q: Which of the following infections can cause multiple sites of osteomyelitis of the jaw?

Hematogenous infection. **Explanation:** **1. Why Hematogenous Infection is Correct:** Osteomyelitis of the jaw is typically a localized process resulting from odontogenic infections (e.g., dental caries or periodontal disease). However, when the infection is **hematogenous** (spread via the bloodstream), the pathogen can seed into the bone marrow at **multiple, non-contiguous sites** simultaneously. This is more common in pediatric populations or immunocompromised individuals where a primary focus (like a skin or respiratory infection) leads to bacteremia, allowing the bacteria to settle in the highly vascularized areas of the mandible or maxilla. **2. Why the Other Options are Incorrect:** * **Peritonsillar Abscess (Quinsy):** This is a localized collection of pus in the peritonsillar space. While it can spread to the parapharyngeal space, it rarely involves the bone and would be limited to a single anatomical region. * **Local Trauma:** Trauma (like a compound fracture) introduces bacteria directly into a specific site. The resulting osteomyelitis is strictly localized to the area of injury. * **Buccal Space Infection:** This is a soft tissue infection of the cheek. While it can occur secondary to an infected tooth, the spread is contiguous and localized to the adjacent bone, rather than causing multifocal involvement. **Clinical Pearls for NEET-PG:** * **Most Common Site:** The **mandible** is more frequently affected by osteomyelitis than the maxilla due to its poorer collateral blood supply and dense cortical bone. * **Microbiology:** *Staphylococcus aureus* is the most common organism in hematogenous spread; however, odontogenic cases are usually polymicrobial (anaerobes + streptococci). * **Garre’s Osteomyelitis:** A specific type of chronic osteomyelitis with proliferative periostitis, typically seen in children/young adults, presenting with a "layered" or "onion-skin" appearance on X-ray.

Q: Which of the following can cause a painless ulcer of the tongue?

Syphilis. **Explanation:** The correct answer is **Syphilis**. In the context of the tongue, a painless ulcer is a classic presentation of **Primary Syphilis**, manifesting as a **Chancre**. 1. **Why Syphilis is correct:** The primary stage of syphilis, caused by *Treponema pallidum*, presents as a solitary, indurated, and characteristically **painless** ulcer (chancre) at the site of inoculation. While most common on genitalia, extragenital chancres frequently occur on the lips or tongue. Additionally, the **Gumma** of tertiary syphilis is also a painless, punched-out ulcer, typically involving the midline of the dorsum of the tongue. 2. **Why other options are incorrect:** * **Dyspepsia:** This is a symptom of indigestion, not a disease entity that causes tongue ulcers. However, associated conditions like Aphthous ulcers (canker sores) are exquisitely **painful**. * **Tuberculosis (TB):** A tubercular ulcer of the tongue is classically **extremely painful**. It typically presents as a shallow, undermined ulcer with a pale, granulating base, often secondary to pulmonary TB. **High-Yield Clinical Pearls for NEET-PG:** * **Painful Ulcers:** Aphthous ulcers, Vincent’s angina, and Tuberculosis. * **Painless Ulcers:** Syphilis (Chancre/Gumma) and early-stage Squamous Cell Carcinoma (though malignancy becomes painful as it infiltrates deeper tissues/nerves). * **Location Clue:** A midline ulcer on the tongue dorsum should strongly raise suspicion of a **Syphilitic Gumma**. * **Mnemonic:** "S" for Syphilis is "S" for Silent (Painless); "T" for TB is "T" for Terrible pain.

Q: Submaxillary calculi can be visualized by X-ray in what percentage of cases?

80% of cases. **Explanation:** The correct answer is **80% of cases**. The submaxillary (submandibular) gland is the most common site for salivary calculi (sialolithiasis), accounting for approximately 80% of all cases. The high incidence of stone formation in this gland is due to the alkaline pH of the saliva, high calcium and phosphate concentration, and the long, upward course of Wharton’s duct. Crucially, **80% of submandibular stones are radiopaque** (visible on X-ray) because they contain high amounts of calcium salts. In contrast, stones in the parotid gland are radiolucent in about 60-80% of cases, making them much harder to detect via standard radiography. **Analysis of Options:** * **Option A (80%):** Correct. This reflects the high mineral content of submandibular stones, making the majority visible on an Intraoral Periapical (IOPA) view or an Occlusal view of the floor of the mouth. * **Options B, C, and D:** These are incorrect as they underestimate the radiopacity of submandibular calculi. While 20% of submandibular stones are radiolucent (invisible on X-ray), the vast majority are easily visualized. **High-Yield Clinical Pearls for NEET-PG:** * **Best Initial Investigation:** For suspected submandibular stones, an **Occlusal view X-ray** is the standard initial imaging. * **Gold Standard Investigation:** **Sialography** (though contraindicated during acute infection). * **Modern Choice:** **Non-contrast CT (NCCT)** is highly sensitive for detecting even small or poorly calcified stones. * **Rule of 80s:** 80% of salivary stones occur in the submandibular gland; 80% of these are radiopaque; 80% of parotid stones are radiolucent.

Q: What is the most common site for carcinoma of the oral tongue?

Lateral border. **Explanation:** The **lateral border** of the tongue is the most common site for squamous cell carcinoma (SCC) of the oral tongue. This is primarily due to the pooling of saliva containing carcinogens (like tobacco and alcohol) in the lateral gutters of the mouth and the constant mechanical irritation from sharp or jagged teeth, which can lead to chronic inflammation and malignant transformation. **Analysis of Options:** * **Lateral Border (Correct):** Approximately 50% of all oral tongue cancers occur here, typically in the middle third. It is the most vulnerable area to both chemical and mechanical trauma. * **Tip (Incorrect):** While SCC can occur here, it is much less common than the lateral border. * **Dorsum (Incorrect):** The dorsal surface is a rare site for primary carcinoma. If a lesion is found here, it is often associated with chronic hyperplastic glossitis or syphilis in older literature. * **Ventral Surface (Incorrect):** While the ventral surface and the floor of the mouth are high-risk areas, the lateral border remains the statistically dominant site for tongue-specific malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site of Oral Cavity Cancer:** Lower lip (globally), but in India, it is the **buccal mucosa** (due to tobacco/betel nut chewing). * **Most common site of Tongue Cancer:** Lateral border of the oral tongue (anterior 2/3rd). * **Lymphatic Spread:** Tongue cancer has a high rate of early bilateral lymphatic spread. The tip drains to Submental nodes (Level Ia), while the lateral border drains to Submandibular (Level Ib) and Deep Cervical nodes. * **Prognosis:** Carcinoma of the posterior 1/3rd (base of tongue) generally has a poorer prognosis than the anterior 2/3rd because it is often diagnosed late and is more aggressive.

Q: What is the most common location of ectopic submandibular salivary gland tissue?

Angle of mandible. **Explanation:** The correct answer is **Angle of mandible**. This clinical entity is famously known as a **Stafne’s Bone Cavity (or Stafne’s Cyst)**. **1. Why it is correct:** Ectopic (or aberrant) submandibular gland tissue occurs when a portion of the salivary gland becomes entrapped during the development of the mandible. It is typically found as a well-defined, cortical depression on the lingual aspect of the posterior mandible, located **below the inferior alveolar nerve canal** near the **angle of the mandible**. Radiographically, it appears as a classic "punched-out" radiolucency. **2. Why the other options are incorrect:** * **Cheek (A):** While ectopic salivary tissue can occur here (often associated with the accessory parotid gland), it is not the most common site for submandibular ectopia. * **Palate (B):** The palate is the most common site for **minor salivary gland tumors** (like Pleomorphic Adenoma), but not for ectopic submandibular tissue. * **Tongue (D):** Ectopic thyroid tissue (Lingual Thyroid) is common at the base of the tongue, but ectopic submandibular tissue is rare in this location. **3. High-Yield Clinical Pearls for NEET-PG:** * **Stafne’s Cyst is a "Pseudocyst":** It is not a true cyst because it lacks an epithelial lining; it is simply a bone depression containing normal salivary tissue. * **Gender Predominance:** It is significantly more common in **males** (80-90%). * **Management:** It is usually asymptomatic and discovered incidentally on OPG. No treatment is required; observation is the standard of care. * **Differential Diagnosis:** Must be distinguished from a keratocystic odontogenic tumor (KCOT) or ameloblastoma, which are usually located *above* the mandibular canal.

Question 1

A 60-year-old male patient presents with a parotid lump and facial weakness (House Brackmann grade 6). A fine needle aspiration biopsy is arranged under ultrasound guidance. What is the likely cytology report?

Accepted Answer

Pleomorphic adenoma

Answer

Warthin's tumor

Answer

Mucoepidermoid carcinoma

Answer

Oncocytic adenoma

Question 2

Death in Ludwig's angina occurs due to which of the following?

Accepted Answer

Respiratory obstruction

Answer

Sepsis

Answer

Cavernous sinus thrombosis

Answer

Carotid blow-out

Question 3

What are the three stages in the progression of acute odontogenic infection?

Accepted Answer

Periapical osteitis, cellulitis, abscess

Answer

Abscess, cellulitis, periapical osteitis

Answer

Cellulitis, abscess, periapical osteitis

Answer

Periapical osteitis, abscess, cellulitis

Question 4

In which of the following conditions is sialography contraindicated?

Accepted Answer

Acute sialadenitis

Answer

Ductal calculus

Answer

Chronic parotitis

Answer

Parotid obstruction

Question 5

Preauricular pain, grating sensation, and partial trismus are the symptoms of which condition?

Accepted Answer

Temporomandibular joint (TMJ) pain dysfunction syndrome

Answer

Temporomandibular joint (TMJ) fibrous ankylosis

Answer

Temporomandibular joint (TMJ) bony ankylosis

Answer

Ear infection

Question 6

Which of the following infections can cause multiple sites of osteomyelitis of the jaw?

Accepted Answer

Hematogenous infection

Answer

Peritonsillar abscess

Answer

Local trauma

Answer

Buccal space infection

Question 7

Which of the following can cause a painless ulcer of the tongue?

Accepted Answer

Syphilis

Answer

Dyspepsia

Answer

Tuberculosis

Answer

None of the above

Question 8

Submaxillary calculi can be visualized by X-ray in what percentage of cases?

Accepted Answer

80% of cases

Answer

20% of cases

Answer

50% of cases

Answer

60% of cases

Question 9

What is the most common site for carcinoma of the oral tongue?

Accepted Answer

Lateral border

Answer

Tip

Answer

Dorsum

Answer

Ventral surface

Question 10

What is the most common location of ectopic submandibular salivary gland tissue?

Accepted Answer

Angle of mandible

Answer

Cheek

Answer

Palate

Answer

Tongue

Diseases of the Oral Cavity and Salivary Glands — MCQs

Diseases of the Oral Cavity and Salivary Glands — MCQs

On this page

Practice by Chapter

Want unlimited practice?