Diseases of the Oral Cavity and Salivary Glands — MCQs

Diseases of the Oral Cavity and Salivary Glands Indian Medical PG Practice Questions and MCQs

Question 111: What is a constant feature associated with a radicular cyst?

A. An impacted tooth
B. A missing tooth
C. A non-vital tooth (Correct Answer)
D. An anomalous tooth

Explanation: ### Explanation **Radicular Cyst (Periapical Cyst)** is the most common inflammatory odontogenic cyst of the jaws. It arises from the **epithelial rests of Malassez** in the periodontal ligament as a direct result of inflammation following the death of the dental pulp. #### Why "A Non-vital Tooth" is Correct: The pathogenesis of a radicular cyst begins with dental caries or trauma that leads to **pulpal necrosis (death of the tooth)**. Once the tooth becomes non-vital, bacterial toxins and inflammatory mediators exit the apical foramen into the periapical tissues. This chronic stimulus triggers the proliferation of the rests of Malassez, eventually forming a fluid-filled cyst at the root apex. Therefore, a **non-vital tooth** is a mandatory clinical prerequisite for a radicular cyst. #### Why Other Options are Incorrect: * **A. An impacted tooth:** This is a constant feature of a **Dentigerous cyst** (Follicular cyst), which attaches to the cemento-enamel junction of an unerupted tooth. * **B. A missing tooth:** A cyst found in place of a missing tooth (where it failed to develop) is typically a **Primordial cyst**. * **D. An anomalous tooth:** While anomalies can lead to decay, they are not a defining diagnostic feature of radicular cysts. #### NEET-PG High-Yield Pearls: * **Radiological Appearance:** Presents as a well-defined, unilocular radiolucency at the apex of a non-vital tooth with a distinct sclerotic border. * **Most Common Site:** Maxilla (specifically the anterior region). * **Treatment:** Root canal treatment (RCT) for small cysts; enucleation with apicoectomy for larger ones. * **Residual Cyst:** If the non-vital tooth is extracted but the cyst is left behind, it is then termed a "Residual Cyst."

Question 112: What is the most common site of sialolithiasis?

A. Submandibular gland (Correct Answer)
B. Parotid gland
C. Sublingual gland
D. Equally common in all salivary glands

Explanation: **Explanation:** The **submandibular gland** is the most common site for sialolithiasis, accounting for approximately **80–90%** of all salivary stones. This high incidence is attributed to several anatomical and physiological factors: 1. **Wharton’s Duct Anatomy:** The duct is long and follows an upward, tortuous course, leading to stasis of saliva against gravity. 2. **Saliva Composition:** Submandibular saliva is more **alkaline** (promoting calcium salt precipitation) and has a higher concentration of **calcium and phosphate** compared to parotid saliva. 3. **Mucin Content:** It contains a higher concentration of mucus, making the secretions more viscous. 4. **Punctum Size:** The orifice (opening) of Wharton’s duct is narrower than the duct itself, facilitating the entrapment of stones. **Analysis of Incorrect Options:** * **B. Parotid gland:** Accounts for only 10–15% of cases. Parotid saliva is serous (watery) and acidic, which keeps calcium salts in solution. Stensen’s duct is also wider and shorter. * **C. Sublingual gland:** Rarely involved (approx. 1–5%) because the gland has multiple small ducts (ducts of Rivinus) rather than one long, large-caliber duct. * **D. Equally common:** Incorrect, as the physical and chemical properties of saliva vary significantly between glands. **High-Yield Clinical Pearls for NEET-PG:** * **Radiopacity:** 80% of submandibular stones are **radiopaque** (visible on X-ray), whereas 80% of parotid stones are **radiolucent**. * **Best Imaging:** **Non-contrast CT (NCCT)** is the gold standard. For clinical screening, an **Intraoral Periapical (IOPA)** view or Occlusal view is used for submandibular stones. * **Clinical Presentation:** "Mealtime syndrome"—recurrent painful swelling of the gland triggered by the sight or smell of food. * **Management:** Small stones are managed with sialogogues; larger stones require surgical removal or Lithotripsy/Sialendoscopy.

Question 113: Which of the following is untrue regarding Ludwig's angina?

A. Involves the submandibular, sublingual, and submental spaces.
B. Involves bilateral mandibular spaces and lymphadenopathy.
C. Involves bilateral submandibular, sublingual, and submental spaces along with salivary gland enlargements. (Correct Answer)
D. None of the above.

Explanation: **Explanation:** **Ludwig’s Angina** is a rapidly spreading, life-threatening cellulitis involving the submandibular, sublingual, and submental spaces. It is typically odontogenic in origin (usually the 2nd and 3rd lower molars). **Why Option C is the Correct (Untrue) Statement:** While Ludwig’s Angina involves the bilateral submandibular, sublingual, and submental spaces, it is characterized by **cellulitis of the connective tissue and fascia**, not the involvement of the salivary glands or lymph nodes. The absence of lymphadenopathy and salivary gland enlargement is a classic diagnostic feature that distinguishes it from other neck infections. **Analysis of Other Options:** * **Option A:** This is a **true** statement. The infection must involve all three spaces (submandibular, sublingual, and submental) to be classified as Ludwig’s Angina. * **Option B:** This is also **true**. The hallmark of Ludwig’s Angina is its **bilateral** nature. Furthermore, the clinical definition specifically notes the **absence of lymphadenopathy**, making the presence of lymphadenopathy a common distractor in exams. **High-Yield Clinical Pearls for NEET-PG:** 1. **Source:** Most common cause is dental infection (Streptococcus and anaerobes). 2. **Clinical Features:** "Woody" or "Brawny" edema of the neck, superior-posterior displacement of the tongue (causing airway obstruction), and "Hot potato voice." 3. **Management:** The priority is **Airway Management** (often requiring tracheostomy if intubation fails). Treatment includes IV antibiotics and surgical incision and drainage (I&D) if there is no response to medical therapy. 4. **Key Diagnostic Rule:** It is a cellulitis, not an abscess; therefore, pus is rarely found in the early stages.

Question 114: Multiple painful ulcers on the tongue are seen in all the following conditions EXCEPT?

A. Aphthous ulcers
B. Tuberculous ulcers
C. Herpes ulcers
D. Carcinomatous ulcers (Correct Answer)

Explanation: **Explanation:** The key to answering this question lies in distinguishing between inflammatory/infective conditions and neoplastic conditions of the oral cavity. **1. Why Carcinomatous Ulcers are the Correct Answer:** Carcinomatous ulcers (Squamous Cell Carcinoma) are typically **painless** in their early stages. Pain only occurs in advanced stages when there is secondary infection or involvement of deep nerves (e.g., lingual nerve). Furthermore, malignancy usually presents as a **solitary**, indurated ulcer with everted edges, rather than multiple lesions. **2. Analysis of Incorrect Options:** * **Aphthous Ulcers:** These are the most common cause of painful oral ulcers. They are typically multiple, small, shallow, and extremely painful due to exposed nerve endings. * **Tuberculous Ulcers:** Secondary tuberculosis of the tongue presents as **multiple, severely painful** ulcers. They are characterized by an "undermined edge" and a pale, flabby base with granulations. The pain is often out of proportion to the size of the ulcer. * **Herpes Ulcers (Herpetic Stomatitis):** Caused by HSV-1, these present as multiple small vesicles that rupture to form clusters of painful, shallow ulcers. **Clinical Pearls for NEET-PG:** * **Tuberculous Ulcer:** Classically described as a "painful ulcer with an undermined edge" (High-yield). * **Carcinoma Tongue:** The most common site is the lateral border of the tongue. The most common histological type is Squamous Cell Carcinoma. * **Induration:** This is the hallmark of malignancy. If an ulcer feels firm/hard on palpation, suspect carcinoma. * **Vincent’s Angina:** Another cause of painful oral ulcers, characterized by a "punched-out" appearance and a pseudomembrane.

Question 115: A patient presents with bilateral diffuse swelling in the neck below the chin. Intraorally, the lower left molar is infected. Severe cellulitis in the submandibular, sublingual, and submental spaces may cause death due to which of the following?

A. Severe sepsis
B. Asphyxiation
C. Both severe sepsis and asphyxiation (Correct Answer)
D. Edema of the glottis

Explanation: ### Explanation The clinical presentation described—bilateral diffuse swelling of the submandibular, sublingual, and submental spaces following a dental infection—is a classic description of **Ludwig’s Angina**. **Why Option C is Correct:** Ludwig’s Angina is a rapidly spreading cellulitis (not an abscess) of the submandibular space. It is life-threatening due to two primary mechanisms: 1. **Asphyxiation:** As the sublingual space becomes involved, the floor of the mouth swells, pushing the tongue upward and backward. This leads to acute upper airway obstruction. 2. **Severe Sepsis:** Being a virulent polymicrobial infection (often involving *Streptococcus* and anaerobes), it can rapidly progress to systemic inflammatory response syndrome (SIRS), septic shock, and multi-organ failure. **Analysis of Incorrect Options:** * **Option A (Severe Sepsis):** While sepsis is a major cause of mortality, it is not the *only* cause. Ignoring the immediate threat of airway compromise makes this answer incomplete. * **Option B (Asphyxiation):** Airway obstruction is the most common *immediate* cause of death, but the systemic spread of infection (sepsis) also contributes significantly to mortality. * **Option D (Edema of the glottis):** While laryngeal edema can occur, the primary cause of respiratory distress in Ludwig’s Angina is the **mechanical displacement of the tongue** obstructing the oropharynx, rather than isolated glottic edema. **NEET-PG High-Yield Pearls:** * **Source of Infection:** Most commonly the **2nd and 3rd lower molars** (roots lie below the myohyoid line). * **Clinical Sign:** "Woody" or "brawny" edema of the neck; the patient often presents with a "bull-neck" appearance and drooling. * **Management Priority:** The first priority is **Airway Maintenance** (often requiring tracheostomy, as intubation may be impossible due to trismus and tongue displacement). * **Treatment:** High-dose IV antibiotics and surgical decompression (incision and drainage) if conservative management fails.

Question 116: Which premalignant lesion of the oral cavity has the highest potential for malignancy?

A. Leukoplakia
B. Erythroplakia (Correct Answer)
C. Submucous fibrosis
D. Hyperplasia

Explanation: **Explanation:** The potential for malignant transformation in oral premalignant lesions depends on the degree of cellular atypia and epithelial dysplasia present at the time of clinical presentation. **Why Erythroplakia is the Correct Answer:** Erythroplakia is defined as a fiery red patch that cannot be characterized clinically or pathologically as any other definable disease. It has the **highest malignant potential** among all oral mucosal lesions. Histologically, about **90%** of erythroplakia cases show severe dysplasia, carcinoma-in-situ, or invasive squamous cell carcinoma at the time of biopsy. The red appearance is due to the extreme thinning of the epithelium (atrophy), allowing the underlying vascularity to show through. **Analysis of Incorrect Options:** * **Leukoplakia:** While it is the most common premalignant lesion, its overall transformation rate is lower (approx. 1–5%). Only specific subtypes, like **Non-homogeneous/Speckled leukoplakia**, carry a high risk, but still less than pure erythroplakia. * **Submucous Fibrosis (OSMF):** This is a premalignant *condition* (not a localized lesion) common in the Indian subcontinent due to betel nut chewing. While it has a significant transformation rate (approx. 7–13%), it is lower than that of erythroplakia. * **Hyperplasia:** Simple epithelial hyperplasia is a benign reactive process. Unless it is "atypical hyperplasia" (dysplasia), it does not carry an inherent risk of malignancy. **High-Yield Clinical Pearls for NEET-PG:** * **Most common site for Erythroplakia:** Floor of the mouth, retromolar trigone, and lateral tongue. * **Speckled Leukoplakia (Erythroleukoplakia):** A mix of red and white patches; it carries a higher risk than plain leukoplakia but lower than pure erythroplakia. * **Rule of Thumb:** In the oral cavity, "Red is more dangerous than White." Any red patch persisting for >2 weeks must be biopsied.

Question 117: Which of the following malignant salivary gland tumors has a tendency for perineural invasion?

A. Mucoepidermoid carcinoma
B. Adenoid cystic carcinoma (Correct Answer)
C. Adenocarcinoma
D. Acinous cell carcinoma

Explanation: **Explanation:** **Adenoid cystic carcinoma (ACC)** is the correct answer because it is classically characterized by its high propensity for **perineural invasion (PNI)**. This tumor spreads along the nerve sheaths, often extending far beyond the visible surgical margins. This unique biological behavior explains why ACC frequently presents with pain or cranial nerve palsies and has a high rate of local recurrence and late distant metastasis (often to the lungs). Histologically, it is known for its "Swiss cheese" or cribriform pattern. **Analysis of Incorrect Options:** * **Mucoepidermoid carcinoma:** This is the most common malignant salivary gland tumor overall. While it can be aggressive (high-grade), its hallmark is a mixture of mucus-secreting, epidermoid, and intermediate cells, rather than a specific affinity for nerves. * **Adenocarcinoma:** This is a broad category of tumors. While some subtypes may show neural involvement, it is not a defining characteristic or a "classic" association like it is for ACC. * **Acinous cell carcinoma:** This is generally a low-grade malignancy with a relatively good prognosis. It typically presents as a slow-growing mass and rarely exhibits the aggressive perineural spread seen in ACC. **High-Yield NEET-PG Pearls:** * **Most common site for ACC:** Submandibular gland (though it is the most common malignancy of the minor salivary glands). * **Most common salivary gland tumor (overall):** Pleomorphic Adenoma (Benign). * **Most common malignant salivary gland tumor:** Mucoepidermoid carcinoma. * **Clinical Sign:** If a patient presents with a parotid mass and **facial nerve palsy**, think of a malignancy, most characteristically Adenoid Cystic Carcinoma due to its perineural spread.

Question 118: Which of the following statements is NOT true regarding Ludwig's angina?

A. Usually arises from an infected molar.
B. Involves the submandibular space.
C. May necessitate an emergency tracheostomy.
D. None of the above. (Correct Answer)

Explanation: **Explanation:** Ludwig’s Angina is a rapidly spreading, life-threatening **cellulitis** (not an abscess) involving the submandibular space. The correct answer is **D (None of the above)** because options A, B, and C are all accurate clinical descriptions of the disease. 1. **Why Option A is true:** The most common cause (up to 90% of cases) is odontogenic infection, typically involving the **2nd and 3rd mandibular molars**. This is because their roots extend below the attachment of the mylohyoid muscle, allowing infection to spread directly into the submandibular space. 2. **Why Option B is true:** Ludwig’s Angina is defined by the bilateral involvement of the **submandibular space**, which is further divided by the mylohyoid muscle into the sublingual and submaxillary compartments. 3. **Why Option C is true:** The hallmark of the disease is "woody" edema of the floor of the mouth, which pushes the tongue upward and backward. This leads to acute airway obstruction, often necessitating an **emergency tracheostomy** if fiberoptic intubation fails. **High-Yield Clinical Pearls for NEET-PG:** * **Microbiology:** Usually a polymicrobial infection (Streptococci, Staphylococci, and anaerobes). * **Clinical Presentation:** Characterized by "Brawny edema," "Woody hard" swelling, and a "Hot potato voice." * **Key Sign:** There is typically **no fluctuance** because it is a cellulitis, not a localized abscess. * **Management:** Airway maintenance is the priority, followed by IV antibiotics and surgical decompression (incision and drainage) if conservative management fails.

Question 119: Adenoid cystic carcinoma is also known as?

A. Cylindroma (Correct Answer)
B. Pindborg tumor
C. Warthin's tumor
D. Pleomorphic adenoma

Explanation: **Explanation:** **Adenoid Cystic Carcinoma (ACC)** is a slow-growing but highly malignant tumor of the minor and major salivary glands. It is also known as a **Cylindroma** because of its characteristic microscopic appearance. Histologically, the tumor cells are arranged in nests and columns surrounding "cylindrical" spaces filled with hyaline or mucoid material, creating a classic **"Swiss-cheese" pattern**. **Analysis of Options:** * **A. Cylindroma (Correct):** This term describes the tubular/cylindrical arrangement of cells seen in the cribriform pattern of the tumor. * **B. Pindborg tumor:** This is the eponym for **Calcifying Epithelial Odontogenic Tumor (CEOT)**, a rare benign but locally aggressive odontogenic tumor characterized by "Liesegang rings." * **C. Warthin's tumor:** Also known as **Papillary Cystadenoma Lymphomatosum**, it is a benign tumor almost exclusively found in the parotid gland, strongly associated with smoking. * **D. Pleomorphic adenoma:** Known as **Benign Mixed Tumor**, it is the most common salivary gland tumor overall. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** Minor salivary glands (especially the palate). * **Characteristic Feature:** It has a high propensity for **perineural invasion**, which often leads to pain and skip lesions. * **Prognosis:** It is notorious for a "relentless" course; while 5-year survival is good, the **long-term (20-year) prognosis is poor** due to late distant metastases (most commonly to the **lungs**). * **Histological Patterns:** Cribriform (most common/Swiss-cheese), Tubular, and Solid (worst prognosis).

Question 120: White raised painless areas on peeling exhibit painful erythematous areas in case of?

A. Oral thrush (Correct Answer)
B. Pemphigus vulgaris
C. Leukoplakia
D. Erythroplakia

Explanation: ### Explanation **Correct Answer: A. Oral thrush** **Why it is correct:** Oral thrush, or **Pseudomembranous Candidiasis**, is a fungal infection caused by *Candida albicans*. The classic clinical presentation is the presence of creamy white, curd-like patches (pseudomembranes) on the oral mucosa. The pathognomonic feature of this condition is that these white patches **can be scraped off** (peeled). Upon removal, they reveal a raw, **painful, erythematous (bleeding) base**. This distinguishes it from other white lesions of the oral cavity. **Why the other options are incorrect:** * **B. Pemphigus vulgaris:** This is an autoimmune blistering disease. It presents as fragile vesicles and bullae that rupture to leave behind painful, irregular erosions (Nikolsky sign positive). It does not typically present as a "peelable" white membrane. * **C. Leukoplakia:** Defined as a clinical white patch that cannot be characterized as any other disease. Crucially, leukoplakia **cannot be scraped off**. It is a premalignant condition associated with tobacco use. * **D. Erythroplakia:** This presents as a persistent fiery red velvety patch. It does not have a white raised component and is associated with a much higher risk of malignancy than leukoplakia. **Clinical Pearls for NEET-PG:** * **Scrapability Test:** If a white patch scrapes off and bleeds, think **Candidiasis**. If it does *not* scrape off, think **Leukoplakia** or **Lichen Planus**. * **Predisposing factors for Thrush:** Immunosuppression (HIV/AIDS), prolonged antibiotic use, inhaled corticosteroids (asthma), and uncontrolled Diabetes Mellitus. * **Diagnosis:** Confirmed by KOH mount showing pseudohyphae and budding yeast cells. * **Treatment:** Topical Nystatin or Clotrimazole; systemic Fluconazole for resistant cases.

Practice by Chapter

Stomatitis

Practice Questions

Oral Ulcers

Practice Questions

Oral Leukoplakia

Practice Questions

Oral Cancers

Practice Questions

Sialadenitis

Practice Questions

Sialolithiasis

Practice Questions

Salivary Gland Tumors

Practice Questions

Ranula

Practice Questions

Xerostomia

Practice Questions

Sjögren's Syndrome

Practice Questions

Oral Manifestations of Systemic Diseases

Practice Questions

Temporomandibular Joint Disorders

Practice Questions

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