Diseases of the Oral Cavity and Salivary Glands Practice Questions

Q: What is true about Ludwig's angina?

Sublingual and submandibular spaces are involved. **Ludwig’s Angina** is a life-threatening, rapidly spreading cellulitis (not an abscess) involving the submandibular, sublingual, and submental spaces bilaterally. ### **Explanation of Options** * **Correct Answer (D):** The hallmark of Ludwig’s Angina is the involvement of the **submandibular and sublingual spaces**. These spaces are divided by the mylohyoid muscle but communicate posteriorly. Infection typically starts in the submandibular space (often from the 2nd or 3rd molar teeth) and spreads to the sublingual space. * **Option A:** While it is a rapidly spreading cellulitis, it specifically involves the **submandibular region** rather than the general "neck." It is a "woody" or "brawny" edema that does not involve the lymph nodes. * **Option B:** The most common organisms are **Streptococcus viridans** and **Staphylococcus aureus**, often in a polymicrobial mix with anaerobes (Peptostreptococcus, Bacteroides). *H. influenzae* is more commonly associated with acute epiglottitis. * **Option C:** While edema of the floor of the mouth occurs, it is a **clinical sign**, not the defining anatomical characteristic. The involvement of the specific fascial spaces (Option D) is the definitive anatomical description. ### **High-Yield Clinical Pearls for NEET-PG** * **Source of Infection:** Dental infections (80%), specifically the **lower 2nd and 3rd molars**, as their roots lie below the mylohyoid line. * **Clinical Presentation:** "Brawny" or "Woody" induration of the neck, **tongue protrusion** (due to floor of mouth elevation), and "Hot potato voice." * **Primary Risk:** Airway obstruction is the most common cause of death. * **Management:** 1. **Airway maintenance** (Tracheostomy if needed). 2. Intravenous antibiotics. 3. **Incision and Drainage:** Indicated if there is no improvement or if fluctuation occurs (though it is primarily a cellulitis).

Q: All of the following are true about a ranula except:

Diagnosed by MRI. **Explanation:** A **ranula** is a clinical term for a pseudocyst (mucous extravasation cyst) that occurs in the floor of the mouth, typically arising from the **sublingual gland**. **Why Option D is the correct answer (False statement):** Diagnosis of a ranula is primarily **clinical**. While imaging like MRI or CT can be used to assess the extent of a "plunging ranula" (one that extends into the neck through the mylohyoid muscle), it is not the standard or required method for diagnosing a simple ranula. The diagnosis is usually made by the characteristic "frog’s belly" appearance—a translucent, bluish, fluctuant swelling in the floor of the mouth. **Analysis of other options:** * **Option A:** True. It is most commonly a **mucous extravasation cyst** caused by trauma or obstruction of the ducts of the sublingual gland (Ducts of Rivinus). * **Option B:** True. **Marsupialization** is a standard surgical treatment where the cyst is opened and the edges are sutured to the oral mucosa to allow continuous drainage. However, for recurrent cases, excision of the sublingual gland is the definitive treatment. * **Option C:** True. The **submandibular duct (Wharton’s duct)** runs in close proximity to the sublingual gland in the floor of the mouth, making it the most vulnerable structure during surgical excision or marsupialization. **Clinical Pearls for NEET-PG:** * **Plunging Ranula:** Occurs when mucus extravasates below the **mylohyoid muscle**, presenting as a neck swelling in the submandibular space. * **Treatment of Choice:** For simple ranula, marsupialization; for plunging or recurrent ranula, **excision of the sublingual gland**. * **Aspiration:** Typically reveals thick, straw-colored fluid with high amylase content.

Q: A tumor arising from the crown of an unerupted tooth is called what?

Dentigerous cyst. ### Explanation **Correct Answer: C. Dentigerous cyst** **1. Why it is correct:** A **Dentigerous cyst** (also known as a follicular cyst) is an odontogenic cyst that develops from the accumulation of fluid between the reduced enamel epithelium and the **crown of an unerupted (impacted) tooth**. It characteristically attaches to the **cemento-enamel junction (CEJ)**. Radiographically, it appears as a well-defined unilocular radiolucency surrounding the crown of a tooth, most commonly the mandibular third molar or maxillary canine. **2. Why the other options are incorrect:** * **Periapical cyst (Radicular cyst):** This is an inflammatory cyst that arises at the **apex (root tip)** of a non-vital, erupted tooth, usually due to dental caries or pulpitis. It does not involve the crown of an unerupted tooth. * **Odontogenic keratocyst (OKC):** Arises from the dental lamina. While it can sometimes involve an unerupted tooth, it is not defined by its attachment to the crown. It is known for its aggressive behavior, high recurrence rate, and association with **Gorlin-Goltz syndrome**. * **Ameloblastoma:** This is a true odontogenic neoplasm (tumor), not a simple cyst. While it can arise from the wall of a dentigerous cyst (mural ameloblastoma), it typically presents with a characteristic **"soap-bubble" or "honeycomb"** multilocular appearance on X-ray. **3. High-Yield NEET-PG Pearls:** * **Most common developmental odontogenic cyst:** Dentigerous cyst. * **Most common inflammatory odontogenic cyst:** Radicular (Periapical) cyst. * **Key Radiographic Sign:** A unilocular radiolucency larger than 3-4 mm surrounding an impacted tooth crown. * **Potential Complications:** If left untreated, a dentigerous cyst can transform into an Ameloblastoma or Squamous Cell Carcinoma. * **Treatment:** Enucleation and extraction of the associated tooth.

Q: Areca nut chewing is an etiological factor in which of the following conditions?

Oral submucous fibrosis. **Explanation:** **Oral Submucous Fibrosis (OSMF)** is a chronic, progressive, and premalignant condition of the oral cavity characterized by juxta-epithelial inflammatory reaction followed by fibroelastic change of the lamina propria. **Why Areca Nut is the Cause:** The primary etiological factor is the chewing of **areca nut** (betel nut). Areca nut contains alkaloids (such as **arecoline**) that stimulate fibroblasts to increase collagen synthesis. Simultaneously, it contains flavonoids (tannins) that inhibit collagenase activity, leading to a net accumulation of collagen in the oral mucosa. This results in the characteristic "vertical bands" and restricted mouth opening (trismus). **Analysis of Incorrect Options:** * **Leukoedema (A):** A benign anatomical variation of the oral mucosa (milky white appearance) that disappears on stretching. It is not related to areca nut; it is more common in smokers and dark-skinned individuals. * **Erythema Multiforme (C):** An acute, self-limiting hypersensitivity reaction (Type IV) often triggered by infections (HSV) or drugs (NSAIDs, Sulfonamides). It presents with "target lesions" on the skin and hemorrhagic crusting of lips. * **Oral Lichen Planus (D):** A chronic inflammatory T-cell mediated autoimmune condition. While it presents with Wickham’s striae, its etiology is idiopathic or related to stress/immune dysfunction, not areca nut. **High-Yield Clinical Pearls for NEET-PG:** * **Clinical Features:** Burning sensation on eating spicy food (earliest symptom), blanched/marble-like mucosa, and restricted tongue protrusion. * **Pre-malignant Potential:** OSMF has a high malignant transformation rate (approx. 7–13%) to Squamous Cell Carcinoma. * **Management:** Cessation of habit, intralesional steroids (to reduce inflammation), and Hyaluronidase (to break down collagen). Surgical release is reserved for severe trismus.

Q: What is the earliest sign of Oral Submucous Fibrosis (OSMF)?

Blanching. **Explanation:** **Oral Submucous Fibrosis (OSMF)** is a chronic, progressive, premalignant condition primarily associated with the habit of chewing areca nut (betel nut). **1. Why Blanching is the Correct Answer:** **Blanching** of the oral mucosa is considered the **earliest clinical sign** of OSMF. It occurs due to subepithelial inflammatory changes and early collagen deposition, which leads to a decrease in vascularity. The mucosa loses its normal pink appearance and becomes pale, marble-like, or "chalky white." This may be localized or generalized and is often first noticed on the buccal mucosa or soft palate. **2. Analysis of Incorrect Options:** * **Burning Sensation (Option A):** This is the **earliest symptom** (subjective) reported by the patient, especially when consuming spicy food. However, the question asks for the earliest **sign** (objective finding), which is blanching. * **Restricted Mouth Opening (Option C):** This is a **late feature** of the disease caused by the formation of dense fibrous bands in the cheeks and pterygomandibular raphe. It is the most common reason patients seek medical attention. * **Circumoral Bands (Option D):** These are palpable fibrous bands that develop as the disease progresses. While characteristic of OSMF, they appear after the initial blanching phase. **Clinical Pearls for NEET-PG:** * **Etiology:** Areca nut (alkaloids like arecoline) increases collagen synthesis and decreases degradation. * **Pathognomonic Sign:** Palpable vertical fibrous bands. * **Uvula Appearance:** Often described as **"Bud-shaped"** or shrunken due to fibrosis. * **Malignant Transformation:** OSMF has a high transformation rate (approx. 7–13%) to Oral Squamous Cell Carcinoma. * **Treatment:** Cessation of habit, intralesional steroids (Hyaluronidase), and in advanced cases, surgical release of bands.

Q: Oral lesions are rarely seen in which of the following conditions?

Tuberculosis. **Explanation:** The correct answer is **Tuberculosis (B)**. While tuberculosis (TB) is a systemic infection, oral manifestations are considered **rare**, occurring in only 0.05% to 5% of all TB cases. The oral cavity is relatively resistant to *Mycobacterium tuberculosis* due to the protective nature of saliva (which has antibacterial properties), the presence of saprophytic organisms, and the thickness of the oral epithelium. When it does occur, it is usually secondary to pulmonary TB (via infected sputum) and typically presents as a **painless, undermined ulcer** on the dorsum of the tongue. **Why other options are incorrect:** * **AIDS:** Oral lesions are a hallmark of HIV/AIDS. Common manifestations include Oral Candidiasis (most common), Oral Hairy Leukoplakia (caused by EBV), and Kaposi Sarcoma. * **Syphilis:** Oral lesions occur in all three stages: Primary (Chancre on lips/tongue), Secondary (Mucous patches and Snail-track ulcers), and Tertiary (Gumma of the hard palate). * **Leukemia:** Oral manifestations are frequently the first sign of leukemia, especially in Acute Myeloid Leukemia (AML). Common signs include gingival hyperplasia, petechiae, and mucosal bleeding. **High-Yield Clinical Pearls for NEET-PG:** * **TB Ulcer:** Classically described as a **painless ulcer with undermined edges** and a pale, granulating base. * **Syphilitic Ulcer:** Secondary syphilis presents with **"Snail-track ulcers"** (multiple, superficial, coalescing ulcers). * **Vincent’s Angina:** A painful, pseudomembranous ulceration of the gums and tonsils caused by *Borrelia vincentii* and *Fusobacterium*. * **Behçet’s Syndrome:** Characterized by the triad of recurrent oral ulcers, genital ulcers, and uveitis.

Q: A 60-year-old man presents with an ulcer on the lateral border of the tongue. What is the probable diagnosis?

Carcinomatous ulcer. **Explanation:** The most probable diagnosis for a chronic ulcer on the lateral border of the tongue in an elderly patient is a **Carcinomatous ulcer (Squamous Cell Carcinoma)**. **Why Carcinomatous Ulcer is correct:** The lateral border of the tongue is the most common site for intraoral Squamous Cell Carcinoma (SCC). In a 60-year-old patient, any non-healing ulcer persisting for more than 2–3 weeks must be considered malignant until proven otherwise. These ulcers typically present with **everted (rolled-out) edges** and a **特征性 (characteristic) indurated base** due to tissue infiltration. **Analysis of Incorrect Options:** * **Dental Ulcer:** Usually caused by a sharp or jagged tooth. While it also occurs on the lateral border, it typically heals rapidly once the offending tooth is filed or extracted. In an elderly patient, a "dental ulcer" that doesn't heal is often a precursor to or a misdiagnosed malignancy. * **Tuberculosis Ulcer:** Classically presents as a **shallow, painful ulcer with undermined edges** and a pale, granulating base. It is usually secondary to pulmonary TB and most commonly affects the dorsum of the tongue. * **Syphilitic Ulcer:** Primary syphilis (chancre) is usually painless and occurs on the tip or dorsum. Tertiary syphilis presents as a **Gumma**, which is a "punched-out" ulcer, typically located on the midline of the dorsum of the tongue. **NEET-PG High-Yield Pearls:** * **Most common site of Oral Cavity Cancer:** Lower lip (Global), but in India, it is the **Buccal Mucosa** (due to tobacco chewing). * **Most common site of Tongue Cancer:** Lateral border (Middle third). * **Lymphatic Spread:** Tongue tip drains to Submental nodes (Level Ia); Lateral borders drain to Submandibular (Level Ib) or Deep Cervical nodes. * **Premalignant conditions:** Erythroplakia carries a much higher risk of transformation than Leukoplakia.

Question 1

Which of the following is NOT true regarding sialadenitis in AIDS?

Accepted Answer

Unilateral parotid enlargement is common

Answer

May present as Sjogren's syndrome

Answer

Non-tender enlargement of salivary gland

Answer

May present as xerostomia

Question 2

What is true about Ludwig's angina?

Accepted Answer

Sublingual and submandibular spaces are involved

Answer

Rapidly spreading cellulitis of the neck

Answer

H. influenzae is the most common organism

Answer

Edema of the floor of the mouth

Question 3

All of the following are true about a ranula except:

Accepted Answer

Diagnosed by MRI

Answer

Mucous extravasation cyst arising from sublingual gland

Answer

Treated by marsupialization

Answer

Most common structure injured during ranula surgery is submandibular duct

Question 4

A tumor arising from the crown of an unerupted tooth is called what?

Accepted Answer

Dentigerous cyst

Answer

Periapical cyst

Answer

Odontogenic keratocyst

Answer

Ameloblastoma

Question 5

Unilateral TMJ ankylosis is associated with the following features, except:

Accepted Answer

Facial asymmetry with fullness on the normal side of the mandible

Answer

Multiple carious teeth

Answer

Chin deviated towards the affected side

Answer

Prominent antegonial notch on the affected side

Question 6

Areca nut chewing is an etiological factor in which of the following conditions?

Accepted Answer

Oral submucous fibrosis

Answer

Leukoedema

Answer

Erythema multiforme

Answer

Oral lichen planus

Question 7

Which of the following are predisposing factors for the development of oral carcinoma?

Accepted Answer

All of the above

Answer

Smoking

Answer

Alcohol

Answer

Syphilis

Question 8

What is the earliest sign of Oral Submucous Fibrosis (OSMF)?

Accepted Answer

Blanching

Answer

Burning sensation

Answer

Restricted mouth opening

Answer

Circumoral bands

Question 9

Oral lesions are rarely seen in which of the following conditions?

Accepted Answer

Tuberculosis

Answer

AIDS

Answer

Syphilis

Answer

Leukemia

Question 10

A 60-year-old man presents with an ulcer on the lateral border of the tongue. What is the probable diagnosis?

Accepted Answer

Carcinomatous ulcer

Answer

Dental ulcer

Answer

Tuberculosis ulcer

Answer

Syphilitic ulcer

Diseases of the Oral Cavity and Salivary Glands — MCQs

Diseases of the Oral Cavity and Salivary Glands — MCQs

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