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 201: Histologic sections of a parotid gland tumor found to be infiltrating along the facial nerve are most likely to reveal which of the following?

A. Atypical cells forming tubular and cribriform patterns (Correct Answer)
B. Infiltrating groups of vacuolated epithelial cells
C. A mixture of epithelial structures and mesenchyme-like stroma
D. A mixture of squamous epithelial cells and mucus-secreting cells

Explanation: **Explanation:** The clinical scenario describes a parotid gland tumor with a high propensity for **perineural invasion** (infiltrating along the facial nerve). This is the hallmark characteristic of **Adenoid Cystic Carcinoma (ACC)**. **1. Why Option A is Correct:** Adenoid Cystic Carcinoma is a slow-growing but highly invasive malignant salivary gland tumor. Histologically, it presents in three patterns: **Cribriform** (the most classic "Swiss-cheese" appearance with cylinders of hyaline or mucinous material), **Tubular**, and **Solid**. Its most distinctive clinical feature is its tendency for **perineural spread**, often leading to facial nerve palsy or pain long before a large mass is palpable. **2. Why Other Options are Incorrect:** * **Option B (Vacuolated cells):** This describes **Acinic Cell Carcinoma**, which typically shows cells with granular basophilic cytoplasm resembling normal serous acini. It is less likely to show aggressive neural invasion compared to ACC. * **Option C (Epithelial + Mesenchyme-like stroma):** This is the classic description of **Pleomorphic Adenoma** (Benign Mixed Tumor). Being benign, it does not typically infiltrate nerves. * **Option D (Squamous + Mucus cells):** This describes **Mucoepidermoid Carcinoma**, the most common malignant salivary gland tumor. While it can be aggressive, it does not have the same pathognomonic association with perineural spread as ACC. **High-Yield Clinical Pearls for NEET-PG:** * **Adenoid Cystic Carcinoma:** Most common malignant tumor of the **submandibular and minor salivary glands**. * **Perineural Invasion:** ACC is the most common tumor to show this; always suspect it if a patient presents with a parotid mass and **facial nerve palsy**. * **Prognosis:** It has a paradoxically "good" short-term but "poor" long-term prognosis due to late distant metastases (most commonly to the **lungs** via hematogenous spread). * **Histology:** Look for the "Swiss-cheese" pattern (Cribriform).

Question 202: Which of the following is a premalignant lesion of the oral cavity?

A. Lichen planus
B. Erythroplakia (Correct Answer)
C. Bowen disease
D. Behçet disease

Explanation: **Explanation:** **Erythroplakia** is the correct answer because it is defined as a fiery red patch of the oral mucosa that cannot be characterized clinically or pathologically as any other definable disease. Among all oral premalignant lesions, erythroplakia carries the **highest risk of malignant transformation** (approximately 50% or higher). Histologically, it often shows severe epithelial dysplasia, carcinoma in situ, or even invasive squamous cell carcinoma at the time of biopsy. **Analysis of Incorrect Options:** * **Lichen Planus (Option A):** While the World Health Organization (WHO) classifies Oral Lichen Planus as a *premalignant condition* (specifically the erosive type), it is not a primary premalignant *lesion* like erythroplakia. Its transformation rate is significantly lower (approx. 1%). * **Bowen Disease (Option B):** This is a form of intraepidermal squamous cell carcinoma (carcinoma in situ) typically involving the **skin**. While it represents a malignant process, it is not a standard clinical term used for oral cavity premalignant screening in the same context as erythroplakia or leukoplakia. * **Behçet Disease (Option D):** This is a multi-system inflammatory vascular disorder characterized by recurrent aphthous ulcers, genital ulcers, and uveitis. It is **not** a premalignant condition. **High-Yield Clinical Pearls for NEET-PG:** * **Most common premalignant lesion:** Leukoplakia. * **Most common site for Leukoplakia:** Buccal mucosa. * **Highest malignant potential:** Erythroplakia > Speckled Leukoplakia (Erythroleukoplakia) > Leukoplakia. * **Premalignant Conditions:** Oral Submucous Fibrosis (OSMF), Lichen Planus, and Xeroderma Pigmentosum. * **Key Histology:** Look for "Dysplasia" (hyperchromatic nuclei, increased mitotic figures, and loss of polarity).

Question 203: Newman and Seabroocks operation is done for?

A. Parotid fistula (Correct Answer)
B. Sialothiasis
C. Sjogren syndrome
D. Thyroglossal cyst

Explanation: **Explanation:** **Newman and Seabrook’s operation** is a surgical procedure specifically designed for the management of a **persistent parotid fistula**. The underlying medical concept involves the **re-routing of the parotid duct**. In this procedure, the proximal end of the injured parotid duct (or the fistulous tract) is dissected and transplanted into the buccal mucosa. This converts an external cutaneous fistula into an internal opening, allowing saliva to drain normally into the oral cavity rather than onto the skin of the cheek. **Analysis of Options:** * **B. Sialolithiasis:** This refers to salivary stones. Management typically involves sialendoscopy, lithotripsy, or surgical removal of the stone (e.g., via a trans-oral incision for submandibular stones). * **C. Sjogren Syndrome:** This is an autoimmune systemic disease characterized by keratoconjunctivitis sicca and xerostomia. Management is primarily medical (artificial tears, sialagogues) rather than surgical. * **D. Thyroglossal Cyst:** The definitive surgical treatment for this is the **Sistrunk Operation**, which involves the removal of the cyst, the tract, and the central portion of the hyoid bone. **High-Yield Clinical Pearls for NEET-PG:** * **Parotid Fistula Management:** Initial management is conservative (anti-sialagogues like Glycopyrrolate, pressure dressings, or Botox injections into the gland). Surgery is reserved for refractory cases. * **Tympanic Neurectomy (Frey’s Procedure):** Another surgical option for parotid fistula/Frey's syndrome, where the Jacobson’s nerve is severed to stop parasympathetic stimulation to the gland. * **Stensen’s Duct:** Opens opposite the crown of the upper second molar; this is the anatomical landmark for ductal re-implantation.

Question 204: What is the most common complication following the removal of a mandibular third molar?

A. Lingual nerve damage
B. Dry socket (Correct Answer)
C. Mandibular fracture
D. Bleeding

Explanation: **Explanation:** The most common complication following the extraction of a mandibular third molar is **Dry Socket**, also known as **Alveolar Osteitis**. **1. Why Dry Socket is the Correct Answer:** Dry socket occurs when the blood clot at the extraction site either fails to form or undergoes premature lysis (fibrinolysis). This exposes the underlying alveolar bone, leading to intense, radiating pain typically starting 2–4 days post-extraction. It occurs in approximately 5–30% of mandibular third molar extractions, making it statistically the most frequent postoperative issue. **2. Analysis of Incorrect Options:** * **Lingual nerve damage:** While a significant concern due to the proximity of the nerve to the third molar, it is a relatively rare complication (occurring in ~1–2% of cases) compared to dry socket. * **Mandibular fracture:** This is a rare, severe complication usually resulting from excessive force during the use of elevators in a weakened or deeply impacted bone. * **Bleeding:** While primary hemorrhage is common immediately after surgery, persistent or secondary bleeding is less frequent than the incidence of alveolar osteitis. **3. NEET-PG High-Yield Pearls:** * **Risk Factors:** Smoking, oral contraceptives, poor oral hygiene, and excessive irrigation/trauma during surgery increase the risk of dry socket. * **Clinical Feature:** Characterized by "exquisite pain" and a foul odor (halitosis), but notably **lacks signs of infection** like fever or pus. * **Management:** Treatment is symptomatic. The socket is irrigated with saline and packed with a sedative dressing (e.g., **Zinc Oxide Eugenol** or Alvogyl). Antibiotics are generally not required unless systemic infection is present.

Question 205: Which of the following tumors is of salivary gland origin?

A. Acinic cell carcinoma (Correct Answer)
B. Granular cell myoblastoma
C. Chondrosarcoma
D. All of the above

Explanation: ### Explanation **Acinic Cell Carcinoma (Correct Answer)** Acinic cell carcinoma is a low-grade malignant epithelial neoplasm of the salivary glands. It is unique because its cells demonstrate serous acinar differentiation, characterized by cytoplasmic zymogen-type granules. It most commonly occurs in the **Parotid gland** (80% of cases) and is the second most common pediatric salivary gland malignancy after Mucoepidermoid carcinoma. **Why the other options are incorrect:** * **Granular cell myoblastoma:** Despite the name, this is a benign neuroectodermal tumor derived from **Schwann cells** (not muscle or glands). It most commonly involves the tongue and is histologically characterized by pseudoepitheliomatous hyperplasia (PEH), which can be mistaken for squamous cell carcinoma. * **Chondrosarcoma:** This is a malignant mesenchymal tumor that produces **cartilage** matrix. While it can occur in the head and neck (most commonly in the larynx or maxilla), it originates from bone or cartilaginous tissue, not glandular epithelium. **High-Yield NEET-PG Pearls:** * **Most common benign salivary tumor:** Pleomorphic Adenoma (Mixed tumor). * **Most common malignant salivary tumor:** Mucoepidermoid Carcinoma. * **Warthin’s Tumor (Adenolymphoma):** Associated with smoking, usually occurs in the tail of the parotid, and shows "hot spots" on Technetium-99m pertechnetate scans. * **Adenoid Cystic Carcinoma:** Known for **perineural invasion**, causing pain and early nerve palsy; it has a characteristic "Swiss-cheese" appearance on histology. * **Frey’s Syndrome:** A post-parotidectomy complication diagnosed by the Minor’s Starch-Iodine test.

Question 206: Mikulicz's disease presents as:

A. Enlargement of upper cervical lymph nodes
B. Enlargement of parotid, submandibular salivary, and lacrimal glands (Correct Answer)
C. Systemic illness with dry mouth, joint pain, and fever
D. Fever, hepatosplenomegaly, and lymphadenopathy

Explanation: **Explanation:** **Mikulicz’s Disease** is a benign, chronic condition characterized by the symmetrical, painless enlargement of the **lacrimal, parotid, and submandibular glands**. Historically considered a subset of Sjögren’s syndrome, it is now recognized as a manifestation of **IgG4-related disease (IgG4-RD)**. The underlying pathology involves a dense lymphoplasmacytic infiltration of the glandular tissue, leading to hypertrophy without the systemic autoimmune destruction typically seen in Sjögren’s. **Analysis of Options:** * **Option B (Correct):** This accurately describes the classic triad of glandular involvement. The hallmark is the bilateral, non-tender swelling of major salivary and lacrimal glands. * **Option A:** Enlargement of upper cervical lymph nodes is characteristic of lymphomas or metastatic head and neck cancers, not Mikulicz’s disease. * **Option C:** This describes **Sjögren’s Syndrome**. Unlike Mikulicz’s disease, Sjögren’s is an autoimmune disorder characterized by "sicca" symptoms (dry eyes/mouth) and systemic involvement like rheumatoid arthritis. In Mikulicz’s, glandular function is often relatively preserved despite the swelling. * **Option D:** Fever, hepatosplenomegaly, and lymphadenopathy suggest systemic infections (like Mononucleosis) or hematological malignancies. **High-Yield Clinical Pearls for NEET-PG:** * **Mikulicz’s Syndrome vs. Disease:** "Disease" is primary/idiopathic (IgG4-related), while "Syndrome" refers to glandular enlargement secondary to other diseases (e.g., Sarcoidosis, Leukemia, Tuberculosis). * **Histology:** Look for "epimyoepithelial islands" and lymphocytic infiltration. * **Key Association:** Elevated serum **IgG4 levels** and responsiveness to glucocorticoids are diagnostic markers. * **Differential:** Always rule out **Heerfordt’s Syndrome** (Uveoparotid fever) in Sarcoidosis, which presents with parotid swelling, uveitis, and facial nerve palsy.

Question 207: Granular cell myoblastoma of the tongue is:

A. A benign tumor (Correct Answer)
B. A malignant tumor of the tongue
C. Lymphatic enlargement of the tongue
D. A developmental anomaly of the tongue

Explanation: **Explanation:** **Granular Cell Myoblastoma (GCM)**, also known as Abrikossoff’s tumor, is a rare, typically **benign neoplasm**. Despite its name, modern immunohistochemistry (S-100 positivity) has proven it originates from **Schwann cells** (neural origin) rather than muscle cells. The tongue is the most common site, where it presents as a firm, painless, slow-growing solitary nodule. **Why the other options are incorrect:** * **Option B:** While a very rare malignant variant exists (<1%), GCM is classically defined and encountered as a benign lesion. It does not metastasize in its typical form. * **Option C:** Lymphatic enlargement of the tongue is termed **Lymphangioma** (often causing macroglossia), which is a different pathological entity involving lymphatic vessel proliferation. * **Option D:** Developmental anomalies of the tongue include conditions like **Lingual Thyroid** or **Ankyloglossia** (tongue-tie). GCM is an acquired neoplastic growth, not a defect in embryological development. **High-Yield NEET-PG Pearls:** 1. **Pseudoepitheliomatous Hyperplasia (PEH):** This is the most critical pathological feature. The overlying epithelium often shows marked hyperplasia that can mimic **Squamous Cell Carcinoma**. A biopsy must be deep enough to avoid a misdiagnosis of malignancy. 2. **Histology:** Characterized by large, polygonal cells with abundant **eosinophilic granular cytoplasm** (due to accumulation of lysosomes). 3. **Marker:** It is strongly **S-100 protein positive**, confirming its neural (Schwann cell) derivation. 4. **Treatment:** Conservative surgical excision is the treatment of choice; recurrence is rare.

Question 208: Which of the following is not a risk factor for oropharyngeal carcinoma?

A. Chronic hypertrophic candidiasis
B. Oral submucous fibrosis
C. Erythroplakia
D. None of the above (Correct Answer)

Explanation: **Explanation:** The correct answer is **None of the above** because all the conditions listed (Chronic hypertrophic candidiasis, Oral submucous fibrosis, and Erythroplakia) are well-recognized **premalignant (potentially malignant) disorders** of the oral cavity and oropharynx. 1. **Chronic Hypertrophic Candidiasis:** Unlike acute thrush, this variant is characterized by a fixed white patch that cannot be scraped off. It has a significant risk of malignant transformation (approx. 10-15%) due to chronic inflammation and the production of endogenous nitrosamines by *Candida* species. 2. **Oral Submucous Fibrosis (OSMF):** Primarily caused by areca nut (betel nut) chewing, it leads to progressive juxta-epithelial fibrosis. It is a high-risk condition in the Indian subcontinent with a malignant transformation rate of 7-13%. 3. **Erythroplakia:** This is defined as a fiery red patch that cannot be characterized clinically or pathologically as any other condition. It is the **most dangerous** premalignant lesion, with over 90% of cases showing cellular dysplasia, carcinoma in situ, or invasive squamous cell carcinoma at the time of biopsy. **Clinical Pearls for NEET-PG:** * **Highest Malignant Potential:** Erythroplakia > OSMF > Leukoplakia. * **Speckled Leukoplakia:** A clinical variant (erythroleukoplakia) that carries a higher risk than homogenous leukoplakia. * **Most Common Site:** The lateral border of the tongue and the floor of the mouth are high-risk sites for malignancy. * **Other Risk Factors:** Tobacco (smoking/chewing), Alcohol (synergistic effect), and HPV (specifically types 16 and 18) are major etiological factors for oropharyngeal SCC.

Question 209: Oral ulcers which occur in groups, persist for about 6 weeks, and leave scars on healing are:

A. Recurrent aphthous major (Correct Answer)
B. Recurrent aphthous minor
C. Recurrent herpetiform ulcers
D. Acute herpetic gingivostomatitis

Explanation: ### Explanation **Recurrent Aphthous Stomatitis (RAS)** is a common inflammatory condition characterized by painful, recurring oral ulcers. To differentiate between the types, one must look at the size, duration, and scarring potential. **1. Why Major Aphthous Ulcers (Sutton’s Disease) is correct:** * **Size & Depth:** These are large (>1 cm), deep ulcers that often occur in groups of 1–10. * **Duration:** Unlike minor ulcers, they persist for several weeks (typically **3–6 weeks**). * **Healing:** Because they involve deeper layers of the submucosa, they characteristically **heal with scarring**, which is a hallmark feature for NEET-PG questions. **2. Why the other options are incorrect:** * **Recurrent aphthous minor (Mikulicz’s ulcer):** These are the most common type. They are small (<1 cm), shallow, heal within 7–10 days, and **never leave a scar**. * **Recurrent herpetiform ulcers:** These present as crops of multiple tiny, pin-head sized ulcers (up to 100). While they occur in groups, they heal quickly (10–14 days) without scarring. * **Acute herpetic gingivostomatitis:** This is a primary viral infection (HSV-1) typically seen in children. It presents with systemic symptoms (fever, lymphadenopathy) and diffuse vesicles, rather than chronic, scarring ulcers. **Clinical Pearls for NEET-PG:** * **Site:** Aphthous ulcers occur on **non-keratinized mucosa** (buccal mucosa, floor of mouth) whereas Herpetic ulcers often involve keratinized mucosa (hard palate, gingiva). * **Treatment:** Topical corticosteroids (Triamcinolone) are the first-line treatment. For Major RAS, systemic steroids or Thalidomide may be required. * **Associations:** Always rule out systemic causes like **Behçet’s disease** (triad of oral ulcers, genital ulcers, and uveitis), Celiac disease, or B12/Iron deficiency.

Question 210: Which of the following statements about salivary gland tumors is false?

A. Pleomorphic adenoma is the most common tumor of the parotid gland.
B. Adenoid cystic carcinoma most commonly occurs in minor salivary glands.
C. Warthin's tumor is the most common malignant tumor of the salivary glands. (Correct Answer)
D. Perineural invasion is seen in adenoid cystic carcinoma.

Explanation: **Explanation:** **1. Why Option C is the correct (False) statement:** Warthin’s tumor (Papillary Cystadenoma Lymphomatosum) is a **benign** tumor, not malignant. It is the second most common benign tumor of the parotid gland and is strongly associated with smoking and older males. The **most common malignant tumor** of the salivary glands (both major and minor) is **Mucoepidermoid Carcinoma**. **2. Analysis of other options:** * **Option A:** Pleomorphic adenoma (Benign Mixed Tumor) is indeed the most common tumor of the parotid gland, accounting for approximately 80% of all parotid neoplasms. * **Option B:** While Adenoid cystic carcinoma can occur in major glands, it is the most common malignancy found in the **minor salivary glands** (palate). * **Option D:** **Perineural invasion** is a hallmark pathological feature of Adenoid cystic carcinoma. This characteristic leads to its clinical presentation of pain and a high rate of local recurrence and "skip lesions" along nerve sheaths. **Clinical Pearls for NEET-PG:** * **Rule of 80s (Parotid):** 80% are in the parotid, 80% are benign, 80% are Pleomorphic Adenoma, 80% occur in the superficial lobe. * **Most common site for minor salivary gland tumors:** Hard palate. * **Malignancy Risk:** The smaller the gland, the higher the risk of malignancy (Sublingual > Submandibular > Parotid). * **Warthin’s Tumor:** Often bilateral (10%), occurs in the tail of the parotid, and shows "hot spots" on Technetium-99m pertechnetate scans.

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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