Diseases of the Oral Cavity and Salivary Glands Practice Questions

Q: Ludwig's Angina spreads by which route?

Contiguity via fascial planes. **Explanation:** **Ludwig’s Angina** is a rapidly spreading, life-threatening cellulitis of the submandibular, sublingual, and submental spaces. **Why Option C is correct:** The hallmark of Ludwig’s Angina is that it is a **fascial space infection**, not a glandular one. It spreads by **contiguity via fascial planes** rather than through the lymphatic system. The infection typically originates from the second or third mandibular molars (80% of cases). The roots of these teeth lie below the **mylohyoid line**; thus, infection penetrates the lingual cortical bone and spreads directly into the submandibular space. From there, it travels via the fascial layers to involve the sublingual and submental spaces bilaterally. **Why other options are incorrect:** * **Options A & D:** Unlike cervical lymphadenitis, Ludwig’s Angina characteristically **spares the regional lymph nodes**. The absence of significant lymphadenopathy is a classic diagnostic feature. * **Option B:** While systemic sepsis can occur in advanced stages, the primary mode of initial spread is local anatomical extension through connective tissue planes, not the bloodstream. **Clinical Pearls for NEET-PG:** * **Most common cause:** Odontogenic infection (2nd/3rd mandibular molars). * **Clinical Presentation:** "Woody" or "Brawny" edema of the neck, elevation and protrusion of the tongue (causing airway obstruction), and "Hot potato voice." * **Microbiology:** Usually polymicrobial (Streptococci, Staphylococci, and anaerobes). * **Management:** The priority is **Airway Management** (often requiring tracheostomy if intubation fails). Treatment includes IV antibiotics and surgical incision and drainage if there is fluctuance or failed medical management.

Q: Which oral lesion is associated with ulcerative colitis?

Pyostomatitis Vegetans. **Explanation:** **Pyostomatitis Vegetans (PV)** is a rare but highly specific oral manifestation of **Inflammatory Bowel Disease (IBD)**, most commonly associated with **Ulcerative Colitis** (and occasionally Crohn’s disease). It is characterized by multiple small, friable, cream-colored pustules on an erythematous base, often described as having a **"snail-track" appearance**. These pustules eventually rupture to form vegetating erosions. The severity of the oral lesions often mirrors the activity of the intestinal disease. **Analysis of Incorrect Options:** * **Lichen Planus:** An inflammatory condition affecting the skin and mucous membranes (Wickham striae). While it can be associated with Hepatitis C, it has no direct link to Ulcerative Colitis. * **Sarcoidosis:** A multisystem granulomatous disease. Oral involvement typically presents as non-caseating granulomas or salivary gland enlargement (Heerfordt's syndrome), not PV. * **Dermatitis Herpetiformis:** This is the cutaneous manifestation of **Celiac Disease** (Gluten-sensitive enteropathy), not Ulcerative Colitis. It presents as pruritic vesicles on the elbows, knees, and buttocks. **High-Yield Clinical Pearls for NEET-PG:** * **"Snail-track" ulcers:** Pathognomonic clinical description for Pyostomatitis Vegetans. * **Histology:** Characterized by intraepithelial abscesses filled with **eosinophils** (eosinophilic microabscesses). * **Management:** Treatment of the underlying Ulcerative Colitis (e.g., Sulfasalazine or Corticosteroids) typically leads to the resolution of oral lesions. * **Other IBD associations:** Aphthous ulcers are common in both, but "cobblestoning" of the mucosa is more specific to Crohn’s disease.

Q: A median round lesion located anterior to the circumvallate papillae, showing epithelial hyperplasia, is diagnosed as:

Median rhomboid glossitis. **Explanation:** **Median Rhomboid Glossitis (MRG)** is a clinical condition characterized by a well-demarcated, erythematous, depapillated area located in the **midline of the dorsum of the tongue**, specifically **anterior to the circumvallate papillae**. 1. **Why it is correct:** Historically thought to be a developmental defect (failure of the lateral lingual swellings to fuse over the tuberculum impar), it is now primarily considered a form of **chronic hyperplastic candidiasis**. Histologically, it shows **epithelial hyperplasia** (acanthosis) and a loss of filiform papillae, which matches the description in the question. Its classic location is always the midline, just anterior to the "V" of the circumvallate papillae. 2. **Why the other options are incorrect:** * **Erythema Migrans (Geographic Tongue):** Presents as multiple, migratory, red patches with white circumferential borders. It is not fixed to the midline. * **Aphthous Ulcer:** These are painful, shallow ulcers with a necrotic center and erythematous halo, typically found on non-keratinized mucosa (like the buccal mucosa), not as a hyperplastic midline lesion. * **Chemical Burn:** Presents as a painful, white, sloughing membrane (necrosis) following contact with agents like aspirin or phenol; it lacks the specific midline anatomical predilection. **High-Yield Clinical Pearls for NEET-PG:** * **Association:** Strongly associated with **Diabetes Mellitus**, immunosuppression, and smoking. * **Appearance:** Can be flat (atrophic) or raised (exophytic/nodular). * **"Kissing Lesion":** Often associated with a matching erythematous patch on the hard palate (contact candidiasis). * **Treatment:** Usually asymptomatic and requires no treatment; however, topical antifungals (Nystatin/Clotrimazole) are used if symptomatic.

Q: What is the most common site for Adenoid cystic carcinoma?

Minor salivary glands. **Explanation:** Adenoid cystic carcinoma (ACC) is a unique salivary gland malignancy known for its indolent but relentless growth and a high propensity for **perineural invasion**. **1. Why Minor Salivary Glands are correct:** While the parotid gland is the most common site for salivary tumors overall, the distribution of malignancy changes as the glands get smaller. In the **minor salivary glands**, approximately 50% of all tumors are malignant, and **Adenoid cystic carcinoma is the most common malignancy** found at this site (specifically the palate). Conversely, in the parotid, the vast majority of tumors are benign (Pleomorphic adenoma). **2. Analysis of Incorrect Options:** * **Parotid Gland:** This is the most common site for salivary gland tumors in general, but the most common malignancy here is **Mucoepidermoid carcinoma**, not ACC. * **Submandibular Gland:** ACC is the most common malignancy of this gland, but in terms of absolute frequency across the body, it occurs more often in the minor salivary glands. * **Sublingual Gland:** While tumors here are rare and 80% are malignant, the total volume of cases is significantly lower than those found in the minor salivary glands. **3. NEET-PG High-Yield Pearls:** * **Histology:** Classically shows a **"Swiss-cheese" appearance** (Cribriform pattern). * **Clinical Feature:** Characterized by early **perineural spread**, often leading to "skip lesions" and local recurrence. * **Prognosis:** It has a good 5-year survival rate but a **poor 15-20 year survival rate** due to late distant metastasis (most commonly to the **Lungs**). * **Rule of Thumb:** The smaller the salivary gland, the higher the chance that a lump is malignant.

Q: Which of the following is an example of a scrapable white lesion?

All of the above. ### Explanation The core clinical concept here is the differentiation of white lesions of the oral cavity based on their adherence to the underlying mucosa. **Scrapable white lesions** are those where the white material (pseudomembrane, debris, or fungal hyphae) can be removed with a tongue depressor, often leaving behind an erythematous or bleeding base. **Why "All of the Above" is correct:** 1. **Pseudomembranous Candidiasis (Oral Thrush):** This is the classic example of a scrapable lesion. It consists of desquamated epithelial cells, fibrin, and fungal hyphae. When scraped, it reveals a raw, friable, and bleeding surface. 2. **Diphtheritic Patch:** Caused by *Corynebacterium diphtheriae*, this is a "true" pseudomembrane. While it is strongly adherent, it is technically a scrapable membrane; however, scraping it is clinically discouraged because it causes profuse bleeding and may facilitate systemic absorption of the diphtheria toxin. 3. **Syphilitic Mucous Patch:** Seen in secondary syphilis, these are shallow ulcers covered by a grayish-white membrane. This membrane is loosely adherent and can be scraped off. **Clinical Pearls for NEET-PG:** * **Non-Scrapable Lesions:** The most important differential is **Leukoplakia**, which is a clinical diagnosis of exclusion and **cannot** be scraped off. Other non-scrapable lesions include Lichen Planus and Oral Submucous Fibrosis (OSMF). * **The "Bleeding Base" Sign:** If a white patch scrapes off and bleeds, think Candidiasis or Diphtheria. * **EBV Association:** Hairy Leukoplakia (seen in HIV) occurs on the lateral borders of the tongue and is also **non-scrapable**, distinguishing it from Candidiasis. * **Diphtheria Key Point:** The membrane in Diphtheria is unique because it often extends beyond the tonsils to the soft palate and uvula.

Q: Reduction in the flow of saliva is not generally seen in which of the following conditions?

Patients suffering from Parkinsonism. **Explanation:** The core concept tested here is the distinction between **Xerostomia** (dry mouth) and **Sialorrhea** (excessive salivation/drooling). **Why Parkinsonism is the correct answer:** In **Parkinson’s disease**, patients actually experience **Sialorrhea** (drooling). This is not typically due to an absolute increase in saliva production, but rather due to **infrequent spontaneous swallowing** and poor neuromuscular coordination of the oral phase of deglutition. Because the saliva is not cleared effectively, it pools in the mouth and leaks out, representing an *apparent* increase in flow rather than a reduction. **Analysis of Incorrect Options (Conditions causing reduced saliva):** * **Elderly Diabetics:** Uncontrolled diabetes causes dehydration and autonomic neuropathy, both of which lead to decreased salivary gland function and xerostomia. * **Radiation Therapy:** Radiotherapy for head and neck cancers causes permanent damage to the serous acini of the salivary glands (especially the parotid), leading to severe, often irreversible xerostomia. * **Phenothiazine Drugs:** These are antipsychotics with significant **anticholinergic properties**. Since salivary secretion is primarily mediated by parasympathetic (cholinergic) stimulation, these drugs block the receptors, leading to a dry mouth. **NEET-PG High-Yield Pearls:** * **Drugs causing Xerostomia:** Atropine, Antihistamines, Tricyclic Antidepressants (TCAs), Phenothiazines, and Diuretics. * **Drugs causing Sialorrhea:** Pilocarpine (miotic), Physostigmine, and Lithium. * **Sjögren’s Syndrome:** A classic autoimmune cause of xerostomia (keratoconjunctivitis sicca + xerostomia). * **Frey’s Syndrome:** Gustatory sweating following parotid surgery due to aberrant reinnervation of sweat glands by auriculotemporal nerve fibers.

Q: Which of the following drug classes is essential in the management of dry socket?

Analgesics. **Explanation:** **Dry Socket (Alveolar Osteitis)** is a painful dental condition that occurs after tooth extraction when the blood clot fails to form or is prematurely dislodged from the socket. This exposes the underlying bone and nerve endings to the oral environment. **Why Analgesics are the Correct Answer:** The primary clinical feature of dry socket is **intense, radiating pain** that typically begins 3–5 days post-extraction. Since the condition is an **inflammatory process** rather than a primary infection, the mainstay of management is symptomatic relief. Treatment involves irrigation of the socket with saline and the placement of a medicated dressing (e.g., Zinc Oxide Eugenol), supplemented by systemic **Analgesics** (NSAIDs) to manage the severe pain until the socket heals by secondary intention. **Why Other Options are Incorrect:** * **Antibiotics:** Dry socket is not a primary bacterial infection; it is a failure of clot formation/retention. Routine use of systemic antibiotics is not indicated unless there is evidence of spreading cellulitis or the patient is immunocompromised. * **Antihistaminics:** These have no role in managing alveolar osteitis as the pathophysiology does not involve an allergic or histamine-mediated response. * **Antacids:** These are unrelated to the localized inflammatory process of a dental socket. **High-Yield Clinical Pearls for NEET-PG:** * **Risk Factors:** Smoking, oral contraceptives (estrogen increases fibrinolysis), traumatic extraction, and mandibular third molar extractions. * **Pathophysiology:** Increased **fibrinolytic activity** (plasminogen to plasmin conversion) leads to the dissolution of the blood clot. * **Clinical Presentation:** Empty-looking socket, "halitosis" (foul odor), and severe pain radiating to the ear. * **Management Gold Standard:** Local debridement and **Obtundent dressing** (Alvogyl).

Q: Pericoronitis is most commonly seen in relation to which of the following dental conditions?

Around an incompletely erupted crown. **Explanation:** **Pericoronitis** is the inflammation of the soft tissues (the gingival flap or operculum) surrounding the crown of a tooth. **Why Option B is correct:** The condition occurs most frequently **around an incompletely erupted crown**. When a tooth has only partially broken through the gum line, a pocket of soft tissue called an **operculum** remains over the occlusal surface. This space acts as a "food trap," accumulating bacterial plaque and debris that are nearly impossible to clean. The resulting infection leads to pain, swelling, and sometimes trismus (lockjaw). **Analysis of Incorrect Options:** * **Option A (Impacted third molars):** While pericoronitis is most commonly associated with mandibular third molars (wisdom teeth), the *state* of eruption is the defining factor. A completely impacted tooth (buried under bone/soft tissue) does not communicate with the oral cavity and thus cannot develop pericoronitis. It is only when the tooth is **partially erupted** that the infection occurs. * **Option C (Completely erupted crowns):** Once a tooth is fully erupted, the gingival attachment is firm around the neck of the tooth, eliminating the operculum and the space for debris entrapment. **Clinical Pearls for NEET-PG:** * **Most Common Site:** Mandibular third molars (lower wisdom teeth). * **Microbiology:** Usually a mixed infection (aerobes and anaerobes like *Prevotella*). * **Complications:** Can lead to peritonsillar abscess, Ludwig’s angina, or parapharyngeal space infection if left untreated. * **Management:** Saline irrigation and antibiotics for acute phases; **Operculectomy** (removal of the flap) or extraction of the tooth for definitive treatment.

Question 1

Ludwig's Angina spreads by which route?

Accepted Answer

Contiguity via fascial planes

Answer

Lymphatics

Answer

Vascular route

Answer

Both Lymphatics and blood vessels

Question 2

Which of the following is true about Odontogenic keratocyst?

Accepted Answer

Seen in the posterior mandible

Answer

Most common in females

Answer

Not premalignant

Answer

Treatment is observation

Question 3

Which oral lesion is associated with ulcerative colitis?

Accepted Answer

Pyostomatitis Vegetans

Answer

Lichen planus

Answer

Sarcoidosis

Answer

Dermatitis herpetiformis

Question 4

A median round lesion located anterior to the circumvallate papillae, showing epithelial hyperplasia, is diagnosed as:

Accepted Answer

Median rhomboid glossitis

Answer

Erythema migrans

Answer

Aphthous ulcer

Answer

Chemical burn

Question 5

In which of the following conditions does internal derangement cause mandibular deviation to the same side?

Accepted Answer

Unilateral disk displacement anteriorly without reduction

Answer

Bilateral temporomandibular joint dislocation

Answer

Temporomandibular joint ankylosis

Answer

Unilateral temporomandibular joint dislocation

Question 6

What is the most common site for Adenoid cystic carcinoma?

Accepted Answer

Minor salivary glands

Answer

Parotid gland

Answer

Submandibular gland

Answer

Sublingual gland

Question 7

Which of the following is an example of a scrapable white lesion?

Accepted Answer

All of the above

Answer

Diphtheritic patch

Answer

Syphilitic mucous patch

Answer

Pseudomembranous candidiasis

Question 8

Reduction in the flow of saliva is not generally seen in which of the following conditions?

Accepted Answer

Patients suffering from Parkinsonism

Answer

Elderly diabetics

Answer

Patients undergoing radiation therapy

Answer

Patients on phenothiazine drugs

Question 9

Which of the following drug classes is essential in the management of dry socket?

Accepted Answer

Analgesics

Answer

Antibiotics

Answer

Antihistaminics

Answer

Antacids

Question 10

Pericoronitis is most commonly seen in relation to which of the following dental conditions?

Accepted Answer

Around an incompletely erupted crown

Answer

Impacted third molars

Answer

Completely erupted crowns

Answer

None of the above

Diseases of the Oral Cavity and Salivary Glands — MCQs

Diseases of the Oral Cavity and Salivary Glands — MCQs

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