MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Medicine and Pathology Questions and Answers — Questions and Answers
Question 1: A 65-year-old patient, who is a heavy smoker, presents with a painless, indurated ulcer on the lateral border of the tongue that has persisted for 4 weeks. According to NICE guideline [NG12] 'Suspected cancer: recognition and referral', what is the most appropriate immediate action?
- Prescribe a topical antiseptic mouthwash and schedule a review in one month.
- Take an incisional biopsy in the primary care dental practice immediately.
- Refer the patient for an urgent appointment under the 'two-week wait' pathway for suspected cancer. (Correct answer)
- Advise the patient to stop smoking and review the lesion's progress in two weeks.
Correct answer: Refer the patient for an urgent appointment under the 'two-week wait' pathway for suspected cancer.
NICE guideline [NG12] specifies that an unexplained oral ulceration or mass persisting for more than 3 weeks warrants an urgent referral under the 'two-week wait' pathway to rule out malignancy. Delaying referral for review or attempting a biopsy in a primary care setting for a lesion highly suspicious of squamous cell carcinoma is inappropriate and goes against established UK national guidance.
Question 2: A 48-year-old female presents with asymptomatic, bilateral, symmetrical, white, lace-like striations on her buccal mucosa. The lesions are non-wipeable. What is the most likely diagnosis?
- Leukoplakia
- Oral Lichen Planus (Correct answer)
- Pseudomembranous candidiasis
- Frictional keratosis
Correct answer: Oral Lichen Planus
The clinical description of bilateral, asymptomatic, white, reticular (lace-like) patterns (Wickham's striae) on the buccal mucosa is the classic presentation of reticular oral lichen planus. Leukoplakia is typically a more homogenous patch and often unilateral, candidiasis can be wiped off, and frictional keratosis would correspond to an area of trauma.
Question 3: A 25-year-old male is diagnosed with an odontogenic keratocyst (OKC) in the angle of the mandible. Which of the following is the most important characteristic of this lesion that influences its long-term management?
- Its frequent association with a non-vital tooth.
- Its high potential for malignant transformation.
- Its notable tendency for recurrence following surgical removal. (Correct answer)
- Its typical presentation as a painful, rapidly expanding swelling.
Correct answer: Its notable tendency for recurrence following surgical removal.
The odontogenic keratocyst (OKC) is well-known for its high recurrence rate, which can be up to 60% depending on the surgical technique used. This characteristic necessitates meticulous surgical removal and mandates long-term radiographic follow-up. It is not typically associated with a non-vital tooth (unlike a radicular cyst), malignant change is very rare, and it often grows with minimal expansion.
Question 4: A 52-year-old female patient complains of a persistently dry mouth and dry eyes for over six months. Clinical examination reveals a high caries rate and a lobulated tongue. Which investigation is most specific for confirming a diagnosis of primary Sjögren's syndrome?
- A full blood count to check for anaemia.
- Measurement of unstimulated whole salivary flow rate.
- Parotid sialography to assess ductal architecture.
- Serological testing for anti-Ro (SSA) and anti-La (SSB) autoantibodies. (Correct answer)
Correct answer: Serological testing for anti-Ro (SSA) and anti-La (SSB) autoantibodies.
While reduced salivary flow confirms hyposalivation, and other tests may show non-specific changes, the presence of specific autoantibodies, particularly anti-Ro (SSA) and/or anti-La (SSB), is a key diagnostic criterion for Sjögren's syndrome according to UK and international guidelines. These serological markers point towards the underlying autoimmune nature of the disease.
Question 5: A 28-year-old patient presents with recurrent, painful, small, round ulcers on the non-keratinised mucosa, each healing within 10-14 days without scarring. According to UK clinical practice, what is a suitable first-line agent to prescribe for symptomatic relief during an acute episode?
- Systemic prednisolone tablets
- Aciclovir 5% cream
- Chlorhexidine gluconate 0.2% mouthwash (Correct answer)
- Nystatin oral suspension
Correct answer: Chlorhexidine gluconate 0.2% mouthwash
For minor recurrent aphthous stomatitis (RAS), the primary goal is symptomatic relief. An antimicrobial mouthwash such as chlorhexidine gluconate 0.2% is commonly recommended as a first-line measure in the UK to reduce pain and prevent secondary infection, which can aid healing. Systemic steroids are reserved for severe cases, Aciclovir is for herpes viruses, and Nystatin is for fungal infections.
Question 6: A 45-year-old man presents with non-painful, non-wipeable, white, corrugated lesions along the lateral borders of his tongue. This clinical sign, known as oral hairy leukoplakia, is most strongly associated with an underlying infection by which virus?
- Human Papillomavirus (HPV)
- Herpes Simplex Virus (HSV-1)
- Varicella-Zoster Virus (VZV)
- Epstein-Barr Virus (EBV) (Correct answer)
Correct answer: Epstein-Barr Virus (EBV)
Oral hairy leukoplakia is caused by the Epstein-Barr Virus (EBV). It is not a premalignant condition itself but serves as an important clinical marker for immunosuppression, most classically associated with HIV infection. Its presence often indicates a declining immune status.
MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Medicine and Pathology Questions and Answers
A 65-year-old patient, who is a heavy smoker, presents with a painless, indurated ulcer on the lateral border of the tongue that has persisted for 4 weeks.
According to NICE guideline [NG12] 'Suspected cancer: recognition and referral', what is the most appropriate immediate action?