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In normal persons
A. parathyroid hormone raises serum calcium
B. parathyroid hormone enhances bone resorption
C. in the UK dietary intake of Vitamin D usually exceeds
synthesis in the skin
D. calcitonin stimulates osteoclasts
E. osteoporosis increases with age
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True, calcium is mobilised from bone. By which cells?
B. True, thus raising serum calcium levels.
C. True, a normal British diet contains enough vitamin D.
Which groups of patients might have an inadequate
vitamin D intake and/or sunlight exposure?
D. False, calcitonin inactivates osteoclasts and lowers
serum calcium, hence it can be used therapeutically.
In which conditions might it be useful?
E. True, a basic fact you should know.
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In uncomplicated healing of a tooth socket
A. woven bone appears at about 1 week
B. the old lamina dura has disappeared radiographically by 7 weeks
C. small sequestra are common
D. epithelialisation should be complete by 5 days
E. lamellar bone is laid down by 3 weeks
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A. False, woven bone appears at about 4 weeks.
Basic fact you should know. At one week the socket is still
filled mostly by clot.
B. False, the lamina dura may persist for years in older
patients and would only be gone after 7 weeks in a young
growing child.
C. True, microscopically small pieces of bone and cementum
are commonly displaced and remain in the socket but do
not usually impair healing.
D. False, you should know what a healing socket looks like
at a one week recall appointment. Look more carefully
at the next one you see
E. False, lamellar bone appears after woven bone, certainly not
at 3 weeks and forms and remodels for months.
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Which, if any, of the following are true
A. incisive canal cysts can be lined by respiratory epithelium
B. all odontogenic cysts with keratinising linings are odontogenic
keratocysts
C. a dentigerous cyst always contains a tooth
D. an odontogenic keratocyst often replaces a tooth
E. some fissural cysts lack an epithelial lining
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A. True, all cysts in the maxilla can have part or all
of the lining made of respiratory epithelium.
What type of epithelium is respiratory epithelium?
Simple or stratified?, columnar or squamous?
B. False, keratin is found in part of the wall of 15%
of dental (inflammatory) cysts. This is why you
must use the whole name odontogenic keratocyst to
define this cyst. Some people use keratocyst to
describe any cyst with a keratinising lining.
C. True, by definition it contains a crown and is
attached at the amelocemental junction.
D. True. You should know several lesions which can
replace teeth.
E. False, the so called "fissural" cysts all have
epithelial linings. You should be able to name
at least two cysts which do not.
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Which of the following are odontogenic cysts?
A. Residual cyst
B. Lateral periodontal cyst
C. Nasopalatine cyst
D. Gingival cyst
E. Odontogenic keratocyst
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A. True, because it is a presentation of dental cyst.
B. True, because it arises from rests of Malassez.
C. False, there is no odontogenic epithelium in the
nasopalatine (incisive) canal.
D. True, because they form from dental lamina left
near the surface. What is a common name for these
cysts?
E. True, odontogenic keratocysts are thought to arise from
rests of Serres which are odontogenic epithelium.
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Which, if any, of the following are true?
A. the thyroglossal cyst has no epithelial lining
B. the nasolabial cyst is a fissural cyst
C. the epidermoid cyst may be traumatic in origin
D. the dental cyst nearly always has a non vital tooth associated
E. the residual cyst is an odontogenic cyst
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A. False, it is lined by thyroid epithelium (the thyroid gland
is epithelial like other endocrine glands).
B. False, there is no fusion of epithelial covered processes on
the surface of the face during development. These probably
arises from the nasolacrimal duct (FDS question)
C. True, if skin epithelium is implanted into deeper tissues
by trauma it may proliferate and give rise to an epidermoid cyst.
D. True, by definition. The exception is the residual cyst. This
is basic information you must know.
E. True, revise your classification of cysts. It is a type of
dental cyst arising from rests of Malassez.
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Dental (inflammatory) cysts
A. may be diagnosed from their radiographic appearance
B. most commonly affect molars
C. often contain cholesterol clefts
D. may contain Rushton bodies
E. usually devitalise adjacent teeth
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A. False, they do not have diagnostic features on radiography
The key feature for diagnosis is detecting an associated
non-vital tooth and epitheial lined cavity. Radiography
may be suggestive, but cannot be diagnostic.
B. False, they most commonly affect upper lateral incisors.
You should know the reason why this is so. If not look it up
or ask someone on the staff.
C. True, because cholesterol clefts reflect inflammation and dental
cysts are inflammatory in origin.
D. True. Rushton bodies (hyaline bodies) are found in about 10% of
all types of odontogenic cysts.
Who was Rushton? - clue: He worked at Guy's.
E. False, they arise from non-vital teeth but do not devitalise
adjacent teeth even though they involve their apices.
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Dentigerous cysts
A. are the same as follicular cysts
B. are a type of primordial cyst
C. occur in younger patients than inflammatory dental cysts
D. histologically can be diagnosed by their characteristic lining
E. may have daughter cysts in their walls
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Dentigerous cysts
A. have a lining epithelium derived from the reduced enamel
epithelium
B. have an epithelial lining which is parakeratinised in 50% of
cases
C. have a total protein content approximately equal to that in serum
D. may show mucous metaplasia of the lining
E. always surround the crowns of unerupted teeth
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A. True, the cyst is formed by separation of the reduced
enamel epithelium from the crown of the tooth.
What other cysts arise by a similar process? (2 types, one
for honours, two for FDS)
B. False, although keratin can occur in dentigerous
and dental cysts it is unusual.
C. True, explain why.
D. True, mucous metaplasia can occur in all odontogenic cysts
and is most common in cysts in the maxilla.
Can you define metaplasia?
E. True. If you got this wrong learn the definition. This
is a basic fact you must know.
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Odontogenic keratocysts
A. have a thick wall
B. may recur following enucleation
C. have a characteristic histological appearance which is
usually diagnostic
D. usually have a very high protein content
E. usually contain less than 2g/100ml soluble protein
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A. False, they have thin walls which often tear easily on
enucleation, one of the reasons for the high recurrence rate.
What other reasons for the high recurrence rate do you know?
You should know about 3 in total.
B. True. Basic fact you must know. See the previous question
and its explanation screen.
C. True. You should be able to describe the characteristic
features seen histologically. Basic information for exams.
D. True. But, the protein is insoluble (it is keratin). A bit of
a trick question to see if you knew that keratocysts have a low
soluble protein concentration. You must ask for the right test
when investigating cysts, the fact that there is a high total
protein is of no help in differential diagnosis.
E. True. Occasionally a useful diagnostic test.
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The following are fibroosseous lesions which affect the jaws
A. hyperparathyroidism
B. cementifying fibroma
C. Paget's disease
D. Garre's osteomyelitis (proliferative periostitis)
E. osteogenesis imperfecta
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A. False, hyperparathyroidism is a giant cell lesion.
B. True. Learn the list of fibroosseous lesions of the jaws.
C. True. Learn the list of fibroosseous lesions of the jaws.
D. False, this is a form of low grade osteomyelitis.
E. False. Learn the list of fibroosseous lesions of the jaws.
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n monostotic fibrous dysplasia
A. the diagnosis can be made with certainty by the microscopic
appearance of the fine trabeculae of woven bone in a fibrous
matrix
B. giant cells are a dominant feature
C. the lesions are sharply demarcated from the surrounding bone
D. the lesion ceases to progress with skeletal maturation
E. the radiographic appearance of punctate radio-opacities
in a multilocular cystic space is characteristic
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A. False, the appearance is right but you can't tell it is
monostotic histologically. Either kick yourself for not
reading the question or go and discover what monostotic means.
B. False, giant cells are not a significant feature. Learn the
list of giant cell lesions which affect the jaws.
C. False, the merging of fibrous dysplasia with surrounding bone
is a key feature seen histologically and radiologically.
D. True, fibrous dysplasia is usually self limiting though disfiguring.
E. False, punctate radio-opacities are not seen, the lesion
gradually becomes more sclerotic with age but does not
contain discrete islands of mineralisation (which is what
punctate radio-opacities look like histologically)
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Fibrous dysplasia may be distinguished from
ossifying fibroma and cherubism
A. because the lesions in fibrous dysplasia are encapsulated
B. because the age of onset is earlier in fibrous dysplasia
C. by blood chemistry in most cases
D. only when aided by radiographic examination
E. by the presence of additional lesions in the long bones
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A. False, the lesions in fibrous dysplasia are not encapsulated.
This is an important diagnostic feature. What about ossifying
fibroma and cherubism, are they encapsulated, and is it useful
information for differential diagnosis?
B. False, fibrous dysplasia occurs in a younger age group than
ossifying fibroma but an older age group than cherubism.
You should know the age ranges approximately.
C. False. Systemic blood changes are not usual in any except
perhaps fibrous dysplasia in its polyostotic form, and even
then are not diagnostic. Which fibro-osseous lesion(s) are
diagnosed partly on the basis of blood chemistry?
D. True. Encapsulation and bilateral lesions are the key features
which would help you distinguish.
Which feature goes with which lesion?
E. True, if long bone lesions are present then fibrous dysplasia
is the only possible diagnosis. Jaw lesions associated with long bone lesions
(polyostotic form) are rarer than solitary jaw lesions (ie most
fibrous dysplasia of the jaws is monostotic.
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Fibrous dysplasia
A. becomes inactive with cessation of skeletal growth
B. has no capsule
C. is always bilateral
D. is neoplastic
E. produces an enlargement on the affected bone before
spreading to the whole bone
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A. True, it is usually quiescent by 25 yrs, but is amenable
to cosmetic reduction after that age of about 18yrs when
it has nearly stopped growing.
B. True. Basic fact for differential diagnosis.
C. False, cherubism is always bilateral.
D. False, fibrous dysplasia is not neoplastic, its growth is self
limiting so it cannot be a neoplasm.
E. True, expansion is an early feature in fibrous dysplasia as
opposed to Paget's which gradually extends to involve the
whole of the maxilla or mandible before expansion occurs.
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Polyostotic fibrous dysplasia
A. is the same as cherubism
B. is always seen in Allbright's syndrome
C. is active after somatic growth has stopped
D. involves the skull in most cases with skin pigmentation
E. is histologically indistinguishable from the monostotic form
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A. False. Learn your definitions. Basic fact.
B. True, by definition Allbright's syndrome includes polyostotic
fibrous dysplasia. What other features do you know?
C. False. Like monostotic fibrous dysplasia the polyostotic form
ceases to grow after skeletal maturation.
D. True.
E. True.
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Paget's disease
A. in the jaws displaces teeth before it as it spreads
B. affects more than 3% of the elderly
C. in the jaws causes hypercementosis and tooth ankylosis
D. predisposes to malignancy
E. causes a rise in serum acid phosphatase
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. False, the disease spreads around teeth and roots. The teeth
drift later as the alveolus changes shape.
B. True, but not their jaws, mostly the lower spine,
pelvis and femur and most of these cases are asymptomatic.
Jaws are affected in a minority only.
C. True, basic fact you must know.
D. True, basic fact you must know. Osteosarcoma arises in
affected bones. Chondrosarcoma also, though less commonly.
This is an important complication in a small percentage
of the more severely affected patients.
E. False, serum alkaline phosphatase rises. Make sure you ask
for the right investigation. In what disease(s) is the serum
acid phosphatase level raised?
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Paget's disease
A. bones are weaker than normal
B. often causes increased urinary hydroxyproline excretion
C. affects males predominantly
D. complications include fractures, hypercementosis and
arteriovenous anastomoses
E. is complicated by osteosarcoma in up to 10% of cases
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A. True, they bend under weight hence the deformity of the
spine and femur and sagging of the calvarium.
B. True, any increased bone turnover can do this but it is
marked in Paget's. It reflects collagen destruction.
C. True. Basic fact you should know.
D. True. Basic facts you should know.
E. True. An important complication as Paget's disease
is relatively common in the population.
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Paget's disease can be easily distinguished from
A. ossifying fibroma by the radiographic appearance
B. fibrous dysplasia by the radiographic appearance
C. active cherubism by the clinical findings
D. brown tumour of hyperparathyroidism by its histology
E. hyperparathyroidism by blood chemistry
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A. True, because one is encapsulated and one isn't.
You must know which way round. Go and look it up later
and write it down now so that you don't forget.
B. False, they may look very similar radiographically.
What features of the history might be helpful in
differentiating them?
C. True, the age difference, bilateral lesions and
multilocular appearance of cherubism are enough to
tell them apart without difficulty. An easy one.
D. True, Paget's is fibro-osseous and hyperparathyroidism
is a giant cell lesion. You should know this.
E. True. Which tests would you request.
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Aneurysmal bone cysts
A. contain loose vascular connective tissue
B. contain a bilirubin rich fluid
C. are commoner in the jaws than the long bones
D. have no epithelial lining
E. often contain multinucleate giant cells
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A. True. That is why blood wells up from the lesion when
it is opened at operation.
B. False, you are confused with solitary bone cyst.
C. False, long bones are the commoner site.
D. True. Which other bone cyst lacks an epithelial lining?
E. True, they are scattered around in areas of haemorrhage.
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Multinucleate giant cells are prominent in
A. cherubism
B. ossifying fibroma
C. hyperparathyroidism
D. multiple myeloma
E. fibrous dysplasia
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A. True, cherubism has a histological appearance half way
between a giant cell lesion and a fibro-osseous lesion.
B. False, it is essentially a fibro-osseous lesion.
C. True, it is a giant cell lesion, basic fact
D. False, If you got this wrong you must go and
revise multiple myeloma, an important condition in
differential diagnosis of jaw lesions.
E. False, the lesions are essentially fibro-osseous. The
only giant cells are occasional osteoclasts on the surface
of some bony trabeculae.
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Cherubism
A. affects an older age group than fibrous dysplasia
B. is a fibro-osseous lesion with giant cells as well
C. is commoner in the maxilla than the mandible
D. is a form of polyostotic fibrous dysplasia
E. shows a mutilocular radiographic appearance
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A. False, go and revise. You deserve to lose 2 marks.
B. True.
C. False, you should know that the ramus of the mandible is
the predominant site.
D. False, though some older textbooks say it is a familial form of
fibrous dysplasia, cherubism has a quite distinct presentation,
clinical course and histology.
E. True.
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The following are giant cell lesions which affect the jaws
A. fibrous dysplasia
B. osteoporosis
C. osteoma
D. aneurysmal bone cyst
E. cherubism
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A. False, fibrous dysplasia is a fibro-osseous lesion. You should
be able to list the giant cell lesions of the jaws.
B. False, osteoporosis is not due to osteoclastic resorption.
C. False, you should know that an osteoma is a benign primary
bone neoplasm. Bone resorption is not a significant feature.
D. True, though not a classical giant cell lesion in the same way as
hyperparathyroidism etc, aneurysmal bone cyst does contain foci
of giant cells associated with haemorrhage and is included in the
giant cell lesion list you should know.
E. True, this is a basic list of lesions you must learn.
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Osteomyelitis
A. is a complication of radiotherapy
B. in the jaws is usually haematogenous in origin
C. should not be treated with antibiotics before a specific
sensitivity is known
D. is commoner in patients with Paget's disease
E. appears as a poorly demarcated radiolucency in the early stages
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A. True, infection is a risk in bone rendered less vascular by
radiotherapy.
B. False, osteomyelitis in the jaws usually arises from dental
infection or some other local infection.
C. False, osteomyelitis is a severe infection which, if acute, must
be treated quickly, if necessary changing antibiotics after
culture and sensitivity. What would your choice of antibiotic
be while awaiting the sensitivity result.
D. True. You should know this basic fact. Bone is late Paget's
disease is less vascular than normal.
E. True. Basic fact.
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Osteomyelitis of the jaws may present because of
A. painless sequestration of a piece of bone
B. chance finding of a large radiolucency
C. mental nerve paraesthesia
D. continuous pulpitis-like pain
E. loosening of teeth
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A. True.
B. False, large radiolucencies caused by osteomyelitis are
symptomatic and usually drain pus.
C. True, because of raised intramedullary pressure.
D. False. It might be muddled with continuous periapical type
pain by the patient but is not like dental pain at all.
What questions would you ask to differentiate these causes
E. True, though usually associated with other signs as well.
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Infected sockets are distinguished from dry sockets because
A. lymph nodes are enlarged
B. pain starts several days later than with dry socket
C. pus is not present in a dry socket
D. they always retain a root fragment
E. they are confined to the upper jaw
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A. False, lymph nodes may be enlarged in both, though they are
usually larger and more tender if infection is present.
B. True, socket infection usually presents after several days.
C. True, because a dry socket is not an infection. Bits of food
debris are a more likely finding.
D. False, though retained fragments can be a cause of a socket
infection, any socket can get infected.
E. False, any socket can be infected though the poorer blood supply
of the mandible predisposes lower sockets to infection.
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