Multiple Choice Questions Section

Saudi Medical Journal introduces this new section on multiple choice questions as part of its commitment
to continuous education and learning. Board residents are encouraged to read this section to improve
their knowledge and direct their reading for written examinations.

All questions are supplied by and published with permission from the
Examination Department, Saudi Commission For Health Specialties
Riyadh, Kingdom of Saudi Arabia.

Choose the most appropriate single answer.

1. A 5-year-old child presents to the dental office with the chief complaint of the loss of most primary
teeth. The patient appears relatively short and gives a history of excessive thirst. Intraoral examination
reveals that almost all of the patient’s deciduous teeth have already exfoliated and are extremely mobile.
Orthopantomogram reveals multiple radiolucent areas of alveolar bone destruction. Histologically,
numerous eosinophilic leukocytes with intracellular lipid accumulation are observed.

The lesion is MOST likely:

(A) Papillon-LeFèvre syndrome

(B) Chèdiak Hagashi syndrome
(C) Hand-Schüller-Christian disease
(D) Eosinophilic granuloma

2. A 56-year-old patient presents for extraction of the root stump of tooth #10 whose crown is destroyed
up to the alveolar margin, as shown. An implant under local anesthesia will be placed immediately.

Six years ago, the patient was diagnosed with type 2 diabetes mellitus which, for the past 7 months has
been well-controlled with glipizide along with diet and exercise. Preoperative laboratory tests are as
follows:
Test Patient’s values Normal values
Random blood glucose 7.1 mmol/L 3.3 to 7.7 mmol/L
Fasting blood glucose 5.6 mmol/L 3.3 to 5.0 mmol/L
Postprandial blood glucose 7.2 mmol/L 5.6 to 7.7 mmol/L
HbA1c 42 mmol/mol 42 to 64 mmol/mol

1322 Saudi Med J 2011; Vol. 32 (12) www.smj.org.sa

 Multiple choice questions

Based on the given information, which of the following is the MOST appropriate protocol to follow
regarding perioperative diabetes management?

(A) Follow the usual oral diabetic medication and diet

(B) Discontinue glipizide the day before surgery
(C) Discontinue glipizide 2 days before surgery
(D) Receive 10% glucose in half-normal saline with rapid acting insulin

3. After reporting for extraction of teeth, a 52-year-old patient suddenly complains of polydipsia,
polyphagia, polyuria, and lethargy. The patient takes glipizide for diabetes. A laboratory investigation
is performed with the following results:

Test Patient’s values Normal values

pH of arterial blood 7.22 7.4
Partial pressure of arterial carbon dioxide 24 mmHg 40 mmHg
Bicarbonate 12 mmol/L 25 mmol/L
Sodium 130 mmol/L 135 – 147 mmol/L
Chloride 94 mmol/L 99 – 106 mmol/L
Potassium levels blood test 4.5 mmol/L 3.5 – 5.5 mmol/L
Blood glucose test 33.3 mmol/L >10 mmol/L

The provisional diagnosis is:

(A) Metabolic acidosis

(B) Respiratory acidosis
(C) Metabolic alkalosis
(D) Respiratory acidosis

4. Over the past 8 weeks, a 36-year-old patient has had pain in the lower right posterior region of the
mouth, the pain began as sensitivity to hot and cold. The pain now involves chewing on the right
side, but it subsides within several minutes. There is no history of previous trauma or any associated
swelling, discharge, or odor. An examination only reveals mild tenderness in the lower right second
molar, which appears to have no abnormal wear or dental caries. Clinically, the lower right third molar
is not visible intraorally. An orthopantomogram is as shown.

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 Multiple choice questions

Based on the findings, which of the following is the MOST likely diagnosis?

(A) Periapical abscess lower right second molar

(B) Impacted lower right third molar
(C) Odontogenic keratocyst
(D) Dentigerous cyst

5. A 51-one-year-old male patient, who smokes 10 to 15 cigarettes a day and has used chewing tobacco
for the past 30 years, presents with a 5 x 3 cm ulceroproliferative growth of 2 months’ duration in the
left alveolobuccal sulcus opposite the lower premolar teeth. The associated premolar teeth are mobile,
and the second premolar is extruded. The patient reports onset of numbness in the left lower lip
beginning 10 days ago. The lesion shows moderate induration but no associated pain or tenderness.
There is no fixation to the overlying skin. Clinical palpation reveals 2 firm, non-tender lymph nodes
in the left submandibular region. A screening IOPA is as shown.

A contrast enhanced CT scan of the oral cavity and the neck reveals destruction of the buccal cortex
and apparent lymph node metastases in the left submandibular and level II nodes. An incisional biopsy
reveals a well-differentiated squamous cell carcinoma. A surgical wide excision, including mandibular
resection and MND II is planned.

Which of the following would be an appropriate reconstructive option for this patient?

(A) Fibula osseocutaneous free flap

(B) Temporalis myofascial flap
(C) Sternocleidomastoid flap
(D) Full thickness skin graft

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Answers on page: 1337

1324 Saudi Med J 2011; Vol. 32 (12) www.smj.org.sa

 Multiple choice questions

ANSWERS:

1. Answer: C
Specialty Domain: Diagnosis
Section: Applied Pathology
Type: Problem Solving
Reference: Shafer WG, Hine MK, Levy BM. A textbook of oral pathology. 3rd ed.
Philadelphia: WB Saunders; 1974. p. 1024.
2. Answer: A
Specialty Domain: Diagnosis
Section: Patient Assessment and Management
Type: Problem Solving
Reference: Perioperative Management of the Diabetic Patient. p. 31-37
3. Answer: A
Specialty Domain: Diagnosis
Section: Patient Assessment and Management
Type: Problem Solving
Reference: Miloro M, Larsen P, Ghali GE, Waite P. Peterson’s Principles of Oral and
Maxillofacial Surgery. Volume 2. Hamilton, Ontario: BC Decker Inc; 2004.
p. 53
4. Answer: D
Specialty Domain: Diagnosis
Section: Patient Assessment and Management
Type: Problem Solving
Reference: Oral and Maxillofacial Pathology. p. 573-633
5. Answer: A
Specialty Domain: Diagnosis
Section: Reconstruction
Type: Problem Solving
Reference: Oral Cavity Reconstruction. p. 79-94

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