BAILEY’S CH 3

NO24-51
24. Which of the following glands produce the majority of the unstimulated saliva?
◦ A. Parotid glands
◦ B. Minor salivary glands
◦ C. Sublingual glands
◦ D. Submandibular glands
◦ 24. Answer: D. Average daily salivary flow is 1 , 00 0 to 1 , 5 0 0 mL. The parotid glands
produce
◦ about 20%, while the paired submandibular glands produce about 6 5 %, and the
sublingual
◦ glands produce about 8%.
◦ 2 5 . Which of the following attributes of a health-related quality-of-life instrument would
◦ be particularly important in planning a study to evaluate the effect of an intervention?
◦ A. Construct validity
◦ B. Interobserver reliability
◦ C. Face validity
◦ D. Responsiveness
25. Answer: D . Responsiveness of an instrument indicates the extent to
which changes in
value correlate with true changes in status. Validity is the extent to which an
instrument
measures what it claims to measure. Reliability is a measure of the
reproducibility of the
results.
◦ 26. Which of the following is important in the evaluation of burning mouth syndrome?
◦ A. Punch biopsy of the tongue
◦ B. Patch testing of oral mucosa
◦ C. Trial of a-lipoic acid
◦ D. Serum ferritin and B vitamin levels
◦ 26. Answer: D . There is no clinical feature, pathologic finding, or drug response that is
diagnostic
◦ of burning mouth syndrome. Since there is no treatment for this disorder, evaluation
◦ for alternative diagnosis such as nutritional deficiency of iron or B vitamins is
◦ important.
◦ 2 7. Based on the multicellular theory of tumorigenesis, mucoepidermoid carcinoma
◦ arises from:
◦ A. Excretory duct cells
◦ B. Acinar cells
◦ C. Striated duct cells
◦ D. Intercalated duct cells
◦ 27. Answer: A. The excretory duct cells can give rise to either mucoepidermoid or,
perhaps,
◦ squamous cell carcinoma. The intercalated duct cells are supposed to give rise to
pleomorphic
◦ adenoma, Warthin tumor, and adenocarcinoma.
◦ 28. Appropriate management of an 18-year-old patient with infectious mononucleosis
◦ with a positive monospot test includes:
◦ A. Rest, hydration, antipyretics, and analgesics
◦ B . A single dose of intramuscular ceftriaxone
◦ C. Oral penicillin
◦ D. Intravenous penicillin
◦ E. Oral acyclovir
◦ 28. Answer: A. Mononucleosis is treated supportively. Antibacterial pharmacotherapy is
not
◦ helpful for this viral infection. Clinical data do not support the use of acyclovir in acute
◦ mononucleosis, despite the good virologic activity demonstrated by this drug against
the
◦ Epstein-Barr virus
◦ 29. How many cell types are there in a taste bud?
◦ A. Five
◦ B. One
◦ C. Three
◦ D. More than 1 0
◦ 29. Answer: C. The life span of a taste cell is about 1 0 days. The taste bud contains
sensory
◦ cells, supporting cells, and basal cells. As the sensory cells die, the basal cells
differentiate
◦ into new receptor cells
◦ 30. Which of the following antibiotics represents the most appropriate empiric
treatment
◦ of an odontogenic infection?
◦ A. Amikacin
◦ B . Clindamycin
◦ c. Erythromycin
◦ D . Doxycycline
◦ 30. Answer: B. The prevalent bacteria in odontogenic infections are gram-positive
anaerobic
◦ cocci and gram-negative anaerobic rods . The usual empire choice is clindamycin or
◦ amoxicillin-clavulanate. Amikacin, erythromycin, and doxycycline are not as effective
◦ against anaerobic bacteria
◦ 31 . Temporomandibular disorders (TMDs) are associated with:
◦ A. Depression
◦ B. Irritable bowel
◦ c. Fibromyalgia
◦ D . All o f the above
◦ 3 1 . Answer: D . Depression, irritable bowel, and fibromyalgia are all associated with
TMD .
◦ Trauma to the j oint i s also associated with TMD .
◦ 32. Tasters and nontasters are identified based on the individual's ability to perceive:
◦ A. Capsaicin
◦ B. Alcohol
◦ C. Sucrose
◦ D. 6-n-Propyl-thiouracil (PROP)
◦ 32. Answer: D . Tasters can be distinguished from nontasters based on the ability to
perceive
◦ PRO P. Compared with supertasters, non tasters experience less-negative (e.g.,
bitterness)
◦ and more-positive (e.g., sweetness) sensations from certain foods and beverages like
◦ alcohol .
◦ 3 3 . Which of the following statements regarding juvenile recurrent parotitis is false?
◦ A. The disease typically resolves by the end of adolescence.
◦ B. Treatment during acute parotitis episodes is similar to acute bacterial sialadenitis.
◦ C. Ligation of Stenson duct and tympanic neurectomy have been shown to be
effective
◦ treatment options.
◦ D . Sialendoscopy with dilation, saline irrigation, or steroid irrigation has been shown to
◦ improve symptoms.
◦ 3 3 . Answer: C. This idiopathic, but difficult, problem is sometimes self-limiting, but when
◦ active causes a tremendous burden on the patient and family. Attempts to use duct
ligation
◦ and neurectomy have failed to produce good results .
◦ 34. Which cells are responsible for producing the primary salivary secretion?
◦ A. Myoepithelial cells
◦ B. Ductal cells
◦ C. Acinar cells
◦ D. Basal cells
◦ 34. Answer: C. The acinar cells produce serous secretions which are protein rich. The
◦ myoepithelial cells contribute to moving the saliva toward the excretory duct. Basal
cells
◦ are capable of differentiating into ductal epithelium.
◦ 3 5 . Which of the following statements best describes concurring occlusal appliance
◦ (splint) therapy?
◦ A. The type of appliance is of critical importance.
◦ B. Use of the device repositions the displaced articular disc over time.
◦ C. This therapy is effective for temporomandibular j oints (TMJs) -related myofacial pain.
◦ D . This therapy slows the progression of arthritis in the TMJ.
◦ 3 5 . Answer: C. The utility of TMJ splints is in the improvement of myofacial pain and
protection
◦ of dentition against parafunctional habits (bruxism) . The splints do not reposition
◦ the disc or arrest progression of degenerative or inflammatory disease
◦ 3 6 . Which structure directly contributes to the borders of the retropharyngeal space?
◦ A. Pharyngobasilar fascia
◦ B. Pharyngeal constrictor musculature
◦ C. Buccopharyngeal fascia
◦ D. Prevertebral fascia
◦ 3 6 . Answer: C. The retropharyngeal space is medial to the carotid sheath, anterior to
the
◦ danger space, and posterior to the buccopharyngeal fascia. The constrictor muscles
are
◦ anterior to the buccopharyngeal fascia and the prevertebral fascia is the posterior
border
◦ of the danger space. The pharyngobasilar fascia is anterior to the visceral musculature
◦ 3 7 . Which muscle attachment helps predict the spread of odontogenic infections into
the
◦ submandibular space?
◦ A. Anterior digastric muscle
◦ B. Genioglossus muscle
◦ C. Mylohyoid muscle
◦ D. Stylohyoid muscle
◦ 3 7 . Answer: C. Many odontogenic infections initially spread to the sublingual space
from
◦ mandibular teeth . O nly dental infections from the second and third molars, where the
◦ tooth roots extend below the mylohyoid line of the mandible, generally spread directly
to
◦ the submandibular space
◦ 3 8 . Which of these salivary glands are most sensitive to injury from radiation treatment?
◦ A. Submandibular glands
◦ B. Parotid glands
◦ C. Sublingual glands
◦ D. Minor salivary glands
◦ 38. Answer: B . The parotid glands are more susceptible to radiation injury. D amage is
severe
◦ when exposed to 2 0 Gy to 3 0 Gy
◦ 3 9 . According to the World Health Organization's International Classification of
Functioning,
◦ Disability, and Health (ICF) definitions, tinnitus would be classified as a(n) :
◦ A. Disorder
◦ B . Handicap
◦ c. Disability
◦ D . Impairment
◦ 3 9 . Answer: D . Tinnitus is most commonly perceived as impairment. If truly severe, it
could
◦ be considered a handicap that prevents an individual from carrying out his/her life role
or,
◦ for a few, a disability leading to a restriction in performing some or all of life's duties
◦ 40. Generic health-related quality-of-life instruments are usually divided for
measurement
◦ into three core domains. They are:
◦ A. Physical, social, and psychological
◦ B. Physical, emotional, and self-help
◦ C. Physical, role functioning, and mood
◦ D. Physical, interpersonal interactions, and vocational
◦ 40. Answer: A . The core o f health-related quality-of-life assessment i s the perception
that
◦ physicaL emotional (psychological), and social well-being are factors that affect
satisfaction
◦ with life
◦ 41 . Odontogenic infections are most likely to arise from:
◦ A. Maxillary central incisor
◦ B. Mandibular lateral incisor
◦ C. Maxillary first molar
◦ D. Mandibular second molar
◦ 4 1 . Answer: D . I n adults, most infections arise from mandibular molars. Children have
fewer
◦ odontogenic infections, but are more likely to occur in maxillary teeth .
◦ 42. Which of the following disorders can be confused with oral mucosa drug eruptions,
◦ contact allergies, and lupus?
◦ A. Lichen planus
◦ B. Beh<;et disease
◦ C. Recurrent aphthous stomatitis
◦ D. Orofacial granulomatosis
◦ 42 . Answer: A. Lichen planus drug eruptions, allergic reactions to dental restorative
materials,
◦ graft-versus-host disease, and discoid lupus, all cause oral lichenoid lesions. The other
◦ choices cause oral aphthous ulcers, and in the case of orofacial granulomatosis, lip
◦ enlargement and lymphatic obstruction.
◦ 43 . Which of the following statements is not true regarding temporomandibular disorder
◦ (TMD) pathology?
◦ A. Studies have shown abnormal pain processing in patients with chronic myofascial
◦ pain.
◦ B . Cytokines, metalloproteinases, free radicals, and reperfusion inj ury likely all contribute
◦ to intracapsular pathology and symptoms in TMD .
◦ C . The disc o f the temporomandibular j oint has a central, abundantly neurovascular
◦ zone which contributes to pain when it is damaged.
◦ D . Disc displacement in intracapsular disorders moves the disc anteriorly, and may be
◦ followed by reduction and accompanied by j oint noise, or may be nonreducing and
◦ have an absence of j oint noise.
◦ 43 . Answer: C. Trauma to the vascular and richly-innervated retrodiscal tissues can
cause effusion
◦ and pain. The central disc is thin and avascular. Various theories of TMD pathology
◦ http://medical.dentalebooks.com
◦ Chapter 3: General Otolaryngology 89
◦ implicate free radicals, cytokines, metalloproteinases, and reperfusion injury. Deviation
of
◦ the j aw towards the affected site without j o int sounds is a sign of disc displacement
without
◦ reduction.
◦ 44. After a positive rapid antibody detection test (RADT) for group A 􀃨 -hemolytic
streptococcus
◦ (GABHS) in a 4-year-old patient, which of the following is the next appropriate
◦ step in management?
◦ A. Confirmation with GABHS culture on blood agar
◦ B. Symptomatic therapy
◦ C. Treatment with amoxicillin
◦ D. Treatment with azithromycin
◦ E. Treatment with acetaminophen
◦ 44. Answer: C. Because of the time required to obtain culture and the desire to treat
GABHS
◦ infections to prevent late complications of rheumatic heart disease, the RADT is
recommended
◦ for the initial office visit with immediate treatment of patients with positive results
◦ using amoxicillin for patients who are not allergic to this antibiotic. Penicillin-allergic
◦ patients can be treated with azithromycin
◦ 45 . In a patient with suspected acute retroviral syndrome pharyngitis, initial diagnostic
◦ testing for human immunodeficiency virus (HIV) is performed by:
◦ A. Western blot
◦ B. Southern blot
◦ C. Culture on chocolate agar
◦ D. Enzyme-linked immunosorbent assay (ELISA)
◦ E. Monospot test
◦ 45 . Answer: D. The initial testing for the diagnosis of acute HIV infection is by ELISA,
followed
◦ by Western blot analysis for confirmation. The viruses cannot be cultured on chocolate
◦ agar; this media is used to grow fastidious respiratory bacteria. The monospot test is
◦ for Epstein-Barr virus.
◦ 46. A 34-year-old man with drooling and fever. What is the most likely source for the
◦ abscess seen on this CT?
◦ A. Hematologic
◦ B . Palatine tonsils
◦ c. Odontogenic
◦ D . Suppurative node
◦ E. Osteomyelitis
◦ 46. Answer: C. Abscess that arises along a mandibular surface is most likely from an
odonotogenic
◦ source. The unhealed tooth socket confirms that there was a recent extraction in this
◦ case. Although the tonsil is inflamed, this is not the usual location and spread for a
peritonsillar
◦ abscess . There are no lymph nodes in this location.
◦ 47. A 19-year-old girl with deep space neck infection. What is the most likely
complication
◦ that should be sought through further imaging?
◦ A. Retropharyngeal abscess
◦ B. Danger space extension to the mediastinum
◦ C. Osteomyelitis
◦ D. Intracranial infection
◦ E. Lung abscess
◦ 47. Answer: E. This image demonstrates jugular thrombophlebitis. The most likely
complication
◦ is Lemierre syndrome (lung abscesses from septic emboli from jugular thrombophlebitis)
◦ . Although there is edema in the retropharyngeal space, there is no abscess in that
◦ location, so the danger space is not at risk. Intracranial infection and osteomyelitis
would
◦ be less commonly seen in this scenario.
◦ 48. A 29-year-old with neck swelling. The key finding on this CT is:
◦ A. Submandibular sialadenitis
◦ B. Sublingual sialadenitis
◦ C. Sialolithiasis
◦ D. Cellulitis
◦ E. All of the above
◦ 48. Answer: E. This CT depicts a stone lodged at the puncta of Wharton duct, causing
enlargement
◦ and increased enhancement of both the sublingual and submandibular glands .
◦ Stranding of the surrounding fat and thickening of the platysma muscle are indicators
of
◦ cellulitis
◦ 49. A 68-year-old woman with headaches and facial pain. What is the most likely
cause?
◦ A. Sinusitis
◦ B. Paget disease
◦ C. Cervical spondylopathy
◦ D . Cerebrospinal fluid leak
◦ E. Temporomandibular osteoarthropathy
◦ 49 . Answer: E. This coronal CT shows marked narrowing of both temporomandibular j
oints
◦ (TMJs ), with large osteophytes and remodeling of the glenoid fossa. The skull base is
◦ otherwise intact, and the skull is normal . There is no sinusitis in this limited view of the
◦ sphenoid sinuses. TMJ disease is an often-overlooked cause of facial pain
◦ 50. A 38-year-old woman with sinus pain. What is the most likely source of maxillary
◦ sinusitis?
◦ A. Odontogenic
◦ B. Isolated nasal polyp
◦ C. Nasal polyposis
◦ D. Cystic fibrosis
◦ E. Nasal cavity malignancy
◦ 5O. Answer: A. The eroded bone overlying the apical abscess makes an odontogenic
source
◦ most likely. Nasal polyposis and cystic fibrosis would affect both sides . The nasal polyp
is
◦ secondary to the odontogenic infection.
◦ 51 . A healthy, nonsmoking 48-year-old man with painless neck mass. What is the most
◦ likely diagnosis?
◦ A. Branchial cleft cyst
◦ B. Thyroglossal duct remnant
◦ C. Mycobacterial infection
◦ D . Bacterial abscess
◦ E. Squamous cell carcinoma (SCC)
◦ 5 1 . Answer: E. This is a classic location for a branchial cleft cyst; but in an adult, a
cystic neck
◦ mass at this location is most likely SCC, often from an oropharyngeal primary. This is the
◦ wrong location for a thyroglossal duct remnant, and the wrong age group for
mycobacterial
◦ infection. The surrounding fat lacks the inflammation that would be associated with
◦ an abscess.
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