Chapter 09: Oral Manifestations of Systemic Diseases Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

Q. Excess production by the anterior pituitary gland is termed

a. hyperparathyroidism

b. hyperthyroidism

c. hyperpituitarism

d. hyperglycemia

c. hyperpituitarism

Q. The most common cause of hyperpituitarism is

a. hepatomegaly

b. hypercalcemia

c. pituitary adenoma

d. hypoglycemia

c. pituitary adenoma

Q. Characteristics of acromegaly include

a. an increase in growth hormone production before the closure of long bones

b. a rapid and dramatic onset

c. thinned lips and microglossia

d. enlargement of the maxilla and mandible, resulting in separation of the teeth and malocclusion

d. enlargement of the maxilla and mandible, resulting in separation of the teeth and malocclusion

Q. The most common cause of hyperthyroidism is

a. hyperplasia of the gland

b. benign and malignant tumors of the gland

c. pituitary gland disease

d. an autoimmune disorder

d. an autoimmune disorder

Q. Which clinical feature is associated with hyperthyroidism?

a. Gigantism

b. Exophthalmos

c. Myxedema

d. Hypercalcemia

b. Exophthalmos

Q. An enlarged tongue is associated with

a. hyperpituitarism

b. hyperthyroidism

c. hypothyroidism

d. hyperparathyroidism

c. hypothyroidism

Q. Which statement is characteristic of hyperparathyroidism?

a. It is characterized by low blood levels of calcium

b. It is characterized by high levels of blood phosphorus

c. Primary hyperparathyroidism occurs when calcium is abnormally excreted by the kidneys and the parathyroid glands increase their production of parathyroid hormone to maintain adequate blood levels of calcium

d. Kidney failure is the most common cause of secondary hyperparathyroidism

d. Kidney failure is the most common cause of secondary hyperparathyroidism

Q. Hyperparathyroidism may result in bone lesions that appear microscopically to be indistinguishable from a(n)

a. osteogenic sarcoma

b. osteoma

c. cemento-osseous dysplasia

d. central giant cell granuloma

d. central giant cell granuloma

Q. Insulin is manufactured by

a. fatty tissue in long bones

b. beta cells of the pancreas

c. the liver

d. the gallbladder

b. beta cells of the pancreas

Q. Which statement about type 1 diabetes is true?

a. It is called non-insulin-dependent diabetes mellitus

b. About 30% of all patients with diabetes have type 1 diabetes

c. The onset of this type of diabetes is gradual and usually occurs in patients who are 35 to 40 years of age or older

d. It can be complicated by polydipsia, polyuria, and polyphagia

d. It can be complicated by polydipsia, polyuria, and polyphagia

Q. Advantages of an insulin pump for therapy of type 1 diabetes include

a. blood sugar levels no longer need to be monitored

b. the pump is internal

c. the pump can maintain a more predictable control of blood sugar levels than multiple insulin injections

d. the insulin dosage with the pump is limited to once-a-day dosing

c. the pump can maintain a more predictable control of blood sugar levels than multiple insulin injections

Q. The most common cause of death among patients with diabetes is

a. stroke

b. gangrene

c. heart attack

d. kidney failure

c. heart attack

Q. Which statement is true concerning oral complications for adult patients with diabetes mellitus?

a. Patients with diabetes mellitus have a decreased response to plaque

b. Slow wound healing and decreased susceptibility to infection occur as a result of the immunologic changes and defective collagen production

c. The gingiva may be hyperplastic and erythematous

d. Periodontal disease is not considered to be a complication of diabetes

c. The gingiva may be hyperplastic and erythematous

Q. Pernicious anemia is caused by a deficiency of intrinsic factor, which is secreted by

a. beta cells of the pancreas

b. parietal cells of the stomach

c. the gallbladder

d. the adrenal glands

b. parietal cells of the stomach

Q. A megaloblastic anemia is characterized by red blood cells that are

a. hypochromic and macrocytic

b. hyperchromic and macrocytic

c. microcytic and have nuclei

d. macrocytic and have nuclei

d. macrocytic and have nuclei

Q. Thalassemia is

a. caused by an abnormal type of hemoglobin in red blood cells

b. a disorder of hemoglobin synthesis

c. caused by a severe depression of bone marrow activity

d. caused by an increase in the number of circulating red blood cells

b. a disorder of hemoglobin synthesis

Q. Mediterranean or Cooley anemia

a. is caused by a deficiency of vitamin B₁₂

b. has a sex-linked inheritance pattern and occurs predominantly in males

c. is called thalassemia major in the homozygous form

d. is caused by a dietary deficiency of folic acid

c. is called thalassemia major in the homozygous form

Q. A "salt and pepper" effect may be noted on intraoral radiographic images of a patient with which type of anemia?

a. Sickle cell anemia

b. Aplastic anemia

c. Thalassemia

d. Pernicious anemia

c. Thalassemia

Q. Because of an abnormal type of hemoglobin in the red blood cells of a patient with sickle cell anemia, the cells develop a sickle shape in the presence of

a. low blood sugar

b. decreased oxygen

c. wheat gluten

d. increased carbon dioxide

b. decreased oxygen

Q. A "hair-on-end" pattern may be noted on skull radiographic images of a patient with

a. polycythemia

b. aplastic anemia

c. sickle cell anemia

d. thalassemia

c. sickle cell anemia

Q. Which disorder of red blood cells and hemoglobin is associated with sensitivity to dietary gluten found in wheat and wheat products?

a. Aplastic anemia

b. Polycythemia vera

c. Secondary polycythemia

d. Celiac sprue

d. Celiac sprue

Q. What statement about primary aplastic anemia is true?

a. It is caused by a virus

b. The bone marrow failure is the result of a drug or chemical agent

c. It is associated with chemotherapy, radioactive isotopes, radium, or radiant energy

d. The cause is unknown

d. The cause is unknown

Q. Polycythemia is caused by

a. a neoplastic proliferation of bone marrow stem cells

b. a physiologic response to decreased oxygen

c. decreased plasma volume

d. smoking

a. a neoplastic proliferation of bone marrow stem cells

Q. Which statement concerning polycythemia vera is true?

a. It may be caused by living at high altitudes or by an elevation in carbon monoxide

b. Causes include use of diuretics, vomiting, diarrhea, and excessive sweating

c. It occurs primarily in children

d. The cause is unknown

d. The cause is unknown

Q. Leukopenia most commonly involves

a. neutrophils

b. basophils

c. eosinophils

d. monocytes

a. neutrophils

Q. Which statement is true concerning acute lymphoblastic leukemia versus acute myeloblastic leukemia?

a. Acute lymphoblastic leukemia primarily affects children and young adults and has a poor prognosis

b. Acute myeloblastic leukemia primarily affects children and young adults and has a poor prognosis

c. Acute lymphoblastic leukemia primarily affects children and young adults and has a good prognosis

d. Acute myeloblastic leukemia primarily affects children and young adults and has a good prognosis

c. Acute lymphoblastic leukemia primarily affects children and young adults and has a good prognosis

Q. The Philadelphia chromosome is associated with __________ leukemia.

a. acute lymphoblastic

b. acute nonlymphoblastic

c. chronic lymphoblastic

d. chronic granulocytic

d. chronic granulocytic

Q. The normal laboratory value for prothrombin time is

a. 1 to 3 seconds

b. 11 to 16 seconds

c. 25 to 40 seconds

d. 1 to 6 minutes

b. 11 to 16 seconds

Q. The International Normalized Ratio (INR) is an expression of the ratio of prothrombin time to

a. fibrinogen

b. thromboplastin activity

c. proaccelerin

d. proconvertin

b. thromboplastin activity

Q. Thrombocytopenic purpura results from a

a. defect in the capillary walls

b. disorder of platelet function

c. severe reduction in circulating platelets

d. reduction in white blood cells

c. severe reduction in circulating platelets

Q. Which drug may be taken during the course of radiation treatment to reduce the severity of radiation-induced xerostomia?

a. Prednisone

b. Pilocarpine hydrochloride

c. Aspirin

d. Nonsteroidal anti-inflammatory drugs

b. Pilocarpine hydrochloride

Q. Osteonecrosis of the maxilla and mandible is a complication associated with what type of drug?

a. Phenytoin

b. Nifedipine

c. Bisphosphonate

d. Cyclosporine

c. Bisphosphonate

Q. Bisphosphonate therapy is used to treat all diseases except one. Which is the exception?

a. Hyperparathyroidism

b. Osteoporosis

c. Multiple myeloma

d. Metastatic breast cancer

a. Hyperparathyroidism

Q. Which medication can decrease the severity of radiation-induced xerostomia in patients with oral cancer?

a. Bisphosphonates

b. Cyclosporine

c. Indomethacin

d. Pilocarpine hydrochloride

d. Pilocarpine hydrochloride

Q. Type A hemophilia is less common than type B hemophilia. Type A hemophilia is caused by a deficiency of the clotting factor called plasma thromboplastinogen or factor VIII.

a. Both statements are true

b. Both statements are false

c. The first statement is true; the second is false

d. The first statement is false; the second is true

d. The first statement is false; the second is true

Q. A reddish-blue or purple discoloration of the skin or mucosa that results from spontaneous extravasation of blood and is caused by an increase in capillary fragility or a deficiency in blood platelets is termed

a. hemophilia

b. Burkitt lymphoma

c. purpura

d. pernicious anemia

c. purpura

Q. A malignant neoplasm of the hematopoietic stem cells and characterized by an excessive number of abnormal white blood cells is termed

a. leukemia

b. hemophilia

c. thrombocytopenic purpura

d. DiGeorge syndrome

a. leukemia

Q. Which is not a chronic disorder associated with sensitivity to dietary gluten?

a. Celiac disease

b. Gluten-sensitive enteropathy

c. Celiac sprue

d. Sickle cell trait

d. Sickle cell trait

Q. In aplastic anemia, patients experience a dramatic decrease in all the circulating blood cells because of a severe depression of bone marrow activity.

a. Both the statement and reason are correct and related

b. Both the statement and reason are correct but not related

c. The statement is correct, but the reason is not

d. The statement is not correct, but the reason is correct

e. Neither the statement nor the reason is correct

a. Both the statement and reason are correct and related

Q. The recommended treatment for folic acid and vitamin B₁₂ deficiency anemias is

a. surgery

b. dietary supplements

c. medications

d. radiation therapy

b. dietary supplements

Q. All statements are true regarding type 2 diabetes mellitus except one. Which is the exception?

a. It is non-insulin-dependent

b. The majority of patients are diagnosed with type 2 diabetes

c. Contributing factors include a decrease in metabolic rate and weight gain

d. Complications include polydipsia, polyuria, and polyphagia

d. Complications include polydipsia, polyuria, and polyphagia

Q. Which vitamin is needed for deoxyribonucleic acid (DNA) synthesis and, when lacking, affects the development of rapidly dividing cells in bone marrow and epithelium?

a. Thiamin

b. Vitamin B₁₂

c. Riboflavin

d. Vitamin C

b. Vitamin B₁₂

Q. Elevated blood levels of calcium, low levels of blood phosphorus, and abnormal bone metabolism are characteristic of which endocrine disorder?

a. Hyperpituitarism

b. Hypothyroidism

c. Hyperthyroidism

d. Hyperparathyroidism

d. Hyperparathyroidism

Q. Which type of hyperparathyroidism is the result of an overproduction of parathyroid hormone (PTH) in response to long-term decreased levels of serum calcium often associated with chronic renal disease?

a. Primary hyperparathyroidism

b. Secondary hyperparathyroidism

c. Tertiary hyperparathyroidism

d. Familial hyperparathyroidism

b. Secondary hyperparathyroidism

Q. Myxedema is caused by __________ of the __________ gland.

a. hypersecretion; thyroid

b. hyposecretion; thyroid

c. hypersecretion; adrenal

d. hyposecretion; adrenal

b. hyposecretion; thyroid

Q. Diabetes is characterized by abnormally high blood __________ levels.

a. phosphorus

b. calcium

c. glucose

d. neutrophil

c. glucose

Q. __________ is characterized by insufficient production of adrenal steroids.

a. Addison disease

b. Addison syndrome

c. Cushing disease

d. Cushing syndrome

a. Addison disease

Q. The production of adrenal steroids is normally stimulated by release of __________ hormone from the pituitary gland.

a. follicle-stimulating

b. luteinizing

c. adrenocorticotropic

d. growth

c. adrenocorticotropic

Q. Plummer-Vinson syndrome can develop as a result of long-standing __________ anemia.

a. pernicious

b. iron-deficiency

c. thalassemia

d. aplastic

b. iron-deficiency

Q. Iron deficiency anemia may first result in loss of __________ papillae on the dorsum of the tongue because these papillae have the highest metabolic requirement.

a. filiform

b. fungiform

c. circumvallate

d. foliate

a. filiform

Q. The red blood cells appear __________ and __________ in cases of iron deficiency anemia.

a. microcytic; hypochromic

b. microcytic; hyperchromic

c. macrocytic; hypochromic

d. macrocytic; hyperchromic

a. microcytic; hypochromic

Q. The Schilling test detects an inability to absorb an oral dose of vitamin _____

a. B₆

b. B₁₂

c. C

d. E

b. B₁₂

Q. A platelet count of less than __________/mm³ is considered thrombocytopenia.

a. 20,000

b. 100,000

c. 150,000

d. 400,000

b. 100,000

Q. __________ is an autosomal-dominant inherited disorder of platelet function.

a. Bruton disease

b. von Willebrand disease

c. DiGeorge syndrome

d. Hemophilia

b. von Willebrand disease

Q. Type A hemophilia is caused by a deficiency of factor _____

a. VII

b. VIII

c. IX

d. X

b. VIII

Q. Which term describes an opposite condition to anemia?

a. Polycythemia

b. Arthralgia

c. Hemolysis

d. Neutropenia

a. Polycythemia

Q. Which condition necessitates emergency intervention?

a. Hemostasis

b. Ketoacidosis

c. Insulin shock

d. Myalgia

c. Insulin shock

Q. All terms describe a decrease in circulating red or white blood cells except one. Which is the exception?

a. Thrombocytopenia

b. Anemia

c. Hypochromic

d. Neutropenia

c. Hypochromic

Q. Which system consists of a group of integrated glands and cells that secrete hormones?

a. Endocrine

b. Viral

c. Neoplastic

d. Immune

a. Endocrine

Q. All are clinical features of gigantism except one. Which is the exception?

a. Headache

b. Chronic fatigue

c. Extreme height

d. Gastrointestinal issues

d. Gastrointestinal issues

Q. Persons with acromegaly may experience an enlargement of the maxillary sinuses that may lead to what condition?

a. Deep voice

b. Nasal septum deformities

c. Perforation of the oral mucosa

d. Maxillary molars requiring endodontic treatment

a. Deep voice

Q. Children affected with hyperthyroidism may demonstrate which characteristic?

a. Lack of energy

b. Fatigue

c. Hyperactivity

d. Dry skin

c. Hyperactivity

Q. Which condition may cause children to demonstrate premature exfoliation of the primary dentition as well as premature eruption of the permanent teeth?

a. Diabetes

b. Hyperthyroidism

c. Hypothyroidism

d. Hypoparathyroidism

b. Hyperthyroidism

Q. In infants, facial and oral changes in hypothyroidism include these characteristics except one. Which is the exception?

a. Thickened lips

b. Delayed eruption of teeth

c. Macroglossia

d. Exophthalmos

d. Exophthalmos

Q. Secondary hyperparathyroidism occurs when calcium is abnormally excreted by the liver. The most common cause of secondary hyperparathyroidism is liver failure.

a. Both statements are true

b. Both statements are false

c. The first statement is true; the second statement is false

d. The first statement is false; the second statement is true

d. The first statement is false; the second statement is true

Q. Oral manifestations of a person with Addison disease include which finding?

a. Intraoral melanotic macules

b. Gingival hyperplasia

c. Tooth mobility

d. Macroglossia

a. Intraoral melanotic macules

Q. Identify a common nutritional deficiency associated with anemia:

a. Calcium

b. Phosphorus

c. Iron

d. Vitamin D

c. Iron

Q. Skin and mucosal pallor, angular cheilitis, and loss of filiform and fungiform papillae on the tongue are characteristics of what condition?

a. Type 1 diabetes

b. Cretinism

c. Graves' disease

d. Anemia

d. Anemia

Q. Physical characteristics of a person with type 1 diabetes include all except one. Which is the exception?

a. Peak age of 50 years

b. Thin body build

c. Polydipsia, polyuria, polyphagia

d. Abrupt onset

a. Peak age of 50 years

Q. When a patient is taking long-term antibiotic therapy, what is a common oral manifestation that may be seen?

a. Risk of candidiasis

b. Xerostomia

c. Tooth discoloration

d. Gingival enlargement

a. Risk of candidiasis

Q. Hepatomegaly →

K. Enlargement of the liver

Q. Myalgia →

H. Muscle pain

Q. Polydipsia →

B. Chronic excessive thirst and intake of fluid

Q. Thrombocyte or mucus membrane →

C. Small, flat, hemorrhagic patch larger than a petechia on the skin

Q. Osteoporosis →

M. Abnormal rarefaction of bone

Q. Polycythemia →

E. Increase in the total red blood cell mass in the blood

Q. Ecchymosis →

I. Small, flat, hemorrhagic patch larger than a petechia on the skin

Q. Receptor →

E. Cell surface protein to which a specific molecule (e.g., a hormone) can bind

Q. Fibrin →

N. Insoluble protein that is essential for the clotting of blood

Q. Anemia →

G. Reduction in the number of red blood cells

Q. Agranulocytosis →

J. Decrease in number of granulocytes

Q. Thrombocytopenia →

G. Decrease in the number of platelets in circulating blood

Q. Arthralgia →

A. Severe pain in a joint

Q. Hemostasis →

F. Stoppage or cessation of bleeding