Formative Assessment 1

A 53 year old male patient came to opd with the complaint of stiffness in check muscles. Upon examination the buccal mucosa had a marble like appearance with patches of white colored lesions. Bands of fibrous tissues were also palpable. He has been consuming betel nuts since childhood. What is the most likely diagnosis?

• Lichen planus

• Leukoplakia

• Erythroplakia

• Oral Submucous Fibrosis

Diagnosing leukoplakia is crucial because it can develop into a cancerous condition. Among the given options, which one does not represent a characteristic feature of leukoplakia?

• Can be homogenous or wrinkled surface of mucosa

• Floor of the mouth is considered to be premalignant

• May vary from transparent and filmy to thick and dense

• White lesion and less than 5 mm

A 29 year old female came to the opd with the complaint of burning sensation in mouth, along with difficulty and pain in swallowing. Upon examination, her tongue appeared to be smooth and shiny with absence of lingual papillae and crack sores on the corner of the mouth. She also has a history of iron deficiency anemia. What is most likely your diagnosis?

• Angular chelitis

• Plummer – Vinson syndrome

• Systemic lupus erthymetosus

• Discoid lupus erythematosus

A 46-year-old man presents with a persistent white patch on the buccal mucosa. He reports occasionally biting the inside of his cheek while chewing. On examination, there is a white, irregularly bordered plaque with a rough, frayed surface along the line of occlusion. The lesion cannot be scraped off. There are no indurated margins, ulcerations, or palpable cervical lymph nodes. The patient is otherwise healthy and takes no medications.
Which of the following is the most appropriate next step in the management of this lesion?

• Immediate incisional biopsy to rule out carcinoma

• Prescription of topical corticosteroids for 2 weeks

• Observation after removal of the traumatic source, with re-evaluation in 2 weeks

• Empirical antifungal therapy with clotrimazole

Answer explanation

The lesion’s appearance (white, rough, non-scrapable plaque at a trauma-prone site) and history of mechanical irritation (cheek biting) are typical of frictional keratosis. The first-line approach is removal of the irritant and observation.
If the lesion does not resolve within ~2 weeks, an incisional biopsy is warranted to exclude epithelial dysplasia or leukoplakia.

What is the recommended treatment regimen for trigeminal neuralgia using carbamazepine (Tegretol)?

• Start with 100 mg and Maintain a maximum daily dose of 600-800 mg.

• Start with 100 mg twice daily and gradually increase by 100 mg each day until pain control, with a maximum daily dose of 800-1000 mg

• Initiate with carbamazepine 500 mg twice daily and gradually increase to 1000 mg

• start with 50 mg and increase the dosage by 300 mg every day until pain is relieved.

A 65-year-old patient presents to the dental outpatient department with pain on the right side of the chin for 3 days, followed by the appearance of a painful rash over the same area. On examination, there are clusters of vesicular eruptions on an erythematous base distributed unilaterally over the chin and lower lip, corresponding to the mental nerve region. Intraoral examination reveals no significant ulcerations. The patient recalls having chickenpox during childhood.What is the recommended treatment for this condition?

• Topical acyclovir ointment alone

• Oral acyclovir therapy with analgesics

• Systemic corticosteroids alone

• Oral antibiotics to prevent secondary infection

Answer explanation

Correct Answer (B):
This presentation is characteristic of Herpes zoster (shingles) involving the mandibular branch (V3) of the trigeminal nerve.
Management includes systemic antiviral therapy started within 72 hours of rash onset to reduce viral replication, pain, and risk of postherpetic neuralgia. Analgesics or neuropathic pain medications (e.g., gabapentin) may be added for pain control.

A 32-year-old woman presents to the clinic with recurrent episodes of throbbing right-sided headache associated with nausea, photophobia, and phonophobia. The pain lasts for about 8–10 hours and is often preceded by visual disturbances. She denies any recent head trauma or visual loss. On examination, there are no focal neurological deficits. She requests medication for the next time she develops such an episode.
What is the first-line treatment for managing the acute phase of her migraine attacks?

• Paracetamol, NSAID or Aspirin

• Sumatriptin

• Beta blockers

• Ergotamin

Answer explanation

For acute migraine attacks, the first-line therapy consists of simple analgesics such as paracetamol (acetaminophen) and nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen.
These agents relieve pain by inhibiting prostaglandin synthesis and are most effective when taken early in the attack.

A 70-year-old patient presents to the emergency department with complaints of a severe headache and tenderness over the right temporal region. The patient also reports visual disturbances. On examination, an enlarged and painful temporal artery is noted. Laboratory investigations reveal an elevated ESR and CRP. Based on these findings, what is the next step in the management of this patient?

• MRI of the brain

• Temporal artery biopsy

• CT angiography of the head and neck

• CBCT

Answer explanation

Correct Answer (B):
The presentation is highly suggestive of Giant Cell Arteritis (Temporal Arteritis), a large-vessel vasculitis affecting branches of the external carotid artery, particularly the temporal artery.
The next step to confirm the diagnosis is a temporal artery biopsy, which reveals granulomatous inflammation with multinucleated giant cells and disruption of the internal elastic lamina.
Biopsy confirmation is critical for guiding and monitoring long-term management.

A 45-year-old patient visits the clinic with complaints of flushing and sweating on the right side of the face following meals. The patient underwent parotid gland surgery six months ago. On examination, there is no pain reported, but the patient describes a burning sensation during episodes. Between episodes, there is numbness in the affected area. What condition is most likely affecting the patient?

• Bell's palsy

• Trigeminal Neuralgia

• Frey syndrome

• Glossopharyngeal Neuralgia

What is the most important component of ulcer?

• margin

• floor

• edge

• base