4.

1 Behcet’s syndrome is characterized through:

a. major aphthous ulcerations
b. herpetiform aphthae
c. minor aphthous ulcerations
d. eye lesions
e. Central Nervous System involvement
A: a,b,c,d,e
4.2 For the topical treatment of aphthous ulcerations, the following can be used:
a. colchicine
b. mouthwashes with sodium bicarbonate
c. mouthwashes with tetracycline (250 mg tetracycline / 30 ml warm water)
d. dapsone
e. topical treatment is not recommended
A:a,b,c,d

4.3 What are the elements that allow a differential diagnostic between ulcerative lesions
associated with herpetic infection and aphthous ulcers:
a. prodromal syndrome
b. multiple painful ulcerations preceded by bullae
c. positive Nikolsky’ sign
d. ulcerative lesions preceded by vesicles
e. cracks in the oral mucous membrane
A: a,d

4.4 Write down the investigations recommended for a patient with aphthous ulcerations.
A: investigations for highlighting - immunological
abnormalities;
gastrointestinal disorders (deficiency of vitamin B12 or folate secondary to
malabsorption, coeliac disease); haematological deficiencies (deficiencies of
vitamin B12, folate, iron); hormonal disturbance, etc.
4.5 Mention the elements that allow the differential diagnostic between traumatic ulcerations
and aphthous ulcers:
a. multiple, confluent ulcerations
b. prodromal syndrome
c. the possibility of identifying the traumatic agent
d. correspondence between the identified traumatic agent and the lesion
e. the lesions are recurrent
A: c,d

4.6 Mention the elements that allow the differential diagnostic between lesions associated
with vulgar pemphigus and aphthous ulcers:
a. positive Nikolsky’sign
b. the healing of the lesions after identifying and removal of the traumatic factor
c. associated genital lesions
d. multiple painful ulcerations preceded by bullae
e. prodromal syndrome
A: a,d

4.7 Write down the information that suggests the diagnostic for Behcet’s syndrome
Is a multisystem disorder with varied manifestations characterized by the classical
triad of recurrent aphthous stomatitis, genital ulceration, eye lesions, and o variety of
other manifestations: cutaneous, joint, neurological, vascular and intestinal disorders.

4.8 Write down the clinical characteristics of aphthous ulcers.

- abrupt onset of painful and recurrent ulcers wich typically affect only the
non-keratinized mucosal surfaces; individual ulcers heal in a predictable period of
time which is variable for each patient.

4.8 Write down the characteristics of aphthous lesions that suggest an immune deficit.
- more severe clinical forms, major aphthae, can occur on any part of the oral mucoasa

4.9 Treatment of herpetiform aphthous ulcerations.

- corticosteroids (topic, systemic), tetracycline mouth rinses (the contents of a tetracycline
capsue, 250 mg can be stirred in a little water and held in mouth for 2 – 3 minutes, three
times daily) ± an antifungal drug (prevent superinfection by Candida albicans)

6.1 Patient presented with multiple ulcerative lesions, with a diameter bigger
than 0.5 cm, irregular – oval shape and crater-like aspect. From the patient history we
find out that the lesions are recurrent. Specify the most probable diagnostic:
a. candidiasis infection
b. HSV infection
c. aphtheous ulcerations
d. shingles infection
e. Paramyxovirus infection
A: c (major aphthae - diameter bigger than 0.5 cm, crater-like,
recurrent)

6.2 Second stage syphilis is characterized by:

a. gumma
b. lesions in the nervous central system and cardio-vascular system
c. cutaneous vesicle eruption
d. mouth ulcerations covered by grey membranes
e. chronic ulceration with firm base
A: d

6.3 Specify the oral lesions that can be present in gonorrhea

a. nodules with wood-like consistency
b. generalized erythema
c. unique, chronic, firm ulceration
d. multiple, painful ulcerations
e. exfoliating gingivitis
A: b, d
6.4 Specify the characteristics of the lesions caused by the Koch bacillus
a. a fistula that drains pus that contains small yellow granules
b. minor mouth ulcerations
c. painless, aphthous mouth ulcerations
 d. firm ulcerations, chronic, without any tendency of healing, often multiple
e. gumma
A: d

6.5 A profound fungal infection can be suspected in the presence of the

following manifestations:
a. aphthous mouth ulcers
b. chronic, firm ulceration, without any healing tendency
c. systemic manifestations: coughing, fever, weight loss
d. generalized erythema of the oral mucous membrane
e. maculopapular eruption (cutaneous)
A: b,c

6.6 A 28 years old male presented with oral aphthous ulcerations, relatively
painless, arthritis, conjunctivitis and urethritis. Specify the most probable diagnostic:
a. Behcet’s syndrome
b. gonorrhea
c. Reiter’s syndrome
d. Wegener’s granulomatosis
e. erythematous lupus
A: c

6.7 Specify the elements that allow a diagnostic of acute traumatic ulceration.
A: three criteria should be fulfilled
- a cause of traumatic must be identified;
- the cause must fit the site, size and shape of the
ulcer;
- on the removal of the cause the ulcer must show
signs of healing within 10 days.

6.8 Specify the clinical characteristics of the lesions from necrotising

sialometaplasia.
A: deep crater ulcer on the hard plate
 the ulcer may be preceded by an indurated swelling
may take up to 8 weeks to heal

6.9 Specify the most probable diagnostic for a patient with multiple
ulcerations, with a diameter smaller than 0.5 mm, localized in the keratinized and not
keratinized mucous membrane, that are recurrent.
a. Crohn’s disease
b. pemphigus vulgaris
c. pemphigus mucous membrane
d. herpetiform aphthae
e. minor mouth ulcerations
A: d (recurrent, multiple, smaller …,, keratinized and not-keratinized )

6.10 A 40 years old female presented with erythematous and ulcerative lesions,
on the jugal, gingival mucous membrane and on the vermilion, with white radial
keratinized areas arranged around the lesions. Specify the most probable diagnostic:
a. oral lichen planus
b. multiforme erythema
c. Reiter’s syndrome
d. erythematous lupus
e. Behcet’s syndrome
A: d

6.11 A pacient presented with multiple ulcerative lesions of small dimensions,

with erythematous margins, without any systemic manifestations; from the patient
history we note that the patient had similar lesions in the background and did not take
any drug treatment. Specify the most probable diagnostic:
a. cyclic neutropenia
b. multiforme erythema
c. minor aphthous mouth ulcerations
d. herpes-like aphthous mouth ulcerations
e. major aphthous mouth ulcerations
A: c
 6.12 Wegener granulomatosys is characterized by:
a. unifocal destructive and progressive process, on the nose, palate, sinuses
b. pulmonary, renal and upper lungs inflammatory lesions, associated with
gingival lesions
c. desquamative gingivitis
d. artritis, urethritis, conjunctivitis and oral aphthous ulcers
e. chronic ulceration localized at hard palate.
A: b
6.13 Young adult requests a dental consultation for spread, painful oral
ulcerative lesions, ulcers covered with crusts on the lips and conjunctiva. Specify the
most probable diagnostic:
a. aphthous stomatitis
b. Ludwig’s angina
c. multiforme erythema
d. pemphigus vulgaris
e. Reiter’s syndrome
A: c

6.14 Specify the clinical characteristics of the chronic traumatic ulcerations.

A: present for several weeks
may be deep crater-like lesions with rolled edges which are
indurated on palpation (because of surrounding fibrosis)

6.15 Specify the clinical characteristics of the acute traumatic ulcerations

A: tender ulceration, with yellowish-grey floor of fibrin slough and red
margins; inflammation, swelling and erythema are variable, depending
on the cause and time since trauma

6.16 Specify the elements that allow a differential diagnosis between

erythema multiforme and primary herpetic gingvo-stomatitis.
erythema multiforme primary herpetic gingvo-stomatitis
- Ulcerative lesions without preceding vesiculation - Ulcerative lesions preceded by
vesicles
- usually gingiva not involved - usually gingivitis
- ulcers more extensive

- cutaneous target lesions (red macules with a bluish cyanotic centre) / no

6.17 In the case of a patient who accuses sinusitis symptoms or pain thought to
be coming from the teeth, occlusal dysfunction, unstable teeth, ulcerous lesion on the
palate or alveoli, the most probable diagnostic is:
a. cyclic neutropenia
b. maxillary sinus carcinoma
c. median granuloma
d. Wegener’s granulomatosis
e. erythematous lupus
A: b