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Chapter 01: Introduction to Preliminary Diagnosis of Oral Lesions

Ibsen: Oral Pathology for the Dental Hygienist, 7th Edition

MULTIPLE CHOICE

1. Which descriptive term is described as a segment that is part of the whole?

a. Bulla
b. Vesicle
c. Lobule
d. Pustule
ANS: C
A lobule is described as a segment or lobe that is part of a whole. A bulla is a large, elevated lesion that contains serous fluid and
may look like a blister. A vesicle is a small, elevated lesion that contains serous fluid. Pustules are circumscribed elevations
containing pus.

REF: Vocabulary, Clinical of Soft Tissue Lesions, page 1 OBJ: 1

2. A lesion with a sessile base is described as

a. an ulcer.
b. stemlike.
c. pedunculated.
d. flat and broad.
ANS: D
Sessile describes the base of a lesion that is flat and broad. An ulcer is a break in the surface epithelium. A stemlike lesion is
referred to as pedunculated. A pedunculated lesion is stemlike or stalk-based (similar to a mushroom).

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

3. Which condition is not diagnosed through clinical appearance?

a. Mandibular tori
b. Fordyce granules
c. Black hairy tongue
d. Compound odontoma
ANS: D
The compound odontoma is initially identified radiographically as a radiopaque area in which tooth structure can be identified. No
clinical component exists. Mandibular tori are identified clinically as areas of exostosis on the lingual aspects of mandibular
premolars. Fordyce granules are yellow clusters of ectopic sebaceous glands diagnosed through clinical appearance. Black hairy
tongue is diagnosed clinically. The filiform papillae on the dorsal tongue elongate and become brown or black. Causes include
tobacco, alcohol, hydrogen peroxide, chemical rinses, antibiotics, and antacids.

REF: Radiographic Diagnosis, page 9 OBJ: 3

4. Another name for geographic tongue is

a. median rhomboid glossitis.
b. benign migratory glossitis.
c. fissured tongue.
d. black hairy tongue.
ANS: B
Benign migratory glossitis is another name for geographic tongue. Research suggests that median rhomboid glossitis is associated
with a chronic fungal infection from Candida albicans. Sometimes the condition resolves with antifungal therapy. Fissured tongue
is seen in 5% of the population. It is a variant of normal. Genetic factors are typically associated with the condition. Black hairy
tongue is caused by a reaction to chemicals, tobacco, hydrogen peroxide, or antacids. The filiform papillae on the dorsal tongue
become elongated and are dark brown to black.

REF: Geographic Tongue, page 24 OBJ: 7

5. This bony hard structure in the midline of the hard palate is genetic in origin and inherited in an autosomal dominant manner. The
diagnosis is made through clinical appearance. Which condition is suspected?
a. Palatal cyst
b. Torus palatinus
c. Mixed tumor
d. Ranula
ANS: B
A torus palatinus is developmental and bony hard and is found on the midline of the palate. Diagnosis is made on the basis of
clinical appearance. A palatal cyst appears radiolucent on a radiographic examination and is not diagnosed through clinical
appearance. A mixed tumor or pleomorphic adenoma is a benign tumor of salivary gland origin, found unilaterally off the midline
of the hard palate. It is composed of tumor tissue that is not bony hard to palpation. Ranula is a term used for a mucocele-like
lesion that forms unilaterally on the floor of the mouth.

REF: Torus Palatinus, page 21 OBJ: 4

Copyright © 2017, by Elsevier, Inc. All rights reserved. 1

 6. The gray-white opalescent film seen on the buccal mucosa of 85% of black adults is a variant of normal that requires no treatment
and is termed
a. linea alba.
b. leukoedema.
c. leukoplakia.
d. white sponge nevus.
ANS: B
Leukoedema is a diffuse opalescence most commonly seen on the buccal mucosa in black individuals. Linea alba is a “white line”
that extends anteroposteriorly on the buccal mucosa along the occlusal plane. It is most prominent in patients who have a clenching
or grinding habit. Leukoplakia is a clinical term for a white lesion, the cause of which is unknown. White sponge nevus is a genetic
(autosomal dominant) trait. Clinically, it is characterized by a soft white, folded (or corrugated) oral mucosa. A thick layer of
keratin produces the whitening.

REF: Leukoedema, page 23 OBJ: 8

7. Which condition most likely responds to therapeutic diagnosis?

a. Angular cheilitis
b. Amelogenesis imperfecta
c. Paget disease
d. Stafne bone cyst
ANS: A
Angular cheilitis most commonly responds to antifungal therapy once nutritional deficiencies have been ruled out. Amelogenesis
imperfecta is a genetic condition associated with abnormal development of the enamel. Paget disease is a chronic metabolic bone
disease. A highly elevated serum alkaline phosphatase level contributes significantly to the diagnosis. A Stafne bone cyst is
determined through surgical diagnosis in which entrapped salivary gland tissue is identified.

REF: Therapeutic Diagnosis, page 18 OBJ: 3

8. The gingival enlargement in this patient was caused by a calcium channel blocker. Which medication is the likely cause?
a. Dilantin
b. Nifedipine
c. Quinidine
d. Clozapine
ANS: B
Nifedipine is a calcium channel blocker. Dilantin is an anticonvulsant used to prevent or control seizures. Quinidine is an
antiarrhythmic agent used to treat cardiac arrhythmias. Clozapine is an antipsychotic used in the management of psychotic
symptoms in schizophrenia.

REF: Historical Diagnosis, Fig. 1.38, page 17 OBJ: 3

9. Radiographic features, including cotton-wool radiopacities and hypercementosis, are especially helpful in the diagnosis of
a. Paget disease.
b. dentinogenesis imperfecta.
c. anemia.
d. diabetes.
ANS: A
Paget disease is a chronic metabolic bone disease. Radiographically, cotton-wool radiopacities and hypercementosis are
characteristic features. Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin. Anemia, a
decrease in red blood cells, requires blood tests to determine the etiologic factors. Diabetes is a chronic disorder of carbohydrate
metabolism characterized by abnormally high blood glucose levels.

REF: Laboratory Diagnosis, Fig. 1.40, pages 16, 18 OBJ: 3

10. In internal resorption, the radiolucency seen on radiographic examination is usually

a. well circumscribed.
b. diffuse.
c. multilocular.
d. unilocular.
ANS: B
Diffuse borders are ill defined, making it impossible to detect the exact parameters of the lesion. Therefore treatment is more
difficult. Well circumscribed describes borders that are specifically defined. Exact margins of the lesion are identified. Multilocular
has also been described as resembling “soap bubbles”; lobes seem to fuse together to make up the lesion. This term has been used
to describe the odontogenic keratocyst. Unilocular means having one compartment or unit that is well defined. This term is often
used to describe the radicular cyst.

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ: 1

Copyright © 2017, by Elsevier, Inc. All rights reserved. 2

 11. Which condition is diagnosed through clinical appearance?
a. Fordyce granules
b. Unerupted mesiodens
c. Periapical cemento-osseous dysplasia
d. Traumatic bone cyst
ANS: A
Fordyce granules are diagnosed on the basis of their clinical appearance. They are ectopic sebaceous glands seen on the lips and
buccal mucosa. Clinically, they appear as yellow lobules in clusters and are considered a variant of normal. Unerupted mesiodens
requires a radiographic image for diagnosis. Periapical cemento-osseous dysplasia requires a radiographic image, specific patient
history, and a pulp test to evaluate tooth vitality. Traumatic bone cyst requires a radiographic image and surgical intervention to
establish a diagnosis.

REF: Clinical Diagnosis, page 7 | Fordyce Granules, page 20 OBJ: 3

12. Retrocuspid papillae are located on the

a. palate.
b. floor of the mouth.
c. gingival margin of the lingual aspect of mandibular cuspids.
d. canine eminence.
ANS: C
Retrocuspid papillae are located on the gingival margin of the lingual aspect of mandibular cuspids. Retrocuspid papillae are not
located on the palate. Retrocuspid papillae are not located on the floor of the mouth. Retrocuspid papillae are not located on the
canine eminence.

REF: Retrocuspid Papilla, page 22 OBJ: 3

13. Which condition is not considered a variant of normal?

a. Fordyce granules
b. Leukoedema
c. Linea alba
d. Pyogenic granuloma
ANS: D
Pyogenic granuloma is a reactive inflammatory response to injury. It is not a variant of normal. Fordyce granules are seen in more
than 80% of adults over 20 years of age and are considered a variant of normal. Leukoedema is observed in about 85% of black
individuals and is considered a variant of normal. Linea alba is located on the buccal mucosa along the occlusal plane of the teeth.
It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is considered a variant of normal.

REF: Box 1-1, Case Study, page 20 | Variants of Normal, pages 21-23
OBJ: 6

14. When antifungal therapy is used to treat angular cheilitis, which diagnostic process is being applied?
a. Microscopic
b. Laboratory
c. Surgical
d. Therapeutic
ANS: D
Therapeutic diagnosis is used here in the treatment and management of angular cheilitis, which is most commonly a fungal
condition. A careful patient history should be obtained to rule out a contributory nutritional deficiency. Microscopic diagnosis
requires a biopsy. Laboratory diagnosis involves the use of clinical laboratory tests, including blood chemistries and urinalysis.
Surgical diagnosis requires surgical intervention.

REF: Therapeutic Diagnosis, page 18 OBJ: 3

15. A lesion with a stemlike base is described as

a. sessile.
b. macular.
c. pedunculated.
d. lobulated.
ANS: C
Pedunculated means the lesion has a stemlike or stalklike base similar to that of a mushroom. A sessile base is broad and flat. A
macular lesion is flat, does not protrude, and is distinguished by its color. A freckle is an example of a macule. Lobulated means the
lesion consists of lobules making up the whole.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 8

Copyright © 2017, by Elsevier, Inc. All rights reserved. 3

 16. A small, circumscribed lesion, usually less than 1 cm in diameter, that is elevated or protrudes above the surface of normal
surrounding tissue is termed a
a. papule.
b. macule.
c. vesicle.
d. bulla.
ANS: A
A papule is defined as a small circumscribed lesion, usually less than 1 cm in diameter, that is elevated or protrudes above the
surface of normal surrounding tissue. A macule is flat and does not protrude above the surface of normal tissue. A vesicle is
elevated and contains serous fluid. A bulla is elevated, contains serous fluid, and looks like a blister.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

17. Which condition is considered a genetic/inherited disorder?

a. Linea alba
b. Amelogenesis imperfecta
c. Necrotizing ulcerative gingivitis
d. Internal resorption
ANS: B
Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth. Linea alba is a variant of normal
characterized by the white line that extends anteroposteriorly on the buccal mucosa, along the occlusal plane. Necrotizing
ulcerative gingivitis is an ulcerating gingival condition caused by anaerobic bacteria. Internal resorption is usually a ssociated with
an inflammatory response in the pulp.

REF: Historical Diagnosis, page 15 OBJ: 3

18. Ectopic geographic tongue can be found in which location?

a. On the lateral border of the tongue
b. Within bone
c. On mucosal surfaces other than the tongue
d. The dorsal surface of the tongue
ANS: C
Ectopic geographic tongue is also called stomatitis areata migrans and is found on mucosal surfaces other than the tongue.
Geographic tongue may be seen on any surface of the tongue, including the lateral borders. Ectopic geographic tongue is a mucosal
condition and is unrelated to the bone. Geographic tongue may be seen on any mucosal surface and is commonly seen on the dorsal
surface of the tongue.

REF: Geographic Tongue, page 24 OBJ: 7

19. A Stafne bone cyst contains

a. salivary gland tissue.
b. an empty void.
c. inflammatory cells.
d. an epithelium-lined cyst containing serous fluid.
ANS: A
Stafne bone cyst is a developmental invagination in the lingual aspect of the mandible that is filled with salivary gland tissue. An
empty void describes the contents of a traumatic bone cyst. A Stafne bone cyst has no inflammatory response. It is developmental
and requires no treatment. A Stafne bone cyst is not a true cyst and does not have an epithelial lining. It contains normal salivary
gland tissue.

REF: Surgical Diagnosis, page 18 OBJ: 3

20. Which papillae are elongated in the condition black hairy tongue?
a. Circumvallate
b. Foliate
c. Filiform
d. Fungiform
ANS: C
The filiform papillae are composed primarily of keratin and are the papillae that elongate in black hairy tongue. Circumvallate
papillae on the posterior dorsal tongue do not elongate. Foliate papillae are located on the posterior lateral borders o f the tongue.
They are vertical, slightly exophytic folds of tissue located in the same area as the lingual lymphoid tissue (lingual tonsils) and do
not elongate. Fungiform papillae on the dorsal areas do not elongate.

REF: Hairy Tongue, page 24 OBJ: 3

Copyright © 2017, by Elsevier, Inc. All rights reserved. 4

 21. Diagnosis of anemia is best accomplished through which examination?
a. Laboratory tests
b. Evaluation of the color of the gingiva
c. Bleeding on probing
d. Patient medical history
ANS: A
Laboratory blood tests provide the best information with which to diagnose anemia. Although the color of the gingiva may be a
clinical sign, a diagnosis of anemia, or more specifically the type of anemia, must be made through laboratory testing. Bleeding on
probing is not useful in the diagnosis of anemia. The patient’s medical history may be helpful in the diagnosis of anemia, but it is
only contributory. The final diagnosis comes from appropriate laboratory tests.

REF: Laboratory Diagnosis, page 16 OBJ: 3

22. A radiolucency that “scallops around the roots of teeth” is often used to describe which condition?
a. Traumatic bone cyst
b. Stafne bone cyst
c. Lingual mandibular bone concavity
d. Median palatine cyst
ANS: A
Scalloping around the roots is a term often used to describe the radiographic appearance of a traumatic bone cyst. A Stafne bone
cyst usually presents as an oval radiolucency anterior to the angle of the ramus and inferior to the mandibular canal. A lingual
mandibular bone concavity is the same lesion as a Stafne bone cyst. A median palatine cyst is a developmental cyst that presents as
a unilocular radiolucency found in the midline of the hard palate.

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ: 3

23. When geographic tongue occurs on the dorsal tongue, the erythematous areas are described as
a. inflamed.
b. depapillated.
c. allergic.
d. fungal.
ANS: B
In geographic tongue, the erythematous areas on the dorsal tongue are devoid of filiform papillae and therefore are appropriately
described as depapillated. The erythematous areas seen on the dorsal tongue in geographic tongue are not caused primarily by
inflammation. Geographic tongue is not an allergic reaction. Geographic tongue is not a fungal infection.

REF: Geographic Tongue, page 24 OBJ: 7

24. It has been suggested that Candida albicans is associated with which condition?
a. Median rhomboid glossitis
b. Linea alba
c. Leukoedema
d. Retrocuspid papillae
ANS: A
Research has suggested that median rhomboid glossitis may be associated with Candida albicans. Linea alba is a variant of normal.
Leukoedema is a variant of normal. Retrocuspid papillae are developmental and found on the gingiva of the lingual aspect of
mandibular canine teeth.

REF: Median Rhomboid Glossitis, page 23 OBJ: 7

25. Which term is used to describe a radiographic lesion with borders that are specifically defined, revealing the exact margins and
extent of the lesion?
a. Unilocular
b. Well circumscribed
c. Diffuse
d. Multilocular
ANS: B
Well circumscribed defines a lesion with borders that are specifically defined and in which one can see the exact margins and
extent of the lesion. Unilocular means having one compartment or unit that is well defined (as in a radicular cyst). Diffuse describes
a lesion with borders that are not well defined. Multilocular lesions are described radiographically as resembling “soap bubbles”
(i.e., a lesion with many lobes beyond the confines of one distinct area).

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 5

OBJ: 1

26. Fordyce granules

a. are ectopic sebaceous glands.
b. are seen on the dorsal surface of the tongue.
c. require antibiotic treatment.
d. are lesions that require biopsy for diagnosis.
ANS: A
Fordyce granules are ectopic sebaceous glands. Fordyce granules are seen on the buccal and labial mucosa, not the dorsal tongue.
Fordyce granules require no treatment. Fordyce granules are diagnosed through clinical appearance. Biopsy is not necessary.

REF: Fordyce Granules, page 20 OBJ: 4

Copyright © 2017, by Elsevier, Inc. All rights reserved. 5

 27. The base of this lesion is correctly described as
a. pedunculated.
b. lobule.
c. bulla.
d. sessile.
ANS: D
The base of this lesion is sessile, or broad and flat. A pedunculated lesion has a stemlike base similar to that of a mushroom stem. A
lobule is a segment or lobe that is part of the whole. A bulla usually contains serous fluid and looks like a blister.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, Fig. 1.5, A, pages 1, 3
OBJ: 1

28. This torus palatinus is correctly described as

a. bullous.
b. papular.
c. lobulated.
d. nodular.
ANS: C
This torus palatinus is lobulated (i.e., lobes that are fused together). Bullous lesions contain serous fluid and resemble blisters. A
papule is a soft tissue lesion that is elevated above the surface of normal surrounding tissue. A nodule is a palpable solid lesion
found in soft tissue.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, Fig. 1.1, pages 1, 2
OBJ: 1

29. Another term for an amalgam tattoo is a

a. melanoma.
b. focal argyrosis.
c. nevus.
d. multiple myeloma.
ANS: B
Focal argyrosis is a synonym for amalgam tattoo. A melanoma is a malignant tumor. A nevus is a benign overgrowth of
melanocytes. Multiple myeloma is a malignant proliferation of plasma cells.

REF: Clinical Diagnosis, page 7 OBJ: 2

30. Which finding is not apparent in leukoedema?

a. Intracellular edema in the spinous cells
b. Acanthosis of the epithelium
c. Generalized opalescence of the buccal mucosa
d. A white diffuse material on the buccal mucosa that can be wiped off
ANS: D
A white diffuse material that can be wiped off is significant in diagnosing pseudomembranous candidiasis. Intracellular edema in
the spinous cells is found in leukoedema. Acanthosis of the epithelium is found in leukoedema. Generalized opalescence of the
buccal mucosa is seen in leukoedema.

REF: Leukoedema, page 23 OBJ: 8

31. Which term best describes an elevated, 5-mm soft tissue lesion containing serous fluid?
a. Macule
b. Vesicle
c. Lobule
d. Pustule
ANS: B
A vesicle is a small (less than 1 cm in diameter), elevated lesion that contains serous fluid. A macule is a flat area usually
distinguished by a color different from the surrounding tissue. A lobule is described as a segment or lobe that is part of a whole. A
pustule is a circumscribed elevation containing pus.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

32. A lesion with a pedunculated base is best described as

a. an ulcer.
b. stemlike.
c. pallor.
d. broad and flat.
ANS: B
A stemlike lesion is referred to as pedunculated. An ulcer is a break in the surface epithelium. Pallor is a paleness of the skin or
mucosal tissues. Broad and flat describes the base of a sessile lesion.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

Copyright © 2017, by Elsevier, Inc. All rights reserved. 6

 33. The following lesions can be identified radiographically except one. Which one is the exception?
a. Root resorption
b. Fordyce granules
c. Interproximal dental caries
d. Compound odontoma
ANS: B
Fordyce granules are yellow clusters of ectopic sebaceous glands that are diagnosed through clinical appearance. Root resorption is
identified radiographically when the apex of the tooth appears shortened or blunted. Interproximal dental caries are seen as
radiographic radiolucencies. A compound odontoma is initially identified radiographically as a radiopaque area in which tooth
structure can be identified.

REF: Clinical Diagnosis, page 7 | Fordyce Granules, page 20 OBJ: 3

34. These reddish-purple clusters observed on the ventral surface of the tongue and diagnosed through clinical observation are referred
to as which variants of normal conditions?
a. Palatal cyst
b. Mandibular tori
c. Lingual varicosities
d. Ranula
ANS: C
Lingual varicosities are prominent lingual veins usually observed on the ventral and lateral surfaces of the tongue. A palatal cyst is
radiolucent and not diagnosed through clinical appearance. Mandibular tori are outgrowths of hard dense bone and found on the
lingual aspect of the mandible. Ranula is a term used to describe a mucocele-like lesion that forms unilaterally on the floor of the
mouth.

REF: Lingual Varicosities, page 22 OBJ: 4

35. An elevated serum alkaline phosphate level, significant in the diagnosis of Paget disease, is determined from which diagnostic
category?
a. Laboratory
b. Therapeutic
c. Clinical
d. Surgical
ANS: A
Laboratory tests, including blood chemistries, can provide information that contributes to a diagnosis. Therapeutic testing applies
the principle of diagnosis based on clinical and historical information with confirmation by the response of the condition to therapy.
Clinical diagnosis suggests that the strength of the diagnosis comes from the clinical appearance of the lesion. Surgical diagnosis is
based on information about a lesion gained during surgical intervention.

REF: Laboratory Diagnosis, page 16 OBJ: 2

36. The following conditions most likely respond to therapeutic diagnosis except one. Which one is the exception?
a. Angular cheilitis
b. Necrotizing ulcerative gingivitis
c. Nutritional deficiencies
d. Stafne bone cyst
ANS: D
Stafne bone cyst, in which entrapped salivary gland tissue is identified, is diagnosed through surgical examination. Angular
cheilitis commonly responds to antifungal therapy once nutritional deficiencies have been ruled out. Necrotizing ulcerative
gingivitis responds to hydrogen peroxide rinses. Nutritional deficiencies are common conditions diagnosed by therapeutic means.

REF: Surgical Diagnosis, page 18 OBJ: 3

37. The variant of normal coloration seen on the mandibular gingival surface is termed
a. lingual varicosities.
b. leukoedema.
c. melanin pigmentation.
d. linea alba.
ANS: C
Melanin pigmentation is most commonly seen in dark-skinned individuals and gives color to the oral mucosa and gingiva. Lingual
varicosities are prominent lingual veins observed on the ventral and lateral surfaces of the tongue. Leukoedema is a generalized
opalescence imparted to the buccal mucosa. Linea alba is a white line that extends anteroposteriorly on the buccal mucosa along the
occlusal plane of the teeth.

REF: Melanin Pigmentation, Fig. 1.50, pages 21-22 OBJ: 6

Copyright © 2017, by Elsevier, Inc. All rights reserved. 7

 38. A white lesion that cannot be rubbed off and cannot be diagnosed on the basis of clinical characteristics alone is termed
a. leukoplakia.
b. dentinogenesis imperfecta.
c. erythroplakia.
d. squamous cell carcinoma.
ANS: A
Leukoplakia is a clinical term for a white lesion that cannot be rubbed off and cannot be diagnosed on the basis of clinical
characteristics alone. Dentinogenesis imperfecta is a genetic condition involving a defect in the development of dentin.
Erythroplakia is a clinical term for a red lesion that cannot be diagnosed on the basis of clinical features alone. Squamous cell
carcinoma is diagnosed by microscopic evaluation and does not refer to all white lesions that cannot be rubbed off.

REF: Microscopic Diagnosis, page 18 OBJ: 9

39. The radiographic appearance of a simple radicular cyst is best described as

a. coalescence.
b. diffuse.
c. multilocular.
d. unilocular.
ANS: D
Unilocular means having one compartment or unit that is well defined. This term is often used to describe a radicular cyst.
Coalescence refers to the process by which parts of a whole join together, or fuse, to make one. Diffuse describes a lesion with
ill-defined borders, making it impossible to detect the exact parameters of the lesion. A multilocular lesion has also been described
as “soap bubble”–like; the lobes appear to fuse together to make up the lesion.

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, Fig. 1.13, pages 5, 6
OBJ: 1

40. A pathologic lesion found frequently in 30-year-old black women that requires a radiographic image and historical data for
diagnosis is termed
a. verrucous vulgaris.
b. necrotizing ulcerative gingivitis.
c. periapical cemento-osseous dysplasia.
d. amalgam tattoo.
ANS: C
Periapical cemento-osseous dysplasia requires a radiograph, specific patient history, and a pulp test to evaluate tooth vitality. It is
frequently found in black women in the third decade of life. Verrucous vulgaris is diagnosed on the basis of its clinical and
microscopic appearance and does not require a radiograph. Necrotizing ulcerative gingivitis requires clinical and historical data for
diagnosis and does not require a radiograph. An amalgam tattoo relies on clinical and historical data for diagnosis and does not
require a radiograph.

REF: Historical Diagnosis, page 16 OBJ: 5

41. Leukoedema is a generalized opalescence appearing on the buccal mucosa; linea alba is a dark pigmented line appearing on the
buccal mucosa.
a. Both statements are true.
b. Both statements are false.
c. The first statement is true, and the second statement is false.
d. The first statement is false, and the second statement is true.
ANS: C
The first statement is true, and the second statement is false. Leukoedema is a generalized opalescence appearing on the buccal
mucosa, as stated, but linea alba is not a dark pigmented line. The statement that leukoedema is a generalized opalescence
appearing on the buccal mucosa is true; the statement that linea alba is a dark pigmented line is false. (Linea alba is a white line.)
Leukoedema is a generalized opalescence appearing on the buccal mucosa, but linea alba is not a dark pigmented line.

REF: Leukoedema, Fig. 1.54, page 23 | Linea Alba, Fig. 1.53, page 23
OBJ: 8

42. Each condition is considered a variant of normal except one. Which is the exception?
a. Melanin pigmentation
b. Linea alba
c. Geographic tongue
d. Retrocuspid papilla
ANS: C
Geographic tongue is characterized by diffuse areas devoid of filiform papillae. It is not a variant of normal. Melanin pigmentation
is commonly seen in dark-skinned individuals and is considered a variant of normal. Linea alba is located on the buccal mucosa
along the occlusal plane. It is most prominent in patients who have a clenching or bruxism habit. It is so common that it is
considered a variant of normal. Retrocuspid papilla is a sessile nodule on the gingival margin of the lingual aspect of the
mandibular cuspids and is considered a variant of normal.

REF: Geographic Tongue, page 24 | Variants of Normal, pages 20-23

OBJ: 6

Copyright © 2017, by Elsevier, Inc. All rights reserved. 8

 43. The term erythroplakia is best used in which context?
a. Microscopic
b. Laboratory
c. Surgical
d. Clinical
ANS: D
Erythroplakia is a descriptive clinical term for a red lesion. Microscopic diagnosis requires a biopsy. Laboratory diagnosis involves
the use of clinical laboratory tests, including blood chemistries and urinalysis. Surgical diagnosis requires surgical i ntervention.

REF: Vocabulary, Color of Lesion, page 2 OBJ: 9

44. The pathologic lesion seen on the dorsal surface of the tongue is characteristic of
a. fissured tongue.
b. hairy tongue.
c. median rhomboid glossitis.
d. migratory glossitis.
ANS: C
Median rhomboid glossitis appears as a flat or slightly raised oval or rectangular erythematous area in the midline of the dorsal
surface of the tongue. Fissured tongue is characterized by deep fissures or grooves. Hairy tongue has the appearance of white,
elongated filiform papillae. Migratory glossitis is another name for geographic tongue and appears as patches on the lateral and
dorsal surfaces of the tongue.

REF: Median Rhomboid Glossitis, page 23 | Fig. 1.20, page 8 OBJ: 7

45. Each condition is considered benign and of unknown cause except one. Which one is the exception?
a. Hairy tongue
b. Amelogenesis imperfecta
c. Migratory glossitis
d. Fissured tongue
ANS: B
Amelogenesis imperfecta represents a group of inherited conditions affecting the enamel of teeth. Hairy tongue is a benign
condition of unknown cause. Migratory glossitis is a benign condition of unknown cause. Fissured tongue is a benign condition of
unknown cause.

REF: Historical Diagnosis, page 15 OBJ: 7

46. A medical history of a patient prescribed a calcium channel blocker may reveal which condition?
a. Gingival enlargement
b. Cementoma
c. Paget disease
d. Ulcerative colitis
ANS: A
A patient taking a calcium channel blocker may exhibit gingival enlargement. A cementoma is not a result of a patient taking a
calcium channel blocker. An elevated serum alkaline phosphatase level is significant for Paget disease but not for use of a calcium
channel blocker. Ulcerative colitis may contribute to oral lesions but not gingival enlargement.

REF: Historical Diagnosis, Fig. 1.38, B, pages 16, 17 OBJ: 3

47. Urticaria is an example of a(n)

a. genetic disorder.
b. developmental disturbance.
c. immediate response to an allergen.
d. immunodeficiency response.
ANS: C
Urticaria is an immediate response to an allergen. Urticaria is not the result of a genetic disorder. Urticaria is not the result of a
developmental disturbance. Urticaria is not a result of immunodeficiency.

REF: Historical Diagnosis, page 16 OBJ: 3

48. Which term describes a lesion in which parts of a whole are joined together, or fused, to make one?
a. Fissured
b. Coalescence
c. Diffuse
d. Multilocular
ANS: B
Coalescence describes the process by which parts of a whole join together, or fuse, to make one. Fissured describes a cleft or
groove, normal or otherwise, showing prominent depth. Diffuse describes a lesion with borders that are not well defined.
Multilocular lesions are described radiographically as “soap bubbles” (i.e., a lesion with many lobes beyond the confines of one
distinct area).

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 3

OBJ: 1

Copyright © 2017, by Elsevier, Inc. All rights reserved. 9

 49. While obtaining diagnostic information from a patient, the dental hygienist learns that the appearance of this patient’s teeth is
familial. The correct diagnosis is
a. tetracycline staining.
b. pulpal dysplasia.
c. extrinsic staining.
d. dentinogenesis imperfecta.
ANS: D
Dentinogenesis imperfecta is a pathologic condition in which the family history plays a significant role in the diagnosis.
Tetracycline staining is not a familial condition. Pulpal dysplasia is not a pathologic familial condition. Extrinsic staining is not a
familial condition.

REF: Historical Diagnosis, Fig. 1.37, pages 15, 16 OBJ: 3

50. The eight categories that provide information leading to a definitive diagnosis are as follows: microscopic, clinical, laboratory,
surgical, differential findings, radiographic, therapeutic, and
a. etiology.
b. historical.
c. chief complaint.
d. treatment.
ANS: B
Historical information reveals past experiences that may be relevant to the diagnosis. Etiology is not a component of the definitive
or final diagnosis. The chief complaint may be helpful in understanding the patient’s perspective but is not considered a diagnostic
tool. Treatment is decided after the definitive or final diagnosis is made, and it is not part of the information leading to the
diagnosis.

REF: Making a Diagnosis, page 6 OBJ: 3

51. What is the radiographic appearance of periapical cemento-osseous dysplasia in its earliest stage?
a. Radiolucent
b. Radiopaque
c. Radiolucent and radiopaque
d. Cotton-wool radiolucencies
ANS: A
In stage I of periapical cemento-osseous dysplasia, the appearance is radiolucent. Radiopacities are not seen in the early stage of
perioapical cemento-osseous dysplasia. In stage II, the appearance is radiolucent and radiopaque. Cotton-wool radiopacities are
seen in patients with Paget disease.

REF: Vocabulary, Radiographic Terms Used to Describe Lesions in Bone, page 3

OBJ: 5

52. All conditions are associated with lingual varicosities except one. Which is the exception?
a. Red to purple enlarged vessels
b. May be associated with varicosities in the legs
c. Age-related condition
d. May swell during eating
ANS: D
Lingual varicosities do not swell during the eating process. Red to purple enlarged vessels are seen with lingual varicosities.
Lingual varicosities may be associated with varicosities in the legs. Lingual varicosities are considered an age-related condition,
often seen in individuals over the age of 60.

REF: Variants of Normal, pages 22-23 OBJ: 4

53. Various sizes of circumscribed elevations that contain pus are termed
a. vesicles.
b. pustules.
c. papules
d. lobules
ANS: B
Pustules are variously sized circumscribed elevations containing pus. Vesicles are elevated lesions that contain serous fluid.
Papules are elevated lesions that protrude above the surface of normal surrounding tissue. Lobules are segments or lobes that are
part of the whole.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

54. Studies have linked the presence of a lingual thyroid in association with the following life events except one. Which is the
exception?
a. Pregnancy
b. Infancy
c. Menopause
d. Puberty
ANS: B
Infancy is not associated with the presence of a lingual thyroid. The emergence of a lingual thyroid is linked to hormonal changes,
such as pregnancy. The emergence of a lingual thyroid is linked to hormonal changes, such as menopause. The emergence of a
lingual thyroid is linked to hormonal changes, such as puberty.

REF: Benign Conditions of Unknown Cause, page 23 OBJ: 11

Copyright © 2017, by Elsevier, Inc. All rights reserved. 10

 55. The lingual thyroid is most often found in which intraoral location?
a. Posterior to the circumvallate papillae in the midline of the tongue
b. Along the occlusal plane on the buccal mucosa
c. At the junction of the hard and soft palate
d. At the labial commissures
ANS: A
The lingual thyroid is seen as a mass in the midline of the dorsal surface of the tongue, posterior to the circumvallate papillae. The
lingual thyroid is not seen on the buccal mucosa. The lingual thyroid is not found at the junction of the hard and soft palate. The
lingual thyroid is not found at the labial commissures.

REF: Benign Conditions of Unknown Cause, page 23 OBJ: 11

56. Your patient is diagnosed with a lingual thyroid. What is the next step on the treatment plan?
a. Biopsy
b. Surgical removal
c. Thyroid scan
d. Radiographic evaluation
ANS: C
A thyroid scan should be performed to determine if the thyroid gland is functioning normally. A biopsy is not needed for a lingual
thyroid because it is composed of normal thyroid tissue. Surgical removal is not recommended since this may represent the
patient’s functioning thyroid. Radiographic evaluation is not helpful in the confirmation of a lingual thyroid.

REF: Benign Conditions of Unknown Cause, page 23 OBJ: 11

57. Because of its size and location, patients with a lingual thyroid may complain of
a. dysphagia.
b. gingival inflammation.
c. intraoral ulcers.
d. tooth erosion.
ANS: A
Clinical symptoms of lingual thyroid can include dysphagia, or difficulty swallowing, because of the mass located at the posterior
dorsal surface of the tongue. Gingival inflammation is not associated with patients with a lingual thyroid. Intraoral ulcers are not
associated with patients with a lingual thyroid. Tooth erosion is not associated with patients with a lingual thyroid.

REF: Benign Conditions of Unknown Cause, page 23 OBJ: 11

58. Where is the common intraoral location for leukoedema?

a. Lateral borders of the tongue
b. Soft palate and uvula
c. Floor of the mouth
d. Buccal mucosa
ANS: D
A generalized opalescence is imparted to the buccal mucosa in leukoedema. Leukoedema is not evident on the lateral borders of the
tongue. The soft palate and uvula is not a location to find leukoedema. The floor of the mouth is not a location to see leukoedema.

REF: Variants of Normal, page 23 OBJ: 8

59. The human papillomavirus (HPV) is associated with what condition?

a. Thrush
b. Tuberculosis
c. Verruca vulgaris
d. Herpangina
ANS: C
Verruca vulgaris (the common wart) is caused by a low-risk type of the human papillomavirus. Thrush, or pseudomembranous
candidiasis, is a superficial fungal infection seen in the oral cavity. Tuberculosis is a bacterial infection caused by inhalation of
airborne droplets from someone with active disease. Herpangina is caused by a coxsackie virus and is characterized by fever, sore
throat and oral lesions.

REF: Microscopic Diagnosis, page 18 OBJ: 10

60. A “white” hairy tongue indicates an increase in the amount of

a. keratin.
b. medications.
c. fluoride use.
d. HPV circulating in the blood.
ANS: A
The increased amount of keratin on the filiform papillae gives the tongue a white appearance. Medications may affect the surface of
the tongue but generally do not produce a white color. Fluoride use does not cause a “white” hairy tongue. The presence of the
HPV does not cause a “white” hairy tongue.

REF: Benign Conditions of Unknown Cause, page 24 OBJ: 7

Copyright © 2017, by Elsevier, Inc. All rights reserved. 11

 61. Benign migratory glossitis is a condition that does not remain static. What does this statement mean?
a. A variety of over-the-counter treatments are available for this condition.
b. Surgical intervention may be required.
c. Remission and changes in the surface of the tongue occur.
d. An intraoral habit is responsible for this condition.
ANS: C
Benign migratory glossitis (geographic tongue) is a condition that does not stay the same over time; remission and changes in the
surface of the tongue occur. A condition that does not remain static does not refer to treatment protocol. A condition that does not
remain static does not refer to treatment protocol. Intraoral habits are not related to benign migratory glossitis.

REF: Benign Conditions of Unknown Cause, page 24 OBJ: 7

62. Which statement about a palatal torus is true?

a. A palatal torus is symptomatic.
b. A palatal torus appears as a radiolucent mass on a radiograph.
c. Palatal tori are typically bilateral, seen along the lingual side of the maxilla.
d. Palatal tori are inherited.
ANS: D
Palatal tori are inherited. Palatal tori are asymptomatic. A palatal torus appears as a radiopaque mass on a radiograph. Palatal tori
can take on various shapes and sizes yet occur in the midline of the palate.

REF: Variants of Normal, page 21 OBJ: 4

63. Serous fluid can typically be found in which lesion?

a. Bulla
b. Lobule
c. Macule
d. Papule
ANS: A
Bullae are circumscribed, elevated lesions that usually contain serous fluid and resemble a blister. Lobules are segments or lobes
that are part of a whole. Macules are areas distinguished by a different color than the surrounding tissue. Papules are small,
circumscribed lesions that protrude above the surface.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

64. Which term describes a lesion that displays a color different from surrounding tissue?
a. Bulla
b. Lobule
c. Macule
d. Papule
ANS: C
Macules are areas distinguished by a different color than the surrounding tissue. Bullae are circumscribed, elevated lesions that
usually contain serous fluid and resemble a blister. Lobules are segments or lobes that are part of a whole. Papules are small,
circumscribed lesions that protrude above the surface.

REF: Vocabulary, Clinical Appearance of Soft Tissue Lesions, page 1

OBJ: 1

65. Trying to establish the correct number of primary and permanent teeth present in a 7-year-old child may best be accomplished by
which diagnostic component?
a. Clinical
b. Historical
c. Radiographic
d. Differential
ANS: C
A radiographic examination including intraoral and extraoral images would provide sufficient information to establish the correct
number of teeth present. The clinical diagnosis would be adequate to view only the erupted teeth, not the unerupted permanent
teeth. Some historical data might be helpful in this case but would not be considered the best diagnostic component. Enough
information should be present in the clinical and radiographic examinations that a differential diagnosis is not necessary.

REF: Making a Diagnosis, page 9 OBJ: 3

Copyright © 2017, by Elsevier, Inc. All rights reserved. 12

Another random document with
no related content on Scribd:
Hevosetkin olivat tämmöiseen kulkuun tottuneet ja astuivat ripeästi
eteen päin hoputusta tarvitsematta.

Iloisella mielellä matkasivat miehet kotiinpäin. Matkaa uurastettiin

yötä ja päivää. Yhdessä jaksossa kuljettiin aina pari peninkulmaa,
sitten lepuutettiin ja syötettiin hevosia joitakuita tuntia ja sitten taas
jatkettiin matkaa, ja niin tehtiin yhtämittaa, huolimatta siitä oliko yö
vai päivä. Antti iloitsi hevosestaan ja moneen kertaan hän ihmetteli,
mitä kotiväki nyt sanoisi. Hänen uusi hevosensa näyttäytyi todellakin
hyväksi hevoseksi. Tyytyväisenä se veti kuormaansa, astellen niin
joutuisasti eteenpäin, että miehet saivat ravakasti jäljestä astua
yhdessä pysyäkseen.

Sitä myöten kun he lähestyivät kotiseutua, kävivät he

varovammiksi. Kaikilta, joita tavattiin, tiedusteltiin, oliko
rajantakalaisia nähty liikkeellä. Hetkeksikään ei antauduttu
huolettomaan, rauhalliseen kulkuun, vaan aina oli huomiokyky
täysissä vireissä. Tarkoin huomattiin jokainen outo ääni, eikä
rauhoituttu, ennenkuin oli päästy selville, mistä mikin kolina ja
risahdus aiheutui. Ei myöskään koskaan levätty maantien vieressä,
vaan poikettiin vähän kauemmas johonkin tiheään pensaikkoon tai
muuhun turvalliseen paikkaan. Kun lähestyttiin omaa pitäjää,
poikettiin pois valtatieltä. Syrjäkylien kautta, metsäpolkuja kierrettiin
eteenpäin. Vaikka matka siten kävikin hankalammaksi ja vei
enemmän aikaa, ei Yrjö tahtonut laiminlyödä mitään
varovaisuuskeinoa, ettei kallis viljanhankinta-retki menisi tällä kertaa
hukkaan. Heidän oli saatava suuri kaski kylvetyksi, oli päästävä
leivästä elämään. Sen hän oli maalikseen pannut eikä hän tahtonut
jättää mitään keinoa käyttämättä, sen saavuttamiseksi. Siten
saivatkin he onnellisesti kaikki vaarat vältetyksi, kalliin saaliinsa
turvaan saatetuksi.
 Kun tultiin lähelle oman pitäjän kirkonkylää, oli vieras hevonen
vietävä pois. Viljasäkit ja muu tavara kätkettiin näreikköön
Mustankorven laitaan. Antti jäi läheistölle vartioimaan ja Yrjö meni
vierasta hevosta pois viemään. Puolen päivän perästä palasi Yrjö
takaisin ja päästiin kulkemaan viimeistä taivalta kotia kohti. Purit
hylättiin tähän, koska loppumatkalla kulku oli kovin huonoa, oli
suoportaita, oli huononpäiväisiä siltoja purojen yli. Noin neljäs osa
tavaroista sälytettiin hevosen selkään, muu oli perästä päin haettava.

Ilosin mielin lähdettiin viimeistä taivalta kulkemaan. Jos Yrjöllä ja

Antilla oli ollut syytä iloita hevoskauppansa johdosta, niin nyt se
vasta näyttäytyi, että Nopsa se oli oikea hevonen heille.
Kärsivällisenä ja iloisena se oli nopein askelin astellut teitä ja vetänyt
purikuormaa perästään. Nyt se vakavasti kantoi raskasta taakkaa
selässään, tynnörin ruista ja vielä vähän muuta tavaraa. Olisihan sen
kuorman kantanut muukin hevonen hyvällä tiellä, tasaisella
metsäpolulla.

Mutta pian tultiin suolle, siihen oli tehty kapulasilta, halottuja

mäntypölkkyjä oli pantu poikittain kahden pitkittäin asetetun riu'un
päälle. Aikojen kuluessa olivat puut lahonneet ja osalta suohon
painuneet. Musta suomilta oli noussut niiden päälle. Kun Nopsa tuli
sellaiseen paikkaan, käsitti se varsin hyvin sillan rakenteen ja
kulkupaikan vaikeuden. Se astui varovaisesti eteenpäin. Ja missä
silta oli suohon painunut, siinä koetteli se varovaisesti jalallaan,
ennenkuin polki. Jos puu oli siltä kohti lahonnut pilalle, etsi se toisen
lujemman paikan. Kun se näin varovaisesti kulki, ei se kertaakaan
polkenut harhaan, ei kertaakaan jalka pehmeään uponnut.

Menihän se tämmöinen matka vielä. Verrattain turvallista ja

mukavaa oli kapulasiltaa myöten kulkeminen. Mutta kapulasiltoja ei
pitkälle riittänyt. Kapulasiltatie kääntyi kohta luoteiseen, vanhoille
kalastus- ja karjamökeille. Ahmavaaralaisten oli käännyttävä
koilliseen asunnottomille aloille. Hevosella ei sinne oltu koskaan
kuljettu. Oli soita kierreltävä, mutkia tehtävä, vähän kovempia maita
etsittävä. Oli sentään osalta tientapaista vielä nytkin. Oli pitkinpäin
suon yli pantu kaksi riukua rinnan ja, missä ei ollut, siihen pantiin.
Omituista oli, että siitäkin osasi Nopsa kulkea, pitkin riu'un selkää.
Pienen puron yli oli huononpäiväinen sillan tapainen. Kivien varaan
oli asetettu kaksi hirttä rinnan. Siitäkin Nopsa pääsi, kiviröykkiön yli
kulki, hirsille kiipesi ja niitä myöten meni puron yli. Jalat viisas
hevonen sovitti hirsien väliseen rakoon, kavioitaan sisäänpäin
kallistellen. Tämmöisissä vaikeissa paikoissa ei sitä ohjattu eikä
neuvottu. Antti kulki edellä ikäänkuin tietä osoittaen. Nopsa seurasi
vapaana perästä, itse katsoen ja suunnitellen, mistä ja miten
paraiten pääsisi kulkemaan. Ihmeissään oli Antti, kun näki tämän
Nopsan kulun, ei olisi ihminen sen ymmärtävämmin ja taitavammin
voinut siitä mennä.

Ennenkuin perille päästiin, oli vielä mentävä joesta yli. Pieni lautta
kyhättiin vitsaksilla yhteen nivotuista pölkyistä, sillä vietiin tavarat yli,
Nopsa seurasi perästä uiden.

Tämä varovainen ja hankala kulkutapa vei paljon aikaa. Mutta

perille viimeinkin tultiin. Kaikkiaan oli matkalla viivytty kaksitoista
päivää, kun vihdoinkin kiivettiin Ahmavaaran rinnettä ylös. Ylpeänä
ja iloisena talutti Antti hevostaan kodin aukeamalle, Hermin hurjasti
haukkuessa ilosta nähdessään isäntänsä palaavan pitkältä matkalta,
mutta ihmeissään kun niin outo olento, kuin hevonen, oli eksynyt
rauhalliseen saloon. Hermin haukunta houkutteli muun väen ulos.
 "Kenen hevosella te noita säkkejä kuljetatte", ehätti Olli
ensimäiseksi sanomaan.

"Saittepahan siementä", sanoi Jaakko.

Mutta vanha Liisa arveli: "No nyt minäkin alan uskoa, että loppuu
tämä metsäläisten elämä viimeinkin. Ehkäpä Jumala siunaa meidän
työmme, antaa siemenestä sadon ja suo meille rukiisen leivän
jokapäiväiseksi ravinnoksemme."

"Ehkäpä antaa, ehkäpä antaa", sanoi Yrjö, "siinä on yksi kuorma,

kolme kuormallista tavaraa on meillä vielä kätkössä Mustankorven
reunassa, ne ovat sieltä haettavat. Nyt on meillä siementä, ehkäpä
Jumala kasvun antaa."

"Mutta eikö se ole kaunis, ja se on oikein meidän oma", selitteli

Antti kesken muiden puhetta, hevostaan näytellen. "Ja se on niin
viisas. Olisittepa nähneet miten se meni hirsiporrasta myöten puron
yli."

"Onko se meidän? Mistä se on saatu? Oikeinko se tänne jääpi? Ja

osaako sillä ratsastaa?" kyseli Olli.

"Meidän se on. Yrjö osti sen Sallisten talosta Havuvaaralta. Ja se

on niin sukkela astumaankin."

Vielä kesti toista viikkoa, ennenkuin kaikki tavarat oli kotiin tuotu.
Yhden retken tekivät niitä hakemaan Yrjö ja Olli, toisen ja kolmannen
Jaakko ja Olli. Menomatkan sai Olli ratsastaa ja se oli hänelle hyvin
mieleen. — Kolme viikkoa oli mennyt siemenen hankkimispuuhassa.
Monien peninkulmien takaa sitä oli haettu, halki melkoisen osan
Karjalaa oli kuljettu. Paljon oli vaivaa nähty ja poikien perintö oli
kätköstään kaivettu esille ja oli maksuksi käytetty. Ei ollut kartettu
mitään uhrausta, ei mitään vaivaa. Ja niin oli saavutettu se, mitä oli
tahdottu. — Viisi tynnöriä ruista ja hevonen. Eihän se meidän ajan
mitalla paljon ollut. Mutta sen ajan oloihin nähden se oli avain uuteen
elämään. Nyt voitiin suuri kaski kylvää. Voitiin huoletta työtä jatkaa.

Mutta pojilla oli ainainen ilo Nopsasta. He sitä kilvan hoitivat, sitä
syöttivät ja juottivat. Ja vuoron perään ajoivat selässä, kun
kaskimaalle mentiin rankoja vetämään tai joen varrelle heiniä
kokoamaan. Ikävä vain, että oli niin huonoa ruokaa hevoselle
annettavana. Heinää kesällä vielä oli, kun se sitä sai hakea vapaasti
metsästä, mistä itse halusi, mutta talven varaksi sitä korjattiin soitten
varsilta ja jokien, ja se oli enimmäkseen saraheinää. Jos olisi ollut
viljaa antaa, joka tämmöisille keveille, sitkeille, jänterille hevosille on
omansa, mutta ei Nopsa parka monta kertaa viljan makuun päässyt,
eihän sitä Ahmavaaralla vielä ollut ihmisillekään.

Kerran kun Olli kaskimaan reunalla söi evästään kuivaa kalaa, ja

Nopsa haukkaili heiniä hänen vieressään, ojensi hän leikin vuoksi
kalaa Nopsalle. Hänen ihmeekseen haukkasi Nopsa ison palan ja
söi sen mielikseen. Sen jälkeen sille usein annettiin vaihteeksi
kuivaa kalaa, etenkin milloin sitä oli syötettävä pelkällä suoheinällä.

*****

Hyvissä ajoin syyskesästä kylvettiin kaski, sinne kätkettiin

nokiseen maahan siemen, niin monen vaivan takaa hankittu siemen.
Syksyllä kaunis, kirkkaan vihanta oras ilahdutti uutisasukkaiden
mieltä. Laajan huuhdan verhosi heleällä vaipallaan, peitti mustan
maan, vain nokisia kantoja törrötti tiheässä sen keskeltä. Toivorikkain
mielin lähdettiin uutta talvea kohti, ikävöimään kevättä ja kesää. Yksi
vuosi oli vielä elettävä vesien ja metsän riistalla.
KUUDESTOISTA LUKU.

Ruis lainehtii.

Oli Juhannuksen aika, sunnuntaipäivä. Aamiaisen syötyä lähti Yrjö

ulos kävelemään. Luonto säteili alkukesän heleässä kirkkaudessa.
Koivujen lehdet kimaltelivat loistavan vihreinä auringon paisteessa.
Yrjö ei kuitenkaan sitä ajatellut, vaan suuntasi kulkunsa
kaskesmaalle samaa polkua, jota hän viime vuosina niin usein oli
kulkenut. Noustuaan harjanteen yli ja kuljettuaan rinnettä alas ja taas
toista ylös tuli hän suurelle aukealle metsän keskellä. Siinä oli vielä
muutamia vuosia sitten kasvanut koskematon metsä, suuria
lakkapäähonkia, tuuheaoksaisia kuusia ja koivuja, joilla oli rungot
täysiä hirsiä. Nyt oli metsä poissa ja sen sijalla aaltoili viheriä laiho.

Sitä pysähtyi nyt Yrjö katsomaan. Vienossa tuulessa aaltoili laaja

pelto. Rukiin oras alkoi tähkää tehdä. Tasapitkä, rehevä laiho heloitti
rehevimmillään. Tuulenhenki synnytti harmahtavan aallon, joka kiiti
yli viheriän selänteen. Toinen, kolmas harmahtava aalto seurasi
perästä. Nyt aaltoili koko laaja laiho. Yrjöstä tuntui siltä, että se oli
kauneinta, mitä hän eläissään oli nähnyt.
 Ilma oli lämmin. Routa oli jo kauan sitten lähtenyt maasta, kevät oli
ollut aikainen. Kevätkesän halloja ei enää tarvinnut pelätä. Varmasti
voi toivoa hyvää satoa. Ja Yrjö ajatteli sitä kiirettä, mikä heille tulisi,
kun syksyllä suuri ruispelto oli leikattava. Ja sitten päästäisiin
vihdoinkin uutisen makuun. Käsikivet oli hän jo viime talvena
varustanut. Niillä oli vilja kotona jauhettava.

Nyt oli siis saavutettu se maali, jota varten he olivat koko ajan
työtä tehneet. Ahmavaaran rinteelle oli jo kohonnut muutamia taloja
ja tässä aaltoili suuri pelto. Ensi talvena voi koko siirtola elää
rukiisella leivällä. Karjan alku oli heillä myös. Tästedes he voivat elää
maanviljelyksen ja karjanhoidon turvissa. Tästä se alkoi säännöllinen
elämä.

Luonnossa vallitsi rauha. Rauha vallitsi Yrjön mielessä.

Sunnuntaista ei täällä salolla oltu paljon tiedetty. Kirkossa ei oltu
vuosiin käyty. Koko uskonnollinen elämä oli vähiin kuivunut. Mutta
nyt tuli Yrjön mieleen outo sunnuntai-rauha. Vuosiin ei hän
semmoista ollut tuntenut. Hänelle juohtui mieleen menneet ajat,
jolloin hän nuoren vaimonsa kanssa oli käynyt kirkossa vihillä. Se oli
ollut tämmöinen kaunis, kesäinen sunnuntaipäivä kuin tämäkin.
Aurinko oli paistanut pilvettömältä taivaalta, kun he hiljalleen olivat
astelleet kirkolta ruisoraan aaltoillessa läheisillä pelloilla ja kirkon
kellojen juhlallisesti kumahdellessa.

Sama mieliala lienee muihin tarttunut. Tuolta tulivat Liisa ja Kerttu,

Jaakko ja Anni ja heidän kintereillään pikku Jaakko, tulivat Antti ja
Olli, Yrjön ystävän pojat. Tallella olivat orvot, miehiksi alkoivat
varttua, kodittomilla oli nyt koti, leivättömillä oli leipää. Eikä
vainolainenkaan ollut koskaan tänne löytänyt suurten soitten taa,
suurelle suosaarekkeelle suuressa suomeressä. Tallella olivat kaikki,
varttuneet ja edistyneet. Yrjö oli pitänyt lupauksensa, oli uuden,
turvallisen kodin rakentanut ystäviensä perheille.

Kaikki Ahmavaaralaiset tulivat Yrjön luo. Yhdessä he ihailivat

ruispeltoaan. Hiljalleen kävelivät pellon reunaa. Aina pysähtyivät ja
katselivat. Ja heidätkin valtasi sama sunnuntai-rauha.

"Pitäisi mennä kirkkoon Jumalaa kiittämään kaikesta siitä hyvästä,

mitä hän on meille antanut", sanoi Liisa.

"Kiittäkäämme Jumalaa täällä, missä nyt olemme", sanoi Yrjö.

Mutta pikku Kerttu sanoi: "Minusta tuntuu, niinkuin täällä olisikin

kirkko."

Ja rukiin oras aaltoili hiljalleen kesän vienossa tuulessa.

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