Chapter 08: Nonneoplastic Diseases of Bone

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

Multiple Choice

1. Which statement is true of periapical cemento-osseous dysplasia?

a. It is a neoplasm.

b. The lesion is painful and occurs most often in the posterior maxilla.

c. Teeth in the area are usually not vital.

d. Older lesions are primarily radiopaque.

ANS: D

Early lesions of periapical cemento-osseous dysplasia are radiolucent, whereas older lesions become more radiopaque. Periapical cemento-osseous dysplasia does not represent a neoplasm. The periapical cemento-osseous dysplasia lesion is asymptomatic and is discovered on routine radiographic examination. It occurs most commonly in the anterior mandible of patients older than 30 years of age. Teeth in the area affected by periapical cemento-osseous dysplasia are vital unless they are coincidentally carious or have been traumatized.

REF: Periapical Cemento-Osseous Dysplasia, pages 259-260 OBJ: 4 a. Periapical cemento-osseous dysplasia b. Focal cemento-osseous dysplasia c. Florid cemento-osseous dysplasia d. Monostotic fibrous dysplasia

2. Which type of lesions typically arises in the posterior mandible and appears as an isolated, well-delineated radiolucent-to-radiopaque lesion that is less than 1.5 cm in size?

ANS: B

Focal cemento-osseous dysplasia typically arises in the posterior mandible and appears as an isolated, well-delineated radiolucent-to-radiopaque lesion that is less than 1.5 cm in size. Periapical cemento-osseous dysplasia occurs most commonly in the anterior mandible. Florid cemento-osseous dysplasia typically affects more than one quadrant of the maxilla and mandible, often in the posterior area. Monostotic fibrous dysplasia commonly affects the mandible or maxilla, and the maxilla is more frequently involved than the mandible.

REF: Focal Cemento-Osseous Dysplasia, page 260

OBJ: 4 a. periapical cemento-osseous b. focal cemento-osseous c. florid cemento-osseous d. fibrous

3. Surgical treatment would most likely be recommended for a patient with ________ dysplasia.

ANS: D

Surgical treatment would most likely be recommended for a patient with fibrous dysplasia. Fibrous dysplasia is treated surgically by recontouring the affected bone for cosmetic reasons. No treatment exists for severe and progressive polyostotic fibrous dysplasia. No treatment is necessary for periapical cemento-osseous dysplasia once the condition is recognized. Once a definitive diagnosis has been established for focal cemento-osseous dysplasia, no further treatment is necessary. Treatment for florid cemento-osseous dysplasia is often unnecessary. However, in an edentulous patient, the sclerotic masses may perforate the mucosa, resulting in a communication between the oral environment and the underlying bone. This may lead to osteomyelitis, requiring surgical intervention.

REF: Polyostotic Fibrous Dysplasia, page 262 OBJ: 6

4. Fibrous dysplasia is characterized by a. necrosis and sloughing of bony sequestra. b. replacement of bone with normal fibrous connective tissue with no calcification. c. replacement of bone with abnormal connective tissue with no calcification. d. replacement of bone with abnormal connective tissue with varying amounts of calcification.

ANS: D

Fibrous dysplasia is characterized by replacement of bone with abnormal connective tissue with varying amounts of calcification. Fibrous dysplasia is characterized by replacement of bone with abnormal connective tissue with varying amounts of calcification rather than necrosis and sloughing of bony sequestra. Fibrous dysplasia is characterized by replacement of bone with abnormal connective tissue with varying amounts of calcification. Fibrous dysplasia is characterized by replacement of bone with abnormal connective tissue with varying amounts of calcification.

REF: Fibrous Dysplasia, page 261 OBJ: 6

5. Characteristics of monostotic fibrous dysplasia include that a. it is commonly diagnosed in middle-aged women. b. the expanding nature of the lesion may lead to malocclusion, tipping, or displacement of adjacent teeth. c. it involves a painful swelling or bulging of the buccal plate of the maxilla or mandible when seen orally. d. it involves multiple bones.

ANS: B

Characteristics of monostotic fibrous dysplasia include the possibility that the expanding nature of the lesion may lead to malocclusion, tipping, or displacement of adjacent teeth. Monostotic fibrous dysplasia is most commonly diagnosed in children and young adults; no sex predilection is seen. Clinical examination of a patient with monostotic fibrous dysplasia reveals a painless swelling or bulging of the buccal plate of the maxilla or mandible. Monostotic fibrous dysplasia involves a single bone.

REF: Monostotic Fibrous Dysplasia, page 261 OBJ: 6

6. Café au lait skin macules are associated with a. monostotic fibrous dysplasia. b. polyostotic fibrous dysplasia. c. Paget disease of bone. d. osteomalacia.

ANS: B

Café au lait skin macules are associated with polyostotic fibrous dysplasia. Café au lait skin macules are associated with polyostotic fibrous dysplasia rather than monostotic fibrous dysplasia. Café au lait skin macules are associated with polyostotic fibrous dysplasia rather than Paget disease of bone. Café au lait skin macules are associated with polyostotic fibrous dysplasia rather than osteomalacia.

REF: Polyostotic Fibrous Dysplasia, page 261 OBJ: 8

7. Paget disease of bone a. typically occurs in children under the age of 18. b. is painless. c. may reveal a “cotton-wool” appearance on radiographs. d. results in shrinkage of affected bone.

ANS: C

Paget disease of bone may reveal a “cotton-wool” appearance on radiographs. Paget disease of bone occurs most commonly in men over the age of 50. The patient often complains of pain in cases of Paget disease. Enlargement of the affected bone is common in cases of Paget disease.

REF: Paget Disease of Bone, page 262 OBJ: 9

8. Mosaic bone may be observed in a patient with Paget disease as a result of a. lack of trabeculae. b. prominent reversal lines resulting from resorption and deposition of bone. c. the presence of “giant cells.” d. a “ground glass” appearance.

ANS: B

Mosaic bone may be observed in a patient with Paget disease as a result of prominent reversal lines caused by resorption and deposition of bone. Mosaic bone may be observed in a patient with Paget disease as a result of prominent reversal lines caused by resorption and deposition of bone. With Paget disease, the connective tissue between the bony trabeculae is so well vascularized that overlying skin may feel warm to the touch. Mosaic bone may be observed in a patient with Paget disease as a result of prominent reversal lines caused by resorption and deposition of bone. Giant cells are located around foreign bodies. Mosaic bone may be observed in a patient with Paget disease as a result of prominent reversal lines caused by resorption and deposition of bone. A “ground glass” appearance is associated with fibrous dysplasia.

REF: Paget Disease of Bone, page 263 OBJ: 9 a. It is the result of a deficiency in phosphate. b. In adults it may be related to various problems such as malabsorption syndrome. c. It may be treated by the use of antacids. d. Accelerated tooth eruption is associated with osteomalacia.

9. Which statement is true of osteomalacia?

ANS: B

In adults, osteomalacia may be related to various problems such as malabsorption syndrome, drugs, liver and kidney disease, and the long-term use of antacids. Osteomalacia is the result of deficiency in calcium, not phosphate. Treatment of osteomalacia includes nutritional supplementation with vitamin D and dietary calcium, not antacids. Delayed tooth eruption and periodontal disease have been associated with osteomalacia. Pathologic fractures may also occur.

REF: Osteomalacia, page 264 OBJ: 11 a. Periapical cemento-osseous dysplasia b. Fibrous dysplasia c. Florid cemento-osseous dysplasia d. Gingival fibromatosis

10. All conditions are benign fibrous-osseous lesions that affect the maxilla and mandible except one. Which is the exception?

ANS: D

Gingival fibromatosis is an inherited disorder that affects the gingiva and periodontium. Periapical cemento-osseous dysplasia is a benign fibrous-osseous lesion that affects the maxilla and mandible. Fibrous dysplasia is a benign fibrous-osseous lesion that affects the maxilla and mandible. Florid cemento-osseous dysplasia is a benign fibrous-osseous lesion that affects the maxilla and mandible.

REF: Benign Fibro-Osseous Lesions, pages 259-261

OBJ: 3 a. Periapical cemento-osseous dysplasia b. Focal cemento-osseous dysplasia c. Florid cemento-osseous dysplasia d. Monostotic fibrous dysplasia

11. Which type of lesion occurs most often in black women older than age 40 and is characterized by disordered cementum and bone, typically affecting more than one quadrant of the maxilla and mandible in the posterior regions?

ANS: C

Florid cemento-osseous dysplasia occurs most often in black women older than 40 years of age and is characterized by disordered cementum and bone, typically affecting more than one quadrant of the maxilla and mandible, and often in the posterior area. Periapical cementoosseous dysplasia affects the periapical bone and occurs most often in the anterior mandible. Focal cemento-osseous dysplasia is more common in white women between 30 and 50 years of age. Monostotic fibrous dysplasia is characterized by involvement of a single bone and is commonly diagnosed in children and young adults.

REF: Florid Cemento-Osseous Dysplasia, page 260

OBJ: 4 a. Both statements are true. b. Both statements are false. c. The first statement is true, and the second is false. d. The first statement is false, and the second is true.

12. Cementoma is a term once used for periapical cemento-osseous dysplasia. Because the disease does not represent a neoplasm, cementoma has been replaced with periapical cementoosseous dysplasia.

ANS: A

Both statements are true. Cementoma is a term once used for periapical cemento-osseous dysplasia. Because the disease does not represent a neoplasm, cementoma has been replaced with periapical cemento-osseous dysplasia. Both statements are true, and the other options are false.

REF: Periapical Cemento-Osseous Dysplasia, page 259 OBJ: 4 a. Periapical cemento-osseous dysplasia b. Florid cemento-osseous dysplasia c. Polyostotic fibrous dysplasia d. Focal cemento-osseous dysplasia

13. For which disease of bone is surgical recontouring most often recommended as its treatment modality?

ANS: C

Most often, the recommended treatment for polyostotic fibrous dysplasia is surgical recontouring. Treatment for periapical cemento-osseous dysplasia is typically unnecessary. Treatment for florid cemento-osseous dysplasia is typically unnecessary. Treatment for focal cemento-osseous dysplasia is typically unnecessary.

REF: Polyostotic Fibrous Dysplasia, page 262 OBJ: 7 a. Focal cemento-osseous dysplasia b. Central cementifying fibroma c. Florid cemento-osseous dysplasia d. Ossifying fibroma

14. Numerous gritty pieces of soft and hard tissue that contain fibrous connective tissue interspersed with bone trabeculae and cementum-like material is characteristic of which condition?

ANS: A

Numerous gritty pieces of soft and hard tissue that contain fibrous connective tissue interspersed with bone trabeculae and cementum-like material are characteristic of focal cemento-osseous dysplasia. This characteristic is distinctly different from the surgical features of central cementifying or ossifying fibromas. This characteristic is not found in florid cemento-osseous dysplasia. This characteristic is distinctly different from the surgical features of central cementifying or ossifying fibromas.

REF: Focal Cemento-Osseous Dysplasia, page 260

OBJ: 5

15. The most common type of fibrous dysplasia, characterized by involvement of a single bone, is termed a. Paget disease. b. polyostotic fibrous dysplasia. c. monostotic fibrous dysplasia. d. central giant cell granuloma.

ANS: C

Monostotic fibrous dysplasia, the most common type of fibrous dysplasia, is characterized by involvement of a single bone. Paget disease is characterized by resorption, osteoblastic repair, and remineralization of involved bone, typically the pelvis and spinal column. It is not a type of fibrous dysplasia. Polyostotic fibrous dysplasia is characterized by involvement of more than one bone. Central giant cell granuloma is not a type of fibrous dysplasia.

REF: Monostotic Fibrous Dysplasia, page 261

OBJ: 6

16. Light brown skin macules associated with polyostotic fibrous dysplasia are termed a. Koplik spots. b. café au lait spots. c. brown tumors. d. gritty tissue.

ANS: B

Café au lait skin macules are associated with polyostotic fibrous dysplasia and appear as light brown skin macules. Koplik spots are erythematous macules associated with measles. Brown tumors are associated with hyperparathyroidism. Gritty tissue is characteristic of focal cemento-osseous dysplasia.

REF: Polyostotic Fibrous Dysplasia, page 261

OBJ: 6 a. Central giant cell granuloma b. Jaffe-Lichtenstein c. Paget disease d. Albright syndrome

17. Osteitis deformans and leontiasis ossea are other names for what chronic metabolic bone disease?

ANS: C

Osteitis deformans and leontiasis ossea are other names for Paget disease. Central giant cell lesion is another name for central giant cell granuloma. Jaffe-Lichtenstein is a type of fibrous dysplasia. Albright syndrome is the most severe form of fibrous dysplasia.

REF: Paget Disease of Bone, page 262 OBJ: 9 a. Osteomalacia b. Paget disease of bone c. Fibrous dysplasia d. Florid cemento-osseous dysplasia

18. This 74-year-old patient presents with an enlargement of the maxilla, pain, and a chief complaint that his dentures no longer fit. Radiographic examination reveals a patchy radiolucency and radiopacity that resembles cotton wool. These findings are indicative of what disease of bone?

ANS: B

This description and photograph are indicative of Paget disease. Osteomalacia does not present with an enlarged maxilla and cotton-wool appearance on radiographs. Fibrous dysplasia does not present with an enlarged maxilla and cotton-wool appearance on radiographs. Florid cemento-osseous dysplasia does not present with an enlarged maxilla and cotton-wool appearance on radiographs.

REF: Paget Disease of Bone, page 262 OBJ: 9 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.

19. Giant cell granulomas located in the gingiva or alveolar mucosa are referred to as central Giant cell granulomas located within the maxilla or mandible are referred to as peripheral.

ANS: B

Both statements are false. Central giant cell granulomas are located within the maxilla or mandible, and peripheral giant cell granulomas are located in the gingiva or alveolar mucosa. Both statements are false. The first statement is also false. The second statement is also false.

REF: Central Giant Cell Granuloma (Central Giant Cell Lesion), page 263

OBJ: 10 a. Hyperparathyroidism b. Peripheral giant cell granuloma c. Hypothyroidism d. Peripheral ossifying granuloma

20. A lesion of bone identical to the central giant cell granuloma and termed brown tumor occurs in patients with what type of disease?

ANS: A

A lesion of bone identical to the central giant cell granuloma and called a brown tumor occurs in patients with hyperparathyroidism. A brown tumor does not occur in patients with peripheral giant cell granuloma. A brown tumor does not occur in patients with hypothyroidism. A brown tumor does not occur in patients with peripheral ossifying granuloma.

REF: Central Giant Cell Granuloma (Central Giant Cell Lesion), page 264

OBJ: 10 a. Fibrous connective tissue b. Epithelial lining c. Multinucleated giant cells d. Blood-filled spaces

21. An aneurysmal bone cyst contains the following except one. Which is the exception?

ANS: B

An aneurysmal bone cyst is a pseudocyst that has no epithelial lining. An aneurysmal bone cyst is a pseudocyst that consists of fibrous connective tissue. An aneurysmal bone cyst is a pseudocyst that consists of multinucleated giant cells. An aneurysmal bone cyst is a pseudocyst that consists of blood-filled spaces surrounded by multinucleated giant cells and fibrous connective tissue.

REF: Aneurysmal Bone Cyst, page 264 OBJ: 1 a. Both statements are true. b. Both statements are false. c. The first statement is true, and the second is false. d. The first statement is false, and the second is true.

22. Osteomalacia is a disease of bone that develops over a long period as a result of an iron deficiency. Delayed tooth eruption and periodontal disease are associated with osteomalacia.

ANS: D

Osteomalacia is a result of a calcium deficiency, not iron deficiency. Delayed tooth eruption and periodontal disease are associated with osteomalacia. The first statement is false, and the second is true.

REF: Osteomalacia, page 264 OBJ: 11 a. It is the result of a deficiency in calcium. b. In adults it may be related to the chronic use of antacids. c. It is treated with vitamin D and calcium nutritional supplements. d. The pattern of diseased bone is best described as mosaic bone.

23. All statements are characteristic of osteomalacia except one. Which is the exception?

ANS: D

The pattern of disease best described as mosaic bone is seen in Paget disease and is not associated with osteomalacia. Osteomalacia is the result of a deficiency in calcium. In adults osteomalacia may be related to various problems such as malabsorption syndrome, drugs, liver and kidney disease, and the long-term use of antacids. Treatment of osteomalacia includes nutritional supplementation with vitamin D and dietary calcium.

REF: Osteomalacia, page 264 OBJ: 11 a. Craniofacial b. Jaffe-Lichtenstein type c. Albright syndrome d. Monostotic

24. _______________ fibrous dysplasia is characterized by endocrine abnormalities, including precocious puberty in females and stunting or deformity of skeletal growth in both sexes as a result of early epiphyseal plate closure.

ANS: C

Albright syndrome fibrous dysplasia is characterized by endocrine abnormalities, including precocious puberty in females and stunting or deformity of skeletal growth in both sexes as a result of early epiphyseal plate closure. Craniofacial fibrous dysplasia involves the maxilla with extension into the sinuses and adjacent zygoma, sphenoid, and occipital bones. JaffeLichtenstein type fibrous dysplasia involves multiple bones along with café au lait macules on the skin. Monostotic fibrous dysplasia is characterized by involvement of a single bone.

REF: Polyostotic Fibrous Dysplasia, page 261 OBJ: 8 a. Osteomalacia b. Paget disease of bone c. Fibrous dysplasia d. Florid cemento-osseous dysplasia

25. “Ground glass” is the classic radiographic description of _________________.

ANS: C

“Ground glass” is the radiographic description that is associated with fibrous dysplasia. A “ground glass” appearance is associated with fibrous dysplasia, not osteomalacia. A “ground glass” appearance is associated with fibrous dysplasia, not Paget disease of bone. A “ground glass” appearance is associated with fibrous dysplasia, not florid cemento-osseous dysplasia.

REF: Fibrous Dysplasia, page 261 OBJ: 7 a. alkaline phosphatase b. platelet c. hematocrit d. leukocyte

26. Laboratory evaluation reveals that the serum _______________ level is significantly elevated in active Paget disease.

ANS: A

Laboratory evaluation reveals that the serum alkaline phosphatase level is significantly elevated in active Paget disease. Laboratory evaluation reveals that the serum alkaline phosphatase level, not the platelet level, is significantly elevated in active Paget disease. Laboratory evaluation reveals that the serum alkaline phosphatase level, not the hematocrit level, is significantly elevated in active Paget disease. Laboratory evaluation reveals that the serum alkaline phosphatase level, not the leukocyte level, is significantly elevated in active Paget disease.

REF: Paget Disease of Bone, page 262 OBJ: 9 a. A b. D c. E d. K

27. When osteomalacia occurs in young children, it is usually caused by a nutritional deficiency in vitamin _____.

ANS: B

When osteomalacia occurs in young children, it is usually caused by a nutritional deficiency in vitamin D. The associated disease is called rickets. When osteomalacia occurs in young children, it is usually caused by a nutritional deficiency in vitamin D, not vitamin A. When osteomalacia occurs in young children, it is usually caused by a nutritional deficiency in vitamin D, not vitamin E. When osteomalacia occurs in young children, it is usually caused by a nutritional deficiency in vitamin D, not vitamin K.

REF: Osteomalacia, page 264 OBJ: 11 a. Periapical abscess b. Benign cementoblastoma c. Odontoma d. Osteoma

28. Early lesions of periapical cemento-osseous dysplasia are well circumscribed and radiolucent and may resemble which condition?

ANS: A

Early lesions of periapical cemento-osseous dysplasia are well circumscribed and radiolucent which may resemble a periapical abscess. The benign cementoblastoma is a well-defined radiopaque mass in continuity with the root of the affected tooth. The odontoma is an odontogenic tumor composed of enamel, dentin, cementum, and pulp. It appears as a cluster of miniature teeth, or, a radiopaque mass. The osteoma is a benign tumor of normal compact bone, which also has a radiopaque component.

REF: Periapical Cemento-Osseous Dysplasia, page 260 OBJ: 4 a. The lesions are seen in the anterior mandible. b. The common patient complaint is pain upon chewing. c. A predilection for black women exists. d. The condition is discovered on routine radiographic examination.

29. Characteristics of periapical cemento-osseous dysplasia include the following except one. Which is the exception?

ANS: B

This condition is asymptomatic. No pain upon chewing is experienced. Periapical cementoosseous dysplasia occurs most commonly in the anterior mandible. A predilection for black females older than age 30 exists. Because it is asymptomatic, periapical cemento-osseous dysplasia is discovered on radiographic examination.

REF: Periapical Cemento-Osseous Dysplasia, page 260 OBJ: 4 a. Florid cemento-osseous dysplasia usually affects more than one quadrant of the maxilla and mandible, including posterior regions. b. Periapical cemento-osseous dysplasia affects black females; florid cementoosseous dysplasia affects all ethnicities. c. The two conditions have various radiographic appearances. d. Symptoms of the two conditions vary from asymptomatic to extremely painful.

30. What is one difference between the diagnosis of periapical cemento-osseous dysplasia and florid cemento-osseous dysplasia?

ANS: A

Florid cemento-osseous dysplasia usually affects more than one quadrant of the maxilla and mandible, including posterior regions. It differs radiographically in location from periapical cemento-osseous dysplasia, which occurs most commonly in the anterior mandible. Black women older than 30 appear to be more commonly affected by both conditions. Periapical cemento-osseous dysplasia is asymptomatic and visible on radiographs with well-defined radiolucency to radiopacity at the area of the tooth apex. Florid cemento-osseous dysplasia is also asymptomatic in most cases and visible on radiographs with multiple areas of radiolucency and radiopacity.

REF: Periapical Cemento-Osseous Dysplasia, page 260 | Florid Cemento-Osseous Dysplasia, page 260 OBJ: 4 a. Fibrous dysplasia b. Aneurysmal bone cyst c. Osteomyelitis d. Central giant cell granuloma

31. Asymptomatic florid cemento-osseous dysplasia usually requires no treatment. However, in an edentulous patient, the sclerotic masses may perforate the mucosa causing which complication?

ANS: C

Osteomyelitis is the infection and inflammation of the bone and bone marrow that may occur if the edentulous mucosa is perforated. Fibrous dysplasia is the replacement of bone with abnormal fibrous connective tissue. An aneurysmal bone cyst is a pseudocyst seen in young adults; it may cause expansion of the involved bone. Central giant cell granuloma is composed of connective tissue containing multinucleated giant cells.

REF: Florid Cemento-Osseous Dysplasia, page 260 a. Reddish pink b. Light brown c. Yellow white d. Black

32. Café au lait spots appear on the skin as which color(s)?

ANS: B

OBJ: 5

This name was given to these lesions because the spots mimic the color of coffee with milk. Café au lait spots appear as light brown macules. Yellow white may be a color to describe Fordyce granules.

REF: Polyostotic Fibrous Dysplasia, page 261

OBJ: 8 a. Tooth mobility b. Malocclusion c. Displacement of adjacent teeth d. Tipping of teeth

33. The painless jaw swelling seen in monostotic fibrous dysplasia may cause all symptoms except one. Which is the exception?

ANS: A

A clinical examination reveals a painless swelling or bulging of the buccal plate of the mandible or maxilla, yet the teeth are rarely mobile. Malocclusion may be seen because of the swelling and bulging jaws. Displacement of adjacent teeth is common if the swelling continues. Tipping of the teeth may be seen because of the expanding nature of this lesion.

REF: Fibrous Dysplasia, page 261 OBJ: 6 a. Most cases are asymptomatic. b. Male predilection c. Occurs in children under 10 years of age d. Seen in association with skin lesions

34. Characteristics of polyostotic fibrous dysplasia include the following except one. Which is the exception?

ANS: B

A definite female predilection is seen. Polyostotic fibrous dysplasia is characterized by involvement of more than one bone, usually affecting the skull, clavicles, and long bones. Most cases are asymptomatic. Most cases involve children under 10 years of age. The skin lesions associated with polyostotic fibrous dysplasia are café au lait spots.

REF: Polyostotic Fibrous Dysplasia, page 261

OBJ: 6 a. It is too severe of a treatment for a young child. b. An association exists with malignant transformation to osteosarcoma. c. Because of the defined borders of the lesions, surgery is the treatment of choice. d. The lesions remain asymptomatic and localized.

35. Why is treatment with radiation therapy for polyostotic fibrous dysplasia contraindicated?

ANS: B

Radiation treatment is contraindicated because it has been associated with malignant transformation to osteosarcoma. If necessary, radiation therapy may be used on a young child. The abnormal bone blends into the adjacent normal bone, making it difficult to determine the periphery of the lesion. Polyostotic fibrous dysplasia involves more than one bone, so it is not a localized condition.

REF: Polyostotic Fibrous Dysplasia, page 262

OBJ: 8 a. “My partial denture does not fit.” b. “I can’t hear you, can you speak louder?” c. “I have spaces between my teeth that I never had before.” d. “My tongue is always sore.”

36. All are likely complaints of a patient with Paget disease of bone except one. Which is the exception?

ANS: D

Tongue soreness should not be a common complaint. Edentulous or partially edentulous patients may complain that their dentures no longer fit as the bone enlarges with Paget disease. Common manifestations of Paget disease include deafness, dizziness, and headache. Spacing between the teeth increases as the bone enlarges.

REF: Paget Disease of Bone, pages 262-263 OBJ: 9 a. Historical b. Laboratory c. Therapeutic d. Differential

37. The serum alkaline phosphatase level is significantly elevated in persons with active Paget disease. This is detected through which diagnostic process?

ANS: B

An elevated serum alkaline phosphatase level is significant in the diagnosis of Paget disease. This information can be gained from clinical laboratory tests. Historical information includes personal, family, and medical histories not related to the serum alkaline phosphatase level. Therapeutic means may not be an appropriate diagnostic process for Paget disease. Differential diagnosis is not necessary when correct laboratory procedures are performed.

REF: Paget Disease of Bone, page 262 OBJ: 9

38. The aneurysmal bone cyst is a “pseudocyst” which means: a. No epithelial lining exists. b. The cyst does not appear on radiographic images. c. The cyst is really a fibroma. d. Malignant potential is present.

ANS: A

Pseudocysts, including the aneurysmal bone cyst, contain no epithelial lining. This cyst does appear on radiographic images with a honeycomb or soap bubble appearance. The cyst is not a fibroma. Malignant potential is not present.

REF: Aneurysmal Bone Cyst, page 264 OBJ: 10 a. Heat and cold sensitivity b. Fast-growing lesion c. High recurrence rate d. Divergence of roots of teeth adjacent to the lesion

39. What is a common feature of the central giant cell granuloma?

ANS: D

Divergence of the roots of teeth adjacent to the lesion is a common feature of central giant cell granuloma. Heat and cold sensitivity has not been reported with central giant cell granuloma. The lesion is slow growing and destructive. Lesions are treated by surgical removal and occasionally recur.

REF: Central Giant Cell Granuloma (Central Giant Cell Lesion), page 263

OBJ: 10 a. Connective tissue b. Calcium c. Fluoride d. Vitamin A

40. Osteomalacia is a disease of bone that develops over a long period of time as a result of deficiency of which substance?

ANS: B

This is a disease of bone that occurs because of a calcium deficiency. Osteomalacia is not related to a deficiency of connective tissue. Osteomalacia is not related to a deficiency of fluoride. When osteomalacia occurs in young children, it is caused by a deficiency of vitamin

D.

REF: Osteomalacia, page 264 OBJ: 11 a. Nasal cavity b. Orbits c. Maxillary sinus d. Periapical areas of maxillary molars

41. Where does the disease extend when fibrous dysplasia involves the maxilla?

ANS: C

Obliteration of the maxillary sinus may be seen when fibrous dysplasia involves the maxilla, as well as involvement with the zygoma, sphenoid, and occipital bones. Fibrous dysplasia does not typically affect the area of the nasal cavity. Fibrous dysplasia does not typically affect the area of the orbits. Fibrous dysplasia can affect the periapical regions of maxillary molars, but the enlargement extends further.

REF: Monostotic Fibrous Dysplasia, page 261

OBJ: 6 a. 2 years b. 4 years c. 6 years d. 8 years

42. The most severe form of polyostotic fibrous dysplasia is termed Albright syndrome. This condition is characterized by endocrine abnormalities such as precocious puberty that may begin at which age?

ANS: A Precocious puberty, such as menses, pubic hair, and breast development, may begin in children as young as age 2.

REF: Polyostotic Fibrous Dysplasia, page 261

OBJ: 6