2
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
What marks the boundary between the sublingual and submandibular spaces? Select all
correct answers.
Geniohyoid muscle
Mylohyoid groove
Genioglossus muscle
Mylohyoid line --
Mylohyoid muscle --
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
,2
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
Into which space/s has the infection apparently traveled in this patient? Select all correct
answers.
Submandibular space --
Maxillary sinus
Inferior nasal meatus
Sublingual space --
Retropharyngeal space
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
The most likely pathway of infection was:
Abscess >> carotid sheath >> sublingual space >> submandibular space
,2
Abscess >> submandibular space >> sublingual space --
Abscess >> infratemporal space >> submandibular and sublingual spaces
Abscess >> sublingual space >> submandibular space
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
To what other spaces could the infection travel if untreated? Select all correct answers.
Mediastinum --
Carotid sheath --
Parotid space --
Retropharyngeal space --
Patient: An elderly female patient, age 78
Chief Complaint: Dry eyes and dry mouth, joint pain
, 2
Background / Patient History: Has been diagnosed with rheumatoid arthritis 20 years prior.
Now she has consistent dry eyes and mouth.
Current Findings: Her minor salivary gland biopsy shows extensive lymphocytic infiltration,
but intact ductal cells and myoepithelial islands.
What is the likely diagnosis?
Systemic Lupus Erythematosus
Rheumatoid arthritis
Primary Sjogren's syndrome
Secondary Sjogren's syndrome --
Type 2 Diabetes
Patient: An elderly female patient, age 78
Chief Complaint: Dry eyes and dry mouth, joint pain
Background / Patient History: Has been diagnosed with rheumatoid arthritis 20 years prior.
Now she has consistent dry eyes and mouth.
Current Findings: Her minor salivary gland biopsy shows extensive lymphocytic infiltration,
but intact ductal cells and myoepithelial islands.
What is the explanation for the appearance of the tongue?
Absence of the circumvallate papillae
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
What marks the boundary between the sublingual and submandibular spaces? Select all
correct answers.
Geniohyoid muscle
Mylohyoid groove
Genioglossus muscle
Mylohyoid line --
Mylohyoid muscle --
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
,2
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
Into which space/s has the infection apparently traveled in this patient? Select all correct
answers.
Submandibular space --
Maxillary sinus
Inferior nasal meatus
Sublingual space --
Retropharyngeal space
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
The most likely pathway of infection was:
Abscess >> carotid sheath >> sublingual space >> submandibular space
,2
Abscess >> submandibular space >> sublingual space --
Abscess >> infratemporal space >> submandibular and sublingual spaces
Abscess >> sublingual space >> submandibular space
Patient: 62-year-old female
Chief complaint: The patient says, "My lower back teeth hurt a lot! On the left side. Also, I
think I look swollen under my chin, and my tongue feels thick."
Background/or patient history: None.
Current Findings: The patient has a temperature of 101.8 F. She has redness and swelling in
the suprahyoid region of the neck, and her tongue is swollen. An x-ray reveals a periapical
abscess of the left 3rd mandibular molar. You diagnose Ludwig's angina.
To what other spaces could the infection travel if untreated? Select all correct answers.
Mediastinum --
Carotid sheath --
Parotid space --
Retropharyngeal space --
Patient: An elderly female patient, age 78
Chief Complaint: Dry eyes and dry mouth, joint pain
, 2
Background / Patient History: Has been diagnosed with rheumatoid arthritis 20 years prior.
Now she has consistent dry eyes and mouth.
Current Findings: Her minor salivary gland biopsy shows extensive lymphocytic infiltration,
but intact ductal cells and myoepithelial islands.
What is the likely diagnosis?
Systemic Lupus Erythematosus
Rheumatoid arthritis
Primary Sjogren's syndrome
Secondary Sjogren's syndrome --
Type 2 Diabetes
Patient: An elderly female patient, age 78
Chief Complaint: Dry eyes and dry mouth, joint pain
Background / Patient History: Has been diagnosed with rheumatoid arthritis 20 years prior.
Now she has consistent dry eyes and mouth.
Current Findings: Her minor salivary gland biopsy shows extensive lymphocytic infiltration,
but intact ductal cells and myoepithelial islands.
What is the explanation for the appearance of the tongue?
Absence of the circumvallate papillae
