INBDE Oral Pathology & Oral Medicine
Practice Exam 2026 | 100 Advanced
Questions & Answers with Detailed
Rationales | Integrated National Board
Dental Examination Prep & Study Guide
1. A 54-year-old patient presents with a persistent, nonhealing ulcer on the
lateral border of the tongue that has been present for 6 weeks. The lesion
is indurated and associated with ipsilateral cervical lymphadenopathy.
Which diagnosis is most concerning?
A. Traumatic ulcer
B. Aphthous ulcer
C. Squamous cell carcinoma
D. Necrotizing sialometaplasia
Answer: Squamous cell carcinoma
Rationale: A persistent indurated ulcer on the lateral tongue, particularly when
accompanied by regional lymphadenopathy, is highly suspicious for oral
,squamous cell carcinoma. Duration greater than 2 weeks without healing
warrants evaluation and biopsy.
2. A patient develops a rapidly enlarging, painless, bluish-purple gingival mass.
The lesion bleeds easily and has a “cobblestone” surface. Which condition
should be strongly considered?
A. Peripheral ossifying fibroma
B. Kaposi sarcoma
C. Pyogenic granuloma
D. Peripheral giant cell granuloma
Answer: Kaposi sarcoma
Rationale: Kaposi sarcoma classically presents as red, purple, or violaceous
macules, plaques, or nodules and is associated with HHV-8, particularly in
immunocompromised patients. Oral lesions commonly involve the palate and
gingiva.
3. A 38-year-old patient has recurrent painful oral ulcers involving the
nonkeratinized mucosa. The ulcers are round, shallow, and surrounded by
an erythematous halo. There is no associated systemic disease. Which
diagnosis is most likely?
A. Recurrent herpes labialis
B. Recurrent aphthous stomatitis
C. Herpetic gingivostomatitis
D. Pemphigus vulgaris
Answer: Recurrent aphthous stomatitis
Rationale: Recurrent aphthous stomatitis typically affects nonkeratinized
mucosa such as the labial and buccal mucosa, ventral tongue, floor of mouth,
and soft palate. The lesions are painful, shallow ulcers with an erythematous
halo.
, 4. A patient presents with diffuse desquamative gingivitis. Biopsy
demonstrates intraepithelial clefting, and direct immunofluorescence
shows intercellular IgG deposition in a “fish-net” pattern. What is the
diagnosis?
A. Mucous membrane pemphigoid
B. Pemphigus vulgaris
C. Lichen planus
D. Erythema multiforme
Answer: Pemphigus vulgaris
Rationale: Pemphigus vulgaris is an autoimmune intraepithelial blistering
disorder caused by antibodies against desmosomal proteins, particularly
desmoglein 3. Direct immunofluorescence demonstrates intercellular IgG in a
characteristic fish-net or chicken-wire pattern.
5. A patient has painful oral erosions and intact bullae are rarely observed.
Histology shows a subepithelial separation, while direct
immunofluorescence demonstrates linear deposition of IgG and C3 along
the basement membrane zone. Which condition is most likely?
A. Pemphigus vulgaris
B. Mucous membrane pemphigoid
C. Lichen planus
D. Aphthous stomatitis
Answer: Mucous membrane pemphigoid
Rationale: Mucous membrane pemphigoid produces subepithelial separation
and linear immunoreactant deposition along the basement membrane zone.
Ocular involvement is particularly important because scarring can lead to
serious visual complications.
6. Which oral lesion is most strongly associated with Epstein-Barr virus and
severe immunosuppression?
, A. Hairy leukoplakia
B. Fordyce granules
C. Linea alba
D. Leukoedema
Answer: Hairy leukoplakia
Rationale: Oral hairy leukoplakia is associated with EBV and occurs
predominantly in immunocompromised individuals. It typically appears as a
corrugated white lesion on the lateral tongue that cannot be scraped off.
7. A patient presents with a white lesion on the buccal mucosa that
disappears when the mucosa is stretched. What is the most likely
diagnosis?
A. Leukoplakia
B. Leukoedema
C. Lichen planus
D. White sponge nevus
Answer: Leukoedema
Rationale: Leukoedema is a benign variation characterized by diffuse gray-white
opalescence of the buccal mucosa. The lesion becomes less apparent or
disappears when the mucosa is stretched.
8. A patient has bilateral reticular white striations on the buccal mucosa with
intermittent erosive areas. Which diagnosis is most likely?
A. Oral lichen planus
B. Leukoplakia
C. Candidiasis
D. White sponge nevus
Answer: Oral lichen planus
Practice Exam 2026 | 100 Advanced
Questions & Answers with Detailed
Rationales | Integrated National Board
Dental Examination Prep & Study Guide
1. A 54-year-old patient presents with a persistent, nonhealing ulcer on the
lateral border of the tongue that has been present for 6 weeks. The lesion
is indurated and associated with ipsilateral cervical lymphadenopathy.
Which diagnosis is most concerning?
A. Traumatic ulcer
B. Aphthous ulcer
C. Squamous cell carcinoma
D. Necrotizing sialometaplasia
Answer: Squamous cell carcinoma
Rationale: A persistent indurated ulcer on the lateral tongue, particularly when
accompanied by regional lymphadenopathy, is highly suspicious for oral
,squamous cell carcinoma. Duration greater than 2 weeks without healing
warrants evaluation and biopsy.
2. A patient develops a rapidly enlarging, painless, bluish-purple gingival mass.
The lesion bleeds easily and has a “cobblestone” surface. Which condition
should be strongly considered?
A. Peripheral ossifying fibroma
B. Kaposi sarcoma
C. Pyogenic granuloma
D. Peripheral giant cell granuloma
Answer: Kaposi sarcoma
Rationale: Kaposi sarcoma classically presents as red, purple, or violaceous
macules, plaques, or nodules and is associated with HHV-8, particularly in
immunocompromised patients. Oral lesions commonly involve the palate and
gingiva.
3. A 38-year-old patient has recurrent painful oral ulcers involving the
nonkeratinized mucosa. The ulcers are round, shallow, and surrounded by
an erythematous halo. There is no associated systemic disease. Which
diagnosis is most likely?
A. Recurrent herpes labialis
B. Recurrent aphthous stomatitis
C. Herpetic gingivostomatitis
D. Pemphigus vulgaris
Answer: Recurrent aphthous stomatitis
Rationale: Recurrent aphthous stomatitis typically affects nonkeratinized
mucosa such as the labial and buccal mucosa, ventral tongue, floor of mouth,
and soft palate. The lesions are painful, shallow ulcers with an erythematous
halo.
, 4. A patient presents with diffuse desquamative gingivitis. Biopsy
demonstrates intraepithelial clefting, and direct immunofluorescence
shows intercellular IgG deposition in a “fish-net” pattern. What is the
diagnosis?
A. Mucous membrane pemphigoid
B. Pemphigus vulgaris
C. Lichen planus
D. Erythema multiforme
Answer: Pemphigus vulgaris
Rationale: Pemphigus vulgaris is an autoimmune intraepithelial blistering
disorder caused by antibodies against desmosomal proteins, particularly
desmoglein 3. Direct immunofluorescence demonstrates intercellular IgG in a
characteristic fish-net or chicken-wire pattern.
5. A patient has painful oral erosions and intact bullae are rarely observed.
Histology shows a subepithelial separation, while direct
immunofluorescence demonstrates linear deposition of IgG and C3 along
the basement membrane zone. Which condition is most likely?
A. Pemphigus vulgaris
B. Mucous membrane pemphigoid
C. Lichen planus
D. Aphthous stomatitis
Answer: Mucous membrane pemphigoid
Rationale: Mucous membrane pemphigoid produces subepithelial separation
and linear immunoreactant deposition along the basement membrane zone.
Ocular involvement is particularly important because scarring can lead to
serious visual complications.
6. Which oral lesion is most strongly associated with Epstein-Barr virus and
severe immunosuppression?
, A. Hairy leukoplakia
B. Fordyce granules
C. Linea alba
D. Leukoedema
Answer: Hairy leukoplakia
Rationale: Oral hairy leukoplakia is associated with EBV and occurs
predominantly in immunocompromised individuals. It typically appears as a
corrugated white lesion on the lateral tongue that cannot be scraped off.
7. A patient presents with a white lesion on the buccal mucosa that
disappears when the mucosa is stretched. What is the most likely
diagnosis?
A. Leukoplakia
B. Leukoedema
C. Lichen planus
D. White sponge nevus
Answer: Leukoedema
Rationale: Leukoedema is a benign variation characterized by diffuse gray-white
opalescence of the buccal mucosa. The lesion becomes less apparent or
disappears when the mucosa is stretched.
8. A patient has bilateral reticular white striations on the buccal mucosa with
intermittent erosive areas. Which diagnosis is most likely?
A. Oral lichen planus
B. Leukoplakia
C. Candidiasis
D. White sponge nevus
Answer: Oral lichen planus
