INBDE QUESTIONS AND ANSWERS
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. - 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.
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. - 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: - Answers- Abscess >> carotid sheath >>
sublingual space >> submandibular space
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. -
Answers- Mediastinum --
Carotid sheath --
Parotid space --
Retropharyngeal space --
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 likely diagnosis? - Answers- 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? - Answers- Absence of the
circumvallate papillae
Absence of fungiform papillae
Absence of von Ebner's glands
Absence of filiform papillae --
Absence of foliate papillae
Which of the following BEST describes the primary ionic movement during the
depolarization phase of a nerve action potential? - Answers- Sodium ions moving from
outside the membrane to inside the membrane --
Potassium ions moving into the fiber from interstitial fluid
Sodium ions moving from inside the membrane to outside the membrane
Large organic-negative ions moving from inside the fiber to outside the fiber
Potassium ions moving from inside to outside the membrane
What are predominant linkages in glycogen between glucose units? - Answers- Alpha-
1,4 --
Alpha-1,6
Beta-1,3
Beta-1,4
Beta-1,6
Which of the following is produced when a mutation occurs in an enzyme controlling a
signal pathway involved in cell growth processes? - Answers- Transgene
Oncogene --
Epigene
Monogene
Antigene
Which of the following is caused by vitamin D deficiency in adults? - Answers-
Myxedema
Rickets
Osteomalacia --
Acromegaly
Osteitis fibrosa cystica
, Patient: Female, 25-years-old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 year-old female with HIV that is well controlled
on combination antiretroviral therapy. She recently was prescribed antibiotics for a
urinary tract infection. HR also has liver disease.
Current Findings: She presents with creamy white lesions on her tongue.
What does HR have? - Answers- Oral candidiasis --
Lichen planus
Oral mucositis
Patient: Female, 25-years-old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 year-old female with HIV that is well controlled
on combination antiretroviral therapy. She recently was prescribed antibiotics for a
urinary tract infection. HR also has liver disease.
Current Findings: She presents with creamy white lesions on her tongue.
What will be a preferred medication to use to treat HR? - Answers- Nystatin --
Fluconazole
Clotrimazole
Triamcinolone
Clindamycin
Patient: Female, 25 years old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 yo F with HIV that is well controlled on
combination antiretroviral therapy. She recently was prescribed antibiotics for a urinary
tract infection. HR also has liver disease. She presented one week ago with creamy
white lesions on her tongue, and you prescribed Nystatin.
Current Findings: HR's HIV infection is out of control and the creamy white lesions are
spreading to the esophageal area.
Please note that there is now additional information in the patient box.
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. - 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.
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. - 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: - Answers- Abscess >> carotid sheath >>
sublingual space >> submandibular space
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. -
Answers- Mediastinum --
Carotid sheath --
Parotid space --
Retropharyngeal space --
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 likely diagnosis? - Answers- 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? - Answers- Absence of the
circumvallate papillae
Absence of fungiform papillae
Absence of von Ebner's glands
Absence of filiform papillae --
Absence of foliate papillae
Which of the following BEST describes the primary ionic movement during the
depolarization phase of a nerve action potential? - Answers- Sodium ions moving from
outside the membrane to inside the membrane --
Potassium ions moving into the fiber from interstitial fluid
Sodium ions moving from inside the membrane to outside the membrane
Large organic-negative ions moving from inside the fiber to outside the fiber
Potassium ions moving from inside to outside the membrane
What are predominant linkages in glycogen between glucose units? - Answers- Alpha-
1,4 --
Alpha-1,6
Beta-1,3
Beta-1,4
Beta-1,6
Which of the following is produced when a mutation occurs in an enzyme controlling a
signal pathway involved in cell growth processes? - Answers- Transgene
Oncogene --
Epigene
Monogene
Antigene
Which of the following is caused by vitamin D deficiency in adults? - Answers-
Myxedema
Rickets
Osteomalacia --
Acromegaly
Osteitis fibrosa cystica
, Patient: Female, 25-years-old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 year-old female with HIV that is well controlled
on combination antiretroviral therapy. She recently was prescribed antibiotics for a
urinary tract infection. HR also has liver disease.
Current Findings: She presents with creamy white lesions on her tongue.
What does HR have? - Answers- Oral candidiasis --
Lichen planus
Oral mucositis
Patient: Female, 25-years-old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 year-old female with HIV that is well controlled
on combination antiretroviral therapy. She recently was prescribed antibiotics for a
urinary tract infection. HR also has liver disease.
Current Findings: She presents with creamy white lesions on her tongue.
What will be a preferred medication to use to treat HR? - Answers- Nystatin --
Fluconazole
Clotrimazole
Triamcinolone
Clindamycin
Patient: Female, 25 years old
Chief complaint: She describes a cotton-like feeling in her mouth and lack of taste. She
has tried brushing her tongue but this just caused slight bleeding.
Background/or patient history: HR is a 25 yo F with HIV that is well controlled on
combination antiretroviral therapy. She recently was prescribed antibiotics for a urinary
tract infection. HR also has liver disease. She presented one week ago with creamy
white lesions on her tongue, and you prescribed Nystatin.
Current Findings: HR's HIV infection is out of control and the creamy white lesions are
spreading to the esophageal area.
Please note that there is now additional information in the patient box.
