A Guide to Clinical Differential Diagnosis of Oral Mucosal Lesions

Michael W. Finkelstein, DDS, MS

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  1. A 19 year old woman has painful ulcers on the labial mucosa and buccal mucosa of 4 days duration. She has had similar ulcers on previous occasions, and each time the lesions healed in approximately 7 days. The best diagnosis is:

    • aphthous ulcers

    • mucous membrane pemphigoid

    • recurrent herpes

    • primary herpes

    • pemphigus

  2. A 67 year old woman has a chronic sore mouth of 2 years duration. The lesions consist of multiple persistent ulcers adjacent to white rough thickened areas which do not rub off and are arranged in a striated pattern. The lesions are bilateral and involve the buccal mucosa, lateral borders of the tongue, and gingiva. Of the following, the best diagnosis is:

    • epidermolysis bullosa

    • pemphigus

    • herpangina

    • lichen planus

    • recurrent herpes

  3. A patient has multiple, asymptomatic, irregular, flat patches on the dorsum of the tongue. Each patch has a red center and an irregular white periphery. The patient reports that the lesions come and go. The best diagnosis is:

    • lichen planus

    • geographic tongue (erythema migrans)

    • epithelial dysplasia

    • pemphigus

    • superficially invasive squamous cell carcinoma

  4. A 16-year old woman has a compressible, nontender, 5x5 mm soft tissue enlargement of the lower labial mucosa. The lesion has a blue mucosal surface which does not blanch upon palpation. The patient states that she has been aware of the lesion for 2 months and that it has increased and decreased in size during this time. Which one of the following is the best diagnosis?

    • peripheral ossifying fibroma

    • pleomorphic adenoma (mixed tumor)

    • pyrogeen granuloom
    • hemangioma

    • mucocele

  5. A 13-year-old female patient has mild fever, lymphadenopathy and vesicles and ulcers of the soft palate and tonsillar pillars bilaterally, of 5 days duration. No other oral lesions are present. The best diagnosis is:

    • herpangina

    • herpes zoster

    • recurrent herpes

    • primary herpes

    • infectious mononucleosis

  6. A patient has a white, nontender, 5 x 6 mm, soft tissue enlargement on the right soft palate of at least 2 years duration. The surface is rough and resembles a wart. The lesion is pedunculated. The best diagnosis is:

    • irritation fibroma

    • lipoma

    • papilloma

    • epulis fissuratum

    • mucocele

  7. A 44 year old man has rough, white, nonpainful lesions which do not rub off located bilaterally on the buccal mucosa, floor of the mouth, and hard and soft palates. He states that he has been aware of the lesions since childhood. Which of the following is the best diagnosis?

    • white sponge nevus

    • lichen planus

    • leukoedema

    • squamous cell carcinoma

    • squamous cell carcinoma

  8. A 25 year old woman has a 5x6 mm, nontender, compressible soft tissue enlargement located on the interdental papilla between teeth #10 and #11. The lesion is erythematous and bleeds easily. She states that she has been aware of the lesion for approximately 3 days. The patient is in her second trimester of pregnancy. Which one of the following is the best diagnosis?

    • papilloma

    • irritation fibroma

    • pleomorphic adenoma

    • pyogenic granuloma

    • hemangioma

  9. Which white surface lesion rubs off?

    • epithelial dysplasia

    • subepithelial fibrosis

    • burn

    • Fordyce granules

    • hairy leukoplakia

  10. Which of the following lesions is asymptomatic and smooth to palpation?

    • burn

    • familial epithelial hyperplasia

    • fibrin clot

    • nicotinic stomatitis

    • scarring

  11. Which pigmented surface lesion is consistently flat and not thickened?

    • oral melanotic macule

    • hemangioma

    • Kaposi's sarcoma

    • melanoma

    • varix

  12. Which one of these clinical features would be most helpful in distinguishing hematoma from nevus?

    • color of the lesion

    • duration of the lesion

    • whether the lesion blanches upon pressure

    • whether the lesion is thickened

    • whether the lesion is painful

  13. A patient has a thickened, compressible, blue pigmentation of the buccal mucosa that blanches upon pressure. Which of the following should be included in the clinical differential diagnosis?

    • ecchymosis

    • petechiae

    • lentigo

    • tattoo

    • varix

  14. Which of the following diseases initially forms oral vesicles?

    • aphthous ulcers

    • infectious mononucleosis

    • mucous membrane (cicatricial) pemphigoid

    • toxische mucositis
  15. Which of the following lesions have/has an abrupt or sudden onset?

    • pemphigus

    • recurrent herpes

    • mucous membrane pemphigoid

    • lichen planus

  16. Which disease has the worst prognosis?

    • pemphigus vulgaris

    • mucous membrane pemphigoid

    • bullous pemphigoid

    • discoid lupus erythematosus

    • toxic mucositis

  17. A 35 year old man has painful ulcers on the lips and buccal mucosal and asymptomatic macules and vesicles on the face, hands, and trunk. He has a mild fever but no lymphadenopathy. The lesions had an acute onset 3 days ago. The best diagnosis is:

    • pemphigus

    • lichen planus

    • erythema multiforme

    • toxic epidermal necrolysis

    • primary herpes

  18. Which disease typically begins with the abrupt onset of pain or altered sensation followed by vesicles and ulcers unilaterally in the distribution of a peripheral nerve?

    • herpes zoster

    • herpangina

    • primary herpes

    • carcinoma-in-situ

    • varicella

  19. Which of the following lesions is usually congenital?

    • hemangioma

    • dermoid cyst

    • irritation fibroma

    • pleomorphic adenoma

    • papilloma

  20. Which of the following lesions is/are encapsulated?

    • neurofibroma

    • rhabdomyoma

    • Schwannoma

    • neuroma

    • granular cell tumor

  21. Which of the following lesions is/are compressible to palpation?

    • keratoacanthoma

    • verruca vulgaris

    • granular cell tumor

    • peripheral fibroma

    • low-grade mucoepidermoid carcinoma

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