MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Medicine and Pathology Questions and Answers

Question 1

A 65-year-old patient, who is a heavy smoker, presents with a painless, indurated ulcer on the lateral border of the tongue that has persisted for 4 weeks. According to NICE guideline [NG12] 'Suspected cancer: recognition and referral', what is the most appropriate immediate action?

Accepted Answer

Refer the patient for an urgent appointment under the 'two-week wait' pathway for suspected cancer.

Answer

NICE guideline [NG12] specifies that an unexplained oral ulceration or mass persisting for more than 3 weeks warrants an urgent referral under the 'two-week wait' pathway to rule out malignancy. Delaying referral for review or attempting a biopsy in a primary care setting for a lesion highly suspicious of squamous cell carcinoma is inappropriate and goes against established UK national guidance.

Question 2

A 48-year-old female presents with asymptomatic, bilateral, symmetrical, white, lace-like striations on her buccal mucosa. The lesions are non-wipeable. What is the most likely diagnosis?

Accepted Answer

Oral Lichen Planus

Answer

The clinical description of bilateral, asymptomatic, white, reticular (lace-like) patterns (Wickham's striae) on the buccal mucosa is the classic presentation of reticular oral lichen planus. Leukoplakia is typically a more homogenous patch and often unilateral, candidiasis can be wiped off, and frictional keratosis would correspond to an area of trauma.

Question 3

A 25-year-old male is diagnosed with an odontogenic keratocyst (OKC) in the angle of the mandible. Which of the following is the most important characteristic of this lesion that influences its long-term management?

Accepted Answer

Its notable tendency for recurrence following surgical removal.

Answer

The odontogenic keratocyst (OKC) is well-known for its high recurrence rate, which can be up to 60% depending on the surgical technique used. This characteristic necessitates meticulous surgical removal and mandates long-term radiographic follow-up. It is not typically associated with a non-vital tooth (unlike a radicular cyst), malignant change is very rare, and it often grows with minimal expansion.

Question 4

A 52-year-old female patient complains of a persistently dry mouth and dry eyes for over six months. Clinical examination reveals a high caries rate and a lobulated tongue. Which investigation is most specific for confirming a diagnosis of primary Sjögren's syndrome?

Accepted Answer

Serological testing for anti-Ro (SSA) and anti-La (SSB) autoantibodies.

Answer

While reduced salivary flow confirms hyposalivation, and other tests may show non-specific changes, the presence of specific autoantibodies, particularly anti-Ro (SSA) and/or anti-La (SSB), is a key diagnostic criterion for Sjögren's syndrome according to UK and international guidelines. These serological markers point towards the underlying autoimmune nature of the disease.

Question 5

A 28-year-old patient presents with recurrent, painful, small, round ulcers on the non-keratinised mucosa, each healing within 10-14 days without scarring. According to UK clinical practice, what is a suitable first-line agent to prescribe for symptomatic relief during an acute episode?

Accepted Answer

Chlorhexidine gluconate 0.2% mouthwash

Answer

For minor recurrent aphthous stomatitis (RAS), the primary goal is symptomatic relief. An antimicrobial mouthwash such as chlorhexidine gluconate 0.2% is commonly recommended as a first-line measure in the UK to reduce pain and prevent secondary infection, which can aid healing. Systemic steroids are reserved for severe cases, Aciclovir is for herpes viruses, and Nystatin is for fungal infections.

MFDS Part 1 Practice Test

MFDS Part 1 Practice Test

MFDS Part 1 - Membership of Faculty of Dental Surgery Oral Medicine and Pathology Questions and Answers