Examination tasks of the specialty "Dentistry"

№1.

The pathology department received biopsy material with a clinical diagnosis of cervical leukoplakia. Histological examination revealed hyperkeratosis (excessive keratinization) and parakeratosis (abnormal keratinization) in the mucous membrane of the vaginal portion of the cervix.

1. A type of dystrophy that has developed in a multilayered squamous epithelium.
2. Definition of this dystrophy.
3. The clinical significance of this pathology.
4. An example of another disease in which there is hyperkeratosis.

№ 2.

An endoscopic examination of the stomach revealed a 1 cm diameter polypoid formation in the antrum, from which a biopsy was taken. Microscopic examination of the mucous membrane revealed the following changes: active proliferation of the glandular epithelium with impaired histoarchitectonics, multilayering, polymorphism and atypia. Cellular atypia is represented by different cell sizes and shapes, an increase in the size of nuclei and their hyperchromia, an increase in the number of mitotic patterns, and the appearance of atypical mitoses. The basement membrane of the glands is preserved.

1. A pathological process that has developed in the gastric mucosa.
2. Its definition.
3. Its clinical significance.
4. What general pathological process does it belong to?
5. The modern name of this process.

№ 3.

The patient developed a sudden loss of consciousness at the height of the hypertensive crisis. A day later, death occurred in the intensive care unit. An autopsy revealed a 7x7x5cm cavity filled with blood clots in the right hemisphere of the brain.

1. The type of hemorrhage detected, its definition.
2. Three causes of bleeding.
3. The cause of this hemorrhage.
4. Pigments that can be found in the area of hemorrhage.
5. Outcomes of such hemorrhages.

№ 4.

During the flu epidemic, the child developed rhinitis, accompanied by the release of copious mucous exudate from the nasal cavity. When examined by a polyclinic doctor, the mucous membranes of the pharynx and nose are hyperemic, swollen, and there is abundant discharge in the form of a clear liquid.

1. The type of exudative inflammation in this case.
2. The main types of acute forms of this type of inflammation.
3. The peculiarity of exudate in this inflammation.
4. Possible consequences of the chronic form of this inflammation.
5. The biological meaning of mucus hypersecretion.

№ 5.

An elderly patient suffering from severe diabetes mellitus and atherosclerosis of the arteries of the lower extremities went to the surgeon complaining of blackening of the skin and loss of sensitivity of the first toe of the right foot. On examination: the skin of the finger is dry, wrinkled, dense, black in color. The pulsation of the arteries of the foot is not detected. It was decided to amputate the affected finger.

1. A pathological process in the toe.
2. Its clinical and morphological form.
3. Define this form and name its other variants.
4. Name other clinical and morphological forms of this pathological process.
5. Define mutation.

№ 6.

A young man has a small brown nodular formation on the back of his neck, rising above the surface of the skin. Going to the doctor is related to his accidental injury. A nevus has been diagnosed. After surgical removal and histological examination, the diagnosis was confirmed.

1. Definition of a nevus.
2. The pigment that turns the nevus brown.
3. There are different types of nevi depending on their location in the skin.Prognosis for surgical removal of the nevus.
4. Indications for removal of a number of nevi.

№ 7.

A few minutes after intravenous administration of the antibiotic, the patient developed itching, erythema, dyspnea, bronchospasm, vomiting, tachycardia, and a sharp drop in blood pressure, resulting in death. An autopsy revealed edema, hemorrhages, focal atelectasis, and acute emphysema in the lungs.

1. A complication that has developed in the patient.
2. The group of immunopathological processes to which this reaction belongs.
3. There are two forms of these reactions.
4. The type of reaction to which this complication should be attributed.

№ 8.

A 4-year-old child's body temperature rose to 39 °C. He developed a runny nose, cough, conjunctivitis, and a large-spotted skin rash. On examination in the oral cavity, small whitish rashes surrounded by a corolla of hyperemia were found on the mucous membrane of the cheeks opposite the small molars. After 3 days, shortness of breath appeared, moist wheezing appeared in the lungs, and death occurred with acute asphyxia.

1. The intended diagnosis.
2. The causative agent of the disease.
3. The name of the rash on the mucous membrane of the cheeks.
4. The process in the lungs that complicated this disease.
5. A complication that led to asphyxia.

№ 9.

The patient was admitted to the clinic to open an abscess of the buttock formed after an intramuscular injection of magnesia. After the operation, the body temperature reached 39 ° C, shortness of breath appeared, darkening of consciousness, and bilateral pneumonia was diagnosed. Death occurred on the fourth day with symptoms of acute heart failure.

1. The intended diagnosis.
2. The clinical and morphological form of the disease, its type, depending on the nature of the entrance gate of infection.
3. Characteristics of changes in the entrance gate of infection.
4. Pathological processes that develop in this form of the disease in the lungs, heart, brain and its membranes.
5. Changes in the spleen in this pathology.

№ 10.

A 55-year-old man went to a dental clinic for pain in the area of the removed first molar of the lower jaw on the right. The patient was prescribed the use of an antibacterial drug for 10 days. There was no positive effect from the treatment. After 2 months, the patient was admitted to the Department of Maxillofacial surgery. Computed tomography was performed, and a 1.5 x 2 cm bone destruction site was detected in the bone tissue of the lower jaw from the side of the first right molar. After surgical removal of this lesion, a microscopic examination was performed, which revealed the presence of necrotized fragments of bone tissue, an overgrowth of connective tissue infiltrated by plasma cells, lymphocytes and small numbers of neutrophils.

1. What complication of tooth extraction has the patient developed?
2. What is the etiology of this complication?
3. What complications could a patient develop in the absence of surgical treatment?
4. What is the prognosis of the disease?

№ 11.

A 25-year-old patient was admitted to the Department of Maxillofacial surgery complaining of swelling and soreness in the buccal region on the right. On examination, there was a moderate asymmetry of the face, tension of the skin and mucous membrane in this area. The symptoms appeared a month ago after treatment of the 2nd right lower molar. Computed tomography from the body of the right half of the lower jaw reveals mottled areas of illumination with indistinct boundaries, small areas of sequestration. The general blood test showed leukocytosis with a shift of the leukocyte formula to the left.

1. What kind of disease has the patient developed?
2. What adverse background conditions should be excluded in such cases?Describe the microscopic picture of the affected area of the bone.
3. What pathology will develop if the soft tissues of the face are involved in the inflammatory process?
4. Possible complications of the disease.

№ 12.

Patient D., 22 years old, went to the doctor complaining of a painless swelling in the lower jaw area. On examination: slight protrusion of the lower jaw area in the area of 3 molars. X-ray examination revealed extensive bone dilution with clear polycyclic contours, which gave the impression of a multi-chamber formation. A biopsy examination was performed: a thin fibrous capsule lined with multilayer squamous epithelium with parakeratosis phenomena was found. The formation was removed surgically. Macroscopic picture: the formation consisted of a cavity with bay-shaped indentations into the surrounding bone, covered with a shell, amorphous gray masses with an unpleasant odor in the lumen.

1. What pathological process of the mandible took place in this patient?
2. What are the possible complications and outcomes of this pathological process?
3. What other diseases of the mandible have you had a differential diagnosis with?

№ 13.

Patient R., 34 years old, has been noticing the appearance of a thickening and its gradual growth in the area of the angle of the lower jaw for 1.5 months. On examination, there is a thickening to about 5 cm, dense on palpation, but it easily creases under pressure — a symptom of a "ping—pong ball", 6 and 7 teeth are mobile. Radiologically, a multi-chamber illumination in the form of "soap bubbles" is revealed.

1. What is the diagnosis of the patient?
2. What are the tactics of a dentist in a specialized hospital?
3. The prognosis of the disease.

№ 14.

Patient P., 27 years old, went to the dentist due to the appearance of a deformity of the lower jaw in the area of the 7th tooth on the left. An X-ray examination revealed a cavity not connected to the root canal of the tooth, the formation partially passes to the angle and branch of the lower jaw. Objectively, tooth 8 is missing, teeth 7 and 6 are intact.

1. What is the most likely nature of the cyst?
2. What method allows you to accurately diagnose the pathological process?
3. Prognosis of the disease.

№ 15.

A 14-year-old patient complains of enlargement of the right half of her face with pain for 20 days. On examination, the magnification area is quite clearly delimited, measuring 3x2.5 cm, of a dense consistency. Enlarged lymph nodes are palpated in the submandibular region. Radiologically, a rarefaction site containing an uncut 23 tooth will be determined. The formation has been removed. Macroscopically, the formation is spherical, brown in color, dense in consistency, and contains a tooth. Microscopically, the proliferation of cubic and cylindrical cells was noted, which formed rosette-like and ductal structures with a single-row arrangement of cells.

1. What kind of education was found in the patient?
2. What formations can have a similar microscopic pattern?
3. What is the reason for the increase in the patient's lymph nodes?
4. What is the prognosis of the disease?

№ 16.

The teeth of a 13-year-old patient are half embedded in the gums, the latter are compacted, whitish in color, and painless. The patient lives and studies in a special institution for children with intellectual disabilities.

1. What gum disease has the patient developed?
2. What is the composition of the cellular infiltrate?
3. Mainly due to which tissue is hypertrophy noted?
4. Describe the changes in the epithelium.

№ 17.

A 42-year-old patient applied to the dental clinic. On examination, the incisors and canines of the lower jaw with sharply exposed roots are mobile in all directions, and are not damaged by caries. Other teeth are intact. The gums in the area of the incisors and canines of the lower jaw are hyperemic.

1. What kind of disease has the patient developed?
2. What pathological processes are present in this disease?
3. Changes in the bone beams of the alveolar processes in this disease.
4. Prognosis of the disease.

№ 18.

An 18-year-old patient using braces for the treatment of malocclusion complained of pain in the gum area of the anterior upper incisors. On examination, pronounced redness, loss of gingival papillae, and the presence of crater-like defects were noted in this area. Painful nodular formations are detected in the submandibular area. Body temperature is 37.8 °C.

1. Formulate a diagnosis.In addition to the risk factor specified in the task condition, name other unfavorable background conditions in relation to the pathology presented.
2. Specify the etiological factors that determine the development of the disease in question.
3. How to assess the revealed changes in the submandibular area?
4. Possible complications of the presented disease.

№ 19.

The patient complains of severe soreness in the area of the first upper molar on the right. When examined from the side of the specified tooth, a carious cavity is determined, the tooth protrudes above the gum, the gum is sharply swollen along the periphery. X-ray examination showed that in the area of the tip of the 26th tooth, a focus of illumination with indistinct boundaries is determined.

1. What kind of disease has the patient developed?
2. Briefly describe the pathogenesis of the disease.
3. Describe the microscopic picture of the lesion.
4. List the possible complications of the disease.
5. What changes are usually made to the roots of the tooth in the presented conditions?

№ 20.

A 35-year-old woman came to the dental clinic complaining of pain in the area of the first upper molar on the right. From the medical history, it was found that the patient's pain worsens in response to a cold temperature that lingers for several minutes, and there were also episodes of spontaneous pain. During the examination of the oral cavity, the presence of a carious cavity in the first upper right molar communicating with the tooth cavity was noted. There was moderate pain during tooth percussion and severe pain during cold testing.

1. What kind of disease has the patient developed?
2. Specify the most likely etiology of the disease.
3. Describe the possible histological picture of the lesion.
4. Possible complications of the disease.

№ 21.

A 48-year-old man suffering from chronic alcoholism reported severe pain in the area of the first upper molar on the right for a week. The following week, the body temperature rose to 38 ° C, edema appeared in the right cheek area with further spread to the temporal region. These symptoms were accompanied by severe pain syndrome. Some time later, severe swelling of the periorbital areas developed with progressive ophthalmoplegia. An MRI scan of the skull revealed filling defects in both cavernous sinuses and pronounced dilation of the ocular veins.

1. Specify the options for the spread of odontogenic infection presented in the description of the clinical case.
2. What is the term for the symptoms that the patient develops in the second week of the disease?
3. What anatomical and topographic feature of the facial region can explain the possibility of the spread of inflammation from the buccal region to the temporal?
4. Specify other options for the contact spread of the odontogenic infection.
5. What pathology was detected in the patient during an MRI scan of the skull?

№ 22.

Patient K., 44 years old, went to the clinic for oral sanitation. On examination: on the vestibular surface of the upper third tooth on the right in the cervical region, a defect in the hard tissues of the tooth of medium depth, oval shape was revealed; the dentin is dense, pigmented, the bottom is rough, probing and exposure to cold water causes short-term rapidly passing pains. Microscopically: the dentin-enamel joint is destroyed, the lesion of the Toms fibers is in the form of their decay, the dentinal tubules are dilated, filled with microorganisms; three zones are clearly distinguishable.

1. The name of the pathological process of the hard tissues of the tooth that took place in this patient.
2. The stage of the described pathological process.
3. The name of the zones identified by microscopic examination.
4. Complications of the described pathological process.

№ 23.

A 30-year-old patient went to the dentist complaining of an enlarged right parotid gland. These symptoms occurred after fasting for weight loss. On examination, the salivary gland is enlarged, painful on palpation, and the skin above it is slightly hyperemic. When pressed, cloudy yellowish-white contents are released from the duct. The mucous membrane around the duct is hyperemic.

1. What pathology of the salivary gland has developed in the patient?
2. What etiological factors play the most important role in the development of this disease?
3. Describe the microscopic picture of the salivary gland.What complications are possible?

№ 24.

A 37-year-old patient went to a dentist about an enamel defect in the neck area of the upper canines on the vestibular side. The doctor diagnosed a "wedge-shaped defect". This phenomenon has been observed in the patient for 8 years.

1. Which group of dental diseases does the presented pathology belong to?
2. Which teeth are most often affected by this disease?
3. Which components of the tooth are affected?
4. The pathology of which internal organs can have a significant impact on the pathogenesis?

№ 25.

Patient M., 47 years old, had a tumor-like formation removed in the area of the right parotid salivary gland. Macroscopically, the tumor is represented by the formation of a light gray color with a soft consistency. Microscopic picture: the presence of areas represented by densely arranged ductal structures and the presence of areas resembling hyaline cartilage.

1. What pathological process of the parotid salivary gland took place in this patient?
2. What is the form of the described pathological process?
3. What are the possible outcomes of this pathological process?

Answers to situational tasks

№ 1.

1. Horny dystrophy.
2. Horny dystrophy is an excessive formation of horny matter in the keratinizing epithelium or its formation where it is not normally present.
3. Precancerous process.
4. Ichthyosis.

№ 2.

1. Dysplasia.
2. Dysplasia is a pathological regeneration with the development of cellular atypia and a violation of histoarchitectonics.
3. It is regarded as a precancerous process.
4. To pathological regeneration.
5. Intraepithelial neoplasia.

№ 3.

1. A hematoma is a hemorrhage with an accumulation of blood in tissues with a violation of their integrity.
2. Tearing, corroding, increased permeability.
3. Rupture of the vessel.Hemosiderin, hematoidin.
4. Blood resorption, cyst formation at the site of hemorrhage.

№ 4.

1. Catarrhal inflammation.
2. Serous, mucous, purulent, hemorrhagic.
3. The presence of mucus.
4. The development of atrophy or hypertrophy of the mucous membrane.Hypersecretion of mucus in catarrhal inflammation is aimed at removing the damaging agent and inflammatory products, which is considered as a protective reaction.

№ 5.

1. Necrosis.
2. Dry gangrene.
3. Gangrene is the necrosis of tissues in contact with the external environment. Wet gangrene, gas gangrene, a type of gangrene – pressure sores.
4. Coagulation, colliquation, and fatty necrosis.
5. Mutation (self–amputation) is an independent rejection of dead tissues and organs.

№ 6.

1. A nevus is a congenital or acquired hamartoma consisting of nevus cells.
2. Melanin.Borderline, intradermal, complex (mixed).
3. Favorable.
4. The danger of malignancy (malignancy of benign skin formation).

№ 7.

1. Anaphylactic shock.
2. Hypersensitivity reactions.
3. Hypersensitivity of the immediate type and delayed type.
4. Type I reactions (anaphylaxis).

№ 8.

1. Measles.An RNA virus from the paramyxavirus family.
2. The Koplik–Filatov enanthema spots.
3. Pneumonia (giant cell measles).
4. False croup.

№ 9.

1. Sepsis.
2. Septicopyemia, surgical sepsis.
3. At the entrance gate of infection there is purulent inflammation with purulent lymphangitis and lymphadenitis, purulent thrombophlebitis.
4. There are metastatic ulcers in the lungs, acute septic polypous ulcerative endocarditis in the heart, abscesses and purulent meningitis in the brain.Hyperplastic changes (septic spleen): the organ is enlarged, has a flabby consistency, and the pulp scrapes profusely.

№ 10.

1. Focal chronic osteomyelitis.
2. Infectious, most often bacterial.
3. Formation of fistulas, periostitis, cellulitis, transformation into diffuse osteomyelitis, facial phlegmon, sepsis.
4. Favorable.

№ 11.

1. Acute osteomyelitis of the lower jaw.
2. Immunodeficiency, autoimmune diseases, diabetes mellitus and other endocrinopathies.
3. There is an overgrowth of granulation tissue in the inter-girder space with pronounced neutrophil infiltration, deposition of fibrin deposits, and the possible presence of areas of necrotic bone tissue (sequesters).
4. Cellulite.
5. Formation of fistulas, phlegmon of the face, sepsis.

№ 12.

1. Keratocystic odontogenic tumor.
2. Suppuration, bone resorption, malignancy.
3. Radicular cyst, ameloblastoma.

№ 13.

1. Ameloblastoma.
2. A biopsy of the tumor site.
3. Favorable, in case of surgical treatment.

№ 14.

1. Of odontogenic origin (dysontogenetic).
2. Histological.
3. Favorable with timely treatment.

№ 15.

1. Adenomatoid odontogenic tumor.
2. Cysts of dysontogenic origin, keratocystic odontogenic tumor, monocystic ameloblastoma.
3. Inflammatory lymphadenopathy.
4. Favorable.

№ 16.

1. Hypertrophic gingivitis.
2. Mainly lymphoplasmocytic.
3. Connective tissue.
4. Acanthosis and hyperkeratosis.

№ 17.

1. Periodontitis.
2. Inflammation in the soft tissues surrounding the tooth, bone resorption, dystrophic changes in bone and periodontium.
3. Thickening of bone trabeculae, smooth bone resorption.
4. It depends on the stage of the disease, with advanced cases, tooth loss is possible.

№ 18.

1. Ulcerative necrotic gingivitis.
2. The task specifies a risk factor – wearing braces.
3. Other risk factors: smoking, immunosuppression (HIV), poor nutrition, poor oral hygiene, systemic diseases, stress.
4. Fusobacterium nucleatum, Treponema denticola, Treponema macrodentium, Prevotella intermedia.Inflammatory lymphadenopathy of the submandibular nodes, as a result of the lymphogenic spread of infection.
5. It may progress to ulcerative necrotic periodontitis and necrotic stomatitis.

№ 19.

1. Periapical abscess.
2. The inflammation is caused by an infection that comes from the root canal.
3. The inflammatory reaction is characterized by the presence of a large number of neutrophils and tissue lysis.
4. Sometimes the formation of an abscess may be preceded by a periapical granuloma.Densely located neutrophils, necrotic masses, colonies of microorganisms.
5. Periostitis, osteomyelitis, cellulitis, facial phlegmon, sepsis.Tooth root resorption.

№ 20.

1. Irreversible pulpitis.
2. Infection.
3. Extracellular matrix edema, venous fullness, infiltration by neutrophils and macrophages.
4. The formation of secondary and softened dentin is noted at the bottom of the carious cavity.
5. Apical granuloma, apical abscess, radicular cyst, tooth root resorption.

№ 21.

1. Contact and hematogenic.
2. Cellulite.The presence of a fatty body of the cheek, which is associated with the temporal and cranial regions, as well as with the orbital fissure.
3. Pronounced subcutaneous fat in the buccal region.
4. The infection can spread to the fatty tissue of the eye socket, the temporopterygoid space, the subaponeurotic space of the temporal region, the masticatory space and into the bed of the parotid salivary gland.
5. Thrombosis of the cavernous sinus.

№ 22.

1. Dental decay.
2. Deep.
3. The zone of softened dentin, the zone of preserved dentin, the zone of transparent (hypermineralized) dentin; the zone of secondary (irregular) dentin.
4. Pulpitis with further complications in the form of periodontitis, formation of periapical cysts, sepsis.

№ 23.

1. Acute purulent sialoadenitis.
2. Staphylococcus aureus; Staphylococcus epidermidis.
3. Marked swelling of the interstitium, diffuse infiltration by neutrophils.
4. Phlegmon of the surrounding soft tissues, osteomyelitis of the lower jaw, fistulas, sepsis.

№ 24.

1. Non-carious lesions of the teeth.
2. Canines and premolars.
3. Enamel and dentin.
4. Gastrointestinal tract, endocrine glands.

№ 25.

1. A tumor (neoplasia).
2. Pleomorphic adenoma.
3. The prognosis is generally favorable, in rare cases, tumor recurrence and malignancy are possible.