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80 Cards in this Set
- Front
- Back
This patient has a long history of anemia, infections and some neurological deficits. The panorex shows a generalized radiopacity. Which of the following is the most likely which of the following?
a) Osteopetrosis b) Osteoporosis c) Paget disease d) Osteomalacia e) Fibrous dysplasia |
Osteopetrosis
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Which of the following is the most likely diagnosis of the peripheral radiopacity observed at the apex of this non-vital tooth?
a) Idiopathic osteosclerosis b) Focal sclerosing osteomyelitis c) Cementoblastoma d) Focal cemento-osseous dysplasia e) Hypercementosis |
Cementoblastoma
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This 53 year old black female was a new patient admit. Her health was described as very good and the generalized radiopacity of the jaws did not cause jaw expansion and was entirely asymptomatic. Which of the following is the most likely diagnosis of her condition?
a) Osteopetrosis b) Florid cemento osseous dysplasia c) Chronic osteomyelitis d) Osteoblastic osteosarcoma e) Multiple complex odontomas |
Osteopetrosis
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This asymptomatic radiolucency is most likely which of the following?
a) Traumatic bone cyst b) Static bone cyst (Stafne) c) Aneurysmal bone cyst d) Residual cyst e) Primordial cyst |
Static bone cyst (Stafne)
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The patient in this case was a 64 year old male, whose chief complaint was bone pain. This brief history coupled with the radiographic appearance of his skull film suggests which of the following disease entities should head the list of differential diagnoses?
a) Langerhans cell disease b) Paget disease c) Osteosarcoma of the skull d) Either multiple myeloma or metastatic carcinoma e) Osteomalacia |
Either multiple myeloma or metastatic carcinoma
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This projection shows three examples of multiple socket sclerosis. This condition has been associated with which of the following?
a) Paget disease b) Renal disease c) Cleidocranial dysplasia d) Gardner syndrome e) McCune-Albright syndrome |
Paget disease
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Which of the following is the most common Primary Malignant tumor of bone in patients less than 40 years of age?
a) Melanoma b) Chondrosarcoma c) Osteosarcoma d) Osteoma e) Squamous cell carcinoma |
Osteosarcoma
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Which of the following is a common component of McCune Albright syndrome?
a) Polyostotic fibrous dysplasia b) Multiple basal cell carcinomas c) Multiple oral papillomas d) Multiple odontogenic keratocysts e) Adenocarcinomas of the colon |
Polyostotic fibrous dysplasia
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Which of the following is true of focal cemento osseous dysplasia?
a) It is commonly associated with vital teeth b) It occurs most commonly in females c) It is more common in Whites than Blacks d) All of the above e) A & C |
All of the above
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What are the symptoms of Osteogenesis Imperfecta?
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1. Osteopenia - decrease in amount of bone mass
2. Bone Fragility - fractures 3. Blue sclera - collagen in eyes is thin so vitreous humor shows 4. Dentinogenesis imperfecta 5. Hypoacusis (hearing loss) 6. Long bone and spine deformity 7. Joint hyperextensibility 8. Maxillary HypOplasia w/class III maloclussion 9. Radiographic lesions similar to osseous dysplasia 10.Long bone & spine deformity 11. Joint hyperextensibility |
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What is the most common type of heritable bone disease?
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Osteogenesis imperfecta
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What is a heterogeneous group of heritable disorders characterized by impairment of Collagen Maturation?
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Osteogenesis Imperfecta
- Collagen is the matrix into which ossification occurs. So, where there is a problem in collagen, it leads to defective bone maturation. Mutation of COL1A1 or COL1A2 |
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What is a group of Rare hereditary skeletal defects of Increased Bone Density resulting from defective remodeling due to failure in osteoclast function?
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Osteopetrosis (Albers-Schonberg Disease, Marble Bone)
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What is this mechanism for?
Bone forms, but doesn't remodel. This is a problem because the bone marrow space becomes obliterated. These patients develop severe anemia, thrombocytopenia and leukopenia, because of the lack of marrow. Endochondral, Endosteal, and Periosteal growth without concomitant Resorption results in thickening of bone. There is bone growth but NO Remodeling. |
Osteopetrosis (Albers-Schonberg Disease, Marble Bone)
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What are two forms of Osteopetrosis?
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Infantile (Malignant form)
Adult (Benign form) |
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What hereditary disease is the result of mutated CBFA1 gene (6p21), resulting in osteoblastic differentiation and bone formation?
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Cleidocranial Dysplasia
(named for the malformed clavicle & skull) |
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What are the characteristics of Cleidocranial Dysplasia?
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Short stature, Large head with frontal & parietal bossing, hypertelorism (wide set eyes). depressed nasal bridge
Narrow, High arched palate Supernumerary teeth Unerupted permanent teeth |
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What rare development condition do you see a progressive change in the jaws. You see gradual expansion of Max&Mand, in which there are multinucleated giant cells that look just like Central Giant Cell Granuloma and Hyperparathyroidism. It occurs most often in All Four Posterior Quadrants Simultaneously. Unlike CGCG it runs a clinical course until puberty, then is stable. Bilateral Symmetric Multilocular Expansion.
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Cherubism
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What are the dental implications of Cherubism?
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Involved bone produces widening & distortion of Alveolar Ridge
Tooth displacement Altered eruption Impaired mastication & speech difficulties |
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What is a rare inherited disorder within the spectrum of familiar colorectal polyposis that produces Osteomas, Supernumerary teeth, & Adenomatous colonic polyps > colon cancer?
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Gardner Syndrome
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What happens to patients with Gardner syndrome who do not have their polyps removed?
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50-50 chance of developing colon cancer by age 30
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What are the symptoms of Gardner Syndrome?
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Osteomas of any bone, skull, paranasal sinuses and mandible common
Supernumerary teeth in 20% Adenomatous colonic polyps > colon cancer Epidermoid cysts of the skin (these are benign but common cystic lesions of the skin) Desmoid tumor of skin (these are benign fibrous tumors) Pigmented lesions of ocular fundus 100x increase in thyroid cancer in females |
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How is Gardner Syndrome Treated?
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Colonectomy
Elective prophylactic thyroidectomy Elective removal of osteomas Cysts & other tumors |
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What are 5 Inherited Bone Diseases?
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Cherubism
Osteopetrosis Gardner's syndrome Osteogenesis imperfecta Cleidocranial dysplasia |
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What are the features of Metastatic Tumors to the Jaws?
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1.Jaws are an uncommon site for metastasis
2. 80% of cases are in Mandible 3. Pain, loosening of tooth, a mass or paresthesia (Numb-Chin Syndrome) 4. Radiolucent either well-defined or moth-eaten 5. Stage IV cancer (Not oral) of whatever primary cancer 6. Adults: breast, lung, colon, prostate, kidney, thyroid, testis 7. Children: Adrenal Neuroblastoma, embronal rhabdomyosarcoma, Wilms' tumor |
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T/F
Aneurysmal Bone Cyst is a True Cyst |
False, no epithelial lining
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What is a non-neoplastic lesion that may result from Trauma, vascular malformation or associated neoplasm that disrupts the normal hemodynamics of bone?
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Aneurysmal Bone Cyst
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What are the important features to remember about Aneurysmal Bone Cyst?
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Microscopically, we find some Sinusoidal Spaces
Shaft of long bones Unilocular or Multilocular radiolucency with cortical expansion Ballooning "vlow-out" distension of bone contour Radiopaque trabeculae At surgery lesion is described as Blood-Soaked Sponge 20% of jaw lesions associated w/CGCG |
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Where do Central Giant Cell Granulomas occur most frequently?
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70% in Anterior 2/3 Mandible
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What Lesion has the following features?
Non-neoplastic lesion of the jaws <30 year old Females Asymptomatic Radiographically lesions are 5cm-10cm (Huge) Unilocular or Multilocular Histopathologically consist of multinucleated giant cells in a stroma of spindle shaped fibroblasts and small vessel that hemorrhage and leak blood. Rule out other causes for giant cell lesions |
Central Giant Cell Granuloma
Indistinguishable from Hyperparathyroidism, Cherubism, & Aneurysmal bone cyst |
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What is the Most common Primary malignancy of bone (non-hematopoietic)?
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Osteosarcoma
(primary meaning originating from bone as a tissue) |
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T/F
If a person has breast cancer or colon cancer and it metastasizes to bone, it is still breast cancer or colon cancer. It is NOT bone cancer |
True
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What accounts for 6-8% of all osteosarcomas, have a mean age of 33, swlling & pain, loosening of teeth, paresthesia & nasal obstruction, spiking of roots, WIDENING of PDL (common), osteophytic reaction.
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Osteosarcoma of Jaws
Widening of PDL can also occur in trauma, periodontitis, or systemic sclerosis |
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What ages are most commonly affected by osteosarcoma?
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10-20 Located in distal femur or proximal tibia (around the knee)
Secondary group >50 associated w/Paget's disease located in axial skeleton 33 Osteosarcoma of the Jaws |
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What are the subvarieties of Osteosarcoma?
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Chondroblastic Osteosarcoma
Osteoblastic Osteosarcoma Giant Cell Osteosarcoma |
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What type of osteosarcoma is involved in producing cartilage in their array of microscopic features?
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Chondroblastic osteosarcoma
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What type of osteosarcoma primarily produce osteoid?
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Osteoblastic osteosarcomas
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What type of osteosarcoma are tumors of osteoclasts?
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Giant Cell osteosarcomas
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What is the treatment for osteosarcoma?
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Take an aggressive approach. Can metastasis to regional nodes, lung, and brain (> for long bones than jaw)
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What primary malignancy of bone of uncertain histogenesis with recent evidence of neuroendocrine origin, reciprocal translocation t(11;22) (q24;q12)?
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Ewing's Sarcoma
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Who is most affected by Ewing's Sarcoma?
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<20 years old
males slightly>females Rare in blacks |
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What kind of primary malignancy of bone has Onion skin periosteal reaction of long bones?
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Ewing's Sarcoma
concentric layers of bone on the cortex |
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What is a malignant neoplasm of bone characterized by the formation of cartilage?
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Chondrosarcoma
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What are Benign tumors of mature compact or cancellous bone that are restricted to the craniofacial skeleton?
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Osteomas
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What are two subcategories of osteomas?
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Periosteal lesions
Endosteal lesions |
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What is a benign neoplasm of hyaline cartilage?
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Chondroma
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T/F
Chondromas are Uncommon in the jaw |
True
Because this is so rare in the jaws a diagnosis of chondroma should always be regarded by the clinician as a mistaken diagnosis. Microscopic distinction from low-grade chondrosarcomas are difficult, therefore possible misdiagnosis. |
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What is a benign, empty or fluid-filled cavity within bone devoid of epithelial lining?
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Simple bone cyst (IDIOPATHIC BONE CAVITY, traumatic bone cyst, hemorrhagic bone cyst, solitary bone cyst)
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Who is affected by Simple bone cyst/idiopathic bone cavity?
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10-20 year olds
Mandible Males (prone to trauma) |
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What are the manifestations of simple bone cyst/idiopathic bone cavity?
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Well delineated radiolucency, usually in PM-M region of mandible, often Scalloped upward between the roots of teeth
Associated w/cementoosseous dysplasia |
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Who is affected by paget's disease?
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>40 years old
Males Whites Maxilla > Mand |
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How does Paget's disease manifest?
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Idiopathic disorder of abnormal anarchic resorption & deposition of bone (abnormal remodeling)
Polyostotic (multiple bones affected) Maxilla 17% Progressive alveolar ridge expansion, spacing of teeth, dental appliances that no longer fit the mouth. Altered trabecular pattern initially from decreased bone density evolves to Patchy sclerotic areas having a Cotton Wool radiographic appearance |
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T/F
Paget's disease Increases the risk of Osteosarcoma and giant cell tumors of the bone |
True
Slightly 1% |
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What bone condition presents microscopically as alternating resorption and formation of bone producing MOSAIC pattern and marrow replaced by highly vascular fibrous connective tissue**test question
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Paget's Disease
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In Paget's disease when is serum alkaline phosphatase treated?
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If elevated more than 25-50%
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What is used to treat Paget's disease?
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Calcitonin and Bisphosphates (things that will slow down the abnormal remodeling)
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What condition should be suspected if a tooth is extracted and instead of the extraction site filling in within new bone, it fills in with bone marrow, which could be either hematopoietic marrow or fatty marrow?
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Focal Osteoporotic Marrow Defect
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Who & what location is affected by Focal Osteoporotic Marrow Defect?
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Females
<50 Posterior Mandible |
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What is the problem with Focal Osteoporotic Marrow Defect?
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No problem other than a Persistent Radiolucency of mandibular X-rays
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What is a Focal area of increased RadioDensity of unknown cause?
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Idiopathic Osteosclerosis
common 5% of population 20 years old Mandible |
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T/F
Giant Cell Tumors (not CGCG) are considered a True Neoplasm usually found in long bones (Not in jaw). Histologically indistinguishable from CGCG. Has a higher recurrence rate and 10% rate of matastasize (this is Not how CGCGs behave) |
True
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T/F
Fibrous dysplasia and Cemento-osseous dysplasia look similar under the microscope but do NOT behave in the same clinical manner |
True
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Is Fibrous dysplasia a polyostotic disease or a monostotic disease?
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Both
Early embryonic mutation produces polyostotic disease (This is the more serious form; McCune Albright syndrome is associated with this form) Postnatal mutation is a monostotic disease (most common form, Maxilla, radiographic ground glass, narrow PDL w/indistinct lamina dura, IA nerve canal displaced superiorly & can appear larger than usual) |
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What condition histopathologically consists of trabeculae of woven bone in a cellular, fibrous stroma (Chinese characters)
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Fibrous Dysplasia
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What condition has a mutation in the GNAS 1 gene?
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Fibrous dysplasia
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What condition specifically is most common variation, Max>mand, radiographic ground-glass apearance, PDL narrow & lamina dura indistinct, IA nerver displaced superiorly and can appear larger than normal?
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Fibrous Dysplasia Postnatal mutation: Monostotic Disease
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What is the prognosis for fibrous dysplasia?
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Good
It will run its course for many years then stabilize 25-50% regrowth after shave down |
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What is a Non-neoplastic fibro-osseous alteration of bone in the tooth bearing areas of the jaws. (these do not occur in other bones)
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Cemento-osseous dysplasia
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What does the cellular components of cemento-osseous dysplasia contain?
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Cellular connective tissue containing a mixture of woven bone, lamellar bone and cementum-like particles; ratio of fibrous tissue decreases over time as it becomes slerotic by fusion of calcified elements
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What are 3 distinct radiographic/clinical patterns that share a common histopathologic appearance in Cemento-osseous dysplasia?
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Focal cemento-osseous dysplasia - Young to middle aged WHITE Females, Solitary radiolucent to radiopaque lesion, Post Mand, near root of tooth
Periapical cemento-osseous dysplasia - Black Females, Anterior Mand, Multifocal,periapical to Vital teeth, Must Pulp Test (can look like periapical granuloma or cyst) Florid cemento-osseous dysplasia - Middle aged to Older Black Females |
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What type of cemento-osseous dysplasia occurs most frequently in White Females, Posterior Mandible, Near root of the tooth?
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Focal cemento-osseous dysplasia
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What type of cemento-osseous dysplasia occurs most frequently in Black Females 30-50 years old, Anterior Mandible, Multifocal?
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Periapical cemento-osseous dysplasia
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What type of cemento-osseous dysplasia occurs most frequently in Middle aged to Older Black Females?
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Florid cemento-osseous dysplasia
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How do you treat Periapical cemento-osseous dysplasia?
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No Tx needed tooth is perfectly sound
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Which form of cemento-osseous dysplasia requires pulp testing to distinguish it from a periapical granuloma or cyst?
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Periapical cemento-osseous dysplasia, these are found on vital teeth
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What type of cemento-osseous dysplasia is a solitary radiolucent to radiopaque lesio, less than 1.5 cm that may appear opaque with a thin radiolucent rim?
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Focal cemento-osseous dysplasia
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Which type of cemento-osseous dysplasia can be associated with osteomyelitis?
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Florid cemento-osseous dysplasia
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What is a true neoplasm of an admixture of fibrous tissue & bony trabeculae, cementum-like spherules, or both, clinically they grow in a spherical mass that keeps enlarging. Females in 30-40 age range. Most frequent site is Premolar to Molar region of Mandible?
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Ossifying Fibroma (Cemento-ossyfying fibroma)
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What type of ossyfying fibroma is in younger patients, Maxilla, and is rapid?
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Juvenile Ossifying Fibroma
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Which of the following statements is true of Gardner syndrome?
a) Gnathic osteomas may occur in the mandible b) Dental abnormalities in Gardner syndrome often include Supernumerary Teeth c) The major problem for patients with Gardner syndrome is the development of an adenocarcinoma of the bowel d) All of the above e) A&C |
All of the above
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