# INBDE practice questions: FK6 — General and oral pathology Ten original INBDE practice questions on FK6 — General and oral pathology, each answered on this page with a rationale and a source. Last updated: 2026-08-10. ## Question 1 A 55-year-old man with type 2 diabetes and an A1C of 9.2 % has generalised severe periodontitis with several deep pockets. His physician writes to ask whether periodontal treatment should wait until glycaemic control improves. What is the best reply? - A. Treatment should wait, because healing is unreliable until his A1C has fallen below 6.5 - B. Periodontal disease is a consequence of diabetes only, so better control alone will settle it - C. The relationship runs both ways, so periodontal treatment is part of caring for his diabetes - D. Treatment should wait, because periodontal therapy will raise his blood glucose further **Answer C:** The relationship runs both ways, so periodontal treatment is part of caring for his diabetes The module states that the relationship between diabetes and periodontitis runs both ways: poor control brings dry mouth, candidiasis, burning mouth, delayed healing, and more severe and faster periodontal destruction, while severe periodontitis is associated with worse glycaemic control — so periodontal treatment is part of caring for the diabetic patient rather than an optional extra. A turns a laboratory value into a gate and leaves an active infection untreated; 6.5 % is a diagnostic threshold, not a permission line for treatment. B makes the relationship one-directional, which is exactly what the two-way finding denies, and would leave established destruction to resolve on its own. D asserts an effect of periodontal therapy that the module does not describe, and uses it to justify the same delay. **Common trap:** Sequencing dental care behind a target number when the two conditions drive each other. Source: Newman and Carranza's Clinical Periodontology and Implantology ## Question 2 A 66-year-old man on haemodialysis every Monday, Wednesday and Friday needs a lower molar extracted. He has an arteriovenous fistula in his left forearm and asks for something strong for the pain afterwards. Which plan fits his condition best? - A. Treat on a dialysis day immediately after his session and prescribe ibuprofen for pain - B. Treat on a dialysis day just before his session and use the fistula arm for the cuff - C. Treat on any day, since dialysis fully corrects the bleeding tendency of renal failure - D. Treat on a non-dialysis day, keep cuffs off the fistula arm, and avoid NSAIDs entirely **Answer D:** Treat on a non-dialysis day, keep cuffs off the fistula arm, and avoid NSAIDs entirely The module's practical rules for chronic kidney disease are to avoid NSAIDs because they are nephrotoxic, to adjust or avoid renally cleared drugs, never to place a blood-pressure cuff or take blood from the arm carrying an arteriovenous fistula or graft, and to schedule a haemodialysis patient on a non-dialysis day — usually the day after — because heparin given during dialysis raises bleeding risk and the patient is fluid- and electrolyte-shifted immediately afterwards. A picks the single worst slot and then prescribes the drug class to avoid. B keeps the dialysis-day timing and uses the limb that must be left alone. C claims dialysis abolishes bleeding risk; uraemia impairs platelet function, so expect more oozing regardless. **Common trap:** Timing treatment around the dialysis session for convenience rather than around the heparin. Source: Little & Falace's Dental Management of the Medically Compromised Patient ## Question 3 A 24-year-old woman with epilepsy has a generalised convulsive seizure in the chair. Instruments have been removed, the chair lowered and her head protected. The convulsion is still continuous when the assistant calls out six minutes on the timer. What does the six minutes signify? - A. Nothing yet, because continuous convulsive activity is not status until thirty minutes - B. It has passed the threshold for status epilepticus, so activate emergency services - C. It is time to insert a padded bite block, protecting her tongue from laceration - D. It is time to restrain her limbs, preventing her from injuring herself further **Answer B:** It has passed the threshold for status epilepticus, so activate emergency services Status epilepticus is the point at which a seizure stops being self-limiting, and for convulsive seizures five minutes or more of continuous activity is the operational threshold for treating it as status; thirty minutes is the separate point beyond which long-term neurological consequences are expected. Repeated seizures without recovery of awareness between them count the same way, and the response is to activate emergency medical services. A confuses those two time points and would delay the call by nearly half an hour. C and D each do something the module forbids during a seizure: put nothing in the mouth and do not restrain the patient. Injuries — a tongue laceration, a luxated or avulsed tooth, a jaw injury — are checked for afterwards, during the confused post-ictal period. **Common trap:** Remembering both time points but attaching the action to the wrong one. Source: [ILAE Task Force operational definition of status epilepticus](https://onlinelibrary.wiley.com/doi/abs/10.1111/epi.13121) ## Question 4 A 62-year-old woman describes bursts of electric-shock pain lasting seconds in her right cheek and upper teeth, set off by cold wind or by touching her face with a towel. Between attacks she is entirely pain-free. The upper right teeth are unrestored, test vital and are not tender. What best explains this? - A. Trigeminal neuralgia in the maxillary division, triggered by light touch and wind - B. Irreversible pulpitis in an upper molar, calling for endodontic treatment this week - C. Post-injection paraesthesia following an earlier block in that area of the face - D. Burning mouth syndrome, a diagnosis of exclusion after deficiency and candidiasis **Answer A:** Trigeminal neuralgia in the maxillary division, triggered by light touch and wind Trigeminal neuralgia is brief, severe, electric-shock pain in the distribution of a trigeminal division — usually V2 or V3 and almost always unilateral — triggered by light touch, chewing or wind, with pain-free intervals between attacks. Her right cheek and upper teeth are the V2 distribution, and the teeth themselves are sound and vital. B is the classic and avoidable harm the module names, because irreversible treatment would be done on a sound tooth for pain the tooth is not producing. C describes a numbness or altered sensation following an injection she has not had. D is a diagnosis of exclusion presenting as burning, not as shocks. Carbamazepine is the conventional first-line drug, and imaging is warranted to exclude a structural cause. **Common trap:** Answering the location of the pain instead of its character, and treating a sound tooth. Source: Neville, Oral and Maxillofacial Pathology ## Question 5 A 68-year-old woman with asthma complains of soreness and a bad taste. Her palate and buccal mucosa carry creamy white plaques that come away on gauze, leaving a red, slightly bleeding base. She uses a corticosteroid inhaler twice daily and does not rinse afterwards. What is the diagnosis and next step? - A. Leukoplakia; arrange an incisional biopsy of the largest palatal patch soon - B. Oral hairy leukoplakia; investigate for immunosuppression before any treatment starts - C. Erosive lichen planus; prescribe a topical corticosteroid and review in a month - D. Pseudomembranous candidiasis; treat it and correct the unrinsed inhaler habit **Answer D:** Pseudomembranous candidiasis; treat it and correct the unrinsed inhaler habit The first question for any white lesion is whether it wipes off: if gauze removes it and leaves a red, sometimes bleeding base, it is pseudomembranous candidiasis — an infection, not a premalignancy. The second question is why, and inhaled corticosteroids used without rinsing sit at the top of that list alongside dry mouth, a denture worn overnight, poorly controlled diabetes, recent broad-spectrum antibiotics and immunosuppression. Treating the thrush without finding the reason guarantees recurrence. A applies a clinical label reserved for a fixed white plaque of equivocal risk once other diseases are excluded, and leukoplakia does not wipe off. B names a lateral-tongue, Epstein-Barr-driven lesion that also does not wipe off. C describes a chronic bilateral disease with lacy Wickham striae. **Common trap:** Diagnosing a white lesion by colour and site before performing the wipe test. Source: Neville, Oral and Maxillofacial Pathology ## Question 6 A 59-year-old man who smokes has a white patch on the floor of mouth with a nodular, speckled surface. It does not wipe off, and there is no denture, sharp edge or habit to account for it. He asks how worried he should be compared with the plain white patches he has read about. - A. It is safer than a uniform white patch, since an irregular surface means keratin - B. A non-homogeneous patch carries about four times the risk of a homogeneous one - C. The white colour itself excludes dysplasia, so clinical photographs are enough here - D. Nothing can be said about his risk until the patch has been watched for months **Answer B:** A non-homogeneous patch carries about four times the risk of a homogeneous one Leukoplakia is a clinical term for a white plaque of equivocal risk once other known diseases and disorders have been excluded, and it says nothing about what the microscope will show, because it may be dysplastic or non-dysplastic. Its estimated prevalence is about 2 per cent, its collective annual malignant transformation rate about 1 per cent, and pooled transformation across large series about 9.8 per cent — with non-homogeneous forms, meaning verrucous, nodular or speckled, carrying roughly four times the risk of homogeneous ones. A inverts that relationship. C claims colour excludes dysplasia, which is precisely what a clinical diagnosis of exclusion cannot do. D delays: the short review interval belongs to a seemingly innocuous lesion with a removable cause, and he has none. **Common trap:** Hearing "leukoplakia" as a reassuring label instead of an unresolved question needing tissue. Source: [AAOMS Position Paper — Oral Mucosal Dysplasia](https://aaoms.org/wp-content/uploads/2024/03/oral_mucosal_dysplasia_position_paper.pdf) ## Question 7 A 64-year-old man who smokes and drinks daily has a soft, velvety, fiery red patch on the floor of mouth. It does not wipe off, he wears no denture, and there are no candidal changes elsewhere. A prompt incisional biopsy is arranged. What is the most likely histological finding? - A. Hyperkeratosis without dysplasia, matching the benign behaviour of most red patches - B. Candidal hyphae in the surface epithelium over an inflammatory cell infiltrate - C. At least moderate or severe dysplasia, or carcinoma in situ already present - D. A lichenoid interface reaction of the kind found beneath Wickham striae **Answer C:** At least moderate or severe dysplasia, or carcinoma in situ already present Erythroplakia is a fiery red patch that cannot be characterised clinically or pathologically as any other definable disease. It is far less common than leukoplakia — reported prevalence between about 0.02 and 0.83 per cent against roughly 2 per cent — and far more dangerous: histologically it typically shows at least moderate or severe dysplasia or carcinoma in situ, and the vast majority undergo malignant transformation. That is why prompt incisional biopsy is indicated rather than observation. A predicts the benign result the red colour argues against. B belongs to erythematous candidiasis, which tells a different story — denture stomatitis confined to the denture-bearing area, median rhomboid glossitis, angular cheilitis. D describes lichen planus, which presents with lacy white striae rather than an unexplained red patch. **Common trap:** Expecting a red patch to be inflammatory because red usually means inflammation. Source: [AAOMS Position Paper — Oral Mucosal Dysplasia](https://aaoms.org/wp-content/uploads/2024/03/oral_mucosal_dysplasia_position_paper.pdf) ## Question 8 A 71-year-old man has a soft blue-purple swelling on the ventral tongue found at a recall visit. Pressed firmly with a glass slide it empties and goes pale, then refills as soon as the pressure is released. He has no pain and no history of trauma there. What does this manoeuvre establish? - A. The lesion is vascular, so it should not be biopsied as though it were pigmented - B. The lesion is an amalgam tattoo, confirmed by this change in colour under pressure - C. The lesion is an oral melanotic macule, which is small, flat and uniformly coloured - D. The lesion is Kaposi sarcoma, which calls for immediate testing for advanced HIV **Answer A:** The lesion is vascular, so it should not be biopsied as though it were pigmented Pressing the lesion is one of the two bedside tests that do most of the work with red, blue and pigmented lesions: a lesion that blanches under pressure is vascular — a haemangioma, a vascular malformation or a varix — and recognising that stops you from biopsying something that will bleed. B names a localised grey-blue macule near a restoration or an old extraction site, which does not empty under pressure and may show metal particles on a radiograph, the useful discriminator there. C names a small, flat, uniformly coloured and stable lesion, which likewise does not blanch. D names a red-purple macule or nodule of advanced HIV disease, often palatal or gingival; nothing in this history points there, and the blanching test identifies vascularity rather than naming a tumour. **Common trap:** Reading blue as pigment and reaching for a biopsy before pressing the lesion. Source: Neville, Oral and Maxillofacial Pathology ## Question 9 A 26-year-old woman has crops of painful ulcers under 1 cm on her labial mucosa and ventral tongue every few weeks. They heal in about ten days without scarring, and she has never had a fever with them. She asks for the antiviral cream that helped her partner's cold sores. What is the correct assessment? - A. Recurrent intraoral herpes; the antiviral is appropriate and should be started early - B. Primary herpetic gingivostomatitis; the absence of fever makes each episode milder - C. Minor aphthous ulceration; antivirals do nothing, and recurrence warrants a work-up - D. Erythema multiforme; the recurring crops indicate a drug trigger to be identified **Answer C:** Minor aphthous ulceration; antivirals do nothing, and recurrence warrants a work-up Recurrent aphthous stomatitis sits on movable, non-keratinised mucosa — labial and buccal mucosa, floor of mouth, soft palate and ventral tongue — and minor aphthae are under 1 cm and heal in 7 to 14 days without scarring. They are not caused by herpes virus, so antivirals do nothing, and recurrent or severe disease justifies looking for iron, folate or B12 deficiency, coeliac disease, inflammatory bowel disease, HIV and Behçet disease. A puts recurrent herpes on the wrong tissue: it favours keratinised, bound-down mucosa such as the hard palate and attached gingiva. B describes a first-exposure illness, usually in a young child, with fever, malaise and fiery painful gingivitis. D is acute, with target-shaped skin lesions and haemorrhagic crusted lips. **Common trap:** Letting a patient's analogy to cold sores decide the diagnosis instead of the tissue involved. Source: Neville, Oral and Maxillofacial Pathology ## Question 10 A 58-year-old woman has had sore, peeling, fiery red gingivae for several months. Her plaque control is good and repeated scaling has not helped. Epithelium strips away when the tissue is rubbed with a gauze square. A biopsy is planned. How should the specimen be taken and handled? - A. From the floor of the deepest erosion, where inflammation appears most intense - B. As an exfoliative cytology smear from the stripped surface, avoiding surgical trauma - C. No biopsy; manage this as plaque-induced gingivitis and reinforce oral hygiene - D. Perilesional tissue from beside an affected area, for direct immunofluorescence **Answer D:** Perilesional tissue from beside an affected area, for direct immunofluorescence Desquamative gingivitis is a sign, not a diagnosis; its usual causes are lichen planus, mucous membrane pemphigoid and pemphigus, and the way to tell them apart is a biopsy that includes perilesional tissue submitted for direct immunofluorescence, not a specimen taken from the ulcer floor. The distinction matters because pemphigus vulgaris is an intraepithelial suprabasilar split whose fragile blisters leave ragged erosions, while mucous membrane pemphigoid is a subepithelial split that can scar and whose ocular involvement can blind, so it needs ophthalmology referral. A is the named sampling error. B substitutes a smear for the immunofluorescence specimen the diagnosis depends on. C treats a mucocutaneous disease as a plaque problem, though her plaque control is already good. **Common trap:** Sampling the most dramatic-looking tissue rather than the tissue the test requires. Source: Neville, Oral and Maxillofacial Pathology ## Next step [Take the free INBDE practice test](https://dentovio.com/inbde/free-practice-test) Official reference: [JCNDE — Integrated National Board Dental Examination](https://jcnde.ada.org/inbde). Original exam-style questions written for study, never recalled exam content. Independent educational preparation, not clinical advice, and not affiliated with or endorsed by the Joint Commission on National Dental Examinations.