Dental MCQ
Mucosal pattern recognition · Oral Pathology · INBDE Patient Cases

Mucosal & Soft Tissue Lesions INBDE Patient Cases

By Dr. Isaac Sun, DDS

9 ADA INBDE-format patient cases on mucosal & soft tissue lesions. Each case is a shared patient box (chief complaint, history, medications, allergies, exam) followed by linked multiple-choice questions with full distractor explanations. Practice the way the real exam is structured.

9 patient cases45 linked questionsADA INBDE formatFull distractor explanations

Nine ADA INBDE-format patient cases on oral mucosal and soft tissue lesions: reticular lichen planus and its Wickham striae with the small malignant-transformation risk, a pregnancy-associated pyogenic granuloma and hygiene-first management, recurrent aphthous stomatitis and how it differs from recurrent intraoral herpes, pemphigus vulgaris with a positive Nikolsky sign and desmoglein autoantibodies diagnosed by immunofluorescence biopsy, drug-influenced gingival enlargement from calcium channel blockers, an amalgam tattoo versus melanoma and when a pigmented lesion needs biopsy, benign geographic and fissured tongue, epulis fissuratum from an ill-fitting denture, and erythema multiforme with its drug and herpes simplex triggers. Topics include white lesions, reactive and hyperplastic growths, immune-mediated ulcerative and vesiculobullous diseases, pigmented lesions, and benign tongue and developmental variants.

Case Coverage Map
What each case is testing
Lacy white lines found at a checkup:
Reticular lichen planus, Wickham striae, reticular versus erosive, monitoring, and the small malignant-transformation risk.
A bleeding gum lump in pregnancy:
Pyogenic granuloma (pregnancy tumor), hormones plus local irritants, hygiene-first management, deferring excision, and biopsy.
Recurring painful mouth ulcers:
Recurrent aphthous stomatitis, the movable-mucosa clue versus herpes, non-viral nature, systemic associations, and symptomatic care.
Chronic painful erosions and peeling gums:
Pemphigus vulgaris, the Nikolsky sign, desmoglein autoantibodies, the intraepithelial split, immunofluorescence biopsy, and referral.
Overgrown gums on a new medication:
Drug-influenced gingival enlargement, the culprit drug classes, the role of plaque, hygiene-first management, and physician coordination.
A grey spot near a filling:
Amalgam tattoo versus melanoma, the confirming radiograph, the worrying features that demand biopsy, and high-risk sites.
A tongue that keeps changing patterns:
Geographic tongue and fissured tongue, the benign migratory course, reassurance, and what would change the plan.
A fold of tissue under a loose denture:
Epulis fissuratum, the ill-fitting denture cause, correcting the denture, and biopsy to exclude malignancy in an older patient.
Sudden bloody, crusted lips and target spots:
Erythema multiforme, drug and herpes triggers, removing the cause, supportive care and referral, and recurrent HSV-associated disease.
Patient case: Lacy white lines found at a checkup
0 of 5 answered, 0 correct
Patient
Female, 52 years old
Chief Complaint
"You pointed out some white lines in my cheeks. Should I worry?"
Background and/or Patient History
  • Asymptomatic white lines noticed on routine exam
  • No pain except occasional sensitivity to spicy food
  • No tobacco use
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • Bilateral lacy white striae on the buccal mucosa
  • No ulceration or induration
  1. Question 1
    Moderate
    The bilateral lacy white striae are most consistent with:
  2. Question 2
    Moderate
    The reticular form differs from the erosive form of lichen planus in that reticular lichen planus is usually:
  3. Question 3
    Moderate
    Lichen planus is best described as a:
  4. Question 4
    Moderate
    Appropriate management of asymptomatic reticular lichen planus is to:
  5. Question 5
    Hard
    Why is periodic monitoring still reasonable for oral lichen planus?

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Patient case: A bleeding gum lump in pregnancy
0 of 5 answered, 0 correct
Patient
Female, 28 years old
Chief Complaint
"A lump grew on my gum and it bleeds when I brush."
Background and/or Patient History
  • Currently pregnant (second trimester)
  • A soft red gingival growth that appeared over a few weeks
  • Bleeds easily with brushing
  • Plaque accumulation around the area
Allergies
NKDA
Medications
  • Prenatal vitamins
Current Findings
  • Soft, red, lobulated gingival mass that bleeds on contact
  • Local plaque and calculus near the lesion
  1. Question 1
    Moderate
    The soft, red, easily bleeding gingival mass in pregnancy is most likely a:
  2. Question 2
    Moderate
    The main local factors contributing to its development are:
  3. Question 3
    Moderate
    Initial management of this lesion in pregnancy is to:
  4. Question 4
    Moderate
    Regarding timing of excision, a reasonable approach is to:
  5. Question 5
    Moderate
    If the lesion is excised, it should be:

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Patient case: Recurring painful mouth ulcers
0 of 5 answered, 0 correct
Patient
Male, 24 years old
Chief Complaint
"I keep getting painful ulcers inside my lips and cheeks."
Background and/or Patient History
  • Recurrent crops of small painful ulcers every few weeks
  • Ulcers occur on the inner lip, cheek, and under the tongue
  • Heal in about a week to ten days without scarring
  • No skin or genital lesions
Allergies
NKDA
Medications
  • None
Current Findings
  • Two shallow ulcers with a yellow-grey base and red halo on the labial mucosa
  • Keratinized gingiva and palate unaffected
  1. Question 1
    Moderate
    His recurrent ulcers on movable mucosa that heal without scarring are most consistent with:
  2. Question 2
    Moderate
    A feature that argues against recurrent herpes here is that the ulcers are on:
  3. Question 3
    Moderate
    Recurrent aphthous stomatitis is best described as:
  4. Question 4
    Hard
    If a young adult develops unusually severe or persistent aphthous-like ulcers, it is reasonable to consider an underlying:
  5. Question 5
    Moderate
    Typical management of uncomplicated minor aphthous ulcers is:

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Patient case: Chronic painful erosions and peeling gums
0 of 5 answered, 0 correct
Patient
Female, 56 years old
Chief Complaint
"My mouth has painful raw areas and my gums peel."
Background and/or Patient History
  • Weeks of painful oral erosions that will not heal
  • Gingiva appears red and sloughs with minor trauma
  • Some skin blisters reported as well
  • Difficulty eating due to pain
Allergies
NKDA
Medications
  • None
Current Findings
  • Widespread irregular oral erosions; desquamative gingivitis
  • Gentle lateral pressure causes the epithelium to slough (positive Nikolsky sign)
  1. Question 1
    Moderate
    Chronic painful erosions with a positive Nikolsky sign in an adult should raise concern for:
  2. Question 2
    Hard
    Pemphigus vulgaris results from autoantibodies against:
  3. Question 3
    Hard
    The split in pemphigus vulgaris is:
  4. Question 4
    Moderate
    The appropriate diagnostic step is:
  5. Question 5
    Moderate
    Because pemphigus vulgaris can be a serious systemic disease, the dentist should:

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Patient case: Overgrown gums on a new medication
0 of 5 answered, 0 correct
Patient
Male, 60 years old
Chief Complaint
"My gums have been growing over my teeth."
Background and/or Patient History
  • Progressive generalized gingival overgrowth over several months
  • Started a calcium channel blocker for blood pressure around that time
  • Plaque accumulation worsened by the enlarged tissue
  • No pain
Allergies
NKDA
Medications
  • Nifedipine (calcium channel blocker)
Current Findings
  • Generalized firm gingival enlargement partly covering the crowns
  • Heavy plaque in the enlarged areas
  1. Question 1
    Moderate
    His generalized gingival enlargement is most likely:
  2. Question 2
    Moderate
    Which medication class is a recognized cause?
  3. Question 3
    Moderate
    A factor that worsens the severity of drug-influenced enlargement is:
  4. Question 4
    Moderate
    Initial management includes:
  5. Question 5
    Moderate
    Regarding the medication itself, the dentist should:

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Patient case: A grey spot near a filling
0 of 5 answered, 0 correct
Patient
Female, 45 years old
Chief Complaint
"There's a grey mark on my gum that I just noticed."
Background and/or Patient History
  • A flat grey-black area on the gingiva adjacent to a heavily restored molar
  • Stable, no change reported
  • No pain or bleeding
  • No history of skin melanoma
Allergies
NKDA
Medications
  • None
Current Findings
  • Flat, well-defined grey-black macule next to an amalgam-restored tooth
  • No induration or ulceration
  1. Question 1
    Moderate
    The most likely diagnosis for a flat grey-black macule next to an amalgam restoration is:
  2. Question 2
    Moderate
    A simple test that can support the diagnosis of amalgam tattoo is:
  3. Question 3
    Moderate
    Which finding would instead prompt a biopsy to exclude melanoma?
  4. Question 4
    Moderate
    If radiographs show no metal and the lesion cannot be confidently explained, the appropriate step is to:
  5. Question 5
    Hard
    The site that makes a pigmented oral lesion most concerning for melanoma is the:

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Patient case: A tongue that keeps changing patterns
0 of 5 answered, 0 correct
Patient
Female, 33 years old
Chief Complaint
"The red patches on my tongue keep moving and changing. Is it serious?"
Background and/or Patient History
  • Red patches with white borders that appear and shift over days
  • Mild sensitivity to spicy or acidic foods
  • Pattern has come and gone for years
  • Otherwise healthy
Allergies
NKDA
Medications
  • None
Current Findings
  • Erythematous depapillated patches with serpentine white borders on the tongue dorsum
  • Deep grooves also present on the tongue
  1. Question 1
    Easy
    The migrating red patches with white borders are characteristic of:
  2. Question 2
    Moderate
    The deep grooves also seen on her tongue represent:
  3. Question 3
    Moderate
    The clinical course of geographic tongue is:
  4. Question 4
    Moderate
    Appropriate management is to:
  5. Question 5
    Moderate
    What would change the plan and warrant biopsy?

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Patient case: A fold of tissue under a loose denture
0 of 5 answered, 0 correct
Patient
Male, 68 years old
Chief Complaint
"There's a flap of sore tissue where my denture rubs."
Background and/or Patient History
  • Wears an old, loose complete denture
  • A fold of tissue developed along the denture border
  • Mild soreness in the area
  • Denture has not been relined in years
Allergies
NKDA
Medications
  • None
Current Findings
  • Folds of firm fibrous tissue paralleling the denture flange in the vestibule
  • Ill-fitting, over-extended denture border
  1. Question 1
    Moderate
    The folds of tissue along the denture flange represent:
  2. Question 2
    Moderate
    The underlying cause is:
  3. Question 3
    Moderate
    A key part of management is to:
  4. Question 4
    Moderate
    When the lesion is excised, the tissue should be:
  5. Question 5
    Moderate
    Why is biopsy of denture-related hyperplastic tissue particularly prudent in an older patient?

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Patient case: Sudden bloody, crusted lips and target spots
0 of 5 answered, 0 correct
Patient
Male, 26 years old
Chief Complaint
"My lips suddenly cracked, bled, and crusted, and I have spots on my skin."
Background and/or Patient History
  • Acute onset of severe lip crusting and oral erosions over a day or two
  • Started a new medication about a week ago
  • Target-shaped lesions appearing on the skin
  • Feels generally unwell
Allergies
NKDA
Medications
  • Recently started a new drug
Current Findings
  • Hemorrhagic, crusted lips with diffuse oral erosions
  • Target (iris) lesions on the skin of the hands
  1. Question 1
    Moderate
    Acute hemorrhagic crusted lips with target skin lesions are characteristic of:
  2. Question 2
    Moderate
    Common triggers of erythema multiforme include:
  3. Question 3
    Moderate
    Given the recent new medication, an important step is to:
  4. Question 4
    Moderate
    Appropriate care for this patient is:
  5. Question 5
    Hard
    If a patient has recurrent erythema multiforme episodes, a common underlying trigger to consider is:

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Keep studying
Mucosal & Soft Tissue Lesions core recall

Refresh the anatomy facts these cases depend on: nerve numbers, foramina, functions, and lesion findings.

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