Oral pathology and oral medicine practice questions for the periodontics Qualifying Exam
The ABP has long said the Qualifying Exam places emphasis on oral medicine and oral pathology. Expect gingival and mucosal lesions, biopsy choices, histology and the oral signs of systemic disease.
2027 ABP blueprint domain: Oral Pathology and Oral Medicine
9%of our mock exams
~18of 200 full-length mock questions
87questions on this domain in the bank
What the blueprint covers
The 2027 Qualifying Exam blueprint lists these objectives for this domain:
Differential diagnosis of hard and soft tissue lesions
Choosing the right biopsy technique
Definitive diagnosis from histology, laboratory reports and pathology consultations
Treating hard and soft tissue lesions, and knowing when to refer
Oral manifestations of systemic and infectious diseases
High-yield areas
Desquamative gingivitis: lichen planus, mucous membrane pemphigoid and pemphigus, and direct immunofluorescence
Leukoplakia, erythroplakia and squamous cell carcinoma presenting as periodontal disease
Lateral periodontal cyst, odontogenic keratocyst and cemento-osseous dysplasia
Leukemia, HIV, Crohn disease and granulomatosis with polyangiitis in the gingiva
How to study it
Learn lesions by where they appear, how they look and what the biopsy shows. For each, know the one feature that separates it from its closest mimic and when it needs a referral.
Free practice questions: Oral pathology and oral medicine
4 questions from the bank, with the full rationale and source. Pick your answer, then open the rationale.
Question 1 of 4 · moderateOral Pathology and Oral Medicine
A 26-year-old man has several painless, slightly raised, gray-white mucosal patches on the gingiva, tongue and soft palate. He also has a non-itchy, scaly, reddish-brown rash on his palms and soles and enlarged cervical lymph nodes. Two months ago he had a painless genital sore that healed without treatment. Which laboratory approach is most appropriate to support the suspected diagnosis?
RPR alone, treating if the result is reactive
Treponemal immunoassay alone, treating if reactive
RPR and a treponemal test, interpreted together
Biopsy of a palatal patch before any serology
Herpes PCR and fungal culture of the patches
Show answer and rationale
Answer: C. RPR and a treponemal test, interpreted together
A (incorrect): A nontreponemal test alone is not enough for diagnosis. False-positive results occur with other infections, autoimmune conditions, pregnancy, injecting drug use and older age. A reactive RPR must be confirmed with a treponemal test.
B (incorrect): Most people with a reactive treponemal test stay reactive for life, regardless of treatment or disease activity. A positive result alone cannot separate current from past treated infection, and it gives no titer to follow treatment response. Both test types are needed.
C (correct): The healed painless genital sore, mucous patches, palmar and plantar rash and lymphadenopathy point to secondary syphilis. A presumptive diagnosis requires two serologic tests: a nontreponemal test (VDRL or RPR) and a treponemal test. Using only one type of test is insufficient and can give false-negative or false-positive results.
D (incorrect): Biopsy, darkfield examination or PCR of lesion material are useful when clinical findings suggest syphilis but serology is nonreactive or unclear. Serology is accurate for most patients with secondary syphilis and should come first. A biopsy is not the initial test.
E (incorrect): Herpes lesions are painful vesicles and ulcers, and candidiasis does not explain a palmar rash or a healed genital sore. These tests address the wrong diagnoses. Syphilis serology is the right investigation.
Question 2 of 4 · easyOral Pathology and Oral Medicine
A 4-year-old boy has a mild fever and refuses to eat. Small ulcers with a fibrinous coating are present on the attached gingiva, tongue and buccal mucosa, and small vesicles are seen on his palms and the soles of his feet. Two other children at his daycare have similar lesions. Which agent is the most likely cause?
Varicella-zoster virus
Herpes simplex virus type 1
Measles virus
Epstein-Barr virus
Coxsackievirus A16
Show answer and rationale
Answer: E. Coxsackievirus A16
A (incorrect): Primary varicella causes a generalized itchy vesicular rash concentrated on the trunk, not one limited to the palms and soles. Reactivation as zoster follows a single dermatome on one side. Neither pattern matches this child.
B (incorrect): Primary herpetic gingivostomatitis causes painful, inflamed gingiva with coalescing ulcers and lymphadenitis. It does not produce vesicles on the hands and feet. The acral skin lesions point to a coxsackie infection instead.
C (incorrect): Measles causes small white spots on the buccal mucosa before a maculopapular rash that spreads from the face downward, with cough, coryza and conjunctivitis. It does not cause oral vesicles with vesicles on the palms and soles. The pattern here is that of hand-foot-and-mouth disease.
D (incorrect): Epstein-Barr virus causes infectious mononucleosis with pharyngitis, palatal petechiae and lymphadenopathy, and oral hairy leukoplakia in immunosuppressed adults. It does not cause vesicles on the palms and soles. The acral distribution points elsewhere.
E (correct): Hand-foot-and-mouth disease is a common, contagious vesicular disease of children, caused mainly by coxsackie viruses A6, A10 and A16. Small vesicles rupture to leave fibrin-coated ulcers in the mouth, including the gingiva, with similar lesions on the hands and feet. The age, the skin distribution and the daycare cluster fit this diagnosis.
Question 3 of 4 · moderateOral Pathology and Oral Medicine
A 26-year-old man who does not smoke has sudden, painful necrosis of the interdental papillae with early attachment loss, plus white plaques on the palate that wipe off. He has had several recent sexual partners and has never been tested for HIV. Which test is most appropriate to recommend through his physician?
HIV-1/2 antigen/antibody combination immunoassay
Oral fluid HIV antibody-only rapid test
CD4 count to decide whether HIV testing is needed
Western blot as the initial screening test
Absolute neutrophil count, then HIV test if low
Show answer and rationale
Answer: A. HIV-1/2 antigen/antibody combination immunoassay
A (correct): HIV infection is clearly associated with necrotizing periodontal disease and raises the risk of oral candidiasis and hairy leukoplakia. Testing is generally recommended with a combination immunoassay that detects HIV antibody and p24 antigen, with a PCR-based viral load depending on the stage of infection. Detecting p24 antigen shortens the window after recent exposure, which matters with several recent partners.
B (incorrect): An antibody-only test misses infection in the window before antibodies form. With several recent partners, early infection is a real possibility. The antigen/antibody combination assay is preferred.
C (incorrect): A CD4 count measures immune status in a person known to have HIV; it does not diagnose infection. Many conditions lower CD4 counts, and a normal value does not exclude HIV. The diagnostic test should be ordered directly.
D (incorrect): The Western blot is no longer used as the initial test in the current laboratory algorithm, which starts with a combination immunoassay and confirms reactive results with a differentiation assay. It is also less sensitive in early infection. It is not the right first test.
E (incorrect): Acquired neutropenia can raise periodontal risk, and a neutrophil count is part of evaluating that possibility. But necrotizing disease with candidiasis in a man with sexual risk calls for HIV testing regardless of the neutrophil count. Making the HIV test conditional would delay diagnosis.
Source: Albandar JM, Susin C, Hughes FJ. Manifestations of systemic diseases and conditions that affect the periodontal attachment apparatus: case definitions and diagnostic considerations. J Periodontol. 2018;89(Suppl 1):S183-S203. Section 1.2 Acquired immunodeficiency diseases; Table 5. https://doi.org/10.1002/JPER.16-0480
Question 4 of 4 · moderateOral Pathology and Oral Medicine
A 63-year-old man who smokes and drinks daily has a 1.2 cm, sharply demarcated, velvety red patch on the floor of the mouth with no white component. It is painless, has no obvious traumatic cause, and has not changed after 2 weeks of topical antifungal therapy. Which is the most likely clinical diagnosis?
Erythematous candidiasis
Traumatic erythema
Erythroplakia
Erosive oral lichen planus
Median rhomboid glossitis
Show answer and rationale
Answer: C. Erythroplakia
A (incorrect): Erythematous candidiasis causes red, often sore mucosa, typically on the palate or dorsal tongue, and usually follows antibiotics, steroids or immunosuppression. It should respond to antifungal therapy. A painless velvety patch that persists after treatment is not explained by candidiasis.
B (incorrect): Traumatic erythema has an identifiable cause, such as a denture flange, sharp cusp or burn, and resolves once the cause is removed. No traumatic cause is present here. A persistent, sharply demarcated red patch in a high-risk patient fits erythroplakia.
C (correct): Erythroplakia is the red counterpart of leukoplakia: a red lesion that cannot be diagnosed as any other disease. It has a higher premalignant potential than leukoplakia, and the floor of the mouth in a smoker and drinker is a high-risk site. A persistent red patch with no other explanation needs biopsy.
D (incorrect): Erosive lichen planus is usually bilateral, painful and bordered by white striae. This lesion is a solitary, painless red patch with no white component. Its lack of striae and its high-risk site point to erythroplakia.
E (incorrect): Median rhomboid glossitis is a Candida-associated, smooth red area on the midline dorsal tongue anterior to the circumvallate papillae. It does not occur on the floor of the mouth. It would also be expected to improve with antifungal therapy.
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