MCQs on Vesiculobullous Lesions of the Oral Cavity

Test Your Knowledge in Oral & Maxillofacial Pathology

Vesiculobullous diseases are an important group of disorders encountered in oral pathology. They are characterized by the formation of vesicles or bullae, which may rupture rapidly in the oral cavity and present clinically as painful erosions or ulcers.

The differential diagnosis includes viral infections, autoimmune blistering diseases, hypersensitivity reactions, and inherited disorders.

This MCQ quiz is designed to help dental students revise the important clinical, histopathological, and immunopathological features of vesiculobullous lesions.

MCQ 1

Which of the following is a vesicle?

A. A fluid-filled lesion larger than 5 mm
B. A fluid-filled lesion smaller than 5 mm
C. A solid elevated lesion
D. A lesion containing pus

Answer: B. A fluid-filled lesion smaller than 5 mm

MCQ 2

A bulla is defined as:

A. A fluid-filled lesion less than 1 mm
B. A fluid-filled lesion less than 5 mm
C. A fluid-filled lesion greater than 5 mm
D. A solid nodular lesion

Answer: C. A fluid-filled lesion greater than 5 mm

MCQ 3

Which of the following is an intraepithelial vesiculobullous disease?

A. Pemphigus vulgaris
B. Mucous membrane pemphigoid
C. Bullous pemphigoid
D. Dermatitis herpetiformis

Answer: A. Pemphigus vulgaris

MCQ 4

The primary target in pemphigus vulgaris is:

A. Hemidesmosomes
B. Desmogleins
C. Type IV collagen
D. Laminin

Answer: B. Desmogleins

MCQ 5

Pemphigus vulgaris is primarily associated with antibodies against:

A. Desmoglein 1 only
B. Desmoglein 3
C. Type VII collagen
D. BP180

Answer: B. Desmoglein 3

MCQ 6

The characteristic histopathological finding in pemphigus vulgaris is:

A. Subepithelial clefting
B. Suprabasal clefting
C. Subcorneal clefting
D. Intraepidermal neutrophilic abscess

Answer: B. Suprabasal clefting

MCQ 7

Which cells are characteristically seen attached to the roof of the blister in pemphigus vulgaris?

A. Langhans cells
B. Tzanck cells
C. Acantholytic cells
D. Reed-Sternberg cells

Answer: C. Acantholytic cells

MCQ 8

The characteristic microscopic appearance of the epithelium in pemphigus vulgaris is:

A. Saw-tooth rete ridges
B. Tombstone appearance
C. Fish-net appearance
D. Civatte bodies

Answer: B. Tombstone appearance

MCQ 9

Direct immunofluorescence in pemphigus vulgaris typically demonstrates:

A. Linear IgG at the basement membrane
B. Granular IgA deposits
C. Intercellular IgG deposition in a fish-net pattern
D. Linear IgA deposition

Answer: C. Intercellular IgG deposition in a fish-net pattern

MCQ 10

Which of the following is usually the earliest and most common site of oral involvement in pemphigus vulgaris?

A. Hard palate
B. Buccal mucosa
C. Gingiva
D. Tongue

Answer: B. Buccal mucosa

MCQ 11

The oral lesions of pemphigus vulgaris most commonly appear as:

A. Intact bullae persisting for several weeks
B. Painful erosions
C. Painless nodules
D. White plaques

Answer: B. Painful erosions

MCQ 12

Nikolsky sign is commonly positive in:

A. Pemphigus vulgaris
B. Fibroma
C. Mucocele
D. Leukoplakia

Answer: A. Pemphigus vulgaris

MCQ 13

Which disease is characterized by subepithelial separation and autoantibodies against basement membrane components?

A. Pemphigus vulgaris
B. Mucous membrane pemphigoid
C. Herpangina
D. Recurrent aphthous stomatitis

Answer: B. Mucous membrane pemphigoid

MCQ 14

Mucous membrane pemphigoid primarily affects:

A. Skeletal muscle
B. Mucosal surfaces
C. Salivary glands
D. Bone

Answer: B. Mucosal surfaces

MCQ 15

A common oral manifestation of mucous membrane pemphigoid is:

A. Desquamative gingivitis
B. Geographic tongue
C. Fordyce granules
D. Leukoedema

Answer: A. Desquamative gingivitis

MCQ 16

The level of blister formation in mucous membrane pemphigoid is generally:

A. Suprabasal
B. Intraepithelial
C. Subepithelial
D. Subcorneal

Answer: C. Subepithelial

MCQ 17

Direct immunofluorescence in mucous membrane pemphigoid typically shows:

A. Intercellular IgG
B. Linear deposition along the basement membrane zone
C. Granular IgA in dermal papillae
D. No immune deposits

Answer: B. Linear deposition along the basement membrane zone

MCQ 18

Which vesiculobullous disease is particularly associated with ocular involvement and scarring?

A. Mucous membrane pemphigoid
B. Pemphigus vulgaris
C. Herpangina
D. Hand-foot-and-mouth disease

Answer: A. Mucous membrane pemphigoid

MCQ 19

Bullous pemphigoid primarily involves antibodies against:

A. Desmoglein 3
B. BP180 and BP230
C. Type VII collagen only
D. Desmoplakin

Answer: B. BP180 and BP230

MCQ 20

Bullous pemphigoid demonstrates:

A. Suprabasal separation
B. Subepithelial separation
C. Acantholysis only
D. Viral cytopathic changes

Answer: B. Subepithelial separation

MCQ 21

Which disease is strongly associated with IgA deposition?

A. Pemphigus vulgaris
B. Dermatitis herpetiformis
C. Bullous pemphigoid
D. Mucous membrane pemphigoid

Answer: B. Dermatitis herpetiformis

MCQ 22

Dermatitis herpetiformis is associated with:

A. Crohn disease
B. Celiac disease
C. Ulcerative colitis
D. Sjögren syndrome

Answer: B. Celiac disease

MCQ 23

Which viral infection commonly produces vesicular lesions involving the oral mucosa?

A. Herpes simplex virus infection
B. Epstein-Barr virus infection
C. Hepatitis B
D. Human papillomavirus infection

Answer: A. Herpes simplex virus infection

MCQ 24

The characteristic cells seen in herpes simplex infection may demonstrate:

A. Acantholysis
B. Multinucleation and margination of chromatin
C. Keratin pearl formation
D. Russell bodies

Answer: B. Multinucleation and margination of chromatin

MCQ 25

Which of the following is characteristic of herpangina?

A. Vesicles involving the posterior oral cavity
B. Vesicles confined to the skin
C. Bilateral parotid enlargement
D. Desquamative gingivitis

Answer: A. Vesicles involving the posterior oral cavity

MCQ 26

Herpangina is most commonly caused by:

A. Herpes simplex virus
B. Coxsackievirus A
C. Epstein-Barr virus
D. Varicella-zoster virus

Answer: B. Coxsackievirus A

MCQ 27

Hand-foot-and-mouth disease is most commonly associated with:

A. Coxsackievirus A16 and enteroviruses
B. HSV-1 only
C. VZV
D. CMV

Answer: A. Coxsackievirus A16 and enteroviruses

MCQ 28

The classic distribution of hand-foot-and-mouth disease includes:

A. Oral cavity, hands and feet
B. Oral cavity and scalp only
C. Gingiva and palate only
D. Tongue and genitalia only

Answer: A. Oral cavity, hands and feet

MCQ 29

Which disease is characterized by painful oral vesicles followed by ulcers and skin lesions on the hands and feet?

A. Pemphigus vulgaris
B. Hand-foot-and-mouth disease
C. Mucous membrane pemphigoid
D. Bullous pemphigoid

Answer: B. Hand-foot-and-mouth disease

MCQ 30

A patient presents with recurrent vesicles and ulcers on the lips, preceded by burning and tingling. The most likely diagnosis is:

A. Recurrent herpes labialis
B. Pemphigus vulgaris
C. Mucous membrane pemphigoid
D. Erosive lichen planus

Answer: A. Recurrent herpes labialis

Quick Revision Table

Disease	Main target/mechanism	Level of separation	Key diagnostic feature
Pemphigus vulgaris	Desmoglein 3	Suprabasal	Fish-net IgG
Mucous membrane pemphigoid	Basement membrane proteins	Subepithelial	Linear BMZ deposits
Bullous pemphigoid	BP180/BP230	Subepithelial	Linear IgG/C3
Dermatitis herpetiformis	IgA-associated autoimmune disease	Subepithelial	Granular IgA
Herpangina	Coxsackievirus	Viral cytopathic injury	Posterior oral vesicles
HFMD	Enteroviruses	Viral cytopathic injury	Hand, foot and oral lesions
Herpes simplex	HSV	Viral cytopathic injury	Multinucleation, chromatin margination

High-Yield NEET MDS Points

🦷 Pemphigus vulgaris → Desmoglein 3 → suprabasal split → acantholysis → fish-net IgG

🦷 Mucous membrane pemphigoid → subepithelial split → linear BMZ immunofluorescence → scarring

🦷 Bullous pemphigoid → BP180/BP230 → subepithelial split

🦷 Dermatitis herpetiformis → IgA → celiac disease

🦷 Herpangina → Coxsackievirus → posterior oral cavity

🦷 Hand-foot-and-mouth disease → oral lesions + hands + feet

Challenge Question

A 45-year-old patient presents with multiple painful oral erosions. Biopsy reveals suprabasal separation with acantholytic cells. Direct immunofluorescence demonstrates intercellular IgG in a fish-net pattern.

What is the most likely diagnosis?

Answer: Pemphigus vulgaris

Conclusion

Vesiculobullous lesions form an important part of oral mucosal pathology. For examinations, focus particularly on the level of epithelial separation, autoantigen involved, immunofluorescence pattern, clinical distribution, and characteristic histopathological findings.

Remember:

Pemphigus = intraepithelial + acantholysis + fish-net IgG
Pemphigoid = subepithelial + basement membrane + linear deposits