Sjögren syndrome with xerostomia — ORE Part 1 MCQ

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HardOral Medicine and Oral PathologySjögren syndrome with xerostomiaORE Part 1

A 54-year-old woman reports dry mouth, gritty eyes and increasing cervical caries. She takes no xerogenic medicines. Saliva pools poorly in the floor of mouth, parotid glands are mildly enlarged, and blood tests from her GP show positive anti-Ro antibodies. What is the most appropriate investigation?

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Correct answer: A — Specialist assessment with salivary gland and autoimmune evaluation

Explanation lettering: E = shown as A · A = shown as D · D = shown as E

Option E is correct. This patient presents with a typical clinical picture of primary Sjögren syndrome: systemic symptoms (xerostomia, xerophthalmia), oral signs (parotid enlargement, reduced saliva flow), accelerated caries, and positive anti-Ro antibody serology. According to international diagnostic criteria adopted in UK practice, positive serology combined with objective evidence of salivary dysfunction constitutes sufficient basis for specialist referral. Specialist assessment includes formal salivary gland testing (unstimulated/stimulated sialometry, scintigraphy, or ultrasound), complete autoimmune serology (anti-La/SSB, ANA, anti-centromere, rheumatoid factor), and labial minor salivary gland biopsy to demonstrate focal lymphocytic sialadenitis. Options A (extraction) and B (radiography alone) are diagnostically inadequate; option C (patch testing) is irrelevant; option D (ranula aspiration) is factually incorrect—no ranula is present, and this investigation would not address the diagnostic question.

Reference: American-European Consensus Group. Classification criteria for Sjögren's syndrome: a revised version of the European criteria (2002, updated in guidance); labial gland biopsy interpretation. Available via National Center for Biotechnology Information, PubMed Central (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11222351/). UK specialist practice follows these internationally agreed criteria via rheumatology and oral medicine services.