Oral Path CUdental exam 1
Terms
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- _____ is serous clear fluid filled.
- Vesicle
- A large vessicle a.k.a. ______.
- bulla
- A purulent filled papule.
- pustule
- An epithelial lined cavity.
- cyst
- An elevated solid lesion < 5 mm.
- papule
- An elevated solid lesion > 5 mm.
- nodule
- 95 % of oral primary herpes is due to HSV-__ while genital herpes is caused by HSV-__.
- 1, 2 (linked to cervical cancer)
- Herpes mode of transmission?
- physical contact
- Most cases of primary herpes occur btween the ages of ___ and ___.
- 0.5, 5
- The incubation period of primary herpes is ____.
- 2 weeks
- T/F Herpetic lesions affect both keratinized and non-keratinized mucosa.
- TRUE
- Herpes runs a __ to __ day course.
- 7 to 14
- Define gingivostomatits
- edematous, intense erythema and painful gingiva
- A 5 year old patient presents with ulcers which show a yellow, fibrinous base with a erythematous halo. The patient also suffers from fever, headache, weight loss and swollen lymph nodes. Dx: _______.
- Primary Herpes
- Lab results: biopsy shows vessicles, multinucleated giant cells and PCR is positive for HSV-1 virus. Dx: ________.
- Primary herpes
- A patient complains of prodromal sx's including itching burning and pain 6-24 hrs prior to multiple, fragile group lesions appearing on the vermilion. According to her hx she is stressed, immunosupressed and has significant sun exposure. Dx: _____.
- Secondary herpes (also found on palate or attached gingiva (masticatory mucosa))
- Herpes infection of the finger either primary or secondary.
- herpetic whitlow
- The latent herpes virus is sequestered in the __________.
- trigeminal ganglion
- Primary VZV cause _______ while secondary cause _____.
- chicken pox, herpes zoster (shingles)
- VZV is transmitted via ______. The virus multiples in ______ and is very contagious yet self limiting.
- droplet inhalation, macrophages
- An 65 year old male recently treated with chemo/radioation (immunocompromised) presents with prodrome pain and paresthesia followed by a unilateral vesicular, pustular, ulcerating eruptions. Dx: _______.
- Herpes zoster
- _________ occurs in 15% of those affected by herpes zoster after the lesions have healed causing burning and throbbing to the previously infected area and is aggravated by light touch.
- post herpetic neuralgia
- ________ syndrome is due to herpes zoster involvement of the facial and auditory nerves causing possible unilateral facial paralysis, vesicles of the external ear, tinnitis, deafness and vertigo.
- Ramsay Hunt
- Hand, foot and mouth disease is is a common childhood infection caused by the _______ virus. It is highly contagious and is spread via __________. Oral vessicles which rupture and ulerate are covered by a yellow fibrinous membrane surrounded by a red hal
- coxsackie (A16 or A10), airborne or fecal-oral, non-keratinized
- A child complains of acute onset phayngitis and dysphagia in late August. A macular erythematous area preceded a vessicular eruption followed by ulceration of the posterior oral cavity (soft palate and tonsilar pillars. Dx:______.
- Herpangina
- Herpangina is caused by the ________ virus. It has a one week incubation and a self limiting course of _____ weeks
- Coxsackie group A, 1-2 week course
- Two forms of measles are ________, due to the paramyxovirus, and ________ caused by the togavirus.
- Rubeola, Rubella (German measles)
- Rubeola or Rubella: children-fever, rash, respiratory, photophobia
- Rubeola
- Rubeola or Rubella: mild symptoms, Forcheimer's sign (dark red palatal papules)
- Rubella
- Rubeola or Rubella: may cause congenital defects in developing fetus especially in first trimester leading to deafness (80%), heart disese and cataracts.
- Rubella
- Rubeola or Rubella: Koplick spots, small red macules with white necrotic centers preceding skin rash and Warthin Findlay giant cells (multinucleated giant cells in lymphoid tissue).
- Rubeola
- Rubeola or Rubella: complications include encephalitis, thrombocytopenic purpura, ities of immunocompromised.
- Rubeola
- Rubeola or Rubella: contagious from 1 week prior to rash to 5 days after, last outbreak was in the 60's
- Rubella
- A middle aged patient of Jewish decent presents with painful shallow ulcers leading to intraepithelial blisters on non-keratinized mucosa with a + Nikolsky's sign. According to her med hx she has an autoimmune disorder. Dx:____
- pemphigus vulgaris
- Pemphigus vulgaris is differentiated histologically by the presence of free floating acantholytic spinous cells in blister fluid called ______. The remaining basal cells form a ______ row due the detruction of desmoglein __, a componet of desmosomes foun
- Tzanck cells, toombstone, 3, epithelial
- Steroids are used to treat pemphigus. Consequences of using long term steroids include: osteoporosis, diabetes, problems with healing and infection including ________and ______ syndrome.
- candidiasis, Cushing's
- ________ pemphigus is an autoimmune disease triggered by malignant or benign tumors (usually leukemia or lymphoma) resembles oral pemphigus accompanied by severe heorragic, crusted chelitis and ocular lesions (70%).
- Paraneoplastic
- Previously known as desquamative gingivitis ____________ is typically found in females (50-60's, 2:1) due to autoantibodies directed against basement membrane antigens causing _______ gingival bullae and vessicles rarely affecting the skin. _____ adhesio
- Mucous membrane pemphigoid (MMP), subepithelial, ocular (symblepharon)
- Histologically MMP shows _________ clefting due to autoantibodies (not found circulating) to _______________ which anchor the epithelium to subepithelial tissue. Tx is usually topical ______ placed in custom trays.
- subepithelial, hemidesmosomes, corticosteroids
- Bullous Pemphigoid usually have detectable circulating ________ in serum which also attack the basement membrane resulting in lessions identicle to MMP yet are also found on the ____.
- autoantibodies, skin
- Pemphigus or pemphigoid: tissue ab IgG, IgA and C3
- pemphigoid (pemphigus shows no IgA)
- Pemphigus or pemphigoid: circulating auto-IgG
- pemphigus (pemphigoid no circulating)
- Pemphigus or pemphigoid: target proteins Laminin 5 and BP180
- Pemphigoid
- Pemphigus or pemphigoid: intraepithelial vessicles
- pemphigus
- Pemphigus or pemphigoid: subepithelial vessicles
- pemphigoid
- Pemphigus or pemphigoid: sites = oral and eyes
- pemphigoid
- Pemphigus or pemphigoid: sites = oral and skin
- pemphigus
- Pemphigus or pemphigoid: prognosis = fair, significant mortality
- pemphigus
- Pemphigus or pemphigoid: prognosis = good
- pemphigoid
- ____________ is an autoimmune disease showing IgA in tissues. It is associated with gluten-sensitive enteropathy of young middle aged s causing pruritic lesions of elbows shoulders and buttocks rarely found in the oral cavity
- Dermatitis herpetiformis
- _________ is a chronic autoimmune disease of the skin commonly affecting mucous membranes including the gingiva causing bullae then ulcers. Neutrophils and eosinophils fill the area between epithelium and CT with linear IgA deposits.
- Linear IgA disease
- ______________ is a hereditary disease causing an attachment defect of epithelial cells to underlying CT which leads to blisters and bulla formation after minor truama.
- Epidermolysis bullosa
- T/F An ulcer is defined as the full thickness loss of epithelial covering; elevated margins often appear with acute ulcers.
- T, F elevated margins=chronic
- SCCA comprise _____% of all oral cancers.
- 90-95
- SCCA is caused by loss of cell cycle control due to the activation of _____ and inactivation of ________ genes resulting in increased proliferation and decreased apoptosis. Increased angiogenesis and degredation of basement membrane lead to ________ and
- oncogenes, tumor suppressor, metastesis
- SCCA incidence is_____ cases/year. ___% die from their disease.
- 31,000, 25-30
- List from most to least risk for SCCA: alcohol, reverse smoking, smokeless tobacco, cigar/pipe, cigarette
- reverse smoking > cigar/pipe > cigarette > smokeless tobacco > alcohol (additive effect)
- Smokers increase their risk of SCCA __X while heavey smoking and alcohol consumption increased the risk __X.
- 10, 40
- Other SCCA risk factors include UV light (SCCA lower lip), _________ syndromes (Plummer-Vinson), DNA repair deficiency syndromes, HPV, candidiasis, chronic irritation and male : female ratio is _:_.
- iron deficiency, 3:1 (high in African Americans)
- EBV and HIV are risk factors for SCCA? T/F
- False, for lymphomas
- The ____________ is the most common intraoral site for SCCA which can manifest themselves as red, white, mixed or ulcerated aggressive lesions capable of metastasis to regioinal ______ ______.
- lateral tongue, lymph nodes
- The ____________ is the 2nd most common intraoral site for SCCA causing painless non-healing ulcers.
- floor of the mouth (especially w/ smoking/drinking Hx)
- Which is not an area where SCCA is normally found: buccal mucosa, gingiva, hard palate, lower lip, soft palate.
- hard palate (usually adenocarcinoma)
- SCCA of the gingiva can resemble localized ___________.
- periodontal disease
- SCCA of the lower lip is more common in males than females and is caused mainly by ______ and ______.
- sun exposure, pipe smoking
- T/F Usually there is an epithelial change evident due to SCCA?
- TRUE
- Considering all the following possibilities, which clinical presentation of SCCA is most uncommon: non-healing ulcer, exophytic mass, red, white, mixed red/white, verrucopapillary mass, submucosal/intraosseous mass.
- submucosal/intraosseous mass
- Which is not a warning sign for SCCA: persistant lesions with no obvious cause, isolated perio defects, tingling / numbness, unexplained cervical lymphadenopathy, dysphonia, dysphagia, dyspnea.
- dyspnea in not a warning sign. Tingling/numb, lesions w/o cause are most important
- T/F Histologic grading is the most important parameter for the prognosis and treatment planning of SCCA.
- False, Clinical staging is most important
- Staging is used to identify the extent of the disease before treatment and is based on the TNM system which stands for _____________.
- Tumor size, Nodal involvement, Metastesis.
- Tumors can be spread by all the following except: local extension, lymphatic spread, hematogenous spread.
- all are true
- T/F Posterior tumors are more prone to early metastesis.
- TRUE
- If a lymph node is ______ to tissue, it implies that the cancer has perforated the capsule of the lymph node resulting in a bad prognostic indicator.
- fixed (along with enlarged, hard and non-tender)
- T/F Improvement in early stage detection of SCCA has improved in the last 25 years.
- FALSE
- Treatment for SCCA includes ______, the primary modality, radiation and chemo.
- surgery
- External beam radiation treatment typically last ___ weeks 5 days/week using 5000 cGy to the tumor. Other forms of radiation include hyperfractional therapy (2 times/day), IMRT (intensity-modulated radiotherapy - spares normal tissue) and __________ (rad
- 5 to 6, brachytherapy
- Pretreatment planes for SCCA include all the following except: indicated extractions (esp. mandibular), alveoloplasty, 14-21 day healing time prior to radiation, complete restorations, impressions for fluoride carriers, daily fluoride for 6 weeks, jaw ex
- daily fluoride should be administered for life to avoid radiation caries
- Which is not a short term side effect of head and neck radiation therapy: mucositis, loss of taste, pain, radiation dermatitis, xerostomia, redness, hypersensitivity.
- xerostomia is a long term side effect
- Time frame for head and neck radiation: 1-2 weeks ____________, 3 weeks ___________, 4-5 weeks __________.
- loss of taste + thick saliva, mucositis of pharynx, mucositis of buccal mucosa and tongue
- All are long term effects fo head and neck radiation except: xerostomia, radiation caries, dysphagia, bone changes, trismus, hyperpigmentation of skin, altered development of jaw/teeth in young patients, carotid atheromas.
- all are true
- ______________ occurs more frequently in the mandible when radiation exceeds 6500 cGy causing avascular necrosis.
- Radiation osteonecrosis
- Treatment for osteoradionecrosis includes surgical removal of bone and ________.
- hyperbaric O2
- The five year survival rate for SCCA on the lower lip is __% while the tongue is __%.
- 94, 48
- Reasons for poor prognosis of oral SCCA are: late diagnosis, difficult anatomy and _____________, which describes the concept of the remaining tissue surrounding the SCCA had already undergone some genetic change and is more prone to developing additiona
- field cancerization
- Clinical signs of maxillary sinus SCCA include: dull ache, referred pain to teeth, failure of an extraction site to heal, palatal ulcer and most importantly ________.
- parasthesia
- Traumatic ulcers are caused by al trauma, chemical/thermal burns, iatrogenically or are _________ meaning self induced. These ulcers can be difficult to differentiate from ______, for this reason if there is no obvious etiology consider an immediate biop
- factitial, SCCA
- TUGSE is short for "traumatic ulcerative granuloma with stromal epithelia" and is used to describe _______ ulcers which usually have elevated margins with minimal pain.
- chronic traumatic
- ________ disease is due to the traumatic ulceration to the anterior tongue of infants with natal teeth.
- Riga-Fede
- Which is not considered an immunologic-mediated ulcer: aphthous ulcers, erythema multiforme, lupus, rxn, contact allergies, Wegner's granulomatosis, midline lethal granuloma, cyclic neutropenia, chronic granulomatous disease.
- all are immunologic
- Apthous ulcers are to __________ mucosa as recurrent herpes is to _________.
- non-keratinized non-attached, keratinized attached
- Aphthous ulcers; major, minor or herpetiform: most common.
- minor
- Aphthous ulcers; major, minor or herpetiform: heal with scaring in 1-2 months
- major aka Sutton's disease
- Aphthous ulcers; major, minor or herpetiform: often on soft palate.
- major
- Aphthous ulcers; major, minor or herpetiform: TX = systemic steroids.
- major
- Aphthous ulcers; major, minor or herpetiform: heal without scaring in 7-10 days.
- minor
- Aphthous ulcers; major, minor or herpetiform: recurrent crops of very small ulcers.
- herpetiform
- Aphthous ulcers; major, minor or herpetiform: attached gingiva or hard palate.
- none⬦gotcha ha!, that would be herpes
- Aphthous ulcers; major, minor or herpetiform: non-keratinized unattached mucosa.
- all the above
- Aphthous ulcers; major, minor or herpetiform: TX = topical steroids.
- minor
- Aphthous ulcers; major, minor or herpetiform: pain out of proportion to size of lesion.
- all the above
- Which medical conditions are associated with aphthous ulcers: celiac and crohn's disease, PFAPA, behcet's, Reiter's, HIV.
- all the above, HIV = large atypical ulcers
- PFAPA stands for ______________.
- periodic fever, aphthous stomatitis, pharyngitis and cervial adenitis. TX: corticosteroids
- Behcet's disease + aphthous ulcers is characterized by recurrent aphthous ulcers plus which 2 of the following: genital ulceration, eye lesions, skin lesions, positive pathergy test.
- 2 of any from the list
- Nick Coles presents with aphthous ulcers along with a triad of lower limb arthritis, non-specific urethritis and conjunctivitis. He also divulges that being such "p-i-m-p" left him with an STD, which likely caused the above sx's due to an abnor
- Reiter's syndrome TX: NSAIDS
- A patient presents with target-like skin lesions caused by a allergy. She is most likely suffering from ______.
- Erythema multiforme
- Erythema multiforme; minor, major, toxic epidermal necrolysis: aka Stevens Johnson syndrome
- major
- Erythema multiforme; minor, major, toxic epidermal necrolysis: most severe always triggered.
- TEN
- Erythema multiforme; minor, major, toxic epidermal necrolysis: skin, oral, ocular and genital lesions.
- major. Hint: aka Stevens-Johnson⬦..genitals, they both start with juh, perv!
- Erythema multiforme; minor, major, toxic epidermal necrolysis: young patients, acute onset, 2-6 weeks.
- minor
- Erythema multiforme; minor, major, toxic epidermal necrolysis:
- requires hospitalization
- Erythema multiforme; minor, major, toxic epidermal necrolysis: like a burn patient.
- TEN
- The most common reactions are caused by: sulfa , ______ and gold injections (arthritis).
- local anesthetics
- A patient presents with rapid, diffuse, painless swelling of the lips, neck and face. He must be treated quickly to avoid respiratory distress. He said he had shellfish with peanut sauce for lunch. He is most likely suffering form angioedema caused by __
- an IgE mediated allergic response to food
- Which of the following may cause contact allergies: cinnamon, denture acrylic, silver amalgam, cheap crowns, meluca oil and tartar control tooth paste.
- all the above T-cell mediated response (type IV)
- A patient presents with a triad of systemic inflammation (necrotizing vasculitis and granulomatous) involving the URT, kidneys and lungs. Despite his sx's you proceede with the exam and find "strawberry gingivitis." You know it's ________ but d
- Wegener's granulomatosis TX: steroids
- A patient presents with a destructive process of the palate and midface which perforates the nasal septum. His medical history states he has peripheral T-cell lymphoma. He is most likely suffering from a ___________. You refer this one to an OMFS and go
- Lethal Midline Granuloma
- _________ is a rare inherited dyscrasia which leaves the patient neutropenic every 21 days causing severe perio making the perio dept happy.
- cyclic neutropenia
- Which is not a deep fungal disease: Coccidiodomycosis, histoplasmosis, Blastomycosis, Tuberculosis, Cryptococcosis.
- TB
- Deep fungal infections are contracted via inhalation of spores typically causing _________ lung involvement and _______ non-healing ulcers, yet in many cases the patient may be asymptomatic.
- granulomatous, chronic
- A patient presents with a chronic non-healing ulcer and is otherwise asymptomatic. You find out he has been farming in the Mississippi-Ohio river valley. You suspect he is suffering from the most common fungal infection in the US ___________.
- histoplasmosis
- A patient presents with URTI sx's and a chronic ulcer. You find he was camping in the San Juachin Valley last month . He is most likely suffering from _______ akaValley fever.
- Coccidiodomycosis
- Other rare fungal infections include blastomycosis and cryptococcus, which is found in people with T-cell deficiencies specially AIDS?
- cryptococcus
- This fungal infection found on vegetables infects the sinuses, brain, orbit and lungs of patients with immune disorders especially diabetics. Oral manifestations include palatal perforations.
- mucormycosis
- This opportunistic fungal infection commonly causes allergic fungal sinusitis.
- aspergillosis
- Syphilis, gonorrhea or TB: Treponema pallidum
- syphilis
- Syphilis, gonorrhea or TB: Hutchinson's triad = interstitial keratitis, 8th nerve deafness, dental anomalies including Hutchinson's (notched) incisors and mulberry molars.
- congenital syphilis
- Syphilis, gonorrhea or TB: Your patient presents with generalized stomatits of the pharynx. Due to your "thorough" head and neck exam you find the patient is also suffering from dysuria and has a yellow-white-green "drip-drip-drip" di
- gonorrhea (sx's occur 2-5 days after infeciton)
- Syphilis, gonorrhea or TB: re-activation --> hemoptysis, rare oral chronic ulcers and osteomyelitis
- TB
- Syphilis, gonorrhea or TB: 3 stages including primary chancre, secondary mucous patches, rash and condyloma lata and tertiary gummas.
- syphilis ***primary and secondary are infectious
- Syphilis, gonorrhea or TB: localized lung infection aka "Ghon complex"
- TB
- Syphilis, gonorrhea or TB: may cause perforation of the palate and glossitis
- syhilis
- Syphilis, gonorrhea or TB:
- Syphilis, gonorrhea or TB: causes blindness of newborns
- gonorrhea
- Syphilis, gonorrhea or TB: most common
- TB > gonorrhea > syphilis
- T/F A patient with latent TB is infectious; a patient with acitve TB should not be treated.
- False; True
- Mucormycosis, lethal midline granuloma and syphilis may all cause ________ of the palate.
- perforation
- A patient presents with a draining sinus tract on the skin. "Sulfur granules" are present in the exudate. What bacteria may be causing these sx's?
- Actinomyces israelii (Actinomycosis)
- While volunteering in a S. American clinic a mal-nourished patient presents with a rapidly progessing, ulcerating necrotic lesion of the lips and cheek. Surrounding gingival tissue presents as ANUG. The patient may be suffering from ________ aka cancrum
- Noma
- An African American patient presents with an asymptomatic white opacification bilaterally on his buccal mucosa. It has a wrinkled, corrugated appearance which disappears when stretched. This is most likely _______.
- leukoedema
- This rare, non-treatable disease is due to an autosomal nt keratin mutation which manifests itself bilaterally and symmetrically on the buccal mucosa forming deep white folds or corrugations which are asymptomatic. Similar pathology is found on other muc
- WSN (white sponge nevus)
- HBID, an acronym for ___________________, is an extremely rare autosomal nt disease characterized by foamy conjuctival ______ in the corner's of the eye along with white lesions of the buccal mucosa similar to white sponge nevus.
- hereditary benign epithelial dyskeratosis, plaques
- Eric presents with 2-3 mm white, cobblestone-like papules on his hard palate. Before giving him a hard time for how bad he smells you notice his fingernails are splintering and has hyperkeratotic papules on his face and trunk. These sx's, including bad o
- follicular keratosis
- Which is not a hereditary white lesion: HBID, follicular keratosis, WSN, leukoedema.
- leukoedema (not hereditary) rest are autosomal nt
- A patient presents with a "callus" like hyperkeratosis on his edentulous ridge, lateral tongue and buccal mucosa. This is most likely a case of _________.
- Frictional hyperkeratosis (increased thickness of the keratin layer)
- Frictional hyperkeratosis is premalignant. T/F
- FALSE, if there is no obvious etiology biopsy just in case
- A former smokeless tobacco chewer presents with a persistent white lesion which was biopsied 4 weeks ago. The histo slide showed acanthosis, hyperkeratosis and "_____" formation. You inform the patient there is a ___ risk of dysplasia/malignant
- chevron, small
- _________ carcinoma is most diagnosed on male smokeless tobacco users > 55 years old.
- Verrucous
- A patient presents with a white keratinization of the palate with pinpoint red spots. He couldn't stop talking about how good pipe smoking is. He most likely has ___________ and the red pinpoint spots are ________.
- nicotinic stomatitis, minor salivary duct openings
- An HIV patient presents with hyperkeratotic plaque-like lesions on the lateral tongue. Upon reviewing her med hx you find she also has EBV. The histo shows nuclear viral inclusions. She is most likely suffering from _________.
- oral hairy leukoplakia
- T/F Oral hairy leukoplakia is caused by HIV.
- False EBV, although 80% are HIV+
- T/F Oral hairy leukoplakia and hairy tongue are one in the same.
- FALSE
- A patient presents with thick matted, brownish-white (sometimes black) dorsum of the tongue due to the overgrowth of the ______ papillae. Her hx reveals she is a smoker and is currently taking antibiotics. She may have ________.
- filiform, hairy tongue
- You are about to misdiagnose a patient with superficial white slough with pemphigus or pemphigoid when she tells you it started a few weeks ago when she switched tooth paste brands. You consult her to change back to the old brand because she has ________
- dentifrice-associated slough
- 6 months later, the same patient presents with leukoplakia of the maxillary vestibule and alveolar mucosa. She said she followed your directions and bought a different brand tooth paste called Viadent at an herbal store. You know she is suffering from __
- Sanguniaria-related keratosis
- A 40 year old male smoker presents with white patches on the mandibular and buccal mucosa that can't be rubbed off. He is likely suffering from ________ and a biopsy should be taken since ____ % eventually undergo malignant transformation due to dysplasi
- idiopathic leukoplakia, 5-15
- Histological features of moderate dysplasia include: increased _:_ ratio, _______ pleomorphism and increased or abnormal ______.
- N:C, nuclear, mitosis
- Carcinoma-in-situ invades the basement membrane. T/F
- False, however is pre invasive, full thickness dysplasia
- SCCA invades the basement membrane. T/F
- TRUE
- Tx for idiopathic leukoplakia includes _______ for large lesions, ________ if no dsyplasia, ________ for mild dysplasia and ______ for moderate to severe along with counseling for smoking cessation .
- multiple biopsies, biopsy PRN, excision, complete excision
- From highest % to lowest, dysplasia risk of idiopathic leukoplakia: lower lip, tongue, floor of mouth.
- floor of mouth > tongue = lower lip
- Idiopathic leukoplakia: most common intraoral location.
- mandibular mucosa > buccal mucosa
- A 50 year old "butt" white male presents with a blurring of the vermillion and hyperkeratotic plaques on his ing, mottled lower lip. Due to sun exposure he may have ________. Due to it's severity a biopsy was taken revealing atrophic epithelium
- Actinic (solar) Chelitis, elastosis
- T/F Actinic chelitis is a precursor to SCCA and malignantly transforms 6-10% of the time.
- TRUE
- A female patient presents with asymptomatic, erythematous, well-demarcated areas of papillary atrophy surrounded by yellow-white border which "migrate" with time. You reassure the patient that her condition in benign and fairly common (1-3% pop
- geographic tongue aka migratory glossitis aka erythema migrans
- A middle aged partially edentulous patient presents with bilateral, interlacing white keratotic line lesions with a "wax and wane" appearance on the buccal mucosa. You also notice she has cutaneous lesions on her knees and elbows along with fin
- Reticular Lichen Planus (most common form), Wickham's striae
- Lichen planus is a mucocutaneous disease caused by a T-cell mediated "hypersensitivity" which causes ________ of basal epithelial cells (civatte bodies) and degradation of the cell layer. Histologically saw toothed ________ and band like infilt
- apoptosis, rete pegs, lymphocytes
- Oral lichen planus appears in what 3 forms. These forms may coexist. T/F
- reticular (most common), plaque (normally on dorsum of tongue) and erythematous/erosive. True
- Erythematous/erosive lichen planus presents as ulcerating atrophic reddened areas with fine white striae on the periphery that may also be confined to the __________. Clinically it can be confused with pemphigoid, pemphigus and oral lichen planus.
- gingiva
- SLE, SCLE or CCLE (discoid): scaly erythematous skin patches, no systemic involvement, non-characteristic oral appearance.
- CCLE (chronic cutaneous)
- SLE, SCLE or CCLE (discoid): multi-system disease, butterfly rash.
- SLE
- SLE, SCLE or CCLE (discoid): Women 8:1, arthritis, pulmonary, and renal problems.
- SLE
- SLE, SCLE or CCLE (discoid): AB prophylaxis required due to Libman-Sacks endocarditis.
- SLE
- SLE, SCLE or CCLE (discoid): lesions in sun exposed areas, no scarring, musculoskeletal problems.
- SCLE (subactute cutaneous)
- SLE, SCLE or CCLE (discoid): serum ANA and anit-double stranded DNA.
- all esp. SLE
- An infant presents with mildly burning white soft plaques which rub off. It appears to be fungal in origin; she may be suffering from ________.
- Acute Pseudomembranous Candidiasis (Thrush)
- Also known as antibiotic stomatitis this fungal disease presents as generalized red patches and depapillation of the dorsal tongue.
- Acute erythematous
- aka "denture sore mouth"
- chronic erythematous candidiasis
- Angular cheilitis occurs frequently in edentulous patients due to their loss of ___ which causes deep folds at the commissures which trap saliva, fungi and bacteria (staph aureus).
- VDO
- Hyperplastic tissue response to chronic candidal infection causes __________ candidiasis.
- Chronic hyperplastic
- Involving an area anterior to the circumvallate papilla in the shape of a rhomboid, this form of candidiasis also causes a "kissing lesion" on the ________.
- Median rhomboid glossitis, hard palate
- Form of candidiasis involving mucous membranes and skin.
- Mucocutaneous
- After a sample is scraped from the area, fixed and stained confirming the presence of fungi, which Tx should not be used to treat candidiasis: fluconazole, clotrimazole, nystatin pastilles, nystatin topical powder, penicillin.
- penicillin
- Mucosal burns may be thermal, chemical or electrical. At times a ____ must be placed to prevent contracture.
- splint
- A patient presents with pallor and stiffening of his oral mucosa which restricts him from opening. You find he runs a local Quick-E-Mart which sells paan, or betel quid. You inform the patient that his condition is precancerous and he will need to return
- Submucous Fibrosis Doh!
- Fordyce granules are ectopic sebaceous glands found on the buccal mucosa; they are a variant of normal. T/F
- True; True
- Ectopic lymphoid tissue may be found at the floor of the mouth, ventral tongue, soft palate and palatine tonsils. The key to ruling out pathology is to see if they are _______.
- bilateral
- Oral lymphoepithelial cysts are submucosal masses and, as the name suggests, are a keratin-filled cysts with lymphoid tissue in the cyst wall. They are commonly found on the _______ and ______.
- floor of the mouth, ventral-posterior-lateral tongue
- Gingival cysts are more common in s than newborns: in s they commonly appear near the mandibular PM-canine area of attached gingiva and in newborns as single-multiple 2mm off-white nodules on the midline or other areas of the gingiva. T/F
- False: True
- A ______ may be found at the apex of a non-vital tooth, or less likely at the base of a periodontal pocket and is aka "gum boil."
- Parulis
- A lipoma is a malignant adipocyte neoplasm. T/F
- False - benign