2nd Week Discussion Flashcards

1
Q

clinical features of erythema multiforme (3)

A

Clinical features EM minor: –Skin (extremities) –Mucosa (oral, conjunctival, genitourinary, respiratory) –Hemorrhagic crusting of vermilion zones

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2
Q

ID

A

Erythema multiforme

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3
Q

describe the erythema multiforme lesions on skin (2)

A

Variety of appearances “multiforme”
• Round, dusky-red patches on skin of
extremities “target lesions

” • Bullae with necrotic centers

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4
Q
A

Erythema multiforme (EM)

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5
Q

• Erythematous patches oral mucosa
that undergo necrosis and result in
large, shallow erosions and ulcers with
irregular borders

A

Erythema multiforme

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6
Q
A

erythema multiforme

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7
Q

clinical features of erythema multiforme major

A

–2 or more mucosal sites in conjunction
with skin lesions
• Mucosal, lip and skin lesions as seen
in EM minor

–Ocular involvement can produce
symblepheron

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8
Q
Erythema multiforme (EM)
• Treatment (supportive therapy):
A

–Systemic or topical steroids early on

–IV re-hydration

–Topical anesthetic or analgesic for pain

(controversial)

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9
Q

“Punched-out” interdental papillae

A

Necrotizing Ulcerative Gingivitis

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10
Q

Severe pain, oral malodor, spontaneous
hemorrhage

A

Necrotizing Ulcerative Gingivitis

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11
Q

describe Necrotizing Ulcerative Gingivitis (3)

A

“Punched-out” interdental papillae
 Localized or diffuse gingival involvement
 Severe pain, oral malodor, spontaneous
hemorrhage

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12
Q
A

Necrotizing Ulcerative Gingivitis

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13
Q
A

Necrotizing Ulcerative Gingivitis

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14
Q
A

Necrotizing Ulcerative Gingivitis

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15
Q

NUG - Treatment (4)

A

Debridement (using topical or local anesthesia)
 Mild salt water rinse or chlorhexidine
 Improve oral hygiene and diet
 Broad spectrum antibiotic may be helpful,
particularly if systemic symptoms

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16
Q

aka – Herpetic Gingivostomatitis

A

Primary Herpes

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17
Q

describe symptoms of primary herpes

A

Acute fever, cervical lymphadenopathy, oral sores

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18
Q

Small ulcers often coalesce, resulting in larger
ulcers having serpentine borders

A

Primary Herpes

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19
Q
A

primary herpes

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20
Q
A

primary herpes

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21
Q

ID + tx

A

first 2-3 days–> acyclovir or valacyclovir (valtrex)

Symptomatic care – analgesics, antipyretics
 Topical anesthetics so patient can eat and
drink – important to avoid dehydration
 Popsicles can be soothing for pediatric
patients

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22
Q

how long does primary herpes last?

A

10 to 14 days

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23
Q

primary herpes has an approximately _____chance of developing at
least one episode of recurrent disease

A

Approximately 25% chance of developing at
least one episode of recurrent disease

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24
Q

Recurrent Herpes Two forms:

A

Recurrent Herpes Labialis
 Recurrent Intraoral Herpes

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25
Q

aka – cold sore, fever blister

A

Recurrent Herpes Labialis

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26
Q

Recurrent Herpes Labialis affects where?

A

Affect vermilion zone or perioral skin

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27
Q

symptoms of Recurrent Herpes Labialis (5)

A

Prodromal itching, tingling, burning, erythema
 followed by cluster of vesicles

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28
Q

what happens with Recurrent Herpes Labialis with no treatmet

A

With no treatment, vesicles rupture, form a
crust, and lesions heal in 7-10 days

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29
Q
A

Recurrent Herpes Labialis

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30
Q
A

Recurrent Herpes Labialis

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31
Q
A

Recurrent Herpes Labialis

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32
Q

Recurrent Herpes Labialis

is triggered by what

A

Triggered by UV light exposure or trauma

33
Q

Recurrent Herpes Labialis -Treatment (4)

A

Avoid excess sun exposure
 Sunblocks may be helpful to prevent lesion
development
 Topical antiviral agents - statistically significant
decrease in healing time
 Patient-initiated systemic valacyclovir seems to
have best results
*Treatment must be started within first 2-3 days of onset*

34
Q

recurrent intraoral herpes occurs where?

A

Confined to mucosa bound to periosteum (hard
palate and attached gingiva)

35
Q

describe Recurrent Intraoral Herpes

A

Cluster of shallow ulcers

36
Q

tx for recurrent intraoral herpes

A

Heal in one week with no treatment

37
Q
A

Recurrent Intraoral Herpes

38
Q
A

Recurrent Intraoral Herpes

39
Q
A

Recurrent Intraoral Herpes

40
Q

Chronic immune-mediated disorder

A

Lichen planus (LP)

41
Q

name two types of lichen planus

A

Cutaneous – may resolve in 7 – 10 yr

s • Mucosal – typically managed as chronic
condition

42
Q

Cutaneous lichen planus
• Clinical features:

A

Purple polygonal pruritic papules with
Wickham’s striae (lacy white lines)

43
Q

– Cutaneous lichen planus
• Clinical features-location

A

Flexor surface of wrists, lumbar region,
shins, but other locations

44
Q
A

Cutaneous lichen planus

45
Q

Oral lichen planus (OLP)
• 2 forms:

A

–Reticular (lacy white lines)
–Erosive (ELP)- erythematous, may
ulcerate

46
Q

most common form of oral lichen planu

A

Reticular form

47
Q

most symptomatic form of oral lichen planus

A

Erosive form is most symptomatic,
especially with acidic, salty or spicy foods

48
Q

desribe reticular lichen planus

A

interlacing white lines

49
Q

describe erosive lichen planus

A

shallow ulcers, peripheral
erythema and radiating white lines

50
Q

location of oral lichen planus

A

Bilateral buccal mucosa, tongue, gingiva
common but any intraoral surface and
lips

51
Q
A

lichen planus

52
Q

Oral lichen planus (OLP/ELP)
• Treatment: for reticular lichen planus

A

usually no Tx needed
• Patient may feel “rough” areas of
hyperkeratosis, but no pain

53
Q

treatment for erosive lichen planus

A

ELP treat with potent topical steroid
• “off label” • Systemic steroids not needed

54
Q

In PV autoantibodies destroy _____ so waht happens

A

desmosomes

Desmosomes bond epithelial cells
together; antibodies inhibit
adherence, so a split develops in the
epithelium

55
Q

describe pemphigus vulgaris

A

• Superficial, ragged erosions and
ulcerations

56
Q

pemphigus vulgaris occurs where

A

Any mucosal surface

57
Q

Oral lesions “first to show, last to go”

A

Pemphigus vulgaris (PV)

• In other words – the oral lesions
often are the initial manifestation
of the disease and the most
difficult to resolve with treatment

58
Q

+ Nikolsky sign

A

Pemphigus vulgaris (PV)

59
Q
A

Pemphigus vulgaris (PV)

60
Q
A

Pemphigus vulgaris (PV)

61
Q
A

Pemphigus vulgaris (PV)

62
Q
Pemphigus vulgaris (PV)
• Treatment:
A

–Systemic corticosteroids, often with
azathioprine or other steroid-sparing agents
–Topical corticosteroids have little effect

63
Q

Also known as cicatricial (scarring) pemphigoid

A

Mucous membrane pemphigoid (MMP)

64
Q

Resembles PV due to blister formation

A

Mucous membrane pemphigoid (MMP)

65
Q

Mucous membrane pemphigoid (MMP)
• linical features (con’t):

occurs where

A

–Any mucosal surface, occasionally affects
skin

66
Q

scarring of mucous membrane pemphigoid occurs where

A

–Scarring
• Skin • Symblepheron (conjunctiva) • Scarring on oral mucosa rare

67
Q

May see intact intraoral blisters

A

Mucous membrane pemphigoid (MMP)

68
Q
A

Mucous membrane pemphigoid (MMP)

69
Q
A

Mucous membrane pemphigoid (MMP)

70
Q
A

Mucous membrane pemphigoid (MMP)

71
Q
A

Mucous membrane pemphigoid (MMP)

72
Q

Mucous membrane pemphigoid (MMP)
• Most significant aspect of this condition is

A

ocular involvement of symblepheron

73
Q
A

Mucous membrane pemphigoid (MMP)

74
Q

Mucous membrane pemphigoid (MMP)
• Treatment:

A

–Depends on extent of involvement
• Oral lesions alone - topical steroids,
tetracycline/niacinamide or dapsone
may be sufficient • Frequent dental prophylaxis, q 3-4
mos.

–Refer patient to ophthalmologist for
exam and follow-up
• If ocular involvement, systemic
immunosuppressive therapy indicated

75
Q

Pruritus early symptom, followed by the
development of multiple, tense bullae, blisters on normal or erythematous skin

A

Bullous pemphigoid (BP)

76
Q
A

Bullous pemphigoid (BP)

77
Q
Bullous pemphigoid (BP)
• Treatment:
A

–Management similar to cicatricial
pemphigoid, but most BP cases resolve spontaneously in 1-2 years

78
Q
A