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Oral Medicine - My deck > 30 Most Common Lesions > Flashcards

30 Most Common Lesions Flashcards

1
Q

What is a differential dx?

A

A list of all the possibilities arranged from the most common to the least common

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2
Q

What is the #1 most common lesion of the oral cavity?

A

Leukoplakia

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3
Q

What is is a leukoplakia?

A

A pre-malignant intraoral white plaque (1) that does not rub off (2) and can not be identified as any known entity (3)

Also, #1 most common

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4
Q

What are 5 other white lesions that can be scraped off?

A
  1. Materia Alba
  2. White Coated Tongue
  3. Burn (thermal, chemical, cotton roll)
  4. Pseudomembranous candidiasis
  5. Allergy (toothpaste or mouthwash)
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5
Q

What is the treatment for white coated tongue?

A

Treatment is tongue scraping or brushing

Best is a flat, stainless steel bar in a horse shoe shape

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6
Q

What are 6 other white plaques that do not rub off?

A
  1. Linea Alba
  2. Leukoedema
  3. Nicotine Stomatitis
  4. Oral Hairy Leukoplakia
  5. Tobacco Pouch Keratosis
  6. Lichen Planus
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7
Q

What is the treatment for linea albua?

A

No treatment necessary

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8
Q

In what population is leukoedema most common? What is the treatment?

A

In 70-90% of African people (bilateral)

No treatment necessary

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9
Q

What is the cause of nicotine stomatitis? What is another name for nicotine stomatitis? What is the treatment?

A

It is a callous from heat

Smoker’s keratosis

Stop smoking to see if the lesion disappears withing 2 weeks

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10
Q

What population is at risk for oral hairy leukoplakia? What virus is associated?

A

AIDS patients *remember this is bilateral!

Epstein Barr Virus

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11
Q

What is the treatment for Tobacco Pouch Keratosis?

A

Move the tobacco to see if the lesion disappears withing 2 weeks

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12
Q

What is a pathognomonic sign of lichen planus? What is the cause of lichen planus? What is the treatment?

A

Wickham Striae

Autoimmune –> CD4 T cells = saw tooth rete ridges and a band of leukocytes

tx with an anti-inflammatory or topical steroid

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13
Q

What are the different results possible for leukoplakia?

A

Hyperkeratosis
Mild/Moderate/Severe Dysplasia
Carcinoma in stiu (SQCC)

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14
Q

What does carcinoma in situ mean?

A

Cancerous cells that are getting ready to invade

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15
Q

What are the high risk sites for leukoplakia?

A

Floor of mouth, tongue, and lip

*if there is a leukoplakia in these areas do not wait to do a biopsy

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16
Q

What is the best guide for the potential progression to cancer of leukoplakias ?

A

Degree of dysplasia

Severe = 16% transformation
Moderate = 3-15% (take it out)
Mild = <5% (watch it, and biopsy again if it changes)
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17
Q

What was the mean transformation time of leukoplakias into cancer? What does this mean for patients?

A

About 4.3 years

This means that leukoplakias need good follow up! Even if they have been removed, they need to be continually evaluated for reappearance and change

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18
Q

What is the 2nd most common lesion of the oral cavity?

A

Tori (palatinus and mandibularis)

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19
Q

When should tori be removed?

A

If they cause the patient pain (usually from frequent trauma), if it bothers the patient, or if they need dentures

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20
Q

What are the common different types of inflammation or irritation in the oral cavity?

A

Traumatic Ulcer
Pericoronitis
Periodontal Abscess
ANUG

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21
Q

What is the name for persisting traumatic ulcers involving skeletal muscles?

A

Traumatic ulcerative granuloma with stromal eosinophilia

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22
Q

What is the treatment for traumatic ulcerative granulomas with stromal eosinophilia?

A

Excise the inflamed tissue or/and inject a steroid

A topical steroid will not penetrate enough since this is a deep ulcer!

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23
Q

What steroid is used and what dose of steroid is used for traumatic ulcerative granulomas with stromal eosinophilia?

A

Kenalog 10 or 40
Need 10 mg of steroid for every 1 cm of granuloma tissue

10 = 10 mg/ml --> 1ml/cm
40 = 40 mg/ml --> .25 ml/cm
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24
Q

What is the tissue called that overlies the occlusal table?

A

Operculum

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25
Q

What is the most common neoplasm of the oral cavity? And where do they commonly occur?

A

Fibroma (but it is not a true neoplasm)

Buccal mucosa > labial mucosa > tongue > gingiva

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26
Q

What is the treatment for a fibroma?

A

Excision and submit biopsy to pathologist

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27
Q

What term describes ectopic sebacious glands?

A

Fordyce’s Granules

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28
Q

How common are Fordyce’s granules? Where do they occur and what is the treatment?

A

Occur in 80% of the population (yellowish white papules)

Buccal mucosa>lips

No treatment necessary

29
Q

What term describes a benign proliferation of blood vessels?

A

Hemangioma

30
Q

In what population are hemangiomas most common? How can a hemangioma dx be confirmed? What is the treatment?

A

In 10-12% of children

Clinically blanches under pressure

Treatment is surgery, laser tx, embolization

31
Q

Where do recurrent aphthous ulcers occur? What is a characteristic feature of recurrent aphthous ulcers?

A

On non-keratinized, movable mucosa

Yellow fibrin membrane

32
Q

How common are recurrent aphthous ulcers? What is the treatment?

A

Occur in 20-25% of the the popluation

Treat with topical steroids

33
Q

What are the differences between minor, major, and herpetiform recurrent aphthous ulcers?

A

Minor: 3-10 mm in size, 1-2 weeks healing time, 1-5 lesions with fewest recurrences

Major: 1-3 cm in size, 2-6 weeks healing, possible scarring, 1-10 lesions

Herpetiform: 1-3 mm in size, 7-10 days healing, up to 100 lesions with the most recurrences

34
Q

What term describes a benign proliferation of squamous epithelium? What is a characteristic of these lesions? What is the cause of the these lesions?

A

Papilloma

Pedunculated with “finger like” projections

HPV 6, 11

35
Q

What are the most common locations of papillomas and what is the treatment?

A

Tongue > soft palate

Treatment is surgical excision

36
Q

What are the different variations of papillomas? What are they caused by?

A

Verruca Vulgaris - HPV 2, 4, 6, 40
Condyloma Acuminatum - HPV 6, 11 and 16, 18 high risk
Focal Epithelial Hyperplasia (heck’s disease) - HPV 13, 32
Sinonasal Papillomas

37
Q

What is caused by an ill fitting denture? What is the treatment?

A

Epulis Fissuratum

Excise the extra tissue and reline the denture

38
Q

What is the histopathologic dx for epulis fissuratum?

A

Focal inflammatory fibrous hyperplasia

39
Q

What term describes superficial veins on the ventral tongue?

A

Lingual variosities

40
Q

What term describes numerous grooves or fissures on the dorsal tongue? What is it often associated with?

A

Fissured tongue

Often associated with Geographic tongue

41
Q

What should be done if the patient experiences mild burning or soreness with fissured tongue?

A

Brush the tongue!

42
Q

What are the other names for geographic tongue?

A

Erythema areata migrans, benign migratory glossitis –> erythema migrans if it is not on the tongue

43
Q

What term describes something that looks like geographic tongue but in the vestibule, and is in celiac patients?

A

Pyostomatitis vegetans

44
Q

What term describes a pebbly mucosa of patients who wear their dentures all day? How is it treated? What if it is erythematous too?

A

Inflammatory papillary hyperplasia

Surgical excision and reline the denture

Red indicates a yeast infection, so use an antifungal on the mouth and the denture

45
Q

Where do recurrent herpes simplex lesion occur?

A

Almost always on keratinized, bound mucosa (like the palate)

46
Q

What terms describe the initial exposure of herpes virus and is based on age?

A

Young children = acute herpetic gingivostomatitis

18 and older = pharyngotonsillitis

47
Q

What are the antiviral medications for HSV?

A

Best to start with prodromal stages

Acyclovir 5% ointment, apply 6x a day
Acyclovir 200 mg capsule - take 3 stat, one 5x day
Famciclovir tablets
Penciclovir 1% cream
Prophylaxis = lysine 500 mg tab 1x a day
48
Q

What term describes a vesicle filled with clear fluid? What if it is filled blood?

A

Mucocele

Blood filled is probably due to autoimmune disease like mucous membrane pemphigoid

49
Q

What is the most common location for a mucocele? What causes them? What is the treatment?

A

The lower lip

Trauma to salivary duct
Excise the feeding gland

50
Q

Why is it important to ask the history of the present lesion?

A

16 most common is scar tissue

Because it might be scar tissue from trauma or surgery and does not require treatment

51
Q

What term describes a yeast infection at the corners of the mouth? What is the treatment?

A

Angular cheilitis

Treat with an antifungal and increase the vertical dimension to prevent pooling of saliva and folding of skin

52
Q

What term describes lymphoid hyperplasia on the posterior lateral tongue? What is the treatment?

A

Lingual tonsil

No treatment

53
Q

What term describes an accumulation of blood withing the tissues secondary to trauma? What is the treatment?

A

Hematoma

No treatment

54
Q

What might tobacco pouch keratosis progress to if tobacco use continues?

A

Verrucous carcinoma

55
Q

What are the terms that describe chronic biting of the cheeks, lips, or tongue? What is the treatment?

A

Morsicatio buccarum
Morsicatio labiorum
Morsicatio linguarum

No treatment or bite guard

56
Q

What must lichen planus be differentiated from?

A

Lichenoid drug reactions (lichenoid mucositis)

57
Q

What are the two forms of lichen planus?

A

Reticular and Erosive

58
Q

What is the treatment of lichen planus?

A

Biopsy is the standard of care and then treat erosive with an anti-inflammatory

59
Q

What do cutaneous lichen planus lesions look like?

A

Purple, pruritic, polygonal papules

60
Q

What term describes bony protuberances on the buccal of the mandible/maxilla? What is the treatment?

A

Buccal exostoses

Removal if repeated trauma, aesthetic concerns, or if the patient is in need of dentures

61
Q

What term describes an implantation of amalgam into oral tissue? How is diagnosis confirmed?

A

Amalgam tattoo

Take a radiograph, and if amalgam is not visible on radiograph, then biopsy lesion to rule out melanoma
(hint: amalgam tattoos generally have a more blue tint, NOT brown)

62
Q

What term describes an oral freckle?

A

Oral melanotic macule

63
Q

What term describes a central papillary atrophy of the tongue due to a yeast infection? What is the treatment?

A

Median Rhomboid glossitis

Treat with antifungals and brushing of the tongue

64
Q

What can occur with hairy tongue?

A

Gagging, bad taste, halitosis and esthetic concerns

65
Q

What can cause a smooth red tongue? What symptoms accompany this?

A

Pernicious anemia, medications, vitamin deficiencies

Burning and pain

66
Q

What term describes a slow growing, painless, skin cyst associated with inflammation of a hair follicle? What is the treatment?

A

Epidermoid cyst

Surgical removal

67
Q

Where do oral cysts occur?

A

Midline of the FOM

68
Q

What term describes a benign tumor of fat? Where do they usually occur in the mouth? What is the treatment?

A

Lipoma

Buccal mucosa, tongue, FOM, lips

Surgical excision

Oral Medicine - My deck (7 decks)

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