Chapter 9

Question 1

What is the likely Dx?

Answer 1

Transient lingual papillitis.

Question 2

What are the three patterns of transient lingual papillitis? What causes it?

Answer 2

Likely represents hypersensitivity or allergy and is a clinical alteration to the fungiform papilla.

Localized: One to several fungiform papilla involved, anterior dorsal tongue, painful, red or yellow in color.

Generalized: A large percent of fungiform papilla involved, become red, tip and lateral dorsal tongue, very sensitive and painful, associated with fever and lymphadenopathy.

Diffuse: Papulokeratotic variant, large number affected, yellow or white papules and is asympomatic.

Question 3

What is the likely Dx?

Answer 3

Minor aphthous ulcer.

Question 4

What is one of the most common oral pathoses?

Answer 4

Recurrent aphthous ulcerations (30% population)

Question 5

Where do aphthous ulcers occur and what is the acception?

Answer 5

Occur on moveable mucosa unless patient is immunocompromised.

Question 6

What are the three clinical variations of ulcers and what are their characteristics?

Answer 6

Minor: Occurs in childhood and most common form. Ulcerations are less than 1 cm heal in 7-14 days, 1-5 lesions. Least recurrent.

Major: Occurs more in adolescents, measure 1-3 cm in diameter, demonstrate the longest duration (2-6 wks) and may cause scaring.

Herpetiform: Occurs more commonly in adults, lesions are 1-3 mm in diameter (smallest), and up to 100 ucerations per occurance that can coalesce. Heals in 7-10 days. Most recurrent.

Question 7

What is the likely Dx?

Answer 7

Bahcet’s syndrome.

Question 8

In what population does Bahcet’s syndrome occur?

Answer 8

Turkish, Japanesse, and mediterranean countries.

Question 9

What is the clinical presentation of Bahcet’s syndrome?

Answer 9

Oral aphthous-like ulcerations, ocular inflammation, genital ulcers, and skin lesions.

Question 10

What is the term for a multisystem granulomatous disorder of unknown cause and occurs more commonly in african americans than caucasians?

Answer 10

Sarcoidosis.

Question 11

What is the likely Dx?

Answer 11

Sarcoidosis.

Question 12

What organs are most commonly involved with Sarcoidosis?

Answer 12

Lungs, Lymph nodes, skin, eyes, salivary glands.

Question 13

With Sarcoidosis, what are the skin lesions of the H&N termed and what are they termed when on the lower legs?

Answer 13

H&N called lupus pernio which are chronic, purple indurated lesions. Lower legs Erythema nodosum which are tender red nodules.

Question 14

What are the two syndromes associated with Sarcoidosis?

Answer 14

Lofgren’s syndrome: Presents with erythema nodosum, bilateral hilar lymphadenopathy, arthralgia.

Heerfordt’s syndrome: Parotid enlargement, inflammation of the eye, facial paralysis, fever.

Question 15

What are the histological features of Sarcoidosis? How is it Dx?

Answer 15

Granulomatous inflammation, elevated serum angiotensin-converting enzyme levels.

Question 16

What is the likely Dx? Hint: crepitis on palpation.

Answer 16

Orofacial Granulomatosis.

Question 17

What area of the body is most commonly involved with Orofacial Granulomatosis?

Answer 17

Lips.

Question 18

What is orofacial granulomatosis called when only the lips are involved?

Answer 18

Cheilitis granulomatosa.

Question 19

What syndrome is associated with orofacial granulomatosis and how does it present?

Answer 19

Melkersson-Rosenthal syndrome: Cheilitis granulomatosa, facial paralysis, fissured tongue.

Question 20

What is the likely Dx?

Answer 20

Wegener’s Granulomatosis.

Question 21

What is the classical oral lesion associated with Wegener’s granulomatosis?

Answer 21

Strawberry gingivitis

Question 22

What is the difference between limited and superficial wegener’s granulomatosis?

Answer 22

Limited is the upper respiratory system with no renal lesions while superficial lesions occur primarily on skin and mucosa.

Question 23

How do you Dx wegener’s granulomatosis?

Answer 23

indirect immunoflourescence detects presence of perinuclear antineutrophil cytoplasm antibodies or cytoplasmic antineutrophil cytoplasm antibodies(most useful)

Question 24

What is the likely Dx?

Answer 24

Contact stomatitis from cinnamon.

Question 25

What is the likely Dx?

Answer 25

Contact stomatitis from cinnamon.

Question 26

Contact stomatitis from cinnamon is associated with which products?

Answer 26

Candy(localized), chewing gum(localized), toothpaste(diffused).

Question 27

What is the term for a diffuse edematous swelling of the soft tissues?

Answer 27

Angioedema.

Question 28

What is the likely Dx? Hint, soft upon palpation.

Answer 28

Angioedema.

Question 29

What is the most common cause of angioedema?

Answer 29

Mast cell degranulation leading to histamine release and IgE mediate hypersensitivity.

Question 30

Diffuse involvement of head and neck with angioedema is usually cause by what?

Answer 30

Angiotensin-converting enzyme inhibitors such as lisinopril.