Clinical Ddx Flashcards
Mucosal changes
Blue/purple lesions
- Mucocele
- Salivary gland tumor
- Gingival cyst
- Melanoma
- Kaposi sarcoma
- Varix
Mucosal changes
Cobblestone pattern
- Crohn’s
- Heck’s
- Darier’s
Mucosal changes
Pigmented lesions (single):
- Amalgam tattoo
- Melanotic macule
- Melanoma
- Nevus
- Melanoacanthoma
Mucosal changes
Pigmented lesions (multiple/diffuse):
- Racial pigmentation
- Smoker’s melanosis
- Drug-‐induced pigmentation
- Melanoacanthoma
- Peutz-‐Jeghers
- Addison’s disease
- Heavy metal intoxication
Mucosal changes
Red lesion
- Erythroplakia
- Candidiasis
- Burn
- Hemangioma
- Mucositis
- Lupus
Mucosal changes
Red/white mixed lesions
- Candidiasis
- Lichen planus
- Lupus
- Erythroleukoplakia
- Burn
- Cinnamon reaction
Mucosal changes
Telangiectasias:
- Hereditary hemorrhagic telangiectasias (Osler-‐Weber-‐Rendu syndrome)
- CREST syndrome
- Primary biliary cirrhosis
Mucosal changes
Ulceration (single)
- Traumatic ulcer
- Apthous ulcer
- Tuberculosis
- Leprosy
- Deep fungal infection
- Squamous cell carcinoma
- Wegener’s
- Syphilis
- Chron’s
Mucosal changes
Ulceration (multiple)
- Aphthae
- Inflammatory bowel disease: Chron’s and ulcerative colitis
- Celiac disease
- Behcet’s disease
- Reiter’s syndrome
- MAGIC syndrome
- Sweet’s syndrome
- PFAPA (periodic fever, aphthous ulcers, pharyngitis, cervical adenitis)
- Heavy metal intoxication (lead, mercury, arsenic, gold)
- Blood dyscrasias (neutropenia, agranulocytosis, cyclic neutropenia, aplastic anemia, leukemia)
- Lack of nutrients (iron, folate, vit B, zinc)
- Vesiculo-‐bullous and AI (pemphigus, pemphigoid, ELP, EM)
- Mucositis (CT and RT)
- GVHD
Mucosal changes
Warty Lesions:
- Papilloma
- Verruca vulgaris
- Condyloma acuminatum
- Heck’s Disease
- Condyloma lata
- Verruciform leukoplakia
- Verrucous carcinoma
- Verruciform xanthoma
- Giant cell fibroma
- Warty dyskeratoma/Darier’s disease
- Acanthosis nigricans
- Ductal papillomas
Mucosal changes
White lesion:
- Candidiasis
- Leukoplakia (Hyperkeratosis, dysplasia, carcinoma)
- Morsicatio
- Thermal/Chemical burn
- Lichen planus
- Lupus
- Genodermatoses (White sponge nevus, HBID, pachyonychia congenita I, dyskeratosis congenita)
- Uremic stomatitis
Mucosal changes
Yellow lesions
- Parulis
- Lymphoepithelial cyst
- Lymphoid aggregate
- Granular cell tumor
- Lipoma
- Verruciform xanthoma
- Pyostomatitis vegetans (snail track ulceration)
Floor of mouth
Nodule:
- Ranula
- Lymphoepithelial cyst
- Dermoid cyst
- Salivary gland tumors
- Mesenchymal tumor
Gingiva
Desquamative Gingivitis:
- Lichen planus
- Pemphigoid
- Pemphigus vulgaris
- Linear IgA disease
- Epidermolysis bullosa
- Lupus erytematosus
- Chronic ulcerative stomatitis
- Paraneoplastic pemphigus
Gingiva
Gingival hemorrhage
- Gingivitis
- Hemophilia
- Thrombocytopenia
- Leukemia
- Chemotherapy
Gingiva
Gingival enlargement:
- Hyperplastic gingivitis
- Gingival fibromatosis/Familial gingival fibromatosis
- Juvenile hyaline fibromatosis
- Drug induced: cyclosporine, phenytoin and nifedipine
- Plasma cell gingivitis
- Leukemia
- Scurvy
- Wegener’s granulomatosis (strawberry gingivitis)
- Cinnamon stomatitis
- Diabetes
- Blood dyscrasias
Gingiva
Gingival nodules:
- Fibroma
- 3P’s (pyogenic granuloma, peripheral ossifying fibroma, peripheral giant cell lesion)
- Mesenchymal (neurofibroma, lipoma, etc)
- Squamous cell carcinoma (~ PG)
- Kaposi sarcoma
- Odontogenic tumors/cysts (eruption cyst, gingival cyst, Gorlin cyst, ameloblastoma)
- Metastatic tumors
Gingiva
Necrotizing gingivitis
- NUG
- Primary herpes (affects also ST, such as tongue, lips)
- Gonorrhea (no odor)
- Mononucleosis
- Measles (if pt is malnourished)
- Agranulocytosis (pt under CT)
Tongue
Dorsal tongue bumps
- Fibroma
- Granular Cell Tumor
- Mesenchymal Tumors
- Lingual thyroid
- Enlarged Circumvallate Papilla
- Osseous choristoma
- Lipoma
Tongue
Fissured tongue
- Melkerson-‐Rosenthal syndrome
- Down syndrome
- Sjogren syndrome
- Psoriasis
- Geographic tongue
Tongue
Loss of papillae
- Candidiasis
- Anemia
- Vitamin B deficiency
- Iron deficiency
Tongue
Macroglossia:
- Hemangiona/Lymphangioma/Vascular malformation
- Beckwith-‐Wiedemann syndrome
- Down’s syndrome
- Neurofibromatosis
- MEN 2B
- Mucopolysaccharidoses
- Hemihyperplasia
- Cretinism
- Amyloidosis
- Acromegaly
- Angioedema
- Myxedema
- Carcinomas or other tumors
- Edentulism
Tongue
Nodules:
- Lymphangioma
- Lingual thyroid
- Mesenchymal (neuroma, neurofibroma, traumatic neuroma)
- Cartilage/bone choristoma
- Amyloidosis
- Granular cell tumor
- Pyogenic granuloma
- Fibroma
Palate
Newborns:
- Gingival cysts (more in MX alveolar process)
- Palatal cysts (Epstein pearls-‐midline; Bohn’s nodules-‐scattered)
- Congenital epulis
- Melanotic neuroectodermal tumor of infancy
Palate
Deep palatal ulcerations:
- Nasal NK/T cell lymphoma
- Syphilis
- Mucormycosis (aka zygomycosis, phycomycosis)
- Wegener’s
- Cocaine use - drug-induced palatal perforation
- Leprosy
- Necrotizing ulcerative mucositis
Palate
Masses:
- Fibrous dysplasia
- Segmental odontomaxillary dysplasia
- Lymphoma
- Abscess
- Nasopalatine duct cyst (anterior)
- Salivary gland tumor
- Renal osteodystrophy-‐ the mass is a brown tumor
- Kaposi sarcoma
Palate
Petecchiae/Ecchymosis
- Scarlet fever
- Mononucleosis
- Blood dyscrasias (thrombocytopenia, anemia)
- Trauma (felatio, coughing, vomiting, convulsions, giving birth, increased thoracic pressure)
- Upper respiratory tract infections
- Hemophilia
Lip
Ulceration and crusts:
- Trauma (mechanical, chemical, electrical)
- Erythema multiforme
- Actinic cheilits
- Squamous cell carcinoma
- Exfoliative cheilitis
- Cheilocandidiasis
- Cheilitis glandularis
Lip
…involving perioral skin:
- Cheilocandidiasis
- Circumoral dermatitis
- Perioral dermatitis
- Impetigo
- Sialorrhea
Lip
Vesicles
- Herpes simplex
- Varicella
- Herpes zoster
- Impetigo
Lip
Nodule:
Upper lip-‐
- Nasolabial cyst
- Fibroma
- Salivary gland tumor (canalicular >40; PA <40)
- Mesenchymal (Hemangioma, NF, lipoma)
Lip
Nodule:
Lower lip
- Mucocele
- SCC/ KA
- Fibroma
- Mesenchymal (Hemangioma, NF, lipoma (most common))
Childhood/newborn lesions
- Congenital epulis of the newborn
- Melanotic neuroectodermal tumor of infancy
- Ameloblastic fibroma/fibro-‐odontoma
- Cystic hygroma
- Cherubism
- Hemangioma
- Eruption cyst
- Palatal cysts of the newborn
- Teratoma
Extraction site growths
- Epulis Granulomatosa
- Pulse Granuloma
- Mylospherulosis
- Ameloblastoma
- Mets
Extraoral
Epidermoid cysts:
- Gardner syndrome
- Nevoid basal cell carcinoma syndrome
Extraoral
Erythema nodosum
- Valley fever (coccidioidomycosis and erythema nodosum)
- Sarcoidosis
- Lofgren’s syndrome
- Behçet syndrome
-TB?
Facial paralysis:
- Bell’s palsy (idiopathic)
- Melkersson-‐Rosenthal Syndrome
- Heerfordt’s Syndrome
- Ramsay-‐Hunt Syndrome
- Multiple sclerosis
- Guillan-‐Barre syndrome
- Sarcoidosis
- Lyme disease
- Wegener’s
- Leprosy
- Osteopetrosis
Frontal bossing:
- Gorlin syndrome
- Osteopetrosis
- Crouzon
- Cleidocranial dysplasia
- Acromegaly
Intestinal polyps
- Cowden (most are benign)
- Peutz-‐Jeghers (most are benign)
- Gardner syndrome (most are malignant)
Increased cancer susceptibility
- Xeroderma pigmentosum (BCC, SCC)
- Papillon-‐Lefreve
- Plummer Vinson
- Gorlin syndrome
- Peutz-‐Jeghers (GI carcinoma, breast cancer)
- Cowden’s
- Gardner
- Acanthosis nigricans
- Recessive dystrophic epidermolysis bullosa (SCC)
- Immunosuppressed patients (AIDS, transplant)
Joint laxity:
- Kabuki syndrome
- Ehlers-‐Danhlos
- Cleidocranial dysplasia
- Osteogenesis imperfecta
Leukemia:
- Down syndrome
- Bloom syndrome
- NF1
- Klinefelter
- Fanconi’s anemia
- Schwachman syndrome
- Ataxia-‐telangiectasia syndrome
- Wiskott-‐Aldrich syndrome
Lateral neck swelling:
- Lymphangioma (cystic hygroma)
- Metastastic node
- Reactive node (cat-‐scratch disease, toxoplasmosis, mononucleosis)
- Branchial cleft cyst
- Hodgkin’s lymphoma
- Paraganglioma
Leonine facies
- Leprosy
- Paget’s
- Amyloidosis
- Mycosis fungoides
- Lipoid proteinosis
Midline neck swelling:
- Thyroglossal duct cyst
- Dermoid cyst
- Ranula
- Diphteria (bull neck)
- Ludwig’s angina (bull neck)
- Thryroid disease
Multiple nodules of mouth and or/face:
- MEN 2B (neuromas)
- Neurofibromatosis (NF-‐omas)
- Cowden’s (Trichilemmomas of the skin and oral fibromas)
- Tuberous Sclerosis (mouth-‐fibromas; face-‐angiofibromas)
- Lepromatous (multibacillary) leprosy (“leonine facies”)
- Blastomycosis
- Coccidioidomycosis (esp. nasolabial fold)
- Cryptococcosis (skin papules)
- Molluscum contagiosum (skin papules)
Nail Changes:
- Pachyonychia congenita
- Dyskeratosis congenita
- Dyskeratosis follicularis (Darier’s disease)
- APECED (endocrine-‐candidiasis) syndrome
- Ectodermal Dysplasia (incl. odonto-‐onychodermal dysplasia)
- Papillon-‐Lefevre (and Haim-‐Munk & Meleda’s disease)
- Darier’s disease
- Lichen planus
- Plummer-‐Vinson
Orofacial granulomatosis:
- Angioedema
- Melkersson-‐Rosenthal syndrome/cheilitis granulomatosa
- Sarcoidosis
- Crohn’s
- Tuberculosis
- Leprosy (macrochelia)
- Cheilitis granulomatosa (macrochelia)
Painful skin lesion (ANGEL)
- Angiolipoma
- Neuroma
- Glomus tumor
- Eccrine spiradenoma
- Leiomyoma
Palmoplantar keratosis
- Papillon-‐Lefevre
- Haim Munk
- Unna Thost syndrome
- Meleda disease
- Pachyonychia congenita
- Darier’s disease (dyskeratosis follicularis)
- Cowden’s syndrome
Pheochromocytomas
- MEN 2A
- MEN 2B
- NF1
- Sturge-‐Weber
- Von Hippel-‐Lindau
Pigmented lesions of the skin:
- Peutz-‐Jeghers syndrome (perioral)
- Addison’s disease
- McCune-‐Albright (café au lait -‐ rough edges)
- Neurofibromatosis (café au lait -‐ smooth edges)
- LEOPARD syndrome
- Nevus
- Melanoma
- Ephelis (freckles)
- Actinic lentigo
- Lentigo simplex
- Seborrheic keratosis
- Pigmented basal cell carcinoma
Port wine stain (nevus flammeus)
- Sturge Weber
- Beckwith-‐Wiedemann
- Hemihyperplasia
Salivary gland enlargement:
- Salivary gland tumors
- Sjogrens/BLEL
- MALT lymphoma
- Sarcoidosis/Heerfordt
- Sialadenosis
- Mumps
- CMV infection
- AIDS-‐related multicystic disease
Strike of the sword (en coup de sabre):
- Progressive hemifacial atrophy (Romberg syndrome)
- Limited scleroderma
Syndromes with seizures:
- Sturge-‐Weber
- Tuberous sclerosis
- Incontinentia pigmenti
- Mucopolysaccharidosis
Syndromes with development of head/neck tumors:
- Neurofibromatosis 1 and 2
- MEN 2B
- Cowden
- Gardner
- Sjogren
- Gorlin syndrome
- Xeroderma pigmentosum
Thyroid gland enlargement
- Goiter (Hyperthyroidism)
- Autoimmune disease
- Adenoma
- Carcinoma (Papillary, Follicular, Medullary)
Waxy eye skin lesions
- Amyloidosis
- Lipoid proteinosis
- Plasminogen deficiency
- Xanthelasma
Cancer viruses
HHV8, H.pylori, HTLV-1, HPV
- HHV8: KS, primary effusion lymphoma, Castleman’s disease, and plasmablastic lymphoma
- H.pylori: stomach MALT lymphoma
- HTLV-‐1: leukemia, peripheral T cell lymphoma
- HPV: cervical cancer (16/18)
EBV Positive Lesions:
- Burkitt’s lymphoma
- Hodgkin’s disease
- Mononucleosis
- Nasopharyngeal carcinoma
- Hairy leukoplakia
- AIDS related lymphomas (includes plasmablastic lymphoma)
- Post-‐transplant lymphoproliferative disorder
- Gastric carcinomas
- NK-‐T cell lymphoma
HPV-‐induced diseases
Virus Disease
26, 37 Keratoacathoma
16, 18, 31, 33 High risk cervical cancer
13, 32 Heck’s disease
6,11 Squamous papilloma, fungiform papilloma
2, 4, 6, 40 Verruca vulgaris
2, 6, 11, 16, 18, 31, 53, 54 Condyloma acuminatum
6, 11, 16, 18 Inverted papilloma (CD44+)
7, 32 Butcher’s warts (immunocompromised pts)
HHVs
- HHV1 : HSV1 – Labial herpes
- HHV2 : HSV2 – Genital herpes
- HHV3 : VZV – Varicella and Herpes Zoster
- HHV4 : EBV
- HHV5 : CMV
- HHV6 : Roseola (exanthema subitum)
- HHV7 : Roseola-‐like cutaneous eruption
- HHV8 : KSHV
Infections caused by group A β-‐hemolytic streptococci:
- Impetigo
- Erysipelas
- Streptococcal tonsilitis and pharyngitis
- Scarlet fever
Tonsilitis/Pharyngitis
- Streptococcal tonsillitis/pharyngitis
- Scarlet fever
- Diphteria
- Gonorrhea
- Mononucleosis
- Enteroviroses (Hand-‐foot-‐and-‐mouth, Herpangina, Acute lymphonodular pharyngitis)
Dentin dyplasia-‐like teeth:
- Tumoral calcinosis
- Calcinosis universalis
- Skeletal anomalies/Sclerotic bone
- Rheumatoid arthritis
- Vitaminosis D
Hypercementosis:
- Occlusal problems
- Paget’s disease of bone
- Inflammation from adjcent teeth
- Calcinosis
- Goiter
- Arthritis
- Vit. A deficiency
- Acromegaly
Premature tooth loss
- Hypophosphatasia
- Papillon-‐Lefreve
- Ectodermal dysplasia
Pulp calcifications:
- Dentin dysplasia (Id and II)
- Pulpal dysplasia
- Tumoral calcinosis
- Calcinosis universalis
- Ehlers-‐Danlos syndrome
Pulp obliteration:
- Dentinogenesis imperfecta
- Osteogenesis imperfeta (teeth + other altered bones)
- Fibrous dysplasia of dentin (has small RL foci)
- Calcific metamorphosis
Stains:
Extrinsic-‐
- Chromogenic bacteria (green, black, orange)
- Medications (doxycycline; stannous fluoride, chlorhexidine)
- Gingival hemorrhage (green from hemoglobin breakdown into biliverdin)
- Habits (tobacco, food, beverages)
- Iron
- Restorative materials
Stains:
Intinsic-‐
- Amelogenesis imperfecta
- Dentinogenesis imperfecta
- Dental fluorosis
- Erythropoietic porphyria
- Hyperbilirubinemia (erythroblastosis fetalis and biliary atresia)
- Ochronosis
- Trauma
- Red blood cell breakdown
- Medications (minocycline, tetracycline)
Stains:
Supernumary teeth:
- Gardner’s Syndorme
- Sturge-‐Weber
- Crouzon
- Apert
- Cleidocranial dysplasia
Stains:
Taurodontism:
- Tricho-‐dento-‐osseous (AI + taurodontism)
- Oro-‐facial-‐digital syndrome, type II (Mohr)
- Hyper/hypophosphatasia
- Kleinfelter
- Oculo-‐dental-‐digital dysplasia
- Down syndrome
- Ectodermal dysplasia
Beaten metal skull:
- Crouzon syndrome (craniofacial dysostosis)
- Apert syndrome (acrocephalosyndactyly)
- Hypophosphatasia (childhood)
Bowing deformity of long bones
- Osteogenesis imperfecta
- Rickets
- Hypophosphatasia
- Fibrous dyplasia
Cotton wool:
- Cemento-‐osseous dysplasia
- Paget’s disease
- Gardner syndrome
- Gigantiform familial cementoma
Ground glass:
- Fibrous dysplasia
- Hyperparathyroidism
- Renal osteodystrophy
- Juvenile active ossifying fibroma (when in the sinus)
Hair-‐on-‐end:
- Sickle cell anemia
- Thalassemia
- Gaucher disease
Loss of lamina dura:
- Burkitt’s lymphoma
- Osteomalacia (vit D deficiency)
- Paget’s disease
- Hyperparathyroidism
- Fibrous dysplasia
Maxillary sinus opacity/cloudiness:
- Antral pseudocyst
- Sinus mucocele
- Anthrolith
- Juvenile active ossifying fibroma
- Aspergilloma
- Sinusitis
Mixed radiolucent/ radiopaque lesions (well-‐defined):
- Cemento osseous dysplasia
- Ossifying fibroma
- Odontoma
- Ameloblastic fibro-‐odontoma
- Calcifying odontogenic cyst (Gorlin cyst)
- Calcifying epithelial odontogenic tumor (Pindborg)
Mixed radiolucent/ radiopaque lesions (ill-‐defined):
- Osteomyelitis
- Bisphosphonate associated osteonecrosis
- Osteosarcoma
- Chondrosarcoma
- Metastatic tumor
Multilocular Radiolucency (M A C H O M A C H O):
- Myxoma
- Ameloblastoma/Ameloblastic fibroma
- Central giant cell granuloma
- Hemangioma
- Odontogenic cysts (OKC, OOC, Gorlin)
- Metastatic tumors, mucoepidermoid carcinoma
- Aneurysmal bone cyst
- Cherubism
- Hyperparathyroidism
- Odontogenic fibroma
Multilocular Radiolucency
cross midline
- Myxoma
- Ameloblastoma
- CGCG
- Hemangioma
- Glandular odontogenic cyst
Neck radiopacities
- Calcified lymphnode (TB most common)
- Sialolith
- Tonsilolith (midportion of Md ramus)
- Phlebolith
- Dystrophic calcification of cystic acne
- Carotid artery calcification (multiple radiopacities)
Radiographic changes
Onion skin
- Osteomyelitis with proliferative periostitis (so-‐called Garret osteomyelitis)
- Ewing’s sarcoma
- Langerhans cell histiocytosis
- Osteosarcoma
- Trauma
- Fluorosis
- Congenital syphilis
Radiopaque lesions:
- Condensing osteitis (no RL rim)
- Bone scar (no RL rim)
- Idiopathic osteosclerosis (no RL rim, can be multifocal)
- Cemento-‐osseous dysplasia (can be multifocal)
- Odontoma (with RL rim)
- Osteoma (can be multifocal in Gardner syndrome)
Severe periodontal bone loss:
- Periodontitis
- Blood dyscrasia (leukemia, lymphoma)
- Langerhans cell histiocytosis
- Cyclic Neutropenia
- Papillon-‐Lefevre syndrome
- Haim-‐Munk syndrome
Solitary lytic bone lesions (**especially outside jaws) FOG MACHINES
- Fibrous dysplasia
- Osteoblastoma
- Giant cell tumor
- Multiple myeloma (punched-‐out RL)/metastasis
- Aneurysmal bone cyst (long bone or vertebral column)
- Chondroblastoma/chondromyxoid fibroma
- Hyperparathyroidism/hemangioma
- Infections
- Non-‐ossifying fibroma
- Eosinophilic granuloma/Enchondroma
- Solitary bone cyst (long bones)
Sunburst:
- Osteosarcoma
- Chondrosarcoma
- Hemangioma
- Melanotic neuroectodermal tumor of infancy
Tram-‐track calcifications
- Cleidocranial dysplasia
- Sturge-‐Weber syndrome
Unilocular Radiolucency (pericoronal):
- Dentigerous cyst
- Keratocyst
- Ameloblastoma
- Adenomatoid odontogenic tumor
- Gorlin cyst
Unilocular radiolucency (periapical)
- Granuloma
- Radicular cyst
- Periapical cemento-‐osseous dysplasia
- Periapical scar
Unilocular radiolucency (other locations)
- Ameloblastoma
- Keratocyst
- Ossifying fibroma
- Cemento-‐osseous dysplasia
- Odontogenic fibroma
Unilocular radiolucency (multifocal)
- Odontogenic keratocyst
- Langerhans cell histiocytosis
- Periodontal disease
- Metastatic tumors
- Multiple myeloma
Unilocular radiolucency (poorly defined borders)
- Osteomyelitis
- Metastatic tumor
- Multiple myeloma
- Osteosarcoma
- Ewing sarcoma
- Lymphoma
Widening of the PDL:
- Osteosarcoma
- Chondrosarcoma
- Scleroderma (generalized widening)
- Periapical abscess
- Metastasis
Ddx for Ellis-van Creveld
Jeune syndrome (JS), Orofaciodigital syndrome (OFDS), McKusick-Kaufman syndrome (MKK) and Weyers acrofacial dysostosis (WAD)
Ddx for taurodontism
Ellis-van creveld
Oro-facial-digital