Diagnosis/ Management Symposium Flashcards
Steps in making diagnosis?
Hx Examination Diagnosis/ differential Special test/ investigations Modify diagnosis Management strategy
What is involved hx?
PC/ HPC PDH MH SH FH
How take hx for ulcer hx?
Hx - onset, duration, frequency, size, shape, healing time, area affected, ulcer free period, QoL, previous tx, MH
Other: FH, genital ulcer, skin rash, GI or joint problem, drug hx, smoking cessation, stress
What can help w/ diagnosis of ulcers?
MH/ FH/ SH
Examination
Special test - try detect predisposing/ exacerbating factors
What can cause ulcers?
Manifestation systemic disease
Iatrogenic
What should you consider in EO/IO examination of ulcer?
EO - general appearance, symmetry and swelling, lymph nodes, TMJ and muscle
IO - mucosa, lubrication, OH, dental condition
Examples of investigations?
Imaging Tissue sampling - biopsies Blood sampling Oral rinse/ swab Dental - probing, vitality, percussion
What are types of biopsies?
Incisional
Excisional
Core
Fine needle aspiration
Use of tissue biopsy?
To confirm diagnosis and exclude other pathology
Can be used to remove lumps
Use of blood sampling?
Check there is no underlying conditions
Monitor conditions
Ensure safe for pt to receive specific tx
What are different types of blood sampling?
Haematology Clinical chemistry Coagulation Immunology Microbiology/ virology
What is important to remember when requesting investigations?
Always have justification
Check and follow up on results
Requesting clinician responsibility ensure results are checked
What should the results of investigations provide?
Provide additional information
Diagnosis and differential diagnosis
What is the immediate aim of the consultation?
Make a working diagnosis (inform pt) Arrange special tests if needed Address pt concern Consider pt discomfort/ dysfunction e.g pain relief Education e.g smoking cessation
What is the short term aim of the consultation?
Reassurance
Education about condition and management
Address RFs
Management if medication
What is long term aim of consultation?
Reassurance Education Address RFs Control of condition Multi-discipline management if needed
Definition of biopsy?
Removal of tissue for histopathological examination
What is an incisional biopsy?
Part of the lesion is remove
Full thickness of lesions w/ adjacent normal tissue
Need sufficient depth
Use of incisional biopsy?
Used for large lesions to establish diagnosis or where tx depends on diagnosis
What is an excisional biopsy?
The entirety of the lesion is removed
Use of excisional biopsy?
Used as part of management of lesion
Used for small lesions to confirm the diagnosis
Sinister lesions to establish completeness of excision
What is fine needle aspirate?
Used to obtain cells from deep lesions
When are fine needle aspiration used?
Suspected malignancy or cystic lesions
NOT appropriate for oral cavity or jaw lesions
What is core/needle biopsy?
Used to obtain a small sample of core tissue from deep needle
What are smears used for?
Examination of cells e.g fungal infections
Can GDP do biopsy?
Only if easy to biopsy and are confident to carry out tx/ diagnose
What should GDP NEVER biopsy?
Bone
Lesions which suspect premalignant/ malignant
If GDP how should sample be packaged?
Biopsy in 10% formol saline in screw top jaw
Needs to be in pathological specimen bag
What must carriage of specimen in post comply with?
IATA 650 packaging
What is IATA 650 packaging?
Specimen surrounded be absorbent material in leakproof secondary container in rigid strong outer container
What are use of microbiological tests?
Samples to see cause of infection
How to tx infection
What is sampling practice for microbiological tests?
Collect specimen prior to administration of ab therapy
Specimen from actual infection site
Sample collection and transportation critical
What are different types of microbiological sampling?
Aspiration
Plain swab
What can happen if transport is delayed for microbiological sampling?
Pathogens can die in transit = flash negative
Use transport medium to prevent
What is microbiological aspirate sample?
Introduce needle into centre of swelling
Re-cap syringe needle and tape cap on - send whole syringe in post
Adv of aspirate sample > swab?
In anaerobic microorganism will maintain environment as oppose swab
How to take swab microbiological sample?
Plain red ended swab - dampen first w/ sterile water
Black ended swab - transport medium
Swab and put back in tube
What is transport medium?
Transport media contains no growth supporting nutrients - objective is to maintain vitality w/o supporting growth
What additives are in transport medium?
Reducing agent (thioglycolate) - preserve anaerobes but allow aerobes to survive
CO2 - support vitality certain pathogens
Charcoal, gelatin, corn starch - absorb toxic metabolic products
How to sample pus?
Swabs -clean mucosa prior to incision and catch sample on swab
Aspirates - leave in syringe
Paper point - send in transport medium
How to sample mucosa and skin?
Swabs or oral rinse
How to take swabs of mucosa skin?
Dry site - moisten swab and transport medium
If suspect viral - viral swab in viral transport medium
How to take oral rinse of mucosa?
10ml sterile saline, rinse mucosa 30 sec and spit into sterile bottle/tube
Disadv of mucosal rinses?
Not that informative
What is included on specimen request form?
Type of sample Where from Clinical sign/ symptoms Provisional diagnosis Ask for culture and sensitivity
What to do if sending sample to local lab?
Take as soon as possible
Refrigerate if delay
What to do if sending sample by post?
Label as diagnostic specimen
Place in correct packaging
Wrap in absorbent material
Itemise list of content
What does category A infectious substance apply to?
If capable of causing permanent disability, life-threatening or fatal disease
e.g HIV/ hep B or C
Only applies to cultures/ concentrates (not swabs/ aspirates)
Will dentist take category A samples?
No all will be category B
How long to get results from lab?
Preliminary possible after 24 hours
Normally 48 hours
