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
