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5th Oral Disease - Other > Diagnosis/ Management Symposium > Flashcards

Diagnosis/ Management Symposium Flashcards

1
Q

Steps in making diagnosis?

A 
Hx
Examination
Diagnosis/ differential
Special test/ investigations
Modify diagnosis
Management strategy
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2
Q

What is involved hx?

A 
PC/ HPC
PDH
MH
SH
FH
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3
Q

How take hx for ulcer hx?

A

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

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4
Q

What can help w/ diagnosis of ulcers?

A

MH/ FH/ SH
Examination
Special test - try detect predisposing/ exacerbating factors

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5
Q

What can cause ulcers?

A

Manifestation systemic disease

Iatrogenic

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6
Q

What should you consider in EO/IO examination of ulcer?

A

EO - general appearance, symmetry and swelling, lymph nodes, TMJ and muscle

IO - mucosa, lubrication, OH, dental condition

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7
Q

Examples of investigations?

A 
Imaging 
Tissue sampling - biopsies
Blood sampling
Oral rinse/ swab
Dental - probing, vitality, percussion
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8
Q

What are types of biopsies?

A

Incisional
Excisional
Core
Fine needle aspiration

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9
Q

Use of tissue biopsy?

A

To confirm diagnosis and exclude other pathology

Can be used to remove lumps

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10
Q

Use of blood sampling?

A

Check there is no underlying conditions
Monitor conditions
Ensure safe for pt to receive specific tx

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11
Q

What are different types of blood sampling?

A 
Haematology
Clinical chemistry
Coagulation
Immunology
Microbiology/ virology
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12
Q

What is important to remember when requesting investigations?

A

Always have justification
Check and follow up on results
Requesting clinician responsibility ensure results are checked

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13
Q

What should the results of investigations provide?

A

Provide additional information

Diagnosis and differential diagnosis

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14
Q

What is the immediate aim of the consultation?

A 
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
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15
Q

What is the short term aim of the consultation?

A

Reassurance
Education about condition and management
Address RFs
Management if medication

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16
Q

What is long term aim of consultation?

A 
Reassurance
Education
Address RFs
Control of condition 
Multi-discipline management if needed
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17
Q

Definition of biopsy?

A

Removal of tissue for histopathological examination

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18
Q

What is an incisional biopsy?

A

Part of the lesion is remove
Full thickness of lesions w/ adjacent normal tissue
Need sufficient depth

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19
Q

Use of incisional biopsy?

A

Used for large lesions to establish diagnosis or where tx depends on diagnosis

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20
Q

What is an excisional biopsy?

A

The entirety of the lesion is removed

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21
Q

Use of excisional biopsy?

A

Used as part of management of lesion
Used for small lesions to confirm the diagnosis
Sinister lesions to establish completeness of excision

22
Q

What is fine needle aspirate?

A

Used to obtain cells from deep lesions

23
Q

When are fine needle aspiration used?

A

Suspected malignancy or cystic lesions

NOT appropriate for oral cavity or jaw lesions

24
Q

What is core/needle biopsy?

A

Used to obtain a small sample of core tissue from deep needle

25
Q

What are smears used for?

A

Examination of cells e.g fungal infections

26
Q

Can GDP do biopsy?

A

Only if easy to biopsy and are confident to carry out tx/ diagnose

27
Q

What should GDP NEVER biopsy?

A

Bone

Lesions which suspect premalignant/ malignant

28
Q

If GDP how should sample be packaged?

A

Biopsy in 10% formol saline in screw top jaw

Needs to be in pathological specimen bag

29
Q

What must carriage of specimen in post comply with?

A

IATA 650 packaging

30
Q

What is IATA 650 packaging?

A

Specimen surrounded be absorbent material in leakproof secondary container in rigid strong outer container

31
Q

What are use of microbiological tests?

A

Samples to see cause of infection

How to tx infection

32
Q

What is sampling practice for microbiological tests?

A

Collect specimen prior to administration of ab therapy
Specimen from actual infection site
Sample collection and transportation critical

33
Q

What are different types of microbiological sampling?

A

Aspiration

Plain swab

34
Q

What can happen if transport is delayed for microbiological sampling?

A

Pathogens can die in transit = flash negative

Use transport medium to prevent

35
Q

What is microbiological aspirate sample?

A

Introduce needle into centre of swelling

Re-cap syringe needle and tape cap on - send whole syringe in post

36
Q

Adv of aspirate sample > swab?

A

In anaerobic microorganism will maintain environment as oppose swab

37
Q

How to take swab microbiological sample?

A

Plain red ended swab - dampen first w/ sterile water

Black ended swab - transport medium

Swab and put back in tube

38
Q

What is transport medium?

A

Transport media contains no growth supporting nutrients - objective is to maintain vitality w/o supporting growth

39
Q

What additives are in transport medium?

A

Reducing agent (thioglycolate) - preserve anaerobes but allow aerobes to survive

CO2 - support vitality certain pathogens

Charcoal, gelatin, corn starch - absorb toxic metabolic products

40
Q

How to sample pus?

A

Swabs -clean mucosa prior to incision and catch sample on swab

Aspirates - leave in syringe

Paper point - send in transport medium

41
Q

How to sample mucosa and skin?

A

Swabs or oral rinse

42
Q

How to take swabs of mucosa skin?

A

Dry site - moisten swab and transport medium

If suspect viral - viral swab in viral transport medium

43
Q

How to take oral rinse of mucosa?

A

10ml sterile saline, rinse mucosa 30 sec and spit into sterile bottle/tube

44
Q

Disadv of mucosal rinses?

A

Not that informative

45
Q

What is included on specimen request form?

A 
Type of sample
Where from
Clinical sign/ symptoms
Provisional diagnosis 
Ask for culture and sensitivity
46
Q

What to do if sending sample to local lab?

A

Take as soon as possible

Refrigerate if delay

47
Q

What to do if sending sample by post?

A

Label as diagnostic specimen
Place in correct packaging
Wrap in absorbent material
Itemise list of content

48
Q

What does category A infectious substance apply to?

A

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)

49
Q

Will dentist take category A samples?

A

No all will be category B

50
Q

How long to get results from lab?

A

Preliminary possible after 24 hours

Normally 48 hours

5th Oral Disease - Other (13 decks)

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