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oral medicine and diagnosis > diagnosis techniques > Flashcards

diagnosis techniques Flashcards

1
Q

Clinical Decisions

A
  • requires succinct evaluation
  • it’s frustrating at best
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2
Q

Objective info

A

Information that can be measured or
perceived by the investigating clinician;
i.e. signs
e.g. temperature, size , color, duration,
consistency, surface contour, etc..

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3
Q

subjective info

A

Subjective
Patient’s own interpretation of a clinical
circumstance; i.e., symptoms
Relies on neurologic and psychologic
experiences
e.g. patient awareness of presence of a
lesion, pain intensity, pain quality
(stabbing, burning, shocking, etc…),
temperature, etc…

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4
Q

Differential Diagnosis components
* Orderly?
* Gathering?
* Knowledge and experience enable?
* Include and/or exclude disease processes
based on?

A
  • Orderly sequential approach
  • Gathering and analyzing data
  • Knowledge and experience enable
    recognition of abnormal findings
  • Include and/or exclude disease processes
    based on an educated assessment of the
    process
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5
Q

Gather and analyze data

A

– History
– Clinical findings
* Specific/unique signs
* Specific/unique symptoms

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6
Q

Differential Diagnosis
* Be aware of characteristic what?

A
  • Be aware of characteristic radiographic
    appearances
  • Be aware of characteristic clinical
    manifestations
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7
Q
  • Be aware of characteristic manifestations based on:
A

– Age
– Gender
– location

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8
Q

inspection

A

visual observations

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9
Q

Clinical Description components

A

single vs multiple, (aka systemic)
* location
* relative proximity to adjacent structures
* size in dimension (mm)
* outline - well-demarcated vs diffuse
* color – red, white, mixed, pigmented
* consistency – firm, flaccid, compressible
* intensity – mild, moderate, intense, striated, lacy
* base and surface

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10
Q

surface descriptors

A

smooth, corrugated, eroded, raised,
depressed

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11
Q

base descriptors

A

base – pedunculated, sessile, nodular, dome-shape

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12
Q

mucosal lesion morphologies

A
  • bulla
  • ulcer
  • pustule
  • fissure
  • macule
  • nodule
  • papule
  • plaque
  • vesicle
  • wheal
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13
Q

bulla

A

raised, fluid filled, larger than vesicle

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14
Q

fissure

A

crack/break in skin

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15
Q

macule

A

flat, colored

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16
Q

nodule

A

solid/raised, larger than papule

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17
Q

papule

A

small, circular, raised

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18
Q

plaque

A

raised, flat

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19
Q

pustule

A

raised, contains pus

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20
Q

ulcer

A

destrcution of epithelium lining

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21
Q

vesicle

A

small, fluid filled, raised

23
Q

wheal

A

smooth, rounded, slightly raised, associated with itching

24
Q

diascopy

A

compressing tissue with a glass slide to
determine vascular nature of a lesion

25
Palpation
* feel and press a lesion to yield information about texture, consistency, temperature and function
26
27
Probing
* palpation with an instrument * instruments include perio probe, caries explorer, needle tip, etc..
28
Percussion
* striking tissues with fingers or an instrument and listening to resulting pressure changes in the tissues * eg. tooth ankylosis
29
Aspiration
* withdrawl of fluids from a body cavity * E.g., needle aspiration of cysts, vascular tumors, purulent swellings, etc...
30
Auscultation
* listening for sounds within the body (TMJ)
31
types of biopsies
Incisional Excisional Aspirational Needle
32
Diagnostic Lab Tests for Oral Lesions
1. Biopsy 2. Immunofluorescence 3. Exfoliative Cytology
33
incisional biopsy
only part of lesion taken (larger lesions)
34
excisional biopsy
entire lesion taken (smaller lesions)
35
aspirational lesion
fluid filled lesions, some fluid removed for analysis
36
needle biopsies
aka Fine Needle Aspiration (FNA) or Fine Needle Aspiration and Cytology (FNAC) similar to aspiration but may have cellular elements
37
BIOPSY INDICATIONS
* Lesion with > 14 day duration * Unusual location * Unusual appearance * Suspicion of neoplasia * Any excised tissue * Confirm diagnosis of systemic disease
38
Suspicion of neoplasia
– Persistent ulceration – Induration – Fixation – Chronicity – Lymphadenophathy – Unexplained leukoplakia – Persistent erythroplasia
39
needle biopsy indications
* To determine the cause of tissue enlargement. * To distinguish between benign and malignant processes. * To stage metastatic cancer
40
limitations of needle biopsy
* More technique sensitive with additional preservatives and lab processing * does not localize cells to affected tissues * appositional information to adjacent tissues is lost
41
IF
use of binding pro to Ag of interest with a flourescent tag
42
ORAL EXFOLIATIVE CYTOLOGY * Indications
– Innocuous lesion – Suspicious lesion with negative biopsy – Patient refuses biopsy – Follow-up of treated malignancy – Lesion where patient is a poor risk for surgery
43
ORAL EXFOLIATIVE CYTOLOGY * Contraindications
– Keratotic or crusty mucosa – Red, vesicular or velvety mucosa – Submucosal swelling with normal mucosa – Suspicion of malignancy
44
ORAL EXFOLIATIVE CYTOLOGY method
45
CULTURE AND SENSITIVITY TESTING * Indications
– Life threatening infection – Unsuccessful previous antibiotic therapy – Immunosuppressed patien
46
CULTURE AND SENSITIVITY TESTING * use in dentistry
* Limited use in dentistry – Difficult for anaerobic conditions – Turnover time too long; best to attempt trial therapies of certain antibiotics as results may occur quicker than the time interval of the tes
47
oral cancer screening aids/ adjuncts
* Assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone * Non-invasively assesses the malignant potential of a mucosal abnormality
48
Tissue Autofluorescence Imaging * Increase the ability to distinguish? * sensitivity/ specificity in distinguishing premalignant and chronic inflammatory lesions * sensitivity/ specificity in identifying areas of dysplasia and invasive cancer that extends beyond the clinically evident lesion.
* Increase the ability to distinguish the lesional mucosa and healthy mucosa * High sensitivity but low specificity in distinguishing premalignant and chronic inflammatory lesions * High sensitivity and specificity in identifying areas of dysplasia and invasive cancer that extends beyond the clinically evident lesion.
49
dysplasia flouresence
Decreased Levels of Normal Autofluorescence
50

oral medicine and diagnosis (6 decks)

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