Diagnostic Technique Flashcards
what is objective clinical information
information that can be measured or perceived by the investigating clinician - signs
what are examples of objective clinical info
- temperature
- size
- color
- duration
- consistency
- surface contour
describe subjective clinical info
- patients own interpretation of a clinical circumstance - symptoms
- relies on neurologic and psychologic experiencs
what are examples of subjective clinical info
patient awareness of presence of a lesion, pain intensity, pain quality, temperature
describe the differential dx
- 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
what data do you gather for the diff dx
- history
- clinical findings- specific/unique signs and symptoms
- lab data
what are the ways to clinically describe something
- 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, intensity, striated, lacy
- base and surface
what are the ways you can describe the surface of a lesino
- smooth
- corrugated
-eroded - raised
- depressed
what are the ways you can describe the base of a lesion
- pedunculated
-sessile - nodular
- dome-shaped
what is diascopy
compressing tissue with a glass slide to determine vascular nature of a lesion
describe what palpation is
feel and press a lesion to yield information about texture, consistency, temperature and function
what is probing
palpation with an instrument
what instruments are used to probe
- perio probe
- caries explorer
- needle tip
what is percussion
striking tissues with fingers or an instrument and listening to resulting pressure changes in the tissues
what might percussion might tell you
ankylosis
what is aspiration
withdrawal of fluids from a body cavity
what is an example of aspiration
needle aspiration of cysts, vascular tumors, purulent swellings
what is auscultation
listening for sounds within the body
what are the diagnostic lab tests for oral lesions
- biopsy
- immunofluorescence
- exfoliative cytology
what are the types of biopsy
incisional
- excisional
- aspirational
- needle
what are the indications for a biopsy
- lesion with less than or equal to 14 day duration
- unusual location
- unusual appearance
- suspicion of neoplasia
- any excised tissue
- confirm the dx of systemic disease
what would cause suspicion of neoplasia
- persistent ulceration
- persistent erythroplasia
- induration
- fixation
- chronicity
- lymphadenopathy
- unexplained leukoplakia
what are the other names for needle biopsy
- fine needle aspiration (FNA)
- fine needle aspiration and cytology (FNAC)
what are the indications for needle biopsy
- to determine the cause of tissue enlargement
- to distinguish between benign and malignant processes
- to stage metastatic cancer
what are the indications for oral exfoliative cytology
- innocuous lesion
- suspicious lesion with negative biopsy
- patient refuses biopsy
- follow up of treated malignancy
- lesion where patient is a poor risk for surgery
what are the limitations to 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
what are the contraindications for oral exfoliative cytology
- keratotic or crusty mucosa
- red, vesicular or velvety mucosa
- submucosal swelling with normal mucosa
- suspicion of malignancy
what are the indications for culture and sensitivity testing
- life threatening infection
- unsuccessful previous antibiotic therapy
- immunosuppressed patient
why is culture and sensitivity testing use limited in dentistry
- difficult for anaerobic conditions
- turnover time too long; best attempt trial therapies of certain antibiotics as results may occur quicker than the time interval of the test
what do oral cancer screening aids do
- assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone
- non invasively asses the malignant potential of a mucosal abnormality
what is the goal of tissue autofluorescense imaging
increase the ability to distinguish the lesional mucosal and healthy mucosa
describe the sensitivity and specficity in tissue autofluorescence imaging
- high sensitivity but low specificity in distinguishing premalignant and chronic inflammatory lesions
- high sensitivity and specificity in identifying areas on dysplasia and invasive cancer that extends beyond the clinically evident lesion
describe the light that is seen in autofluoirescence
- we see 500-600nm
- blue light of the scope is 400-460 nm
- UV is less than 400nm
what are the endogenous fluorescing products in autofluorescence
tryptophan, porphyrins, collagen, elastin, flavins, NADH, and fluorophores
what are the epithelial fluoresencing compounds in autofluorescence and what does it excite at
- FAD (flavin adenine dinucleotide) excites at 515nm
- NADH (nicotinamide adenine dinucleotide) excites at 450 nm
what are the commerically available devices for visualization of oral tissue autofluorescence
- identafi 3000
- VELScope
- VELScope Vx
- DOE Dental Oral Exam System
what does dysplasia show on autofluorescence
decreased levels of normal autofluorescence
what is an excisional biopsy
where the entire lesion is removed
what is an incisional biopsy
only removing a portion of the lesion
what type of biopsy is a suture pull
incisional
