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Pathology II > Disease & Mucosa Disease- Part 2 > Flashcards

Disease & Mucosa Disease- Part 2 Flashcards

1
Q

Common, chronic disease that affects skin & oral mucosa that is an immune mediated mucocutaneous disorder:

A

Lichen planus

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2
Q

What may cause a similar appearance to lichen planus? What is this called?

A

Medications; lichenoid mucositis

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3
Q

List the clinical features of lichen plaque:

A
  1. MC in middle-aged females
  2. skin lesions
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4
Q

Describe the skin lesions associated with lichen planus:

A

-often affect flexor surfaces of extremities
(4 P’s)
1. purple
2. pruritic
3. polygonal
4. papules

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5
Q

4 P’s to lichen planus skin lesions

A
  1. purple
  2. pruritic
  3. polygonal
  4. papules
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6
Q

What type of lichen planus is the most common?

A

Reticular type

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7
Q

Describe the clinical features of the RETICULAR TYPE of lichen planus:

A
  1. involves buccal mucosa bilaterally
  2. interlacing white lines (Wickham striae)
  3. Wax & wane
  4. post-inflammatory melanosis
  5. usually asymptomatic
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8
Q

Describe the clinical features of the EROSIVE TYPE of lichen planus:

A
  1. atrophic, erythematous areas with central ulceration
  2. patients often symptomatic
  3. periphery bordered by fine, white radiating striae
  4. atrophy & ulceration confined to the gingiva (desquamative gingivitis)
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9
Q

How do you diagnose lichen planus?

A

Clincal, histopathology, direct immunofluorescence

10% Formalin vs. Michels solution

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10
Q

What treatment is indicated for lichen planus?

A

Reticular: usually asymptomatic no treatment is needed

Erosive: topical corticosteroids

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11
Q

Diagnose the following image:

A

Lichen planus

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12
Q

Diagnose the following image:

A

Lichen planus

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13
Q

Diagnose the following image:

A

Lichen planus

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14
Q

Diagnose the following image:

A

Lichen planus

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15
Q

Diagnose the following image:

A

Lichen planus

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16
Q

Diagnose the following image:

A

Lichen planus

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17
Q

Diagnose the following image:

A

Lichen planus

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18
Q

Diagnose the following image:

A

Lichen planus

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19
Q

Diagnose the following image:

A

Lichen planus

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20
Q

Diagnose the following image:

A

Lichen planus

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21
Q

Diagnose the following based on the histological image:

A

Lichen planus

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22
Q

Diagnose the following based on the histological image:

A

Lichen planus

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23
Q

Ulcerative mucocutaenous condition of uncertain etiology but likely an immune mediated process:

A

Erythema multiforme

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24
Q

50% of erythema multiform causes have a ____ cause. Give some examples

A

Precipitating cause- infections (HSV) & mediations (infrequently)

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25
Q

List the clinical features of erythema multiform:

A
  1. observed in young adults (20s-30s)
  2. Prodromal symptoms (fever, malaise, headache, cough)
  3. slightly elevated. round, dusky-red patches on skin
  4. concentric, circular, erythematous rings (target lesion)
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26
Q

Where is the most frequently involved mucosal site for erythema multiform?

A

oral cavity

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27
Q

Although the oral cavity is the most frequently involved mucosal site for erythema multiforme, other mucosa may be involved including:

A
  1. genitourinary
  2. ocular
  3. respiratory
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28
Q

Describe the oral lesions associated with erythema multiforme:

A

shallow erosions or ulcerations with irregular borders located on the lips, labial & buccal mucosa, tongue, FOM & soft palate

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29
Q

Describe what can occur with the lips in a patient with erythema multiforme:

A

hemorrhagic crusting of vermillion zone

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30
Q

Describe the clinical features of erythema multiforme MINOR:

A

-milder cases
-skin lesions & 1 mucosal site (usually oral)

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31
Q

Describe the clinical features of erythema multiforme MAJOR:

A

-more severe
-widespread skin lesions & 2 or more mucosal sites
-severe ocular involvement (scarring & symblepharon formation)

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32
Q

What is the indicated treatment for erythema multiforme?

A

Usually self-limiting in 2-6 weeks but may use systemic or topical corticosteroids

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33
Q

Diagnose the following image:

A

erythema multiforme

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34
Q

Diagnose the following image:

A

erythema multiforme

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35
Q

Diagnose the following image:

A

erythema multiforme

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36
Q

Diagnose the following image:

A

erythema multiforme

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37
Q

Diagnose the following image:

A

erythema multiforme

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38
Q

Severe blistering diseases triggered by drug exposure include:

A
  1. Steven-Johnson syndrome (SJS)
  2. Toxic epidermal necrolysis (TEN)
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39
Q

Describe Steven-Johnson syndrome (SJS):

A

Less than 10% of skin & mucosal involvement

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40
Q

Describe Toxic epidermal necrolysis (TEN):

A

Greater than 30% of skin & mucosal involvement

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41
Q

Clinical features of SJS are usually seen in:

A

younger patients

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42
Q

Clinical features of TEN are usually seen in:

A

patients above 60 years

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43
Q

Both SJS & TEN initially present with ____ and after a few days ______ appear on the ____

A

flu-like symptoms; cutaneous lesions; trunk

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44
Q

Describe the cutaneous lesions seen in SJS & TEN. What may also occur?

A

Erythematous macules; sliuhginh of skin (flaccid bullae); may have mucosal changes as well

45
Q

What treatement is indicated for patients with SJS & TEN?

A
  1. identify & immediately discontinue offending drug
  2. management in burn unit of hospital
46
Q

What is the mortality rate for the following?

SJS:

TEN:

A

SJS: 1-5%

TEN: 25-30%

47
Q

Diagnose the following image:

48
Q

Autoimmune disease caused immune attack on desmosomes resulting in intra-epithelial split:

A

Pemphigus vulgaris

49
Q

Pemphigus vulgaris effects ___ per million people

50
Q

Pemphigus vulgaris is an autoimmune disease that attacks:

A

desmosomes (desmoglein 3)

51
Q

List the clinical features of pemphigus vulgaris:

A
  1. oral lesions (first sign of disease & most difficult to treat)
  2. average diagnosis age: 50 years old
  3. superficial ragged erosions & ulcerations
  4. affect any mucosal location
  5. desquamative gingivitis
  6. skin lesions (flaccid vesicles & bullae that rupture quickly)
  7. ocular lesions: conjunctivitis
52
Q

Describe the lesion seen in pemphigus vulgaris:

A

-superficial ragged erosions & ulcerations
-lesions persist & progress without treatment
-lesions are painful

53
Q

In pemphigus vulgaris cases, what sign is positive?

A

Nikolsky signs; bullae appears with firm lateral pressrue

54
Q

How do you diagnose pemphigus vulgaris?

A
  1. clinical, histopathology & direct immunofluorescence
  2. 10% Formalin vs. Michels solution
  3. Perilesional biopsy
55
Q

What treatment is indicated with pemphigus vulgaris?

A

systemic corticosteroids & immunosuppressive drugs

56
Q

Diagnose the following image:

A

Pemphigus vulgaris

57
Q

Diagnose the following image:

A

Pemphigus vulgaris

58
Q

Diagnose the following image:

A

Pemphigus vulgaris

59
Q

Diagnose the following image:

A

Pemphigus vulgaris

60
Q

Diagnose the following image:

A

Pemphigus vulgaris

61
Q

Diagnose the following image:

A

Pemphigus vulgaris

62
Q

Diagnose the following histological image:

A

Pemphigus vulgaris

63
Q

Diagnose the following histological image:

A

Pemphigus vulgaris

64
Q

Diagnose the following histological image:

A

Pemphigus vulgaris

65
Q

An autoimmune disease characterized by chronic blistering due to tissue-bound autoantibodies against components of the basement membrane (hemidesmosomes):

A

Mucous membrane pemphigoid (Cicatricial pemphigoid)

66
Q

Mucous membrane pemphigoid is a ____ & ____ disease and results in _____

A

autoimmune & mucocutaneous; chronic blistering

67
Q

What is more common between the following?

-pemphigus vulgaris
-mucous membrane pemphigoid

A

mucous membrane pemphigoid (Cicatricial pemphigoid) is atleast 2x more common

68
Q

mucous membrane pemphigoid is an autoimmune disease that attacks the:

A

components of the basement membrane (hemidesmosomes)

69
Q

Clinical features of mucous membrane pemphigoid (cicatricial pemphigoid):

A
  1. 50-60 years of age
  2. MC mucosal site is the oral cavity
  3. can also be seen: ocular, nasal, esophageal, laryngeal & vaginal mucosa
  4. oral vesicles or bullae
  5. painful lesions
  6. desquamative gingivitis
70
Q

The oral lesions (vesicles or bullae) in mucous membrane pemphigoid may:

A

rupture causing large erosions & uclerations

71
Q

What is the most significant complication of mucous membrane pemphigoid?

A

Ocular involvment- symblepharon formation - may result in blindness

72
Q

How do you diagnose mucous membrane pemphigoid?

A
  1. Clinical, histopathology, direct immunofluorescence
  2. 10% Formalin vs. Michels solution
  3. Periolesional biopsy
73
Q

What treatment is indicated in mucous membrane pemphigoid?

A
  1. if oral lesions present may be controlled with topical corticosteroids
  2. patients should be referred to opthalmologist
  3. OHI measures for gingival lesions
74
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

75
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

76
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

77
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

78
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

79
Q

Diagnose the following image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

80
Q

Diagnose the following histological image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

81
Q

Diagnose the following histological image:

A

Mucous membrane pemphigoid (cicatricial pemphigoid)

82
Q

Autoimmune disease characterized by chronic blistering caused by tissue-bound antibodies against components of the basement membrane (mucocutaenous disease):

A

Bullous pemphigoid

83
Q

Give an example of a basement membrane component that may be attacked in bullous pemphigoid:

A

hemidesmosomes

84
Q

List the clinical features of bullous pemphigoid:

A
  1. 75-80 years old
  2. pruritis is often an early symptom
  3. bullae develop on skin & rupture several days after
  4. healing without scarring
85
Q

Diagnose the following image:

A

Bullous pemphigoid

86
Q

Possibly an immune-mediated condition in which dense collagen is deposited throughout the tissue; most organs of the body affected:

A

systemic sclerosis (scleroderma)

87
Q

List the clinical features of systemic sclerosis (scleroderma):

A
  1. female predominance (2-3x more common)
  2. mainly observed in adults
  3. often first noticed by cutaneous changes
  4. skin develops diffuse, hard texture
  5. surface is usually smooth
  6. involvement of facial skin (smooth, taut, mask-like appearance)
  7. microstomia develops with perioral involvement
  8. tongue becomes stiff
  9. dysphagia
  10. xerostomia
  11. nasal Ala becomes atrophied (pinched appearance)
  12. Raynaud phenomenaum
  13. Resorption of terminal phalanges (claw-like fingers)
88
Q

Vasoconstrictive event triggered by exposure to cold or stress often the 1st sign of systemic sclerosis:

A

Raynaud phenomenon

89
Q

Systemic sclerosis may involve other organs including:

A
  1. fibrosis of lungs
  2. fibrosis of heart
  3. fibrosis of GI tract
  4. pulmonary fibrosis

(all of these may lead to organ failure)

90
Q

List the radiographic features of systemic sclerosis:

A
  1. widening of the PDL
  2. resorption of the posterior mandibular ramus
  3. resorption of condyle
  4. resorption of coronoid process
91
Q

What treatment is indicated for systemic sclerosis?

A

systemic medications like Penicillamine however prognosis is poor

92
Q

CREST syndrome may also be called:

A

limited scleroderma

93
Q

Describe the components of CREST syndrome:

A
  1. Calcinosis cutis
  2. Raynaud phenomenon
  3. Esophageal dysfunction
  4. Scerlodactyly
  5. Teliangiectasia
94
Q

Describe the clinical features of CREST syndrome:

  1. Calcinosis cutis
  2. Raynaud phenomenon
  3. Esophageal dysfunction
  4. Scerlodactyly
  5. Teliangiectasia
A
  1. Calcinosis cutis - movable subcutaneous nodules
  2. Raynaud phenomenon- severe vasospasm in fingers/toes
  3. Esophageal dysfunction- abnormal collagen deposition
  4. Scerlodactyly- fingers become stiff; skin is smooth & shiny
  5. Telangiectasia- superficial dilated capillaries
95
Q

CREST syndrome is most commonly seen in:

A

females 6th-7th decade

96
Q

Diagnose the following image:

A

CREST syndrome

97
Q

Diagnose the following image:

A

CREST syndrome

98
Q

Diagnose the following image:

A

CREST syndrome

99
Q

Diagnose the following image:

A

CREST syndrome

100
Q

Diagnose the following histological image:

A

CREST syndrome

101
Q

Immune related inflammatory bowel disease:

A

Crohn’s disease

102
Q

A ____ factor may be implicated in Crohn’s disease

A

genetic factor

103
Q

Crohn’s disease can occur anywhere in the:

A

GI tract (mouth to anus)

104
Q

In Crohn’s disease, what may precede the GI lesions?

A

Oral lesions

105
Q

List the clinical features of Crohn’s disease:

A
  1. MC diagnosed in 2nd decade
  2. abdominal cramping, pain, nausea, diarrhea
  3. weight loss & malnutrition
  4. anemia
  5. decreased growth
  6. diffuse, nodular oral swelling & oral ulcers
106
Q

Describe the oral manifestations of Crohn’s disease:

A

-diffuse, nodular oral swelling
-oral ulcers
-cobblestone appearance
-erythematous macules & plaques

107
Q

What treatment is indicated in cases of Crohn’s disease:

A

Oral lesions typically clear with GI treatment of Sulfasalazine, antibiotics & corticosteroids

108
Q

Diagnose the following image:

A

Crohn’s disease

109
Q

Diagnose the following image:

A

Crohn’s disease

Pathology II (17 decks)

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