Diseases Flashcards
Other name for marie-strumpell disease
Ankylosing spondylitis
Other name for pagets disease
Osteitis de formans
Bence-jones protein in urine
Multiple myeloma
Most common primary bone tumor
Multiple myeloma
Plasma cell malignancy / nonfunctional immunoglobulins
Multiple myeloma
*bence jones proteins
*punched out
*inc serum alkaline phosphatase
Osteoblast neoplasm
Osteosarcoma
Most common true primary bone tumor
Osteosarcoma
Rx: codman’s triangle or sunburst
Osteosarcoma
Inc in serum alkaline phosphatase
Osteitis de formans
Multiple myeloma
Osteosarcoma
Hyperparathyroidism
Liver cirrhosis
Prostate cancer
Bone infection due to staph aureus
Osteomyelitis
Rx: moth eaten (3)
Osteomyelitis (specifically chronic!)
Ewing’s sarcoma
Root resorption
chondrosarcoma
rx: sawtoothing/saw tooth rete pegs
lichen planus
hx; absence of rete pegs
lichen planus
most common skin cancer
basal cell carcinoma
most common skin cancer in the oral cavity
squamous cell carcinoma
deadliest skin cancer
melanoma
rx: orange peel/ ground glass
- Hyperparathyroidism
- Albers-schonberg /marble bone disease/ osteopetrosis -osteoblast ang active
- Fibrous dysplasia
rx: punch out in the skull
multiple myeloma
Clotting factor deficient in Hemophilia A, B, C?
A - VIII (anti hemophilic)
B - IX (christmas factor)
c - XI (plasma thromboplastin antecedent)
*Hemophilia c = rosenthal syndrome
Excess dopamine or serotonin or glutamate
Schizophrenia
Deficient dopamine
Parkinson’s disease
Neuroblastoma is seen where
Adrenal gland with immature nerve cells
Destruction of myelin sheath in CNS by autoimmune cells
Multiple sclerosis resulting to plaques
Destruction of myelin sheath in PNS by autoimmune cells
Guillan-Bare syndrome resulting to paralysis
Degeneration of motor neurons in the brain and spinal cord
Amyotropic Lateral Sclerosis resulting to muscle weakness and atrophy
Otitis externa /swimmer ear
bacteria
Pseudomonas aeruginosa
Otitis Media or Glue ear bacteria
Streptococcus pneumoniae
Hx: jigsaw/ mosaic pattern
pagets disease
Patient has excessive elastic fibers
Marfan syndrome
Patient has defective collagen fibers
Ehler-danlos syndrome
Patient has deficient collagen fibers
Osteogenesis imperfecta
Presentation of osteogenesis imperfecta
Blue sclera
Bone deformities
DENTINOGENESIS IMPERFECTA (Type I)
Excessive cortisol will result
Cushing’s disease
Pituitary adenoma -> inc ACTH -> cortisol
Deficient cortisol will result to?
Addison’s disease
Excessive thyroid hormones will result to?
Hyperthyroidism
primary adrenal insufficiency
Addison’s disease
Other name for ALS
Lou Gehring’s disease
Presentation of sturge-weber syndrome
Ocular pathologies
Neurological disorder
Port-wine stain
aka encephalotrigeminal angiomatosis
Neurocutaneous disease
Reddish purplish discoloration following the branches of CN V (primarily V1 and V2)
Port-wine stain or nevus flammeus
Aschoff bodies
Rheumatic fever
Deficiency of antidiuretic hormone or vasopressin
Diabetes insipidus
Clinical feature: polyuria and polydipdisia
Most common cause of hyperthyroidism
Grave’s disease
Creates abnormal antibodies that mimics TSH
Grave’s disease
Most common cause of hypothyroidism
- Hashimoto’s thyroiditis
- Iodine deficiency
Hypothyroidism in children may result to
Cretinism -physical and mental retardation
Severe type of hypothyroidism
Myxedema
General presentation of hyper vs hypothyroidism
Hyper- thin, warmer temp, heat intolerant, moist
Hypo- fat colder body, cold intolerant, dry
Radiographic appearance hyperparathyroidism
Ground glass/orange peel
*Absence of lamina dura
Severe form of hyperparathyroidism
Von recklinghausen’s disease OF BONE / osteitis fibrosa cystica
Presentation of von recklinghausen’s disease of the SKIN
Neurofibromatosis I
1. Neurofibromas (benign tumor)
2. Cafe-au-lait spots
3. Lisch spots/nodules -eyes
4. Crowe’s sign -axillary freckles
2 types of fibrous dysplasia
Monostotic
Polystotic (Mccune Albright syndrome and jaffe lichtenstein syndrome)
Differentiate mccune albright and jaffe-lichtenstein
Both have cafe-au-lait skin, polystotic fibrous dysplasia BUT J.L has no endocrine dysfunction. Only M.A. have early maturation of endocrine system
Hyper vs hypoparathyroidism
Hyper- osteoporotic bone, hypercalcemia (arrhythmia)
Hypo- hypocalcemia (arrhythmia) and tetany (Chvostek sign and Trousseous sign)
State of hyperexcitability of nervous system due to hypocalcemia
Tetany
*Chvostek sign - hypersensitive facial nerve
*Trousseous sign - brachial artery compression (hand of obstetrician)
Excessive back curvature
Opisthotonos due to tetanus toxin (clostridium tetani)
Starvation may lead to rise in ketone bodies
Ketoacidosis
1. Acetoacetic acid
2. B-hydroxybutyric acid
3. Acetone
*Ketone breath and urine
*Diabetic ketoacidosis
ketone is produced by liver
Cafe au lait skin
- Mccune albright
- Jaffe-lichtenstein
- Von recklinghausen’s disease of the skin (neurofibromatosis I)
- Chediak - higashi
X-linked muscle dystrophies
Duchenne (loss of dystrophin)
Becker’s (mishapen dystrophin)
-shows waddling gait, Gower’s sign
-high creatine kinase
-with presentation MALE
-carriers FEMALE
Ureter spasms caused by kidney stones
Renal colic
Test for acromegaly
Oral glucose tolerance test
Sloughing of tissue is? It is a pathognomonic sign of?
Nikolsky sign
*Toxic epidermal necrolysis
*Staphyloccocal scalding syndrome
*Pemphigous vulgaris
Hx: acantholysis
*separation of squamous epithelial cells
Pemphigous vulgaris
Blistering disorder due to auto-antibodies damaging desmosomes
Pemphigous vulgaris
*With nikolsky sign
Blistering disorder due to auto-antibodies damaging hemidesmosomes
Hx???
Bullous pemphigoid
No nikolsky sign
Bullae: 2-8cm
Hx: subepidermal non-acantholytic blisters
marked by iron-deficiency anemia and esophageal webs leading to dysphagia (Triad)
Plummer-vinson syndrome
test for thrombocytopenia
tourniquet test / rumpel-leede test / capillary fragility test
tx of iron def anemia
ferrous sulfate
dental implication iron def anemia: perleche (angular cheilitis), glossitis, bald tongue, (black stain teeth)
Vitamin deficient in Beriberi?
B1 (Thiamine) - for nerve function
Hx: keratin pearls
Squamous cell carcinoma
accumulation of methemoglobulin
*hemoglobin that cannot carry oxygen
methmoglobinemia
disease with cyanosis
erythtoblastosis fetalis
congenital heart disease (tetralogy of fallot)
methemoglobinemia
chromosome 22 deletion pathophysiology
diGeorge’s syndrome
-failure 3rd and 4th pharyngeal pouches (endoderm) -> gives rise to thymus and parathyroid -> tetany and infections
-can cause congenital heart diseases (tetralogy of fallot)
CATCH 22
y-linked general hair growth
hypertrichosis
bow legs
rickets
congenital syphilis
gigantism vs acromegaly
gigantism - high Gh before epiphyseal closure (child)
acromegaly- high GH after epiphyseal closure (adult)
Breathing disorder in preterm infants caused by the deficiency of surfactant
Respiratory distress syndrome
Congenital disease caused by absence of the myenteric plexus
Hirschsprung’s disease - decreased parasympathetic activity -> decreased motility and obstruction of intestines
Myenteric plexus (motility): auerbach and meissner plexi
Submucosal plexus (secretions)
**PSNS stimulates enteric nervous system. SNS inhibits ENS*
Beefy tongue
Pernicous anemia (B12)
Elevated PSA and acid phosphatase is associated with?
PSA = Prostate-specific antigen
Prostate tumor
non necrotizing inflammation of the skin (esp subcutaneous tissues) usually associated with acute bacterial infection
cellulitis
-usually does NOT involve fascia or muscles
most common stage of chronic apical periodontitis
granuloma stage
other stages: abscess, cyst
onset of delayed hypersensitivity
48 to 72 hrs
extracellular hyaline accumulation
amyloidosis (amyloid - abnormal protein fragments) - congo red staining
*diabetic glomerulosclerosis/kimmel stiel-wilson syndrome = INTRAcellular hyaline accumulation
pigmentation of carbon monoxide poisoning? silver nitrate?
cherry red tissue for carbon mon
black pigmentation for silver nitrate
tetracycline is greenish-black
iron def anemia is black stains in teeth
copper accumulation disease and pigmentation
wilson’s disease - brown green bordered eyes (keyser-fleisher ring)
strawberry/raspberry tongue
- Kawsaki’s disease (vasculitis, immune system attacks vessels)
- scarlet fever (Group A strep -strep pyogenes)
skin disease with pus
impetigo or pyoderma (can be caused by staph or strep)
localized pus-containing skin boil
Furuncle
carbuncle for extensive furuncle
abnormal involuntary movements (rheumatic fever)
syndenham chorea (st. vitu’s dance)
other presentation of RF
-polyarthritis, pancarditis, valvular damage, erythema marginatum (aka pink torso rings)
pericarditis associated with Rheumatic heart fever
bread and butter pericarditis or fibrinoid pericarditis
presentation of diphtheria
caused by corynebacterium
barking cough
diphtheric membrane (necrotic epithelium, do not remove!!!)
Bull’s neck (enlarged lymph nodes)
features of anthrax
central black eschar
hemorrhagic necrosis and edema of mediastinum
hemorrhagic pleural effusion
sepsis
meningitis
chronic suppurative and granulomatous infection that produces pyogenic lesions with interconnecting sinus tracts that contain granules composed of microcolonies of bacteria
actinomycosis (cervicofacial, thoracic, abdominal) - pus looks like yellowish sulfur granules
“lumpy jaw”
INTRAcellular hyaline accumulation (2 names)
*diabetic glomerulosclerosis/kimmel stiel-wilson syndrome
XXY
Klinefelter’s
Xxxy
Xxxxy
Gynecomastia
Micropenis
Taurodontism
XO
Turner’s (female)
Walang YO/OY!!!
Trisomy 21
Down syndrome
Trisomy 18
Edward’s
Trisomy 8, 9, 13
Patau
Other name for syphilis
Lus disease
Great pox
Presents painful punched out/crater of grayish pseudomembrane in the gingiva, fetid odor. TX??
NUG/vincent’s disease/trench mouth
Tx. Debridement
Irrigation with NSS and 0.12% CHX
Antibiotics (penicillin)
Pulmonary TB features
Ghon’s focus (coin lesion)
Ghon’s complex
Hx:
epitheloid cells
Langhans giant cells (fused epitheloid cells)
Most common form of TB in children that affects mid-lower zones of lungs
Primary complex
*Remember most common site of primary pulmonary TB is the apex of the lungs (high O2!!)
TB of the bone is called
Pott’s disease (spiral TB)
TB of the neck (lymph nodes)
Scrofula
Disseminated form of TB
Miliary TB
Necrosis seen in TB if untreated
Caseous necrosis
Hx: owl’s eye inclusion bodies
Hx: owl’s eye nucleus
Cytomegalovirus - inclusion bodies
Hodgkin lymphoma (associated with EBV) - nucleus (reed sternberg cells)
Hx: Reed-sternberg cells
Hodgkin’s lymphoma (associated with EBV)
Hx: starry sky/moth eaten
Burkitt’s lymphoma -non-hodgkin (EBV) - POSTERIOR MAXILLA
Forms:
1. Endemic -jaw
2. Sporadic -adbomen
3. Immunodeficiency-associated
Tx: chemotherapy
Kissing’s disease
Infectious mononucleosis
**cytomegalovirus - mono-like
Differentials for white patches on the tongue
White hairy leukoplakia
Oral candidiasis
Secondary syphilis (condyloma lata)
Frog face
Crouzon’s syndrome (craniofacial dysostosis)
Mid-face deficiency
Bird face
Treacher-collin’s syndrome
Mandibulofacial dysostosis
Deficient zygoma and mandible
Fish face or bird face
Pierre-robin syndrome
Lion’s face, bone resorption, shortening of digits
Leprosy / Hansen’s disease
*Causes disfigurement of bones
Mycobacterium leprae
Associated with Reye’s syndrome
Chicken pox and aspirin
Reye’s syndrome causes Hepatotixicity, Encephalitis. Can be due to viral infection of child and aspirin
“Serum hepatitis” , “Dane particle”
Hepatitis B (causes liver inflammation and associated with hepatocellular carcinoma)
Ulcers in posterior of oral cavity
Herpangina caused by Coxsackie A (picornavirus)
**Coxsackie AHH, acute hemorrhagic conjunctivitis, hand foot mouth disease, herpangina
gastric contents moving up to the lower esophagus due to incompetent lower esophageal constrictor
gastroesophageal reflux disease (GERD)
complication: Barrett’s esophagus (squamous to simple columnar /metaplastic changes)
King of Multiples.
most commonly involved in the rectum
gardner’s syndrome or familial colorectal polyposis
*associated with colorectal cancer
clinical features of gardner’s syndrome and the differential dx?
king of multiples aka familial colorectal polyposis
multiple polyps
multiple supernumerary teeth
multiple soft tissue tumors (fibroma)
multiple hard tissue tumors (multiple osteoma, odontoma)
epidermal cyst
vs Peutz-Jeghers syndrome na hereditary intestinal polyposis (with normal number of teeth and assoc with skin pigmentation)
autoimmune disease that damages the salivary and lacrimal glands and it’s TRIAD
Sjogren’s syndrome / Sicca syndrome
1. xerostomia
2. keratoconjunctivitis sicca
3. rheumatoid arthritis
1&2 - primary
1,2,3 - secondary
(Vs sjogren’s syndrome) disease that leads to enlargement of salivary and lacrimal gland (2 names)
Mikulikz disease (Benign lymphoepithelial lymphomatosum)
autodigestion of pancreas due to early activation of pancreatic juices because of stones obstructing the opening to the duodenum. What are the labs and signs?
acute pancreatitis
lab findings: increase serum amylase and lipase, decrease calcium levels
signs of internal bleeding
1. grey turner sign (flank ecchymosis)
2. cullen’s sign (discoloration around navel)
liver tissues are being replaced by scar fibrous tissue resulting to decrease blood flow to liver and its types
cirrhosis
1. alcohol cirrhosis (Laennec’s cirrhosis) - presence of Mallory bodies
2. biliary cirrhosis (due to obstruction of bile ducts)
3. cardiac cirrhosis (due to chronic Right CHF)
inflammation of the gall bladder
gall bladder or bile duct stones
cholecystitis
cholelithiasis
type hypersensitivity of glomerulonephritis? rheumatic fever?
type 3. it is a post strep hypersensitivity (strep pyogenes)
type 2 ang RF! assoc din with strep pyogenes
differentiate nephritic syndrome from nephrotic syndrome
both have impaired nephrons soo madaming na eexcrete.
for nephritic, inflammatory rupture of the glomerular capillaries so blood enters nephron (hematuria) tas may increase excretion of substances with nephritis
for nephrotic, increase excretion of substance without nephritis but with proteinuria
basic types of edema
Peritoneal cavity? Pleural cavity? Pericardial sac? Generalized edema? Lung spaces?
ascites - peritoneal cavity
hydrothorax/pleural effusion - pleural cavity
cardiac tamponade - pericardial sac
anasarca - generalized edema or head to toe
pulmonary edema - lung spaces
types of hemorrhage
petechiae - small size hemorrhage ( <3mm)
purpura - moderate size (3mm - 10mm)
ecchymoses - large (>10mm)
hematoma - tumor like regardless of size
types of anemia
- iron def anemia (assoc with plummer vinsons and tooth discoloration due to ferrous sulfate)
- aplastic anemia - inability of marrow cells to produce rbc
- megaloblastic anemia
- vit b9 (foliate def) or
-b12 anemia (pernicious -beefy tongue) - hemolytic anemia
-thalassemia (abnormal hemoglobin formation)
-sickle cell anemia (glutamic acid to valine)
-erythroblastosis fetalis
hx. heinz bodies
thalassemia
rx. crewcut or hair-on-end
hemoglobin H
glutamic acid is replaced by valine forming hemoglobin S causing short life span of rbc. xR?
sickle cell anemia
xr: crewcut or hair-on-end
dental xr: step ladder
most common leukemia
chronic lymphocytic leukemia (CLL)
least common leukemia
acute monocytic leukemia (AML)
most common leukemia in children with null proliferation
acute lymphocytic leukemia
null cells are large lymphocytes with decreased organelles
translocation of 22 to 9 chromosome (Philadelphia chromosome)
chronic myelogenous leukemia
Presence of Mallory bodies
Alcoholic cirrhosis or laennec’s cirrhosis
Presents as patchy, confluent, whitish pseudomembrane (3 names). Tx?
Thrush / oropharyngeal candidiasis/ oral moniliasis
-common with immunocompromised, smokers, long term Abx
Tx. Topical nystatin or oral ketoconazole/fluconazole
Disease of the coronary artery leading to heart complications and stages?
Coronary heart disease
Stages
1. Atherosclerosis
2. Ischemic heart disease
3. Angina pectoris
4. Myocardial infarction
Types of angina pectoris
- Unstable - chest pain without physical exertion
- Stable - chest pain during physical exertion
- Variant or prinzmetal’s angina - intermittent chest pain at rest
Cause of myocardial infarction
Thromboembolism
Features of heart attack:
1. Severe chest pain radiation to the left side of body
2. Numbness in the left side of body
Factors that contribute to thrombosis formation
Virchow’s Triad (virCHEows)
Changes in vascular flow (turbulence or stasis)
Hypercoagulability (gene mutation or drugs ex. Tranexamic acid, cox 2 inhibitor)
Endothelial injury
The heart cant pump enough blood? Cause and complications?
Congestive heart failure
Common cause: ischemic heart disease and valvular damage
Complication: congestion or fluid buildup in lungs
Left CHF cause and complications
most common cause: coronary artery disease (ischemic heart disease)
complications: low cardiac output, backflow of blood to lungs (two-pillow orthopnea, tachypnea, paroxysmal nocturnal dyspnea, pleural effusion, pulmonary edema)
may lead to R-CHF
right CHF cause and complications
common cause: L-CHF, or chronic lung disease (cor pulmonale)
complications: congestion of systemic circulation (jugular venous distention, pitting edema of lower limbs, hepatospenomegaly due to cardiac cirrhosis or ascites)
accumulation of fluid in pericardial space and triad
cardiac tamponade
*beck’s triad: Distended neck veins, distant muffled heart sounds, decreased arterial BP
Beck’s triad
seen in cardiac tamponade
*Distended neck veins, distant muffled heart sounds, decreased arterial BP
bacterial colonization of heart valves
bacterial/infective endocarditis
subacute (strep viridans)
acute (staph aureus)
high-risk to develop endocarditis
previous infective endocarditis
prosthetic valve replacement
valve repair with prosthetic material
unrepaired cyanotic congenital heart disease (CHD)
CHD repaired with prosthetic material
CHD with palliative shunt or conduit
moderate risk to develop endocarditis
rheumatic fever
non-rheumatic valve disease
congenital valve anomalies
most common congenital heart disease among the cyanotic type
tetralogy of fallot (PROV) (congenital heart disease)
Pulmonary stenosis
Right ventricular hypertrophy
overriding aorta over the ventricular septal defect
Ventricular septal defect
*pentalogy - atrial septal defect
most common congenital heart disease among the acyanotic type. (2 names)
ventricular septal defect or roger’s disease (congenital heart disease)
narrowing of descending aorta and effect to BP?
coarctation of the aorta (congenital heart disease)
*upper body hypertension
*lower body hypotension
failure of ductus arteriosus to close at birth
patent ductus arteriousus (Congenital heart disease)
*ductus arteriosus connects pulmonary artery and aorta to bypass pulmonary circulation
collapsed alveoli of lungs
atelectasis
collapsed bronchi (dilation of respiratory tract)
bronchiectasis usually due to cystic fibrosis (excessive mucus production)
most common chronic disease of the lungs (COPD)
emphysema - “pink puffers”
loss of elasticity of alveoli = increase in size of the air spaces
Clinical feature: barrel-chest appearance
inflammation of the bronchi (COPD)
chronic bronchitis “blue bloaters”
cause: inhalation of pollutants
1. smoking
2. pneumoconiosis
general term for lung diseases that is due to inhalation of dust leading to interstitial fibrosis of lung tissue. Types??
pneumoconiosis
1. silicosis “stone mason’s Disease” - most common and serious (silica); assoc with TB
2. asbestosis - inhalation of asbestos (assoc with bronchogenic carcinoma)
3. anthracosis “black lung or coal worker’s disease” - inhalation of carbon or coal dust
4. berylliosis - inhalation of beryllium
consequences of chronic bronchitis
- cor pulmonale (R-CHF due to COPD)
- bronchogenic carcinoma - bronchial epithelium to squamous
most common death-causing cancer in males? how about in females?
males - lung
females - breast
most common cancer in males? how about in females?
males - prostate
females - breast
types of seizure
partial seizure - one hemisphere
generalize seizure - both hemispheres
subtypes:
1. absence seizures = petit mal = short period of blanking out
2. myoclonic - brief, shock-like jerks of a single or group of muscles (hiccups hypnic jerk)
3. atonic = drop seizure - muscles suddently become limp for typically 15 seconds
4. tonic-clonic seizures = grand mal = absence of consciousness, stiffed muscles then starts to jerk; difficulty breathing; 1-3mins (more than = danger)
*status epilepticus
repeated grand mal? tx?
status epilepticus
tx: diazepam (valium) same as grand mal
condition with deficiency in nicotinic receptor
myasthenia gravis
Autoimmune disease that affects glomerular basement membrane and alveolar membrane
Good pasture syndrome / anti-glomerular basement membrane
Sudden attack of severe shortness of breath during the night associated with left CHF
Paroxysmal nocturnal dyspnea
Oral manifestations of Addison’s disease
Oral lesions on the buccal mucosa, sometimes labial mucosa, rarely gingiva
most common facial malformation
cleft lip
Iris lesion that is drug induced
Erythema multiforme
Most common inherited disorder of the reticuloendothelial system caused by a deficiency of beta-glucocerebrosidase
Gaucher’s disease (classified as Lipid storage diseases)
Caused by a deficiency of spuingomyelinase
Niemann-pick disease (classified as Lipid storage diseases/ inherited disorder of reticuloendothelial system)
Caused by a deficiency of hexosaminidase A
Tay-Sachs disease (classified as Lipid storage diseases/ inherited disorder of reticuloendothelial system)
Caused by a deficiency in alpha-galactosidase
Fabry’s disease (classified as Lipid storage diseases/ inherited disorder of reticuloendothelial system)
other name for cleidocranial dysplasia
Marie-sainton disease
Most common inherited nephropathy
Adult polycystic kidney disease -large multicystic kidneys, liver cyst, berry aneurysm, autosomal dominant
Classic presentation of acute poststreptococcal glomerulonephritis
Nephritic syndrome (with hematuria)
Causes of portal hypertension
Prehepatic cause - obstructive thrombosis
Posthepatic - severe right sided heart failure
Intrahepatic - cirrhosis
📌Splenomegaly indicates portal hypertension
Four major consequences of portal hypertension
Ascites, formation of portosystemic venous shunts, congestive splenomegaly, hepatic encephalopathy
Other name for spider angiomas
Spider telangiectasis - small lesion on skin containing centrally dilated, enlarged blood vessels from which several smaller vessels radiate
Characteristic pathologic change in chronic bronchitis
Hyperplasia of bronchia submucosal glands and bronchial smooth muscle hypertrophy
what is the fenton reaction and where does it happen?
reaction in which hydrogen peroxide is converted into a hydroxyl free radical via a catalytic process. mitochondria
superoxide –> hydrogen peroxide + Fe2+ –> hydroxyl radical
differentiate the three nuclear changes
karyolysis (basophilia of chromatin)
pyknosis (nuclear shrinkage in increased basophilia)
karyorrhexis (fragmentation of the pyknotic nucleus)
complement responsible for chemotaxis
c5a
for activating white blood cells: c3a c4a c5a
the repair process: inflammation, proliferation, maturation
inflammation: clot formation, chemotaxis
proliferation: reepithelialization, neovascularization (angiogenesis - from pre-existing vessels regulated by vascular edothelial growth factor aka VEGF), presence of fibroblast
maturation: collage deposition by the fibroblast, wound contraction
acute edema of cutaneous or mucosal structure, most commonly involving the lips and eyelids
angioedema
what type of edema is seen in right sided heart failure px? left sided?
Right sided - peripheral
left sided - pulmonary
differentiate kwashiorkor and marasmus
Kwashiorkor - protein def, edema, fatty liver, enlarged abdomen
marasmus - macronutrients def (carbs, protein, fat), no edema, usually seen in 1y/o, thin limbs, abdomen/overall.
differentiate the 3 herniation in the brain
- subfalcine - brain tissue slips under the FALX CEREBRI
- transtentorial - tentorium cerebelli (roof of posterior cranial fossa)
- tonsillar - foramen magnum (worst prognosis)
what is a nutmeg liver?
hepatic congestion - hepatic vein is DILATED
transudate vs exudate
transudate - noninflammatory, low protein content, low lactate dehydrogenase (LDH)
exudate - inflammatory - high protein, high LDH
deep vein thrombosis can lead to what type of embolism?
pulmonary embolism
thrombus that adheres to one wall of a heart chamber or major artery
mural thrombus
*arterial emboli usually arises from mural thrombus
site of arrest for wedge-shaped pale infarcts
renal artery
observed in deep sea divers who return to the surrface too rapidly (2 names)
caisson disease / decompression sickness
- nitrogen
Consists of ptosis, miosis, and anhidrosis due to infiltrate of Pancoast tumor into the paravertebral sympathetic chain and stellate ganglion
Horner syndrome
*pancoast tumor is a superior sulcus tumor type of lung cancer
Originate from totipotential cells which contains recognizable mature or immature cells representative of more than one germ cell layer
Teratoma
*Carcinoma - malignant tumor of epithelial origin
*Adenocarcinoma - glandular epithelium
*Sarcoma - mesenchymal of origin
Benign tumor from the smooth muscles? Striated muscles?
Leiomyoma (malignant: leiomyosarcoma)
Striated: rhabdomyoma (rhabdomyosarcoma)
Tumors of mesenchymal origin
Fibroma
Lipoma
Chondroma
Osteoma
Small benign mass of normal tissue misplaced within another organ
Choristoma (ex. Liver cells within the walls of intestines)
Benign tumor-like overgrowth of cell types that are regularly found within the affected organ
Hamartoma
(Ex. Hemangioma - irregular accumulation of blood vessels)
Sickle cell anemia: globin portion - amino acid valine is substituted by??
Glutamic acid
Thickening of the costochondral junction or beadlike prominence? A clinical manifestation of?
Rachitic rosary due to deficiency in Calcium- seen in rickets
Signs that may be associated with appendicitis
Rovsing sign - (+) palpation of LLQ referred pain to RLQ
Psoas sign -retrocecal appendicitis, pain with extension of right thigh while px lying on left side
Obturatior sign - pelvic appendicitis, pelvic pain upon internal rotation of the right thigh
Dunphy sign - pain on any abdominal wall movement ex. Cough
Presents with Liontiasis ossea
Pagets disease
-lion face / hats and denture become too tight
Hx: Tzanck cells, intraepithelial vesicle
Pemphigus vulgaris
bullous pemphigoid vs mucous membrane pemphigoid
MMP and BP - IgG against basement membrane
MMP - oral and ocular mucous membrane
BP - skin and mucous membrane
Behcet’s syndrome affects?
multisystem: GI, CV, ocular, CNS, articular, pulmonary, dermal
Ocular: uveitis, conjunctivitis, retinitis
Oral and genital: ulcers
*blood vessel inflammation throughout the body
Triad of reiter’s syndrome (other name)
aka Reactive Arthritis
urethritis, conjunctivitis, arthritis
oral: aphthous-like ulcers
-reaction to bacterial infection
resembles geographic tongue
what is Wegener’s granulomatosis?
idiopathic condition in which destructive inflammatory lesions featuring necrotizing vasculitis are seen in lung, kidney and URT
oral: strawberry gingivitis
erythema multiforme vs Steven Johnson syndrome
both are hypersentivity reaction to HSV, TB, or histoplasmosis; barbiturates, sulfonamides, antiseizures
Minor form: EM
major form: SJS
*target / iris / bull’s eye lesion
Oral lesions described to have a cobblestone appearance (2)
follicular keratosis / Darier-White disease (white lesion) - hereditary, gingiva and hard palate
papillary hyperplasia (non-epithelial white lesion) - candidiasis due to ill fitting dentures, palate
hereditary: opalescence of the buccal mucosa disappears when the it is stretched
Leukoedema
White sponge nevus / Cannon’s disease - tongue and vestibular mucosa, do not disappear
Hereditary benign intraepithelial dyskeratosis (HBID) - dorsum of tongue is spared, witkop’s disease, assoc conjunctivitis
common site of hairy leukoplakia
lateral margins of tongue
*assoc with EBV, px w/ HIV AIDS
geographic tongue is aka as? it is the loss of?
benign migratory glossitis
erythema migrans
loss of filiform papilla = atrophic areas / erythematous
white reactive lesion in the oral cavity that is caused by smokeless tobacco? usually seen in what area of the oral cavity?
snuff dipper lesion - buccal mucosa
reactive lesion due to tobacco which presents as red dots surrounded by white keratotic rings
nicotine stomatitis
If caused by reverse smoking, more associated with premalignancy
reactive white lesion due to chronic irritation from eating or chewing without teeth
focal (frictional) hyperkeratosis
reactive white/black lesion on the dorsum of the tongue, asymptomatic, and overgrowth of filiform papilla
hairy/coated tongue - often due to cigarette smoking; lesion can be stained to gray-black etc.
- not to be confused with hairy leukoplakia (affects lateral of tongue, assoc with EBV, HIV)
-nor geographic tongue - LOSS of filiform papilla
tx: brushing tongue, none
most common site of occurrence of idiopathic leukoplakia? highest risk for malignant transformation
buccal vestible - most common
floor of the mouth - highest risk
white patch or plaque of oral mucosa that cannot be rubbed off and cannot be characterized clinically as any other disease
idiopathic leukoplakia
Diagnose by biopsy
Hx: hyperkeratosis – dysplasia – CA in situ – SCCA
preneoplastic speckled white and red lesion
erythroleukoplakia
different from erythroplakia - which is a neoplastic lesion (severe dysplasia), SSCA
preneoplastic lesion that represents accelerated tissue degeneration of the vermillion secondary to chronic exposure to sunlight
Actinic cheilitis / solar cheilitis
- loss of vermillion border with leukoplakic and atrophic areas
white, interlacing lines on the buccal mucosa are a characteristic clinical feature of?
wickham striae yun so –> Lichen planus
chronic mucocutaneous disease of unknown cause but resembles a hypersensitivity reaction (T lymphocytes)? enumerate types.
Lichen planus
1. reticular - wickham’s, buccal, most common
2. plaque - resembles leukoplakia, tongue, buccal
3. erythematous / atrophic - attached gingiva == burning sensation, pain
4. erosive - ulcer + pseudomembrane
5. buttons / bullous - ulcer, buccal
H: saw tooth appearance of rete pegs
types of candidiasis
1. acute pseudomembranous - curdlike patches that can be wiped away –> painful, erythematous surface
2. acute erythematous - atrophic, antibiotic stomatitis / glossitis (beefy tongue)
3. chronic erythematous
3.1. denture sore mouth or
3.2. angular cheilitis (s. aureus, vit B def., loss of VD)
4. chronic hyperplastic
4.1. candidal leukoplakia
4.2. median rhomboid glossitis (kissing lesion) - occurs on dorsum of the tongue anterior to circumvallate papillae and on adjacent hard palate
4.3. papillary hyperplasia - due to poor denture hygiene, cobble stone
5. chronic mucocutaneous - resistant to treatment, with only temporary remission, can involve the nails
hemangioma vs vascular malformation
both are congenital
CVM:
with mix of arteries, veins and capillaries
produce thrill, bruit
does not involute,
recurrence is common and difficult to resect,
poorly circumbscribed
usually affects bone
Tx: surgery, arterial embolizaiton, sclerosant therapy, laser therapy (Hemangioma: none)
associated with Sturge weber syndrome while hemangioma is associated with Rendu-osler-weber syndrome
abnormal dilation of capillaries resulting in red macules or papules and frequent epistaxis
Rendu-Osler-Weber syndrome
Hereditary Hemorrhagic Telangiectasia
*telangiectasia = spidery in appearance
reactive red lesion composed predominantly of hyperplastic granulation tissue which capillaries are very prominent
Pyogenic granuloma - common in gingiva, frequent trauma, hormonal changes, calcular deposits
differentiate pyogenic granuloma from peripheral giant cell granuloma
both are reactive red-blue hyperplasias but histologic apperance are different.
Pyogenic - granulation and capillaries only
PGCG - presence of multinucleated giant cells
red blue neoplastic lesion
erythroplakia, kaposi sarcoma
Oral wart aka? etiology?
squamous papilloma
E: HPV 2, 6, 11, 57 (2 and 4)
*dysplastic oral warts = HPV 16 and 18 (cervical cancer and hot wart related, HIV positive)
anogenital wart
Condyloma cuminatum
HPV 6 and 11
focal epithelial hyperplasia
Heck’s disease
HPV 13 and 32
*similar color with surrounding tissue
traumatic fibroma of gingival variation and its subtypes
peripheral fibroma
subtypes:
1. peripheral ossifying fibroma - with islands of bones
2. peripheral odontogenic fibroma - with odontogenic epithelium (sometimes resembles enamel, dentin)
3. giant cell fibroma - mesenchymal cells are larger (different from peripheral/central giant cell granuloma)
etiologic factor for focal fibrous hyperplasia
aka irritation fibroma / denture hyperplasia / epulis fissuratum
chronic trauma - overextended dentures etc
**General gingival hyperplasia etiologic factors: local factors (plaque, calculus, bacteria), hormonal imbalance, drugs (nifedipine, phenytoin, cyclosporine), leukemia, genetic factors
which of the ff is atroublesome fibroblastic neoplasm that is locally aggressive and infiltrative?
a. peripheral fibroma
b. traumatic neuroma
c. nodular fasciitis
d. fibromatosis
D. fibromatosis
connective tissue neoplasm: submucosal mass, rapid growth (2 names)
nodular fasciitis / pseudosarcomatous fasciitis -often misdiagnosed as sarcoma,
DDx: fibromatosis (much larger and more infiltrative, beta-catenin), benign fibrous histiocytoma (usually in dermis), fibrosarcoma (Hx: herringbone or interlacing/intersecting fascicular pattern)
lymphangioma found on the neck
cystic hygroma / hygroma coli / cavernous lymphangioma - fluid filled mass on the neck
lymphangiomas - congenital, macroglossia, cystic hygroma
nerve tumor of the nerve sheath
schwannoma / neurilemmoma
- from schwann cells (myeline sheath for PNS)
**share many clinical and histo features with solitary neurofibroma
Etiology and presentation of traumatic neuroma
E: injury to peripheral nerve (mental foramen, anterior maxilla, posterior mandible)
Hx: bundles of nerves + collagen
pain
uncommon benign soft tissue lesion that usually arises from the alveolar mucosa of neonates usually found in the maxillary gingiva
congenital epulis / congenital gingival granular cell tumor
–Lesion is composed of cells that are identical to granular cell tumor / granular cell myoblastoma
differentiate mucocele, ranula and necrotizing sialometaplasia
mucous retention and extravasation (pseudocyst)
mucocele - minor salivary glands
ranula - sublingual glands, can be simple or plunging (extends to submandibular space)
necrotizing sialometaplasia - minor salivary gland of palate
most common benign salivary gland tumor that shows 2 cell type in histologic sections and affects, histologic appearance?
pleomorphic adenoma (benign neoplasm)
- parotid, palate
H: 2 cell types: ductal epithelial cell, myoepithelial cell
benign salivary gland tumor that almost exclusively affects the parotid gland especially the tail, and histologic appearance?
Warthin’s tumor aka papillary cystadenoma lymphomatosum
-parotid gland
H: epithelial and lymphoid
types of monomorphic adenoma
canalicular adenoma: upper lip minor salivary gland
basal cell adenoma: parotid gland
most common malignant salivary gland tumor that shows 3 cell type in histologic sections
Mucoepidermoid carcinoma
-parotid, palate
3 cell types: mucous, epidermoid, clear
*more epidermoid cells, more aggressive
low-grade malignancy of minor salivary glands found at the junction of hard and soft palate
polymorphous low-grade adenocarcinoma
malignant salivary gland tumor that has a poor prognosis and shows swiss cheese pattern in histologic sections
adenoid cystic carcinoma
-parotid and palate
H: swiss cheese or cribriform pattern
differentiate the odontogenic cysts (from odontogenic epithelium)
primordial cyst - not associated with impacted tooth
dentigerous cyst / follicular cyst (REE) - encloses the crown of unerupted tooth / impacted tooth
periapical cyst / radicular cyst (malassez) - pre-existing PA granuloma, non-vital, Russell bodies, rushton bodies
Residual cyst - incomplete removal of PA cyst
lateral periodontal cyst - no displacement of teeth, Md premolar and cuspid region same with gingival cyst (but no xr findings) *botyroid odontogenic cyst
multilocular lateral periodontal cyst
botyroid odontogenic cyst (grape bunch)
types of gingival cyst of the newborn
Dental lamina cysts of the newborn, Bohn’s nodules - alveolar ridge
palatine cysts of the new born (epstein pearls) - seen in palate
appear as swelling prior to eruption; fluid accumulation within the follicular space
eruption cyst
no tx
ghost cell keratinization, dystrophic mineralization (radiopacities), lucent to mixed xr
calcifying odontogenic cyst (fluid filled) / calcifying cystic odontogenic tumor (solid)
-dual nature
aggressive odontogenic cyst with recurrence and resembles low-grade mucoepidermoid carcinoma
glandular odontogenic cyst
parakeratinized epithelium showing palisading of basal cells
odontogenic keratocysts (OKC)
-aggressive, significant reucrrence rate, tooth can be displaced
multiple odontogenic keratocysts are associated with?
basal cell nevus-bifid rib syndrome / gorlin goltz / nevoid basal cell carcinoma
high recurrence of OKC may be associated to satellite cysts
non-odontogenic cyst that reveal inverted pear-shaped radiolucency between roots of maxillary and lateral and canine, assoc with vital teeth
globulomaxillary cyst
non odontogenic cyst found associated with vital maxillar central incisors
nasopalatine canal cyst / incisive canal cyst, cysts of the palatine papilla, median palatine cyst
Hx: 2 or more types of lining cells (resp epithelium and strat squamous)
soft tissue cyst of the upper lip or over the canine region or the mucobuccal fold
nasolabial cyst (non odontogenic cyst)
no XR manifestation
histologic appearance of aneurysmal bone cyst
(pseudocyst)
Hx: blood-filled spaces lined by CT and multinucleated giant cells
*no thrill or bruit
pseudocyst that presents as empty dead space and is commonly associated with florid cemento-osseous dysplasia
traumatic (simple) bone cyst
(pseudocyst)
developmental defect on the posterior lingual mandible which is seen as radiolucency below the mandibular canal (2 names)
static bone cyst (Stafne’s bone defect)
(pseudocyst)
asymptomatic radiolucencies commonly associated with highly hematopoietic bones
Hx: hematopoietic cells
Focal osteoporotic bone marrow defect (pseudocyst)
developmental cyst - epithelium entrapped in lymph node; lateral neck mass (usually anterior to SCM)? where is the intraoral counterpart?
branchial cyst / cervical lymphoepithelial cyst (soft tissue cysts of the neck)
intraoral: floor of the mouth
soft tissue cyst which can be found in any area of the body that histologically contains hair follicles, sebaceous glands, sweat glands, or possibly teeth.
dermoid cyst (teratoma? Choristoms)
above mylohyoid: Floor of the mouth
below mylohyoid: neck
(soft tissue cysts of the neck)
most common developmental cyst of neck
thyroglossal tract cyst
*failure to descend of thyroid: lingual thyroid
most common type of ameloblastoma
solid (multicystic or polycystic)
(odontogenic tumors)
most aggressive odontogenic tumor
ameloblastoma
Epithelial odontogenic tumor and subtypes??
XR: soap bubble or multi-locular
Hx: similar to ameloblasts (palisading layer of epithelial cells)
adults with a mean age of 40
ameloblastoma
1. solid/multicystic
2. unicystic - can be fluid filled
3. peripheral (extraosseous) - gingiva and buccal mucosa
malignant variants are usually rare:
malignant ameloblastoma and ameloblastomic CA
Tx: simple excision, resection
most common location for a pindborg tumor is?
molar-ramus area
odontogenic tumor
Hx: Liesegang rings, calcified amyloid
XR: honeycombed, impacted teeth, uni/multilocular, calcified islands
Calcifying epithelial odontogenic tumor (CEOT) or Pindborg tumor
*when there are few or none calcified island, can be a clear cell variant
odontogenic tumor
R: lucent-opaque patterns
Hx: ductlike / glandlike structures, rosettes
adenomatoid odontogenic tumor
anterior maxilla
20s females
odontogenic tumor
Hx: squamous islands
XR: semilunar lesion associated with the cervical regions of roots of teeth
Squamous odontogenic tumor
alveolar process, anterior maxilla, posterior mandible
similar to ameloblastoma histologically but lacks columnar palisading layer of epithelial cells
locally aggressive odontogenic tumor with no cytoplasm
clear cell odontogenic tumor
mesenchymal tumor from follicular connective tissue resembling pulp tissue
XR: honeycombed
HX: dental pulp/follicle
odontogenic myxoma / fibromyxoma
aggressive and infiltrative
*myxoma = filled with collagen
mesenchymal tumor of unknown origin
XR: multilocular radiolucency with cortical expansion
central odontogenic fibroma
Mesenchymal tumor
XR: opaque with radiolucent rings
Teeth are vital
Hx: cementum, cementoblasts, cementoclasts
cementoblastoma / true cementoma
mesenchymal tumor associated with the apex of vital asymptomatic mandibular anterior teeth
XR: 3 stages: radiolucent, mixed, radiopaque
Hx: fibrous CT + bone + cementum
Periapical cemental (cemento-osseous) dysplasia
predilection for middle-aged black women
exuberant form of Periapical cemental dysplasia
associated with hypercementosis
XR: ground glass
florid cemento-osseous dysplasia (FCOD)
vital teeth
bilateral, associated with traumatic bone cyst
most common odontogenic tumor
common in children and its subtypes?
Odontoma (mixed tumors)
1. compound - multiple miniature teeth, anterior maxilla
2. complex - conglomerate mass, posterior jaws
Tx. removal (bec hinders eruption)
ameloblastic fibroma vs fibro-odontoma
molar-ramus
younger patients
fibroma: radiolucent (resembles pulp)
FO: opaque focus with dental tissue
benign nonodontogenic tumor
XR: mixed, well-defined margins
Hx: fibrous CT + bone (osteoblast only)
presents cortical expansion
young adult
mandible
Ossifying fibroma
osteoblastoma vs osteoid osteoma
both common in 2nd decade, males
severe pain
Hx: osteiod + various degrees of calcification
XR: well defined, mixed
OB: bigger >1.5cm
OO: <1.5cm
benign nonodontogenic tumor which is asymptomatic, slow growing, bony hard masses
Hx: mature compact or cancellous bone
associated with Gardner’s syndrome
Osteoma
central giant cell granuloma presents radiographically as
XR: multi/unilocular radiolucency often presenting a scalloped border
Hx: fibroblasts + M giant cells
anterior mandible
intraosseous vascular malformation common in the posterior mandible
-associated root resorption
XR: multilocular radiolucency, soap bubble / honeycomb
hemangiomas of bone
XR: floating teeth
HX: Birbeck granules
Langerhans cell disease
(Histiocytosis X)
Birbeck: rod-shaped Langerhan cells
- eosinophilic granuloma
- hand-schuller-christian
- letterer-siwe
Least severe type of Histiocytosis X (Langerhans cell disease)
Eosinophilic granuloma
other types:
2. Hand-Schuller-Christian - chronic disseminated, bone lesions, exophthalmos, diabetes insipidus
3. Letterer-Siwe - acute disseminated, bone + skin + internal organs
different inflammatory jaw lesions
- acute osteomyelitis
- chronic osteomyelitis
- chronic osteomyelitis with proliferative periostitis / Garre’s osteomyelitis - onion skin (mottled + periosteal reaction)
- Diffuse sclerosing osteomyelitis - chronic perio disease
- Focal sclerosing osteitis - chronic pulpitis
OSTEOMYELITIS = INFECTION = PAIN
chondrosarcoma
Hx
XR?
XR: moth-eaten, mottled densities
Hx: chondroid, myxoid
XR: moth-eaten, cortical expansion
Hx: round-cell cytologic morphology
Ewing’s sarcoma
conditions that can lead to supernumerary teeth
cleidocranial dysplasia
gardner’s syndrome
Trisomy 21
conditions that can lead to delayed eruption
cleidocranial dysostosis
hypothyroidism
down syndrome
conditions that can lead to early eruption
osteogenesis imperfecta
hyperparathyroidism
hypophosphatemia
hyperthyroidism
types of osteogenesis imperfecta
Type I: most common, mildest
Type II: most severe (perinatal)
Type III: most severe beyond perinatal
Type IV: mild to moderate bone fragility
slow progressive bone disease in which fibrovascular tissue proliferates and may completely replace the involved bone (4 names)
Phantom bone disease / massive osteolysis / Gorham’s disease / vanishing bone disease
XR: radiolucencies –> enlarge –> coalesce
cortical thickening of bones (mandible)
average age of onset: 9 weeks
acerage duration: 9 months
Infantile cortical hyperostosis / Caffey’s disease / battered baby syndrome
XR: soap bubble
upwardly gazing eyes
bilateral
painless
symmetric enlargement
Cherubism
5 years old, male
hypotrichosis, anhidrosis, anodontia / oligodontia, cone shaped teeth
Ectodermal dysplasia
sparse hair
absence of sweat glands
midface hypoplasia, high arched palate, bird-like
Treacher-collins / mandibulofacial dysostosis
severe hypoplasia of maxilla and mandible
mandibular hypoplasia leading to glossoptosis (tongue falls back to the back of throat), foreshortening geniohyoid
Pierre-robin syndrome
micrognathia, mandibular hypoplasia
Cranial deformity, exophthalmos, and midface hypoplasia
Crouzon’s syndrome
craniofacial dysostosis
froglike
Prognathism
oral findings in Ehlers-danlos
pulp stones
dilacerated roots
dentin abnormalities, enamel hypoplasia
extensible tongue
oral findings in Marfan’s syndrome
narrow, high arched palate, dental crowding, dolicocephalic
oral findings in down syndrome (trisomy 21, upward slanting palpebral fissures)
cleft lip and palate
taurodontism
periodontal disease
decreased palatal width and length
delayed eruption
hypodontia
macroglossia
microdontia
bifid uvula
fissured tongue
cleft occurs in ___ of embryonic life
cleft lip: 6th-7th week
cleft palate: 8th week
oral findings for Fragile X syndrome
prominent palatine ridge
dental crossbites
increased attrition
large ears, macroorchidism, mental retardation
russel bodies / rushton bodies
periapical cyst
also seen in dentigerous cyst
Purple lesion
Kaposi’s sarcoma
Type of rheumatic arthritis that occurs in young people
Still’s disease
Cardinal feature of osteoarthritis
Osteophyte (bony spur) formation
**Boucher’s nodes, heberden nodes
Neurofibromatosis type 2
Bilateral eighth nerve schwannomas
Multile menongiomas
Honey colored crust, superficial skin infection common in children; infection caused by group A strep or staph aureus
Impetigo
Hyperthyroidism due to a long standing simple goiter
Plummer’s disease (toxic nodular goiter)
-protruding eyes does not occur. Sa grave’s disease lang yun
Hutchinson’s triad
interstitial keratitis, malformed teeth ( Hutchinson incisors,andmulberry molars ), and eighth nerve deafness
Rootless teeth with completely obliterated pulp
Type I (radicular) dentin dysplasia
Tx: CD
deciduous teeth with opalescent color with completely obliterated pulp
type II (Coronal) dentin dysplasia
permanent: thistle tube
teratoma vs hamartoma vs choristoma
teratoma - composed of cells originating from three germ layers
hamartoma - abnormal cells, normal location (ex. odontoma)
choristoma - normal cells, abnormal location (ex. fordyce spots)
hallmarks of anaplasia
pleomorphism, hyperchromatism, abnormal mitosis, loss of polarity
hindi kasama ang dysplasia/metaplasia
PP mi hyper 😂
carcinoma in situ vs invasive carcinoma
carcinoma means it involves the epithelium
in situ – full thickness of epith
invasive - full thickness of epith AND penetrates the basement membrane
characteristics of malignant (-sarcoma, -carcinoma)
less diff, no differentiation (anaplasia)
rapid growth
poorly circumscribe
metastasis
immovable
BIGFEUD (bleeds easily, indurated, grows rapidly, fixated, erythroplasia, ulcerated, duration of >2weeks)
TNM clinical staging stands for
tumor size
node involvement
metastasis
*STUDY
most common epithelial odontogenic tumor
ameloblastoma
-most aggressive but benign
biological subtypes of ameloblastoma
peripheral/extraosseous
cystic/unicystic
solid/multicystic (most common)
malignant ameloblastoma (rare)
ameloblastic carcinoma
Soap bubble/honeycomb radiographic presentation
Cherubism
Ameloblastoma
myxoma
aneurysmal bone cyst
CAMA
microscopic/histopath of ameloblastoma
palisading of columnar cells (ameloblasts-like in enamel organ)
aspirate: straw-colored or pale yellow
always radiolucent with well-defined sclerotic border
histologic patterns of ameloblastoma? whats the most common?
follicular/simple - most commmon - islands that mimic the dental follicle with stelate inside and palisading of columnar cells at the periphery
plexiform - interconnected strands/cords
granular - granular cells/ cuboidal to rounded
basaloid/basal cell - resembles basal cell carcinoma / FARMER’S carcinoma
desmoplastic - thin strands/fibrous tissue scattered all over the stroma
acanthomathous - many islands, squamous metaplasia, keratin plearls
tx for ameloblastoma
GOAL IS COMPLETE REMOVAL
excision
partial resection
marsupialization/ partch technique / decompression –> excision
Absence of more than six permanent teeth is called?
Oligodontia
Hypodontia is absence of 1-5 teeth NOT including molars
driven snow appearance radiographically
Cacifying epithelial odontogenic tumor / PIndborg tumor
adenomatoid odontogenic tumor usual location?
maxilla anterior region
associated with maxillary canine
histopath: rosettes and ductlike structures
differential: Dentigerous cyst
most common mesenchymal odotogenic tumor
odontogenic myxoma - mimics dental pulp microscopically
loose gelatinous consistency
Soap bubble / honeycomb
AMO
Ameloblastoma (Apethelial)
Myxoma (mesenchymal)
Odontoma (others)
DDx and Tx of cementoblastoma
aka true cementoma (PCOD ang cementoma lang)
surgical excision with removal of associated tooth
DDx: condensing osteitis (but nonvital, no radiolucent ring), osteoblastoma (mixed opaque lesion and not continuous)
has predilection to black african american women
Periapical cemento-osseous dysplasia
Tx for PCOD
none
most common odontogenic tumor
odontoma
AMO
Ameloblastoma (Apethelial)
Myxoma (mesenchymal)
Odontoma (others)
usual location of compound odontoma? of complex odontoma?
Maxilla
compound odontoma - anterior region (tooth like)
complex odontoma - posterior region (amorphous conglomeration)
lesions with microscopic:
fibroblast
multinucleated giant cells
well-vascularized stroma
PGCG
CGCG
cherubism too pero may perivascular collagen cuffing
most common tumor of childhood
congenital hemangioma
most common cyst of the jaw
periapical cyst (radicular, apical periodontal)
most common odontogenic cyst
periapical cyst
most common fibro-osseous dysplasia
cemento-osseous dysplasia
what lesion mimics the tooth?
compound odontoma
Ossifying fibroma vs fibrous dysplasia
Mandible (OF) - Maxilla (FD)
abnormal bone (OF) - abnormal fibrous (FD)
cellular histopath (OF) - vascular histopath (FD)
well-defined rx (OF) - poorly defined (FD) “foorly”
surgical exision (OF) - none/surgical recontouring (FD)
Tx for ossifying fibroma
surgical excision
pathologies with multinucleated giant cell
HAC PC
hyperparathyroidism
aneurysmal bone cyst
cherubism
PGCG
CGCG
cotton wool appearance
osteoma, pagets disease
where can you see central giant cell granuloma
most of the time: jaws!
mandible: anterior to the molars or between 1st molar and incisors
radiographic presentation of CGCG? DDx based on radio?
radiolucent with scalloped border (cloud-like)
scalloping between the roots: traumatic bone cyst
needle used during aspiration biopsy
gauge 16 or 18
creamy white/cheese colored aspiration is associated with?
OKC
air aspiration is associated with?
traumatic bone cyst or you are in a sinus
used for punch biopsy to get the full thickness
trephine punch
storage of specimen
10% buffered formalin
used 20x volume of specimen and can be stored up to 7 days
Tx and DDx of PGCG
surgical excision up to the periosteum and PDL, remove source of irritation
DDx: pyogenic granuloma
Radio for peripheral giant cell granuloma
may or may not be seen
in the edentulous ridge, superficial cup-shaped radiolucency
lesions seen in the maxilla
Max, FAC OP
Fibrous dysplasia
Adenomatoid odontogenic tumor (AOT)
Calcifying odontogenic cyst
Odontoma
Periapical cyst
histopath of pyogenic granuloma
hyperplastic granulation tissue with many capillaries
Tx for cherubism
none - self limiting
other self-limiting:
PCOD, congenital hemangioma, bohn’s nodules
lesion found anterior to 1st molar initiated by trauma/irritation exclusively in the gingiva
PGCG - often sa mandible. common in females same with PCOD (black african american women)!
Tx for congenital vascular malformation
surgery
arterial embolization (block blood flow), sclerosant therapy (thickens –> blocks –> shrinks), laser therapy
histologically similar to congenital hemangioma
pyogenic granuloma - maraming capillaries din
how will you determine if it is periapical granuloma or periapical cyst?
biopsy/microscopic exam
similar sila in radio etc.
epithelial lining of periapical/radicular cyst?
nonkeratinized stratified squamous epithelium
same with lateral periodontal cyst
source of epithelial lining of periapical/radicular cyst
rest of malassez
*tx for cyst is enucleation EXCEPT for periapical cyst.. exo, rct, apicoectomy
usual location of lateral periodontal cyst
between the roots of mandibular premolar and canine
radiographic: round or teardrop-shaped radiolucency
source of epithelial lining of lateral periodontal cyst
rest of serres
Tx: enucleation
when does Bohn’s nodule involute or rupture?
before 3 months old
palatine cyst of the newborn (epstein pearls) is included in the fusion of?
palatal shelves and nasal process
epstein pearls are found in the midline of the palate
lesions with mixed radiolucency
OFC CAP
ossifying fibroma
fibrous dysplasia
CEOT
COC
AOT
PCOD
Dentigerous cyst vs Adenomatoid odontogenic tumor radiographically
Dentigerous cyst attached to the CEJ
AOT - may be attached until the apex, not always radiolucent
Second most common odontogenic cyst
Dentigerous cyst /follicular cyst
Most common developmental cyst
Dentigerous cyst/ follicular cyst
Source of epithelial lining of dentigerous cyst
Reduced enamel epithelium (REE)
Soft tissue variant of dentigerous cyst
Eruption cyst - common in primary teeth
Source of lining of OKC
Rest of serres
OKC is aggressive with High recurrence!!
Classification of OKC
Solitary - one OKC - more common
Multiple -associated with Gorlin-Goltz; seen more in children
Tx for Odontogenic keratocyst (OKC) or keratocystic odontogenic tumor (KCOT)
Enucleation with curettage, marsupialization
Since aggressive and high recurrence rate
Salt and pepper pattern in radio
Calcifying odontogenic cyst / calcifying cystic odontogenic tumor
Salt and pepper - equal in size, equal distribution, equal distance
Ghost cell keratinization histopath
Calcifying odontogenic cyst - absence of organelle; cytoplasm and cell membrane lang siya which undergoes keratinization
Tx of fibrous dysplasia
None if small
Surgical recontouring if big
Syndrome associated with odontogenic keratocyst / keratcystic odontogenic tumor
Nevoid Basal Cell carcinoma syndrome / basal cell nevus / gorlin-Goltz / bifid rib
Nevoid Basal Cell carcinoma syndrome / basal cell nevus / gorlin-Goltz / bifid rib clinical presentation
Multiple OKC/KCOT
basal cell carcinoma (aka Farmer’s carcinoma -at the canthus of eye, side of nose)
palmar and plantar keratotic pitting
bifid ribs
Calcified falx cerebri (normally radiolucent ang falx but in gorlin goltz, it calcified)
Fissural cysts between the roots of maxillary lateral incisor and canine associated with vital tooth (divergence of the roots)
Fissural = non-odontogenic
globulomaxillary cyst
radiographic: inverted pear-shaped radiolucency
DDx: lateral periodontal cyst - but between the roots of mandibular premolar and canine
soft tissue cyst with swelling at the canine region or its mucobuccal fold
nasolabial cyst / nasoalveolar cyst = no bone involvement!
extraorally: swelling/elavation at the nasolabial fold, can affect ala and floor of nose
Tx of nasolabial cyst
enucleation using sublabial incision (half-moon shape)
epithelial lining of nasolabial cyst
non-keratinized stratified squamous (if within intraoral/canine lang)
pseudostat ciliated columnar epithelium (if abot sa ala and floor of nose)
most common non-odontogenic cyst
nasopalatine duct cyst / incisive canal / median anterior maxillary
-symmetric swelling between maxillary central incisors (vital)
radio: bilateral ovoid or heart-shaped radiolucency
true fissural cyst
nasopalatine duct cyst / incisive canal / median anterior maxillary
more posterior presentation of nasopalatine duct cyst
median palatine cyst
presensation of nasopalatine duct cyst at the point of opening of the incisive canal
cyst of the palatine papilla
oral patho with female predilection
PCOD
PGCG
focal osteoporotic bone marrow defect (hematopoietic bone marrow defect)
pyogenic granuloma
PEMALE
“blood soaked sponge”
aneurysmal bone cyst (pseudocyst)
rx: radiolucent, soap bubble (CAMA)
micro: fibroblast, multinucleated giant cells (HAC PC), blood filled spaces
Tx of aneurysmal bone cyst
excision NOT enucleation.. it’s a pseudocyst so no lining
radiolucent, scalloping beneath the roots
traumatic bone cyst, simple bone, idiopatic bone, hemorrhagic bone
**not proper wound healing after trauma –> early lysis –> dead space –> tx: intiate bleeding
static bone cyst usually contains what kind of tissue?
submandibular gland
fordyce granules represent what kind of tissue
sebaceous gland (choristoma)
areas of hematopoiesis in the oral cavity
angle of mandible and maxillary tuberosity
areas of hema in children: long bones
areas of hema in adults: center! skull, spine etc
associated with focal osteoporotic bone marrow defect.. osteoporotic = osteoclasts
cause of focal osteoporotic bone marrow defect and treatment
abnormal healing following tooth extraction causing porous
tx: none: since poorly circumscribe
microscopic/histopath of focal osteoporotic bone marrow defect
hematopoietic cells (most abundant), fat cells, lymphoid tissues
cause of mucocele
accumulation of saliva in the lips
-due to mechanical trauma to the excretory duct (mucus extravasation phenomenon) = more common
-due to blockage of salivary flow (mucus retention cyst)
*painless, soft, smooth, bluish-gray mass, broad base
cause of ranula
due to mechanical trauma to the excretory duct (mucus extravasation cyst)
due to blockage of salivary flow - mucus retention cyst (more common)
non-neoplastic change of the minor salivary glands of the palate that mimics malignancy clinically and histologically (with erythroplasia, rapid growth, ulceration, >2weeks)
Necrotizing Sialometaplasia
-glands change from cuboidal to squamous
HEALS WITHIN 6-10 weeks
Tx: none (perform incisional biopsy -for lesions that are large and u suspect malignancy)
benign salivary gland tumor composed of bilayer strands of epithelial cells
canalicular adenoma
myoepithelioma - myoepithelial cells
most common salivary gland malignancy
mucoepidermoid carcinoma
-mucus producing cells (goblet cells)
-epidermoid (squamous cells)
most common tumor of salivary glands
pleomorphic adenoma (parotid and palate) -most common benign tumor of major and minor salivary glands.
most common salivary gland malignancy: mucoepidermoid carcinoma
group of benign salivary gland tumors composed of single cell type
monomorphic adenoma (parotid and upper lip)
inflammation of salivary glands
sialadenitis
smooth denuded, red lesion of tongue devoid of filiform papillae
median rhomboid glossitis
-midline of the dorsum of the tongue
cause: chronic candidiasis / failure of tuberculum impar to close
tx: treat candidiasis
cause of geographic tongue
unkown
tx: none - self limiting; manage symptoms - mouth wash with baking soda, topical corticosteroids
cause of hairy tongue
prolonged use of Abx or corticosteroids, smoking
color is due to trapped bacteria and debris
tx: remove source of irritation
umbilicated lesions in the palate with keratosis
stomatitis nicotina - inflamed salivary duct orifices
small red spots with white keratotic rings
NOT a premalignant lesion
peristent low grade trauma
focal keratosis/ frictional hyperkeratosis
tx of papillary hyperplasia / papillomatosis
surgery, remove denture, maintain good oral hygiene
cause: ill filling denture + poor oral hygiene
ill filling denture + chronic trauma = epulis fissuratum / denture-induced fibrous hyperplasia
Gustatory sweating is the chief symptom in
Auriculotemporal syndrome / Frey Syndrome
Sweating of cheeks, temple, back of ear, common after parotidectomy
What is meniere’s disease
Vertigo
Tinnitus
Hearing loss
Due to build up of endolymph in the ears –> increase pressure
Common Teratogens
CHEAP TORCH
Chicken pox
Hepa B
Enterovirus
AIDS
Parvovirus
Toxoplasmosis
Other agents (group B strep)
Rubella
CMV
HSV
Metabolic disorder characterized by massive accumulation of glycogen in the liver and kidney and its ability to be immobilized is known as
Von Gierke’s Disease - cannot break down glycogen
Mutation of chromosome 7
Cystic fibrosis - elevated Na+ and Cl- sweat test (chloride reabsorption)
Anitschkow’s myocyte
Rheumatic fever -brain, joints, pancarditis, skin
-aschoff bodies
Monro’s abscess are findings in
Psoriasis
Fatal progressive and massive destruction of nose, face, and pharynx, usually begins as a superficial ulceration of the palate or nasal septum, preceded by a feeling of stiffness of nose
Juvenile nasopharyngeal angiofibroma
Ulceration at nasal septum and leads to dysfigurement
Cancrum oris (noma) -oro-facial gangrene
Cause: borrelia vincenti
What is summer illness
Herpangina
XYY
Jacob’s syndrome
Inactive X chromosome
Barr bodies
-in turner syndrome, this is absent
What is rhagades
Radiating scars around the mouth, seen in congenital syphilis
What is Ranke complex
seen in ‘healed’ primary pulmonary tuberculosis and is a later manifestation of the Ghon complex. It consists of two components: a Ghon lesion that has undergone calcification. an ipsilateral calcified mediastinal node.
Lipschutz bodies
Herpetic lesion
Civatte bodies
Dead keratinocytes
Shilling test
Vit B12 absorption test for pernicious anemia
Other name for hyperaldosterism
Conn’s disease
Bitot’s spots
Vitamin A deficiency
Brown tumors are destructive cystlike bone lesions associated with
Hyperparathyroidism
Civatte bodies
Dead keratinocytes
Schilling test used to detect
Pernicious anemia
