Exam 3 - Acute/Chronic Ulceration Part 2 Flashcards
What is another name for Aphthous Stomatitis/ulcer?
Canker Sore
What category does Aphthous Stomatitis/ulcer fall under?
Immune-mediated
Describe the etiology of aphthous ulcer
______________ produce ___________ (inflammatory cytokine)]
CD8+ T-cells produce TNF-a (inflammatory cytokine)]
Trigger is “different things in different people”
T/F You are more liekly to see an Aphthous Stomatitis/ulcer in young adults or children.
True
Name the pathology:
Ulcer with yellow-white fibrinopurulent membrane, encircled by an erythematous halo
Aphthous Stomatitis “Canker Sores”
T/F Aphthous Stomatitis “Canker Sores” occur on nonkeratinized (moveable) mucosa.
TRUE
Where do Aphthous Stomatitis “Canker Sores” occurs?
Non-kerat tissue moveable mucosa)
Name the pathology:
CD8+ T-cells produce TNF-a (inflammatory cytokine)]
Trigger is “different things in different people”
Aphthous Stomatitis “Canker Sores”
How to diagnose aphthous stomatitis/ulcer?
Clinically
Histopath is NOT diagnostic
How would you tx an aphthous stomatitis?
Also include how you would tx recurrent cases.
Heal without tx
Topical steroid or steroid rinse for recurrent cases
Laser ablation shorten duration and decreases symptoms, but may not be practical in all cases
Name the aphthous ulcer (minor, major, or herpetiform)
MOST COMMON (80%)
Fewer recurrence
Shortest duration
Minor
Larger than minor aphthae
Tend to be recurrent
Take 2-6 weeks to heal
Scarring can occur
Major
What type of apthous ulcer can a scar occur?
Major
How long does it take for a major apthous ulcer to heal?
2-6 weeks
What aphthous ulcers tend to recur?
All can recur
Minor experience fewer recurrences
Major and Herpetiforme tend to recur
Name the aphthous ulcer (minor, major, or herpetiform)
Tend to have multiple ulcers, but each ulcer is smaller than minor aphthae
Tend to recur
Heal in 7-10 days
Herpetiforme
How long does it take for herpetiform aphthous ulcers to heal?
Heal in 7-10 days
T/F Minor aphthous ulcers are smaller than herpetiform aphthous ulcers.
FALSE
each herpetiforme ulcer is smaller than minor aphthae
What are reported causes of aphthous stomatitis? (10 things)
A
G
H
H
I
I
N
S
S
T
Allergies
Genetic predisposition
Hematologic abnormalities
Hormonal influence - progesterone hypersensitivity
Immunologic factors
Infectious agents
Nutritional deficiencies
Smoking cessation
Stress (Mental and physical)
Trauma
What is the name for multiple aphthous ulcers that often recurr?
Recurrent aphthous stomatitis
Recurrent aphthous stomatitis
What are the 6 associated systemic disorders?
Mnemonic:
Big
Cool
Cats
Chase
Unlucky
Nachos
Behcet disease- Genital and oral ulcers
Celiac disease- itchy rash, GI problems, allergy to gluten
Cyclic neutropenia- Ulcers occur repeatedly on 21 day cycle
Crohn’s disease- Pyostomatitis vegetans, Cobblestone lesions, Linear ulcers/fissure in the vestibule
Ulcerative colitis
Nutritional deficiencies
Name the associated systemic disorder for recurrent aphthous stomatitis.
Genital and oral ulcers
Behcet disease
Name the associated systemic disorder for recurrent aphthous stomatitis.
itchy rash (puritis), GI problems, allergy to gluten
Celiac disease
Name the associated systemic disorder for recurrent aphthous stomatitis.
Inherited condition where there is a mutation that affect the maturation of neutrophils
Ulcers occur repeatedly on 21 day cycle because every 21 days neutrophils really plummet
You will notice a pattern to ulcers appearing
Cyclic neutropenia
T/F Pyostomatitis vegetans that occurs in IBD can be painful.
True - variability of pain
Name the oral lesions that are found in Crohn’s disease and Ulcerative Colitis.
Both can have aphthous ulcers and pyostomatitis vegetans.
Crohn’s disease also has cobblestone lesions and linear ulcer/fissure sin the vestibule.
Describe the clinical presentation of pyostomatitis vegetans (4 things)
“Snail track” lesions
Variable Painful
Yellow-ish, slightly elevated, pustule on red oral mucosa
Most common on buccal and labial mucosa, soft palate, and ventral tongue
Where is it most common to find pyostomatitis vegetans?
Most common on buccal and labial mucosa, soft palate, and ventral tongue
What category does Allergic contact stomatitis fall under?
Immune mediated
T/F Allergic contact stomatitis is more common in females.
TRUE
Name the pathology:
Immune-mediates
Burning sensation
Erythema with or without edema
Superficial ulcerations may be present
Rarely vesicles are seen
Allergic contact stomatitis
T/F Vesicles are common clinical presentation of allergic contact stomatitis
FALSE
How to diagnose Allergic contact stomatitis? (2 things)
Temporal relationship between use of the agent and eruption
Patch testing may be used in identifying allergen
How to tx Allergic contact stomatitis?
Allergic contact stomatitis?
Erythema multiforme falls under what category?
Immune-mediated
Name the pathology
Triggered by infection:
Mycoplasma pneumoniae (Respiratory tract infection)
Herpes simplex virus 1 (HSV-1)
Triggered by medication: 4 things
NSAIDs, Sulfonamides (Antibiotic), Anti seizure medications, Antibiotics
Erythema multiforme
What can trigger Erythema multiforme? give examples
Infections:
Mycoplasma pneumoniae (Upper respiratory tract infections)
Herpes simplex virus 1 (HSV-1)
Medications: (mnemonic NASA)
NSAIDs
Antibiotics
Sulfonamides (Antibiotic)
Anti seizure medications
What is the average age to see Erythema multiforme?
Average age range is 20-40 yrs old
T/F Generally medication induced Erythema multiforme is seen on the first time the pt takes the medication.
TRUE - so then recommend the pt stand clear of that drug
What are the three main clinical presentations of Erythema multiforme?
Diffuse oral ulcerations
Hemorrhagic crusting of the lips
Targetoid skin lesions on extremities
How would you diagnose Erythema multiforme ?
Clinical history and presentation - usually the best
Identification of drug
Bloodwork for mycoplasma pneumonia and HSV-1 IgM antibodies (IgM - recent infection marker whereas Ig-G would just be an indication the person had previously had infection)
Diagnosis of Erythema multiforme:
Bloodwork for _________ ___________ and _________, _______antibodies
Bloodwork for mycoplasma pneumonia and HSV-1, IgM antibodies
How do you tx erythema multiforme?
Self limiting (2-6 wks) - supportive care sometimes steroids work
Name the pathology:
Area of erythema around a central yellow fibrinopurulent membrane
May develop a rolled white border of hyperkeratosis adjacent to ulceration
Some form of injury (biting, sharp tooth, puncture, etc.)
Traumatic ulcer
T/F There is no need to biopsy a traumatic ulcer.
FALSE If lesion persist beyond two weeks you should biopsy to rule out SSC. Note it could also be a chronic ulcer.
How would you tx a traumatic ulcer?
Remove source of trauma
Heals with time
What is the etiology of syphilis? What are the two examples of how it can spread.
Treponema pallidum (spirochete)
Spread by direct contact with mucosal surfaces: Sexual contact and Mother to fetus
There are Three stages of syphillis (primary, secondary, tertiary).
Which stage is the most hard to detect?
Which two stages are you most infectious?
First stage hard to detect
Most infectious first two stages
What are the clinical presentation of primary syphilis?
Chancre
Solitary papular lesion with central ulceration
85% genital, 4% oral
Regional LAD
T/F Symptoms resolve in a few days for primary syphillis, even without tx.
True!
When does secondary syphilis usually occur?
Occurs 4-10 weeks after initial infection
What are the systemic symptoms of Secondary Syphilis? 6 things
Painless!!! LAD
Sore throat
Malaise
Headache
Weight loss
Fever
What are the clinical presentations of secondary syphilis?
Systemic symptoms (Painless LAD, Sore throat, Malaise, Headache, Weight loss, Fever)
Diffuse maculopapular cutaneous rash
Split papule (Papule in the crease of the oral
commissure)
Mucous patch (Whitish, elevated plaque that cant be wiped off, Frequently on tongue, lip, buccal mucosa, and palate) - sometimes doesnt look like a patch
What are the clinical presentations of tertiary syphilis?
Gumma:
Indurated, nodular, ulcerated lesion
May cause extensive tissue destruction through and through
Usually affect palate or tongue
You make think of necrotizing sialometaplasia but these lesions are often even deeper than those
Affects vascular system and CNS.
Can result in paralysis, psychosis, dementia, and death.
Match with the correct stage of syphilis.
Gumma:
Indurated, nodular, ulcerated lesion
May cause extensive tissue destruction through and through
Usually affect palate or tongue
You make think of necrotizing sialometaplasia but these lesions are often even deeper than those
Tertiary Syphilis
Match with the correct stage of syphilis.
Affects vascular system and CNS.
Can result in paralysis, psychosis, dementia, and death.
Tertiary Syphilis
Match with the correct stage of syphilis.
Split papule (Papule in the crease of the oral
commissure)
Secondary Syphilis
Match with the correct stage of syphilis.
Mucous patch (Whitish, elevated plaque that can’t be wiped off, Frequently on tongue, lip, buccal mucosa, and palate)
Secondary Syphilis
Match with the correct stage of syphilis.
Diffuse maculopapular cutaneous rash
Secondary Syphilis
Match with the correct stage of syphilis.
Chancre
Solitary papular lesion with central ulceration
85% genital, 4% oral
Primary Syphilis
Primary Syphilis
Chancre
Solitary papular lesion with central ulceration
______ genital, ____ oral
85% genital
4% oral
T/F Syphilis incidence is increasing.
True
How to diagnose syphilis?
Biopsy: Spirochetes under microscope
Blood tests:
Venereal disease Research Laboratory (VDRL)
Rapid Plasma Reagin (RPR)
Results can be negative for up to 6 weeks after initial infection
T/F Results can be negative for up to 10 weeks after initial infection of syphilis
FALSE 6 wks not 10
How do you tx syphilis?
Antibiotics (penicillin)
Mucous Membrane Pemphigoid falls under what category?
Immune mediated (Chronic)
Pemphigus Vulgaris falls under what category?
Immune-mediated Chronic
Name the pathology:
Autoantibodies against hemidesmosomes and
components of basement membrane”
Mucous Membrane Pemphigoid
Name the pathology:
Autoantibodies against components of desmosomes
Pemphigus Vulgaris
