Final 1 - Infections of the Oral Cavity

Question 1

Actinomycosis Clinical Features

Answer 1

Bacterial infection (tricky, sounds fungal, but it’s not!)

Periapical is the most common orofacial type - can also see on face and neck
Firm swelling with drainage
Visible abscess

Question 2

Actinomycosis Histological Appearance

Answer 2

Sulfur granules! (yellow granules in pus)
Filamentous Gram positive bacteria
Radiating Neutrophil band

Question 3

Actinicomycosis Treatment

Answer 3

Penicillin

I guess Amoxicillin works if we need to write the prescription

Question 4

Other soft tissue bacterial infection Clinical Features

Answer 4

Associated with immunocompromised pts

Abscess with pain, swelling, drainage

Question 5

Other soft tissue bacterial infection Treatment

Answer 5

Identify underlying problem
Incision and drainage
Culture
Antibiotics (Amoxicillin)

Question 6

Superficial Fungal Infections

Answer 6

Candida (C. albicans)- Acute, Chronic, Median Rhomboid Glossitis

Question 7

Deep Fungal Infections

Answer 7

Histoplasmosis
Zygomycosis
Aspergillosis
Cryptococcosis

Question 8

Candida Predisposition Factors

Answer 8

Hyposalivation
Dentures
Diabetes
Iron/B12 deficiency
Immunocompromise

Question 9

Acute Candidiasis Clinical Features

Answer 9

Rapid onset

Pseudomembranous (Thrush):
Yellow-white plaques and papules that scrape off red base

Atrophic: Angular chelitis

Question 10

Angular Chelitis Clinical Features

Answer 10

Acute candidiasis of corners of mouth

Cracked, fissured, weepy

Question 11

Chronic Candidiasis Clinical Features

Answer 11

Atrophic: bright, red sore area under denture

Hyperplastic: chronic muco-cutaneous candidiasis
Looks like leukoplakia, doesn’t wipe off

Question 12

Candidiasis Treatment

Answer 12

Nystatin Suspension
Topical Antifungals
Fluconazole if systemic needed

Treat denture with chlorox (plastic) or nystatin (metal)

Question 13

Median Rhomboid Glossitis Clinical Features

Answer 13

Candida infection of midline tongue anterior to circumvallate papillae

Question 14

Candidiasis Histological Appearance

Answer 14

Penetrating hyphae, spores

Question 15

Deep Fungal Infections Clinical Appearance

Answer 15

Persistent single necrotic ulcer (fungi occlude blood vessels)

Zygomycosis - persistant sinus infection in diabetics

Cryptococcosis - meningitis in HIV

Question 16

Viral Infections

Answer 16

Herpes Simplex
Erythema Multiforme
Varicella-Zoster
Post-herpetic Neuralgia
Hairy Leukoplakia
CMV
HHV-8
HPV
Coxsackie virus & Enterovirus

Question 17

Herpes Simplex Pathology

Answer 17

Primary herpetic gingivostomatitis
Lives in ganglia & can reactive (especially during stress, trauma)
Young, immunocompromised

Question 18

Herpes Simplex Clinical Features

Answer 18

Mucosal sores - vesicles, ulcers

Herpes labialis, gingiva

Question 19

Herpes Simplex Treatment

Answer 19

Hydration
Topical pain control (lidocaine)
Antivirals (Acyclovir, Valcyclovir)
Culture to rule out shingles

Question 20

Erythema Multiforme

Answer 20

Hypersensitivity reaction to HSV
Crusting, hemorrhagic blisters and ulcers on lips

Steven-Johnson Syndrome - eye & genital involvement

Question 21

Erythema Multiforme Treatment

Answer 21

Antivirals

Pain control - lidocaine & benedryl

Question 22

Varicella-Zoster Clinical Features

Answer 22

Primary - Chicken Pox
multiple itchy red vesicles all over

Secondary - Shingles
single dermatome, unilateral
multiple painful red vesicles

Question 23

Varicella-Zoster Treatment

Answer 23

Hydration
Antivirals
Pain control

Question 24

Hairy Leukoplakia Pathology

Answer 24

EBV infection in epithelial cells

Immunocompromised

Question 25

Hairy Leukoplakia Clinical Features

Answer 25

White plaque on lateral tongue or buccal mucosa Painless, vertical fissures May also have candida infection

Question 26

Hairy Leukoplakia Treatment

Answer 26

No tx unless candida (antifungal)

Question 27

CMV Infection Clinical Features

Answer 27

Single/multiple persistant large painful ulcers | Immunocompromised

Question 28

CMV Treatment

Answer 28

Biopsy | Antiviral

Question 29

HHV-8 Pathology

Answer 29

Associated with Kaposi sarcoma in AIDS

Question 30

HHV-8 Treatment

Answer 30

For Kaposi sarcoma: Biopsy Excision Radiation

Question 31

HPV Pathology

Answer 31

>100 subtypes Warts or dysplasia leading to SCC Verruca vulgaris - white keratotic projections Papilloma - soft, pink Condyloma - large

Question 32

HPV Treatment

Answer 32

Excision if needed

Question 33

Coxsackie virus & Enterovirus Treatment

Answer 33

Supportive care

Question 34

Coxsackie virus and Enterovirus Clinical Features

Answer 34

Hand-Foot-Mouth disease Children Oropharyngeal ulcers Lesions on hands and feet

Question 35

Mycobacterial Infections

Answer 35

Tuberculosis Leprosy Mycobacterium avian (MAI)

Question 36

Tuberculosis

Answer 36

Primary - lung Secondary - nodules or ulcer in mouth (mucosa, tongue) Caseating granulomas

Question 37

Leprosy

Answer 37

Mycobacterium leprae attacks nerve fibers Painless deformation, auto-amputation Non-caseating granulomas

Question 38

Leprosy Treatment

Answer 38

Dapsone

Question 39

MAI

Answer 39

Rare, seen with HIV Rarely causes granulomas

Question 40

Spirochetal Infections

Answer 40

Borrelia vincentis - NUG Syphillis Borrelia burgdorferi - Lyme

Question 41

NUG Treatment

Answer 41

Necrotizing Ulcerative Gingivitis Antibiotics

Question 42

Syphilis Clinical Features

Answer 42

Primary - chancre - painless ulcer Congenital - Hutchinson incisor, Mulberry molar