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Oral path 2 final > final > Flashcards

final Flashcards

1
Q

what is due to defect in normal keratinization of oral mucosa?

A

white sponge nevus

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2
Q

white sponge nevus affects what and what are the signs and symptoms

A

WSN affects buccal mucosa mainly but can also affect nasal, esophageal, laryngeal, anogenital mucosa
asymptomatic thick white appearance

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3
Q

Biopsy of WSN shows what?

A

WSN: parakeratosis w acanthosis, perinuclear eosinophilic condensation which is pathognomic to WSN

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4
Q

WSN tx and prognosis

A

WSN tx is NOT necessary, harmless condition Good prognosis

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5
Q

what % of Peutz Jeghers syndrome pts are new mutations?

what gene is affected in Peutz Jeghers

A

35% new mutations!

SKT 11 gene affected which encodes for a serine threonine kinase

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6
Q

what is the frequency of Peutz Jeghers syndrome cases

A

1:100,00- 1:200,000 births

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7
Q

Peutz Jeghers syndrome dead giveaway sign?

Are the polyps from PJ pre-cancerous?

A

PJ= freckle like lesions which develop on hands, periorifical skin, and oral mucosa
Polyps in GI tract are NOT precancerous like in Gardners Syndrome

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8
Q

Peutz Jeghers syndrome pts have how many times INC risk for cancer?
what happens to their bowels?

A

PJ pts 18X more at risk for cancer!

Their bowel obstruct due to intussusception (telescoping of proximal segment)

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9
Q

What is the frequency of hereditary hemorrhagic telangiectasia?
lesions of HHT are most common where?

A

1: 10,000

lesions of HHT most common on vermillion zone of lips, tongue, and buccal mucosa

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10
Q

what is the initial clue to HHT?

where else may HHT be seen besides orally?

A

frequent spontaneous epistaxis

HHT may also be seen on hands and feet, GI mucosa, genitourinary mucosa, and conjunctival mucosa

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11
Q

what % of HHT pts have AV fistulas of lungs?
of liver?
of brain?

A

HHT AV fistula in lungs= 30%!
AV fistulas in liver = 30%
AV fistulas in brain 10-20%

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12
Q

3 out of what 4 things must be present for diagnosis of HHT

A

recurrent, spontaneous epistaxis
telangiectasias of mucosa and skin
AV malformation involving lung, liver, or brain
family history of HHT

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13
Q

What is the tx for mild HHT?
moderate HHT?
Severe HHT?

A

Mild HHT: no Tx
moderate HHT: selective cryotherapy or electrocautery of bothersome lesions
Severe: septal dermoplasty

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14
Q

HHT brain AV fistulas that get bacteremia from dental procedures occur in what % of pts? so what should be done for these pts?

A

HHT AV fistulas of brain bacteremia occurs 1% of pts : so these pts should get prophylactic ABs

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15
Q

What is the mortality rate for HHT pts?

what is the mortality rate for HHT pts with brain abscesses?

A

HHT mortality rate= 1-2% due to blood loss

HHT mortality rate w brain abscess= 10%

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16
Q

Pemphigus vulgaris autoantibodies destroy what? so a split occurs where in the tissue?

A

PV= autoAB destroy desmosomes

PV inhibits adherence so a split develops within the epithelium

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17
Q

PV occurs in who?

what percent of PV pts present w oral lesions? what are the oral lesions?

A

Rare no sex predilection but in older pts around 50.

More than 50% have oral lesions of superficial ragged erosions and ulcerations

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18
Q

where does PV occur?

PV is positive for what?

A

PV occurs on any oral mucosa, flacid bull on skin, intact oral blisters rare
+ Nikolsky sign!

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19
Q

in PV what is the 1st to show and last to go? common oral lesion?

A

ORAL LESIONS!

shallow ulcerations right along the marginal gingival area

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20
Q

DIF is used for what and what animal?

IFF is used for what and what animal?

A 
DIF: detects autoABs bound to pts tissues
DIF= goat
IIF: detects autoAbs 
circulating in blood
IIF: monkey
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21
Q

For each disease is DIF +/-? IIF +/-?
PV?
MM pemphigoid?
Bullous pemphigoid?

A

PV: + DIF and + IIF
MM pemphigoid: + DIF, - IIF
Bullous pemphigoid: + DIF and + IIF

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22
Q

PV shows what microscopically?

A

PV= INTRAepithelial clefting in basal layer and acantholysis- breakdown of spinous layer

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23
Q

Mortality rate of PV?

tx of PV?

A

PV= 5-10% mortality rate!

PV tx= systemic corticosteroids

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24
Q

what is 2x more common than PV and has a 2:1 female predilection? what is the average age?

A

Mucous membran pemphigoid: 2:1 females

average age 50-60 y/o

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25
Q

In MM pemphigoid what tissue is affected?

Is oral scarring common?

A

MM pemphigoid affects any mucosal surface and skin
cutaneous lesion and conjunctival scarring is common
ORAL Scarring is RARE!

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26
Q

What diseases present with desquamative gingivitis?

A

MM pemphigoid, oral lichen planus, pemphigus vulgaris

27
Q

what is the most significant aspect of MM Pemphigoid

A

MM pemphigoid- ocular involvement! could lead to blindness

28
Q

MM pemphigoid shows what under the microscope?

pemphigoid attacks what?

A

MM pemphigoid= SUBepithelial cleft cromation- separation of epithelium from CT at BMZ
MM pemphigoid attacks hemidesmosomes

29
Q

what % of Bullous pemphigoid pt have oral lesions? what is the initial complaint of bullous pemphigoid?

A

8-39% of bullous pemphigoid pts have oral involvement

Pruritus is common initial complaint

30
Q

what two diseases have SUBepithelial clefts?

A

bullous pemphigoid and MM (cicatrical) pemphigoid have SUBepithelial clefts

31
Q

Tx of Bullous pemphigoid

A

most cases of BP resolve spontaneously in 1-2 years

32
Q

what is a acute, self limiting ulcerative disorder that resolves in 2-6 weeks? what is the sexual predilection and average age?

A

Erythema multiform

EM: female predilection, adults in 20-30s

33
Q

EM etiology

A

50% unknown
25% preceding infections
25%: medication related

34
Q

clinical features of EM include what

A

target lesions of skin,
hemorrhagic crusting of lips, widespread oral ulcers w ragged margins, l and B mucosa, tongue
bright red conjunctiva- blood shot eye

35
Q

Erythema multiform histo

A

keratinocyte destruction, sub epithelial edema, perivascular inflammation

36
Q

What % of EM recur? when?

A

EM: 20% of cases recur in autumn and spring

37
Q

EM mortality rate, EM major? TEN?

A

EM Major : 2-10% mortality

TEN: 34% mortality rate

38
Q

What is similar to psoriasis?

A

Erythema Migrans is similar to psoriasis

Erythema migrans AKA geographic tongue, migratory glossitis

39
Q

Cutaneous lichen Planus affects who?

what is a characteristic sign of cutaneous lichen planus? along with the oral cavity where can this occur?

A

CLP: female predilection 30-60 y.o
CLP: purple polygonal pruritic papules w Wickham striae
flexor surface of wrists, lumbar region and shins

40
Q

SLE affects who more? average age?

A

SLE affect women 8-10 times more than men especially black women!
Average age 31 y/o

41
Q

SLE clinical signs include

A

Malar butterfly rash which spares nasolabial folds, and skin lesions that flare w sun exposure

42
Q

what percent of SLE pts have renal involvement?

what percent of SLE pts have sterile vegetations on heart valves?

A

40-50% of SLE pts have renal involvement

50% of SLE pts have vegetations on heart valves

43
Q

what % of SLE pts have oral lesions? what tissues do they affect?

A

5-25% of SLE pts have oral lesions

SLE affects palata, buccal mucosa, or gingiva

44
Q

What diseases are treated with anti-malarial drugs?

A

Mild SLE and severe Chronic cutaneous lupus

45
Q

what is the 5 year survival of SLE?
15 year of SLE?
prognosis worst for who

A

SLE 5 year: 95%
SLE 15 year: 75%
prognosis for SLE is worse for men

46
Q

what almost exclusively affects skin and mucosa that resembles erosive LP

A

Chronic cutaneous lupus: waxes and wanes

47
Q

what % of Chronic cutaneous lupus pts transform to SLE?

what % resolve after a few years?

A

5%

CCL 50% resolve after several years

48
Q

systemic scleroris show autoABs directed against what

A

Systemic sclerosis= Scl70 topoisomerase 1

49
Q

Crest syndrome is associated with what

A

Crest syndrome= anticentromere ABs

50
Q

Crest syndrome 6 year survival?

Crest syndrome 12 year survival?

A

Crest 6 year: 80%

12 year: 50%

51
Q

what is the sensitivity of COE?
Specificity of COE?
are auxiliaries as accurate as dentists?

A

COE sensitivity = 85%
COE specificity= 97%
YES!

52
Q

what is a test used to analyze abnormal finding or symptomatic pt in order to establish or suggest a diagnosis?

A

case finding test

53
Q

what is a test used on people apparently free of disease in order to detect the disease in early stages

A

a screening test

54
Q

what is the only diagnostic aid that is a case finding test aid?
what is it used for?

A

Brush test Oral Cdx: used to test the common, small, harmless appearing white or red tissue spots you see several times each
NO DIAGNOSIS IS GIVEN!!!

55
Q

Brushtest gives a lot of what kind of results

A

Brushtest gives a lot of false negative results

56
Q

Vizilite components?

Vizilite lit review results?

A

Vizilite components include acetic acid, light stick and Toluidine blue dye
Vizilite is unable to discriminate benign from pre-malignant lesions
No clear evidence better than COE

57
Q

What does VELscope stand for?

Reviews of VELscope

A

VELScope= Visually enhanced lesion scope
VELscope normal tissue is pale green, abnormal tissue is dark
False negatives and False positives for VELscope

58
Q

VELScope has what % of false positives?

VELScope is also used how?

A

VELScope= 90% false positives

VELscope also used as case finding tool in surgical margin delineation- extends margins beyond COE alone

59
Q

Describe Identafi

A

Identafi: hand-held cordless multi spectral fluorescence and reflectance spectroscopy w 3 colors: white for COE, violet for tissue fluorescence, and amber light for suspected abnormalities

60
Q

describe OralD which was introduced in 2013

A

uses a light, glasses and CytID for fluorescence and liquid base cytology but clinical application of device has NOT been proven

61
Q

What percent of oral cancer is diagnosed in stage 3-4

A

63% of oral cancer is diagnosed in stage 3-4

62
Q

what are the high risk sites for oral cancer/ dysplasia

A

ventro lateral tongue, floor of mouth and lateral soft palate/ anterior tonsillar pillars

63
Q

what are the suspicious physical features

A

crisply defined red, white, or mixed red and white lesions, persistent ulceration and induration

Oral path 2 final (1 decks)

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