Final Review

Question 1

Red area surrounded by white areas on tongue, buccal, floor of mouth, soft palate. geographic tongue on area of mouth, not just on tongue? dx is ?

Answer 1

Migratory mucositis

Question 2

Migratory mucositis is usually associated with what?

Answer 2

Fissured tongue

Question 3

Old patient, red/bluish/purple, elevated areas in ventral tongue. What test do you dofirst?

Answer 3

Pressure test

Question 4

Old patient, red/bluish/purple, elevated areas in ventral tongue. what is it?

Answer 4

Variscosities

Question 5

Patient with multiple, hard, growths on buccal/lingual, 30 yo, male. dx is

Answer 5

Exostosis

Question 6

Young, 18 yo, white lesions in mouth, skin rash, concentric target lesions on palm and soles, dx in this case is ?

Answer 6

secondary syphilis

b/c syphilitic roseola and the skin rash, and the secondary lesions are common in syphilis and not in erythema multiforme ….

Question 7

T/F -(target lesions are in secondary syphilis and erythema multiforme)

Answer 7

True

Question 8

Asthma patient, using steroids inhaler, red, flat areas, commonly dorsum of tongue and palate. dx is?

Answer 8

atrophic candida

is usually red and flat (with or without white areas). commonly in steroid inhaler patients

Question 9

uni- or bi-lateral, fissures, ulcerations in corner of mouth. also produced by candida. very few times associated with bacteria. produced by decreased vertical dimension.

Answer 9

angular chelitis

Question 10

What is the tx of angular chelitis?

Answer 10

tx = antifungal (eg. nystatin).

Question 11

Very young boy, vesicles (characteristic of viruses), fever, lymphadenopathy, on skin and mucosa. dx is ?

Answer 11

primary herpes simplex

b/c of age and located everywhere.

Question 12

is unilateral. vesicles, on lip, typical vesicles, inside mouth = on palate or gingiva. on ATTACHED mucosa, NOT movable (movable is canker sore). usually can’t see vesicles in mouth b/c they break easily. group of ulcers on palate or gingiva. side note - herpes virus is DNA virus.

Answer 12

recurrent herpes (two cases, 1 inside the mouth on fixed mucosa and 1 on the lip)

Question 13

Ulcers, crusts, vesicles, on part of face/mouth, unilateral, not cross midline, painful. dx is ?

Answer 13

herpes zoster (aka recurrent chickenpox)

Question 14

Young boy, fever, large lymphadenopathy, petechia on palate. What does he have?

Answer 14

mononucleosis

Question 15

What is the etiology of mononucleosis?

Answer 15

EBV

Question 16

Male, fever, recurrent infections, candidiasis, herpes, skin lesions, brown spots. dx is ?

Answer 16

HIV/AIDS

Question 17

Male, fever, recurrent infections, candidiasis, herpes, skin lesions, brown spots. brown spots on skin and mucosa. dx is ?

Answer 17

kaposi sarcoma.

sarcoma = malignant tumor of mesenchymal tissue. kaposi sarcoma is cancer of blood vessels? superficial multiple blood vessel cancer, etiology is AIDS HERPES 8

Question 18

Osteoporosis patient, exposed bone, gingiva is broken. dx is ?

Answer 18

BON.

Put the patient on antibiotics and clean the area as much as you can NO AGGRESSIVE SURGERY

Question 19

Brown lesion. take an x-ray, see amalgam. dx is ?

Answer 19

amalgam tattoo.

most common pigmented lesion. don’t actually need to have amalgam restoration since particles are in the mucosa.

Question 20

Extreme pain on floor of mouth, two small ulcers white surrounded by red, inflamed tissue, on MOVABLE mucosa not fixed (ex gingiva). multiple and recurrent and painful dx is

Answer 20

aphthous ulcers

Question 21

How do you tx aphthous ulcers ?

Answer 21

don’t usually treat, will go away on its own

Question 22

Enlarged, red, firm, uniform, not bleeding (unless it’s plaque related). Dx?

Answer 22

allergic gingivitis

most common cause in mouth = ARTIFICIAL cinnamon.

Question 23

White, verrucous, pedunculated, cauliflower-like. benign. pressure test on the red lesions, if blanches = benign blood vessel lesion (could also be varicosity or hemangioma but in this case its papilloma), malignant ones don’t blanch.

Answer 23

papilloma

etiology = HPV.

Question 24

Young child, multiple, usually pink (sometimes white), slightly elevated lesions, on buccal mucosa, tongue, and lip. dx is ?

Answer 24

Heck’s disease/focal epithelial hyperplasia

is an HPV lesion. almost always in children, all over mouth, not painful, will heal by themselves but it takes a long time, benign, no tx needed

Question 25

Single, small, is flat, uniformly pigmented, well circumscribed, in anywhere, freckle in mouth. dx is ?

Answer 25

focal melanotic macule do biopsy

Question 26

Elevated and usually on skin. pigmented, small, one, elevated, uniform, circumscribed, non-ulcerated

Answer 26

Nevus

Question 27

Generalized,multiple, white, irregular, elevated, verrucous, old patient, disease of old people, 80% will be cancerous (pre-malignant). What is it?

Answer 27

proliferative verrucous leukoplakia (PVL)

Question 28

What is the tx of Proliferative verrucous leukoplakia?

Answer 28

tx = remove the lesion, but usually comes back. most patients likely will get SCC.

Question 29

Crown prep the day before. injected anesthesia with epi. today, painful, ulceration, on hard palate, after dental treatment. What is dx?

Answer 29

necrotizing sialometaplasia due to epi b/c of vasoconstriction of blood vessels. tx = none needed b/c will heal by itself. can do biopsy if unsure

Question 30

Blistering conditions. autoimmune, bilateral, buccal mucosa. What do you do?

Answer 30

do biopsy = one in formalin solution and one in mischel solution. immunofluorescence

Question 31

Blistering condition, biopsy in formalin, epithelium destroyed, autoimmune, more common in females. antibodies against DESMOSOMES. blisters are INTRA-epithelium (+). Dx is?

Answer 31

pemphigus vulgaris

Question 32

Sessile, covered by normal mucosa, on cheek. dx is ?

Answer 32

traumatic fibroma most common diagnosis

Question 33

Appears as long hair on tongue, can be white or brown. Dx is?

Answer 33

hairy leukoplakia etiology = EBV. condition of HIV/immunocompromised patients.

Question 34

Baby with mass on alveolar ridge, newborn, growth on gingiva. dx is ?

Answer 34

congenital epulis/epulis of the newborn tx = will go away by itself, but remove via excision b/c parents

Question 35

Pressure test is positive, baby born with irregular, red mark on face, congenital. Dx is?

Answer 35

hemangioma It’s a benign tumor of blood vessels.

Question 36

Antibodies against HEMIDESMOSOMES (34) on basement membrane. SUB-epithelial vesicle (+). Dx is?

Answer 36

pemphigoid

Question 37

RED/erythematous. most commonly in floor of mouth, not usually painful, old people. do biopsy (if not hemangioma or trauma). hyperchromatic cells, diff shapes, looks malignant, but only within epithelium/no vessels/ no metastasis if left untreated becomes invasive via blood or lymphatic vessels (not yet broken basement membrane to CT), old people.

Answer 37

carcinoma in situ.

Question 38

Etiology = HPV, radiation, chemicals, tobacco, alcohol, genetics. if metastasizes, it travels through lymph vessels, first on unilateral side, later to contralateral side. most common location for SCC = lateral border of tongue. (answer most likely all the above) (mentioned genetics is most important) (37).

Answer 38

SCC.

Question 39

Old patient, blurring of vermillion border, produced by the SUN, diffuse, ulceration, scar, crater. dx is ?

Answer 39

actinic cheilitis

Question 40

Not inside mouth, produced by sun, crater-like ulcer, rarely metastasizes, UV radiation is a risk factor

Answer 40

basal cell carcinoma All is true regarding basal cell carcinoma EXCEPT: answer would be “inside the mouth” (since it’s false) (39)

Question 41

Hyperchromatism (appear black), Pleomorphism, Keratin pearls , Alteration, Cytoplasm­:Nucleus ratio, Atypical mitosis, Dyskeratosis, Disorganization of cells, Lack of cohesiveness. This is histology of what?

Answer 41

Squamous cell carcinoma

Question 42

Not uniform, not flat, no hair, satellite lesions, different colors, irregular borders, ulcerations, may not always be pigmented (variation of colors), may arise from a previous nevus. most common place on palate. prognosis worse in mouth than skin. also, prognosis is worse going posteriorly. vertical growth indicator of aggressiveness and malignancy.

Answer 42

melanoma

Question 43

Most common salivary gland tumor in KIDS, most commonly inside bone, most common malignant salivary gland tumor, ulcerated.

Answer 43

mucoepidermoid carcinoma

Question 44

41. Most common of all salivary gland tumor is what?

Answer 44

pleomorphic adenoma/mixed tumor malignancy: sublingual = 99% (43), submandibular = 60%, palate = 50%, parotid = 30%. no salivary gland tumor in gingiva or in midline of palate. benign tumors of salivary gland are less benign than any other benign tumor. cancer of salivary gland tumors are less aggressive than other cancers

Question 45

Where are salivary glands NOT found?

Answer 45

NO SALIVARY GLAND TUMORS IN GINGIVA or midline of palate (44). gingiva doesn’t have salivary glands

Question 46

Patient with lots of tissue coming out from under denture. usually due to ill-fitting denture. can also be associated with fungus and palatal papillomatosis as well.

Answer 46

Epulis fissuratum (aka Inflammatory fibrous hyperplasia)

Question 47

Patient bit lower lip, translucent, bluish look now. Dx is?

Answer 47

Mucocele

Question 48

What are the 3 P's of red lesions?

Answer 48

1. pyogenic granuloma 2. peripheral ossifying fibroma 3. peripheral giant cell granuloma

Question 49

You did an extraction and now patient has a mass near area of surgery,--> the nerve start growing and become a mass covered by normal mucosa. Nerve was cut. What is the dx?

Answer 49

traumatic neuroma tx = usually remove

Question 50

Patient has anemia, infections, bleeding, Radiolucency in bone. Dx?

Answer 50

multiple myeloma

Question 51

What is a malignancy seen as in an X-ray?

Answer 51

diffuse and radiolucent