HD 10- Clinical cases

Question 1

What are some key features of Acromegaly?

Answer 1

Too much GH production in pituitary gland
Large extremities and large mandible

Teeth spaced out as large jaw.
Dentures cant fit- too tight.

Question 2

What is Addison’s disease?

Answer 2

Adrenal hypofunction
Pigmentation in buccal mucosa/ FOM/ palmar creases of hands
Primary autoimmune disease – restriction of adrenal cortex = not produced in same quantities = TOO LITTLE CORTISOL
Bronzed look

Question 3

How do you classify oral pigmentation?

Answer 3

Extrinsic – caused by drugs (amlodipine)

Intrinsic – anatomical (RACIAL)

Question 4

What is the difference between upper neurone and lower neurone disease?

Answer 4

• Upper – forehead is spared (facial nerve has bilateral innervation to the forehead)
• Facial nerve weakness – stroke (LOWER MOTOR NEURONE)

Lower motor neurone – WHOLE SIDE OF FACE AFFECTED (INCLUDING FOREHEAD)
Bell’s palsy is a LMN, but not all LMN are bell’s palsy – IDOPATHIC
LA IV = lower motor neurone problem = whole side of face affected

Question 5

What are some key features of Cushing’s syndrome?

Answer 5

Cushing’s syndrome – excess steroid long term
Cushing’s disease – primary pituitary problem

Very happy/ depressed
Deposition of fat = 4 classic faces
1)	Face = MOON FACE
2)	Abdomen
3)	Gynaecomastia 
4)	Fat around shoulder blades
Increased susceptibility to infection
AB prophylaxis if have Cushing’s pre MOS
Never have NSAIDs with steroids = gastric problems (ulcer)
Long term steroids = cause these effects
Can prescribe steroids to pt in dentistry = prescribed for lichen planus

Question 6

What is a clinical sign of hypoglossal nerve palsy?

Answer 6

Tongue strayed to left hand side.

12th cranial nerve.

Question 7

What is a clinical sign of herpetic whitlow?

Answer 7

Herpetic whitlow is a viral condition where small blisters form on the fingers and the fleshy area around the fingertips. These sores or blisters are often painful and develop after direct contact with a contagious sore. The herpes simplex virus (HSV) causes this condition.

Question 8

How would you describe a lump in your notes?

Answer 8

• Site/position – use anatomical names ie Pre auricular lump (in front or his ear)
• Size – appropriate scale
• Shape – roughly
• Surface – smooth or irregular
• Edge – is it well defined or poorly defined
• Consistency – hard, soft, rubbery, fluctuant (fluid in in i.e. cyst/abscess), pulsatile (expands with each pulse beat), transmitting pulsatile (comes out but doesn’t expand)
• Fixed