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Clinical Med I > HEENT - Oral Lesions - Exam 2 > Flashcards

HEENT - Oral Lesions - Exam 2 Flashcards

1
Q

What are risk factors for Leukoplakia?

A
  • Tobacco use

- Alcohol use

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2
Q

What is the clinical presentation of leukoplakia?

A
  • Adherent white patches/plaques on oral mucosa or tongue

- Painless

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3
Q

What is the treatment for leukoplakia?

A
  • Prevent/decrease risk of oral SCC
  • Refer for ENT evaluation/surgical removal
  • Monitor size/depth
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4
Q

How do you prevent/decrease risk of oral SCC?

A

Avoid tobacco, alcohol, cheek biting, tongue chewing, regular dental care

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5
Q

Leukoplakia is common and usually benign, but what can it be a precursor for and should be a concern?

A

Oral SCC

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6
Q

What is the clinical presentation for Erythroplakia?

A
  • Red, velvety patch commonly located on mouth floor, ventral aspect of tongue, soft palate
  • Asymptomatic
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7
Q

While Erythroplakia is uncommon, what is significant about it and should be cause for concern?

A

Carries very high risk of malignant transformation (>80%)

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8
Q

What population is at the highest risk for Erythroplakia?

A

Older patients who consume tobacco and alcohol

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9
Q

What induces Oral hairy leukoplakia?

A

Epstein-Barr virus

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10
Q

What population is at the highest risk for Oral hairy leukoplaki?

A

Immunosuppressed individuals

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11
Q

What is the clinical presentation for oral hairy leukoplakia?

A
  • Vertically corrugated adherent white lesions on lateral surface of the tongue
  • Painless
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12
Q

What is the treatment for oral hairy leukoplakia?

A

No treatment usually indicated

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13
Q

What are the risk factors for oral SCC?

A
  • Tobacco use
  • Alcohol use
  • UV light
  • Radiation
  • HPV
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14
Q

What is the clinical presentation for oral SCC?

A
  • Painful ulcers or masses that do not heal
  • Tongue/lip: exophytic or ulcerative lesions that are often painful
  • Dysphagia, odynophagia, bleeding, weight loss
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15
Q

What is the treatment for oral SCC?

A
  • ENT referral

- Surgical resection and/or radiation/chemoradiation may be required

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16
Q

What is the presentation for oral melanoma?

A
  • Pigmentated oral lesions often following ABCDEs

- Painless bleeding mass, an area of ulceration, mucosal discoloration

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17
Q

What is the treatment for oral melanoma?

A
  • Excision with clear margins

- Radiation therapy may be needed

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18
Q

What are evaluation methods for oral melanoma?

A
  • Endoscopic evaluation for paranasal disease
  • CT and/or MRI of primary site
  • CT and/or PET imaging to assess for lymph node involvement and distant metastases
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19
Q

What is the etiology for mucoceles?

A

Mild or minor oral trauma

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20
Q

What is the clinical presentation for mucoceles?

A
  • Pinkish/blue soft papules or nodules filled with gelatinous fluid on mucous glands
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21
Q

What is the treatment for mucoceles?

A
  • Avoid cheek/lip biting
  • If symptomatic: remove with cryotherapy or excision
  • CO2 laser vaporization
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22
Q

What is the most common clinical manifestation of primary HSV in childhood?

A

Herpetic gingivostomatitis

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23
Q

What is the etiology of Herpetic gingivostomatitis and how is it transmitted?

A

HSV-1

Transmitted during direct contact during viral shedding (with or without lesions); can infect multiple sites

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24
Q

What are precipitating factors for Herpetic gingivostomatitis?

A
  • Sunlight
  • Fever
  • Trauma
  • Stress
  • Menses
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25
Q

What are risk factors for malignant transformation of leukoplakia?

A
  • Female
  • Long duration of leukoplakia
  • Nonsmoker
  • Located on tongue or floor of mouth
  • Greater than 200 mm
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26
Q

What is the clinical presentation of a primary infection of oral herpes simplex virus?

A
  • May be asymptomatic
  • Sudden onset of painful intraoral grouped vesicles on an erythematous base
  • May have associated fever, lymphadenopathy, decreased oral intake
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27
Q

What is the clinical presentation of a recurrent infection of oral herpes simplex virus?

A
  • Prodrome: pain/burning/tingling 6-48 hours before lesions appear; fatigue, low-grade fever
  • “Cold sore” (herpes labialis)
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28
Q

How is oral herpes simplex virus diagnosed?

A
  • Viral culture
  • Tzanck smear: multinucleated giant cells
  • Serology: HSV-1 antibodies
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29
Q

What is the treatment for oral herpes simplex virus?

A
  • Oral antiviral (at onset of prodrome)
  • Supportive care (fluids, analgesics, Miracle Mouthwash
  • Patient education
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30
Q

What populations should an individual infected with herpes simplex virus avoid?

A
  • Immunocompromised
  • Pregnant women
  • Elderly
  • Newborns
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31
Q

How could you differentiate oral herpes simplex virus from herpes zoster?

A

In herpes zoster, grouped vesicles or erosions are typically unilateral on the hard palate

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32
Q

What is the clinical presentation for the Coxsackie Virus (hand, foot, mouth)?

A
  • Prodrome: fever, malaise, sore throat

- Painful oral lesions: small aphthae (tend to spare gingiva and lips)

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33
Q

What is the treatment for Coxsackie virus?

A
  • Frequent hand washing to prevent spread
  • Supportive care (hydration, analgesics)
  • Throat lesions resolve in 5-6 days
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34
Q

What is Oropharyngeal Candidiasis commonly called?

A

Thrush

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35
Q

What is the etiology for Oropharyngeal Candidiasis?

A

Candida albicans

36
Q

When does the infection occur in Oropharyngeal Candidiasis?

A

When conditions are right for overgrowth; opportunisitc infection

37
Q

What are predisposing factors for Oropharyngeal Candidiasis?

A
  • Infancy
  • Denture wear
  • Immunocompromised
  • Diabetes mellitus
  • Chemotherapy or radiation
  • Antibiotics (broad spectrum)
  • Corticosteroids (topical and systemic)
38
Q

If you found a pigmented oral lesion, what must you consider and rule out?

39
Q

What is the clinical presentation for Oropharyngeal Candidiasis?

A
  • Pain or sore throat
  • Creamy white patches/plaques with underlying erythematous mucosa on buccal mucosa, palate, tongue, or oropharynx
  • Angular cheilitis
40
Q

How is the diagnosis of Oropharyngeal Candidiasis confirmed?

A

KOH prep: budding yeast with or without pseudohyphae

41
Q

What is the treatment for Oropharyngeal Candidiasis?

A
  • Topical antifungal (Nystatin oral suspension or Clotrimazole lozenges)
  • Disinfect/replace toothbrushes, pacifiers, bottle nipples
  • Patient education (clean dentures, rinse mouth after steroid inhalers)
42
Q

What is the etiology of Erythema Multiforme Major (EMM)?

A
  • Commonly induced by HSV infection

- Uncommonly associated with medications

43
Q

What is the clinical presentation of Erythema Multiforme Major (EMM)?

A
  • Distinctive target-like lesion on the skin
  • Often accompanied by diffuse areas of mucosal erythema, painful erosions or bullae (mostly oral, but can be genitals or ocular)
  • Lesions appear over 3-5 days and resolve within about 2 weeks
44
Q

What is the treatment for Erythema Multiforme Major (EMM)?

A
  • Generally self-limiting
  • Symptomatic relief (topical corticosteroids, anti-histamines, Miracle Mouthwash)
  • Consider systemic glucocorticods for severe oral involvement
  • Immediate ophthalmology referral for ocular involvement
45
Q

What is the clinical presentation of SJS/TEN?

A

Mucosal involvement (90%):

  • Erythema and edema of lips
  • Intraoral bullae
  • Ruptured bullae/painful friable raw surfaces
  • Oral, genital, and or ocular involvement
46
Q

What is the treatment for SJS/TEN?

A
  • Stop the offending medication
  • Admit to hospital
  • Supportive care
47
Q

What is the clinical presentation of Pemphigus?

A
  • Painful erosive lesions (bullae have usually ruptured)
48
Q

What is the treatment for Pemphigus?

A
  • Systemic corticosteroids

- Immunosuppressants

49
Q

What is the clinical presentation of Mucous membrane pemphigoid?

A
  • Prodrome lasts weeks to months

- Tense bullae

50
Q

What is the treatment for Mucous membrane pemphigoid?

A
  • Topical and/or systemic corticosteroids

- Dermatology referral

51
Q

What are other names for Aphthous ulcers?

A

Ulcerative stomatitis, aphthae, “canker sores”

52
Q

What is the most common cause of mouth ulcers?

A

Recurrent aphthous stomatitis

53
Q

What is the clinical presentation for Aphthous ulcers?

A
  • Single or multiple oral lesions that are shallow, round/oval, painful with grayish base on buccal/labial mucosa
  • Lesions have yellow-gray centers with red halos
54
Q

What is the treatment for Aphthous ulcers?

A
  • Typically heal within 10-14 days
  • Avoid irritating foods/drink
  • Symptomatic relief (topical steroid: Oralone)
55
Q

What is Behcet Syndrome?

A

Neutrophilic inflammatory disorder

56
Q

What is the clinical presentation of Behcet Syndrome?

A
  • Recurrent oral and genital ulcers

- Painful, shallow or deep ulcers with central yellowish necrotic base

57
Q

How is Behcet Syndrome diagnosed?

A
  • Recurrent oral ulcers (greater than or equal to 3 times per year)
    AND
  • 2 other clinical findings (recurrent genital ulcers, ocular lesions, or cutaneous lesions, positive pathergy test)
58
Q

What is the treatment for Behcet Syndrome?

A

Refer to Rheumatology

59
Q

If patient has esophageal candidiasis, recurrent candidiasis or a lack of predisposing factors, what needs to be considered?

A

Further testing for underlying disease such as HIV or diabetes

60
Q

What is a pathergy test?

What marks a positive test?

A
  • Nonspecific hyperreactivity of the skin following minor trauma
  • Intradermal injection with 20-gauge needle
  • Positive if an erythematous sterile papule develops within 48 hours
61
Q

What does oral lichen planus increase the risk for?

A

Increases risk for oral cancer

62
Q

What are the clinical presentations of oral lichen planus?

A
  • Reticular: Lacy white plaques with Wickham’s striae on the buccal mucosa
  • Erythematous: Painful, red patches often in conjunction with reticular features
  • Erosive: Painful, erosion/ulcers often with reticular and erythematous LP
63
Q

What is the treatment for oral lichen planus?

A
  • High potency topical corticosteroids (Oralone or clobestasol)
64
Q

What is another name for Black hairy tongue?

A

Lingua villosa nigra

65
Q

What is Black hairy tongue often associated with?

A
  • Antibiotic use
  • Candida albicans infection
  • Poor oral hygiene
66
Q

What is the clinical presentation of Black hairy tongue?

A
  • Elongated filiform papillae

- Pseudohairy tongue: yellowish white to brown dorsal tongue surface

67
Q

What is the treatment for Black hairy tongue?

A

Brush affected area of the tongue with a soft-bristle toothbrush and toothpaste BID-TID

68
Q

What is another name for Geographic tongue?

A

Benign migratory glossitis

69
Q

What is the clinical presentation of Geographic tongue?

A
  • Erythematous patches on dorsal tongue with circumferential white borders
  • Lesions can change location, pattern and size within minutes to hours
  • Numerous exacerbations/remissions over time
  • Usually asymptomatic; sometimes oral discomfort, burning, or foreign body sensations
70
Q

What is the treatment for Geographic tongue?

A

Reassurance

71
Q

What is Atrophic Glossitis?

A

Inflammatory disorder that leads to atrophy of the filiform papillae

72
Q

What is the etiology of Atrophic Glossitis?

A
  • Nutritional deficiency
  • Dry mouth
  • Sjogren’s syndrome
  • Oral candida infection
  • Celiac disease
73
Q

What is the clinical presentation of Atrophic Glossitis?

A
  • Tongue appears smooth, glossy, erythematous

- Burning sensation and increased sensitivity when eating acidic or salty foods

74
Q

What is the treatment of Atrophic Glossitis?

A

Address underlying conditions

75
Q

When would you use a gel form of topical steroids for oral lesions?

What are the principles for applying this medication?

A
  • Use if there are few localized lesions.
  • Patient should dry the area prior to application
  • Avoid eating or drinking for 30 minutes after
76
Q

When would you use a rinse for the oral cavity?

A

Use for widespread or generalized erythema

77
Q

What is acantholysis?

A

Sloughing of the skin

78
Q

What is an enanthem?

A

Mucous membrane eruption

79
Q

What is an exanthem?

A

Skin eruption

80
Q

What is an exophytic?

A

Lesion that grows outward from an epithelial surface

81
Q

What is glossitis?

A

Inflammation of the tongue

82
Q

What is odynophagia?

A

Pain with swallowing

83
Q

What is stomatitis?

A

Inflammation of the mucous membranes of the mouth

84
Q

What is leukoerythroplakia?

A

White mucosal plaques with red, speckled appearance

85
Q

What is angular cheilitis?

A

Painful fissuring at the corners of the mouth

Clinical Med I (24 decks)

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