L1: approach to oral diagnosis Flashcards
what does SOCRATES stand for
Site: where, localised/generalised, single/multiple
Onset: when, sudden/gradual
Character: sharp/dull
Radiation
Association: system features (eg fever, malaise loss of weight)
Time course: episodic/continuous, diurnal changes
Exacerbating/relieving factors
Severity: got worse/ better, rate pain 1-10
what to ask when taking history?
what are some things to cover
- demographics – age, race
- past medical history
- medications/ supplements
- social history (smoker or drinker?)
what should we take note of during e/o examination?
- scars
- symmetry
- muscles of mastication
- tmj
- salivary glands
- lymph nodes: texture, enlargement, fixed/ mobile/ tender
- dysphagia
what to watch out for for i/o examinations (soft&hard tissue) ?
- site
- single/multiple
- size
- shape (regular/irregular)
- surface character (eg plaque, verrucous)
- colour
- distinctive patterns eg reticulate, changing positions
- fluctuant (fluid filled) & colour of fluid
- margins: well/ill defined (eg fading margins)
- borders: rolled or flat
- base of lesion: clean or dirty
what should we be feeling for i/o examination?
see whether the lesion:
- rubs off
- blanches
- pulsates?
- pedunculated/sessile?
- is indurated?
- pain?
what should we ask the px when they have lesion in mouth?
got preceding blister?
definition of vesicle
fluid filled blister <0.5cm in diameter
defn of bulla
fluid filled blister >0.5cm in diameter
defn of induration
firm upon palpation in tissue that would normally be soft
defn of macule
well defined flat lesion with colour or texture changes
defn of papule
well defined elevated lesion <0.5cm in diameter
defn of plaque
well defined elevated lesion >0.5cm in diameter on skin or mucosal surface
defn of nodule
solid mass visible or palpable within or underneath mucosa
defn of pedunculated
exophytic lesion attached to mucosa by a thinner stalk
defn of sessile
exophytic lesion firmly attached to mucosa by broad base
defn of ulcer
loss of epithelium, typically presents with yellow or whitish grey pseudomembrane
defn of erosion
loss/thinning of superficial epithelial layers not extending through full thickness of epithelium, typically secondary to inflammation
defn of verrucous
papillary and deeply folded epithelial changes which appear wart like
what do we call
“loss/thinning of superficial epithelial layers not extending through full thickness of epithelium, typically secondary to inflammation”
erosion
what do we call
loss of epithelium, typically presents with yellow or whitish grey pseudomembrane
ulcer
what are 2 different histopathological tests
- H&E
- Immunofluorescence
what are 2 microbiology tests
- culture
- molecular techniques
what are the 2 acronyms we use to rule out differential diagnosis?
VITAMIN and NIRDS
Vascular
Infective/inflammatory
Trauma
Autoimmune
Metabolic
Idiopathic/iatrogenic
Neoplastic
Neoplastic: is it benign or malignant
Infectious: viral, fungal, bacterial
Reactive: allergy, trauma, drug induced, disease induced
Developmental: congenital, syndromes
Systemic: drug induced or disease induced?
