L1: approach to oral diagnosis

Question 1

what does SOCRATES stand for

Answer 1

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

Question 2

what to ask when taking history?
what are some things to cover

Answer 2

• demographics – age, race
• past medical history
• medications/ supplements
• social history (smoker or drinker?)

Question 3

what should we take note of during e/o examination?

Answer 3

• scars
• symmetry
• muscles of mastication
• tmj
• salivary glands
• lymph nodes: texture, enlargement, fixed/ mobile/ tender
• dysphagia

Question 4

what to watch out for for i/o examinations (soft&hard tissue) ?

Answer 4

• 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

Question 5

what should we be feeling for i/o examination?

Answer 5

see whether the lesion:
- rubs off
- blanches
- pulsates?
- pedunculated/sessile?
- is indurated?
- pain?

Question 6

what should we ask the px when they have lesion in mouth?

Answer 6

got preceding blister?

Question 7

definition of vesicle

Answer 7

fluid filled blister <0.5cm in diameter

Question 8

defn of bulla

Answer 8

fluid filled blister >0.5cm in diameter

Question 9

defn of induration

Answer 9

firm upon palpation in tissue that would normally be soft

Question 10

defn of macule

Answer 10

well defined flat lesion with colour or texture changes

Question 11

defn of papule

Answer 11

well defined elevated lesion <0.5cm in diameter

Question 12

defn of plaque

Answer 12

well defined elevated lesion >0.5cm in diameter on skin or mucosal surface

Question 13

defn of nodule

Answer 13

solid mass visible or palpable within or underneath mucosa

Question 14

defn of pedunculated

Answer 14

exophytic lesion attached to mucosa by a thinner stalk

Question 15

defn of sessile

Answer 15

exophytic lesion firmly attached to mucosa by broad base

Question 16

defn of ulcer

Answer 16

loss of epithelium, typically presents with yellow or whitish grey pseudomembrane

Question 17

defn of erosion

Answer 17

loss/thinning of superficial epithelial layers not extending through full thickness of epithelium, typically secondary to inflammation

Question 18

defn of verrucous

Answer 18

papillary and deeply folded epithelial changes which appear wart like

Question 19

what do we call
“loss/thinning of superficial epithelial layers not extending through full thickness of epithelium, typically secondary to inflammation”

Answer 19

erosion

Question 20

what do we call
loss of epithelium, typically presents with yellow or whitish grey pseudomembrane

Answer 20

ulcer

Question 21

what are 2 different histopathological tests

Answer 21

• H&E
• Immunofluorescence

Question 22

what are 2 microbiology tests

Answer 22

• culture
• molecular techniques

Question 23

what are the 2 acronyms we use to rule out differential diagnosis?

Answer 23

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?