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X Clin Med Exam 1 > L9 Oral Lesions > Flashcards

L9 Oral Lesions Flashcards

1
Q

Leukoplakia risk factors

A

Tobacco use (70-90%), alcohol use (increase 1.5 fold), HPV

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2
Q

Risk factors for malignant transformation of leukoplakia

A

Female, long duration, nonsmoker (idiopathic), located on tongue/floor of mouth, >200 mm

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3
Q

Clinical presentation of leukoplakia

A

Adherent white patched/plaques on oral mucosa or tongue, not painful

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4
Q

Erythroplakia

A

Associated redness with white plaques of leukoplakia, higher risk of dysplasia/cancer

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5
Q

DDx of leukoplakia

A

Oral hairy leukoplakia

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6
Q

Oral hairy leukoplakia

A

Not premalignant, vertically corrugated white lesions on lateral tongue, usually soft so if indurated/hard then that’s not good

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7
Q

Disease associated with oral hairy leukoplakia

A

HIV (Epstein-Barr virus), this can be the presenting symptom

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8
Q

Risk factors of SCC

A

Tobacco and alcohol use, exposure to UV light, radiation exposure, HPV-16

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9
Q

Clinical presentation of SCC

A

Ulcers or masses that do not heal (persistent papules, plaques, ulcers, erosions), poor fitting dentures, sore throat etc that does not resolve

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10
Q

Treatment of SCC

A

Depends on stage/extent disease (surgical resection or radiation/chemo)

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11
Q

Presentation of melanoma

A

Painless, bleeding mass, area or ulceration, regional of mucosal discoloration (if pigmented oral lesion, must consider this!) or ill-fitting dentures

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12
Q

Amalgam tattoo

A

Blue-black macule seen in area adjacent to amalgam dental filling (gingival margin or buccal mucosa), irritates the tissue

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13
Q

Melanosis

A

Pigmented lesion that is extremely common in individuals with dark skin, symmetric pattern

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14
Q

Oral melanotic macules

A

Darkly pigmented benign macules on lips and oral mucosa, usually symmetric with sharp borders, stable and are present in adulthood

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15
Q

What are mucoceles?

A

Fluid-filled cavities with mucous glands lining the epithelium, due to minor oral trauma

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16
Q

Clinical presentation of mucoceles

A

Pinkish/blue soft papules or nodules filled with gelatinous fluid, variable in size and may rupture spontaneously

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17
Q

Treatment of mucoceles

A

Remove with cryotherapy/excision if symptomatic, CO2 laser vaporization, aspiration (draw fluid out but usually returns)

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18
Q

Herpetic gingivostomatitis

A

Most common clinical manifestation of primary HSV in childhood (before 5)

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19
Q

Etiology of Herpes Simplex Virus

A

HSV type 1

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20
Q

Clinical presentation of primary infection of Herpes Simplex Virus

A

Sudden onset of painful, intraoral grouped vesicles on an erythematous base, usually on buccal mucosa, when viral shedding is greatest

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21
Q

Clinical presentation of recurrent infection of Herpes Simplex Virus

A

Prodrome of pain/burning/tingling 6-48 hours before lesion appears, fatigue and low-grade fever, “cold sores”

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22
Q

Definitive diagnosis of Herpes Simplex Virus

A

Viral culture if there’s an active lesions

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23
Q

When is Tzanck smear used?

A

Herpes simplex virus and varicella zoster virus

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24
Q

Antiviral treatment of Herpes Simplex Virus

A

At onset of prodrome, acyclovir/valacyclovir/famiciclovir

25
Q

Miracle Mouthwash

A

Combo of Diphenhydramine (Benadryl) and aluminum hydroxide/magnesium carbonate (Maalox or Gaviscon-antacid)

26
Q

What is miracle mouthwash used for?

A

Herpes simplex virus, erythema multiforme major

27
Q

How can you tell herpes zoster virus from herpes simplex virus?

A

Herpes zoster is unilateral on the hard palate

28
Q

Etiology of oropharyngeal candidiasis (thrush)

A

Candida albicans (opportunistic infection)

29
Q

Predisposing factors for thrush

A

Infancy, dentures, immunocompromised, DM, chemo, antibiotics or corticosteroids

30
Q

Clinical presentation of oropharyngeal candidiasis

A

Mouth pain/sore throat, creamy white patches/plaques with underlying erythematous mucosa, “thrush will brush”

31
Q

How to diagnosis oropharyngeal candidiasis

A

Use KOH prep and see budding yeasts with or without pseudohyphae

32
Q

When should you think about an underlying disease associated with the thrush?

A

Esophageal candidiasis, recurrent candidiasis, associated pain somewhere else or lack of predisposing factors

33
Q

Treatment of oral candidiasis

A

Topical antifungal (nystatin oral suspension or clotrimazole oropharyngeal lozenges/troches)

34
Q

Genetic susceptibility for erythema multiforme major

A

HLA gene

35
Q

Etiology of erythema multiforme major

A

Commonly due to infection (HSV) but can be from medication

36
Q

Clinical presentation of erythema multiforme

A

Target-like lesions on skin, often with mucosal erythema, painful erosions or bullae

37
Q

Treatment of erythema multiforme major

A

Symptomatic relief that topical corticosteroid, oral anti-histamines, miracle mouthwash

38
Q

Clinical presentation of SJS

A

Mucosal involvement with erythema and edema of lips, intraoral bullae, ruptured bullae and must look for gentital and ocular involvement

39
Q

What are aphthous ulcers?

A

Canker sores

40
Q

Most common cause of mouth ulcers

A

Recurrent aphthous stomatitis

41
Q

Clinical presentation of aphthous ulcers

A

Single or multiple lesions that are shallow, round/oval, painful with grayish base on mucosa, usually do not bleed

42
Q

Treatment of aphthous ulcers

A

Typically heal but can use symptomatic steroid (triamcinolone orpharyngeal paste)

43
Q

What is behcet syndrome?

A

Neutrophilic inflammatory disorder

44
Q

Clinical presentation of behcet syndrome

A

Recurrent oral and genital ulcers that are painful, shallow or deep with central yellowish necrotic base with raised edges, NOT CONTAGIOUS

45
Q

Diagnos of behcet syndrome

A

Recurrent oral ulcers (>3x per year) AND 2 of the following (recurrent genital ulcers, ocular lesions, cutaneous lesions or positive pathergy test)

46
Q

Treatment of behcet syndrome

A

Refer to rheumatology

47
Q

Pathergy test

A

Do an intradermal injection with a 20 gauge needle under sterile conditions and positive test if an erythematous sterile papule develops within 48 hours

48
Q

Progression of oral lichen planus

A

Reticular, erythematous, erosive

49
Q

Clinical presentation of oral lichen planus

A

Reticular (lacy white plaques with Wickham’s striae on buccal mucosa), erythematous (red patches of mucosal atrophy-pain), erosive (erosions/ulcers-pain)

50
Q

Treatment of oral lichen planus

A

Pain relief and topical corticosteroids (high potency like triamcinolone oropharyngeal Oralone or clobetasol topical ointment BID)

51
Q

What is black hairy tongue associated with?

A

Antibiotic use, candida albicans infection or poor oral hygiene

52
Q

Clinical presentation of black hair tongue

A

Elongated filiform papillae

53
Q

Clinical presentation of geographic tongue

A

Erythematous patches on dorsal tongue with circumferential white borders, can change location pattern and size

54
Q

What is atrophic glossitis?

A

Inflammatory disorder that leads to atrophy of the filiform papillae, must think about what else is going on with this patient!

55
Q

Etiology of atrophic glossitis

A

Nutritional deficiencies, dry mouth, Sjogren’s syndrome, oral candida infection, celiac disease

56
Q

Clinical presentation of atrophic glossitis

A

Tongue appears smooth, glossy, erythematous, burning sensation and sensitivity with salty foods

57
Q

When should you prescribe gel application?

A

For a few localized lesions (gel form of topical steroids)

58
Q

When should you prescribe a rinse?

A

For widespread or generalized erythema

X Clin Med Exam 1 (7 decks)

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