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Oral Pathology 1/2/16 > Lec 4: Red Lesions > Flashcards

Lec 4: Red Lesions Flashcards

1
Q

Vesicle vs. Ulcer

A

A vesicle may eventually lose the overlying epithelium and then present as an ulceration

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2
Q

EPIDERMOLYSIS BULLOSA defect in?

A

Defect in the attachment mechanisms of the epithelial cells

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3
Q

EPIDERMOLYSIS BULLOSA cure?

A

No cure

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4
Q

EPIDERMOLYSIS BULLOSA management?

A

supportive

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5
Q

EPIDERMOLYSIS BULLOSA–Vesicles and bullae due to?

A

minor trauma

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6
Q

EPIDERMOLYSIS BULLOSA–oral lesions? (2)

A

Bullae may heal with scarring; restricted opening

Hypoplastic teeth

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7
Q

VIRAL DISEASES onset?

A

acute

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8
Q

VIRAL DISEASES symptoms?

A

May have malaise, fever, lymphadenopathy

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9
Q

Lymphadenopathy not present with?

A

recurrent herpes and zoster

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10
Q

Viral diseases all have?

A

vesicle stage

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11
Q

Viral diseases multiple___

A

ulcers

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12
Q

Spread predominantly through infected saliva or active perioral lesions
Adapted best to the oral, facial and ocular areas
Developed nations show 20% exposure at age 5 and 50-60% at adulthood

A

Herpes simplex 1

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13
Q

Adapted best to genital zones

Transmitted through sexual contact, typically involving the genitalia

A

Herpes simplex 2

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14
Q

Primary infection? occurs at? symptomatic or asymptomatic?

A

Initial exposure of individual without antibodies to virus
Typically occurs at young age
Often asymptomatic or subclinical

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15
Q

Latency? most common?

A

Virus taken up by sensory nerves

Most common site for HSV-1 is trigeminal ganglion

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16
Q

Recurrent? affect the? usually symptomatic or asymptomatic?

A

Reactivation of the virus
Affect the epithelium supplied by sensory gangilion
Usually symptomatic

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17
Q

Primary Herpetic Gingivostomatitis

A

Lymphadenopathy present
Multiple vesicles and ulcers anywhere in oral cavity, pharynx, and perioral skin
May present subclinically

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18
Q

Primary Herpes

A

Numerous pinhead vesicles develop

Lesions enlarge slightly and develop central ulceration

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19
Q

In primary herpes, Sometimes yellow fibrin covers the ulcers, which may?

A

coalesce

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20
Q

Primary herpes involves

A

keratinized and non-keratinized mucosa

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21
Q

In Primary herpes, the gingiva is always enlarged and..

A

painful and extremely red

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22
Q

Primary Herpes treatment?

A

Acyclovir (Zovirax)
Adults: 200mg
resolves in 10-14 days

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23
Q

HERPES SIMPLEXRECURRENT HERPES aka

A

cold sore and fever blisters

Prodrome: tingling, burning, paresthesia

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24
Q

RECURRENT HERPES occur in? appears on?Lymphadenopathy present?

A

small clusters;
Appears on On vermilion border, perioral skin and keratinized oral mucosal surfaces; Recur in same location each time; NO

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25
Q

HERPETIC WHITLOW (HERPETIC PARONYCHIA): due to? common in what profession?

A

Due to self-innoculation in children. Used to be common in dentists before gloves.

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26
Q

HERPES GLADIATORUM (SCRUMPOX): common in

A

wrestlers and rugby players

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27
Q

CHRONIC HERPETIC INFECTION: seen in?

A

immunocompromised hosts

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28
Q

TZANCK CELL?

A

free floating epithelial cell

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29
Q

Recurrent Herpes treatment? (2)

A

Medication most effective if taken at prodrome
RX: Valacyclovir (Valtrex)
Rx: Acyclovir

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30
Q

HEREPES ZOSTER (SHINGLES)-zooster represents a?

A

recurrence

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31
Q

Herpes Zoster (Shingles)-unilateral or bilateral?

A

Unilateral distribution

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32
Q

Herpes Zoster (Shingles) follows peripheral?

A

nerve distribution

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33
Q

Herpes Zoster (Shingles)–prognosis?

A

Post-herpetic neuralgia: chronic severe pain in nerve distribution after lesions resolve

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34
Q

INFECTIOUS MONONUCLEOSIS etiology?

A

Epstein-Barr virus (EBV, HHV-4)

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35
Q

EBV also associated with:

A

Burkitt’s lymphoma
Nasopharyngeal carcinoma
Hairy leukoplakia

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36
Q

INFECTIOUS MONONUCLEOSIS– Laboratory features?

A

Leukocytosis
Lymphocytosis with atypical T lymphocytes
Positive serology

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37
Q

INFECTIOUS MONONUCLEOSIS–oral mucosa?

A

Erythematous
Petechiae on palate
Ulcers without vesicles, later in disease

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38
Q

HAND, FOOT AND MOUTH DISEASE etiololgy?

A

coxsackievirus, group A

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39
Q

HAND, FOOT AND MOUTH DISEASE lesions?

A

Vesicles and ulcers throughout oral cavity

Macules and vesicles on hands and feet

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40
Q

HERPANGINA etiology?

A

coxsackievirus, group A

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41
Q

HERPANGINA-lesions?

A

Similar to HFM, but confined to posterior oral cavity

Soft palate, uvula, tonsillar pillar

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42
Q

MEASLES (RUBEOLA)–Viral infection caused by a member of the?

A

paramyxovirus family

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43
Q

MEASLES (RUBEOLA)–spread through?

A

respiratory droplets

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44
Q

MEASLES (RUBEOLA)–appearance signs?

A

Koplik’s spots

“Grains of salt”

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45
Q

AUTOIMMUNE DISEASES onset? progressive? These diseases cannot be cured but can be?

A

Gradual onset: weeks to months; progressive; controlled with corticosteroids

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46
Q

Treatment of Non-Microbial Mucositis with Corticosteroids

A

Topical Steroids
Systemic Steroids
Intralesional Steroids

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47
Q

Treatment of Non-Microbial Mucositis with Corticosteroids–Topical Steroids?

A

Mouthrinse
Dexamethasone
Triamcinolone acetonide
Ointment

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48
Q

Treatment of Non-Microbial Mucositis with Corticosteroids–Systemic Steroids?

A

Prednisone: 30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QOD

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49
Q

Treatment of Non-Microbial Mucositis with Corticosteroids–Intralesional Steroids?

A

Triamcinolone acetonide, inject 10-40 mg

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50
Q

EROSIVE LICHEN PLANUS–cause?

A

Immune abnormality involving T lymphocytes
Lichenoid drug reactions
Graft-versus-host reactions

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51
Q

Erosive Lichen Planus: Oral Lesions–appearance? vesicles are? bilateral or unilateral?

A

white striae along periphery;
Vesicles are rare;
Bilateral; focal or generalized

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52
Q

PEMPHIGUS VULGARIS–etiology?

A

autoantibodies to intercellular protein in desmosomes

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53
Q

PEMPHIGUS VULGARIS–type of blisters?

A

Fragile blisters rupture easily forming painful ulcers

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54
Q

PEMPHIGUS VULGARIS-sign? Large areas of skin or mucosa involved; usually?

A

Nikolsky sign sometimes present; multifocal

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55
Q

Pemphigus Vulgaris-microscopic?

A

Tzanck cells

Direct immunofluorescence on biopsy

56
Q

Pemphigus Vulgaris- 2 biopsy specimens needed?

A

1 submitted in formalin

1 submitted in Michels solution

57
Q

_______ Vesicle In Pemphigus Vulgaris

A

Intraepithelial

58
Q

Pemphigus Vulgaris and Mucous Membrane Pemphigoid–treatment?

A 
Corticosteroids 
 Mouthrinse
   Dexamethasone
   Triamcinolone acetonide
 Systemic
     Prednisone:  30-60 mg A.M. x 5 days, followed by 5-20 mg A.M. QOD
59
Q

MUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID and Bullous Pemphigoid etiology?

A

antibodies against basal lamina (hemidesmosomes)

60
Q

MUCOUS MEMBRANE (CICATRICIAL) PEMPHIGOID extraoral lesions?

A

Conjunctiva: may cause blindness
Nasal, pharyngeal, vaginal mucosa
Skin

61
Q

SYMBLEPHARON

A

Adhesion between the bulbar and palpebral conjunctivae. May lead to blindness.

62
Q

DESQUAMATIVE GINGIVITIS:

A

diffuse gingival erythema

63
Q

Most common auto-immune blistering condition

A

Bullous pemphigoid

64
Q

Compared with MMP (Mucous Membrane Pemphigoid) vs. BP (Bullous pemphigoid)

A

BP more limited

No scarring with BP

65
Q

LUPUS ERYTHEMATOSUS 3 types

A

Systemic lupus erythematosus (SLE)
Chronic cutaneous lupus erythematosus (CCLE)
Subacute cutaneous lupus erythematosus (SCLE)

66
Q

Chronic cutaneous lupus erythematosus (CCLE) aka

A

Aka discoid lupus erythematosus

67
Q

Chronic cutaneous lupus erythematosus (CCLE) confined to?

A

skin and oral cavity

68
Q

Intermediate features between SLE and CCLE is what disease?

A

Subacute cutaneous lupus erythematosus (SCLE)

69
Q

Systemic lupus–organ involvement?

A

May lead to kidney failure

Cardiac involvement also common

70
Q

LIBMAN-SACKS ENDOCARDITIS:

A

warty vegetations affecting the heart valves. Found at autopsy in 50% of SLE patients

71
Q

Chronic Cutaneous Lupus–limited to? symptoms?

A

skin or mucosal surfaces; Scaly, erythematous patches, Scarring and pigmentation

72
Q

CHRONIC DESQUAMATIVE GINGIVITIS presents as

A

diffuse sloughing of gingiva

73
Q

Riga-Fede disease?

A

ulcer on tongue of neonates due to trauma from erupting teeth

74
Q

Most common oral fungal infection in humans

A

CANDIDOSIS

75
Q

CANDIDOSIS agent?

A

Candida albicans

76
Q

CANDIDOSIS?

A

Fungal infection on the surface of the mucosa

77
Q

Acute Erythematous Candidosis-most common or rare? symptoms? typically follow?

A

Most common form (more common than pseudomembranous)
Generalized pain, burning and erythema
Typically follow broad-spectrum antibiotics (“antibiotic sore mouth”)

78
Q

What diseases is commonly seen in denture wearers, aka denture stomatitis?

A

Chronic Erythematous Candidiasis

79
Q

Denture stomatitis- causes?

A

poorly fitting dentures, prolonged wearing of denture, poor hygiene, (may not be caused by candida)

80
Q

What disease typically occurs with reduced vertical dimension of occlusion, but does not have to be?

A

Angular Cheilitis

81
Q

Syphilis caused by?

A

Treponema pallidum

82
Q

Syphilis primary symptoms?

A

Chancre at site of inoculation

Solitary lesion, usually at genitalia

83
Q

Syphilis secondary symptoms?

A

Maculo-papular cutaneous rash
Mucous patches
Condyloma lata

84
Q

Syphilis tertiary symptoms?

A

CNS (neurosyphilis) and CV problems

85
Q

Syphilis aka

A

Great imitator

86
Q

Congenital Syphilis symptom?

A

Hutchinson’s triad

87
Q

Hutchinson’s triad? (3)

A

Hutchinson’s teeth, ocular interstitial keratitis and eight nerve deafness

88
Q

APHTHOUS ULCERS what immunologic reaction?

A

T-cell mediated immunologic reaction

89
Q

APHTHOUS ULCERS types (3)

A

Minor, Major, and Herpetiform

90
Q

APHTHOUS ULCERS on what type of mucosa?

A

non-keratinized mucosa

91
Q

APHTHOUS ULCERS aka

A

canker sore

92
Q

MINOR APTHOUS ULCERATION–size? healing time? scaring?

A

Size between 3-10 mm

Heal in 7-14 days

No scarring

93
Q

MAJOR APTHOUS ULCERATION–sized? healing time? scaring?

A

Size between 1-3 cm

Healing in up to 6 wks

More frequent recurrence

May cause scarring

94
Q

HERPETIFORM APTHOUS ULCERATION - size? healing time?

A

Size between 1-3 mm; may coalesce with one another

Heal in 7-10 days

95
Q

Aphthous Ulcers-Microscopic features: Biopsy is not diagnostic. Diagnosis is based on history and clinical features. True or False?

A

True

96
Q

APHTHOUS ULCERSTreatment for Mild and Major Aphthae ulcers?

A

Mild disease: topical corticosteroids

Major aphthae: more potent steroids

97
Q

Aphthous Ulcers gives way to what syndrome?

A

Behcet’s Syndrome

98
Q

Behcet’s Syndrome

A

Serious, multisystem disease

Aphthous-like oral ulcers, genital ulcers, ocular inflammation, skin pustules

99
Q

ERYTHEMA MULTIFORME cause?

A

unknown

100
Q

ERYTHEMA MULTIFORME predisposing factors?

A

In 50% of the cases, preceded by herpes or pneumonia

Medications: antibiotics, analgesics, sulfanomides

101
Q

ERYTHEMA MULTIFORME forms (3)

A

minor, major and toxic epidermal necrolysis

102
Q

ERYTHEMA MULTIFORME onset?

A

acute

103
Q

ERYTHEMA MULTIFORME skin lesion feature?

A

“Iris” or “target” lesion: erythematous macule with central vesicle

104
Q

ERYTHEMA MULTIFORME oral lesion features?

A

Diffuse painful ulcers: may have vesicles

Common lips, buccal and labial mucosa

105
Q

Stevens-Johnson syndrome (EM major):

A

oral and skin lesions + ocular or genital

106
Q

Toxic epidermal necrolysis (Lyell’s disease):

A

diffuse sloughing of skin

107
Q

Erythema Multiforme key clinical feature?

A

lesions appear suddenly

108
Q

Stevens-Johnson Syndrome:

A

A more severe form of erythema multiforme

Lesions involve skin, conjunctiva, oral mucosa, genital mucosa

109
Q

Granulomatous lesions of the upper respiratory tract
Necrotizing glomerulonephritis
Systemic vasculitis of small arteries and veins
What disease?

A

GRANULOMATOSIS WITH POLYANGIITIS

110
Q

Granulomatosis with Polyangiitis what test is done?

A

c-ANCA test

111
Q

ERYTHROPLASIA symptoms?

A

Asymptomatic, persistent, red, or red/white lesion.

112
Q

ERYTHROPLASIA is microscopically diagnosed as

A

epithelial dysplasia, carcinoma-in-situ, superficial squamous cell carcinoma

113
Q

HHV1

A

Human Herpes Types 1 (HSV1)–Herpes simplex

114
Q

HHV2

A

Human Herpes Types 2 (HSV2)-Herpes simplex

115
Q

HHV3

A

Varicella Zoster Virus (VZV)

116
Q

HHV4

A

Epstein-Barr Virus (EBV)

117
Q

HHV5

A

Cytomegalovirus (CMV)

118
Q

HHV6

A

Roseola virus

119
Q

HHV7

A

Roseola-like virus

120
Q

HHV8

A

Kaposi sarcoma herpes virus (KSHV)

121
Q

Does recurrent herpes have lymphadenopathy?

A

NO

122
Q

Is lymphadenopathy present in primary herpes?

A

YES

123
Q

post-auricular lymphandenopathy

A

Infectious mononucleosis

124
Q

Herpangia vs. herpes

A

Herpangia is only on the soft palate unlike herpes that is everywhere.

125
Q

Measles is DNA or RNA virus?

A

RNA

126
Q

Koplik’s spot refers to

A

Measles (Rubeola)

127
Q

Do autoimmune disease have lymphandenopathy?

A

NO

128
Q

Autoimmune vs. viral disease?

A

Unlike viral, autoimmune diseases keep getting worse and worse as time goes on.

129
Q

Which attacks the eyes Pemphigoid or pemphigus?

A

Pemphigoid

130
Q

Murberry molars and Hutchinson’s incisors are related to

A

syphilis

131
Q

Primary herpes what time of tissue is it on?

A

keratinized AND non-keratinized

*must be both

132
Q

Recurrent herpes tissue?

A

keratinized

133
Q

Happens acutely onset?

A

erythema multiforme

134
Q

Crohn’s disease-same ulcerations in colon can appear in the

A

mouth thus oral ulcerations

135
Q

hemangioma aka

A

vascular malformation

Oral Pathology 1/2/16 (11 decks)

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