midterm3

Question 1

most common benign “tumor” of oral cavity. Reactive hyperplasia (not neoplasia) of fibrous CT in response to local irritation or trauma. Most commonly seen along bite line. Grows as long as you keep trauma on it. Normal colored, sessile (non-mobile), bump. TX: cut it out, get it biopsied

Answer 1

Fibroma

Question 2

Fibrous CT tumor, not associated with chronic irritation. Predilection for gingiva. (retrocuspid papilla: is bilateral and behind mandibular canines). Have a papillary surface. Occurs at younger age

Answer 2

Giant cell fibroma

Question 3

tumor-like hyperplasia of fibrous CT. Epulis Fissuratum is name for IFH associated with flange of ill-fitting denture. Usually develops on facial aspect of alveolar ridge. TX: surgical excision and remake denture

Answer 3

Inflammatory Fibrous Hyperplasia

Question 4

reactive tissue growth that develops under a denture (from bacteria: wearing the denture 24/7). Typically occurs on hard palate. Asymptomatic erythemous tissue with a pebbly or papillary surface. TX: remove denture, antifungal, excision

Answer 4

Inflammatory Papillary Hyperplasia

Question 5

not a true granuloma. Reactive lesion to local irritation or trauma (poor oral hygiene). Most common on gingiva (75%), then lips, tongue, buccal mucosa. Children and young adults. Typically pedunculated, lobular mass, that is red, ulcerated, and bleeds easily. Frequently in pregnant women (pregnancy tumor).

Answer 5

Pyogenic Granuloma

Question 6

reactive lesion cause by local irritation or trauma. Occurs exclusively on gingiva or edentulous alveolar ridge. Blue, purple, red. May produce “cupping” resorption of underlying bone. 10% recur after excision. Average age is 35

Answer 6

Peripheral Giant Cell Granuloma

Question 7

exclusively on gingiva. Pink (normal color), or pale and hard. Average age is 15. 2/3 in females.50% in incisor/cuspids area. 15% recur

Answer 7

Peripheral Ossifying Fibroma

Question 8

benign tumor of fat. Most common mesenchymal (non-epithelial) neoplasm. Soft smooth nodular mass. Yellow or mucosal colored. 50% in buccal mucosa. Older than 40. Floats in formalin.

Answer 8

Lipoma

Question 9

Traumatic neuroma (proliferation of neural tissue after injury [not neoplasm], common in mental foramen area, 1/3 is painful. TX surgical excision) Palisading encapsulated neuroma (benign neural tumor)

Answer 9

Neuroma

Question 10

benign neural tumor of Schwann cell origin. Slow growing encapsulated nerve tumor. Tongue is the most common origin. Bilateral Schwannoma is characteristic of neurofibromatosis type 2(chromosome 22, AD) Antoni A: spindle shaped Schwann cells organized (palisading) around verocay bodies- eosinophils. Antoni B: disorganized

Answer 10

Schwannoma

Question 11

most common type of peripheral nerve neoplasm. Can arise as solitary tumor or be a component in neurofibromatosis. Slow growing, soft, painless lesion. Tongue and buccal mucosa. Evaluate for neurofibromatosis.

Answer 11

Neurofibroma

Question 12

• Type 1: hereditary condition, termed von Recklinghausen’s disease of skin. Plexiform variant of NF is pathognomonic (feels like a bag of worms), most common NF. DX (2 or more) 1) six or more café au lait macules (big milk colored coffee macules. “c

Answer 12

Neurofibromatosis (Types 1 & 2):

Question 13

narrow face with thick lips, marfinoid limb structure. Bilateral neuromas of the commissural mucosa. 50% develop pheochromocytoma (adrenal gland tumor), 90% get medullary carcinoma of the thyroid gland. Also tumors of parathyroid, pituitary, pancreas.

Answer 13

Multiple Endocrine Neoplasia, Type 2B

Question 14

rare pigmented lesion, usually occurs in first year of life. More common in anterior maxilla. Black/blue. High urinary levels of vannillylmandelic acid. Benign.

Answer 14

Melanotic Neuroectodermal Tumor of Infancy

Question 15

most common tumor of infancy. More common in white females. 60% on head or neck. Capillary (red and does not blanch) or cavernous (red to purple, blanches)

Answer 15

Hemangioma

Question 16

not genetic developmental condition. Born with a dermal capillary vascular malformation known as “port wine stain” or “nevus flammeus”. Unilateral distribution along segments of the trigimenal nerve (not all that have this have disease). Involvement of opthalamic segment more likely to have the disease. Pts have leptomeningeal angiomas. Typically associated with a convulsive disorder (think phenytoin-drug induced gingival hyperplasia). May result in retardation and contralateral hemiplegia.

Answer 16

Sturge-Weber-Angiomatosis

Question 17

benign tumor of lymphatic vessels. Capillary, cavernous (mouth), or cystic (neck). Younger patients get diagnosed (under 2) common on anterior 2/3 of tongue (macroglossia) resembles frog eggs or tapioca pudding.

Answer 17

Lymphangioma

Question 18

benign smooth muscle tumor. Common in uterus, GI, skin. 75% of oral cases are vascular variant. Asymptomatic, firm mucosal nodule. TX: Excision

Answer 18

Leiomyoma

Question 19

(malignant counterpart): 60% of soft tissue sarcomas of childhood. Skeletal muscle. Face and orbit and males common. Painless, infiltrative mass that grows rapidly. Tx. Surgery and chemo

Answer 19

Rhabdomyoma

Question 20

may spread by lymphatics, from lower part of body is probably blood borne. Bratson’s plexus: valve-less vertebral venous plexus that allows retrograde spread bypassing lungs. Gingiva is most common site for soft tissue (50%), then tongue (25%). Nodular hyperplastic growth. Carcinomas rather than sarcomas.

Answer 20

Metastases to oral soft tissues

Question 21

decreased in volume of RBCs. Often a sign of underlying disease. Symptoms: tired, headache, fainting/lightheadedness, pallor. Oral symptoms: pallor, bald tongue, burning/pain on tongue.

Answer 21

Anemia

Question 22

decreased platelet count. Decreased production, increased destruction of sequestration in spleen. No clinical symptoms until under 100k, small capillaries leak (small=petechiae, ecchymosis, hematoma)- Thrombotic Thrombocytopenia pupura (ttp): endothelial damage causes a serious coagulation disorder. Bad news- refer to physician- Idiopathic thrombocytopenia pupura (itp): classically after a viral infection, resolves in 6 months

Answer 22

Thrombocytopenia

Question 23

enlargement of tissue due to infection. Lymph nodes, weldeyer’s ring, or any lymphatic tissue. Acute: enlarged, tender, soft, freely movable nodules. Chronic: enlarged, non-tender, firm, freely movable nodules. Look for symmetry (might be normal). Posterior lateral tongue is commonly bilateral.

Answer 23

Lymphoid Hyperplasia

Question 24

hematopoietic stem cell derivation: proliferated in bone marrow. Acute: aggressive and lead to death in a few months if untreated. Chronic is more indolent. Myeloid or lymphoid. CML associated with 9/22 translocation (Philadelphia). Environmental factors like: pesticides, benzene, ionizing radiation, HTLV-1 virus. ALL more common in children. CLL most common. Pts have decreased 02 carrying capacity, bruise easily. Boggy, ton-tender pus filled swelling in mouth.

Answer 24

Leukemia

Question 25

antigen presenting cells- dendritic mononuclear cells found in epidermis, mucosa, lymph nodes, and bone marrow. Eosinophilic granuloma of bone: one or multiple lesions, no visceral involvement. Acute disseminate histiocytosis: visceral involvement, mostly in infants, (letterer-siwe disease). Chronic disseminate histiocytosis: bone skin and viscera (hand-schuller-christian disease). Pain and tender bone lesions in skull, ribs, vertebrae, and mandible (15%). XRAY: sharply demarcated punched out radiolucency, mandibular lesions appear scooped out, teeth look like they are “floating in air”.

Answer 25

Langerhan’s Cell Histiocytosis

Question 26

malignant lymphoproliferative disorder. Neoplastic cells are reed-sternberg cells (typically binucleated). Linked to EBV. 75% occur in cervical or supraclavicular nodes. Bimodal age (15-35 and 50+). Persistently enlarging, nontender, discrete mass, in lymph node region, early they are movable but late are more secure. Nodular lymphocyte is more dominant and Classical has 5 histio subtypes. 15 years post tx mortality likely due to complications of tx.

Answer 26

Hodgkin’s Lymhoma

Question 27

malignancy of plasma cell origin. If metastatic disease is excluded this accounts for 50% of malignancies. Symptoms result from uncontrolled proliferation of cells and protein products- bone pain, most common is spine) Average age is 65. Most common hematologic malignancy in African Americans. XRAYS: multiple well defined punched out RL, may be ragged, may be evident on skull film. Renal failure from excess proteins: termed bence jones proteins. Bisphosphonates given to reduce fractures

Answer 27

Multiple Myeloma

Question 28

“marble bone disease” increased density of bone, defect in remodeling caused by a failure of normal osteoclast function. Marrow failure (infantile), frequent fractures (nutrients go away). Really white radiograph. Adult is mild and have long term survival. Infantile does not

Answer 28

Osteopetrosis

Question 29

clavicle hypoplasia. Short stature, frontal bossing, ocular hypertelorism, broad nose, supernumerary teeth, prolonged retention of primary teeth.

Answer 29

Cleidocranial Dysplasia

Question 30

area of hematopoietic marrow that produces a radiolucency. NOT pathology but looks like one. Typically asymptomatic, ill-defined borders with central trabeculations. Most common in adult females

Answer 30

Focal Osteoporotic Bone Marrow Defect

Question 31

Hardening of bone with no known cause (not by a massive restoration). Arise in teenage years and stays static. XRAY: well definied, elliptical/round RO, usually associated with root apex, NO RL rim, 2-3mm. Biopsey only if continued growth , symptoms, expansion.

Answer 31

Idiopathic Osteosclerosis

Question 32

abnormal resorption and deposition of bone, bone pain common, weakened bones. Older people, more males. Forms near joints and promotes osteoarthritic changes (joint immobility). Increases circumference of skull (hat/denture doesn’t fit anymore). More common in max (enlargement of middle 1/3) than mand. XRAY: patchy sclerotic areas, cotton roll appearance, hypercementosis. Pts have elevated serum alkaline phosphatase with normal calcium and phosphorus levels. Tx: NSAIDs and bisphosphonates. Can cause an osteosarcoma.

Answer 32

Paget’s Disease of bone

Question 33

considered non-neoplastic lesion (plateaus). Most common in anterior jaw and crosses midline. Most are asymptomatic. XRAY: not diagnostic, RL multi or unilocular, well delineated, non-corticated margins. Tx: curettage with 20% chance of regrowth. Good long term prognosis, no chance of metastasis

Answer 33

Central Giant Cell Granuloma

Question 34

AD. Bilateral involvement of posterior mandible (chubby cheeks), eyes turned up to heaven (wide rim and stretched skin). Ages 2-5. After puberty it slowly recedes. XRAY: multilocular, expansile, RL, usually bilateral. Unpredictable prognosis: may go away, may have complications.

Answer 34

Cherubism

Question 35

scalloped radiograph with clinical picture of empty cavity. Benign empty or fluid filled space. Not a true cyst due to no epithelial lining. Trauma and hemorrhage theory. Frequently in mandible of teens. Curettage to fill up with blood

Answer 35

Traumatic Bone Cyst

Question 36

full of spongey material (CT) and blood. Not a true cyst. In mandible of 20 y/o. XRAY: RL with marked cortical expansion and thinning. Usually unilocular, variable borders, described as blow out or ballooning distension (of posterior inferior mandible) . “Blood soaked sponge”

Answer 36

Aneurysmal Bone Cyst

Question 37

tumor like condition, bone gets replaced with fibrous CT interspersed with bone. Sporadic condition resulting from a postzygotic mutation. Tends to stabilize at skeletal maturation. Orange peel on xray1) Monostotic: one bone. 80% of cases. Teenage jaws. “ground glass” RO, results from superimposition of poorly calcified bone in disorganized fashion. Margins blend into rest of bone. Maxilla leads to obliteration of maxillary sinus.2) Polyostotic: more than 1 bone. • Jaffe-Lichtenstein: Café au lait (coast of maine-ragged)• McCune Albright syndrome: café au lait (coast of maine), multiple endocrinopathies, sexual precocity, pituitary adenoma, and or hyperthyroidism.

Answer 37

Fibrous Dysplasia

Question 38

occurs in tooth bearing areas of jaws. 1) Focal cemento-osseous dysplasia: single site of involvement. 90% in females. About 40 years old. Posterior mandible lesion smaller than 1.5 cm. XRAY: RL to RO (usually mixed), thin RL rim, well defined. 2) Periapical cemento-osseous dysplasia: involves periapical area of anterior mandible. Multi focal. PDL stays intact (lesion doesn’t fuse with teeth). Mainly women, blacks. XRAY: circumscribed areas of RL involving apex of tooth, progress to mixed RL and RO, end RO with RL rim. 3) Florid cemento-osseous dysplasia: multiple focal involvement, not limited to anterior mandible. Females and blacks. Bilateral and symmetrical. Same maturation as before

Answer 38

Cemento-osseous Dysplasia

Question 39

true neoplasm (unlimited growth potential) composed of fibrous tissue that contains a variable of bone and cementum. XRAY: well defined, typically unilocular, mixed RL-RO, affects the roots (resorption), characteristic downward bowing of the inferior cortex of the mandible. Easily enucleated.

Answer 39

Ossifying Fibroma

Question 40

rapidly growing, well-circumscribed, RL with central RO. More in males, and maxillary. 2 types: trabecular and psammatoid

Answer 40

Juvenile (Active) Ossifying Fibroma

Question 41

benign tumors of mature bone (look like tori). Surface of bone or within medullary bone. Pain, swelling, sinusitis, or nasal discharge. In compact bone RO, in cancellous it’s mixed. XRAY: circumscribed masses, exhibit continued growth

Answer 41

Osteoma

Question 42

bowel polyps (develop during teenage years, will become adenocarcinoma- get removed as they come up), skeletal abnormalities (osteomas common), dental abnormalities (supernumerary teeth, impacted, odontomas), epidermoid cysts

Answer 42

Gardner Syndrome

Question 43

closely related benign bone tumors. Arise from osteoblasts. Non-tooth bearing areas. • Osteoblastoma (2-4 cm, pain, tenderness, and swelling, aspirin does not relieve pain (too big). XRAY: RL with varying degrees of central RO• Osteoid osteoma: nocturnal pain, relieved by aspirin. Well circumscribed, RL defect, less than 2 cm (usually about 1 cm), small RO nidus resulting in a target like appearance.

Answer 43

Osteoid Osteoma/ Osteoblastoma

Question 44

75% arise in premolar area of mandible. Typically before age 30 with pain and swelling. XRAY: RO mass fused to roots, outline of root/roots is obscured, surrounded by thin RL rim.

Answer 44

Cementoblastoma

Question 45

mesenchymal malignancy. Excluding hematopoietic neoplasms (leukemia, Langerhans ect) it is the most common type of malignancy to originate within bone. Intramedullary, juxtacortical, or extraskeletal (soft tissue). Bimodal: between 10-20 and above 50. Most common in distal femur or proximal tibia. Mandible is more common in posterior and maxillary is more common inferior (palate alveolar ridge, (not eyes)). XRAY: ill defined border, spiking resorption (root resorption causes narrowing), classic sunburst appearance, triangle elevated periosteum (codman’s triangle), early finding is symmetrical PDL widening.

Answer 45

Osteosarcoma

Question 46

metastatic cancer is most common form of cancer involving bone. Most common origin for gnathic mets: Females: breasts and lungs, males: lung and prostate. Numb chin syndrome: metastasis involves inferior alveolar nerve. XRAY: ill-defined borders (“moth eaten”), widening of PDL, Some may stimulate new bone formation (mixed RL-RO)

Answer 46

Metastatic Tumors to Jaws

Question 47

cyst that originates from the separation of the follicle from the crown of an uninterrupted cyst. Fluid accumulates between reduced enamel epithelium and tooth crown. Most common developmental cyst. Most often in 3rd molars. Can grow to considerable size and expand bone. XRAY: unilocular RL associated with crown of uninterrupted cyst. TX: enucleate along with tooth

Answer 47

Dentigerous Cyst

Question 48

soft tissue analog of dentigerous cyst. Soft translucent swelling in the gingiva mucosa overlying the crown of an erupting tooth. Surface trauma results in blood (blue/black).

Answer 48

Eruption Cyst

Question 49

30% recurrence rate. Associated with a syndrome. Arise from cell rests of the dental lamina. Posterior mandible, tend to grow in anterior-posterior direction. Does not cause bone expansion. XRAY: smaller lesions: well-defined, unilocular RL with corticated margins. Larger: multilocular. Cheese like filling- pop like a pimple. Friable margins, test for Gorlin’s syndrome. Palisading basal cell layer on histo, made from parakeratin. (orthokeratinizeed odontogenic cyst is irtho and no palisading layer)

Answer 49

Odontogenic Keratocyst

Question 50

AKA Gorlin’s syndrome. Chromosome 9 PTCH gene. Multiple basal cell carcinomas (around puberty on skin not associated with sunlight), odontogenic keratocycts, calcification of the falx cerebri, rib anomalies,

Answer 50

Nevoid Basal Cell Carcinoma Syndrome

Question 51

soft tissue counterpart of lateral periodontal cyst. Derived from rests of serres. Predilection for mandibular canine and premolar region. Facial gingiva or alveolar mucosa, painless domelike swellings which are less than 5mm.

Answer 51

Gingival Cyst of the Adult

Question 52

intrabony counterpart of gingival cyst of the adult. Predilection for mandibular canine-premolar-lateral central area. XRAY: well circumcised lesion on lateral root surface, multilocular/grape like. Teeth are vital

Answer 52

Lateral Periodontal Cyst

Question 53

AKA Gorlin’s cyst. 65% are in incisor/canines. Mx=md. Average age 35. XRAY: unilocular, well defined RL with calcified flecks. 1/3 in unerrupted tooth

Answer 53

Calcifying Odontogenic Cyst

Question 54

buccal aspect of mandibular first permanent molar. 1/3 is bilateral. XRAY: well circumscribed, unilocular radiolucency involving buccal bifurcation. 1.5 cm. root apices are tipped toward the lingual mandibular cortex. Perio probing reveal pocket formation on buccal aspect (enamel extension)

Answer 54

Buccal Bifurcation Cyst

Question 55

most common clinically significant odontogenic tumor. Conventional solid or multicystic (85%), unicystic (15%), peripheral (1%). Equal prevalence from 3-7 decade. 85% in mandible (molar ascending ramus area). Can grow to grotesque sizes. XRAY: “soap bubble” when RL loculations are large. “Honeycombed” when they are small. Buccal and lingual cortical expansion is present. Resorption of roots common. 6 different patterns. (desmoplastic ameloblastoma does not share features with the other forms: predilection for anterior maxilla, mixed RO-RL, due to osseous dysplasia) palisading and reverse polarity on Histo. Tx. Simple enucleation and curettage to en bloc resection.

Answer 55

Ameloblastoma

Question 56

young patients (10-20) Anterior jaws, mx>md, Asymptomatic and discovered during xray to see why tooth hasn’t erupted. 75% of time it’s a circumscribed unilocular RL involving the crown of an unerrupted tooth (most often canine). XRAY: fine snowflake calcifications (helps ddx from dentigerous). Enucleation easy.

Answer 56

Adenomatoid Odontogenic Tumor

Question 57

AKA pindborg cyst. M=F, md>mx, posterior>anterior. Older aged. Painless slow growing swelling. XRAY: uni or multilocular, margins are scalloped and well defined, corticated or ill-defined, frequently associated with impacted tooth, calcifications around crown in “driven snow” pattern. Amyloid like ECM, congo red, green under polarized light. Calcifications with concentric rings in the amyloid like areas (liesgangs ring).

Answer 57

Calcifying Epithelial Odontogenic Tumor

Question 58

Most common odontogenic tumor. (most common clinically significant is ameloblastoma). Developmental abnormality (hamartomas) rather than true neoplasm. Compound (multiple, small tooth like structures) and complex (conglomerate mass of enamel and dentin, bears no anatomic resemblance to a tooth.) Average age 15. Completely asymptomatic. Discovered when XRAY taken to see why tooth hasn’t erupted. Compound more common in anterior maxilla. Complex more common in molar region. Tx. excision

Answer 58

Odontoma

Question 59

2 or more ectodermal anatomic structures fail to form. Skin, hair, nails, teeth, sweat glands. Best known is hipohidrotic ectodermal dysplasia. X linked, male prevalence, fine sparse hair. Small pointy teeth.

Answer 59

Ectodermal Dysplasia

Question 60

genetically determined skin lesion (genodermatosis). AD. Defect in keratins 4,13. Lesions appear at young age/birth. Symmetrical thickened white corrugated diffuse papules on the bilateral buccal mucosa. Benign asymptomatic with no treatment. Biopsy to check

Answer 60

White Sponge Nevus

Question 61

rare. Freckle like lesions of hands, perioral skin, and oral mucosa, and anus. Intestinal polyps (not malignant). Predisposition for affected people to get cancer (18x). Intestinal blocking due to intussusception (telescoping of the proximal segment of the bowel into the distal portion). Monitor for intussusception and cancer.

Answer 61

Peutz-Jeghers Syndrome

Question 62

Facial angiofibromas (multiple smooth surface papules occurring primarily on nasolabial fold area). Ungual fibromas (same as angiofibromas but around the nails). Shagreen patches (CT harmartomas- is a benign (noncancerous) tumorlike malformation made up of an abnormal mixture of cells and tissues found in areas of the body where growth occurs). Ash-leaf spots (ovoid areas of hypopigmentation), tubers (75%), seizure (75%- think phenytoin and gingival hyperplasia), mental retardation. Rarely see rhambomyoma (heart tumor), angiomyolipoma (kidney). Developmental enamel pitting on anterior permanent teeth, fibrous oral papules.

Answer 62

Tuberous Sclerosis

Question 63

oral lesions are first to show and last to go. Autoantibodies directed at desmosomes. (cell to cell), result in a split in epithelium. Ulcers in oral tissue and other epthelium. Skin lesions are flaccid bullae that rupture quickly (rupture when speaking or eating in mouth). Get sepsis without tx. Positive Nikolsky sign (firm lateral pressure causes bullous, spraying air separates tissue. Direct immunofluorescence is positive for c3 and IgG between epitheliual layers. Indirect immunofluorescence correlates with disease activity. Systemic corticosteroids and immunosuppressive drugs. 75% have long term resolution (hayley-hayley disease: familial localized pemphigus)

Answer 63

Pemphigus Vulgaris

Question 64

oral vesicles that rupture, but able to see before rupture. Intraoral blood blister is pathognomonic. Oral lesions dont scar. Up to 25% ocular involvement, conjunctiva becomes inflamed and attempt of healing lead to scarring. Adhesions called symplepharons develop. Scarring turns eyelids in (entropion), closes lacrimal glands, keratin deposits.

Answer 64

Benign Mucous Membrane Pemphigoid

Question 65

blistering, ulcerative mucocutaneous condition of uncertain etiopathogenesis (likely immune related). 50% of cases clinician can identify a preceding infection (herpes simplex or mycoplasma pneumoniae) or exposure to a medication (abx or analgesics). EM minor, EM major (stevens-johnson syndrome) and toxic epidermal necrolysis (lyell’s disease). Acute onset with wide spectrum. Acute=oral lesions (erythemous patches that undergo necrosis and ucerate)[ entire oral cavity except gingiva and hard palate), chronic = all lesions (flat round red w necrotis center (bulls eye)). 20-30. Prodromal: fever, headache, cough, sore throat 1 week before onset. TX. Take off causing drug, antivirals for herpes, IV fluids. (steroids for minor and major but NOT TEN), Ten in burn unit.

Answer 65

Erythema Multiforme

Question 66

erythema multiforme major. Triggered by drug, skin, oral mucosa, and either ocular or genital mucosa involvement.

Answer 66

Steven-Johnsons

Question 67

most severe form. Almost always triggered by drug. Diffuse sloughing, older people, more females, if survive 2-4 weeks heal time.

Answer 67

Toxic epidermal necrolysis

Question 68

common chronic dermatologic disease from medications, amalgam, ect. Female middle aged adults. 1% of population. Skin lesions (purple, pruritis (itchy), polygonal, papule (raised)) too painful to itch, have thin lacelike network of lines called wickham’s straie. Drug induced on lower lip as non-healing ulcers. • Reticular: much more common, asymptomatic, involves posterior buccal mucosa bilaterally, (wickhams straie), if on tongue It's plaque like, lesions wax and wane. No need to biopsy• Erosive: symptomatic, atrophic, erythematous area with central ulceration. If confined to gingiva it’s called desquamative gingivitis. Biopsy. 28% have vaginal ulcer. Ulcers induced by stress, trauma, Advil (nsaid), yeast (STAY)

Answer 68

Lichen Planus

Question 69

30. F. immune mediated, collagen vascular or CT disease. Weight loss, arthritis, fatigue, maylar rash (butterfly, sunlight worsens it). Kidneys affected in 50%. Cardiac issues (pericarditis, warty vegetations on valves called libman-sacksendocarditis). 40% get lichenoid like oral lesions. • Chronic cutaneous lupus erythemous: lesions on skin and mucosal surface. Begin as scaly erythematous patches on sun exposed skin, especially head and neck. Heal and recur. Leads to atrophy, scarring, and altered pigmentation. Oral lesions resemble lichen planus• DIF of clinically normal skin will show IgM, IgG, or C3 at the Basal membrane zone (positive lupus band test). 90% have antinuclear antibodies. Give antimalarial drugs (may give blue palate)

Answer 69

Lupus Erythematosis

Question 70

dense collagen is deposited in the tissues of the body in extraordinary amounts. F. disease of adults. Raynauds phenomena (vasoconstrict to emotional distress or cold- tips of fingers are pale and tingle like funny bone). Resorption of terminal phalanges and flexion to make claw-like fingers. Vascular events and collagen depositon contribute to fingernail lesions. Skin develops hard diffuse smooth surface. Subcutaneous collagen deposition make face taught and masklike. Fibrosis of lung, heart, kidney, GI tract. Microstomia. Xerostomia. Localized scleroderma-en coup de sabre. Waxes and wanes.

Answer 70

Systemic Sclerosis

Question 71

women in their 60s. monitor for pulmonary hypertension• Calcinosis cutis: multiple, movable, nontender, subcutaneous, nodular calcifications• Raynauds phenomena: severe blanching of fingertips when in cold. Turn blue. Red.• Esophageal dysfunction: abnormal collagen deposition in esophageal submucosa• Sclerodactyly: fingers stiff, skin shiny, claw deformation, abnormal collagen deposition in dermis• Telengectaisis: scattered red papules. Blanch. Vermillion zone of lips and facial skin. Bleeding

Answer 71

CREST Syndrome

Question 72

deposition of extracellular, proteinaceous substance called amyloid. Cause of macroglossia. Organ-limited (rarely seen in oral cavity, amyloid nodule [solitary, asympt, submucosal deposit], no association with any systemic condition), systemic- primary and myeloma associated (older adults, M, 20% due to multiple myeloma, carpals tunnel, mucocutaneous, hepatomegaly, smooth firm waxy nodules, eyelid, neck, lips.), systemic-secondary (result of chronic inflammatory process such as TB/sarcoidosis/osteomyelitis, spares heart but affects liver, kidney, spleen), systemic-hemodialysis associated (secondary, protein not removed by dialysis so it accumulates, then deposits into bone and joint, systemic-heredofamilial (uncommon AD, polyneuroopathies, heart issues and kidneys) most pts die from cardiac failure/ arrhythmia/ renal disease in a few years.

Answer 72

Amyloidosis

Question 73

(retinol): essential for vision. May lead to blindness.

Answer 73

• Vitamin A

Question 74

thiamin): maintain proper functioning of neurons. Beriberi

Answer 74

• Vitamin B1

Question 75

riboflavin): necessary for cellular oxidation-reduction reactions. Oral alterations like angular cheilitis, glossitis.

Answer 75

• Vitamin B2

Question 76

niacin): acts as a coenzyme for oxidation-reduction reactions. Pellagra= dermatitis, dementia, diarrhea.

Answer 76

• Vitamin B3

Question 77

pyridoxine): cofactor associated with enzymes that participate in amino acid synthesis.

Answer 77

• Vitamin B6

Question 78

ascorbic acid): necessary for the proper synthesis of collagen. Scurvy

Answer 78

• Vitamin C

Question 79

considered a hormone, necessary for calcium absorption from the gut. Rickets, Osteomalacia.

Answer 79

• Vitamin D

Question 80

α-tocopherol): antioxidant.

Answer 80

• Vitamin E

Question 81

necessary for proper clotting (needed in clotting factors II,VII, IX, X). Coagulopathy because of inadequate synthesis or prothrombin.

Answer 81

• Vitamin K

Question 82

• Most common cause of anemia in the U.S and the World• Develops from excessive blood loss, increased demand for RBC’s, decreased uptake of iron, decreased absorption of iron.• 20% women of childbearing years (menorrhagia) from chronic blood loss.• Oral manifestations: angular cheilitis, atrophic glossitis (bald tongue)• Laboratory finding: hypochromic microcytic RBC’s

Answer 82

Iron-deficiency Anemia

Question 83

Iron deficiency anemia, glossitis, dysphagia. Associated with a high frequency of oral and esophageal squamous cell carcinoma. Premalignant process. Burning in mucosa, angular cheitis, smooth, red tongue. Esophagus shows abnormal bands of tissues termed esophageal webs. Brittle, spoon shaped nails. Tx: iron pills, track for cancer (50%).

Answer 83

Plummer-Vinson Syndrome

Question 84

• Megaloblastic anemia• Caused by poor absorption of cobalamin (Vitamin B12, extrinsic factor)• Most patients lack intrinsic factor because of autoimmune destruction of the parietal cells of the stomach, which results in decreased absorption of cobalamin.• Oral manifestations: atrophic glossitis- beefy red tongue

Answer 84

Pernicious Anemia

Question 85

• Increased production of growth hormone, usually related to a functioning pituitary adenoma.o Takes place before the closure of the epiphyseal plates- teenagero Oral finding: generalized macrodontia (big teeth)

Answer 85

Gigantism

Question 86

• Excessive production of growth hormone after the closure of the epiphyseal plates• Increased growth of mandible (prognathism) with diastema formation, macroglossia

Answer 86

Acromegaly