Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

BDS4 Oral medicine > One doc oral med > Flashcards

One doc oral med Flashcards

1
Q

Give 5 signs and symptoms of TMD (5 marks)

A

Headaches, Ear pain, Muscle pain, Joint pain, Trismus, Clicking or popping noises, Crepitus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Give 5 aspects of causative advise for TMD (5 marks)

A
  • Soft diet
  • Stop parafunctional habits e.g. nail biting,
  • Support mouth upon opening e.g. yawning,
  • Relaxation e.g. physiotherapy,
  • Don’t incise foods,
  • Chew bilaterally,
  • Cut food into small pieces,
  • No wide opening,
  • No chewing gum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Dawn is a final year university student and is a regular attender at your practice. She presents in the Easter holidays complaining of difficulty opening her mouth widely, facial pain and jaw clicking when chewing food. You suspect she has temporomandibular joint dysfunction syndrome.
What information could be elicited from your clinical examination in relation to your suspected diagnosis? (5)

A

Range of movement, TMJ clicking/crepitus, MoM hypertrophy, Tenderness on palpation
Intra-oral - intercisial opening distance (measure), Signs of bruxism, Wear facets, Scalloped tongue, Linea alba

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What factors could predispose to temporomandibular dysfunction? (2)

A
  • Female>Males,
  • 18-30yrs,
  • Stress,
  • Habits - chewing gum
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Having conducted your examination, you confirm the diagnosis of temporomandibular dysfunction. What would your first line of management be? (5)

A
  • Counselling,
  • Reassurance,
  • Soft diet,
  • Mastication on both sides,
  • Avoid wide mouth opening,
  • Stop habits: avoid chewing gum,
  • Cut food in small pieces
  • Splint therapy - Hard splints: michigan (bite raising appliance)
  • Joint therapy - Acupuncture,
  • Physiotherapy,
  • Relaxation therapy
  • Medication - Ibuprofen, Paracetamol, Muscle relaxants - tricyclic antidepressants
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Are there any other conditions that might present with similar signs/symptoms and how might you exclude these? (2

A
  • Myofascial pain syndrome: no clicky,
  • Pericoronitis of L8: no clicky
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

You decide to construct a stabilisation splint. As your technician is unsure what this is, describe how you would like your splint made. (6)

A
  • Cover all teeth,
  • Hard acrylic,
  • full occlusal coverage,
  • Upper and lower alginates,
  • face bow registration required,
  • Requires to be ground in both in the lab and clinically to achieve maximum bilateral intercuspation,
  • Wear facets,
  • Sloping canine guide plane
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

A 48-year-old male patient presents for the first time in your practise. He is otherwise fit and healthy and takes no medications. He also wears a complete upper denture which is 9 years old.
What is noticeable about the patient’s palatal tissue? (2)
What diagnosis would you make? (1)

imagine pic..

A

Erythematous, Papillary hyperplasia

Denture induced stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What would be your first line of treatment for denture induced stomatitis? (2)

A
  • Denture hygiene advice including cleaning,
  • Tissue conditioner on the fitting surface of the denture
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

If this condition (denture induced stomatitis) persisted, what would be the next line of treatment you would pursue? (1)

A

Appropriate antifungal treatment (fluconazole)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

You decide to make a new denture. What instructions would you give to the lab technician regarding the construction of the upper special tray for the new master impression? (1)

A

Please construct an upper special tray with a 2mm wax spacer, intra-oral handles, non-perforated, intra-oral finger rests in light cure PMMA

(3mm???)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

This is a photograph of a slide prepared from a biopsy taken from a 58-year-old man with a (something, I’ve cut it off, any ideas?) palate
What is layer A formed from? (1)

layer A = keratin

A

Keratin is formed from the basal layer

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What type of epithelium can you see in this picture? (1)

A

Keratinised stratified squamous epithelium

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the brown pigment at B?

A

melanin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Describe the lesion clinically based on what you can identify in the slide. (2)

A

White area/patch with some areas of brown/grey colour.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Name two possible aetiological factors for the development of this lesion. (2)

White area/patch with some areas of brown/grey colour.

A

Smoking, Chronic inflammation, Drugs - hydroxychloroquine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Using the photograph, how would you assess if the lesion was potentially malignant (1)

melanin

A

Hyperchromatism and atypia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What features in the clinical appearance would make you highly suspicious that the lesion was potentially malignant? (1)

A

Exophytic growth, Raised rolled margins, Indurated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

A patient presents for a regular check-up when you notice a lesion that is white and lacey in appearance in the left buccal mucosa.
What is your diagnosis? (2)

A

Lichenoid tissue reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What made you arrive at this diagnosis and how does this condition occur? (2)

lichenoid tissue reaction

A

As the lesion is adjacent to a large amalgam restoration, Type IV hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Name TWO types of biopsy you could carry out to further investigate this lesion (2)

lichenoid tissue reaction

A

Incisional biopsy (punch), Fine needle aspiration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Name FOUR histological features of this condition (4)

lichenoid tissue reaction

A
  • Keratinisation,
  • “Hugging” band of lymphocytes,
  • Basal cell liquefaction,
  • Apoptosis,
  • Sawtooth rete pegs
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Candida Infection. You would be provided with one picture showing redness at the corner of the mouth. Diagnosis of this disease. (1)

A

Angular cheilitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Name 2 microorganisms involved in this condition. (2)

angular cheilitis

A

Staphylococcus aureus​, ​candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What microbiological sampling method should you ask for? (1)

angular cheilitis

A

swab

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Name one immune deficiency disease and one gastrointestinal intestinal bleeding disease. And why are they more susceptible for this lesion. (2)

angular cheilitis lesion

A
  • HIV: impaired immune function
  • Coeliac: impaired nutrient absorption
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Name one intra-oral disease that would be associated with this? (1)

angular cheilitis

A

Oral facial granulomatosis (OFG)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Why is miconazole prescribed to patient when microbiological sampling is not available? (1)

of angular cheilitis

A

Effective against both fungi and bacterial pathogens

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

What two instructions should be given to this patient who wears a denture. (2)

A

Denture hygiene: chlorhexidine or hypochlorite
Wear as little as possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

A patient attends with inflamed gingiva extending beyond the mucogingival margin. Give a diagnosis (1 mark)

A

Desquamative gingivitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Give 1 descriptive term to describe it’s appearance (1 mark)

desquamative gingivitis

A

Erythematous, Ulcerated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Give 3 oral mucosal conditions associated with in this? (3 marks)

desquamative gingivitis

A

Pemphigus, Pemphigoid, Lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Give 2 local factors that may contribute to this (2 marks)

desquamative gingivitis

A

SLS, Plaque

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What are 2 typical treatments you could use? (2 marks)

A
  • Betamethasone mouthwash
  • Tacrolimus ointment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Pemphigus Vulgaris.
What is this method? (2)

A

Direct immunofluorescence

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What would the pathologist report with the result of the test?(3)
Diagnosis. (2)

direct immunoflorescence

A

Pemphigus vulgaris

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Reasons behind this condition? (2)

pemphigus vulgaris

A

Autoimmune: type 2 hypersensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

Name one condition that would represent the lesion in the same way clinically, but would be different histopathologically? (1)

pemphigus vulgaris

A

pemphigoid

answer says “drug induced pemphigus”

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Oral Squamous Cell Carcinoma.
This patient has a squamous cell carcinoma at the lateral border of the tongue. It is 5cm in width. There are bilateral ipsilateral lymph nodes palpated but <2cm. The presurgical examination shows that the cancer is not spread to any other structures.
List only two factors for oral squamous cell carcinoma. (2)

A

Alcohol, Smoking, HPV

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Stage tumour with the TNM system. (1)

A

T3 N2 M0

T3 N2 M0

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

How would you grade the dysplasia histopathologically? (3)

A

Hyperplasia, Dysplasia (mild, moderate, severe), Carcinoma in situ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

What interventions (medical or surgical) other than surgery could the patient have? (3)

OSCC

A

Radiotherapy, Chemotherapy, Immunotherapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

After removal of the lesion, how would you restore the function of the tongue? (1)

A

soft tissue grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Organism for denture stomatitis - picture (1)

A

Candida albicans

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

3 local factors for this (3)

denture stomatits

A

Poor OH, Wearing denture at night, Trauma, Smoking, Xerostomia, Inhaler

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

4 management options (4)

denture stomatitis

A

Chlorhexidine x2 daily (0.2%), Denture Hygiene, Tissue conditioner, Antifungals (fluconazole), Smoking cessation, Rinse after inhaler use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

What will be seen on occlusal surfaces of teeth + what could you do in short term (2)

denture stomatitis???

A

Erosion due to inhaler - rinse mouth out and F varnish

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Recurrent Aphthous Stomatitis:
Diagnose which type

A

Major, Minor, Herpetiform

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

State difference between major/minor

Recurrent Aphthous Stomatitis:

A

Minor: 1-20 ulcers, <10mm, heals in 1-2weeks, heals without scar, generally on non-keratinised mucosa

Major: Usually singular, 1-5, >10mm, heals with scar, heals within 6-12 weeks, can be found on all types of mucosa

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

Causes of recurrent aphthous stomatitis

A

Haematinic deficiency (iron, B12, folate), Trauma, SLS toothpaste, Allergy: Dietary problems & others, Anxiety & stress, Systemic disease, Menorrhoea, Chronic GI blood loss, Dietary malabsorption (Pernicious anaemia, Coeliac, Crohns), Ulcerative colitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

treatment for recurrent apthous stomatitis

A
  • Chlorhexidine: x2 daily (0.2%) 10ml,
  • Dietary avoidance (chocolate, cinnamon aldehyde, benzoates),
  • Toothpaste change (SLS-free),
  • Blood tests + correct deficiency (e.g. iron),
  • Betamethasone mouthwash (0.5mg x2-4 times daily)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Potential problems of recurrent apthous stomatits

A

Infection, Dehydration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

A patient enters your surgery and you suspect after your initial examination that they may have trigeminal neuralgia.
Describe the nature of the pain from trigeminal neuralgia (2 marks)

A

severe paroxysmal pain, worst ever, electric shock like lasting a few seconds, usually unilateral

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

The 2 most frequent causes of trigeminal neuralgia are? Name an investigation you could do into these. (3 marks)

A
  • focal demyelination of the peripheral nerve
  • trigeminal nerve compression from aberrant artery

MRI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

If the patient had Trigeminal Neuralgia due to MS or a brain tumour what symptoms might they experience? 1 for MS, 2 for brain tumour. (3 Marks)

A

MS: intention tremor/loss of proprioception
Brain Tumour: Diplopia, memory loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How could you manage this patients pain from trigeminal neuralgia? Give 1 surgical and 1 medical (2 marks)

A
  • Carbamazepine 100mg 2x daily,
  • Microvascublar decompression, Balloon compression, Gamma knife
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

What investigation/tests would you take before giving the medical management and why? (3 marks)

A

Blood tests - FBC
LFT (liver function test)
U&E - Sodium reduced, liver function reduced

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Give 3 side-effects of this medical intervention (3 marks)

carbamazepine

A

GI disturbances, drowsiness, headache, visual disturbance, facial dyskinesias, folate deficiency, hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Intra-oral manifestations of herpes?

A

Herpes labialis, Primary herpetic gingivostomatitis, Oral ulceration

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

Three causes of vesicles?

A

Erythema multiforme, Pemphigoid, Pemphigus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

2 groups that cause oral ulceration?

of viruses

A

Herpes simplex, Coxsackie virus, EBV, Varicella Zoster virus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Coxsackie oral lesions?

A

Herpangina, Hand foot and mouth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

Disorders caused by EBV?

A

Hairy leukoplakia, Glandular fever (infectious mononucleosis), Burkitt’s lymphoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How herpes labialis forms?

A

Primary infection, Latency, Reactivation (Upper = maxillary, Lower = mandibular), Secondary infection: causing a herpes labialis lesion

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
65
Q

Picture of candidosis – Diagnose (1)

A

acute pseudomembranous candidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
66
Q

2 med conditions associated with it (2)

acute pseudomembranous candiasis

A

HIV, Poorly controlled diabetes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

Swab + rinse – advantages and disadvantages of each(4)

A

Swab - Adv: site specific Dis: uncomfortable,
Rinse - Adv: quantifiable amount Dis: more difficult to standardise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

What to ask pathologist for when sending sample (1)

acute pseudomembranous candidosis

A

Culture and sensitivity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
Q

2 drug interactions and the effects

A

Warfarin and statins

need another plus effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
70
Q

Picture of apthous ulcers - Diagnose (1)

A

Minor apthous

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
71
Q

2 investigations (2)

minor apthous

A

Haematinics, FBC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
72
Q

Given values from FBC + told normal values – had to diagnose which type of anaemia (1)

A

microcytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
73
Q

2 reasons what causes microcytic (2)

A

Iron deficiency, Thalassaemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
74
Q

3 topical treatments available for apthous ulcers - not brand name (3)

A

Benzydamine, Fluticasone, Beclomethasone, Doxycycline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
75
Q

Mid age female complaining of burning mouth with diffuse erythema (1)

A

Oral dysaesthesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
76
Q

Male mid age, dull throbbing pain in maxillary region, made worse by bending over (1)

A

Sinusitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
77
Q

Unilateral episodic pain lasting up to 20 mins, nose dripping + worse when shaking head (1)

A

Chronic Paroxysmal Hemicrania

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
78
Q

Elderly + sharp shooting pain in right cheek when biting + lacrimation (1)

A

Trigeminal neuralgia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
79
Q

Temporal pain + weakness of shoulder muscles (1)

A

Temporal arteritis (accompanied by shoulder girdle weakness)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
80
Q

Denture induced stomatitis
Causes?

A

Immunosuppressed, Poor dental hygiene, Dentures worn over night, Trauma from ill fitting dentures, Xerostomia. Systemic steroids & broad spectrum antibiotics

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
81
Q

Hygiene instruction?

for denture induced stomatitis

A
  • Chlorhexidine mouthwash,
  • Soak denture x2 daily (15mins) and rinse mouth x2, + Alkaline hypochlorite/Sodium hypochlorite (10 mins CoCr, 20 mins PMMA),
  • Leave dentures out as often as possible,
  • Brush denture after every meal with soft brush (esp on fitting surface),
  • Take out at night time and leave in water overnight,
  • Brush palate daily
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
82
Q

Treatment If denture hygiene doesn’t work:

for denture stomatits

A

Antifungals (Miconazole, Nystatin),
Tissue conditioner,
New dentures: when resolved denture induced stomatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
83
Q

How to restore excessive FWS with worn dentures?

A

Occlusal pivots, Restore occlusal surface with auto-polymerising acrylic resin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
84
Q

Pigmented tongue
Local causes?

A

Smoking,
Medication - hydroxychloroquine,
Chromogenic bacteria causing black hairy tongue,
Melanoma,
Melanotic macule

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
85
Q

Pigmented tongue
Systemic causes?

A

Racial, Lead poisoning, Addison’s, Kaposis sarcoma, Haemochromatosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
86
Q

Lichen planus
Histological images

A

Keratosis, Atrophy or Hyperplasia, Lymphocyte hugging band, Lymphocyte epitheliotropism, Basal cell liquefaction, Apoptosis, Acanthosis, Saw tooth rete pegs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
87
Q

Comment on appearance of lichen planus

A

PPBREAD (Papular, plaque, bullous, reticular, atrophic, desquamative gingivitis)

(not the asked for answer??)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
88
Q

Features of disease (lichen planus)

A
  • 30-50yo
  • 1% malignant potential
  • Recurrence common
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
89
Q

Causes of lichen planus

A

Stress, Autoimmune, Idiopathic, Amalgam, SLS, Medications (NSAIDS, Anti-hypertensive, Anti-malarials, Anti-diabetics, Sulphonamides, Penicillamine)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
90
Q

Special investigations for lichen planus

A

Biopsy in: smoker, symptomatic, high risk area, Direct Immunofluorescence (DIF)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
91
Q

Treatment for lichen planus

A
  • Asymptomatic: Observe, CHX, remove cause,
  • Symptomatic: Remove cause, corticosteroids, antiseptic mouthwash
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
92
Q

Pemphigus
Histological images

A
  • Tzank cells
  • Supra-basal split: attacks the desmosomes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
93
Q

Pemphigus
Comment on appearance

A
  • Superficial blisters: clear fluid filled (on skin and mucosa)
  • Rarely intact blisters/non-specific erosions
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
94
Q

Pemphigus
Features of the disease

A

S - superficial, S - serious, S - steroids, potentially
Fatal: Protein and electrolyte imbalance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
95
Q

Causes of pemphigus

A

Autoimmune: type II hypersensitivity reaction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
96
Q

Treatment for pemphigus

A
  • Azathioprine and steroids
  • Special investigation for pemphigus
  • direct immunofluorescence.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
97
Q

Order the salivary gland tumours by incidence

A

Pleomorphic adenoma (75%), Warthin’s tumour (15%), Adenoid Cystic Carcinoma (5%) (NB most common MINOR salv gland tumour), Mucoepidermoid Carcinoma (3%), Acinic Cell carcinoma (<1%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
98
Q

What are the histological features of a pleomorphic adenoma?

A

Complete/incomplete capsule, duct-like structures, chondroid and myxomatous tissue, epithelium.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
99
Q

What histological feature is related to recurrence?

pleomorphic andenoma

A

Non/poorly encapsulated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
100
Q

What are the histological signs of Warthin’s tumour?

A

Cystic, distinct epithelium, lymphoid tissue

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
101
Q

Histology of adenoid cystic carcinoma?

A

No capsule, tubular/swiss cheese like, solid.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
102
Q

What features of a parotid swelling would make you suspicious of malignancy?

A

Firm, attached to underlying structures, fast growth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
103
Q

Describe Desquamative gingivitis (2 Marks)

A

Clinically descriptive, Erythematous shedding and ulceration which involves the full width of the gingiva

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
104
Q

Name two other conditions that you would see Desquamative gingivitis in? (2 Marks)

A

Pemphigus, Pemphigoid, Lichen planus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
105
Q

Describe how you would manage Desquamative gingivitis (4 Marks)

A
  • Change of toothpaste (SLS–free),
  • Improve oral hygiene (Plaque aggravates the lesions),
  • Topical steroids - rinse or meter dose inhaler (MDI; or Steroid cream in (gum shield),
  • Topical tacrolimus (immune modulator, rinse or cream),
  • Systemic immunosuppression if required (rarely needed)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
106
Q

Mrs Patel is a 45 year old patient who is new to your practice. She is fit and well but complains of some soreness in her right cheek which she has had for a number of years. Your examination reveals a reddened area of buccal mucosa with a white lacy edge immediately adjacent to tooth 47. This tooth is almost entirely restored with a perfectly sound amalgam and is the abutment for rest seats and clasps on a chrome/cobalt partial denture which Mrs Patel has happily worn for the past 5 years and has a bleeding 6mm mesio-buccal pocket with associated grade I mobility. A periapical radiograph of tooth 47 reveals some mesial bone loss but no periapical pathology. All the other teeth are sound or minimally-restored with composite and the partial denture is well fitting.
What are your provisional diagnoses? (4 marks)

A

Traumatic lesions, Lichenoid reaction: amalgam, Chronic periodontal disease, Lichen planus, Oral cancer: squamous cell carcinoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
107
Q

What additional investigations could be undertaken and how would you arrange these? (6 marks)

Traumatic lesions, Lichenoid reaction: amalgam, Chronic periodontal disease, Lichen planus, Oral cancer: squamous cell carcinoma

A

Incisional biopsy for histological examination, Blood tests (FBC, haematinics, auto-antibodies, random blood glucose) Referral to GMP, Clinical photography = dental hospital, Chronic perio disease: PGI, 6PPC, Patch testing: refer to dermatologist (for chrome)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
108
Q

What are Mrs Patel’s options for management of these problems? (10 marks)

Traumatic lesions, Lichenoid reaction: amalgam, Chronic periodontal disease, Lichen planus, Oral cancer: squamous cell carcinoma

A
  • Traumatic lesions: smooth or take off the clasp
  • Lichenoid reaction: amalgam replacement with composite
  • Chronic periodontal disease: HPT
  • Lichen planus: correct deficiency, medication, SLS free toothpaste
  • Oral cancer: squamous cell carcinoma (remove the suspected possible causes and see if it resolves in 3 weeks. 3 weeks review, if not resolved. Refer.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
109
Q

Arthur is a 68 year old retired mechanic who presents at your practice after an absence of 2 years. He is partially dentate in the upper and lower arch and wears upper and lower acrylic prostheses. These prostheses were well fitting when provided by you 2 years ago. He now complains that the upper prosthesis no longer fits well and is uncomfortable. On examination the upper prosthesis does not seat fully in the edentulous regions. In addition, there are numerous early to moderately deep primary carious cavities. Periodontal examination reveals no periodontal pockets greater than 3-4 mm and minimal bleeding on probing. Radiographic examination confirms no obvious peri-radicular radiolucencies. To the contrary, there are large radio-opacities in relation to the roots of several teeth. There is minimal periodontal bone loss. In relation to his medical history he says he is taking medication for Paget’s disease.
Describe the anatomical changes, pathology and incidence behind the reason why the denture no longer fits? (4 marks)

A

Paget’s is a disease causing increased bone turnover. Bone swelling occurs as a result and thus the dentures don’t fit anymore. (increased osteoclastic and osteoblastic activity.) >55yrs, M>F

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
110
Q

Why could Arthur have developed dental caries? (2 marks)

A

Polypharmacy and xerostomia in aging population, Diet and lifestyle factors - increased sugar intake, Non-fitting denture acting as plaque trap, Reduced manual dexterity for OH

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
111
Q

Account for the most likely cause of the radio-opacities on the radiograph. (1 mark)

A

Paget’s caused hypercementosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
112
Q

How are you going to manage his clinical care? Describe the treatment you would provide and treatment you would seek to avoid? (6 marks)

A

DHE & OHI (Diet, Fluoride), HPT (Scale, RSD), Caries management (excavation, RCT?), New dentures - may need to be replaced more frequently due to jaw enlargement, Regular monitoring - reassessment, Refer to specialist if complications arise

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
113
Q

You decide Arthur needs to have extraction of a lower molar which does not have a radio-opacity associated with its root and you are aware he is taking bisphosphonates. What precautions would you take when you extract the tooth? (7 marks)

A

Chlorhexidine x2 daily 1 week pre-operatively, immediately before the extractions, post-operative chlorhexidine, Maintain OH, Achieve Primary intention closure, Use an atraumatic extraction technique, Refer to a specialist if complications develop, Avoid raising flaps

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
114
Q

Name a life-threatening Vesicullo-bullous disease (1 mark)

A

Pemphigus

115
Q

Name 2 methods of testing for this disease and describe the histology of a positive result (4 marks)

pemphigus

A

Direct Immunofluorescence: chicken wire appearance, H&E staining microscopy: tzank cells, supra-basal split, acantholysis

116
Q

Describe how your management of this disease (4 mark)

A
  • Topical/systemic steroid - beclometasone inhaler/prednisolone
  • Immunomodulating drug: azathioprine, Analgesics
117
Q

Primary herpetic gingivo-stomatitis - give symptoms/signs to identify it

A

Generalised Ulceration, Blood crusted lips, Pyrexia, Treatment, Fluid and electrolyte balancing, Self limiting - 10-14 days, Rest

118
Q

Picture: generalised white plaque that scrape off easily and leave an erythematous base Diagnosis

A

Hairy leukoplakia

119
Q

Two medical conditions that we might see this in

hairy leukoplakia

A

HIV, EBV

120
Q

Advantages and disadvantages of mouth swab and oral rinse

A

Advantages: non-invasive, Disadvantages: often not diagnostic

get better answer

121
Q

What to ask pathologist for when sending sample (1)

A

serology

122
Q

Fluconazole interacts with many drugs…. Name 2 drugs and the effect the interaction would have

A

Warfarin (increased bleeding) and statins (hepatotoxicity)

123
Q

3 causes for generalised pigmentation around the mouth

A

Racial, Medication, Addisons, Smoking

124
Q

3 causes of localised pigmentation (brownish grey) in the mouth

A

Vascular malformations (Haemangiomas, Sturge-Weber), Macule/naevus, Pigmentary incontinence, Amalgam tattoo

125
Q

Name two types of haemangioma

A

Capillary, Cavernous

126
Q

What is the histological difference between them

(Capillary and cavernous haemangioma)

A
  • Capillary: groups of smaller vessels, most of which are capillaries
  • Cavernous: larger, dilated vascular spaces
127
Q

Trigeminal neuralgia
2 clinical investigations you would do

A

MRI, Blood: FBC, haematinics, blood glucose

128
Q

Trigeminal neuralgia: 2 neurological disorders that may give rise to this type of pain

A

MS, Brain tumour

129
Q

First line drug management for trigeminal neuralgia

A

carbamazepine

130
Q

What blood tests would you have to do before giving the above drug (Carbamazepine)

A

Must check: FBC, LFT, U&E’s for reduced Na (causes forgetfulness)

131
Q

2 indications for surgery for trigeminal neuralgia

A
  • Medical intervention ineffective
  • Medical intervention contraindicated
132
Q

Name one type of surgery

for trigeminal neuralgia

A

Microvascular decompression, Balloon compression, Gamma knife

133
Q

Trigeminal neuralgia. – What conditions may this be a side effect of?

A

MS or brain tumour.

134
Q

Trigeminal neuralgia: What special investigations may help your diagnosis?

A

MRI, OPT to rule out dental pain.

135
Q

What investigations should you do if you are going to use Carbamazepine?

A

FBC, Liver function test, urea and electrolytes before, during and after.

136
Q

What are the side effects of carbamazepine?

A

liver dysfunction, allergy, ataxia, nausea, sedation, nightmares

137
Q

What are 2 ways TN can occur?

A

1 ​→​ demyelination causing CNV ischaemia.
2​→​ aberrant arteriole in the cerebello-pontine region lying on the nerve

138
Q

How else can TN be managed?

A

Balloon compression ​→​ necrosis of nerve, microvascular decompression to separate blood vessel and nerve, cryosurgery, Gamme Knife, long acting bupivacaine.

139
Q

What are the indications for these types of procedure?

surgery for TN

A

Symptoms persist despite medical intervention, pts with adverse effects of medication.

140
Q

What muscles are examined in a patient with temporomandibular disorder?

A

Masseter, temporalis, (lateral pterygoid, medial pterygoid)

141
Q

What are the common causes? (TMD)

A

Stress, parafunction, occlusal discrepancies, trauma.

142
Q

What nerve supplies the TM?

TMJ?

A

auriculotemporal nerve.

143
Q

What are the signs and symptoms of TMD

A

Pain, stiffness, limited opening, click, crepitus, deviation on opening, locking, headache.

144
Q

Detail conservative management advice for TMD

A

limit mouth opening, soft diet, avoid habits e.g. nail biting, cut up food, stifle yawns, wear BRA, analgesics, warm compress, de-stress, limit posturing, stop gum chewing

145
Q

What are the mechanisms of a bite splint?

how can it help TMD

A

Minimise parafunctional habits. Minimise load on TMJ. Provide stable occlusion. Eliminate occlusal interferences.

146
Q

What is arthrocentesis?

A

Washing of the upper superior joint space of the TMJ. Carried out under LA. Solution injected in which breaks fibrous adhesion and washes away inflammatory exudate.

147
Q

Give 2 other possible surgical options for TMD

other than arthrocentesis

A

arthroscopy, arthroplasty, condylectomy, total joint replacement, high condylar shave

148
Q

What are the histological features of lichen planus?

A
  1. Keratinisation
  2. Lymphocytes/macrophages
  3. Atrophy/hyperplasia
  4. Apoptosis
  5. Basal Cell liquefaction leading to colloid bodies
  6. Blue band of chronic inflammatory cells
  7. Saw tooth rete ridges (not always).
149
Q

What are the types of lichen planus?

A

PPBREAD – papular, plaque, bullous, reticular, erosive, atrophic, desquamative gingivitis.

150
Q

What is the aetiology of lichen planus

A

Idiopathic OR LTR ​→​ drugs (NSAIDS, beta-blockers, hypoglycaemics, diuretics, anti-malarials), Hep C, amalgam, gold or SLS.

151
Q

When do you biopsy with lichen planus

A

All symptomatic, All smokers, and high risk site

152
Q

How is lichen planus managed?

A

Asymptomatic and reticular ​→​ monitor and reduce risk factor.
Others ​→​remove cause if known, topical steroids, systemic steroids, immunomodulators. Can use difflam MW and CHX MW.

153
Q

Patient has suspected trigeminal neuralgia.
What tests would you conduct before arriving at this diagnosis? (2 marks)

A
  • Performing inferior alveolar block (to rule out TMD/muscle pain)
  • MRI
  • FBC
154
Q

What drug therapy would you provide? (1 mark)

TN

A

carbamazepine

155
Q

What tests would you carry out every 3 months? (1 mark)

TN

A

Checking for any improvement, giving patient pain scale to monitor

156
Q

TN: Blood tests?

A

FBC
LFT

157
Q

TN:
When would you decide to go for surgical management? (2 marks)

A
  • No improvement of condition with carbamazepine and had been tried for substantial period
  • Medication causing side effects
  • If the patient requested it
158
Q

Give an example of surgical management (1 mark)

TN

A

balloon compression

159
Q

What are the I/O manifestations of herpes?

A

Vesicles that burst to form blisters, 1-3mm.

160
Q

Name 2 other types of human herpes virus

A

Epstein-Barr Virus (HHV4), Varicella Zoster (HHV3), HHV8 ass.w/ Kaposi’s sarcoma, Cytomegalovirus

161
Q

Which cranial nerve does herpes become associated with?

A

trigeminal

162
Q

Name the common triggers for reactivation of herpes.

A

stress, being unwell, sunlight, immunosuppression.

163
Q

What is anaemia?

A

A reduction in the oxygen carrying capacity of the blood due to a deficiency of haemoglobin or red blood cells.

164
Q

What are the general signs and symptoms of anaemia?

A

Fatigue, malaise, pallor, weakness, dizziness.

165
Q

What are the oral signs of anaemia?

A

Recurrent oral ulceration, candida, glossitis/smooth(- iron), beefy (-VitB12/folate), oral disaesthesia, mucosal pallor.

166
Q

Name the type of anaemia from MCV

A
  • Microcytic <80fL ​→​ Iron deficiency, Thalassemia
  • Normocytic 80-95fL ​→​ pregnancy, bleeding, sickle cell anaemia
  • Macrocytic >96fL ​→​ VitB12 and Folate.
167
Q

What are the causes of xerostomia?

A
  • Local: Mouth breathing, Candida, Alcohol, Smoking, Sialolith
  • Salivary gland diseases: Sjogren’s, CF, HIV, Sarcoidosis, Amyloidosis, Haemochromatosis
  • Drugs: Tricyclic Antidepressants, Antipsychotics, Antihistamines, Diuretics, Atropine, Cytotoxics
  • Dehydrating conditions: Diabetes (1+2), Renal disease, Stroke, Addison’s, Persisting vomiting
  • Radiotherapy and cancer treatments
  • Anxiety and somatisation disorders
168
Q

How can you assess this intraorally?

xerostomia

A

Mirror stick test to cheek and tongue, check saliva pooling, salivary flow rate test

169
Q

What are the oral signs and symptoms?

xerostomia

A

Increased cervical caries, frothy saliva, loss of gingival architecture, glossy appearance of gingiva, tongue fissuring, increased perio, difficulty eating, speaking, swallowing, denture control, halitosis, candida.

170
Q

How can it be managed?

xerostomia

A
  • Treat cause: hydration, modify drugs, control diabetes, control somatoform disorder.
  • Prevent diseases: caries, candida/angular cheilitis.
  • Saliva substitute/stimulator: Saliva Orthana/Pilocarpine
171
Q

Name 3 salivary substitutes

A

Glandosane, saliva orthana, Biotene

172
Q

Name 3 sugar substitutes

A

xylitol, manitol, sorbitol

173
Q

List 3 salivary proteins

A

IgA, PRP, mucins, histatin

174
Q

List 3 salivary enzymes

A

lipase, lysozyme, amylase.

175
Q

When are antibiotics indicated for dental treatment?

A
  1. Temporary treatment of acute infection where drainage or XLA is not possible.
  2. With spreading infection e.g. cellulitis.
  3. Adjunctive to surgical treatment e.g. aggressive periodontitis.
  4. Immunocompromised patients.
176
Q

Give 5 ways antibiotics work?

A
  • Cell wall destruction
  • Protein synthesis inhibition
  • DNA synthesis inhibition
  • DNA replication inhibition
  • Cell membrane inhibition
177
Q

Give 3 disadvantages of antibiotics

A

Resistance, GI upset, Drug interactions, hypersensitivity

178
Q

Name 3 antibiotics used in dental treatment and include regime example

A

Metronidazole (200mg 3x day 3-5 days)
Amoxicillin (500mg 3x day 5 days)
Erythromycin (250mg 4xday 5 days).

179
Q

What are the mechanisms of antibiotic resistance?

A

Drug inactivation, altered target site, reduced accumulation, altered metabolism

180
Q

What is desquamative gingivitis?

A

Descriptive term: Gingivae appear erythematous, ulcerated and desquamative (shedding).

181
Q

Give three differential diagnoses

desquamative gingivitis

A

lichen planus, pemphigoid, pemphigus.

182
Q

How is it managed?

desquamative gingivitis

A

Confirm diagnosis and manage diagnosis appropriately. May involve blood tests/direct immunofluorescence. Control local irritating factors e.g. plaque, poor restorations. Modify OH if pt cannot manage regular toothbrushing due to pain. Consider replacing removable with fixed pros.

183
Q

How can you differentiate between upper and lower motor neuron disease?

A

‘Upper spares upper” – everything above eyebrows still functions in UMN

184
Q

How does this difference occur?

How can you differentiate between upper and lower motor neuron disease?

A

The upper part of the facial motor nucleus receives innervation from both crossed and uncrossed fibres so the frontalis and orbicularis oculi muscles are spared.

185
Q

Give 5 possible causes for LMN disease

lower motor neuron disease

A

Reactivated HSV causing Bell’s Palsy, MS, trauma, parotid tumour, misplaced LA

186
Q

How is LMN managed?

A

80% resolve in weeks. Prednisolone to reduce swelling of facial nerve at stylomastoid foramen, eye protection

187
Q

What is geographic tongue?

A

Intraoral psoriasis of dorsum of tongue. Affects 1-2%

188
Q

How is it managed?

geographic tongue

A

reassure and monitor

189
Q

What is coxsackie virus?

A

RNA virus

190
Q

Name 3 diseases it causes (coxsackie virus)

A

Hand foot and mouth, herpangina, haemorrhagic conjunctivitis, aseptic meningitis

191
Q

What is Epstein-Barr Virus?

A

Human herpes virus 4

192
Q

Name 3 diseases it causes

EBV

A

Hairy leukoplakia, Burkitt’s lymphoma, infectious mononucleosis (glandular fever)

193
Q

Your patient is an asthmatic and takes 2 inhalers. What kind of inhalers will these likely be?

A
  • Beta-agonist (e.g. blue salbutamol)
  • Corticosteroid (e.g. brown beclomethasone).
194
Q

What is asthma?

A

Reversible airflow obstruction. 1. Smooth muscle contraction 2. Inflamed mucosa causing swelling, 3. Increased mucus secretion.

195
Q

What are the signs and symptoms of asthma?

A

Wheeze, cough, rash, shortness of breath.

196
Q

What are the dental effects of inhalers and what advice should be given?

A
  • Increased candida infections due to steroid effects
  • increased erosion due to acidic
  • decrease in saliva exacerbating both
  • Dry mouth
  • Patients should be advised to rinse with water after using inhalers
  • use inhalers correctly and use a spacer
  • Regular preventative advice applies.
197
Q

What other considerations should be given?

asthma

A

Possible allergy to colophony in fluoride varnish.
Medical emergencies for asthma attacks.

198
Q

What percentage of people in Scotland are being treated for asthma?

A

Up to 7% (asthma.org.uk)

199
Q

You have biopsied a potentially malignant lesion. List 11 histological signs of epithelial dysplasia

A
  1. Hyperchromatism
  2. Pleomorphism
  3. Basal cell hyperplasia
  4. Drop shaped rete ridges
  5. Altered basal cell polarity
  6. Increase/abnormal mitoses
  7. Increased area:vol of nucleus:cytoplasm
  8. Enlarged nuclei
  9. abnormal stratification
  10. Abnormal keratinisation
  11. Loss of intercellular adhesion.
200
Q

How is dysplasia graded?

A

Basal Cell Hyperplasia, Mild dysplasia (low 1/3, mild atypia and architecture changes), Mod dysplasia (mid 1/3), severe dysplasia (upper 1/3), carcinoma-in-situ (full thickness).

201
Q

You believe your patient to be suffering from oral dysaesthesia. What is another name for this?

A

Burning mouth syndrome

202
Q

Who is most likely affected?

burning moouth

A

F»>M – Mostly menopausal women, 50yo

203
Q

What are your differential diagnoses?

burning mouth

A

Lichen planus, pulpitis/dental effect, ROU, Denture problems, xerostomia, diabetes.

204
Q

What are the likely signs and symptoms?

burning mouth

A

Burning tongue, xerostomia, paraesthesia ​→​ Mucosa appears clinically normal.

205
Q

What investigations might you carry out?

burning mouth

A

FBC, haematinics, glucose, salivary flow rate, parafunction assessment, denture assessment, psychiatric assessment

206
Q

How is it managed?

burning mouth

A

Reassurance, correct any deficiencies/blood sugar, correct parafunction or denture fault, difflam mouthwash, Gabapentin (antineuropathic therapy)/antidepressant therapy, CBT

207
Q

What is orofacial granulomatosis?

A

Type IV sensitivity reaction. Granulomatous inflammation resulting in lymphomatous swelling due to blockage of lymph channels.

208
Q

What condition is it associated with?

OFG

A

Crohn’s 15%.

209
Q

What is the aetiology?

OFG

A

Autoimmune, hypersensitivity to SLS, benzoates, cinnamon. Non-caseating giant cell granulomas.

210
Q

What is the histological appearance?

OFG

A

Non-caseating giant cells, oedema, dilated lymph.

211
Q

What are the signs and symptoms?

OFG

A

Lip swelling and crusting, angular cheilitis, buccal cobblestoning, ulceration of mandibular buccal sulcus, staghorning of sublingual folds, full thickness gingivitis.

212
Q

How is it managed?

OFG

A

Dietary advice for allergens, antibiotics (erythromycin), tacrolimus on lips, oral steroids, NO surgery.

213
Q

What does dentally fit mean?

A

Being free from any dental disease before the start of cancer treatment.

214
Q

What is a multi-disciplinary team?

A

Team of individuals of various disciplines/specialties who work together to provide the best holistic care for the patient.

215
Q

List 4 members of an MDT for someone being treated for oral cancer

A

Oncologist, special care dentist, restorative dentist, physiotherapist, nutritionist, speech and language therapist, radiologist, hygienist, OMFS etc etc

216
Q

What risks is the patient at following radiotherapy, apart from mucositis?

A

Xerostomia, osteoradionecrosis, increased infection, poor wound healing

217
Q

What are the grades of mucositis?

A
  1. Sore and erythematous
  2. Erythema and ulcer but can eat
  3. Ulcers and liquids only
  4. Cannot take anything orally
218
Q

How is it managed?

mucositis

A

Prevention, CHX, good OH, ice chips, topical lidocaine, SLS free TP, tea tree oil, analgesics.

219
Q

What is the histological difference between pemphigus and pemphigoid?

A
  • Pemphigoid - Sub-basal split, autoantibodies attack hemidesmosomes
  • Pemphigus - Supra-basal split, autoantibodies attack desmosomes, Tzank cells, acantholysis
220
Q

How do they differ clinically?

pemphigus and pemphigoid

A
  • Pemphigoid has thick, full epidermis blood blisters that may persist to be seen clinically.
  • Pemphigus has clear, superficial fluid filled blisters that often burst.
221
Q

How may these conditions be investigated?

pemphigus and pemphigoid

A
  • Immunofluorescence: Direct – biopsied area autoantibodies
  • Indirect – serum autoantibodies
222
Q

How are they managed?

pemphigus and pemphigoid

A
  • Topical: Betamethasone mouthwash (0.5mg x2-3/day)
  • Beclometasone inhaler (50mg x2-3/day)
  • Systemic: Systemic steroids
  • Immunomodulator (azathioprine)
  • Referral to ophthalmologist if worried about pemphigoid
223
Q

What are the risk factors for oral cancer?

A

Multifactorial ​→​ Smoking, alcohol (combo x35), poor OH, diet, viral e.g. HPV 16&18, age, betel quid

224
Q

What are the signs and symptoms of oral cancer?

A

Sites: lateral border of tongue, floor of mouth, soft palate. Signs: >3months unexplained white/red patch, ulcer, swelling, hoarseness, unexplained mobility, dysphagia. Ulcer w/ rolled border, indurated, bleeding, numbness, pain (late presentation), exophytic

225
Q

How does cancer spread?

A

Locally, lymphatic, blood.

226
Q

What is the metastatic cascade?

A

Intravasation ​→​ survive in circulation ​→​ arrest in organ/tissue ​→​ Extravasation ​→​Survive extravasation ​→​ Initial proliferation ​→​ established growth

227
Q

What is the TNM staging?

A

Tumour (Tx, Tis, T0-4), Nodes (Nx, N0-3), Metastases (M0-M1). Combine the scores to get an overall stage 1-4 increasing in severity.

228
Q

What is necrotising sialometaplasia?

A

Vascular damage of palatine vessels causing blockage in flow to minor salivary gland

229
Q

What is the aetiology?

necrotising sialometaplasia

A

Vascular damage of palatine vessels causing blockage in flow to minor salivary gland

230
Q

What is the aetiology?

necrotising sialometaplasia

A

Small vessel infarct ​→​ smoking, trauma, LA

231
Q

How does it appear histologically?

necrotising sialometaplasia

A

Surface slough necrotic tissue, hyperplasia, metaplasia of the ducts, necrosis of salivary acini

232
Q

How is it managed?

necrotising sialometaplasia

A

Spontaneous healing

233
Q

A patient presents with a swollen lower lip. Give three differential diagnoses other than a mucocele.

A

Trauma, OFG, SSC.

234
Q

What is a mucocele?

A

Recurrent lip swelling due to a damaged minor salivary gland. Burst and recur.

235
Q

How does it appear histologically?

A

Macrophage lined cavity with saliva and granulation tissue ​→​ foam cells.

236
Q

How is it managed?

mucoele

A

Excision of mucocele and gland.

237
Q

What is it called in the floor of the mouth?

a mucocele

A

Ranula.

238
Q

Give 6 types of oral candida

A
  1. Pseudomembraneous
  2. Erythematous
  3. Hyperplastic
  4. Angular cheilitis
  5. Median rhomboid glossitis
  6. denture induced stomatitis
239
Q

Where does median rhomboid glossitis occur?

A

Dorsum of the tongue anterior to the sulcus terminalis.

240
Q

Give 3 histological features of it

oral candida

A

candida hyphae infiltration, PMNL infiltration, elongated rete ridges, hyperplastic rete ridges.

241
Q

Give 3 methods of testing for candida

A

swab, oral rinse, biopsy.

242
Q

What are the virulence factors of candida?

A

Adhesins, switching mechanism, germ tube formation, extracellular enzymes, acidic metabolites.

243
Q

Give 5 antifungal agents

A

miconazole, fluconazole, chlorhexidine, nystatin, itraconazole.

chlorhexidine??

244
Q

What medication is contraindicated for azoles?

A

Warfarin and statins.

245
Q

What are the signs of adrenal insufficiency?

A

Oral pigmentation, weakness, anorexia, loss of body hair, postural hypotension, lethargy.

246
Q

What emergency can be associated with this?

adrenal insufficiency

A

Adrenal crisis.

247
Q

What information should be on a prescription?

A

Pt name and address, age if under 12, date, number of days of treatment, generic drug name, SEND, LABEL, score out extra space, GDP name in capitals, signature, GDP stamp.

248
Q

What are the common dosages for 2 antibiotics given for dental infections?

A
  • Amoxcillin 500mg capsules. SEND:15 capsules. LABEL: 1 capsule 3 times daily.
  • Metronidazole 200mg tablets. SEND: 15 tablets. LABEL: 1 tablet 3 times daily.
249
Q

What is the rate of infection for HIV on exposure?

A

0.3%

250
Q

Same for HepC and HepB

rate of infectioni on exposure

A

HepC 3%, HepB 30%

251
Q

Name 6 oral lesions associated with HIV

A
  1. Candida – erythematous and pseudomembraneous, especially without risk factors.
  2. Candida associated lesions e.g. angular cheilitis and median rhomboid glossitis.
  3. Hairy leukoplakia
  4. Kaposi’s sarcoma
  5. Non-Hodgkin’s lymphoma
  6. Periodontal disease e.g. NUG/NUP
252
Q

How is HIV diagnosed and treated?

A

Diagnosis with ELISA and treatment with HAART.

253
Q

What is a fibrous epulis?

A

Localised fibrous enlargement of gingival tissues.

254
Q

What is the aetiology?

fibrous epulis

A

low grade chronic irritation

255
Q

How does it appear histologically?

fibrous epulis

A

Ulceration, granulation, metaplastic bone

256
Q

How is it known on sites other than gingivae?

fibrous epulis

A

Localised fibrous enlargement of gingival tissues.

257
Q

What is a pyogenic granuloma?

A

Granulation tissue response to trauma.

258
Q

How does it appear histologically?

pyogenic granuloma

A

Granulation tissue, blood vessels.

259
Q

What MCV is indicative of microcytic iron deficiency anaemia?

A

<80fL.

260
Q

Name 3 GI diseases that may cause this

microcytic iron deficiency anaemia

A

Crohn’s, ulcerative colitis, coeliac disease

261
Q

Give 4 intraoral signs of anaemia

A

recurrent aphthae, beefy tongue, mucosal pallor, poor wound healing, smooth tongue, mucosal atrophy, candida.

262
Q

A generalised white plaque wipes off to reveal underlying erythematous tissue. What is your diagnosis?

A

Pseudomembraneous candidosis

263
Q

Give 2 medical conditions this may be seen in

Pseudomembraneous candidosis

A

HIV, diabetes, any oral steroids, immunocompromised etc etc.

264
Q

What are the advantages and disadvantages of a swab and an oral rinse?

A

SWAB​→​ simple and site specific but can be contaminated.
RINSE ​→​ records whole mouth and can separate healthy organisms but not site specific and some pts find it difficult.

265
Q

Name 2 drugs that interact with Fluconazole

A

Warfarin and statins (e.g. simvastatin)

266
Q

What information is provided on a lab sheet for a sample?

A

Pt name and details, GDP name and details, clinical description and prov.diagnosis, Tests ​→​previous, required today e.g. culture, viral, ESR, specimen site and type, ABs ​→​ previous, current, today, resistance, Drug and MH, DH, signature, date, time of sample.

267
Q

What is Sjogren’s syndrome?

A

Autoimmune disease causing WBC (B-cell proliferation) destruction of exocrine glands.

268
Q

What other conditions can it be associated with?

A

Rheumatoid arthritis, SLE, Scleroderma

269
Q

Name 6 investigations used to help diagnose it

Sjogrens

A
  • Subjective dry eyes ​→​ >3 months, gravel/sand feel, using tear subs 3x daily.
  • Objective dry eyes ​→​ Schirmer test <5mm in 5mins.
  • Subjective dry mouth ​→​ >3 months need liquid to swallow or gland swelling.
  • Objective dry mouth ​→​ unstimulated salivary flow <1.5ml in 15mins.
  • Auto-antibody findings ​→​ anti-Ro and anti-La.
  • Histopathology ​→​ biopsy of labial gland @ premolar region of inner lip w/>5 minor glands.
270
Q

What are the minor histological findings? Minor

Sjogrens

A

Acinar loss, focal lymphocytic sialadenitis, fibrosis.

271
Q

Major histological findings

sjogrens

A

​Myoepithelial islands, Epithelial hyperplasia, Acinar loss, Lymphocytic infiltrate.

272
Q

Name 4 oral complications

sjogrens

A

increased caries, increased perio, denture retention difficulty, increased infection eg. Candida, salivary lymphoma.

273
Q

Give 3 other causes of xerostomia

A

dehydration, medications, head and neck radiotherapy, smoking.

274
Q

What systemic drug may be used to manage Sjogrens?

A

Prilocarpine.

275
Q

Name a hereditary white patch

A

White sponge naevus

276
Q

How does it appear histologically?

White sponge naevus

A

Parakeratosis, oedema in prickle layer.

277
Q

How does smoker’s keratosis appear histologically?

A

Keratosis, Melanin pigment

278
Q

Give 6 causes of pigmentation

A
  • Exogenous: amalgam, smoking, lead poisoning
  • Endogenous: racial, melanotic macule, melanoma
279
Q

Name two types of haemangioma

A

capillary, cavernous, Sturge-Weber syndrome

280
Q

What are the histological differences between them?

capillary, cavernous, Sturge-Weber syndrome haemangioma

A

Vary with the type of haemangioma e.g. capillary has capillaries all the same size with no blood outside them, cavernous has large spaces and irregular sizes.

281
Q

A patient presents with denture induced hyperplasia. Give 2 differential diagnoses?

A

SCC, leaf fibroma, pyogenic granuloma.

282
Q

What factors have resulted in denture induced hyperplasia?

A

Ill fitting denture causing chronic trauma. Fibrous reaction of gingiva.

283
Q

How would you manage this?

denture induced hyperplasia.

A

LA, excision of hyperplastic area. Denture requires short term tissue conditioner and then remade.

284
Q

Name 2 histological features of denture induced hyperplasia

A

Pseudo-epithelial hyperplasia, often with candida.

BDS4 Oral medicine (3 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions