Oral Cavity

Question 1

2 common infections in oral cavity

Answer 1

Herpes simplex and candidiasis

Question 2

Herpes simplex (orally) is usually due to which strain?

Answer 2

HSV-1

Question 3

What features do you see in a Herpes simplex-infected cell?

Answer 3

Acantholysis (intracellular/intercellular edema)
Giant cells (multinucleate polykaryons) 
Eosinophilic intranuclear viral inclusions

Question 4

How do you dx Herpes simplex?

Answer 4

Tzanck test (using vesicle fluid)

Question 5

Triggers for reactivation of latent HSV?

Answer 5

Stress, sunlight/UV light, upper RT infxns, allergies,pregnancy, menstruation

Question 6

Where (nerve) does latent HSV remain dormant?

Answer 6

Ganglia of Trigeminal (CN5)

Question 7

Orofacial herpetic infxn?

Answer 7

Herpes labialis

Question 8

What is the most common fungal infxn of oral cavity?

Answer 8

Candidiasis

Question 9

Flora in candidasis

Answer 9

Candida albicans –> normal in 50% of people

Question 10

Most common type of candidiasis?

Answer 10

Thrush/pseudomembranous

Question 11

What does thrush look like?

Answer 11

Gray to white, cruddy, can be scrapped off to show underlying erythematous base

Question 12

When is thrush most commonly seen (2)

Answer 12

Immunocompromised and w/broad-based antibiotics (b/c normal flora altered)

Question 13

What is HNSCC?

Answer 13

Head and Neck Squamous Cell Carcinoma

Malignant neoplasm of squamous cells that line oral cavity

Question 14

Major risk factors for HNSCC?

Answer 14

Tobacco and alcohol

Question 15

Classic presentation for HNSCC?

Answer 15

Middle aged men who are chronic smokers and drinkers (worse w/both)

Question 16

Most common location for HNSCC?

Answer 16

Floor of mouth

Question 17

Field cancerization?

Answer 17

Multiple primary tumors «< survival b/c tend to infiltrate locally before metastasizing to other sites

Question 18

2 precancerous lesions for HNSCC?

Answer 18

leukoplakia and erythroplakia

Question 19

What is leukoplakia?

Answer 19

White plaque that cannot be scrapped away

Represents squamous dysplasia

Question 20

What is erythroplakia?

Answer 20

Red plaque that represents vascularized leukoplakia and is highly suggestive of squamous cell dysplasia

Question 21

Which is worse: leukoplakia or erythroplakia?

Answer 21

Erythroplakia

Question 22

What is hairy leukoplakia?

Answer 22

White rough (“hairy”) patch that arises on lateral tongue; think immunocompromised (e.g. AIDS); due to EBV-induced squamous cell HYPERPLASIA; NOT pre-malignant

Question 23

When leukoplakia and erythroplakia are found, what should you do?

Answer 23

Biopsy to rule out carcinoma