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(J2) GI II Test 1 > Oral Cavity and Salivary Glands > Flashcards

Oral Cavity and Salivary Glands Flashcards

1
Q

What are dental caries?

(causes and prevention)

A

Tooth decay

Cause:

-demineralization of of tooth due to acid producing bacteria (Streptococcus mutans)

Prevention:

  • good oral hygine
  • avoid high sugar intake
  • fluoride
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2
Q

What is gingivitis?

(cause)

A

gingival erythema, edema, and bleeding

Cause:

  • biofilm that forms on and between teeth
  • accumulation leads to plaque formation which can calcify (tartar)
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3
Q

What is periodontitis?

(cause)

A

inflammation of support structures of the teeth (ie. periodontal ligament)

Cause:

-shift in oral flora from gram (+), facultative anaerobes to gram (-), anaerobes -> inflammation

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4
Q

What are possible complications of periodontitis?

A
  • tooth loss (periodontal ligament damage)
  • brain abscess
  • infective endocarditis
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5
Q

What are aphthous ulcers?

(cause)

A

shallow, grayish painful ulcerations; thin layer of exudate and narrow rim of erythema

  • resolve spontaneously (7-10 days)
  • likely to recur

Cause:

  • unknown etiology
  • associated with immune disorders
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6
Q

What is an oral traumatic/irritation fibroma?

(description and treatment)

A

benign, fibrous, nodular mass on inner buccal surface along bite line (caused from irritaiton of biting cheek)

-submucosal fibrous proliferation; fairly circumscribed

Treatment:

-complete excision

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7
Q

What is an oral pyogenic granuloma?

(description and treatment)

A

benign, soft, ulcerated red/purple mass along gingiva

-high vascularized (red -> not truly pyogenic) proliferation of granulation tissue

Treatment:

  • complete excision
  • can regress or progress to ossifying fibroma
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8
Q

What condition are pyogenic granulomas classically associated with?

A

pregnancy: they are also called “pregnancy tumors”

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9
Q

What is an oral ossifying fibroma?

(description and treatment)

A

benign, firm, red ulcerated/nodular lesion on gingiva

-fibrous and ossifying -> firm (differentiates from pyogenic granuloma)

Treatment:

  • excision down to periosteum
  • recurrent and originate form periodontal ligament
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10
Q

What are oral tori?

A

bony outgrowth (exostoses) in the oral cavity

  • most commonly of the palate -> torus palatinus
  • typically asymptomatic
    (ddx: adenoid cystic carinoma -> commonly forms mass on palate)
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11
Q

How does HSV infection present in the oral cavity?

A

Acute herpetic gingivostomatitis:

HSV-1 > HSV-2

  • vesicles with clear fluid; rupture to form painful, red-rimmed, shallow ulcers
  • vesicles/ulcers last for ~3-4 weeks
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12
Q

How is an HSV infection diagnosed?

A

Tzanck test:

-vesicular fluid/base sample shows multinucleated giant cells w/ possible viral inclusion bodies

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13
Q

What is a long-term complication of oral HSV infection?

A

Recurrent herpetic stomatitis:

  • original infection migrates to nerve ganglia where it become dormant
  • can later be reactivated (sunlight and stress) to affect area associated with infected ganglia -> cold sores
  • trigeminal ganglia most commonly affected
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14
Q

How does candidia infection present in the oral cavity?

(appearance and risk factors)

A

Thrush:

white/gray membrane that is easily scraped off revealing erythematous base

-pseudohypae on budding yeast (microscopic)

Risk factors:

  • broad spectrum abx -> change in oral flora
  • compromised immune system (HIV/AIDS, pregnancy, DM)
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15
Q

What deep fungal infections present in the oral cavity?

(risk factor and potential complication)

A
  • Aspergillus
  • Cryptococcus
  • Zygomycetes (mucor)

Risk factor:
-immunosupression

Complications:

-brain, sinus, and orbital infections

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16
Q

What is an identifying characteristic of Aspergillus?

A

45° angle, branching pseudohypae w/ septae

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17
Q

How does scarlet fever present in the oral cavity?

A

Strawberry/raspberry tongue (white/red, respectively, tongue with prominent papilae)

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18
Q

How does measles present in the oral cavity?

A

Koplik spots

-ulcerations surrounding opening of parotid duct

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19
Q

How does mononucleosis present in the oral cavity?

A
  • palatal petheciae
  • pharyngitis/tonsilitis
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20
Q

How does diptheria present in the oral cavity?

A

tough pseudomembrane over tonsils/retropharynx -> heavy bleeding if removed

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21
Q

How does HIV present in the oral cavity?

A

Hairy leukoplakia:

-“hairy” thickening that can’t be scraped off of side of tongue

-hyperkeratotis and acanthotic w/ “balloon” cells in stratum spinosum (microscopic)

-caused by EBV infection

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22
Q

How does SJS/TEN present in the oral cavity?

A
  • oral ulcers
  • stomatitis
  • cheilitis
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23
Q

How does leukemia present in the oral cavity?

A

monocytic AML w/ leukemia cutis:

-infiltration of skin and gingiva with monocytes

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24
Q

How does Peutz-Jeghers syndrome present in the oral cavity?

(what is this a risk factor for)

A

polyps and hyperpigmented spots in the mouth

risk factor for cancer (particularly colon cancer)

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25
What **drug** is particularly associated with **gingival hyperplasia**?
**phenytoin** (dilantin) anticonvulsant medication
26
What is **Osler-Weber-Rendu disease**?
_Hereditary hemorrhagic telangiectasia_ autosomal dominant vasulopathy resulting in telangiectasias in skin and mucosa -favors face (**nasal** and **oral cavities**) -\> **epistaxis** and GI bleeds
27
What is a **multilocular keratocystic odontogenic tumor**? What sets it apart from other odontogenic cysts?
**epithelium-lined cyst** derived from odontogenic epithelium - this particualr type is **especially aggressive and can recur** - more common in **males** between age of **10-40** (epithelium lined cysts are relatively rare in the skeleton aside from the odontogenic type which occurs in the jaw)
28
What is the most common cancer of the head and neck?
Squamous cell carcinoma
29
What are the **risk factors** for **oral squamous cell carcinoma**?
- **HPV** - **tobacco** - **alcohol** - betel quid and paan (India/Asia) - radiation
30
What are the **main types** of **oral SCC**?
- **HPV**-induced SCC - **classic** oral SCC (**tobacco related**/HPV negative)
31
What is the **clincal presentation** of **oral SCC**?
- dysphagia - weight loss - sore throat - ear ache - lymph node mass (cervical)
32
What is the **histological appearance** of **oral SCC**?
wide variety of appearances based on varying degrees of differentiation -well differentiated shows more keratinization level of differentiation has little impact on behavior of lesion
33
**Where** does **HPV-induced oral SCC** typcially occur?
- tonsils - base of tongue - pharynx HPV has a tropism for lymphoid structures which are largely located in the **oropharynx**
34
What is the **mechanism** of **EBV-induced oral SCC**?
EBV proteins **E6 and E7** **inhibit** tumor supressors **p53 and RB** respectively
35
What molecule acts as a **diagnostic marker** for **HPV-induced oral SCC**? What else is this marker used for?
**p16**; it is upstream of Rb which is inhibited by HPV E7, causing it to accumulate It is **also used as a prognostic factor**
36
**Where** does **classic oral SCC** typcially occur?
- ventral tongue - floor of mouth - lower lip - soft palate - gingiva (think more **oral cavity** compared to HPV-induced)
37
What is the **mechanism** of **classic oral SCC**?
Typically **preceded** by premalignant lesions (**erythroplakia/leukoplakia**) loss of function of **p53** -\> tobacco related carcinogens cause **accumulation of mutations** **p63 and NOTCH1** mutations also common
38
What are the **premalignant lesions** of oral SCC?
- leukoplakia - erythroplakia
39
What is **leukoplakia**?
precancerous lesion for SCC **White plaque** that **cannot be scraped off** (not the same as hairy leukoplakia)
40
What is **erythroplakia**?
precancerous lesion for SCC **red, velvety lesion** (essentially a more vascularized leukoplakia) - possible erosion - can be raised or depressed
41
Which oral precancerous lesion is more concerning?
erythroplakia: almost always has severe dysplasia
42
What is the treatment for leukoplakia and erythroplakia?
**biopsy**, both have high enough risk of becoming malignant
43
What is a common epidemiological feature of oral SCCs and precancerous lesions?
they all have **male predominance**
44
What is the **prognosis** of **HPV-induced oral SCC**?
better than classic oral SCC, responds better to therapy -p16 used as prognostic factor
45
What is the **prognosis** of **classic oral SCC**?
worse than HPV-induced - classic is typically **caught in later stages** - **screening for precancerous lesions improves survivability** - has a propensity to form **multiple, independent primary tumors** -\> **field cancerization** (tobacco induced carcinogenesis occurs in multiple places due to prolonged, diffuse exposure of oral cavity) - **secondary tumors** are **most common cause of death**
46
What is **xerostomia**? | (causes)
**dry mouth** due to lack of saliva production from salivary glands Cause: - **medications** (**_anti_**cholinergic, **_anti_**depressant/psychotic, **_anti_**hypertensive, **_anti_**histamine, diuretics, muscles relaxants, sedatives, analgesics) - **Sjö****gren syndrome** (autoimmune) - **radiation**
47
What is **sialadenitits**? | (causes)
inflammation of the salivary glands Causes: - **trauma** (mucocele and ranula) - autoimmune (**Sjögren**) - viral (**mumps**) - **bacterial** (**sialolithaiasis** -\> Staph aureus/Strep viridians)
48
What is the most common lesion of the salivary glands?
mucocele
49
What is a **mucocele**? | (cause and appearance)
blueish fluctuant, **fluid-filld lesion** -**granulation tissue lined** cyst (microscopic) **-**most commonly on the **lower lip** caused by **trauma** resulting in damage/obstruction to **salivary gland ducts** -\> secretions spill out into surrounding tissue most prominent in **tolders and elderly** (due to **increased fall risk**)
50
What is a **ranula**? | (cause and appearance)
**fluid-filled lesion** of the **sublingual gland duct** - **epithelial-lined** cyst (microscopic) - **under the tongue** caused by trauma resulting in damage/obstruction to **sublingual gland duct** -\> secretions spill out into surrounding tissue -can worsen to disect down through mylohyoid -\> **plunging ranula**
51
What is the most common tumor of the salivary glands? (benign or malignant)
**pleomorphic adenoma**/mixed tumor (benign)
52
What is the most common _malignant_ tumor of the salivary glands?
mucoepidermoid cacinoma
53
What is the **general trend** of **tumor location** in salivary glands? What is the **general trend** of a tumor being **malignant vs. benign** salivary gland tumors?
**Larger glands** have an **increased tumor risk** tumor prevalence: parotid \> submandibular \> sublingual **Smaller glands** have an **increased risk of metastatic** tumors metastatic prevalence sublingual \> submandibular \> parotid
54
What is the **epidemiology** of **salivary gland neoplasms**?
- **female** predominance - 50-70 for benign - 70+ for malignant
55
What is a **pleomorphic adenoma/mixed tumor**? (description)
**benign**, mixed **epithelial and mesnchymal** (divergent differentiation) salivary gland tumor -well demaracted, partially encapsulated, rounded mass -\> **protrusions into surrounding tissue** **-very heterogenous** appearing (microscopic)
56
**Where** are salivary **pleomorphic ademona**/mixed tumors seen?
- predominately **parotid glands** (60% of all parotid tumors) - less common in submandibular glands - rare in minor salivary glands - _almost never multifocal or bilateral_
57
What is the **prognosis** for **pleomorphic adenoma/mixed tumor**?
- **incompletely encapsulation** -\> **protrusions** that are missed upon **enucleation -\> recurrence** - _parotidectomy_ -\> _greatly reduced recurrence_ - can transform to an aggressive malignant cancer - transformation risk increases with age
58
What **gene rearrangement** is associated with **pleomorphic adenoma**/mixed tumor?
**PLAG1** (**PL**eomomorphic **A**denoma)
59
What is a **Warthin tumor** (**papillary cystadenoma lymphomastosum**)? (description)
benign salivary gland tumor - well encapsulated, rounded mass - **cystic** spaces lined by a **double layer of epithelium cells** - "**oncocytic**" appearance of epithelial cells - **lymphocytic infiltrate** of the stroma
60
What is associated with development of a Warthin tumor? What characteristic of Warthin tumor is partially explained by this?
**Smoking** -\> 8x increased risk (it can occur bilaterally, that is likely attributed to smoking and field cancerizatin or some similar mechanism)
61
Where are **Warthin tumors** seen?
- **only parotid** gland - **can be bilateral** (unlike pelomorphic adenoma)
62
What is odd about the epidemiology of Warthin tumors?
they are **male predominant**, **unlike most other salivary gland tumors** which are female predominant
63
What is **mucoepidermoid carcinoma**? | (description)
**malignant** tumor of salivary glands -cyst-like spaces filled with **mucus**
64
**Where** are **mucoepidermoid carcinomas** seen?
-primarily **parotid gland**
65
What **gene rearrangement** is associated with **mucoepidermoid carcinoma**?
**MEC**T1-MAML2 | (**M**uco**E**pidermoid **C**arcinoma)
66
What is **adenoid cystic carcinoma**? | (description)
**malignant** salivary gland tumor - **cribiform** pattern - perineural spread
67
**Where** are **adenoid cystic carcinomas** seen?
mostly **minor salivary glands** -**palatal mass** (ddx torus palatinus)
68
What is the **prognosis** of **adenoid cystic carcinoma**?
- **good short term prognosis**, it is slow growing - it tends to **spread along nerves** so it can **recur years later** with a greatly **poorer prognosis**
69
What part of the clinical presentation of adenoid cystic carcinoma seperates it from most of the other salivary gland tumors?
- it has **perinerual growth -\> pain** - more predominant in **minor salivary glands** than other tumors

(J2) GI II Test 1 (14 decks)

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