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clinical med exam 2 > Oral lesion > Flashcards

Oral lesion Flashcards

1
Q
  • Precancerous lesion
  • risk factors: tobacco use/alcohol use

clinical presentation

  • adherent white patches/plaques on oral mucosa or tongue
  • generally not painful
  • if associated erythematous appearance: higher risk of cancer (90%)
A

Leukoplakia

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2
Q

how do you diagnose and treat leukoplakia

A
  • biopsy
  • refer to ENT
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3
Q

risk factors: tobacco use; alcohol use

clinical presentation

  • ulcers or masses that do not heal
  • tongue, lip areas are often painful
A

squamous cell carcinoma

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4
Q

clinical presentation

  • often older patients (50-70 yo)
  • painless, bleeding mass, an area of ulceration, region of mucosal discoloration, or with ill-fitting dentures
  • ABCD
A

melanoma

** if pigmented oral lesion, must consider in DDX and rule out melanoma

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5
Q

evaluation and treatment of melanoma

A
  • evaluation: endoscopic eval for paranasal dz; CT and/or MRI or primary site
  • treatment: excision with clear margins; radiation therapy
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6
Q

amalgam tattoo

A

blue-black macule seen in area adjacent to amalgam dental filling (gingival margin or buccal mucosa)

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7
Q

clinical presentation

  • pinkish/blue soft papules or nodules filled with gelatinous fluid
  • etiology: mild/minor oral trauma
A

mucoceles

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8
Q

treatment of mucoceles

A

if symptomatic, remove with cryotherapy or excision

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9
Q

most common clinical manifestation of primary HSV in childhood

A

herpetic gingivostomatitis

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10
Q

clinical presentation

  • primary infection: sudden onset, painful intraoral grouped vesicles on an erythematous base
  • may see associated fever, lymphadenopathy, decreased oral intake
A

HSV

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11
Q

clinical presentation:

  • recurrent infection
  • prodrome: pain/burning/ tingling about 24 hrs before lesion appears
  • cutaneous lesions on surface or keratinized areas (lip border)
A

HSV

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12
Q

diagnosis of HSV

A
  • viral culture
  • Tzanck prep: multinucleated giant cells
  • serology: HSV-1 antibodies
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13
Q

treatment of HSV

A
  • ANTIVIRAL at ONSET of prodrome (acyclovir, valacyclovir)
  • supportive care
  • educate regarding sunscreen
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14
Q

clinical presentation

  • grouped vesicles or erosions unilaterally on the hard palate
  • may also involve buccal mucosa, tongue, and gingiva
A

varicella zoster virus

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15
Q

clinical presentation

  • prodrome: fever, malaise, sore throat
  • painful oral lesions: small aphthae (tend to spare gingiva and lips)
  • palmar/plantar lesions
A

hand, foot, mouth disease (coxsackie virus)

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16
Q

treatment for hand, foot, mouth disease

A
  • supportive
  • maintain hydration
  • analgesics (acetaminophen)
  • throat lesions resolve in 5-6 days
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17
Q

etiology of oropharyngeal candidiasis (thrush)

A
  • candida albicans

opportunistic infection

  • infancy; dentures; HIV; DM; Abx; corticosteroids
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18
Q

clinical presentation

  • mouth pain
  • creamy white patches/plaques with underlying erythematous mucosa
A

“thrush will brush”

oropharyngeal candidiasis (thrush

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19
Q

confirm diagnosis of oropharyngeal candidiasis (thrush)

A
  • clinical
  • KOH prep
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20
Q

esophageal candidiasis; recurrent candidiasis or a lack of predisposing factors warrants what?

A

further investigation for underlying disease (HIV; DM)

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21
Q

treatment for oropharyngeal candidiasis (thrush)

A

TOPICAL

  • nystatin suspension
  • clotrimazole troche

Patient education

  • clean dentures carefully and frequently
  • rinse mouth after use of steroid inhalers
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22
Q

etiology of erythema multiforme major

A
  • commonly induced by infection (HSV most common)
  • acute, immune-mediated condition
  • genetic susceptibility (HLA)
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23
Q

clinical presentation

  • target like lesions on the skin
  • affects oral mucosa (70%) and genitals
  • mucosal erythema, painful erosions or bullae
A

erythema multiforme major

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24
Q

treatment for erythema multiforme major

A
  • usually resolves in 2 weeks on its own

symptomatic

  • topical corticosteroids
  • oral anti-histamines

ocular involvement? immediate ophthalmology referral

25
Q

etiology of steven-johnson syndrome (SJS)

A
  • severe mucocutaneous reaction: life threatening
  • medication induced
  • incidence is 100 x higher in HIV infected people
26
Q

clinical presentation

  • prodrome: fever > 102.2 F, flulike sx 1-3 days before lesions
  • skin lesions: tender erythematous, purpuric macules -> vesicles/bullae form -> skin sloughing
  • mucosal involvement (90%)
A

steven johnson syndrome (SJS)

27
Q

clinical presentation:

  • prodrome: fever > 102.2 F, flulike sx 1-3 days before lesions
    skin lesions: tender erythematous, purpuric macules -> vesicles/bullae form -> skin sloughing
  • detachment of skin > 30% TBSA
A

toxic epidermal necrolysis (TEN)

28
Q

treatment for SJS/ TEN

A
  • discontinue offending medication
  • corticosteroids (prednisone)
  • may need treatment in burn unit
29
Q

complications of SJS/TEN

A

bacteremia (S.aureus and P. aeruginosa)

30
Q

etiology of pemphigus

A
  • rare life threatening blistering disorder
  • autoimmune (antibodies cause acantholysis: seperation of epidermal cells from each other)
  • some cases are drug induced
31
Q

what sign is positive when gentle application of lateral pressure is an uninvolved area causes superficial layer to slough

A

Nikolsky sign

32
Q

clinical presentation

  • flaccid bullae begin in oropharynx, may spread to involve skin
    • Nikolsky sign
A

Pemphigus

33
Q

diagnosis of pemphigus

A
  • Acantholysis: hallmark finding; Nikolsky sign
  • biopsy: routine histological examination AND perilesional skin biopsy
    *
34
Q

treatment of pemphigus

A
  • systemic corticosteroids, immunosuppressive agents are the mainstay
35
Q

clinical presentation

  • chronic autoimmune blistering disorder
  • prodrome lasts weeks to months: pruritic eczematous, papularm or urticaria-like lesions
  • tense bullae
  • with or without mucosal involvement
A

pemphigoid

36
Q

treatment of pemphigoid

A

topical and/or systemic corticosteroids

37
Q

predisposing factors of aphthous ulcers

A
  • familial tendency
  • trauma
  • stress
  • infection
  • immunocompromised
38
Q

what are aphthous ulcers

A

synonyms: canker sores; ulcerative stomatitis; aphthae

39
Q

what are the most common cause of mouth ulcers

A

recurrent aphthous stomatitis

40
Q

clinical presentation

  • single or multiple oral lesions: shallow; round/oval, painful with grayish base on buccal or labial mucosa
A

aphthous ulcers

41
Q

treatment for aphthous ulcers

A
  • typically heal within 10-14 days
  • symptomatic relief : topical steroid (triamcinolone acetonide in orabase)
42
Q

clinical presentation

  • neutrophilic inflammatory disorder
  • recurrent oral and genital disorder
  • painful, shallow, or deep with central yellowish necrotic base
  • more extensive, often multiple
A

Behcet’s syndrome

43
Q

confirm diagnosis of Behcet’s syndrome

A
  1. recurrent oral ulcers ( > or + 3x in one year)
  2. 2 other clinical findings (recurrent genital ulcers; eye lesions; skin lesions
44
Q

treatment of Behcet’s syndrome

A

refer to rheumatology

45
Q

clinical presentation:

  • may increase risk for oral CA
  • reticular: lacy white plaques (wickham’s striae) on the buccal mucosa
  • erythematous
  • erosive
A

oral lichen planus

46
Q

treatment of oral lichen planus

A
  • relief of pain

topical corticosteroids

  • high potency: clobetasol proprionate
  • dry with gauze first; avoid eating and drinking for 30 minutes
47
Q

clincal presentation

  • benign condition associated with abx use, candida albicans infection; poor oral hygiene
  • elongated filiform papillae
  • pseudohairy tongue, yellowish to white to brown dorsal tongue surface
A

black hairy tongue: lingua villosa nigra

48
Q

treatment of black hairy tongue

A

brush affected area of tongue with a soft bristle toothbrush and toothpaste BID-TID

49
Q

clinical presentation

  • erythematous patches on dorsal tongue with circumferential white borders
A

geographic tongue (benign migratory glossitis)

50
Q

clinical presentation

  • atrophy of the filiform papillae of tongue
  • smooth, glossy, erythematous
  • burning sensation and increased sensitivity when eating acidic or salty foods
A

atrophic glossitis

51
Q

etiology and treatment of atrophic glossitis

A

etiology

  • nutritional deficiencies (iron, vit B12, folic acid)
  • dry mouth
  • oral candida infection
  • celiac dz

treatment: treat underlying condition

52
Q

principles for use of medications in the oral cavity

A
  1. use gel application for few localized lesions: topical steroid
  2. use rinse for widespread or generalized erythema
  3. education about possibility of oral candidiasis with topical immunosuppressants
  4. systemic therapy for more severe lesions and symptoms
53
Q

acantholysis

A

skin sloughing

54
Q

enanthem

A

mucous membrane eruption

55
Q

exanthem

A

skin eruption

56
Q

exophytic

A

lesion that grown outward from an epithelial surface

57
Q

glossitis

A

inflammation of tongue

58
Q

odynophagia

A

pain with swallowing

59
Q

stomatitis

A

inflammation of mucous membranes of the mouth

clinical med exam 2 (6 decks)

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