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
2
Q
how do you diagnose and treat leukoplakia
A
- biopsy
- refer to ENT
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
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
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
6
Q
amalgam tattoo
A
blue-black macule seen in area adjacent to amalgam dental filling (gingival margin or buccal mucosa)
7
Q
clinical presentation
- pinkish/blue soft papules or nodules filled with gelatinous fluid
- etiology: mild/minor oral trauma
A
mucoceles
8
Q
treatment of mucoceles
A
if symptomatic, remove with cryotherapy or excision
9
Q
most common clinical manifestation of primary HSV in childhood
A
herpetic gingivostomatitis
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
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
12
Q
diagnosis of HSV
A
- viral culture
- Tzanck prep: multinucleated giant cells
- serology: HSV-1 antibodies
13
Q
treatment of HSV
A
- ANTIVIRAL at ONSET of prodrome (acyclovir, valacyclovir)
- supportive care
- educate regarding sunscreen
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
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)
16
Q
treatment for hand, foot, mouth disease
A
- supportive
- maintain hydration
- analgesics (acetaminophen)
- throat lesions resolve in 5-6 days
17
Q
etiology of oropharyngeal candidiasis (thrush)
A
- candida albicans
opportunistic infection
- infancy; dentures; HIV; DM; Abx; corticosteroids
18
Q
clinical presentation
- mouth pain
- creamy white patches/plaques with underlying erythematous mucosa
A
“thrush will brush”
oropharyngeal candidiasis (thrush
19
Q
confirm diagnosis of oropharyngeal candidiasis (thrush)
A
- clinical
- KOH prep
20
Q
esophageal candidiasis; recurrent candidiasis or a lack of predisposing factors warrants what?
A
further investigation for underlying disease (HIV; DM)
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
22
Q
etiology of erythema multiforme major
A
- commonly induced by infection (HSV most common)
- acute, immune-mediated condition
- genetic susceptibility (HLA)
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
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
etiology of steven-johnson syndrome (SJS)
* severe mucocutaneous reaction: life threatening
* medication induced
* incidence is 100 x higher in HIV infected people
26
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%)
steven johnson syndrome (SJS)
27
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**
toxic epidermal necrolysis (TEN)
28
treatment for SJS/ TEN
* discontinue offending medication
* corticosteroids (prednisone)
* may need treatment in burn unit
29
complications of SJS/TEN
bacteremia (S.aureus and P. aeruginosa)
30
etiology of pemphigus
* rare life threatening blistering disorder
* autoimmune (antibodies cause acantholysis: seperation of epidermal cells from each other)
* some cases are drug induced
31
what sign is positive when gentle application of lateral pressure is an uninvolved area causes superficial layer to slough
Nikolsky sign
32
clinical presentation
* **flaccid bullae** begin in oropharynx, may spread to involve skin
* + Nikolsky sign
Pemphigus
33
diagnosis of pemphigus
* **Acantholysis**: hallmark finding; Nikolsky sign
* biopsy: routine histological examination AND perilesional skin biopsy
*
34
treatment of pemphigus
* systemic corticosteroids, immunosuppressive agents are the mainstay
35
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
pemphigoid
36
treatment of pemphigoid
topical and/or systemic corticosteroids
37
predisposing factors of aphthous ulcers
* familial tendency
* trauma
* stress
* infection
* immunocompromised
38
what are aphthous ulcers
synonyms: canker sores; ulcerative stomatitis; aphthae
39
what are the most common cause of mouth ulcers
recurrent aphthous stomatitis
40
clinical presentation
* single or multiple oral lesions: **shallow; round/oval, painful with grayish base** on buccal or labial mucosa
aphthous ulcers
41
treatment for aphthous ulcers
* typically heal within 10-14 days
* symptomatic relief : topical steroid (triamcinolone acetonide in orabase)
42
clinical presentation
* neutrophilic inflammatory disorder
* r**ecurrent oral and genital disorder**
* painful, shallow, or deep with central yellowish necrotic base
* more extensive, often multiple
Behcet's syndrome
43
confirm diagnosis of Behcet's syndrome
1. recurrent oral ulcers ( \> or + 3x in one year)
2. 2 other clinical findings (recurrent genital ulcers; eye lesions; skin lesions
44
treatment of Behcet's syndrome
refer to rheumatology
45
clinical presentation:
* may increase risk for oral CA
* _reticular:_ lacy white plaques (**wickham's striae**) on the buccal mucosa
* erythematous
* erosive
oral lichen planus
46
treatment of oral lichen planus
* relief of pain
topical corticosteroids
* high potency: clobetasol proprionate
* dry with gauze first; avoid eating and drinking for 30 minutes
47
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
black hairy tongue: lingua villosa nigra
48
treatment of black hairy tongue
brush affected area of tongue with a soft bristle toothbrush and toothpaste BID-TID
49
clinical presentation
* **erythematous patches on dorsal tongue with circumferential white borders**
geographic tongue (benign migratory glossitis)
50
clinical presentation
* atrophy of the filiform papillae of tongue
* smooth, glossy, erythematous
* burning sensation and increased sensitivity when eating acidic or salty foods
atrophic glossitis
51
etiology and treatment of atrophic glossitis
etiology
* nutritional deficiencies (iron, vit B12, folic acid)
* dry mouth
* oral candida infection
* celiac dz
treatment: treat underlying condition
52
principles for use of medications in the oral cavity
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
acantholysis
skin sloughing
54
enanthem
mucous membrane eruption
55
exanthem
skin eruption
56
exophytic
lesion that grown outward from an epithelial surface
57
glossitis
inflammation of tongue
58
odynophagia
pain with swallowing
59
stomatitis
inflammation of mucous membranes of the mouth
