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Clinical Medicine Unit 2 & 3 > Oral Lesions > Flashcards

Oral Lesions Flashcards

Know etiology, presentation, and treatment

1
Q

etiology of thrush

A

Candida albicans

Thrush is also called “Oral Candidiasis” and is an oportunistic infection.

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2
Q

clinical presentation and diagnosis of thrush

A

Sore throat, oral erythema, white plaques that can be brushed off

Diagnosis can be confirmed with KOH prep showing budding yeast.

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3
Q

treatment of thrush

A

Nystatin, Clotrimazole (topical suspensions); Fluconazole (oral)

counsel patient regarding cleaning dentures/retainers and rinsing mouth after oral steroid use; check for HIV/Diabetes if infection is recurrent or involves esophagus

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4
Q

etiology of herpes

A

HSV type 1 (usually)

symptoms are brought on by precipitating factors:sunlight, trauma, stress

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5
Q

clinical presentation of herpes

A

Initial infection: grouped vesicles on an erythematous base, gingivostomatitis, lymphadenopathy, fever.

Recurrent: prodrome of pain, burning, or tingling 24 hours before lesions present

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6
Q

diagnosis of herpes

A

Diagnosis confirmed with Tzanck smear (only shows that it is a type of herpes); viral culture, serology showing HSV-1 antibodies

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7
Q

etiology of hand, foot & mouth disease

A

Coxsackie A16 virus

Usually a childhood disease

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8
Q

clinical presention of hand, foot & mouth disease

A

Prodrome: low grade fever, malaise, abdominal pain, URI symptoms,

Painful oral lesions - pale papules on an erythematous base that spares the gingiva and lips. Lesions also found on hands and feet.

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9
Q

treatment of hand, foot & mouth disease

A

supportive treatment: analgesics, popsicles, rest, hydration

resolves in 2-3 days

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10
Q

treatment of herpes

A

acyclovir (cream); acyclovir, valacyclovir, famciclovir (oral)

Abreva OTC

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11
Q

etiology of herpangina

A

Coxsackie A16 virus

usually in children 3-10 yo

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12
Q

clinical presentation of herpangina

A

sudden onset with symptoms similar to hand, foot & mouth; high fever (up to 105.8F), papules on soft palate become ulcers, oral lesions that spare lips and gingiva; sore throat, malaise, headache, myalgias, vomiting

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13
Q

treatment of herpangina

A

supportive treatment: analgesics, popsicles, rest, hydration

resolves in about a week

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14
Q

etiology of aphthae

A

etiology is not well defined - may be a cell mediated immunity brought on by predisposing factors (stress, immune irregularity, nutritional deficiencies, or specific foods)

Also called “oral ulcers” and “canker sores”

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15
Q

clinical presentation of aphthae

A

painful, small grey oral lesions on an erythematous base

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16
Q

treatment of aphthae

A

symptomatic - triamcinolone acetonide in orabase

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17
Q

etiology of Behcet’s

A

inflammatory disorder

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18
Q

clinical presentation of Behcet’s

A

recurrent aphthae lesions - may be oral or genital

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19
Q

diagnosis of Behcet’s

A

more than 3 oral lesions plus 2 other clinical findings (genital lesions or elsewhere) within a 1 year period

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20
Q

treatment of Behcet’s

A

refer to rheumatology

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21
Q

etiology of mononucleosis

A

Ebstein-Barr Virus

Spread by saliva exchange; saliva may be infectious for more than 6 months after onset of symptoms (even after all symptoms resolve).

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22
Q

clinical presentation of mononucleosis

A

strep-like symptoms; low grade fever, malaise, exudates in throat, cervical adenopathy, no cough; splenomegaly (always do an abdominal exam if mono is suspected)

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23
Q

diagnosis of mononucleosis

A

confirm with a monospot test, throat culture

rule out strep with rapid strep test, throat culture

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24
Q

treatment of mononucleosis

A

supportive; rest and fluids

spleen precautions (risk of splenic rupture if splenomegaly is present)

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25
Q

etiology of acute HIV

A

the initial period of HIV infection, patient is highly infective with a high viral load

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26
Q

clinical presentation of acute HIV

A

highly variable- viral syndrome with rash/oral lesions - difficult to distinguish from mono, flu, and strep

Fever, fatigue, malaise, rash, headache, pharyngitis, myalgias, lymphadenopathy, oral ulcers, night sweats, weight loss

27
Q

etiology of leukoplakia

A

benign precancerious lesion

associated with HPV, inflammatory/autoimmune diseases, tobacco and alcohol use

28
Q

treatment of acute HIV

A

immediate referral to an HIV specialist

make sure patient understands they are highly infective

29
Q

clinical presention of leukoplakia

A

oral lesions that appear as white or grey plaques, painless, and does NOT brush

30
Q

diagnosis of leukoplakia

A

biopsy

31
Q

treatment of leukoplakia

A

refer to ENT, monitor, evaluation, and biopsy

32
Q

etiology of lichen planus

A

chronic inflammatory/autoimmune disease

33
Q

clinical presentation of lichen planus

A

lacy leukoplakia (may be a purple-ish white), may be erosive and painful

34
Q

diagnosis of lichen planus

A

exfoliative cytology, biopsy

35
Q

treatment of lichen planus

A

manage pain/discomfort with topical or systemic corticosteroids, refer to ENT

36
Q

risk factors for oral squamous cell carcinoma

A

tobacco and alcohol use

37
Q

clinical presentation of squamous cell carcinoma

A

papules, plaques, erosions, ulcers or masses that do not heal

38
Q

diagnosis and treatment of squamous cell

A

refer to ENT for biopsy to assess stage and extent

39
Q

etiology of syphilis

A

bacterium treponem pallidum

40
Q

clinical presentation of syphalis

A

painless chancre

41
Q

diagnosis of syphalis

A

RPR (rapid plasma reagin) blood test

good sexual history

42
Q

treatment of syphalis

A

Benzathine PCN G 2.4 mu IM x1

check in with county health department

43
Q

etiology of mucoceles

A

oral trauma

44
Q

clinical presentation of mucoceles

A

fluid filled cavities with mucous glands lining the epithelium

45
Q

treatment of mucoceles

A

may rupture spontaneously, can be removed with cryotherapy or excision of entire cyst, refer to ENT or dentist

46
Q

etiology of lingua nigra

A

benign condition associated with antibiotic use, candida, and poor oral hygiene

47
Q

clinical presentation of lingua nigra

A

black hairy tongue

48
Q

treatment of lingua nigra

A

brush tongue using soft toothbrush and toothpaste 2-3 times daily

49
Q

etiology of geographic tongue

A

unknown

a benign migratory glossitis

50
Q

clinical presentation of geographic tongue

A

erythematous patches on dorsal tongue with white borders, patterns vary and may change, the condition may come and go; some complain of discomfort

51
Q

diagnosis and treatment of geographic tongue

A

biopsy to rule out any more serious conditions

patient reassurance

52
Q

etiology of Stevens Johnson Syndrome

A

hypersensitivity reaction usually to drugs - sulfa’s, antibotics, phenytoin etc.

53
Q

clinical presentation of Stevens Johnson Syndrome

A

erythema/edema of the lips, painful ulcerations at >2 sites, skin lesions on trunk (may be widespread), involvement of mucosal layers; intraoral bullae and denudation are signs the syndrome is severe

54
Q

diagnosis of Stevens Johnsons Syndrom

A

clinical and biopsy

55
Q

treatment of Stevens Johnsons Syndrome

A

discontinue offending medications

admit patient, esp if there is blistering, mucosal involvement interferes with nutrition/hydration, or if there is excessive skin denudation (tx in burn unit)

56
Q

etiology of pemphigus

A

Rare, chronic autoimmune blistering disease that usually occurs in middle age

cause unknown, may be drug induced

57
Q

clinical presentation of phemphigus

A

acantholysis (separation of epidermal cells from each other), insidious onset, tender flacid bullae that are easy to rupture, lesions appear on oral mucous first, scalp also involved early, exhibits a positive Nikolsky’s sign.

58
Q

diagnosis of phemphigus

A

Nikolsky’s sign: rubbing cotton swab or finger on surface fo uninvolved skin causes the superficial skin to slip free from deeper layers

biopsy, microscopy, derm consult

59
Q

treatment of phemphigus

A

urgent referral to derm

systemic corticosteroids, immunosuppressive agents; antibiotics (high risk for secondary infections); hospitalization if severe.

60
Q

etiology of bullous pemphigoid

A

autoimmune blistering benign disease that comes and goes, usually occurs after age 60 and more common in men

cause unknow, may be drug induced

61
Q

clinical presentation of bullous pemphigoid

A

tense blisters in flexural areas, blisters may be preceded by uticarial lesions, oral lesions in 1/3 of patients

62
Q

diagnosis of bullous pemphigoid

A

biopsy, light microscopy, derm referral

63
Q

treatment of bullous pemphigoid

A

systemic corticosteroids, immunosuppressive agesnts

Clinical Medicine Unit 2 & 3 (4 decks)

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