Oral Lesions

Question 1

etiology of thrush

Answer 1

Candida albicans

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

Question 2

clinical presentation and diagnosis of thrush

Answer 2

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

Diagnosis can be confirmed with KOH prep showing budding yeast.

Question 3

treatment of thrush

Answer 3

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

Question 4

etiology of herpes

Answer 4

HSV type 1 (usually)

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

Question 5

clinical presentation of herpes

Answer 5

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

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

Question 6

diagnosis of herpes

Answer 6

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

Question 7

etiology of hand, foot & mouth disease

Answer 7

Coxsackie A16 virus

Usually a childhood disease

Question 8

clinical presention of hand, foot & mouth disease

Answer 8

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.

Question 9

treatment of hand, foot & mouth disease

Answer 9

supportive treatment: analgesics, popsicles, rest, hydration

resolves in 2-3 days

Question 10

treatment of herpes

Answer 10

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

Abreva OTC

Question 11

etiology of herpangina

Answer 11

Coxsackie A16 virus

usually in children 3-10 yo

Question 12

clinical presentation of herpangina

Answer 12

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

Question 13

treatment of herpangina

Answer 13

supportive treatment: analgesics, popsicles, rest, hydration

resolves in about a week

Question 14

etiology of aphthae

Answer 14

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”

Question 15

clinical presentation of aphthae

Answer 15

painful, small grey oral lesions on an erythematous base

Question 16

treatment of aphthae

Answer 16

symptomatic - triamcinolone acetonide in orabase

Question 17

etiology of Behcet’s

Answer 17

inflammatory disorder

Question 18

clinical presentation of Behcet’s

Answer 18

recurrent aphthae lesions - may be oral or genital

Question 19

diagnosis of Behcet’s

Answer 19

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

Question 20

treatment of Behcet’s

Answer 20

refer to rheumatology

Question 21

etiology of mononucleosis

Answer 21

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).

Question 22

clinical presentation of mononucleosis

Answer 22

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

Question 23

diagnosis of mononucleosis

Answer 23

confirm with a monospot test, throat culture

rule out strep with rapid strep test, throat culture

Question 24

treatment of mononucleosis

Answer 24

supportive; rest and fluids

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

Question 25

etiology of acute HIV

Answer 25

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

Question 26

clinical presentation of acute HIV

Answer 26

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

Question 27

etiology of leukoplakia

Answer 27

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

Question 28

treatment of acute HIV

Answer 28

immediate referral to an HIV specialist make sure patient understands they are highly infective

Question 29

clinical presention of leukoplakia

Answer 29

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

Question 30

diagnosis of leukoplakia

Answer 30

biopsy

Question 31

treatment of leukoplakia

Answer 31

refer to ENT, monitor, evaluation, and biopsy

Question 32

etiology of lichen planus

Answer 32

chronic inflammatory/autoimmune disease

Question 33

clinical presentation of lichen planus

Answer 33

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

Question 34

diagnosis of lichen planus

Answer 34

exfoliative cytology, biopsy

Question 35

treatment of lichen planus

Answer 35

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

Question 36

risk factors for oral squamous cell carcinoma

Answer 36

tobacco and alcohol use

Question 37

clinical presentation of squamous cell carcinoma

Answer 37

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

Question 38

diagnosis and treatment of squamous cell

Answer 38

refer to ENT for biopsy to assess stage and extent

Question 39

etiology of syphilis

Answer 39

bacterium treponem pallidum

Question 40

clinical presentation of syphalis

Answer 40

painless chancre

Question 41

diagnosis of syphalis

Answer 41

RPR (rapid plasma reagin) blood test good sexual history

Question 42

treatment of syphalis

Answer 42

Benzathine PCN G 2.4 mu IM x1 check in with county health department

Question 43

etiology of mucoceles

Answer 43

oral trauma

Question 44

clinical presentation of mucoceles

Answer 44

fluid filled cavities with mucous glands lining the epithelium

Question 45

treatment of mucoceles

Answer 45

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

Question 46

etiology of lingua nigra

Answer 46

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

Question 47

clinical presentation of lingua nigra

Answer 47

black hairy tongue

Question 48

treatment of lingua nigra

Answer 48

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

Question 49

etiology of geographic tongue

Answer 49

unknown | a benign migratory glossitis

Question 50

clinical presentation of geographic tongue

Answer 50

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

Question 51

diagnosis and treatment of geographic tongue

Answer 51

biopsy to rule out any more serious conditions | patient reassurance

Question 52

etiology of Stevens Johnson Syndrome

Answer 52

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

Question 53

clinical presentation of Stevens Johnson Syndrome

Answer 53

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

Question 54

diagnosis of Stevens Johnsons Syndrom

Answer 54

clinical and biopsy

Question 55

treatment of Stevens Johnsons Syndrome

Answer 55

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)

Question 56

etiology of pemphigus

Answer 56

Rare, chronic autoimmune blistering disease that usually occurs in middle age cause unknown, may be drug induced

Question 57

clinical presentation of phemphigus

Answer 57

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.

Question 58

diagnosis of phemphigus

Answer 58

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

Question 59

treatment of phemphigus

Answer 59

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

Question 60

etiology of bullous pemphigoid

Answer 60

autoimmune blistering benign disease that comes and goes, usually occurs after age 60 and more common in men cause unknow, may be drug induced

Question 61

clinical presentation of bullous pemphigoid

Answer 61

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

Question 62

diagnosis of bullous pemphigoid

Answer 62

biopsy, light microscopy, derm referral

Question 63

treatment of bullous pemphigoid

Answer 63

systemic corticosteroids, immunosuppressive agesnts