Oral lesions Flashcards
1
Q
where can candida albicans be cx’ed
A
mouth, vagina, feces
2
Q
treatment of geographic tongue
A
reassurance
3
Q
diagnosis for aphthous ulcers
A
clinical
4
Q
non specific entities describe mucosal plaques as red or speckeled
A
erythroplakia, leukoplakia
5
Q
____% of population are candida albicans carriers
A
20-30%
6
Q
diagnosis of behcet syndrome
A
clinical (>3 x per year recurrence for oral ulcers) AND 2 other clinical findings (recurrent genital ulcers, ocular lesions, and or cutaneous lesions, pos pathergy test)
7
Q
diagnosis of oropharyngeal candidasis
A
clinical confirmed by KOH prep: budding yeasts with or without pseudohyphae
8
Q
coxsackie A16 virus
A
HFM
9
Q
adherent white patches/ plaques on oral mucosa/ tongue, not painful, erythroplakia, leukoplakia
A
leukoplakia
10
Q
treatment for severe EMM oral mucosal involvement
A
systemic glucocorticoids if can’t tolerate PO may need to be hospitalized
11
Q
treatment for EMM mild/ moderate
A
1- self limited 2- symptomatic relief (top corticosteroids, oral antihistamines, miracle mouthwash)
12
Q
oral lichen planus treatment
A
- pain relief - high potency topical corticosteroids (triamcinolone oropharyngeal (oralone) or clobestasol)
13
Q
fever, malaise, sore throat prodrome
A
coxsackie
14
Q
oral lichen planus diagnosis
A
biopsy/ ENT referral
15
Q
denture wearers have painful red palate (atrophic form)
A
thrush
16
Q
prodome of mucose membrane pemphigoid lasts
A
weeks to months
17
Q
ways to evaluate melanoma
A
- endoscopic- paranasal disease - CT and/or MRI of primary site - Ct and/or PT lymph to assess metastasis
18
Q
glossitis
A
inflammation of the tongue
19
Q
- ulcers or masses that don’t heal - persistent papules, plaques, ulcers, erosions - dental changes or poorly fitting dentures - painful exophytic/ ulcerative lesions on tongue orlip - dysphagia, odynophagia, sore throat, hoarseness
A
SCC
20
Q
fluid filled cavities with mucous glands lining the epithelium
A
mucoceles
21
Q
- maybe asymptomatic - symptomatic- sudden onset, painful intraoral grouped vesicles on an erythematous base usually on buccal mucosa - high fever, lymphadenopathy, decreased oral intake
A
primary infxn of HSV
22
Q
exanthem
A
skin eruption
23
Q
<10% TBSA
A
SJS
24
Q
amount of mucosal involvement with SJS
A
90%
25
\_\_\_ of leukoplakia lesions will progress to carcinoma within 10 years
1-20%
26
what kind of infection is oropharyngeal candidiasis
opportunistic infection- when conditions are right for growth
27
mouth pain/ sore throat, beefy red tongue, difficulty eating, creamy white patches/ plaques with underlying erythematous mucosa on buccal mucosa, palate, tongue, or oropharynx (pseudomembranous form)
oropharyngeal candidasis
28
pale oval shaped puapules with a rim of erythema on the palmar/ plantar surfaces
coxsackie
29
most common clinical manifestation of primary HSV in childhood
herpetic gingivostomatitis
30
variable in size, pinkish/ blue soft papules or nodules filled with gelatinous fluid, may be seen in labia, may spontaneously rupture
mucoceles
31
mucoceles diagnosis
clinical
32
often on older pts 50-70
melanoma
33
SNE labs
ANA- double stranded DNA, anti-smith antibody
34
supportive care treatments of HSV
fluids, analgesics, "miracle mouthwash", diphenhydramine (benadryl), aluminum hydroxide/ magnesium carbonate (Maalox or gaviscon)
35
neutrophilic inflammatory lesions
behcet syndrome
36
diagnosis for EMM
clinical and Bx
37
diagnosis of leukoplakia is by
biopsy
38
- lacy white plaques (wickham's striae) on buccal mucosa sometimes with large, painful, hyperkeratotic plaques - painful red patches (muscular atrophy) - painful erosions/ ulcers
oral lichen planus
39
fever, fatigue, myalgia, unintentional weigh loss, painless oral &/ or nasal ulcers
SLE
40
benign migratory glossitis
geographic tongue
41
when is viral shedding the highest with HSV-1
the primary infection lessens with recurrences
42
tongue appears smoothy, glossy, erythematous with burning sensation and increased sensitivity to acidic/ salty foods
atrophic glossitis
43
acute immune mediated condition that has genetically susceptibility
EMM- Erythema Multiforme Major
44
autoimmune disease that w/ oral ulcers malar rash, photosensitivity, and discoid lupus that also affects many organs and has mild to severe remissions/ relapses
SLE- systemic lupus erythematosus
45
recurrent oral or genital ulcers (75% scrotum , vulva) that are painful, shallow, or deep with central yellowish necrotic base, extensive and often multiple
behcet syndrome
46
treatment for atrophic glossitis
address underlying condition
47
w/ coxsackie, throat lesions resolve in
5-6 days
48
\>30% TBSA
TEN
49
HSV treatment
- antiviral at onset of prodrome - supportive care
50
when do aphthous ulcers occur and why
20's, idopathic
51
painful lesions usually on cutaneous surface or keratinized areas (lip)
active phase of HSV-1 recurrent infxn "cold sores"
52
affects eptihelium of tongue
benign migratory glossitis
53
behcet syndrome treatment
refer to rheumatology
54
single/ multiple oral lesions: shallow, round/ oval, painful with grayish base, yellow- gray centers with red halos on buccal/ labial mucosa
aphthous ulcers
55
infancy, dentures, immunocompromised, DM, chemo/ radiation, abx (broad spectrum), corticosteroids (topical & systemic)
predisposing factors for oropharyngeal candidasis
56
there is a possibility of ____ with topical immunosuppressants
oral candidas
57
- elongated filiform plpillae - pseudohairy tongue (yellow/ white/ brown dorsal tongue surface)
lingua villosa nigra
58
treatment for oropharyngeal candidiasis
disinfect/ replace toothbrushes, pacifiers topical antifungal pt education
59
SCC diagnosis
biopsy
60
treatment for ocular involvement of EMM
refer to opthamologist
61
severe or many oral lesions can be treated by
systemic therapy
62
painful oral lesions- small aphthae that spare gingiva and lips
coxsackie
63
- ENT referral - surgical resection/ radiation/ chemoradiation- dependent on stage/ extent of disease
SCC treatment
64
inflammatory disorder that leads to atrophy of the filiform papillae
atrophic glossitis
65
mucoceles treatment
avoid cheek/ lip biting, if symptomatic remove (cryo/ excision), CO2 laser vaporization, aspiration
66
etiology of EMM
-infection (HSV most common) - \<10% assoc with meds (NSADIS, sulfa, antiepiletics, abx)
67
usually asymptomatic, occasional oral discomfort, burning, or foreign body sensations with numerous exacerbations/ remissions over time
geographic tongue
68
coxsackie diagnosis
clinical
69
severe life threatening mucotaneous rxn
SJS
70
treatment for lingua villosa nigra
brush area of tongue BID-TID w/ toothbrush and toothpaste
71
treatment for pemphigus
systemic corticosteroids and immunosuppressants, viscous lidocaine (topical for oral lesions), triamcinolone acetonide (dental paste), abx (for secondary infxn), maybe hospitalization often chronic course of treatment
72
odynophagia
symptoms of gastroesophageal reflux
73
erythema and edema of lips, intraoral bullae, ruptured bullae, painful friable raw surfaces with hemorrhagic crusts
SJS
74
diagnosis of geographic tongue
clinical or bx
75
caused by nutritional deficiencies, malnutrition, dry mouth, sjogrens syndrome, oral candida infxn, celiac
atrophic glossitis
76
topical steroid for aphthous ulcers
triamcinolone oropharyngeal paste (oralone)
77
ulcerative stomatitis apthae, "canker sores"
apthous ulcers
78
nonspecific hyperreactivity of the skin after minor trauma intradermal injection into skin with 20 gauge needle, pos if erythematous papule develops w/in 48 hours
pathergy test
79
female, long duration of leukoplakia, nonsmoker, location on the tongue or floor of mouth, and being \>200 mm are risk factors for
risk factors for precancerous leukolpakia SCC's becoming malignant
80
tobacco, alcohol, UV exposure, radiation, HPV-16 risk factors for
risk factors SCC
81
chronic inflammatory disorder affecting skin and mucous membranes that may increase risk of oral cancer
oral lichen planus
82
etiology of mucoceles
mild/ minor oral trauma
83
acantholysis
skin sloughing
84
topical antifungal for thrush
nystatin clotrimazole lozenges (troches)
85
angular cheilitis or preleche
painful fissuring at the corners of the mouth, assoc with thrush
86
HSV antivirals
acyclovir, valacyclovir, famciclovir (treat primary infection longer)
87
lesions occur over 3-5 days and resolve in about 2 weeks
EMM
88
most common cause of mouth ulcers
recurrent aphthous stomatitis
89
HSV education
- active lesions --\> avoid immunocompromised - oral transmission spreads - proper hand hygiene - avoid salty/ acidic/ sharp foods - sunscreen - virus will be there indefinitely with recurrence freq varying - high prevalence
90
treatment for aphthous ulcers
heal w/in 10-14 days, avoid irritating drinks/ foods, symptomatic relief (topical steroid)
91
tobacco (esp chewing), alcohol, and HPV are risk factors for
risk factors for leukoplakia
92
exophytic
lesion that grows out from epithelial surface
93
- avoid tobacco, alcohol, cheek biting, tongue chewing - regular dental care - refer to ENT for eval/ oral surgery - monitor closely for enlargement or induration
treatment for leukoplakia
94
candida albicans
oropharyngeal candidas aka thrush
95
pemphigus requires ____ evaluation
urgent dermatology
96
diagnosis of pemphigus
lesional and perilesional bx
97
treatment for melanoma
- excision with clear margins - radiation therapy
98
mucous membrane pemphigoid treatment
topical and/or corticosteroids + dermatology referral
99
odynophagia
pain with swallowing
100
treatment for SJS/TEN
stop meds, admit (maybe burn unit/ICU), supportive care
101
if oral lesion is pigmented you must
consider melanoma in the DDx
102
prodrome of recurrent HSV-1 infxn
- pain/ burning/ tingling 6-48 hours before lesions appear, - fatigue - low grade fever
103
precipitating factors of HSV-1
sunlight, fever, trauma, stress, menses
104
stomatitis
inflammation of the mucous membranes of the mouth
105
few localized oral lesions can be treated with
topical steroid gel- dry the area before applying and avoid eating/ drinking for 30 minutes after
106
diagnosis of HSV
- clinical - viral culture of active lesion - tzanck smear (look for multinucleated giant cells) - serology (look for HSV-1 antibodies)- not reliable
107
- often discovered during routine dental visits - painless bleeding mass - area of ulceration - region of mucosal discoloration - ill-fitting dentures
melanoma
108
target like lesions accompanied by diffuse areas of mucosal erythema, painful erosions, or bullae
EMM
109
leukoplakia associated with erythematous appearance
higher risk of dysplasia or cancer (90%)
110
frequent hand washing to prevent spread maintain hydration (popsicles) analgesics (acetaminophen/ ibuprofen)
treatment for coxsackie
111
painful erosion lesions with ruptured bullae
pemphigus
112
70% effects oral mucosa, as well as genitals and or ocular mucosa
EMM
113
enanthem
mucous membrane eruption
114
benign condition associated with abx use, candida albicans infxn, poor oral hygiene
black hairy tongue (lingua villosa nigra)
115
family hx, trauma, stress, hormones, infxn, immunocompromised, celiac/ IBD, vitamin/ mineral deficiencies
risk factors for aphthous ulcers
116
pt education for thrush
clean dentures carefully and frequently, rinse mouth after use of steroid inhalers
117
erythematous patches on dorsal tongue w. circumferential white borders that can change location, pattern, and size in minutes
geographic tongue
118
EMM gene
HLA
119
esophageal candidiasis, recurrent candidiasis, or lack of predisposing factors warrant
further investigation for underlying disease (HIV, DM)
