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Clinical Medicine I > Oral lesions > Flashcards

Oral lesions Flashcards

1
Q

What are the risk factors for leukoplakia?

A

tobacco and ETOH use.

Tobacco is responsible for 70-90%, ETOH increases risk 1.5 fold

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2
Q

Leukoplakia can lead to which type of cancer?

A

sqamous cell carcinoma

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3
Q

Adherent white patches and plaques on oral mucosa or tongue is called…

A

leukoplakia

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4
Q

How would you diagnose leukoplakia in a patient whom you suspect has it?

A

biopsy can show benign hyperkeratosis, parakeratosis, atrophy, inflammation hyperplasia without dysplasia.

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5
Q

Which is more common: leukoplakia or erythroplakia?

A

erythroplakia is less common.

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6
Q

What percent of erythroplakia developes into cancer?

A

80%

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7
Q

a patient presents with a red, velvety patch on the floor of the mouth. what is your suspected diagnosis?

A

erythroplakia

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8
Q

What is the distinguishing feature of oral hairy leukoplakia?

A

vertically corrugated adherent white lesions.

typically on lateral surface of the tongue

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9
Q

what is the tx of choice for oral hairy leukoplakia?

A

none usually indicated

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10
Q

A patient presents with ulcers or masses that do not appear to heal. Her dentures have started fitting poorly. Pt. complains of odynophagia, sore throat and weight loss. What is the presumptive diagnosis?

A

Oral SCC.

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11
Q

How does oral SCC present?

A
  1. persistent papules, plaques, ulcers and erosions.
  2. changes to dentition, lesions on tongue or lip.
  3. dysphagia, odynophagia, sore throat, hoarseness, bleeding, weight loss
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12
Q

What do you find on biopsy of oral SCC?

A

dysplasia defined by presence of mitoses and prominent nuclei.

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13
Q

How do you treat oral SCC?

A
  1. ENT referral.

2. surgical resection or radiation/chemoradiation

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14
Q

What should be included in the DDx of every pigmented oral lesion?

A

oral melanoma

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15
Q

who typically develops oral melanoma?

A

patients in 5th-7th decade

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16
Q

How do you evaluate suspected oral melanoma?

A
  1. endoscope for paranasal disease
  2. CT/MRI of primary site
  3. CT or PET to asses lymph node involvement or distant mets
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17
Q

Pinkish/blue soft papule filled with gelatinous fluid.

A

mucocele

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18
Q

which herpes virus causes herpetic gingivostomatitis?

A

HSV-1

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19
Q

describe the oral lesions associated with HSV-1

A

grouped vesicles on an erythematous base

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20
Q

HSV-1 can be seen in these locations in the oral cavity…

A

buccal mucosa, tongue, gingiva, hard palate, pharynx, lips, perioral skin.

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21
Q

Describe the prodrome of HSV-1 infection.

A

pain, burning, tingling 6-48 . hours before lesion appear.s

may have fatigue and low grade fever

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22
Q

How do you diagnose HSV-1 infection?

A
  1. clinical presentation
  2. viral culture of active lesion
  3. tzanck smear (also seen w/ varicella)
23
Q

Tx of HSV-1

A

oral antivirals at onset of prodrome: acyclovir, valacyclovir, famciclovir

Supportive care: fluids, miracle mouthwash, analgesics

24
Q

What should you tell a patient who has HSV-1 infection?

A
  1. avoid contact w/ elderly, babies, immunocompromised
  2. don’t kiss, share beverages, etc.
  3. have good hand hygeine
  4. avoid salty, acidic, sharp foods
  5. educate on prevalence to reduce stigma
25
Q

Differentiation of HSV from herpes zoster?

A

h. zoster occurs unilaterally on the hard palate.

26
Q

What areas are spared in coxsackie infection?

A

gingiva and lips

27
Q

What pathogen is responsible for oropharyngeal candidiasis?

A

candida albicans

28
Q

what risk factors are associated with oropharyngeal candidiasis

A
  1. infancy
  2. denture wear
  3. immunocompromised
  4. DM
  5. chemo/radiation
  6. broad spectrum abx
  7. CS
29
Q

How would you describe the presentation of oropharyngeal candidiasis?

A
  1. presents with ST, mouth pain.
  2. creamy white patches/plaques w/ underlying erethematous mucosa.
  3. “thrush will brush”
  4. angular cheilitis
30
Q

Diagnosis of oropharyngeal candidiasis

A

KOH prep.

31
Q

Tx for oropharyngeal candidiasis?

A

1st line: topical nystatin, oral suspension

2nd line: clotramazole oropharengeal lozanges

Pt. education to clean carefully.

32
Q

What induces erythema multiforme major?

A
  1. HSV
33
Q

EMM presents with…

A
  1. target lesions on skin

2. duffuse mucosal erythema, painful erosions or bullae

34
Q

Where can lesions of EMM be found?

A

oral mucosa, genitals

35
Q

Tx for EMM?

A

symptomatic tx including:

  1. topical CS for cutaneous lesions
  2. oral antihistamines
  3. miracle mouthwash
36
Q

Precaution for EMM?

A

ocular involvement, emergent ophthalmology referral

37
Q

A patient presents with a several shallow, oval shaped lesions with a grayish base on the buccal and labialmucosa. What is the presumptive diagnosis?

A
  1. aphthous ulcer.
38
Q

Tx of apthous ulcer?

A
  1. self-limiting (10-14 days)
  2. avoid irritating food/drink
  3. topical CS if needed (oralone)
39
Q

How would you describe the presentation of behcet syndrome?

A
  1. recurrent oral and genital ulcers mostly involving the scrotum and vulva.
  2. painful, shallow to deep, with central yellow necrotic base
40
Q

Dx of behcet syndrome

A 
1. 3 or more ulcers/year and either: 
recurrent genital ulcers 
occular lesions
cutaneous lesions
posive pethergy test
41
Q

Tx for behcet syndrome?

A

rheumatology referral

42
Q

Describe the process of the pathergy test…

A
  1. tests for nonspecific hyperreactivity of the skin following minor trauma
  2. intradermal injection w/ sterile 20 gauge needle
  3. positive if erythematous sterile papule develops within 48 hours
43
Q

Three componants to oral lichen planus presentation:

A
  1. reticular, lacy white plaques on buccal mucosa
  2. erythematous
  3. erosive
44
Q

Tx for oral lichen planus:

A
  1. pain relief

2. high potency CS

45
Q

precaution for topical CS use in oral cavity:

A
  1. dry with gauze first, avoid eating and drinking for 30 minutes.
46
Q

What is associated with black hairy tongue?

A
  1. abx
  2. candida infection
  3. poor hygeine
47
Q

Tx of black hairy tongue

A

brush affected area w/ soft bristles and toothpaste BID/TID

48
Q

Presentation of geographic tongue:

A

erythematous patches on dorsal tongue w/ circumferential white borders.

may change location, pattern and size

49
Q

Etiology of atrophic glossitits?

A

inflammatory disorder leading to atrophy of filiform papillae

50
Q

A pt. presents with a smooth, glossy, erythematous tongue and reports burning sensation when eating acidic or salty foods. What is the presumptive diagnosis?

A

atrophic glossitis

51
Q

What preparations do you prescribe for few localized lesions?

A

gels

52
Q

what preparation do you prescribe for generalized erythema?

A

rinse

53
Q

What should you always educate patients about when prescribing topical CS?

A

oral candidiasis

54
Q

When there are severe lesions and symptoms, what do you prescribe?

A

systemic therapies.

Clinical Medicine I (25 decks)

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