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EENT > Oral Lesions + SSC > Flashcards

Oral Lesions + SSC Flashcards

1
Q

Aphthous Stomatitis : population

A

25%
Females
Congenital

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2
Q

Aphthous Stomatitis : pathogenesis

A 
UNCLEAR
Immunodeficiency
Decrease of mucosal barrier
Genetic
Antigenic exposure
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3
Q

Aphthous Stomatitis :

Associated conditions

A

Inflammatory Bowel Disease (chrohn’s)
Celiac disease
Betchet’s Syndrome (eye, genital)
SMOKING LOWERS

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4
Q

Aphthous Stomatitis:

Patho

A

Recurring, SUPER painful solitary/multiple ulcer

White-yellow pseudomembrane

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5
Q

Aphthous Stomatitis:

Variants?

A

Minor
Major
Herpetiform

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6
Q

Minor Aphthous Stomatitis:

Path

A

Well-circumscribed, superficial
<1cm
Labial / buccal mucosa, ventral tongue

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7
Q

Minor Aphthous Stomatitis:

Duration

A

10-14 days
No scarring
1-3 episodes/year

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8
Q

Major Aphthous Stomatitis:

Path

A

Onset after puberty
Lesions - larger,deeper, more
Tongue, soft palate, tonsillar fauces

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9
Q

Major Aphthous Stomatitis:

Duration

A

2-6 weeks

Heals w/ scarring

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10
Q

Herpetiform Aphthous Stomatitis:

Path

A

Onset - adulthood
Many lesions + recurrences
Small (1-3mm), coalesce
Any oral surface

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11
Q

Herpetiform Aphthous Stomatitis:

Duration

A

7-10 days

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12
Q

Aphthous Stomatitis :

DX

A

history, PE

Should resolve in 2 weeks, if no, biopsy

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13
Q

Aphthous Stomatitis:

Tx

A 
SYMPTOMATIC
Corticosteroids
*Fluocinonide gel
*Clobetasol propionate gel
*Triamcinolone acetonide
Chlorhexidine Gluconate (peridex) mouthwash
Amelexanox Paste (Aphthasol)
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14
Q

Aphthous Stomatitis:

pain relief

A 
Viscous lidocaine
OTC Benzacaine (oragel, anbesol)
MOM antacid + diphenhydramine swish

Possible prednisone

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15
Q

Oral Herpes Simplex :

Etiology

A

15-45%
Primary infection in childhood
Most common site 2ndry Infxn - vermillion border/ perioral area (herpes labialis)

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16
Q

Acute Herpetic Gingiosomatitis:

Etiology

A

6 mos - 5 years
Peak 2-3 years old

Maternal antibodies younger than 6 mos

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17
Q

Acute Herpetic Gingivostomatitis:

Presentation

A 
Abrubt onset
Cervical lymph
High fever
Chills, nausea, anorexia
Irritability
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18
Q

Acute Herpetic Gingivostomatitis:

Path

A

Lesion - vermillion border/lips to perioral area
Pinhead vesicles –> central ulcerations, erythema
Enlarged angry gingiva

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19
Q

Acute Herpetic Gingivostomatitis:

Adult presentation

A

Pharyngotonsillitis
(Vesicle - tonsil, post. Pharynx)
Resolve in 1-2 weeks

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20
Q

Oral Herpes Simplex:

Secondary/Recurrent Infection Triggers

A

UV, Trauma, Stress, Pregger

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21
Q

Herpes Labialis:

Path

A

6-24 hour prodrome
Rupture/Crust 1-2 days
Heal 7 - 10 days

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22
Q

Herpes Labialis:

Dx

A 
History + P.E.
Viral culture
PCR
Serology - 4-8 days
Chronic? biopsy
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23
Q

Tzank prep

A

Herpes (multinucleated epithelial)

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24
Q

Varicella

Differential signs

A

Itching

All lesion phases

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25
Q

Herpes Zoster:

differential signs

A

Dermatome on 1 side

Older

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26
Q

Mononucleosis:

Differential signs

A

posterior tonsil exudate

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27
Q

Hand-and-Foot
(Coxsackie)

differential signs

A

Hands and feet

Younger

28
Q

Herpes simplex:

Tx

A 
SUPPORTIVE
Viscous lidocaine
NSAID
Acyclovir (Zovirax)
Valacyclovir (Valtrex), Famciclovir (Famvir)
1st infxn: acyc, valacy
2nd infxn: famcic, acyc
Penciclovir cream
29
Q

Oral Lichen Planus:

Dx. 5 Ps

A 
Purple
Pleuritic
Planar
Papular
Plaque-like
30
Q

If have Lichen planus, you should screen for

A

Hep C

31
Q

Oral Lichen Planus:

Etiology

A

Women

30-60 y/o

32
Q

Oral Lichen Planus:

Presentation

A

LESIONS - Multiple, bilateral, symmetrical
LOCATION - buccal mucosa, gingiva, tongue dorsum, labial mucosa, lower vermillion
Koebner Phenomenon

33
Q

Oral Lichen Planus :

Presentation types

A

Reticular - white
Erythematous - Atrophic/ulcer
Erosive - bullous, ulcerated

34
Q

Oral Lichen Planus:

Reticular lesions

A

Wickman’s Striae

Asymptomatic

35
Q

Oral lichen planus :

Erythematous

A

Wickman’s Straie

Mucosal atrophy - red patch

36
Q

Oral lichen planus:

Erosive

A

Desquamative gingivitis, frank ulcers, erosions

Bullae - easily rupture

37
Q

Differential - white oral lesions

A

Candidiasis, leukoplakia, secondary syphilis, discoid lupus

38
Q

Differential - Erythematous/Ulcerative lesions

A 
Aphthous ulcers
Discoid lupus
Erythema multiforme
Primary HSV stomatitis
Oral SCC
39
Q

Oral Lichen Planus:

Dx

A

Hx + PE

Bilateral whitman’s straie (one side- biopsy gingiva)

40
Q

Oral Lichen Planus:

Tx

A 
No cure
Oral hygiene
No tobacco/alcohol
1st line - topical corticosteroid
*Clobetasol proprionate
*Betamethasone proprionate
41
Q

Oral Lichen Planus :

prognosis

A

Chronic, variable
No spontaneous remission
Post-inflame hyperpigmentation
Possible turn to SCC (6mos monitor)

42
Q

Oral Lichenoid Drug Reacions (OLDR)

A 
Less common than cutaneous
Adults
UNILATERAL
NAKS 
     (nsaids, ACEI, Ketoconazole, Sulfonylureas)
43
Q

Leukoplakia :

Presentation

A

White patch, doesn’t scrape
Lip vermillion, buccal mucosa, gingiva
Early lesions - exophitic, gray/white
Homogenous/heterogeneous

44
Q

Leukoplakia:

cancer?

A

Slower transform to SCC
Ventral tongue, oral floor
Female, non-smoker
5-25% - epithelial dysplasia

45
Q

Leukoplakia:

Dx

A

Biopsy

Hyperkeratosis, acanthosis

46
Q

Leukoplakia :

Tx

A

No dysplasia - monitor every 6 mos.

Moderate dysplasia - excision

47
Q

Proliferative Verrucous Leukoplakia

A

DO NOT MISS DX
Female
Keratotic plaques, rough surface projection
60% to SCC w/in 7 yrs

48
Q

Erythroplakia:

Etiology

A

Age 65-74

49
Q

Erythroplakia:

Path

A

Mouth floor, ventral tongue, soft palate
Multiple lesions
Well-demarcated, red, asymptomatic, macule/plaque, soft velvety (no keratin)

50
Q

Erythroplakia :

Dx

A

Biopsy

51
Q

Erythroplakia :

Tx

A

Guide by degree of dysplasia
MODERATE - full excision
Follow-up : recurrence

52
Q

Oral SCC :

Etiology

A

90% oral cancer
Male, >40, AA.
Tobacco use + heavy ETOH
UV/radiation, phenolic, Betal, Plummer Vinson, Vit A, 3 syphilis, HPV, immune

53
Q

Oral SCC:

Path

A

Tongue, mouth floor, vermilion lip border

54
Q

Oral cavity

A 
Lips
Buccal mucosa
Front 2/3 of tongue
Teeth
Floor of mouth
Hard palate
Retro molar area
55
Q

Oropharynx

A

Back 1/3 tongue
Soft palate
Tonsils+pillars
Throat Back wall

56
Q

Oral SCC warning sign

A

LESION 2 WEEKS +

Pain, lump, ear pain, bleeding, bad breath

57
Q

Lip Vermillion Carcinoma:

Etiology

A

Light-skin, sun

58
Q

Lip Vermillion Carcinoma

A 
Lower lip
Crusted, nontender, oozing w/ ulcer
<1cm
Slow grower, late meta
Submental nodes
59
Q

Intraoral SCC :

Where

A

Tongue - post. Lat, ventral
Oral floor- from leuko/erythroplakia
Gingival - bone, tobacco, female
Posterior - advanced lesion

60
Q

Intraoral SCC :

Presentation (lesions)

A

Most NO PAIN
Leuko/erythro/erythroleukoplakia
Exophytic/endophytic
Bone - moth bite, radiolucent

61
Q

Intraoral SCC :

Dx

A

Biopsy
Scope 2nd cancer - larynx, lung, esophagus
Head/Neck - CT
Chest - CT/x-ray

62
Q

Intraoral SCC :

Metastases

A

Ipsilateral cervical node
Oral floor –> submental
Lung, liver, bone

63
Q

Carcinoma staging

TNM

A

T : tumor size (I, II, III, IV)
N: node
M: metastases

64
Q

Intraoral SCC:

Tx

A

Guided by stage

Excision, radiation, chemo/radio

65
Q

Intraoral SCC :

Prognosis

A

1/2 die w/in 5 yrs (BAD)
Survive 1st cancer - 20x for next
Early Dx + prevention

EENT (10 decks)

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