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BDS5 OSCE > Oral Medicine > Flashcards

Oral Medicine Flashcards

1
Q

what can acyclovir be used for

A

primary herpetic gingivostomatitis
recurrent herpetic lesions
shingles

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2
Q

what can antifungals be used for

A

acute pseudomembranous candidiasis
acute erythematous candidiasis

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3
Q

what is on a prescription

A

patient details
CHI
number of days
drug prescribed
formulation and dose
quantity
directions to patient
signed and dated

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4
Q

how long is a prescription valid for

A

6 months from issue date

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5
Q

what advice is given to patients when giving them a prescription

A

take drugs at correct time and finish the course
unexpected reactions to stop and contact prescriber
known side effects discussed
keep away from children

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6
Q

when is topical steroid therapy used

A

disabling immunologically driven lesions

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7
Q

what medicines can be used for non-steroid topical treatment of oral mucosal lesions

A

chlorhexidine mouthwash
benzydamine mouthwash or spray
igloo/bonjela

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8
Q

what are the topical steroids used in dentistry

A

hydrocortisone mucoadhesive pellet
betamethasone mouthwash
beclomethasone MDI

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9
Q

what are the instructions for using betamethasone tablets

A

1 tablet dissolved in 10ml water as a mouthwash 4x daily

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10
Q

what are the instructions for beclomethasone MDI

A

1-2 puffs directed onto ulcers twice daily

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11
Q

what are the risks of long term systemic steroid medication

A

adrenal suppression
cushingoid features
osteoporosis
peptic ulcer
mood/sleep alteration

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12
Q

what are the risks of immunotherapy medication

A

infection risk
cancer risk
adverse drug reactions

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13
Q

if a patient is going to start immunomodulatory treatment what do they need before this

A

BBV screen
FBC
electrolytes
liver function
zoster antibody screen
EBV
chest x-ray
cervical smear
pregnancy test

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14
Q

how would you explain geographic tongue to a patient

A

variation of normal
small areas of change in tongue with semicircular white and red areas
doesnt need any treatment but can make it uncomfortable to eat spicy foods
can be associated with deficiencies

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15
Q

when do you refer a swelling

A

symptomatic
abnormal overlying and surrounding mucosa
increasing in size
rubbery consistency
trauma from teeth
unsightly

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16
Q

what are the generic causes of oral white lesions

A

hereditary
smoking/frictional
lichen planus
candida leukoplakia
carcinoma

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17
Q

localised causes of brown/black lesions

A

amalgam
melanotic macule
melanotic naevus
malignant melanoma
peutz-jegers syndrome
pigmentary incontinence
kaposi’s syndrom

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18
Q

generalised causes of brown/black lesions

A

racial/familial
smoking/drugs
addisons disease (raised ACTH)

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19
Q

what are the characteristic features of a mucosal melanoma

A

variable outline
irregular outline
raised surface
itchy/bleeds

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20
Q

what can cause a single episode of oral ulceration

A

trauma
first recurrent episode
primary viral infections
OSCC

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21
Q

what are the causes of recurrent oral ulceration

A

aphthous
lichen planus
vesiculobullous lesions
recurrent viral lesion
trauma
systemic disease

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22
Q

what are the questions to ask in oral ulceration history

A

where
size and shape
blister or ulcer
how long for
recurrent at the same site or different sites
painful
ulcer free period

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23
Q

what do you look for when examining an ulcer

A

margins
base
surrounding tissue
systemic illness

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24
Q

features of recurrent herpetic lesions

A

ulceration limited to one nerve group/branch
hard palate usually
recurs in same place
aware of prodrome period
pain = zoster
no pain = simplex

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25
4 types of RAS
minor major herpetiform behcets
26
features of minor RAU
<10mm up to 2 weeks non-keratinised mucosa no scarring
27
features of major RAU
last for months >10mm any part of mucosa may scar
28
features of herpetiform RAU
multiple small ulcers on non-keratinised mucosa only heal within 2 weeks coalesce into larger areas of ulceration
29
criteria for diagnosis of behcets
3 episodes of mouth ulcers in a year 2 of: genital sores, eye inflammation, skin ulcers, pathergy
30
predisposing factors for RAS
genetic predisposition systemic diseases stress mechanical injuries hormonal level fluctuations microelement deficiencies viral and bacterial infections
31
how to explain the immunology of an ulcer to a patient
usually your cells will shed and be replaced with new ones but with ulcers there is damage to the cells that make up the mucosa meaning that new cells cannot be made to replace the old ones which shed which causes the ulceration and exposes the tissue underneath the gum
32
what kind of ulcer is it likely to be if it is recurrent and self-healing exclusively affecting the non-keratinised mucosa
aphthae
33
tests for ulcers
ferritin, folate, vit B12 coeliac allergy testing
34
treatment of recurrent aphthae
correct deficiencies refer for investigations if coeliac positive avoid dietary triggers
35
what topical treatment is recommended for ulcers as per SDCEP
non-steroid for infrequent ulcers steroid based for disabling and frequent ulcers
36
causes of lichen planus
genetics stress injury localised skin disease like herpes zoster systemic viral infection contact allergy drugs
37
how to explain lichen planus to a patient
immune reaction to irritation which it is trying to remove which can be either something localised that we can change (filling/drugs) or can be an illness
38
what investigation is usually done for lichen planus
incisional biopsy
39
medications which commonly cause lichen planus
ACE inhibitors B blockers diuretics NSAIDs DMARDs
40
appearance of a lichenoid drug reaction to medication
widespread lesions bilateral and mirrored poorly respond to standard steroid treatment
41
what is the management of lichenoid drug reactions
weigh up benefit of drug to risk of removing it and liaise with GP treat discomfort
42
tests for lichen planus
biopsy haematinics FBC autoantibody if lupus suspected
43
treatment used for mild intermittent lesions of lichen planus
chlorhexidine benzydamine avoid SLS containing toothpaste
44
treatment used for persisting symptomatic lesions of lichen planus
topical steroids (beclo/beta) clobetasol/tacrolimus creams
45
high risk sites for mouth cancer
floor of mouth lateral border of tongue retromolar regions soft and hard palate tonsillar areas
46
risk level for smokers who dont drink
2X increased with quantity, duration and frequency duration more important than frequency
47
risk level for drinkers
2X risk frequency more important than duration (more drinks each day)
48
risk level for someone who smokes and drinks
5X risk increases with frequency and duration of smoking and alcohol consumption
49
chance of white lesions becoming oral cancer in 10 years and in 20 years
1.4% in 10 4% in 20
50
what is TNM staging for cancer
T - size N - nodal spread M - metastatic spread
51
name some vesiculobullous conditions
erythema multiforme pemphigus pemphigoid angina bullosa haemorrhagica bullous lichen planus
52
presentation of erythema multiforme
skin target lesions ulcers in mouth crusty lips
53
what to tell patients about angina bullosa haemorrhagica
blood blisters in mouth initiated by minor trauma (eating and steroid inhalers) heals with no scars within days can use CHX mouthwash after burst can recur it is benign!
54
what is mucous membrane pemphigoid
subepithelial antibody attack causing separation of epithelium at basement membrane from connective tissue (thick blister formation)
55
antibodies involved in pemphigoid
C3 and IGG
56
what is pemphigus vulgaris
intraepithelial attack on the desmosomes making it more of an erosive ulcerative appearance than pemphigoid
57
causes of dry mouth
salivary gland disease drugs medical conditions dehydration radiotherapy and cancer treatment anxiety and somatisation disorders
58
what types of drugs cause a dry mouth
ANTI-MUSCARINIC CHOLINERGIC DRUGS - tricyclics - antipsychotics - antihistamine - atropine - diuretics - cytotoxics
59
what medical problems induce dehydration
diabetes renal disease stroke addisons disease vesiculobullous diseases
60
what direct problems to the salivary gland would reduce salivary flow
aplasia (ectodermal dysplasia) sarcoidosis HIV disease gland infiltration cystic fibrosis
61
tests for investigating salivary disease
FBC U&Es liver function tests C-reactive protein glucosa anti-ro anti-la antinuclear antibody complement C3 and C4 USS (flow test) labial gland biopsy imaging (US)
62
oral consequences of sjogren's syndrome
caries, denture retention, infections, functional issues salivary enlargement lymphoma risk
63
oral symptoms of sjogrens
daily feeling of a dry mouth > 3 months recurrent swelling of glands as an adult frequently dtink liquid to aid swallowing dry foods
64
management of sjogrens syndrome
diet advice OHI 5000ppm toothpaste salivary stimulant - pilocarpine salivary substitutes
65
how is Crohn's screened for
growth monitoring monitor altered bowel habits faecal calprotectin
66
what to exclude in the diet of an OFG patient
benzoates, sorbate, cinnamon, chocolate
67
management of OFG
3 month exclusion diet topical treatment to angular cheilitis topical treatment to lip swelling (injections)
68
how to explain OFG to a patient
the lymphatic drainage of your face has been blocked with cells due to an immune reaction to something this can take weeks/months to go down or not go down at all
69
oral features of OFG
perioral erythema angular cheilitis stag horning of FoM linear fissure ulcer in the buccal sulcus proliferative full thickness erythematous gingivitis
70
what results from an unstimulated salivary flow test and a schirmer test be abnormal
USS - <1.5ml in 15mins schirmer test - <5mm wetting of paper in 15 mins
71
what saliva substitutes are available
glandosane (acidic) saliva orthana lozenges chewing gum
72
what are the true causes of hypersalivation
drugs dementia CJD stroke
73
name a few drugs that would cause hypersalivation
clozapine buprenorphine clonazepam
74
how to treat problems with excess saliva
treat cause (anxiety) drug tor educe salivation gland botox swallowing control gland removal/duct repositioning
75
symptoms of mumps
gland inflammation joint pain nausea dry mouth tiredness pyrexia loss of appetite
76
how to explain a mucocele to a patient
blocked small salivary gland small lump filled with saliva usually bursts in days and will taste salty related to minor injuries such as lip biting
77
signs of neuropathic pain
constant burning/aching pain with no apparent cause fixed location fixed intensity history of injury in that area usually creates damage to the nerve
78
topical and systemic medication for neuropathic pain
EMLA, benzydamine pregabalin gabapentin tricyclics
79
what facial pain conditions are important to be aware of
atypical odontalgia oral dysaesthesia (burning mouth, touch dysaesthesia, dry mouth dysaesthesia) trigeminal neuralgia TMD cluster headaches
80
what is oral dysaesthesia
abnormal sensory perception in absence of abnormal stimulus
81
predisposing factors to oral dysaesthesia
deficiencies fungal and viral infections anxiety and stress gender (women)
82
what systemic issue is burning mouth syndrome most likely to be associated with
haematinic deficiency
83
how do you manage dysaesthesia
explain condition to patient assess degree of anxiety treatment to empower patient anxiolytic medication (nortriptyline, mirtazapine)
84
physical signs in TMD
clicking joint locking with reduction limitation of opening mouth tenderness of MoM tenderness of neck muscles
85
management of TMD
information about the joint itself and the condition physical therapy (soft diet, exercises, splint) tricyclics physiotherapy acupuncture clinical psychology
86
causes of trigeminal neuralgia
idiopathic classical (vascular compression) secondary (MS/tumour)
87
presentation of trigeminal neuralgia
unilateral maxillary or mandibular division pain stabbing pain 5-10 seconds continuous or sudden remission and relapses
88
triggers for trigeminal neuralgia
cutaneous wind/cold touch chewing
89
first line drugs for trigeminal neuralgia
carbamazepine 100mg oxcarbazepine lamotrigine
90
management of trigeminal neuralgia
carbamazepine pain diary
91
side effects of carbamazepine
blood dyscrasias electrolyte imbalances neurological deficits liver toxicity skin reactions
92
surgical options for trigeminal neuralgia
microvascular decompression stereotactic radiosurgery radiofrequency thermocoagulation balloon compression destructive peripheral neurectomies
93
what are the characteristics of painful trigeminal neuropathy (post-herpetic neuralgia etc)
localised to trigeminal nerve distribution burning/squeezing/pins and needles primary pain continuous but superimposed by brief pain paroxysms
94
what nerve does trigeminal autonomic cephalalgias affect
ophthalmic division of trigeminal nerve (V1)
95
what prominent cranial parasympathetic autonomic features are present with trigeminal autonomic cephalalgias
conjunctival injection nasal congestion eyelid oedema ear fullness miosis and ptosis
96
features of a cluster headache
pain orbitally and temporally unilateral only rapid onset lasts 15 mins - 3 hours rapid cessation of pain can come in bouts
97
features of paroxysmal hemicrania
pain orbitally and temporally unilateral only rapid onset lasts 2-30 mins rapid cessation of pain
98
what drug therapy can be used for cluster headaches
sumatriptan/zolmitriptan oxygen
99
name 3 types of fibrous overgrowths
fibrous epulis pyogenic granuloma giant cell lesions
100
name some reactive hyperplastic lesions
fibroepithalial polyp denture induced hyperplasia leaf fibroma papillary hyperplasia of palate
101
features of chronic hyperplastic candidosis
commissures smokers dysplasia may be present
102
treatment of chronic hyperplastic candidosis
systemic antifungal biopsy smoking cessation observation
103
what is the grading categories of epithelial dysplasia
hyperplasia mild moderate severe carcinoma in situ

BDS5 OSCE (14 decks)

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