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Oral Path- ABGD Flashcards

1
Q

What is “ cobweb trabeculation” imaging descriptors suggestive of?

A

odontogenic myxoma

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1
Q

What is “ beaten copper/beaten metal” imaging descriptors suggestive of?

A

Crouzon and Apert Syndromes
Hypophosphatasia

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2
Q

What is “ Cotton ball opacification” imaging descriptors suggestive of?

A

chondrosarcom

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3
Q

What is “cotton wool opacification” imaging descriptors suggestive of?

A

pagets disease

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4
Q

What is “floating in air” imaging descriptors suggestive of?

A

langerhans cell histiocytosis

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5
Q

What is “garrington sign (symmetric PDL widening)” imaging descriptors suggestive of?

A

osteosarcoma, chondrosarcoma

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6
Q

What is “ground/etched glass, orange peal” imaging descriptors suggestive of?

A

fibrous dysplasia

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7
Q

What is “hair on end pattern” imaging descriptors suggestive of?

A

sickle cell anemia
thalassemia

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8
Q

What is “honeycomb pattern” imaging descriptors suggestive of?

A

hemangioma/av malformation

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9
Q

What is “moth eaten radiolucency” imaging descriptors suggestive of?

A

osteomyelitis
ewing sarcoma

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10
Q

What is “onion skin opacification” imaging descriptors suggestive of?

A

osteomyelitis with proliferative periostitis
ewing sarcoma

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11
Q

What is “Punched out lesion” imaging descriptors suggestive of?

A

myeloma (adults)
LCH (children)
(Langerhan Cell Histiocytosis)

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12
Q

What is “snow driven, snow plow calcification” imaging descriptors suggestive of?

A

CEOT Calcifying epithelial odontogenic tumor (Pindborg tumor)

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13
Q

What is “snow flake calcification” imaging descriptors suggestive of?

A

AOT

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14
Q

What is soap ubble trabeculation” imaging descriptors suggestive of?

A

ameloblastoma

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15
Q

what is “Stepladder trabeculation” imaging descriptors suggestive of?

A

sickle cell disease

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16
Q

what is “sunburst/sunray opacification” imaging descriptors suggestive of?

A

osteo sarcoma
chondrosarcoma
hemangioma

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17
Q

What is “Tower skull “ imaging descriptors suggestive of?

A

apert syndrome

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18
Q

What is “tramline calcification (skull film) “ imaging descriptors suggestive of?

A

sturge weber angiomatosis

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19
Q

What is “wormian (sutural) bones (skull film)” imaging descriptors suggestive of?

A

cleidocrandial dysplasia
osteogenesis imperfecta

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20
Q

When to use an incisional biopsy? What solution do you put it in

A

for high risk lesions and for ulcerative/fermatologic disease
10% formalin
Michel’s solution (immunofluorescence)
Fresh (frozen, oncology protocol)

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21
Q

When do you use an excisional biopsy?

A

for small nodule on the buccal mucosa or gingiva, a small mucocele.

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22
Q

What might be your diff dx for a gingival nodule? What is the recurrent rate?

A

Pyogenic granuloma
Peripheral ossifying fibroma
peripheral odotogenic fibroma
peripheral giant cell granuloma
fibroma

*3-16% recurrence

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23
Q

What are common causes for generalized gingival overgrowth?

A

local factors
immunologic/immunodeficient/immunosenescent
hormonal (pregnancy)
medications (dilantin, CCBs, cyclosporine)
genetic/developmental/syndromic
neoplastic (leukemia/lymphona or metastatic)

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24
Q

What re diff dx for papillary/verrucous nodules

A

squamous papilloma (HPY, low risk)
condyloma acuminatum (HPV, sex transmit)
fibroma
verruciform xanthoma

Verrucous hyperplasia, proliferative verrucous leukoplakia, carcinoma may also be considered

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25
Q

What are the diff dx for soft tissue/multiple nodules?

A

Granular cell tumors
neuromas and neurofibromas (like in MEN and neurofibromatosis)

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26
Q

If youre concerned about multiple nodules what else should you look for?

A

cafe au lait spots, endocrinopathies

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27
Q

What is the differential for a single lower lip dark macule that is unchanged?

A

melanotic macule
melanocytic nevus
ephelis (freckle)

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28
Q

What are potential sources of pigmentation of the oral tissues?

A

physiologic
melanin deposition
melanocyte activity
medications
foreign bodies
vascular
syndromic (addisons, Sturge-Weber, ORWD, Peutz-Jeghers)

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29
Q

What are the clinical findingsthat may make you concerned for melanoma?

A

A: asymmetry
B: border irregularity
C: color variation
D: diameter >5-6mm
E: Evolution (change over time

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30
Q

What are the three most common skin cancers?

A
  1. basal cell carcinoma
  2. squamous cell carcinoma
  3. melanoma
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31
Q

How would you prescribe valacyclovir for a viral stomatitis?

A

2g STAT, then 2g 12 hrs later (+/- Q12 hr for 2-5 days)

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32
Q

What is an oral manifestation of crohn’s disease called?

A

pyostomatitis vegetans

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33
Q

What infectious diseases are associated with oral ulcers and granulomatous ulcers?

A

herpes (HSV1, HSV2, VZV, EBV, CMV, HHV6, HHV7, HHV8/KSV)
enteroviruses- usually towards the oropharynx
actinomycetes
treponema- syphilis
histoplasmosis, coccidiodiomycosis, blastomycosis (fungi)

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34
Q

What treatment options do you have for aphthous stomatitis?

A
  1. none
  2. rx: fluocinonide (lidex) 0.05% gel, 30 gram tube, apply 2-3x per day, with 1 refill
  3. rx: clobetasol (temovate) 0.05% gel, 30 gm tube, apply 2-4x/day
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35
Q

whats the fancy name for frictional irritation like chronic cheek biting?

A

morsicatio

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36
Q

What are some considerations for clinical licehnoid mucositis?what might cause it?

A

licehn planus
rxn to materials- amalgam, mouth rinse, toothpaste etc
dietary: cinnamon rxn
lichenoid rxn ot meds
oral GVHD
systemic lupus erythematosus or other autoimmunue disease

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37
Q

With lichen planus, what are you looking for?

A

striations, examine skinfor other dematologic dz

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38
Q

what do you look for with pemphigus?

A

spontaneous ulceration, hx of reveal systemic dz or neoplasm

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39
Q

What to look for with pemphigoid?

A

bullae (blisters), examine skin, eyes, nasal mucosa

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40
Q

What to look for with erythema multiform

A

desquamation, crusting lesions, burn like lesions, target lesions

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41
Q

For lichenoid mucositis, how might you treat?

A
  1. Lidex
  2. temovate
  3. if non responsedoxy 20mg 1 tab Q6 hr, 60 tabs
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42
Q

What are the high risk strains for HPV with regards to oral cancer?

A

high risk HPV (16, 18, 31, 33, 51, 52)

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43
Q

What is gardisil and when should it be used?

A

HPV vaccine:
routine vaccination 11-12 yo females (started at age 9)
13-26 yo high risk groups
to 26 yo

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43
Q

Where are you most likely to find HPV related cancer?

A

base of tongue
tonsils, oropharynx, nasopharynx

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44
Q

cysts in the sinus on a pano? what might that be?

A

Antral pseudocyst
refer if symptomatic or concerns regarding tx.

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45
Q

If you see what appears to be an antral pseudocyst on a pano what things would you want to clarify with the examiner/test on the patient?

A

restorationsvs no restorations
pulp vitality, apical tissue status (periodontal probing, transillumination)
surgical/traumahistory
symptomatic vs asymptomatic

46
Q

If an antral pseudocyst is symptomatic, what meds might you give?

A

antihistamine
decongestant
antibiotic (if systemic symptoms)

47
Q

What are some OTC antihistamines?

A

oxymetazoline (Afrin) – vasoconstrictor
phenylephrine (Sudafed PE)* – vasoconstrictor
pseudoephedrine (Sudafed )* –vasoconstrictor

48
Q

What cautionary concerns should you have with antihistamines?

A

sympathomimetic effects, MAOI interactions, mydriasis (dilation), abuse potential

49
Q

What are some OTC antihistamines?

A

cetirizine (Zyrtec
fexofenadine (Allegra
loratidine (Claritin
diphenhydramine (Benadryl)

be careful of sedating effects

50
Q

What things could you prescribe antihistamine/decongestant/steriod for antral pseudocyst?

A

Entex LA (guaifenesin, phenylephrine) - decongestant/mucolytic
Astelin (azelastine) - antihistamine
Dymista® (azelastine/fluticasone) -antihistamine/steroid
Flonase® (fluticasone) steroid (OTC or RX)

51
Q

What are common inflammatory odontogenic cysts?

A

periapical cyst / periradicular cyst ** MOST COMMON
buccal bifurcation cyst / paradental cyst
residual cyst (remaining cyst after treatment)

52
Q

What are the most common developmental odotogenic cysts?

A

dentigerous / follicular cyst (MOST COMMON DEVELOPMENTAL)
odontogenic keratocyst
primordial (no tooth develops; often histologically odontogenic keratocysts)
orthokeratinizing odontogenic cyst
glandular odontogenic cyst

53
Q

What are common odotogenic tumors

A

ameloblastoma (MOST COMMON TUMOR)
adenomatoid odontogenic tumor
ameloblasticfibroma ameloblastic
fibro odontoma/fibro dentinoma
odontoma (hamartomas (normal tissue, but malformed or)

54
Q

What are two other odotogenic cyst/tumors that are not as common

A

calcifying odontogenic cyst (Gorlin cyst); often included as a tumor
calcifying epithelial odontogenic tumor (Pindborg tumor)

55
Q

What is what are the characteristics of nevoid basal cell carcinoma syndrome also known as?

A

(Gorlin Syndrome)

56
Q

What are the common characteristics of Gorlin syndrome?

A

Basal Cell Carcinomas (<20yo)
OKC (<20yo)
Palmer/planter pitting
family member with Gorlin Syndrome

57
Q

Whats the recurrence rate on ameloblastomas? Will this often require adjunctive treatments or resective surgeries?

A

30-90%
yes

58
Q

What is the recurrence rate on OKC? Will this often require adjunctive treatments or resective surgeries?

A

5-60%
yes

59
Q

What is the recurrent rate on ameloblastic
fibroma? Will this often require adjunctive treatments or resective surgeries?

A

0-18%
yes

60
Q

What is the recurrent rate on adenomatoid
odontogenic tumor? Will this often require adjunctive treatments or resective surgeries?

A

RARE
no

61
Q

What are the signs and symptoms of Gardner syndrome? Who should you refer to?

A

osteomas, odontomas, supernumeraries
adenomatous polyposis
premalignant / malignant polyps of colon
extracolonic tumors
thyroid
desmoids (intestinal fibromas), liver, kidney

gastroenterology

62
Q

What are the signs and symptoms of eagle syndrome and who should you refer to?

A

pain in neck
dysphagia
dysgeusia (altered taste)
dystonia
tinnitus
vertigo
visual disturbances
TIA (vascular Eagle Syndrome)
intracranial pressure increase

Neurology

63
Q

Whats another name for dense bone island?

A

idiopathic osteosclerosis (NOT CONDENSING OSTEITIS = CHRONIC INFECTION)

64
Q

describe what cemento-osseous dysplasia looks like clinically?

A

non-expansile (normally)
not attached to roots with PDL intact
RL rim with opacify from center out

65
Q

How can you tell the difference between cemtno-osseous dysplasia and cementoblastoma

A

cementoblastoma does not have a PDL intact- its attached to the roots

66
Q

If something looks like a cementoblastoma is associated with pain and responds to NSAIDs what might you consider?

A

osteoid osteoma

67
Q

describe an ossifyng fibroma

A

expansile
not attached to tooth
mixed radiodensity

68
Q

describe fibrous dysplasia

A

expansile, often ground glass appearance, ill defined radiographically, may be associated with endocrinopathy (McCune Albright Syndrome)

overlaps with fibro-osseous, giant cell, and bone metabolic disorders

69
Q

What things should you consider when encountering giant cell lesions?

A

cherubism
primary and secondary hyperparathyroidism
CKD
chronic gastrointestinal dz/malabsorption

70
Q

What is the most common bone malignancy other than myeloma?

A

osteosarcoma

71
Q

What is a normal EF?

A

50-70%

72
Q

What tools can you use to help identify oral cancer?

A

Velscope Vx- blue exitation light

73
Q

What scale is MET’s and what does it mean?

A

Metabolic equivalents
1-10. 1= self care, 10= stenuous sports
4= flight of stairs or short run

74
Q

Common soft tissue masses of the upper lip

A

Fibroma
Minor gland sialolith
Salivary gland tumor
Salivary duct cyst
Other mesenchymal tumors
Nasolabial cyst

75
Q

Common soft tissue masses of the buccal mucosa?

A

Fibroma
Lipoma
Mucocele
Hyperplastic lymph node
Other mesenchymal tumors
SCC
Salivary gland tumor

76
Q

What are common masses of the floor of mouth

A

Ranula/mucocele
Sialolith
Lymph-epithelial cyst
SCC
Epidermoid or dermoid cyst
Salivary gland tumors
Mesenchymal tumors

77
Q

When there is a RL above the impacted 3rd that is <5mm thickness?

A

hyperplastic dental follicle

78
Q

What do you call it when the perm tooth is damaged due to periapical inflammation on the primary tooth?

A

Turner tooth

79
Q

What are the fixatives/media used for biopsy specimens?

A

10% buffered formalin

Michel’s solution
- preservative, potassium citrate, buffered
used for immunofluorescence

80
Q
A

Describe: white and pink papillary lesions approx 3-4mm located on th epapilla adjacent to the FGM of #29

Diffdx: squamous papilloma, verruciform xantoma, giant cell fibroma

squamous papilloma
-papillary bumpy, usually white to pink
-association HPV 6, 11

Verruciform xanthoma
-papillary (bumpy), white to white-yellow to pink
-association: none specific

Giant cell fibroma
-papillary (bumpy), usually pink
-assocation: none specific

81
Q
A

antral pseudocyst aka mucous retention cyst

inflammatory
2/2 sinus inflammation (sinusitis)
2/2 dental inflammatory
relative radiopacity in sinus
consider: vitality of teeth, perio eval

82
Q

What are the 2 most common sites for salivary gland tumors?

A

Parotid: 80%
Minor Glands: 20%

83
Q

Which salivary glands have the highest frequency of malignancy? Which is the lowest?

A

80-50-20 rule
80% benign Parotid
50% benign- submandibular/minor
20% benign sublingual

84
Q

Which is the most common benign salivary gland tumor?

A

Pleomorphic adenoma (mixed tumor)

85
Q

Which is the most common MALIGNANT salivary gland tumor?

A

Mucoepidermoid carcinoma

86
Q

What are the diagnostic findings for sjogrens syndrome?

A

Blood work determines SS–> Anti-Ro (SS-A), Anti-La (SS-B)

1.: ocular >3month of dry eyes
2: dry mouth >3 months
and more

87
Q

and described the lesion

A

Ill defined lesion on the R mandibule.

DDx: Fibrous Dysplasia (ground glass)
Paget’s disease (Cotton wool)

Often displaces teeth as lesion expands
may be symptomatic if it impinges on nerves
not age specific
warrants a full body exam for polyostotic disease or endocrine disturbance

Thyroid–> Calcitonin= activates osteoblasts, therefore decrease blood calcium levels by decreasing bone breakdown by inhibiting osteoclast. Whereas, PTH(antagonist with calcitonin) activates osteoclast and thereby increases blood calcium.

88
Q
A

lichenoid mucositis
linea alba

89
Q
A

Herpes zoster

90
Q

What would you find from the biopsy of a traumatic bone cyst

A

Uncomplicated non-epithelial lined cavity within the jaw.
No known cause, however trauma is suspected.
Inside the cyst = nothing

91
Q

What are sialoliths, and how do you manage them in the parotid duct and sublingual duct?

A

salivary gland stones, painful swelling

tx: sour foods to stimulate flow
increase fluid intake
OTC pain meds
if too bad, need sx

92
Q

DDX for a multilocular radiolucent lesion of the mandible

A

MACHO
Myxoma
Ameloblastoma
Centra Giant Cell Granuloma
Hemangioma
OKC

93
Q

Alveolar osteitis- what is it and how do you treat it?

A

dry socket- loss of blood clot frmo a healing ext socket

Increases risk: smoking, BC, hx of infection, traumatic extraction, inadeuqate irrigation

Decrease risk: CHX pre-rinse, Good OH

Tx: pallative, numb, irrigate, dry socket dressing (eugenol on gel foam)
daily f/u

94
Q

What is the retromolar pad? What is it?

A

Contains mucous glands, temporalis tendon, buccinator tendon

occlusal plane reference for denture teeth setup

95
Q

What types of tissues are apthous ulcers located on?

A

Non-keratinized

96
Q

What type of treatment would you prescribe for aphthous ulcers?

A

CHX
viscous lidocaine
Lidex-TID (Fluocinonide Ointment 0.05%)

97
Q

Lichenoid Reaction: How do you manage, What would you prescribe?

A

Discontinue and med causing allergy Ie: cinnamon, new meds, toothpaste, mouthwashes
Ensure ot rule out pemphigus, pemphigoid and desquamative gingicitis

Lidex- TID (Fluocinonide 0.05%)
Doxycycline 20mg BID

98
Q

Pseudomembranous candidiasis…why would someone have this?

A

taking ABX
denture
RPD
dry mouth
inhaler
smoker
immunocompromised

99
Q

What do you prescribe for pseudomembranous candidiasis

A

Nystatin Solution (soak denture)
Clotrimazole Troche

100
Q

What contributes to gingival overgrowth

A

meds:
Antiseizure (Dilantin)
Chemotheraputic (cyclosporine)
CC Blocker(enalapril)

Necrotizing gingivitis
leukemic overgrowth- soft boggy
Pregnancy

101
Q

What is the tx for gingival overgrowth

A

plasty
stop meds
oral hyg

102
Q

Hypoparathyroidism- discuss it

A

Parathyroid- affects calcium and phosphorous metabolism –> bones and teeth

Types:
Primary: increased PTH from tumor
2ndary: increased PTH due to abnormality low Ca or Vit D
Tertiary: long standing 2ndary hyperparathyroid

Findings:
Osteoporosis
vauge jaw pin, pulp stone, altered eruption, perio issues

Brown tumor- often in the jaw- mostly RL little mix.

103
Q

Bump on the side of the tongue- Diff Dx

A

fibroma
Neuroma
Lipoma
Neurofibroma
papilloma
Squamous cellCarcinoma

104
Q

What is it?

A

melanotic macule
physiologic pigmentation
melanocytic nevus
tattoo
melanoma

105
Q

ABCDEs of melanoma

A

A: asymmetry
B: irregular boarder
C: color reddish
D: diameter >6mm
E: evolution raised, changed?

106
Q

What are syndromes associated with neurofibromas?

A

Neurofibromatosis
Cowden
Peutz-Jeuger’s syndrom

107
Q

If there appeared to be an enlarged
cyst around a canine…could you still
extrude it?
Give DDX

A

No

Dentigerous cyst
Eruption cyst
OKC
AOT
Ameloblastoma

108
Q

Supernumerary tooth in the maxilla with a white lesion around the tooth — what is it?

A

Odontogenic lesions with calcifications
Odontoma
COC: Gorlin cyst (Calcifying odontogenic cyst )
CEOT (Calcifying epithelial odontogenic tumor) Pindborg
AOT (adenomatoid odontogenic tumor)

109
Q

What are the DiffDx for a radiopacity lesion at the apex of the tooth?

A

Condensing osteitis (non-vital)
Idiopathic osteosclerosis (vital)
Odontoma
Fibro-osseous lesion
cementoblastoma
osteoblastoma

110
Q

What are the diffDx for white lesions intraorally?

A

leukedema
white sponge nevus
hyperkeratosis acanthuses
Epithelial dysplasia
SCC
lichen planus
cadidiasis
traumatic fibroma

111
Q

Gum bumps- “Ps”

A

4 P’s
Pyogenic granuloma
peripheral giant cell granuloma
peripheral ossifying fibroma
“Plain” fibroma

112
Q

What are Wickham’s Striae?

A

Fine white or gray lines (dots) seen on top of oral mucosa lesions associated with lichen planus.

113
Q
A

Steven’s Johnson
erythema Multiform

*Pemphigoid: -Ophthamlic concerns, Nikolsku sign +/-

Pemphigus- dem concerns, nikolsky sign +

Biopsy x 2: 1 with formalin, one with Miche’;s

Tx: topical or systemic steriods, F/u

ABGD study (15 decks)

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