Oral Path Exam 2 - Other White and Red Lesions Flashcards
1
Q
Which lesion?
Common (~2% of population) benign condition of unknown cause primarily affecting the tongue (i.e. geographic tongue or benign migratory glossitis)
A
Erythema migrans
2
Q
Which lesion?
Rarely affects soft palate, buccal mucosa, and FOM
A
Erythema migrans
3
Q
Which lesion?
Yellowish/white
Serpentine or scalloped border
Central erythema
Loss of filiform papillae
A
Erythema migrans
4
Q
Which lesion?
Immune-mediated
A
Erythema migrans
5
Q
Which lesion?
Lesions move around the mouth in days to weeks
A
Erythema migrans
6
Q
Which lesion?
1/3 of patients with a fissured tongue will have this
A
Erythema migrans
7
Q
Which lesion?
Active lesions may cause sensitivity to spicy foods
A
Erythema migrans
8
Q
Which lesion?
No tx needed
A
Erythema migrans
9
Q
Which lesion?
Caused by a variety of caustic agents, many are OTC
A
Chemical injury
10
Q
What are the most common causes of chemical injuries? (3)
A
Aspirin
Hydrogen peroxide
Phenol
11
Q
Which lesion?
White surface change due to coagulation necrosis of epithelium
A
Chemical injury
12
Q
Which lesion?
Heals within 1-2 weeks once offending agent is removed
A
Chemical injury
13
Q
Which oral mucosal hemorrhage?
Round, pinpoint area of hemorrhage ≤ 0.2 cm
A
Petechiae
14
Q
Which oral mucosal hemorrhage?
Non-elevated area of hemorrhage 0.3 - 1 cm
A
Purpura
15
Q
Which oral mucosal hemorrhage?
Non-elevated area of hemorrhage > 1 cm
A
Ecchymosis (bruise)
16
Q
Which oral mucosal hemorrhage?
Solid swelling of blood in tissues
A
Hematoma
17
Q
Which lesion?
Caused by blunt trauma and increased BP
A
Oral mucosal hemorrhage
18
Q
Which lesion?
If generalized, considered a clotting problem or viral infection (mono, measles, etc)
A
Oral mucosal hemorrhage
19
Q
Which lesion?
Most often a viral cause (adenovirus, enterovirus, influenza, parainfluenza, EBV)
A
Tonsillitis
Pharyngitis
20
Q
Which lesion?
Bacterial etiology = Group A, beta-hemolytic streptococci; can lead to scarlet fever with a rash (exanthem)
A
Tonsillitis
Pharyngitis
21
Q
This bacteria causes ~30% of acute cases of tonsillits/pharyngitis in children and 5-15% in adults
A
Group A, beta-hemolytic strep
22
Q
Which lesion?
Transmitted by respiratory droplets or oral secretions
A
Tonsillitis
Pharyngitis
23
Q
Which lesion has the following signs and symptoms?
Sudden onset of sore throat
Fever 101-104
Dysphagia
Tonsillar hyperplasia
Redness of oropharynx and tonsils
Yellowish tonsillar exudate
Palatal petechiae
Cervical LAD
A
Tonsillitis
Pharyngitis
24
Q
Which lesion has the following signs and symptoms in children:
HA
Malaise
Anorexia
Abdominal pain
Vomiting
A
Tonsillitis
Pharyngitis
25
Which lesion?
If the following are present, a viral etiology is suggested:
Conjunctivitis
Rhinorrhea
Cough
Hoarseness
Diarrhea
Viral exanthem
Absence of fever
Tonsillitis
Pharyngitis
26
Which lesion?
Do a rapid antigen detection (good sensitivity + specificity) if bacterial origin is suspected
Tonsillitis
Pharyngitis
27
Which lesion?
If rapid test is negative, do a throat culture
Tonsillitis
Pharyngitis
28
Which lesion?
Antibiotic like penicillin or amoxicillin should only be prescribed when bacterial infection is confirmed
Tonsillitis
Pharyngitis
29
Which lesion?
Tx rationale = to avoid complications of glomerulonephritis, rheumatic fever, or tonsillar abscess
Tonsillitis
Pharyngitis
30
Which lesion?
Typically self-limited (3-4 days)
Tonsillitis
Pharyngitis
31
Which lesion?
Chronic infection w/ candida albicans
Oral candidiasis
32
Which lesion?
Dimorphic (yeast and hyphal forms)
Oral candidiasis
33
Which lesion?
Most common oral fungal infection
Oral candidiasis
34
Which lesion?
~30-50% carrier state w/ subclinical infection
Oral candidiasis
35
Which lesion?
One or more clinical patterns may exist
Oral candidiasis
36
Which lesion?
Affects young/elderly, immunosuppressed, following broad-spectrum antibiotics, steroid therapy, cigarette smoking, denture wearers, and xerostomics
Oral candidiasis
37
What are the 3 clinical presentations of oral candidiasis?
Pseudomembranous
Erythematous
Chronic hyperplastic
38
Which clinical presentation of oral candidiasis?
Removable white
Pseudomembranous
39
Which clinical presentation of oral candidiasis?
Red, occasional white component
Erythematous
40
Which clinical presentation of oral candidiasis?
Acute atrophic (AB sore mouth)
Angular cheilitis
Central papillary atrophy (median rhomboid glossitis)
Central papillary atrophy +/- palatal erythema (kissing lesion)
Any combo of these = chronic multifocal candidiasis
Erythematous
41
Which clinical presentation of oral candidiasis?
Non-removable white
Chronic hyperplastic
42
Which clinical presentation of oral candidiasis?
AKA "thrush"
Pseudomembranous
43
Which clinical presentation of oral candidiasis?
Removable cheesy, white plaques on buccal mucosa, palate and tongue
Pseudomembranous
44
Which clinical presentation of oral candidiasis?
Scraping reveals a normal or erythematous (non-bleeding) surface
Pseudomembranous
45
Which clinical presentation of oral candidiasis?
Burning sensation or bad taste in the mouth
Pseudomembranous
46
Which clinical presentation of oral candidiasis?
Often acute onset with antibiotic exposure; slower onset with immunosuppression
Pseudomembranous
47
Which clinical presentation of oral erythematous candidiasis?
“Antibiotic sore mouth”- comes on after antibiotic use
Acute atrophic candidiasis
48
Which clinical presentation of oral erythematous candidiasis?
Scalded sensation to tongue
Acute atrophic candidiasis
49
Which clinical presentation of oral erythematous candidiasis?
Diffuse loss of filiform papillae
Acute atrophic candidiasis
50
Which clinical presentation of oral erythematous candidiasis?
Median rhomboid glossitis
Central papillary atrophy
51
Which clinical presentation of oral erythematous candidiasis?
Well-demarcated red zone, posterior dorsal tongue, midline, flat, smooth, symmetric
Central papillary atrophy
52
Which clinical presentation of oral erythematous candidiasis?
Often asymptomatic
Central papillary atrophy
53
Which clinical presentation of oral erythematous candidiasis?
Central papillary atrophy + an additional site (kissing lesion on palate and/or angular cheilitis)
Chronic multifocal candidiasis
54
Which clinical presentation of oral erythematous candidiasis?
Erythema, fissuring, and scaling of the angles of the mouth; waxes and wanes
Angular cheilitis
55
Which clinical presentation of oral erythematous candidiasis?
Can occur alone or with other forms of erythematous candidiasis
Angular cheilitis
56
Which clinical presentation of oral erythematous candidiasis?
Reduced VDO predisposes to this presentation
Angular cheilitis
57
Which clinical presentation of oral erythematous candidiasis?
20% candida alone
60% candida + staph aureus
20% staph aureus alone
Angular cheilitis
58
Which clinical presentation of oral erythematous candidiasis?
More extensive perioral involvement = cheilocandidiasis
Angular cheilitis
59
Which lesion?
Also called chronic atrophic candidiasis
Denture stomatitis
60
Which lesion?
Erythema of palatal denture bearing area, typically asymptomatic; may be related to continuous denture wear
Denture stomatitis
61
Which lesion?
Mostly a tissue response rather than true infection of mucosa as the denture is often contaminated with candidal organisms, but invasion of mucosa is seldom seen
Denture stomatitis
62
Which lesion has the following differential diagnosis?
Improper denture fit
Allergy to denture base
Inadequate cure of acrylic
Denture stomatitis
63
What can predispose to erythematous or pseudomembranous candidiasis of the hard/soft palate?
Steroid inhalers
64
What are the general signs of a neoplasm?
One lesion/location
Pain if malignant (or large benign)
Elevated
65
Which clinical presentation of oral candidiasis?
Non-removable white plaques
Chronic hyperplastic
66
Which clinical presentation of oral candidiasis?
Common sites are buccal mucosa and tongue
Chronic hyperplastic
67
Which clinical presentation of oral candidiasis?
If superimposed on a pre-neoplastic lesion, it will look speckled
Chronic hyperplastic
68
What are the 3 ways to diagnose oral candidiasis?
Culture
Cytology
Biopsy
69
Which type of diagnosis for oral candidiasis?
More sensitive
Culture
70
Which type of diagnosis for oral candidiasis?
Tales 2-3 days to grow yeast colonies (2-3mm creamy white)
Culture
71
Which type of diagnosis for oral candidiasis?
KOH prep
Cytology
72
Which type of diagnosis for oral candidiasis?
Periodic acid-Schiff (PAS) stained slide; next day results
Cytology
73
Which method of cytology to diagnose oral candidiasis?
Quick (several mins) and inexpensive
KOH prep
74
Which method of cytology to diagnose oral candidiasis?
Not as sensitive as culture or stained slide
KOH prep
75
Which method of cytology to diagnose oral candidiasis?
Not permanent
KOH prep
76
Which method of cytology to diagnose oral candidiasis?
Can't assess maturation of epithelial cells
KOH prep
77
Which method of cytology to diagnose oral candidiasis?
Apply drop of 1% KOH -> coverslip and examine
KOH prep
78
Which type of diagnosis for oral candidiasis?
Fix cells to slide w/ alcohol -> send to lab for staining
Cytology
79
Which type of diagnosis for oral candidiasis?
Not necessary in most cases
Biopsy
80
What are the 5 main groups of anti-fungal medications?
Polyene agents
Imidazole agents
Triazoles
Echinocandins
Other
81
Which group of anti-fungal medication?
Nystatin
Polyene agent
82
Which group of anti-fungal medication?
Clotrimazole (Mycelex)
Imidazole agent
83
Which group of anti-fungal medication?
Miconazole
Imidazole agent
84
Which group of anti-fungal medication?
Fluconazole (Diflucan)
Triazole
85
Which group of anti-fungal medication?
Iodoquinol + hydrocortisone
Other
86
Which specific anti-fungal prescription?
Disp: 7 tabs
Sig: take 1 tab p.o. each day for 1 wk
Note: Interactions with oral hypoglycemics, coumadin, phenytoin, others
Absolute contraindication with warfarin!
Fluconazole (Diflucan)
(preferred Rx due to ease of use)
87
Which specific anti-fungal prescription?
Disp: 350 mL
Sig: swish with 2 tsp (10ml) for 3 min then spit (or swallow), 5x/day for a week
Note: can also soak partial dentures overnight in solution to treat dentures
Nystatin oral suspension
88
Which specific anti-fungal prescription?
Disp: 50
Sig: Dissolve 1 troche in mouth 5x/day for 1 week
Clotrimazole (Mycelex)
89
Which specific anti-fungal prescription?
Disp: 1 oz tube
Sig: apply to corners of mouth 3x/day (TID) for up to 2 weeks.
Note: used for angular cheilitis; add another antifungal if there are intraoral signs of candidiasis
Iodoquinol + hydrocortisone
90
Angular cheilitis and/or patchy or diffuse red patches and atrophy or even ulceration of the tongue (glossitis) that does not respond to antifungal therapy could be from what? Which pts are at risk?
Nutritional deficiency
Pts w/ malabsorption due to GI disease are at risk
91
Deficiency in which vitamins can cause angular cheilitis?
Iron
Vitamin B2, 3, 6, 12
92
What do nutritional deficiencies cause systemically?
Fatigue
Weakness
93
How are nutritional deficiencies identified by a PCP?
Serum levels (bloodwork)
94
Which lesion?
May occur only in mouth or with skin lesions (itchy purplish bumps)
Oral lichen planus
95
Which lesion?
Symmetrical lesions of the bilateral mucosa, tongue, and gingiva
Oral lichen planus
96
Which lesion?
Desquamative gingivitis is possible
Oral lichen planus
97
Which lesion?
Occurs in adults; tends to come and go in severity
Oral lichen planus
98
What are the 2 major forms of oral lichen planus?
Reticular
Erosive/ulcerative
99
Which form of oral lichen planus?
Most common type
Reticular
100
Which form of oral lichen planus?
Not painful
Reticular
101
Which form of oral lichen planus?
Interlacing white lesions/striations ("Wickham's striae") or papules
Reticular
102
Which form of oral lichen planus?
Dorsal tongue involvement shows patchy keratosis and atrophy
Reticular
103
Which form of oral lichen planus?
No tx needed
Reticular
104
Which form of oral lichen planus?
Painful
Erosive/ulcerative
105
Which form of oral lichen planus?
Shallow ulcers, peripheral erythema, and radiating white lines (striated border)
Erosive/ulcerative
106
Which form of oral lichen planus?
When involving gingiva, may create a bright red, eroded appearance called "desquamative gingivitis"
Erosive/ulcerative
107
Which form of oral lichen planus?
Treated with one of the stronger topical
corticosteroids (e.g. fluocinonide gel, clobetasol gel); systemic steroids usually not needed
Erosive/ulcerative
108
Which lesion?
Incurable but manageable; not contagious; pt education is important
Oral lichen planus
109
Which lesion?
Candida may be superimposed on this lesion, altering the appearance and making it more symptomatic; management first includes treatment of any associated candidiasis
Oral lichen planus
110
Which lesion?
Meticulous OH helps disease control
Oral lichen planus
111
Which lesion?
Prognosis is good; may last for many years
Oral lichen planus
112
What is the diagnosis for oral lichen planus a combination of?
Clinical + histological features
113
What is the histology of oral lichen planus?
Lichenoid mucositis
(rete ridges are efaced)
114
What does the following histology describe?
Direct immunofluorescence shows shaggy band of fibrinogen at BM zone; no antibody production
Lichenoid mucositis
115
What does the following histology describe?
Hydropic degeneration of basal layer keratinocytes
Bandlike lymphocytic infiltrate
Saw-tooth rete ridges
Hyperparakeratosis
Lichenoid condition
116
Which lesion?
Looks similar to oral lichen planus clinically and/or microscopically
Lichenoid lesions
(clinically looks similar when "Wickham striae" are present)
117
Which lichenoid lesion?
Caused by cinnamon or other fresh flavors (e.g. mint) gum/candy; white/striated; typically on buccal mucosa and lateral tongue
Contact stomatitis
118
Which lichenoid lesion?
Tissue usually touching old amalgam restorations (isolated lesion)
Lichenoid amalgam rxn
119
Which lichenoid lesion?
New medication or increased dose of medication within month of lesion onset; typically multiple sites including tongue and buccal mucosa
Lichenoid drug rxn
120
Which lichenoid lesion?
Flaring of skin lesions along with mouth lesions
Lupus erythematosus
121
Which lichenoid lesion?
Must correlate with patient history
Chronic graft vs host disease
122
Which lichenoid lesion?
Leukoplakia/erythroplakia can appear striated- expect an isolated lesion and more plaque-like appearance; PVL also occurs in a multifocal situation
Premalignant
123
T/F: There is controversy regarding the cancer risk of oral lichen planus
True
124
__________ __________ that are isolated or begin to show leukoplakia (thickening, verrucous changes) or erythroplakia may possess a higher risk to turn into cancer
Lichenoid lesions
125
What should you look for in regards to the cancer risk of oral lichen planus?
Developing leukoplakia/erythroplakia
