ORAL PATH II exam 1-RED & WHITE lesions

Question 1

Prov Clin Dx: A 57 year old female presented complaining of a “painful mouth”. Clinical examination revealed multiple, irregular WHITISH plaques MIXED with areas of ERYTHEMA… it is WIPEABLE

Answer 1

Pseduomembranous Candidiasis

Question 2

What are the three possible treatments for Candidiasis and what is the method of delivery of each?

Answer 2

1.NYSTATIN (tablets or rinse) 2.CLOT-RIM-AZOLE (tablets) 3.FLU-CON-AZOLE (systemic pill)

Question 3

Whats the Diff Dx (2) and Provisional Clincial Dx of a 25 y/o white male that presents with a large irregular white plaque in his R buccal mucosa that is BOTH wipeable AND non-wipeable..

Answer 3

1.Frictional Keratosis 2.Chemical/Physical Burn…Prov Clin Dx: Chemical/Physical Burn

Question 4

Diff Dx: A 62 year old white female presented with a 1 cm white plaque on the left lateral border of her tongue.

Answer 4

1.Frictional Keratosis 2.Leukoplakia 3.Lichen Planus (Determined to be Leukoplakia)

Question 5

Diff Dx (4): A 27 year old male had asymptomatic WHITEISH PAPULES of his buccal mucosae. He was unaware of their presence.

Answer 5

1.Focal Epithelial Hyperplasia (Heck’s Disease) **2.Papular Lichen Planus (prov clin dx) 3.Candidosis 4.Morsicatio Buccarum

Question 6

What are the 4 (maybe 5?!?!lol) variants of Lichen Planus?

Answer 6

1.Erosing Form 2.Bullous Form 3.Pigmented Form 4.Striated/Retucilar (5. Papillary?!)

Question 7

What is the most common form of Lichen Planus?

Answer 7

Reticular

Question 8

Say Whaaat??! Please give me the provisional clincial dx for this crazy one…A 29 year old white male came with buccal mucosae were covered with EXTENSIVE WHITE PALQUES. He stated the condition was ASYMPTOMATIC and had been present AS LONG AS HE COULD REMEMBER. (What is the GROUP of lesions called? What is the SPECIFIC Dx?)

Answer 8

GENO-KERATOSIS-the name for a GROUP of lesions that cause white lesions caused by genetics (wide spread, asymptomatic)..the ONE that a Dentist should remember is WHITE SPONGE NEVUS (Autosomal Dom)

Question 9

Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth…What are the 2 possibilities if it is wipeable?

Answer 9

1.Candidiasis 2.Burn

Question 10

Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth…What are the 4 possibilities if it is NON-wipeable?

Answer 10

1.Hypertrophic Candidiasis 2.Frictional Keratosis 3.Lichen Planus 4.Leukoplakia (which can then be diagnosed histologically as Hyperkeratosis, Carcinoma in situ, Squamous cell carcinoma, or epithelial dysplasia

Question 11

Say a 59 y/o white male comes into the office with a WHITE lesion about 1cm on the FLOOR of the mouth and its NON-wipeable…whats your Provisional Clinical Dx?

Answer 11

Leukoplakia

Question 12

WHAT DO 80% OF LEUKOPLAKIA’S REPRESENT HISTOLOGICALLY??? What about the other 20%?

Answer 12

80%-HYPERKERATOSIS…20%-Epithelial Dysplasia

Question 13

Why are areas like the ventral and lateral tongue, the floor of the mouth, and the lower lip more susceptible to epithelial dysplasia during leukoplakia than other sites? (3 reasons)

Answer 13

1. Gravity keeps carcinogens (EtOH, tobacco) in the area 2.Thin epithelium in those areas (carcinogen closer to basal cells undergoing change) 3.Non-keratinized tissue

Question 14

What is the treatment protocol for finding a hyperkeratotic leukoplakia?

Answer 14

1. Biopsy once every 3-4years. 2. Monitor/Recall 4x/year

Question 15

Diff Dx (3): A 68 year old white female, with a 1 x 3 cm white plaque on the left posterior lateral border of her tongue. Painful and occasionally BURNED, especially when eating spicy foods.

Answer 15

1.Frictional Keratosis 2.Hypertrophic Candidiasis 3.Leukoplakia (the prov clin dx here)

Question 16

Why is a NON-homogeneous leukoplakia more troubling than a homogenious lesion?

Answer 16

50-80% of non-homogenous leukoplakias are dysplastic

Question 17

Diff Dx (2) and Prov Clin Dx: A 66 year old male complains of the unsightly appearance of his lower lip. The
lesion does not rub off.

Answer 17

1.Leukoplakia 2.AC-TIN-IC KERATOSIS…Actinic Keratosis is provisional clinical diagnosis

Question 18

Diff Dx (3): A 72 year old white male presented to your office for the fabrication of new dentures. During your soft tissue exam you find a small 1cm WHITE plaque on the left posterior LATERAL BORDER of his tongue at the junction with the FLOOR OF THE MOUTH.

Answer 18

1.Leukoplakia 2.Candidiasis 3.SQUAMOUS CELL CARCINOMA

Question 19

PROVISIONAL CLINICAL DX: A 31 year old white male, multiple areas of mild erosion on the DORSAL and LATERAL borders of his tongue. Many of the areas are bordered by distinct WHITE LINES. The patient is ASYMPTOMATIC and unaware of the condition.

Answer 19

Erythemia Migrans (Geographic Tongue)

Question 20

Diff Dx (3): This 46 year old white female had a PAINFUL and BURNING mouth. Multiple RED, eroded areas BILATERALLY on her BUCCAL mucosa.

Answer 20

1.Erosive Lichen Planus 2.Mucus Membrane pemphagOID 3. Allergic Reaction

Question 21

What is the key determinant in a POSITIVE Nikolsky sign? What is a prime example of a pathology with a positive Nikolsky sign?

Answer 21

Sloughing. If there is sloughing, it is a POSITIVE Nikolsky sign and is therefore PemphagOID

Question 22

What is the key determinant in a NEGATIVE Nikolsky sign and what are two examples that will show this result?

Answer 22

NO sloughing of the tissue…1. Lupus 2.Lichen Planus

Question 23

If our microscopic/histologic analysis comes back from this pt: This 46 year old white female had a PAINFUL and BURNING mouth. Multiple RED, eroded areas BILATERALLY on her BUCCAL mucosa….and there were WHITE STRIAE, what does that indicate?

Answer 23

Erosive Lichen Planus

Question 24

What is the name and type of medication we can use OFF LABEL for treating the painful side effects of Erosive Lichen Planus?

Answer 24

Topical Cortico-Steroids: FLU-O-CIN-O-NIDE gel (Lidex)

Question 25

If a pt does not respond to a topical corticosteroid like Flucinonide for the treatment of Erosive Lichen Planus what are two alternatives and what “category” do they fit in?

Answer 25

ULTRA potency corticosteroids: 1. CloBETAsol 2.BETA-meth-A-sone

Question 26

Diff Dx (4), Prov Clin Dx: 17 y/o white female: For a couple days her lip has been RED and ERODED. She states her lip BURNS and that the condition was of fairly RAPID onset. The lip is also slightly SWOLLEN.

Answer 26

1.Erythema Multiforme 2.Type I Hypersensitivity Reaction *ProvClinDx 3.Phemphagous 4. Herpes Labialis

Question 27

What is the condition called when a 47 year old female presented with PAINFUL gingivae and multiple areas of DESQUAMATION of her attached gingiva. The epithelium
of the gingiva could be REMOVED with slight finger pressure. What is our provisional clinical dx?

Answer 27

Chronic Desquamative Gingivitis…caused by PEMPHAGOID

Question 28

What are 4 conditions that can produce CHRONIC DESQUAMATIVE GINGIVITIS?

Answer 28

1.Erosive Lichen Planus 2.PemphagUS Vulgaris 3.Bullus PhemphagOID 4. Benign mucus membrane pemphagoid

Question 29

What is the clinical term for epithelium of the gingiva being able to be removed with slight finger pressure?

Answer 29

Positive Nikolski Sign

Question 30

Which Nikolski sign will Erosive Lichen Planus present?

Answer 30

Negative Nikolski (so unable to remove any epithelium while finger wiping)

Question 31

Pemphagus/Pemphagoid: one can cause blindness, one can cause death…which one does which?

Answer 31

Pemphigus=DEATH, pemphigOID=blindness

Question 32

WHat are three general diff dx possibilities? A 64 year old white female complained of a BURNING sensation of her right posteriorlateral soft palate and tonsillar pillar. Clinical examination of the area revealed a large, irregular REDDENED area.

Answer 32

1.Viral Infection 2.Trauma (Denture Stomatitis?) 3.Erythroplakia

Question 33

What % of Erythroplakia demonstrate dysplasia or early invasive disease?

Answer 33

100 FUCKING PERCENT

Question 34

NO diff dx needed for this one…jump right to clinical Dx…BUT what are TWO names for the same condition? Which one does Dr. Wright prefer?? A 68 year old white female had a chief complaint of a BURNING maxilla. Upon removing her DENTURES, the denture bearing tissues of the maxilla appeared RED….WHY do you only need this info for a DX?

Answer 34

Atrophic Candidosis (Dr. W’s preference) OR AKA Denture Stomatitis….only the areas that the denture is touching are affected

Question 35

How do you treat Atrophic Candiosis/Denture Stomatits (3 drug possibilities)?

Answer 35

1.NYSTATIN (tablets or rinse) 2.CLOT-RIM-AZOLE (tablets) 3.FLU-CON-AZOLE (systemic pill) AND clorox disinfection for 2-3 nights

Question 36

If you thought a patient had what appears to be atrophic candidosis, but their denture was just delivered a short time ago, what is another possibility?

Answer 36

Uncured monomer causing a chemical burn

Question 37

Diff Dx(3): A 62 year old white female with a SPECKLED RED and WHITE lesion of her left posterior buccal mucosa. The lesion has been present “for years” and is sporadically SYMPTOMATIC. The patient had an intraoral CARCINOMA of her right mandibular alveolar ridge treated 8 years previously. Her physician is treating her left cheek for LICHEN PLANUS…NON-wipeable

Answer 37

1. Chronic Pseudomembranous Candiosis 2.Physical or Chemical injury 3. NON-homogeneous Leukoplakia

Question 38

If a patient has been successfully treated for oral cancer, what are the percentages that it may develop a second, independent cancer?

Answer 38

10-40%

Question 39

Diff Dx (3)…16 year old male with bilateral WHITE and RED areas of his buccal mucosa..What is a good question to ask in this case and what does the answer indicate?

Answer 39

1.Lichen Planus 2.Physical or Chemical Injury 3.Genokeratosis…What are the borders of the lesion/where do they end? In this case they end at the vestibule, so the patient was chewing his cheeks (aka..MOR-SIC-ATIO BUCC-ARUM)

Question 40

Diff Dx: (3) and Provisional Clin. Dx: A 14 year old African-American male comes to your office in ACUTE distress. He relates that within the past 24 hours, he has developed a SEVERE “RASH” over much of his BODY and MOUTH. You observe numerous cutaneous MACULES, EROSIONS and ULCERATIONS of his oral cavity. His LIPS are ULCERATED and CRUSTED. He has SEVERE PAIN and can not eat. In addition, the patient states that he was taking SULFONAMIDES for a urinary tract infection.

Answer 40

1.Erythemia Multiforme 2.Hypersensitivity Reaction 3.Primary Herpes Simplex…SLAM DUNK prov clin dx: ERYTHEMIA MULTIFORME

Question 41

How would you treat a patient in SEVERE PAIN going through an Erythemia Multiforme outbreak? What is it likely caused by?

Answer 41

High Dose of Systemic Steriods and in 24-48hrs the Pt should feel relief…an immune response likely triggered by a bacterial or viral infection

Question 42

Diff Dx (3) and Prov Clin Dx: A 41 year old white female complained of an EROSIVE condition of her mouth and skin. Clinical examination revealed WHITISH PLAQUES with RED ERODED areas bilaterally on her buccal mucosa. In addition, she had multiple erythematous areas on her skin which were especially prominent across the BRIDGE OF HER NOSE.

Answer 42

1.Pemphagous 2.Pemphagoid 3.Systemic Lupus Erythematosis<

Question 43

What are the two forms of SLE? How do you distinguish between them?

Answer 43

1. Discoid-confined to skin 2.Systemic-skin mucus mem, joints, kidneys