Oral Path II-Exam 2 THE.LAST.TEST.EVER. Flashcards
Please give me the Diff Dx AND most likely culprit of a 14yo male who was concerned becasue of unsightly pigmented spots on his lips and buccal mucosa..(diffuse pigmentation on palms and souls of feet, family hx, and GI polyps)
1.Peutz-Jeghers Syndrome(*likely culprit) 2. Addison’s Disease 3.Hemochromatosis
Side note-what are three common etiologies (drugs/health conditions) for multifocal pigmentation?
1.Anti-malarial drugs 2.AIDS 3.Smoking
Whats the Diff Dx (and likely culprit) for a 28yo male presenting with a small, slightly raised pigmented lesion on his left buccal mucosa? He was unaware of its presence.
- Melanotic Macule 2.Nevus(*likely culprit) 3.Melanoma
Diff Dx (4) and likely Dx: A 39 y/o male presents with a small pigmented spot on his lower lip. Over the next 6mo the lesion increased to include almost HALF of the vermillion boarder. The lesion was mostly FLAT and had NO palpable nodules…
1.Melanoma (*most likely) 2.Nevus 3.Melanotic Macule 4.Hemangioma
What are the ABCDs of Melanoma? What is the standard for each?
A-asymmetry, B-boarders(regular/irregular), C-Color(variation), D-diameter (6mm or more)
What are the three major types of melanoma? Which type comprises 70% of the melanoma lesions?
- Superficial Spreading (70%) 2. nodular melanoma 3.lentigo (len-tie-go)
Diff Dx: a 52 yo male is referred to you in a state of panic, and ENT said he has melanoma. You see a 1cm blueish pigmented area on his R buccal mucosa…
1.Amalgam tattoo(clinical dx) 2.Melanotic Macule 3.Hemangioma
What are two clinical tools you can use to differentiate an amalgam tattoo from other pigmented lesions?
1.an x-ray will show radiopaqueness 2.see if the lesion blanches (diascopy)
Diff Dx (5 please): A 52 year old male had a small, slightly elevated bluish nodule on the vermilion border of his upper lip. Asympomatic, unknown duration
1.Varix (varicose vein) 2.Hemangioma 3.Kaposi’s Sarcoma 4.Melanoma 5.Melanotic Macule
What is a clinical tool that can help you differentiate between a verix and a melanoma?
diascopy-if it blanches it is a verix
Diff Dx (4) & Prov Clin Dx: 22 year old white male comes to your office complaining of a sore on the side of his tongue. 2 cm area of ulceration, firm but extremely painful on palpation. The patient also has several small, TENDER but enlarged LYMPH NODES on that side.
1.Non-Hemogeneous Leukoplakia 2.Traumatic or Apthous Ulcer (Provisional Clin Dx) 3.Squamous Cell Carcinoma 4. TB
What are TENDER, enlarged lymph nodes typically a sign of?
inflammation…hard, asymptomatic lymph nodes tend to indicate cancer
Ulcers are TAN in color because _______ migrates to the surface of the lesion. This is SPECIFICALLY not a _______ coloration.
Fibrinogen…white (white indicates dead cells)
Tough w/o seeing the picture, but Diff Dx (4 plz): An 86 year old white female complained of LOOSE TEETH. Clinical examination revealed a poor state of oral hygiene with CALCULUS on many of the teeth. The tissues were INFLAMMED and EDEMATOUS. The tissues were especially bad in the left mandibular cuspid-premolar area where there were also erosions and ulceration.
1.Periodontitis 2.Squamous Cell Carcinoma 3.Tuberculosis 4.Deep Fungal Infection (ended up being SCC)
DiffDx&ProvClinDx: This 68 year old FARMER developed an ulceration on the skin below his left eye. The lesion was umbilicated, with a central ulcerated depression and rolled elevated borders. He stated the lesion had been present for a COUPLE YEARS.
1.Kerato-Acanthoma(really a reactive lesion that should go away w/in6mo-yr) 2.Squamous Cell Carcinoma 3.Basal Cell Carcinoma**ProvClinDx*80% of skin cancers)
What is the most common form of Basal Cell Carcinoma? What is the recurrence rate of a BCC after excision?
Nodulo-Ulcerative form…25%
Diff Dx: This 22 year old African-American male presented with a chief complaint of an ulcer on his TONGUE. Clinical examination revealed a SMALL, slightly ELEVATED ULCER on the mid-dorsum of his tongue. The lesion had been present for one week.
1.Syphilis (primary-chancre)(provclindx)2.Squamous Cell Carcinoma 3.Traumatic Ulcer
What are the three lesions that characterize the three phases of Syphilis?
1.Chancre 2.rash 3.Gumma
Diff Dx: This 20 y/o in pain, ULCERATION on the lateral and ventral surfaces of his tongue. Started as a small break in the tongue mucosa and had slowly ENLARGED over a period of several WEEKS. He related that he had experienced NIGHT SWEATS and had LOST WEIGHT.
1.Squamous Cell Carcinoma 2. TB (**NIGHT SWEATS) 3.hiv/AIDS/fungal infection assoc w aids
What two cell types are commonly present in a granulomatous inflammation (like in TB)?
T-lymphocyts and Macrophages
Diff Dx (4): This 43 year old white female developed “BLISTERS” of her hard palate over the last couple days. She now has multiple small ULCERS of her HARD PALATE.
1.Nicotinic Stomatitis 2.Physical/Chemical Injury 3.Hypersensitivity 4. Herpes (after dental tx)
If you have a patient who ALWAYS has a recurrent/activated Herpes outbreak after a dental appointment, what is a possible prophylaxis that can be used?
2gm of VALTREX 12hrs before appointment, and then again after the appointment
What is the main SITE difference between Apthous Ulcer and Herpes?
AU-NON-keratinized tissue, Herpes-Keratinized tissue (the first outbreak can happen anywhere, but recurrent is usually confined to keratinized tissue)
Whats the Provisional clinical diagnosis?? This 4th year dental student developed a small cluster of VESICLES on the VERMILLION BIRDER of his lower lip. The night before, he stated that his lip itched…What is the eitology and pathogenesis (healing time)?
Herpes Labialis…HSV 1, 1-2weeks should be gone
Diff Dx(4)&ProvClinDx: A 25 year old white female presents to your office complaining of PAIN in her left CHEEK. Clinical examination reveals a 1cm ULCERATION of the posterior buccal mucosa. The ulcer had a WHITE surface and was surrounded by an ERYTHEMATOUS border. She stated the lesion had been present for 4 days
1.Traumatic Ulcer 2.Apthous Ulcer(**ProvClinDx) 3.Behcet’s Syndrome (autoimmune attack on blood vessles) 4.Crohn’s Disease
What are two possible treatments for an apthous ulcer? When are these taken?
High potency steroids (Fluo-cin-o-mide or Triamcinolone) taken at prodrome