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NBDE II Board Busters > Oral Pathology > Flashcards

Oral Pathology Flashcards

1
Q

Osteogenesis Imperfecta “Brittle Bones”

A

genetic defect, affects production of COLLAGEN

  • weak bones that break easily
  • blue sclera, deaf, loose joints, low muscle tone, triangle face, curved spine
  • dentally: bulbous crowns with cervical constriction, obliterated pulps, narrow and short roots, dentin malformation (dentinogenesis type I)

tx: no cure

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2
Q

Hypophosphatasia

A

resembles Osteogensis Imperfecta

  • inherited
  • LOW levels of ALKALINE PHOSPHATASE (important for calcifying bone)
  • characteristics: looseness, hypocalcification, premature loss of deciduous teeth, large pulp chambers, bone loss
  1. Perinatal - fails to form skeleton, stillborn
  2. Infantile - severe rickets, hypercalcemia, bone abnormalities, most cases lethal
  3. Childhood - premature exfoliation of teeth, more infxn, skeletal anormalities, DWARFS
  4. Adult - spontaneous fractures, hx of ricks, osseous radiolucencies
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3
Q

Paget’s Disease (Osteitis Deforman)

A

chornic, non-metabolic disease

  • INCREASE in serum ALKALINE PHOSPHATASE
  • bones big, deformed, dnse but fragile, has potential to undergo malignant transformation
  • affects middle aged and old ppl
  • pts predisposed to OSTEOSARCOMAS

clinical features - hx of increasing size of hats or new denture made (bony changes), bones warm

lab tests - high serum alkaline phosphatase, urinary calcium and hydroxyproline

xray - COTTON WOOL, hypercementosis, loss of lamina dura

tx: antimetabolites or CALCITONIN, or tx with high protein and calcium

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4
Q

Osteomalacia

A

SOFTENING of bones in adults (adult form of Rickets)
-lack of VIT D

-STEATORRHEA one of the common causes due to fat malabsorption

signs and symptoms - pain in bones of arm, leg, spine, pelvis

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5
Q

Rickets

A

osteomalacia in kids, accompanied by listelessness, irritable, muscle weakness

  • bowlegs, pigeon breast, protruding stomach
  • dentally: delayed eruption, malocclusion, dentin and enamel abnormality, higher caries rate
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6
Q

Dwarfism (pituitary dwarfs)

A

arrested growth from undersecretion of growth hormone

oral manifestation - delayed eruption and exfoliation, smaller crowns and roots, small dental arch, malocclusion, underdeveloped mandible

ACHONDROPLASIA is most common type of dwarfism - kid is short, stubby fingers, bowed legs, bulging forehead

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7
Q

Cerebral Palsy

A

body movement and muscle coordination, damage to motor control centers
-spastic paralysis, impairment of coordination over voluntary muscles, accompanied by MR, seizures, vision and communication disorders

-NO oral manifestations unique to them but more commmon for: perio disease, caries, bruxism, malocclusion, gingival hyperplasia (if Dilantin for seizures), trauma

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8
Q

Down Syndrome

A

oral manifestations - mandibular prognathism, incr. perio disease, thick tongue, delayed tooth eruption, more missing teeth, malocclusion, enamel dysplasia

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9
Q

Muscular Dystrophy

A

weakness and degeneration of skeletal or voluntary muscles that control movement

oral manifestations - incr. in dental disease if OH neglected, weak in muscles of mastication, mouth breathing, open bite

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10
Q

Fibrous Dysplasia

A

GROUND GLASS appearance of bone

  1. Monostotic - 1 bone
  2. Polyostotic - 1+ bone
  3. Polyostotic with ENDOCRINE disturbances (Albright’s Syndrome -> pathologic fractures

swelling mass of bone

tx - surgery

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11
Q

Ectodermal Dysplasia

A

HEREDITARY, abnormal development of skin and hair, nails, teeth, sweat glands

Clinical signs - hypothrichosis, anhidrosis (no sweat or sebaceous glands, heat intolerance), anodontia, oligodontia, lack of salivary glands, kid looks old

no tx

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12
Q

Cleidocranial Dysostosis

A

INHERITED, absent or incomplete collar bones, supernumerary teeth, unerupted teeth

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13
Q

Pierre-Robin Syndrome

A

INHERITED, following findings in the neonate:

micrognathia, glossoptosis, breathing problems, cleft palate

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14
Q

Lateral clefting of lip

A

failure of MAXILLARY and FRONTAL NASAL PROCESSES to merge

in 5th-6th week of life

more common in males; more common left side

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15
Q

Cleft palate

A

6th-8th week of life, more common in females

  • fissure in midline of palate
  • speech and swallowing
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16
Q

Exostosis

A

slow growing, benign knots on hard palate, tori

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17
Q

Cherubism

A

BENIGN INHERITED autosomal dominant disease, in kids by 5 yrs., 2x affects males, mostly MANDIBLE

BILATERAL expansion of jaw gives kid a round face

histo - looks like central giant cell granulomas

xrays - multiple, well defined, multi-locular radiolucencies

  • perivascular collagen cuffing is pathognomonic
  • no systemic manifestations
  • may have early exfoliation, delayed eruption
  • tends to regress in adulthood so don’t radiate!
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18
Q

Acromegaly

A

hormonal disorder, when pituitary gland produces excess growth hormone due to a BENIGN tumor after adolescence (fusion of epiphyses)
-in > 90% it’s from ADENOMA

clinical signs - soft tissue swelling of hands and feet, change in ring or shoe size, brow and lower jaw protrude, nasal bone enlarges, teeth spacing increases

oral manifestation - enlarged tongue, mand prognathism, teeth tipped to side, long roots

gigantism - caused by benign tumor BEFORE adolescence

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19
Q

Cystic fibrosis

A

congenital/heredity metabolic disorder involving EXOCRINE glands, affect GI and respiratory systems

  • thick secretions
  • most common inherited disease causing death in white ppl in US

characterized by COPD, exocrine pancreatic insufficiency, high sweat electrolytes

oral manifestations - staining of teeth (dark), reduced caries rate

signs and symp - poor growth, malabsorption, steatorrhea, COPD, clubbed fingers/toes, barrel chest

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20
Q

Osteomyelitis

A

inflammation of bone marrow and adj. bone, caused by Staphylococci due to trauma/surgery

signs - pain, red, swelling, malaise

xray - poorly circumscribed radiolucency with central sclerotic nidus

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21
Q

Condensing osteitis (chronic focal sclerosing osteomyelitis)

A

bone rxn to infxn, mandibular 1st molar most involved

xray - well circumscribed radiopaque sclerotic bone surruound and extending below apex of root (entire root visible! distinguishes from benign cementoblastoma)

tx - RCT, EXT (sclerosing bone will remain)

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22
Q

Periapical Abscess

A

from pulpal infxn of tooth, follows caries

Acute - painful to percussion, mobile
Chronic - presents as granuloma or cyst (radiolucent at apex), asymptomatic

tx - DRAIN or ext

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23
Q

Osteoporosis

A

rdxn of total skeletal mass due to increased bone resorption

  • predisposed to fractures caused by clacium or estrogen hormone deficiences
  • thin, old, white women

tx - estrogen therapy, calcium, vit D

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24
Q

Osteopetrosis “Albers-Schonberg Disease” or “Marble Bone Disease”

A

HEREDITARY/congenital, manifests in infancy

  • overgrowth and denseness of bones from defect in osteoclasts
  • long bones dense and hard so bone marrow is obliterated

signs - abnormal bone and dental development, fragile bones, stunted growth anemia, spleen and liver enlargement, blind, deaf

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25
Q

Von Recklinghausen’s Disease (Neurofibromatosis)

A

multiple tumors of nerve tissue origin, inherited autosomal dominant trait by multiple neurofibromas, cutaneous cafe-au-lait macules, bone abnormalitis, CNS changes

signs - 6 or more cafe-au-lait macules > 1.5 cm in diameter

tx - no good ones, run high risk of transforming into malignancy

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26
Q

Scleroderma

A

rare autoimmune disease affecting blood vessels and CT

  • hard and rigid skin/subcutaneous tissue
  • deposition of collagen in major organs
  • middle age females (4:1)

x-rays - wide PDL (also a finding in osteosarcomas)

tx - none really

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27
Q

Oral Traumatic Neuroma

A

lesion caused by trauma to nerve, small nodule of mucosa by the MENTAL FORAMEN, but also wherever a tooth was ext
-painful on palpation, “electric shock”

tx - excise

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28
Q

multiple neuromas on lips, tongue, palate can indicate pt has

A

MEN III (multiple endocrine neoplasia syndrome)

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29
Q

Neurilemoma (Schwannoma)

A

benign soft tissue tumor of Schwann cells around nerve, usually on tongue

tx - excise

can be derived from Schwann cell or perineural fibroblast

  1. Solitary - asymptomatic nodule -> excise
  2. Multiple - part of Neurofibromatosis syndrome -> can transform to malignant!!
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30
Q

Fibroma (Irritation or Traumatic)

A

most common intra-oral benign neoplasm of CT
-most common on buccal mucosa, lateral tongue, lower lip

clinical - pink, smooth, sessile
microscopic - bundles of collagen interspersed with fibroblasts and small blood vessels
histogenesis - fibrous CT

comparable to hyperplasias from denture irritation (epulis fissuratum)

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31
Q

Peripheral Fibroma

A

hyperplastic tissue with sessile or pedunculated base, may be ulcerated, rare recurrence

  1. peripheral ossifying - calcified islands of bone, ulcerated surface, young adult females, this may recur
  2. peripheral odontogenic fibroma - well vascularized, non-encapsulated fibrous CT
  3. giant cell fibroma - fibrous hyperplasia of multi-nucleated CT cells
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32
Q

Giant cell tumor

A

multinucleated giant cells, resemble osteoclasts scattered in matrix of spindle cells
-myelomas can be benign or malignant, can cause pain, sometimes bone fracture

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33
Q

Papillary fibroma

A

benign CT neoplasm

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34
Q

Lipoma

A

benign soft tissue tumor from ADIPOSE tissue

  • yellowish mass, soft, smooth
  • FLOAT in FORMALIN
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35
Q

Rhabdomyoma

A

rare benign tumor of SKELETAL MUSCLE

tongue most common place

sessile, non painful

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36
Q

Leiomyoma

A

benign tumor of smooth muscle, not painful

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37
Q

Lymphangioma

A

benign, yellow-tan tumor made of DILATED LYMPH VESSELS
-most common is TONGUE

microscopic characteristics - simple, circumscriptum, cystic

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38
Q

Benign tumors of Epithelium

A
  1. Papilloma - viral, caulfiflower-like, white, verrucous, pedunculated, must do surgery
  2. Verruca (warts) - not pedunculated, VIRAL, excise
  3. Keratocanthoma - VIRAL, crater lesion growing in skin that looks like SCC or BCC, can heal by itself
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39
Q

Multiple Endocrine Neoplasia Syndromes (MEN)

A

endocrine glands
-MEDULLARY CARCINOMA of THYROID

  1. Men I - tumors/hyperplasias of pituitary, parathyroids, adrenal cortex, pancreatic islets
  2. Men II (Sipple’s) - parathyroid hyperplasia or adenoma, NO tumor of pancreas, have PHEOCHROMOCYTOMAS of adrenal medulla and medullary carcinoma of thyroid!!
  3. MEN III - mucocutaneous neuromas, pheochromocytomas of adrenal medulla, medullary carcinoma of thyroid gland, presence of neuromas in oral cavity!!
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40
Q

Epulis granulomatosum

A

caused by retained foregin material due to iatrogenic error

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41
Q

Congenital Epulis of Newborns (Gingival Granular Cell Tumor)

A

cells identical to cell of a granular cell myoblastoma (granular cell tumor)

anterior gingiva of newborns, non-inflamed, pedunculated or broad based mass

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42
Q

Granular cell myoblastoma

A

unknown eitiology, uninflamed asymptomatic mass
-most common on TONGUE

*congenital epulis and granular cell myoblastoma are histologically identical BUT congenital epulis does not have pseudoepitheliomatous hyperplasia of overlaying epithelium

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43
Q

Pyogenic granuloma (pregnancy tumor)

A

bleeds easily, more common in females

microscopic - GT

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44
Q

Pregnancy tumor

A

pyogenic granuloma, maybe secondary to hormone changes, during FIRST trimester

remove AFTER pregnanc

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45
Q

Autograph (autologous graph)

A

tissue/organ transferred to new position in SAME body

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46
Q

Biopsy

fixative?

A

formalin 10%

only way to distinguish btw a granuloma and cyst

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47
Q

choristoma

hamartoma

A

overgrowth of tissues abnormal to organ from which it arises

overgrowth of tissues NORMAL to organ from which it arises

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48
Q

anaplasia

dysplasia

hyperplasia

metaplasia

A

feature of malignancy, absence of cell differentiation

non-malignant, structureless, disorganized, atypical cells without invasion, epithelium exhibits acanthosis

increase in size of tissue from incr. in # of cells

cell changes to another type in response to stress, NOT a feature of malignancy

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49
Q

hypertrophy

A

incr. in size of tissue from SIZE of cells

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50
Q

nosocomial

A

infxn from hospital

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51
Q

teratoma

A

benign or malignant made of multiple tissues foreign to organ from which it arises

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52
Q

carcinoma vs. sarcoma

A

carcinoma - malignant EPITHELIAL neoplasm

sarcoma - malignant MESENCHYMAL (C.T.) neoplasm

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53
Q

Lymphoepithelioma

A

poorly differentiated SCC involving lymphoid tissue in tonsils and nasopharynx regions

swelling of lymph nodes, sore throat, nasal obstruction

METASTASIS at early stage to cervical lymph nodes

tx - radiation, POOR PROGNOSIS (30% 5 yr survival)

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54
Q

Metastatic Carcinoma

A

most common malignancy of SKELETAL bones

clinical features - paresthesia or anesthesia of lip/chin

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55
Q

metastases to jaws originate from primary cancers of:

A 
Breast
Lung
Thyroid
Kidney
Prostate
Colon
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56
Q

most common osseous malignancies are

A

OSTEOSARCOMAS

then chondrosarcomas, fibrosarcomas, Ewing’s sarcom

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57
Q

Osteosarcoma (osteogenic sarcoma)

A

malignant bone tumor, in LONG BONES, peak before epiphyseal fusion (10-25 yr.s)

early xray feature is SYMMETRIC WIDENED PDL SPACE, sclerotic SUN-RAY appearance, lytic, mixed

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58
Q

diff dx for osteosarcoma of jaw include

A

chondrosarcoma, metastic carcinoma, pindborg tumor

ossifying subperiosteal hemangioma, peirpheral odontogenic fibroma

scleroderma, chronic osteomyeleitis

symp - tumor, mass swelling, pain, loose teeth, paresthesia, bleeing

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59
Q

histo classification of osteosarcoma based on dominant type of tissue cell

A
  1. osteoblastic - produces osteoid
  2. chrondroblastic - makes cartilage
  3. fibroblastic - makes fibrous tissue
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60
Q

osteosarcomas classified by site of origin

A
  1. conventional - medullary cavity
  2. juxtacortical - periosteal surface
  3. extraskeletal osteosarcomas - soft tissue
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61
Q

Ewing’s Sarcoma

A

malignant tumor from bone marrow, long bones or pelvis of young boys, HIGHLY LETHAL

sites - pelvis, thigh, body trunk

cells contain GLYCOGEN

when jaw is involved, predilection for RAMUS of mandible

xray MOTH EATEN radiolucency of medulla with erosion of cortex, periosteal ONION-SKIN rxn

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62
Q

Multiple Myeloma (Plasma Cell Myeloma)

A

bone marrow and plasma cells, MOST LIKELY FATAL

  • elevated blood levels of BENCE JONES PROTEIN
  • plasma cells that destroy osseous tissues
  • older males
  • mostly involves vertebrae, ribs, skull
  • jaws rarely a primary site but become involved 70% of the time -> molar-ramus area
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63
Q

xray features of Multiple Myeloma

lab findings?

tx?

A

PUNCHED OUT radiolucencies
take a lateral ceph

lab - hypergammaglobulinemia (IgG), BENCE JONES proteinuria

tx by chemo, radiation. POOR PROGNOSIS, survival 2-3 yrs

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64
Q

Odontogenic Myxoma

A

rare slow growing, asymptomatic jaw tumor in mandible
-localized expansion of jaw

tx - curettage

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65
Q

TNM - stage, assess prognosis and therapy of malignant neoplasma (tumors)

A 
T = SIZE of tumor
N = presence of regional lymph node involvement
M = presence of distant metasasis
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66
Q

melanoma exhibits 2 growth phases in skin

A
  1. Radial (horizontal) - INITIAL phase, just above and below dermo-epidermal jxn in horizontal plane
  2. Vertical - neoplastic cells populate the underlying dermis. METASTASIS is possible
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67
Q

Malignant Melanoma

A

MOST SEVERE and serious type of SKIN CANCER

  • from excessive exposure to UV radiation
  • often develops from a MOLE (nevus)
  • uncommon in oral mucosa but has predilection for palate and maxillary gingiva/alveolar ridge
  • 5 yr. survival is 7%
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68
Q

what cancer is the most common malignancy in the US. 1 in 100 will develop it

A

SKIN CANCER

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69
Q

most common intra-oral site for melanoma is

A

hard palate

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70
Q

4 clinical types of Melanoma

A
  1. Superficial Spreading - most COMMON, tan, brown, sun-exposed skin, radial growth, clinically macular or slightly elevated
  2. Nodular - no radial growth
  3. Lentigo Maligna - elderly, radial before vertical
  4. Acrolentiginous - hands and feet
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71
Q

Nevus

A

mole

atypical (dysplastic) - bigger, can mark a greater risk of malignant melanoma

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72
Q

Basal cell carcinoma

A

malignant epithelial cell tumor

  • central crater that erodes, crusts, bleeds
  • ONLY skin (never mouth)
  • caused by sun exposure

tx by electrodessication or cryotherapy

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73
Q

Squamous Cell Carcinoma (Epidermoid Carcinoma)

sites?

A

most common malignancy in oral cavity (90%)
-malignant epithelial tumor, more in males

  • more on lower lip than intra-orally
  • intra-orally on LATERAL and VENTRAL tongue -> cervical lymph nodes
  • FOM is 2nd most common site with worst prognosis

-can be red, irregular, non-painful, or white

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74
Q

risk factors for SCC

tx?

A

smoking, smokeless tobacco, alcohol, painful and ill fitting dentures, chronic inflammation

tx by surgery and radiation

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75
Q

most reliable histologic criterion for dx of oral SCC

A

INVASION

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76
Q

SCC H&N locations (9)

A
  1. nasopharynx
  2. palate
  3. oropharynx
  4. maxillary sinus
  5. tongue** lateral and ventral surface
  6. lips** lower lip (most easily managed when it’s here)
  7. FOM
  8. buccal mucosa
  9. gingiva and alveolar mucosa
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77
Q

3 types of SCC

A
  1. Verrucous Carcinoma
  2. Carcinoma IN SITU
  3. Carcinoma Invasive
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78
Q

Verrucous Carcinoma

A

rare form of SCC, does NOT metastasize

  • from tobacco, smoking, snuff
  • old men
  • UPPER ALVEOLAR RIDGE
  • white, cauliflower/coral like papillary appearance
  • can transform into invasive kind of carcinoma
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79
Q

Carcinoma IN SITU

A

only intraepithelial, atypical mitosis, hyperchromatism, but DOES NOT INVADE C.T.
-can’t metastasize cause lack of blood in epithelium

ex. old alcoholic female with red FLAT area in FOM

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80
Q

Carcinoma Invasive

A

ex. old alcoholic female with red area in FOM, med hx non-contributory

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81
Q

Erythroplasia

A

red, or speckled, non-ulcerated

-early carcinoma often begins as erythroplasia

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82
Q

characteristics of lesions that may be malignant include

A 
erythroplasia
rapid growth
ulceration
bleeding
induration (firm to touch)
fixation
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83
Q

abrasion

attrition

erosion

A
  1. abnormal pathologic wearing away ex. toothbrush (V-shaped wedges); occlusal (flat cusps)
  2. physiologic wearing of enamel and dentin from NORMAL FUNCTION, or bruxism
  3. chemical loss from non-mechanical means, ex. acid
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84
Q

internal resorption

A

begins in root canal (looks like balloon)

-first evidence may be pink-hued area on crown

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85
Q

intrinsic staining of teeth can be caused by the following

A 
dentinogenesis imperfecta
erythroblastosis fetalis
porphyria
fluorosis
pulpal injury
internal resorption
tetracyclines

NOT DIABETES

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86
Q

ankylosis

A

fusion of alveolar bone to tooth

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87
Q

gemination (twinning)

A

division of single tooth germ by invagination causing incomplete formation of 2 teeth

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88
Q

gomphosis

A

fibrous joint where conical process is inserted into socket-like portion

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89
Q

taurodontism

A

enlarged pulp, shortened roots, usually molars

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90
Q

hypercementosis

A

excess cementum around/on root after tooth eruption

  • seen in ACROMEGALY
  • affects VITAL teeth
  • usually premolars
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91
Q

enamel hypoplasia

A

incomplete formation of matrix

  • enamel hard, but thin and deficient
  • genetic forms are types of amelogenesis

clinically - lack of contact, rapid breakdown of occlusal, yellow-brown stain that appears from exposed dentin

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92
Q

enamel hypocalcification

A

hereditary defect, enamel is soft and undercalcified

  • normal in quantitiy due to defective maturation of ameloblasts
  • defect in mineralization of formed matrix
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93
Q

amelogenesis imperfecta

A

hereditary ectodermal condition

  • enamel is soft, thin, yellow
  • dentin, pulp, cementum NOT affected
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94
Q

3 types of amelogenesis imperfecta

A

Type 1 Hypoplastic AI: enamel not formed to full thickness or might be absent on newly erupted teeth due to defective FORMATION of enamel matrix

Type 2 Hypomaturation AI: enamel can be pierced and chipped away, has IMMATURE CRYSTALLITES

Type 3 Hypocalcified AI: quantity of enamel is normal but so soft it can be removed during prophy due to defective MINERALIZATION

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95
Q

Dentinogenesis Imperfecta (Hereditary Opalescent Dentin)

features?

sometimes assoc. with what condition?

A

RARE, only 1:7,000 kids. Hereditary MESODERMAL defect.

clinical features - amber, gray, purple teeth, pulp chambers obliterated, short and bulbous crowns, narrow roots, constriction at enamel-cementum junction

-sometimes linked to osetogenesis imperfecta, blue sclera common

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96
Q

3 types of dentinogenesis imperfecta

A

Type 1 - in pts with osteogenesis imperfecta, blue sclera, hx bone fractures

Type 2 - most common, only dentin is weird

Type 3 (Brandywine) - only dentin abnormal, but variations incl. multiple pulp exposures

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97
Q

dentin dysplasia (rootless teeth)

A

hereditary disease, autosomal dominant

clinical features - normal enamel, atypical dentin, pulp obliteration, defective roots, radiolucencies, early exfoliation

Type 1 (Radicular) - more common, mobile teeth, premature exfoliation, short roots, obliterated pulp, CRESCENT shaped pulpal remnant, radiolucencies, “CHEVRON” shaped pulp chambers

Type 2 (Coronal) - blue gray, obliterated pulp, amorphous and atubular dentin, THISTLE tube pulp and stones, true denticles, pulp stones

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98
Q

Oral Candidiasis (Thurs or Moniliasis)

symptoms?

predisposing factors?

tx?

A

fungal infxn caused by Candida

  • diffuse, curly, velvety white mucosal plaque
  • CAN BE WIPED OFF -> red, raw, bleeding surface
  • symptoms = discomfort, burning, altered taste

-factors that stimulate growth = abx, steroids, diabetes, pregnancy, vit deficiency (iron, folate, b12, zn)

tx - lozenges (trouches) and Nystatin rinse

99
Q

Angular Cheilitis (Perleche)

predisposing factors?

tx?

A

inflammatory lesion at corners of mouth

predisposing factors - candida infxn, loss of vertical dimension, trauma, vit deficiency (riboflavin, thiamine)

tx - NYSTATIN

100
Q

Actinic Cheilitis (Solar Cheilitis)

A

premalignant, caused by sun

  • counterpart of actinic keratosis
  • can develop into SCC

-thick, white discoloration of lip at border and sharp demarcation btw red of lip and normal skin

101
Q

White sponge nevus (familial white folded dysplasia)

A

buccal mucosa abnormality often mistaken for leukoplakia
-soft, thick, corrugated folds

NO TX

102
Q

Leukoplakia

A

PREMALIGNANT, white patch or plaque, WON’T RUB OFF, DOESN’T DISAPPEAR WHEN STRETCHED

-etiologic factors = tobacco, alcohol, oral sepsis, chronic irritation

tx = biopsy! all leukoplakias must be biopsied and completely excised

103
Q

carcinoma in situ

A

mucosal lesions that resemble leukoplakia except that dysplasia is prnounced and involves almost all epithelial layers, shows no tendency to metastasize or invade

-exhibits all histo characteristics of malignancy but DOES NOT show invasiveness or extension

104
Q

diff dx of white patch includes

A 
leukoplakia
lupus erythematosus
leukoedema
white sponge nevus
chemical burn
candidiasis
lichen planus
migratory glossitis
105
Q

Stomatitis Nicotina (Pipe Smoker’s Palate, Nicotinic Stomatitis)

A

related to pipe smoking, ONLY ON PALATE, mostly males

  • palate red, inflamed, then diffuse gray-white multi-nodular appearance with small red “spot” in center of each nodule
  • leathery white hyperkeratosis (inflamed minor salivary glands)
  • the only lesion produced by tobacco that is not cancerous

tx = stop smoking

PREMALIGNANT

106
Q

Leukoedema

A

mimics leukoplakia, along occlusal line, DISAPPEARS on STRETCHING

tx = none

histo - epithelium is parakeratotic and acanthotic, marked with edema

diff dix = leukoplakia, white sponge nevus, herditary benign intraepithelial dyskeratosis

107
Q

Lichen Planus

A

oral lesion on buccal mucosa, appears as white or gray-white STRIAE in a lace-like pattern “WICKMAN’S STRIAE”’
-may be autoimmune

microscopic features = hyperparakeratosis, thickened granular layer, saw-tooth appearance of rete pegs, degeneration of basal cell layer, infiltration of inflammatory cells
-more common in women

tx - topical STEROIDS

2 forms

  1. Bullous lichen planus - fluid filled vesicles
  2. Erosive lichen planus - RED, when involves gingiva looks like desquamative gingivitis
108
Q

Hairy Tongue

A

hypertrophy of FILIFORM PAPILLAE

  • BENIGN condition
  • discolaration of dorsum tongue
  • can be white, green, brown (stained from debris)

etiology - overgrowth of fungal microorganisms from smoking or poor OH

109
Q

4 types of Papillae on Tongue

taste buds are on which ones?

A
  1. Filiform - most numerous, V-shaped rows, NO taste buds
  2. Fungiform - scattered along filiform, flat, mushroom shaped at tip and lateral margins
  3. Circumvallate - largest but least numerous, circular in V-shaped row at back of tongue, assoc. with ducts of von Ebner
  4. Foliate - lateral margins as 3-4 vertical folds

Taste buds are on fungiform, circumvallate, foliate

110
Q

Benign Migratory Glossitis “Geographic Tongue” or “Erythema Migrans”

A

harmless, desquamation of filiform papillae

  • slight burning of tongue
  • often occurs with fissured tongue
111
Q

Fissured tongue “Scrotal Tongue”

found in what Syndrome?

A

deep, asymptomatic MEDIAN FISSURE with laterally radiating grooves, arranged across dorsum of tongue

found in Melkersson-Rosenthal Syndrome (along with Cheilitis Granulomatosum and Facial Nerve paralysis)

112
Q

Fordyce’s Granules

A

ectopic sebaceous glands in oral mucosa, in > 75% adults

-yellow clusters, NORMAL

113
Q

Purpura

A

hemorrhages, looks like purple spots or patches
-extractions are contraindicated due to potential excess bleeding

2 types

  1. Thrombocytopenic Purpura (Werlhof’s Disease) - deficiency in # of platelets, can be caused by heparin
  2. Thrombotic Thrombocytopenic Purpura (TTP) - fatal form, low platelets and thrombosis in terminal arterioles and capillaries
114
Q

Agranulocytosis

A

rdxn in # of neutrophils

  • LEUKOPENIA with rdxn in # of PMNs
  • toxic effect of certain ANTITHYROID DRUGS (propylthiouracil, methimazole, carbimazole)

WBC < 2000, almost no nutrophils

  • high fever, chills, sore throat, infection in oral cavity
  • oral lesions - necrotizing ulcerations, ragged ulcers covered by gray membrane

tx - figure out what drug and stop it, give abx

115
Q

Cyclic Neutropenia

A

form of agranulocytosis where pts exhibit severe gingivitis, usually no ulcerations

116
Q

Sickle Cell Anemia (Sickle Cell Disease)

A

inherited anemia, crescent shaped RBCs, characterized by fever, leg ulcers, jaundice, pain in joints

  • production of abnormal hemoglobin (hemoglobin S)
  • usually blacks, females
  • signs of anemia (weak short breath, joint pain)

dental xrays are diagnostic -> marrow spaces are enlarged, trabeculae are prominent, osteosclerotic areas noted in midst of large radiolucent marrow spaces

117
Q

Leukemia

what agents are assoc. with its development?

A

cancer, uncontrolled proliferation of leukocytes -> replacement of red bone marrow with leukemic cells
-unknown etiology

agents assoc. with its development

  1. ionizing radiation
  2. viruses - herpes like viral particles, and they have high titer to Epstein Barr
  3. genetic mutations - Philadelphia chromosome in 90% pts with CML; in Down’s
  4. Other - benzol, aniline dyes
118
Q

3 types of Leukemia

A
  1. Myelogenous - granulocytes and megakaryocytes
    - CML is 4 yrs. with death from hemorrhage or infxn
    - Philadelphia chromosome and low levels of leukocyte alkaline phosphatease
    - massive splenomegaly
  2. Lymphocytic Leukemia - lymphocytes
    - CLL variable course
    - lymph node enlargement main finding
  3. Monocytic Leukemia - monocytes
    - oral lesions (gingivitis, gingival hemorrhage, gingival hyperplasia, petechiae, ecchymoses, ulcerations)
    - RARE
119
Q

clinical features of chronic leukemia

A
  • insidious (slow) onset with weakness and weight loss
  • organ involvement similar to acute leukemia: skin involved, manifest as petechiae or ecchymoses, recurrent hemorrhages, bacterial infxns
  • lab findings: leukocytosis > 100K with mature forms (granulocytes and lymphocytes) predominating
120
Q

Chronic Myelogenous Leukemia (CML)

A

myeloproliferative disorder

  • the least malignant leukemia
  • affects middle age

clinical signs - spongy bleeding gums, fatigue, fever, weight loss, moderate splenomegaly, joint pain

PHILADELPHIA CHROMOSOME - translocation btw chromosomes 9 and 22

survival time = 4 years with death due to hemorrhage or infxn

121
Q

Polycythemia Vera (Primary Erythemia)

A

chronic myeloproliferative disorder of TOO MANY RBCs

  • blood is too thick to pass through small vessels -> clot formation and blockage -> CVA
  • splenomegaly in 75% pts

clinical features - headache, weak, weight loss, pruritis, hemorrhage, thrombosis

oral manifestations - gingiva and tongue deep purple-red, gingiva swollen and bleeds, submucosal petechiae, hematomas

Secondary Polycythemia - incr. in total # of RBCs due to another condition

122
Q

Acute Myeloid/Myelogenous Leukemia (AML)

A

malignant disease of bone marrow, hematopoietic precursors arrested in early development

  • has > 30% myeloblasts in blood, which contain AUER RODS
  • MOST MALIGNANT leukemia
123
Q

Acute Leukemia

A

abrupt onset of few months
-pt dies within 6 due to brain hemorrhage or bacterial infxn

clinical features - anemia, hemorrhages, enlargement of lymph nodes or spleen, petechiae

primary organs involves = bone marrow, spleen, liver

lab findings - leukocytosis with immature forms predominating (myeloblasts, lymphoblatss); anemia, thrombocytopenia, prolonged bleeding and coagulation times, tournique test +

124
Q

acute myelogenous leukemia more common in kids or adults?

A

adults

125
Q

Acute Lymphocyt (Lymphoblastic) Leukemia more common in kids or adults?

A

CHILDREN

  • most common leukemia in children
  • lymph node enlargement
  • lymphocytes are not B or T cells but “null” cells
126
Q

Aleukemic Leukemia

A

-leukemic cells in bone marrow, but circulating WBC are neither immature nor increased in number

127
Q

Leukemoid Reaction

A

increase in # circulating granulocytes (neutrophils)

128
Q

Stem Cell Leukemia

A

abnormal cells are the precursors of lymphoblasts, myeloblasts, monoblasts

129
Q

Subleukemic Leukemia

A

leukemic cells appear in blood but no significant increase in # of circulating WBC

130
Q

Plummer Vinson Syndrome

A

severe and chronic IRON DEFICIENCY anemia, mainly mid aged women
-predisposition to carcinoma in oral mucous membranes

systemic symp - weak, pallor, dysphagia, dyspnea

oral symp - angular stomatitis, smooth, red painful tongue with atrophy of papillae

131
Q

Aplastic Anemia

2 types?

A

capacity of bone marrow to produce RBCs is defectie
-most serious and life threatening blood dyscrasia assoc. with drug toxicity

  1. Primary - unknown cause, affects young adults, usually fatal. oral symp = bleeding, petechiae, gingival infxns
  2. Secondary - exposure to toxic agents, any age, good prognosis
132
Q

Pernicious Anemia

deficiency in what?

what are the symptoms?

A

inability to absorb Vit B12 from digestive tract
-megaloblastic anemia caused by lack of INTRINSIC FACTOR

triad of symptoms = weak, sore painful tongue, tingling of extremities

133
Q

Thalassemia Major and Minor

A

hemolytic anemias caused by genetic defect
-low level of erythrocytes and abnormal hemoglobin

oral manifestations - oral mucosa shows anemic pallor, flaring of max anteriors

134
Q

Erythroblastosis Fetalis (hemolytic disease of newborn)

A

production of maternal antibodies for fetal RBC

  • involves RH FACTOR INCOMPATIBILITY
  • destruction of RBCs
  • only occurs when MOM is RH(-) and KID is RH(+)

oral manifestations - teeth green blue, brown, enamel hypoplasia

135
Q

Erythrocyte Sedimentation Rate (ESR)

A

non-specific test that monitors progression of disease

  • rate at which RBC settle out in a tube of unclotted blood
  • elevated sedimentation rates indicates presence of inflammation (makes blood proteins heavier)

ESR rises in inflammation, tissue degen., suppuration, necrosis, pregnancy

136
Q

Wiskott-Aldrich Syndrome

A

only boys, causes eczema, low platelets, deficiency of B and T cells
-if they survive past 10 -> lymphoma and leukemia

137
Q

Trigeminal neuralgia

A

stab-like pains, provoked by a trigger zone near nose or mouth, caused by degen. of trigem nerve or pressure

tx - CARBAMAZEPINE (tegretol), an analgesic/anticonvulsant

138
Q

Multiple Sclerosis

A

chronic, attacks CNS (brain, spinal cord) due to AI response, facial and jaw weakness
-predisposed to Bell’s Palsy, Trigem. Neuralgia

139
Q

Glossopharyngeal Neuralgia

A

sharp, sudden, shooting, UNILATERAL

140
Q

Postherpetic Neuralgia

A

burning, aching, itching, hyperesthesia along a cutaneous nerve after attack by HERPES ZOSTER
-facial nerve CN VII and geniculate ganglion -> Ramsey Hunt Syndrome

141
Q

Myasthenia Gravis

A

extreme muscle weakness due to AI dosrder, antibodies against Ach receptors in NMJs.

  • xerostomia, caries
  • more in women
  • droopy eyelids, double vision, fatigue

tx - pyridostigmine, neostigmine

142
Q

Eaton-Lambert Syndrome

A

like myasthenia gravis, AI disease

-caused by inadequate release of Ach

143
Q

Muscle spasm

A

prime factor that initiates Myofascial Pain-Dysfunction Syndrome (MPD). Mostly in women, unilateral.

Usually LATERAL PTERYGOID

tx - self limiting but can use NSAIDS and diazepam (valium)

144
Q

4 cardinal signs and symp of MPD

A

pain, muscle tenderness, clicking/popping, limited jaw movement

145
Q

Frey’s Syndrome (Auriculotemporal)

A

damage of auriculotemporal nerve and innervation of sweat glands

146
Q

Bell’s Palsy

A

facial paralysis from damge to facial nerve

signs - unilateral paralysis with loss of wrinkles, drooping eyebrows, etc.

if you do IA block into parotid gland can get Bell’s Palsy

147
Q

Congenital Cysts

A
  1. Branchiogenic - anterior border of sternocleidomastoid
  2. Dermoid - contains hair, sebaceous and sweat glands, tooth structures, in FOM
  3. Thyroglossal Duct Cyst - midline, dark, vascular, hemorrhage into mouth
148
Q

Developmental Cysts (Fissural)

A
  1. Nasopalatine Duct Cyst (Incisive) - heart shaped, non-odontogenic, teeth are VITAL; soft tissue counterpart is Palatine Papilla Cyst
  2. Nasolabial Cyst - swelling by nostril, NOT in bone, fibrous CTs
  3. Globulomaxillary Cyst - pear shaped btw roots of max. lateral and canine, IN BONE, epithelial remnants at line btw globular and mx processes
  4. Median Palatal Cyst
    5 Median Alveolar Cyst - btw central incisors, adjacent teeth are vital
149
Q

Fibrous Dysplasia (3 types)

A
  1. Monostotic Fibrous Dysplasia - most common, GROUND GLASS xray. Craniofacial Fibrous Dysplasia (of the jaw) causes EXPANSION and deformity, see a thickening at skull base
  2. Polyostotic Fibrous Dysplasia - during childhood, long bones, face, clavicles
  3. McCune-Albright Syndrome - bones, pigmentation, premature puberty (endocrine), hallmark is FEMALE PREMATURE PUBERTY
    - triad of symp - polyostotic fibrous dysplasia, Cafe au lait spots, endocrine abnormalities
    - malignant transformation potential into osteosarcomas
    - tx is nonspecific but can use something that inhibits estrogen production
150
Q

Gardner’s Syndrome

A

POLYPOSIS -> usually malignant transformation -> colon cancer

  • impacted, supernumerary teeth
  • COTTON WOOL appearance
  • fibromatosis, epidermoid skin cysts
151
Q

Central Giant Cell Granuloma

A

within jawbones caused by trauma, more in kids

-anterior jaw

152
Q

Condylar Hyperplasia

A

unilateral enlargment, unknown cause, deviate chin away from affected side

153
Q

Central Ossifying Fibroma

A

slow-growing, painless, asymptomatic

154
Q

Histiocytosis X

A

abnormal scavenger cells (histiocytes/macros), eosinophils proliferate -> scars
-defects in reticuloendothelial system, proliferation of macros of loose CT

  1. Eosinophilic Granuloma - most benign
  2. Letterer-Siwe Disease - before 3, usually fatal, pneumothorax
  3. Hand-Schuller-Cristian - exophthalmos, diabetes insipidus

can treat with corticosteroids and cyto-toxic drugs, should radiate bone

death from respiratory or heart failure

155
Q

Eosinophilic Granuloma

A

benign form of Histio X, affects bones and lungs as a result of metabolic defects in the reticuloendothelial system
-pneumothorax a complication

156
Q

Verruciform Xanthoma (Histocytosis Y)

A

benign, soft tissue tumor, large FOAM cells in CT papilla

157
Q

Nevoid Basal Cell Carcinoma (Basal Cell Nevus - Bifid Rib Syndrome/Gorlin & Goltz Syndrome)

A
  1. multiple basal cell carcinomas
  2. multiple OKCs, bifid ribs
  3. blindness
  4. MR, dural calcification, hydrocephalus
  5. sexual anomalies - hypogonadism, ovarian tumors
158
Q

Dentigerosu Cyst (Follicular)

A

assoc. with crown of unerupted tooth or dental anomaly, usually by 3rd molar

AMELOBLASTOMA most likely to develop in wall

159
Q

Eruption Cyst

A

swelling of alveolar ridge over crown, can be mistaken for hemangioma or hematoma

160
Q

Primordial Cyst (Follicular)

A

no calcified structures, found in place of a tooth

161
Q

Odontogenic Keratocyst

A

follicular and dentigerous cysts that contain keratinizing material

  • tendency to RECUR (over 30%)
  • grow cause of epithelial cell multiplication
162
Q

Traumatic Bone Cyst

A
  • usually btw mand canine and ramus
  • teeth are vital
  • case: radiolucency apical to PM and molars
163
Q

Lateral Periodontal Cyst

A

inflammatory, a RADICULAR cyst

  • most in mandibular canine-premolar area
  • apposition with root of vital tooth, asymptomatic
164
Q

Dental Granuloma

A
  • sequelae of pulpitis, can only be distinguished by histo
  • asymptomatic, tooth NON-VITAL
  • histo - fibrous CT with macros, lymphocytes

tx -> RCT or EXT

165
Q

Radicular Cyst (Apical Periodontal Cyst or Periapical Cyst)

A

most common odontogenic cyst, develops within a pre-existing dental granuloma, incr. osmotic pressure in cyst lumen

-histo: lumen (true cyst)

tx -> RCT with apico or ext

166
Q

Residual Cyst

A

tooth with a radicular (periapical) cyst is ext, but the radicular cyst persists, asymptomatic -> curette

167
Q

Gingival Cyst

A

canine and premolar areas of mandible

168
Q

MOST COMMON EPITHELIAL (ECTODERMAL) odontogenic tumor

A

Ameloblastoma

169
Q

Ameloblastoma

A
  • odontogenic epithelium that shows differentiation of histologic layers of enamel organ
  • slow growing, invasive, usually BENIGN
  1. Multicystic (Solid) - most cases, more aggressive, do marginal resection
  2. Unicystic - usually younger, most in mandible, tx by ENUCLEATION
  3. Peripheral (Extraosseous) = uncommon, from rests of dental lamina
170
Q

radiographic appearance of ameloblastoma

microscopic feature?

recurrence?

A

lesion on VITAL teeth with SOAP bubble (if big) or HONEYCOMB (if small)
-irregular scalloped borders, looks like a central giant cell granuloma

-nonencapsulated

recurs 50-90% if not treated well

171
Q

Adenomatoid Odontogenic Tumor (Adenoameloblastoma)

A

ectodermal origin, younger ppl, in ANTERIOR MAXILLA, females, asymptomatic
-looks like gingival fibrous lesion

histo - well defined, surounded by thick fibrous capsule, enamel organ, lining of dentigerous cyst, reduced enamel epithelium, rests of malassez

SPINDLE SHAPED epithelial cells -> form sheets, strands, whorls

BENIGN -> enucleate

rare recurrence, not aggressive

172
Q

Calcifying Epithelial Odontogenic Tumor “Pindborg Tumor”

A

derived from ectoderm (epithelial), amyloid production

xray - scalloped margin, assoc. with impacted tooth (3rd molar)

histo - islands of epithelial cells

173
Q

Squamous Odontogenic TUmor

A

BENIGN, ectodermal (epithelial), asymptomatic

xray - radiolucency lateral to roots

histo - rests of malassez

174
Q

Cementoma (Periapical Cemental Dysplasia)

A

mandible (incisor region), VITAL teeth, black women

175
Q

Benign Cementoblastoma (True Cementoma)

A

young males, md premolars/molars, vital tooth

176
Q

Gigantiform Cementoma (Familial Multiple Cementomas)

A

middle aged black women, can cause jaw expansion, multiple (often symmetrical)

tx -> excise

177
Q

Cementifying Fibroma

A

well defined radiolucency with scattered radiopaque foci, mandible

178
Q

Complex Odontoma

A

may prevent eruption, posterior, from ectodermal and mesenchymal, in md premolar/molar area, asymptomatic, unorganized mass of dental tissues (enamel, dentin, cementum)

tx -> enucleation

179
Q

Compound Odontoma

A

from ecto and mesenchymal parts of tooth germ, more common in max incisor-canine rea, can cause delayed eruption

xray - small tooth-like structures

microscopic features - small, malformed teeth

180
Q

Odontogenic Myxoma

A

aggressive tumor from papilla, dental sac, or PDL

xray - poorly defined, multilocular, assoc. with unerupted or displaced teeth

tx -> curette, cauterize

181
Q

Odontogenic Fibroma

A

from dental papilla, dental sac, PDL. painless swelling in mandible of young ppl

tx -> enucleation

182
Q

Odontogenic Tumors of MIXED origin (Eco-Mesodermal components)

A
  1. Ameloblastic Fibroma - often mistaken for ameloblastoma, young ppl, in md premolar-molar area, painless swelling, assoc. with unerupted tooth, see nests and strands of odontogenic epithelium, young cellular fibrosis
    - tx by excision
  2. ameloblastic fibro-odontoma - kids under 20, may have foci of calcification with dentin and enamel (induction effect)
    - tx by excision
  3. Ameloblastic Odontoma - painless swelling, looks like ameloblastoma with combo of composite odontoma
183
Q

Peutz-Jeghers Syndrome (Hereditary Intestinal Polyposis Syndrome)

A

inherited, AD, intestinal polyps (tendency to go malignant), intraoral pigmentations,

184
Q

Dilantin

A

anticonvulsant to control epileptic seizures, causes fibrous hyperplasia

185
Q

Acquired nevi (5 kinds)

A

intramucosal nevus - most common in mouth, in CT or lamina propria

blue nevus - congenital, painless

compound nevus - rare, at epithelium-lamina propria interface, raised and solid

jxn nevus - rare, btw epithelium and lamina propria, flat, can undergo transformation into malignant melanoma

intradermal nevus (common mole)

186
Q

BK Mole Syndrome and Dysplastic Nevus Syndrome

A

numerous large pigmented atypical nevi with high risk for developing malignant melanoma

187
Q

Focal Melanosis (2)

A

mostly LOWER LIP

  1. labial melanotic macule - lower lip, midline, < 5 mm
  2. oral melanotic macule - intra-orally, < 1 cm

tx -> excise to rule out malignant melanoma

188
Q

3 conditions with PIGMENTATION of intra-oral mucosa

A
  1. Addison’s - adrenocortical insufficiency, hypocorticolism, lab shows low blood conc. of Na and glucose and incr. K+
  2. Albright’s - polyostotic fibrous dysplasia, cafe au lait spots, endocrine dysfunction, incr. incidence of osteosarcoma
  3. Petuz-Jegher’s - intestinal polyps, intraoral pigmentations
  4. Peutz-Jegher’s
189
Q

Aneurysmal Bone Cyst

A

benign lesion of bone, expansile, proliferaiton of vacular tissue that forms a lining around blood-filled cysts, in humerus/femur/tibia/pelvis

xray - honeycomb or soap bubble

190
Q

Median Rhomboid Glossitis

A

chronic candida albicans infection

  • smooth, denuded, beefy, red lesion devoid of filiform papillae
  • located in midline of dorsum of tongue anterior to circumvallate papillae

no tx

191
Q

Pyogenic Granuloma

A

interdental gingiva, from trauma, pregnant pts
-soft, pedunculated, smooth red surface, hyperplastic granulation

tx -> excision

192
Q

Erythroplakia

A

red patch, most common in md mucobuccal fold, oropharynx and FOM, especially old ppl

193
Q

Rendu-Osler-Weber Disease (Hereditary Hemorrhagic Telangiectasia)

A

congenital hereditary form of hemangioma, SPIDER-LIKE telangiectases
-epistaxis (nosebleeds)

194
Q

Encephalotrigeminal Angiomatosis (Sturge-Weber Disease)

A

unilateral facial lesion (PORT WINE STAIN) over trigem nerve

195
Q

Juvenile Nasopharyngeal Angiofibroma

A

adolescent males, benign, produces a nasopharynx mass

tx - surgery

196
Q

Burning Tongue Syndrome

A

no detectable lesions, usually mid-aged females

etiologic factors - anemias, diabetes mellitus, gastric disturbances, psychogenic factors, trigem neuralgia, bacteria, xerostomia, vit B deficiency

197
Q

Peripheral Giant Cell Granuloma

A

pedunculated broad absed with smooth surface, on gingiva btw 1st perm molar and incisors or alveolar process

-histo is diagnostic - non-encapsulated with multi nucleated giant cells

198
Q

Hemangioma

A

benign, proliferation of blood vessels, more in females

etiology - endothelial cells, C. T. origin

microscopic features - capillary, cavernous, hemangioendothelioma

tx - laser or surgery

199
Q

Benign Salivary Gland Tumors (2)

A
  1. Pleomorphic Adenoma (Mixed) - most common benign one
  2. Monomorphic - basal cell, etc.

common site for MINOR = palate
for MAJOR = parotid

200
Q

Necrotizing Sialometaplasia

A

of MINOR salivary glands, necrosis of glandular parenchyma with assoc. squamous metaplasia and hyperplasia of ductal epithelium

hard palate most common

201
Q

Mumps

A

most common viral disease of salivary glands caused by RNA-Paramyxovirus

  • salivary gland swelling without purulent discharge
  • PAROTID GLAND involved

complications - orchitis, epididymitis, can cause sterility, meningitis, encephalitis

serum AMYLASE may be elevated

202
Q

RNA paramyxoviruses cause what 2 diseases

A
  1. Rubeola - KOPLIK SPOTS (small blue white lesions surrounded by red ring), can’t be wiped off
  2. Mumps - enlarged parotid glands, can cause deafness and orchitis
203
Q

Mucocele

A

usually lower lip, minor salivary glands and ducts

204
Q

Ranula (True Retention Cyst)

A

fluctuant, painless, occurs UNILATERALLY, assoc. with SUBMANDIBULAR or SUBLINGUAL glands

hx - incr. before meal and decr. in size btw meals

tx -> excise

205
Q

Mikulicz’s Disease (Benign Lymphoepithelial Lesion)

A

related to Sjogren’s, asymptomatic enlargement of PAROTID and SUBMANDIBULAR glands, unilateral, middle aged women

histo - scattered epimyoepithelial islands

-most are benign but malignant transformation of island can happen

206
Q

Malignant Salivary Gland TUmors

A
  1. Adenocarcinoma (NOS) - major and minor glands, asymptomatic mass
  2. Adenoid Cystic Carcinoma - minor glands of palate, pain, facial paralysis, weakness
  3. Acinic Cell Carcinoma - parotid gland, pain, facial weakness or paralysis
  4. Mucoepidermoid Carcinoma - in parotid gland, asymptomatic, facial weakness or parlysis
207
Q

Metabolic Conditions assoc. with Chronic Salivary Gland Enlargement

A

diabetes, alcoholism, malnutrition, obesity, HTN, hyperlipidema, not hypothyroidism, PAROTID GLAND

208
Q

Conditions assoc. with parotid gland enlargement

A
  1. Sjogren’s and Sarcoidosis
  2. Warthin’s tumor (papillary cystadenoma lymphomatosum)
  3. Infxn - mumps, actinomycosis, TB
  4. benign lymphoepithelial lesion (Mikulicz’s disease)
  5. Acute epidermic parotitis
  6. Malnutrition
209
Q

Sjogren’s Syndrome

A

autoimune, inflammation of sliavary and lacrimal glands, progresses to fibrosis and atroph, post menopausal women

symp - rheumatoid arthritis, xerostomia, keratoconjunctiva sicca

-some pts get malignant lymphomas and pseudolymphomas

210
Q

Sialoliths

A

more common in submandibular gland and duct > parotid or sublingual

use occlusal xray to detect it in Wharton’s duct (submand)

211
Q

Oncocytomas (Oxyphilic/Acidophilic Adenoma)

A

benign, made of large cells with granular and eosinophilic cytoplasm, related to aging

  • seen in parotid glands
  • histo - bright pink cytoplasm, small round nuclei
212
Q

Sialoscintigraphy

A

separate Warthin’s tumor and oncocytoma from malignant tumors

213
Q

Warthin’s Tumor (Papillary Cystadenoma Lymphomatosum)

A

in parotid gland

  • old males
  • over angle or ramus of mandible

histo - eosinophilic coagulum

214
Q

Stevens Johnson Syndrome

A

severe bullous form of Eythema Multiforme

clinically - BULLS EYE shaped lesions

triad - eye lesion, genital lesion, stomatitis

tx - steroids, abx

215
Q

Erythema Multiforme

A

allergic hypersensitivity

TARGET or BULLS EYE shaped SKIN lesion

oral lesions - red macules, papules, vesicles

216
Q

Granulomas

A

nodules of epithelioid cells that are modified macrophages with eosinophilic tyoplasm

217
Q

Granulomatous infxns include

A 
mycobacterial diseases
fungal
parasitic
syphilis
silicosis and berylliosis
sarcoidosis
218
Q

acute/chronic inflammation is involved with pneumonia?

A

acute, where there is purulent exudates in response to a bacterial infxn

219
Q

Actinomycosis

A

gram + filamentous, can cause abscesses and sinus tracts -> CHRONIC SUPPRATIVE LESION

220
Q

Cervicofacial Actinomycosis “lumpy jaw”

A

most common manifestation of actinomycosis

221
Q

Histoplasmosis

A

caused by fungus Histoplasma Capsulatum
-affects lungs

oral manifestations - nodular, ulcerative, vegetative lesions, covered by gray membrane, indurated

222
Q

Mucormycosis “Phycomycosis/Zygomycosis”

A

caused by water mold fungus Mucorales

Rhinocerebral Mucormycosis - in nose and brain, usually fatal, in pts with diabetes or chronic diseases
-symp - orbital cellulitis, bulging eye

tx - Amphotericin B

223
Q

Syphilis

A

by spirochete Treponema Pallidum, tx with penicillin

  1. Primary - CHANCRE< non painful ulcer
  2. Secondary - rash, brown sores
  3. Tertiary - GUMMA (focal mass), on palate and tongue

CONGENITAL Syphilis
Sequela - Hutchinson’s teeth, mulberry molars, NO chancre

224
Q

HSV 1

A

oral herpes, transmitted by direct contact
-NO CORTICOSTEROID tx

  1. Primary Herpetic Gingivostomatitis (Acute Herpetic) - young kids, flue like symp, on free and attached mucosa
    - stays inactive in CN V Trigeminal Ganglion then later appears as RECURRENT HERPES LABIALIS (cold sore)
  2. Secondary (Recurrent) Herpetic Stomatitis - adults, cold sores, localized, dormant in CN V ganglion
  3. Herpes Labialis (Fever Blisters or Cold Sores) - BALLOONING degeneration of epithelial cells with loss of cohesion to adjacent cells, intra-nuclear inclusions called LIPSCHULTZ BODIES
225
Q

HSV 2

A

GENITAL, via sexual contact

226
Q

HSV 3

A

by herpes varicella zoster, does NOT cross midline, causes recurrent herpes and chickenpox, lesion follows path of trigeminal nerve

227
Q

Varicella Virus

A

can cause Herpes Zoster lesions

  1. chickenpox - pruritic vesicular lesions, contagious
  2. shingles - reactivate latent varicella zoster, reaches sensory ganglia of spinal and cranial nerves, does NOT CROSS midline
228
Q

HSV 4

A

caused by Epstein Barr Virus

  1. Hairy Leukoplakia - in HIV pts, white furry lingual lesions on latearl border, can coexist with recurrent herpes
  2. Infectious Mononucleosis - no oral manifestations, neck swellings
  3. Burkitt’s Lymphoma - high grade Non-Hodgkin’s with viral etiology, looks MOTH EATEN
229
Q

HSV 5

A

cytomegalovirus affects salivary glands

230
Q

HSV 8

A

assoc. with Kaposi’s sarcoma - AIDS/HIV, lesions on palate, negative to pressure test

231
Q

Kaposi’s Sarcoma

A

common with AIDS, MALIGNANT neoplasm, usually hard palate

232
Q

Tests to dx Herpes

A
  1. Tzanck smear - exam of fluid from unopened vesicle, look for epithelial cells with intranuclear inclusions called LIPSHULTZ BODIES
  2. Fluorescent stasining - use HSV immune serum and globulin, to distinguish btw herpes zoster and herpes simplex
  3. Isolation in tissue culture
  4. Antibody titiers (Anti HSV Ab)
  5. Biopsy
233
Q

Herpangina

A

acute disease, affects young kids by GROUP A COXSACKIE virus
-stomatitis, papules/vesicles form in pharynx -> ulcers

heals on its own

234
Q

Hand, Foot, and Mouth Disease

A

VIRAL infx, makes red lesions

-self healing

235
Q

Benign Mucous Membrane Pemphigoid (BMMP)

A

autoimmune, vesiculobullous disease, act against basement membrane (SUBEPITHELIAL)

-oral lesions look like desquamative gingivitis

tx - biopsy and steroids!

236
Q

Pemphigus Vulgaris

A

chornic, rare, vesicles and bullae made by dyhesion (ACANTHOLYSIS) of epidermal cells, autoimmune

oral lesions - NIKOLSKY’S SIGN (also in BMMP)

histo - suprabasilar vesicles, intercellular edema, loss of intercellular bridges, clumps of cells floating around called TZANCK CELLS

237
Q

Rubella

A

German measles - rash, flat pink spots on face, swollen tonsils, red macules

238
Q

Hep A

A

caused by RNA enterovirus, transmitted by fecal-oral route, disease of LIVER, shellfish is a source too

-damage to liver causes incr. serum levels of TRANSAMINASES

self-limiting

239
Q

Hep B

A

LIVER disease caused by DNA virus
-transmission is contaminated blood or serum, sexually

signs - longer incubation of mounths

carrier state - presence of surface antigen (a or b) indicated pt might be infected

VERY heat resistant

240
Q

Verruca Vulgaris (Squamous Papilloma)

A

common wart of viral etiology (caused by papilloma)
-sessile, soft, cauliflower like

microscope - shows alternating hyperkeratosis, parakeratosis, long epithelial ridges

241
Q

Papilloma

A

most common benign neoplasm of epithelial tissue origin, pedunculated, sessile

microscope - projections of stratified sq. epithelium, cores of vascular fibrous CT

tx - excise

242
Q

Inflammatory Fibrous Hyperplasia (Epulis FIssuratum)

A

area of denture borders, more in max

clinically - rolls of tissue in muco labial fold

tx - excise; re-evaluate prosthesis or remake

243
Q

Inflammatory Papillary Hyperplasia (Palatal Papillomatosis)

A

hard palate, caused by bad OH and ill fitting dentures

clinically - numerous red papillary projections

tx - excise; correct prosthesis

NBDE II Board Busters (11 decks)

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