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Otolaryngology > Oral pathology > Flashcards

Oral pathology Flashcards

1
Q

What is herpes simplex virus (HSV)?

A

Herpes simplex virus is an enveloped double stranded DNA virus that belongs to alpha herpes virus

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2
Q

What are the 2 types of HSV?

A

HSV-1
HSV-2 (Rarely oral, usually causes genital herpes)

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3
Q

When do most people acquire HSV?

A

Childhood

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4
Q

What percentage of UK adults have been infected with HSV?

A

70%

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5
Q

How is HSV transmitted?

A

Via infected oral secretions during close contact

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6
Q

How may primary infection with HSV-1 present?

A
  • Asymptomatic
  • May cause primary gingivostomatitis
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7
Q

What is primary gingivostomatitis?

A

Disease of preschool children, represents the worst end of spectrum of disease seen during primary HSV1 infection

A severe inflammatory reaction with vesicle formation leading to painful ulcers (gingivostomatosis)

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8
Q

How does primary gingivostomatitis present?

A

Systemic upset (Fever, local lymphadenopathy)
Vesicles and ulcers on lips, buccal mucosa and hard palate

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9
Q

What is shown?

A

Primary gingivostomatitis (Severe inflammatory reaction to primary HSV-1 infection)

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10
Q

How long does primary gingivostomatitis usually take to recover?

A

3 weeks

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11
Q

What is an infective hallmark of all herpes viruses?

A

The hallmark of all herpes viruses is the ability of viruses to establish latent infections that persist for the life of the individual

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12
Q

What are some factors that can cause reactivation of HSV-1 from the trigeminal ganglia?

A

Stress
Trauma
Febrile illnesses
UV radiation

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13
Q

What is the common name for latent HSV-1 reactivation?

A

Cold sore (Herpes labialis)

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14
Q

Describe the pattern of latency and activation in HSV-1

A
  • Not all reactivations are symptomatic, and only 1/2 of infected people get clinical recurrences
  • Multiple cycles of latency and activation possible but natural history is for decreasing frequency
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15
Q

How does latent HSV infection present?

A

Oral herpetic lesions

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16
Q

What is herpetic whitlow?

A

HSV infection of the finger

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17
Q

How does herpetic whitlow occur?

A

Innoculation of the virus through a break in the skin barrier

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18
Q

Who is most at risk of herpetic whitlow?

A
  • Dentists
  • Anaesthetists
  • Children at the time of primary oral infection through finger biting
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19
Q

What is shown?

A

Herpetic whitlow

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20
Q

What is a possibly fatal form of HSV-1 infection?

A

Herpes simplex encephalitis

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21
Q

How does herpes simplex encephalitis present?

A

Rapid onset of:
- Fever
- Headache
- Seizures
- Focal neurological signs
- Impaired consciousness

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22
Q

How is HSV-1 infection investigated?

A

Swab of lesion in virus transport medium - detection of HSV DNA by PCR

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23
Q

How is HSV-1 infection managed?

A

Antiviral medications e.g. acyclovir help to reduce the severity and frequency of symptoms, but cannot cure the infection

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24
Q

What is herpangitis?

A

Benign clinical syndrome characterised by fever and painful papulo-vesiculo-ulcerative oral enanthem

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25
Q

What causes herpangina?

A

Coxsackie viruses (enterovirus)

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26
Q

Who is most at risk of herpangina?

A

Children

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27
Q

How does herpangina present?

A
  • High fever
  • Throat - hyperemia and yellow/greish-white papulovesicular lesions
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28
Q

What is shown?

A

Herpangina

29
Q

How is herpangina investigated?

A

Clinical diagnosis or by PCR test of swab in viral transport medium

30
Q

How is herpangina managed?

A

Supportive - viral, self-limiting

31
Q

What is hand, foot and mouth disease?

A

Clinical syndrome characterised by an oral enanthem and a macular, maculopapuar, or vesicular rash of the hands and feet, usually spreading around a family

32
Q

What causes hand, foot and mouth disease?

A

Coxsackie viruses

33
Q

How does hand, foot and mouth disease present?

A

Oral enanthem and a macular, maculopapuar, or vesicular rash of the hands and feet

34
Q

What is shown?

A

Hand, foot and mouth disease

35
Q

How is hand, foot and mouth disease investigated?

A

Clinical diagnosis or by PCR test of swab in viral transport medium

36
Q

How is hand, foot and mouth disease managed?

A

Supportive

37
Q

What is an aphthous ulcer?

A

An aphthous ulcer is typically a recurrent round or oval sore or ulcer inside the mouth on an area where the skin is not tightly bound to the underlying bone

They are usually surrounded by an inflammatory halo

38
Q

What are some common locations in the mouth for aphthous ulcer formation?

A

Inside of the lips and cheeks or underneath the tongue

39
Q

What causes aphthous ulceration?

A

Most likely due to immune dysfunction triggered by an external factor e.g. emotional stress, certain foods (salty foods)

40
Q

What is another name for aphthous ulcer?

A

Canker sore

41
Q

How long do aphthous ulcers usually last?

A

Self limiting - each ulcer lasts less than 3 weeks

42
Q

What is oral candidiasis?

A

Fungal mouth infection that causes white spots or patches in the mouth

43
Q

What causes oral candidiasis?

A

Candida albicans

44
Q

What are some risk factors for oral candidiasis?

A

Post antibiotics
Immunosuppressed
Smokers
Inhaled steroids

45
Q

How does oral candidiasis present?

A

White patches on red, raw mucous membranes in the throat/mouth

46
Q

What is shown?

A

Oral candidiasis

47
Q

How is oral candidiasis managed?

A

Nystatin or fluconazole

48
Q

What are some causes of oral ulceration?

A

Primary syphilis
Mucosal leishmaniasis
Behcet’s disease
Coeliac disease
IBD
Reactive arthritis (Reiter’s disease)
Drug reactions
Skin disease

49
Q

How does primary syphilis spread?

A

Direct sexual contact with the infectious lesions of another person

50
Q

What bacteria causes primary syphilis?

A

Treponema pallidum

51
Q

What are some common sites of entry for syphilis?

A

Genitals
Mouth
Pharynx

52
Q

What is shown?

A

Mucosal leishmaniasis

53
Q

Where are leishmania species most commonly found?

A

Africa
Americas

54
Q

What is Behcet’s disease?

A

Inflammatory, multisystemic disorder

55
Q

What are some features of Behcet’s disease?

A

Oral ulceration
Genital ulceration
Uveitis
Visceral organ involvement (E.g. GI, resp, cardio, MSK)

56
Q

Where is Behcet’s disease most commonly found?

A

Middle East and Asia

57
Q

How does coeliac’s disease or IBD present in the mouth?

A

Recurrent aphthous ulcers

58
Q

How can reactive arthritis present in the mouth?

A

Painless oral ulcers

59
Q

What are some drugs that can cause mouth ulcers?

A

NSAIDs
ß-blockers
Sulfonamides

60
Q

What are some skin diseases that present with oral ulceration?

A

Lichen planus
Pemphigus
Pemphigoid

61
Q

What is squamous cell papilloma?

A

Generally benign papilloma that arises from the stratified squamous epithelium

62
Q

Describe the aetiology of squamous cell papilloma of the mouth

A
  • Two peaks of incidence - <5 years and between 20-40 years
  • Related to HPV exposure - types 6 and 11
  • Children - aggressive disease
  • Adults - often solitary
63
Q

How does squamous cell papilloma of the mouth present?

A
  • Painless lesion most commonly found in the mucosa of the hard and soft palate
  • Commonly involves soft palate, tongue, lips, tonsils but can occur anywhere there is stratified squamous epithelium (e.g. skin, oesophagus, cervix)
64
Q

What is shown?

A

Squamous cell papilloma of the mouth

65
Q

What will macroscopic biopsy show in squamous cell papilloma?

A

Exophytic, sessile or pedunculated mass

66
Q

What will microscopic biopsy show in squamous cell papilloma?

A

Finger-like projection, fibrovascular core covered by stratified squamous epithelium

67
Q

How is squamous cell papilloma managed?

A
  • Most cases require no treatment
  • When treatment required, options include cryotherapy, topical salicylic acid and surgical excision
68
Q
A

Otolaryngology (23 decks)

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