Oral Pathology Flashcards
1
Q
A 60 year old female patient has a bony enlargement on the middle of her palate that has been present for all her adult life which has not changed. She will be getting a complete denture, her dentist states the boy enlargement on her mid-palate must first be removed before fabrication of the new denture. What is the most likely diagnosis?
A. Pyogenic granuloma
B. Osteosarcoma
C. Palatal torus
D. Osteoma
A
Palatal torus
2
Q
What is a lesion?
A
Pathological change in tissues or organs resulting from injury or disease.
3
Q
What tissues can develop a lesion?
A
Epithelium
Connective tissue
4
Q
Where does a lesion present in epithelial tissue?
A
Surface Mucosa
Under Surface: Salivary or Odontogenic
5
Q
Where does a lesion present in connective tissue?
A
Bone or cartilage (Hard)
Vessels or cells (blood)
Fibrous, nerve, fatty (other)
6
Q
What lesions can present from diseases or syndromes?
A
Systemic
Neoplastic
7
Q
A 3yr old boy has multiple purple and reddish-colored vascular lesions present on his head and also intraoral, which blanch when compressed. His mother states they developed and rapidly enlarged right after birth. Which is the best diagnosis?
A. Hemangioma
B. Kaposi’s sarcoma
C. Hematoma
D. Neurofibroma
A
A. Hemangioma
8
Q
What is a pyogenic granuloma?
A
Relatively common skin growths that are small, round, and usually bloody-red in color. They tend to bleed because they contain a very large number of blood vessels. They’re also known as lobular capillary hemangioma, or granuloma telangiectaticum.
9
Q
What is an osteosarcoma?
A
A malignant tumor of bone in which there is a proliferation of osteoblasts.
10
Q
What are palatal torus?
A
A bony protrusion on the palate.
11
Q
What is an osteoma?
A
An osteoma (plural: “osteomata”) is a new piece of bone usually growing on another piece of bone, typically the SKULL. It is a BENIGN tumor. When the bone tumor grows on other bone it is known as “homoplastic osteoma”; when it grows on other tissue it is called “heteroplastic osteoma”.
12
Q
What immunological disease is associated with Kaposi’s sarcoma?
A
Aids
13
Q
What is kaposi’s sarcoma?
A
A form of cancer involving multiple tumors of the lymph nodes or skin, occurring chiefly in people with depressed immune systems, e.g., as a result of AIDS.
14
Q
What is a hematoma?
A
A solid swelling of clotted blood within the tissues. Occurs outside of the blood vessels.
15
Q
What is a neurofibroma?
A
A peripheral nerve neoplasm. A tumor formed on a nerve cell sheath, frequently symptom-less but occasionally malignant.
16
Q
How are lesions classifed?
A
Benign
Pre-malignant
Malignant
17
Q
What does benign mean?
A
Encapsulated; abnormal cell growth, usually slow growing, the cells are confined to original tissue, localized.
18
Q
What does pre-malignant mean?
A
Abnormal cell growth, the cells have the POTENTIAL to metastasize. AKA “carcinoma in situ”
19
Q
What does malignant mean?
A
Abnormal cell growth, cells have metastasized (moved) from original tissue, usually fast growing, invade and destroy…AKA “cancer”
20
Q
What are the two types of clinical lesions seen?
A
Blisterform lesions
Non-blisterform lesions
21
Q
Describe a blisterform lesion.
A
Contains fluid, translucent appearance, soft consistency. Usually seen in the mucosa.
22
Q
What are some examples of blisterform lesions?
A
Vesicle, pustule, bulla.
23
Q
Describe a non-blisterform lesion.
A
Solid, contains no fluid, firm consistency.
24
Q
What are the two types of non-blisterform lesions?
A
Pedunculated
Sessile
25
Describe and give an example of a peduculated non-blisterform lesion.
Attached by stem-like or stalk-like base.
| i.e. papilloma (wart or fibroma)
26
Describe and give an example of a sessile non-blisterform lesion.
Attached by broad base.
| i.e. papule, nodule, tumor, plaque
27
What does it mean if a lesion is described as elevated?
Above the plane of mucosa i.e. nodule.
28
What does it mean if a lesion is described as depressed?
Below the level of mucosa, flat or raised border, superficial or deep.
i.e. ulcer
29
What does it mean if a lesion is described as flat?
On the same level as mucosa, regular or irregular shape.
i.e. macule
30
How should you measure a clinical lesion?
Probe at least two dimensions (width & length) - height appropriate for elevated lesions.
10mm = 1cm
31
What are common colors of a lesion?
Red, pink, salmon, white, blue-black
32
When a lesion is described like erythema what does that mean?
Abnormal redness of mucosa or gingiva.
33
When a lesion is described as pallor?
Paleness of skin or mucosa.
34
When the color of a lesion is described as having melanin pigmentation?
Brown color, more prominent in dark skinned races.
35
A 68 year-old male patient resents with a 35-40 pack/year history of smoking. He drinks alcohol occasionally. Intraoral exam reveals 12mmX8mm indurated non-healing ulceration on the right posterior lateral border of the tongue which has been present for 6 months and is enlarging. Which is the best diagnosis.
A. Lichen planus
B. Papilloma
C. Squamos cell carcinoma
D. Pemphigus vulgaris
C. Squamos cell carcinoma
36
What is the most common of all malignancies?
Squamos cell carcinoma
37
What location is the worst possible diagnosis?
Floor of the mouth.
38
Where is the most common place that squamous cell carcinoma occurs?
Posterior lateral border of the tongue.
39
What is a squamous cell carcinoma?
Abnormal growth of squamous cell carcinoma. "CANCER"
40
What is a pemphigus vulgaris?
A rare autoimmune disease that causes painful blistering on the skin and mucous membranes. If you have an autoimmune disease, your immune system mistakenly attacks your healthy tissues. Pemphigus vulgaris is the most common type of a group of autoimmune disorders called pemphigus.
41
A lesion which is separate and distinct would be considered:
A. Verrucous
B. Linear
C. Indurated
D. Discrete
D. Discrete
42
What are the different ways to describe the surface texture of a lesion?
```
Verrucous
Fissured
Corrugated
Crusted
Discrete
Coalescing
Circumscribed
Unilocular/Multiocular
Indurated
Fluctant
```
43
What does verrucous mean?
Wart-like or caulifolower-like appearance/growth.
44
What does fissured mean?
Cracked surface.
45
What does corrugated mean?
Wrinkled appearance.
46
What does crusted mean?
Dry or scab-like
47
What does discrete mean?
Separate & distinct not attached to others
48
What does coalescing mean?
Numerous, proximity to one another. The margins may emerge to form one mass.
49
What does circumscribed mean?
"fluid filled" To encircle, encompass, or to limit or confine, distinctly outlined (homogenous)
50
What does Unilocular/Multiocular mean?
Radiographic term referring to an image of a lesion that has single or multiple chambers.
51
What does indurated mean?
To become hard, hardened.
i.e. nodule, tumor
52
What does fluctuant mean?
Wave-like motion detected when a structure containing fluid is palpated.
i.e. Bulla greater than 5mm
53
What are warning signs and signals to watch for in the IEOE exam?
- hoarseness, raspy voice
- persistent cough, or feeling of "lump in throat"
- Dysphagia (difficulty swallowing)
- Sore that does not heal or bleeds
- Asymmetry, firmness, fixed to tissues
- Enlargement, metastasizing
- Paresthesia, facial paralysis
- Drainage from lacrimal system
- Protrusion of eyes, color changes in sclera of eyes
- any lesion present over 2-3 weeks (biopsies)
- Pain typically found in later stages of cancer
54
What is the best way to distinguish between leukoedema and other similar lesions of the oral cavity?
A. biopsy
B. compression
C. stretching cheek
D. Watching it
C. Stretching cheek
Leukodema disappears when stretched, while other lesions do not.
55
Which of the following microorganisms is associated with Median rhomboid glossitis?
a. Candida
b. Mycobacteria
c. Treponema
d. Epstein-Barr
a. Candida
Median rhomboid glossitis is associated with fungal infections.
56
What is mycobacteria associated with?
Tuberculosis
57
What is treponema associated with?
Syphillis
58
What is Epstein-Barr associated with?
Mononucleousas
59
What are common variations from normal and physical injuries?
- Leukoedema
- Median rhomboid glossitis
- Geographic tongue
- Hairy tongue
- Tori/torus
- Bony exostosis
- Fordyce granules
- Ankyloglossia
- Lingual variocosities
- Lingual thyroid nodule
- Linea alba
- Melanin pigmentation
60
What are reactive lesions?
Result from reaction in the environment, causing damage/injury to tissues.
61
What are the common causes of reactive lesions?
- physical or mechanical trauma
- Nutritional deficiencies, medications
- chemical, heat
- microorganisms
62
How do you treat reactive lesions?
Identify the key factor, take causative agent away otherwise recurrence is likely. Tissue may regenerate and repair.
63
A healthy 24yr old female has developed a focal enlargement in her mandibular anterior gingiva. It has slowly growing within the last year in an area with significant amounts of calculus. Which of the following is LEAST likely to be the diagnosis?
a. peripheral giant cell granuloma
b. medication-induced gingival enlargement
c. fibroma
d. pyogenic granuloma
b. medication-induced gingival enlargement.
64
In the seventh month of her pregnancy, your 25 year-old patient develops a red spongy, vascular lesion on the marginal gingiva of #14. What is the best diagnosis?
a. Pyogenic granuloma
b. Neurofibroma
c. Granular cell tumor
d. Mucosal neuroma
a. pyogenic granuloma
Pyogenic granuloma is a response to local irritation or trauma.
65
Which reactive growth develops under an ill-fitting denture and clinically resents with multiple small pebbly nodules?
a. hemangioma
b. peripheral giant cell granuloma
c. epulis fissuraum
d. inflammatory papillary hyperplasia
d. inflammatory papillary hyperplasia
66
What are the common reactive lesions?
- Fibroma
- Epulis Fissuratum
- Inflammatory papillary hyperplasia
- Peripheral Giant Cell Granuloma
- Peripheral Ossifying Fibroma
- Pyogenic Granuloma
67
What is a fibroma?
(irritation/traumatic fibroma) not a true neoplasm - a reactive hyperplasia in response to local irritation.
68
Where is the most common location of a fibroma?
Buccal mucosa on the bite line
69
What does a fibroma look like?
Smooth surfaced pink nodule.
70
What is the proper treatment of a fibroma?
Conservative surgical excision.
71
What is an epulis fissuratum (inflammatory fibrous hyperplasia)?
Tumor-like hyperplasia in association with flange of an ill-fitting denture.
72
Where is epulis fissuratum look like?
Hyperplastic tissue in the vestibule.
73
When your patient presents with epulis fissuratum how does their denture usually fit?
The flange of denture fits into the fissure.
74
What is the proper treatment for epulis fissuratum?
Surgical removal of hyperplastic tissue and correction of the denture.
75
What is inflammatory papillary hyperplasia?
"denture sore mouth" associated with candida, presents as mucosa red with pebbly/papillary surface.
76
What typically causes inflammatory papillary hyperplasia?
- ill-fitting denture
- poor denture hygiene
- wearing denture 24hrs a day
77
Where does inflammatory papillary hyperplasia typically occur?
Hard palate beneath a denture.
78
What is the proper treatment for inflammatory papillary hyperplasia?
Excise lesion before fabricating a new denture.
79
What is a peripheral giant cell granuloma?
Reactive growth on interdental gingiva or edentulous ridge.
80
Describe a peripheral giant cell granuloma.
Red or reddish-blue nodular mass, that can be sessile or peducaulated.
81
What causes proliferation of a peripheral giant cell granuloma?
Proliferation arises from irritation or trauma.
82
What percentage of peripheral giant cell granulomas are ulcerated?
50%
83
Typically how big are pheripheral giant cell granulomas?
less than 2 cm, some are bigger.
84
What is a peripheral ossifying fibroma?
Reactive growth found exclusively on gingiva.
85
Describe a peripheral ossifying fibroma.
Pedunculated/sessile nodular mass, Red-pink in color ulcerated from trauma.
86
What is a common issue with a peripheral ossifying fibroma?
Can become large and interfere with eating or speaking.
87
What is a pyogenic granuloma?
proliferation by local irritation.
88
Describe a pyogenic granuloma?
Smooth/lobulated mass that bleeds easily and is vascular.
89
Where is a pyogenic granuloma typically found?
Common on gingiva in children and young adults.
90
What is are common causes of a pyogenic granuloma?
Poor oral hygiene, or hormones it can be called a "pregnancy tumor".
91
What is the proper treatment of a pyogenic granuloma?
May resolve without treatment but reccurence is common.
92
What are common types of physical injuries of the oral tissues?
Nicotine Stomatitis
Mucocele
Amalgam tattoo
93
What is nicotine stomatitis?
Long-term cigar & pipe smoking, palatal mucosa diffusely gray or white.
94
Descibe the typical patient that may present with Nicotine stomatitis.
Male, 45+, smoker.
95
How is nicotine stomatitis developed?
Develops in response to HEAT not chemicals in tobacco smoke.
96
Describe what nicotine stomatitis looks like in the oral cavity.
Numerous slightly elevated papules with pinpoint red centers, inflamed and altered minor salivary gland ducts.
97
Is nicotine stomatitis reversible?
Yes, if there is discontinued use of the source that causes it.
98
What is a mucocele (mucous retention cyst)?
Dilation of minor salvary glands secondary to duct obstruction or trauma. Mucus secretion accumulates, and eventually ruptures.
99
What does a mucocele look like?
Mobile, smooth soft.
100
Where is the most common place a mucocele presents in the mouth?
Lower lip is the most common area.
101
What is a mucocele in the floor of the mouth called?
Ranula
102
Describe a ranula.
Blue, dome-shaped, fluctuat swelling that is typically unilateral.
103
What is an amalgam tattoo?
Silver particles of amalgam accidentally embedded into tissue during restoration.
104
How does an amalgam tattoo present on a x-ray?
Radiopaque
105
What is Tobacco Pouch Keratosis?
Site at which pt holds snuff typically in the vestibule, gingiva, labial & buccal mucosa.
106
Describe what a snuff pouch (tobacco pouch keratosis) looks like.
Velvety pouch or thin gray white translucent plaque may appear wrinkled in appearance.
107
What does a tobacco pouch keratosis cause?
painless gingival recession.
108
How do the chances of getting cancer change for a person who uses snuff?
Chances are 4 times greater for a patient who uses snuff.
109
How long does a snuff pouch need to be there before it is biopsied?
1 month
110
What is cellulitis?
Acute inflammation of the periapical infection, particularly an abscess, surrounding soft tissues of the jaws.
111
How do you treat cellulitis?
Antibiotics
112
What is actinomycosis?
Abscess has no where to drain and causes a bacterial infection.
113
What is a severe swelling of the tongue?
Ludwig's angina
114
What can cause ludwig's angina?
A dental abscess that spreads along facial planes causing a parapharyngeal abscess resulting in constriction of airway.
115
What is the proper treatment of a dental abscess?
Antibiotics, extraction, endo tx.
116
Where is an operculum found?
Over partially erupted 3rd molars.
117
What is pericoronitis?
Acute inflammation of mucosa around crown of a partially soft-tissue and/or osseous impacted tooth.
118
What causes pericoronitis?
Normal flora composed of many types of bacteria proliferate in pocket between soft tissue & crown.
119
What is the proper treatment for pericoronitis?
Mechanical debridement
Oral irrigation
Antibiotic therapy
120
What is the etiology of syphilis?
Treponema pallidum (spirochete)
121
What is congenital syphilis?
Syphilis passed from mother to child during fetal development or at birth.
122
What clinical implication is associated with congenital syphilis?
Hutchinson's incisors
123
What are the 3 stages of syphilis?
Primary: Chancre
Secondary: Mucous patch
Tertiary: Gumma
124
When does a chancre typically appear?
2-3 weeks after infection, the sore heals within 6 weeks.
125
When does the secondary presentation of syphillis occur?
4-6 weeks after the primary presentation "chancre".
126
What does a tertiary presentation of syphilis look like?
The tertiary presentation called a gumma looks like a granuloma.
127
What is the proper treatment of syphilis?
Penicillin at all stages.
128
What are characteristics of a malignant neoplasm?
- Result of abnormal cell division, mitotic activity
- Reproduce abnormally in disorderly fashion
- Good blood supply (oxygen & nutrients)
- Invasive, change in size & shape of cells
- Carcinogens cause neoplasm and alter DNA of cell
129
What are different types of carcinogens?
```
Chemical
Bacterial toxins
Virus
Physical
Radioactivity
Actinic radiation
```
130
What are chemical carcinogens?
Hydrocarbons from tobacco, colvents, cosmetic sprays, etc.
131
What is dysplasia?
Mutations that lead to cell proliferation. Abnormal changes in formation of tissue.
132
How does dysplasia begin?
Can begin as harmless looking lesion but often visible as a change in color to white, red, or mixture.
133
Is it possible for a dysplasia lesion to revert back to normal?
Yes, if the stimulus is removed (smoking).
134
What is low grade dysplasia?
Transformation of low grade dysplasia to cancer is low.
135
What is high grade dysplasia?
Some risk of transformation to cancer.
136
What is epithelial dysplasia?
Pre-malignant condition.
137
What is leukoplakia?
"White patch" or plaque that can't be SCRAPED off and characterized clinically or pathologically as any other disease - WHO
138
What is the percentage of oral cancer that starts as a white lesion?
80-90%
139
Where are the common sites leukoplakia can be found?
Lateral and ventral tongue, and floor of the mouth.
140
What percentage of Leukoplakia is pre-malignant?
10-20%
141
What is erythroplakia?
Clinical term for chronic red macule/plaque which cannot be rubbed off.
142
Which prognosis is worse, erythroplakia or leukoplakia?
Erythroplakia
143
What is erythroplakia NOT attributed to?
Inflammation
Candidiasis
Vascular lesions
144
What can contribute to erythroplakia?
Alcohol & tobacco use
145
Who typically gets erythroplakia?
Common in older men
146
Where is erythroplakia typically found?
Floor of the mouth, tongue, soft palate
147
What percentage of severe dysplasia is carcinoma in situ or squamous cell carcinoma?
90%
148
What is the most common epithelial malignancy of the oral cavity?
Squamous Cell Carcinoma
149
What other malignancies can occur in the mouth?
Salivary gland, blood cells, bone, and melanocytic
150
What does squamous cell carcinoma develop from?
Dysplasia
151
What are risk factors for squamous cell carcinoma?
```
Tobacco
Heavy alcohol use
Sun exposure
Products containing betel nut
HPV
```
152
What are clinical features of squamous cell carcinoma?
```
Exophytic
Endophytic
Leukoplakic
Erythroplakic
Erythrolukoplakic
```
153
What does exophytic mean?
Mass-forming
154
What does endophytic mean?
Ulcerating
155
What does leukoplakic mean?
White patch
156
What does Erthropakic mean?
Red patch
157
What does Erythroleukoplakic mean?
Speckled
158
Where are common locations squamous cell carcinoma can be found?
```
Ventral-lateral posterior tongue
Floor of the mouth
Soft palate
Tonsillar pillars
Retromolar area
```
159
What is the MOST common location squamous cell carcinoma is found?
Ventral-lateral posterior tongue
160
What location of squamous cell carcinoma is the worst prognosis?
Floor of the mouth.
161
Why is the floor of the mouth the worst prognosis for squamous cell carcinoma?
In this area the squamous cell carcinoma is most likely to metastasize.
162
What is the proper treatment and prognosis for squamous cell carcinoma?
```
Excision
Radiation
Chemotherapy
Neck dissection (if metastasized)
TNM Clinical staging (higher stage = worse prognosis)
```
163
What are the best indicators for the prognosis of squamous cell carcinoma?
Tumor size & extent of metastatic spread.
164
What is the most common skin cancer, malignant tumour, that does not occur intraorally?
Basal cell carcinoma
165
What is believed to be the origin of basal cell carcinoma?
Hair shaft in origin.
166
What is basal cell carcinoma associated with?
Sun exposure
167
What are characteristics of basal cell carcinoma?
Non-healing skin ulcer with rolled boarders
Cratered center
Occasionally bleeds
168
What is the proper treatment of basal cell carcinoma?
Surgical and/or radiation therapy
169
What is the prognosis of basal cell carcinoma?
Good, but may have recurrences or other sun-related malignancies.
170
What is a melanoma?
Malingant tumor of melanocytes.
171
Where can melanomas be found?
Skin (acute sun damage)
Oral cavity
Eye
Nasal cavity
172
What neumonic is used to evaluate a melanoma?
```
A: asymmetry
B: irregular borders
C: color variation
D: diameter larger than a pencil eraser
E: evolving
```
173
What is the prognosis of a melanoma?
Poor prognosis, 5-20% have a 5 year survival rate.
174
What is common treatment for a melanoma?
Radical surgery, often hemimaxillectomy.
175
What viral infections affect the oral cavity?
```
HPV
Hairy Leukoplakia
Epstein Barr Virus
Herpes Simplex
HIV
```
176
What is HPV?
Verruca Vulgaris, benign squamous papilloma.
177
What causes HPV?
Paipillomavirus
178
How does HPV spread?
Contagious spreads by autoinoculation.
179
How does HPV affect skin cells?
Causes skin cells to proliferate forming a wart.
180
Where is HPV commonly found intraorally?
Labial mucosa, and anterior tongue.
181
What is the recommended treatment for HPV?
Excision
182
What is oral hairy leukoplakia?
Faint white vertical to thickened & furrowed areas of leukoplakia.
183
What is the etiology of oral hairy leukoplakia?
Epstein Barr Virus
184
Where does hairy leukoplakia occur?
Lateral of the tongue
185
What patients typically present with oral hairy leukoplakia?
Immuno-compromised patients
HIV
Smoking more than 1pk/day
Ulcerative colitis
186
What is epstein barr virus?
The cause of infectious mononucleosis.
187
How is Epstein Barr virus transmitted?
Saliva
188
What are clinical symptoms of Epstein Barr virus?
Fatigue, fever, enlarged spleen
189
What are clinical oral signs of Epstein Barr virus?
Palatal petechiae
190
How is Epstein Barr virus diagnosed?
Blood work
191
What is the treatment for Epstein Barr virus?
Rest, or steroids if severe.
192
What are the two types of herpes simplex virus?
Type 1: Oral
| Type 2: Genital
193
Where does herpes simplex virus lie dormant?
HSV is dormant in the trigeminal ganglion and travels back and forth via sensory axons on the peripheral skin or mucosa.
194
What is primary acute herpes gingivostomatitis?
First exposure to herpes simplex virus usually seen in young children ages 6months - 6 years
195
What are characteristics of acute herpes gingivostomatitis?
Numerous mucous membrane lesions
Acute gingivitis and eruption of vesicles that rupture leaving ulcers
Heals in 10-14 days
196
What is the proper treatment of acute herpes gingivostomatitis?
Palliative
197
What are secondary herpes simplex infections?
Secondary lesions called fever blisters or cold sores.
198
What triggers the recurrence of secondary herpes simplex infections?
UV light
| Trauma
199
What are prodromal symptoms?
When the patient can feel the secondary herpes simplex infection coming on...
200
How early is the onset of prodromal symptoms of a secondary herpes simplex infection?
6-24 hours before the lesion appears the patient can feel pain and itching.
201
Where are secondary herpes simplex infections typically found?
Usually located extra orally
202
How do secondary herpes simplex infections appear?
They appear as vesicles that rupture to form ulcers.
203
How do secondary herpes simplex infections present intraorally?
Intraoral lesions are in form of ulcers & located on the bound to bone mucosa. Found on keratinized mucosa and follow certain stimuli.
204
What does AIDS stand for?
Acquired immunodeficiency syndrome
205
What is the etiology of aids?
Human immunodefiency virus (HIV)
206
How is aids transmitted?
Sexual contact
Blood or blood products
