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OM > Oral Ulcers > Flashcards

Oral Ulcers Flashcards

1
Q

RAS associated factors

A

Positive family history
Non smoker
Traumatic
Haematinic deficiency
Age <30yrs

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2
Q

Strong associated features of RAS

A

Females
High socioeconomic status
Hugh stress
Hormone imbalance
Food intolerance
SLS toothpaste and drugs

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3
Q

Predisposing factor of RAS

A

Cytokine polymorphism

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4
Q

Diagnosis of RAS

A

Clinical diagnosis
Ulcer hx
Medical hx
Medications
System enquiry

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5
Q

Questions to ask about ulcer history?

A

Onset
Number
Pattern
Location
Size
Pain
Prodrome
Triggers

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6
Q

Systems ususally involved with RAS

A

Skin
Eyes
Genitals
Gastrointestinal

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7
Q

Signs of GI involvement for RAS

A

Weight loss
Constipation
Diarrhoea
Bloating
Reflux
Blood in stool

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8
Q

Clinical findings of RAS

A

Round/ avoid shape
Grey base
Erythematoua halo

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9
Q

Minor RAS

A

Less than 1cm
7-10 days
Non keratinised mucosa
Heals with no scarring

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10
Q

Major RAS

A

Greater than 1cm
Last longer than 2-3 weeks
Can affect all mucosa
Heals with scarring

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11
Q

Herpetiform RAS

A

Multiple tiny ulcers
Resemble hermetic ulcers
Can coalesce (join)
Keratinised and non keratinised surfaces

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12
Q

Investigations for RAS

A
  • Bloods
    Standard (FBC, haematinics, coeciliad screen)
    Additional (ESR, ANA, Viral screens for HSV, EBV, HIV

-REFERRAL

-Biopsy

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13
Q

Is it RAS or ALU (aphthous like ulceration )?

A

Oral and genital
- could be complex apthosis or Behcets

GI
- could be IBD and Coeliac

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14
Q

What is Behçet’s disease?

A

Chronic , relapsing , multisystem inflammatory vasculitis
Affects large and small vessels
Common sites are: oral, genital, skin, GI tract

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15
Q

How to grade Behçet’s disease?

A

ISG 1990
International Criteria for Behçet’s disease - score of 4 indicates disease

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16
Q

What is the 1st line management?

A

Change diet
Investigate trauma
Toothpaste (SLS Free)
Topical:
-Benzydamine
-Lidocaine
-Covering agents
-CHX

17
Q

What is 2nd line management?

A

Topical corticosteroids (creams/gel/sprays/mw)
-check potency of steroid

Topical antibiotics
- dissolve contents of doxycycloine 100mg in 10ml water
- hold for 4 mins over ulcer
- spit
- don’t eat/ drink for 20 mins after

Vitamin B12
- Suggest 100mcg sublingual nugget

18
Q

What is the 3rd line management?

A

Corticosteroids
Colchicine
Pentoxyphilline
Thalidomide
Azathioprine
Mycophenolate
Biologics

19
Q

What is TUGSE?

A

Traumatic ulcerative granuloma with stromal eosinophillia

20
Q

Explain TUGSE

A

Rare, benign and self limiting oral ulceration
Usually in complex MH, dry mouth, persistant ulcers
Resolution following biopsies

21
Q

Medication causing TUGSE?

A

Methotrexate - cytotoxic drug
NSAIDs
Nicorandil (angina) - inhibits cell migration needed for healing

22
Q
A

OM (8 decks)

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