Oral ulcers and mouth lesions

Question 1

recurrent aphthous stomatitis (minor)

Answer 1

80% of cases
few painful small ulcers <1cm
shallow lesions heal without scarring in 7 to 10 days

Question 2

recurrent aphthous stomatitis ulcer (major)

Answer 2

large, deep painful ulcer >1 cm)
affects lips and soft palate
lesions heal with scarring in 6 weeks

Question 3

Herpetiform recurrent aphthous ulcer

Answer 3

female predominance
up to 100 very small ulcers that can coalesce
extremely painful
may have virutally continuous recurrence

Question 4

recurrent aphthous stomatitis is categorized by:

Answer 4

minor, major, and herpetiform variants

Question 5

canker sore is also known as

Answer 5

minor recurrent aphthous stomatitis ulcer

Question 6

Diagnosis of recurrent aphthous stomatitis is

Answer 6

clinical and any work up (if any) is to identify the underlying conditions such as those suggested by history and physical exam

Question 7

what can cause recurrent aphthous stomatitis?

Answer 7

celiacs dx can first present as aphthous ulcers

HIV, Crohn’s dx, Behcet’s syndrome

Question 8

medical treatment of recurrent aphthous stomatitis

Answer 8

topical glucocorticoids, severe RAS that doesn’t respond needs colchicine or thalidomide

Question 9

Is RA associated with recurrent aphthous stomatitis?

Answer 9

no

Question 10

recurrent aphthous stomatitis and abdominal pain and anemia and leukocytosis consider

Answer 10

RAS with crohn’s dx and would do an evaluation for this

Question 11

pathergy testing

Answer 11

formation of inflammatory papule after insertion of a sterile needle into skin

Question 12

positive for pathergy, aphthous ulcers, uveitis and genital lesions

Answer 12

Behcet’s dx

Question 13

when can we also see aphthous ulcers?

Answer 13

with menstrual periods and with stress.

Question 14

secondary HSV-1 is

Answer 14

herpes simplex labialis

reactivates in the trigeminal sensory ganglion and see recurrent painful vesicles at the vermillion border of the lips

Question 15

Secondary infection of HSV1 will have prodromal symptoms of

Answer 15

pain, burning, tingling, and pruritis near reactivation site that lasts 5 days from onset to resolution of lesion

Question 16

Primary HSV1 seen in kids and adutls can cause

Answer 16

significant pharyngitis and intraoral lesions

Question 17

treatment of HSV-1 depends on

Answer 17

if infection is primary (more severe and symptomatic) or secondary

depends also on severity of symptoms and frequency of recurrences

Question 18

Treatment options of HSV-1 include:

Answer 18

symptomatic, episodic, chronic suppressive treatment

Question 19

Recurrent HSV-1 with minimal clinical symptoms can be treated with

Answer 19

symptomatic therapy (anesthetics or antiseptics) without need for antiviral therapy

Question 20

recurrent HSV-1 pain or discomfort requires

Answer 20

oral antiviral therapy at prodromal symptom onset
These help to decrease prevent viral replication and are effective early on in course

Treatment speeds up healing of lesions and shortens symptom duration and severity

Question 21

chronic daily suppressive therapy is meant for

Answer 21

pts who have >4 episodes of HSV1 outbreaks
or painful disfiguring lesions without prodrome
HSV recurrences accompanied by complications like recurrent aseptic meningitis

Give daily acyclovir or valacyclovir