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Oral Med > Orofacial Infection > Flashcards

Orofacial Infection Flashcards

0
Q

T/F Candida can be isolated from

Healthy mouths?

A

T

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1
Q

What is the most common type of fungal oral mucosal infective agent?

A

Candida albicans

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2
Q

What are local factors which predispose to oral candidiasis?

A

Denture wearing at night
Dry mouth
Steroid therapy esp inhaled
High carb diet

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3
Q

How can candida be categorised?

A

Acute

Chronic

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4
Q

What systemic factors predispose to or candidiasis?

A 
Immunocompromised 
T cell defects (HIV, diabetes,leukaemia)
Age extreme
AB therapy
Diabetes mellitus
Anaemia
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5
Q

What are examples of acute candida ?

A

Acute pseudo membranous candidiasis

Acute erythmatous/strophic candidiasis

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6
Q

Name examples of chronic candidal infection?

A

Chronic hyperplastic candidiasis (leukoplakia )
Chronic erythmatous candidiasis (denture stomatitis)

Candida associated lesion:
Angular chelitis
Median rhomboid glossitis

Mucocutaneous candidiasis

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7
Q

How does oral thrush present?

A

White patches on the oral mucosa which are easily removed by rubbing off may leave mucosal erythema
A disease if a disease

Seen in neonates which haven’t yet developed immunity

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8
Q

What microbiological tests can be performed with people that babe candidiasis?

A

Swab: culture and sensitivity testing

Phosphate buffered mouthwash: not site specific

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9
Q

What tests can be done for thrush?

A

Correct any local or systemic cause

Check FBC/B12/folate/blood glucose and HIV tests

Microbiological

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10
Q

How do you threat thrush?

A

Topical: MAN

Systemic: for Immunocompromised or where wide spread lesions

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11
Q

What is another name for chronic hyperplastic candida?

A

Candidal leukoplakia

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12
Q

How does candidal leukoplakia

Present?

A

Non remove able white lesion on commissaries of buccal mucosa

Frequently
Bilateral
Typically seen in smokers

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13
Q

How do you diagnosis CHC?

A

Clinicslly BUT need histopathology confirmed

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14
Q

How do you manage CHC?

A

Manage risk factors
Topical AF
Systmic AF

Follow up long term since malignancy risk of 9-40

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15
Q

How does acute erythematous candida present?

A

Erythmatous area

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16
Q

What are the risk factors for acute erythmatous candida?

A

Steroid inhalers and AB

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17
Q

What is another name for denture stomatitis?

A

Chronic erythmatous candida

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18
Q

How do you treat acute erythmatous candid?

A

Topical AF

rinse mouth after steroid inhaler

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19
Q

How does chronic erythmatous candida present?

A

Usually on palate with upper surface of denture it is often a symptomatic

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20
Q

How do you treat chronic erythmatous candida?

A

Topical AF therapy and denture hygiene

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21
Q

What is an example of a candida associated lesions?

A

Median rhomboid glossitis

Angular chelitis

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22
Q

How does median rhomboid glossitis present?

A

Lobulated lesion at junction between post and anterior tongue

It is usually asymptomatic
And dx is clinical

Topical AF therapy needed

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23
Q

What is a less common bacterial infectjon of the mouth?

A

Alveolar abscess/cellulitis

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24
Q

name some bacterial infections of the mouth?

A 
ANUG
Osteomyelitis
Periaplical abscess 
Periodontal abscess
Periocoronitis
Infected cyst
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25
Q

What is the difference between alveolar abscess and cellulitis ?

A

Abscess is collection of pus

Cellulitis diffuse pus

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26
Q

Which spaces can infection spread in head and neck?

A 
SM space
SL space
Submental space
Mental space
Buccal space
Canine/infraorbital space 
Submasseteric space
Pterygomandibular space
Deep temporal space
Superficial temporal space
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27
Q

Where does infection from upper centrals drain?

A

Labial

Nasal cavity if long roots

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28
Q

Where does infection from upper 2’s spread?

A

Palate

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29
Q

Where does infection from

Upper canines spread?

A

Labial sulcus or infraorbital

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30
Q

Where does infection from maximal let posterior teeth drain?

A

Buccal sulcus due to thin buccal place and high attachment of buccinator

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31
Q

Where do lower incisors point?

A

Since mentalis attaches above apices, it usually drains at chin point or submental space

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32
Q

Where do mandibular molars drain to?

A

If apices are above Mylohyoid then sublingual

If below Mylohyoid then submandibular

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33
Q

Where do periodontal abscesses drain to?

A

Via gingival sulcus or laterally

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34
Q

Which bacteria are commonly imbued in periodontal abscesses?

A

Gram neg anaerobes eg PG/ fusobacteria

spirochete sand actinomyces

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35
Q

What agents are involved in ANUG?

A

Poly microbial

Anaerobes

Boriella vincentii
Fusobacteria nucleatum

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36
Q

What predisposes you to ANUG?

A 
Poor OH
Smoking
Immunocompromised
Stress
Vit C def
Viral resp infections
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37
Q

What key features relate to ANUG?

A

Halitosis
Loss of interdental papilla
Slough
Pyrexia?

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38
Q

How do you treat ANUG?

A

Metronidazole 400mg tds

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39
Q

What are the potential risks of untreated dental infections?

A 
Osteomyelitis
Cellulitis
Fistula formation
Septacaemia
Spread into tissue spaces
Meningitis
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40
Q

Which organisms are associated with CST?

A

Staph aureus

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41
Q

What is cavernous sinus thrombosis?

A

Formation of blood clot in Cavernous sinus

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42
Q

What can predispose to CST?

A 
Nasal infection 50%
Sinus infection (30%)
Dental infection (10%)
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43
Q

What is osteomyelitis ? And how can it be classified?

A

Inflammation of the bone marrow
Suppurative
-acute suppurative osteo
-chronic suppurative osteo

non suppurative

  • diffuse sclerosimg
  • focal sclerosimg
  • proliferative periostitis
  • ORN
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44
Q

What are the symptoms of CST?

A 
Palpebral oedema
Cyanosis
Exophthalmos
Proptosis
Dilated pupil
Limited eye movement
Rigors
Pyreixa
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45
Q

What are the sources of osteomyelitis?

A

Periaplical or peridontal infection
Fractures
Penetrating injuries

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46
Q

What are the predisposing factors for osteomyelitis?

A

Osteoradionecrosis

Osteopetrosis

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47
Q

What are the signs and symptoms of osteomyelitis ?

A 
Deep seated throbbing pain
Sweeping
Halitosis
Anorexia
Parasthesia 
Malaise
Fever
Cervical lymphadenopathy
Tooth mobility
Pus
Leukocytosis
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48
Q

What causes syphylis?

A

STI

Treponema palladium

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49
Q

What are the sequelae following infection with T Pallidium?

A

Primary syphylis: primary chancre at site of inoculation following oral sex, causes painless ulcer and lymphadenopathy
Secondary : snail track ulcers 2-6 weeks later
Terriary: leukoplakia and gumma on palate

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50
Q

What causes TB?

A

Mycobacterium Tuberculosis

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51
Q

How do you treat syphylis?

A

Benzathine pencillin for 1 month

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52
Q

Oral lesions are rare in TB? T/F

A

T

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53
Q

How may TB present in Head and neck?

A

Ulcer on dorsal of tongue
Salivary gland swelling
Lymphadenopathy

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54
Q

How do you treat TB?

A

Rifampicin
Isomiazid
Ethambutol
Spiramycin

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55
Q

How do oral lesions in TB develop in mouth?

A

Tubercle bacilli in sputum coughed into mouth

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56
Q

What is erysipelas?

A

Acute streptococcal infection which spreads via lymphatic system
Usually caused by strep pyogenes which produced exotoxin and then rash

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57
Q

What is actinomycosis?

A

Chronic supportive infection which is rare. Swelling at angle of the mouth

Multiple sinus formation and trimsus and caused by gram pos organisms, a israelli and aa
Tropical country

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58
Q

What signs indicate acinomycosis?

A

Extra oral sinus with no oral cause

May occur following jaw surgery or neck

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59
Q

What are the demographics associated with actinomycosis?

A

30-60 male

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60
Q

When does a israelli become pathogenic?

A

When tissue is non vital and reduced oxygen

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61
Q

How do you treat actinomycosis?

A

Pencillin

Drainage

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62
Q

What are the 5 of infective periodontal diseases?

A 
Linear gingival erythema 
NUG
NUP
ANUG
Cancrum oris
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63
Q

What is the agent involved in Linear Gingival Erthema?

A

Fungus

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64
Q

Which bacteria are involved in acute ulcerative gingivitis?

A

Spirochete and fusiform

They invade muscle

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65
Q

What happens to the tissue in AUG?

A

Gross oedema which spreads outwards destroying soft tissues and bone

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66
Q

Why do the tissues slough away in AUG?

A

Because gangrenous infection occurs leading to loss of teeth and necrotic sequestra

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67
Q

In what demographics is AUG mainly seen in?

A 
Children under 10
Immunocompromised 
Protein deficiency
Anaemia
Poor OH
Systemic infection  eg measles
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68
Q

What can AUG lead to?

A

Cancrum oris

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69
Q

Which fusiform bacteria are involved in Cancrum oris?

A

Porphyromonas
Fusiform necrophorum
Boriella vincentii

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70
Q

How can viral infections be diagnosed?

A

In the lab

Clinically

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71
Q

What features are considered when diagnosing viral infection clinically?

A

History of contact
Incubation period
Clinical features

72
Q

What effect can viruses have on the tissues?

A

Cell death and Persistant infection

73
Q

What is an example of a latent viral infection?

A

Herpes simplex

74
Q

What is an example of a chronic viral infection?

A

Hep B

75
Q

What is an example of a slow viral infection?

A

HIV

76
Q

What is an example of an acute viral infection?

A

Measles

77
Q

How can you use lab methods to detect viruses?

A 
Antibody response
Viral particles( Culture, smear, PCR, EM)
78
Q

what type of viruses are herpes viruses?

A

large
icosahedral
dsDNA

79
Q

Which herpes viruses exist?

A 
HSV1/HSV2= HHV1 and 2
HHV3=VZV 
HHV4=EBV (GF)
HHV5=CMV (GF)
(HHV6= GF HHV7) 
HHV8 = kaposi sarcoma
80
Q

What disease is associated with HSV1/HSV2 primary infection?

A

HSV1: herpes labialis and oral ulceration
Primary infection as a child is usually sub clinical but when is clinical leads to Primary herpetic gingivostomatitis only affects around 5% of people,

HSv2: oral ulceration

81
Q

What disease is associated with latent HSV1 infection?

A

Latent virus in periods of stress fever UV and immuno suppression there is either:

  1. asymp shedding of virus
  2. Herpes labilis
  3. RIOHU
82
Q

how do you diagnose HSV1 infection?

A

mainly clinical but can do viral and serolgy testing

83
Q

how is HSV transmitted between persons?

A

saliva

Direct contact with infected lesions

84
Q

What disease is associated with latent infection of HSV2?

A

cold sores

85
Q

how are HSV2 infections transmitted?

A

infected saliva, semen and bodily fluids

more sever infections with HSV2 than HSV1

86
Q

what diseases can HSV1 and HSV2 cause?

A

primary herpetic gingivostomatis
herpetic whitlow
herpes labialis
recuurent herpes

87
Q

What disease is caused upon contraction of VZV?

A 
Chicken pox
Herpes zoster (Shingles)
88
Q

What are the sequale following VZV infection? How can it be diagnosed?

A

macular, papular rash
latent infection as virus remains dormant in the posterior root ganglion and nerve cells bodies
in those that become immunocomprimsed and elderly there is recrudescence.
this leads to shingles infection (follows dermatome) doesnt cross the midline introrwl and extra oral distribution

Diagnosis: clinical and history but can do lab tests to confirm.

  1. Serology: specific VZV IgM AB only occurs during chickenpox or active herpes zoster
  2. Four fold rise in VZV specific IgG which can be demonstrated over a 2 week period in a true phase so retrospective only
  3. Swab taken and in special transport media for PCR
89
Q

Where is the DNA held in EBV?

A

nucelocapsid

90
Q

What is the incubation period of EBV?

A

20-40 days

91
Q

What can EBV cause? How is EBV transmitted?

A

GF/IM/hairy leukoplakia, burkitts lymphoma

saliva

92
Q

What disease is caused by Coxsackie A virus?

A

Hand foot and Mouth

Herpangina

93
Q

How does Herpangina present?

A

Fever, sore throat, vesicles, vominitkng and a do pain,
ulcers on the soft palate, and post aspect of pharynx
Fever subsides within 2-4 days
cervical lymph

Takes one week to resolve

94
Q

how does HFM presnt?

A

mild malaise, oral ulceration and
rash on hands and feet more commonly seen in children than adults

5-10 vesicles that rupture and show shallow ulceration
caused by coxscakie A

Management: spontaneous resolution

95
Q

What type of DNA are paramyxoviruses?

A

RNA!!

Large pleiomophic enveloped

96
Q

what do paramyxoviruses cause?

A

Measles and Mumps

97
Q

How do measles presnt?

A

koplik spots
macular papular rash
fever and malaise

98
Q

What is the incubation period for paramyxoviruses when causing measles?

A

7-14 days

99
Q

How do mumps present?

A

mainly affects parotid glands causing sialadentitis

adults can get orchitis, balanitits and meningioencephalitis

100
Q

what should adults suffering from mumps take? and why?

A

steroids to prevent infertitly

101
Q

how long is the paramyxoviruses incubation period in mumps?

A

2-3 days

102
Q

T/F people develop immunity o further attacks of acute viral sialadentits?

A

TRUE

103
Q

what is the structure of papilloma virus?

A

small icosahedrral DNA

104
Q

What do papilloma virus cause?

A

Soft tissue neoplasms, wart like any location in the oral cavity

105
Q

How do papillomas present?

A

pedunculated or sessile may also be on digits of patients with oral infecting

106
Q

Which other viruses are associated with papilloma virus?

A

HPV 13 + 33 HECKS and FEH

HPV 6 and 16: cancer

107
Q

what is the structure of poxvirus?

A

Large DNA, brick shaped and enveloped

108
Q

what causes molluscum contagiosum and what is its clinical appearance?

A

poxvirus

umbilicated papules on the face and body

109
Q

which people are commonly affected with molluscum contagiosum?

A

children and HIV

common STI

110
Q

what are the symptoms of herpetic whitlow?

A

Lymphadenopathy

swollen finger

111
Q

which species of candida are seen more commonly in immunocompromised patients?

A

glabrata
kruisei
trpoicalis

112
Q

which serotype of candida is more commonly seen in immunocompromised pts?

A

B

113
Q

which serotype of candida is more commonly seen in healthy individuals?

A

A=B

114
Q

What are the four host defenses against candida?

A

oral epithelium
microbial interactions
salivary non immune(mechanical washing) and immune (IgA)

115
Q

when would you prvide prophylaaxis for people against candidiasis?

A

chemotherapy,immunosuppressant therapy,prlonfed ab, history of candida followinf short course of ab

NOT HIV

116
Q

white colour lesions are present in candidiasis?

A

red and white

117
Q

which form of candida does white lesions predominate in?

A

hyphal

118
Q

which form of candida does red lesions predominate in?

A

yeast

119
Q

where is primary candida confined to?

A

oral and peri-oral tissues

120
Q

where is secondary candida confined to?

A

other parts of the body

121
Q

what is a complication arising from acute erythmatous candidasis?

A

lesions for more than month can lead to chronic multifocal candida

122
Q

what other organism other than candida is implicated in angular chelitis?

A

staph aureus

123
Q

which factors predispose to angular chelitis?

A

decreased vertical dimension
denture wearer
deficiency state

enlarged lips (OFG, Crohns, Downs)

124
Q

how does angular chelitis present?

A

fissurung at angle of mouth
triangular in shape
lesions may extend beyond the vermillion border in linear furrows and rhagades
chin may also be affected

125
Q

how do you manage angular chelitis?

A

MAN and consider fusidic acid if staph aureus possible cause

126
Q

what is the definition of chronic hyperplastic candidasis?

A

persistant white plaques which cannot be wiped off

127
Q

what is chronic mucocutanous candidais ? and how do you treat it?

A

candida that affects the nails mouth and skin.

treat using systemic AF

128
Q

what is chronic mucocutanoues candidasis associated with?

A

immune defect and endocrine diseases (autoimmune hypoparathyoidism and hypoadrenocortiscm) or thymus disease

129
Q

what can CMV cause?

A

HHV5 and associated with oral ulceration and retitnits

130
Q

How do you manage herpes zoster infection?

A

antivirals: 10 days aciclovir 800mg 5 times/day

131
Q

where does EBV replicate?

A

replicates in the mucosal cells and salivary glands then spreads to B cells and blood stream

132
Q

how do you manage OHL?

A

valaciclovir therapy

133
Q

what are the viral causes of lymph node enlargment?

A 
URTI
paramyxic virus (measles)
herpex simplex
zoster
HFM
herpangina
GF
HIV
134
Q

what are the causes of bacterial lymph node enlargement?

A

syphilis
Local head and neck infections
Cat scratch

135
Q

What are the protozoal causes of infection?

A

toxoplasmosis

136
Q

in children less than 10 what are the causes of cervical lymph node enlargemet?

A

Viral infection (URTI)
kawasaki disease
HSV

137
Q

in an adolescent less than 20 years old, what are the causes of cervical lymph?

A 
viral URTI
bacterial infection
GF
HIV
Toxoplasmosis
138
Q

what is kawasaki disease?

A 
AI vascilitis which occurs when there is an underlying systemic infection
Fever for more than 5 days plus 4 of:
Cervical lymphadenopathy (>1.5cm)
Non supparative conjuctivitits
Oral MM changes eg strawverry tongue
Periperheral odema, erthythema, desquamm
Polymorphous rash on trunk
139
Q

A bcaterial infection of the mandible can lead to what?

A

ludwigs angina

polymicrobial infection of the sublingual and aubmanidbular neck spaces

140
Q

what is GF syndrome caused by?

A

EBV (HHV4)
CMV (HHV5)
acute HIV
Toxoplasmosis

141
Q

What are the symptoms of GF?

A 
Fever, malaise and weightloss
Cervival lymphadenopathy
Exudative tonsillitis
petechial rash on palate
splenomegaly
142
Q

What happens when amoxicillin is adminstred to people with GF?

A

Rash if EBV is cauastive agent

143
Q

how do you diagnose GF syndrome?

A 
Atypical lymphocytosis
Paul-bunnel test
Monospot test
Viral serological tests
raised liver enzyme
144
Q

what causes toxoplasmosis?

A

Toxoplasma gondii

145
Q

what are the sources of t.gondii?

A

cats and soil, incompletely cooked meat

146
Q

what are the symptoms of Toxoplasmosis?

A

Fever, malaise, cervical lymphadenopathy

147
Q

what is the histology behind toxoplasmosis?

A

follicular hyperplasia of lymph nodes

148
Q

how do you treat toxoplasmosis?

A

self lumiting or long course tetracycline

149
Q

what are the complications of toxoplasmosis?

A

congenital defects since can cross the placenta

immunocomprised pateints can cause multifocal necrotising encephalitis

150
Q

what is the causative agent in cat scratch?

A

bartonella henselae

151
Q

what is the source of bartonella henselae?

A

cats/thorns/animals

152
Q

what are the symptoms of cat scratch?

A

papules which arise 3-4 days post infection
fever and malaise
lymph uniltaeral
LN suppuration

153
Q

what is the histology behind cat scratch?

A

Necrotising granulamatous inflam

154
Q

what is the treatment for cat scratch?

A

self limiting/long dose tetracycline

155
Q

what are the causes of lymph node enlargement in a patient of less then 40?

A 
malignancy
HIV
Bacterial
syphilis
GF/IM
156
Q

what are the causes of lymph node enlargement in a patient less more the 40?

A

HIV and malignancy

157
Q

what are the neoplasms of the lymph nodes?

A

Primary: Lymphoma and Leukaemia
Secondary: Metastatic

158
Q

which drugs can cause cervical lymph?

A

phenytoin, carbamezapine

159
Q

which connective tissue disorders can cause lymph node enlargement?

A

SLE

160
Q

what is sarcoidosis?

A

mutlisystem granulomatous disease

161
Q

what is the incidence of sarcdoidosis?

A

young adults mainly

F:M 2:1

162
Q

what are the symptoms of sarcoidosis?

A

Pulmonary lesions, fever, malaise, weight loss, bilateral hilar lymph, cervical lymph, cough, dysponea, oral lesions

163
Q

what oral lesions occur in sarcoidosis?

A 
lip swelling
skin lesions
cobble-stoning mucosa
ulcers and swellings
hyperplastic gingivitis
salivary swellings/dry eyes/dry mouth
heerfodt syndrome
164
Q

what s heerfordt syndrome?

A

Pyrexia
parotitis
uveitis
facial nerve palsy

165
Q

what are the microscopial features of sarcoidosis?

A 
HELLN
heals with scars
Epitheloid cels
Langerhans giant cells
Lymphocytes
Noncaseatig epitheloid granulomas
166
Q

how do you investigate sarcodiosis?

A 
chest x ray
liver US
SACE enzyme is raised
ESR/Serum calcium
Transbronchial lung biopsy
Minor salivary gland biopsy
Kveim test
167
Q

how do you treat sarcoidosis?

A

systemic steroids

168
Q

what is a branchial cyst?

A

developmental remnant of any of the paired pharyngeal/branchial pouches in the side of the throat of an early embryo

169
Q

what type of cyst is a branchial cyst?

A

lymphoepithelial cyst

170
Q

how do you treat branchial cysts?

A

surgical removal otherwise branchial fistula may develop

171
Q

what skin cysts can cause neck lumps?

A

dermoid cyst: epidermis and skin appedndages

epidermoid cysts: epidemis only

172
Q

what is the incidence of dermoid cysts?

A

15-35, M=F

173
Q

how do dermoid cysts present?

A

doughy/fluctutant swelling in the FOM or midline of neck, can dssplace the tongue affecting speech, eting and breathing

174
Q

how do you treat dermoid cysts?

A

surgical removal

175
Q

how do you test for syphylis?

A

VRDL test

176
Q

What causes verruca vulgaris?

A

Human papilloma 2 and 4

177
Q

How do verruca vulgaris appear?

A

Skin warts involving the oral mucosa
White sessile and pedunculated
Solitary or multiple

Most commonly on lips, hard palate and gingival

178
Q

What are the causes of cervical lumps?

A

Lymph: Infective, Neoplastic, sarcoidoisis, drugs, CTD

glands: Salivary gland, thyroid gland
other: branchial cyst, skin cyst, soft tissue neoplasm

Oral Med (31 decks)

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