Pathology - Full Review Flashcards
What is the “Rule of 10s” when regarding tx of cleft lip?
Child should ideally be 10 weeks old, weigh 10 lbs, and have 10 g hemoglobin before treating cleft lip
Which is most common? Cleft lip alone, cleft palate alone, or both together.
Both CL and CP together is most common (45% incidence)
What is the minimum manifestation when palatal shelves fail to fuse?
Bifid Uvula
Cleft palate, mandibular micrognathia, and glossoptosis all together characterize what syndrome?
Pierre Robin Sequence
Which population gets orofacial clefts most commonly?
Native Americans
Paramedian lip pits are classic manifestations of what syndrome?
Van der Woude Syndrome
What are ectopic sebaceous glands? Appear as yellow-ish papular lesions on buccal/labial mucosa
Fordyce Granules
What happens if epithelium is left behind along the path the thyroid takes from foramen cecum to the neck?
Thyroglossal Duct Cyst
Fissured tongue is frequently seen with what other pathology?
Geographic tongue
Hairy tongue is keratin accumulating on what type of papillae?
Filiform papilla
The mandible will deviate to which side with coronoid hyperplasia?
toward the affected side
The mandible will deviate toward which side with condylar hyperplasia?
toward opposite side
A common exostosis occurring on the midline of the palate?
Torus Palatinus
A focal concavity of the cortical bone in the lingual surface of the mandible?
Stafne Defect (aka Lingual mandibular salivary gland depression)
The most common non-odontogenic cyst in the oral cavity? (hint: 6mm or greater is pathologic)
Nasopalatine Duct Cyst
The most common yellow pathology/finding in the mouth
Lymphoepithelial cyst (most common around FOM, waldeyer’s ring, ventral tongue, soft palate)
What syndrome demonstrates “beaten metal” pattern on a cephalometric x-ray?
Crouzon Syndrome
How does turner’s hyperplasia occur?
A periapical inflammatory disease of the overlying deciduous tooth
What is hutchinson’s triad and what disease is it associated with?
Triad = Hutchinson’s teeth, interstitial keratitis, 8th nerve deafness
Associated with Congenital Syphilis
Most common teeth to be congenitally missing?
3rd molars, 2nd premolars, upper lateral incisors
Most common supernumerary tooth to see?
mesiodens
A pt has a funky looking tooth. You count all the teeth, including the anomalous tooth, and the count is normal. What your diagnosis?
Gemination
A pt has a funky looking tooth. You count all the teeth, including the anomalous tooth, and the count is one short. What your diagnosis?
Fusion
Pt has fine, wispy hair, lacks sweat glands, has xerostomia, and conical shaped teeth - what’s your diagnosis?
Hypohidrotic Ectodermal Dysplasia
Taurodontism can be seen associated with what three syndromes?
Kleinfelter’s Syndrome (XXY), Amelogenesis Imperfecta, Tricho-Dento-Osseous Syndrome
What type of amelogenesis imperfecta has “snow-capped” teeth?
Hypomaturation
Diagnose. Pt’s x-ray shows bulbous crowns because the roots are so thin.
Dentinogenesis Imperfecta (can also be Dentin Dysplasia Type II)
Rootless teeth is characteristic of what autosomal dominant disease?
Dentin Dysplasia Type I
Thistle tube-shaped pulpal anatomy is characteristic of what autosomal dominant disease?
Dentin Dysplasia Type II
“Ghost teeth” (not very opaque on x-ray) demonstrates what pathology?
Regional Odontodysplasia
Rapid swelling of the sublingual, submandibular, and submental spaces due to an abscessed mandibular molar, is called what?
Ludwig’s Angina
Swelling along the lateral border of the nose due to an abscessed maxillary anterior/premolar tooth, is called what?
Cavernous Sinus Thrombosis
“Punched-out” papillae is a sign for what periodontal pathology?
NUG
Differential for desquamative gingivitis.
Lichen planus, mucous membrane pemphigoid, pemphigus vulgaris, SLE, hypersensitivity rxn
Drug-related gingival hyperplasia can be associated with what drugs?
Cyclosporin, Phenytoin, Ca channel blockers (amlodipine often seen in SOD clinic)
Teeth seen as “floating in air” due to accelerated periodontitis might be a sign of what syndrome?
Papillon-Lefevre Syndrome
Strawberry tongue is a sign of what sickness?
Scarlet fever (white during first 2 days of infection, red later on)
Pt currently has glossitis and reports they used to have a chancre elsewhere on the body. What’s your dx? (hint: sexually transmitted)
Syphilis
Sulphur granules exhibited within a yellow discharge represents what pathology?
Actinomycosis
Young pt has a scratch near their eye and swelling around the eye. Dx?
Cat-Scratch disease (caused by Bartonella henselae)
Pt presents with adherent, but wipeable, white plaques resembling cottage cheese. What’s your initial diagnosis?
Pseudomembranous Candidiasis
median rhomboid glossitis, angular cheilitis, and denture stomatitis are all examples of _____________ candidiasis.
Erythematous candidiasis
Most common site for HSV-1 infection?
Vermillion border - called Herpes Labialis
Multinucleation, ballooning degeneration of nucleus and tzanck cells are all histopathologic features of what?
HSV
What is HHV-3? And what does it cause?
Varicella-Zoster virus - causes chickenpox and shingles
Herpetic lesions appearing unilaterally in a well-demarcated area. Dx?
Shingles
What is HHV-4? What does it cause?
Infectious Mononucleosis (EBV) - causes mono, hairy leukoplakia, nasopharyngeal carcinoma
What is HHV-5? What does it cause?
Cytomegalovirus - causes mucosal ulcerations seen in AIDS patients
What is HHV-8? What does it cause?
Kaposi’s Sarcoma Herpesvirus - causes Kaposi’s sarcoma on hard palate or gingiva in HIV+ patients
Pt has red macules/vesicles on soft palate, a sore throat, fever, and dysphagia. Dx?
Herpangina
Pt has swollen salivary glands and it hurts upon salivation. Dx?
Epidemic Parotitis (mumps)
Oral manifestations of HIV/AIDs?
candidiasis, oral hairy leukoplakia (EBV), kaposi’s sarcoma, non-hodgkin’s lymphoma, periodontitis
What appears as bilateral thickened, shredded white areas on buccal mucosa (hint: along occlusal plane)
Morsicatio Buccarum
Aspirin, bisphosphonates, chlorpromazine, or promazine held in the mouth to dissolve might cause what?
Chemical-related Mucosal Necrosis
95% of BRONJ occurs in patients who have received ____________ delivery of bisphosphonates.
Intravenous delivery
What is your tx plan modification for a pt taking IV bisphosphonates?
Avoid bone manipulation
Pigmentation is seen on anterior facial gingiva in a patient that smokes. Dx?
Smoker’s Melanosis
Dome-shaped, slightly radiopaque lesion(s) arising from the intact floor of the maxillary sinus.
Antral Pseudocyst
Cervicofacial Emphysema can be caused by what?
Introduction of air into subcutaneous or fascial spaces, possibly by using an air-driven handpiece during oral surgery
One or two fungiform papillae on the tongue are swollen and painful. Dx?
Localized Transient Lingual Papillitis
What painful, non-vesicular lesion is commonly seen on movable mucosa?
Recurrent aphthous stomatitis
Joint pain, aphthous lesions, genital ulcers, and ocular involvement are characteristics of what syndrome?
Behcet’s Syndrome
What is a multisystem granulomatous disorder of unknown cause, and seen more commonly in African Americans?
Sarcoidosis
Cheilitis granulomatosa, facial paralysis, and fissured tongue when seen together are characteristic of what syndrome?
Melkersson-Rosenthal Syndrome
Strawberry gingivitis is an early manifestation of what granulomatous disease?
Wegener’s Granulomatosis
Mast cell degranulation leads to histamine release, and is mediated by what immunoglobulin?
IgE hypersensitivity reactions
Differential diagnosis when you see a papillary-like surface lesion in the mouth?
- squamous papilloma
- verruca vulgaris (wart)
- condyloma acuminatum (sexual transmission)
- verruciform xanthoma
verruca vulgaris is caused by what?
Herpes type 2, 4, 6 or 40
Condyloma acuminatum (considered an STD) is caused by what?
HPV-6 or 11 most commonly (also 16, 18 and 31)
What brown lesion becomes more pronounced with sun exposure?
Ephelis (aka freckle)
What brown lesion doesn’t become more pronounced with sun exposure?
Actinic Lentigo
What is a freckle called when inside the mouth?
Oral Melanotic Macule
Usually seen more in African American females, what pigmentation occurs on oral mucosa due to irritation?
Oral Melanoacanthoma
Order the types of leukoplakia ranked from highest to lowest chance to be pre-cancerous.
- Erythroleukoplakia (highest chance of cancer)
- Leukoplakia
- Erythroplakia (lowest chance)
Name a white keratotic change on the palate associated with smoking.
Nicotine Stomatitis
Name a common premalignant lesion caused by cumulative UV radiation exposure over a person’s lifetime.
Actinic Keratosis
What do you call it when the lower lip becomes atrophied, smooth and blotchy from long-term UV exposure?
Actinic Cheilosis
Most common sites for oral SCCA?
- Posterior lateral tongue
- ventral tongue
- FOM
- soft palate
- gingiva
Snuff dipper’s cancer is also called what?
Verrucous carcinoma
The first sign of nasopharyngeal carcinoma is what?
cervical lymph node metastases
Lesion is found during an H&N exam, and it demonstrates rolled borders and telangiectatic blood vessels. Dx?
Basal Cell Carcinoma
What causes basal cell carcinoma?
UV exposure and frequent sunburns
What increases risk for melanoma?
fair complexion, light hair, a tendency to sunburn easily, acute sun exposure
What is the ABCDE system used to describe clinical features of melanoma?
Asymmetry Border irregularity Color variation Diameter greater than 6mm Evolving lesions (it changes appearance)
Where are mucoceles most often seen?
- lower lip
- FOM (called a ranula)
- anterior tongue
- buccal mucosa
An epithelium-lined cavity that arises from salivary gland tissue and can occur in minor or major glands.
Salivary duct cyst
Sialoliths are most common where?
Submandibular gland duct
Locally destructive inflammatory condition of the salivary glands on the palate, usually associated with dental injections
Necrotizing Sialometaplasia
What gland is likely to have a malignant tumor?
Sublingual
Minor salivary gland tumors are more likely to be malignant if it’s in these locations:
lower lip, tongue, retromolar pad
What is the most common benign salivary gland neoplasm?
Pleomorphic Adenoma
What is the most common malignant salivary gland neoplasm?
Mucoepidermoid Carcinoma
What is the most common “tumor” in the oral cavity? (hint: caused by trauma/irritation)
Fibroma
You find two giant cell fibromas lingual to the mandibular anterior teeth. What is this called?
Retrocuspid Papilla
______ _________ (aka ___________ ________ _______) is associated with the flange of an ill-fitting denture.
Epulis Fissuratum (aka Inflammatory Fibrous Hyperplasia)
Reactive tissue growth on the palate under an ill-fitting denture
Inflammatory Papillary Hyperplasia
A bright red nodule on the gingiva, and seen commonly in pregnant women.
Pyogenic Granuloma
A purple nodule on gingiva that might cause cupping resorption of underlying alveolar bone.
Peripheral Giant Cell Granuloma
A pale-colored nodule on the anterior gingiva.
Peripheral Ossifying Fibroma
Your differential for a bump on the gums:
- Pyogenic Granuloma
- Peripheral giant cell granuloma
- Peripheral ossifying fibroma
- Fibroma
Any patient with a neurofibroma should be evaluated for _____________.
neurofibromatosis
Coast of California café au lait macules, neurofibromas, Crowe’s sign, and Lisch nodules together all represent what disease?
Neurofibromatosis Type I
What kind of hemangioma blanches during dioscopy?
Cavernous hemangiomas
A person born with a vascular malformation called Port Wine Stain has what developmental condition?
Sturge-Weber Angiomatosis
A person with petechiae, ecchymosis, or hematomas may be exhibiting what disorder?
Thrombocytopenia
What kind of leukemia is caused by the Philadelphia Chromosome?
Chronic Myeloid Leukemia (CML)
“Punched-out radiolucencies in the skull represents what two pathologies?
- Langerhans Cell Histiocytosis (also see floating teeth)
2. Multiple Myeloma (also see Bence Jones proteins in urine)
Reed-Sternberg Cells are seen in what hematologic malignancy?
Hodgkin’s Lymphoma
Blue sclera and Wormian bones in the skull demonstrate what inherited bone disease?
osteogenesis imperfecta
Prolonged eruption of deciduous teeth, delayed eruption of permanent teeth, and numerous supernumerary teeth characterize what disease?
Cleidocranial dysplasia
A unilocular RL lesion in posterior mandible on women that is NOT associated with a tooth or symptoms.
Focal osteoporotic marrow defect
Increased radiodensity of unknown cause
Idiopathic osteosclerosis
radiodensity associated with pulpal inflammation
condensing osteitis
radiodensity with a RL rim associated with the apex of multiple anterior teeth or one posterior tooth.
Cemento-osseous dysplasia
radiodensity associated with the root of a tooth and the PDL is obscured.
Cementoblastoma
Pt complains their hats don’t fit anymore and that their upper teeth have gaps between them
Paget’s disease of bone
Patchy slcerotic areas of the maxilla have cotton wool or cotton roll appearance.
Paget’s Disease
A RL most common in the anterior mandible and crosses the midline, and appears identical to Brown Tumor of Hyperparathyroidism.
Central Giant Cell Granuloma
An empty or fluid-filled cavity within the mandible that shows domelike projections that scallop between the roots of several teeth.
Traumatic Bone Cyst
Upon panoramic x-ray, there is ballooning distention. Upon biopsy, the surgeon says it looked like a blood-soaked sponge.
Aneurysmal Bone Cyst
On the radiograph, it looks like fine ground glass opacification.
Fibrous Dysplasia
What two syndromes are associated with polyostotic fibrous dysplasia?
- Jaffe-Lichtenstein Syndrome
- McCune-Albright Syndrome
* coast of Maine café au lait spots in both*
Cemento-osseous dysplasia occurs mostly in what population?
Middle-aged African American females
Upon radiograph, you notice a mixed RL/RO lesion that is resorbing roots and causing a downward bowing of the inferior cortex of the mandible. Dx?
Ossifying Fibroma
A RO lesion with RL rim that is painful. Aspirin does NOT relieve pain.
Osteoblastoma
A RL lesion with a small RO center that is painful at night. Aspiring relieves the pain.
Osteoid Osteoma
Spiking resorption and a sunburst appearance on the occlusal radiograph.
Osteosarcoma
The pt has numb-chin syndrome and the x-ray shows ill-defined borders of a “moth eaten” looking lesion
Metastatic Carcinoma of the Jaw
Unilocular lesion involving the crown of an unerupted 3rd molar. Appears to attach at the CEJ
Dentigerous Cyst
Child has lost a deciduous tooth and now the gingiva in that spot is nodular and purple. Dx?
Eruption Cyst. No tx needed.
Lesion grows in an anterior-posterior direction. Surgeon said there was a cheese-like material in the cyst. Dx?
Keratocystic Odontogenic Tumor (aka OKC)
What syndrome are KOT’s (aka OKC’s) associated with?
Gorlin syndrome (nevoid basal cell carcinoma syndrome)
What gene causes gorlin syndrome?
PTCH gene
A RL that occurs along the lateral root surface, usually in mandibular premolar/canine/lateral incisor area.
Lateral periodontal cyst
This lesion is usualy found around the crown of an unerupted canine/incisor and has ghost cells which can calcify within the lesion.
Calcifying Odontogenic Cyst (GORLIN CYST)
What is the most common clinically significant odontogenic tumor?
Ameloblastoma
This multicystic mandibular lesion is described with a soap bubble or honeycombed appearance in the ramus of the mandible.
Ameloblastoma
This asymptomatic RL lesion attaches beyond the CEJ of a maxillary canine and shows snowflake calcifications on the x-ray. Dx?
Adenomatoid Odontogenic Tumor
This lesion is associated with an impacted mandibular molar and shows “driven snow” pattern on the x-ray. Dx?
Calcifying Epithelial Odontogenic Tumor (CEOT)
aka PINDBORG TUMOR
Looks like a dentigerous cyst around the crown of an unerupted tooth, but it has enamel and dentin deposition inside the lesion like an odontoma. Name?
Ameloblastic Fibro-Odontoma
The most common odontogenic tumor:
odontoma
Compound odontomas look like ______, and complex odontomas look like ________.
compound = tooth-like complex = a blob
A pt has freckle-like lesions on the hands, perioral skin and oral mucosa. Dx?
Peutz-Jegher’s Syndrome
What syndrome has freckling on hands and in/around mouth, has intestinal polyps, and are 18x more likely to develop malignant cancer?
Peutz-Jegher’s Syndrome
Looks like desquamative gingivitis and has intraepithelial split on histo slide.
Pemphigus vulgaris
Looks like desquamative gingivitis and has interepithelial split on histologic exam (split at basement membrane)
Mucous Membrane Pemphigoid
Leukoerythematous lesion with whickam striae.
Reticular Lichen Planus
Systemic Lupus Erythematosis demonstrates this kind of rash in 50% of cases.
Malar rash (butterfly shape on face)
A lack of vitamin B2 might cause what two manifestations?
angular cheilitis, glossitis
Anemia, whether it be iron deficiency or pernicious, can cause what oral manifestation?
atrophic glossitis
What is your differential for a RL lesion around an unerupted tooth?
- dentigerous cyst
- ameloblastoma
- Calcifying odontogenic tumor (can have calcifications)
- Adenomatoid odontogenic tumor
- calcifying epithelial odontogenic tumor (can have calcifications)
- ameloblastic fibro-odontoma (can have calcification)
