Pathology of the GI Tract- Oral cavity and salivary glands (part 2 of 4)

Question 1

what are Tori?

Answer 1

bony outgrowths or exostoses which are typically incidental findings on routine oral examinations; localized, benign bony protrusions

Question 2

what demographic of people are most at risk for primary infections of HSV?

Answer 2

children between 2 and 4 years of age

Question 3

If primary HSV infections are not asymptomatic, how do they present?

Answer 3

acute herpetic gingivostomatitis; these lesions can be accompanied by lymphadenopathy, fever, and anorexia

Question 4

how do the oral lesions of HSV infections appear?

Answer 4

the vesicles range from lesions of a few mm to large bullae; first filled with a clear serous fluid but rapidly rupture to yield a painful, red-rimmed, shallow ulceration.

Question 5

how can you test for HSV infection?

Answer 5

you can do a Tzanck test

Question 6

when is the Tzanck test positive?

Answer 6

if acantholytic keratinocytes or multinucleated giant acantholytic keratinocytes are detected

Question 7

what is the Tzank test looking for?

Answer 7

the viral cytopathic effects that are associated with HSV–> multinucleation

Question 8

what is the most common fungal infection of the oral cavity and the most frequent cause of human fungal infections?

Answer 8

candidal infections

Question 9

what are the three factors that influence clinical infection with candida?

Answer 9

the strain of C. albicans; the composition of individual oral flora; the immune status of the patient

Question 10

what three things are important for the protection against Candida infection?

Answer 10

neutrophils, macrophages, and Th17 cells

Question 11

how can candida infections be characterized?

Answer 11

thrush; superficial, gray to white inflammatory membrane composed of matted organism enmeshed in a fibrinosuppurative exudate that can be readily scraped off

Question 12

what are the histologic features associated with candida?

Answer 12

pseudohyphae and budding yeast

Question 13

what 3 conditions are associated with a compromised immune state that may predispose a person to candida infection?

Answer 13

diabetes mellitus, broad spectrum antibiotics or steroid inhalers, vaginal yeast infection in a pregnant woman

Question 14

certain fungi have a predilection for the oral cavity and head/neck region; which class did we focus on?

Answer 14

zygomycetes–> Mucor

Question 15

what is the key predisposing factor associated with these deep fungal infections?

Answer 15

immunosuppression

Question 16

what are some characteristics of rhinocerebral mucormycosis?

Answer 16

opacification of the sinuses; this organism loves to go to vascular spaces and that’s how it spreads

Question 17

what is often the first sign of underlying systemic conditions?

Answer 17

oral lesions

Question 18

what are the oral changes associated with scarlet fever?

Answer 18

fiery red tongue with prominent papillae; white-coated tongue through which hyperemic papillae project

Question 19

what are the oral changes associated with measles?

Answer 19

spotty enanthema in the oral cavity often precedes the skin rash; ulcerations on the buccal mucosa; koplik spots

Question 20

what are the oral changes associated with infectious mononucleosis?

Answer 20

acute pharyngitis and tonsillitis that may cause coating with a gray-white exudative membrane; palatal petechiae

Question 21

what are the oral changes associated with diphtheria?

Answer 21

characteristic dirty white, fibrinosuppurative, tough, inflammatory membrane over the tonsils and retropharynx

Question 22

what is hairy leukoplakia?

Answer 22

a distinctive oral lesion on the lateral border of the tongue that is usually seen in immunocompromised patients and is caused by EBV

Question 23

what is the gross presentation of hairy leukoplakia?

Answer 23

white confluent patches of fluffy hyperkeratotic thickenings, almost always situated on the lateral border of the tongue that cannot be wiped off

Question 24

what population of people are at risk for hairy leukoplakia?

Answer 24

the immunocompromised- HIV patients, cancer therapy, transplant associated immunosuppression, and advancing age

Question 25

what is the distinctive microscopic appearance of hairy leukoplakia?

Answer 25

the microscopic appearance consists of hyperkeratosis and acanthosis with “balloon cells” in the upper spinous layer

Question 26

what type of tumors often infiltrate the skin and the gingiva?

Answer 26

tumors with monocytic differentiation

Question 27

what is a common feature of myeloid neoplasms?

Answer 27

an origin from hematopoietic progenitor cells

Question 28

what could be a cause of gingival hyperplasia aka an overgrowth of gum tissue around the teeth?

Answer 28

the anti-seizure medication: Dilantin