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Oral Pathology Exam 2 > Quiz 4 > Flashcards

Quiz 4 Flashcards

1
Q

Which papillae are involved in transient lingual papillitis?

A

Fungiform papillae

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2
Q

6 causes of transient lingual papillitis

A 
Local irritation
Stress
Hormonal imbalances
GI disease
Viral infection
Local hypersensitivity rxn
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3
Q

3 patterns of transient lingual papillitis

A
  1. A few on anterior dorsal tongue
  2. Most of papillae on tip/lateral tongue
  3. Diffuse + hyperkeratotic (papulokeratotic variant)
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4
Q

Most common oral non traumatic ulcer

A

Aphthous stomatitis (canker sores)

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5
Q

6 etiological factors for aphthous stomatitis

A 
Immune
Genetic
Microbiologic
Nutrition
Stress
Trauma
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6
Q

What appears to be the key to the development of aphthous stomatitis?

A

Mucosal barriers

Disruption = increased ulcers
Increased barrer = less ulcers

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7
Q

3 examples of mucosal barrier disruption associated with increased incidence of aphthous stomatitis ulcers

A

Trauma
Unattached mucosa
Smoking cessation

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8
Q

Smoking is associated with increased or decreased incidence of aphthous stomatitis?

A

Decreased

Smoking increases the mucosal barrier

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9
Q

Aphthous stomatitis typical locations

A

UNATTACHED MUCOSA such as:

Tongue
Vesibule
Buccal mucosa

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10
Q

Herpetiform aphthae

A

Form of aphthous stomatitis

Multiple small ulcers NOT preceded by vesicles + show NO virus infected cells

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11
Q

5 features of major aphthous stomatitis

A 
> 1 cm
Deep
Forms scars
6-8+ weeks
Severe pain
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12
Q

5 features of minor aphthous stomatitis

A 
< 1 cm
Shallow
No scarring
10-14 days
Uncomfortable
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13
Q

3 differences between canker + cold sores

A

Canker = intraoral, unattached (movable) mucosa, crateriform

Cold = lip, attached mucosa, vesicular

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14
Q

Aphthous stomatitis NEVER begin as ___

A

Vesicles

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15
Q

3 features of the clinical appearance of aphthous stomatitis

A

Round ulcers
Red halo
Fibrin coat

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16
Q

Aphthous stomatitis lesions are coated with?

A

Fibrin

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17
Q

What kind of immunologic response is assoc. with aphthous stomatitis

A

T-cell mediated

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18
Q

The (T cell mediated) immune response assoc with aphthous stomatitis produces which cytokine?

A

TNF-alpha

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19
Q

Describe the immunologic response in apthous stomatitis

A

Increase # of CD8 T-suppressor cells (relative to CD4 T-helper cells)

Cytokine TNF-alpha produced - targets oral mucosa for destruction by CD8 T suppressor cells

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20
Q

Simple canker sores usually only require palliative tx unless quality of life is altered, in which case there are 4 different tx options:

A

NSAID (Aphthasol)
Silver nitrate
Acid (Debacterol)
Protective coatings (Orobase)

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21
Q

2 tx options for diffuse minor or herpetiform canker sores

A

CORTICOSTEROIDS:

  1. Dexamethasone rinse (.5mg/mL)
  2. Betamethasone dipropionate (or Flucinonide) gel .05%
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22
Q

Tx for resistant cases of major aphthous stomatitis

A

Systemic steroids: Prednisone

Oral suspension (swish + swallow) preferred over tablets

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23
Q

6 tx methods for major aphthous stomatitis

A
  1. Triamcinolone acetonide injections (in lesion)
  2. Clobetosol proprionate gel .05%
  3. Halobetasol propionate ointment .05%
  4. Triamcinolone tablets (dissolved directly on ulcers)
  5. Beclomethosone dipropionate spray (hard to reach areas)
  6. Systemic steriods - Prednisone (resistant cases)
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24
Q

What is the GENERAL plan of attack for tx of severe (+ major) apthtous cases

A

Break cycle + clear with systemic corticosteroids (high dose, short burst)

Prevent recurrence w topical corticosteroids

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25
Are aphthous stomatitis ulcers associated with systemic conditions different from those seen in healthy pts?
No - ulcers are identical But will decrease in frequency + severity following resolution of systemic condition
26
12 systemic conditions assoc w aphthous stomatitis (4 important ones in caps)
``` BEHCET SYNDROME CYCLIC NEUTROPENIA IMMUNOCOMPROMISED PTS (HIV) INFLAMMATORY BOWEL DISEASE Celiacs Nutritional deficiencies IgA deficiency MAGIC syndrome PFAPA syndrome Reactive arthritis Sweet syndrome Ulcus vulvae acutum ```
27
7 nutritional deficiencies assoc with aphthous stomatitis
``` Iron Folate Zinc B1 B2 B6 B12 ```
28
MAGIC syndrome
*assoc with aphthous stomatitis Mouth + genital ulcers w inflamed cartilage
29
PFAPA syndrome - what do the letters stand for
Periodic Fever Apthous stomatitis*** Pharyngitis Cervical Adenitis
30
What is Behcet's Syndrome?
Multisystem disease Abnormal immune process triggered by infectious or environmental antigen ----> systemic vasculitis
31
Triggers for Behcet's Syndrome (4)
Infectious OR environmental HLA-B51 Bacteria Viruses Pesticides
32
7 systems that are affected by Behcet's syndrome (+ assoc symptoms)
GI Cardio CNS (paralysis, dementia) Lungs Eyes (uveitis, conjunctivitis, cataracts, galucoma) Skin (erythema nodosum, pseudofolliculitis, acneiform nodules) Genitals (painful ulcers - esp. in men)
33
How does aphthous stomatitis present in Behcet's Syndrome?
Consistent feature 6(+) High prevalence of MAJOR aphthae
34
Diagnostic criteria for Behcet's Syndrome
Recurrent oral ulceration (minor, major or herpetiform) + 2 of the following: Recurrent genital ulcers, eye lesions, skin lesions, (+) pathergy test
35
3 prognostic factors for Behcet's Syndrome
Gender - F better Age - older better Eye + CNS involvement = worse
36
What is sarcoidosis
Chronic granulomatous disorder Improper degradation of antigenic material (infectious or env) leading to INAPPROPRIATE DEFENSE RESPONSE with formation of noncaseating granulomatous inflammation
37
What kind of inflammation is invoved in sarcoidosis
Noncaseating granulomatous inflammation
38
4 etiological routes for sarcoidosis
1. Prolonged/heavy antigenic exposure 2. Immunodysregulation preventing adequate cell-mediated response 3. Defective regulation of initial immune response 4. Combo
39
Does sarcoidosis have a genetic predisposition?
Yes (+) associations w certain HLA types
40
8 triggers (antigens) of sarcoidosis
``` Epstein-Barre virus HHV-8 Wood dust Pollen Clay Mold Silica ```
41
Incidence of sarcoidosis
BLACKS 10-17x >> whites Female > (slightly) Bimodal age distribution (25-35, 45-65)
42
8 acute (days-weeks) symptoms of sarcoidosis
``` Dyspnea Dry cough Chest pain Fever Malaise Fatigue Arthralgia Weight loss ```
43
In sarcoidosis, any organ can be affected but there are 5 predominant sites:
``` Lungs Lymph nodes Skin Eyes Salivary glands ``` *intraosseous lesions also reported
44
Which tissue is involved in almost all cases of sarcoidosis?
Lymphoid tissue
45
25% of sarcoidosis cases show cutaneous manifestations - what are the 2 examples of this?
Lupus pernio (widespread violaceous (purple) indurated lesions) Erythema nodosum (tender erythematous on lower legs)
46
Lupus pernio
Cutaneous manifestation of sarcoidosis Widespread violaceous (purple) indurated lesions
47
25% of cases of sarcoidosis have ocular involvement - what are the 2 presentations?
Anterior uveitis Keratoconjunctivitis sicca (lacrimal gland involved)
48
Sarcoidosis can minic _____ syndrome because it can show which 3 symptoms?
Sjogren's syndrome Enlarged salivary glands Xerostomia Keratoconjunctivitis sicca
49
What are the 2 syndromes associated with acute sarcoidosis?
Lofgren's syndrome | Heerfordt's syndrome (uveoparotid fever)
50
Lofgren's Syndrome - 4 features
1. Associated with acute sarcoidosis 2. Erythema nodosum 3. Bilateral hilar lymphadenopathy 4. Arthralgia
51
Heerfordt's Syndrome (uveoparotid fever) - 5 features
1. Associated w acute sarcoidosis 2. Parotid enlargement 3. Anterior uveitis 4. Facial paralysis 5. Fever
52
In most cases of intraoral sarcoidosis, the oral lesion was the 1st documented clinical manifestation of the disease. What are the 6 most common intraoral sites (in order)?
``` BUCCAL MUCOSA Gums Lips FOM Tongue Palate ```
53
Histological features of sarcoidosis
Schaumann bodies | Asteroid bodies
54
What enzyme will be elevated in sarcoidosis pts? (Diagnosic feature)
Angiotensin converting enzyme (ACE)
55
What should be biopsied to diagnose sarcoidosis and avoid misdiagnosing Sjogrens?
Posterior superficial parotid lobe 93% success rate
56
Etiology of orofacial granulomatosis (+ cheilitis granulomatosa)
Idiopathic but probs represents abnormal immune rxn
57
Orofacial granulomatosis affects _____ MUCH more than any other mucosa
Lips (= cheilitis granulomatosis)
58
Cheilitis granulomatosis
Non-tender persistent swelling of lips Appears alone or as part of orofacial granulomatosis
59
Histology of orofacial granulomatosis + cheilitis granulomatosa
Non-caseating granulomatous inflammation
60
Describe the lesions of orofacial granulomatosis in: ``` Buccal mucosa Gingiva Tongue Palate Vestibular sulcus ```
Buccal mucosa = cobblestone pattern + submucosal swelling Gingiva = swelling, erosions, erythema, pain Tongue = fissures, edema, erosions, altered taste Palate = papules Vestibular sulcus = linear hyperplastic tissue + erosions
61
Melkersson-Rosenthal Syndrome - 3 features
1. Fissured tongue 2. Facial paralysis 3. Orofacial (cheilitis) granulomatosa
62
3 local processes that can present as orofacial granulomatosis
Chronic oral infection Foreign material Allergy
63
Wegener's Granulomatosis
Uncommon, abnormal immune response to an inhaled environmental or infectious agent NECROTIZING granulomatous process of respiratory tract, necrotizing glomerulonephritis, + systemic vasculitis of small arteries + veins
64
Incidence of Wegener's Granulomatosis
Wide age range (most cases in elderly pts but 20% in <20 yrs) 90% White
65
Generalized/Classic Wegener's granulomatosis
Upper + lower respiratory + renal
66
Limited Wegener's granulomatosis
Respiratory lesions WITHOUT renal involvement
67
Superficial Wegener's granulomatosis
Skin/mucosal lesions + slow development of systemic lesions
68
Wegener's granulomatosis - upper respiratory symptoms (8)
``` Purulent nasal drainage Sinus pain Nasal ulceration + congestion Fever Ear ache Sore throat Epistaxis (nose bleed) Saddle-node deformity (progressive disease) ```
69
Wegener's granulomatosis - lower respiratory symptoms (4)
Dry cough Hemoptysis Dyspnea Chest pain
70
Wegener's granulomatosis - most common cause of death
Glomerulonephritis
71
Oral lesions present in 2% of cases of Wegener's granulomatosis. What are the 3 features of the lesions?
STRAWBERRY GINGIVITIS Ulceration Major salivary gland enlargement
72
What is the most useful diagnostic tool of Wegener's granulomatosis?
Blood test for antineutrophil cytoplasmic antibodies (specifically PR3-ANCA)
73
Prognosis of Wegener's granulomatosis
Most pts die within 5 mo if untx
74
5 reasons why the oral mucosa is much LESS sensitive than the skin
1. Contact is short 2. Saliva dilutes, digests, removes antigens 3. Limited keratinization = harder antigen building 4. Increased vascularity = faster antigen removal 5. Less antigen presenting cells = allergen not recognized
75
Perioral dermatitis is idiopathic but associated with what 3 things
Topical corticosteroids Fluorinated toothpaste Cosmetics
76
Perioral dermatitis rashes are worsened by what 3 things
UV Heat Wind
77
3 clinical presentations of perioral dermatitis lesions/rashes
Erythematous papules Papulovesicles Pustules (sometimes)
78
What is the gold standard for treating perioral dermatitis?
Oral tetracycline *avoid during pregnancy + kids
79
Angioneurotic edema basic etiology
Commo allergic rxn caused by mast cell degranulation = histamine release
80
2 causes of angioneurotic edema
Hereditary | Acquired
81
What causes aquired angioneurotic edema
ACE inhibitors
82
Cause of hereditary angioneurotic edema
Deficiency in inhibitor that converts C1 to C1 esterase C1 esterase cleaved C4 + C2 = edema
83
3 tx methods for angioneurotic edema
Antihistamines Epinephrine IM IV steroids + antihistamines
84
Simple definition of ectodermal dysplasia
2(+) ectodermally derived structures fail to develop Skin, teeth, nails, hair, sweat glands
85
Etiology of ectodermal dysplasia
Inherited | AD, AR, or X linked
86
ectodermal dysplasia is an inherited condition in which only 20% of cases have genes that are IDed. These genes are involved in which 3 processes
Cell signaling Adhesion Transcriptional regulators
87
What is the best known syndrome assoc w ectodermal dysplasia
Hypohidrotic ectodermal dysplasia
88
Hypohidrotic ectodermal dysplasia has what inheritance pattern
X linked
89
Incidence of ectodermal dysplasia
Men >> | Bc can be x linked
90
8 clinical features of ectodermal dysplasia
1. Heat intolerance (less sweat glands) 2. Fine/sparse hair 3. Hyperpigmentation + wrinkling in periocular skin 4. Midfacial hypoplasia 5. Xerostomia (hypoplastic salivary glands) 6. Brittle nails 7. Hypo/oligodontia 8. Cone incisors, small molars
91
Lyon's hypothesis
Partial expression of hypohidrotic ectodermal dysplasia in women (x linked)
92
White spongy nevus - cause
Genetic skin disease (genodermatosis) Autosomal dominant inheritance
93
White spongy nevus - etiology
Defect in normal keratinization of oral mucosa Mutations in keratin 4 + 13
94
White spongy nevus clinical presentation
BILATERAL SYMMETRICAL Thick white corrugated velvety diffuse plaques on buccal mucosa
95
Symptoms of white spongy nevus
None
96
2 histological features of white spongy nevus
1. Hyperparakeratosis + acanthosis (epi thickening) showing perinuclear clearing of the spinous cells 2. Perinuclear eosinophilic condensation
97
Tx of white spongy nevus
None - benign
98
Inheritance pattern of hereditary benign intraepithelial dyskeratosis
Autosomal dominant
99
Incidence of hereditary benign intraepithelial dyskeratosis
Descendants of a triracial isolate (Haliwa-Saponi Native American, Black, White) of people originally from North Carolina (Hailfax County)
100
What tissues are affected by hereditary benign intraepithelial dyskeratosis
Oral + conjuctival mucosa
101
Clinical presentation of oral lesions of hereditary benign intraepithelial dyskeratosis
Similar to white spongy nevus (thick, white, corrugated, velvety, diffuse plaques) Buccal + labial mucosa May have secondary candidal infection
102
Describe the eye lesions in hereditary benign intraepithelial dyskeratosis
Thick gelatinous opaque plaques in bulbar conjuctiva
103
5 Symptoms of active eye lesions in hereditary benign intraepithelial dyskeratosis
``` Tearing Photophobia Itching Most active in spring RARE - blindness ```
104
Cause of hereditary benign intraepithelial dyskeratosis
Associated with duplication in chromosome 4q35

Oral Pathology Exam 2 (1 decks)

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