random theme 5/6

Question 1

what is hairy tongue?

Answer 1

clinical manifestation of elongation of filiform papillae - no etiologic cause

asymptomatic

Question 2

4 things hairy tongue is often a response to?

Answer 2

infection
fever
xerostomia
substances - antibiotics, tobacco

Question 3

keratinolytic drug used for hairy tongue

Answer 3

podophydllin 25% in tincture of benzoin

Question 4

what is geographic tongue

Answer 4

depapillation of the filiform papillae on the dorsal of the tongue causing erythmatosus configurations

often white border

Question 5

microscopical signs of geographic tongue

Answer 5

loss of filiform papillae
elongated rete ridges
neutrophil accumulation in the superficial epithelium

Question 6

what is median rhomboid glossitis?

Answer 6

rhomboidal or elliptical reddish smooth or nodular surface located in midline of tongue

often associated with candida

Question 7

what are fordyce granules? how can they be removed?

Answer 7

manifestation of heterotic sebaceous glands

co2 laser therapy

Question 8

what causes white sponge naevus?

Answer 8

mutation in keratin 13 or 4 - hyperkeratosis

Question 9

features of white spongy naves?

Answer 9

asymptomatic, diffuse, bilateral, white lesions, shaggy/spongy/wrinkled surface

Question 10

how to diagnose leukodema?

Answer 10

stretch buccal mucosa - opaque change will dissipate

Question 11

difference between erosion + ulcerations

Answer 11

erosion - epithelium only

ulceration - whole epithelium breached

Question 12

3 types of white oral lichen planus

Answer 12

1. papular
2. reticular
3. plaque - like

Question 13

when is lichen Planus most common + uncommon?

Answer 13

most common - posterior buccal mucosa

spread to tongue, gingiae, labial mucosa, vermillion of lower lip

uncommon - palate, FOM, upper lip

Question 14

3 types of red oral lichen planus

Answer 14

1. atrophic - erythematous
2. erosive - ulcerative
3. bullous - blisters

Question 15

what is planopilaris?

Answer 15

Lichen Planus involving scalp + hair follicles

Question 16

most common place to find lichen Planus skin lesions

Answer 16

volar wrists + forearms

Question 17

what is lichen planus

Answer 17

chronic inflammatory disorder of stratified squamous epithelium

Question 18

4 histopathological characteristic of lichen Planus

Answer 18

1. hyperkeratosis
2. civatte bodies - basal cell liquefaction with apoptic cells
3. bank-like inflammatory infiltrate mainly composed of T cells
4. absence of epithelia dysplasia

Question 19

how to determine difference between LP + OLCL (oral lichenoid contact lesion)

Answer 19

cannot distinguish histologically

patch testing

Question 20

what reaction can amalgam cause orally?

Answer 20

oral lichenoid contact lesion

Question 21

which virus may cause oral lichen Planus?

Answer 21

HCV

Question 22

2 features of OLP that cause increased risk of malignant transformation

Answer 22

reticular plaque

atrophic-erosive

Question 23

5 special investigation in oral med

Answer 23

1. blood test
2. skin patch testing
3. exfoliate cytology
4. biopsy
5. direct/indirect immunofluorescence

Question 24

difference between direct + indirect immunofluroence

Answer 24

direct = detect in situ deposition of Ig and/or complements

indirect = detect circulating autoantibodies

Question 25

colour coding scheme for oral lesions

Answer 25

``` green = GDP monitor amber = GDP in conjunction with specialist unit red = specialist referral centre ```

Question 26

description of smokers keratosis

Answer 26

lesion on palate with small red spots

Question 27

what virus causes oral hairy leukoplakia

Answer 27

EBV

Question 28

what is hydroxychloroquine sulphate used to treat?

Answer 28

oral lichen Planus

Question 29

skin condition associated with geographic tongue?

Answer 29

psoriasis

Question 30

characteristics of aphthous ulcers/stomatitis

Answer 30

``` superficial oral mucosa ulceratin recurrent no obvious cause usually self limiting individual healthy occur on non-keratinised oral ep usually ```

Question 31

difference between major and minor recurrent aphthous stomatitis

Answer 31

minor = 1-5 ulcers, lasts 7-14 days, no scarring major = 1-2 ulcers, lasts >14 days, scar (deeper)§

Question 32

what is herpetiform RAS

Answer 32

small ulcers merge to form irregular shaped larger ulcers >10 per crop lasts 7-21days +/- scarring

Question 33

9 causes of RAS

Answer 33

1. genetics 2. haematinic deficiency 3. food allergy 4. gluten sensitivity 5. sex hormones 6. drugs - NSAIDs, B blockers, nicorandil 7. immunodeficiency 8. infections 9. trauma ulcers in systemic conditions too but not technically ras- behcets, reiters, cyclic neutropenia

Question 34

deficiencies causing RAS

Answer 34

iron, folic, zinc, B1, B2, B6, B12

Question 35

what is behcets disease?

Answer 35

recurrent oral ulceration with 2 of the following: recurrent genital ulcers, eye lesions, skin lesions, positive pathergy test

Question 36

1st line of treatment for oral ulcers

Answer 36

topical corticosteroids

Question 37

pemphigus lesions are threatening to what?

Answer 37

life

Question 38

pemphigoid lesions are threatening to what?

Answer 38

sight

Question 39

what causes pemphigus ?

Answer 39

anti-epithelial auto-antibodies against surface of the keratinocytes

Question 40

characteristics of pemphigus

Answer 40

1. blisters + ulcerations 2. acantholysis 3. intra-epithelial 4. autoantibodies 5. intracellular deposits of IgG + c3 in immunofluorescence

Question 41

2 types of oral pemphigus

Answer 41

pemphigus vulgaris | pemphigus paraneoplastic

Question 42

most common oral pemphigoid

Answer 42

mucous membrane pemphigoid (MMP)

Question 43

process of diagnosising bullis disease

Answer 43

1. history 2. clinical evaluation 3. direct immunofluorescence 4. indirect IF, immunoprecepitation, ELISA 5. diagnosis

Question 44

what cell type is predominant in chronic inflammation/ granulomatosis

Answer 44

activated macrophages

Question 45

4 clinical manifestations of orofacial granulomatosis

Answer 45

1. erythema 2. ulceration 3. oedema 4. tissue enlargement

Question 46

3 types of infection granulomatous disorders

Answer 46

1. TB 2. tertiary syphilis - gumma 3. mycotic granulomatous infection

Question 47

bowel condition causing orofaical granulomatosis

Answer 47

crohns disease

Question 48

triad for diagnosis of melkersson-rosenthal syndrome?

Answer 48

persistent orofacial swelling fissured tongue facial paralysis

Question 49

7 causes of non-infectious orofacial granulomatosis

Answer 49

1. idiopathic OFG 2. crohns 3. melkerson-rosenthal syndrome 4. cheilitis granulomatosis of miescher 5. sarcoidosis 6. wegeners granulomatosis 7. foreign body reaction

Question 50

what is chelitis granulomatosa

Answer 50

painless enlargement of 1/both lips - recurrent

Question 51

triad to diagnose wegeners granulomatosis

Answer 51

1. necrotising granulomatous lesions upper/lower respiratory tract 2. systemic vasculitis 3. necrotising glomulonephritis

Question 52

what is sarcoidosis

Answer 52

multisystem granulomatous disorder of unknown cause

Question 53

what is orofacial granulomatosis

Answer 53

persistent enlargement of face/oral cavity | caused by inflammation

Question 54

orofacal manifestations of granulomatosis

Answer 54

soft tissue swellings major salivary gland enlargement - mainly parotid ulcerations

Question 55

bacteria causing TB

Answer 55

mycobacterium tuberculosis/tb bacilli

Question 56

staining test for TB

Answer 56

ziehl Neelson

Question 57

colour of amalgam tattoo

Answer 57

grey-blue

Question 58

histology of malanotic macule

Answer 58

increased melanin pigmentation in basal cell layer | no increase in melanin number

Question 59

how to tell difference between freckle + melanotic macules

Answer 59

``` freckle = worse with sun melanotic = no change with sun ```

Question 60

what is naevi

Answer 60

mole - proliferation of melanocytes

Question 61

how would you treat oral naevi

Answer 61

excision - may be melanoma

Question 62

what is melanoma

Answer 62

aggressive tumour of melanocytes

Question 63

where are melanomas mostly found

Answer 63

hard palate, gingiva, tongue

Question 64

clinical appearance of melanomas

Answer 64

pigmented plaques with asymmetrical irregular borders dark brown/black (5-15% amelanotic/pink) rapidly enlarging nodes causing - ulcers, bleeding, pain, tooth mobility normally metastic not primary

Question 65

2 types of oral melanomas

Answer 65

radial growth phase - in situ | vertical growth phase - invasive

Question 66

clinical appearance of smokers melanosis

Answer 66

patchy brown macular pigmentations - buccal mucosa

Question 67

histology of smokers melanosis

Answer 67

basilar melanosis without melanocyte proliferation

Question 68

oral manifestation of peutz-jehgers syndrome

Answer 68

lips + buccal mucosa pigmentation GI involvement too

Question 69

most common drug induced pigmentation

Answer 69

minocycline induced pigmentation

Question 70

6 options for peripheral diagnosis of soft tissue lump

Answer 70

``` cyst abscess granuloma hyperplasia neoplasia benign neoplasia malignant ```

Question 71

6 examples of hyper plastic soft tissue lumps

Answer 71

``` fibroepithelial polylp pyogenic granuloma epulides denture granuloma squamous cell papilloma mucoceles ```

Question 72

what is an epulis

Answer 72

any swelling on gingiva | development or reactive (calculus, partial)

Question 73

When to treat OLP

Answer 73

if erosive or symptomatic

Question 74

treatment options for OLP

Answer 74

1. high potency topical steroids 2. systemic steroids or ciclosporin if SS contradicated SS +/- azathiopine

Question 75

treatment order of minor RAS

Answer 75

1. chlorhexidine mouthwash 2. topical steroids 3. systemic steroids

Question 76

treatment of major RAS

Answer 76

1. topical steroids | 2. systemic steroids

Question 77

treatment of herpetiform

Answer 77

systemic steroids | then topical

Question 78

treatment for MMP or PV

Answer 78

topical or systemic steroids with adjunct agents or other immunosuppressants if contraindicated