Schwartz Feb 3rd Flashcards
waht are the approaches to any pathological lesion
- establish dd
with blood tests
TF
blood tests are rarely diagnostic
true
if you use blood test, which two things do you screen for
parathyroid hormone level
prostate specific antigen (PSA)
what markers of bone metabolism may be diagnosis
calcium
phosphours
alkaline phosphatase
waht immunological biomarkers are elevated in cancer
HPV
CEA
EVB
AFP
what are standard x ray and ct best for
bone pathlogy
CT is best for
soft tissue structures
3D CT good for
neurofibromatosis - benign disease a neurofibroma
contrast studies
inject a radioopaque dye into a body cavity and is injected into ______
blood vessel [most common]
salivary duct
why do you want to inject dye into the BV
outline
diagnosis
BVs
whartons duct is attached to waht salivary gland
submandibular gland
what general approach to any pathological lesion waht types of imaging are used
CT angiography
contrast imaging
MRI
what is MRI best used for
soft tissue pathology
TF
MRI shows bone marrow BUT NOT good for bone detail
true
waht are the 3 types of MRI
T1 weighted scan
T2 weigthed scan
Contrast MRI
which of the 3 MRI scans are the standard scan
T1 weigthed scan
which MRI scan is used for fluid contrast like CSF fluid
T2 weighted scan
for contrast MRI ____ is used to inject IV
and
increases vascular contrast
gadolinium
allows us to highlight brain tumors [helps stands out]
TF
tumors tend to have a higher vascular flow
true
what are the 3 types of scan?
PET
bone scan
White blood cell scans
TF
scan are non specific you inject the pt with a pharamceutical and wait to be taken up by the body and some tissues are going to uptake more than others
true
where does tracer uptake in areas of increased metabolic activity
tumors
infection
active growth
what OFFICE PROCEDURE that may be preferable to open biopsy
fine needle aspriation
fine needle aspiration
- withdraw some blood
- cells smeraed on glass slide
- cytologist [pap smear]
TF
very rarely does fine needle aspiration have a diagnosis
- can tell the difference bt benign and malignant
true
true
TF
using fine needle aspriation can determine bt the cysts and solid
true
cyst [syringe filled with cyst fluid]
if tumor [will not fill the syringe]
what do you need to do to get a definative diagnosis
biopsy
then TREATMENT PLAN
- what biopsy takes a rim around the biopsy
- if its a benign lesion you can take a diagnosis and biopsy at the same time
excisional biopsy
what lesions are huge and require waht type of biopsy
incisional biopsy
what lesion involves the entire tongue that you would use an incisional biopsy
verrucous vulgara
this biopsy done RARELY on some face
some exophytic lesions can be done with this
shave biopsy - amputate the surface
if require extensive treatment you can go back in there
what biopsy is rapid
little scarring
and no sutures
shave biopsy
unique to the jaw are ____ bc only seen with jaw bones
odonotogenic lesions
tumore like diseases aka metabolic bone disease of the
jaw
fibrous dysplasia
pagets disease
…
…
most common benign jaw lesion
cysts
what factors do you consider when planning treatment of cyst
size
location
aggressiveness
need for reconstruction
lower mandible
thinning of the mandible [patholgical fracture, fracture that impacts normal function]
impacts the teeth [if removed the pt would lose lots of teeth]
impacts the inferior alveolar nerve
cyst
what is the gold standard of treatment jaw cyst
enucleation
since most since are encircled by fibrous capsule
and not true cyst tissue it allows for removal around the fibrous capsule for removal
TF
true
what is enucleation
removal of a cyst in a single piece
but depends on …
like incisonal biopsy could diagnosis and biopsy at the same time
and can biopsy the entire lesion
is waht
enucleation
what location would make enucleation difficult for removal
posterior part of the maxilla
curretage
cutting instrument to remove tissue
BEYONd borders of the cyst
currettage is good for
and bad for
- good:
- decrease risk of recurrence with odontogenic keratosis
- recurrent cysts - bad:
increase
marsupilization
creating a connection bt two body cavities:
surgical window bt
cyst and adjacent body cavity
adjacent body cavity
oral cavity
maxillary sinus
nasal cavity
indications for marsupilization
- prevent:
injury to adj sturctures
devitalization of teeth
- assit:
eruption of teeth
- difficul to surgical access
- risk of pathologic fracture
- medically compromised pt : short surgical procedure under LA
TF can marsupulization be combo with enucleation
true
for marsupilization you MUST have a reliable pt
true
cyst going in the tumor walls
unicystic ameloblastoma
waht is a fluid filled benign tumor
cyst
treatment of choice for most jaw and has a FIBROUS CAPUSULE for tumors
enuceltion MUST BE fibrous capusule bc some tumors can erode into the bone and not good for enucleation
waht is the mechnaical removal of tumor
and
is when you dont have a tumor with fibrous capsule
curettage
most simple resection
segmental resection
segmental resection
- removal of geometic piece of tissue
including tumor AND surrouding boen and soft tissues
TF segmental resection is appropriate for aggresive tumor
true
in the case of a tumor invloving the alveolar process of the mandible is called _____
marginal resection
leave a margin of the lower border and jaw retains integrity
TF can do marginal resection and not numb the pt by not cutting into the inferior alveoalr nerve
true
when you cant leave the lower border intact waht is the type of resection
partial resection
partial resection
appropriate for __ tumore
requires ___
large tumors
reconstruction
removal of tumor along with a porton of the jaw
as to leave a gap
partial resection
treatment of soft tissue lesions
simple surgical excision
viral lesions may be managed with ____ or ___
chemcials
heat
why dont we want to use surgical excison to treat soft tissue lesions taht are virallly induced
can spread the virus
vascualr lesions can be managed with 3 things
embolization
laser coagulation
camouflage
