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Oral Medicine BDS4 > Summary of Notes > Flashcards

Summary of Notes Flashcards

1
Q

what is non-steroid topical therapy for

A

inconvenient lesions

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2
Q

what is steroid topical therapy for

A

disabling immunologically driven lesions

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3
Q

name some non-steroid topical therapies

A

chlorhexidine
benzydamine
bonjela

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4
Q

name some steroid topical therapies

A

hydrocortisone mucoadhesive pellet
betamethasone
beclomethasone MDI

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5
Q

what is the betamethasone prescription

A

dissolve 1mg in 10mls of water
rinse for 2 mins twice daily

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6
Q

what is beclomethasone prescription

A

50mcg inhaler
position over area
2 puffs 2-4x daily

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7
Q

what blood tests do patients need before starting systemic steroids

A

BBV screen
ferritin, folate, vitamin B12
FBC
electrolytes
liver function
pregnancy

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8
Q

what is keratosis

A

keratin production

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9
Q

what is acanthosis

A

thickening due to hyperplasia of stratum spinosum

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10
Q

what is elongated rete ridges

A

hyperplasia of basal cells

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11
Q

what is geographic tongue and what does it look like

A

alteration to maturation and replacement of normal epithelial surface
areas are semicircular white and red patches which can become sensitive

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12
Q

what is black hairy tongue and treatment

A

elongation of surface papilla becoming food stained
can be from bacterial colonisation/smoking
tongue scraper/nectarine stone

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13
Q

what is fissured tongue and implications

A

asymptomatic variation of normal
food trapping so inflammation and candida

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14
Q

what is glossitis and what treatment

A

smooth tongue with red appearance (atrophy)
investigate haematinics and fungal cultures

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15
Q

when are swellings referred

A

symptomatic
abnormal overlying and surrounding mucosa
increasing in size
rubbery
unsightly

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16
Q

why are lesions white

A

thickening of keratin meaning you cant see blood
less blood in tissues

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17
Q

what are fordyce spots

A

ectopic sebaceous glands

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18
Q

what is hereditary keratosis

A

white sponge naevus starting posteriorly and spreading anteriorly
fluid accumulation between cells

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19
Q

when do you refer a white lesion

A

raised/thickened
it is without cause
if on lateral tongue/soft palate/FoM

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20
Q

what are red lesions caused by

A

reduced flow causing inflammation
reduced thickness of epithelium

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21
Q

what are the features of mucosal melanoma

A

variable irregular outline with raised surface and would itch/bleed

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22
Q

what do you ask for ulcer history

A

where
blister or ulcer
if recurrent
size/shape
how long
same place
ulcer free period

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23
Q

what is recurrent herpetic lesions and where are they

A

ulceration is limited to one nerve group/branch
hard palate and recurs in the same place
patient aware of prodromal period with vesiculation

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24
Q

what is minor RAS

A

<10mm
lasts 2 weeks
non-keratinised mucosa
heal without scarring
responds to topicals

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25
Q

what is major RAS

A

> 10mm
lasts months
any part of mucosa
can scar
intralesional steroids better

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26
Q

what is herpetiform RAS

A

many small ulcers on non-keratinised mucosa
lasts 2 weeks
coalesce
not herpes

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27
Q

what is Behcets

A

oral-genital ulceration
need 3+ episodes of mouth ulcers a year and 2 of genital sores/eye inflammation/skin ulcers/pathergy

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28
Q

how do you treat Behcets

A

treat RAS
systemic immunomodulation (colchicine/azathioprine/mycophenolate)

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29
Q

what is the predisposition to RAS

A

genetics
systemic disease
stress
trauma
hormone fluctuations
viral and bacterial

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30
Q

what is aphthous ulcers like on a cellular level

A

damage to basal cells at basement membrane so cannot produce epithelial replacement cells

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31
Q

what are the investigations for aphthous ulcers

A

haematinics
coeliac disease
allergy testing

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32
Q

how do you manage RAS

A

correcting deficiencies
refer if coeliac
avoid SLS toothpaste
non-steroid topicals for inconvenient lesions
steroid topicals for disabling lesions

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33
Q

what are the patterns of lichen planus

A

reticular
atrophic
erosive

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33
Q

how do you manage RAS in children

A

3 month iron supplements
refer if no working treatment and children under 12

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34
Q

what is lichen planus like histologically

A

lymphocytic band hugging membrane
saw tooth rete ridges
basal cell damage
patchy acanthosis
parakeratosis

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35
Q

what is the immunology of lichen planus

A

langerhans cells present antigen to immune cells and lymphocytes activate to remove irritation

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36
Q

what drugs cause lichen planus

A

DMARDS - gold, quinine, B blockers, ACE inhibitors

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37
Q

what is lichen planus like on the gingiva

A

desquamative gingivitis

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38
Q

what do lichenoid drug reactions look like

A

bilateral
mirrored
respond poorly to treatment

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39
Q

when is amalgam replaced for amalgam reactions

A

if symptomatic or potentially malignant

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40
Q

management for mild lichenoid lesions

A

OTC chlorhexidine
benzydamine
avoid SLS

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41
Q

management for persisting lichenoid lesins

A

topical steroids - beclomethasone/betamethasone

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42
Q

what is the specialist management for lichenoid lesions

A

higher strength topicals
tacrolimus
clobetasol
hydroxychloroquine
azathioprine
mycophenolate

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43
Q

what is GVHD and what is histology

A

transplant marrow sees host marrow as foreign and rejects the host
lymphocytic band along basement membrane and change in keratinisation
NO SAW TOOTH RETE RIDGES

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44
Q

what is lupus erythematous histologically

A

lymphocytic infiltrate deeper into connective tissue away from basement membrane

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45
Q

name 2 lichen like lesions

A

GVHD
lupus erythematous

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46
Q

how do you treat lichen like lesions

A

symptomatically like LP and liaise with physician

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47
Q

risks for oral cancer

A

smoking
drinking
socioeconomic
poor oral health
sexual activity

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48
Q

how to reduce oral cancer risk

A

stopping smoking and drinking
increase intake of fresh fruit and veg

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49
Q

what does low grade dysplasia show

A

tumour comes from normal epithelium
architectural changes in lower third
slight atypia
increased keratin production
well defined tumour islands with basal cell layer
invasion pattern with large rete ridges into connective tissue

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50
Q

what does high grade dysplasia show

A

little resemblance to epithelium
architectural change in upper third
lots of atypia
non-cohesive invasion
prominent mitotic figures

51
Q

what is carcinoma in situ

A

cytologically malignant but not invading
abnormal architecture with severe atypia

52
Q

what are the prognostic factors histologically for oral cancer

A

pattern of invasion
depth of invasion
perineural invasion
invasion of vessels

53
Q

what does multi stage promotion mean for oral cancer

A

there was a tendency for cell division already but environmental changes promote it

54
Q

what is field characterisation

A

higher risk of cancer with 5cm radius of primary lesion

55
Q

screening tools for HPV16

A

screening
toluidene blue
velscope
photodynamic diagnosis
clinical judgement

56
Q

what is vesiculobullous diseases

A

antibody mediated immune diseases

57
Q

what is needed for DIF and what do you see

A

need biopsy, see antibody bound to tissue

58
Q

what is needed for IIF and what do you see

A

blood plasma, see circulating antibodies

59
Q

what does erythema multiforme look like

A

skin target lesions and oral ulceration
crusty lips and bleeding

60
Q

what is the cellular level of erythema multiforme

A

large complex made of antigen and antibody unable to pass through capillaries so it gets stuck and activates complement causing perivascular inflammatory response

61
Q

what is treatment for erythema multiforme

A

betamethasone, difflam, gelclair as barrier
40-60mg prednisolone for severe
400mg acyclovir for recurrent

62
Q

what is the histology of erythema multiforme

A

inter and intracellular oedema overlying epithelium
acantholysis
elongation of rete pegs
vasodilation
connective tissue oedema

63
Q

what is angina bullosa haemorrhagica clinical findings

A

blood blisters in mouth come on fast but burst after 1hr
DIF and IIF are negative

64
Q

treatment for ABH

A

none
explain eating and steroid inhalers are triggers

65
Q

what is pemphigoid

A

subepithelial antibody attack causing separation of epithelium from connective tissue and thick blister formation

66
Q

what is the cellular level of pemphigoid

A

attack on hemidesmosomes of which BP180 and BP230 more commonly targeted

67
Q

what does DIF of pemphigoid show

A

linear deposition of immunoglobulins along basement membrane

68
Q

what does IIF show for pemphigoid

A

C3 and IgG

69
Q

what is the treatment of pemphigoid

A

topical steroids (betamethasone rinse)
azathioprine, mycophenolate - immunosuppressive
rituximab - biologic

70
Q

what is pemphigus

A

intraepithelial blistering disease attacking the desmosomes (desmoglein 1 and 3)

71
Q

what does pemphigus appear as clinically

A

oral ulcerative lesions
desquamative gingivitis
open skin lesions
Nikolsky sign positive

72
Q

what do you see histologically for pemphigus

A

acantholysis in lower spinous layers
suprabasal split and Tzank cells

73
Q

what does DIF show for pemphigus

A

intralesional intercellular deposition of IgG and C3 along epidermal cell surfaces in areas of acantholysis

74
Q

what does IIF for pemphigus show

A

circulating antibodies targeting epidermal cell surfaces

75
Q

what is the treatment for pemphigus

A

betamethasone and difflam
prednisolone, azathioprine, mycophenolate
rituximab

76
Q

what can dry mouth be caused by

A

salivary gland disease
drugs
medical conditions
radiotherapy
anxiety and somatisation disorders

77
Q

what drugs cause dry mouth

A

ANTIMUSCARINIC CHOLINERGIC DRUGS
tricyclics
antipsychotics
antihistamine
atropine
diuretics
cytotoxics

78
Q

what medical problems cause dry mouth

A

diabetes
renal disease
burns
vesiculobullous diseases

79
Q

what are the direct salivary gland problems

A

aplasia
sarcoidosis
HIV
gland infiltration
cystic fibrosis

80
Q

what is sarcoidosis

A

enlargement of glands due to granuloma change

81
Q

gland changes with HIV

A

lymphoproliferative gland changes - increased size but decreased function

82
Q

what is amyloidosis

A

deposition of protein

83
Q

scale used to assess mucosal dryness

A

challacombe scale

84
Q

investigations for salivary disease

A

FBC, U&E, liver function, C reactive protein, glucose, antibody, complement, functional assay, tissue assay, sialography, radiography

85
Q

what is the unstimulated salivary flow test

A

spitting into tube for 15 mins
expected amount >1.5ml for normal function

86
Q

treatable causes for dry mouth

A

dehydration
medication related
poor diabetes control
somatoform disorders

87
Q

what is true hypersalivation caused by

A

drugs - buprenorphine, clozapine
dementia
CJD
stroke

88
Q

how to manage hypersalivation

A

treat cause
give drugs
biofeedback training
surgery

89
Q

causes of salivary gland enlargement

A

mumps, HIV
mucocele obstruction
sialosis and sjogrens

90
Q

what is a mucocele

A

secretion retention in duct extravasated into tissues

91
Q

what is subacute obstruction associated with

A

eating caused by sialolith, mucous plugging and duct damage from chronic infection

92
Q

imaging for subacute obstruction

A

lower true occlusal
sialography if no infection
ultrasound

93
Q

how to treat duct stricture

A

stretch with balloon catheters

94
Q

how to treat duct dilatation

A

remove gland if reccurent

95
Q

what is sialadenitis look like on histology

A

ducts and acini replaced with scar tissue

96
Q

management of subacute obstruction

A

surgical sialolith removal
sialography
potential gland removal if swelling not going away

97
Q

what is sialosis

A

enlargement with no identifiable cause

98
Q

cause of sjogrens on cellular level

A

incomplete cell apoptosis leading to antigens being improperly exposed so there is dysregulation of inflammatory process

99
Q

what does sjogrens cause

A

gradual loss of gland tissue through inflammatory destruction
enlarged glands
increased risk of lymphoma
oral and ocular effects

100
Q

components of AECG

A

require 4 of the following:
dry eyes/mouth
autoantibody
imaging
radionucleotide assessment
histopathology >1 focus

101
Q

components of ACR-EULAR

A

score more than 4
histopathology - weight 3
autoantibody - weight 3
dry eyes/mouth - weight 1

102
Q

oral symptoms of sjogrens criteria

A

dry feeling >3 months
recurrent gland swelling
have to drink liquid to aid swallowing

103
Q

ocular symptoms of sjogrens criteria

A

include dry eyes >3 months
feels like sand in eyes
tear substitutes used >3x/day

104
Q

abnormal results of unstimulated salivary flow and schirmer test

A

<1.5ml/15mins
<5mm wetting/5 mins

105
Q

tests for sjogrens

A

unstimulated saliva
schirmer test
anti-ro, anti-la
MRI
labial gland biopsy

106
Q

management of sjogrens

A

OHI
5000ppm
diet
symptomatic treatment
pilocarpine

107
Q

complications of sjogrens

A

caries
infections
speech
lymphoma with gland enlargement

108
Q

signs of OFG in mouth

A

peripheral oedema
angular cheilitis
full thickness erythematous gingivitis
stag horning of FoM
linear fissure ulcer on labial sulcus

109
Q

management of OFG

A

3 month exclusion diet
topical treatment for angular cheilitis and lip swelling
miconazole and tacrolimus ^
intralesional traimcinolone steroid
azithromycin, prednisolone pulse, azathioprine/mycophenolate (systemic)

110
Q

what to assess for facial pain

A

PAIN scores
psychological scores
quality of life scores

111
Q

what is chronic regional pain

A

autonomic nerve damage after an injury can cause a reflex arc of pain
- delocalised pain
- feeling of swelling and heat
- colour change in overlying skin
- autonomic changes
- disabling pain

112
Q

example of neuropathic pain condition

A

post herpetic neuralgia

113
Q

what medications can treat neuropathic pain such as post herpetic neuralgia

A

capsaicin
EMLA
benzydamine
pregabalin
gabapentin
tricyclics

114
Q

what is oral dysaesthesia

A

abnormal sensory perception in absence of stimulus

115
Q

symptoms of oral dysaesthesia

A

burning mouth
dysgeusia
paraesthesia
dry mouth

116
Q

what is burning mouth syndrome linked to

A

haematinic deficiencies

117
Q

how do you manage dysaesthesia

A

explaining condition to patient assess degree of anxiety and anxiolytics/neuropathics

118
Q

symptoms of trigeminal neuralgia

A

unilateral maxillary/mandibular division pain lasting 5-10 seconds with remissions and relapses
triggers including wind/cold/touch

119
Q

drug therapy for TN

A

carbamazepine 100mg MR

120
Q

side effects of carbamazepine

A

blood problems
electrolyte imbalances
neurological defects

121
Q

what is trigeminal autonomic cephalalgias

A

unilateral severe head pain occurring with congestion/eyelid oedema and ear fullness

122
Q

cluster headache symptoms

A

unilateral orbital/temporal pain lasting 15 mins - 3 hours
1-3 attacks per day
can get bouts of these at the same time of year and attack at same time of day

123
Q

treatment for cluster headache

A

sumatriptan 6mg and 100% O2 (attack)
lidocaine injection/prednisolone (bout)
verapamil (prevent)

124
Q

symptoms of paroxysmal hemicrania

A

unilateral orbital/temporal pain lasting 2-30 mins
2-40 attacks per day with no rhythm

125
Q

prophylaxis of paroxysmal hemicrania

A

indomethacin

Oral Medicine BDS4 (28 decks)

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