Tutorial 3 Flashcards
pt presents with
“red erythematous lesions on palate, irregular, smooth”
what is your diagnosis
acute erythematous candidosis
give risk factors for acute erythematous candidosis
diabetes
corticosteroid use
recent broad spectrum abx
smoker
HIV
nutritional
initial management for acute erythematous candidosis
remove risk factors, use of spacer, OH
topical miconazole gel, nystatin MW
on 2 week review of acute erythematous candidosis - lesions are unchanged
what do you do now
oral rinse to determine fungal
consider nutritional deficiency, HIV, inflammatory
- FBC, haematinics, HbA1c, HIV
- biopsy, culture and sensitivity testing
how do you exclude HIV
[re-acute erythematous candidosis q]
blood test for antibodies
p24 antigen
what oral lesions are strongly associated with HIV and why
acute necrotising ulceration, kaposi sarcoma, oral hairy leukoplakia, aphthous-ulcers, candidiasis
increased susceptibility to infections due to weakened immune system
how is HIV managed and what is the long-term prognosis
ART - antiretroviral therapy, halts replication and allows for normal CD4 count, undetectable viral load
very good long term prognosis if treated
what information would you include in referral
pt details
clinical photos
description
any changes
symptoms
biopsy of ulcer reads
“no underlying dysplasia or malignancy, immunohistochemistry confirmed T.pallidum”
- what us provisional diagnosis
- further referral?
- any other investigations
- definitive management
T.pallidum = syphilis related ulcer
sexual health clinical, contact tracing
sti testing, blood test for IgG + IgM antibodies
tx = STAT dose IM benzylpenicillin
what classification of denture stomatitis is used
describe the stages
newton’s
1- localised inflammation
2 - generalised erythema covering denture bearing area
3 - granular type
local + systemic risk factors for denture stomatitis
local - poor OH, overnight wear, poor denture hygiene, elderly, dry mouth, acrylic base
systemic - poly pharmacy
management of denture stomatitis
- predisposing
- denture hygiene, OHI
- miconazole gel fitting surface
2 y/o presents with
“fiery red oedematous gingival, ulcers on lips, scabbing inner corners, sore”
refusing to eat, up all night
what is diagnosis
primary herpetic gingivostomatitis
describe the clinical course of primary herpetic gingivostomatitis
prodromal phase of fever, malaise, headache, lymphadenopathy
production of painful vesicles on mucosa/gingiva/lips which rupture to form ulcers
resolves 1-2weeks
mostly self-limiting
specialist care for pregnant/neonates
what management advice for primary herpetic gingivostomatitis
supportive care
analgesia, fluids, soft diet, CHX or difflam
discuss pathophysiology of recurrent herpes simplex
primary infection via primary herpetic gingivostomatitis
remains latent in dorsal ganglion, reactivation by trigeminal ganglia via sunlight, injury, trauma, stress, immunosuppression, hormones
discuss management of recurrent herpes simplex virus
avoid triggers
antivirals for prodrome
acyclovir 5% cream - 2hrs
aciclovir 200mg tabs 5x 5 days
what are potential complications of recurrent herpes simplex virus
disseminated herpes infection
bells palsy
erythema multiforme
herpetic whitlow
herpetic keratoconjunctivitis
pt presents with
“white or red/white speckled buccal mucosa and labial commissure, corners of mouth lesions”
what is differential diagnosis
chronic hyperplastic candidosis
risk factors for chronic hyperplastic candidosis
middle age men
smokers
poor OH
recent broad spectrum abx
diabetes
gdp management of chronic hyperplastic candidosis
predisposing
systemic fluconazole
careful follow uo
dysplasia management - consider referral for biopsy
what should a pt be informed of prior to a biopsy
purpose - rule out malignancy, definite diagnosis
procedure details
risks [bleeding, infection, scarring]
aftercare
what steps to you take to mitigate risks of biopsy and ensure it is optimal for the reporting histopathologist
aseptic technique
atraumatic, LA
biopsy site selection so representative of lesion
adequate sample size
proper handling
clear labelling
what features of histology would you see for chronic hyperplastic candidosis
hyperkeratosis
inflammatory infiltrate
acanthosis
parakeratosis
which stain would you use to highlight organisms in fungal infection
PAS - periodic acid-schiff
highlights fungal cell walls
what microorganism and what form
in chronic hyperplastic candidosis
candida albicans
hyphal or pseudohypal
how would chronic hyperplastic candidosis be managed in OM
any risks associated
potential malignant disorder - 12.1%
systemic fluconazole, careful follow up, dysplasia management
