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Oral Med > Ulceration > Flashcards

Ulceration Flashcards

1
Q

What are the differential diagnoses for oral ulceration?

A 
So (BIGS) Systemic: Blood/Infection/GI/Skin
Many: Malignancy
Laws: Local
And: Apthae
Directives: Drugs
Oh!: Others
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2
Q

What are examples of ‘Other’ causes of ulceration?

A

Necrotising Sialometaplasia
Vasculitides: Wegners and Bechets
Rheumatoid: SLE

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3
Q

What are examples of malignant causes of oral ulceration?

A

SCC

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4
Q

What are examples of Local causes of oral ulceration?

A

Trauma

burns

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5
Q

What are examples of Apthae causes of oral ulceration?

A

RAS

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6
Q

What are examples of Drugs causes of oral ulceration?

A 
Olanzapine
Serataline inhibitors
Nicorandil
carbamezapine
losartan
cytotoxic
cocaine
immunosupressants
phenytoin
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7
Q

What are the causes of blood related ulceration?

A

Anaemia, Leukamia, Neutropaenia, Haematinic deficiency

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8
Q

what are the causes of infection related ulceration?

A

Viral: VZV, Herpesm Coxsackie, Herpangina, EBV
Bacteria: syphylis, TB
fungi: Histoplasmosis

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9
Q

What are the causes of GI related oral ulceration?

A

Coeliac, Crohns, UC

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10
Q

What are the causes of Skin related ulceration?

A

Lichen plaunus and VB diseases

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11
Q

What is the clinical appearance of traumatic ulceration? How does this differ from chmical ulceration?

A

single localized deep ulcer

chemical ulceration is much more diffuse and often has a fibrous slough present

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12
Q

What is the pathogenesis of Bechets disease?

A

HLA B5, HLA BW51, HLA-DR7

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13
Q

Which population is more commonly affected Becets syndrome?

A

Mediterranean, middle east, Japan

3-rd-4th decade, males

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14
Q

What is RAS?

A

A common cause of oral ulceration

Affects 10-20% of the population

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15
Q

What is the aetiology of RAS?

A

AB mediated cytotoxicity reaction

T cells and humoral component

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16
Q

What are the predisposing factors of RAS?

A 
Trauma: may instigate RAS in a predisposed patient 
Stress
Vit B12 def
Systemic disease : Anaemia, Becets 
Smoking cessation
Chemical:SLS
Hormonal 
Food allergies: cinnamon aldehyde and Benzoates
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17
Q

What is the clinical appearance of RAS?

A

Yellow white fibrinopirulent membrane

Erythmatous halo

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18
Q

What are the three types of RAS?

A

Minor
Major
Herpetiform

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19
Q

Which form of RAS is most common?

A

Minor

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20
Q

How do you diagnosis RAS?

A

Clinically
DO NOT biopsy

Bloods taken too
FBC/ferritin/folate/b12/ATTG

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21
Q

How do you manage RAS?

A

Caramellose sodium paste
Clobetesol

Topical steroids:
Betamethasone: betnesol (500mcg 10ml water). Spit and rinse tds
Beclomethasone diproprionate spray: 2 puffs on ulcer tds
Hydrocortisone hemmisuccinate pellets: 2.5mg dissolve next to ulcer up to four time per day

Topical antiseptics: CHX

Systemic: prednisalone, azothiarpine

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22
Q

In which diseases is ATTG positive in?

A

Rheumatoid arthritis
Coeliac
Type 1 diabetes

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23
Q

List all the drug management options for RAS?

A

Caramellose sodium paste
CHX

Lidocaine

Benzydamine mouthwash (diff lam)
Betamethasone tablets
Beclomethasone disproportionate inhaler 50mcg

Hydrocortisone Oralmucosal tablets

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24
Q

What are the signs and symptoms of becets?

A

Eyes: relapsing iridocyclitis, uveitis, retinal vascular changes, optic atrophy
Skin: pathergy, erythema nodosum
Others: neurological diseases and thrombosis of vena cavae

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25
Q

What are the causes of oral mucosal soreness?

A 
Dry mouth
Epithelial thinning eg candida LP and VB
Psychogenic: BMS/OD
Deficiency state: B12 def
Neuropathies: Diabetes
26
Q

What diseases can arise from haematological diseases?

A 
RAS
Glossitis
Oral dysaesthesia
Candidiasis 
Kelly Paterson Syndrome
27
Q

What is the difference between RAS and Apthous like?

A

Apthous like:

Doesn't start in childhood
No positive FH
Doesn't resolve with age
Signs and symptoms unusual for RAS
Occurs usually with drugs
28
Q

What are the different types of anaemia?

A

Microcytic
Normocytic
Macrocytic

29
Q

What are the causes of microcytic anaemia?

A

Anaemia of chronic disorder
Thalassemia
Fe def anaemia

30
Q

What are the causes of normocytic anaemia?

A

Anaemia of chronic disorder
Acute blood loss
Marrow infiltration
Hemolysis

31
Q

What are the causes of macrocytic anaemia?

A 
Folate and B12 def
Hypothyroidism
Alcohol excess
Liver disease
Myelodysplasia
32
Q

What are the causes of fe def anaemia?

A

Microcytic anaemia

Caused by:
Diet
Blood loss
Physiological
Malabsorption eg coeliac
33
Q

How much iron is stored in Hb?

A

3 grams

34
Q

What are the features if Fe def anaemia?

A

Glossitis
Kolionychia
Angular chelitis
Pharyngeal webs

35
Q

What are the causes of anaemia of chronic disorder?

A

Malignancy
Uraemia
Endocrine diseases
Chronic Inflam

36
Q

What is the main problem in Anemia of chronic disorder?

A

Failure of iron transport from RE cells to rbc

GIVR erythropoietin

37
Q

What is thalassaemia?

A

Inherited problem with Hb synthesis AR

Normal adult is alpha 2 beta 2

38
Q

What is the aetiology behind sickle cell anaemia?

A

Abnormal beta chain synthesis

39
Q

Which group of people are more commonly affected by thalassemia?

A

Mediterranean

40
Q

What are the two types of haemolytic anaemia?

A

Inherited and acquired

41
Q

What happens to the RBC in Haemolytic anaemia?

A

Increased rate of RBC destruction

Usual survival is 100-120 days

42
Q

What are the inherited haemolytic anaemia diseases?

A

Sickle cell anaemia

Deficiency in metabolic enzymes eg G6PD

43
Q

What are the main causes of aquired haemolytic anaemia?

A

Infection

Traumatic hemolysis

44
Q

What types of diseases are associated with marrow infiltration anaemia?

A 
Aplastic anaemia associated with infection and drugs 
leukoerthroblastic anaemia (associated with metastatic cancer)
45
Q

Where is B12 stored?

A

Liver 2-3mg

46
Q

How is B12 absorbed?

A

combines with intrinsic factor secreted by the gastric parietal cells

This then is absorbed in the terminal ileum

47
Q

What are the causes of B12 def?

A

Diet
IF def: pernicious anaemia
Malabsorption

48
Q

What are the signs and symptoms of B12 def?

A

Anaemia
Jaundice
Glossitis
Neurological lesions

49
Q

What tests can be done if suspect B12 def?

A

Bloods
Bone marrow shows megaloblastic chnage
Tests for ab against pareital and IF
Schilling test

50
Q

What happens to folic acid once absorbed into body?

A

Converted to H4 folate

51
Q

What are the causes of folic acid def?

A

Drugs: anticonvulsants OCP, alchoholis
Increased use: pregnant, malignancy
Loss: dialysis

52
Q

What are the symptoms of folate def?

A

Glossitis
Megaloblastic bone marrow
Jaundice

53
Q

What is pathergy and what syndrome is this seen in?

A

It is when you get severe brusing even from a small bump/graze

seen in bechets

54
Q

What is erythema nodusum and what syndrome is it seen in?

A

inflammation of the fat cells under the skin

seen in bechets

55
Q

People with RAS should avoid which food types?

A

Benzoates

56
Q

What is cyclic neutropenia?

A

Absolute reduction in circulating neutrophils and in bone marrow too

57
Q

What are the symptoms of cyclic neutropenia?

A

During episodes of reduced neutrophils :
Fever
Malaise
Cervical lymphadenopathy
Infections
Oral ulcers mainly on non keratinised surfaces

Patients more prone to severe perio

58
Q

What is the cause if necrotising sialometaplasia?

A

Is it caused by altered blood supply which leads to local ischemia which then causes the salivary glands to infarct

59
Q

What are the signs and symptoms of necrotising sialometaplasia?

A

Deep non healing ulcer usually on the palate and also associated with anaesthesia to the surrounding area

60
Q

What are the causes of recurrent oral mucosal ulceration?

A

Recurrent Apthous ulceration
Apthous like ulceration
Erythema multiforme
Recurrent intra oral herpes

Oral Med (31 decks)

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