Ulcerative Soft Tissue & Vesiculo-bullous Disease Flashcards
A 65 year old female presents with erythematous, desquamatous and ulcerated appearance of the gingiva. Direct immunofluorescence microscopy shows a positive linear fluoresence for IgG at the basment membrane zone. Which of the following diagnosis matces with the clinical and histological findings?
Oral lichen planus
Oral lichenoid lesion
Pemphigus vulgaris
Mucous membrane pemphigoid
Mucous membrane pemphigoid
A 50 year old female patient visits your dental clinic for a dental checkup. She has been complaining of pain since a week ago. Intraoral examination revealed irregularly shaped ulcerations on the mucosa surface and a positive Nikolsky’s sign is noted. You took a sample of fresh perilesional tissue and sent it to the lab for direct immunofluorescence examination. Results show chicken-wire staining of intracellular spaces. What is the most likely diagnosis?
Herpes Simplex
Mucous membrane pemphigoid
Oral lichen planus
Pemphigus vulgaris
Pemphigus vulgaris
A friend of yours brought his 3 y.o. son to you as you are his only “doctor friend”. Your friend says that he noticed small ulcers started appearing on his son’s soft palate, buccal mucosa, tongue after he pick his son up from his child care centre yesterday. He decided to seek help as the ulcers are numerous and his child keeps crying due to the pain. Upon closer examination, you noticed that the ulcers has coalesce into larger, shallow, irregular ulcerations. After reasurring that his son has contracted a common viral infection from his child care buddies, what other advice can you give to your friend?
“You can bring your son to his child care as per usual starting from tomorrow onwards”
“Apply either viscous lidocaine or topical benzocaine on ulcers shall the pain become untolerable”
“If ulcers persists for the next 3 days, visit an OMS surgeon to get them surgically removed”
“Let your child rest for the next few days and ensure that he drinks enough water and eat enough food”
“Let your child rest for the next few days and ensure that he drinks enough water and eat enough food”
Which type of pemphigus affects the oral cavity?
Pemphigus vulgaris
Pemphigus foliaceus
IgA pemphigus
Paraneoplastic pemphigus
Pemphigus vulgaris
Patient presents with large shallow ulcers with irregular borders, and crusting of lips. She does not complain of any pain. Which of the following corresponds to the treatment required?
Anti-inflammatory therapy
Steroid therapy
Withdrawal of the trigger if known
Antifungals
Withdrawal of the trigger if known
Which disease should be immediately referred to an ophthalmologist upon diagnosis, due to risk of blindness?
Epidermolysis bullosa
Mucous membrane pemphigoid
Verrucous carcinoma
Pemphigus vulgaris
Mucous membrane pemphigoid
Which of the following statements is true regarding ulcerative soft tissue lesions and vesiculo-bullous diseases?
Recurrent aphthous stomatitis is usually found on non-keratinised epithelium and triggers include stress, trauma and allergies. Diagnosis is best done with histological investigations.
Pemphigus vulgaris usually presents in younger patients (as compared to mucous membrane pemphigoid). It is caused by antigenic targets on desmosomes. Diagnosis is best done via direct immunofluorescence.
Herpangina is often caused by Coxsackie A16 and Enterovirus A17 in more severe cases. It initially presents as macules before transforming into vesicles and oral ulcers on the tongue and buccal mucosa in the oral cavity.
Ulcerations on the buccal mucosa that last for 1 week and are associated with a temporal relationship to an event are highly suspicious of cancer and malignancy.
Pemphigus vulgaris usually presents in younger patients (as compared to mucous membrane pemphigoid). It is caused by antigenic targets on desmosomes. Diagnosis is best done via direct immunofluorescence.
Which of the following is a true regarding pemphigus vulgaris and mucous membrane pemphigoid?
Pemphigus vulgaris has an older demographics compared to mucous membrane pemphigoid
Pemphigus vulgaris is a type I hypersensitivity reaction while mucous membrane pemphigoid is a type II hypersensitivity reaction
Mucous membrane pemphigoid is more common in females than males
Pemphigus vulgaris is a blistering disease and blisters are often seen clinically
Mucous membrane pemphigoid is more common in females than males
Which of the following is not a systemic cause of ulcers?
Crohn’s disease
Uremic stomatitis
Celiac disease
Epidermolysis Bullosa
Epidermolysis Bullosa
Which of the following describes the histologic features of lichen planus?
Acantholysis, bandlike chronic inflammatory infiltrate, saw tooth-like rete ridges
Acanthosis, bandlike chronic infilammatory infiltrate and saw tooth-like rete ridges
Acanthosis, acute inflammatory infiltrate, saw tooth-like rete ridges
Acantholysis, acute inflammatory infiltrate, normal appearance of rete ridges
Acanthosis, bandlike chronic infilammatory infiltrate and saw tooth-like rete ridges
Which of the following factors does NOT differentiate MMP from PV?
Positive/negative Nikolsky signs
They have different antigenic targets
involvement of other mucosal sites especially the eye
Presence of oral lesions
Presence of oral lesions
Which of the following accurately describes Varicella Zoster Virus?
Its form of transmission is through direct cutaneous contact with vescicle fluid from skin lesions
Even when the skin lesions have fully crusted, it is still infectious
It is not possible to have a reinfection of the virus
It is not a self limiting condition
Its form of transmission is through direct cutaneous contact with vescicle fluid from skin lesions
What can be done to differentiate between pemphigus vulgaris and mucous membrane pemphigoid?
H&E stain
Visual observation
Direct and indirect immunofluorescence
Biopsy
Direct and indirect immunofluorescence
Which is not an appropriate means of management for Epidermolysis Bullosa?
Corticosteroid use
Drainage of large blisters
Symptomatic care such as use of antidepressants for pain
Use of topical antibiotics
Corticosteroid use
Which of the following statements regaridng oral ulcers is true?
a) Histological investigation is necessary to establish a definite diagnosis for recurrent aphthous stomatitis
b) OLP is a autoimmune disorder that has a unique histological feature of predominantly B-cell lymphocytes in the lamina propria
c) Pemphigoid and Pemphigus is caused by antibodies directed against hemi-desmosomes and desmosomes respectively
d) Recurrent aphtous stomatitis / ulcerations have malignant transformation potential
c) Pemphigoid and Pemphigus is caused by antibodies directed against hemi-desmosomes and desmosomes respectively
What type of defect is attributed to Dystrophic Epidermolysis Bullosa (EB)?
a) Defect in type Vll collagen
b) Keratin gene defect
c) Hypothalamic defect
d) Defects of hemidesmosomes
a) Defect in type Vll collagen
A 5 year old child presents to your clinic with small aphthae-like ulcers on the palate and buccal mucosa. You notice that the child also has prurititic rashes on his face and his arms and neck. His mother mentions that the kindergarten that the child is attending has been closed as many children had fallen sick in the past 2 weeks. Which of the following would you not expect in the lab results of samples taken from the child?
Tzank cells present in cytological swabs.
Viral inclusion cells present in histological sample.
Owl-eye cells present in histological sample.
VZV IgM positive in serology testing,
Owl-eye cells present in histological sample.
A 63 year old patient presents with multiple oral lesions. On examination, you observe irregularly shaped ulcers with a denuded surface. Additionally, there are blisters on the skin. Histological examination of a biopsy from the oral lesion shows suprabasal acantholysis. Direct immunofluorescence reveals intraepithelial IgG deposits. What is the most likely diagnosis?
Mucous Membrane Pemphigoid
Pemphigus Vulgaris
Epidermolysis Bullosa
Cyclic Neutropenia
Pemphigus Vulgaris
Which type of lesion (ulcer) best fits the following description: “presents with blisters & postive Nikolsky sign”?
Neoplastic ulcers
Infectious ulcers
Reactive ulcers
Developmental ulcers
Reactive ulcers
An 8 year old child comes into your clinic presenting with a fever and multiple small ulcers found on her oropharynx, soft palate, tonsils and uvula. What is the most likely diagnosis?
Cytomegalovirus
Hand Foot Mouth Disease
Herpangina
Varicella Zoster Virus
Herpangina
What would be the treatment method for a recurrent apthous ulceration?
Chlorhexidine rinse
Leave the ulcers alone as it will heal on its own
Prescribe ibuprofen
Prescribe prednisolone
Chlorhexidine rinse
At the 1-week recall visit of your denture patient, your patient presents with contact stomatitis. What type of hypersensitivity occurred?
Type I
Type II
Type III
Type IV
Type IV
A 16 year old patient whom had undergone chemotherapy presented with multiple small apthae-like ulcers and vesicles on the palate. The dentist told him to come back after a week for a review to observe the progress of the condition. During the review, it was noted that some of the vesicles had already fallen out. Which of the following viruses could have been the reason for the patient’s condition?
Varicella Zoster Virus
Cytomegalovirus
Herpes Simplex Virus
Coxsackie Virus
Varicella Zoster Virus
Which layer of the oral mucosa is commonly targeted by genetic defects and autoimmune disorders such as lichen planus, pemphigus and pemphigoid?
Basal layer
Submucosa
Prickle cell layer
Lamina propria
Basal layer
