Ulcers

Question 1

Describe the clinical photos (4)

Answer 1

Single white, yellowish oval bump on the (insert area), surrounded by red swelling. Multiple irregular yellowish bump with red swelling on the side.

Question 2

4 causes of the ulcer. (2)

Answer 2

• Genetics • Immunologic or hematologic abnormalities • Trauma • Hematinic deficiency • Sodium lauryl sulfate containing toothpaste • Stress • Microbial challenge • Gluten sensitive enteropathy/celiac disease, inflammatory bowel disease • Drugs

Question 3

Differential diagnosis of ulcers

Answer 3

• Recurrent aphtous ulcers • Bechet’s disease • Nutritional deficiencies • Drug reactions • GI disorders • Cyclical neutropenia • HJIV infection • MAGIC syndrome • Fever, aphtous stomatitis, pharyngitis, cervical dentis (FDPA)

Question 4

Management of ulcers

Answer 4

• Relieve discomfort (use lignocaine gels) • Reduce secondary infection (can use CHX) • Promote healing of existing ulceration • Prevent new ulcers occurring

Question 5

List three common causes of painful submandibular swelling (3)

Answer 5

Teeth infection (Ludwig’s angina), submandibular gland tumour, mumps, cysts

Question 6

What are the clinical features of a malignant ulcer? (2)

Answer 6

Irregular ulcer margins, raised or everted edges, induration (hardness) of the ulcer base and fixity to the surrounding tissues e.g. for SCC: red, white, red-white, exophytic, or ulcerative lesion; asymptomatic at first

Question 7

How can you confirm your diagnosis (1)

Answer 7

Biopsy

Question 8

This patient has tongue cancer. What pathologic typing will pathologic examination show?(1)

Answer 8

association between cell proliferation markers in the basal lamina and connective tissue

Question 9

Management strategy of RAU

Answer 9

RAS: lignocaine gel, benzydamine hydrochloride mouthwash (Relieve discomfort) CHX – reduce secondary infection If very severe, can use corticosteroids