white and red patches

Question 1

what are the 8 questions you need to answer when examining a white or red patch?

Answer 1

1. size?
2. site?
3. Texture?
4. Duration?
5. Localised?
6. Multiple?
7. associated with systemic symptoms/ signs?
8. Treatment?

Question 2

what is a leukoplakia?

Answer 2

a white patch plaque of questionable risk with no other histological diagnosis

Question 3

what is the prevalence of leukoplakia?

Answer 3

prevalence - 1-2%
(increased x6 by smokers)

Question 4

what is the appearance of leukoplakia?

Answer 4

> speckled
verrucous
the more unusual the appearance the more likely there is some dysplastic

Question 5

what is erythroplakia?

Answer 5

red patch, velvet type appearance not histologically confirmed as any other condition

Question 6

what are the key points on erythroplakia?

Answer 6

> high rate of malignant transformation >80%
high rate of dysplastic change at biopsy
urgent sampling required

Question 7

what are the 8 risk factors for progression red/ white patches?

Answer 7

1. female gender
2. long duration of leukoplakia
3. leukoplakia in non smokers (idiopathic leukoplakia/ drinkers (synergy
4. location on the tongue and/ or floor of the mouth
5. non-homogenous type
6. presence of candida
7. size >200mm2
8. presence of epithelial dysplasia

Question 8

what is an ulceration?

Answer 8

a break in the oral mucosa

Question 9

what are the possible causes of an ulcer?

Answer 9

congenital
acquired
vascular
infective
traumatic
autoimmune
metabolic
neurological
neoplastic
degenerative
environmental
unknown

Question 10

what are the 5 descriptors for ulcer examinations?

Answer 10

1. SIZE : RAS : minor, major, hepetiform v large erosive areas
2. EDGES : smooth, kerototic, or ragged
3. SHAPE : regular or irregular
4. BASE : fibrinous or otherwise
5. MARGIN : regular or rolled and raised

Question 11

what is RAS?

Answer 11

Recurrent aphthous stomatitis (RAS), or what is commonly referred to as “canker sores”, is a form of benign inflammation of the mouth.

Question 12

what are 5 common things to watch out for with ulcers?

Answer 12

1. ulcerations on the edge of tongue, buccal mucosa with keratitis edges
2. RAS - history of starting young age regular margins, transient nature
3. minor, major, hepetiform
4. watch out for non healing long standing ulcers
5. older populations generally do not develop RAS therefore what is driving this?

Question 13

what special investigations would you take?

Answer 13

> full blood count
(Hb, Hct, MCV, Pt, WBC, neutrophils)

Question 14

what is anaemia?

Answer 14

low Hb

small cells - microcytic
big cells - macrocytic
normal cells - normocytic

Question 15

what is microcytic anaemia ?

Answer 15

> mean corpuscular volume of less than 80 micro m3
normally deficient in iron
other causes include thalessemia and chronic disease

Question 16

what is macrocytic anaemia?

Answer 16

> large cells
usually B12/ folate deficient
watch out for chronic alcohol illness

Question 17

what is normocytic anaemia?

Answer 17

normal MCV 80-100
low Hb count
most likely due to chronic disease- numerous causes

Question 18

what is another cause of ulcers?

Answer 18

coeliac disease
> anti-transglutaminase antibodies (Ttg)
>sign of gluten sensitivity
> may also be raised in inflammatory bowel disease

Question 19

what are the treatments for an ulcer/

Answer 19

1. corsydyl
2. difflam
3. topical steroids: betamethasone, predsol, flixonase
4. antibiotic/ doxycycline
5. triple mouthwash

Question 20

systemic treatments for ulcers

Answer 20

1. colchicine (need FBC, Urea and Electrolytes, LFT)
2. dapsone : (all above + G6PD)
3. Azathioprine : (all above + TPMT)