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BDS Finals > Oral Medicine > Flashcards

Oral Medicine Flashcards

OM and histology

1
Q

Fordyce Spots (4)

A
  1. Yellowish bumps
  2. Sebaceous spots
  3. Buccal mucosa and lips
  4. No associated pathology
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2
Q

Linea Alba (2)

A
  1. Horizontal asymptomatic white lesion
  2. Along the occlusal plane
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3
Q

Linea Alba Histology (3)

A
  1. Hyperkeratinosis
  2. Prominent or reduced granular layer
  3. Acanthosis
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4
Q

Other names for geographic tongue (2)

A

Benign migratory glossitis
Erythema migrans

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5
Q

Geographic Tongue (4)

A
  1. Loss of filiform papillae
  2. Areas of tongue atrophy and hyperkeratinisation
  3. Can affect other areas of oral mucosa
  4. Asymptomatic but sometimes sensitive to hot and spicy foods
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6
Q

Fissured Tongue (4)

A
  1. Variation of normal
  2. Can occur later in life
  3. Commonly presents with geographic tongue
  4. Consider lightly brushing tongue
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7
Q

Black Hairy Tongue (3)

A
  1. Hyperplasia of filiform papillae
  2. Build-up of commensal bacteria, food debris
  3. Pigment inducing fungi and bacteria
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8
Q

Black Hairy Tongue Associations (4)

A

Smoking
Antibiotics
Chlorhexidine mouthwash
Poor OH

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9
Q

Black Hairy Tongue Advice (5)

A
  1. Stop smoking
  2. Stay hydrated
  3. Lightly brush tongue
  4. Suck peach stone
  5. Eat fresh pineapple
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10
Q

Desquamative Gingivitis (4)

A
  1. Full thickness erythema of the gingiva
  2. Descriptive - not diagnosis
  3. Bidirectional relationship with periodontal disease
  4. Not caused by plaque - exacerbated by it
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11
Q

Bony Exostosis (4)

A
  1. Tori
  2. Can present on palate, mandible or buccal alveolus
  3. More prone to ulceration as mucosa thinner
  4. Rarely associated with pathology if not in normal regions
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12
Q

Tori Questions/Suspicions (3)

A

Ask about GI symptoms
Increased suspicion if growing new ones or asymmetrical
Atypical site

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13
Q

Haemangioma (3)

A

Collection of blood vessels whose walls have burst
Can grow to be large
Can be removed by a specialist

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14
Q

Atrophic Glossitis (4)

A

Smooth tongue
Caused by iron or B12 deficiency
Will ulcer if not fixed
Ask GP for routine bloods

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15
Q

Frictional keratosis (3)

A

Due to trauma
Keratinisation
If you can discern where a white patch has come from (trauma) you must get a biopsy

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16
Q

Denture stomatitis (2)

A

Candida infection
Patient must remove denture at night and soak in solution

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17
Q

Angular cheilitis (5)

A
  1. Can be due to denture hygiene
  2. Or Staphylococcus
  3. Or skin folds - face not dried
  4. Uncommonly low iron levels
  5. Treat reasons before medicating
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18
Q

Which salivary replacement should never be used for patients with natural teeth

A

Glandosane as it is pH 5

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19
Q

Lichen Planus vs Lichenoid Reactions

A

Lichen Planus is an autoimmune condition
Lichenoid reactions mimic lichen this but are reactions to drugs

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20
Q

CRPS

A

Chronic Regional Pain

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21
Q

What causes neuropathic pain?

A

Damage to the nervous system - nerve itself

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22
Q

What will make neuropathic pain worse?

A

Surgery

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23
Q

Dental pain without pathology

A

Atypical Odontalgia

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24
Q

Pain which poorly fits in to standard chronic pain syndromes

A

Persistent Idiopathic Facial Pain

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25
Q

Epithelium of the oral mucosa

A

Stratified squamous

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26
Q

Types of oral mucosa (3)

A

Lining
Masticatory
Gustatory

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27
Q

Acanthosis

A

Hyperplasia of stratum spinosum

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28
Q

Elongated rete ridges

A

Hyperplasia of basal cells

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29
Q

Keratosis

A

keratinisation on a non keratinised site

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30
Q

Atrophy

A

Reduction in viable layers

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31
Q

Erosion

A

Partial thickness loss

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32
Q

Ulceration

A

Full thickness loss with fibrin on surface

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33
Q

Oedema types

A

Intracellular
Intercellular - spongiosis

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34
Q

Nutritional deficiencies for smooth tongue (2)

A

Iron
Vitamin B group vitamins

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35
Q

Nutritional deficiencies for geographic tongue (3)

A

Haematinics
B12
Folate
Ferritin

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36
Q

If fissures in fissured tongue are painful (3)

A

Could be another disease process
Candida
Lichen planus

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37
Q

Investigations for smooth tongue (2)

A

Haematinics
Fungal cultures

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38
Q

What is smooth tongue

A

Atophy
Sometimes called glossitis but not technically glossitis

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39
Q

When should swellings be referred? (6)

A
  1. Symptomatic
  2. Abnormal surrounding mucosa
  3. Increasing in size
  4. ‘Rubbery’
  5. Trauma from teeth
  6. Unsightly
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40
Q

Leaf Fibroma (3)

A
  1. Polyp which has be become flat due to denture
  2. Removed and healed before new denture constructed
  3. Friction will cause it to increase in size
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41
Q

Pyogenic granuloma (4)

A
  1. Granulation tissue - mixed inflammatory infiltrate on fibromyalgia vascular background
  2. Not a granuloma, not pyogenic
  3. Response to trauma
  4. Also called vascular epulis on the gingiva
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42
Q

Investigations for Addisons disease (2)

A

BP
Electrolyte check

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43
Q

What do herpetic lesions tend to follow

A

Innervation of mucosa

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44
Q

What condition produces target like lesions on the skin

A

Erythema multiforme

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45
Q

Why are teeth red in porphyria

A

Haem products are incorporated into dental hard tissues

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46
Q

1-3 on Challacombe scale

A

Mirror sticks to buccal mucosa
Sticks to tongue
Saliva frothy

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47
Q

1-3 on Challacombe scale treatment

A

Sips of water and sugar free gum

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48
Q

Sjogrens Syndrome Complications (3)

A
  1. Effects of oral dryness
  2. Sialosis
  3. Lymphoma risk
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49
Q

Effects of oral dryness (5)

A
  1. Caries
  2. Candida
  3. Denture retention
  4. Speech
  5. Swallowing
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50
Q

Types of pemphigoid (3)

A

Bullous
Mucous membrane
Cicatritial pemphigoid

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51
Q

What does bullous pemphigoid affect

A

Skin

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52
Q

What does mucous membrane pemphigoid affect

A

All mucous membranes

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53
Q

What does cicatricial pemphigoid affect

A

Mucosa with scarring

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54
Q

Functions of saliva (4)

A
  1. Acid buffering
  2. Mucosal lubrication
  3. Taste facilitation
  4. Antibacterial
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55
Q

4-6 Challacombe scale

A

No saliva pooling on FoM
Tongue shows shortened papillae
Altered gingival architecture (smooth)

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56
Q

7-10 Challacombe scale

A

Mucosa glossy
Tongue lobulated/fissured
Cervical caries (>2 teeth)
Debris on palate or stuck to teeth

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57
Q

Antibodies found in pemphigoid (2)

A

C3
IgG

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58
Q

Antibodies found in pemphigus vulgaris (2)

A

C3
IgG

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59
Q

Antiviral therapy for shingles

A

800mg ACV
5x a day for 7 days

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60
Q

Pemphigoid histological appearance (immunofluorescence)

A

Linear staining along basement membrane

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61
Q

Pemphigus histological appearance (immunofluorescence)

A

Basket weave pattern

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62
Q

What ages can use a steroid mouthwash

A

> 12

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63
Q

Lichen Planus histology (5)

A
  1. Chronic inflammatory cell infiltrate
  2. Saw tooth rete ridges
  3. Basal cell damage
  4. Patch acanthosis
  5. Parakeratosis
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64
Q

Causes of giant cell lesions (2)

A

Unphagocytosable material
1. Local chronic irritation
2. Infective agents (TB)

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65
Q

Causes of oral white lesions (6)

A
  1. Hereditary
  2. Smoking
  3. Frictional
  4. Lichen planus
  5. Candidal leukoplakia
  6. Carcinoma
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66
Q

Causes of true increase in salivary flow (4)

A
  1. Drugs
  2. Dementia
  3. CJD
  4. Stroke
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67
Q

Clinical appearance of pemphigoid intraorally (2)

A

Thick walled blisters
Clear or blood filled blisters

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68
Q

Clinical features of HSV 1 and 2 (6)

A
  1. Gingivostomatitis
  2. Herpes labialis
  3. Keratoconjunctivitis
  4. Herpetic whitlow
  5. Bell’s palsy
  6. Genital herpes
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69
Q

Common sites for mucoceles

A

Vibrating line
Lower lip

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70
Q

Common viruses implicated in lichen planus (2)

A

Hep C
Herpes

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71
Q

Most common oral lichen planus site

A

Buccal mucosa

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72
Q

Risk factors for oral cancer (4)

A
  1. Smoking
  2. Drinking
  3. Low SES
  4. Betel quid
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73
Q

Consequences of Sjogrens Syndrome (4)

A
  1. Loss of salivary gland/lacrimal tissue
  2. Enlargement of major salivary glands (symmetrical)
  3. Increased risk of lymphoma
  4. Oral and ocular effects - dry mouth and dry eyes
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74
Q

Hyposalivation cut off (resting)

A

< 0.1ml / min

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75
Q

Dysplasia definition

A

Disorder maturation in a tissue

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76
Q

Hamartoma

A

Benign mass of disorganised tissue native to a particular anatomical location

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77
Q

Describe an apthous ulcer

A

Yellow/grey base with erythematous margin

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78
Q

Characteristics of Crohn’s Specific Apthous Ulceration (3)

A

Linear at depth of sulcus
Full of crohn’s associated granulomas
Persist for months

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79
Q

Angina bullosa haemorrhagica (5)

A
  1. Blood blisters on mucosa
  2. Appear within minutes of eating
  3. Last an hour then burst
  4. Leave behind a small ulcer with no scarring
  5. Heal within days
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80
Q

Field cancerisation concept

A

High cancer risk in the 5cm radius of the original primary

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81
Q

Diagnostic aids to oral cancer screening (2)

A
  1. Toluidene blue
  2. VELscope
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82
Q

Dysplasia vs atypia

A

Dysplasia disordered maturation in a tissue
Atypia disordered change in cells

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83
Q

Pemphigus vs pemphigoid

A

Pemphigus bullae are intra rather than inter epithelial
Pemphigus desmosomes joining epithelial cells affected rather than the hemidesmosomes connecting the epithelium to the connective tissue

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84
Q

Primary Sjogrens

A

No connective tissue disease

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85
Q

Secondary Sjogrens (4)

A

Connective tissue disease
SLE
RA
Scleroderma

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86
Q

Discoid lupus

A

No auto antibodies

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87
Q

Systemic lupus

A

Antibody involvement

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88
Q

Do major apthae respond well to topical steroids

A

No

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89
Q

Do major apthae scar

A

They may scar when healing

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90
Q

Do minor apthae scar

A

No

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91
Q

Drug classes that may induce gingival growth (3)

A
  1. Anti-hypertensives (calcium channel blockers)
  2. Anti-epileptics (phenytoin)
  3. Immunosuppressants (ciclosporin)
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92
Q

Drugs used for systemic immunomodulation in Behcets disease (3)

A
  1. Colchicine
  2. Azathioprine
  3. Biologics
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93
Q

Epstein Barr virus symptoms (6)

A
  1. Fatigue
  2. Fever
  3. Sore throat
  4. Head and body aches
  5. Lymphadenitis (cervical and axillary)
  6. Rash
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94
Q

Example of large vessel vasculitis disease

A

Giant cell arteritis

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95
Q

Example of medium vessel vasculitic disease (2)

A

Polyarteritis nodosa
Kawasaki disease

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96
Q

Example of small vessel vasculitis disease

A

Granulomatosis with polyangiitis

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97
Q

Examples of generalised brown or black lesions (4)

A
  1. Racial/familial
  2. Smoking
  3. Drugs
  4. Addisons disease
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98
Q

Examples of intrinsic mucosal pigmentation (4)

A
  1. Melanotic macule
  2. Melanocytic naevus
  3. Melanoma
  4. Effect of systemic dx
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99
Q

Examples of localised brown/black lesions (4)

A
  1. Amalgam
  2. Melanotic macule
  3. Melanotic naevus
  4. Malignant melanoma
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100
Q

From which type of mucosa do most oropharyngeal cancers in the UK arise

A

Clinically normal mucosa

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101
Q

Examples of drugs which can induce oral ulceration (4)

A
  1. Potassium channel blockers
  2. Bisphosphonates
  3. NSAIDs
  4. DMARDs
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102
Q

Steroid based topical treatments for mucosal lesions (3)

A
  1. Hydrocortisone mucoadhesive pellet
  2. Betamethasone mouthwash
  3. Beclomethasone metered dose inhaler
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103
Q

Systemic iatrogenic causes of oral ulceration (3)

A
  1. Chemotherapy
  2. Radiotherapy
  3. Graft versus host disease
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104
Q

Food triggers to avoid for patients with RAS/OFG (3)

A
  1. SLS
  2. Chocolate
  3. E210-219 (benzoate and sorbate, cinnamon)
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105
Q

Scale for emotional symptoms of pain

A

HAD psychological score

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106
Q

Scale for physical symptoms of pain

A

McGill pain score

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107
Q

High risk oral sites for mouth cancer (7)

A
  1. FoM
  2. Lateral borders of tongue
  3. Retromolar regions
  4. Palate
  5. Gingivae
  6. Buccal mucosa
  7. Tonsils
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108
Q

Histologically what is pemphigoid (3)

A
  1. Sub-epithelial antibody attack
  2. Epithelium and connective tissue split at junction
  3. Hemidesmosomes attaching at the basement membrane lose their attachment
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109
Q

How are immunogenic blistering diseases investigated

A

Direct immunofluoresence

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110
Q

How are recurrent herpetic lesions treated

A

Aciclovir

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111
Q

How can salivary flow be measured on clinic

A

Resting flow rate
Spit into a tube continuously for 15 mins

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112
Q

Mucosa on fibroepithelial polyp

A

Same as surrounding mucosa

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113
Q

How common are fordyce spots

A

60-75% of adults

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114
Q

How common is geographic tongue

A

3%

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115
Q

Antineoplastic drug impact on salivation

A

They can accumulate in glands and kill off acinar cells over time

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116
Q

How do blisters form in vesiculobullous disease (2)

A

Auto-antibody attack on skin components which hold skin layers together
A split forms and fills with inflammatory exudate

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117
Q

Behcets disease diagnosis (~5)

A
  1. Three episodes of mouth ulcers in a year
    At least two of the following
  2. Genital sores
  3. Eye inflammation
  4. Skin ulcers
  5. Pathergy
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118
Q

Difference between herpetiform apthae and primary herpetic gingivostomatitis (2)

A

HSV affects keratinised mucosa
Patient may have systemic symptoms with HSV

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119
Q

Erythroleukoplakia management

A

Urgent referral

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120
Q

Lichenoid drug reaction management (2)

A

Risk benefit analysis
Assess severity

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121
Q

How can you prove pigmentation is due to amalgam

A

Biopsy

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122
Q

Enterovirus treatment (2)

A

Relieve symptoms
Prevent dehydration

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123
Q

How does aciclovir work

A

Inhibits viral DNA

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124
Q

Amyloidosis impact on major salivary glands

A

Deposition of protein in glands

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125
Q

Graft versus host impact on salivation

A

Immune damage to glands

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126
Q

Haemachromatosis impact on glands

A

Excess storage of iron within gland

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127
Q

HIV impact on salivary glands

A

Lymphoproliferative changes in glands

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128
Q

How does shingles present

A

Over the distribution of a dermatome

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129
Q

Mumps diagnosis

A

Oral swab for DNA detection

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130
Q

How long should an exclusion diet last (2)

A

3 months
Then start reintroducing foods one by one

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131
Q

How common is it for patients with oral lichen planus to get skin lesions

A

50% of the time

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132
Q

Gingival biopsies

A

Job for a specialist

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133
Q

Persistent oral lichen planus management (3)

A
  1. Topical steroids
  2. Beclomethasone inhaler
  3. Betamethasone rinse
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134
Q

Mild intermittent lichen planus treatment (4)

A
  1. Topical OTC remedies
  2. Chlorhexidine mw
  3. Benzdamine mw
  4. Avoid SLS containing toothpaste
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135
Q

Traumatic keratosis management (3)

A
  1. Encourage smoking cessation
  2. Get a photograph
  3. Reverse traumatic element
136
Q

How should you treat apthous ulcers with topical steroids

A

Pt. needs to be trained to notice ulcer in the prodrome period as epithelial damage happened before ulcer appears

137
Q

Denture hyperplasia which does not resolve when denture is removed

A

Biopsy the area

138
Q

What diagnosis should be considered when you see lichen planus or lichenoid lesions

A

Lupus

139
Q

Imaging to investigate dry mouth (2)

A
  1. Sialography
  2. Salivary ultrasound
140
Q

Who are apthous ulcers more common in (4)

A
  1. Children and teenagers
  2. Adults with occult GI/GU pathology
  3. Anaemics
  4. Malnourished pts
141
Q

Initial management of OFG

A

Consider Crohn’s
Dietary history and discuss exclusion diet

142
Q

Sialosis investigations - not dental (5)

A
  1. Bloods - FBC, U&E, bilirubin
  2. BBV screen
  3. Autoantibody screen
  4. Glucose
  5. MRI of major glands
143
Q

Obstruction of salivary glands investigations (4)

A
  1. Low dose plain radiography
  2. Lower true occlusal
  3. Sialography when infection free
  4. Ultrasound assessment of duct
144
Q

Is erythroplakia malignant

A

High malignant transformation
Urgen referral

145
Q

Is leukoplakia malignant

A

No but has malignant potential

146
Q

Main histological feature of OFG

A

Multinucleated giant cells

147
Q

Topical treatment for OFG (3)

A

Miconazole for angular chelitis
Tacrolimus ointment for swollen areas
Intralesional steroid weekly for 3 weeks

148
Q

Medicines commonly associated with oral lichen planus (5)

A
  1. ACE inhibitors
  2. Beta blockers
  3. Diuretics
  4. NSAIDs
  5. DMARDs
149
Q

Issue with burst blisters in pemphigoid (2)

A
  1. Exposed connective tissue and leaking inflammatory exudate
  2. Leads to dehydration and infection
150
Q

Oral cancer risk in those who smoke and drink

A

5x

151
Q

What causes pigmentation in Addisons disease

A

Raised ACTH

152
Q

Prolonged steroid use risks (5)

A
  1. Adrenal suppression
  2. Osteoporosis risk
  3. Peptic ulcer risk
  4. Cushingoid fatures
  5. Mania/depression risk
153
Q

Sialosis in sjogrens

A

Usually permanent

154
Q

Side effect of betamethasone mw

A

Small candida risk

155
Q

Stage III and above oral cancer cure and survival rate

A

Cure < 50%
Survive < 30%

156
Q

Symblepharon

A

A sign of cicatricial pemphigoid

157
Q

Diseases that can look like lichen planus (2)

A
  1. Lupus
  2. GvH
158
Q

Systemic medications for management of neuropathic pain (4)

A

Pregablin
Gapapentin
Amitriptyline
Duloxetine

159
Q

Investigations for dry mouth (5)

A
  1. Salivary flow test
  2. Blood tests
  3. Imaging
  4. Dry eyes screen
  5. Tissue examination
160
Q

Sialosis associations (4)

A
  1. Alcohol abuse
  2. Cirrhosis
  3. Diabetes mellitus
  4. Drugs
161
Q

Pemphigus symptoms timeline

A

Mucosa often affected up to 3 years before skin lesions

162
Q

Topical medications for neuropathic pain (4)

A
  1. Capsaicin
  2. EMLA
  3. Benzdamine
  4. Ketamine
163
Q

Tori and Bisphosphonates

A

Pts more likely to have avascular necrosis of tori than other parts of mandible

164
Q

Tx for oral lesions seen in erythema multiform (5)

A
  1. High dose systemic steroid
  2. Systemic acyclovir secondary to this
  3. Stay hydrated
  4. Encourage analgesia
  5. Allergy test
165
Q

Anti-microbials (3)

A
  1. Anti viral
  2. Anti fungal
  3. Antibiotics
166
Q

Antifungal examples (3)

A
  1. Miconazole
  2. Fluconazole
  3. Nystatin
167
Q

Bethamethasone

A

Topical steroid mouthwash - unlicenced

168
Q

Beclomethasone

A

Topical steroid metered dose inhaler (MDI) - unlicensed

169
Q

Dry mouth treatments (5)

A
  1. Salivix pastilles
  2. Saliva orthana
  3. Biotene oral balance
  4. Artificial saliva DPF
  5. Glandosane
170
Q

Tricyclic antidepressant examples (2)

A
  1. Amitriptilene
  2. Nortriptilene
171
Q

How do tricyclic antidepressants work

A

Work centrally in CNA to reduce pain transmission

172
Q

Immunosuppressant examples (2)

A
  1. Azathioprine
  2. Mycophenolate
173
Q

Immune modifying drug examples (2)

A
  1. Hydroxycoloquine
  2. Colchicine
174
Q

Lichen planus and fungus

A

Often lichen planus presents with a fungal infection on top of the cell changes to treatment started with an anti fungal

175
Q

Info for prescriptions (7)

A
  1. Pt sticker
  2. Number of days tx
  3. Drug to be prescribed
  4. Formulation and dosage
  5. Quantity to be dispensed
  6. Instructions to pt
  7. Signature
176
Q

How long is a prescription valid

A

6 months

177
Q

Drug prescribing for mucosal diseases (2)

A

Non steroid topical therapy for uncomfortable lesions
Steroid topical therapy for disabling immunologically driven lesions

178
Q

How to use bethamethasone mouthwash (6)

A
  1. Betnesol 0.5mg tablets
  2. Dissolve 2 tablets in 10mls (2tsp) water
  3. 2 mins rinsing
  4. Twice daily
  5. Don’t rinse/eat afterwards for 30 mins
  6. Don’t swallow
179
Q

PIL

A

Patient instruction leaflet

180
Q

How to use beclomethasone (5)

A
  1. 50mcg/puff
  2. Position vent over ulcer area
  3. 2 puffs
  4. 2-4 times daily
  5. Do not rinse after use
181
Q

Why should steroids not be stopped suddenly (2)

A
  1. Should taper dose
  2. Steroid dependancy
182
Q

Immunosuppression preparation (9)

A
  1. BBV screen
  2. FBC
  3. Electrolytes
  4. Liver function
  5. Zoster antibody screen
  6. EBV
  7. Chest x-ray
  8. Cervical smear
  9. Pregnancy test
183
Q

What should be tested for before azathioprine

A

Thiopurine methyltransferase (TPMT)

184
Q

Long term risk of azathioprine

A

Skin cancer risk

185
Q

Why are red lesions red? (3)

A
  1. Inflammation
  2. Dysplasia
  3. Reduced thickness of epithelium
186
Q

Types of haemangioma (2)

A

Capillary
Cavernous

187
Q

Types of lymphangioma (2)

A

Most are cavernous
Cystic hygroma

188
Q

When to refer mucosal pigmentation (3)

A
  1. Not easily explained
  2. Increasing in size/quantity
  3. NEW systemic problem
189
Q

Melanoma Signs (5)

A
  1. Variable pigmentation
  2. Irregular outline
  3. Raised surface
  4. Itchy
  5. Bleeds
190
Q

Types of lichen planus (3)

A

Reticular
Atrophic/Erosive
Ulcerative

191
Q

Things that contribute to the colour of the mucosa (7)

A
  1. Epithelial thickness
  2. Vasculature
  3. Inflammation
  4. Keratinisation
  5. Candida
  6. Melanin
  7. Exogenous factors
192
Q

Risk factors for candida infection (4)

A
  1. Immunocompromised
  2. Dentures
  3. Smoking
  4. Inhaler use
193
Q

Anti-fungal drugs (3)

A
  1. Fluconazole
  2. Miconazole
  3. Nyastatin
194
Q

Local measures to prevent candida (4)

A
  1. Rinse after inhalers
  2. Use a spacer
  3. Denture hygiene
  4. Smoking cessation
195
Q

Things to assess when you examine a patch (8)

A
  1. Location
  2. Colour
  3. Homo/heterogeneity
  4. Induration (hard or soft)
  5. Raised or flat
  6. Texture
  7. Wipeable?
  8. Symmetry
196
Q

General approach to white patches (5)

A
  1. Thorough history
  2. Identify a cause
  3. Reverse reversible
  4. Photos
  5. No clear cause or pt has additional risk factors - refer
197
Q

What type of hypersensitivity is erythema multiforme

A

Type 3

198
Q

Immune systemic diseases with local effects (6)

A
  1. Erythema multiforme
  2. Pemphigus
  3. Pemphigoid
  4. Lupus
  5. Sjogrens
  6. Systemic sclerosis
199
Q

OM diseases with cell mediated immunity (2)

A
  1. Lichen planus
  2. OFG
200
Q

OM diseases with antibody mediated immunity (2)

A
  1. Pemphigus
  2. Pemphigoid
201
Q

Vesicle size

A

1-2mm

202
Q

Epitopes

A

Part of protein antigen

203
Q

Target of many antigens in vesicullobullous diseases

A

Desmoglein

204
Q

Which type of immunofluorescence is preferable

A

Direct

205
Q

Direct immunofluorescence (2)

A
  1. Antibody mediated tissue disease
  2. Antibody bound to tissue
206
Q

Indirect immunofluorescence (3)

A
  1. Circulating antibody not yet bound to tissue
  2. Detected from plasma sample
  3. Not always useful for diagnosis
207
Q

Vesicullobullous conditions (5)

A
  1. Erythema multiforme
  2. Pemphigus
  3. Pemphigoid
  4. Angina bullosa haemorrhagica
  5. Bullous lichen planus
208
Q

Target lesions

A

Erythema Multiforme

209
Q

Steven Johnsons syndrome

A

Most extreme form of erythema multiforme with multi system involvement

210
Q

Aetiology of erythema multiforme (2)

A
  1. Antigen which has usually been encountered before
  2. Large antigen/antibody complex which gets stuck in tissues
211
Q

Where is erythema multiforme most likely to present

A

Lips and anterior part of mouth

212
Q

Erythema Multiforme Tx (4)

A
  1. Systemic steroids
  2. Systemic aciclovir
  3. Stay hydrated
  4. Encourage analgesia
213
Q

What is the most common reason for hospitalisation in erythema multiforme

A

Dehydration - pt unable to eat or drink

214
Q

Reccurent erythema multiforme tx (3)

A
  1. Consider prophylactic aciclovir daily
  2. Allergy test
  3. Consider infective agent - mycoplasma
215
Q

ABH

A

Angina Bullosa Haemorrhagica

216
Q

ABH Aetiology (3)

A
  1. Most common oral blistering condition
  2. Relatively painless
  3. Common at vibrating line & occlusal line
217
Q

ABH Blisters (3)

A
  1. Rapid onset - (few minutes)
  2. Last days then burst
  3. Heal with no scarring
218
Q

ABH Tx (3)

A
  1. Pt education
  2. Reassurance
  3. No tx available
219
Q

In pemphigoid, where does the epithelium split

A

Sub basement membrane

220
Q

Pemphigoid/Pemphigoid biopsies (2)

A
  1. Peri-lesional biopsy essential
  2. Epithelium almost always splits away from the sample
221
Q

RAS - Types (3)

A
  1. Minor
  2. Major
  3. Herpetiform
222
Q

Ulcer free period for minor apthous ulcers

A

Good guide to morbidity - longer ulcer free, less morbidity

223
Q

Minor apthous ulcers (3)

A
  1. <10mm diameter
  2. <2 weeks
  3. Only affect NON-KERATINISED mucosa
224
Q

Do minor apthous ulcers respond well to topical steroids

A

Usually

225
Q

Major apthous ulcers (4)

A
  1. Months
  2. Any part of mucosa
  3. May scar when healing
  4. Usually larger than 10mm
226
Q

Herpetiform Apthae (4)

A
  1. Non keratinised mucosa
  2. 2 weeks
  3. Can coalesce into larger areas of ulceration
  4. Early stages looks like primary herpetic gingivostomatitis
227
Q

Herpetiform apthae and herpes viruses (2)

A
  1. Herpetiform apthae nothing to do with herpes viruses
  2. HSV keratinised involvement, herpetiform apthae only non-keratinised mucosa
228
Q

What is Behcet’s disease

A

Primarily vasculitis - inflammation of blood vessels

229
Q

RAS Tx (4)

A
  1. Colchicine - first tx
  2. Azathioprine/Mycophenolate
  3. Biologics (infliximab)
  4. Managed with help of rheumatology
230
Q

Treating apthous ulcers (4)

A
  1. Damage before ulcer appears
  2. Prodrome period
  3. Tx on top of ulcer will do nothing, damage is underneath
  4. Daily topical steroid mouth rinse may be of benefit
231
Q

Apthous Ulcers Investigations (3)

A
  1. Haematinics
  2. Coeliac
  3. Allergies
232
Q

Coeliac disease tests (2)

A
  1. TTG
  2. If TTG+, test anti-gliadin and anti-endomysial antibodies
233
Q

Apthous Ulcers Tx (3)

A
  1. Correct blood deficiencies
  2. Refer for investigations if coeliac +
  3. Avoid dietary triggers
234
Q

Apthous ulcers in children (4)

A
  1. Typically during growth spurts
  2. Feet grow first - new shoes?
  3. Usually respond to 3/12 iron supplements
  4. If from birth - genetic
235
Q

Genetic apthous ulcers in children (4)

A
  1. Consider allergy testing as well as bloods
  2. Symptomatic tx during ulcer periods
  3. Issues with betnesol <12 - license
  4. Betnesol - child must be able to rinse and spit
236
Q

What should be done for RAS/apthous ulcers before referral (3)

A
  1. Simple investigations
  2. If iron deficient - 3/12 iron supplements
  3. Topical tx outlined in SDCEP
237
Q

Gingival lichen planus

A

OH very important in settling lesion especially interdental

238
Q

Gingival biopsies

A

Difficult - take care when deciding to do this or not

239
Q

Tongue biopsies

A

Easy but painful when healing

240
Q

Difference between lichen planus and lichenoid lesions histologically

A

Very little difference

241
Q

Gingival veneer for lichen planus (2)

A
  1. Vacuum formed splint
  2. Topical steroid placed inside
242
Q

Intermittent lichen planus

A

No need for medication during good times

243
Q

GVHD

A

Graft vs Host Disease

244
Q

Things that look like lichen planus intra-orally (2)

A

GVHD
Lupus

245
Q

What looks similar to lichen planus histologically (2)

A

Lichenoid reactions
GVHD

246
Q

Lichen planus and lymphocytes

A

Lymphocytic band along basement membrane

247
Q

Lupus with systemic autoantibodies

A

Termed systemic lupus erythematosis

248
Q

Lupus (4)

A
  1. Palate
  2. Can be only oral
  3. Can be systemic
  4. If only oral - treat symptomatically as lichen planus
249
Q

Intra-oral examination for salivation problems (3)

A
  1. Minor salivary glands
  2. Duct orifices
  3. Fluid expression - quality and quantity
250
Q

Causes of dry mouth (5)

A
  1. Salivary gland disease
  2. Drugs
  3. Medical conditions and dehydration
  4. Cancer treatments
  5. Anxiety
251
Q

Why are changes to gland stimulation more noticeable in older patients

A

Acinar tissue loss over the years makes changes more pronounced

252
Q

Medical conditions impacting salivary glands (2)

A

Indirect effect - external to gland
Direct effect

253
Q

Anti-muscarinic cholinergic drugs (6)

A
  1. Tricyclic antidepressants
  2. Antipsychotics
  3. Antihistamine
  4. Atropine
  5. Diuretics
  6. Cytotoxics
254
Q

What types of drugs can cause dry mouth (3)

A
  1. Anti muscarinic
  2. Diuretics
  3. Lithium
255
Q

Chronic medical problems which can reduce salivation (5)

A
  1. Diabetes
  2. Renal disease
  3. Stroke
  4. Addisons
  5. Vomiting
256
Q

Acute medical problems which can reduce salivation (4)

A
  1. Acute oral mucosal diseases
  2. Burns
  3. Vesicullobullous diseases
  4. Haemorrhage
257
Q

Direct salivary gland problems (5)

A
  1. Aplasia
  2. Sarcoidosis
  3. HIV
  4. Gland infiltration
  5. Cystic fibrosis
258
Q

Dry mouth in children

A

They may not complain of a dry mouth if they’ve never had normal salivation

259
Q

Ectodermal dysplasia impact on salivation

A

Salivary aplasia

260
Q

Sarcoidosis impact on salivation

A

Enlargement of submandibular and parotid gland

261
Q

HIV impact on salivation (2)

A

Enlargement of glands
Any pt that presents with this should be offered HIV test

262
Q

Haemochromatosis

A

High level of ferritin

263
Q

Salivary disease investigations (4)

A
  1. Blood tests
  2. Functional assay
  3. Tissue assay
  4. Imaging
264
Q

Minor salivary gland biopsy (2)

A

Preffered to major gland biopsy
Minor salivary glands reflect inflammatory issues in major glands

265
Q

Dry mouth with no dry mouth (3)

A

Anxiety and somatisation disorders
Anxiety causes dryness
Information from mouth misunderstood by small changes at synapses

266
Q

Hyposalivation (stimulated)

A

<0.5ml/min

267
Q

Dry mouth with only symptomatic treatment (3)

A
  1. Sjogrens
  2. Cancer tx
  3. Salivary gland disease
268
Q

Symptomatic dry mouth tx (3)

A
  1. INTENSE dental prevention
  2. Salivary substitutes
  3. Salivary stimulants
269
Q

Dry mouth from somatoform disorders - diagnosis

A

Diagnosis of exclusion

270
Q

Blood tests for dehydration (2)

A

U&Es
Glucose

271
Q

Dry eyes test

A

Shirmer test

272
Q

Salivary stimulants (2)

A
  1. Pilocarpine (Salagen)
  2. Side effects - sweating, tachycardia
273
Q

Perceived increased in salivary flow (2)

A
  1. Swallowing
  2. Postural drooling
274
Q

Drug causes of hypersalivation (4)

A
  1. Anticholinesterases
  2. Bromides
  3. Clonazepam
  4. Ketamine
275
Q

Dealing with excess saliva (4)

A
  1. Treat cause
  2. Drugs to reduce salivation
  3. Biofeedback training - swallowing
  4. Surgery to salivary system
276
Q

Changes in gland size (3)

A
  1. Viral inflammation
  2. Secretion retention
  3. Gland hyperplasia
277
Q

Mucocele

A

Recurrent mucous retention cyst

278
Q

Duct Dilation (4)

A

Prevents normal emptying
Micro-organisms lead to persisting and recurrent sialadenitis
Sausage shape in ducts
Stagnant saliva - infection risk

279
Q

Classification of Sjogrens (3)

A
  1. Sicca (Partial)
  2. Primary
  3. Secondary
280
Q

What is Sjogrens

A

Autoimmune disease which affects salivary glands and other parts of the body

281
Q

Diagnosis of Sjogrens (3)

A
  1. Complex - no single test
  2. American-European Consensus Group (AECG)
  3. ACR-EULAR joint criteria
282
Q

Autoantibodies involved in Sjogrens (2)

A
  1. Anti Ro
  2. Anti La
283
Q

How many criteria from the AECG need to have a positive finding for Sjogrens diagnosis

A

4

284
Q

Abnormal unstimulated salivary flow

A

<1.5ml/min

285
Q

AECG Criteria for Sjogrens (5)

A
  1. Dry eyes/mouth
  2. Autoantibody
  3. Imaging findings
  4. Radio nucleotide assessment
  5. Histopathology
286
Q

First tests for Sjogrens (5)

A
  1. Least harmful first
  2. UWS
  3. Salivary USS
  4. Anti-Ro antibody
  5. Baseline MRI of major glands - for comparison for future lymphoma screen
287
Q

Next test for Sjogrens

A

Labial gland biopsy

288
Q

Sjogrens Management (4)

A
  1. Enhanced prevention
  2. Salivary stimulants
  3. Consider immune modulating tx - hydroxychloroquine, methotrexate
  4. Liaise with rheumatologist
289
Q

Tooth substance pigmentation (2)

A
  1. Billirubin
  2. Tetracycline
290
Q

Oral mucosal effects from systemic disease (5)

A
  1. Giant cell granuloma
  2. OFG
  3. RAS
  4. Dermatoses
  5. Drug reactions
291
Q

Giant cell lesions - Types

A

Peripheral
Central

292
Q

Giant cell lesions (4)

A
  1. Check PTH
  2. Renal failure
  3. Hypocalcaemia
  4. Parathyroid tumour
293
Q

Crohns Screening (3)

A

Faecal Calprotecting assay - screening test for endoscopy
Unreliable in younger children
Good predictor of Crohn’s disease activity

294
Q

UWS

A

Unstimulated Whole Saliva

295
Q

USS

A

Salivary Ultrasonography

296
Q

MCTD

A

Mixed connective tissue disease

297
Q

Reasons for haematinic deficiencies (4)

A
  1. Poor dietary intake
  2. Malabsorption
  3. Blood loss
  4. Increased demand - growth
298
Q

Which has more malignancy potential - OLL or OLP

A

Oral lichenoid lesions
3% transformation rate

299
Q

OLL

A

Oral lichenoid lesions

300
Q

OLP

A

Oral Lichen Planus

301
Q

Pathogenesis of lichen planus

A

CD8+ T cells trigger apoptosis of the basal cells of oral epithelium

302
Q

OLP and OLL infiltrate

A

OLP - mixed infiltrate
OLL - Strict lymphohistocytic infiltrate

303
Q

Where is infiltrate in OLP vs OLL

A

OLP - Limited to lamina propria
OLL - Deeper distribution

304
Q

Primary care treatment of OLL (2)

A
  1. Remove or replace cause
  2. Suppress immune system with corticosteroids
305
Q

Secondary care treatment of OLL/OLP (4)

A
  1. Hydroxychloroquine
  2. Azathioprine, mycophenolate
  3. Topical tacrolimus
  4. Systemic steroids
306
Q

Special investigations for Sjogrens (5)

A
  1. Salivary gland biopsy
  2. Antibody positivity
  3. Ocular staining score
  4. Schirmer test
  5. Sialometry
307
Q

Labial gland biopsy score on ACR/EULAR for Sjogrens

A

3

308
Q

Anti Ro antibody positivity score on ACR/EULAR

A

3

309
Q

OSS

A

Ocular Staining Score

310
Q

Histopathology of salivary glands in Sjogrens (3)

A
  1. Lymphocyte infiltration
  2. Proliferation of lining
  3. Duct dilation
311
Q

What antibodies are implicated in SLE

A

Antinuclear antibodies
ANA

312
Q

Intra-oral manifestations of SLE (8)

A
  1. Ulcers
  2. Erosion
  3. Hyposalivation
  4. Pigmentation
  5. Burning mouth
  6. Fissured tongue
  7. Cheilitis
  8. Secondary Sjogrens
313
Q

Types of mucosal lesions in SLE (2)

A
  1. Discoid
  2. Non-specific apthous ulcers
314
Q

Extra-oral manifestations of SLE (5)

A
  1. Anaemia
  2. Arthritis
  3. Butterfly rash
  4. Increased stroke risk
  5. Pericarditis
315
Q

Lupus arthritis

A

Also known as Jaccouds arthropathy

316
Q

Lupus nephritis

A

Inflammation of kidneys due to formation of immune complexes

317
Q

How many of the ACR/EULAR criteria must a patient meet to be classed as having SLE

A

10+

318
Q

SLE disease severity (3)

A
  1. Mild
  2. Moderate
  3. Severe or organ threatening
319
Q

Severe organ threatening SLE tx

A

Hydroxychloroquine with high dose IV glucocorticosteroids for flare ups

320
Q

Treatment foal for SLE/SS (4)

A

Control of symptoms
Remission of disease
Better QoL
Prevent organ damage

321
Q

When are methotrexate and azathioprine used for SLE

A

When a pt fails to respond to the max dose of glucocorticosteroids

322
Q

Mechanism of action of NSAIDs

A

Inhibit COX enzymes thus reducing the synthesis of prostaglandins involved in inflammatory process

323
Q

Why should Sjogrens patients be monitored

A

To look out for complications like lymphoma

324
Q

What is OFG (2)

A
  1. Blockage of lymphatic drainage due to immune reaction
  2. Angio-oedema
325
Q

Granulomatous conditions (4)

A
  1. Crohns
  2. OFG
  3. Sarcoidosis - rare
  4. TB - rare
326
Q

How long does angio-oedema last in OFG

A

Quick onset
Slow to settle
Weeks/months

327
Q

Systemic treatment for OFG (~2)

A
  1. Pulsed azithromycin - 3 months
  2. Systemic immune modulation - prednisolone for short term, azathioprine/mycophenolate for long term
328
Q

Patterns of oral cancer (2)

A
  1. Oral cavity cancer (OCC)
  2. Oro-pharyngeal cancer (OPC)
329
Q

Unconfirmed potential risks for oral cancer (3)

A
  1. Family history
  2. OH
  3. Sexual activity
330
Q

What can MMP result in if left untreated (2)

A

Eosophageal and laryngeal stenosis
Blindness

331
Q

How to distinguish pemphigus and bulbous pemphigoid

A

Nikolkys Sign

332
Q

Nikolskys Sign (2)

A

Apply lateral pressure on peri-lesional skin
Shearing force dislodges upper layers of epidermis from lower layers

333
Q

ELISA testing

A

Indirect immunofluorescence
Requires serum collection

334
Q

Pemphigus tx (3)

A
  1. Dapsone
  2. Prednisolone
  3. Azathioprine/mycophenolate
335
Q

Primary care for MMP and PV (3)

A
  1. Maintaining OH
  2. Diet advice
  3. Anti-inflammatory and analgesics

BDS Finals (23 decks)

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