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ORAL PATHOLOGY! > Exam 5-NON-Infective Stomatitis > Flashcards

Exam 5-NON-Infective Stomatitis Flashcards

1
Q

What is the common name for recurrent apthous stomatitis (RAS)?

A

“canker sores”

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2
Q

About what % of the population is affected by recurrent apthous ulcers (canker sores)?

A

20-50%

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3
Q

What are two typical precursors to recurrent apthous stomatitis?

A
  1. trauma 2.emotional stress
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4
Q

What is the evidence that apthous ulcers have an immunologic origin?

A

they are T-cell mediated

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5
Q

For recurrent aphtous ulcers: specific histocompatibility (HLA) antigens have been associated, indicating a possible WHAT KIND OF predisposition??

A

GENETIC!!

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6
Q

What % of apthous ulcers are considered to be minor in nature?

A

80%

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7
Q

When do minor apthous ulcers typically begin to develop?

A

childhood or adolescence

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8
Q

Which sex is affected more by minor apthous ulcers?

A

Females

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9
Q

What are two desriptors of prodromal symptoms of a minor apthous ulcer?

A

burning, itching

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10
Q

What is the arbitrary measurement for a “minor” apthous ulcer?

A

1.5cm

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11
Q

Minor apthous ulcers can be described as painful WHAT COLOR ulcers with erythematous borders?

A

tan

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12
Q

Minor apthous ulcers are almost EXCLUSIVELY on _________ (not _________)!!

A

moveable mucosa (not covering bone)

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13
Q

Most minor apthous ulcers often occur on the ______ and _______ mucosa

A

buccal and labial mucosa

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14
Q

Minor apthous ulcers heal spontaneously in ____-____ days without scarring

A

7-14 days

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15
Q

What are the three forms of recurrent apthous ulcers and what % of the time do each occur?

A

minor: 80%, major: 10%, herpetiform: 10%

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16
Q

What is a nickname for MAJOR apthous ulcers?

A

“sutton’s disease”

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17
Q

When is the typical onset of major apthous ulcers?

A

adolecence

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18
Q

What are the arbitrary measurements of major apthous ulcers?

A

1.5-3cm

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19
Q

What are the three most common sites for MAJOR apthous ulcers?

A

1.soft palate 2.tonsilar fauces 3.pharyngeal mucosa

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20
Q

For MAJOR apthous ulcers, they can take HOW LONG to heal? AND they may cause ________

A

2-6 weeks…SCARRING

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21
Q

What type of apthous ulcers are typically 1-3mm and occur in clusters?

A

herpetiform apthae

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22
Q

When is the typical onset of herpetiform apthae?

A

adulthood

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23
Q

Which sex is more affected by herpetiform apthae?

A

females

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24
Q

Herpetiform apthous ulcers closely resemble WHICH type of herpes virus??

A

herpes simplex virus

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25
Q

What is the main difference between herpetiform apthous ulcers and herpes simplex lesions?

A

herpetiform apthous ulcers occur ANYWHERE in the oral cavity (HSV only on mucosa covering bone)

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26
Q

Are there systemic signs/symptoms associated with herpetiform apthous uclers?

A

Nope

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27
Q

How long does it take for herpetiform apthous ulcers to heal?

A

7-10 days

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28
Q

What are the two TOPICAL STERIOD treatment options for apthous ulcers?

A
  1. DexaMethaSone elixer 2.FLU-cin-ON-ide (Lidex)
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29
Q

Besides the use of topical steriods to treat apthous ulcers, what other two mediciaments can be used?

A

Chlorhexidine and Am-LEX-a-NOX (ApthaSOL)

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30
Q

Which type of apthous ulcer is associated with systemic disease?

A

“pseudo” apthae

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31
Q

What is the most common source of “pseudo” apthae?

A

GI malabsorption diseases-c.j. CROHN’s disease

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32
Q

What are the typical nutritional deficiencies that can lead to “pseudo” apthae? (6 of them please)

A

Iron, folate (B9), B1, B2, B6, B12

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33
Q

What is the name of the syndrome that presents “pseudo” apthous ulcers and is chronic, recurrent disease resulting from a systemic vasculitis??

A

BEH-CET’s syndrome

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34
Q

Behcet’s syndrome has a _________ basis with strong association with specific HLA types (B51)

A

Immunogenetic

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35
Q

What % of Begcet’s syndrome will present in the oral cavity?

A

99%

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36
Q

In Behcet’s syndrome, oral lesions are similar to aphthous ulcers and there are usually ___ or more of them in which two areas of the mouth?

A

6 or more…soft palate and oropharynx

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37
Q

Which type of apthous ulcer can be descibed as having RUGGED borders and vary in size and surrounded by diffuse erythema?

A

pseudo apthae from Behcet’s syndrome (Behcet=rugged Borders)

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38
Q

Along with the oral manifestations of Behcet’s syndrome there are also _______ on skin of trunk and limbs with genital and corneal ulceration

A

Pustules

39
Q

In Behcet’s syndrome 10-25% of people will show WHAT TYPE OF involvement, can􏰀paralysis and and dementia?

A

CNS

40
Q

Which component of Behcet’s Syndrome may affect cardiovascular, GI, hematologic, pulmonary, muscular, renal systems?

A

the VASCULITIS

41
Q

Behcet’s syndrome can be treated with systemic and topical _______ anlong with oither immunosuppressives like ________…and then there is always this mouth rinse: ________

A

steriods…AM-LEX-A-NOX…Chlorhexidine

42
Q

The CAUSE of Lichen Planus is unknown but pathogenesis is ________ mediated through ______ cells, slight association with hepatitis ___:

A

IMMUNE…T-Cells…Hep C

43
Q

Most patients experiencing Lichen Planus are of what age?

A

middle-aged adults

44
Q

Which sex does Lichen Planus affect more? How much so?

A

Females are every 2/3 patients

45
Q

When Lichen Planus affects tissues that are irritated or traumatized its called the _______ phenomenon

A

KOE-BNER

46
Q

What are the 4 p’s of Lichen Planus on the SKIN?

A

1.purple 2.pruritic 3.polygonal 4.papules

47
Q

Clinically Oral Lichen Planus is described as ________/erosive/bullous/plaque-like clinical appearance

A

RETICULAR

48
Q

What type of Lichen Planus is characterized by redness and/or ulceration and symptoms??

A

EROSIVE

49
Q

What is the most common cause of desquamative gingivitis?

A

LICHEN PLANUS

50
Q

Lichen planus is the MOST common cause of which type of gingivitis???

A

DESQUAMATIVE gingivitis

51
Q

Histologic features of LICHEN PLANUS: “_______” rete ridges with destruction of the ______ cell layer (aka ________ degeneration)

A

“Saw-toothed”…. BASAL….liquefactive degeneration

52
Q

Histologic features of LICHEN PLANUS: ______ like infiltrate of small ________ (_____) just under the epithelium

A

BAND like…lymphocytes (T cells)

53
Q

What are lesions that look like LP but aren’t? They are associated with systemic drugs and hypersensativity reactions…especially WHAT 3 culprits??

A

Lichenoid reactions…1.cinnamon 2.amalgam 3.epithelial dysplasia

54
Q

We talked about TB showing Squamous Cell Carcinoma signs, what is yet another condition that can be diagnosed as such?

A

Lichen Planus

55
Q

What are the two most common sites for Lichen Planus?

A
  1. buccal mucosa 2.gingiva (a distant 3rd is tongue)
56
Q

What are the two topical steriods that can help control the symptoms of Lichen Planus?

A

FLU-CIN-ON-IDE (Lidex) and CLO-BET-A-SOL (Temovate)

57
Q

What are the ___ conditions we can treat with FLU-CIN-ON-IDE?

A

Apthous Ulcers and Lichen Planus

58
Q

What are the 4 types of PemphiGUS? Whats the most common?

A

1.Vulgaris (MOST COMMON) 2.Vegetans 3.Erythematosis 4.Foliaceus

59
Q

PemphiGUS is a severe progressive ______ disease that affects the skin and mucous membranes

A

AUTOIMMUNE

60
Q

Where do the first lesions of pemphiGUS appear?

A

ORAL lesions are first to appear

61
Q

What age range is most common for pemphiGUS?

A

adults in their 40’s and 50’s

62
Q

Which connective protein (2 names please) is sought and destroyed in pemphiGUS?

A

DESMOSOMES (desmo-GLEIN 3)

63
Q

In pemphiGUS Circulating _________ to components of epithelial cell attachments: desmosomes (desmoglein 3)

A

autoantibodies

64
Q

Clinical features of pemphiGUS: Epithelial __________ produces painful superficial erosions and ulcerations.

A

deSquamation

65
Q

PemphiGUS affects most mucosal surfaces but often affects _______ producing chronic desquamative gingivitis.

A

GINGIVA

66
Q

What is the procedure for inducing epithelial separation by manipulating tissue or using lateral pressure?

A

if there is movement, you have a POSITIVE NIK-OL-SKI sign

67
Q

DO you see blisters in pemphiGUS?

A

Rarely, the deSquamation breaks early

68
Q

Histologic features of pemphiGUS: the individual cells lose their cohesion and round up (________) producing a suprabasilar separation within the epithelium

A

(A-canth-o-lysis)

69
Q

Diagnosis of pemphiGUS: Biopsy shows characteristic ________ epithelial separation with ________.

A

suprabasilar….a-canth-o-lysis

70
Q

Diagnosis of pemphiGUS….Direct immunofluorescence demonstrates autoantibodies (usually WHICH 2???) around the individual keratinocytes (WHAT IS THE ANALOGY??)

A

IgG and C3…CHICKEN COOP WIRE

71
Q

What is the go to Tx for pemphiGUS?

A

systemic Steriods

72
Q

What is the term for the fatal form of pemphiGUS?

A

PARA-neoplastic PemphiGUS

73
Q

Paraneoplasm PemphiGUS affects people who have a neoplasm…WHICH two neoplasms are most common with this condition?

A

Lymphoma and leukemia

74
Q

What is the term for benign mucous membrane PemphiGOID? (BMMP)

A

Cica-Tri-cial PemphiGOID

75
Q

What is the chronic, autoimmune disease where patients produce antibodies against the structural proteins in their hemidesmosomes?? (2 names please)

A

1.BMMP (benign mucous membrane pemphiGOID) 2.Cica-Tri-Cial pemphiGOID

76
Q

BMMP (cicatricial pemphiGOID) is a chronic, autoimmune disease where patients produce antibodies against the structural proteins in their ___________

A

HEMI-desmosomes (HEMI = GOID)

77
Q

BMMP affects HEMIdesmosomes which anchor the basal ___________ to the underlying connective tissue

A

keratinocytes

78
Q

What is the average age of BMMP? Does it have a sex preference?

A

Ages 50-60 MORE COMMON IN FEMALES

79
Q

Which is more common: pemphiGUS vulgaris OR BMMPemphiGOID?

A

BMMPemphiGOID is CONSIDERABLY more common

80
Q

One way to distinguish between pemphiGUS and pemphiGOID is the amount of proteins they affect….how many for which condition?

A

pemphiGUS=1 protein (desmosomes)….pemphiGOID=10 proteins that comprise hemidesmosomes

81
Q

Which condition affects oral, ocular, and genital mucosa ± larynx and esophagus and ± skin?

A

BMMPemphiGOID

82
Q

Which condition can lead to OCULAR SCARRING and BLINDNESS if left untreated??

A

BMMPemphiGOID

83
Q

Which condition is more severe? PemphiGUS or PemphiGOID?

A

PemphiGUS is more Severe than pemphiGOID

84
Q

What is the clincial test for BOTH pemphiGUS and pemphiGOID?

A

a positive Nikolski sign

85
Q

What is the most common site for Benign Mucous Membrane PemphiGOID???

A

Gingiva

86
Q

Which condition yields BULLAE form at separation of epithelium from connective tissue, producing a subepithelial split from the connective tissue?

A

Benign Mucous Membrane PemphiGOID

87
Q

In Benign Mucous Membrane PemphiGOID, it can show _______ form at separation of epithelium from connective tissue

A

BULLAE

88
Q

In the late stages of BMMP blisters rupture, leaving large areas of ________

A

ulceration

89
Q

What is the normal treatment for benign mucous membrane pemphiGOID?

A

topical or systemic steroids

90
Q

I REPEAT: DESQUAMATIVE GINGIVITIS can be a clincial menifestation of WHAT 4 conditions?

A

1.Lichen Planus 2.PemphiGUS Vulgaris 3.Mucous membrane PemphiGOID 4.Allergic reaction

91
Q

Allergic reactions causing DESQUAMATIVE GINGIVITIS: toothpaste: most commonly _____ control toothpastes

A

TARTAR

92
Q

Allergic reactions causing DESQUAMATIVE GINGIVITIS: CINNAMON: flavored products (containing a flavoring agent called __________)

A

Cinn-amic Aldehyde

93
Q

Allergic reactions causing DESQUAMATIVE GINGIVITIS: Preservatives like ___________

A

sodium benzoate

ORAL PATHOLOGY! (40 decks)

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