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Oral Medicine > L2 - Vesicular, Ulcerative, and Bullous Lesions > Flashcards

L2 - Vesicular, Ulcerative, and Bullous Lesions Flashcards

1
Q

recurrent ulcers

A

recurrent apthous stomatitis

behcet’s disease

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2
Q

acute lesions

A

herpes simplex virus infection

varicella zoster virus infection

erythema multiforme

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3
Q

chronis lesions

A

pemphigus

bullous pemphigoid

mucous membrane pemphigoid

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4
Q

recurrent apthous stomatitis

A

most common soft tissue lesion

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5
Q

requirement for course

A

common lesions and know how to deal with it

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6
Q

incidence of apthous stomatitis

A

17%s

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7
Q

associated with apthous stomatitis

A

hematologic deficiency

- serum iron, folate, vit b 12

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8
Q

etiology of apthous stomatitis

A

90% vs 20%

- parent with this lesion – 90% more likely to have it

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9
Q

clinical manifestations of minor ulcers (apthous)

A

less than 1.0 cm, round, shallow, multiple, healing begins within 1 week and completes in 10-14 days
without scars

benign and subclinical a lot of t

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10
Q

clinical manifestations of major apthous ulcers

A

over 1,0 cm, round, deep, extremely painful, last for months, heal slwly and leave scars, result in decreased mobility

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11
Q

inflammation is simpy

A

dilated blood vessels caused by ___ whatever it is

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12
Q

clinical housmanifestations of herpetic form apt ulcers

A

less common, multiple small punctuate ulcers scatterd over the oral mucosa

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13
Q

DD for apthous stomatitis

A

viral stomatitis, pemphigoid, drug reactions

- biopsy only needed to exclude other lesions

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14
Q

reference ranges for serum iron, folate, b-12, and ferrtin

A

iron - 50-160 in men 40-150 in woman

folate 1.8- 9.0 ng/ ml

serum b12- 140-170

serum ferritin
male - 15-200
female - 12-150

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15
Q

tx for mild cases - apthous ulcer

A

orabase paste
- 20% benzocaine -

for maximum strenght pain relief and protective film for long lasting pain relief and protective film on lesions

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16
Q

tx for severe cases of apthous ulcers

listed in?

A

topical streoid preperations
* listed in increasing potency of anti-inflammatory effect by altering the way the immune system responds to certain stimuli

  1. ## triamcinolone
  2. ## flucinonide
  3. ## clobetasol
  4. flucinonide - lidex 0.05%
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17
Q

behcet’s disease

A

autoimmune disease

- recurrent oral ulcers recurrent genital ulcers occular inflammation

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18
Q

etiology of behcet’s disease

A

cross reactivity antigens –> humoral antibody or cell mediated immune responses –> leads to cytotoxic effects –> then epithelial damage

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19
Q

clinical manifestations of behcet’s disease

A

recurrent oral ulcers (like RAS)

recurrent genital ulcers

occular inflammation

skin lesions

based on these 4 points – so 4 points system is used to describe this disease

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20
Q

primary infection HSV

A

prodromal symptoms
- fever, headache, malasie, nausea, vomitting

thin walled small vesicles–QUICKLY RUPTURE – shallow, round, discrete ulcers– large irregular painful ulcers of the lips and oral cavity (gingivostomatitis) – surrounded by an arythematous halo – heal spontaneously in 7-14 days

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21
Q

recurrent infections

A

of HSV 1 - prodromal period is 1 day with tingling, burning, swellling at the site of muccocutaenous junction of upper lip triangle zone beneath the nose –

cluster 1-2 cm of small vesicles of 1-3 mm

may or may not rupture to form shallow ulcers

heal in about 7 days

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22
Q

HHV 8

A

kaposi’s sarcoma

involved with immunosuppresion and HIV patients

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23
Q

HHV 8

A

kaposi’s sarcoma

involved with immunosuppresion and HIV patients

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24
Q

tx for HSV

A

acyclovir (zovirax) – for all members of herpes
- synthetic purine nucleoside specificall against human herpes virus

mechanism – highly selective – ONLY ACTIVE WHEN INFECTED

  • viral thymidine kinase (contained in the virus)

the TK converts to active form – now active acyclovir triphosphate from which can be inorporated into growing chains of viral DNA, resulting in termination of viral DNA

terminates viral DNA

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25
Q

marginal gingiva is not affected in

A

pemphigoid

26
Q

acyclovir work on latent?

A

no - does not elminate latent virus

27
Q

acyclovir dependent on

A

renal excretion, thus the half-life is dependent on renal function

so risk of renal dysfunction in patients haing nephrotix agents

28
Q

acyclovir dependent on

A

renal excretion, thus the half-life is dependent on renal function

so risk of renal dysfunction in patients haing nephrotix agents

29
Q

contraindications for primary viral infections

A

use of corticosteroids – because it can cause immunosuppression

if get very severe infection then maybe but should not be getting these from you

30
Q

Herpes zoster aja

A

shingles

31
Q

primary infection of varicella zoster

A

chickenpox- varicella – occurs in susceptible children with no antibodies

become lifeling carriers - antibodies positive latent virus persist in ganglia of spinal nerves and cranial nerves

32
Q

reactivation of varicella zoster

A

immunosuppression
trauma
local x ray radiation
malignancy of ganglia

33
Q

reactivatino of v2 and v3 vs reactivation of herpes

A

herpes - bilateral distriubtion vs v2 / v3 - unilateral and segmental distribution with SHOOTING PAIN

34
Q

shooting pain along the affected seneory of ____ nerves

A

prodromal period of herpes zoster

35
Q

treatment for herpes zoster

A

acyclovir tablet

36
Q

tx for immunocompromised for herpes zoster

A

acyclovir sodium intravenous solution (50 mg/ml) for immunocompromised cases

37
Q

important in terms of treatment with acyclovir and herpes zoster

A

PROMPTNESS of tx within 72 hours of rash onset – may significantly influence the degree of beenfir from therapy

38
Q

herpes zoster of v2 and 3?

A

oral and facial lesions - but HZ of V1 is more common

39
Q

which is an acute lesion

A

erythema multiforme

40
Q

definition of erythema multiforme

A

immune mediated acute inflammatory disease of the skin and mucosal membranes frequently in young adults and children

41
Q

location of EM

A

involved lesions in SUPERFICIAL VESSELS

- this is where immune reaction is occuring

42
Q

most common site of EM simplex

A

LIPS !!!

prominent and diagnostic site (NOT gingiva)

43
Q

skin leison of EM looks

A

target or iris lesion - consisting of a central bulla or pale cleaning area surrounded by edema and bands of erythema OR
non specific macules, papules, and vesicles possibly containing petachiae in the center of the lesion

44
Q

steven johnson syndrome

A

acute and generalized vesicles, bullae, erosive or denuded lesions involving skin, mouth, eyes, and genitals with prodromal symptoms of fever and malaise

45
Q

tx for mild cases of EM

A

topical anesthetic mouthwashes - dexamethasone (decadron) elixir 0.5 mg/ 5 ml

46
Q

prednisone

A

for severe cases of EM - this is a steroid

oral capsule that is ANTI-INFLAMMAOTRY AND SUPPRESSES T - CELL MEDIATED IMMUNE SYSTEM

47
Q

use of prednison - basic

A

alternate day therapy or daily tx

48
Q

daily therapy for prednisone

A

20-50 mg every morning 5-7 days

once a day morning before 8 am to limit the suppression of patients own immune

max function with be between 2pm- 8 am

49
Q

give prednisone when for least side affect

A

before 8 am

50
Q

alternative day therapy gives

A

least side effect if need to do this long term

40 mg to 100 mg every other day before 8 am for 5-7

51
Q

following course with prednisone?

A

decrease the dose

so if did daily therapy of 20-40 decrease by 5 mg to 10 mg on each succesive day in the morning at 8 am

if did the alternate day therapy then decrease by 10 to 20 mg on every oter morning before 8 am

52
Q

percautions of steroid use

have to know this

A

drug induced secondary adrenal suppresive effect (drug induced secondary adrenocortical insufficiency)

suppression of immune system –> more susceptible to infections

elevation of bp, salt and water retention, and increased excretion of postassium and calcium

peptic ulcer, impaired wound healing, menstrual irregularities

53
Q

contact allergic stomatitis

A

this is NOT erythema multiform

this is a delayed type hypersensitivity reaction to TOPICAL ANTIGENS

54
Q

etiology of contact allergic stomatitis

A

chewing gum, dental amalgam, gold crowns, acrylic denture, impression materials, toothpaste, benzocaine, etc

55
Q

IgM

A

EM

56
Q

type IV

A

delayed type hyerpsensitivity

IgG

57
Q

definition of pemphigus vulgaris

A

autoimmune (IgG) involving the skin and oral mucosa with acantholysis and intraepithelial bullae formation in adults

58
Q

diagnosis of contact allergic stomatitis

A

skin patch test (place suspected allergen on normal non hairy skin for 48 hours, examines for persistent erythema after 2-4 hours of allergen removal

59
Q

where is mucous membrane pemphigoid

A

subepithelial

IgG target basement membrane

60
Q

most signifivant presentnation of pemphigoid in oral

A

non-specific desquamative gingivitis

Oral Medicine (11 decks)

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