Ch. 16 Robbins GI Path

Question 1

What are dental carries?

Answer 1

Most common diseases world wide
- tooth loss before age 35

Colonization of teeth by bacteria (s. mutans) due to poor hygiene and high sugar diet

Question 2

What are associated complications with dental carries

Answer 2

Pain
Weight loss/Nutrition deficits
Life threatening infections

Question 3

What is dental plaque?

Answer 3

a sticky, colorless, biofilm that collects between and on the surface of teeth

Question 4

What is periodontitis?

Answer 4

an inflammatory process that affects the supporting structures of the teeth (periodontal ligaments) alveolar bone, and cementum

Question 5

Are gingivitis and periodontitis reversible?

Answer 5

yes!

Question 6

What is the difference between inflammatory and reactive lesions?

Answer 6

Inflammatory has assaulting agent (ie bacteria) that causes local reaction

Reactive - response to stimulus and injurious stimuli (ie chemicals, hypoxia, drugs)

Question 7

Describe aphthous ulcers and who the afflict

Answer 7

common. recurrent. exceedingly painful superficial ulcer of oral mucosa without know etiology

occur in people less than 20

resolve spontaneously in 7-10 days

Question 8

Where do most traumatic fibrous proliferations occur?

Answer 8

Buccal mucosa from repeated trauma ie chewing on cheek.

Well circumscribed (benign) and easily removed surgically.

Question 9

what is a pyogenic granuloma?

Answer 9

Inflammatory lesion typically found on the gingiva of children, young adults, and pregnant women

Question 10

Why is pyogenic granuloma a misnomer?

Answer 10

on histology it is very vascular and lobular

NOTHING pyogenic or granulomatous about it

Question 11

Describe a peripheral ossifying fibroma

Answer 11

Hard, red, ulcerated, and/or nodular lesion on gingiva

young teenage females

Question 12

What layer must be removed during the excision of a peripheral ossifying fibroma?

Answer 12

periosteum - otherwise will reoccur

Question 13

Describe tori palatini (torus palatinus)

Answer 13

a bony lesion on the roof of the mouth. Painless and often asymptomatic

Question 14

Which subtype of HSV causes orofacial lesions

Answer 14

HSV-1

Question 15

When do primary infections of HSV occur in most people?

Answer 15

2-4 y/o

herpetic stomatitis

Question 16

What test can you run for HSV to confirm the presence of a herpes infection

Answer 16

Tzank test, however positive for all herpes? ie herpes zoster

Question 17

What is the most common fungal infection of the oral cavity and the most frequent cause of human fungal infections?

Answer 17

Candidiasis

Question 18

What factors influence clinical candidiasis infection?

Answer 18

the strain of C. albicans
composition of individual oral flora
immune status of the patient

Question 19

Deficiency in which types of cells might predispose a patient to Candida

Answer 19

Neutrophils
macrophages
Th17

Question 20

What is the major difference between candidiasis and leukoplakia

Answer 20

you can scrape off candidiasis

Question 21

you prepare a wet mount slide of an exudate from your patient and see pseudohyphae, budding yeast, what organism are you looking at?

Answer 21

candida

Question 22

What disease is associated with hairy leukoplakia?

Answer 22

EBV

Question 23

What is the oral change associated with scarlet fever?

Answer 23

Strawberry tongue - white coated tongue with hyperemic papillae

Raspberry tongue - fiery red tongue with prominent papillae

Question 24

What is the oral change associated with measles?

Answer 24

spotty enanthma precedes skin rash - koplik spots

Question 25

what is the oral change associated with infectious mononucleosis

Answer 25

acute pharyngitis and tonsillitis, grey-white exudative membrane, palatal petichiae

Question 26

What is the oral change associated with diphtheria

Answer 26

characteristics dirty white, fibrinosupurrative, tough, inflammatory membrane over the tonsils

Question 27

What is the oral presentation of myeloid neoplasms? ie AML

Answer 27

tumors with monocytic differentiation often infiltrate the skin (leukemia cutis) and the gingiva

Question 28

a patient presents with gingival hyperplasia, they have decent hygiene and you see a med in their hx. what medication are they on?

Answer 28

Dilantin (Phenytoin)

Question 29

Describe Osler-Weber-Rendu (Hereditary Hemorrhagic Telangiectasia)

Answer 29

a rare AD disorder that affects blood vessels throughout the body (causes vascular dysplasia) and results in tendency for bleeding

Question 30

Why must the multicellular keratocystic odontogenic tumor be differentiated from other odontogenic tumors?

Answer 30

due to the aggressive nature of the neoplasm occur mostly in males within the posterior mandible

Question 31

what type of carcinomas make up 95% of all head and neck cancers

Answer 31

Squamous Cell Carcinoma

Question 32

An old curmudgeon sits on his porch with a shotgun after the second american civil war in November of 2020. The porch isnt covered and he puffs tobacco from a pipe waiting for someone to fuck around and find out. what cancer is he predisposing himself too

Answer 32

SCC/Cancer of the lower Lip

Question 33

Which variants of HPV are highly responsible for oral and pharyngeal squamous cell carcinomas

Answer 33

HPV 16 a lot HPV 18 also

Question 34

Who is most at risk for oropharyngeal squamous cell carcinoma?

Answer 34

White, non smoking males age 35-55 ....so dylan

Question 35

Which two viral genes of HPV inactivate which cellular pathways

Answer 35

E6 P53 E7 RB

Question 36

If a patient has HPV pos SCC, do they have a better or worse long term survival?

Answer 36

greater

Question 37

If a white, male, non-smoking patient presents with fatigue, weight loss, painful swallowing, and a lump on his neck what is your top DX

Answer 37

HPV SCC

Question 38

acquired and mutations involved in classic oral SCC target which genes

Answer 38

p53 Notch1 p63

Question 39

Where does classic oral SCC present?

Answer 39

``` ventral tongue floor of mouth lower lip Soft Palate Gingiva ```

Question 40

Is erythroplakia or leukoplakia more omonous

Answer 40

erythroplakia - almost always associated with carcinoma in situ

Question 41

If the early stage survival for classic SCC is 80% why is it so dangerous

Answer 41

many neoplasms are associated with other primary tumors that are missed and many lesions are asymptomatic until late stage where 5 yr survival is 20%

Question 42

which gland produces salivary amylase?

Answer 42

parotid gland

Question 43

which gland produces lingual lipase?

Answer 43

submucosal layer of the tongue

Question 44

what is xerostomia?

Answer 44

dry mouth incidence higher in pts over 70.

Question 45

presence of xerostomia in burning mouth syndrome suggests what other possible pathology?

Answer 45

hypofunctioning PNS

Question 46

which group of people are most prone to mucoceles

Answer 46

toddlers, the elderly, and tanner on a table at Leinenkugel's. Basically any one with a predisposition to falling

Question 47

what is the treatment of mucocele

Answer 47

complete excision

Question 48

What autoimmune disorder is known for having dry mouth

Answer 48

Sjogren syndrome

Question 49

how common are salivary gland neoplasms

Answer 49

not very common at all

Question 50

What is the relationship between size of gland and likelihood of a neoplasm to become malignant?

Answer 50

inverse bigger gland -> less likely malignant

Question 51

What is a pleomorphic adenoma/mixed tumor?

Answer 51

divergent differentiation of a single neoplastic clone well demarcated mass can become malignant (aggressive) PLAG1 rearrangements

Question 52

Which malignancy of the mouth and face area has a male predominance, it is exclusively parotid, and smokers are at an 8X greater risk?

Answer 52

Warthin Tumor AKA Papillary Cystadenoma Lymphomatosum

Question 53

What is the most common primary malignancy of the salivary glands

Answer 53

Mucoepidermoid Carcinoma (15% of all salivary tumors) 60-70% in parotid but also minor glands

Question 54

What is the chromosomal translocation in Mucoepidermoid carcinoma

Answer 54

11:19(q21;p13) balanced translocation producing MECT1-MAML2

Question 55

What is dangerous about adenoid cystic carcinoma?

Answer 55

50% in minor glands (poor prognosis) unpredictable - 50% disseminate before primary tumor removal

Question 56

What is gingivitis?

Answer 56

Inflammation of the oral mucosa (gums)