Diagnostic Technique

Question 1

what is objective clinical information

Answer 1

information that can be measured or perceived by the investigating clinician - signs

Question 2

what are examples of objective clinical info

Answer 2

• temperature
• size
• color
• duration
• consistency
• surface contour

Question 3

describe subjective clinical info

Answer 3

• patients own interpretation of a clinical circumstance - symptoms
• relies on neurologic and psychologic experiencs

Question 4

what are examples of subjective clinical info

Answer 4

patient awareness of presence of a lesion, pain intensity, pain quality, temperature

Question 5

describe the differential dx

Answer 5

• orderly sequential approach
  -gathering and analyzing data
• knowledge and experience enable recognition of abnormal findings
• include and/or exclude disease processes based on an educated assessment of the process

Question 6

what data do you gather for the diff dx

Answer 6

• history
• clinical findings- specific/unique signs and symptoms
• lab data

Question 7

what are the ways to clinically describe something

Answer 7

• single vs multiple (aka systemic)
• location
• relative proximity to adjacent structures
• size in dimension (mm)
• outline- well demarcated vs diffuse
• color- red, white, mixed, pigmented
• consistency- firm, flaccid, compressible
• intensity- mild, moderate, intensity, striated, lacy
• base and surface

Question 8

what are the ways you can describe the surface of a lesino

Answer 8

• smooth
• corrugated
  -eroded
• raised
• depressed

Question 9

what are the ways you can describe the base of a lesion

Answer 9

• pedunculated
  -sessile
• nodular
• dome-shaped

Question 10

what is diascopy

Answer 10

compressing tissue with a glass slide to determine vascular nature of a lesion

Question 11

describe what palpation is

Answer 11

feel and press a lesion to yield information about texture, consistency, temperature and function

Question 12

what is probing

Answer 12

palpation with an instrument

Question 13

what instruments are used to probe

Answer 13

• perio probe
• caries explorer
• needle tip

Question 14

what is percussion

Answer 14

striking tissues with fingers or an instrument and listening to resulting pressure changes in the tissues

Question 15

what might percussion might tell you

Answer 15

ankylosis

Question 16

what is aspiration

Answer 16

withdrawal of fluids from a body cavity

Question 17

what is an example of aspiration

Answer 17

needle aspiration of cysts, vascular tumors, purulent swellings

Question 18

what is auscultation

Answer 18

listening for sounds within the body

Question 19

what are the diagnostic lab tests for oral lesions

Answer 19

• biopsy
• immunofluorescence
• exfoliative cytology

Question 20

what are the types of biopsy

Answer 20

incisional
- excisional
- aspirational
- needle

Question 21

what are the indications for a biopsy

Answer 21

• lesion with less than or equal to 14 day duration
• unusual location
• unusual appearance
• suspicion of neoplasia
• any excised tissue
• confirm the dx of systemic disease

Question 22

what would cause suspicion of neoplasia

Answer 22

• persistent ulceration
• persistent erythroplasia
• induration
• fixation
• chronicity
• lymphadenopathy
• unexplained leukoplakia

Question 23

what are the other names for needle biopsy

Answer 23

• fine needle aspiration (FNA)
• fine needle aspiration and cytology (FNAC)

Question 24

what are the indications for needle biopsy

Answer 24

• to determine the cause of tissue enlargement
• to distinguish between benign and malignant processes
• to stage metastatic cancer

Question 25

what are the indications for oral exfoliative cytology

Answer 25

- innocuous lesion - suspicious lesion with negative biopsy - patient refuses biopsy - follow up of treated malignancy - lesion where patient is a poor risk for surgery

Question 26

what are the limitations to needle biopsy

Answer 26

- more technique sensitive with additional preservatives and lab processing - does not localize cells to affected tissues - appositional information to adjacent tissues is lost

Question 27

what are the contraindications for oral exfoliative cytology

Answer 27

- keratotic or crusty mucosa - red, vesicular or velvety mucosa - submucosal swelling with normal mucosa - suspicion of malignancy

Question 28

what are the indications for culture and sensitivity testing

Answer 28

- life threatening infection - unsuccessful previous antibiotic therapy - immunosuppressed patient

Question 29

why is culture and sensitivity testing use limited in dentistry

Answer 29

- difficult for anaerobic conditions - turnover time too long; best attempt trial therapies of certain antibiotics as results may occur quicker than the time interval of the test

Question 30

what do oral cancer screening aids do

Answer 30

- assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone - non invasively asses the malignant potential of a mucosal abnormality

Question 31

what is the goal of tissue autofluorescense imaging

Answer 31

increase the ability to distinguish the lesional mucosal and healthy mucosa

Question 32

describe the sensitivity and specficity in tissue autofluorescence imaging

Answer 32

- high sensitivity but low specificity in distinguishing premalignant and chronic inflammatory lesions - high sensitivity and specificity in identifying areas on dysplasia and invasive cancer that extends beyond the clinically evident lesion

Question 33

describe the light that is seen in autofluoirescence

Answer 33

- we see 500-600nm - blue light of the scope is 400-460 nm - UV is less than 400nm

Question 34

what are the endogenous fluorescing products in autofluorescence

Answer 34

tryptophan, porphyrins, collagen, elastin, flavins, NADH, and fluorophores

Question 35

what are the epithelial fluoresencing compounds in autofluorescence and what does it excite at

Answer 35

- FAD (flavin adenine dinucleotide) excites at 515nm - NADH (nicotinamide adenine dinucleotide) excites at 450 nm

Question 36

what are the commerically available devices for visualization of oral tissue autofluorescence

Answer 36

- identafi 3000 - VELScope - VELScope Vx - DOE Dental Oral Exam System

Question 37

what does dysplasia show on autofluorescence

Answer 37

decreased levels of normal autofluorescence

Question 38

what is an excisional biopsy

Answer 38

where the entire lesion is removed

Question 39

what is an incisional biopsy

Answer 39

only removing a portion of the lesion

Question 40

what type of biopsy is a suture pull

Answer 40

incisional