Diagnostic Techniques

Question 1

Objective

Answer 1

Information that can be measured or
perceived by the investigating clinician;
i.e. signs
e.g. temperature, size , color, duration,
consistency, surface contour, etc…

Question 2

Subjective

Answer 2

Patient’s own interpretation of a clinical
circumstance; i.e., symptoms
Relies on neurologic and psychologic
experiences
e.g. patient awareness of presence of a
lesion, pain intensity, pain quality
(stabbing, burning, shocking, etc…),
temperature, etc…

Question 3

Differential Diagnosis
* Orderly sequential approach
* Gathering and analyzing data
* Knowledge and experience enable
recognition of abnormal findings
* …

Answer 3

Include and/or exclude disease processes
based on an educated assessment of the
process

Question 4

Gather and analyze data
– History
– Clinical findings
(2)
– Lab data

Answer 4

• Specific/unique signs
• Specific/unique symptoms

Question 5

Differential Diagnosis
* Be aware of characteristic (2)

Answer 5

radiographic
appearances

clinical
manifestations

Question 6

• Be aware of characteristic manifestations
  (3)

Answer 6

– Age
– Gender
– location

Question 7

Clinical Description
* single vs multiple, (aka systemic)
* location
* relative proximity to adjacent structures
* size in dimension (mm)
* outline - (2)
* color –(4)
* consistency – (3)
* intensity –(5)
* base and surface

Answer 7

well-demarcated vs diffuse
red, white, mixed, pigmented
firm, flaccid, compressible
mild, moderate, intense, striated, lacy

Question 8

• surface – (5)

Answer 8

smooth, corrugated, eroded, raised,
depressed

Question 9

• base – (4)

Answer 9

pedunculated, sessile, nodular, dome-shape

Question 10

Diascopy

Answer 10

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

Question 11

Palpation

Answer 11

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

Question 12

Probing

Answer 12

• palpation with an
  instrument
• instruments include
  perio probe, caries
  explorer, needle tip, etc.

Question 13

Percussion

Answer 13

• striking tissues with
  fingers or an
  instrument and
  listening to resulting
  pressure changes in
  the tissues
• eg. tooth ankylosis

Question 14

Aspiration

Answer 14

• withdrawl of fluids
  from a body cavity
• E.g., needle aspiration
  of cysts, vascular
  tumors, purulent
  swellings, etc

Question 15

Auscultation

Answer 15

• listening for sounds
  within the body

Question 16

Diagnostic Lab Tests
for Oral Lesions
(3)

Answer 16

1. Biopsy
2. Immunofluorescence
3. Exfoliative Cytology

Question 17

1. Biopsy -
   (4)

Answer 17

Incisional
Excisional
Aspirational
Needle

Question 18

I. BIOPSY INDICATIONS
(3)

Answer 18

• Lesion with > 14 day duration
• Unusual location
• Unusual appearance

Question 19

Suspicion of neoplasia
(7)

Answer 19

– Induration
–Fixation
– Chronicity
– Lymphadenophathy
– Unexplained leukoplakia
–Persistent erythroplasia
–Persistent ulceration

Question 20

III. BIOPSY INDICATIONS
* Any — tissue
* Confirm diagnosis of —

Answer 20

excised
systemic disease

Question 21

Needle Biopsy
aka
(2)

Answer 21

Fine Needle Aspiration (FNA)
Fine Needle Aspiration and Cytology (FNAC)

Question 22

Needle Biopsy
Indications
(3)

Answer 22

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

Question 23

Needle Biopsy
Limitations
(3)

Answer 23

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

Question 24

ORAL EXFOLIATIVE
CYTOLOGY
* Indications
(5)

Answer 24

– 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 25

ORAL EXFOLIATIVE CYTOLOGY * Contraindications (4)

Answer 25

– Keratotic or crusty mucosa – Red, vesicular or velvety mucosa – Submucosal swelling with normal mucosa – Suspicion of malignancy

Question 26

CULTURE AND SENSITIVITY TESTING * Indications (3)

Answer 26

– Life threatening infection – Unsuccessful previous antibiotic therapy – Immunosuppressed patient

Question 27

CULTURE AND SENSITIVITY TESTING * Limited use in dentistry (2)

Answer 27

– Difficult for anaerobic conditions –Turnover time too long; best to attempt trial therapies of certain antibiotics as results may occur quicker than the time interval of the test

Question 28

oral cancer screening aids * Assist in the detection of... * Non-invasively assesses the --- of a mucosal abnormality

Answer 28

early potentially malignant mucosal changes that are difficult to discern by visual inspection alone malignant potential

Question 29

Tissue Autofluorescence Imaging * Increase the ability to distinguish the --- * High sensitivity but low specificity in distinguishing (2) * High sensitivity and specificity in identifying areas of (2) that extends beyond the clinically evident lesion

Answer 29

lesional mucosa and healthy mucosa premalignant and chronic inflammatory lesions dysplasia and invasive cancer

Question 30

❑ Refractory index of tissue drives this -- We see -- Blue light of the scope = -- UV =

Answer 30

500-600 nm 400-460 nm <400 nm

Question 31

Many endogenous fluorescing products: (7)

Answer 31

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

Question 32

Epithelial fluoresencing compounds: -- FAD (flavin adenine dinucleotide) excites at --- nm -- NADH (nicotinamide adenine dinucleotide) excites at --- nm

Answer 32

515 450