Diseases

Question 1

Most common type of oral cancer is?

Answer 1

oral squamous cell carcinoma

Question 2

What can cause mouth ulcers?

Answer 2

systemic disease
idiopathic
trauma
neoplasia

Question 3

Give some examples of systemic conditions which could cause mouth ulcers.

Answer 3

Bechets
Anaemia
HIV
Primary heretiform gingiva stomatitis
Pemphigus
Pemphigoid
Lupus erythematosus
IBD
Peutz Jeghers
Gardener's syndrome

Question 4

Persistant oral white patches which don’t rub off are likely to be?

Answer 4

leucoplakia (premalignant lesion)

Question 5

What would a histological biopsy of leucoplakia show?

Answer 5

alteration in keratinization (hence looks white) AND dysplasia of epithelium

Question 6

what is lichenoid inflammation?

Answer 6

chronic inflammation along the base of the epithelium causing damage to keratinocytes (seen in Lichen planus)

Question 7

which is more concerning a red or white oral patch and why?

Answer 7

red, many are due to dysplasia or malignancy

Question 8

Name 2 causative diseases of oral pigmentation.

Answer 8

Addison’s disease

Peutz-Jegher’s syndrome

Question 9

What is Sjorgren’s syndrome?

Answer 9

a disorder of the immune system with common symptoms of dry mouth and eyes

Question 10

What systemic disease can cause boggy gingivae and why?

Answer 10

leukaemia due to infiltration by malignant cells and immune-compromise

Question 11

How can lymphoma affect the mouth?

Answer 11

palable lymph nodes causing

extra/intraoral diffuse swellings causing ulceration and tooth migration

Question 12

What is recurrent aphthous ulceration (explain the types)?

Answer 12

multiple oral ulcers: 2 types minor (common, <10mm diameter with grey/white centre and thin halo, heals within 14 days with NO scar) and major (>10mm in diameter, persist for weeks/months, heal WITH scarring)

Question 13

Recurrent aphthous ulceration is most common in who?

Answer 13

females and non-smokers

Question 14

How would you treat recurrent aphthous ulceration?

Answer 14

Avoiding triggering food and drink

Corticosteroids may be used to lessen duration and severity

Question 15

Where are the high risk sites for oral squamous cell carcinoma?

Answer 15

floor of mouth, lateral border and ventral surface of the tongue, soft palate and retromolar pad/tonsillar pillars

Question 16

Where will oral squamous cell carcinoma rarely present?

Answer 16

on hard palate or dorsum of the tongue

Question 17

which pre-malignant lesions could become oral squamous cell carcinoma?

Answer 17

leukoplakia (white patch)
lichen planus
submucous fibrosis
erythroplakia (red patch)

Question 18

what are some risk factors for oral squamous cell carcinoma?

Answer 18

Smoking
Alcohol
HPV
Chronic infection
Nutritional deficiencies 
UV exposure

Question 19

How might an oral squamous cell carcinoma present?

Answer 19

Variably: white/red/speckled ulcer/lump
non-healing ulcer
unexplained pain in head or back of neck
numbness
dysphagia
odynophagia

Question 20

What is the prognosis for oral squamous cell carcinoma?

Answer 20

5 year survival in 40-50% of cases as is normally detected late

Question 21

What is more common in the oesophagus, a benign or malignant tumour?

Answer 21

malignant

Question 22

which types of malignancy affect the oesophagus?

Answer 22

squamous cell carcinoma

adenocarcinoma

Question 23

What can GORD be caused by?

Answer 23

incompetent LOS
poor oesophageal clearance
barrier/visceral sensitivity
hiatus hernia
systemic sclerosis

Question 24

what are the risk factors for GORD?

Answer 24

increased abdominal pressure (pregnancy or obesity)
high fat diet
caffeine
alcohol
smoking

Question 25

What are the main presentations for GORD?

Answer 25

heartburn (mainly) | regurgitation and odynophagia (due to oesophagitis)

Question 26

What does GORD cause?

Answer 26

Oesophagitis and if long standing can progress to Barrett's oesophagus which predisposes to cancer

Question 27

what pharmacological treatment would you give a patient with GORD?

Answer 27

Antacids (symptom relief) H2 antagonists (symptom relief) PPI (symptom relief + healing) - best eg: omeprazole

Question 28

which drugs may cause reflux?

Answer 28

``` antihistamines steroids CCBs benzodiazepines antidepressants ```

Question 29

what is Barrett's oesophagus?

Answer 29

A complication of GORD where intestinal metaplasia has occured (change from squamous to columnar epithelium), hiatus hernia is almost always present

Question 30

what does Barrett's oesophagus increase your risk of?

Answer 30

adenocarcinoma

Question 31

why does Barrett's oesophagus occur?

Answer 31

a protective response aiming to change to have goblet cells (stomach mucosa) which will secrete mucin to neutralise the acid but instead results in unstable muscosa at risk of dysplasia

Question 32

How do you diagnose Barrett's oesphagus?

Answer 32

endosopy and biopsy

Question 33

What is the treatment for Barrett's oesophagus?

Answer 33

surveillance PPI removal of lesion endoscopically radiofrequency ablation of lesion

Question 34

What is reflux oesophagitis?

Answer 34

inflammation of the oesophagus due to refluxed gastric contents causing hyperplasia

Question 35

What occurs pathologically in reflux oesophagitis?

Answer 35

basal zone hyperplasia and elongation of CT papillae (due to contant stress on the cells)

Question 36

Why could the LOS be defective?

Answer 36

CNS depressants (alcohol) Pregnancy Hypothyroidism Systemmic sclerosis

Question 37

What is eosinophilic oesophagitis?

Answer 37

inflammation of the oesophagus due to increased eosinophils even though no reflux is occuring

Question 38

what does eosinophilic oesophagitis cause the oesophagus to look like?

Answer 38

corrugated or spotty

Question 39

how would someone with eosinophilic oesophagitis present?

Answer 39

long history of dysphagia heartburn oesophageal pain

Question 40

where is squamous cell carcinoma and adenocarcinoma of the oesophagus most likely to affect?

Answer 40

squamous cell carcinoma: middle and upper thirds adenocarcinoma: lower 1/3 (normally due to reflux)

Question 41

what is squamous cell carcinoma of the oesophagus associated with?

Answer 41

smoking and alcohol

Question 42

what is adenocarcinoma associated with?

Answer 42

Barrett's and GORD

Question 43

how do patient's with oesophageal malignancy often present (is same for both types)?

Answer 43

initially asymptomatic then progressive dysphagia, wt loss, loss of appetite, anorexia and lymphadenopathy