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Oral Pathology II > Exam 1 - Soft Tissue Diseases 1 > Flashcards

Exam 1 - Soft Tissue Diseases 1 Flashcards

1
Q
  1. A 57 y/o female presents complaining of a “painful mouth,” with multiple, irregular whitish plaques mixed with areas of erythema. The plaques wipe off.

Differential Diagnosis?

A
  • Acute Pseudomembranous Candiasis
    • If it did not wipe off:
    • White sponge nevus
    • Lichen Planus
  • But since it wipes off = candidiasis
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2
Q

What are some predisposing factors of candiasis?

A
  • Systemic antibiotic therapy
  • Systemic corticosteroid therapy
  • Dentures
  • Chronic dry mouth
  • Endocrine diseases (diabetes mellitus)
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3
Q

Why is candiasis white and what can be used to treat it?

A
  • Fungal infection - grows on surface of epithelium and leaving dead cells at surface layer
  • Clotrimazole
  • Nystatin
  • Ketoconazole
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4
Q
  1. A 25 y/o white male presents with “toothache” on right posterior mandible. Badly decayed and broken down first molar, but with a large irregular white plaque on his right buccal mucosa.

Is there anything that can be pursued in order to establish a diagnosis? and what is the diagnosis?

A
  • Start by trying to wipe it off (this case, some does but it bleed underneath)
  • Frictional keratosis - does not wipe off
  • Burn (aspirin burn) - pt put aspirin in area to try and alleviate tooth pain = diagnosis
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5
Q
  1. A 62 y/o white female presents with 1 cm white plaque on left lateral border of her tongue. It is fixed and does not wipe off.

Provisional diagnosis?

A
  • Frictional keratosis (hyperkeratosis) - prove this by looking for the irritant and correct it to see if lesions resolves
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6
Q
  1. A 62 y/o white female presents with 1 cm white plaque on left lateral border of her tongue. It is fixed and does not wipe off.

Differential diagnosis?

A
  • Chemical burn
  • Leukoplakia
  • Frictional keratosis
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7
Q
  1. A 62 y/o white female presents with 1 cm white plaque on left lateral border of her tongue. It is fixed and does not wipe off.

Is there a high risk site for intraoral carcinoma in this case?

A
  • Yes, the lateral border of the tongue and FOM are high risk sites for intraoal carcinoma.
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8
Q
  1. **ON EXAM** a 27 y/o male has asymptomatic white papules on his bucal mucosae, and was unaware of their presence.

What are 4 conditions that this pt might have?

A
  1. Trauma (cheek biting)
  2. Lichen planus - stiate lichen planus, spider-web, there is a papular form of lichen planus
  3. Candidosis
  4. White sponge nevus
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9
Q

What are 4 clinical variants of Lichen Planus?

A
  1. Reticular
  2. Erosive
  3. Papular
  4. Plaque
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10
Q
  1. A 29 y/o white male has buccal mucosae that were covered with extensive white plaques. He is asymptomatic and has had these for as long as he can remember. Does not wipe off, wide-spread tissue change (developmental?)

Provisional diagnosis?

A
  • White sponge nevus - genokeratosis
  • Hereditary - mom or dad should have it (autosomal dominant)
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11
Q
  1. A white 59 y/o male has a white lesion about 1cm in the floor of his mouth. Not wipeable, too localized to be lichen planus.

What conditions can produce a similar appearance, and what is the diagnosis?

A
  • Frictional hyperkeratosis
  • Leukoplakia
  • Severe epithelail dysplasia - diagnosis
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12
Q
  1. A 68 y/o white female presents with a 1x3 cm white plaque on the left posterior lateral border of her tongue. Was painful and occasionally burned, especially when eating spicy foods. Does not wipe off.

Differential diagnosis?

A
  • Allergy (hypersensitivity)
  • Chemical burn
  • Leukoplakia
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13
Q
  1. A 68 y/o white female presents with a 1x3 cm white plaque on the left posterior lateral border of her tongue. Was painful and occasionally burned, especially when eating spicy foods. Does not wipe off.

In the event that this lesion could not be diagnosed clinically, what would you call it?

A

Leukoplakia

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14
Q
  1. A 66 y/o white male complains of unsightly appearance of lower lip. Lesion does not rub off.

What is the first question you would ask this patient?

A
  • How long has it been there?
    • 4 days = probably herpes
    • 4 years = not herpes
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15
Q
  1. A 66 y/o white male complains of unsightly appearance of lower lip. Lesion does not rub off.

Differential diagnosis?

A
  • Recurrent herpes labialis
  • Squamous cell carcinoma (chronic sun exposure)
  • Luekoplakia of Actinic Keratosis
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16
Q
  1. **On exam** 72 y/o white male presents with small 1 cm white plaque on the left posterior lateral border of his tongue at the junction with the floor of his mouth.

Clinical differential diagnosis?

A
  • Leukoplakia (can’t be wiped off) - premalignant
  • Oral squamous cell carcinoma (firm upon palpation)
  • Epithelial dysplasia
17
Q
  1. **On exam** 72 y/o white male presents with small 1 cm white plaque on the left posterior lateral border of his tongue at the junction with the floor of his mouth.

What is the most serious condition that can present as a white plaque?

A
  • Oral cancer (Squamous cell carcinoma)
18
Q

What are 5 histologic features of squamous cell carcinoma?

A
  1. Abnormal mitotic activity
  2. Abnormal keratinization
  3. Increased N:C ratio (nuclear cytoplasmic)
  4. Hyperchromatism
  5. Pleomorphism
19
Q
  1. **ON FINAL** 31 y/o white male has multiple areas of mild erosion on dorsal and lateral borders of his tongue. Many are bordered by distinct white lines. Asymptomatic and unaware of condition.

Provisional diagnosis?

A
  • Benign migratory glossitis (geographic tongue)
20
Q
  1. 46 y/o white female had painful and burning mouth, with multiple red, eroded areas bilaterally on her buccal mucosa.

Before beginning a differential diagnosis, what is missing from this history?

A
  • Correlate medical hx
  • Onset and duration (most important)
21
Q
  1. 46 y/o white female had painful and burning mouth, with multiple red, eroded areas bilaterally on her buccal mucosa.

Differential diagnosis? And what is the diagnosis?

A
  • Lichen planus - diagnosis
  • Erythroplakia
  • Lupus
22
Q
  1. 17 y/o white female presents with a red and eroded lower lip, she says her lip burns and had a fairly rapid onset, slightly swollen.

Differential diagnosis?

A
  • Burn
  • Hypersensitivity - Dx - used new sunscreen (type I hypersensitivity with rapid onset)
  • Erythema Multiforme
23
Q
  1. **ON TEST** 47 y/o female presents with painful gingivae, multiple areas of desquamation of attached gingiva. Epithelium of gingiva could be removed with slight finger pressure.

What 4 conditions can produce this clinical pattern?

A
  1. Lichen Pemphigoid - no striae, + Nikolvsky sign
  2. Lichen Pemphigus - lack striae, + Nikolvsky sign
  3. Lichen Planus - #1, affects gingiva, any striae, - Nikolvsky sign
  4. Toothpaste allergy (cinnamon)
24
Q
  1. **ON TEST** 47 y/o female presents with painful gingivae, multiple areas of desquamation of attached gingiva. Epithelium of gingiva could be removed with slight finger pressure.

What is the definition of chronic desquamative gingivitis?

A
  • Gingival epithelium that spontaneously sloughs or can be removed with minor manipulation.
    • A clinical descriptive term only and not a diagnosis!!!
25
Q
  1. A 64 y/o white female presents with burning sensation of right posteriorlateral soft palate and tonsillar pillar. It is large and irregularly reddened.

A number of conditions can present as red lesions of the oral mucosa, list the common ones?

A
  • Inflammation (chemical or physical stimulus)
  • Erthematous candidiasis
  • Squamous cell carcinoma
  • Erythroplakia
26
Q

In general would your clinical suspicion be higher for a red or white lesion for which you can find no apparent cause?

A
  • Red - 90% higher case for a cancerous lesion than white
27
Q
  1. A 68 y/o white female has burning maxilla, after removing dentures the denture has tissue and maxilla appears red.

Differential diagnosis?

A
  • Denture Stomatitis - “Chronic Erythematous Candidiasis”
  • Atrophic glossitis
  • Erythroplakia
  • Stomatitis areata migrans
28
Q
  1. A 68 y/o white female has burning maxilla, after removing dentures the denture has tissue and maxilla appears red.

How can this be prevented?

A
  • Appropriate denture fitting
  • Taking denture out daily

Treated with anti-fungals:

  • Nystatin, Ketoconazole
29
Q
  1. 62 y/o white female presents with red and white lesion of left posterior buccal mucosae. Has been present for years, sporadically symptomatic. Has had intraoral carincoma 8 years ago, physician treating left cheek for lichen planus.

Differential diagnosis?

A
  • Erythroleukoplakia
  • Lichenoid contact stomatitis
  • Carcinoma In-situ
30
Q
  1. 62 y/o white female presents with red and white lesion of left posterior buccal mucosae. Has been present for years, sporadically symptomatic. Has had intraoral carincoma 8 years ago, physician treating left cheek for lichen planus.

Of what significance is the previous history of cancer, and what is indicated?

A
  • Pt 10-40% more likely for recurrence of oral cancer
  • Biopsy the pt’s lesion
31
Q
  1. 16 y/o male presents with bilateral white and red areas of his buccal mucosa.

Differential diagnosis?

A
  • White sponge nevus
  • Lichen Planus - more striae
  • Frictional keratosis - Chronic cheek biting “Morsicatio Buccarum” (not pre-malignant)
32
Q
  1. 14 y/o african american male - has developed a rash over body and mouth over last 24 hrs. Numerous cutaneous macules and erosions and ulcerations, lips are ulcerated and crusted. Severe pain and can’t eat. Was taking sulfonamides for UTI.

Differential diagnosis?

A
  • Erythema Multiforme (diagnosis)
    • Usually not limited to oral cavity
    • Immune reaction
  • Primary herpetic gingivostomatitis
  • Stevens-Johnson syndrome
33
Q
  1. 14 y/o african american male - has developed a rash over body and mouth over last 24 hrs. Numerous cutaneous macules and erosions and ulcerations, lips are ulcerated and crusted. Severe pain and can’t eat. Was taking sulfonamides for UTI.

Provisional diagnosis?

A
  • Erythema Multiforme - classified as target lesions acrally. Lesions present on trunk and face as well.
34
Q
  1. 14 y/o african american male - has developed a rash over body and mouth over last 24 hrs. Numerous cutaneous macules and erosions and ulcerations, lips are ulcerated and crusted. Severe pain and can’t eat. Was taking sulfonamides for UTI.

Is this life threatening? And how would you treat this patient?

A
  • Yes - can cause sepsis and organ damage
  • Discontinue antibiotics
    • Send to ER
    • Systemic steroids to control inflammation
35
Q
  1. 41 y/o white female complains of erosive condition on skin and mouth. Whitish plaques with red eroded areas bilaterally on buccal mucosa. Has had multiple erythematous areas on skin which were prominant across bridge of her nose.

Differential diagnosis?

A
  • Lupus Erythematosus (SLE) - redness and whiteness looks like lichen planus but skin lesions that are vesicular vs papular
  • Erythema multiforme
  • Pephigus vulgaris
36
Q
  1. 41 y/o white female complains of erosive condition on skin and mouth. Whitish plaques with red eroded areas bilaterally on buccal mucosa. Has had multiple erythematous areas on skin which were prominant across bridge of her nose.

Treatment?

A

Steroid application

Oral Pathology II (5 decks)

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