Exam 3 - Acute/Chronic Ulceration Part 2

Question 1

What is another name for Aphthous Stomatitis/ulcer?

Answer 1

Canker Sore

Question 2

What category does Aphthous Stomatitis/ulcer fall under?

Answer 2

Immune-mediated

Question 3

Describe the etiology of aphthous ulcer

______________ produce ___________ (inflammatory cytokine)]

Answer 3

CD8+ T-cells produce TNF-a (inflammatory cytokine)]

Trigger is “different things in different people”

Question 4

T/F You are more liekly to see an Aphthous Stomatitis/ulcer in young adults or children.

Answer 4

True

Question 5

Name the pathology:

Ulcer with yellow-white fibrinopurulent membrane, encircled by an erythematous halo

Answer 5

Aphthous Stomatitis “Canker Sores”

Question 6

T/F Aphthous Stomatitis “Canker Sores” occur on nonkeratinized (moveable) mucosa.

Answer 6

TRUE

Question 7

Where do Aphthous Stomatitis “Canker Sores” occurs?

Answer 7

Non-kerat tissue moveable mucosa)

Question 8

Name the pathology:

CD8+ T-cells produce TNF-a (inflammatory cytokine)]

Trigger is “different things in different people”

Answer 8

Aphthous Stomatitis “Canker Sores”

Question 9

How to diagnose aphthous stomatitis/ulcer?

Answer 9

Clinically

Histopath is NOT diagnostic

Question 10

How would you tx an aphthous stomatitis?

Also include how you would tx recurrent cases.

Answer 10

Heal without tx

Topical steroid or steroid rinse for recurrent cases

Laser ablation shorten duration and decreases symptoms, but may not be practical in all cases

Question 11

Name the aphthous ulcer (minor, major, or herpetiform)

MOST COMMON (80%)
Fewer recurrence
Shortest duration

Answer 11

Minor

Question 12

Larger than minor aphthae
Tend to be recurrent
Take 2-6 weeks to heal
Scarring can occur

Answer 12

Major

Question 13

What type of apthous ulcer can a scar occur?

Answer 13

Major

Question 14

How long does it take for a major apthous ulcer to heal?

Answer 14

2-6 weeks

Question 15

What aphthous ulcers tend to recur?

Answer 15

All can recur

Minor experience fewer recurrences

Major and Herpetiforme tend to recur

Question 16

Name the aphthous ulcer (minor, major, or herpetiform)

Tend to have multiple ulcers, but each ulcer is smaller than minor aphthae

Tend to recur

Heal in 7-10 days

Answer 16

Herpetiforme

Question 17

How long does it take for herpetiform aphthous ulcers to heal?

Answer 17

Heal in 7-10 days

Question 18

T/F Minor aphthous ulcers are smaller than herpetiform aphthous ulcers.

Answer 18

FALSE
each herpetiforme ulcer is smaller than minor aphthae

Question 19

What are reported causes of aphthous stomatitis? (10 things)

A
G
H
H
I
I
N
S
S
T

Answer 19

Allergies

Genetic predisposition

Hematologic abnormalities

Hormonal influence - progesterone hypersensitivity

Immunologic factors

Infectious agents

Nutritional deficiencies

Smoking cessation

Stress (Mental and physical)

Trauma

Question 20

What is the name for multiple aphthous ulcers that often recurr?

Answer 20

Recurrent aphthous stomatitis

Question 21

Recurrent aphthous stomatitis

What are the 6 associated systemic disorders?

Mnemonic:
Big
Cool
Cats
Chase
Unlucky
Nachos

Answer 21

Behcet disease- Genital and oral ulcers

Celiac disease- itchy rash, GI problems, allergy to gluten

Cyclic neutropenia- Ulcers occur repeatedly on 21 day cycle

Crohn’s disease- Pyostomatitis vegetans, Cobblestone lesions, Linear ulcers/fissure in the vestibule

Ulcerative colitis

Nutritional deficiencies

Question 22

Name the associated systemic disorder for recurrent aphthous stomatitis.

Genital and oral ulcers

Answer 22

Behcet disease

Question 23

Name the associated systemic disorder for recurrent aphthous stomatitis.

itchy rash (puritis), GI problems, allergy to gluten

Answer 23

Celiac disease

Question 24

Name the associated systemic disorder for recurrent aphthous stomatitis.

Inherited condition where there is a mutation that affect the maturation of neutrophils
Ulcers occur repeatedly on 21 day cycle because every 21 days neutrophils really plummet
You will notice a pattern to ulcers appearing

Answer 24

Cyclic neutropenia

Question 25

T/F Pyostomatitis vegetans that occurs in IBD can be painful.

Answer 25

True - variability of pain

Question 26

Name the oral lesions that are found in Crohn's disease and Ulcerative Colitis.

Answer 26

Both can have aphthous ulcers and pyostomatitis vegetans. Crohn's disease also has cobblestone lesions and linear ulcer/fissure sin the vestibule.

Question 27

Describe the clinical presentation of pyostomatitis vegetans (4 things)

Answer 27

"Snail track" lesions Variable Painful Yellow-ish, slightly elevated, pustule on red oral mucosa Most common on buccal and labial mucosa, soft palate, and ventral tongue

Question 28

Where is it most common to find pyostomatitis vegetans?

Answer 28

Most common on buccal and labial mucosa, soft palate, and ventral tongue

Question 29

What category does Allergic contact stomatitis fall under?

Answer 29

Immune mediated

Question 30

T/F Allergic contact stomatitis is more common in females.

Answer 30

TRUE

Question 31

Name the pathology: Immune-mediates Burning sensation Erythema with or without edema Superficial ulcerations may be present Rarely vesicles are seen

Answer 31

Allergic contact stomatitis

Question 32

T/F Vesicles are common clinical presentation of allergic contact stomatitis

Answer 32

FALSE

Question 33

How to diagnose Allergic contact stomatitis? (2 things)

Answer 33

Temporal relationship between use of the agent and eruption Patch testing may be used in identifying allergen

Question 34

How to tx Allergic contact stomatitis?

Answer 34

Allergic contact stomatitis?

Question 35

Erythema multiforme falls under what category?

Answer 35

Immune-mediated

Question 36

Name the pathology Triggered by infection: Mycoplasma pneumoniae (Respiratory tract infection) Herpes simplex virus 1 (HSV-1) Triggered by medication: 4 things NSAIDs, Sulfonamides (Antibiotic), Anti seizure medications, Antibiotics

Answer 36

Erythema multiforme

Question 37

What can trigger Erythema multiforme? give examples

Answer 37

Infections: Mycoplasma pneumoniae (Upper respiratory tract infections) Herpes simplex virus 1 (HSV-1) Medications: (mnemonic NASA) NSAIDs Antibiotics Sulfonamides (Antibiotic) Anti seizure medications

Question 38

What is the average age to see Erythema multiforme?

Answer 38

Average age range is 20-40 yrs old

Question 39

T/F Generally medication induced Erythema multiforme is seen on the first time the pt takes the medication.

Answer 39

TRUE - so then recommend the pt stand clear of that drug

Question 40

What are the three main clinical presentations of Erythema multiforme?

Answer 40

Diffuse oral ulcerations Hemorrhagic crusting of the lips Targetoid skin lesions on extremities

Question 41

How would you diagnose Erythema multiforme ?

Answer 41

Clinical history and presentation - usually the best Identification of drug Bloodwork for mycoplasma pneumonia and HSV-1 IgM antibodies (IgM - recent infection marker whereas Ig-G would just be an indication the person had previously had infection)

Question 42

Diagnosis of Erythema multiforme: Bloodwork for _________ ___________ and _________, _______antibodies

Answer 42

Bloodwork for mycoplasma pneumonia and HSV-1, IgM antibodies

Question 43

How do you tx erythema multiforme?

Answer 43

Self limiting (2-6 wks) - supportive care sometimes steroids work

Question 44

Name the pathology: Area of erythema around a central yellow fibrinopurulent membrane May develop a rolled white border of hyperkeratosis adjacent to ulceration Some form of injury (biting, sharp tooth, puncture, etc.)

Answer 44

Traumatic ulcer

Question 45

T/F There is no need to biopsy a traumatic ulcer.

Answer 45

FALSE If lesion persist beyond two weeks you should biopsy to rule out SSC. Note it could also be a chronic ulcer.

Question 46

How would you tx a traumatic ulcer?

Answer 46

Remove source of trauma Heals with time

Question 47

What is the etiology of syphilis? What are the two examples of how it can spread.

Answer 47

Treponema pallidum (spirochete) Spread by direct contact with mucosal surfaces: Sexual contact and Mother to fetus

Question 48

There are Three stages of syphillis (primary, secondary, tertiary). Which stage is the most hard to detect? Which two stages are you most infectious?

Answer 48

First stage hard to detect Most infectious first two stages

Question 49

What are the clinical presentation of primary syphilis?

Answer 49

Chancre Solitary papular lesion with central ulceration 85% genital, 4% oral Regional LAD

Question 50

T/F Symptoms resolve in a few days for primary syphillis, even without tx.

Answer 50

True!

Question 51

When does secondary syphilis usually occur?

Answer 51

Occurs 4-10 weeks after initial infection

Question 52

What are the systemic symptoms of Secondary Syphilis? 6 things

Answer 52

Painless!!! LAD Sore throat Malaise Headache Weight loss Fever

Question 53

What are the clinical presentations of secondary syphilis?

Answer 53

Systemic symptoms (Painless LAD, Sore throat, Malaise, Headache, Weight loss, Fever) Diffuse maculopapular cutaneous rash Split papule (Papule in the crease of the oral commissure) Mucous patch (Whitish, elevated plaque that cant be wiped off, Frequently on tongue, lip, buccal mucosa, and palate) - sometimes doesnt look like a patch

Question 54

What are the clinical presentations of tertiary syphilis?

Answer 54

Gumma: Indurated, nodular, ulcerated lesion May cause extensive tissue destruction through and through Usually affect palate or tongue You make think of necrotizing sialometaplasia but these lesions are often even deeper than those Affects vascular system and CNS. Can result in paralysis, psychosis, dementia, and death.

Question 55

Match with the correct stage of syphilis. Gumma: Indurated, nodular, ulcerated lesion May cause extensive tissue destruction through and through Usually affect palate or tongue You make think of necrotizing sialometaplasia but these lesions are often even deeper than those

Answer 55

Tertiary Syphilis

Question 56

Match with the correct stage of syphilis. Affects vascular system and CNS. Can result in paralysis, psychosis, dementia, and death.

Answer 56

Tertiary Syphilis

Question 57

Match with the correct stage of syphilis. Split papule (Papule in the crease of the oral commissure)

Answer 57

Secondary Syphilis

Question 58

Match with the correct stage of syphilis. Mucous patch (Whitish, elevated plaque that can't be wiped off, Frequently on tongue, lip, buccal mucosa, and palate)

Answer 58

Secondary Syphilis

Question 59

Match with the correct stage of syphilis. Diffuse maculopapular cutaneous rash

Answer 59

Secondary Syphilis

Question 60

Match with the correct stage of syphilis. Chancre Solitary papular lesion with central ulceration 85% genital, 4% oral

Answer 60

Primary Syphilis

Question 61

Primary Syphilis Chancre Solitary papular lesion with central ulceration ______ genital, ____ oral

Answer 61

85% genital 4% oral

Question 62

T/F Syphilis incidence is increasing.

Answer 62

True

Question 63

How to diagnose syphilis?

Answer 63

Biopsy: Spirochetes under microscope Blood tests: Venereal disease Research Laboratory (VDRL) Rapid Plasma Reagin (RPR) Results can be negative for up to 6 weeks after initial infection

Question 64

T/F Results can be negative for up to 10 weeks after initial infection of syphilis

Answer 64

FALSE 6 wks not 10

Question 65

How do you tx syphilis?

Answer 65

Antibiotics (penicillin)

Question 66

Mucous Membrane Pemphigoid falls under what category?

Answer 66

Immune mediated (Chronic)

Question 67

Pemphigus Vulgaris falls under what category?

Answer 67

Immune-mediated Chronic

Question 68

Name the pathology: Autoantibodies against hemidesmosomes and components of basement membrane"

Answer 68

Mucous Membrane Pemphigoid

Question 69

Name the pathology: Autoantibodies against components of desmosomes

Answer 69

Pemphigus Vulgaris