Exam 5-NON-Infective Stomatitis Flashcards
(93 cards)
1
Q
What is the common name for recurrent apthous stomatitis (RAS)?
A
“canker sores”
2
Q
About what % of the population is affected by recurrent apthous ulcers (canker sores)?
A
20-50%
3
Q
What are two typical precursors to recurrent apthous stomatitis?
A
- trauma 2.emotional stress
4
Q
What is the evidence that apthous ulcers have an immunologic origin?
A
they are T-cell mediated
5
Q
For recurrent aphtous ulcers: specific histocompatibility (HLA) antigens have been associated, indicating a possible WHAT KIND OF predisposition??
A
GENETIC!!
6
Q
What % of apthous ulcers are considered to be minor in nature?
A
80%
7
Q
When do minor apthous ulcers typically begin to develop?
A
childhood or adolescence
8
Q
Which sex is affected more by minor apthous ulcers?
A
Females
9
Q
What are two desriptors of prodromal symptoms of a minor apthous ulcer?
A
burning, itching
10
Q
What is the arbitrary measurement for a “minor” apthous ulcer?
A
1.5cm
11
Q
Minor apthous ulcers can be described as painful WHAT COLOR ulcers with erythematous borders?
A
tan
12
Q
Minor apthous ulcers are almost EXCLUSIVELY on _________ (not _________)!!
A
moveable mucosa (not covering bone)
13
Q
Most minor apthous ulcers often occur on the ______ and _______ mucosa
A
buccal and labial mucosa
14
Q
Minor apthous ulcers heal spontaneously in ____-____ days without scarring
A
7-14 days
15
Q
What are the three forms of recurrent apthous ulcers and what % of the time do each occur?
A
minor: 80%, major: 10%, herpetiform: 10%
16
Q
What is a nickname for MAJOR apthous ulcers?
A
“sutton’s disease”
17
Q
When is the typical onset of major apthous ulcers?
A
adolecence
18
Q
What are the arbitrary measurements of major apthous ulcers?
A
1.5-3cm
19
Q
What are the three most common sites for MAJOR apthous ulcers?
A
1.soft palate 2.tonsilar fauces 3.pharyngeal mucosa
20
Q
For MAJOR apthous ulcers, they can take HOW LONG to heal? AND they may cause ________
A
2-6 weeks…SCARRING
21
Q
What type of apthous ulcers are typically 1-3mm and occur in clusters?
A
herpetiform apthae
22
Q
When is the typical onset of herpetiform apthae?
A
adulthood
23
Q
Which sex is more affected by herpetiform apthae?
A
females
24
Q
Herpetiform apthous ulcers closely resemble WHICH type of herpes virus??
A
herpes simplex virus
25
What is the main difference between herpetiform apthous ulcers and herpes simplex lesions?
herpetiform apthous ulcers occur ANYWHERE in the oral cavity (HSV only on mucosa covering bone)
26
Are there systemic signs/symptoms associated with herpetiform apthous uclers?
Nope
27
How long does it take for herpetiform apthous ulcers to heal?
7-10 days
28
What are the two TOPICAL STERIOD treatment options for apthous ulcers?
1. DexaMethaSone elixer 2.FLU-cin-ON-ide (Lidex)
29
Besides the use of topical steriods to treat apthous ulcers, what other two mediciaments can be used?
Chlorhexidine and Am-LEX-a-NOX (ApthaSOL)
30
Which type of apthous ulcer is associated with systemic disease?
"pseudo" apthae
31
What is the most common source of "pseudo" apthae?
GI malabsorption diseases-c.j. CROHN's disease
32
What are the typical nutritional deficiencies that can lead to "pseudo" apthae? (6 of them please)
Iron, folate (B9), B1, B2, B6, B12
33
What is the name of the syndrome that presents "pseudo" apthous ulcers and is chronic, recurrent disease resulting from a systemic vasculitis??
BEH-CET's syndrome
34
Behcet's syndrome has a _________ basis with strong association with specific HLA types (B51)
Immunogenetic
35
What % of Begcet's syndrome will present in the oral cavity?
99%
36
In Behcet's syndrome, oral lesions are similar to aphthous ulcers and there are usually ___ or more of them in which two areas of the mouth?
6 or more...soft palate and oropharynx
37
Which type of apthous ulcer can be descibed as having RUGGED borders and vary in size and surrounded by diffuse erythema?
pseudo apthae from Behcet's syndrome (Behcet=rugged Borders)
38
Along with the oral manifestations of Behcet's syndrome there are also _______ on skin of trunk and limbs with genital and corneal ulceration
Pustules
39
In Behcet's syndrome 10-25% of people will show WHAT TYPE OF involvement, canparalysis and and dementia?
CNS
40
Which component of Behcet's Syndrome may affect cardiovascular, GI, hematologic, pulmonary, muscular, renal systems?
the VASCULITIS
41
Behcet's syndrome can be treated with systemic and topical _______ anlong with oither immunosuppressives like ________...and then there is always this mouth rinse: ________
steriods...AM-LEX-A-NOX...Chlorhexidine
42
The CAUSE of Lichen Planus is unknown but pathogenesis is ________ mediated through ______ cells, slight association with hepatitis ___:
IMMUNE...T-Cells...Hep C
43
Most patients experiencing Lichen Planus are of what age?
middle-aged adults
44
Which sex does Lichen Planus affect more? How much so?
Females are every 2/3 patients
45
When Lichen Planus affects tissues that are irritated or traumatized its called the _______ phenomenon
KOE-BNER
46
What are the 4 p's of Lichen Planus on the SKIN?
1.purple 2.pruritic 3.polygonal 4.papules
47
Clinically Oral Lichen Planus is described as ________/erosive/bullous/plaque-like clinical appearance
RETICULAR
48
What type of Lichen Planus is characterized by redness and/or ulceration and symptoms??
EROSIVE
49
What is the most common cause of desquamative gingivitis?
LICHEN PLANUS
50
Lichen planus is the MOST common cause of which type of gingivitis???
DESQUAMATIVE gingivitis
51
Histologic features of LICHEN PLANUS: "_______" rete ridges with destruction of the ______ cell layer (aka ________ degeneration)
"Saw-toothed".... BASAL....liquefactive degeneration
52
Histologic features of LICHEN PLANUS: ______ like infiltrate of small ________ (_____) just under the epithelium
BAND like...lymphocytes (T cells)
53
What are lesions that look like LP but aren’t? They are associated with systemic drugs and hypersensativity reactions...especially WHAT 3 culprits??
Lichenoid reactions...1.cinnamon 2.amalgam 3.epithelial dysplasia
54
We talked about TB showing Squamous Cell Carcinoma signs, what is yet another condition that can be diagnosed as such?
Lichen Planus
55
What are the two most common sites for Lichen Planus?
1. buccal mucosa 2.gingiva (a distant 3rd is tongue)
56
What are the two topical steriods that can help control the symptoms of Lichen Planus?
FLU-CIN-ON-IDE (Lidex) and CLO-BET-A-SOL (Temovate)
57
What are the ___ conditions we can treat with FLU-CIN-ON-IDE?
Apthous Ulcers and Lichen Planus
58
What are the 4 types of PemphiGUS? Whats the most common?
1.Vulgaris (MOST COMMON) 2.Vegetans 3.Erythematosis 4.Foliaceus
59
PemphiGUS is a severe progressive ______ disease that affects the skin and mucous membranes
AUTOIMMUNE
60
Where do the first lesions of pemphiGUS appear?
ORAL lesions are first to appear
61
What age range is most common for pemphiGUS?
adults in their 40's and 50's
62
Which connective protein (2 names please) is sought and destroyed in pemphiGUS?
DESMOSOMES (desmo-GLEIN 3)
63
In pemphiGUS Circulating _________ to components of epithelial cell attachments: desmosomes (desmoglein 3)
autoantibodies
64
Clinical features of pemphiGUS: Epithelial __________ produces painful superficial erosions and ulcerations.
deSquamation
65
PemphiGUS affects most mucosal surfaces but often affects _______ producing chronic desquamative gingivitis.
GINGIVA
66
What is the procedure for inducing epithelial separation by manipulating tissue or using lateral pressure?
if there is movement, you have a POSITIVE NIK-OL-SKI sign
67
DO you see blisters in pemphiGUS?
Rarely, the deSquamation breaks early
68
Histologic features of pemphiGUS: the individual cells lose their cohesion and round up (________) producing a suprabasilar separation within the epithelium
(A-canth-o-lysis)
69
Diagnosis of pemphiGUS: Biopsy shows characteristic ________ epithelial separation with ________.
suprabasilar....a-canth-o-lysis
70
Diagnosis of pemphiGUS....Direct immunofluorescence demonstrates autoantibodies (usually WHICH 2???) around the individual keratinocytes (WHAT IS THE ANALOGY??)
IgG and C3...CHICKEN COOP WIRE
71
What is the go to Tx for pemphiGUS?
systemic Steriods
72
What is the term for the fatal form of pemphiGUS?
PARA-neoplastic PemphiGUS
73
Paraneoplasm PemphiGUS affects people who have a neoplasm...WHICH two neoplasms are most common with this condition?
Lymphoma and leukemia
74
What is the term for benign mucous membrane PemphiGOID? (BMMP)
Cica-Tri-cial PemphiGOID
75
What is the chronic, autoimmune disease where patients produce antibodies against the structural proteins in their hemidesmosomes?? (2 names please)
1.BMMP (benign mucous membrane pemphiGOID) 2.Cica-Tri-Cial pemphiGOID
76
BMMP (cicatricial pemphiGOID) is a chronic, autoimmune disease where patients produce antibodies against the structural proteins in their ___________
HEMI-desmosomes (HEMI = GOID)
77
BMMP affects HEMIdesmosomes which anchor the basal ___________ to the underlying connective tissue
keratinocytes
78
What is the average age of BMMP? Does it have a sex preference?
Ages 50-60 MORE COMMON IN FEMALES
79
Which is more common: pemphiGUS vulgaris OR BMMPemphiGOID?
BMMPemphiGOID is CONSIDERABLY more common
80
One way to distinguish between pemphiGUS and pemphiGOID is the amount of proteins they affect....how many for which condition?
pemphiGUS=1 protein (desmosomes)....pemphiGOID=10 proteins that comprise hemidesmosomes
81
Which condition affects oral, ocular, and genital mucosa ± larynx and esophagus and ± skin?
BMMPemphiGOID
82
Which condition can lead to OCULAR SCARRING and BLINDNESS if left untreated??
BMMPemphiGOID
83
Which condition is more severe? PemphiGUS or PemphiGOID?
PemphiGUS is more Severe than pemphiGOID
84
What is the clincial test for BOTH pemphiGUS and pemphiGOID?
a positive Nikolski sign
85
What is the most common site for Benign Mucous Membrane PemphiGOID???
Gingiva
86
Which condition yields BULLAE form at separation of epithelium from connective tissue, producing a subepithelial split from the connective tissue?
Benign Mucous Membrane PemphiGOID
87
In Benign Mucous Membrane PemphiGOID, it can show _______ form at separation of epithelium from connective tissue
BULLAE
88
In the late stages of BMMP blisters rupture, leaving large areas of ________
ulceration
89
What is the normal treatment for benign mucous membrane pemphiGOID?
topical or systemic steroids
90
I REPEAT: DESQUAMATIVE GINGIVITIS can be a clincial menifestation of WHAT 4 conditions?
1.Lichen Planus 2.PemphiGUS Vulgaris 3.Mucous membrane PemphiGOID 4.Allergic reaction
91
Allergic reactions causing DESQUAMATIVE GINGIVITIS: toothpaste: most commonly _____ control toothpastes
TARTAR
92
Allergic reactions causing DESQUAMATIVE GINGIVITIS: CINNAMON: flavored products (containing a flavoring agent called __________)
Cinn-amic Aldehyde
93
Allergic reactions causing DESQUAMATIVE GINGIVITIS: Preservatives like ___________
sodium benzoate
