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Oral path 2 final > final > Flashcards

final Flashcards

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1
Q

what is due to defect in normal keratinization of oral mucosa?

A

white sponge nevus

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2
Q

white sponge nevus affects what and what are the signs and symptoms

A

WSN affects buccal mucosa mainly but can also affect nasal, esophageal, laryngeal, anogenital mucosa
asymptomatic thick white appearance

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3
Q

Biopsy of WSN shows what?

A

WSN: parakeratosis w acanthosis, perinuclear eosinophilic condensation which is pathognomic to WSN

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4
Q

WSN tx and prognosis

A

WSN tx is NOT necessary, harmless condition Good prognosis

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5
Q

what % of Peutz Jeghers syndrome pts are new mutations?

what gene is affected in Peutz Jeghers

A

35% new mutations!

SKT 11 gene affected which encodes for a serine threonine kinase

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6
Q

what is the frequency of Peutz Jeghers syndrome cases

A

1:100,00- 1:200,000 births

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7
Q

Peutz Jeghers syndrome dead giveaway sign?

Are the polyps from PJ pre-cancerous?

A

PJ= freckle like lesions which develop on hands, periorifical skin, and oral mucosa
Polyps in GI tract are NOT precancerous like in Gardners Syndrome

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8
Q

Peutz Jeghers syndrome pts have how many times INC risk for cancer?
what happens to their bowels?

A

PJ pts 18X more at risk for cancer!

Their bowel obstruct due to intussusception (telescoping of proximal segment)

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9
Q

What is the frequency of hereditary hemorrhagic telangiectasia?
lesions of HHT are most common where?

A

1: 10,000

lesions of HHT most common on vermillion zone of lips, tongue, and buccal mucosa

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10
Q

what is the initial clue to HHT?

where else may HHT be seen besides orally?

A

frequent spontaneous epistaxis

HHT may also be seen on hands and feet, GI mucosa, genitourinary mucosa, and conjunctival mucosa

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11
Q

what % of HHT pts have AV fistulas of lungs?
of liver?
of brain?

A

HHT AV fistula in lungs= 30%!
AV fistulas in liver = 30%
AV fistulas in brain 10-20%

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12
Q

3 out of what 4 things must be present for diagnosis of HHT

A

recurrent, spontaneous epistaxis
telangiectasias of mucosa and skin
AV malformation involving lung, liver, or brain
family history of HHT

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13
Q

What is the tx for mild HHT?
moderate HHT?
Severe HHT?

A

Mild HHT: no Tx
moderate HHT: selective cryotherapy or electrocautery of bothersome lesions
Severe: septal dermoplasty

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14
Q

HHT brain AV fistulas that get bacteremia from dental procedures occur in what % of pts? so what should be done for these pts?

A

HHT AV fistulas of brain bacteremia occurs 1% of pts : so these pts should get prophylactic ABs

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15
Q

What is the mortality rate for HHT pts?

what is the mortality rate for HHT pts with brain abscesses?

A

HHT mortality rate= 1-2% due to blood loss

HHT mortality rate w brain abscess= 10%

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16
Q

Pemphigus vulgaris autoantibodies destroy what? so a split occurs where in the tissue?

A

PV= autoAB destroy desmosomes

PV inhibits adherence so a split develops within the epithelium

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17
Q

PV occurs in who?

what percent of PV pts present w oral lesions? what are the oral lesions?

A

Rare no sex predilection but in older pts around 50.

More than 50% have oral lesions of superficial ragged erosions and ulcerations

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18
Q

where does PV occur?

PV is positive for what?

A

PV occurs on any oral mucosa, flacid bull on skin, intact oral blisters rare
+ Nikolsky sign!

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19
Q

in PV what is the 1st to show and last to go? common oral lesion?

A

ORAL LESIONS!

shallow ulcerations right along the marginal gingival area

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20
Q

DIF is used for what and what animal?

IFF is used for what and what animal?

A 
DIF: detects autoABs bound to pts tissues
DIF= goat
IIF: detects autoAbs 
circulating in blood
IIF: monkey
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21
Q

For each disease is DIF +/-? IIF +/-?
PV?
MM pemphigoid?
Bullous pemphigoid?

A

PV: + DIF and + IIF
MM pemphigoid: + DIF, - IIF
Bullous pemphigoid: + DIF and + IIF

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22
Q

PV shows what microscopically?

A

PV= INTRAepithelial clefting in basal layer and acantholysis- breakdown of spinous layer

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23
Q

Mortality rate of PV?

tx of PV?

A

PV= 5-10% mortality rate!

PV tx= systemic corticosteroids

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24
Q

what is 2x more common than PV and has a 2:1 female predilection? what is the average age?

A

Mucous membran pemphigoid: 2:1 females

average age 50-60 y/o

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25
In MM pemphigoid what tissue is affected? | Is oral scarring common?
MM pemphigoid affects any mucosal surface and skin cutaneous lesion and conjunctival scarring is common ORAL Scarring is RARE!
26
What diseases present with desquamative gingivitis?
MM pemphigoid, oral lichen planus, pemphigus vulgaris
27
what is the most significant aspect of MM Pemphigoid
MM pemphigoid- ocular involvement! could lead to blindness
28
MM pemphigoid shows what under the microscope? | pemphigoid attacks what?
MM pemphigoid= SUBepithelial cleft cromation- separation of epithelium from CT at BMZ MM pemphigoid attacks hemidesmosomes
29
what % of Bullous pemphigoid pt have oral lesions? what is the initial complaint of bullous pemphigoid?
8-39% of bullous pemphigoid pts have oral involvement | Pruritus is common initial complaint
30
what two diseases have SUBepithelial clefts?
bullous pemphigoid and MM (cicatrical) pemphigoid have SUBepithelial clefts
31
Tx of Bullous pemphigoid
most cases of BP resolve spontaneously in 1-2 years
32
what is a acute, self limiting ulcerative disorder that resolves in 2-6 weeks? what is the sexual predilection and average age?
Erythema multiform | EM: female predilection, adults in 20-30s
33
EM etiology
50% unknown 25% preceding infections 25%: medication related
34
clinical features of EM include what
target lesions of skin, hemorrhagic crusting of lips, widespread oral ulcers w ragged margins, l and B mucosa, tongue bright red conjunctiva- blood shot eye
35
Erythema multiform histo
keratinocyte destruction, sub epithelial edema, perivascular inflammation
36
What % of EM recur? when?
EM: 20% of cases recur in autumn and spring
37
EM mortality rate, EM major? TEN?
EM Major : 2-10% mortality | TEN: 34% mortality rate
38
What is similar to psoriasis?
Erythema Migrans is similar to psoriasis | Erythema migrans AKA geographic tongue, migratory glossitis
39
Cutaneous lichen Planus affects who? | what is a characteristic sign of cutaneous lichen planus? along with the oral cavity where can this occur?
CLP: female predilection 30-60 y.o CLP: purple polygonal pruritic papules w Wickham striae flexor surface of wrists, lumbar region and shins
40
SLE affects who more? average age?
SLE affect women 8-10 times more than men especially black women! Average age 31 y/o
41
SLE clinical signs include
Malar butterfly rash which spares nasolabial folds, and skin lesions that flare w sun exposure
42
what percent of SLE pts have renal involvement? | what percent of SLE pts have sterile vegetations on heart valves?
40-50% of SLE pts have renal involvement | 50% of SLE pts have vegetations on heart valves
43
what % of SLE pts have oral lesions? what tissues do they affect?
5-25% of SLE pts have oral lesions | SLE affects palata, buccal mucosa, or gingiva
44
What diseases are treated with anti-malarial drugs?
Mild SLE and severe Chronic cutaneous lupus
45
what is the 5 year survival of SLE? 15 year of SLE? prognosis worst for who
SLE 5 year: 95% SLE 15 year: 75% prognosis for SLE is worse for men
46
what almost exclusively affects skin and mucosa that resembles erosive LP
Chronic cutaneous lupus: waxes and wanes
47
what % of Chronic cutaneous lupus pts transform to SLE? | what % resolve after a few years?
5% | CCL 50% resolve after several years
48
systemic scleroris show autoABs directed against what
Systemic sclerosis= Scl70 topoisomerase 1
49
Crest syndrome is associated with what
Crest syndrome= anticentromere ABs
50
Crest syndrome 6 year survival? | Crest syndrome 12 year survival?
Crest 6 year: 80% | 12 year: 50%
51
what is the sensitivity of COE? Specificity of COE? are auxiliaries as accurate as dentists?
COE sensitivity = 85% COE specificity= 97% YES!
52
what is a test used to analyze abnormal finding or symptomatic pt in order to establish or suggest a diagnosis?
case finding test
53
what is a test used on people apparently free of disease in order to detect the disease in early stages
a screening test
54
what is the only diagnostic aid that is a case finding test aid? what is it used for?
Brush test Oral Cdx: used to test the common, small, harmless appearing white or red tissue spots you see several times each NO DIAGNOSIS IS GIVEN!!!
55
Brushtest gives a lot of what kind of results
Brushtest gives a lot of false negative results
56
Vizilite components? | Vizilite lit review results?
Vizilite components include acetic acid, light stick and Toluidine blue dye Vizilite is unable to discriminate benign from pre-malignant lesions No clear evidence better than COE
57
What does VELscope stand for? | Reviews of VELscope
VELScope= Visually enhanced lesion scope VELscope normal tissue is pale green, abnormal tissue is dark False negatives and False positives for VELscope
58
VELScope has what % of false positives? | VELScope is also used how?
VELScope= 90% false positives | VELscope also used as case finding tool in surgical margin delineation- extends margins beyond COE alone
59
Describe Identafi
Identafi: hand-held cordless multi spectral fluorescence and reflectance spectroscopy w 3 colors: white for COE, violet for tissue fluorescence, and amber light for suspected abnormalities
60
describe OralD which was introduced in 2013
uses a light, glasses and CytID for fluorescence and liquid base cytology but clinical application of device has NOT been proven
61
What percent of oral cancer is diagnosed in stage 3-4
63% of oral cancer is diagnosed in stage 3-4
62
what are the high risk sites for oral cancer/ dysplasia
ventro lateral tongue, floor of mouth and lateral soft palate/ anterior tonsillar pillars
63
what are the suspicious physical features
crisply defined red, white, or mixed red and white lesions, persistent ulceration and induration

Oral path 2 final (1 decks)

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