FINAL EXAM Flashcards
1
Q
which HPV types are sexually transmitted? (2)
A
condyloma acuminatum
HPV 16, 18
2
Q
cutaneous lichen planus affects where?
A
–Flexor surface of wrists, lumbar region,
shins, but other locations
3
Q
___________precursor lesion for cutaneous squamous cell carcinoma. “________” texture. Tx either _________ or ____________ such as _______. Use of _________, limit __________
A
Actinic keratosis
sandpaper
surgical excision
topical, immune-activating agents
Aldara
sun blocking agents
sun exposure.
4
Q
cutaneous lichen planus may take how long to resolve?
A
7-10 yrs
5
Q
• Treatment:
Hypohidrotic ectodermal dysplasia
(2)
A
–Genetic counseling patients and
parents
–Treatment plan may include fixed,
removable, implants, ortho, etc.
depends on individual case
6
Q
where does bullous pemphigoid occur?
A
primarily on skin, but mucous membrane involvmenet occurs
7
Q
Has also been termed “Scleroderma” sclero
= hard; derma = skin
A
Systemic sclerosis
8
Q
erythema migrans occurs where? Characteristically dorsal and lateral
anterior 2/3 of the tongue
A
Characteristically dorsal and lateral
anterior 2/3 of the tongue
9
Q
A
systemic lupus erythematosus
10
Q
treatment for squamous papilloma
A
conservative excision
11
Q
squamous papilloma common sites (5)
A
tongue, uvula, soft palate, and lip, but any location
12
Q
- ________, cause?, blends with surrounding
- ________.
A
Idiopathic osteosclerosis - dense vital bone, no identifiable etiology, blends with surrounding
trabeculae.
13
Q
HPV enters where? and infects what?
A
epithelial cells- mucosa + skin
infects basal cells
14
Q
Immune-mediated
– Different process than EM (con’t):
• Difference between SJS and TEN: (3)
A
–Degree of skin involvement
• SJS <10% and usually younger patient • TEN >30% and usually over 60 y.o.
15
Q
E6 and E7 in HPV allow cell to what/
A
cell to grow in uncontrolled manner and avoid cell death
16
Q
– CREST syndrome • Treatment:
A
–Symptomatic - similar to systemic
sclerosis
17
Q
clinical features of verruca vulgaris?
A
painless papule
papillary projections or rough surface
18
Q
A
cutaneous lichen planus
19
Q
\_\_\_\_\_-most common in \_\_\_\_\_-food, etc. gets caught between the overlying soft tissue (operculum) and crown of partially impacted tooth. Ideally, remove \_\_\_\_ and opposing \_\_\_\_. May need to initially decrease \_\_\_\_\_\_ e.g. with \_\_\_\_, then \_\_\_\_\_.
A
Pericoronitis-most common in mandibular third molars-food, etc. gets caught between the overlying soft tissue (operculum) and crown of partially impacted tooth. Ideally, remove offending tooth and opposing third molar. May need to initially decrease local inflammation e.g. with rinses, then surgery.
20
Q
____________-focal increase in melanin; also can occur as ________ in response to _________
A
Melanotic macule-focal increase in melanin; also can occur as reactive melanosis in response to local
trauma.
21
Q
Peutz-Jeghers syndrome
can cause what?
A
bowel obstruction due to
intussusception (“telescoping” of proximal segment into distal segment)
22
Q
Lupus erythematosus
• Diagnosis:
for CCLE?
SLE?
A
–Clinical appearance skin lesions in CCLE
characteristic
–SLE - criteria by American Rheumatism
Association for clinical and lab findings
23
Q
-variant of seborrheic keratoses that occur in ___________.
A
Dermatosis papulosa nigra
African Americans
24
Q
Immune-mediated – EM, SJS and TEN
• Histopathologic features: (4)
A
–Subepithelial or intraepithelial vesicles
–Necrotic basal keratinocytes
–Mixed inflammatory cell infiltrate
–May see perivascular inflammation
25
acute exposure of nicotine exposure
mouth, throat irritation, dry cough
adverse physiologic effects on lung function?
no chance in CBC, lung or cardiac function
26
– Systemic sclerosis
• Radiographic features (3)
–Diffuse widening of periodontal
ligament
–Resorption of posterior ramus,
condyle, coronoid process or chin in
10-20%
–May see root resorption
27
what is the term for producing and inhaling vapors by placing e-liquid drops directly onto heated atomizer coils?
dripping
28
measures the amount and pattern
of antibodies in your blood that work against your own body; a non-specific finding but can be used as a screening tool.
anti-nuclear
antibodies
29
Chronic cutaneous lupus erythematosus is exacerbated by
sun exposure
30
pemphigus vulgaris
31
what does crest sydnrome stand for
–Calcinosis cutis
Raynaud’s
phenomenon, Esophageal dysfunction, Sclerodactyly, and Telangiectasia
32
which HPV type is a high risk for cancer?
HPV 16/18
33
-patients may be symptomatic e.g. tongue sensitive to spicy or acidic food, when
lesions are present.
Geographic tongue-patients may be symptomatic e.g. tongue sensitive to spicy or acidic food, when
lesions are present.
34
-intracellular edema
Leukoedema-intracellular edema
35
what is an e-cigarette?
electronic nictoine delivery system
36
mucous membrane pemphigoid (MMP) occurs where?
–Any mucosal surface, occasionally affects
skin
37
chronic cutaneous lupus erythematosus
AKA
discoid lupus
38
– Oral lichen planus (OLP/ELP)
• Treatment: (4)
rule out?
Reticular LP tx?
ELP treat with?
–Rule-out candidiasis; treat if + culture
–Reticular LP usually no Tx needed
• Patient may feel “rough” areas of
hyperkeratosis, but no pain
–ELP treat with potent topical steroid
• “off label”
• Systemic steroids not needed
–Biopsy any suspected pre-
malignant/malignant lesion
39
\_\_\_\_\_\_\_\_\_-punched out _______ that do not regenerate. Seen
in persons with ______ and/or \_\_\_\_\_\_\_
Necrotizing ulcerative gingivitis (NUG)-punched out interdental papillae that do not regenerate. Seen
in persons with poor oral hygiene and/or poor diet and stress.
40
Describe lesions of – Chronic cutaneous lupus erythematosus
| (CCLE) (2)
–Skin – scaly, erythematous patches in
sun-exposed areas, esp. H&N
• Heal then reappear in different area;
may result in atrophy of and scarring
with hypo- or hyperpigmentation
41
• Immune-mediated
– Bullous pemphigoid (BP)
• Treatment:
–Management similar to cicatricial
pemphigoid, but most BP cases resolve spontaneously in 1-2 years
42
– Peutz-Jeghers syndrome
• Prognosis:
–Intussusception may self-correct or
may require surgery to prevent ischemic necrosis
–If cancer develops, treat appropriately
43
describe appearance of MMP mucous membrane pemphigoid?
–May see intact intraoral blisters
–Desquamative gingivitis
– descriptive
term: erythema, desquamation, ulceration
• May be seen in several disorders
44
what erythema migrans caused by?
Erythema is due to atrophy of filiform
papillae and shearing off of the parakeratin - remaining epithelium thins, results in red appearance
45
“freckles” brown pigmentation that develops following sun exposure. More common in _______ and ________ individuals.
ephelides
children + fair skinned individuals
46
erythema migrans
47
describe prognosis of pemphigus vulgaris with corticosteroid therapy?
–Complications of long-term steroid
may lead to mortality –Today, 5-10% mortality, usually due
to complications of therapy (side
effect of steroids, immune-
suppression; azathioprine suppresses
bone marrow and is a carcinogen)
48
erythema migrans occurs in _______ pts who have \_\_\_\_\_\_
1/3
fissured tongue
49
hereditary hemorrhagic telangectasia (HHT)
50
deposition of a
band of immunoreactants at the basement membrane zone of normal skin;
Positive lupus band test
51
most common of autoimmune blistering conditions
bullous pemphigoid
52
-vital lamellar bone.
Mandibular tori-vital lamellar bone.
53
Two forms of oral lichen planus
–Reticular (lacy white lines)
–Erosive (ELP)- erythematous, may
ulcerate
54
-inflamed _________ of the palate with\_\_\_\_\_\_ around the
\_\_\_\_\_. Most commonly seen in \_\_\_\_\_\_\_; can also be seen with long-term use of \_\_\_\_\_\_\_\_
Nicotine stomatitis-inflamed minor salivary glands of the palate with hyperkeratosis around the
orifices. Most commonly seen in pipe smokers; can also be seen with long-term use of hot beverages.
55
–Acute onset ulcerative disorder skin and
mucous membranes
erythema multiforme
56
-collection of \_\_\_\_\_\_\_\_\_. Maxillary sinus lining will be superior to the
\_\_\_\_\_\_\_\_. May get referred pain to maxillary teeth with\_\_\_\_\_\_\_ e.g. during \_\_\_\_\_\_.
Antral pseudocyst-collection of fluid below maxillary sinus. Maxillary sinus lining will be superior to the
fluid collection. May get referred pain to maxillary teeth with altitudes e.g. during flying.
57
CREST syndrome
58
Oral lichen planus – lichenoid mucositis
59
heriditary pattern of
Hereditary hemorrhagic telangiectasia (HHT)
autosomal dominant
60
where do oral mucosa lesions of condyloma acuminatum usually occur? (3)
labial mucosa
lingual frenum
soft palate
61
– Systemic sclerosis
• Histopathologic features:
–Diffuse deposition of collagen
throughout the superficial connective tissue
62
describe apperance of white sponge nevus?
Thick, white appearance of buccal
mucosa bilaterally
63
Immune-mediated
– Different processes than EM
• Prognosis SJS and TEN:
–Mortality rate
• SJS 1% - 5% • TEN 25% - 30%
64
Name 4 clinical features of hypohidrotic ectodermal dysplasia
–Fine, sparse blond or light color hair, eyebrows, eyelashes –Hypodontia –Oligodontia (lack of development of 6 or more teeth) –Conical roots
65
– Erythema multiforme (EM)
• Etiology (3)
–50% cases- unknown
–25% - preceding infection;
• \*Viral (herpes) • Bacterial (Mycoplasma pneumoniae)
–25% - medication-related
(antibiotics and analgesics)
66
– Systemic sclerosis
• Diagnosis (con’t):
–Serologic studies (3)
• Autoantibodies directed against Scl-70
• Anticentromere antibodies
• Limited cutaneous systemic
sclerosis
67
aka venereal warts
condyloma acuminatum
68
– Erythema multiforme (EM)
• Clinical features EM minor (con’t):
–Mucosa
(2)
• Erythematous patches oral mucosa
that undergo necrosis and result in
large, shallow erosions and ulcers with
irregular borders • Gingiva and hard palate usually spared
(2)
69
erythema migran occurs in what % of the population
1-3%
70
Most significant aspect of mucous membrane pemphigoid? MMP is what?
ocular involvement of symblepheron
71
– Peutz-Jeghers syndrome
• Histopathologic features: (2)
–Gastrointestinal polyps are not
precancerous
• Benign growths of intestinal
glandular epithelium
72
describe presentation of pemphigus vulgaris and where?
• Superficial, ragged erosions and
ulcerations • Any mucosal surface
73
– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Histopathologic features:
(2)
–Similar to psoriasis “psoriasiform
mucositis” description on x report
–Parakeratosis with extensive
microabscess (neutrophils) formation in
the superfical spinous layer
74
-part of Waldeyer’s ring. ____ at \_\_\_\_\_\_
Foliate papilla-part of Waldeyer’s ring. Active lymphoid tissue at posterior lateral tongue.
75
condyloma acuminatum affects where? (3)
anogenital region, mouth, larynx
76
– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Prognosis: (2)
–Good
• Reassure patient this is a benign
condition
77
oropharyngeal cancer is located where?
base of tongue, soft palate, palatine tonsils, and pharyngeal wall
78
white sponge nevus is common. T/F
false-relatively rare
79
• Immune-mediated
– Different processes than EM
• Treatment SJS and TENS: (4)
–Discontinue causative drug!
–IV re-hydration
–Topical anesthetic or analgesic for pain
–Avoid steroids in TEN – have been found
to be detrimental
80
systemic lupus erythematosus may involve what locations intraorally
• Palate, buccal mucosa, gingiva • Vermilion zones “lupus cheilitis”
81
describe squamous papilloma
exophytic with fingerlike projections giving a "cauliflower" or "wart-like" appearance
82
-comprised of dense, vital lamellar bone
Maxillary torus-comprised of dense, vital lamellar bone
83
periocular hyperpigmentation is associated with what condition?
Hypohidrotic ectodermal dysplasia
84
– Chronic cutaneous lupus erythematosus
• Prognosis
Good
–~ 50% resolve after several years
–~ 5% - 10% of patients with CCLE
transform to SLE
85
– Systemic sclerosis
• Diagnosis:
(4)
–Generally stiffened skin with
development of Raynaud’s phenomenon suggestive of Dx
–Skin biopsy
–Lab studies
–Serologic studies
86
verruca vulgaris
87
oral effects of e-cigarettes
inflammatory response in periodontal tissues, may promote periodontal disease, impair wound healing vs. reduce inflammation and improve angiogenesis
88
oral lesions of hereditary hemorrhagic telangiectasia are most dramatic and easily identified where? (3)
Vermilion zones
• Tongue
• Buccal mucosa
89
what population is affected by erythema multiforme?
young adults 20-30s
90
mucous membrane pemphigoid
91
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_used
to detect autoantibodies bound to the patient’s tissues
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_used
to detect antibodies circulating in the blood
Direct immunofluorescence (DIF)
Indirect immunofluorescence (IFF)
92
what amount of teens report using e-cigarettes?
1/4
93
hypohidrotic ectodermal dysplasia
94
– Pemphigus vulgaris (PV)
• Treatment:
Systemic corticosteroids, often with
azathioprine or other steroid-sparing agents
–Topical corticosteroids have little effect
95
Erosive lichen planus – erosive lichenoid mucositis
96
systemic lupus erythematosus + CCLE have a ___________ nature
waxing/waning
97
-loss of continuity of an epithelial or epidermal covered surface.
Ulcer-loss of continuity of an epithelial or epidermal covered surface.
98
most common soft tissue mass arising from soft palate
squamous papilloma
99
– Oral lichen planus (OLP/ELP)
• Prognosis
varies
–Some patients are well-controlled, others
can be difficult to control
–Recurring candidiasis a challenge
• Dry mouth, dentures, ATB, inhaler • Topical steroid predisposes to candida
100
clinical features of condyloma acuminatum (6)
contagious, sessile, pink, short blunted, non-tender, exophytic
101
–Acro-osteolysis
• Destruction of the digit tips,
including bone
– Systemic sclerosis
102
– Hereditary hemorrhagic telangiectasia (HHT)
• Diagnosis HHT requires
3 of 4 features:
–Recurrent spontaneous epistaxis
–Telangiectasias of mucosa and skin
–AV malformation involving the lung, liver
or brain –Family history of HHT
103
Name 6 developmental Mucotaneous Conditions
Ectodermal dysplasia • Hypohidrotic ectodermal dysplasia • (polygenetic oligodontia) – White sponge nevus – Peutz-Jeghers syndrome – Hereditary hemorrhagic telangiectasia
104
what are the 4 components of e-cigarettes?
cartridge (reservoir) which holds a liquid solution
heating element (atomizer)
power source (lithium battery)
mouthpiece to inhale
105
squamous papilloma has a low ______ + \_\_\_\_\_\_\_\_
infectivity + virulence
106
pemphigus vulgaris is present in what populations/gender?
Average age 50 y.o.
–No gender predilection
107
– Mucous membrane pemphigoid (MMP)
• Treatment:
(4)
–Depends on extent of involvement
• Oral lesions alone - topical steroids,
tetracycline/niacinamide or dapsone
may be sufficient
• Frequent dental prophylaxis, q 3-4
mos.
–Refer patient to ophthalmologist for
exam and follow-up
• If ocular involvement, systemic
immunosuppressive therapy indicated
108
scarring of mucous membrane pemphigoid occurs where?
Skin • Symblepheron (conjunctiva) • Scarring on oral mucosa rare
109
L1 and L2 in HPV comprise what?
virus capsid (shell) required for virus transmission, spread, and survival
110
what cancer occurs anterior to the tonsillar pillars?
oral squamous cell carcinoma
111
– Erythema multiforme (EM)
• Clinical features EM minor (con’t):
–Skin (3)
• Variety of appearances “multiforme”
• Round, dusky-red patches on skin of
extremities “target lesions” • Bullae with necrotic centers
112
what is Raynaud's phenomenon and what condition(s) is it associated with
• Discoloration of the fingers
and/or toes after exposure to
changes in temperature or
emotional events. Not specific for
systemic sclerosis
systemic sclerosis + crest syndorome
113
which condition is a genodermatosis?
genetially determined skin disorder -white sponge nevus
114
\_\_\_\_\_\_\_\_-focal deposition of mucous. Cause is ________ to associated \_\_\_. Treatment is conservative-remove ____ and \_\_\_\_\_\_\_\_\_
Mucocele-focal deposition of mucous. Cause is damage to associated minor salivary gland duct. Treatment is conservative-remove extravasated mucous and associated minor salivary glands.
115
white sponge nevus is symptomatic or asymptomatic
asymptomatic
116
Parulis (intraoral opening of sinus track)-rule out \_\_\_\_\_\_\_\_\_
Parulis (intraoral opening of sinus track)-rule out an odontogenic source of infection.
117
\_\_\_\_\_\_\_\_\_\_\_\_\_\_ - cheek, tongue, lip nibbling/chewing-\_\_, at a
site(s) accessible to \_\_\_\_.
Morsicatio buccarum, linguarum, labiorum - cheek, tongue, lip nibbling/chewing-shredded keratin, at a
site(s) accessible to teeth.
118
• Immune-mediated
– Systemic sclerosis
• Prognosis: (3)
–Death due to internal organ deposition
of collagen
• Cardiac involvement has worse
prognosis • Most deaths due to pulmonary
involvement
119
what immunofluorescence studies will be positive in pemphigus vulgaris
direct (DIF) and indirect (IIF)
120
primary CLinical features of oral pharyngeal squamous cell carcinoma
enlarged lymph nodes in neck,
dysphagia
subtle, asymtopmatic initially
121
– Bullous pemphigoid (BP)
• Histopathologic features:
–Subepithelial cleft similar to MMP
122
Systemic lupus erythematosus
–Oral involvement in what % of patients
5-25%
123
Milder variant of systemic sclerosis
CREST Syndrome
124
–Diffuse smooth, hard texture of skin,
“hidebound”
systemic sclerosis
125
–Dental findings can mimic ectodermal
dysplasia
• Polygenetic oligodontia
126
what benefits if any are there of using e-cigarettes?
9 contaminants in e-cigarettes
vs 11,000 in tobacco cigarettes
mimics habit so addresses physical/behavioral addiction
127
–Pulmonary, renal, cardiac and GI fibrosis
may be seen, with pulmonary hypertension
systemic scelerosis
128
• Relatively rare condition characterized by
inappropriate deposition of dense collagen
–Replaces and destroys normal tissue
systemic sclerosis
129
verruca vulgaris affects what population?
any age, children
130
what is risk of developing cancer in peutz jegher syndrome compared to control population?
18x greater
131
– Cutaneous lichen planus
• Clinical features:
–Purple polygonal pruritic papules with
Wickham’s striae (lacy white lines)
132
squamous papilloma
133
systemic sclerosis
134
– Systemic lupus erythematosus
• linical features (4)
–Protean manifestations initially
• Fever, weight loss, arthritis, fatigue,
general malaise
–Malar “butterfly rash” spares nasolabial
folds
–Skin lesions flare with UV exposure
135
what population is affected by oral lichen planus
–Adults, with female predilection (3:2)
136
what two ingredients are in e-cigarettes?
propylene glycol
flavoring agents
137
what population/gender is affected by cutaneous lichen planus?
adults 30-60 yrs
female predilection
138
Immune-mediated
– Different processes than EM (con’t):
• Distinguishing features between EM and
SJS/TEN: (2)
• SJS and TEN almost always triggered
by a drug, rather than infection • SJS and TEN skin lesions begin as red
macules on trunk rather than
extremities
139
140
–Varying degrees of xerostomia is associated with?
Hypohidrotic ectodermal dysplasia
141
verruca vulgaris is extremely common where?
skin, especially on hand
142
may have co-infection w/high risk type
low risk: condyloma acuminatum
143
– Lupus erythematosus
• Treatment:
(6)
–Sunscreens, avoid excessive UV exposure
–NSAIDS
–Antimalarial drug therapy, low dose
thalidomide if resistant to topical Tx
–Topical steroids for skin and/or mucosa
–Systemic steroids or
immunomodulating agents for more severe cases
• Complications from long-term
steroids –Kidney transplant may be needed
144
– CREST syndrome
• Prognosis
6-year survival rate ?%
12-year survival rate ?%
better than systemic sclerosis
–6-year survival rate 80%
–12-year survival rate 50%
145
which HPV types are low risk for cancers
squamous papilloma
verruca vulgaris
condyloma acuminatum
146
chronic cutaneous lupus erythematosus
147
• Immune-mediated
– Erythema multiforme (EM)
• Prognosis: (4)
how long does it last?
\_\_\_\_\_\_ who get recurrences when?
if ____ is trigger mainteance \_\_\_\_\_
-not __________ except?
–EM minor and major
- self-limiting (2 – 6
weeks)
–20% of patients get recurrences (esp.
spring and autumn)
• If HSV is trigger maintenance antiviral –Not life-threatening except severe cases
Developmental and Immune-mediated Mucocutaneous Conditions
148
singular erythema migrans is known as
"persistens"
149
prognosis of verruca vulgaris?
may recur
spontaneous remission possible
150
dermatologic term for common wart
verruca vulgaris
151
what causes pemphigus vulgaris?
In PV, autoantibodies destroy desmosomes.
desomosomes bond epithelial cells together. Abs inhibit adherence, so split develops in epithelium
152
systemic lupus ertyematosus
153
bullous pemphigoid
154
–Microstomia “purse-string appearance
systemic sclerosis
155
– Hereditary hemorrhagic telangiectasia (HHT)
• Prognosis:
–Generally good, 1-2% mortality
sometimes noted due to complications related to blood loss
–If brain abscess develops, 10% mortality
can be anticipated, despite early diagnosis and appropriate treatment
156
– Bullous pemphigoid (BP)
• Immunopathologic features:
–Positive DIF and IFF with
immunoreactants deposited at the BMZ
157
• Immune-mediated
– Erythema multiforme (EM)
• Clinical features EM major: (3)
\–2 or more mucosal sites in conjunction
with skin lesions
• Mucosal, lip and skin lesions as seen
in EM minor –Ocular involvement can produce
symblepheron
158
prognosis for squamous papilloma (2)
recurrence unlikely
spontaneous remission possible
159
List two conditions of cardiac involvment from systemic lupus erythematosus?
• Pericarditis • Libman-Sacks endocarditis
160
describe reticular lichen planus
interlacing white lines
161
1-associated with loss of vertical dimension. ________ some may have co-infection with \_\_\_\_\_\_\_\_\_\_\_.
If external only, can use topical application of combination
.\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Angular cheilitis-associated with loss of vertical dimension. Candida, some may have co-infection with Candida and Staph
If external only, can use topical application of combination
Candida and Staph. antifungal/corticosteroid cream.
162
Three Forms of lupus erythematosus
• Chronic cutaneous lupus
erythematosus (CCLE)
• Systemic lupus erythematosus (SLE)
• Subacute cutaneous lupus erythematosis (SCLE)
intermediate between CCLE and SLE will not be
discussed in this lecture
163
Hereditary hemorrhagic telangiectasia (HHT)
• Histopathologic features:
–Collection of thin-walled blood vessels in
the superficial connective tissue
164
apthuous ulcer
165
white sponge nevus can have other oral sites affected. T/F
True Nasal, esophageal, laryngeal,
anogenital mucosa may be involved
166
benign skin lesion with a “stuck on” appearance. Looks like “dropped on candlewax”.
Seborrheic keratosis
167
describe erosive lichen planus?
shallow ulcers, peripheral
erythema and radiating white lines
168
oral mucosa lesions usually occur where for verruca vulgaris?
vermilion border
labial mucosa
anterior tongue
169
leukoplakia- rule-out dysplasia. White patch that does not rub off and cannot be diagnosed clinically or
microscopically as anything else. Perform a _____ to identify exact nature of the lesion.
leukoplakia- rule-out dysplasia. White patch that does not rub off and cannot be diagnosed clinically or
microscopically as anything else. Perform a biopsy to identify exact nature of the lesion.
170
171
• Immune-mediated
– Oral lichen planus (OLP/ELP)
• Histopathologic features (5)
–Varying degrees of hyperkeratosis,
atrophy or ulceration
–!bsent or pointed rete ridges (“saw-
toothed)
–Degeneration of the basal cell layer
• Degenerating keratinocytes
–Band-like infiltrate of lymphocytes –Varying thickness of spinous layer
172
worst prognosis for combining factors of HPV
HPV-, msoker
173
–Protuberant lips due to midface
hypoplasia is associated with?
Hypohidrotic ectodermal dysplasia
174
-ectopic sebaceous glands. Can be seen anywhere in the \_\_\_\_\_\_, ________ most
common location also may be seen on \_\_\_\_\_
Fordyce granules-ectopic sebaceous glands. Can be seen anywhere in the mouth, buccal mucosa most
common location also may be seen on lips
175
–Prodromal symptoms ~ 1 week before
onset (fever, malaise, headache, cough, sore throat)
erythema multiforme
176
Describe radiographic features of hypohidrotic ectodermal dysplasia? (2)
–Hypodontia/oligodontia –Conical roots –Abnormally-shaped crowns (conical, tapered, pointed, smaller)
177
– CCLE and SLE
• Histopathologic features:
(2)
–Lichenoid features with vasculitis
–May show subtle differences (e.g.
subepithelial edema) which may help lead to the Dx
178
at
least two mucosal sites plus skin
involvement
Stevens-Johnson syndrome (SJS)
179
most significant aspect of systemic lupus erythematosus?
–Renal involvement 40% - 50% of patients
is most significant aspect of disease
180
hypohidrotic ectodermal dysplasia affects what gender?
M \>F
181
group of inherited disorders in which two or more ectodermally derived structures do not develop or fail to develop
ectodermal dysplasia
182
traumatic ulcer
183
• Immune-mediated
– Bullous pemphigoid (BP)
Prognosis: (3)
–Many patients experience remission
–Problems may develop with use of
immunosuppressive therapy in older population
• Mortality 3 times higher than age and
sex matched population
184
found along occlusal plane.
Linea alba-found along occlusal plane.
185
– Chronic cutaneous lupus erythematosus
(CCLE)
• linical features (con’t):
–Mucosa (2)
lichenoid mucositis,
essentially identical to ELP, but
seldom occur without skin lesions
–Painful, esp. with acidic, salty or
spicy foods
186
– Mucous membrane pemphigoid (MMP)
• Histopathologic features:
–Subepithelial cleft formation –
separation of the epithelium from the connective tissue at the basement membrane zone (BMZ)
187
Benign hamartomatous polyps of
gastrointestinal tract, esp. jejunum and ileum
peutz jeghers syndrome
188
-immunologically mediated process. Often has “striae” or lacy clinical presentation.
Does not \_\_.
Lichen planus-immunologically mediated process. Often has “striae” or lacy clinical presentation.
Does not wipe off.
189
-found under sub-optimally fitting RPD or full denture, may also
reflect nearly \_\_\_\_\_\_\_. tx= (2)
Inflammatory papillary hyperplasia-found under sub-optimally fitting RPD or full denture, may also
reflect nearly constant wear. Conservative excision, new denture.
190
survival rate for HPV + and oropharyngeal cancer, HPV-?
80%
40%
191
– Peutz-Jeghers syndrome
• Treatment:
(2)
–Genetic counseling, parents and
patient –Monitor for intussusception and for
tumor development
192
\_\_\_\_\_\_ -benign melanocytic lesion. Often notice a decrease in __________ as it progress from _______ to _______ to \_\_\_\_\_\_\_\_\_
Nevus
pigmentation
junctional
compound
intradermal.
193
high risk HPV
HPV 16 and 18
194
• Immune-mediated
– Systemic sclerosis
• Treatment: (4)
–ACE inhibitors for HTN, esp. due to renal
–Esophageal dilatation
–Oral hygiene instruction
–Fabricate prostheses with design to
accommodate microstomia
195
treatment of verruca vulgaris?
skin lesions-topical therapies, surgery
oral lesions-surgery, laser, cryotherapy, electrosurgery
196
gender and age preference of mucous membrane pemphigoid? (MMP)
–Older age than PV, average 50 – 60 y.o. –2:1 female predilection
197
Effects of nicotine exposure?
release of epinephrine
release of dopamine (pleasure reward)
198
Crest Syndrome affects what population
Women, 6th to 7th decade of life
199
diffuse bullous
involvement of skin and mucosa
• Toxic epidermal necrolysis (TEN) -
| (Lyell’s disease)
200
polygenetic oligodontia
201
heat intolerance lack of sweat glands is characteristic of what disorder?
hypohidrotic ectodermal dysplasia
202
types of lichenoid mucositis (7)
• Lichenoid drug reaction; lichenoid amalgam
reaction; oral mucosal cinnamon reaction;
lichenoid foreign body gingivitis; oral lesions
of graft-vs.-host disease (GVHD); oral lesions
of LE; some epithelial dysplasias
203
white sponge nevus
204
AKA cicatricial (scarring) pemphigoid
Mucous membrane pemphigoid (MMP)
205
for mucous membrane pemphigoid
\_\_\_\_\_\_\_ DIF
\_\_\_\_\_\_\_\_\_\_ IIF
–Positive DIF; negative IIF
5-25% of
patients will have circulating
autoantibodies)
206
–Dystrophic or brittle nails
is associated with?
Hypohidrotic ectodermal dysplasia
207
• Immune-mediated
– Different process than EM (con’t):
• Clinical features SJS and TEN:
(3)
–Within 2 weeks skin sloughing and flaccid
bullae develop
–Patients may appear badly scalded -
usually treated in burn unit
–Almost all patients have mucosal
involvement, esp. oral
208
Name 14 Immune Mediated Mucotaneous Conditions
– Pemphigus vulgaris – Mucous membrane pemphigoid – Bullous pemphigoid – Erythema multiforme – Erythema migrans (geographic tongue) – Lichen planus • Cutaneous lichen planus • Oral lichen planus – Lichenoid mucositis – Lupus erythematosus • Systemic (SLE) • Chronic cutaneous (CCLE) – Systemic sclerosis – CREST syndrome
209
most common STI in US
HPV
210
inheritance pattern of white sponge nevus?
autosomal dominant
211
how is Peutz-Jeghers syndrome inherited?
AD
212
peutz jegher syndrome
213
most common cause of death for systemic lupus erythematous?
5 yr survival rate?
15 year survival rate?
renal failure
95%
75%
214
erythema multiforme (minor)
215
– Erythema migrans (geographic tongue, benign
migratory glossitis)
• Treatment: (3)
–None generally necessary
–Occasionally sensitive or painful to hot,
spicy foods
• Potent topical steroid
216
white sponge nevus appears in what population?
birth or early childhood,
sometimes adolescence
217
```
Pemphigus vulgaris (PV)
• Histopathologic features:
```
–Microscopically, intraepithelial clefting
above the basal layer (i.e. within the epithelium)
–Acantholysis (breakdown of spinous
layer; cells appear to fall apart) – is also usually evident
218
Lupus erythematossus diagnosis serum studies show _________________ present in
SLE \_\_\_\_\_\_\_\_\_
CLE \_\_\_\_\_\_\_\_\_
Serum studies show anti-nuclear
antibodies present in 95% of SLE patients, negative in CCLE
219
-prominent vessels, often an indication of \_\_\_\_\_\_\_\_\_\_
Telangectatic capillaries
sun damage
220
benign melanocytic lesion. Macular (flat), increase in number in _________ with \_\_\_\_\_\_\_\_\_\_
lentigo
caucasians with age
221
-fissured tongue-patients often also have \_\_\_\_
Fissured tongue and xerostomia-fissured tongue-patients often also have geographic tongue.
222
where does oral lichen planus usually occur?
Bilateral buccal mucosa, tongue, gingiva
common but any intraoral surface and
lips
223
when is Peutz-Jeghers syndrome noted?
usually noted in childhood
224
-overgrowth of chromogenic bacteria and filiform papillae.
Black hairy tongue-overgrowth of chromogenic bacteria and filiform papillae.
225
what does ectodermal dysplasia affect?
it is hypoplasia or aplasia of • Skin • Hair • Nails • Teeth • Sweat glands
226
-silver in amalgam stains _____ in associated\_\_\_\_\_\_\_. If unusual
presentation, may need to excise to rule out \_\_\_\_\_\_
Amalgam tattoo-silver in amalgam stains reticulin fibers in associated connective tissue. If unusual
presentation, may need to excise to rule out melanoma.
227
–Claw-like deformity of fingers due to
collagen deposition, ulceration of the fingertips
Systemic sclerosis
228
describe the clinical features of peutz jegher syndrome in the head and neck?
```
–Hyperpigmented macules of lips and
oral mucosa (also can occur around eyes, nostrils, anus, hands, feet), may fade with age
```
229
– Mucous membrane pemphigoid (MMP)
• Immunopathologic features:
–Linear deposition of immunoreactants at
the BMZ
230
Autoantibodies in pemphigus vulgaris bind \_\_\_\_\_\_\_\_\_\_
desmosomal
components (desmoglein 1 & 3)
231
• Bullae rupture sooner than on skin
(constant trauma?) leaving large
shallow ulcerations with smooth,
distinct margins
bullous pemphigoid
232
associated with NON-oncogenic human papillomaviruses.
Papilloma
233
– White sponge nevus
• Treatment:
(4)
–None necessary but cosmetic concern
–Tetracycline rinses reported to help
–Reassure the patient that this is a
harmless condition –Good prognosis
234
-bony protuberances arise from cortical plate.
Exostoses-bony protuberances arise from cortical plate.
235
percentage of pemphigus vulgaris lesions that are oral and what is unique to them?
50%
oral lesions “first to show, last to go”
• In other words – the oral lesions
often are the initial manifestation
of the disease and the most
difficult to resolve with treatment
236
systemic sclerosis affects who and what population
Women affected 3 times more frequently
than men; adult age group
237
description of erythema migrans
–Multiple, well-demarcated zones of
erythema surrounded at least partially by
a slightly elevated yellow-white
serpentine or scalloped border
238
– Hereditary hemorrhagic telangiectasia (HHT)
• Treatment: (4)
–Genetic counseling, parent and patient
–Mild HHT – no treatment
–Moderate HHT – selective cryotherapy or
electrocautery bothersome lesions –Severe – septal dermoplasty to prevent
epistaxis
239
white spone nevus is due to
a defect in normal keratinization of oral mucosa
240
chronic exposure of nicotine on lung? on heart?
lung- increased risk of developing COPD, emphysema
heart-fibrosis
241
small collection of
dilated capillaries
telangiectasia
242
-need to do ____ to confirm. Assess \_\_\_\_
Periapical cyst-need to do biopsy to confirm. Assess vitality of adjacent teeth.
243
prognosis for condyloma acuminatum?
condylomata infected w/HPV 16/18 have higher risk for malignant transformation to SCC
oral lesions have not shown this
244
confirmation of diagnosis of HPV + and OPSCC
HPV-16 infection is not characterized by presence of HPV- 16 alone
E6, E7 in tumor cells expressed
and serum presence of E6 or E7 antibodies
245
\_\_\_-benign collection of dense fibrous connective tissue. tx=
Fibroma-benign collection of dense fibrous connective tissue. Conservative removal.
246
– White sponge nevus
• Histopathologic features: (3)
–Exfoliative cytology sometimes more
diagnostic than scalpel biopsy –Parakeratosis with acanthosis
(thickening of spinous layer) –Perinuclear eosinophilic condensation
of cytoplasm is pathognomonic
247
what gender and type of population are affected for bullous pemphigoid?
no gender population
older population affected age 75-80 yrs
248
most common cancer in humans.
basal cell carcinoma
249
– Erythema multiforme (EM)
• Clinical features EM minor: (3)
–Skin (extremities)
–Mucosa (oral, conjunctival, genitourinary,
respiratory) –Hemorrhagic crusting of vermilion zones
250
what is a nikolsky sign and what condition is associated with it?
+ Nikolsky sign - inducing a bulla by
applying firm, lateral pressure to
normal appearing skin
pemphigus vulgaris
251
most often older patients, _____ frequent site. If \_\_\_\_\_, will NOT blanch with diascopy.
Varix-most often older patients, lower lip frequent site. If thrombosed, will NOT blanch with diascopy.
252
– Different processes than EM
• Prognosis SJS and TEN (con’t):
–If patient survives (3)
Skin heals in \_\_\_\_\_\_\_
* ______ take longer
* Ocular damage in _____ of patients
• Skin heals in 3 – 5 weeks • Oral lesions take longer • Ocular damage in 50% of patients
253
treatment for condyloma acuminatum?
excision, cryotherapy, laser
topical agents for anogenital lesions
254
Mucous membrane pemphigoid (MMP)
• Prognosis: (3)
–Condition can usually be controlled
–Blindness results in patients with
untreated ocular disease –Rarely undergoes spontaneous resolution
255
• Immune-mediated
– Erythema multiforme (EM)
• Treatment
supportive therapy):
–Systemic or topical steroids early on
(controversial) –IV re-hydration –Topical anesthetic or analgesic for pain
256
• Flaccid vesicles, bullae on skin;
rarely seen intact intraorally
pemphigus vulgaris
257
Systemic lupus erythematosus
affects what population (3)
–Females affected 8 – 10 times more than
males
–Women of color more than Caucasians
–Average age at diagnosis 31 y.o.
258
hereditary hemorrhagic telangiectasia has mutation in one or two genes which are for what?
blood vessel wall integrity
259
high-risk HPV types make proteins?
E6, E7, L1, L2
260
– Pemphigus vulgaris (PV)
• Prognosis:
(5) w/out corticosteroid therapy
–Usually fatal if not treated
• \*Severe infection • Loss of fluids/electrolytes • Malnutrition due to mouth pain
–Prior to corticosteroid therapy,
60-90% mortality
261
– Systemic lupus erythematosus
• Prognosis: (4)
Variable
–Depends on which organs affected and
how frequently SLE is reactivated
–Worse for men than women
–Worse for blacks than whites
262
Chronic Cutaneous lupus erythematosus primarily affects what?
skin/mucosa
263
T/F. squamous papilloma is painful
false-painless
264
–Genetic testing now would reduce
this error
mistaking ectodermal dysplasia for polygenetic oligodontia
265
systemic lupus erythematosus oral invovlement lesions may appear
non-specific or lichenoid
266
-associated most often with poorly fitting dentures. tx =
Inflammatory fibrous hyperplasia-associated most often with poorly fitting dentures. Conservative
excision, construct well-fitting dentures.
267
A number of conditions can mimic oral
lichen planus, both clinically and
histopathologically
– Lichenoid mucositis
268
–Dysphagia with esophageal involvement
systemic sclerosis
269
describe lesions of heriditary hemorrhagic telangietasia (HHT)?
numerous 1mm-2mm red papules blanch with diascopy
270
describe lesions of bullous pemphigoid?
Pruritus early symptom, followed by the
development of multiple, tense bullae, blisters on normal or erythematous skin
271
color of squamous papilloma depends on?
amount of keratin
272
Most common collagen vascular/connective
tissue diseases
Lupus erythematosus
273
-development of sebaceous glands correlates with \_\_\_\_\_\_\_. Often seen on \_\_\_\_\_\_\_, once achieve _ to _ mm size, ___________ growth.
Sebaceous hyperplasia
puberty.
forehead,
1 to 2 mm size,
minimal to no further
274
\_\_\_\_\_\_\_\_\_\_\_- most common site for recurrent HSV-1 is _________ and/or \_\_\_\_\_\_\_\_\_\_\_\_
Herpes labialis- most common site for recurrent HSV-1 is vermilion border and/or adjacent skin of lips
275
-develops due to \_\_\_\_\_\_
Dentigerous cyst-develops due to fluid entrapment between crown of impacted tooth and reduced
enamel epithelium.
276
-look for
Condensing osteitis-look for tooth or teeth with deep caries in associated area.
