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Clinical Med I > HEENT - Oral Lesions - Exam 2 > Flashcards

HEENT - Oral Lesions - Exam 2 Flashcards

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1
Q

What are risk factors for Leukoplakia?

A
  • Tobacco use

- Alcohol use

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2
Q

What is the clinical presentation of leukoplakia?

A
  • Adherent white patches/plaques on oral mucosa or tongue

- Painless

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3
Q

What is the treatment for leukoplakia?

A
  • Prevent/decrease risk of oral SCC
  • Refer for ENT evaluation/surgical removal
  • Monitor size/depth
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4
Q

How do you prevent/decrease risk of oral SCC?

A

Avoid tobacco, alcohol, cheek biting, tongue chewing, regular dental care

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5
Q

Leukoplakia is common and usually benign, but what can it be a precursor for and should be a concern?

A

Oral SCC

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6
Q

What is the clinical presentation for Erythroplakia?

A
  • Red, velvety patch commonly located on mouth floor, ventral aspect of tongue, soft palate
  • Asymptomatic
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7
Q

While Erythroplakia is uncommon, what is significant about it and should be cause for concern?

A

Carries very high risk of malignant transformation (>80%)

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8
Q

What population is at the highest risk for Erythroplakia?

A

Older patients who consume tobacco and alcohol

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9
Q

What induces Oral hairy leukoplakia?

A

Epstein-Barr virus

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10
Q

What population is at the highest risk for Oral hairy leukoplaki?

A

Immunosuppressed individuals

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11
Q

What is the clinical presentation for oral hairy leukoplakia?

A
  • Vertically corrugated adherent white lesions on lateral surface of the tongue
  • Painless
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12
Q

What is the treatment for oral hairy leukoplakia?

A

No treatment usually indicated

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13
Q

What are the risk factors for oral SCC?

A
  • Tobacco use
  • Alcohol use
  • UV light
  • Radiation
  • HPV
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14
Q

What is the clinical presentation for oral SCC?

A
  • Painful ulcers or masses that do not heal
  • Tongue/lip: exophytic or ulcerative lesions that are often painful
  • Dysphagia, odynophagia, bleeding, weight loss
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15
Q

What is the treatment for oral SCC?

A
  • ENT referral

- Surgical resection and/or radiation/chemoradiation may be required

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16
Q

What is the presentation for oral melanoma?

A
  • Pigmentated oral lesions often following ABCDEs

- Painless bleeding mass, an area of ulceration, mucosal discoloration

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17
Q

What is the treatment for oral melanoma?

A
  • Excision with clear margins

- Radiation therapy may be needed

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18
Q

What are evaluation methods for oral melanoma?

A
  • Endoscopic evaluation for paranasal disease
  • CT and/or MRI of primary site
  • CT and/or PET imaging to assess for lymph node involvement and distant metastases
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19
Q

What is the etiology for mucoceles?

A

Mild or minor oral trauma

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20
Q

What is the clinical presentation for mucoceles?

A
  • Pinkish/blue soft papules or nodules filled with gelatinous fluid on mucous glands
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21
Q

What is the treatment for mucoceles?

A
  • Avoid cheek/lip biting
  • If symptomatic: remove with cryotherapy or excision
  • CO2 laser vaporization
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22
Q

What is the most common clinical manifestation of primary HSV in childhood?

A

Herpetic gingivostomatitis

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23
Q

What is the etiology of Herpetic gingivostomatitis and how is it transmitted?

A

HSV-1

Transmitted during direct contact during viral shedding (with or without lesions); can infect multiple sites

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24
Q

What are precipitating factors for Herpetic gingivostomatitis?

A
  • Sunlight
  • Fever
  • Trauma
  • Stress
  • Menses
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25
What are risk factors for malignant transformation of leukoplakia?
- Female - Long duration of leukoplakia - Nonsmoker - Located on tongue or floor of mouth - Greater than 200 mm
26
What is the clinical presentation of a primary infection of oral herpes simplex virus?
- May be asymptomatic - Sudden onset of painful intraoral grouped vesicles on an erythematous base - May have associated fever, lymphadenopathy, decreased oral intake
27
What is the clinical presentation of a recurrent infection of oral herpes simplex virus?
- Prodrome: pain/burning/tingling 6-48 hours before lesions appear; fatigue, low-grade fever - "Cold sore" (herpes labialis)
28
How is oral herpes simplex virus diagnosed?
- Viral culture - Tzanck smear: multinucleated giant cells - Serology: HSV-1 antibodies
29
What is the treatment for oral herpes simplex virus?
- Oral antiviral (at onset of prodrome) - Supportive care (fluids, analgesics, Miracle Mouthwash - Patient education
30
What populations should an individual infected with herpes simplex virus avoid?
- Immunocompromised - Pregnant women - Elderly - Newborns
31
How could you differentiate oral herpes simplex virus from herpes zoster?
In herpes zoster, grouped vesicles or erosions are typically unilateral on the hard palate
32
What is the clinical presentation for the Coxsackie Virus (hand, foot, mouth)?
- Prodrome: fever, malaise, sore throat | - Painful oral lesions: small aphthae (tend to spare gingiva and lips)
33
What is the treatment for Coxsackie virus?
- Frequent hand washing to prevent spread - Supportive care (hydration, analgesics) - Throat lesions resolve in 5-6 days
34
What is Oropharyngeal Candidiasis commonly called?
Thrush
35
What is the etiology for Oropharyngeal Candidiasis?
Candida albicans
36
When does the infection occur in Oropharyngeal Candidiasis?
When conditions are right for overgrowth; opportunisitc infection
37
What are predisposing factors for Oropharyngeal Candidiasis?
- Infancy - Denture wear - Immunocompromised - Diabetes mellitus - Chemotherapy or radiation - Antibiotics (broad spectrum) - Corticosteroids (topical and systemic)
38
If you found a pigmented oral lesion, what must you consider and rule out?
Melanoma
39
What is the clinical presentation for Oropharyngeal Candidiasis?
- Pain or sore throat - Creamy white patches/plaques with underlying erythematous mucosa on buccal mucosa, palate, tongue, or oropharynx - Angular cheilitis
40
How is the diagnosis of Oropharyngeal Candidiasis confirmed?
KOH prep: budding yeast with or without pseudohyphae
41
What is the treatment for Oropharyngeal Candidiasis?
- Topical antifungal (Nystatin oral suspension or Clotrimazole lozenges) - Disinfect/replace toothbrushes, pacifiers, bottle nipples - Patient education (clean dentures, rinse mouth after steroid inhalers)
42
What is the etiology of Erythema Multiforme Major (EMM)?
- Commonly induced by HSV infection | - Uncommonly associated with medications
43
What is the clinical presentation of Erythema Multiforme Major (EMM)?
- Distinctive target-like lesion on the skin - Often accompanied by diffuse areas of mucosal erythema, painful erosions or bullae (mostly oral, but can be genitals or ocular) - Lesions appear over 3-5 days and resolve within about 2 weeks
44
What is the treatment for Erythema Multiforme Major (EMM)?
- Generally self-limiting - Symptomatic relief (topical corticosteroids, anti-histamines, Miracle Mouthwash) - Consider systemic glucocorticods for severe oral involvement - Immediate ophthalmology referral for ocular involvement
45
What is the clinical presentation of SJS/TEN?
Mucosal involvement (90%): - Erythema and edema of lips - Intraoral bullae - Ruptured bullae/painful friable raw surfaces - Oral, genital, and or ocular involvement
46
What is the treatment for SJS/TEN?
- Stop the offending medication - Admit to hospital - Supportive care
47
What is the clinical presentation of Pemphigus?
- Painful erosive lesions (bullae have usually ruptured)
48
What is the treatment for Pemphigus?
- Systemic corticosteroids | - Immunosuppressants
49
What is the clinical presentation of Mucous membrane pemphigoid?
- Prodrome lasts weeks to months | - Tense bullae
50
What is the treatment for Mucous membrane pemphigoid?
- Topical and/or systemic corticosteroids | - Dermatology referral
51
What are other names for Aphthous ulcers?
Ulcerative stomatitis, aphthae, "canker sores"
52
What is the most common cause of mouth ulcers?
Recurrent aphthous stomatitis
53
What is the clinical presentation for Aphthous ulcers?
- Single or multiple oral lesions that are shallow, round/oval, painful with grayish base on buccal/labial mucosa - Lesions have yellow-gray centers with red halos
54
What is the treatment for Aphthous ulcers?
- Typically heal within 10-14 days - Avoid irritating foods/drink - Symptomatic relief (topical steroid: Oralone)
55
What is Behcet Syndrome?
Neutrophilic inflammatory disorder
56
What is the clinical presentation of Behcet Syndrome?
- Recurrent oral and genital ulcers | - Painful, shallow or deep ulcers with central yellowish necrotic base
57
How is Behcet Syndrome diagnosed?
- Recurrent oral ulcers (greater than or equal to 3 times per year) AND - 2 other clinical findings (recurrent genital ulcers, ocular lesions, or cutaneous lesions, positive pathergy test)
58
What is the treatment for Behcet Syndrome?
Refer to Rheumatology
59
If patient has esophageal candidiasis, recurrent candidiasis or a lack of predisposing factors, what needs to be considered?
Further testing for underlying disease such as HIV or diabetes
60
What is a pathergy test? What marks a positive test?
- Nonspecific hyperreactivity of the skin following minor trauma - Intradermal injection with 20-gauge needle - Positive if an erythematous sterile papule develops within 48 hours
61
What does oral lichen planus increase the risk for?
Increases risk for oral cancer
62
What are the clinical presentations of oral lichen planus?
- Reticular: Lacy white plaques with Wickham's striae on the buccal mucosa - Erythematous: Painful, red patches often in conjunction with reticular features - Erosive: Painful, erosion/ulcers often with reticular and erythematous LP
63
What is the treatment for oral lichen planus?
- High potency topical corticosteroids (Oralone or clobestasol)
64
What is another name for Black hairy tongue?
Lingua villosa nigra
65
What is Black hairy tongue often associated with?
- Antibiotic use - Candida albicans infection - Poor oral hygiene
66
What is the clinical presentation of Black hairy tongue?
- Elongated filiform papillae | - Pseudohairy tongue: yellowish white to brown dorsal tongue surface
67
What is the treatment for Black hairy tongue?
Brush affected area of the tongue with a soft-bristle toothbrush and toothpaste BID-TID
68
What is another name for Geographic tongue?
Benign migratory glossitis
69
What is the clinical presentation of Geographic tongue?
- Erythematous patches on dorsal tongue with circumferential white borders - Lesions can change location, pattern and size within minutes to hours - Numerous exacerbations/remissions over time - Usually asymptomatic; sometimes oral discomfort, burning, or foreign body sensations
70
What is the treatment for Geographic tongue?
Reassurance
71
What is Atrophic Glossitis?
Inflammatory disorder that leads to atrophy of the filiform papillae
72
What is the etiology of Atrophic Glossitis?
- Nutritional deficiency - Dry mouth - Sjogren's syndrome - Oral candida infection - Celiac disease
73
What is the clinical presentation of Atrophic Glossitis?
- Tongue appears smooth, glossy, erythematous | - Burning sensation and increased sensitivity when eating acidic or salty foods
74
What is the treatment of Atrophic Glossitis?
Address underlying conditions
75
When would you use a gel form of topical steroids for oral lesions? What are the principles for applying this medication?
- Use if there are few localized lesions. - Patient should dry the area prior to application - Avoid eating or drinking for 30 minutes after
76
When would you use a rinse for the oral cavity?
Use for widespread or generalized erythema
77
What is acantholysis?
Sloughing of the skin
78
What is an enanthem?
Mucous membrane eruption
79
What is an exanthem?
Skin eruption
80
What is an exophytic?
Lesion that grows outward from an epithelial surface
81
What is glossitis?
Inflammation of the tongue
82
What is odynophagia?
Pain with swallowing
83
What is stomatitis?
Inflammation of the mucous membranes of the mouth
84
What is leukoerythroplakia?
White mucosal plaques with red, speckled appearance
85
What is angular cheilitis?
Painful fissuring at the corners of the mouth

Clinical Med I (24 decks)

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