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Oral Medicine > L2 - Vesicular, Ulcerative, and Bullous Lesions > Flashcards

L2 - Vesicular, Ulcerative, and Bullous Lesions Flashcards

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1
Q

recurrent ulcers

A

recurrent apthous stomatitis

behcet’s disease

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2
Q

acute lesions

A

herpes simplex virus infection

varicella zoster virus infection

erythema multiforme

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3
Q

chronis lesions

A

pemphigus

bullous pemphigoid

mucous membrane pemphigoid

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4
Q

recurrent apthous stomatitis

A

most common soft tissue lesion

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5
Q

requirement for course

A

common lesions and know how to deal with it

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6
Q

incidence of apthous stomatitis

A

17%s

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7
Q

associated with apthous stomatitis

A

hematologic deficiency

- serum iron, folate, vit b 12

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8
Q

etiology of apthous stomatitis

A

90% vs 20%

- parent with this lesion – 90% more likely to have it

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9
Q

clinical manifestations of minor ulcers (apthous)

A

less than 1.0 cm, round, shallow, multiple, healing begins within 1 week and completes in 10-14 days
without scars

benign and subclinical a lot of t

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10
Q

clinical manifestations of major apthous ulcers

A

over 1,0 cm, round, deep, extremely painful, last for months, heal slwly and leave scars, result in decreased mobility

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11
Q

inflammation is simpy

A

dilated blood vessels caused by ___ whatever it is

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12
Q

clinical housmanifestations of herpetic form apt ulcers

A

less common, multiple small punctuate ulcers scatterd over the oral mucosa

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13
Q

DD for apthous stomatitis

A

viral stomatitis, pemphigoid, drug reactions

- biopsy only needed to exclude other lesions

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14
Q

reference ranges for serum iron, folate, b-12, and ferrtin

A

iron - 50-160 in men 40-150 in woman

folate 1.8- 9.0 ng/ ml

serum b12- 140-170

serum ferritin
male - 15-200
female - 12-150

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15
Q

tx for mild cases - apthous ulcer

A

orabase paste
- 20% benzocaine -

for maximum strenght pain relief and protective film for long lasting pain relief and protective film on lesions

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16
Q

tx for severe cases of apthous ulcers

listed in?

A

topical streoid preperations
* listed in increasing potency of anti-inflammatory effect by altering the way the immune system responds to certain stimuli

  1. ## triamcinolone
  2. ## flucinonide
  3. ## clobetasol
  4. flucinonide - lidex 0.05%
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17
Q

behcet’s disease

A

autoimmune disease

- recurrent oral ulcers recurrent genital ulcers occular inflammation

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18
Q

etiology of behcet’s disease

A

cross reactivity antigens –> humoral antibody or cell mediated immune responses –> leads to cytotoxic effects –> then epithelial damage

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19
Q

clinical manifestations of behcet’s disease

A

recurrent oral ulcers (like RAS)

recurrent genital ulcers

occular inflammation

skin lesions

based on these 4 points – so 4 points system is used to describe this disease

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20
Q

primary infection HSV

A

prodromal symptoms
- fever, headache, malasie, nausea, vomitting

thin walled small vesicles–QUICKLY RUPTURE – shallow, round, discrete ulcers– large irregular painful ulcers of the lips and oral cavity (gingivostomatitis) – surrounded by an arythematous halo – heal spontaneously in 7-14 days

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21
Q

recurrent infections

A

of HSV 1 - prodromal period is 1 day with tingling, burning, swellling at the site of muccocutaenous junction of upper lip triangle zone beneath the nose –

cluster 1-2 cm of small vesicles of 1-3 mm

may or may not rupture to form shallow ulcers

heal in about 7 days

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22
Q

HHV 8

A

kaposi’s sarcoma

involved with immunosuppresion and HIV patients

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23
Q

HHV 8

A

kaposi’s sarcoma

involved with immunosuppresion and HIV patients

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24
Q

tx for HSV

A

acyclovir (zovirax) – for all members of herpes
- synthetic purine nucleoside specificall against human herpes virus

mechanism – highly selective – ONLY ACTIVE WHEN INFECTED

  • viral thymidine kinase (contained in the virus)

the TK converts to active form – now active acyclovir triphosphate from which can be inorporated into growing chains of viral DNA, resulting in termination of viral DNA

terminates viral DNA

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25
marginal gingiva is not affected in
pemphigoid
26
acyclovir work on latent?
no - does not elminate latent virus
27
acyclovir dependent on
renal excretion, thus the half-life is dependent on renal function so risk of renal dysfunction in patients haing nephrotix agents
28
acyclovir dependent on
renal excretion, thus the half-life is dependent on renal function so risk of renal dysfunction in patients haing nephrotix agents
29
contraindications for primary viral infections
use of corticosteroids -- because it can cause immunosuppression if get very severe infection then maybe but should not be getting these from you
30
Herpes zoster aja
shingles
31
primary infection of varicella zoster
chickenpox- varicella -- occurs in susceptible children with no antibodies become lifeling carriers - antibodies positive latent virus persist in ganglia of spinal nerves and cranial nerves
32
reactivation of varicella zoster
immunosuppression trauma local x ray radiation malignancy of ganglia
33
reactivatino of v2 and v3 vs reactivation of herpes
herpes - bilateral distriubtion vs v2 / v3 - unilateral and segmental distribution with SHOOTING PAIN
34
shooting pain along the affected seneory of ____ nerves
prodromal period of herpes zoster
35
treatment for herpes zoster
acyclovir tablet
36
tx for immunocompromised for herpes zoster
acyclovir sodium intravenous solution (50 mg/ml) for immunocompromised cases
37
important in terms of treatment with acyclovir and herpes zoster
PROMPTNESS of tx within 72 hours of rash onset -- may significantly influence the degree of beenfir from therapy
38
herpes zoster of v2 and 3?
oral and facial lesions - but HZ of V1 is more common
39
which is an acute lesion
erythema multiforme
40
definition of erythema multiforme
immune mediated acute inflammatory disease of the skin and mucosal membranes frequently in young adults and children
41
location of EM
involved lesions in SUPERFICIAL VESSELS | - this is where immune reaction is occuring
42
most common site of EM simplex
LIPS !!! | prominent and diagnostic site (NOT gingiva)
43
skin leison of EM looks
target or iris lesion - consisting of a central bulla or pale cleaning area surrounded by edema and bands of erythema OR non specific macules, papules, and vesicles possibly containing petachiae in the center of the lesion
44
steven johnson syndrome
acute and generalized vesicles, bullae, erosive or denuded lesions involving skin, mouth, eyes, and genitals with prodromal symptoms of fever and malaise
45
tx for mild cases of EM
topical anesthetic mouthwashes - dexamethasone (decadron) elixir 0.5 mg/ 5 ml
46
prednisone
for severe cases of EM - this is a steroid oral capsule that is ANTI-INFLAMMAOTRY AND SUPPRESSES T - CELL MEDIATED IMMUNE SYSTEM
47
use of prednison - basic
alternate day therapy or daily tx
48
daily therapy for prednisone
20-50 mg every morning 5-7 days once a day morning before 8 am to limit the suppression of patients own immune max function with be between 2pm- 8 am
49
give prednisone when for least side affect
before 8 am
50
alternative day therapy gives
least side effect if need to do this long term 40 mg to 100 mg every other day before 8 am for 5-7
51
following course with prednisone?
decrease the dose so if did daily therapy of 20-40 decrease by 5 mg to 10 mg on each succesive day in the morning at 8 am if did the alternate day therapy then decrease by 10 to 20 mg on every oter morning before 8 am
52
percautions of steroid use have to know this
drug induced secondary adrenal suppresive effect (drug induced secondary adrenocortical insufficiency) suppression of immune system --> more susceptible to infections elevation of bp, salt and water retention, and increased excretion of postassium and calcium peptic ulcer, impaired wound healing, menstrual irregularities
53
contact allergic stomatitis
this is NOT erythema multiform this is a delayed type hypersensitivity reaction to TOPICAL ANTIGENS
54
etiology of contact allergic stomatitis
chewing gum, dental amalgam, gold crowns, acrylic denture, impression materials, toothpaste, benzocaine, etc
55
IgM
EM
56
type IV
delayed type hyerpsensitivity | IgG
57
definition of pemphigus vulgaris
autoimmune (IgG) involving the skin and oral mucosa with acantholysis and intraepithelial bullae formation in adults
58
diagnosis of contact allergic stomatitis
skin patch test (place suspected allergen on normal non hairy skin for 48 hours, examines for persistent erythema after 2-4 hours of allergen removal
59
where is mucous membrane pemphigoid
subepithelial | IgG target basement membrane
60
most signifivant presentnation of pemphigoid in oral
non-specific desquamative gingivitis

Oral Medicine (11 decks)

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