Lecture 1: Diagnostic techniques for evaluating oral diseases

Question 1

List the INDICATIONS of oral exfoliative cytology:

Answer 1

1. Innocuous lesion
2. Suspicious lesion with negative biopsy
3. Patient refuses biopsy
4. Follow up of treated malignancy
5. Lesion where patient is poor candidate for surgery

Question 2

List the CONTRAINDICATIONS of oral exfoliative cytology:

Answer 2

1. Keratotic or crusty mucosa
2. Red, vesiclular or velvety mucosa
3. Submucosa swelling with normal mucosa
4. Suspicion of malignancy

Question 3

T/F: Exfoliative cytology is indicated as a follow up for treated malignancy. Exfoliative cytology is contraindicated if there is suspicion of malignany

Answer 3

Both statements true

Question 4

List the INDICATIONS of culture and sensitivity testing:

Answer 4

1. Life-threatening infection
2. Unsuccessful previous antibiotic therapy
3. Immunosuppressed patient

Question 5

Why is culture and sensitivity testing limited in dentistry?

Answer 5

Because it is difficult for anaerobic conditions

Question 6

Assist in the detection of early potentially malignant mucosal changes that are difficult to discern by visual inspection alone:

Answer 6

Oral cancer screening aids

Question 7

Increases the ability to distinguish the lesional mucosa and healthy mucosa:

Answer 7

Tissue Autofluorescence imaging

Question 8

Tissue autofluorescence imaging has ______ sensitivity but ____ specificity in distinguishing pre-malignant and chronic inflammatory lesions

Answer 8

HIGH sensitivity; LOW specificity

Question 9

Tissue autofluorescence imaging has _____ sensitivity and _____ specificity in identifying areas of dysplasia and invasive cancer that extend beyond the evident lesion

Answer 9

HIGH sensitivity; HIGH specificity

Question 10

What drives autofluorescence of oral mucosa?

Answer 10

Refractory index of tissue

Question 11

With autofluorescence of oral mucosa, we see:

Answer 11

500-600nm

Question 12

With autofluorescence of oral mucosa, blue light of the scope =

Answer 12

400-460nm

Question 13

With autofluorescence of oral mucosa, UV=

Answer 13

<400 nm

Question 14

What are some of the ENDOGENOUS fluorescing products?

Answer 14

1. Tryptophan
2. Porphyrins
3. Collagen
4. Elastin
5. Flavins
6. NADH
7. Fluorophores

Question 15

What does flavin adenine dinucleotide (FAD) excited at?

Answer 15

515 nm

Question 16

What does nicotinamide adenine dinucleotide (NADH) excite at?

Answer 16

450 nm

Question 17

Information that can be measured or perceived by the investigating clinician:

Answer 17

Objective information

Question 18

-Temperature, size
-color, duration
-consistency
-surface contour

These are all examples of:

Answer 18

Signs

Question 19

Signs are _____ information

Answer 19

objective

Question 20

Patients own interpretation of a clinical circumstance. They rely on neurologic and psychologic experiences:

Answer 20

Subjective information

Question 21

-Patient awareness of presence of a lesion
-pain intensity
-pain quality (stabbing, burning, shocking, etc.)

These are all examples of:

Answer 21

Symptoms

Question 22

Symptoms are _____ information

Answer 22

Subjective

Question 23

What is involved in a differential diagnosis?

Answer 23

1. Orderly sequential approach
2. Gathering and analyzing data
3. Knowledge and experience enable recognition of abnormal findings
4. Include/exclude disease processes based on an educated assessment of process

Question 24

-Orderly sequential approach
-Gathering and analyzing data
-Knowledge and experience enable recognition of abnormal findings
-Include/exclude disease processes based on an educated assessment of process

These are all steps in:

Answer 24

Differential diangosis

Question 25

When obtaining a differential diagnosis, one must gather and analyze data- what does this entail?

Answer 25

-History -Specific signs -Specific symptoms -Lab data

Question 26

What should you be aware of when obtaining a differential diagnosis?

Answer 26

Be aware of radiographic appearances, clinical manifestations, age, gender, location

Question 27

What are examples of clinical descriptions?

Answer 27

-Single vs. multiple -Location -Relative proximity to adjacent structures -Size in dimension (mm) -Outline (well demarcated vs. diffuse) -Color (red, white, mixed, pigmented) -Consistency (firm, flaccid, compressible) -Intensity (mild, moderate, intense, striated, lacy) -Base and surface

Question 28

-Single vs. multiple -Location -Relative proximity to adjacent structures -Size in dimension (mm) -Outline (well demarcated vs. diffuse) -Color (red, white, mixed, pigmented) -Consistency (firm, flaccid, compressible) -Intensity (mild, moderate, intense, striated, lacy) -Base and surface These are all examples of:

Answer 28

Clinical descriptions

Question 29

What are descriptive terms for SURFACE?

Answer 29

-Smooth -Corrugated -Eroded -Raised -Depressed

Question 30

What are descriptive terms for BASE?

Answer 30

-Pedunculated -Sessile -Nodular -Dome shape

Question 31

Compressing tissue with a glass slide to determine the vascular nature of a lesion:

Answer 31

Diascopy

Question 32

To feel and press a lesion to yield information about texture, consistency, temperature, and function:

Answer 32

Palpation

Question 33

It is palpation with an instrument (perio probe, caries explorer, needle tip, etc.)

Answer 33

Probing

Question 34

Striking tissues with fingers or an instrument and listening to resulting pressure changes in tissues: -give an example of when this would be useful

Answer 34

Percussion; ankylosis

Question 35

The withdrawal of fluids from a body cavity:

Answer 35

Aspiration

Question 36

Listening for sounds within the body:

Answer 36

Auscultation

Question 37

What are the 3 diagnostic lab tests for oral lesions:

Answer 37

1. Biopsy (incisional, excisional, needle) 2. Immunofluorescence 3. Exfoliative cytology

Question 38

What are some biopsy indications?

Answer 38

-Lesion with >14 day duration -Unusual location -Unusual appearance -Any excised tissue -Confirmed diagnosis of systemic disease -Suspicion of neoplasia

Question 39

A possible indication to biopsy is if there is suspicion of neoplasia:

Answer 39

-Persistant ulceration -Persistent erythroplasia -Induration -Fixation -Chronicity -Lymphadenopathy

Question 40

What is being performed in this image?

Answer 40

excisional biopsy

Question 41

Describe the following surface textures:

Answer 41

1. smooth 2. granular 3. verrucous 4. papillomatous

Question 42

Describe the following surface textures:

Answer 42

1. papillomatosous (pebbly) 2. papillomatosous (cobblestone) 3. bosselated 4. lobulated

Question 43

Describe the lesion:

Answer 43

Nodular smooth

Question 44

Describe the lesion:

Answer 44

Nodular smooth

Question 45

Describe the lesion:

Answer 45

Verrucoid plaque

Question 46

What is being performed in this image?

Answer 46

Diascopy

Question 47

What is being performed in this image?

Answer 47

Probing

Question 48

What is being performed in this image?

Answer 48

Palpation

Question 49

What is being performed in this image?

Answer 49

Percussion

Question 50

What is being performed in this image?

Answer 50

Aspiration

Question 51

What is being performed in this image?

Answer 51

Auscultation

Question 52

What is being performed in this image?

Answer 52

Incisional biopsy

Question 53

What is being performed in this image?

Answer 53

Suture pull

Question 54

What is being performed in this image?

Answer 54

Needle biopsy

Question 55

A needle biopsy may also be referred to as:

Answer 55

-fine needle -fine needle aspiration & cytology

Question 56

List the INDICATIONS for a needle biopsy:

Answer 56

1. to determine the cause of tissue enlargement 2. to distinguish between benign and malignant processes 3. to stage metastatic cancer

Question 57

List the LIMITATIONS to a needle biopsy:

Answer 57

1. more technique sensitive with additional preservative and lab processes 2. does not localize cells to affected tissues 3. appositional information to adjacent tissues is lost

Question 58

A technique for determining the location of an antigen or antibody in tissues by reaction with an antibody or antigen labeled with fluorescent dye:

Answer 58

Immunofluorescence